Cross-post from the Uehiro Centre's Practical Ethics blog 

Last week brought the news that an additional 1.7m people in the UK had been asked to take additional ‘shielding’ measures against COVID-19, following new modelling which considered previously ignored factors such as ethnicity, weight and deprivation. Since many of this group have not yet been vaccinated, they were bumped up the priority list for vaccine access, moving into group 4 of the government’s vaccine plan.

Two other groups, however, have not yet been incorporated into this plan despite appeals from some quarters that they should be. First, new figures reinforced the sense that the virus is disproportionately affecting prisoners, with one in eight of the prison population having had COVID-19, compared with roughly one in twenty in the wider population (in the United States, the prison figure has been estimated to be one in five).

​Second, some GP groups and local councils have offered priority vaccination to homeless residents, despite their not officially qualifying for prioritisation on the government’s plan. There have also been calls for the government to incorporate this into national plans, rather than being left to more local decision-making.

Cross-post from the Uehiro Centre's Practical Ethics blog. Co-written with Gabriel De Marco. 

The UK governments in Westminster and the devolved nations (Northern Ireland, Scotland and Wales) have made a recent about-turn regarding Christmas. Where there were previously plans to relax Covid-related restrictions for five days, they will now be relaxed for only Christmas itself, and not at all in some parts of the country.

The planned relaxations were extensive. And even following the recent changes, Christmas is being treated in a way that is considerably different to other major religious festivals: no relaxation of lockdown was seen for Sikh festival Vaisakhi, Muslim celebration Eid (where more extensive lockdowns were announced just the day before), Jewish Hanukkah, or Hindu Diwali.

Although it has not explicitly been posed as such, it seems reasonable to think that saving Christmas has been a long-term plan.  The timing of the recent ‘second lockdown’ in England is also suggestive. In order to avoid many going into Christmas with infections, and many leaving with new infections, the thought may have been that we needed this “circuit-breaker”; indeed, when Johnson announced the lockdown at the end of October, one hope he expressed was that “taking action” at that point would make Christmas gatherings more likely. And even amid the recent reversal, communal worship can continue even in the new ‘Tier 4’ locations.

Cross-post from the Uehiro Centre's Practical Ethics blog, written with Joshua Parker. 

“COVID-19: Do not resuscitate orders might have been put in place without consent, watchdog says”. This recent headline followed an investigation by the Care Quality Commission into Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) decisions early in the pandemic. In a recent post, Dominic Wilkinson highlights two misconceptions in the coverage of this report, one of which is the ‘consent misconception’.

Dominic’s view is that “there is no ethical requirement…to seek the agreement of patients not to offer or provide a treatment” which a medical professional judges inappropriate. Of course, his position is not that consultation and discussion around CPR is inappropriate, only that consent is not necessary. This is the standard view on consent in this context and, due in part to the Tracey judgment, reflects doctors’ practice. Thus, an important distinction emerges between consenting to the withholding of some treatment, and discussion of that decision. Doctors may be ethically required to discuss a decision without also having an obligation to seek the patient’s consent. The absence of consent, then, does not signal that the DNACPR was unethical, whereas a failure to consult probably will.

Cross post from the Uehiro Centre's Practical Ethics blog.

​I recently watched an excellent panel discussion, ‘Statues, Slavery and the Struggle for Equality’ with Labour MP Dawn Butler, historian David Olusoga, philosopher Susan Neiman, chaired by writer Yassmin Abdel-Magied. The discussion was wide-ranging but, as the title suggests, included a focus on the recent resurgence of demands to remove various statues of figures associated with the slavery and colonialism. One example that will have escaped few readers of this blog is the University of Oxford’s own statue of Cecil Rhodes, which has been the subject of the ‘Rhodes Must Fall’ movement since 2015 and is once again in the headlines. Since initially writing this blog, Oriel College has voted to remove the statue; but it is still important to interrogate the university’s (rather than the college’s) initial response.

That response from university leadership was not promising. The university’s chancellor, Chris Patten, suggested that calls for removal are hypocritical, and that focus should be on “more fundamental” issues such as education and health. Vice-chancellor Louise Richardson claimed that removal of the statue would constitute ‘hiding’ our history, and that we should instead learn from it. She also advised that morally repellent views need to be seen in their historical context.

In these two responses there are at least four arguments against the removal of Rhodes’ statue. I want briefly to explain why none are very plausible. It’s worth noting from the outset, though, that little which I have to say has not already been said by others, including by those involved in the Rhodes Must Fall campaign. Nonetheless, I think it is important as someone employed at Oxford to write about ethics to engage the recent arguments of its institutional leaders.

This is a cross-post of a blog written by me and Josh Parker on Justice Everywhere, based on our recent paper in the Journal of Applied Philosophy. 

Consider the following case, hypothetical but not uncommon. Hamza, a junior doctor working in the UK’s National Health Service (NHS) is working a night shift when he mis-prescribes a large dose of morphine to a patient who doesn’t need it. Fortunately, this error is caught by another member of his team, but at worst it could have killed the patient. Hamza was tired, stressed, and relatively inexperienced, but at his stage of training should have known to double check the dose. How should Hamza’s colleagues, and NHS institutions, respond to his serious mistake?

There has been a shift in the NHS in recent years to the idea that in responding to medical errors, institutions should adopt a ‘no blame’ culture. In our recent paper, we take a critical look at this idea, arguing that the no blame approach may throw the baby of responsibility out with the bathwater of blame.​​

Cross post from the Uehiro Centre's Practical Ethics blog, co-authored with Josh Parker 

One of the impending tragedies of the COVID-19 pandemic is a grave mismatch between the supply of ventilators and the numbers needing them. This situation, as seen in Italy, is predicted to be mirrored here in the UK. Coronavirus can cause acute respiratory distress syndrome for which the management is mechanical ventilation on the ICU. This represents these patients’ only chance at survival. Part of the response to the incoming tsunami of patients requiring ventilation is to produce more ventilators. This is a reasonable way to try to lessen the mismatch between supply and demand. However, producing more ventilators cannot be the solution in isolation. As a complex piece of medical equipment, ventilators need trained staff to operate them and provide the additional care ventilated patients require. There has been a significant push to attempt to ensure enough ventilator trained staff as possible. Both staff and ventilator shortages present significant issues; yet it is shortages of ventilators that account for the bulk of ethical discussion so far. It is therefore worth exploring some of the ethical problems that might arise should there be plenty of ventilators, but not enough staff. 

Cross post from the Uehiro Centre's Practical Ethics blog, co-authored with Josh Parker 

One question occupying politicians and healthcare workers in the middle of this global pandemic is whether there will be enough ventilators when COVID-19 reaches its peak. As cases in the UK continue to increase, so too will demand for ventilators; Italy has reported overwhelming demand for the equipment and the need to ration access, and the UK will likely face similar dilemmas. Indeed, one UK consultant has predicted a scenario of having 8 patients for every one ventilator. Aside from anything else, this would be truly awful for the healthcare professionals having to make such decisions and live with the consequences.
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Ethics is an inescapable part of medical practice, and healthcare professionals face numerous ethical decisions throughout their careers. But ethics is challenging, often involving great uncertainty and ambiguity. Medics often lack the time to sort through the morass that is ethics.  Many therefore prefer heuristics, toolboxes and a handful of principles to simplify, speed up and streamline their ethics.

The right not to know and the obligation to know

​Cross-post from the Uehiro Centre's Practical Ethics blog

Most people accept that patients have a strong claim (perhaps with some exceptions) to be told information that is relevant to their health and medical care. Patients have a Right to Know. More controversial is the claim that this control goes the other way, too. Some people claim, and others deny, that patients also have a Right Not to Know.

A number of considerations (harm to the patient; autonomy; privacy) have been marshalled on either side of this debate over the past few decades (e.g. Laurie 2004; Robertson and Savulescu 2001; Herring and Foster 2012; Takala 2019). In this post, I focus on a distinct argument and its apparently unassailable logic. This is the view that a comprehensive Right Not to Know cannot be justified because in many cases a patient’s ignorance will likely lead harm to third parties (Council of Europe 1997; Rhodes 1998; Harris and Keywood 2001).

Cross-post from the Uehiro Centre's Practical Ethics blog

Last week saw the launch of a campaign (run by the group Vegetarian For Life) that seeks to ensure that older people in care who have ethical commitments to a particular diet are not given food that violates those commitments. This is, as the campaign makes clear, a particularly pressing issue for those who have some form of dementia who may not be capable of expressing their commitment.

Those behind campaign is quite right to note that people’s ethical beliefs should not be ignored simply because they are in care, or have a cognitive impairment (see a Twitter thread where I discuss this with a backer of the campaign). But the idea that one’s dietary ethics must be ‘for life’ got me thinking about a more well-established debate about Advance Directives. (I should stress that what I say here should not be taken to be imputing any particular motivation or philosophical commitments to those behind the campaign itself.)