Skip to content

Rationing/ Resource Allocation

Guest Post: How Should We Evaluate Deaths?

Written by: Carl Tollef Solberg, Senior Research Fellow, Bergen Centre for Ethics and Priority Setting (BCEPS), University of Bergen.
Espen Gamlund, Professor of Philosophy, Department of Philosophy, University of Bergen.

In 2015, there were 56.4 million deaths worldwide (WHO 2017).[i] Most people would say that the majority of these deaths were bad. If this is the case, why is it so, and are these deaths equally bad?

Death is something we mourn or fear as the worst thing that could happen—whether the deaths of close ones, the deaths of strangers in reported accidents or tragedies, or our own. And yet, being dead is not something we will ever live to experience. This simple truth raises a host of challenging philosophical questions about the negativity surrounding our sense of death, and how and for whom exactly it is harmful. The question of whether death is bad has occupied philosophers for centuries, and the debate emerging in the philosophical literature is referred to as the “badness of death.” Are deaths primarily negative for the survivors, or does death also affect the decedent? What are the differences between death in fetal life, just after birth, or in adolescence? When is the worst time to die? These philosophical questions, although of considerable theoretical interest, is particularly relevant for how we evaluate deaths in global health, and policy-makers spending money to finance different health programs need to know how to answer them. Read More »Guest Post: How Should We Evaluate Deaths?

Should PREDICTED Smokers Get Transplants?

By Tom Douglas

Jack has smoked a packet a day since he was 22. Now, at 52, he needs a heart and lung transplant.

Should he be refused a transplant to allow a non-smoker with a similar medical need to receive one? More generally: does his history of smoking reduce his claim to scarce medical resources?

If it does, then what should we say about Jill, who has never touched a cigarette, but is predicted to become a smoker in the future? Perhaps Jill is 20 years old and from an ethnic group with very high rates of smoking uptake in their 20s. Or perhaps a machine-learning tool has analysed her past facebook posts and google searches and identified her as a ‘high risk’ for taking up smoking—she has an appetite for risk, an unusual susceptibility to peer pressure, and a large number of smokers among her friends. Should Jill’s predicted smoking count against her, were she to need a transplant? Intuitively, it shouldn’t. But why not?

Read More »Should PREDICTED Smokers Get Transplants?

Agreement and disagreement about experimental treatment. The Charlie Gard Appeal

by Dominic Wilkinson and Julian Savulescu

@Neonatalethics

@juliansavulescu

RCJ-2

Tomorrow, the UK Court of Appeal will review the controversial case of a British infant, Charlie Gard. Charlie’s parents are appealing a recent High Court decision that gave doctors permission to withdraw his life support. They have raised money for Charlie to travel to the US for an experimental medical treatment.Read More »Agreement and disagreement about experimental treatment. The Charlie Gard Appeal

Damages and communitarianism

By Charles Foster

The Lord Chancellor recently announced that the discount rate under the Damages Act 1996 would be decreased from 2.5% to minus 0.75%. This sounds dull. In fact it is financially tectonic, and raises some important ethical questions.

In the law of tort, damages are intended to put a claimant in the position that she would have been in had the tort not occurred. A claimant who, as result of negligence on the part of a defendant, suffers personal injury, will be entitled to, inter alia, damages representing future loss of earnings, the future cost of care and, often, private medical and other treatment.

Where damages are awarded as a lump sum, there is a risk of over-compensating a claimant. Suppose that the claimant is 10 years old at the time of the award, and will live for 70 years, and the future care costs are £1000 a year for life. Should the sum awarded be £1000 x 70 years = £70,000? (70, here, is what lawyers call the ‘multiplier’). It depends on the assumption one makes about what the claimant will do with the lump sum. If she invests it in equities that give her (say) an annual 5% return, £70,000 would over-compensate her.

In the case of Wells v Wells1, the House of Lords decided that, to avoid the risk of under-compensation, claimants should be treated as risk-averse investors. It should be assumed, said the House, that the discount rate should be fixed by reference to the return on index-linked gilts – Government securities. The rate was 2.5% from 2001 until February of this year. The reasons for the change to minus 0.75% are here. Read More »Damages and communitarianism

Four myths about IVF in older women

Dominic Wilkinson, @Neonatalethics

Reports that a 62-year-old Spanish woman has given birth after IVF treatment have led many to question whether there should be age limits with such treatment. Lina Alvarez, a doctor in north-west Spain, isn’t the oldest person to have had success with IVF. Earlier this year, in India, Daljinder Kaur is said to have given birth at the age of 72, prompting calls from the Indian Medical Council for a ban on fertility treatment in women over the age of 50.

In many countries where there is funding assistance for IVF there is a limit to obtaining treatment over a certain age. In Britain, for example, the bar is set at age 42. But Alvarez received private treatment. So why care about her age? And what business is it of the rest of us whether she has access to IVF?

There are several arguments that typically surface in debates about age and fertility treatment – and they are all deeply flawed.Read More »Four myths about IVF in older women

Should vegans eat meat to be ethically consistent? And other moral puzzles from the latest issue of the Journal of Practical Ethics

Should vegans eat meat to be ethically consistent? And other moral puzzles from the latest issue of the Journal of Practical Ethics

By Brian D. Earp (@briandavidearp)

The latest issue of The Journal of Practical Ethics has just been published online, and it includes several fascinating essays (see the abstracts below). In this blog post, I’d like to draw attention to one of them in particular, because it seemed to me to be especially creative and because it was written by an undergraduate student! The essay – “How Should Vegans Live?” – is by Oxford student Xavier Cohen. I had the pleasure of meeting Xavier several months ago when he presented an earlier draft of his essay at a lively competition in Oxford: he and several others were finalists for the Oxford Uehiro Prize in Practical Ethics, for which I was honored to serve as one of the judges.

In a nutshell, Xavier argues that ethical vegans – that is, vegans who refrain from eating animal products specifically because they wish to reduce harm to animals – may actually be undermining their own aims. This is because, he argues, many vegans are so strict about the lifestyle they adopt (and often advocate) that they end up alienating people who might otherwise be willing to make less-drastic changes to their behavior that would promote animal welfare overall. Moreover, by focusing too narrowly on the issue of directly refraining from consuming animal products, vegans may fail to realize how other actions they take may be indirectly harming animals, perhaps even to a greater degree.

Read More »Should vegans eat meat to be ethically consistent? And other moral puzzles from the latest issue of the Journal of Practical Ethics

How much would you pay to live an extra year?

Dominic Wilkinson, University of Oxford

@Neonatalethics

Medical science continues to push at the boundaries of life and death with new drugs and technologies that can extend life or improve health. But these advances come at a cost. And that inevitably raises difficult questions about whether public health systems should pay for such treatments – and, if so, how much. For example, should the NHS fund the new breast cancer drug Kadycla which comes with a £90,000 price tag per patient?

Some countries make these difficult decisions by looking at the cost-effectiveness of new treatments. How much does the new treatment cost and how effective is it compared with existing treatments? Treatments may help patients live longer, or they may improve a patient’s quality of life (or both). Kadycla appears to extend life by about six months.

One mathematical way of combining these elements uses the concept of a Quality-Adjusted Life Year saved, or QALY. As an example, a treatment that extends life for one year but at a “quality” level of half normal it said to save 0.5 QALY. When treatments are assessed this way, health systems can then use a threshold to work out a maximum cost that is affordable. The National Institute for Health and Care Excellence (NICE) uses a threshold of £20,000-£30,000 for each Quality-Adjusted Life Year saved (QALY). This would mean (assuming full quality of life), that the NHS would be prepared to pay £10,000-15,000 for a course of Kadycla.

Saving time.
Bank by Shutterstock

Read More »How much would you pay to live an extra year?

#IminworkJeremy – the ethics of 24/7 consultant cover

By Dominic Wilkinson @Neonatalethics

 

At the bedside of a critically ill infant at 5am this morning I was tempted to tweet the latest meme, adding my voice to a chorus of NHS clinicians over the weekend. Last week, in a speech to the King’s fund, Health Minister Jeremy Hunt launched a drive towards 7 day NHS. In particular, he focused on consultant contracts, proposing that newly qualified hospital doctors will be required to work weekends as a condition of employment.

Read More »#IminworkJeremy – the ethics of 24/7 consultant cover

Risky Giving

I highly recommend Leif Wenar’s essay “Poverty Is No Pond” – especially to those not yet familiar with, but interested in, the empirical complexities involved in giving to overseas poverty-fighting charities.  Wenar’s main aim in his essay is to criticize Peter Singer’s 2009 book The Life You Can Save for (i) being overly optimistic about the quality of information available on the effects of giving to various charities, and (ii) failing to emphasize that every charitable donation also comes with some risk of harming people living in extreme poverty.  I’ll only briefly address (i), and then turn to and focus primarily on (ii).

Read More »Risky Giving