Practical Ethics

When the heart stops: harvesting organs from the newly (nearly) dead

In the New England Journal of Medicine yesterday, doctors from Denver reported on three controversial cases of heart transplantation from newborn infants. These cases are striking for several reasons. They were examples of so-called ‘donation after cardiac death’ (DCD), an increasingly frequent source of organs for transplantation, but done very rarely in newborns. They are controversial because the transplanted organs were hearts that were ‘restarted’ in recipients after they had stopped in the donor. Transplant surgeons waited only a relatively short period after the donor’s heart had stopped (75 seconds) before starting the organ retrieval process. These transplants raise serious questions about the diagnosis and definition of death.

Would you rather be invisible or be able to fly? (Or: are you a sneaky superhero?)

If, like me, you were one of the kids whose preferred superpower was invisibility, you may soon be in luck. The BBC reports today that US scientists have created a material that could one day be used to make people and objects invisible. The material, which has so far been created only on a microscopic scale, neither absorbs nor reflects light, meaning that anyone looking at an object covered in it would see what lies behind the object rather than the object itself. It’s likely that such technology will be snapped up first by the military, but perhaps, in years to come, invisibility cloaks will be available to all.

For some, the idea of being invisible is distasteful. Being invisible means being able to get away with anything - and why bother to act morally when you can be sure that you’ll never be caught out? In this case, would a world full of people who can turn invisible at the drop of a hat be a world full of thieves, cheats, and sneaks?

Cold and Calculating NICE

Yesterday's Daily Mail online contains an opinion piece bemoaning the decision by NICE - the UK body responsible for rationing healthcare resources - to decline funding for four new treatments for Kidney Cancer. The Mail complains:

...what does NICE offer by way of explanation? A cold, calculating statement that, while the drugs work for many of those with advanced kidney cancer, they are not 'cost-effective'.

What a clinical way to assess whether a person should be afforded precious extra months and years of life, or consigned to a 'death sentence'.

I don't want to defend NICE's decision in this particular case, but the Mail's attack on NICE's "clinical" decision-making process is clearly unjustified.

Slaves to consent?

Nature reports that in response to analysis done by bioethicist Robert Streiffer (and published in the Hastings Center Report), Stanford University may withdraw the use for research of several of its publicly funded stem cell lines because of concerns about consent. In 2001 President Bush decreed that only lines already in existence would be eligible for federal funding – 21 lines were subsequently approved by the NIH.

Are falling house prices good or bad?

House prices have been falling quickly in both the US and, more recently, the UK. Newspaper reports tend to use negative language to refer to this fall. For example, todays edition of The Independent says:

Today's gloomy data, which is worse than economists had forecast, ...

However, it is not at all obvious that low house prices are a bad thing.

Should Karadzic be Punished?

Yesterday the world celebrated the arrest of Radovan Karadzic, the ex-Bosnian Serb leader who has twice been indicted by the UN War Crimes Tribunal in the Hague, and is charged with – among other atrocities -- ordering his forces to kill at least 7,500 Muslim men and boys in Srebenica in July 1995 as part of a campaign to terrorize and demoralize the population.

Reproductive science: is there something we're missing?

Thirty years after the first test-tube baby, Nature asks various experts for their views on what the next thirty years of reproductive medicine will bring. Some of the more startling predictions are:

• No more infertility, with both children and 100-year-olds able to have children
• Embryos created from stem cells, increasing the ease of embryo research and genetic engineering of children
• … with the resulting greater availability of embryos making it easier to create cloned humans
• Artificial wombs, enabling babies to develop outside the mother’s body
• … which, some worry, could become compulsory as an alternative to abortion, or to avoid premature birth or fetal alcohol syndrome
• ‘Genetic cassettes’ implanted in embryos to counteract the effects of inherited diseases
• Increase in litigation following evidence that IVF babies may later suffer adverse effects from the environment in which they were grown as embryos

Art or child porn?

In Australia recently, there has been heated debate about a series of photographs of naked and semi-naked children by photographer Bill Henson. The debate was reignited this month when Art Monthly, a major Australian art magazine, decided to put a picture of a nude 6 year old girl on its front cover. Politicians have attacked the photographs and the magazine’s editors

Care for the Dying and Cost-effectiveness

Yesterday’s news reports the launch of the Government’s End of Life Care Strategy for England. This strategy will dedicate in excess of £250 million allowing patients who are dying to decide, as the Times puts it, “where and how to die.” This is part of a programme to provide better care for the dying. According to the BBC, only one in five deaths takes place at home despite a comfortable majority expressing a preference for such familiar surroundings. This prioritisation raises some interesting ethical issues particularly in the light of cost-effectiveness considerations.

Unpopular policy and public rationality

The BBC reports that the Japanese town of Kamikatsu has become the first ‘zero waste’ town. Residents compost all of their food waste, and must sort the rest of their rubbish into 34 different categories—all of which they must take to public waste centres, since there are no rubbish collections from people’s homes. It seems that the inhabitants of the town are generally enthusiastic about the scheme, which offers small financial rewards for recycling, and has encouraged people to make an effort to reduce the rubbish they produce.

This is one of those relatively rare, uplifting stories about a scheme designed to reduce environmental damage that is not only successful, but supported by the community. Could something similar work in the UK? Recently, many UK councils reduced domestic refuse collections from once-weekly to once-fortnightly, with recyclable waste being collected in the intervening weeks. Whilst this has boosted the amount of rubbish being recycled, some news reports reveal that the new measures are unpopular, and some councils have bowed to public pressure by re-introducing weekly collections. Given the environmental impact of adding to landfill waste sites, ought the government to placate the public by relaxing measures designed to reduce waste, or should unpopular measures be enforced regardless of public opinion?