Practical Ethics

Refusing Cochlear Implants: Is It Child Neglect?

Australian Graeme Clark developed the cochlear implant, or bionic ear, in the 1970s. It does not amplify sound but directly stimulates any functioning auditory nerves in the inner ear. The Australian Government has promised a screening program of all babies for deafness from 2011. At present, only 70 percent children who might benefit are picked up early. The earlier deafness is detected, the more effective treatment can be.

Lobby group Deaf Australia says the implant "implies that deaf people are ill or incomplete individuals, are lonely and unhappy, cannot communicate effectively with others and are all desperately searching for a cure for their condition. [This] demeans deaf people, belittles their culture and language and makes no acknowledgment of the diversity of lives deaf people lead, or their many achievements."
Some deaf parents have denied their children cochlear implants. Is this right?

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.

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.

Nice People Take Drugs (Too)

The drug and human rights charity *Release* recently launched an advertising campaign in which the slogan ‘Nice People Take Drugs’ was displayed on the sides of London buses. Their aim was to encourage society to face up to the reality that a huge proportion of the population does at least experiment with drugs and to combat the popular assumption, which underlies a good deal of political rhetoric and media coverage, that since drugs are simply ‘evil’ there is no point in seriously debating drug policy. Those ads are now being withdrawn by the company that booked the space, after advice from the Committee of Advertising Practice: http://www.guardian.co.uk/media/2009/jun/09/nice-people-drugs-ads-pulled

Apparently, Release has been told that their strap-line would be more acceptable if it included the word ‘too’. This suggests that the CAP may have felt that the public would read the original claim as equivalent to ‘All those who take drugs are nice people’. But even adding the word ‘too’ may not be enough. For the new sentence might be read as: ‘All nice people take drugs, along with other things (such as holidays when they can, advice when they need it, offence when people are rude to them, etc.).’ Of course, no one would have understood either the new or the old sentence in these ways. But in fact, though it should be up to Release how they word their strap-line (the censorship charge they have made doesn’t seem far-fetched), adding ‘too’ does bring out more clearly what they want to say: that we should stop demonizing drug-takers and have an open, impartial, and well-informed debate.

Decisions, decisions.

I’ve just returned from Malta where I came across a story that I had missed at the time.  A decade ago a Catholic woman from the Maltese island of Gozo gave birth to conjoined twins.  Doctors said the twins would both die unless they were operated on; but if this operation went ahead only one of the babies would survive.

Neonatal euthanasia without parental consent

A provocative article soon to be published in the Journal of Bioethical Inquiry argues that parental consent should not be a prerequisite for neonatal euthanasia. At present, the only country to permit neonatal euthanasia is the The Netherlands. Medical personnel there are not prosecuted for actively euthanizing infants in great suffering, provided that they satisfy the requirements of the Groningen Protocol, which include obtaining consent from the infant's parents. In the forthcoming article, Jacob Appel argues that the requirement for parental consent should be dropped. 

Let's first consider the question of whether it could be ethically permissible for medical staff to end the life of a child without the consent of the parents.

Coercion, compulsion and immunisation

The former head of the British Medical Association, Sir Sandy Macara, has called for the Measles Mumps and Rubella immunisation (MMR) to be a compulsory requirement prior to school entry. The UK has seen a surge in cases of measles over the last couple of years because of a fall in the immunisation rate. Many parents have chosen not to immunise their children as a result of the supposed (and now completely discredited) link between MMR and autism. Immunisation rates have fallen to 70% in some parts of the country. Is compulsory immunisation the answer, and if so, what degree of compulsion should we adopt?

Self-control matters - but to what extent can it be taught?

Recently in the news, a report published by the independent think-tank Demos reminds us of the importance of the capacity for self-control (it also mentions empathy, to which most of the following remarks apply) in determining life outcomes. It argues that self-control lessons should be taught at school if children, particularly from deprived backgrounds, are to be given the tools they need to succeed in life – low-self-control has for instance been shown to positively correlate with length of unemployment or criminal behaviour, and negatively with academic achievement. The report echoes renewed interest in the United States in a now famous experiment by Walter Mischel on deferred gratification, dating back to the late 1960s. Mischel tested the capacity of a group of four-year olds to resist the temptation to eat straightaway a marshmallow he had given them. The children who were able to refrain turned out to be better adjusted, more dependable and to do better academically on the whole later in life.

 

The report by Demos makes important points and its proposals deserve to be supported. Nevertheless, even if they are put into practice, we might still feel concerned about how effective we can expect them to be. There is indeed a body of evidence suggesting that the capacity for self-control is to a large extent genetically determined (Wright & Beaver, 2005; Beaver & al., 2009).

 

Biting into the sour apple: liberal society, abortion rights and sex selection

The Swedish National Board of Health and Welfare has recently declared that it is impossible to deny abortions to women who base their decision on the sex of the foetus. This ruling came about after a case where a woman twice aborted foetuses because they were female. This upset not only the medical personnel, but also social minister Göran Hägglund who declared that it was horrible that people valued sexes differently. But while the majority of Swedes probably do think sex selection is immoral, the right to free abortion is equally strongly held. This poses an interesting problem for socially and politically liberal societies like Sweden: allow gender selection, or try to restrict abortion?

Be mindful of results, not the method

David King warns that we should modify society, not childrens' brains. This is a response to a recent Radio 4 documentary on "the criminal mind", which discussed recent evidence for biological underpinnings of some forms of antisocial behaviour and the possibility of reducing it using vitamins, drugs or early interventions. Dr King quite rightly points out that the image given by the program tends to oversimplify things and promote a reductionistic view of the causes of crime. But he also appears to contend that complex social problems cannot be solved through biological interventions. In this he is likely wrong.