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Ethics

Foetal pain and the abortion debate: believing what you want to believe

By Janet Radcliffe-Richards

Last Friday’s BBC morning news headlines included a report of two reviews by the Royal College of Obstetricians and Gynaecologists of evidence about foetal pain. The reviews concluded that foetuses under 24 weeks could not feel pain, because “nerve connections in the cortex, the area which processes responses to pain in the brain, does not form properly before 24 weeks”, and that even after that stage “a foetus is naturally sedated and unconscious in the womb”.

The corresponding article on the BBC website added the comment that “anti-abortion campaigners challenged the reports”. There were no details about the form these challenges took or who they came from, but as the reports were reviews of scientific evidence, it sounds as though a challenge to the reports must have been a challenge to the scientific claims. Of course scientific claims are always potentially open to challenge, so if the article had reported that scientists had come forward to challenge the methodology of key studies, for instance, or the way the reviews represented the data, we would just have known there was an ongoing scientific debate on the subject. But the implication of the BBC article was that people who were against abortion were challenging the scientific claims about foetal pain. And if this is true, it is interesting. Why should people with particular moral views (about the wrongness of abortion) or political ambitions (to prevent it) issue challenges to scientific claims? Most of these people are not scientists, and there is no reason to think they have special knowledge of nerve connections in the foetal cortex. So why are the challenging what the scientists say?

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The Cost of Non-Cash Incentives for Organs

The Times newspaper featured an editorial proposing changes in the organ procurement system last week by Sally Satel, a scholar from the American Enterprise Institute, a conservative think tank. I thought the first few lines were especially revealing about Satel’s attitude to market transactions – she reports that she desperately needed a kidney herself, but dreaded “the constricting obligation that would surely come with accepting” an altruistic donation. She therefore “wished [she] could buy a kidney just to avert the emotional debt.”

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A costly separation between withdrawing and withholding treatment

by Dominic Wilkinson

Television child star Gary Coleman died recently following a severe brain haemorrhage. He was taken to an intensive care unit, but the next day was taken off life support because of the severity of his brain injury.

Decisions like the one made by Gary Coleman’s doctors are common in intensive care. Many deaths follow decisions to stop intensive treatment because it is believed to have no chance of succeeding or because of the burden of illness even if the treatment does work. One question raised about cases like these is about the importance (or risks) of living wills. A separate question (and one that was raised during the critical care grand round earlier today) is about the difference between stopping treatment and failing to start treatment.

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Critical Care ethics grand round

by Dominic Wilkinson

Today I gave a talk at the John Radcliffe Medical Grand Round on Advance Directives and treatment withdrawal decisions in intensive care – based on a case I was involved in last year.

A middle-aged patient presents with acute respiratory failure, and is intubated and transferred to the intensive care unit. After admission he improves, but it transpires that he has a progressive neurodegenerative disorder and has previously expressed a wish not to have intensive life support measures provided.

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Whether to die, or when to die? The distinction between assisted suicide and ‘aid in dying’

Assisted suicide is illegal in the state of Connecticut. But two doctors have sought to circumvent the law by requesting that the administration of lethal agents to terminally ill patients be classed as “aid in dying” rather than assisted suicide. The doctors’ lawyers reportedly drew the distinction as follows:

"Suicide is a choice of whether to die or not. Aid in dying involves not whether a person will die, but when, and how much pain and suffering the patient must endure first."

The judge, Julia Aurigemma, rejected the request, arguing that the cases in question are precisely the sort of case to which the assisted suicide prohibition was intended to apply. But the question remains whether there is a meaningful distinction between assisted suicide and aid in dying, and if so, whether it is morally significant.

The distinction, as formulated by the lawyers, does seem clearly bogus. No-one yet faces choices about whether to die. All actions that might plausibly be classed as suicide are really decisions about the timing of death. But there does seem to be a genuine distinction lurking here somewhere.

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Torture, but do no harm

After the September 11 terrorist attacks, the Bush administration redefined acts that were previously recognised as torture and thus illegal as ‘enhanced interrogation techniques’ (EITs). From then on subjecting detainees to, for example, forced nudity, sleep deprivation, waterboarding and exposure to extreme temperatures could be legal. The line between torture and EITs is a fine one: the classification depends on the level of pain experienced.  

A report issued by the advocacy group ‘Physicians for Human Rights’ has revealed that to ensure that the aggressive interrogation practices conducted by the CIA qualified as EITs they were monitored by doctors and other medical personnel who guaranteed that the legal threshold for  ‘severe physical and mental pain’ was not crossed (NY Times, 6 June 2010).

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