You don't need to be signed in to read BMJ Blogs, but you can register here to receive updates about other BMJ products and services via our Group site.

Guest Post

No Pain, All Gain: The Case for Farming Organs in Brainless Humans

10 Jun, 17 | by Iain Brassington

Guest post by Ruth Stirton, University of Sussex (@RuthStirton) and David Lawrence, Newcastle University (@Biojammer)

It is widely acknowledged that there is a nationwide shortage of organs for transplantation purposes.  In 2016, 400 people died whilst on the organ waiting list.  Asking for donors is not working fast enough.  We should explore all avenues to alleviate this problem, which must include considering options that appear distasteful.  As the world gets safer, and fewer young people die in circumstances conducive to the donation of their organs, there is only so much that increased efficiency in collection (through improved procedures and storage) can do to increase the number of human organs available for transplantation. Xenotransplantation – the transplantation of animal organs into humans – gives us the possibility of saving lives that we would certainly lose otherwise.

There are major scientific hurdles in the way of transplanting whole animal organs into humans, including significant potential problems with incompatibility and consequent rejection.  There is, however, useful similarity between human and pig cells, which means that using pigs as the source of organs is the most likely to be viable.  Assuming, for the moment, that we can solve the scientific challenges with doing so, the bigger issue is the question of whether we should engage in xenotransplantation.

A significant challenge to this practice is that it is probably unethical to use an animal in this way for the benefit of humans. more…

Appealing to the Crowd: Ethical Justifications in Canadian Medical Crowdfunding Campaigns

8 Jun, 17 | by miriamwood

Guest Post: Jeremy Snyder
Paper:Appealing to the crowd: ethical justifications in Canadian medical crowdfunding campaigns

Medical crowdfunding is a practice where users take advantage of the power of social networks to raise funds related to medical needs from friends, family, and strangers by sharing fundraising appeals online. Popular venues include GiveForward, GoFundMe, and YouCaring, among others. This practice appears to be growing in terms of the number of active campaigns, the amount of money raised, and its visibility. An analysis of five crowdfunding sites found that in 2015 41% of all fundraising campaigns were for medical needs.

Medical crowdfunding has not received a great deal of scrutiny from ethicists or other academics. We are interested in a number of questions related to medical crowdfunding, including determining what reasons are given by campaigners for potential donors to contribute to their campaigns. In order to answer this question, we recorded and analyzed the language used in 80 medical crowdfunding campaigns, focusing on campaigns by Canadians.

We found that the reasons given for donating can be broken into three groups. First, campaigners used personal appeals to encourage giving, focusing their attention on friends and family members who already knew the recipient. This personal connection to the recipient was often framed as creating a reason to give, such as that “we should gather around them as one big family and help as much as possible.” These appeals can be linked to the ethics of care and relational ethics. Second, the depth of the recipient’s need and resulting positive impact of donations were framed as creating reasons to give. These arguments echo justifications found in the duty of beneficence and utilitarian thinking. Finally, campaigners argued that donors should contribute as a way of giving back to recipients who had helped others. These campaigns made the point that the recipient’s generosity created a community debt where “now it’s our turn to help.” In this way, the values of fairness and reciprocity were represented in these campaigns.

more…

A Plutocratic Proposal: An Ethical Way for Rich Patients to Pay for a Place on a Clinical Trial

8 Jun, 17 | by miriamwood

Guest Post: Alexander Masters and Dominic Nutt
Paper: A Plutocratic Proposal: an ethical way for rich patients to pay for a place on a clinical trial

Is it ethically possible to fund a clinical trial by charging the participants?  We believe we have discovered a way to do it.  Our suggested method has, as far as we know, never been proposed before.

In A Plutocratic Proposal: an ethical way for rich patients to pay for a place on a clinical trial we show how the system could work and argue that all the usual and obvious objections to patient-funded clinical research do not apply in this case; indeed, in several respects the Plutocratic Proposal is more ethical than established methods of funding human experiments.  Furthermore, we believe the Plutocratic Proposal will provide new money for research, particularly for neglected research into rare diseases; it will not deplete the already limited resources of traditional funders.

The ‘usual ethical objections’ include such points as:

  • paying participants could be exploited by research teams desperate to run their trials;
  • research teams might bend their inclusion criteria to accommodate rich patients and so encourage bad science;
  • by enabling research groups to charge patients directly, they can bypass the peer review process and so promote quack ideas;
  • paying patients will attempt to buy their way off concurrent comparison wings, which is not only ethically but scientifically ruinous.

How can a patient-financed funding scheme overcome such fundamental and, until now, apparently insuperable ethical objections?  Read the paper to find out

Nudges in a Post-truth World.

22 May, 17 | by miriamwood

Guest Post: Neil Levy

Full Article: Nudges in  a Post-Truth World

Human beings are motivated reasoners. We find ways to believe what we want to believe, sometimes even in the face of strong evidence to the contrary. This fact helps to explain why so many political issues are intractable, and why so many of us reject the scientific consensus on urgent issues like GMOs, vaccination and climate change. Given the importance of these issues, any means of increasing our responsiveness to evidence deserves exploration.

Nudges – proposals, stemming from the behavioural sciences, for changing the way people act by changing their environments – may be one way of increasing responsiveness to evidence. In my paper, I briefly review evidence that suggests that people resist messages for (apparently) irrelevant reasons, and that by focusing on these reasons, we can make them more responsive to these messages. For instance, people tend to dismiss testimony that comes from those who do not share their political ideology, even when the issue is an empirical one (like climate change). There is evidence that ensuring that the ideology of the source matches the ideology of the audience makes the audience more receptive to the message.

But nudges are ethically controversial. There are a number of reasons why they are controversial, but the central reason is that many people see them as threatening the autonomy of the nudged. It is one thing to address people are reasoning beings, by giving them arguments. It is another to address them as mechanisms, bypassing their reasoning. The truth of claims about vaccines, say, do not depend on who says them, and if we make people more responsive to these claims by altering their source, we manipulate them. We give them causes for their beliefs, not reasons. Or so many people claim.

more…

The Unusual Case of Ian Paterson and Criminally Harmful Surgery

9 May, 17 | by Iain Brassington

Guest post by Alex Mullock, University of Manchester

On 28th April 2017 in the case of breast surgeon, Ian Paterson, the jury in Nottingham Crown Court agreed that in carrying out unnecessary and mutilating surgery the defendant had done what no reasonable surgeon would do.  Paterson was convicted of seventeen counts of wounding with intent to cause grievous bodily harm (GBH) and three counts of unlawful wounding (under, respectively, sections 18 and 20 of the Offences Against the Person Act 1861) against nine women and one man. These ten victims, however, have been reported to represent a tiny proportion of all Paterson’s alleged victims, a group that might amount to hundreds from his many years of practice in the NHS and private sector.

The “obscure motives” that compelled Paterson may forever remain a mystery but it is interesting that the charges against him relate only to patients he treated in his private practice.  This enabled the prosecution to create a narrative that suggested that financial gain could have been the motivating factor for Paterson’s crimes.  Without greed as a possible motive his actions are baffling, and the prosecution’s case, in alleging that surgery which Paterson argued was performed in the patient’s best interests actually constituted GBH or unlawful wounding, would be more challenging because of the medical context of the allegations.  Importantly, the medical exception to the criminal law – the principle that consensual surgery carried out by qualified professionals is legitimate (“proper medical treatment”) – means that there is an assumption that harm caused by surgery is not a matter for the criminal law because it is a risk that we accept in order to enjoy the benefits of surgical medicine.

Even when surgeons make terribly negligent mistakes, English criminal law, interpreted through legal principles established through the courts, means that even recklessly dangerous surgeons need not fear the criminal law.  (An exception may arise if the patient dies, in which case a charge of gross negligence manslaughter might follow.)  Paterson’s conviction is a landmark case, which might have implications for the prevailing assumption that non-fatal surgical violations are not a criminal matter. more…

Gene Editing For A Long Life – A No Brainer?

28 Apr, 17 | by miriamwood

Guest Post: Isabelle L Robertson
Paper: Student Essay- Designing Methuselah: an ethical argument against germline genetic modification to prolong human longevity

I am 16 years old. I am at the start of my life and looking towards my future, deciding on universities, career options and how I want my life to be. At the moment I can expect to perhaps live to 90 years of age. To me, this seems like a pretty good life. If I was offered more would I take it? I’m not sure; perhaps, if my health and independence can be guaranteed, then yes, I might.

Scientists have identified genes in mice that regulate lifespan. They have then edited these genes and have bred mice that have lived a full generation longer than their peers. These genes have their equivalents in the human genome too. Gene editing is becoming more refined by the day and it is predictable that it will one day be technically possible to edit the genome of human embryos to extend their lifespan. Again, extending from mice trials humans with these same genes altered could live to around 130 years old, the equivalent of a whole extra generation.

Gene editing technology brings with it many exciting opportunities such as the possibility of ridding some individuals of disease causing genetic variants. The possibilities extend beyond this though. It is not an unlikely prospect that in my lifetime I will be faced with the choice of deciding if I want my children to have any genetic alterations. These alterations might not just be limited to lifespan extension either; it is foreseeable that enhancements to traits as varied as intelligence, appearance and athletic capability may be potentially on offer. It’s clear that ethical discussion around each of these scenarios is needed. In my paper I have concentrated on whether genetically editing the human genome to extend lifespan is likely to enhance the quality of a person’s life.

more…

The Implications of Libertarianism for Compulsory Vaccination

24 Apr, 17 | by miriamwood

Guest Post: Justin Bernstein

Paper: The Case Against Libertarian Arguments for Compulsory Vaccination

In a recent political controversy, libertarian Senator Rand Paul articulated his opposition to a policy of compulsory vaccination, stating that he was “all for [vaccines],” but that he was “also for freedom.” U.S. opponents of vaccines often object to compulsory vaccination on the (false) grounds that vaccines cause autism. But Paul’s claim that he was “for freedom” suggests a distinct, libertarian-minded rationale for opposing compulsory vaccination.

Libertarians deny that the state has the right to restrict individual liberty in order to promote welfare. A policy of compulsory vaccination promotes welfare by ensuring herd immunity. But such a policy also restricts individual liberty because it requires parents to subject their children to a medical procedure, and permits the state to punish non-compliance. So, a policy of compulsory vaccination certainly seems at odds with the libertarian’s commitment to liberty–even if herd immunity is threatened.

Some libertarians, however, attempt to avoid the controversial conclusion that libertarianism is incompatible with compulsory vaccination. In my recent paper, “The Case Against Libertarian Arguments for Compulsory Vaccination,” I argue that such attempts are unsuccessful, and so libertarians must either develop new arguments, or join Senator Paul in opposing compulsory vaccination.

more…

Breakthrough Immunotherapies Seem Like a Dream Come True for Children with Leukemia

18 Apr, 17 | by miriamwood

Guest Post: Nancy Jecker, Aaron Wightman, Abby Rosenberg, Doug Diekema

Paper: From protection to entitlement: selecting research subjects for early phase clinical trials involving breakthrough therapies

A breakthrough therapy to cure cancer in children suffering from acute lymphoblastic leukemia (ALL) is a dream for many families.  New immunotherapies appear to make this dream a reality. Such therapies use a person’s own immune cells to recognize and combat their disease. In the largest study to date of ALL patients treated with a form of immunotherapy known as Chimeric Antigen Receptor (CAR) T-Cell therapy, a 93% remission rate was reported. Such results are a glimmer of hope for those whose prognoses were previously considered very poor.

However, the good news is tempered by the fact this potentially lifesaving experimental therapy may not be available to everyone who might benefit. And demand is growing as word spreads. Since CAR T-cell therapy for ALL is available only through clinical trials, do patients have a right to participate? How should we choose among medically suitable candidates?

We have faced these questions before. Most recently, with ZMapp to treat Ebola Virus Disease, azidothymidine (AZT) to treat HIV and AIDS, and Immunitab (Gleevac) to treat Chronic Myleogenous Leukemia. Are patients suffering from devastating, life-threatening diseases entitled to breakthrough therapies?

more…

The Moral Bioenhancement of Psychopaths

18 Apr, 17 | by miriamwood

Guest Post: Elvio Baccarini and Luca Malatesti

Paper: The Moral Bioenhancement of Psychopaths

We argue that the prescription of mandatory moral bioenhancement (from now on MB) of psychopaths is justified because it satisfies the requirement of public reason as elaborated in political philosophy. This is the requirement that a moral or political prescription should be justifiable to all those persons over whom the prescription purports to have authority.

more…

Individually-Randomized Controlled Trials of Vaccines Against the Next Outbreak

11 Apr, 17 | by miriamwood

Guest Post: Nir Eyal, Marc Lipsitch

Paper: Vaccine testing for emerging infections: the case for individual randomisation 

The humbling experience of international response to Ebola taught the world a thing or two on preparing for Zika and for other emerging infections.

Some of those lessons pertain to vaccine development against emerging infections. One lesson was that vigorous vaccine development should start long in advance of outbreaks. CEPI, the Coalition for Epidemic Preparedness Innovations, was recently launched with an initial investment of half a billion US dollars from the Gates Foundation, Britain’s Wellcome Trust and the governments of Japan, Norway and Germany. There is also growing recognition that best practices on vaccine testing should be developed prior to outbreaks, from a study methodology viewpoint.

By contrast, in Zika, ethical guidelines on response in general and on an aspect of vaccine testing were created only once the pandemic erupted. Shouldn’t ethical disputes, e.g. on trial design for vaccine candidates, be ironed out in advance of emerging infections?

One persistent ethical question in vaccine testing pertains to individually-randomized control in efficacy trials. At the height of the 2014-5 Ebola outbreak, individually-randomized controlled trials were much maligned. Our paper at the Journal of Medical Ethics sets out to defend that approach for vaccine efficacy testing in emerging infections, including highly fatal and untreatable ones in developing countries.

more…

JME blog homepage

Journal of Medical Ethics

Analysis and discussion of developments in the medical ethics field. Visit site



Creative Comms logo

Latest from JME

Latest from JME

Blogs linking here

Blogs linking here