Practical Ethics

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.

EightFourteen is enough

As the Guardian reports, what started out as the more usual happy, wonder-of-modern medicine story of octuplets born in California has turned a little bit sour. It turns out that the 33 year old single mother of the eight newborns who lives with her parents, has six children already, the eldest of whom is seven. That’s 14 children below the age of eight. The story gets more difficult. Apparently, the mother is a self described ‘professional student’ who lives on “education grants and her parents’ money” and plans on becoming a “television childcare expert.” Further, the woman’s parents have recently filed for bankruptcy and her mother has previously consulted a psychologist about her daughter’s obsession with children.

I just don’t care about animals that much!

Despite the protestations of those opposed to the use of animals in research, the fundamental differences between people over the treatment of animals seems to lie with the weight that we are prepared to give to animal suffering and death in the pursuit of human goods and interests. Very few, I would have thought, would give animal suffering no weight and similarly, very few would give animal suffering more weight than human suffering.

Travelling for Treatment

A BBC report today suggests that “many” UK couples are going overseas to choose the sex of their children. What seems most odd about this is that in some cases they go to places where sex selection is illegal.

What is interesting here is the fascination with what people do when they go overseas or why they go overseas. There are a whole range of stories about Britons going overseas to get things that they cannot get in the UK – or cannot get in the UK as cheaply. The obvious examples are sex selection, assisted suicide or treatments not available on the NHS.

Publishing Negative Research Results

Ben Goldacre, in the Guardian this weekend, noticed the range of headlines on health and health risks that are to be found in the media. He mentions, among others, the rise of ‘manorexia’, the failure of water to induce weight loss and the dangers of antibiotics to prevent premature birth. I found a couple more: It turns out that dark chocolate can reduce the risk of heart attacks, vegetable rich diets and in particular vegetables like broccoli reduce the chance of heart disease and stroke and turmeric, the spice that makes curries yellow, can reduce the size of hemorrhagic stroke.

It’s quite striking what research is done!

Needles in Haystacks and Individuals in DNA Pools

An article recently published on PLOS Genetics showing that (and how) individuals can be identified by their DNA within large publicly accessible pools DNA has led to genetic data being removed from publicly accessible websites by the NIH and the Wellcome Trust. As one geneticist quoted in Science put it “We have a false sense of security with pooled data.”

Doctors or Resource Allocators?

A recent survey by Myeloma UK, and reported on the BBC website, suggests that many doctors do not tell patients about drugs that may be beneficial and which are licensed in the UK. The trouble is that the drugs have not yet been approved by NICE and so may be difficult to obtain on the NHS. This seems to suggest that something is wrong with the way in which NICE functions with respect to licensing and that doctors are in some way complicit.

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.

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.

Comprehensive treatment for all: The NHS Constitution

The proposed NHS Constitution was published on Monday as a part of a consultation process to shape the future direction of the NHS. Daniel Finklestein in today’s Times suggests that the new constitution is an irresponsible document. Some of his criticisms, however, are wide of the mark.