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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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Oxford Debates — Performance-Enhancing Drugs Should be Allowed in Sport — Moderator’s Opening Statement

Oxford Online Debates

by Roger Crisp

Taking drugs to improve one’s sporting performance seems, on the face of it, a paradigmatic example of a wrong action. It combines two activities usually considered shameful: the use of banned substances, and cheating.

But on closer inspection the issue is more complicated. The use of some drugs, such as nicotine or caffeine (both of which might enhance performance in some cases), carries little or no stigma, and the charge of cheating would be inappropriate were the drugs in question explicitly permitted.

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Mining your past to justify your terminal care: the idea of a ‘retrospective QALY’

There is no end to human suffering. There is a distinct end to the amount of money that governments will spend on reducing it. Someone has to make decisions about healthcare resource allocation. I am very glad it’s not me.

Many tools are used in the decision-making process. Not many emerge well from a viva with a philosopher.

Individual clinicians use intuition, experience, NICE
guidelines, the fear of hospital accountants and, no doubt, prejudice and the
tossed coin. But policy makers do not have the luxury of being able to account
only to their consciences and the local man in a suit. They have to say something in the minutes about the
reason for funding procedure X but not procedure Y. The real reason might be:
‘My grandma, whom I loved very much, had procedure X, and it did her good’, but
they can’t say that.

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Playing God for the first time…

With his new paper Craig Venter is creaking open the most profound door in humanity’s history, potentially peeking into it’s destiny. The challenge is to eat the apple without choking on the worm.

Is anti-ageing worth it?

The Telegraphs proclaims that Anti-ageing drugs 'will fuel euthanasia'. The origin of the story was a lecture by Dr David Gems at UCL. He pointed out that if people were to live much longer healthy lives more would choose to end them themselves, and that centralized control of birthrates might become necessary. Francis Fukuyama argued at a conference in Aarhus last week that life extension also implies problems with age graded hierarchies and generational turnover. Some people, like Fukuyama, find these potential social consequences serious enough that life extension research should be discouraged. But are they strong enough?

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Organ Donation Euthanasia

by Dominic Wilkinson and Julian Savulescu

There are 8000 patients on transplant waiting lists in the UK. Every year 400 patients die while waiting for an organ to come available.
We are all far more likely to be in need of an organ transplant than to be a donor. Most of us expect that if we needed a transplant that someone would donate one. On the basis of the ethical golden rule – do unto others as you would want them to do for you, we should all think seriously about whether and how we could donate our organs if we no longer need them.

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The equal air-time solution for controversial research

When are placebos ethical in medical research? One common answer is that it is only appropriate to use placebos in research when there is no proven effective treatment for the condition (1). On this view, if there is a proven treatment placebos would be unethical, and any trial should compare new drugs or treatments with the existing proven one. But what if the question of ‘proof’ is in dispute? For new medical treatments there often comes a point where some researchers and doctors are convinced that the new treatment is effective and safe while others remain unconvinced. When placebo-controlled trials take place in this setting they are often controversial.

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The real scandals in organ donation consent

Headlines in a number of newspapers in the last day or two have claimed scandalous failures in organ donation consent in the UK. According to ‘Sky News’, organs were “taken without consent”, while the Sun claims that “NHS doctors took the wrong organs from the bodies of donors”. But it is important to put these claims in context. There are some bigger and more serious scandals when it comes to organ donation consent.

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I Don’t Care Too Much for Money, Money Can’t Buy Me Lungs

Is it true that “everyone’s a winner”, as Julian Savulescu suggested recently on this blog , if we price life and body parts? Let’s accept that if there is a valid objection to buying and selling body parts, it must be grounded in the recognition of a harm that would come to some person or group of people. Consider, then, Savulescu’s suggestion that we should price body parts, and engage in buying and selling of them. We could categorize the potential harms that it might generate under the following headings:

(1) Harm to the participants in the transactions: donors, recipients, or facilitators

(2) Harm to specific third parties

(3) Harm to society at large

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