How should the NHS respond to professional errors?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.
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Maximising ventilators: Some ethical complications 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. The Perfect Protocol? Ethics Guidelines in a Pandemic 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. 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). Diet, changing desires, and dementiaCross-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.) Arbitrariness as an ethical criticismThis is a cross-post from the Uehiro Centre's Practical Ethics blog:
We recently saw a legal challenge to the current UK law that compels fertility clinics to destroy frozen eggs after a decade. According to campaigners, the ten-year limit may have had a rationale when it was instituted, but advances in freezing technology have rendered the limit “arbitrary”. Appeals to arbitrariness often form the basis of moral and political criticisms of policy. Still, we need to be careful in relying on appeals to arbitrariness; it is not clear that arbitrariness is always a moral ‘deal-breaker’. On the face of it, it seems clear why arbitrary policies are ethically unacceptable. To be arbitrary is to lack basis in good reasons. An appeal against arbitrariness is an appeal to consistency, to the principle that like cases should be treated alike. Arbitrariness may therefore seem to cut against the very root of fairness. Take back control? Doctors as appointed fiduciariesCross-post from the Uehiro Centre's Practical Ethics blog
There’s a story that’s often told about the evolution of the doctor-patient relationship. Here’s how it goes: back in the bad old days, doctors were paternalists. They knew what was best, and the job of the patient was simply to do as they were told and hopefully get better. Then, in part because of abuses of power, and in part because of cultural changes, a new model emerged. This model cast patients not as passive recipients of instruction, but as active, autonomous agents, put in charge of their own medical decisions. The doctor-patient relationship was remodelled, from a paternalistic relationship (doctor looks after patient’s health) to a service relationship (doctor does what patient wants, within limits). That story is almost certainly too simple to be true. But even histories that aren’t wholly accurate can come to influence our culture and expectations. And the dominant assumption between both patients and medical professionals seems to be that our relationship will be cast on what is sometimes called the “informative model” (Emmanuel and Emmanuel, 1992), where the medical role is simply to provide the patient with empirical information, such as information about likely risks and outcomes. Outcome risk and status risk - Uncertainty for vegansHere are two cases:
1. A trolley is hurtling towards a person on a track. You can divert the trolley so that it plummets over a cliff. You know that there is a small (but not vanishingly small) chance that there is a person in the trolley. 2. Eating plant food involves, indirectly, being complicit in the suffering of animals that are killed during harvest. You could reduce the amount of plant food you eat by eating insects like crickets. You know that there is a small (but not vanishingly small) chance that crickets have whatever feature(s), F, make things into persons. (For instance, crickets might feel pain and pleasure). Bob Fischer (in his 2016 paper 'Bugging the strict vegan', ) wants us to accept that these two situations are equivalent. In both cases, we might say, you 'might kill someone who matters'. Since you clearly ought to divert the trolley, you ought to eat the insect. Suffragettes and suffragists There's been a lot of celebration in the UK news recently of the Suffragette movement, since it's 100 years since the 1918 Representation of the People Act, which granted the vote to (some) women.
Someone I know recently complained about the lack of focus in the associated discussion about the Suffragists. While I don't have the sufficient historical knowledge to offer a comprehensive distinction between the two groups, a rough division seems to be that while the 'ettes were prepared to engage in both violent and non-violent criminality to forward the cause, the 'ists wanted to do things within the letter of the law as it was. The art of politicising a tragedyCaveat: Since this is a blog, and not an article, I play loose with language by treating the left and right as two homogeneous groups. That's not accurate, but is hopefully not so inaccurate as to defeat my purposes.
America seems to be characterised increasingly by acts of gun violence. The response depends on features of the gunman. Typically, those on the left will use the opportunity to call for gun control. If the gunman is white, those on the right will offer thoughts and prayers, and perhaps say something about mental health. If he isn't, they'll say something about immigration, perhaps endorsing Trump's Muslim ban. What follows, in any case, is that each side accuses the other of 'politicising a tragedy'. There have been screenshots on Twitter of people on both the right and the left reacting very differently to an episode of gun violence, depending on whether it supports their narrative. If it doesn't, opponents are reminded not to politicise a tragedy. If it does, a particular policy proposal is made. |
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