Prolonging neonatal lifeThe paradox that medicine’s success breeds medicine’s problems is well known to readers of the Journal of Medical Ethics. Advances in neonatal medicine have worked wonders. Not long ago, extremely premature birth babies, or those born with very serious health problems, would inevitably have died. Today, neonatologists can resuscitate babies born at ever-earlier stages of gestation. And very ill babies also benefit from advances in neonatal intensive care. Infant lives can be prolonged. Unfortunately, several such babies will not (...) survive for long whatever is done for them. Others will live to leave hospital, but face severe health problems. Doctors have gained the ability to prolong neonatal life. But should they always do so? This question is central to the recent report of the Nuffield Council on Bioethics, Critical care decisions in fetal and neonatal medicine.1 In many quarters, the report received a very positive response, commended in The Lancet as “thoughtful, sensitive and sensible” and welcomed by the premature baby charity BLISS. Critics attacked on both flanks. The report goes too far—ushering in a culture of “throw away babies”. Or it does not go far enough—failing to endorse the Dutch precedent to sanction active neonatal euthanasia.TOO FAR?One of the key recommendations of the report is that guidelines be developed in relation to the institution of intensive neonatal care. It is these guidelines, which have been savaged by some parts of the media. The BMA called them “blanket rules” smothering clinical discretion. The guidelines on resuscitation at birth apply to babies born at the borderline of viability, that is, at or before a gestational age of 25 weeks 6 days. The earlier the baby is born, the lower are the chances that he/she will survive to leave hospital. Before 21 weeks 6 days, none of …. (shrink)

In the United Kingdom, the debate about how best to meet the shortfall of organs for transplantation has persisted on and off for many years. It is often presumed that the answer is simply to alter the law to a system of presumed consent. Acting perhaps on that presumption in his annual report launched in July, the Chief Medical Officer, Sir Liam Donaldson, advocated a system of organ donation based on presumed consent, the so-called “opt-out” system.1 He is calling (...) for a change in the law in England and Wales whereby consent to organ donation is presumed, making a person’s organs automatically available for transplantation after death, unless they registered objections to this while alive. Subsequently, the British Medical Association lent its support to the introduction of such a system.2 The BMA contends that “the practice of presumed consent legislation has had a significant effect on the number of cadaveric donors per million population.”2It is often taken for granted that there must be a correlation between the enactment of legislation on presumed consent and an increase in organ donation and procurement. However, the correlation is not as straightforward as it might seem. It may be that other practical measures to encourage organ donation could be implemented without changing the Human Tissue Act 2004, an Act which has been in force for barely a year.An analysis by Abadie and Gay demonstrated that “presumed consent legislation has a positive and sizeable effect on organ donation rates”,3 but they themselves admitted that the correlation between rates of donation and presumed consent legislation is “not completely unequivocal”.3 It is true that among the most successful cases in procurement rates are countries with presumed consent legislation . However, since some of the …. (shrink)

The Francis Report into failures of care at Mid Staffordshire NHS Foundation Trust Hospital documented a series of ‘shocking’ systematic failings in healthcare that left patients routinely neglected, humiliated and in pain as the Trust focused on cutting costs and hitting government targets. At present, the criminal law in England plays a limited role in calling healthcare professionals to account for failures in care. Normally, only if a gross error leads to death will a doctor or nurse face the (...) prospect of prosecution. Doctors and nurses caring for patients under the Mental Health Act 1983 and the Mental Capacity Act 2005 may however be prosecuted for wilful neglect of a patient. In the light of the Francis Report, this article considers whether the criminal offence of wilful neglect should be extended to a broader healthcare setting and not confined to mental healthcare. (shrink)

It is argued by Anderson and also in the BrazierReport that Commercial Surrogate Motherhood (C.S.M.)contracts and agencies should be illegal on thegrounds that C.S.M. involves the commodification ofboth mothers and babies. This paper takes issue withthis view and argues that C.S.M. is not inconsistentwith the proper respect for, and treatment of,children and women. A case for the legalisation ofC.S.M. is made.

The interests or welfare of the child are rightly central to anydiscussion of the ethics of reproduction. The problematic nature of thislegitimate concern is seldom, if ever, noticed or if it is, it ismisunderstood. A prominent example of this sort of misunderstandingoccurs in the Department of Health's recent and important `SurrogacyReview' chaired by Margaret Brazier (The Brazier Report) and thesame misunderstanding makes nonsense of at least one provision of theHuman Fertilization and Embryology Act 1990. (The HFE Act).This (...) paper explores and hopefully resolves this misunderstandingand sets out the ways in which the idea of theinterests of the child can legitimately function inbioethics. (shrink)

McLachlan and Swales dispute my arguments against commercial surrogatemotherhood. In reply, I argue that commercial surrogate contractsobjectionably commodify children because they regardparental rights over children not as trusts, to be allocated in the bestinterests of the child, but as like property rights, to be allocatedat the will o the parents. They also express disrespect for mothers, bycompromising their inalienable right to act in the best interest of theirchildren, when this interest calls for mothers to assert a custody rightin their children.

The right of adults with sound mind to consent to treatment or risk their own health for the benefit of the community in a clinical trial is unequivocally recognised by the law. But what about those vulnerable by virtue of their age, nature or position in society? Experts from the fields of medicine, philosophy, theology and law, explore the ethical and legal principles which seek to reconcile the individual's right to autonomy with the need to protect vulnerable groups. Discussions refer (...) both to specific groups and specific issues. (shrink)

Developing a simple test to identify swiftly neonates with sepsis who carry the genetic variant which means that one dose of the recommended antibiotic, gentamicin, will cause the child to become profoundly deaf looks like an admirable objective. The baby needs antibiotics and needs them within 1 hour of admission to the neonatal intensive care unit. Conventional genetic tests take much longer to yield results. The test being trialled produces results in 25 min; a baby who carries the variant can (...) be treated with a different antibiotic. All the test requires is a gentle swab of the baby’s inner cheek. Babies can be treated for potentially fatal sepsis without the risk that the drugs designed to save their lives will cost them their hearing. Parents and healthcare staff are relieved of worry—a great idea? PALOH is not a trial of the safety or efficacy of the test, only to assess how feasible it will be to carry out this test in a busy NICU, without disrupting the care of the baby. A tiny painless ‘scrape’ will take a sample of DNA—what’s the fuss about? Several other invasive and painful procedures will be carried out without a fuss.1 The problem is DNA. Genetic information must be safeguarded from falling into the wrong hands. In section 45 of Human Tissue Act 2004, Parliament legislated to prohibit non-consensual DNA testing.1 It fits uncomfortably in a statute designed to regulate retention and uses of human material, after revelations that organs and tissue from the …. (shrink)

This paper explores difficulties around consent in the context of organ retention and return. It addresses the proposals of the Independent Review Group in Scotland on the Retention of Organs at Post Mortem to speak of authorisation rather than consent. Practical problems about whose consent determines disputes in relation to organ retention are explored. If a young child dies and his mother refuses consent but his father agrees what should ensue? Should the expressed wishes of a deceased adult override the (...) objections of surviving relatives? The paper suggests much broader understanding of the issues embedded in organ retention is needed to provide solutions which truly meet families' and society's needs. (shrink)

"A potent source of inspiration for anyone interested in the therapeutic potential of Buddhism. David Brazier writes with clarity and authority about the Zen way."—Mark Epstein, M.D. author of Thoughts Without a Thinker: Psychotherapy from a Buddhist Perspective. "Comprehensive and readable... should appeal to anyone broadly interested in Buddhism."—Helen Sieroda psychosynthesis psychotherapist. In this book, psychotherapist David Brazier offers readers in the West a fresh perspective on Buddhist psychology and demonstrates how Zen Buddhist techniques are integrated into psychotherapy. (...) Writing from the viewpoint of a Western psychotherapist, Dr. Brazier successfully demystifies Buddhist psychology, explains the conceptual foundations of Buddhist thought, and with the help of vivid case studies, clearly demonstrates how a Buddhist approach can provide a practical path to personal growth. (shrink)

The aim of this paper is to explore in the light of recent scientific discoveries, coupled with a return to biblical orthodoxy, the question of the Fall, and the apparent intergenerational conditions of original sin. This is the human condition – East of Eden. Invoking Darwin's theory of evolution through natural selection from random mutation as a means of repudiating the existence of original sin can no longer be sustained, scientifically; the biology of horizontal gene transfer, transgenerational epigenetics, accelerated evolution (...) and biological plasticity has rendered Darwinism grounded in a Naturalistic methodology an inadequate explanation. If humanity is ‘born this way’ – mired in sin – have we condemned ourselves and our children to this status? How does this affect the relationship between biology and free will, between a form of predestination and decision-making? Therefore, this paper is towards an understanding of the ontology of the original, or first, sin, and is a biblical and scientific exploration of postlapsarian humanity's self-willed state, ‘East of Eden.’. (shrink)

When Gautama Buddha first set forth the principles of what came to be known as Buddhism, it was, above all, in an effort to help people achieve freedom from mental suffering. In the twenty-five hundred years since the death of the "Great Physician", his disciples have continued to expand upon his teachings and to develop sophisticated psychotherapeutic methodologies. Yet, only recently has Western medicine begun to take its first tentative steps toward recognizing and embracing the therapeutic potential of Buddhism. In (...) a book that will do much to advance the fusion of two great psychotherapeutic traditions, psychotherapist David Brazier offers mental health practitioners in the West a fresh perspective on Buddhist psychology and demonstrates how Zen Buddhist techniques can be integrated successfully into their clinical practices. Writing from the perspective of a Western psychotherapist, Dr. Brazier successfully demystifies Buddhist psychology for fellow practitioners. He carefully explains the conceptual foundations of Buddhist thought, and with the help of numerous case studies, he clearly demonstrates their clinical applications. (shrink)

The Human Tissue Act 2004 is designed to regulate the storage and use of organs and tissues from the living, and the removal, storage and use of the same material from the deceased. It repeals much criticized legislation, including the Human Tissue Act 1961, and establishes a Human Tissue Authority to ensure compliance with the Act via a licensing and monitoring regime. When the Act comes into force, probably in April 2006, it will be a criminal offence not to comply (...) with certain provisions of the Act, and a new offence of DNA 'theft' will be introduced. Importantly, the Act places consent at the centre of the system, both from the living and from or on behalf of the deceased. (shrink)

Volume 1. The Anscombe-Lewis debate : from analogia entis to analogia fidei -- "God ... or a Bad, or Mad, Man" : C.S. Lewis's argument for Christ's divinity--a systematic theological, historical, and philosophical analysis of aut Deus aut malus homo -- Atonement : a unified model and event, the drama of redemption - understanding and rationalizing the tradition -- Scripture and the Christ, the Word of God : C.S. Lewis and Karl Barth--Convergence and Divergence -- The Pittenger-Lewis Debate : fundamentals (...) of an ontological Christology -- The question of multiple incarnations : imagination and paradox, reality and salvation. (shrink)

Manchester's multi-disciplinary approach to medical ethics combines established methods and new initiatives. There is a longstanding Medical Group and also, plans are evolving for the inclusion of medical ethics teaching in the undergraduate curriculum, the start of an MA in Health Care Ethics in October 1987 and the establishment of the Centre for Social Ethics and Policy to act as a focus within the university for research and study in a wider context.

We wish to describe and acknowledge the exceptional contributions to medical ethics, both in the UK and internationally, made by Edward Shotter1 who died at home on 3 July 2019. He was founder of the London Medical Group2 3 and instigator of similar student-led medical ethics groups throughout the UK; founder of the Institute of Medical Ethics4 and founder of the Journal of Medical Ethics. Ted Shotter transformed the study of medical ethics in the UK in the interests of patients (...) and professionals alike. In 1963, he established the pioneering ‘Medical Group’ model, an innovative bottom-up method whereby students in the health professions could gain a grounding in ethics that had previously been denied to the profession.5 It was with these Medical Groups that many of the leading figures in contemporary UK medical ethics and law began their careers in the subject including Sir Kenneth Calman, Sir Ian Kennedy, Professor Margaret Brazier OBE, Professor John Harris and Professor Sir Jonathan Montgomery to name but …. (shrink)

Radical changes are taking place in the United Kingdom in relation to the classification of, and access to, medicines. More and more medicines are being made available over the counter both in local pharmacies and in supermarkets. The provision of more open access to medicines may be hailed as a triumph for patient autonomy. This paper examines whether such a claim is real or illusory. It explores the ethical and legal implications of deregulating medicines. Do patients benefit? What is the (...) impact on pharmacists? Are the true beneficiaries of change largely the pharmaceutical industries? (shrink)

The right of adults with sound mind to consent to treatment or risk their own health for the benefit of the community in a clinical trial is unequivocally recognised by the law. But what about those vulnerable by virtue of their age, nature or position in society? Experts from the fields of medicine, philosophy, theology and law, explore the ethical and legal principles which seek to reconcile the individual's right to autonomy with the need to protect vulnerable groups. Discussions refer (...) both to specific groups and specific issues. (shrink)

Formulated by Aquinas, commented on by post-Copernican philosophers and theologians, analysed in depth by C.S. Lewis, and deliberated by some contemporary writers, the question of multiple incarnations either within humanity or amongst extra-terrestrial sentient species is all too intermittently examined: ‘Can the Christ be incarnated more than once in our reality, or somewhere else in the universe, or another reality?’ In this paper, we examine the debate and the conclusions: that is, Lewis’s position within his philosophical theology and his analogical (...) narratives; also, some contemporary philosophers of religion and theologians (Karl Rahner, with Christopher L. Fisher and David Fergusson; Sjoerd L. Bonting and William B. Drees; E.L. Mascall and Brian Hebblethwaite; Oliver Crisp and Keith Ward). How do they relate to Aquinas’s handling of the question and how do they compare with Lewis’s approach based on a theology of the imagination (grounded in Augustine and Alice Meynell)? Can Lewis resolve the argument? Could alien species have witnessed wholly different acts, equally unique, costly to God, and necessary to the process of salvation? Any answer or explanation relates to the function and purpose of the incarnation: the Fall, original sin—therefore, how we define the boundaries, limits, of atonement. (shrink)

Modern medicine is built on a long history of medical experimentation. Experiments in the past often exploited more vulnerable patients. Questionable ethics litter the history of medicine. Without such experiments, however, millions of lives would be forfeited. This paper asks whether all the ``unethical'' experiments of the past were unjustifiable, and do we still exploit the poorer members of the community today? It concludes by wondering if Harris is right in his advocacy of a moral duty to participate in medical (...) research. (shrink)

Why should we respect the wishes which individuals may have about how their body is treated after death? Reflecting on how and why the law respects the bodies of the living, we argue that we must also respect the ‘dead’. We contest the relevance of the argument ‘the dead have no interests’, rather we think that the pertinent argument is ‘the living have interests in what happens to their dead bodies’. And, we advance arguments why we should also respect the (...) wishes of the relatives of the deceased regarding what happens to the bodies of their loved ones. In our analysis, we use objections to organ and tissue donation for conscientious reasons (often presented as religious reasons) to show why the living can have interests in their dead bodies, and those of their dead relatives, and why these interests should be respected. (shrink)

Protecting the Vulnerable explores the reality of patient control and choice in health care and analyzes how decisions should be made on behalf of those deemed incapable of making decisions. The contributors, distinguished experts from the disciplines of medicine, ethics, theology, and law, look at the complex problem of autonomy and consent in health care and clinical research today from an illuminating perspective--its impact on the vulnerable members of society. The essays move from the exploration of lingering paternalism in health (...) care to the acute dilemma of treatment of and research on newborn babies. In covering both general and specific problems the collection reveals how exploitation can occur when the right of autonomy is eroded and where informed consent is illusory. Particularly vulnerable groups, such as children and people with mental handicaps, are discussed alongside cases where the vulnerability is itself an issue. Other areas covered include: `gesture' suicides, the practical problems of doctors in dealing with dependent patients, and the limits of proxy consent. All health care professionals, ethicists, policy makers, and lawyers currently engaged in the study or practice of health care ethics will find Protecting the Vulnerable to be a vital source of information for many years to come. (shrink)

Witnessing in merging biological, social and algorithmic realities is crucial to trust, as modelled in the YUTPA framework. Being witness and bearing witness is fundamental to human interaction. System participation in human communities of practice challenges the notion of witnessing and therefore the ability to build trust. Nevertheless, through trial and error, people in a variety of practices have found ways to establish the presence and develop trust in merging realities. This paper presents the results of 20 in-depth interviews with (...) professionals from a variety of disciplines and nations. The conclusion of cumulative analysis is that systems do not witness themselves, but their output deeply affects the mental maps that human beings make of each other, the world around them and their own self. Essential qualities human beings seek when being involved with other beings are defined by granularity and reciprocity in the design of time (duration of engagement, synchronizing performance, integrating rhythms and moments to signify), place (body sense, material interaction, emotional space and situated agency), relation (shared meaning, engagement, reputation and use) and action (tuning, reciprocity, negotiation and quality of deeds). By designing granular interaction in 4 dimensions, reciprocity in witnessing obtains significance and the basis for establishing trust in a variety of presences emerges while human agency acquires potential. (shrink)

Medical Ethics has many unsung heros and heroines. Here we celebrate one of these and on telling part of her story hope to place modern medical ethics and bioethics in the UK more centrally within its historical and human contex.

This paper is an examination of the Christology and Pneumatology that C. S. Lewis read from the apparent prefiguring of elements of the Incarnation‐Resurrection narrative in religious myths, and also his assertion that the incarnation‐resurrection narrative operates on us both as fact and myth. After an initial examination of the term myth and mythopoeia, Lewis' writings on the myth that became reality are discussed along with examples of prefigurement. Through his understanding of natural theology and his cautious respect for human (...) imagination and in contrast to his earlier deference for the conclusions of the Victorian religionist and social anthropologist James George Frazer, Lewis came to regard these prefigurements as the work of the Holy Spirit – intimations of God's salvific action in Christ – though Lewis' orthodoxy saw human imagination as flawed through original sin. This leads us to ask three questions: first, how do these prefigured ideas come to be in these myths and how do these intimations, splintered fragments of the true light, relate to Lewis' understanding of Christ as the light of the world; second, how does the Incarnation‐Resurrection narrative act/operate on us as a myth, whether spoken or read ; and third, is there internal evidence for a mythopoeic interpretation within the Incarnation‐Resurrection narrative? Our conclusions can be illustrated by a brief examination of Lewis' own Christian myth – Aslan from The Chronicles of Narnia– originally written for a Christian audience but now read by mainly non‐Christian/post‐Christian children and adults. (shrink)