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Public Health

Focussing on diseases

Further to Julian’s article about Giving What We Can, an important part of helping people as much as possible is to find out which charities do the most good for a certain amount of money. This has been in the news recently with this article. It claims that we are missing out on doing a lot of good by focussing exclusively on certain high-profile diseases, while other diseases impose a greater burden and are much cheaper to treat. This raises the question of why some diseases get much more attention and support than others.

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Could a ban on homebirth be justified?

Agnes Gereb, a midwife in Hungary, has been imprisoned for performing home births http://www.guardian.co.uk/world/2010/oct/22/hungary-midwife-agnes-gereb-home-birth. She faces various charges, including negligent malpractice and manslaughter (relating to a homebirth in which the baby died after a difficult labour). While home birth is theoretically legal in Hungary, in practice independent Hungarian midwives are not certified as being able to ensure safe conditions for home birth.

Media commentary in this country has on the whole been very sympathetic towards Gereb (for example http://www.bbc.co.uk/programmes/b00vhfg2), implying that the rules which prevent women from giving birth at home are unwarranted restrictions on their freedom. Although in most developed countries home births are the exception rather than the rule, they are generally felt to be something women have a right to choose to have. A plausible reason for this is that birth is seen as a very important, as well as personal, experience which the mother should have control over. Is Hungary justified in challenging the existence of such a right?

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Anti Addict Mummy Money

A US group that pays drug addicts to undergo sterilisation visits the UK this week, having recently paid its first British client for undergoing a vasectomy. “Project Prevention” claims that its goal is to make addicts and alcoholics use long-term birth control until they can care for the children they conceive. Founder Barbara Harris has said: “We don’t allow dogs to breed. We spay them. We neuter them. We try to keep them from having unwanted puppies, and yet these women are literally having litters of children.”

The visit has provoked strong responses. Some have compared the group to eugenicists, while supporters point to the cost to the children and society of conception by addicted parents. Dominic Wilkinson has controversially suggested on this blog that a version of the programme could be offered on the National Health Service.

This ethical debate is on the level that Mackie (1977) identifies as first order. However, the issue also highlights second order moral issues about the nature of morality. What are we doing when we express a moral view and how do we know that our views are reliable? One approach to answering these sorts of questions is to understand human morality as an adaptation that contributed to our ancestors’ evolutionary fitness. Without addressing the strengths and weaknesses of such an approach here, if correct, it has the potential to illuminate second, and by implication first, order questions.

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Should we force parents to vaccinate their children? No: let’s just scare them instead

by Rebecca Roache

The BBC recently reported that some homeopaths are offering their patients homeopathic remedies designed to replace the MMR vaccine.  Given that the efficacy of homeopathic remedies is notoriously unproven, this points to the worrying conclusion that some parents who have chosen a homeopathic alternative to the MMR vaccine believe that their children are immune to measles, mumps, and rubella, when in fact they are unprotected against these diseases.

This development marks another blow for the ongoing campaign to ensure that children receive the recommended vaccinations.  Sir Sandy Macara, ex-chairman of the British Medical Association, has claimed that the UK has lower immunisation rates than some developing countries in which people have poor access to healthcare.  The percentage of the UK population currently vaccinated against MMR falls well below the level needed to achieve ‘herd immunity’ – where the number of immune individuals in the population prevents the spread of disease, thereby protecting those who are not immune – and recent outbreaks of measles in Wales has led the Welsh Assembly to consider making the MMR vaccine compulsory.  Such a move would be highly controversial, but is this a price worth paying to protect public health?

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Is the UK’s HPV vaccination programme unethical and/or unlawful?

A colleague recently emailed me. Her daughter, just turned
12, had come back from school bearing an information leaflet about HPV vaccination
with the Glaxo Cervarix vaccine, and a consent form for the parent to sign.

The consent form nodded inelegantly to Gillick, asserting that ‘[t]he decision to consent or refuse is
legally [the girl’s], as long as she understands the issues in giving consent.’
There was no indication given, in the consent form or the accompanying
literature, as to whether and if so how that understanding would be tested. The
reality is that it won’t be tested at all.

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Is it criminal not to breastfeed?

by Rebecca Roache

The Brazilian
model Gisele Bundchen recently—and controversially—claimed that mothers should
be required by law to breastfeed their babies for the first six months of their
lives. 
A few days later, she partially retracted the claim on her blog, insisting that her talk of a breastfeeding law should
not be taken literally.  It was simply a way of expressing her belief in the
importance of doing the best for her child. 
After all, legally enforcing breastfeeding would be madness, right?

Not
according to the Indonesian government. 
It recently passed a law giving babies the right to six months of
exclusive breastfeeding,
except in cases where medical problems prevent their mothers from breastfeeding.  Mothers who do not comply face a year in
prison or a fine of 100,000,000 Rupiahs (around £7,100), and those who prevent
mothers from fulfilling their breastfeeding obligations also face punishments.  Scientists and health professionals generally
agree that breastfeeding is healthier for babies than the alternatives (see,
for example, here),
that not enough mothers do it (see here),
and governments around the world invest huge sums trying to get mothers to
breastfeed.  But is criminalising non-breastfeeding mothers a good idea?

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Why public health campaigns should not promote enhancement

by Rebecca Roache

Human
enhancement is a hot topic in bioethics. 
Typically conceived as the use of technology to raise human capacities
above what is merely healthy or normal, it attracts questions such as, Is it
ethical?  Is it desirable?  Is it cheating? and, Should the state
subsidise it?  A common view is that,
whilst therapy—which aims to restore human capacities to what is healthy or
normal, but not to raise them above this level—is desirable; enhancement is at
best unnecessary [1], and at worst unethical [2].  Human enhancement, one might be tempted to
think, is for oddballs only: the average person is content merely to be
healthy.

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Facilitating, Condoning, and Preventing HIV

The Eighteenth International AIDS Conference is currently underway in Vienna, and one of the issues that has been under discussion is how to reduce HIV transmission within the various at-risk groups. One such group is the prison population, among whom HIV transmission occurs due to both illicit sexual activity and intravenous drug abuse. But prison authorities have often resisted putting in place public health measures such as condom or needle distribution that have been shown to be effective, because they regard sexual activity and drug use as prohibited in their prisons, and do not want to to be seen as condoning these activities. Is this concern a reasonable one?

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