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Is it Worth Living Longer?

Is it Worth Living Longer?

Research recently published in Nature suggests that the drug rapamycin may have the potential to extend human life span by decades: http://news.bbc.co.uk/1/hi/health/8139816.stm

If the life is of ‘positive’ value, it might seem obvious that the drug is worth taking. But not everyone would agree. The Hellenistic philosopher Epicurus famously argued that, since it marks the end of conscious life, ‘death nothing to us’. Fearing death makes as much sense as regretting you weren’t around for all that time before your birth.

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Informed consent in the Googlesphere

Here's an interesting snippet

But there's also the fact that Google is stuffed full of people who just love to experiment on its users. For instance, Google Mail uses a very slightly different blue for links than the main search page. Its engineers wondered: would that change the ratio of clickthroughs? Is there an "ideal" blue that encourages clicks? To find out, incoming users were randomly assigned between 40 different shades of links – from blue-with-green-ish to blue-with-blue-ish. It turned out blue-ness encouraged clicks more than green-ness. Who would have guessed? And who would have cared? Google, of course, which wants to get people clicking around the net.

I take this sort of experimentation as utterly, boringly unproblematic

But on one view – this is surreptitious experimentation without consent including randomisation.

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Oxford Debates Cont’d – Opposer’s Closing Statement

Part of the debate "The NHS should not treat self-inflicted illness"

Opposer: Charles Foster
Closing Statement

The criterion 'self-inflicted' is unworkable in practice. One simply does not know in many cases whether a particular disease or injury is self-inflicted. Yes, there is ample evidence to show that smoking can cause lung cancer. But some lung cancers are not caused by smoking. How can medical decision-makers decide in the case of Patient A, a smoker, that her cancer is a result of her smoking?  Such matters of medical causation are notoriously hard to resolve even in the courts, with the luxury of expert evidence, unlimited time and prolonged argument from counsel.
Many illnesses are caused by a (generally mysterious) interaction of genes and environment. How does Dr. Sheehan take account of the genetic contribution? Suppose that Patient B has a familial predisposition to high cholesterol. She only discovered this in her thirties. Until then she ate a diet that would be fine in someone without her predisposition, but is dangerous in her case. She gets atherosclerosis and needs a coronary stent. Should she have one? Is her condition self-inflicted? Would Dr. Sheehan's decision about her treatment depend on whether she should, with the exercise of appropriate care (what's 'appropriate'?), have cut down on the pies earlier than she did? These questions are horrifically difficult. We can multiply them ad nauseam. They are all raised by Dr. Sheehan's purportedly straightforward criterion.

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Oxford Debates Cont’d – Proposer’s Closing Statement

Part of the debate "The NHS should not treat self-inflicted illness"
Proposer: Dr Mark Sheehan

Closing Statement

What is most difficult about topics such as this one is that there are clear intuitions on both sides. These intuitions pull against each other and tempt us to focus on extremes at either end. The solution lies in the middle, where we can respect the desire to care for all those who are suffering as well as taking seriously the network of rights and responsibilities on which society is based.

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Oxford Debates Cont’d – Opposer’s update 2

Part of the debate "The NHS should not treat self-inflicted illness"

Opposer: Charles Foster
Update 2

Dr. Sheehan has fairly and inevitably surrendered. The motion as it stands is wholly unarguable.

But he contends that there are still important matters to discuss. I agree. Let's look at the 'subset of extreme examples' he relies on, where it is blindingly obvious that injury has been self-inflicted. The three clearest examples are perhaps attempted suicides, injuries resulting from dangerous sports, and some road traffic accidents.

We need to start by chasing away one red herring: insurance.  Of course bungee jumpers and parachutists should be insured. Insurance is mandatory for drivers. I have no difficulty with the proposition that the NHS should recoup the cost of care from the bungee jumper's insurer. But let's suppose that the insurance company won't pay. There could be many reasons. The jumper's wife might have failed to post a letter; the tour operator, unbeknown to the jumper, might not have been on the insurer's approved list; the insurer might litigate long and hard to avoid liability on a technicality.

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Who defines a Jew?

by David Edmonds

 

Here are some of the relevant facts about a landmark legal ruling last week – involving a dispute that illustrates an irresolvable tension within multi-culturalism. 

 

JFS is a Jewish ‘faith school’ in North London.  It achieves impressive academic results.  Faith schools’ are perfectly legal – indeed, they seem to have been encouraged by this government.  If oversubscribed, as the JFS usually is, faith schools are allowed to favour members of their faith.  There are many Christian and Islamic faith schools.

 

The legal case involved a boy, ‘M’.  JFS refused M a place because his mother, who was not born Jewish, converted to Judaism in a Progressive synagogue.  This conversion process is not recognized by the Office of the Chief Rabbi (OCR).  The family of the boy regularly attended Progressive synagogue.  

The Court of Appeal has just ruled that the JFS’s admissions policy contravened the Race Relations Act because of the requirement that for a pupil to qualify for admission “his mother must be Jewish, whether by descent or by conversion’.  This, the court said, was a “test of ethnicity”.

Here are a few minor comments about this case.

 

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‘But it will happen anyway’

When the ethical implication of some scientific or technological advance are debated, it is common for someone to remark that it’s a waste of time to debate whether this technology should be pursued—it will be developed anyway, won’t it, and if we want to spend our time fruitfully, we should ask, not whether this technology should be developed or used, but how it might be best used. I have occasionally been tempted by this line of thought myself, but on reflection, it’s rather puzzling. I’d like to try to get a bit clearer about it.

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Oxford Debates Cont’d – Proposer’s update 2

Part of the debate "The NHS should not treat self-inflicted injuries"

Proposer: Dr Mark Sheehan
Update 2

As Foster suggests we must be clear about the motion. So what might it mean to 'not treat self-inflicted illness'? If it means not treating an illness or condition that was in some way the result of choices of the patient, not only would the motion require that the NHS not treat the flu — if only people had no contact with each other — but it would be a complete waste of time to discuss.

The motion does raise an important issue, and a live issue, and so it should be given a sensible interpretation. Precisely because of this 'self-inflicted' must mean something like 'those illnesses that can be shown to be self-inflicted.' The background to all of this of course is the body of evidence surrounding particular kinds of life-style decisions. So when we refer to self-inflicted illness we do not mean all cases, but the subset of extreme examples where particular choices have been made and the knowledge that is clearly available in society has been ignored.

We also need to be clear about the ways in which the NHS might 'not treat.' First, 'not treating' can involve blocking access to particular care or procedures. Foster concedes that the processes in the NHS for making decisions about funding may conclude (apparently with some justification) that heavy smokers should not be given coronary bypasses — because they smoke. Clearly here, the choice to smoke by the patient means that they are denied treatment. The smoking causes the conditions that the make the coronary bypass likely to fail.

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How bad are heatwaves and flu epidemics?

The UK health media is currently focused on two natural threats to public health: one from swine flu, and the other from the heatwave currently affecting the country. Both flu epidemics and heatwaves frequently cause many deaths. For example, the August 2003 heatwave had a death toll in Europe of around 30,000, and a typical seasonal flu epidemic causes hundreds and thousands of deaths. Yet my impression is that, in the majority of the population, flu epidemics and heatwaves are not regarded as particularly great evils (flu pandemics, such as the current one, may be a different story).There's an obvious explanation for why they are regarded as less bad than killers such as road traffic accidents, wars and terrorism: these involve human action – and often human wrongdoing – in a way that flu epidemics and heatwaves do not. But flu epidemics and heatwaves also elicit a weaker reaction than many other natural events that typically kill far fewer people: for example, floods and earthquakes.

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Pandemic ethics: Party to the flu (or vigilante vaccination)

A public health expert has warned yesterday against the idea of swine-flu parties, arguing that it may undermine the fight against the emerging pandemic. But others, including James Delingpole in the Telegraph have embraced the idea, hoping that mild influenza now will protect against more serious illness later. Exposure parties might be thought of as a form of vigilante vaccination against influenza.

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