119 found
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  1.  51
    A Personalized Patient Preference Predictor for Substituted Judgments in Healthcare: Technically Feasible and Ethically Desirable.Brian D. Earp, Sebastian Porsdam Mann, Jemima Allen, Sabine Salloch, Vynn Suren, Karin Jongsma, Matthias Braun, Dominic Wilkinson, Walter Sinnott-Armstrong, Annette Rid, David Wendler & Julian Savulescu - 2024 - American Journal of Bioethics 24 (7):13-26.
    When making substituted judgments for incapacitated patients, surrogates often struggle to guess what the patient would want if they had capacity. Surrogates may also agonize over having the (sole) responsibility of making such a determination. To address such concerns, a Patient Preference Predictor (PPP) has been proposed that would use an algorithm to infer the treatment preferences of individual patients from population-level data about the known preferences of people with similar demographic characteristics. However, critics have suggested that even if such (...)
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  2. Utilitarianism and the pandemic.Julian Savulescu, Ingmar Persson & Dominic Wilkinson - 2020 - Bioethics 34 (6):620-632.
    There are no egalitarians in a pandemic. The scale of the challenge for health systems and public policy means that there is an ineluctable need to prioritize the needs of the many. It is impossible to treat all citizens equally, and a failure to carefully consider the consequences of actions could lead to massive preventable loss of life. In a pandemic there is a strong ethical need to consider how to do most good overall. Utilitarianism is an influential moral theory (...)
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  3.  56
    Withdrawal Aversion and the Equivalence Test.Julian Savulescu, Ella Butcherine & Dominic Wilkinson - 2019 - American Journal of Bioethics 19 (3):21-28.
    If a doctor is trying to decide whether or not to provide a medical treatment, does it matter ethically whether that treatment has already been started? Health professionals sometimes find it harder to stop a treatment (withdraw) than to refrain from starting the treatment (withhold). But does that feeling correspond to an ethical difference? In this article, we defend equivalence—the view that withholding and withdrawal of treatment are ethically equivalent when all other factors are equal. We argue that preference for (...)
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  4.  55
    The unnaturalistic fallacy: COVID-19 vaccine mandates should not discriminate against natural immunity.Jonathan Pugh, Julian Savulescu, Rebecca C. H. Brown & Dominic Wilkinson - 2022 - Journal of Medical Ethics 48 (6):371-377.
    COVID-19 vaccine requirements have generated significant debate. Here, we argue that, on the evidence available, such policies should have recognised proof of natural immunity as a sufficient basis for exemption to vaccination requirements. We begin by distinguishing our argument from two implausible claims about natural immunity: natural immunity is superior to ‘artificial’ vaccine-induced immunity simply because it is ‘natural’ and it is better to acquire immunity through natural infection than via vaccination. We then briefly survey the evidence base for the (...)
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  5.  33
    The harm principle, personal identity and identity-relative paternalism.Dominic Wilkinson - 2023 - Journal of Medical Ethics 49 (6):393-402.
    Is it ethical for doctors or courts to prevent patients from making choices that will cause significant harm to themselves in the future? According to an important liberal principle the only justification for infringing the liberty of an individual is to prevent harm to others; harm to the self does not suffice.In this paper, I explore Derek Parfit’s arguments that blur the sharp line between harm to self and others. I analyse cases of treatment refusal by capacitous patients and describe (...)
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  6.  98
    Passport to freedom? Immunity passports for COVID-19.Rebecca C. H. Brown, Julian Savulescu, Bridget Williams & Dominic Wilkinson - 2020 - Journal of Medical Ethics 46 (10):652-659.
    The COVID-19 pandemic has led a number of countries to introduce restrictive ‘lockdown’ policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of (...)
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  7. Are Generational Welfare Trades Always Unjust?Walter Veit, Julian Savulescu, David Hunter, Brian D. Earp & Dominic Wilkinson - 2020 - American Journal of Bioethics 20 (9):70-72.
    In their thoughtful article, Malm and Navin (2020) raise concerns about a potentially unjust generational welfare tradeoff between children and adults when it comes to chicken pox. We share their c...
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  8.  40
    Consent-GPT: is it ethical to delegate procedural consent to conversational AI?Jemima Winifred Allen, Brian D. Earp, Julian Koplin & Dominic Wilkinson - 2024 - Journal of Medical Ethics 50 (2):77-83.
    Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy and informed decision-making. Such problems might be addressed in a number of (...)
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  9.  33
    Frailty Triage: Is Rationing Intensive Medical Treatment on the Grounds of Frailty Ethical?Dominic J. C. Wilkinson - 2020 - American Journal of Bioethics 21 (11):48-63.
    In early 2020, a number of countries developed and published intensive care triage guidelines for the pandemic. Several of those guidelines, especially in the UK, encouraged the explicit assessment...
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  10.  46
    Moral uncertainty and the farming of human-pig chimeras.Julian Koplin & Dominic Wilkinson - 2019 - Journal of Medical Ethics 45 (7):440-446.
    It may soon be possible to generate human organs inside of human-pig chimeras via a process called interspecies blastocyst complementation. This paper discusses what arguably the central ethical concern is raised by this potential source of transplantable organs: that farming human-pig chimeras for their organs risks perpetrating a serious moral wrong because the moral status of human-pig chimeras is uncertain, and potentially significant. Those who raise this concern usually take it to be unique to the creation of chimeric animals with (...)
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  11.  51
    Queue questions: Ethics of COVID‐19 vaccine prioritization.Alberto Giubilini, Julian Savulescu & Dominic Wilkinson - 2021 - Bioethics 35 (4):348-355.
    The rapid development of vaccines against COVID‐19 represents a huge achievement, and offers hope of ending the global pandemic. At least three COVID‐19 vaccines have been approved or are about to be approved for distribution in many countries. However, with very limited initial availability, only a minority of the population will be able to receive vaccines this winter. Urgent decisions will have to be made about who should receive priority for access. Current policy in the UK appears to take the (...)
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  12.  75
    Worth living or worth dying? The views of the general public about allowing disabled children to die.Claudia Brick, Guy Kahane, Dominic Wilkinson, Lucius Caviola & Julian Savulescu - 2020 - Journal of Medical Ethics 46 (1):7-15.
    BackgroundDecisions about withdrawal of life support for infants have given rise to legal battles between physicians and parents creating intense media attention. It is unclear how we should evaluate when life is no longer worth living for an infant. Public attitudes towards treatment withdrawal and the role of parents in situations of disagreement have not previously been assessed.MethodsAn online survey was conducted with a sample of the UK public to assess public views about the benefit of life in hypothetical cases (...)
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  13. Should we allow organ donation euthanasia? Alternatives for maximizing the number and quality of organs for transplantation.Dominic Wilkinson & Julian Savulescu - 2010 - Bioethics 26 (1):32-48.
    There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste.In this paper we consider and evaluate a range of ways (...)
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  14.  28
    Expanded terminal sedation in end-of-life care.Laura Gilbertson, Julian Savulescu, Justin Oakley & Dominic Wilkinson - 2023 - Journal of Medical Ethics 49 (4):252-260.
    Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term ‘Expanded TS’ (ETS) can be used to describe the use of sedation at the end of life outside one or (...)
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  15.  83
    Hard lessons: learning from the Charlie Gard case.Dominic Wilkinson & Julian Savulescu - 2018 - Journal of Medical Ethics 44 (7):438-442.
    On 24 July 2017, the long-running, deeply tragic and emotionally fraught case of Charlie Gard reached its sad conclusion. Following further medical assessment of the infant, Charlie’s parents and doctors finally reached agreement that continuing medical treatment was not in Charlie’s best interests. Life support was subsequently withdrawn and Charlie died on 28 July 2017.Box 1 ### Case summary and timeline21–23 Charlie Gard was born at full term, apparently healthy, in August 2016. At a few weeks of age his parents (...)
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  16.  35
    Rationing in a Pandemic: Lessons from Italy.Lucia Craxì, Marco Vergano, Julian Savulescu & Dominic Wilkinson - 2020 - Asian Bioethics Review 12 (3):325-330.
    In late February and early March 2020, Italy became the European epicenter of the COVID-19 pandemic. Despite increasingly stringent containment measures enforced by the government, the health system faced an enormous pressure, and extraordinary efforts were made in order to increase overall hospital beds’ availability and especially ICU capacity. Nevertheless, the hardest-hit hospitals in Northern Italy experienced a shortage of ICU beds and resources that led to hard allocating choices. At the beginning of March 2020, the Italian Society of Anesthesia, (...)
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  17. A life worth giving? The threshold for permissible withdrawal of life support from disabled newborn infants.Dominic James Wilkinson - 2011 - American Journal of Bioethics 11 (2):20 - 32.
    When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of well-being. I (...)
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  18.  20
    Which features of patients are morally relevant in ventilator triage? A survey of the UK public.Walter Sinnott-Armstrong, Hazem Zohny, Julian Savulescu, Dominic Wilkinson, Vincent Conitzer, Jana Schaich Borg & Lok Chan - 2022 - BMC Medical Ethics 23 (1):1-14.
    BackgroundIn the early stages of the COVID-19 pandemic, many health systems, including those in the UK, developed triage guidelines to manage severe shortages of ventilators. At present, there is an insufficient understanding of how the public views these guidelines, and little evidence on which features of a patient the public believe should and should not be considered in ventilator triage.MethodsTwo surveys were conducted with representative UK samples. In the first survey, 525 participants were asked in an open-ended format to provide (...)
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  19.  60
    ICU triage in an impending crisis: uncertainty, pre-emption and preparation.Dominic Wilkinson - 2020 - Journal of Medical Ethics 46 (5):287-288.
    The COVID-19 coronavirus pandemic raises a host of challenging ethical questions at every level of society. However, some of the most acute questions relate to decision making in intensive care. The problem is that a small but significant proportion of patients develop severe viral pneumonitis and respiratory failure. It now seems likely that the number of critically ill patients will overwhelm the capacity of intensive care units within many health systems, including the National Health Service in the UK. The experience (...)
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  20. A Costly Separation Between Withdrawing and Withholding Treatment in Intensive Care.Dominic Wilkinson & Julian Savulescu - 2012 - Bioethics 28 (3):127-137.
    Ethical analyses, professional guidelines and legal decisions support the equivalence thesis for life-sustaining treatment: if it is ethical to withhold treatment, it would be ethical to withdraw the same treatment. In this paper we explore reasons why the majority of medical professionals disagree with the conclusions of ethical analysis. Resource allocation is considered by clinicians to be a legitimate reason to withhold but not to withdraw intensive care treatment. We analyse five arguments in favour of non-equivalence, and find only relatively (...)
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  21.  79
    Harm isn't all you need: parental discretion and medical decisions for a child: Table 1.Dominic Wilkinson & Tara Nair - 2016 - Journal of Medical Ethics 42 (2):116-118.
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  22.  32
    Ectogestation ethics: The implications of artificially extending gestation for viability, newborn resuscitation and abortion.Lydia Di Stefano, Catherine Mills, Andrew Watkins & Dominic Wilkinson - 2019 - Bioethics 34 (4):371-384.
    Recent animal research suggests that it may soon be possible to support the human fetus in an artificial uterine environment for part of a pregnancy. A technique of extending gestation in this way (“ectogestation”) could be offered to parents of extremely premature infants (EPIs) to improve outcomes for their child. The use of artificial uteruses for ectogestation could generate ethical questions because of the technology’s potential impact on the point of “viability”—loosely defined as the stage of pregnancy beyond which the (...)
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  23.  34
    Is withdrawing treatment really more problematic than withholding treatment?James Cameron, Julian Savulescu & Dominic Wilkinson - 2021 - Journal of Medical Ethics 47 (11):722-726.
    There is a concern that as a result of COVID-19 there will be a shortage of ventilators for patients requiring respiratory support. This concern has resulted in significant debate about whether it is appropriate to withdraw ventilation from one patient in order to provide it to another patient who may benefit more. The current advice available to doctors appears to be inconsistent, with some suggesting withdrawal of treatment is more serious than withholding, while others suggest that this distinction should not (...)
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  24.  17
    Sleep softly: Schubert, ethics and the value of dying well.Dominic Wilkinson - 2021 - Journal of Medical Ethics 47 (4):218-224.
    Ethical discussions about medical treatment for seriously ill babies or children often focus on the ‘value of life’ or on ‘quality of life’ and what that might mean. In this paper, I look at the other side of the coin—on the value of death, and on the quality of dying. In particular, I examine whether there is such a thing as a good way to die, for an infant or an adult, and what that means for medical care. To do (...)
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  25.  37
    Vaccine mandates for healthcare workers beyond COVID-19.Alberto Giubilini, Julian Savulescu, Jonathan Pugh & Dominic Wilkinson - 2023 - Journal of Medical Ethics 49 (3):211-220.
    We provide ethical criteria to establish when vaccine mandates for healthcare workers are ethically justifiable. The relevant criteria are the utility of the vaccine for healthcare workers, the utility for patients (both in terms of prevention of transmission of infection and reduction in staff shortage), and the existence of less restrictive alternatives that can achieve comparable benefits. Healthcare workers have professional obligations to promote the interests of patients that entail exposure to greater risks or infringement of autonomy than ordinary members (...)
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  26.  25
    Surrogate decision making in crisis.Dominic Wilkinson & Thillagavathie Pillay - forthcoming - Journal of Medical Ethics.
    Care of the critically ill newborn includes support for the birth mother/parents with regular updates around the clinical condition of the baby, and involvement in discussions around complex decision-making issues. Discussions around continuation or discontinuation of life-sustaining are challenging even in the most straightforward of cases, but what happens when the birth mother is critically unwell? Such cases can lead to uncertainty around who should assume the parental role for these difficult discussions. In this round table discussion, we explore the (...)
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  27.  28
    What is ‘medical necessity’?Dominic J. C. Wilkinson - 2023 - Clinical Ethics 18 (3):285-286.
    Imagine that we are considering whether our healthcare system (or insurer) should fund treatment or procedure X. One factor that may be cited is that of so-called ‘medical necessity’. The claim would be that treatment X should be eligible for funding if it is medically necessary, but ineligible if this does not apply. Similarly, (and relevant to the debates in this special issue), if considering whether a particular treatment should be ethically and/or legally permitted, we may wish to distinguish between (...)
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  28.  28
    Death or Disability? The 'Carmentis Machine' and Decision-Making for Critically Ill Children.Dominic Wilkinson - 2013 - Oxford, GB: Oxford University Press UK.
    Death and grief in the ancient world -- Predictions and disability in Rome.
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  29. Beyond Individual Triage: Regional Allocation of Life-Saving Resources such as Ventilators in Public Health Emergencies.Jonathan Pugh, Dominic Wilkinson, Cesar Palacios-Gonzalez & Julian Savulescu - 2021 - Health Care Analysis 29 (4):263-282.
    In the first wave of the COVID-19 pandemic, healthcare workers in some countries were forced to make distressing triaging decisions about which individual patients should receive potentially life-saving treatment. Much of the ethical discussion prompted by the pandemic has concerned which moral principles should ground our response to these individual triage questions. In this paper we aim to broaden the scope of this discussion by considering the ethics of broader structural allocation decisions raised by the COVID-19 pandemic. More specifically, we (...)
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  30.  42
    ‘Your country needs you’: the ethics of allocating staff to high-risk clinical roles in the management of patients with COVID-19.Michael Dunn, Mark Sheehan, Joshua Hordern, Helen Lynne Turnham & Dominic Wilkinson - 2020 - Journal of Medical Ethics 46 (7):436-440.
    As the COVID-19 pandemic impacts on health service delivery, health providers are modifying care pathways and staffing models in ways that require health professionals to be reallocated to work in critical care settings. Many of the roles that staff are being allocated to in the intensive care unit and emergency department pose additional risks to themselves, and new policies for staff reallocation are causing distress and uncertainty to the professionals concerned. In this paper, we analyse a range of ethical issues (...)
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  31.  77
    In Favour of Medical Dissensus: Why We Should Agree to Disagree About End‐of‐Life Decisions.Dominic Wilkinson, Robert Truog & Julian Savulescu - 2015 - Bioethics 30 (2):109-118.
    End-of-life decision-making is controversial. There are different views about when it is appropriate to limit life-sustaining treatment, and about what palliative options are permissible. One approach to decisions of this nature sees consensus as crucial. Decisions to limit treatment are made only if all or a majority of caregivers agree. We argue, however, that it is a mistake to require professional consensus in end-of-life decisions. In the first part of the article we explore practical, ethical, and legal factors that support (...)
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  32.  83
    The self-fulfilling prophecy in intensive care.Dominic Wilkinson - 2009 - Theoretical Medicine and Bioethics 30 (6):401-410.
    Predictions of poor prognosis for critically ill patients may become self-fulfilling if life-sustaining treatment or resuscitation is subsequently withheld on the basis of that prediction. This paper outlines the epistemic and normative problems raised by self-fulfilling prophecies (SFPs) in intensive care. Where predictions affect outcome, it can be extremely difficult to ascertain the mortality rate for patients if all treatment were provided. SFPs may lead to an increase in mortality for cohorts of patients predicted to have poor prognosis, they may (...)
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  33.  16
    Raqeeb, Haastrup, and Evans: Seeking Consistency through a Distributive Justice-Based Approach to Limitation of Treatment in the Context of Dispute.James Cameron, Julian Savulescu & Dominic Wilkinson - 2022 - Journal of Law, Medicine and Ethics 50 (1):169-180.
    When is life-sustaining treatment not in the best interests of a minimally conscious child? This is an extremely difficult question that incites seemingly intractable debate. And yet, it is the question courts in England and Wales have set out to answer in disputes about appropriate medical treatment for children.
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  34.  25
    Is the non-identity problem relevant to public health and policy? An online survey.Keyur Doolabh, Lucius Caviola, Julian Savulescu, Michael J. Selgelid & Dominic Wilkinson - 2019 - BMC Medical Ethics 20 (1):1-17.
    The non-identity problem arises when our actions in the present could change which people will exist in the future, for better or worse. Is it morally better to improve the lives of specific future people, as compared to changing which people exist for the better? Affecting the timing of fetuses being conceived is one case where present actions change the identity of future people. This is relevant to questions of public health policy, as exemplified in some responses to the Zika (...)
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  35.  31
    Valuing life and evaluating suffering in infants with life-limiting illness.Dominic Wilkinson & Amir Zayegh - 2020 - Theoretical Medicine and Bioethics 41 (4):179-196.
    In this paper, we explore three separate questions that are relevant to assessing the prudential value of life in infants with severe life-limiting illness. First, what is the value or disvalue of a short life? Is it in the interests of a child to save her life if she will nevertheless die in infancy or very early childhood? Second, how does profound cognitive impairment affect the balance of positives and negatives in a child’s future life? Third, if the life of (...)
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  36.  72
    Protecting Future Children from In‐Utero Harm.Dominic Wilkinson, Loane Skene, Lachlan de Crespigny & Julian Savulescu - 2016 - Bioethics 30 (6):425-432.
    The actions of pregnant women can cause harm to their future children. However, even if the possible harm is serious and likely to occur, the law will generally not intervene. A pregnant woman is an autonomous person who is entitled to make her own decisions. A fetus in-utero has no legal right to protection. In striking contrast, the child, if born alive, may sue for injury in-utero; and the child is entitled to be protected by being removed from her parents (...)
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  37.  25
    Conscientious Non-objection in Intensive Care.Dominic Wilkinson - 2017 - Cambridge Quarterly of Healthcare Ethics 26 (1):132-142.
    Abstract:Discussions of conscientious objection (CO) in healthcare often concentrate on objections to interventions that relate to reproduction, such as termination of pregnancy or contraception. Nevertheless, questions of conscience can arise in other areas of medicine. For example, the intensive care unit is a locus of ethically complex and contested decisions. Ethical debate about CO usually concentrates on the issue of whether physicians should be permitted to object to particular courses of treatment; whether CO should be accommodated. In this article, I (...)
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  38.  41
    Cost-equivalence and Pluralism in Publicly-funded Health-care Systems.Dominic Wilkinson & Julian Savulescu - 2018 - Health Care Analysis 26 (4):287-309.
    Clinical guidelines summarise available evidence on medical treatment, and provide recommendations about the most effective and cost-effective options for patients with a given condition. However, sometimes patients do not desire the best available treatment. Should doctors in a publicly-funded healthcare system ever provide sub-optimal medical treatment? On one view, it would be wrong to do so, since this would violate the ethical principle of beneficence, and predictably lead to harm for patients. It would also, potentially, be a misuse of finite (...)
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  39.  22
    Compensation and hazard pay for key workers during an epidemic: an argument from analogy.Doug McConnell & Dominic Wilkinson - 2021 - Journal of Medical Ethics 47 (12):784-787.
    The COVID-19 pandemic has created unusually challenging and dangerous workplace conditions for key workers. This has prompted calls for key workers to receive a variety of special benefits over and above their normal pay. Here, we consider whether two such benefits are justified: a no-fault compensation scheme for harm caused by an epidemic and hazard pay for the risks and burdens of working during an epidemic. Both forms of benefit are often made available to members of the armed forces for (...)
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  40.  22
    Ethical Withdrawal of ECMO Support Over the Objections of Competent Patients.Dominic Wilkinson, John Fraser, Jacky Suen, Mioko Kasagi Suzuki & Julian Savulescu - 2023 - American Journal of Bioethics 23 (6):27-30.
    In their target article, Childress et al provide a detailed analysis of dilemmas arising from disagreement between an ICU team and a competent patient (Mr J) about dis/continuation of extra-corpore...
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  41.  67
    Settling for second best: when should doctors agree to parental demands for suboptimal medical treatment?Tara Nair, Julian Savulescu, Jim Everett, Ryan Tonkens & Dominic Wilkinson - 2017 - Journal of Medical Ethics 43 (12):831-840.
    Background Doctors sometimes encounter parents who object to prescribed treatment for their children, and request suboptimal substitutes be administered instead. Previous studies have focused on parental refusal of treatment and when this should be permitted, but the ethics of requests for suboptimal treatment has not been explored. Methods The paper consists of two parts: an empirical analysis and an ethical analysis. We performed an online survey with a sample of the general public to assess respondents’ thresholds for acceptable harm and (...)
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  42.  36
    Rationing conscience.Dominic Wilkinson - 2017 - Journal of Medical Ethics 43 (4):226-229.
    Decisions about allocation of limited healthcare resources are frequently controversial. These decisions are usually based on careful analysis of medical, scientific and health economic evidence. Yet, decisions are also necessarily based on value judgements. There may be differing views among health professionals about how to allocate resources or how to evaluate existing evidence. In specific cases, professionals may have strong personal views (contrary to professional or societal norms) that treatment should or should not be provided. Could these disagreements rise to (...)
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  43.  32
    Which Vaccine? The Cost of Religious Freedom in Vaccination Policy.Alberto Giubilini, Julian Savulescu & Dominic Wilkinson - 2021 - Journal of Bioethical Inquiry 18 (4):609-619.
    We discuss whether and under what conditions people should be allowed to choose which COVID-19 vaccine to receive on the basis of personal ethical views. The problem arises primarily with regard to some religious groups’ concerns about the connection between certain COVID-19 vaccines and abortion. Vaccines currently approved in Western countries make use of foetal cell lines obtained from aborted foetuses either at the testing stage or at the development stage. The Catholic Church’s position is that, if there are alternatives, (...)
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  44.  57
    Disability, discrimination and death: is it justified to ration life saving treatment for disabled newborn infants?Dominic Wilkinson & Julian Savulescu - 2014 - Monash Bioethics Review 32 (1-2):43-62.
    Disability might be relevant to decisions about life support in intensive care in several ways. It might affect the chance of treatment being successful, or a patient’s life expectancy with treatment. It may affect whether treatment is in a patient’s best interests. However, even if treatment would be of overall benefit it may be unaffordable and consequently unable to be provided. In this paper we will draw on the example of neonatal intensive care, and ask whether or when it is (...)
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  45.  13
    An empirical bioethical examination of Norwegian and British doctors' views of responsibility and (de)prioritization in healthcare.Jim A. C. Everett, Hannah Maslen, Anne-Marie Nussberger, Berit Bringedal, Dominic Wilkinson & Julian Savulescu - 2021 - Bioethics 35 (9):932-946.
    In a world with limited resources, allocation of resources to certain individuals and conditions inevitably means fewer resources allocated to other individuals and conditions. Should a patient's personal responsibility be relevant to decisions regarding allocation? In this project we combine the normative and the descriptive, conducting an empirical bioethical examination of how both Norwegian and British doctors think about principles of responsibility in allocating scarce healthcare resources. A large proportion of doctors in both countries supported including responsibility for illness in (...)
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  46.  18
    Ethical factors determining ECMO allocation during the COVID-19 pandemic.Dominic J. C. Wilkinson, John F. Fraser, Jacky Y. Suen, Julian Savulescu & Bernadine Dao - 2021 - BMC Medical Ethics 22 (1):1-12.
    BackgroundECMO is a particularly scarce resource during the COVID-19 pandemic. Its allocation involves ethical considerations that may be different to usual times. There is limited pre-pandemic literature on the ethical factors that ECMO physicians consider during ECMO allocation. During the pandemic, there has been relatively little professional guidance specifically relating to ethics and ECMO allocation; although there has been active ethical debate about allocation of other critical care resources. We report the results of a small international exploratory survey of ECMO (...)
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  47.  19
    Current controversies and irresolvable disagreement: the case of Vincent Lambert and the role of ‘dissensus’.Dominic Wilkinson & Julian Savulescu - 2019 - Journal of Medical Ethics 45 (10):631-635.
    Controversial cases in medical ethics are, by their very nature, divisive. There are disagreements that revolve around questions of fact or of value. Ethical debate may help in resolving those disagreements. However, sometimes in such cases, there are opposing reasonable views arising from deep-seated differences in ethical values. It is unclear that agreement and consensus will ever be possible. In this paper, we discuss the recent controversial case of Vincent Lambert, a French man, diagnosed with a vegetative state, for whom (...)
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  48.  57
    The window of opportunity: Decision theory and the timing of prognostic tests for newborn infants.Dominic Wilkinson - 2009 - Bioethics 23 (9):503-514.
    In many forms of severe acute brain injury there is an early phase when prognosis is uncertain, followed later by physiological recovery and the possibility of more certain predictions of future impairment. There may be a window of opportunity for withdrawal of life support early, but if decisions are delayed there is the risk that the patient will survive with severe impairment. In this paper I focus on the example of neonatal encephalopathy and the question of the timing of prognostic (...)
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  49.  25
    Minority report: can minor parents refuse treatment for their child?Helen Lynne Turnham, Ariella Binik & Dominic Wilkinson - 2020 - Journal of Medical Ethics 46 (6):355-359.
    Infants are unable to make their own decisions or express their own wishes about medical procedures and treatments. They rely on surrogates to make decisions for them. Who should be the decision-maker when an infant’s biological parents are also minors? In this paper, we analyse a case in which the biological mother is a child. The central questions raised by the case are whether minor parents should make medical decisions on behalf of an infant, and if so, what are the (...)
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  50.  47
    The relational threshold: a life that is valued, or a life of value?Dominic Wilkinson, Claudia Brick, Guy Kahane & Julian Savulescu - 2020 - Journal of Medical Ethics 46 (1):24-25.
    The four thoughtful commentaries on our feature article draw out interesting empirical and normative questions. The aim of our study was to examine the views of a sample of the general public about a set of cases of disputed treatment for severely impaired infants.1 We compared those views with legal determinations that treatment was or was not in the infants’ best interests, and with some published ethical frameworks for decisions. We deliberately did not draw explicit ethical conclusions from our survey (...)
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