Tag: probability

Bioethics Blogs

Talking back to science?

By Stephen Rainey

In June 2017, the European Court of Justice ruled that it was legal for a French citizen to sue a drug company for damages following a vaccination, and an illness. The ruling caused some consternation as it seemed a legal vindication of anecdote over scientific rigour.

This is a dramatic case, not least owing to the position in which vaccines find themselves, post Andrew Wakefield and the rise of the anti-vaxxer movement. Nevertheless, it forms a part of a wider narrative in which scientific activity is not always very open to questions from outside science. This broader theme is worth some scrutiny.

Vaccine injury

Shortly following a vaccination against Hepatitis B a French citizen, JW, found himself in declining health. Soon after the decline began, a diagnosis of Multiple Sclerosis (MS) was made. Having had no prior personal or family history of such an illness, and having been in good health prior to the inoculation, JW concluded that the injections must have been to blame for his developing MS. His assertion of this was not supported by scientific investigation. Rather, he could think of the vaccination as the only unusual event that preceded closely his sudden, unexpected development of the condition.

The French courts found themselves unable to agree on whether such a basis as this is sufficient to sue a pharmaceutical company. Eventually, the case was sent to the European Court of Justice (ECJ) which ruled,

“…that the temporal proximity between the administering of a vaccine and the occurrence of a disease, the lack of personal and familial history of that disease, together with the existence of a significant number of reported cases of the disease occurring following such vaccines being administered, appears on the face of it to constitute evidence which, taken together, may lead a national court to consider that a victim has discharged his burden of proof.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Hard lessons: learning from the Charlie Gard case

by Dominic Wilkinson and Julian Savulescu

 

On the 24th July 2017, the long-running, deeply tragic and emotionally fraught case of Charlie Gard reached its sad conclusion (Box 1). Following further medical assessment of the infant, Charlie’s parents and doctors finally reached agreement that continuing medical treatment was not in Charlie’s best interests. It is expected that life support will be withdrawn in the days ahead.

Over the course of multiple hearings at different levels of the court in both London and Strasbourg, the Charlie Gard case has raised a number of vexed ethical questions (Box 2). The important role of practical ethics in cases like this is to help clarify the key concepts, identify central ethical questions, separate them from questions of scientific fact and subject arguments to critical scrutiny. We have disagreed about the right course of action for Charlie Gard,1 2 but we agree on the key ethical principles as well as the role of ethical analysis and the importance of robust and informed debate. Ethics is not about personal opinion – but about argument, reasons, and rational reflection. While the lasting ramifications of the case for medical treatment decisions in children are yet to become apparent, we here outline some of the potential lessons.

1. Parents’ role in decision-making for children: We need to clarify harm

Much of the media attention to the Gard case has focussed on the rights of parents in decision-making for children, and whether the intervention of the courts in this case means that doctors frequently overrule parents in the UK.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Don’t Feed the Trolls: Bold Climate Action in a New, Golden Age of Denialism

by Marcus Hedahl and Travis N. Rieder

ABSTRACT. In trying to motivate climate action, many of those concerned about altering the status quo focus on trying to convince climate deniers of the error of their ways. In the wake of the  2016 Election, one might believe that now, more than ever, it is tremendously important to convince those who deny the reality of climate science of the well-established facts. We argue, however, that the time has come to revisit this line of reasoning.  With a significant majority of voters supporting taxing or regulating greenhouse gases, those who want to spur climate action ought to focus instead on getting a critical mass of climate believers to be appropriately alarmed. Doing so, we contend, may prove more useful in creating the political will necessary to spur bold climate action than would engaging directly with climate deniers.

Less than a month after the 2016 presidential election, incoming White House Chief of Staff Reince Priebus stated that climate change denialism would be the “default position” of the Trump administration (Meyjes 2016). In March 2017, Scott Pruit, President Trump’s choice to lead the Environmental Protection Agency, expressed his belief—contrary to the estabilished scientific consensus—that carbon dioxide was not one of the primary contributors of climate change (Davenport 2107). Given this existence of climate denialism at the highest reaches of U.S. government, one might believe that, now more than ever, it is tremendously important to convince those who deny the reality of climate science of the well-established facts.[1] Surely, with truth on our side, we must trumpet the evidence, making deniers our primary target and acceptance of the truth of climate change our primary goal.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Press Statement: Gard Legal Decision Questionable on Secular Ethical Grounds

Julian Savulescu

Charlie Gard should have been allowed to go to US for experimental treatment back in April (or better January when it was first considered) because there was some possibility of him having a life worth living after treatment. That possibility may have been slim, but it does not appear (to me) to have been zero. The rational strategy was to give a trial of treatment, say 3 months, and agree with family to withdraw ventilation if there was no improvement. If this had been done, we would now have some information on whether there is any prospect of improvement..

The critical quote in the judgment of Justice Francis in the High Court back in April is from the independent US expert in nucleoside replacement therapy, Dr I:

“He said that he thought that the treatment, if administered, was unlikely to be of any benefit to Charlie’s brain. He described the probability as low, but not zero.”

Dr I said that if Charlie were his patient, he would push for a trial of treatment.

Is 3 months of suffering associated with intensive care worth taking for, say, a 1/10 000 of improvement? This is a value judgement about which there is reasonable disagreement. Sadly, Charlie has experienced the pains and discomforts of intensive care for more than six months, now without any treatment with any prospect of improving his condition.

The state should not have to pay for expensive experimental treatment with low prospect of success but Charlie’s parents have raised the funds. Charlie should have been allowed to go straight away (and saved hundreds of thousands of pounds of scarce British taxpayer funds which have been used to provide months of intensive care) provided a reasonable physician would treat him in the US.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Oxford Uehiro Prize in Practical Ethics: Global Warming & Vegetarianism: What should I do, when what I do makes no difference? By Fergus Peace

This essay received an Honorable Mention in the Graduate Category of the Oxford Uehiro Prize in Practical Ethics 2017

Written by University of Oxford student, Fergus Peace

  1. The Problem of Cumulative Impact

In large, integrated societies, some of the most important moral challenges we face can only be resolved by large-scale collective action. Global poverty and climate change are problems which won’t be solved unless large numbers of people act to address them.

One important part of our response to these problems is to avoid fallacious ‘futility thinking’, a cognitive bias which makes people less likely to act when they see the problem as being too large for them to solve. You aren’t going to end world poverty alone, but that doesn’t mean there’s nothing you should do about it. Your individual donations can make an enormous difference.

Other problems, however, are more philosophically and practically challenging. Sometimes morally significant outcomes are driven by an aggregate which your individual action is powerless to meaningfully affect. In these cases, it’s not just that your individual action won’t completely solve the problem: it won’t do any moral good at all.

Consider a few examples.

  • Voting: No election of any real size is decided by a margin of one vote, so it’s true of your vote that it makes no difference: if you don’t vote and your candidate loses, your vote wouldn’t have made them win; if you do vote and they win, withdrawing your vote wouldn’t have made them lose.
  • Vegetarianism: Butchers don’t respond to every small change in their customers’ purchasing; wholesalers don’t respond to every change in one butcher’s purchasing; abattoirs and farms don’t respond to every change in wholesale orders.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Should Physicians Provide Futile Treatment?

Should Physicians Provide Futile Care?  This is the question posed in a recent blog post over at MD Whistleblower.


When framed in this way, it seems the answer should be “no.”  Indeed, the 2015 Five Society Policy Statement supports this position when the term “futile” is used correctly. The problem is that the term “futile” is often not used correctly.  It is frequently used to refer to a far wider range of things.


Take the very post at MD Whistleblower.  He makes an argument against providing “futile” care.  But in the course of his argument, look at the wide range of concepts cited:

  1. “no medical treatment to offer”
  2. “won’t work”
  3. “most appropriate option”
  4. “won’t help”
  5. “third party is usually paying”
  6. “extremely unlikely to offer benefit”
  7. “right thing to do”

Pursuant to the 2015 Five Society Policy Statement, only the first two concepts above correspond to true “futility.”  The other five suggest the surrogate-requested interventions might work.  Whether or not that probability is high enough or whether the outcome is worthwhile are value judgments, not scientific/medical judgments.  They are not about “futility” but about appropriateness.


Should physicians provide “futile” treatment?  No.  But first make sure that the treatment at issue really is “futile.”  

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Should Physicians Provide Futile Treatment?

Should Physicians Provide Futile Care?  This is the question posed in a recent blog post over at MD Whistleblower.


When framed in this way, it seems the answer should be “no.”  Indeed, the 2015 Five Society Policy Statement supports this position when the term “futile” is used correctly. The problem is that the term “futile” is often not used correctly.  It is frequently used to refer to a far wider range of things.


Take the very post at MD Whistleblower.  He makes an argument against providing “futile” care.  But in the course of his argument, look at the wide range of concepts cited:

  1. “no medical treatment to offer”
  2. “won’t work”
  3. “most appropriate option”
  4. “won’t help”
  5. “third party is usually paying”
  6. “extremely unlikely to offer benefit”
  7. “right thing to do”

Pursuant to the 2015 Five Society Policy Statement, only the first two concepts above correspond to true “futility.”  The other five suggest the surrogate-requested interventions might work.  Whether or not that probability is high enough or whether the outcome is worthwhile are value judgments, not scientific/medical judgments.  They are not about “futility” but about appropriateness.


Should physicians provide “futile” treatment?  No.  But first make sure that the treatment at issue really is “futile.”  

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Debate: The Fiction of an Interest in Death? Justice for Charlie Gard

 

Julian Savulescu

Dominic Wilkinson’s Response

A judge ruled last week that baby Charlie Gard will have his treatment withdrawn, against the wishes of his parents. His doctors argued that the rare mitochondrial disease (MDDS) he was born with was causing him unbearable suffering.

His parents had raised funds to take him to the US for experimental treatment and they wanted the chance to try the treatment. His doctors argued that such treatment could only prolong his suffering. It was their belief that it was in his best interests for treatment to be withdrawn, and for his life to end, a belief which the trial judge endorsed.

“It is with the heaviest of hearts, but with complete conviction for Charlie’s best interests, that I find it is in Charlie’s best interests that I accede to these applications and rule that GOSH may lawfully withdraw all treatment save for palliative care to permit Charlie to die with dignity.”

This is a profoundly difficult decision, and one in which all parties are acting out of care and compassion for the child. My comments are of course limited as I do not have access to all the relevant facts. However, it does raise an important question about the current basis of such decisions.

Ethics of Limitation of Life Prolonging Medical Treatment

In general, medicine has a presumption in favour of saving life, or prolonging life. There are three justifications for departing from this default. That is, there are 3 justifications for withholding or withdrawing life prolonging medical treatment:

  1. the patient autonomously refuses it.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Debate: The Fiction of an Interest in Death? Justice for Charlie Gard

Julian Savulescu

Dominic Wilkinson’s Response

A judge ruled last week that baby Charlie Gard will have his treatment withdrawn, against the wishes of his parents. His doctors argued that the rare mitochondrial disease (MDDS) he was born with was causing him unbearable suffering.

His parents had raised funds to take him to the US for experimental treatment and they wanted the chance to try the treatment. His doctors argued that such treatment could only prolong his suffering. It was their belief that it was in his best interests for treatment to be withdrawn, and for his life to end, a belief which the trial judge endorsed.

“It is with the heaviest of hearts, but with complete conviction for Charlie’s best interests, that I find it is in Charlie’s best interests that I accede to these applications and rule that GOSH may lawfully withdraw all treatment save for palliative care to permit Charlie to die with dignity.”

This is a profoundly difficult decision, and one in which all parties are acting out of care and compassion for the child. My comments are of course limited as I do not have access to all the relevant facts. However, it does raise an important question about the current basis of such decisions.

Ethics of Limitation of Life Prolonging Medical Treatment

In general, medicine has a presumption in favour of saving life, or prolonging life. There are three justifications for departing from this default. That is, there are 3 justifications for withholding or withdrawing life prolonging medical treatment:

  1. the patient autonomously refuses it.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Neuroeconomics and Reinforcement Learning: The Concept of Value in the Neuroscience of Morals

By Julia Haas
Julia Haas is an Assistant Professor in the Department of Philosophy at Rhodes College. Her research focuses on theories of valuation and choice.
Imagine a shopper named Barbara in the pasta aisle of her local market.  Just as she reaches for her favorite brand of pasta, she remembers that one of the company’s senior executives made a homophobic statement. What should she do? She likes the brand’s affordability and flavor but prefers to buy from companies that support LGBTQ communities. Barbara then notices that a typically more expensive brand of pasta is on sale and buys a package of that instead. Notably, she doesn’t decide what brand of pasta she will buy in the future.

Barbara’s deliberation reflects a common form of human choice. It also raises a number of questions for moral psychological theories of normative cognition. How do human beings make choices involving normative dimensions? Why do normative principles affect individuals differently at different times? And where does the feeling that so often accompanies normative choices, namely that something is just right or just wrong, come from? In this post, I canvass two novel neuroethical approaches to these questions, and highlight their competing notions of value. I argue that one the most pressing questions theoretical neuroethicists will face in the coming decade concerns how to reconcile the reinforcement learning-based and neuroeconomics-based conceptions of value.
One popular approach to the problem of normative cognition has come from a growing interest in morally-oriented computational neuroscience. In particular, philosophers and cognitive neuroscientists have turned to an area of research known as reinforcement learning (RL), which studies how agents learn through interactions with their environments, to try and understand how moral agents interact in social situations and learn to respond to them accordingly.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.