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Diet, Changing Desires, and Dementia

Diet, Changing Desires, and Dementia

Written by Ben Davies

Last week saw the launch of a campaign (run by the group Vegetarian For Life) that seeks to ensure that older people in care who have ethical commitments to a particular diet are not given food that violates those commitments. This is, as the campaign makes clear, a particularly pressing issue for those who have some form of dementia who may not be capable of expressing their commitment.

Those behind the campaign are quite right to note that people’s ethical beliefs should not be ignored simply because they are in care, or have a cognitive impairment (see a Twitter thread where I discuss this with a backer of the campaign). But the idea that one’s dietary ethics must be ‘for life’ got me thinking about a more well-established debate about Advance Directives. (I should stress that what I say here should not be taken to be imputing any particular motivation or philosophical commitments to those behind the campaign itself.)

Read More »Diet, Changing Desires, and Dementia

Tafida Raqeeb and Charlie’s Law

by Dominic Wilkinson

Disputes between parents and doctors are back in the media. This morning, in the case of Tafida Raqeeb, the court concluded that her parents should be allowed to take her to Italy for continuing intensive care.

In Tafida’s case, the court found in favour of her parents and against the doctors treating her. That might help address concerns in the minds of some that the courts are biased against parents, and in favour of health professionals.

However, some may still be concerned that the UK legal approach to disagreements is the wrong one. Of relevance, in the next couple of weeks, a Labour politician is planning to put forward a law to the Commons – the Children (Access to Treatment) Bill, otherwise known as ‘Charlie’s law’. (See this separate guest post for a press release from Bambos Charalambous, MP).Read More »Tafida Raqeeb and Charlie’s Law

Press Release: Tafida Raqeeb: Right Outcome, Wrong Reasons

Written by Professor Julian Savulescu

Dominic Wilkinson describes well the decision to allow a severely brain damaged girl, Tafida Raqeeb, to travel to Italy to continue to be kept alive with artificial ventilation.

This is the right outcome. It appears as if Tafida is insensate or unconscious. If Tafida is vegetative, continuing treatment won’t cause suffering. So it is not harmful for her to be transferred to Italy at her parent’s request. (It would also be permissible to discontinue medical treatment.)

There is some chance she might experience something, in other words that she is minimally conscious. If she is minimally conscious, doctors would have to show she is unrelievably suffering in order to discontinue treatment in her interests. That has not been demonstrated in this case.

Medicine is provided to patients in their best interests. It is not clear, at least to me, whether it is against Tafida’s interests to continue to be kept alive. Italian experts cite a number of reasons to continue to keep Tafida alive, not least to clarify prognosis and to allow parents to come to terms with the situation.

Read More »Press Release: Tafida Raqeeb: Right Outcome, Wrong Reasons

Guest Post: Introducing Charlie’s Law, Bambos Charalambous MP (Labour, Enfield Southgate)

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Bambos Charalambous MP (Labour, Enfield Southgate)

The tragic case of Charlie Gard, who sadly died in 2017 following a serious and protracted illness, attracted significant global attention because of the harrowing dilemmas that it highlighted.
Charlie’s story, was fraught with high tensions and unfurled very much in the public eye as a result of the constant media coverage, highlighted the inadequacy of current processes to prevent prolonged and distressing legal conflicts between the parents of seriously ill children and those responsible for their medical care.

Since Charlie’s death Charlie’s parents Connie Yates and Chris Gard have campaigned with dignity and determination to improve the situation for everyone involved: parents, healthcare professionals, hospitals, and the NHS more broadly; recognising that everyone wants the same thing: to maximise the life chances and general welfare of children suffering from serious illnesses and to reduce any stress on their parents who may be coming to terms with the potential death of their child.Read More »Guest Post: Introducing Charlie’s Law, Bambos Charalambous MP (Labour, Enfield Southgate)

Press Release: Tafida Raqeeb

Professor Dominic Wilkinson, Professor of Medical Ethics, University of Oxford. Consultant Neonatologist

 

This morning, the High Court judgement around medical treatment for five-year old Tafida Raqeeb was published. Tafida sustained severe brain damage from bleeding in the brain eight months ago. Her parents wish to take her to a hospital in Italy to continue life support, while the doctors at the London hospital caring for her believe that it would be best to stop life support and allow Tafida to die.

 

Justice MacDonald concluded today that life sustaining treatment for Tafida must continue and her parents should be allowed to take her to Italy.Read More »Press Release: Tafida Raqeeb

Cross Post: Is Mandatory Vaccination the Best Way to Tackle Falling Rates of Childhood Immunisation?

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Written by Dr Alberto Giubilini and Dr Samantha Vanderslott

This article was originally published on the Oxford Martin School website.

Following the publication of figures showing UK childhood vaccination rates have fallen for the fifth year in a row, researchers from the Oxford Martin Programme on Collective Responsibility for Infectious Disease discuss possible responses.

Alberto Giubilini: Yes, “we need to be bold” and take drastic measures to increase vaccination uptake

In response to the dramatic fall in vaccination uptake in the UK, Health Secretary Matt Hancock has said that “we need to be bold” and that he “will not rule out action so that every child is properly protected”. This suggests that the Health Secretary is seriously considering some form of mandatory vaccination program or some form of penalty for non-vaccination, as is already the case in other countries, such as the US, Italy, France, or Australia. It is about time the UK takes action to ensure that individuals fulfil their social responsibility to protect not only their own children, but also other people, from infectious disease, and more generally to make their fair contribution to maintaining a good level of public health.Read More »Cross Post: Is Mandatory Vaccination the Best Way to Tackle Falling Rates of Childhood Immunisation?

The Doctor-Knows-Best NHS Foundation Trust: a Business Proposal for the Health Secretary

By Charles Foster

Informed consent, in practice, is a bad joke. It’s a notion created by lawyers, and like many such notions it bears little relationship to the concerns that real humans have when they’re left to themselves, but it creates many artificial, lucrative, and expensive concerns.

Of course there are a few clinical situations where it is important that the patient reflects deeply and independently on the risks and benefits of the possible options, and there are a few people (I hope never to meet them: they would be icily un-Falstaffian) whose sole ethical lodestone is their own neatly and indelibly drafted life-plan. But those situations and those people are fortunately rare.Read More »The Doctor-Knows-Best NHS Foundation Trust: a Business Proposal for the Health Secretary

Lies

Written by Stephen Rainey.

 

I’ve been thinking, lately, about lying. Not doing it, just puzzling over what it means.

We all know lying can be morally wrong. But sometimes it can also be a kindness, when the truth might serve no good. Within the constraints of a job, lying might be a professional obligation, morals aside. So I was thinking about the word, ‘lying’, and how maybe it labels a variety of acts that may have different moral implications.

There are some clear-cut cases of wrong that we can spot easily. If we saw a bully shoving someone around, we’d know straight away that was bad. Physically intervening on another person for sadistic kicks, and without their cooperation, is plainly egregious. But the inclusion of sadism and cooperation in the description points to other dimensions of physical intervention that aren’t clearly so bad.

Read More »Lies

Video Interview: Jesper Ryberg on Neurointerventions, Crime and Punishment

Should neurotechnologies that affect emotional regulation, empathy and moral judgment, be used to prevent offenders from reoffending? Is it morally acceptable to offer more lenient sentences to offenders in return for participation in neuroscientific treatment programs? Or would this amount too coercion? Is it possible to administer neurointerventions as a type of punishment? Is it… Read More »Video Interview: Jesper Ryberg on Neurointerventions, Crime and Punishment

Press Release: Tafida Raqeeb, International Disagreement and Controversial Decisions About Life Support

by Dominic Wilkinson @Neonatalethics

 

This week the legal case around medical treatment for five-year old Tafida Raqeeb has begun in the High Court. She sustained severe brain damage from bleeding in the brain seven months ago. Her parents wish to take her to a hospital in Italy for further treatment, while the doctors at the London hospital caring for her believe that it would be best to stop life support and allow Tafida to die.

 

In a previous press release, I addressed several common questions about the case:

  • This seems to be another case like that of Charlie Gard and Alfie Evans. How common are cases of disagreement in the medical care of children?
  • Why do disagreements occur?
  • Why don’t parents have the final say about treatment?
  • Who is right in Tafida’s case, her parents, or the doctors?

 

There appear to be two central questions in her case –

  1. Is there any realistic chance of her condition improving if life-support continues?
  2. If Tafida’s condition does not improve, should treatment to keep her alive continue, or should it stop (particularly, if her parents do not give permission to withdraw treatment)?

Read More »Press Release: Tafida Raqeeb, International Disagreement and Controversial Decisions About Life Support