choice

Diet, Changing Desires, and Dementia

Written by Ben Davies

Last week saw the launch of a campaign (run by the group Vegetarian For Life) that seeks to ensure that older people in care who have ethical commitments to a particular diet are not given food that violates those commitments. This is, as the campaign makes clear, a particularly pressing issue for those who have some form of dementia who may not be capable of expressing their commitment.

Those behind the campaign are quite right to note that people’s ethical beliefs should not be ignored simply because they are in care, or have a cognitive impairment (see a Twitter thread where I discuss this with a backer of the campaign). But the idea that one’s dietary ethics must be ‘for life’ got me thinking about a more well-established debate about Advance Directives. (I should stress that what I say here should not be taken to be imputing any particular motivation or philosophical commitments to those behind the campaign itself.)

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Cross Post: Is Mandatory Vaccination the Best Way to Tackle Falling Rates of Childhood Immunisation?

Written by Dr Alberto Giubilini and Dr Samantha Vanderslott

This article was originally published on the Oxford Martin School website.

Following the publication of figures showing UK childhood vaccination rates have fallen for the fifth year in a row, researchers from the Oxford Martin Programme on Collective Responsibility for Infectious Disease discuss possible responses.

Alberto Giubilini: Yes, “we need to be bold” and take drastic measures to increase vaccination uptake

In response to the dramatic fall in vaccination uptake in the UK, Health Secretary Matt Hancock has said that “we need to be bold” and that he “will not rule out action so that every child is properly protected”. This suggests that the Health Secretary is seriously considering some form of mandatory vaccination program or some form of penalty for non-vaccination, as is already the case in other countries, such as the US, Italy, France, or Australia. It is about time the UK takes action to ensure that individuals fulfil their social responsibility to protect not only their own children, but also other people, from infectious disease, and more generally to make their fair contribution to maintaining a good level of public health. Continue reading

Should Iceland Ban Circumcision? A Legal and Ethical Analysis

By Lauren Notini and Brian D. Earp

*Note: a condensed version of this article titled “Iceland’s Proposed Circumcision Ban” is being cross-published at Pursuit.

 

For a small country, Iceland has had a big impact on global media coverage recently, following its proposed ban on male circumcision before an age of consent.

Iceland’s proposed legislation seeks to criminalise circumcision on male minors that is unnecessary “for health reasons,” stating individuals who remove “part or all of the sexual organs shall be imprisoned for up to 6 years.”

The bill claims circumcision violates children’s rights to “express their views on the issues [concerning them]” and “protection against traditions that are harmful.”

According to bill spokesperson Silja Dögg Gunnarsdóttir, a key reason for the bill is that all forms of female genital cutting (FGC), no matter how minor, have been illegal in Iceland since 2005, but no similar legislation exists for males.

“If we have laws banning circumcision for girls,” she said in an interview, then for consistency “we should do so for boys.” Consequently, the bill is not specific to male circumcision, but adapts the existing law banning FGC, changing “girls” to “children.”

There is much to unpack here. We first discuss self-determination and informed consent, before addressing claims about potential health benefits and harms. We then explore the religious significance of circumcision for some groups, and ask what implications this should have.

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Vaccine Refusal Is Like Tax Evasion

Written by Alberto Giubilini: 

Oxford Martin School and Wellcome Centre for Ethics and the Humanities, University of Oxford

 

Vaccination has received a lot of media attention over the past few months following recent measles outbreaks and the introduction of rigid vaccination policies in some countries. Amid this discussion, a rather strange story hit the headlines a few weeks ago. According to reports, a woman in Michigan was sentenced to 7 days in jail because she refused to vaccinate her child, adducing personal religious reasons. Newspapers reported the story with somewhat misleading – though factually correct – titles, such as “Michigan mother jailed for refusing to vaccinate her son” or “Michigan mother sent to prison for failing to vaccinate her son.” Continue reading

Cross Post: Sex Versus Death: Why Marriage Equality Provokes More Heated Debate Than Assisted Dying

Written by Julian Savulescu

A version of this article has been published by The Conversation

Epicurus wrote: “Death does not concern us, because as long as we exist, death is not here. And when it does come, we no longer exist. ”

We are in the midst of two great ethical debates: marriage equality and assistance in dying. The great plebescite is ongoing and the Victorian parliament is debating a new law to allow assistance in dying in the last year of life.

A search of Victorian paper “The Age” reveals about 2400 results for “marriage equality” and only about 1700 for assisted dying related terms. But even more striking is the difference in the strength of the feelings they have embodied: despite the fact that one of these topics is literally a life and death matter, the same-sex marriage debate has been far more polarizing. Continue reading

Organ Donation: Presumed Consent and Focusing on What Matters

Recent newspaper reports covered the story of Jemima Layzell, a 13 year old who died suddenly of a brain aneurysm in 2012. According to reports, shortly before Jemima died, the subject of organ donation had come up in discussions with her family, prompted by the death of a family friend in a car accident. As a result, Jemima’s family were confident she would have wanted her organs to be donated. Subsequently, Jemima’s kidneys, liver, lungs, pancreas, small bowel and heart were transplanted. This meant that a record eight people’s lives were saved, prolonged or dramatically enhanced as a consequence of Jemima’s and her family’s decision.

Decisions about organ donation are extremely difficult. Family members are approached about the prospect of donating their loved one’s organs at a time of extraordinary distress. Uncertainty about the wishes of the person who has died, along with confusion or scepticism about brain death criteria, religious or other spiritual beliefs about bodily integrity, fear about how donated organs will be used, and inability or unwillingness to engage with any form of decision-making can result in the refusal of family members to allow organs to be donated. In England, family members can prevent donation even when the individual has expressed a wish to donate her organs, for instance, by signing up to the organ donor register. Continue reading

Cross Post: Re: Nudges in a Post-truth World 

Guest Post: Nathan Hodson

This article originally appeared on the Journal of Medical Ethics Blog 

In a recent article in the Journal of Medical EthicsNeil Levy has developed a concept of “nudges to reason,” offering a new tool for those trying to reconcile medical ethics with the application of behavioural psychological research – a practice known as nudging. Very roughly, nudging means adjusting the way choices are presented to the public in order to promote certain decisions.

As Levy notes, some people are concerned that nudges present a threat to autonomy. Attempts at reconciling nudges with ethics, then, are important because nudging in healthcare is here to stay but we need to ensure it is used in ways that respect autonomy (and other moral principles). Continue reading

Video Series: Professor Julian Savulescu argues in favour of an experimental treatment for Charlie Gard

Cross Post: Italy has introduced mandatory vaccinations – other countries should follow its lead

Written by Alberto Giubilini

This article was originally published on The Conversation 

In the first four months of this year, around 1,500 cases of measles were reported in Italy. As a response to the outbreak, the Italian government introduced a law making 12 vaccinations mandatory for preschool and school-age children.

Parents will have to provide proof of vaccination when they enroll their children in nursery or preschool. In this respect, the Italian policy follows the example of vaccination policies in the US. But there’s one crucial difference: the Italian law doesn’t allow parents to opt out on the grounds of “conscientious objection”. Continue reading

Are Incentives Corrupting? The Case of Paying People to be Healthy.

Written by Dr Rebecca Brown

Financial incentives are commonplace in everyday life. As tools of states, corporations and individuals, they enable the ‘tweaking’ of motivations in ways more desirable to the incentiviser. A parent may pay her child £1 to practice the piano for an hour; a café offers a free coffee for every nine the customer buys; governments offer tax breaks for homeowners who make their houses more energy efficient. Most people, most of the time, would probably find the use of financial incentives unobjectionable.

More recently, incentives have been proposed as a means of promoting health. The thinking goes: many diseases people currently suffer from, and are likely to suffer from in the future, are largely the result of behavioural factors (i.e. ‘lifestyles’). Certain behaviours, such as eating energy dense diets, taking little exercise, smoking and drinking large amounts of alcohol, increase the risk that someone will suffer from diseases like cancer, heart disease, lung disease and type II diabetes. These diseases are very unpleasant – sometimes fatal – for those who suffer from them, their friends and family. They also create economic harms, requiring healthcare resources to be directed towards caring for those who are sick and result in reduced productivity through lost working hours. For instance,the annual cost to the economy of obesity-related disease is variously estimated as £2.47 billion£5.1 billion and a whopping $73 billion (around £56.5 billion), depending on what factors are taken into account and how these are calculated. Since incentives are generally seen as useful tools for influencing people’s behaviour, why not use them to change health-related behaviours? Why not simply pay people to be healthy? Continue reading

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