Practical Ethics

Testing alternative therapies

The journal Science is today reporting on a controversial plan by the US National Institute of Mental Health (NIMH) to test an alternative treatment for autism on children. The treatment, known as chelation therapy, involves the use of drugs that remove heavy metals from the blood. It's based on a the theory - unsupported by conventional science - that mercury in vaccines triggers autism.

Chelation therapy is widely used, but its benefits and effects are not well understood. The NIMH have therefore argued that there is a "public health imperative" to test the drug. But opponents claim that any such study would be unethical, since the quality of the trial is likely to be poor, and any results - especially negative ones - would be unlikely to alter the behaviour of parents who support the therapy.

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

What’s wrong with the hermaphrodite world?

Making headlines last week, Melbourne bioethicist Rob Sparrow argued that in order to create the best future for their children, parents should select only girl children or hermaphrodites. He imagined a  “post-sex” world in which males are no longer conceived, and women use frozen sperm, or artificial gametes to reproduce.

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?

Paying to top up NHS treatment

The BBC has this week published a story on co-payment in the UK's National Health Service. Sue Matthews, a Buckinghamshire woman with terminal bowel cancer, would like to top up her NHS care by paying for a £30,000 course of cetuximab - a drug which could extend her life, but which is not funded by her NHS trust. However, if she does so, she may also have to pick up the tab for her standard NHS treatment. That's because the NHS guidelines advise against allowing such co-payments: they require that a given instance of treatment be either fully privately funded, or fully publicly funded.

Should co-payments be banned?

Sport, Sudden Cardiac Death and Liberty

Sport, like life, is dangerous. Several fit young footballers have died of sudden unexpected heart attacks. Doctors are now calling for mandatory testing using ECGs of all athletes. Italy has been pursuing mandatory testing for 25 years. This has revealed over 5% have some abnormality. Some people have congenital heart rhythm abnormalities which place them at high risk of sudden heart attack during or after sport. The call for mandatory testing is a sensible one. The interesting question is what is to be done with the results.

Activists and acts of mercy

In Germany this week, and in Australia recently, there has been public concern and significant media attention about the actions of euthanasia activists. A former government official and lawyer, Roger Kusch, went public in Germany with a video of an elderly woman who he had helped to die. In Australia, Phillip Nitschke has been criticised for his involvement and subsequent comments about the death of Graeme Wylie a man suffering from Alzheimer’s disease whose partner and close friend have been found guilty of manslaughter.

Opponents of euthanasia have used these cases to argue against liberalisation of laws on assisted suicide or euthanasia.

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.

Education and the Fairness of Capital Punishment

Regardless of their views on capital punishment most people desire it to be centred on due process and fairness. But a software experiment, by showing that the likelihood of execution of people on death row can be predicted to high accuracy, paradoxically suggests a great degree of arbitrariness in how the death penalty is applied in the US. A death sentence is essentially a lottery ticket: the condemned will be executed with a certain probability and otherwise suffer a long and uncertain imprisonment. But different convicts get different probability tickets, even when the legal system and all criminal circumstances are the same.