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Oxford Debates Cont’d – Proposer’s update 2

Oxford Debates Cont’d – Proposer’s update 2

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

Proposer: Dr Mark Sheehan
Update 2

As Foster suggests we must be clear about the motion. So what might it mean to 'not treat self-inflicted illness'? If it means not treating an illness or condition that was in some way the result of choices of the patient, not only would the motion require that the NHS not treat the flu — if only people had no contact with each other — but it would be a complete waste of time to discuss.

The motion does raise an important issue, and a live issue, and so it should be given a sensible interpretation. Precisely because of this 'self-inflicted' must mean something like 'those illnesses that can be shown to be self-inflicted.' The background to all of this of course is the body of evidence surrounding particular kinds of life-style decisions. So when we refer to self-inflicted illness we do not mean all cases, but the subset of extreme examples where particular choices have been made and the knowledge that is clearly available in society has been ignored.

We also need to be clear about the ways in which the NHS might 'not treat.' First, 'not treating' can involve blocking access to particular care or procedures. Foster concedes that the processes in the NHS for making decisions about funding may conclude (apparently with some justification) that heavy smokers should not be given coronary bypasses — because they smoke. Clearly here, the choice to smoke by the patient means that they are denied treatment. The smoking causes the conditions that the make the coronary bypass likely to fail.

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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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Pandemic ethics: Party to the flu (or vigilante vaccination)

A public health expert has warned yesterday against the idea of swine-flu parties, arguing that it may undermine the fight against the emerging pandemic. But others, including James Delingpole in the Telegraph have embraced the idea, hoping that mild influenza now will protect against more serious illness later. Exposure parties might be thought of as a form of vigilante vaccination against influenza.

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Don’t be Evil — and prove it.

A new angle has recently come to light regarding the unrest in Iran: well known western companies provided the technology the government are using to eavesdrop on its citizens. The Washington Times and Wall Street Journal have reported on the fact that Nokia and Siemens have sold special equipment to Iran's state-owned telecommunications company, which can be used to tap phones, read email messages and observe who is accessing which internet sites. This is not the first such case. In 2006, Amnesty International drew attention to the assistance Yahoo, Microsoft, and Google had given to Chinese authorities in their attempts to suppress free speech on the internet in China. Finally, the networking giant, Cisco, has been a key player in setting up the hardware that China uses to block foreign websites with its 'Great Firewall'.

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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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