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The Ethics of Social Prescribing: An Overview

Written by Rebecca Brown, Stephanie Tierney, Amadea Turk.

This post was originally published on the NIHR School for Primary Care Research website which can be accessed here. 

Health problems often co-occur with social and personal factors (e.g. isolation, debt, insecure housing, unemployment, relationship breakdown and bereavement). Such factors can be particularly important in the context of non-communicable diseases (NCDs), where they might contribute causally to disease, or reduce that capacity of patients to self-manage their conditions (leading to worse outcomes). This results in the suffering of individuals and a greater burden being placed on healthcare resources.

A potential point of intervention is at the level of addressing these upstream contributors to poor health. A suggested tool – gaining momentum amongst those involved in health policy – is the use of ‘social prescribing’. Social prescribing focuses on addressing people’s non-medical needs, which it is hoped will subsequently reduce their medical needs. In primary care, social prescribing can take a range of forms. For example, it may involve upskilling existing members of staff (e.g. receptionists) to signpost patients to relevant local assets (e.g. organisations, groups, charities) to address their non-medical needs. It is also becoming common for GPs to refer patients (or people may self-refer) to a link worker (sometimes called a care navigator) who can work with them to identify their broader social and personal needs. Together, they then develop a plan for how those needs could be met through engagement with activities, services or events in the local community. The resources that link workers direct people towards are often run by voluntary organisations and might include, among other things, sports groups, arts and crafts, drama, gardening, cookery, volunteering, housing advice, debt management, and welfare rights.

Supporting people to establish more stable and fulfilling social lives whilst at the same time reducing healthcare costs seems like a win-win. However, it is essential to evaluate the justifications for the introduction of social prescribing schemes, including their effectiveness. This raises a number of complicating factors, including some questions that require not just a consideration of empirical evidence, but a commitment to certain philosophical and ethical positions.

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Criticising Stigma Whilst Reinforcing it: the Case of the Response to CRUK’s Anti-Obesity Campaign

Written by Rebecca Brown

There has been recent concern over CRUK’s (Cancer Research UK) latest campaign, which features the claim ‘obesity is a cause of cancer too’ made to look like cigarette packets. It follows criticism of a previous, related campaign which also publicised links between obesity and cancer. Presumably, CRUK’s aim is to increase awareness of obesity as a risk factor for cancer and, in doing so, encourage people to avoid (contributors to) obesity. It may also be hoped to encourage public support for policies which tackle obesity, pushing the Overton window in a direction which is likely to permit further political action in this domain.

The backlash is mostly focused around the comparison with smoking, and the use of smoking-related imagery to promote the message (there is further criticism of the central causal claim, since it is actually quite difficult to establish that obesity causes cancer). 

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Responsibility Over Time And Across Agents

Rebecca Brown and Julian Savulescu

Cross-posted from the Journal of Medical Ethics blog, available here.

There is a rich literature on the philosophy of responsibility: how agents come to be responsible for certain actions or consequences; what conditions excuse people from responsibility; who counts as an ‘apt candidate’ for responsibility; how responsibility links to blameworthiness; what follows from deciding that someone is blameworthy. These questions can be asked of actions relating to health and the diseases people may suffer as a consequence. A familiar debate surrounds the provision of liver transplants (a scarce commodity) to people who suffer liver failure as a result of excessive alcohol consumption. For instance, if they are responsible for suffering liver failure, that could mean they are less deserving of a transplant than someone who suffers liver failure unrelated to alcohol consumption.

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Medical Nihilism: When A Dose Of Scepticism Can Be Healthy

In his 2018 book, the philosopher of science, Jacob Stegenga defends the view “that we should have little confidence in the effectiveness of medical interventions.” (Stegenga 2018) On the face of it, he acknowledges, this position seems unreasonable: most of us can think of myriad ways in which modern medicine has improved – perhaps saved – our own lives and the lives of those close to us. The asthma attack I had as a baby, effectively treated at the time and subsequently managed through the use of seemingly magical medications which relax the muscles around the airways, opening them up and allowing air to pass freely again. Or the schoolfriend whose ruptured appendix could have resulted in a fatal infection, but for emergency surgery and the administration of antibiotics. Or the countless lives made less painful by the availability of cheap and safe painkillers. 

Medical sceptics tend to get a bad rep – anti-vaxxers who risk the lives of children by regurgitating debunked myths about the links between vaccines and autism, leading to dips in herd immunity and disease outbreaks; credulous folk who believe in the mystical powers of homeopathy and eschew conventional therapies in favour of potions that contain little more than water. This is not the sort of company one wishes to associate with.Read More »Medical Nihilism: When A Dose Of Scepticism Can Be Healthy

Human In Vitro Gametogenesis and the Same-Sex Marriage Debate

Written by César Palacios-González

It seems that in the not-so-distant future, scientists will be able to create functional human gametes (i.e. eggs and sperm) in a laboratory setting. In other words, they will be able to create human gametes outside of the human body. And just as there is in vitro fertilization (IVF), there will be in vitro gametogenesis (IVG). This means that our already long list of human reproductive acronyms –IVF, PGD, ICSI, PNT, PBT1, PBT2, MST, UTx, CT, etc.–  will get a bit longer. At present, some of the best biology labs from around the world are actively working on how to achieve such goal, and non-human animal models have shown some amazing results.

For starters, scientists have successfully derived in a laboratory setting mouse oocyte-like cells and sperm-like cells from induced pluripotent stem cells and embryonic stem cells. And, most surprisingly, they have been able to create what has been called “cross-sex gametes”. This means that they have been able to create sperm-like cells from female mice, and oocyte-like cells from male mice (I use the terms ‘sperm-like’ and ‘oocyte-like’ because these cells are not identical to naturally occurring gametes). Some of such cross-sex gametes have, in turn, been capable of producing live offspring.Read More »Human In Vitro Gametogenesis and the Same-Sex Marriage Debate

Cross Post: Fresh Urgency in Mapping Out Ethics of Brain Organoid Research

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File 20181120 161641 npf87x.jpg?ixlib=rb 1.1

Written by Julian Koplin, University of Melbourne and

Julian Savulescu, University of Oxford

This article is republished from The Conversation under a Creative Commons license. Read the original article.

 

Researchers have grown groups of brain cells in the lab –
known as ‘organoids’ – that produce brain waves resembling
those found in premature infants.
from www.shutterstock.com

 

Scientists have become increasingly adept at creating brain organoids – which are essentially miniature human brains grown in the laboratory from stem cells.

Although brain organoid research might seem outlandish, it serves an important moral purpose. Among other benefits, it promises to help us understand early brain development and neurodevelopmental disorders such as microcephaly, autism and schizophrenia.

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UK Supreme Court Decision Means Patients No Longer Forced to Live

By Mackenzie Graham

On July 30, The UK’s Supreme Court ruled that there is no requirement to obtain court approval before withdrawing clinically assisted nutrition and hydration (CANH), when there is agreement between physicians and the family that this is in the best interests of the patient.

In the judgement, Lady Black writes:

“If the provisions of the MCA [Mental Capacity Act] 2005 are followed and the relevant guidance observed, and if there is agreement upon what is in the best interests of the patient, the patient may be treated in accordance with that agreement without application to the court.”

Until now, requests to withdraw CANH needed to be heard by the Court of Protection to determine if withdrawing treatment was in the patient’s best interest. In addition to being emotionally difficult for families, this is a time-consuming and expensive process, and often results in the patient dying before a judgement is rendered.

I think this decision has much to be said in its favour. First, it means that when there is agreement that continued treatment is no longer in the best interests of a patient with a prolonged disorder of consciousness, these patients are no longer being ‘forced to live’ until the Court affirms that being allowed to die is in their best interests. In many cases, court decisions take months, meaning that a patient is forced to be kept alive, against their best interests and the wishes of their family. Making the decision to withdraw care from a loved one is highly distressing, and this is likely further compounded by the burden and distraction of court proceedings.

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Dementia and the Social Scaffold of Memory

By Jonathan Pugh

 

The number of individuals suffering with dementia is steadily increasing; as such, the moral issues raised by the neurodegenerative diseases that bring about the symptoms typifying dementia are of pressing practical concern. In this context, Richard Holton’s topic for the first of his three 2018 Uehiro lectures (on the theme “Illness and the Social Self”) is a timely one: What are the ethical implications of the progressive and pervasive loss of memory that is a central feature of dementia?

I shall be blogging a synopsis of each lecture in the series on the Practical Ethics blog – You can find a recording of the lecture here

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Video Series: Tom Douglas Defends the Chemical Castration of Sex Offenders

The Minister of Justice in the UK wants to dramatically increase the use of chemical castration in sex offenders to reduce their risk of reoffending.Dr Tom Douglas (University of Oxford) argues that offering chemical castration to sex offenders might be a better option than current practices to prevent sex offenders from reoffending (e.g. incarceration), and… Read More »Video Series: Tom Douglas Defends the Chemical Castration of Sex Offenders