ethics

Cross-Post: Self-experimentation with vaccines

By Jonathan Pugh, Dominic Wilkinson and Julian Savulescu.

This is a crosspost from the Journal of Medical Ethics Blog.

This is an output of the UKRI Pandemic Ethics Accelerator project.

 

A group of citizen scientists has launched a non-profit, non-commercial organisation named ‘RaDVaC’, which aims to rapidly develop, produce, and self-administer an intranasally delivered COVID-19 vaccine. As an open source project, a white paper detailing RaDVaC’s vaccine rationale, design, materials, protocols, and testing is freely available online. This information can be used by others to manufacture and self-administer their own vaccines, using commercially available materials and equipment.

Self-experimentation in science is not new; indeed, the initial development of some vaccines depended on self-experimentation. Historically, self-experimentation has led to valuable discoveries. Barry Marshall famously shared the Nobel Prize in 2005 for his work on the role of the bacterium Helicobacter pylori, and its role in gastritis –this research involved a self-experiment in 1984 that involved Marshall drinking a prepared mixture containing the bacteria, causing him to develop acute gastritis. This research, which shocked his colleagues at the time, eventually led to a fundamental change in the understanding of gastric ulcers, and they are now routinely treated with antibiotics. Today, self-experimentation is having something of a renaissance in the so-called bio-hacking community. But is self-experimentation to develop and test vaccinations ethical in the present pandemic? In this post we outline two arguments that might be invoked to defend such self-experimentation, and suggest that they are each subject to significant limitations. Continue reading

An Ethical Review of Hotel Quarantine Policies For International Arrivals

Written by:

Jonathan Pugh

Dominic Wilkinson

Julian Savulescu

 

This is an output of the UKRI Pandemic Ethics Accelerator project – it develops an earlier assessment of the English hotel quarantine policy, published by The Conversation)

 

The UK has announced that from 15th Feb, British and Irish nationals and others with residency rights travelling to England from ‘red list’ countries will have to quarantine in a government-sanctioned hotel for 10 days, at a personal cost of £1,750. Accommodation must be booked in advance, and individuals will be required to undergo two tests over the course of the quarantine period.

Failure to comply will carry strict penalties. Failing to quarantine in a designated hotel carries a fine of up to £10,000, and those who lie about visiting a red list country are liable to a 10-year prison sentence.

Continue reading

Guest Post: What Is The Case For Virtual Schooling?

Written by Thomas Moller-Nielsen

News that children in England were to switch to online schooling as part of the country’s third national lockdown in response to the Covid-19 global pandemic was met with widespread support in the British press. Doctors, public health specialists, and even teaching unions similarly applauded the decision. (Nurseries, which have remained open during the latest lockdown period, have also been put under heavy pressure to close.)

The justification for the suspension of in-person schooling during this pandemic, however, is far from obvious. Indeed, there are at least two prima facie plausible reasons for scepticism. Firstly, children are far less susceptible to serious infection or death from Covid-19 than adults are. (While the precise figures are open to dispute, the Medical Research Council Biostatistics Unit at the University of Cambridge has estimated that the infection-fatality rate for 5-14 year-olds in England is 0.0013% – which is roughly 24 times smaller than the infection fatality rate for 25-44 year-olds, and approximately 9000 times smaller than the infection-fatality rate for 75+ year-olds.) Secondly, virtual schooling – in addition to being a poor substitute for in-person schooling – is widely recognized to be a key contributing factor in students’ increased feelings of stress, depression, and anxiety during the pandemic, and has been similarly linked to many physical paediatric disorders such as juvenile hypertension and obesity.

In other words, it seems that: (i) children are not in serious danger of being (directly) harmed by Covid-19; and (ii) children are in very real danger of being harmed by online schooling. Why, then, should students be required to attend virtual school? Continue reading

Consent Without Alternatives

Written by Ben Davies and Joshua Parker

“COVID-19: Do not resuscitate orders might have been put in place without consent, watchdog says”. This recent headline followed an investigation by the Care Quality Commission into Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions early in the pandemic. In a recent post, Dominic Wilkinson highlights two misconceptions in the coverage of this report, one of which is the ‘consent misconception’.

Dominic’s view is that “there is no ethical requirement…to seek the agreement of patients not to offer or provide a treatment” which a medical professional judges inappropriate. Of course, his position is not that consultation and discussion around CPR is inappropriate, only that consent is not necessary. This is the standard view on consent in this context and, due in part to the Tracey judgment, reflects doctors’ practice. Thus, an important distinction emerges between consenting to the withholding of some treatment, and discussion of that decision. Doctors may be ethically required to discuss a decision without also having an obligation to seek the patient’s consent. The absence of consent, then, does not signal that the DNACPR was unethical, whereas a failure to consult probably will.

Continue reading

Climbing the Pension Mountain: A Review of Michael Otsuka’s 2020 Uehiro Centre Lecture Series

Written by Professor Larry Locke (University of Mary Hardin-Baylor and LCC International University)

On three successive Tuesdays last November, Michael Otsuka of the London School of Economics delivered the annual Uehiro Centre Lecture Series.  The Series, entitled “How to Pool Risk Across Generations”, focused on the ethics of pension reform.  Otsuka attacked the real-world problem of low bond yields producing a crisis of pension funding with three alternative models.  Echoing Derek Parfit’s magisterial work, On What Matters, Otsuka presented his proposals as three alternative means for scaling the dangerous summit of pension obligations.

Otsuka’s proposals are important.  Ethics issues rarely come with this much money at stake.  In 2018, the Office of National Statistics published a study showing that UK pension schemes were underfunded by over £5 trillion .  That is an attention-grabbing number but not extraordinary in the context.  The Trustees of the US Social Security system recently published their 2020 report indicating this scheme alone anticipates a shortfall of US$16.8 trillion over the next 75 years.  Like scientists employing standard form when the numbers they use become too large to comprehend, the US Social Security Administration now refers to its shortfall in terms of percentages of total payroll taxes.

The proposals Otsuka has set forth are not amoral financial models.  Each involves shifting risk and responsibility among parties, and sometimes across generations, with diverse arguments as to the fairness of these shifts.  Any resulting pension system’s impact on lifestyles and liberty for workers, employers, and governments may strain the social contract between these groups and set them up for a potential fall. Continue reading

Guest Post: A Relentless Focus on the Given – Reviewing O. Carter Snead’s What it Means to be Human: The Case for the Body in Public Bioethics

Guest Post by Charles Camosy

Professor Carter Snead, at least in my world, is about as important a contemporary voice in bioethics that we have today. A professor on Notre Dame’s law faculty, he is perhaps better known as director of the de Nicola Center for Ethics and Culture—one of the most significant positions in the United States for doing public bioethics. He was heavily involved in the topic before coming to Notre Dame, including when serving as general counsel to the President’s Council on Bioethics chaired by Leon Kass. He currently serves on the Pontifical Academy for Life and as an elected fellow of the Hastings Center.

When Professor Snead came out with a book on public bioethics from Harvard University Press this month, that became good reason for many of us to pay close attention—especially when Alasdair MacIntyre gave a back cover endorsement calling it “indispensable reading” whether “you agree or disagree with Snead’s perspective.” Indeed, Snead makes it clear that he’s not merely preaching to the choir in this book, but instead aiming at making his case to folks with  different perspectives in “the spirit of friendship” and “anchored in the firm belief that we can only govern ourselves wisely, humanly, and justly if we become the kind of people who can make each other’s goods our own.” Continue reading

Pandemic Ethics: Why Lock Down of the Elderly is Not Ageist and Why Levelling Down Equality is Wrong

By Julian Savulescu and James Cameron

Cross-posted with the Journal of Medical Ethics Blog

 

Countries all around the world struggle to develop policies on how to exit the COVID-19 lockdown to restore liberty and prevent economic collapse, while also protecting public health from a resurgence of the pandemic. Hopefully, an effective vaccine or treatment will emerge, but in the meantime the strategy involves continued containment and management of limited resources.

One strategy is a staged relaxation of lockdown. This post explores whether a selective continuation of lockdown on certain groups, in this case the aged, represents unjust discrimination. The arguments extend to any group (co-morbidities, immunosuppressed, etc.) who have significantly increased risk of death.

Continue reading

National Ethics Framework For Use in Acute Paediatric Settings During COVID-19 Pandemic

This ethical framework is a modification of guidance developed for treatment decisions relating to adults. The principles relating to decisions for children in the setting of the pandemic are the same as those for adults. The framework emphasises that decisions should be ethically consistent and apply to patients both with COVID-related and non-COVID related illness.
The focus of the ethical framework provides guidance for a situation where there is extremely high demand and limited critical care capacity. However, it is important to note that at the time of writing (14 April 2020) there is enough paediatric critical care capacity across the UK. At the present time decisions about children in need of critical care should reflect the same fundamental ethical considerations as apply in normal times. Those decisions should be focused on the best interests of the child, and actively involve parents in decision-making.
The framework is available to read in full on the  Royal College of Paediatric and Child Health website.

Cross Post: Boris Johnson Will Be Receiving The Same Special Treatment Other Patients Do In NHS Intensive Care

Written by Dominic Wilkinson, University of Oxford

This article originally appeared in The Conversation

In a world where the adjective “unprecedented” has become commonplace, the news of British Prime Minister Boris Johnson being admitted to the intensive care unit of St Thomas’ Hospital with COVID-19 seemed to take it to a new level.

There is little information in the public domain about Johnson’s medical condition, but this is clearly a very serious step. He will only have been transferred to intensive care because it is perceived that his condition is potentially life threatening and there is a possibility that he would need urgent medical attention, including the possible use of mechanical ventilation.

What would happen if that became necessary? Would Johnson’s treatment be any different from anyone else with the same condition? Would he receive special treatment because of his political position, because of his importance for the country? Would he be prioritised for a ventilator? Continue reading

Oxford Uehiro Prize in Practical Ethics: An Account of Attitudinal Duties Towards Injustice

This essay received an honourable mention in the Graduate Category

Written by University of Oxford Student, Brian Wong

Injustices are ubiquitous around us. From authoritarian regimes’ crackdown on human rights, to exploitative trafficking of illegal migrants, to human-induced destruction of rainforests upon which indigenous groups depend – injustices are negative states of affairs violating moral commitments and duties caused by some level of human agency. Our ability to resist injustices are inevitably constrained, but I argue that even the least able amongst agents still possess attitudinal duties – duties to cultivate and possess particular attitudes towards injustice. Attitudes are mental states; here I focus specifically on explicit attitudes – attitudes that are accessible by introspection and non-automatically/reflexively generated.[1] I open with a pair of cases providing the intuitive preliminaries, prior to offering three interrelated arguments for attitudinal duties, namely from i) functional similarity, ii) relational justice, and iii) aptness. After outlining the plausible contents of such duties, I conclude by examining two objections – i) self-defeasibility, and ii) enforceability. Continue reading

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