Tag: withholding treatment

Bioethics News

Video. Julian Savulescu argues in favour of an experimental treatment for Charlie Gard

We present these videos and selected ideas, wich give a short clear bioethics review of Charlie Gards’s case. Our Observatory fully agrees with his conclusions.
 Julian Savulescu (Uehiro Chair in Practical Ethics, Oxford), argues that Charlie Gard, who suffers from an extremely rare genetic condition called MDDS, should receive the proposed experimental treatment. According to Professor Savulescu, It’d be a reasonable price to pay for a chance of having a life that is worth living. However, there are limits to what babies like Charlie could be subjected to, and there should be a societal debate about what these limits should be, see here “Charlie Gard Legal Decision. Questionable on Secular Ethical Grounds”

In another article by Savulescu, titled “The Moral of the Case of Charlie Gard: Give Dying Patients Experimental Treatment … Early”,  concluded:

Moral of the Story

This case might be a very good example of the detrimental consequences of the act-omission distinction. Because doctors and others are more reluctant to withdraw medical treatment than withholding treatment, often a trial of treatment is not commenced (because of a fear it will have to continue indefinitely). This has disastrous consequences in denying people a chance and also failing to gather more accurate information about prognosis. The best course of action, in this case, would have been to commence experimental treatment while Charlie was anyway being ventilated during various court processes.

There is an important lesson to be drawn. Where there is contention about an experimental treatment that is requested by a dying or severely ill patient (or their representative), it should be provided with a plan for active withdrawal.

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 News

Video. Julian Savulescu argues in favour of an experimental treatment for Charlie Gard

We present these videos and selected ideas, wich give a short clear bioethics review of Charlie Gards’s case. Our Observatory fully agrees with his conclusions.
 Julian Savulescu (Uehiro Chair in Practical Ethics, Oxford), argues that Charlie Gard, who suffers from an extremely rare genetic condition called MDDS, should receive the proposed experimental treatment. According to Professor Savulescu, It’d be a reasonable price to pay for a chance of having a life that is worth living. However, there are limits to what babies like Charlie could be subjected to, and there should be a societal debate about what these limits should be, see here “Charlie Gard Legal Decision. Questionable on Secular Ethical Grounds”

In another article by Savulescu, titled “The Moral of the Case of Charlie Gard: Give Dying Patients Experimental Treatment … Early”,  concluded:

Moral of the Story

This case might be a very good example of the detrimental consequences of the act-omission distinction. Because doctors and others are more reluctant to withdraw medical treatment than withholding treatment, often a trial of treatment is not commenced (because of a fear it will have to continue indefinitely). This has disastrous consequences in denying people a chance and also failing to gather more accurate information about prognosis. The best course of action, in this case, would have been to commence experimental treatment while Charlie was anyway being ventilated during various court processes.

There is an important lesson to be drawn. Where there is contention about an experimental treatment that is requested by a dying or severely ill patient (or their representative), it should be provided with a plan for active withdrawal.

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 News

Bioethics and natural law: an interview with John Keown

Bioethics discourse is often divided into two broad categories: utilitarian perspectives and so-called deontological or Kantian approaches to ethics. An alternative viewpoint that receives far less attention is a natural law perspective on ethics and medicine. The natural law approach emphasizes interests or ends common to all members of humanity, and offers a teleological account of morality and human flourishing.

Professor John Keown of Georgetown University’s Kennedy Institute for Ethics recently co-authored a book on natural law with the late Georgetown Professor Alfonso Gómez-Lobo. The book is entitled Bioethics and the Human Goods: An Introduction to Natural Law Bioethics. The Deputy Editor of BioEdge, Xavier Symons, interviewed Professor Keown about his latest work. 

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Xavier SymonsWhat led you to write Bioethics and the Human Goods: An Introduction to Natural Law Bioethics?

John Keown: The book was largely written by my distinguished colleague and friend, the late Professor Alfonso Gómez-Lobo, who held the Ryan Chair in Metaphysics and Moral Philosophy at Georgetown. Before his untimely death at the end of 2011, he had submitted a manuscript to Georgetown University Press. With the kind permission of his widow, and with the approval of the Press, I completed the project, incorporating amendments that he had indicated, in his comments on the referees’ reports, that he wanted to make, and some amendments that I thought appropriate. About a third of the book is material I added to his original manuscript. I thought it important, given the regrettable dearth of introductory books on bioethics from a natural law perspective, that his manuscript should be enlarged, updated and completed

What contribution do you think natural law can make to the field of bioethics?

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

Does The Work Clinical Ethics Consultation Lend Itself To Professionalization?

Let me say emphatically at the outset of this blog, as someone who has been a clinical ethics consultant for over 20 years, I am quite sure that clinical ethics consultations overall improve the quality of patient care and currently are an important, even essential, part of the providing excellent patient care in hospitals. Contemporary medicine is filled with value laden questions and issues that often can be effectively addressed by someone with expertise and training in clinical ethics. Having said this, I am still somewhat skeptical about clinical ethics consultation becoming a professional area of healthcare that parallels other professional areas like medicine, nursing, and social work. I think there are some special considerations about the field of clinical ethics consultation that makes its future status as a professional activity uncertain.

First of all it is well-known that CEC’s come from a variety of backgrounds and training—from philosophers to physicians to social workers to nurses and lawyers and on and on. People enter the field of clinical ethics consultations from very different disciplinary backgrounds and seemingly learn a common vocabulary and methodology of clinical ethics and a basic familiarity with and ability to function in the clinical setting. They learn this vocabulary in very different ways—some informally, some through short 1-2 week long intensives, some with certificate programs, some with master’s degrees, and some with 1-2 year long fellowships. No other area of healthcare work admits of such diversity. Though this is a positive feature in some ways by providing diverse perspectives in understanding value dilemmas, it creates a challenge of considerable controversy when we try to define the kind of educational training a future CEC should have.

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

Rationing – The Case of NICU and the Place of Cost-effectiveness Thresholds

Julian Savulescu will be delivering the next public lecture at the Australian Centre for Health Law Research:  “Rationing – The Case of NICU and the Place of Cost-effectiveness Thresholds” on May 18.

When health professionals are considering whether or not to provide life-sustaining treatment to a critically ill newborn infant, they often consider the best interests of the child. Frequently, they will consult with the infant’s parents, and take into account parents’ interests and their views about treatment for the child. However, there is one important ethical factor that health professionals do not necessarily consider, or (at least explicitly) acknowledge. Resource limitations and the effect of treatment of others are of fundamental importance for end of life decisions, even in well-resourced countries like Australia.

In this presentation Professor Savulescu will first set out the principles that should underlie resource allocation in a public health system. He reviews arguments for and against rationing. In the second half of the presentation Professor Savulescu will use existing cost effectiveness thresholds to shed light on the question of medical futility in intensive care. He draws on the examples of short-bowel syndrome, spinal muscular atrophy, neonatal ECMO and trisomy 18. 

  • How low a probability of survival is too low
  • How long a course of intensive care is too long? 
  • When are doctors justified in withholding treatment because of future quality of life? 

Rationing is inevitable in intensive care. However, for it to be ethical it must be transparent, consistent and rational.


Professor Julian Savulescu is the Uehiro Chair in Practical Ethics, Director of the Oxford Uehiro Centre for Practical Ethics at the Faculty of Philosophy, University of Oxford and Director of the Institute for Science and Ethics, Oxford Martin School at the University of Oxford.

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

An All-Too-Brief Review of Being Mortal

Being Mortal, which is subtitled “Medicine and What Matters in the End,” is about aging and frailty, decline and death, and dealing with those as well as possible.  It’s not really a book about medical ethics or even about medicine as much as about our latter days.  It’s full of stories about the loss of independence, assisted living, nursing homes, intensive care at the end of life, hospice, and finally having “difficult conversations” and “letting go” (those are two of the chapter titles). 

The point of these stories is to plead for better, whole-person-driven palliative care throughout the practice of medicine.

I found it deeply about human dignity and autonomy, in the best sense of that word.  As the author, Atul Gawande, M.D., puts it in his epilogue, “We’ve been wrong about what our job is in medicine.  We think our job is to ensure health and survival.  But really it is larger than that.  It is to enable well-being.  And well-being is about the reasons one wishes to be alive.”

For me, the book’s key graph is on page 128:

“The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant.  The problem is that they have had almost no view at all.  Medicine’s focus is narrow.  Medical professionals concentrate on repair of health, not sustenance of the soul.  Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days.

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

Freezing critique: privileged views and cryonics

Cryonics – the practice of freezing people directly after death in the hope that future medicine can resuscitate them – is controversial. However, British Columbia is the only jurisdiction with an explicit anti-cryonics law (banning advertising or sale of cryonics services), and a legal challenge is apparently being put together. The motivations for the law appear murky, but to some this is a rights issue. As Zoltan Istvan notes, “In a world where over 90 percent of the people hold religious views of the afterlife, cryonics could become a noteworthy global civil rights issue. ” Maybe the true deep problem for getting cryonics accepted is that it is a non-religious afterlife, and we tend to give undue privilege to religious strange views rather than secular strange views.

Ethically, it seems that disposing of bodies should largely follow the wishes of the deceased. This sometimes leads to legal clashes. Many jurisdictions clearly specify how human remains should be disposed, typically with a list of approved methods. In the past the cremation movement fought for the legal right of their preferred form of disposal, succeeding in most of the West where previously burial (on land or at sea) had been the sole approved form: changes do happen over time. Right now a freeze-drying methods for a low-carbon disposal is struggling to get approval. However, currently cryonics is handled as an anatomical donation and hence works differently legally.

There are also practical limitations to how far wishes can be followed. While some Westerners no doubt find the idea of Tibetan sky burial green and appealing, it would likely not be practical in many parts of the world.

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.