Tom Douglas’ Posts

Wealth versus Happiness

Economists have long used Gross Domestic Product (GDP) per capita as a proxy measure for the average level of wellbeing within a country. GDP is a measure of the goods and services produced in a country and is a fairly good proxy for material wealth. However, it fails to capture many other factors that are clearly important for wellbeing: for example, amount of leisure time, health, quality of one's environment, wealth distribution, employment rates, and changes in wealth over a lifetime. Some negative influences on wellbeing – such as crime – may even contribute positively to GDP since the costly government responses to them are included in a country's GDP. The gap between GDP and wellbeing obviously has important practical implications since policies correlated with higher (lower) GDP are likely to be adopted (rejected) for that reason.

On 14 September an expert group commissioned by French president Nicolas Sarkozy and and including no less than five Nobel prize laureates released a report recommending that official statisticians should move to a wider measure of wellbeing that takes into account some of the factors that GDP leaves out. This move away from 'GDP fetishism' has long been championed by the commission's chair, Joseph Stiglitz.

Everyone seems to acknowledge the problems with GDP, but the commission's report gets a cool response from some of the business press, with the adjective 'Orwellian' cropping up here and there. The Economist admits that 'broadening official statistics is a good idea in its own right', but emphasises that 'these are early days' and remains sceptical about the practicalities of moving away from GDP. The primary concern is about potential abuse of a less well defined measure by governments or interest groups and a resulting lack of public trust. The message seems to be that it's fine to research broader measures and to start collecting figures, but until something robust is found, GDP per capita should remain the gold standard. Policymakers shouldn't put any credence in the broader measures yet.

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What’s special about selling gametes?

Dominic Wilkinson posted yesterday on the issue of whether payment for egg and sperm donation should be legalised. This question attracted significant media attention yesterday after Lisa Jardine, of the HFEA, called for debate on the existing UK ban on payment for donors. Today's Guardian contains a piece highlighting several ways in which people can already sell their bodily parts or products, ranging from livers to breast milk, and from blood to hair. Sale of many of these bodily parts/products is regarded is ethically problematic, and is, in many cases, illegal. But not in all cases. For example, few would have a problem with the sale of hair for use in wigs.

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How bad are heatwaves and flu epidemics?

The UK health media is currently focused on two natural threats to public health: one from swine flu, and the other from the heatwave currently affecting the country. Both flu epidemics and heatwaves frequently cause many deaths. For example, the August 2003 heatwave had a death toll in Europe of around 30,000, and a typical seasonal flu epidemic causes hundreds and thousands of deaths. Yet my impression is that, in the majority of the population, flu epidemics and heatwaves are not regarded as particularly great evils (flu pandemics, such as the current one, may be a different story).There's an obvious explanation for why they are regarded as less bad than killers such as road traffic accidents, wars and terrorism: these involve human action – and often human wrongdoing – in a way that flu epidemics and heatwaves do not. But flu epidemics and heatwaves also elicit a weaker reaction than many other natural events that typically kill far fewer people: for example, floods and earthquakes.

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Neonatal euthanasia without parental consent

A
provocative article soon to be published in the Journal of Bioethical Inquiry
argues that parental consent should not be a prerequisite for neonatal
euthanasia. At present, the only country to permit neonatal euthanasia is the
The Netherlands. Medical personnel there are not prosecuted for actively
euthanizing infants in great suffering, provided that they satisfy the
requirements of the Groningen Protocol, which include obtaining consent from
the infant's parents. In the forthcoming article, Jacob Appel argues that the
requirement for parental consent should be dropped. 

Let's first consider the question of whether it
could be ethically permissible for medical staff to end the life of a child
without the consent of the parents.

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Compulsory chemical castration for sex offenders

A month ago, the Polish Prime Minister, Donald Tusk, called for the introduction of forced chemical castration for sex offenders. The call followed a particularly nasty case of incest and paedophilia in the country: a 45 year old man was found to have sexually abused his 21-year-old daughter over a period of six years, and to have fathered two children by her. A poll showed that 84% of the Polish population supported the Prime Minister’s proposal, however many commentators condemned it as an affront to human rights. In response, the Prime Minister, Donald Tusk, claimed that the sex offenders he has in mind cannot be described as human beings, and therefore have no human rights (see here). Nevertheless, high level opposition has forced the government to replace the proposal with a plan for voluntary chemical castration, which is already allowed in Great Britain, Denmark, Sweden, Germany, Switzerland, and some US states. 

It is interesting to compare the claims that have been made for and against Mr Tusk’s proposal with those that we might expect to surround alternative proposals for reducing rates of re-offending among sex offenders. Suppose the Prime Minister had instead suggested the introduction of a compulsory education programme for sex offenders in which they would be forced to confront the devastating effects that their actions can have on their victims. It is difficult to imagine such a proposal being greeted with the claim that it breaches human rights. And it is also hard to imagine the proponents of such a programme resorting to the claim that sex offenders aren’t human. Instead, the debate would probably focus on weighing the costs and benefits of the proposed programme.

Can these differing responses be justified? Is there any good reason to think that compulsory chemical castration is a matter of human rights, while compulsory re-education is not?

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Bailing out banks

Last week the US congress agreed to a US$7 billion bail-out for the banking sector. This Tuesday, the UK government followed suit with its own bail-out – though with some fairly serious strings attached. In the US case in particular, there was some strong public opposition to the bail-out, with many people claiming that bankers should be made to feel the consequences of their own bad decisions. In response, those who favoured the bail-out tended to make one or both of two main responses. First, they claimed that the bail-out would make everyone better off, and/or second, they implied that the feelings of resentment which many harbour towards bankers are not really the sort of consideration on which economic policy should be based.

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A Nasty Dilemma for NICE

After a prolonged disagreement with patient groups, the NHS’s funding guidance body, NICE, has approved the £10,000-an-eye blindness treatment, Lucentis. The drug has been shown to halt the progression of wet age-related macular degeneration (AMD), the most common cause of blindness in developed countries. But as the BBC  note, in approving it, NICE may have unwittingly deprived the NHS of a much cheaper alternative.

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Cold and Calculating NICE

Yesterday’s Daily Mail online contains an opinion piece bemoaning the decision by NICE – the UK body responsible for rationing healthcare resources – to decline funding for four new treatments for Kidney Cancer. The Mail complains:

…what does NICE offer by way of explanation? A cold, calculating statement that, while the drugs work for many of those with advanced kidney cancer, they are not ‘cost-effective’.

What a clinical way to assess whether a person should be afforded precious extra months and years of life, or consigned to a ‘death sentence’.

I don’t want to defend NICE’s decision in this particular case, but the Mail’s attack on NICE’s "clinical" decision-making process is clearly unjustified.

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Testing alternative therapies

The journal Science is today reporting on a controversial plan by the US National Institute of Mental Health (NIMH) to test an alternative treatment for autism on children. The treatment, known as chelation therapy, involves the use of drugs that remove heavy metals from the blood. It’s based on a the theory – unsupported by conventional science – that mercury in vaccines triggers autism.

Chelation therapy is widely used, but its benefits and effects are not well understood. The NIMH have therefore argued that there is a "public health imperative" to test the drug. But opponents claim that any such study would be unethical, since the quality of the trial is likely to be poor, and any results – especially negative ones – would be unlikely to alter the behaviour of parents who support the therapy.

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Paying to top up NHS treatment

The BBC has this week published a story on co-payment in the UK’s National Health Service. Sue Matthews, a Buckinghamshire woman with terminal bowel cancer, would like to top up her NHS care by paying for a £30,000 course of cetuximab – a drug which could extend her life, but which is not funded by her NHS trust. However, if she does so, she may also have to pick up the tab for her standard NHS treatment. That’s because the NHS guidelines advise against allowing such co-payments: they require that a given instance of treatment be either fully privately funded, or fully publicly funded.

Should co-payments be banned?

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