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Cross post: Pandemic Ethics: Should COVID-19 Vaccines Be mandatory? Two Experts Discuss

Cross post: Pandemic Ethics: Should COVID-19 Vaccines Be mandatory? Two Experts Discuss

Written by Alberto Giubilini (Oxford Uehiro Centre for Practical Ethics and WEH, University of Oxford )

Vageesh Jaini (University College London)

(Cross posted with the Conversation)

 

To be properly protective, COVID-19 vaccines need to be given to most people worldwide. Only through widespread vaccination will we reach herd immunity – where enough people are immune to stop the disease from spreading freely. To achieve this, some have suggested vaccines should be made compulsory, though the UK government has ruled this out. But with high rates of COVID-19 vaccine hesitancy in the UK and elsewhere, is this the right call? Here, two experts to make the case for and against mandatory COVID-19 vaccines.

 

Alberto Giubilini, Senior Research Fellow, Oxford Uehiro Centre for Practical Ethics, University of Oxford

COVID-19 vaccination should be mandatory – at least for certain groups. This means there would be penalties for failure to vaccinate, such as fines or limitations on freedom of movement.

The less burdensome it is for an individual to do something that prevents harm to others, and the greater the harm prevented, the stronger the ethical reason for mandating it.
Read More »Cross post: Pandemic Ethics: Should COVID-19 Vaccines Be mandatory? Two Experts Discuss

Refusal Redux. Revisiting Debate About Adolescent Refusal of Treatment.

by Prof Dominic Wilkinson @Neonatalethics

Last month, in an emergency hearing, the High court in London heard a case that characterises a familiar problem in medical ethics. A 15 year old adolescent (known as ‘X’) with a long-standing medical condition, Sickle Cell disease, had a very low blood count and required an urgent blood transfusion. However, X is a Jehovah’s Witness and did not wish to receive blood as it was contrary to her religious beliefs. X’s doctors believed that she was at risk of very serious health consequences without a blood transfusion (a stroke, or even death).

Of no great surprise to anyone, the court authorised the emergency blood transfusion for X. Although X was “mature and wise beyond her years”, and judged to be ‘Gillick competent’ (see below), the judge made the decision in her best interests.

That decision is consistent with many previous cases that have come to the courts in the UK and overseas (see here, here, here )[1]. It is very similar to the case in Ian McEwan’s novel and film “The Children Act” (the book, had been based on real cases before the courts). The courts, in the UK at least, have always decided to over-rule under-eighteens who wish to refuse potentially life-saving treatment. Once the teenager reaches the age of eighteen, the decision is different, however. At that point, if they are judged to have “capacity”, (ie they have the ability to use, understand, and communicate the information necessary for a decision)  they can refuse even if the treatment would certainly save their life.

Although the decision is unsurprising, the judge made a comment implying that future cases might not always reach the same conclusion. X’s lawyer argued that the traditional legal approach may be “in need of urgent re-analysis and review”, and the judge appeared to agree that these arguments needed careful consideration (not possible acutely given the urgency of X’s case).

Should the ethical and legal approach to adolescents who refuse treatment change?

Read More »Refusal Redux. Revisiting Debate About Adolescent Refusal of Treatment.

Legacies

By Stephen Rainey

Joe Biden won the recent US election. As yet, the normal concession speech from the losing candidate has not been forthcoming. Donald Trump’s actions since losing the presidency have been, well, Trumpian, prompting Biden to label them an ‘embarrassment.’ He also suggested that The Donald was endangering his legacy in not reacting more gracefully. But what use is talk of ‘legacy’? What matters most about it?

It would be easy to ‘Goldwater’ Trump, that is, diagnose some mental incapacity from afar. One could suggest he was ill-equipped to absorb his defeat. He has behaved in ways that could be seen as pathological. Maybe, we might continue, he really doesn’t believe this is the end. If that were the case, there would be no need to consider legacy. It would also be easy to have suspected that, far from sticking around, 45 would flounce out of the White House, his pride wounded. Legacy wouldn’t matter in that case, because the electorate, the people, would have shown themselves to be unworthy, having voted the wrong way. Sad.Read More »Legacies

Antenatal Care During The COVID-19 Pandemic: Couples As Dyads

Written by Rebecca Brown

 

During the pandemic, many healthcare services have been reduced. One instance of this is the antenatal care of expectant mothers. Ordinarily, partners of pregnant women are permitted to attend appointments. This includes the 12 week scan: typically the first opportunity expectant parents get to see the developing foetus, to discover whether it has a heartbeat and is growing in the right place. This can be very exciting and, if there’s bad news, devastating. It also includes scans in mid pregnancy and (for first-time mothers) at 36 weeks, as well as the entirety of labour.

During the pandemic, many healthcare providers have restricted attendance at antenatal appointments as well as labour and postnatal care. Even when lockdown restrictions were eased, with pubs, zoos and swimming pools re-opening and diners in England being encouraged to Eat Out to Help Out, some hospitals continued to exclude partners from all antenatal appointments and all but the final stage of labour, requiring them to leave shortly after birth. This included cases where mother and newborn had to remain on wards for days following delivery. With covid cases rising, it seems likely that partners will once again be absent from much antenatal, labour, and postnatal care across the country.Read More »Antenatal Care During The COVID-19 Pandemic: Couples As Dyads

Cross Post: Pandemic Ethics: Vaccine Distribution Ethics: Monotheism or Polytheism?

Written by Alberto Giubilini, Julian Savulescu, Dominic Wilkinson

(Oxford Uehiro Centre for Practical Ethics)

(Cross-posted with the Journal of Medical Ethics blog)

Pfizer has reported preliminary results that their mRNA COVID vaccine is 90% effective during phase III trials. The hope is to have the first doses available for distribution by the end of the year. Discussion has quickly moved to how the vaccine should be distributed in the first months, given very limited initial availability. This is, in large part, an ethical question and one in which ethical issues and values are either hidden or presented as medical decisions. The language adopted in this discussion often assumes and takes for granted ethical values that would need to be made explicit and interrogated. For example, the UK Government’s JCVI report for priority groups for COVID-19 vaccination reads: “Mathematical modelling indicates that as long as an available vaccine is both safe and effective in older adults, they should be a high priority for vaccination”. This is ethical language disguised as scientific. Whether older adults ‘should’ be high priority depends on what we want to achieve through a vaccination policy. And that involves value choices. Distribution of COVID-19 vaccines will need to maximize the public health benefits of the limited availability, or reduce the burden on the NHS, or save as many lives as possible from COVID-19. These are not necessarily the same thing and a choice among them is an ethical choice.Read More »Cross Post: Pandemic Ethics: Vaccine Distribution Ethics: Monotheism or Polytheism?

Invertebrate Ethics

by Roger Crisp

In a recent and very interesting paper, Irina Mikhalevich and Russell Powell (MP) argue that the same standards of evidence and risk management that justify policy protections for vertebrates also support extending moral consideration to certain invertebrates. In this blog, I’ll offer two lines of argument broadly supportive of MP’s conclusions. First, even if invertebrates are non-sentient, their lives may contain elements of welfare sufficient for moral standing. Second, justice speaks in favour of giving priority to the interests of most invertebrates, since their lives are so much less valuable for them, in terms of welfare, than the lives of most vertebrates.Read More »Invertebrate Ethics

The Duty To Ignore Covid-19

By Charles Foster

This is a plea for a self-denying ordinance on the part of philosophers. Ignore Covid-19. It was important that you said what you have said about it, but the job is done. There is nothing more to say. And there are great dangers in continuing to comment. It gives the impression that there is only one issue in the world. But there are many others, and they need your attention. Just as cancer patients were left untreated because Covid closed hospitals, so important philosophical problems are left unaddressed, or viewed only through the distorting lens of Covid.Read More »The Duty To Ignore Covid-19

Guest Post: A Relentless Focus on the Given – Reviewing O. Carter Snead’s What it Means to be Human: The Case for the Body in Public Bioethics

Guest Post by Charles Camosy

Professor Carter Snead, at least in my world, is about as important a contemporary voice in bioethics that we have today. A professor on Notre Dame’s law faculty, he is perhaps better known as director of the de Nicola Center for Ethics and Culture—one of the most significant positions in the United States for doing public bioethics. He was heavily involved in the topic before coming to Notre Dame, including when serving as general counsel to the President’s Council on Bioethics chaired by Leon Kass. He currently serves on the Pontifical Academy for Life and as an elected fellow of the Hastings Center.

When Professor Snead came out with a book on public bioethics from Harvard University Press this month, that became good reason for many of us to pay close attention—especially when Alasdair MacIntyre gave a back cover endorsement calling it “indispensable reading” whether “you agree or disagree with Snead’s perspective.” Indeed, Snead makes it clear that he’s not merely preaching to the choir in this book, but instead aiming at making his case to folks with  different perspectives in “the spirit of friendship” and “anchored in the firm belief that we can only govern ourselves wisely, humanly, and justly if we become the kind of people who can make each other’s goods our own.”Read More »Guest Post: A Relentless Focus on the Given – Reviewing O. Carter Snead’s What it Means to be Human: The Case for the Body in Public Bioethics

Announcement: 7th Annual Oxford Uehiro Prize in Practical Ethics

Graduate and undergraduate students currently enrolled at the University of Oxford in any subject are invited to enter the Oxford Uehiro Prize in Practical Ethics by submitting an essay of up to 2000 words on any topic relevant to practical ethics.  Eligibility includes visiting students who are registered as recognized students, and paying fees, but does not include informal visitors.  Two undergraduate papers and two graduate papers will be shortlisted from those submitted to go forward to an online public presentation and discussion, where the winner of each category will be selected.

The winner from each category will receive £300, and the runner up £100. Revised versions of the two winning essays will be considered for publication in the Journal of Practical Ethics, though publication is not guaranteed.

To enter, please submit your written papers by the end of Tuesday 9th February 2021 to rocci.wilkinson@philosophy.ox.ac.uk. Finalists will be notified on Tuesday 23rd February of selection. The online public presentation will take place in 8th Week, Hilary term 2021, on Wednesday 10th March, from 5pm. Please save this presentation date, as you will need to attend if selected as a finalist. Read More »Announcement: 7th Annual Oxford Uehiro Prize in Practical Ethics

Press Release: UK Approves COVID-19 Challenge Studies

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Responses to the UK COVID-19 Challenge Studies: 

“In a pandemic, time is lives.  So far, over a million people have died.

“There is a moral imperative to develop to a safe and effective vaccine – and to do so as quickly as possible.  Challenge studies are one way of accelerating vaccine research.  They are ethical if the risks are fully disclosed and they are reasonable.  The chance of someone aged 20-30 dying of COVID-19 is about the same as the annual risk of dying in a car accident.  That is a reasonable risk to take, especially to save hundreds of thousands of lives.  It is surprising challenge studies were not done sooner.  Given the stakes, it is unethical not to do challenge studies.”

Prof Julian Savulescu, Uehiro Chair in Practical Ethics, and Director of the Oxford Uehiro Centre for Practical Ethics, and Co-Director of the Wellcome Centre for Ethics and Humanities, University of Oxford

“Human challenge studies are an important and powerful research tool to help accelerate our understanding of infectious diseases and vaccine development.  They have been used for many years for a range of different infections.

“The announcement of the UK Human Challenge Program is a vital step forward for the UK and the world in our shared objective of bringing the COVID-19 pandemic to an end.  With cases climbing across Europe, and more than 1.2 million deaths worldwide, there is an urgent ethical imperative to explore and establish COVID-19 challenge trials.

“All research needs ethical safeguards.  Challenge trials need to be carefully designed to ensure that those who take part are fully informed of the risks, and that the risks to volunteers are minimised.  Not everyone could take part in a challenge trial (only young, healthy volunteers are likely to be able to take part).  Not everyone would choose to take part.  But there are hundreds of young people in the UK and elsewhere who have already signed up to take part in COVID challenge studies.  They deserve our admiration, our support and our thanks.”

Prof Dominic Wilkinson, Professor of Medical Ethics, Oxford Uehiro Centre for Practical Ethics, University of Oxford

Further Research

Read more about the ethics of challenge studies:

Read More »Press Release: UK Approves COVID-19 Challenge Studies