Is Life-Sustaining Treatment Being Lawfully Withdrawn From Patients In Prolonged Disorders Of Consciousness?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? Continue reading
Daunte Wright: Policing and Accountability
Written by Jake Wojtowicz and Ben Davies
On April 11th, Daunte Wright was pulled over by police in Brooklyn Center, Minnesota. Shortly afterwards, he was shot and killed by police officer Kim Potter. Police Chief Tim Gannon described this as an ‘accidental discharge’. But framing events like this as accidents can be misleading and is just one way the police may insulate themselves from appropriate accountability.
The word ‘accident’ can bring to mind what we might call ‘sheer accidents’: bad fortune, acts of god, cars hitting the ice and veering off of the road. Even the language of an ‘accidental discharge’ can sound like Potter had the gun in her hand and it just somehow went off. But that isn’t what happened. Potter pointed the gun at Wright and pulled the trigger. She claims she meant to fire her taser.
Ethics Doesn’t Rule, OK?
By Charles Foster
Ethics and law are different. Or they should be.
Law has the power to coerce. That is a frightening power. There should be as little law as possible. But there should be more ethics than there is.
The boundary between the two domains is not absolute. Clinicians are probably more frightened of being struck off by the General Medical Council (GMC) (after an adjudication on their ethics by the Medical Practitioners’ Tribunal Service) than they are about an order by a civil court that compels their insurers to pay damages for clinical negligence. The exercise of the GMC’s statutory powers can be draconian: the existence of those powers, and the associated sanctions, is certainly coercive.
But although the boundary is sometimes blurred, it is still real. It is the job of the law to keep it from becoming dangerously permeable. In a recent case the law was caught napping. Continue reading
Ethics of the GameStop Short Squeeze
By Doug McConnell
Recently a large, loosely coordinated group of individual ‘retail investors’ have been buying up stocks that certain hedge funds had bet against (i.e. ‘shorted’). In doing so, the retail investors have driven up the price of those stocks. This has caused hedge funds that shorted the stock to lose billions of dollars and enabled a number of retail investors to get rich in the process. The phenomenon is anthropologically interesting because it is symbolic of a shift in power away from the traditional Wall Street players towards less wealthy, less well-connected individuals. But what are the ethics of this? Did Average Joe Trader just bring a measure of justice to Wall Street? Or did the mob unethically manipulate the market? If they did, are their actions any more unethical than the usual behaviour of institutional investors? Continue reading
Conscience Rights or Conscience Wrongs?: Debating Conscientious Objection in Healthcare
Written by: David Albert Jones, Anscombe Bioethics Centre
& Alberto Giubilini, Oxford Uehiro Centre for Practical Ethics, Wellcome Centre for Ethics and Humanities, University of Oxford
For the purpose of this debate (held online on 12 October 2020), Alberto Giubilini and David Albert Jones each adopted a position on conscientious objection (CO) contrary to the one that he in fact holds. David A. Jones, who is a defender of a right to conscientious objection in healthcare, made the case against it. Alberto Giubilini, who is against a right to conscientious objection in healthcare, made the case in favour of it. What follows is an evaluation by each of the arguments of the other in relation to their strengths and how they were presented. Continue reading
Video Series: Do Health and Social Care Workers Have a Moral Obligation to Keep Working if they Lack Protective Equipment?
This interview is now also available as a video on YouTube:
Pandemic Ethics: Key Workers Have a Stronger Claim to Compensation and Hazard Pay for Working During The COVID-19 Pandemic Than The Armed Forces Do When on Deployment
By Doug McConnell and Dominic Wilkinson
Post originally appeared on the Journal of Medical Ethics Blog
While the general public enjoy the relative safety of social distancing, key workers are at a higher risk of both contracting COVID-19 and transmitting it to their families. This is especially the case for ‘frontline’ workers who are frequently exposed to the virus and may not have access to adequate personal protective equipment (PPE). Tragically, many key workers have died of COVID-19 around the world already, including over 100 in the UK.
Although it is relatively rare for key workers to die from COVID-19, the risk of death is obviously much greater than one would usually expect in these roles and key workers clearly have good reason to be anxious. For ‘frontline’ workers, the distress is compounded by working in harrowing conditions where so many are dying alone. Furthermore, frontline workers have to take on the burdens of ensuring they do not transmit infections to their families, by moving in with patients, living in hotels, or maintaining rigorous social distancing in their own homes.
These atypical costs, risks, and burdens suggest that key workers are owed compensation in addition to their usual pay and a few instances of nationally coordinated applause. Continue reading
Pandemic Ethics: How Much Risk Should Social Care Workers and Their Families Be Expected to Take?
By Doug McConnell
Recently many of the staff at an aged-care home in Sydney, Australia called in sick the day after the report of a CoVid-19 outbreak at that facility.1 Upon investigation of these absences, one of the reasons the workers gave was that they were concerned about protecting their own families. They didn’t want to act as a vector transferring the disease from the aged care home to their own homes. So how much risk should social care workers and their families be obliged to take when responding to infectious diseases like CoVid-19? Continue reading
The Right Not to Know and the Obligation to Know
By Ben Davies
Most people accept that patients have a strong claim (perhaps with some exceptions) to be told information that is relevant to their health and medical care. Patients have a Right to Know. More controversial is the claim that this control goes the other way, too. Some people claim, and others deny, that patients also have a Right Not to Know.
A number of considerations (harm to the patient; autonomy; privacy) have been marshalled on either side of this debate over the past few decades (e.g. Laurie 2004; Robertson and Savulescu 2001; Herring and Foster 2012; Takala 2019). In this post, I focus on a distinct argument and its apparently unassailable logic. This is the view that a comprehensive Right Not to Know cannot be justified because in many cases a patient’s ignorance will likely lead harm to third parties (Council of Europe 1997; Rhodes 1998; Harris and Keywood 2001).
The Doctor-Knows-Best NHS Foundation Trust: a Business Proposal for the Health Secretary
By Charles Foster
Informed consent, in practice, is a bad joke. It’s a notion created by lawyers, and like many such notions it bears little relationship to the concerns that real humans have when they’re left to themselves, but it creates many artificial, lucrative, and expensive concerns.
Of course there are a few clinical situations where it is important that the patient reflects deeply and independently on the risks and benefits of the possible options, and there are a few people (I hope never to meet them: they would be icily un-Falstaffian) whose sole ethical lodestone is their own neatly and indelibly drafted life-plan. But those situations and those people are fortunately rare. Continue reading
Affiliations
Recent Comments