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The Law on Assisted Suicide: Time for the Buck to Stop

The Law on Assisted Suicide: Time for the Buck to Stop

Yesterday, three judges representing the England and Wales Court of Appeal unanimously dismissed a challenge to a High Court ruling that Parliament, rather than judges, should decide whether the law on assisted dying should change.  The challenge was mounted by Paul Lamb (who is paralysed from the neck down and wishes to end his life, but is physically unable to do so) and Jane Nicklinson (the widow of Tony Nicklinson, a sufferer of locked-in syndrome who unsuccessfully appealed to the High Court to change the law on assisted suicide prior to his death).Read More »The Law on Assisted Suicide: Time for the Buck to Stop

The Ethics of Private Payment for Health Care: The Example of Vaccination

30  July. This blog is an extended version of the post ‘Vaccines: All or Nothing’ (posted 29 July). 

A vaccine which would protect children from Meningitis B has been rejected by the Joint Committee on Vaccination and Immunisation (JCVI) as not cost effective, despite the fact the cost is not yet known.

The Department of Health’s director of immunization explained:

“This is a very difficult situation where we have a new vaccine against meningitis B but we lack important evidence. We need to know how well it will protect, how long it will protect and if it will stop the bacteria from spreading from person to person.

“We need to work with the scientific community and the manufacturer to find ways to resolve these uncertainties so that we can come to a clear answer.”

A call for more research is a standard answer to many dilemmas in healthcare, though perhaps one which is easy to ignore. As far as we know there are no current plans to ensure that this research takes place but the vaccine has already been found to be safe, and according to the BBC, “tests have suggested the vaccine is effective against 73% of the different strains of the disease”.

Resource allocation is an inevitable part of any health care system, and perhaps especially so in the NHS. Whilst we would like to provide all available treatments, prioritizing according to effectiveness and cost is necessary, though the exact method of calculating this (currently Quality Adjusted Life Years, or QALYs) is of course under intense debate and scrutiny.

In the meantime, children continue to suffer avoidable, lifelong disability due to infection with Meningitis B. I argue with Lach de Crespigny in a forthcoming paper on homebirth that actions (or failures to act) taken today which cause harm in the future are as wrong as if that harm were realized today. The plight of these children and adolescents should not be ignored.

Put simply, if you could prevent a child from getting brain damage, now or in the future, at little cost to you, you ought to perform that act.

One possible way forward would be to allow parents to pay for the vaccination of their child, at whatever price the company sets, just as holiday vaccinations can be provided by the NHS at a cost to the patient. Vaccinated children could be monitored and their data recorded. Not only would this generate the data that would establish how high up funding agendas this vaccine should be, but some individual children would be prevented from suffering this deadly and debilitating disease. To increase take up, the company would be under market pressure to keep the price as low as possible.

Read More »The Ethics of Private Payment for Health Care: The Example of Vaccination

What to do with the Redundant Churches After the Demise of Religion?

Some weeks ago I attended a lecture by Daniel Dennett at the Oxford Union on religion. As expected, it was a lively presentation that predicted the demise of religion. However, one matter that started me thinking was how Dennett concluded his lecture: he ended by pondering what we might do with all the redundant places of worship once his prophecy was fulfilled. His suggestion was that they might satisfy a secular purpose, as places where the community might come together to address the novel challenges of the modern world. I started me thinking as I wondered whether a belief in religion might be better than atheism for attaining this, or any other, goal. Some, such as Jonathan Haidt (The Righteous Mind (2012)) have suggested that religion is a particularly effective force for bringing people together.Read More »What to do with the Redundant Churches After the Demise of Religion?

Censorship, pornography and divine swan-on-human action

The Prime Minister has declared that Internet service providers should by default block access to pornography, and that some “horrific” internet search terms to be “blacklisted” on the major search engines, not bringing up any search results. The main motivation of the speech appears to be that access to pornography is “corroding childhood” by having children inadvertently seeing images or visiting websites their parents do not want them to see. There is no shortage of critics, both anti-censorship groups, anti surveillance groups, technology groups and people concerned with actual harm-reduction. There are two central problems: defining pornography, and finding its harms.Read More »Censorship, pornography and divine swan-on-human action

I’ve warned you! But I shouldn’t have

Among close friends, or even within the family, the use of SSRI’s (selective serotonin reuptake inhibitors) can be a delicate topic, it may come with connotations of depression, suicidal behaviour, and can be emotionally marginalizing. A new scientific review may further entangle this already vexing situation, in the study (Isacsson, G. & Alhner, J. 2013)… Read More »I’ve warned you! But I shouldn’t have

Doping…When Will We Learn?

The second fastest runner of all time, USA’s Tyson Gay, has reportedly tested positive for a banned substance, along with the Jamaican sprinters Asafa Powell, and Sherone Simpson making for shocked headlines across the world.

But this is just one high profile story amongst a recent rash of news stories across sports and across countries. In athletics, 24  Turkish athletes are confirmed to have tested positive this year; Australian Rules Football is still reeling from the ongoing Essendon scandal; and over in the United States, inquiries into an anti ageing laboratory said to supply human growth hormone to top baseball players are ongoing. Whilst the 100th Tour de France is so far untainted by positive tests, cycling doping cases have continued this year with two Giro D’Italia riders testing positive.

Still there is a sense that we are just seeing the tip of the iceberg. Chris Froome, now tested at the end of each stage as the yellow jersey, has been relentlessly hounded over whether his recent impressive performances are due to doping.

1. The Failure of Zero Tolerance

We don’t know which individuals are doping and which are not. One thing we do know is that the zero tolerance ban on doping has failed.

Read More »Doping…When Will We Learn?

In the genetic supermarket, should parents be allowed to buy?

Imagine a world in which genetic interventions (for hair/eye colour, health, strength, happiness, morality…) were tested, safe, effective and accepted. In this genetic supermarket, who should be allowed to buy – to decide how children should be modified? Parents seem the obvious choice – but on reflection, there seem few reasons to allow this.

Why is it good for people to make their own choices? Firstly, out of liberty: everyone should have the right to do what they want with themselves. Secondly, because people know their own preferences much better than anyone else (one of the reasons that the communist command economies failed). And thirdly because people can experience the consequences of their choices, and become more skilled consumers, driving poor products out of business.

None of these applies to parents choosing their children’s genes. Here they are making the choice for other people, whose preferences they don’t know (because they don’t even exist yet!). And unless parents plan to have ten or twenty children, they have no relevant personal experience to draw on for comparing genetic interventions. And the main effects of these interventions are very long term, making the parents even less suited to making the choice in an informed way.Read More »In the genetic supermarket, should parents be allowed to buy?

How do you want to die?

How do you want to die? Quickly, painlessly, peacefully lying in your own bed?

Most people say that. But then, people seem to cling to their lives, even if that could mean a less peaceful end. When asked whether they would want physicians to perform certain interventions to prolong their lives like CPR (cardiopulmonary resuscitation) or mechanical ventilation (‘breathing machine’), people say ‘yes’.

Interestingly, a study discussed in a Radiolab podcast from earlier this year reveals that contrary to lay people, physicians do not want these life-saving interventions they perform on their patients performed on themselves.Read More »How do you want to die?

‘Losses disguised as wins’: Slot machines and deception

Last week, Canadian researchers published a study showing that some modern slot machines ‘trick’ players – by way of their physiology – into feeling like they are winning when in fact they are losing. The researchers describe the phenomenon of ‘losses disguised as wins’, in which net losses involving some winning lines are experienced in the same way as net wins due to physiological responses to the accompanying sounds and lights. The obvious worry is that players who are tricked into thinking they’re winning will keep playing longer and motivate them to come back to try again.

The game set up is as follows: players bet on 15 lines simultaneously, any of which they might win or lose. A player will accrue a net profit if the total amount collected from all winning lines is greater than the total amount wagered on all 15 lines. Such an outcome is accompanied by lights and sounds announcing the wins. However, lights and sounds will also be played if any of the lines win, even if the net amount collected is less than the total amount wagered on all 15 lines. If a player bets 5 credits per line (5 x 15 = 75) and wins 10 back from 3 (= 30), then the player has actually lost money, even though the lights and sounds indicate winning. The loss, the researchers claim, is thus disguised as a win.Read More »‘Losses disguised as wins’: Slot machines and deception

Pay politicians much more

The Independent Parliamentary Standards Authority (Ipsa) just proposed a rise of MPs’ annual salary to £74,000, from the current £66,396. This is a stupid idea. The MPs should be paid a lot more. In the private sector, and even in most NGOs, it’s well understood that if you want to attract high quality workers, you need… Read More »Pay politicians much more