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Ethics education

How Magic can help Teach Students about Medical Ethics

24 Aug, 13 | by Iain Brassington

Guest post by Daniel Sokol, KCL

For some time, I have been interested in the relationship between magic and medical ethics.  Five years ago, I gave a talk in Prague on how to use magic in medical ethics education.  More recently, I held a workshop on Magic for Anaesthetists, which touched on ethical issues in anaesthesia.  My latest ‘guest’ lecture is entitled Magic, Medicine and Medical Ethics and examines the ways in which the work of professional magicians can shed light on the art and ethics of medicine.

This blog is for those who teach medical ethics.  It explains how a magical effect can help convey ideas in a memorable and thought-provoking way.  I am grateful to Gerry Griffin, a fantastic card magician from the United States, for permission to use one of his effects.  I respectfully ask readers to keep the secret to themselves.

more…

Is Medical Equipment Halal? Kosher?

23 Nov, 12 | by Iain Brassington

A recent intercalating student of mine got in touch with this query the other day:

Total parenteral nutrition is given as a replacement for nutrition where the patient cannot or should not be digesting food: it is given intravenously so bypasses digestion.  Two patients have asked my current educational supervisor if the TPN solution is halal, and no-one, including the manufacturers, seems to know. There are various parts that are derived from animals but the manufacturers can’t say where from, even which animal seemingly.

The two relevant patients have been told the ‘don’t know’ answer and have agreed to continue taking the TPN but the team is now left wondering whether to tell all patients before they commence TPN that they do not know the origin of the products used and therefore the TPN cannot be guaranteed as halal, or indeed kosher either.

A pharmacist has also pointed out that beef gelatine is also used in many tablet coatings and this is generally never discussed with patients.

There is a suggestion in this paper that we should routinely be telling all patients about gelatine in tablets and IV infusions, which is definitely what my instinctual reaction agrees with.  The authors suggest that continuing not to do so would mean modern medicine “might be thought to be following the sort of self certain, paternalistic line that doctors were accused of decades ago in relation to Jehovah’s Witnesses”. I think that sums it up quite nicely!

Another interesting question comes from a legal point of view – of the regulations surrounding labelling of food products, which I think are increasingly strict, and the information provided by manufacturers about origins of medical products and then how much of that is communicated to patients.  (I think Margot Brazier might have mentioned this issue in our regulations seminar.)

Having chatted with the student in the pub since, we agree that, ethically at least, it’s a bit of a no-brainer: since it isn’t an imposition on anyone to warn that we can’t be sure of the origin of the treatment, there’s no harm in doing so – and, for the sake of preserving patients’ control over what goes into their bodies, we ought.

The legal question is potentially quite interesting here.  Going off on one a bit, could there be a negligence issue here – on the grounds that it’s reasonable to suppose that at least some patients might want to know the information, even if they don’t expressly say they would (because it never crosses their mind)?  Not to warn could be a serious omission here – and I’m wondering whether it might make a difference to consent.  I genuinely don’t know: were someone to make a case that they should have been warned and would not have consented had they known, would there be legal mileage in it?

Any thoughts, anyone?

Public Lecture: Mary Midgley on Death and the Human Animal

15 Sep, 11 | by Iain Brassington

Via the Centre for Medical Humanities blog:

Royal Institute of Philosophy Public Lecture

Mary Midgley – Newcastle University

Death and the Human Animal

Wednesday 19th October 2011, 5pm – 7pm (freshments available from 5pm)
The Henry Dyson room, the college of St Hild and St Bede, Durham.

The abstract’s below the fold. more…

Philosophy on the Radio

10 Sep, 11 | by Iain Brassington

You’re all probably way ahead of me on this, but there’s a series called The Philosopher’s Arms currently enjoying a run on Radio 4.  The premise of the programme is that philosophical questions are discussed in the context of a conversation in the pub – which has, of course, been the traditional haunt of philosophers ever since Plato and his mates went out on the razz and decided to publish the transcripts of what was said.

The Practical Ethics blog currently has a survey running on Nozick’s experience machine thought-experiment.  Go and have a look.  Better yet, pour yourself another drink, and then go and have a look.

Conscientious Objection and What Makes a Medic

20 Jul, 11 | by Iain Brassington

Francesca Minerva has drawn my attention to this paper by Sophie Strickland, currently available as a pre-publication download via the JME homepage, concerning conscientious objection among UK medical students.

Students were invited to respond to a set of questions in an online poll to determine whether there were procedures to which they’d object, and in which they’d refuse to participate, and what they were.  They were also asked to identify their religious affiliation.

Respondents were asked to note if their objections to the [...] 11 medical practices [mentioned] were for religious reasons, non-religious reasons or both religious and non-religious reasons.  Of all the objections raised in the study, 19.7% were for religious reasons, 44.1% were for non-religious reasons, and 36.2% were for both religious reasons and non-religious reasons.  Muslim students were more likely to report religious objections (28.4%), followed by Protestant students (27.0%) and then Roman Catholic students (23.01%).  Jewish students were the least likely to report religious objections (15.8%).  The proportion of non-religious objections ranged from 96.7% in atheist students to 21.0% in Protestant students.  The Sikh and Eastern Orthodox students have again been excluded because of their low numbers.

There’s a number of problems with online polls, of course – they’re vulnerable to impersonation and trolling, even if steps are taken to ensure that people can only respond once.  (Strickland doesn’t indicate how she dealt with these problems.)  Still: I’ll take her results at face value. more…

Pratchett and Assisted Dying: A Question of Balance?

15 Jun, 11 | by Iain Brassington

If you’ve not yet seen “Choosing to Die”, Terry Pratchett’s film about Dignitas from Monday night, I recommend that you go and watch it now.  (I don’t know if it’s available outside the UK: I’m sure it’ll appear on YouTube soon, though; or, if you’re outside th UK, get a Brit to download it and put it on a USB for you.  It’s worth it.)  It’s an astonishing piece of film-making: simultaneously gripping, heartbreaking and deeply uncomfortable.  And it raised all kinds of hard questions.  Was Peter Smedley, the man whose death was filmed, making a genuine choice?  He looked as though he was in the process of signing a contract to have his hall decorated, so calm and rational was he.  Wouldn’t you expect a bit less detachment?  A bit less bloody Englishness?  But then, how much emotion do you want?  One of my problems with the unbearable suffering criterion in Joffe’s Assisted Dying for the Terminally Ill Bill a few years ago was that the more someone’s suffering, the more it’s legitimate to worry about the clarity of their thought.  Smedley seemed very clear.

And what about Andrew Colgan?   more…

Good News from Keele

24 Mar, 11 | by Iain Brassington

It was announced yesterday that both the Centre for Professional Ethics, and the philosophy programme at Keele, have been spared the axe.  From Angus Dawson’s Facebook message:

We are delighted to announce that due to substantial discussions over the last two days the proposals to close PEAK (the Centre for Professional Ethics at Keele University) have been withdrawn.  This decision was accepted and endorsed at today’s meeting of Keele University’s Senate.  This means that existing and prospective students need not be concerned about their studies.  PEAK remains committed to teaching and research excellence – and is actively recruiting for next year’s intake to our courses.

However, we are required to produce a business plan outlining ways to ensure the required cost savings over the next few weeks.  This means that we may need to reactivate this campaign, but for now, we are focusing on positive developments for the future.

We would like to thank all of our friends and colleagues from across the world for their support.  We would particularly like to thank all those that took the time to write letters of support that went to our VC, DVC and Dean.  It was very important to our case that they considered our international reputation and you all made this obvious in the strongest terms.

This has been a difficult week (to say the least) for all of us and our families.   However, your solidarity and support has really helped us to put the evidence and arguments forward.

This is a remarkable victory in a relatively short period of time – and it is due to you all.

Congratulations to everyone there.

Medical Ethics at Keele to be Axed?

17 Mar, 11 | by Iain Brassington

This was supposed to be embargoed, but there’ve been enough leaks to make me think I can go public with it: news has emerged today that the Centre for Professional Ethics at Keele (PEAK) is facing the axe, as is the Keele Philosophy programme.

A Senate Paper detailing the proposed cuts is widely available, and people outside Keele can view it here.  The general gist of it is that most of PEAK’s activity is to go, with a small amount absorbed into the Law School.  The Philosophy programme is to go as well.  It also looks as though the problems faced by PEAK and the Philosophy department are attributable to a combination of the recession and bad management by the University; hardly unique, hardly incurable, and hardly grounds to close the academic department.

As far as I know, the decision hasn’t been finalised yet – I believe that the relevant meeting will be in April – so there’s still time to do something about it.

Any decision to shut PEAK would be senseless.  I’m informed that, not so long ago, the department provided Keele with 2% of its overall income.  But even if you put that aside, PEAK is an academic gem, and any half-sane university would do everything it could to keep it going.  PEAK boasts an absurdly high concentration of talent, with world-standard researchers in reproductive ethics, public health ethics, and research ethics (to name just three fields).  Its web of alumni and former staff demonstrates just how successful it has been over the years at attracting and honing talent, and sending it back out in to the world.

I have personal reasons to be very attached to PEAK.  At the start of my career, the Centre went out of its way to provide me with an office, library access, and enough teaching to keep me solvent, and did so for long enough that I could cobble together enough publications to stand a chance of getting my current gig in Manchester.  The three years I spent there were a joy.

And, of course, my co-blogger David Hunter is based at Keele.

This is a very bad day for Keele University, and a very bad day for bioethics in the UK, if not the world.

Facebook groups for both have been set up here (for PEAK) and here (for Philosophy).  If you would like to express your opinion of the proposal (politely please) the VC can be contacted here:
Prof. Nick Foskett, VC: n.h.foskett@vco.keele.ac.uk ; you could cc: Prof. Rama Thirunamachandran, Deputy Vice-Chancellor and Provost: r.thirunamachandran@vco.keele.ac.uk, and Prof. David Shepherd, Dean of Humanities and Social Sciences d.g.shepherd@humss.keele.ac.uk – both of whom are signatories to the proposed restructuring.  Please, though, do keep things polite.

(Thanks to Andrew Willetts for the Senate Paper link)

NHS Treatment and Failed Asylum-Seekers

10 Jan, 11 | by Iain Brassington

A medical student from Newcastle writes:

I am currently writing an ethics assignment relating to a paediatric placement I undertook earlier this academic year.  During the placement I was involved in the care of 11-month old twins from Khartoum, Sudan, whose parents had brought them into hospital because they were suffering from recurrent generalised tonic-clonic (grand mal) siezures.  As part of their treatment, they were administered with intravenous antiepileptic medications, as well as maintenance fluids.  The day after their admission, however, the family were informed that their application for leave to remain in the UK had failed, and that they were to return to the Sudan with immediate effect.

I would like to use this scenario to highlight the ethical, legal and professional issues raised by the medical treatment of failed asylum seekers on the NHS.  The reason I am contacting you is to ask whether, as an expert in medical ethics, you are aware of any textbooks or published documents which may offer some guidance on this issue?  Given the highly specific nature of the subject, I know the best I can hope for is a chapter in an ethics textbook, but the hospital and University libraries I have visited have not yielded any results; furthermore, I am afraid the internet simply does not seem to contain many credible sources of information.

This looks like a really interesting – and important – study; but I have to admit that the best I could do was to recommend a trawl of the journals.

Does anyone out there have any more specific suggestions?  It’d be much appreciated if you’d leave them in the comments.

Teaching, Application and Theory

30 Sep, 10 | by Iain Brassington

Ben Saunders’ paper in this month’s JME dealing with how to teach applied ethics is thought-provoking.  He picks up on an argument between Robin Lawlor and David Benatar that’s been rumbling on for yonks in the Journal‘s pages.  Lawlor and Benatar are worried about how much theory to teach in applied ethics classes – Lawlor wants the theory minimised (see here and here); Benatar (see here and here) isn’t so sure that he’d be quite so minimal.

Saunders is happy to go along with the idea that one of the dangers of introducing theory is that students – at least, those students who are not studying philosophy – will be left with only a caricature of the theory. more…

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