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Puberty-Blocking Drugs: The Difficulties of Conducting Ethical Research

Puberty-Blocking Drugs: The Difficulties of Conducting Ethical Research

The ethics of research trials for young people with gender dysphoria are complicated.
Billion Photos/Shutterstock

Dominic Wilkinson, University of Oxford and Julian Savulescu, University of Oxford

A recent Newsnight programme reported that a major UK puberty-blocking trial is under investigation. Doctors at a London clinic provided drugs to block the development of puberty in young adolescents with gender dysphoria, a condition where the person experiences discomfort or distress because of a mismatch between their biological sex and gender identity.

The trial began in 2011. A year after starting the drugs, the young people were apparently more likely to report thoughts of wanting to harm themselves. The worry is that perhaps the treatment they received was causing them to have these thoughts of self-harm and suicide.

One of the criticisms of the study, put forward on Newsnight, is the design. The study involved giving the drugs to a group of adolescents and monitoring the effects. However, there was no control group, that is, adolescents who did not receive the drugs. This makes it hard to be sure whether the rates of self-harming thoughts are related to the drugs, would have happened anyway, or perhaps were lower than they would have been without treatment.Read More »Puberty-Blocking Drugs: The Difficulties of Conducting Ethical Research

A Proposal for Addressing Language Inequality in Academia

Written by Anri Asagumo

Oxford Uehiro/St Cross Scholar

Although more and more people see the importance of diversity in academia, language diversity is one type of diversity that seems to be diminishing: English is increasingly dominant in both areas. I would like to argue that people who are born and raised in an English-speaking country should be required to acquire a second language to the level they can write a rudimentary paper and give a presentation in that language in order to apply for international conferences and submit papers to international journals. The purpose of this requirement would be to address the significant inequality between native English-speakers and others. I focus on academia here, but ideally the same thing should be applied to the business world, too.Read More »A Proposal for Addressing Language Inequality in Academia

Criticising Stigma Whilst Reinforcing it: the Case of the Response to CRUK’s Anti-Obesity Campaign

Written by Rebecca Brown

There has been recent concern over CRUK’s (Cancer Research UK) latest campaign, which features the claim ‘obesity is a cause of cancer too’ made to look like cigarette packets. It follows criticism of a previous, related campaign which also publicised links between obesity and cancer. Presumably, CRUK’s aim is to increase awareness of obesity as a risk factor for cancer and, in doing so, encourage people to avoid (contributors to) obesity. It may also be hoped to encourage public support for policies which tackle obesity, pushing the Overton window in a direction which is likely to permit further political action in this domain.

The backlash is mostly focused around the comparison with smoking, and the use of smoking-related imagery to promote the message (there is further criticism of the central causal claim, since it is actually quite difficult to establish that obesity causes cancer). 

Read More »Criticising Stigma Whilst Reinforcing it: the Case of the Response to CRUK’s Anti-Obesity Campaign

Doing More Harm Than Good? Should the Police Always Investigate Non-recent Child Sexual Abuse Cases?

Hannah Maslen, University of Oxford, @hannahmaslen_ox

Colin Paine, Thames Valley Police, @Colin_Paine

Police investigators are sometimes faced with a dilemma when deciding whether to pursue investigation of a non-recent case of child sexual abuse. Whilst it might seem obvious at first that the police should always investigate any credible report of an offence – especially a serious offence such as sexual abuse – there are some cases where there are moral reasons that weigh against investigation.

Imagine a case in which a third party agency, such as social services, reports an instance of child sexual exploitation to the police. The alleged offence is reported as having occurred 15 years ago. The victim has never approached the police and seems to be doing OK in her adult life. Although she had serious mental health problems and engaged in self-harm in the past, her mental health now appears to have improved. She does, however, remain vulnerable to setbacks. Initial intelligence gives investigators reason to believe that the suspect has not continued to offend, although there are limits to what can be known without further investigation. Should this alleged offence be investigated?

Read More »Doing More Harm Than Good? Should the Police Always Investigate Non-recent Child Sexual Abuse Cases?

Four Lessons from the Covert Separation and Study of Triplets

Written by Julian Savulescu

Today, the Journal of the American Medical Association published an article entitled “Three Identical Strangers and The Twinning Reaction— Clarifying History and Lessons for Today From Peter Neubauer’s Twins Study” written by Leon Hoffman and Lois Oppenheim.  It provides background to a documentary, Three Identical Strangers, which gained a lot of attention earlier in the year into “the lives of Edward Galland, David Kellman, and Robert Shafran, triplet brothers who stumbled upon each other in their college years and enjoyed a brief period of celebrity before emotionally confronting the implications of their separation.” One triplet ultimately committed suicide.

The triplets were part of a covert research study by child psychiatrist Peter Neubauer who followed them up for many years to study gene-environment interactions in triplets separated at birth. The article alleges that Neuberger was wrongly blamed by the triplets and film makers for their separation at birth. The authors argue it was “Viola Bernard, then a prominent child psychiatrist from Columbia University and consultant to a now-defunct adoption agency” who was responsible for their separation because she “believed that children born of the same pregnancy and placed for adoption would fare better if they were raised by separate families.” The authors review some evidence from the child development literature at the time that supported the idea that twins or triplets would fare better if adopted, experiencing less sibling rivalry and having greater access to parental resources.

Importantly they argue that Bernard and Neubauer acted independently of each other. Moreover, the secrecy was required by laws at the time. “It was illegal at the time of the study to provide information about biological families to adoptive parents, a practice that did not begin to be modified until the late 1970s and 1980s.”

Hoffman and Oppenheim conclude:

“So the study was ethically defensible by the standards of its time—principles of informed consent and the development of institutional review boards lay in the future.10 However, these documentaries demonstrate how unsatisfactory that defense is to the study’s families who live with its legacy.

The films’ message for today’s child specialists and researchers is thus something other than their surface themes of outrage and restitution. They rather provide an unusually dramatic example of the potential for harm from human participant research, even if only observational.”

I would like to draw four other lessons from this episode.

Read More »Four Lessons from the Covert Separation and Study of Triplets

Responsibility Over Time And Across Agents

Rebecca Brown and Julian Savulescu

Cross-posted from the Journal of Medical Ethics blog, available here.

There is a rich literature on the philosophy of responsibility: how agents come to be responsible for certain actions or consequences; what conditions excuse people from responsibility; who counts as an ‘apt candidate’ for responsibility; how responsibility links to blameworthiness; what follows from deciding that someone is blameworthy. These questions can be asked of actions relating to health and the diseases people may suffer as a consequence. A familiar debate surrounds the provision of liver transplants (a scarce commodity) to people who suffer liver failure as a result of excessive alcohol consumption. For instance, if they are responsible for suffering liver failure, that could mean they are less deserving of a transplant than someone who suffers liver failure unrelated to alcohol consumption.

Read More »Responsibility Over Time And Across Agents

Abolish Medical Ethics

Written by Charles Foster

In a recent blog post on this site Dom Wilkinson, writing about the case of Vincent Lambert, said this:

‘If, as is claimed by Vincent’s wife, Vincent would not have wished to remain alive, then the wishes of his parents, of other doctors or of the Pope, are irrelevant. My views or your views on the matter, likewise, are of no consequence. Only Vincent’s wishes matter. And so life support must stop.’

The post was (as everything Dom writes is), completely coherent and beautifully expressed. I say nothing here about my agreement or otherwise with his view – which is comfortably in accord with the zeitgeist, at least in the academy. My purpose is only to point out that if he is right, there is no conceivable justification for a department of medical ethics. Dom is arguing himself out of a job.Read More »Abolish Medical Ethics

Is ‘Dad Joke” Sexist?

Written by Neil Levy

A dad joke is a short joke, often turning on a pun or a play on words. Here are a couple of examples:

  • Did you hear about the restaurant on the moon? It’s got great food, but no atmosphere.
  • A sandwich walks into a bar and orders a beer. “Sorry,” says the bartender, “we don’t serve food here”.

They are called ‘dad jokes’ because they are stereotypically told by fathers. The term is a somewhat backhanded compliment. Like the words “daggy” (in Australian and New Zealand English) and “naff” (in British English) – all of which are words that could appropriately be used to describe jokes in the genre – calling something a dad joke at once conveys that is extremely uncool, but also indicates grudging affection for the target. Dad jokes are bad, in many people’s eyes (not mine, as it happens), but they’re so bad that they’re a kind of artform all of their own, and we convey an affection and grudging respect for those who tell them.Read More »Is ‘Dad Joke” Sexist?

How Should We Regulate Genetic Enhancement Technologies?

A Guest Post Written by Jonny Anomaly

 

It’s been 20 years since Allen Buchanan and his colleagues published From Chance to Choice: Genetics and Justice. The book was a landmark, and it repays careful reading.

But there is at least one kind of question that has been largely (if not entirely) ignored in discussions about whether we should regulate parental choice, once parents have access to technologies that allow them to sculpt the genetic endowment of their children. How should we think about reproductive choices that are good for each but not for all? What should we do when there is a conflict between parents selecting the best traits for their children, when a different distribution of traits might be better from a social standpoint? Another way of asking the question is this: how should we think about situations in which there is a potential conflict between the principle of procreative beneficence and the principle of procreative altruism?Read More »How Should We Regulate Genetic Enhancement Technologies?