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‘Waiver or Understanding? A Dilemma for Autonomists about Informed Consent’

‘Waiver or Understanding? A Dilemma for Autonomists about Informed Consent’

by Roger Crisp

At a recent New St Cross Ethics seminar, Gopal Sreenivasan, Crown University Distinguished Professor in Ethics at Duke University and currently visitor at Corpus Christi College and the Oxford Uehiro Centre, gave a fascinating lecture on whether valid informed consent requires that the consenter have understood the relevant information about what they are being asked to consent to. Gopal argued that it doesn’t.Read More »‘Waiver or Understanding? A Dilemma for Autonomists about Informed Consent’

Guest Post: Frances Kamm- Harms, Wrongs, and Meaning in a Pandemic

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Written by F M Kamm
This post originally appeared in The Philosophers’ Magazine

When the number of people who have died of COVID-19 in the U.S. reached 500,000 special notice was taken of this great tragedy. As a way of helping people appreciate how enormous an event this was, some commentators thought it would help to compare it to other events that involved a comparable number of people losing their lives. For example, it was compared to all the U.S lives lost on the battlefield in World Wars 1 and II and the Vietnam War (or World War II, the Korean War, and Vietnam). Such comparisons raise questions, concerning dimensions of comparison, some of which are about degrees of harm, wrong, and meaningfulness which are considered in this essay. (Since the focus in the comparison was on the number of soldiers who died rather the number of other people affected by their deaths, this discussion will also focus on the people who die in a pandemic rather than those affected by their deaths.)

Read More »Guest Post: Frances Kamm- Harms, Wrongs, and Meaning in a Pandemic

Pfizer Jab Approved for Children, but First Other People need to be Vaccinated

Dominic Wilkinson, University of Oxford; Jonathan Pugh, University of Oxford, and Julian Savulescu, University of Oxford

Moderna and Pfizer have released data suggesting that their vaccines are well tolerated in adolescents and highly effective in preventing COVID-19. Canada, the US and the EU have already authorised the Pfizer vaccine in children as young as 12. And the UK has just approved the use of the Pfizer vaccine in children aged 12 to 15. But there may a case for holding out on an immediate rollout, for several reasons.

Whether a vaccine is beneficial for someone depends on three things: how likely they are to become seriously ill from the infection, how effective the vaccine is, and the risks of vaccination.Read More »Pfizer Jab Approved for Children, but First Other People need to be Vaccinated

Phobias, Paternalism and the Prevention of Home Birth

By Dominic Wilkinson,

Cross post from the Open Justice Court of Protection blog

In a case in the Court of Protection last week, a judge authorised the use of force, if necessary, to ensure that a young woman gives birth in hospital rather than at home.

The woman (call her ‘P’) has severe agoraphobia, and has barely left her home in four years. Her doctors believe that it would be best for her to deliver her baby in hospital. But P has an overwhelming fear of leaving her home and cannot agree to this. Their particular concern is that P might develop a serious complication during her home birth, need emergency transport to hospital, but be unwilling or unable to agree to this because of the severity of her phobia.

At the conclusion of a three-day hearing, Mr Justice Holman declared that P lacked capacity to make the relevant decisions and ordered that it was lawful and in her best interests for medical staff to transfer her to hospital a few days before her estimated due date, and for medical professionals to offer her a choice of induction of labour or Caesarean Section in hospital.  He also gave permission for the use of restraint, if necessary, in the event that she refuses to go to hospital voluntarily.

On the face of it, this looks like an extremely concerning infringement of a patient’s autonomy – a view that has been expressed by members of the public responding to media reports (e.g. see the blog post here).   We normally think that adults should be free to make decisions about their medical care, including the freedom to refuse treatments that doctors are recommending. Decisions about place of birth and mode of birth are deeply personal decisions that can be hugely important for many women. For that reason, doctors and courts should be extremely loathe to infringe upon them.

Is it justified in this case, then, to physically restrain P and treat her against her wishes? In particular, is it justified to do this pre-emptively, before a complication develops?Read More »Phobias, Paternalism and the Prevention of Home Birth

Press Release: ISSCR Guidelines for Stem Cell Research and Clinical Translation

Response to the: ISSCR Guidelines for Stem Cell Research and Clinical Translation “The new ISSCR guidelines provide a much welcomed framework for research that many find ethically contentious. Genome editing, the creation of human gametes in a lab, and the creation of human/non-human chimeras raise fundamental ethical issues that scientists can no longer overlook. The ISSCR… Read More »Press Release: ISSCR Guidelines for Stem Cell Research and Clinical Translation

Special St Cross Seminar summary of Maureen Kelley’s: Fighting Diseases of Poverty Through Research: Deadly dilemmas, moral distress and misplaced responsibilities

Written By Tess Johnson

You can find the video recording of Maureen Kelley’s seminar here, and the podcast here.

Lately, we have heard much in the media about disease transmission in conditions of poverty, given the crisis-point COVID-19 spread and mortality that India is experiencing. Yet, much of the conversation is centred on the ‘proximal’—or more direct—causes of morbidity and mortality, rather than the ‘structural determinants’—or underlying, systemic conditions that lead to disease vulnerability in a population. As a result, much global health research is focussed on infectious disease treatment and prevention, rather than responses to the complex political, economic and social needs that underly disease in vulnerable communities. This can result not only in less efficient and effective research, but also moral distress for researchers, and a disconnect between research goals and the responsibility that researchers feel for addressing a community’s immediate needs.

In her Special St Cross Seminar last week, Maureen Kelley introduced her audience to these problems in global health research. Professor Kelley outlined, first, empirical findings evidencing this problem, a result of research she recently performed with the Ethox Centre’s REACH team, in collaboration with global health research teams around the world. Second, she linked this empirical work to theory on moral distress and researchers’ and institutions’ responsibilities toward participating communities in low and middle-income countries (LMICs).Read More »Special St Cross Seminar summary of Maureen Kelley’s: Fighting Diseases of Poverty Through Research: Deadly dilemmas, moral distress and misplaced responsibilities

Imposter Syndrome And Environmental Sampling

Written by Rebecca Brown

Imposter syndrome has received recent, though still fairly limited, philosophical discussion. Scholars such as Katherine Hawley (and, drawing upon Hawley in a recent and excellent podcast, Rebecca Roache), amongst a handful of others have illuminated issues such as how we can develop a useful definition of imposter syndrome, the extent to which imposter syndrome may be adaptive, and the relationship between imposter syndrome beliefs and rationality. I want to pick up on this last question and suggest a further way in which people might rationally adopt ‘imposter attitudes’.

Imposter syndrome, as described by Hawley, involves believing that the external markers of esteem and success one receives are undeserved, and feeling at risk of being exposed as a fraud. Imposter attitudes refer to the negative attitudes one might hold regarding one’s own ability. Hawley challenges the common assumption that those suffering from imposter syndrome are simply too unconfident. She describes how people might justifiably (though mistakenly) hold imposter attitudes as a result of ‘hostile social environments’. This includes, for instance, people who are less likely to receive positive feedback in their work environment, or have reason to believe that any positive feedback they receive is insincere. For such people, although they have some evidence of their talent (e.g. publishing papers or winning awards), they have other evidence that this could be undeserved (e.g. lack of positive feedback from colleagues). Hawley is particularly concerned about minority groups who she suggests are more likely to experience hostile social environments and feel like impostors.Read More »Imposter Syndrome And Environmental Sampling

Is Life-Sustaining Treatment Being Lawfully Withdrawn From Patients In Prolonged Disorders Of Consciousness? Nobody Seems To Know

By Charles Foster

From the time of the decision of the House of Lords in Airedale NHS Trust v Bland (1993) until the decision of the Supreme Court in An NHS Trust v Y (2018) (which I will refer to here as ‘Y”) it had been understood that the withdrawal of life-sustaining treatment (typically clinically assisted nutrition and hydration – ‘CANH’) from patients in a vegetative state should be endorsed by the court. Over the years, this practice had been extended to cover such withdrawals in Minimally Conscious States too.

In Y, the Supreme Court held that there was no requirement for court review or endorsement. Why?Read More »Is Life-Sustaining Treatment Being Lawfully Withdrawn From Patients In Prolonged Disorders Of Consciousness? Nobody Seems To Know

Stowaway, Self-Defense, and the Sheriff Case

Written by Hazem Zohny.

You and your two fellow astronauts are on your way to Mars when you uncover a stowaway in your spaceship. His mere presence means there won’t be enough oxygen for anyone to survive the journey. You toss him out the spaceship, of course. But what if that stowaway is there by accident – through absolutely no fault of his own? Would you still throw him out, though perhaps feel extra bad about it?

That, without giving too much of the plot away, is the moral dilemma on which the recent Netflix film ‘Stowaway’ is built. It’s an enjoyable watch, especially if you are into the kind of old school science fiction that involves those tense but fairly long scenes of someone just walking on the outside of a spaceship in a spacesuit. Crucially, as films go, it deals with its moral dilemma fairly thoughtfully.

Read More »Stowaway, Self-Defense, and the Sheriff Case