Tom Douglas’ Posts

Pandemic Ethics: Compulsory treatment or vaccination versus quarantine

By Thomas Douglas, Jonathan Pugh and Lisa Forsberg

Governments worldwide have responded to the Covid-19 pandemic with sweeping constraints on freedom of movement, including various forms of isolation, quarantine, and ‘lockdown’. Governments have also introduced new legal instruments to guarantee the lawfulness of their measures. In the UK, the Coronavirus Act 2020 gives the government new powers to detain individuals in order to prevent them from infecting others.

Interestingly, one measure that recent legislative changes in the UK leave off the table, at least for the time being, is the use of compulsory medical interventions—whether treatments or vaccinations. We surmise, however, that once treatments or vaccines for Covid-19 become available, there will be political interest in making them mandatory, since this may allow for the quickest and safest route out of the lockdown. In the case of vaccines, there will be a need to ensure that enough people are vaccinated to confer herd immunity. There may also be an argument for mandating vaccination of people who have contact with many others, such as teachers, retail staff and health care workers. In the case of treatments, we might hope that widespread use of anti-viral therapies will lighten the burden on the NHS by reducing the number of infected individuals who require intensive care. And there may be a need to ensure that people take the treatment even after their symptoms have resolved, to reduce their infectiousness.

From a legal point of view, there are clear barriers to compulsory treatments and vaccinations in the UK. The right of individuals with decision-making capacity to refuse any medical intervention that involves interference with their bodies is, for instance, robust and well-established in English law. This right persists even when the individual’s reasons for refusing the intervention are bizarre, irrational, or non-existent, and when the refusal would certainly lead to her death. The individual’s right to make her own medical decisions, and in particular to refuse interventions that interfere with her body, also enjoys robust protection in human rights law.
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Cross Post: Flouting Quarantine

Written by Dr Thomas Douglas

Dr Tom Douglas has recently published a fascinating article on the Stockholm Centre, For the Ethics of War and Peace blog:

As I write this, COVID-19, an illness caused by the new coronavirus SARS-CoV-2, is sweeping the globe. Over 15,000 people have died, and it is likely that at least one hundred times this many have been infected with the virus.[2]

The outbreak has brought the ethics of quarantine, isolation and enforced social distancing to public attention. Singapore, Hong Kong, Taiwan, South Korea and China have been praised in the press for their rigorous deployment of quarantine and other liberty-restricting measures. By contrast, the US and UK have been widely criticised for their relatively lax approach.

There are differences between quarantine (which applies to individuals who may have been exposed to an infection), isolation (which applies to individuals who are ill) and enforced social distancing (which largely preserves freedom of movement), but for the purposes of this post, I’ll treat all three together under the heading of ‘quarantine’. I’ll use this term loosely to refer to all interventions that significantly constrain a person’s freedom of movement and/or association in order to lower the risk that the person will infect others.

See here to read the full article, and to join in the conversation.

Pandemic Ethics: Infectious Pathogen Control Measures and Moral Philosophy

By Jonathan Pugh and Tom Douglas

Listen to Jonathan Pugh and Tom Douglas on Philosophical Disquisitions  discussing  Covid 19 and the Ethics of Infectious Disease Control, a podcast interview that was inspired by this blog.

Following the outbreak of the SARS-CoV-2 coronavirus, a number of jurisdictions have implemented restrictive measures to prevent the spread of this highly contagious pathogen. In January, Chinese authorities effectively quarantined the entire city of Wuhan, the epicentre of the outbreak, which has a population of around 11 million people. There has since been much discussion of various measures that might be implemented now or in the future to counter the spread, including various forms of social distancing, further mass quarantines and lockdowns, closed borders, mandatory testing and screening and even potentially forced treatment.

There are important questions about the lawfulness of infectious pathogen control (IPC) measures. Here, though, we focus on the moral justification of IPC. How can moral philosophy help us to think through when and whether different IPC measures ought to be employed?

To do so, we will briefly summarise our analysis of the different ways non-consensual medical interventions can be justified in infectious diseases control and criminal justice settings, which we originally published open access here.

 

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The Ethics of Gently Electrifying Prisoners’ Brains

By Hazem Zohny and Tom Douglas

Scientists who want to study the effects of passing electric currents through prisoners’ brains have a PR problem: it sounds shady. Even if that electric current is so small as to go largely unnoticed by its recipient – as in the case of transcranial direct current stimulation (tDCS) – for some, such experiments evoke historical abuses of neuroscience in criminal justice, not to mention bringing to mind some of the more haunting scenes in films like One Flew Over the Cuckoo’s Nest and A Clockwork Orange.

And so, last week the Spanish Interior Ministry put on hold an impending experiment in two Spanish prisons investigating the impact of brain stimulation on prisoners’ aggression. At the time of writing, it remains unclear what the ministry’s reasoning for the halt is, though the optics of the experiment might be part of the story.

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Cross Post: Biased Algorithms: Here’s a More Radical Approach to Creating Fairness

Written by Dr Tom Douglas

File 20190116 163283 1s61b5v.jpg?ixlib=rb 1.1

Our lives are increasingly affected by algorithms. People may be denied loans, jobs, insurance policies, or even parole on the basis of risk scores that they produce.

Yet algorithms are notoriously prone to biases. For example, algorithms used to assess the risk of criminal recidivism often have higher error rates in minority ethic groups. As ProPublica found, the COMPAS algorithm – widely used to predict re-offending in the US criminal justice system – had a higher false positive rate in black than in white people; black people were more likely to be wrongly predicted to re-offend.

Corrupt code.
Vintage Tone/Shutterstock

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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?

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Using AI to Predict Criminal Offending: What Makes it ‘Accurate’, and What Makes it ‘Ethical’.

Jonathan Pugh

Tom Douglas

 

The Durham Police force plans to use an artificial intelligence system to inform decisions about whether or not to keep a suspect in custody.

Developed using data collected by the force, The Harm Assessment Risk Tool (HART) has already undergone a 2 year trial period to monitor the accuracy of the tool. Over the trial period, predictions of low risk were accurate 98% of the time, whilst predictions of high risk were accurate 88% of the time, according to media reports. Whilst HART has not so far been used to inform custody sergeants’ decisions during this trial period, the police force now plans to take the system live.

Given the high stakes involved in the criminal justice system, and the way in which artificial intelligence is beginning to surpass human decision-making capabilities in a wide array of contexts, it is unsurprising that criminal justice authorities have sought to harness AI. However, the use of algorithmic decision-making in this context also raises ethical issues. In particular, some have been concerned about the potentially discriminatory nature of the algorithms employed by criminal justice authorities.

These issues are not new. In the past, offender risk assessment often relied heavily on psychiatrists’ judgements. However, partly due to concerns about inconsistency and poor accuracy, criminal justice authorities now already use algorithmic risk assessment tools. Based on studies of past offenders, these tools use forensic history, mental health diagnoses, demographic variables and other factors to produce a statistical assessment of re-offending risk.

Beyond concerns about discrimination, algorithmic risk assessment tools raise a wide range of ethical questions, as we have discussed with colleagues in the linked paper. Here we address one that it is particularly apposite with respect to HART: how should we balance the conflicting moral values at stake in deciding the kind of accuracy we want such tools to prioritise?

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Asbestos neglect

Written by Tom Douglas

This is an unedited version of an article originally published by The Conversation

 

‘Calais Jungle Camp littered with asbestos’, ‘Buckingham Palace could be vacated to remove asbestos’, ‘Safety concerns for refugees and workers as Nauru asbestos removal program kicks off’.

Headlines such as these occur with monotonous regularity. Widespread asbestos use throughout much of the 20th century has ensured that the next contamination scandal is never far off, and asbestos-related legal decisions and personal tragedies often make the news as well. But despite the ongoing media attention, asbestos has not captured the public imagination as a public health threat, at least, not in comparison to other comparable threats like excessive sun exposure and drink driving.

Asbestos is a versatile fibrous mineral that can be cheaply mined and has unusual fire resistance and durability. Its use exploded in the twentieth century, when it was included in such diverse products as automobile brake linings, pipe insulation, ceiling and floor tiles, textured paints, concrete, mattresses, electric blankets, heaters, ironing boards and even piano felts. There is no safe threshold for exposure to asbestos dust, with even single exposures having been linked to cancer. Rates of asbestos-related cancer have recently been on the rise in Europe and Japan and look set to climb in many developing countries where asbestos is still being widely used, often without safety precautions. According to WHO estimates, asbestos now causes more deaths globally than excessive sun exposure. In the UK it is estimated to cause almost three times as many deaths as road traffic accidents.

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Engineering a Consensus:   Edit Embryos for Research, Not Reproduction

Written by Dr Chris Gyngell, Dr Tom Douglas and Professor Julian Savulescu

A crucial international summit on gene editing continues today in Washington DC. Organised by the US National Academy of Sciences, National Academy of Medicine, the Chinese Academy of Sciences, and the U.K.’s Royal Society, the summit promises to be a pivotal point in the history of the gene editing technologies.

Gene editing (GE) is a truly revolutionary technology, potentially allowing the genetic bases of life to be manipulated at will. It has already been used to create malaria-fighting mosquitoes, drought resistant wheat, hornless cows and cancer killing immune cells. All this despite the fact GE only become widely used in the past few years. The potential applications of GE in a decade are difficult to imagine. It may transform the food we eat, the animals we farm, and the way we battle disease. Continue reading

What’s the moral difference between ad blocking and piracy?

On 16 September Marco Arment, developer of Tumblr, Instapaper and Overcast, released a new iPhone and iPad app called Peace. It quickly shot to the top of the paid app charts, but Arment began to have moral qualms about the app, and its unexpected success, and two days after its release, he pulled it from the app store.

Why the qualms? For the full story, check out episode 136 of Arment’s excellent Accidental Tech Podcast and this blog post, but here’s my potted account: Peace is an ad blocker. It allows users to view webpages without advertisements. Similar software has been available for Macs and PCs for years (I use it to block some ads on my laptop), but Apple has only just made ad blockers possible on mobile devices, and Peace was one of a bunch of new apps to take advantage of this possibility. Although ad blockers help web surfers to avoid the considerable annoyance (and aesthetic unpleasantness) of webpage ads, they also come at a cost to content providers, potentially reducing their advertising revenue. According to Arment, the ethics of ad blocking is ‘complicated’, and although he still believes ad blockers should exist, and continues to use them, he thinks their downsides are serious enough that he wasn’t comfortable with being at the forefront of the ad blocking movement himself.

In explaining his reasons for withdrawing the app, Arment drew a parallel between ad blocking and piracy. He doesn’t claim that the analogy is perfect (in fact, he explicitly disavows this), and nor does he take it to be a knock-down objection to ad-blocking (presumably he believes that piracy is also morally complicated). But he does think there’s something to the comparison.

Like Arment, I think there are considerable moral similarities between ad blocking and piracy. But, also like Arment, ad blocking seems to me, intuitively, to be somewhat less morally problematic. This raises an obvious question: what’s the moral difference?

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