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Professional Ethics

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. Read More »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

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?Read More »Pandemic Ethics: How Much Risk Should Social Care Workers and Their Families Be Expected to Take?

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).

Read More »The Right Not to Know and the Obligation to Know

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.Read More »The Doctor-Knows-Best NHS Foundation Trust: a Business Proposal for the Health Secretary

Conscientious Objection, Professional Discretionary Space, and Good Medicine

By Doug McConnell

 

Some argue that good medicine depends on physicians having a wide discretionary space in which they can act on their consciences (Sulmasy, 2017). Interestingly, those who are against conscientious objection in medicine make the exact opposite claim – giving physicians the freedom to act on their consciences will undermine good medicine. So who is right here?

Read More »Conscientious Objection, Professional Discretionary Space, and Good Medicine

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?

Should Religious Homophobia be a Firing Offence?

By Doug McConnell

It looks as if Isreal Folau will lose his job as a professional rugby player for expressing his apparently genuine religious belief that drunks, homosexuals, adulterers, liars, fornicators, thieves, atheists, and idolators are all going to hell. Morgan Begg, a research fellow at the Australian conservative think-tank, the Institute of Public Affairs, has recently argued that this is the result of a “totalitarian” and “authoritarian desire to impose ideological orthodoxy on Australians.” I respond that it is, in fact, Begg’s ideological position that is more amenable to totalitarianism and authoritarianism.Read More »Should Religious Homophobia be a Firing Offence?

Against Conscientious Objection In Health Care: A Counterdeclaration And Reply To Oderberg

Alberto Giubilini (Wellcome Centre for Ethics and Humanities, University of Oxford) and

Julian Savulescu (Uehiro Centre for Practical Ethics, University of Oxford)

Conscientious objection in health care – that is, healthcare practitioners objecting to performing certain legal, safe, and beneficial medical procedures (e.g. abortion) that a patient requests by appealing to their personal moral values – is one of the most debated topics in medical ethics at present time. Although at the moment doctors’ private conscience enjoys a lot of legal protection – most laws that make abortion legal contain clauses that exempt doctors from performing the procedure if they so wish. We have provided reasons, both in this forum and in our academic work, for why we think that conscientious objection in health care is not morally permissible and should not be allowed in the case of procedures that are legal, safe, beneficial, autonomously requested by patients and, more generally, consistent with the standards of good medical practice (see e.g. Savulescu 2006, Savulescu and Schuklenk 2017, Giubilini 2014, Giubilini 2017). Some people disagree and advance reasons for the opposite view. One of the scholars who has more clearly and straightforwardly articulated the principles and reasons in support of conscientious objection in health care is Professor Oderberg of Reading University. Prof Oderberg was recently invited to debate the issue with Julian Savulescu at the Masters Course in Practical Ethics run by the Uehiro Centre here at the University of Oxford. On that occasion, Prof Oderberg’s defense of conscientious objection centred around a series of principles and considerations that he very effectively formulated in the 17 main points that constitute his “Declaration in support of conscientious objection in health care”, published on the University of Reading website and which is available for people who agree with him to sign.Read More »Against Conscientious Objection In Health Care: A Counterdeclaration And Reply To Oderberg

The Dangers Of Deferring To Doctors

By Charles Foster

(Image: tctmd.com)

There is a dizzying circularity in much medical law. Judges make legal decisions based on the judgments of rightly directed clinicians, and rightly directed clinicians make their judgments based on what they think the judges expect of them. This is intellectually unfortunate. It can also be dangerous.

There are two causes: Judges’ reluctance to interfere with the decisions of clinicians, and doctors’ fear of falling foul of the law.

In some ways judicial deference to the judgment of professionals in a discipline very different from their own is appropriate. Judges cannot be doctors. The deference is best illustrated by the famous and ubiquitous Bolam test, which is the touchstone for liability in professional negligence cases.1 A doctor will not be negligent if their action or inaction would be endorsed by a responsible body of professional opinion in the relevant specialty.

In the realm of civil litigation for alleged negligence this deference is justified. The problem arises when the deference is exported to legal arenas where it should have no place. The classic example relates to determinations of the ‘best interests’ of incapacitous patients. Something done in relation to an incapacitous patient will only be lawful if it is in that patient’s best interests.Read More »The Dangers Of Deferring To Doctors

What’s Wrong With Simulation in Football?

Written by Doug McConnell

The 2018 edition of the football world cup has brought with it a renewed bout of hand wringing over ‘simulation’, e.g. players falling, diving, and tumbling under imaginary fouls, rolling around in mock pain, or clasping their faces pretending to have been hit. Stuart James writes in the Guardian that “play-acting has been commonplace at this World Cup. It’s become a cancer in the game, not just a stain on it, and Fifa needs to find a cure.” But what exactly is wrong with this behaviour? Why is the rise of this behaviour ‘a cancer in the game’?Read More »What’s Wrong With Simulation in Football?