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Julian Sheather

Julian Sheather: Time to debate the ethics of robot care?

17 Apr, 14 | by BMJ

We take it for granted that compassion is at the heart of good care. But what if the hand that reaches out to yours is a robot’s? What if the last face you see on earth is a facsimile? The use of robotics is well established in parts of medicine. Surgery involving remote manipulation of robotic arms is now commonplace. Some have even predicted that surgery will cease to leave a scar: introduced via orifices, robots will travel to the afflicted area, self-assemble and do their robotic thing. But by and large these remain an extension of ordinary human tools—just better. Fully-autonomous robots, our companions and servants—even our nemeses—have not made it far from the pages of science fiction. As an editorial in The Economist has it, set aside car manufacturing and vacuum cleaning, robots have been more successful at parsing our anxieties about technology than delivering real world promise.  But things might be changing. Scientists at Ohio State University have developed an algorithm that enables computers to read human emotions. Google and Amazon are both investing heavily in robots. Big data, cloud computing and the ever-growing crunching power of ever-shrinking processors suggest that robotics may be about to take an automated leap forward. more…

Julian Sheather: Ugandan anti-homosexuality legislation: bad law, bad science

25 Feb, 14 | by BMJ

For all the fanfare that headline science can generate, it is usually quiet science that arouses my sympathies. Carefully uncovered facts can settle like welcome oil, stilling the troubled waters of moral panic and vengeful politics. I am more drawn to the Victorian naturalists who posted songbirds to each other, carefully mapping variation, than to their bullish champions, the Huxleys, and, more latterly, the Dawkins’, who would batter the world’s opinions into quiescence. Disappointing morning then when I return from a week in Norfolk and find that President Yoweri Museveni of Uganda has signed into force draconian anti-homosexuality laws, attaching a life sentence to “aggravated homosexuality.” Even more disappointing to learn that he has done so on the basis of advice from fourteen Ugandan medical “experts.” The clincher, according to these “experts,” is that homosexuality is not genetic behaviour, but learned—not a “natural” occurrence, but a social pathology. more…

Julian Sheather: To see the world in a grain of wheat

14 Oct, 13 | by BMJ

Many years ago I was walking along Kilburn High Road with a sharp-eyed naturalist friend when he spotted an ear of domestic wheat growing in one of those squares of soil cut into the pavement for urban trees—forlorn scraps of earth that litter gets stuck in, cigarettes get put out in, and dogs (and the occasional drunk) like to defecate in. He practically whooped with joy, then spent a good five minutes crouched over it—much to the confusion of passers-by—while he lectured me, excitedly and at length, on the marvel of wheat and the natural history of our relationship with it. It was the first time I had ever really thought about just how dependent we are on a species of grass that was probably first domesticated over ten thousand years ago in what is now Turkey. For most of us urban dwellers, felt knowledge of our dependence on domesticated grass is rare, as rare as, well, finding an ear of wheat growing on Kilburn High Road. more…

Julian Sheather: Do younger doctors take more time off sick?

8 Jul, 13 | by BMJ

I’ve been doing some work recently with a GP trainer. I’m not a good judge of these things, but I would put him in his mid-fifties. He strikes me as the sort of committed, diligent, unassuming doctor who has helped form the backbone of post War British primary care. Committed to the NHS, possessed of a strong sense of social justice, he seems to combine intelligence, sensitivity, and a kind of wily strength or resilience. more…

Julian Sheather: On tweeting black medical humour

13 Jun, 13 | by BMJ

I was at a conference on doctors and social media recently, sharing a platform with the GMC. The organisers put up some darkly funny tweets by doctors at the ends of their tethers, usually fired off in the small hours. There were jokes at the expense of patients and juniors, managers and colleagues…The question for the GMC and me was, more or less, should doctors be posting this stuff? Is it ethical and, slightly more urgently, will the GMC be after them if they do?

Social media are powerful tools and in some form or other are probably here to stay. But among a great many things that are useful lurk a few hazards for the unwary doctor. One of these is the way social media can blur the distinction between our public and private lives. Reading those tweets at the conference—so much compressed spleen—was like watching the collective medical unconscious rear its head: a 4 am outpouring of rage, frustration, and plain disbelief. more…

Julian Sheather: Francis—the ethical challenge

30 Apr, 13 | by BMJ

Medical ethics has positioned itself as a decision making tool, a philosophical spanner if you like in the clinician’s toolbox. For understandable reasons it has concentrated on practical dilemmas: even those landmark legal decisions—the removal of treatment from Anthony Bland comes to mind—are buttressed by intense philosophical scrutiny. In the process medical ethics has attracted some good minds from academic philosophy, pleased no doubt to see some practical pay-off from their more abstract deliberations. more…

Julian Sheather: Is psychiatry a form of torture?

25 Apr, 13 | by BMJ

I doubt few areas of medical practice are more ethically charged than the forced treatment of people with mental disorders. Recently a colleague forwarded me some comments made in March this year by Juan Mendez, the special rapporteur on torture, regarding mental illness. (For anyone unfamiliar with the United Nations human rights structures, a special rapporteur is an independent expert given a mandate by the United Nations Human Rights Council to “examine, monitor, advise, and publicly report” on human rights abuses. Mandates relate either to specific countries, or, as in the case of the rapporteur on torture, particular themes.) Were Mendez’s comments introduced into medical practice, psychiatry, and the care and treatment of adults lacking capacity, would be transformed. Because the issues are so important, I quote Mendez at some length. For the sake of clarity, bear in mind that mental disorder here comes under the rubric of psychosocial disability. more…

Julian Sheather: Should doctors treat violent or abusive patients?

20 Mar, 13 | by BMJ

During the years I have been talking to doctors about medical ethics, I have often heard it said that when push comes to shove, the rights dice are loaded in favour of patients. All this talk of patient autonomy is all very well but what about the autonomy of doctors? What about our rights? With the bathwater of paternalism has surely gone the baby of independent clinicianship. It has been quite a fall—this is a lament I often hear—from demigods to handmaidens in the lurch of a single generation. If doctors are obliged, on pain of retribution from the General Medical Council, to show respect, why do increasing numbers of patients feel no such corresponding duty?

Nowhere are these things more exposed than when it comes to treating abusive, menacing, or even violent patients, nowhere is the apparent asymmetry between patient freedoms and doctors’ duties more acutely in evidence. So how should doctors proceed in the face of a menacing or abusive patient? more…

Julian Sheather: On living to be a hundred

4 Mar, 13 | by BMJ

A gamesome piece by Garrison Keillor in this month’s Prospect on, dare I say it, the prospect of living to be 100 and what it might mean to him. It comes on the back of data from the Office for National Statistics suggesting that a third of babies born last year will live to be 100. “It dawns on me,” he writes, “that living past 70, the Biblical allotment, is an unnatural thing. Longevity is not nature’s plan for us. A man is programmed to degenerate. Nature only wanted me to find a female, mount her, impregnate her, raise the offspring until they could fend for themselves, and then get out of the way, go die and let the young take over.” But then, as Keillor goes on merrily to make self-evident, a great deal of what is good in life can lie well outside these pre-programmed Darwinian urgencies. An evolutionary account of why he became a novelist would make for unusual reading. more…

Julian Sheather: Should I sign him off sick?

15 Feb, 13 | by BMJ Group

Thou shalt not judge. A GP asked me recently whether he should sign patients off sick when he thought they were swinging the lead. I talk to a lot of GPs and I get asked a lot of difficult questions – it goes with the ethics territory – but this one looked like a no-brainer: if you’ve got good reasons to believe that someone is not sick, don’t sign them off. Why lend your hand to a fraud? more…

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