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Oxford Debates Cont’d – Opposer’s update 1

Oxford Debates Cont’d – Opposer’s update 1

Part of the debate "The NHS should not treat self-inflicted injuries"

Opposer: Charles Foster
Update 1

It simply won't do to underplay the practical difficulties posed by this motion. The motion is not 'The NHS should not treat those illnesses which can be shown beyond any doubt to have been self-inflicted', but 'The NHS should not treat self-inflicted illness'.  The world of medical causation is simply not as straightforward as Mark Sheehan suggests. To reiterate: to prove a link in the general population between smoking and lung cancer is a very different thing from proving it in an individual patient.

There are no 'robust' or indeed any systems in the NHS for dealing with this sort of issue. Nor can there be. Questions of individual causation are argued expensively before the courts in clinical negligence cases. They are notoriously nightmarish. The same job can't be done by committees, however enlightened or well meaning.

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Trackr the Most Cloneworthy Dog: Best Friends Again?

According to recent media reports, a competition to find the world’s most cloneworthy dog has been organised by the American firm BioArts International http://www.bioarts.com/about_us.htm. BioArts has a subsidiary, Encore Pet Science, which now offers a commercial dog cloning service. The world’s first commercially cloned god, Lancelot Encore, was born late last year and cost US$155,000-. However, Encore Pet Science are now offering to clone dogs for a mere $138,500-. Encore Pet Science also offer a gene banking service, which enables cloning to occur long after the death of an animal.

 

The competition to find the world’s most cloneworthy dog offered the winning owner the chance to have their dog cloned for free. Of the many entrants, the German Shepherd Trakr was judged to be the most cloneworthy, as result of his heroic efforts at Ground Zero following the 2001 collapse of the World Trade Center, where he worked non-stop for 48 hours and found the last survivor in the rubble. Trackr has also helped recover over $1 million in stolen goods in a long career as a working police dog. Trackr has been rewarded for his efforts by the creation of five cloned puppies, Trustt, Valor, Prodigy, Solace and Déjà vu.


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The good example

Last time I wrote about our potential to model ourselves on others, to be inspired by the good example they might be setting.  In this blog I shift the focus to the role model and the idea of leading by example. How might we recognise the appropriate role model – and perhaps more pressingly – what might the qualification criteria be? There has been a lot of debate on the importance of a strong leadership recently and it seems that expressions like ‘leading by example’, ‘walk the talk’ and ‘leading from the front’ are all the rage. (For some examples ranging from politicians to celebrities see here, here, here and here). At first on-look the idea of setting a good example might indeed sound both attractive and intuitive. Of course one can be inspired by role models; surely observing the deeds and practices of others can trigger a genuine desire to reform one’s behaviour! But do we have good reasons to be so optimistic?

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Oxford Debates Cont’d – Proposer’s update 1

Part of the debate "The NHS should not treat self-inflicted injuries"

Proposer: Dr Mark Sheehan
Update 1

There is a robust system in place in the NHS that grapples with questions like ours regularly. Far from these being my decisions, or the decisions of 'right-minded people', this system is open, publicly accessible, and accountable. Indeed, given the constraints, it is one of the fairest ways of making the kinds of allocation decisions that must be made.

The questions that confront NHS commissioners involve precisely the sorts of issues that concern us. They are not about whether to kill a particular individual but about how to prioritise services and allocate resources. In Foster's terms these are not decisions about whether to kill or let an individual die but decisions about which individuals to choose between. The situation is more akin to a transplantation decision where there is one liver and two potential recipients. Who should receive the liver, the child or the alcoholic? Alternatively — should the intensive care unit admit a car accident victim or a person who has just narrowly failed in their third attempt at suicide?

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To Prosecute or Not to Prosecute: Torture, Politics and the Rule of Law

This past April, The New York Times reported that a form of enhanced interrogation known as “waterboarding” was used on Khalid Shaikh Mohammed, confessed mastermind of the 9-11 attacks, upwards of 183 times, and that the same technique was performed on the high value Al Qaeda operative Abu Zubaydah at least 83 times. This information was contained in a series of memoranda written by the U.S. Department of Justice in response to CIA requests for a legal definition of torture, which in turn stemmed from the Bush administration’s explicit desire to see the legal constraints on interrogation relaxed in its response to the attacks on New York and Washington. One particular worry addressed in the “torture memos” (as they are now widely known) concerned the legal status of waterboarding, which was described as follows: an individual is bound securely to an inclined bench with their feet elevated; a cloth, cellophane or some other air-restricting material is placed over their face, whereupon water is applied to the cloth, further restricting air flow and causing an increase in blood CO2 levels. As is well documented, the procedure reliably simulates the experience of drowning, triggering an involuntary gag reflex and a primal sense of panic in a way that is far more effective than forcibly dunking an individual’s head under water. Again, according to the Bush-era torture memos, after 20 to 40 seconds, the cloth is to be lifted and the individual is allowed three or four full breaths before the procedure is repeated, until the interrogators are satisfied. Medical experts are required to be present throughout the procedure in case they are needed to perform an emergency tracheotomy. The memos concluded, to the great satisfaction of the Bush administration, that waterboarding was not torture for the purposes of the U.S.’s obligations under international law, but rather an “enhanced interrogation technique.”

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Umbilical cord blood donation: opt out or work on Sundays?

Umbilical
cord blood (UCB) contains haematopoietic stem cells, which can be used for the
treatment of several lethal disorders, including leukaemia
and several types of anaemia. Other sources of haematopoietic stem cells are bone marrow and ordinary peripheral
blood. Unlike bone marrow donation, which requires general anaesthesia, UCB
donation does not cause any inconvenience or significant risks for the donor. Peripheral
blood contains very few stem cells. Another major advantage of using UCB stem
cells is that less genetic similarity is required between donor and recipient.
This increases the chance of finding a ‘match’ and thus of the transplantation
being successful.

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Economic uncertainty and epistemic humility

In the last six months I have heard that the current economic crisis proves that free market capitalism is a failure. I have also heard that it proves that government intervention is responsible for market booms and busts. I have read that the causes of the current crisis are greed, irrationality, easy money, low interest rates, preverse incentives, complex financial instruments, subprime mortgages, people believing that house prices would always rise, people insisting that houses must be made affordable,  the US congress laws that force banks to provide a certain percentage of subprime mortgages, the capital ratio requirements on banks being less for subprime mortgage backed securities than for prime mortgages, the distortion of mortgage lending by government sponsored entities (Freddie Mac and Fannie May), the lack of an exchange for credit default swaps creating un-noticed systemic counterparty risk, mark to market valuation of bank assets, too little government regulation, too much government  regulation, the government scaring us, the government not scaring us enough,  the lack of a bail out (stock market falls) , the delay of a bail out (stock market continues to fall), and the bail out (stock market carries on down).

 

Why am I talking about this? Because these circumstances are precisely the kind in which we in general and experts in particular indulge in a certain kind of epistemic irresponsibility: over-confidence in belief. When the stakes are high and circumstances highly uncertain it appears that we can hardly bear to conform our belief to the uncertainty. Paradoxically, uncertainty turns us to dogmatism.

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Oxford Debates Cont’d – Opposer’s Opening Statement

Part of the debate "The NHS should not treat self-inflicted illness"

Opposer: Charles Foster (Barrister & teacher of medical law and ethics at
Oxford. He is attached to the Ethox Centre and is an Associate Fellow
of Green Templeton College)
Opening Statement

'The NHS has shown the world the way to healthcare, not as a privilege to be paid for, but as a fundamental human right', proclaimed the Department of Health in 2008. 'The values of the NHS – universal, tax-funded and free at the point of need – remain as fundamental today to the NHS as they were when it was launched in 1948.'

These values are important. We abandon or dilute them at our peril.

Mark Sheehan suggests that we have to grow up: to shoulder responsibility for our own actions and omissions. Why, he asks, should society pick up the bill for my stupidity?

There are many answers. Some of them will be ventilated over the next few weeks. But here are a few:

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Oxford Debates Cont’d – Proposer’s Opening Statement

Part of the debate "The NHS should not treat self-inflicted illness"

Proposer: Dr Mark Sheehan (Oxford BRC Ethics Fellow at the Ethox Centre and
James Martin Research Fellow in the Program on the Ethics of the New
Biosciences)
Opening Statement

We generally think that people are entitled to live their lives in the way that they see fit, in a way that best coheres with what they take to be meaningful and valuable. This is perhaps the central tenet of western liberal society. Liberal society is centred on permitting and perhaps even encouraging, different conceptions of 'the good' and experiments in living. Alongside this freedom, however, comes a responsibility for the decisions that one makes. Because society remains a collective effort the freedom to choose to live in a certain way brings with it responsibilities — here, responsibilities for the consequences of our choices.

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