Practical Ethics

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.

Brain Boosting and Cheating in Exams: Four Responses

A report by the Academy of Medical Sciences looking at different aspects of drug use and mental health has identified a growing trend for off-label use of drugs intended for the treatment of diseases including narcolepsy, ADHD and Alzheimer’s. The use of such drugs by a healthy individual can improve memory, alertness and concentration. While the report does not condemn the practice, it raises a number of potential concerns over safety, and fairness. Professor Les Iversen, report co-author, highlighted concerns that the use of enhancement in exams would unfairly advantage wealthier students, and suggested that the use of such drugs could be considered cheating. The report recommends that legislation is prepared to tackle the misuse of such drugs, including the potential for urine testing in schools and universities.

Below are responses from Julian Savulescu, Nick Bostrom, Anders Sandberg and Mark Sheehan on the effects of cognitive enhancing drugs, and the issue of cheating

Saviour Siblings Saved!

Two attempts to amend the Human Fertilisation and Embryology Bill’s provision to allow ‘saviour siblings’ failed in the House of Commons yesterday. The first attempt was to block the practice and failed 342 to 163. The second attempt was to limit the provision to life-threatening cases. It was defeated 318 to 149. As it stands the Bill allows embryo testing and hence selection for ‘saviour siblings’ provided that “there is a significant risk that a person [the sibling ‘to be saved’] … will have or develop a serious physical or mental disability, serious illness or any other serious medical condition.”

Towards Ethical Foie Gras?

Often the source of our worries about eating animals and the basis of arguments against it seems to turn on the pain and suffering of the animal in question. With advances in biotechnology such as cloning and genetic manipulation it may at some point be possible to engineer animals that do not feel pain or suffer but still produce meat of the kind that we are accustomed to eating. Producing such animals on a large scale would significantly reduce the total amount of suffering and may enable us to eat meat with a clear conscience.

Academic Integrity and Vioxx

Drug company Merck and its product Vioxx are in the news again. An article in the Journal of the American Medical Association (JAMA) has examined the documents from the legal proceedings against Merck in connection with the withdrawal of Vioxx from the market in 2004. From their analysis, a significant number of journal articles – mostly review articles rather than articles reporting clinical trials – were written in-house and senior academics were brought in late to be lead named author. At least one of these academics has disputed the accusations made in the JAMA article.

Catholic Conscience and Hybrid Embryos

The first hybrid embryo was created yesterday and the debate about it and the HFEA Bill continues. Recently, the most senior Catholic scientist Sir Leszek Borysiewicz has criticised the Church for its position. Sir Leszek is quoted in The Times as saying:

I was brought up as a Catholic at home, both my parents are Catholics and I have continued to be a member of the Church … I go to church but I have had considerable issues with some of the stances the Church has taken on a variety of health-related issues. My conscience tells me very firmly that I should support the Bill as it stands.

The Transparency of Clinical Trials

An article in the current issue of Science examines the extent to which new policies regarding the governance of clinical trials promote transparency. It goes on to suggest further issues that remain unaddressed and require attention. The authors suggest that recent policy changes have improved the extent of public access to clinical trial data. In particular, they suggest that Section 801 of the FDA Amendments Act “should go a long way in ensuring that all patients and all data are publicly accounted for.” However, with the Editor-in-Chief of the New England Journal of Medicine, they do worry that some patients “are left on the cutting room floor to make a drug look better than it really is.”

The Rogue Senator and the Protection of Genetic Information

The editors of Nature have today called for the US Senate to bypass Senator Tom Coburn’s (Republican, Oklahoma ) ‘hold’ the Genetic Information Non-discrimination Bill. The Bill, if enacted “would protect people from being discriminated against by health insurers or employers on the basis of their genetic information” but Senator Coburn has used a procedural manoeuvre called a “hold” to prevent it from coming to a vote in the Senate. In their editorial the editors suggest that by putting a hold on this Bill, the senator from Oklahoma is preventing the enormous research and clinical progress from continuing and further developing the era of personalised medicine.