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Oxford Debates Cont’d – Proposer’s Closing Statement

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.

Read More »Oxford Debates Cont’d – Proposer’s update 2

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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Don’t be Evil — and prove it.

A new angle has recently come to light regarding the unrest in Iran: well known western companies provided the technology the government are using to eavesdrop on its citizens. The Washington Times and Wall Street Journal have reported on the fact that Nokia and Siemens have sold special equipment to Iran's state-owned telecommunications company, which can be used to tap phones, read email messages and observe who is accessing which internet sites. This is not the first such case. In 2006, Amnesty International drew attention to the assistance Yahoo, Microsoft, and Google had given to Chinese authorities in their attempts to suppress free speech on the internet in China. Finally, the networking giant, Cisco, has been a key player in setting up the hardware that China uses to block foreign websites with its 'Great Firewall'.

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Oxford Debates Cont’d – Opposer’s update 1

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

Opposer: Charles Foster
Update 1

It simply won't do to underplay the practical difficulties posed by this motion. The motion is not 'The NHS should not treat those illnesses which can be shown beyond any doubt to have been self-inflicted', but 'The NHS should not treat self-inflicted illness'.  The world of medical causation is simply not as straightforward as Mark Sheehan suggests. To reiterate: to prove a link in the general population between smoking and lung cancer is a very different thing from proving it in an individual patient.

There are no 'robust' or indeed any systems in the NHS for dealing with this sort of issue. Nor can there be. Questions of individual causation are argued expensively before the courts in clinical negligence cases. They are notoriously nightmarish. The same job can't be done by committees, however enlightened or well meaning.

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Trackr the Most Cloneworthy Dog: Best Friends Again?

According to recent media reports, a competition to find the world’s most cloneworthy dog has been organised by the American firm BioArts International http://www.bioarts.com/about_us.htm. BioArts has a subsidiary, Encore Pet Science, which now offers a commercial dog cloning service. The world’s first commercially cloned god, Lancelot Encore, was born late last year and cost US$155,000-. However, Encore Pet Science are now offering to clone dogs for a mere $138,500-. Encore Pet Science also offer a gene banking service, which enables cloning to occur long after the death of an animal.

 

The competition to find the world’s most cloneworthy dog offered the winning owner the chance to have their dog cloned for free. Of the many entrants, the German Shepherd Trakr was judged to be the most cloneworthy, as result of his heroic efforts at Ground Zero following the 2001 collapse of the World Trade Center, where he worked non-stop for 48 hours and found the last survivor in the rubble. Trackr has also helped recover over $1 million in stolen goods in a long career as a working police dog. Trackr has been rewarded for his efforts by the creation of five cloned puppies, Trustt, Valor, Prodigy, Solace and Déjà vu.


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