The COVID 19 pandemic piqued my interrogation of the balance of staff safety and duty of care to imperilled communities.
Front line clinicians fear for themselves and their families. Despite our valorization by communities, I as a frontline emergency specialist have noticed a surge in absenteeism among well nursing staff that claim “mental health days off” to avoid catching corona and spreading it their kids. Their defence of fraudulently claimed sick paid leave is not risking passing on the corona-contagion to young children when they return from school or day care (they remain open in Australia).
One commented that as non-parent, I should take up additional burden of COVID19 health care presentations. This increases the number of my daily encounters with, and the cross-infection risk posed by, patients being screened or treated for corona. Without the nurse, I now take every throat swabs as the patient coughs or gags. There are no hospital contingency plan to make up for unplanned shortfalls in clinical staff. “No kids at home sacrificed” clinicians should not be subjected to the acute stresses, physical and psychological toll exacted by having to compensate for our well colleagues that refuse to turn up for work.
How do you cope if an epidemic disrupted daily life, closing schools, packing hospitals, and putting social gatherings, sporting events and concerts, conferences, festivals and travel plans on indefinite hold? As a frontline doctor, stayi...
The COVID 19 pandemic piqued my interrogation of the balance of staff safety and duty of care to imperilled communities.
Front line clinicians fear for themselves and their families. Despite our valorization by communities, I as a frontline emergency specialist have noticed a surge in absenteeism among well nursing staff that claim “mental health days off” to avoid catching corona and spreading it their kids. Their defence of fraudulently claimed sick paid leave is not risking passing on the corona-contagion to young children when they return from school or day care (they remain open in Australia).
One commented that as non-parent, I should take up additional burden of COVID19 health care presentations. This increases the number of my daily encounters with, and the cross-infection risk posed by, patients being screened or treated for corona. Without the nurse, I now take every throat swabs as the patient coughs or gags. There are no hospital contingency plan to make up for unplanned shortfalls in clinical staff. “No kids at home sacrificed” clinicians should not be subjected to the acute stresses, physical and psychological toll exacted by having to compensate for our well colleagues that refuse to turn up for work.
How do you cope if an epidemic disrupted daily life, closing schools, packing hospitals, and putting social gatherings, sporting events and concerts, conferences, festivals and travel plans on indefinite hold? As a frontline doctor, staying healthily uninfected whilst we strive for containment remains a cause for celebration.
Albert Camus’ The Plague is balm to the fear-riven tear in the fabric of global society. Just as the decimated inhabitants of Shakespeare’s London outlasted the plaque, without modern medicine and public health interventions, the burgeoning coro-demic is but one of Camus' "many plagues in history…yet plagues and wars (still) take people equally by surprise.“ Camus’ contagion will surely go “unaccountably” when it pleases, the sooner if communities adjust and adhere to “bewildering portents” with care and caution to the lives of others. Camus urges the social distancing and lock-downs that today will mitigate the coro-disruption’s festering tenacity, and encourages that the pandemic threat is not fated to last forever.
As we face the rigours of self-isolation, the consumptive poet -doctor John Keats, exiled in the Bay of Naples as typhus raged, reminds the reader of life coming to a premature stop. The threat of cross-infection in my daily patient encounters incites Keat’s “mortality weigh(ing) heavily on me like unwilling sleep,” yet there is consolation in being “half in love with easeful death.” We should all salute the unsung scores of imperilled, some now dead, doctors and nurses that have risen to the occasion.
Joseph Ting, MBBS MSc (Lond) BMedSc PGDipEpi DipLSTHM FACEM.
Adjunct associate professor, School of Public Health and Social Work
O Block, Room O-D610
Victoria Park Road
Kelvin Grove, Brisbane QLD 4059
Queensland University of Technology, Brisbane
Australia
Mob 0404826650
In Ireland, the Health (Regulation of Termination of Pregnancy) Act 2018 provides 'conscientious objection' for doctors and nurses (and their students and trainees). Conscientious objection under this legislation is not provided for pharmacists, pharmacy students or any other healthcare staff. The Irish state does not respect my inalienable human right to freedom of thought, conscience and religion, in this matter. My 'unavoidable personal beliefs' are unrecognised. As a pharmacist my dignity is not respected in the same way that the dignity of doctors and nurses and their students/trainees is respected in the Act.
As an Irish pharmacist I am deeply concerned at the challenge to my right to freedom of conscience and consequently my dignity as a human being. The Irish State must ensure that I as a human being and a pharmacist can enjoy my human and constitutional right to freedom of thought, conscience, religion or belief on the basis of respect for my inherent human dignity. Pharmacists (and others) can have 'unavoidable personal beliefs'.
The right to conscientious objection is not only based on the right to “freedom of conscience”, but also on Article 1 of the Universal Declaration of Human Rights which recognizes that all human beings “are endowed with reason and conscience.” This includes pharmacists.
In his 2013 comprehensive and scholarly review, John Grabenstein (What the World's religions teach, applied to vaccines and immune globulins - https://doi.org/10.1016/j.vaccine.2013.02.026) noted that there are no scriptures associated with any of the World's major religions (Hinduism, Buddhism, Jainism, Judaism, Christianity, and Islam) that prohibit vaccines or vaccination. So no grounds for religious exemption can exist, because vaccines and vaccination do not contravene any religious code.
Glennerster and Hodson should be congratulated on their paper tackling a very important and sensitive issue (1). They have performed a thorough analysis of legal landscape with its consequences. I feel however, that their analysis of ethical implications is lacking. Also, doctors unintentionally become second victims in this paper, appearing as those who do not care.
The United Kingdom is sadly not the only state that chose to pursue a “hostile environment” policy directed towards refugees and other migrants. Readers may recall the recent story of the Spanish humanitarian ship Open Arms who having rescued migrants in the Mediterranean Sea was denied entry into Malta and Italy (2). The rescue ships face fines of one million euros if they enter Italian coastal waters without prior permission under new legislation. Another sad example comes from Hungary, famous for building a fence along its border to keep out refugees and the toxic “Stop Soros” bill (3). A created hostility is not only a threat to life and health, but also a threat to our humanity. By ignoring vulnerability of refugees well described by the 1951 Convention (4), of which incidentally the UK is a signatory, we collectively threaten the very concept of dignity inherent in our humanity. A Polish writer and philosopher Stanisław Lem, once reflected on the roots of Holocaust perpetrated by the Nazi regime (5). He asserted that there occurred a complete reversal of moral compass for the German society. Cle...
Glennerster and Hodson should be congratulated on their paper tackling a very important and sensitive issue (1). They have performed a thorough analysis of legal landscape with its consequences. I feel however, that their analysis of ethical implications is lacking. Also, doctors unintentionally become second victims in this paper, appearing as those who do not care.
The United Kingdom is sadly not the only state that chose to pursue a “hostile environment” policy directed towards refugees and other migrants. Readers may recall the recent story of the Spanish humanitarian ship Open Arms who having rescued migrants in the Mediterranean Sea was denied entry into Malta and Italy (2). The rescue ships face fines of one million euros if they enter Italian coastal waters without prior permission under new legislation. Another sad example comes from Hungary, famous for building a fence along its border to keep out refugees and the toxic “Stop Soros” bill (3). A created hostility is not only a threat to life and health, but also a threat to our humanity. By ignoring vulnerability of refugees well described by the 1951 Convention (4), of which incidentally the UK is a signatory, we collectively threaten the very concept of dignity inherent in our humanity. A Polish writer and philosopher Stanisław Lem, once reflected on the roots of Holocaust perpetrated by the Nazi regime (5). He asserted that there occurred a complete reversal of moral compass for the German society. Clever use of rhetoric of nation, blood and land has made subsequent atrocities viewed as a correct course of action and generated what might be viewed as moral blindness. We are at risk of heading the same way.
Furthermore the paradigm of “informed consent” chosen by the authors is lukewarm, as it assumes a level playing field for a social contract between patient and doctor. This is not the case. Assuming the “consent” is the most suitable concept to use, then “valid” consent presents a better way of thinking about the problem. A valid consent demands absence of duress or fear. This may be possible for economic migrants who cross borders out of choice, but is not the case for refugees. As for access, to use the above examples, the ship has to reach a port, a safe haven for migrants to access healthcare. No doctor will refuse to care for a sick patient and the authors note the existence of that ethical obligation. But to require doctors to climb over the fence built by the legislators, paddle in boats into the sea to reach patients against the policy created by the government or go into communities to explain treacherous legal language is inappropriate and misleading. It gives an impression of apportioning the blame for the human rights crisis in evolution to the medical profession alone. The problem we face as a society is bigger than communication, health promotion or policy interpretation. It concerns our existence as moral, compassionate and responsible beings. It concerns the future of humanity.
References:
1. Glennerster R, Hodson N. Confused out of care: unanticipated consequences of a “Hostile Environment”. J Med Ethics Epub ahead of print: 22.01.2020 doi:10.1136/medethics-2019-105634. [Accessed 22.01.2020].
What stood out most for me about the findings of the paper by Derbyshire and Bockmann is that whatever our moral stance on abortion, there appears to be neuroscientific evidence that supports the distinct possibility of fetal pain before 24 weeks gestation. These findings challenge the common assumption that pain is mostly a “reflective” experience by including unreflective pain as worthy of reasonable concern (as in the case of animal pain). That consideration is one relevant factor which needs to feed into our reflections on how or whether certain abortions will be carried out.
The RCOG in its latest report on fetal pain concluded that “The experience of pain needs cognitive, sensory and affective components, as well as the necessary anatomical and physiological neural connections.” (1) Years before, along the same lines, the House of Commons Science and Technology Committee reported that “while the evidence suggests that foetuses have physiological reactions to noxious stimuli, it does not indicate that pain is consciously felt, especially not below the current upper gestational limit of abortion...these factors may be relevant to clinical practice but do not appear to be relevant to the question of abortion law.”(2) Professor Derbyshire was a member of the Working Party which put this document together and was a key witness before the STC Committee but now, in light of his researches, rejects these confident conclusions.
What stood out most for me about the findings of the paper by Derbyshire and Bockmann is that whatever our moral stance on abortion, there appears to be neuroscientific evidence that supports the distinct possibility of fetal pain before 24 weeks gestation. These findings challenge the common assumption that pain is mostly a “reflective” experience by including unreflective pain as worthy of reasonable concern (as in the case of animal pain). That consideration is one relevant factor which needs to feed into our reflections on how or whether certain abortions will be carried out.
The RCOG in its latest report on fetal pain concluded that “The experience of pain needs cognitive, sensory and affective components, as well as the necessary anatomical and physiological neural connections.” (1) Years before, along the same lines, the House of Commons Science and Technology Committee reported that “while the evidence suggests that foetuses have physiological reactions to noxious stimuli, it does not indicate that pain is consciously felt, especially not below the current upper gestational limit of abortion...these factors may be relevant to clinical practice but do not appear to be relevant to the question of abortion law.”(2) Professor Derbyshire was a member of the Working Party which put this document together and was a key witness before the STC Committee but now, in light of his researches, rejects these confident conclusions.
In the light of the findings of the new paper by Derbyshire and Bockmann, the above conclusions, which reflect the current clinical and legal practice of most abortions in the UK, look outdated at best, and motivated and suspiciously convenient at worst. Derbyshire and Bokcmann point out that fetal analgesia and anaesthesia can serve as immediate answers to the possibility of fetal pain experienced during an abortion. This does not, of course, address the ethics of abortion in itself (or of particular abortions in themselves): inevitably if an abortion is itself wrong, it will also be wrong to instruct clinicians how to perform it. However, as a matter of fact, the legal and moral line currently drawn between a fetus and a newborn is looking increasingly tenuous, and the recognition of pain at an earlier stage, while in no way decisive morally, should be an important step in opening up further debates into the status of the entity experiencing pain.
References:
1. Royal College of Obstetricians and Gynaecologists, Fetal Awareness. Review of Research and Recommendations for Practice, March 2010, p. 23.
2. House of Commons. Science and Technology Committee, Scientific Developments Relating to the Abortion Act 1967, Twelfth Report of Session 2006-07, Vol. I, p. 25.
Understanding the complexity of induced abortion in context of society, culture, health and religion is a domain that should be explored. Many studies have reported ethical consideration of this issue which may be related to parenthood, rights of the fetus and mother, harms/benefits to the fetus and mother involved in abortion of the fetus.
Fetal pain should always be put into consideration before deciding on fetal interventional procedures or deciding on aborting the fetus after 13 weeks of gestation and proper anaesthesia/analgesia should be given to the pregnant woman undergoing the procedure. The knowledge about the concept of fetal pain is important and the neurological aspects of the pain perception of the fetus should be known.
Reference:
1. Bandewar S. Exploring the ethics of induced abortion. Indian journal of medical ethics. 2005 Jan;13(1):18-21.
2. Um YR. A study of the ethics of induced abortion in Korea. Nursing ethics. 1999 Nov;6(6):506-14.
3. Lee SJ, Ralston HJ, Drey EA, Partridge JC, Rosen MA. Fetal pain: a systematic multidisciplinary review of the evidence. Jama. 2005 Aug 24;294(8):947-54.
Interpreting and translation are unregulated activities in most countries, yet interpreters and translators perform challenging work in sensitive domains, such as medicine. Interpreters and translators rarely have access to ethical infrastructure and the function and ethical boundaries of ‘interpreting practice’ are not widely known .
Translators or interpreters do not cease being human beings with human rights, when they enter their profession. All human beings, including interpreters, possess human rights and human freedoms. Conscientious objection is a right derived from the human right to freedom of conscience. Human beings (interpreters) are not machines; machines, when maintained, are on the whole very predictable and reliable. Interpreters like other human beings can be creative, self-aware, imaginative and flexible in their thinking.
Limitations exist in workplaces that cannot allow for a variety of opinions, thoughts, beliefs and conscientious positions.
Moral distress is a wide spread problem for health care providers in a range of acute and community health care settings. The understanding of moral distress may differ depending on the extent to which the problem is located in individual and/or systemic /structural factors. Healthcare staff members (as human beings) react in various ways when ethically/morally challenged: they may withdraw from ethically challenging situations; change their position; and/or continue to raise object...
Interpreting and translation are unregulated activities in most countries, yet interpreters and translators perform challenging work in sensitive domains, such as medicine. Interpreters and translators rarely have access to ethical infrastructure and the function and ethical boundaries of ‘interpreting practice’ are not widely known .
Translators or interpreters do not cease being human beings with human rights, when they enter their profession. All human beings, including interpreters, possess human rights and human freedoms. Conscientious objection is a right derived from the human right to freedom of conscience. Human beings (interpreters) are not machines; machines, when maintained, are on the whole very predictable and reliable. Interpreters like other human beings can be creative, self-aware, imaginative and flexible in their thinking.
Limitations exist in workplaces that cannot allow for a variety of opinions, thoughts, beliefs and conscientious positions.
Moral distress is a wide spread problem for health care providers in a range of acute and community health care settings. The understanding of moral distress may differ depending on the extent to which the problem is located in individual and/or systemic /structural factors. Healthcare staff members (as human beings) react in various ways when ethically/morally challenged: they may withdraw from ethically challenging situations; change their position; and/or continue to raise objections and voice concerns about situations.
Moral courage should be a highly esteemed trait displayed by individuals, who, despite adversity and personal risk, decide to act upon their ethical values during difficult ethical dilemmas. The challenge in today’s constantly changing healthcare and political environments is to be certain that professionals understand what ‘moral courage’ is, why it is important for all settings in which they practice, teach, research, and/or lead, and how moral courage can be demonstrated when ethical challenges face any interpreter or other healthcare staff member. Outcomes of moral distress, such as decisions to leave the role of interpreter (or other roles) will cause concern among health care leaders and society.
Systemic changes are needed as part of a response to apparently rising levels of moral distress in health care. It is important that all healthcare professionals, political leaders and management , value and support their peers who have the courage to stand up and speak out even when others are silent or differ in opinion.
Background:
Joanna Drugan (2017) Ethics and social responsibility in practice: interpreters and translators engaging with and beyond the professions, The Translator, 23:2, 126-142, DOI: 10.1080/13556509.2017.1281204
Dragoje, V., and D. Ellam. 2004. “Shared Perceptions of Ethics and Interpreting in Health Care.” Paper presented at the Critical Link 4 conference, Stockholm, Accessed 19 October 2015 http://www.criticallink.org/cli-5/.
Purtilo, R.B. (2000). Moral courage in times of change: Visions for the future. Journal of Physical Therapy Education, 14(3), 4 – 6.
Murray, J.S., (Sept 30, 2010) "Moral Courage in Healthcare: Acting Ethically Even in the Presence of Risk" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 2.DOI: 10.3912/OJIN.Vol15No03Man02
While I must agree the analogy of the siamese twins do provide a better understanding of some of the issues dealt with by Thomson there is one fatal law not addressed with this analogy. In law of evidence it must always be considered whether the probative value of evidence outweighs the possible prejudice using said evidence could hold. Applying that to this scenario it can be argued that the person attached to the unconscious violinist has an understanding a a frame of reference to what life was like before the incident, what life is like during the attachment and what life could be like after attachment. There is thus a clear understanding of what is being sacrificed and the changes forward this will have. The same can be said for a pregnant woman contemplating abortion. She knows what life was life before pregnancy what life is like during pregnancy and what changes to except after the birth of the child, thus enabling her to make an informed decision. The same can however not be said for the siamese twins as Elizabeth has no framework to base the standard of her life on. Elizabeth only knows what life is like attached to Catherine as she has never been independent of her. Elizabeth can thus not make an informed decision as she has no idea what life will be like without Catherine (she could become depressed for the loss of a loved one she has known her entire life, or she could end up regretting her decision much later on in life when it is too late [if a woman gets an...
While I must agree the analogy of the siamese twins do provide a better understanding of some of the issues dealt with by Thomson there is one fatal law not addressed with this analogy. In law of evidence it must always be considered whether the probative value of evidence outweighs the possible prejudice using said evidence could hold. Applying that to this scenario it can be argued that the person attached to the unconscious violinist has an understanding a a frame of reference to what life was like before the incident, what life is like during the attachment and what life could be like after attachment. There is thus a clear understanding of what is being sacrificed and the changes forward this will have. The same can be said for a pregnant woman contemplating abortion. She knows what life was life before pregnancy what life is like during pregnancy and what changes to except after the birth of the child, thus enabling her to make an informed decision. The same can however not be said for the siamese twins as Elizabeth has no framework to base the standard of her life on. Elizabeth only knows what life is like attached to Catherine as she has never been independent of her. Elizabeth can thus not make an informed decision as she has no idea what life will be like without Catherine (she could become depressed for the loss of a loved one she has known her entire life, or she could end up regretting her decision much later on in life when it is too late [if a woman gets an abortion today and in six years decides she now wants children she can most probably still get pregnant and have a child] ), and in this instance the possible prejudice outweighs the probative value.
Dr Anthony-Pillai is wrong to argue that the BMA and Royal College of Physicians’ guidance on decisions about clinically-assisted nutrition and hydration (CANH) is dangerous in overlooking the symptomatic benefit that CANH can provide.
Our guidance, which was developed over a period of 18 months, in conjunction with a range of medical, legal, and ethical experts, is professional guidance, setting out the process that needs to be followed in order to comply with the law and good practice. We are clear that the guidance should be read in conjunction with the most up-to-date clinical guidelines when reaching a decision, and that any significant divergence from established practice must be justified. It is the clinical guidance which is the most appropriate home for discussion on assessing and responding to symptomatic distress. For patients who are in a prolonged disorder of consciousness (PDOC), this will be the clinical guidelines on PDOC from the Royal College of Physicians – who were the joint authors of our guidance. (These guidelines are currently under review by the RCP’s PDOC guideline development group following recent changes to the law. The updated version is expected to be published in early 2020.)
We do not, as Dr Anthony-Pillai suggests, only “implicitly acknowledge” that CANH can provide symptomatic benefit. We explicitly state at the outset, in determining the scope of the guidance, that “clinical benefit” encapsulates not just prolonging some...
Dr Anthony-Pillai is wrong to argue that the BMA and Royal College of Physicians’ guidance on decisions about clinically-assisted nutrition and hydration (CANH) is dangerous in overlooking the symptomatic benefit that CANH can provide.
Our guidance, which was developed over a period of 18 months, in conjunction with a range of medical, legal, and ethical experts, is professional guidance, setting out the process that needs to be followed in order to comply with the law and good practice. We are clear that the guidance should be read in conjunction with the most up-to-date clinical guidelines when reaching a decision, and that any significant divergence from established practice must be justified. It is the clinical guidance which is the most appropriate home for discussion on assessing and responding to symptomatic distress. For patients who are in a prolonged disorder of consciousness (PDOC), this will be the clinical guidelines on PDOC from the Royal College of Physicians – who were the joint authors of our guidance. (These guidelines are currently under review by the RCP’s PDOC guideline development group following recent changes to the law. The updated version is expected to be published in early 2020.)
We do not, as Dr Anthony-Pillai suggests, only “implicitly acknowledge” that CANH can provide symptomatic benefit. We explicitly state at the outset, in determining the scope of the guidance, that “clinical benefit” encapsulates not just prolonging someone’s life, but also the provision of symptomatic relief (page 16 of the guidance).
With regard to how clinical information is to be used and weighed as part of the best interests decision, we are clear that all relevant clinical information should be taken into consideration. This will include information about the patient’s current condition, the quality of his or her life (from his or her perspective), and the patient’s experience of pain and distress and how it is being managed –including consideration of the symptomatic relief CANH is providing.
All of this information should be considered alongside information about the patient’s wishes, feelings, beliefs and values – past and present – to reach a decision about what is in the patient’s best interests. When the discussion is about the withdrawal of CANH, all of that information must be sufficiently robust to rebut the strong presumption that it will be in the patient’s best interests to prolong his or her life. At all times, the decision must be focused on what is right for that individual patient.
Further, an important requirement of the guidelines is that, if a decision is made to withdraw CANH, an appropriate palliative care plan must be in place to manage any symptoms that might arise. The RCP guidelines provide specific advice and palliative care protocols to ensure optimal palliative care in this situation.
The real danger to patients lies with doctors acting in a way that is not in the best interests of the patient – whether that is by continuing treatment for too long, and forcing them to continue a life that they would not want, or by withholding or withdrawing treatment too soon and depriving patients of the opportunity to live a life they would value. Our guidance aims to ensure that does not happen.
The COVID 19 pandemic piqued my interrogation of the balance of staff safety and duty of care to imperilled communities.
Front line clinicians fear for themselves and their families. Despite our valorization by communities, I as a frontline emergency specialist have noticed a surge in absenteeism among well nursing staff that claim “mental health days off” to avoid catching corona and spreading it their kids. Their defence of fraudulently claimed sick paid leave is not risking passing on the corona-contagion to young children when they return from school or day care (they remain open in Australia).
One commented that as non-parent, I should take up additional burden of COVID19 health care presentations. This increases the number of my daily encounters with, and the cross-infection risk posed by, patients being screened or treated for corona. Without the nurse, I now take every throat swabs as the patient coughs or gags. There are no hospital contingency plan to make up for unplanned shortfalls in clinical staff. “No kids at home sacrificed” clinicians should not be subjected to the acute stresses, physical and psychological toll exacted by having to compensate for our well colleagues that refuse to turn up for work.
How do you cope if an epidemic disrupted daily life, closing schools, packing hospitals, and putting social gatherings, sporting events and concerts, conferences, festivals and travel plans on indefinite hold? As a frontline doctor, stayi...
Show MoreIn Ireland, the Health (Regulation of Termination of Pregnancy) Act 2018 provides 'conscientious objection' for doctors and nurses (and their students and trainees). Conscientious objection under this legislation is not provided for pharmacists, pharmacy students or any other healthcare staff. The Irish state does not respect my inalienable human right to freedom of thought, conscience and religion, in this matter. My 'unavoidable personal beliefs' are unrecognised. As a pharmacist my dignity is not respected in the same way that the dignity of doctors and nurses and their students/trainees is respected in the Act.
As an Irish pharmacist I am deeply concerned at the challenge to my right to freedom of conscience and consequently my dignity as a human being. The Irish State must ensure that I as a human being and a pharmacist can enjoy my human and constitutional right to freedom of thought, conscience, religion or belief on the basis of respect for my inherent human dignity. Pharmacists (and others) can have 'unavoidable personal beliefs'.
The right to conscientious objection is not only based on the right to “freedom of conscience”, but also on Article 1 of the Universal Declaration of Human Rights which recognizes that all human beings “are endowed with reason and conscience.” This includes pharmacists.
In his 2013 comprehensive and scholarly review, John Grabenstein (What the World's religions teach, applied to vaccines and immune globulins - https://doi.org/10.1016/j.vaccine.2013.02.026) noted that there are no scriptures associated with any of the World's major religions (Hinduism, Buddhism, Jainism, Judaism, Christianity, and Islam) that prohibit vaccines or vaccination. So no grounds for religious exemption can exist, because vaccines and vaccination do not contravene any religious code.
Glennerster and Hodson should be congratulated on their paper tackling a very important and sensitive issue (1). They have performed a thorough analysis of legal landscape with its consequences. I feel however, that their analysis of ethical implications is lacking. Also, doctors unintentionally become second victims in this paper, appearing as those who do not care.
The United Kingdom is sadly not the only state that chose to pursue a “hostile environment” policy directed towards refugees and other migrants. Readers may recall the recent story of the Spanish humanitarian ship Open Arms who having rescued migrants in the Mediterranean Sea was denied entry into Malta and Italy (2). The rescue ships face fines of one million euros if they enter Italian coastal waters without prior permission under new legislation. Another sad example comes from Hungary, famous for building a fence along its border to keep out refugees and the toxic “Stop Soros” bill (3). A created hostility is not only a threat to life and health, but also a threat to our humanity. By ignoring vulnerability of refugees well described by the 1951 Convention (4), of which incidentally the UK is a signatory, we collectively threaten the very concept of dignity inherent in our humanity. A Polish writer and philosopher Stanisław Lem, once reflected on the roots of Holocaust perpetrated by the Nazi regime (5). He asserted that there occurred a complete reversal of moral compass for the German society. Cle...
Show MoreDear Editor,
What stood out most for me about the findings of the paper by Derbyshire and Bockmann is that whatever our moral stance on abortion, there appears to be neuroscientific evidence that supports the distinct possibility of fetal pain before 24 weeks gestation. These findings challenge the common assumption that pain is mostly a “reflective” experience by including unreflective pain as worthy of reasonable concern (as in the case of animal pain). That consideration is one relevant factor which needs to feed into our reflections on how or whether certain abortions will be carried out.
The RCOG in its latest report on fetal pain concluded that “The experience of pain needs cognitive, sensory and affective components, as well as the necessary anatomical and physiological neural connections.” (1) Years before, along the same lines, the House of Commons Science and Technology Committee reported that “while the evidence suggests that foetuses have physiological reactions to noxious stimuli, it does not indicate that pain is consciously felt, especially not below the current upper gestational limit of abortion...these factors may be relevant to clinical practice but do not appear to be relevant to the question of abortion law.”(2) Professor Derbyshire was a member of the Working Party which put this document together and was a key witness before the STC Committee but now, in light of his researches, rejects these confident conclusions.
In the light...
Show MoreDear Editor,
Understanding the complexity of induced abortion in context of society, culture, health and religion is a domain that should be explored. Many studies have reported ethical consideration of this issue which may be related to parenthood, rights of the fetus and mother, harms/benefits to the fetus and mother involved in abortion of the fetus.
Fetal pain should always be put into consideration before deciding on fetal interventional procedures or deciding on aborting the fetus after 13 weeks of gestation and proper anaesthesia/analgesia should be given to the pregnant woman undergoing the procedure. The knowledge about the concept of fetal pain is important and the neurological aspects of the pain perception of the fetus should be known.
Reference:
1. Bandewar S. Exploring the ethics of induced abortion. Indian journal of medical ethics. 2005 Jan;13(1):18-21.
2. Um YR. A study of the ethics of induced abortion in Korea. Nursing ethics. 1999 Nov;6(6):506-14.
3. Lee SJ, Ralston HJ, Drey EA, Partridge JC, Rosen MA. Fetal pain: a systematic multidisciplinary review of the evidence. Jama. 2005 Aug 24;294(8):947-54.
Interpreting and translation are unregulated activities in most countries, yet interpreters and translators perform challenging work in sensitive domains, such as medicine. Interpreters and translators rarely have access to ethical infrastructure and the function and ethical boundaries of ‘interpreting practice’ are not widely known .
Translators or interpreters do not cease being human beings with human rights, when they enter their profession. All human beings, including interpreters, possess human rights and human freedoms. Conscientious objection is a right derived from the human right to freedom of conscience. Human beings (interpreters) are not machines; machines, when maintained, are on the whole very predictable and reliable. Interpreters like other human beings can be creative, self-aware, imaginative and flexible in their thinking.
Limitations exist in workplaces that cannot allow for a variety of opinions, thoughts, beliefs and conscientious positions.
Moral distress is a wide spread problem for health care providers in a range of acute and community health care settings. The understanding of moral distress may differ depending on the extent to which the problem is located in individual and/or systemic /structural factors. Healthcare staff members (as human beings) react in various ways when ethically/morally challenged: they may withdraw from ethically challenging situations; change their position; and/or continue to raise object...
Show MoreHelp wanted. No Irish need apply.
https://www.irishtimes.com/news/ireland/irish-news/new-york-times-finds-...
Are we to expect the following?
Healthcare staff wanted. No one with a conscientious objection need apply.
While I must agree the analogy of the siamese twins do provide a better understanding of some of the issues dealt with by Thomson there is one fatal law not addressed with this analogy. In law of evidence it must always be considered whether the probative value of evidence outweighs the possible prejudice using said evidence could hold. Applying that to this scenario it can be argued that the person attached to the unconscious violinist has an understanding a a frame of reference to what life was like before the incident, what life is like during the attachment and what life could be like after attachment. There is thus a clear understanding of what is being sacrificed and the changes forward this will have. The same can be said for a pregnant woman contemplating abortion. She knows what life was life before pregnancy what life is like during pregnancy and what changes to except after the birth of the child, thus enabling her to make an informed decision. The same can however not be said for the siamese twins as Elizabeth has no framework to base the standard of her life on. Elizabeth only knows what life is like attached to Catherine as she has never been independent of her. Elizabeth can thus not make an informed decision as she has no idea what life will be like without Catherine (she could become depressed for the loss of a loved one she has known her entire life, or she could end up regretting her decision much later on in life when it is too late [if a woman gets an...
Show MoreDr Anthony-Pillai is wrong to argue that the BMA and Royal College of Physicians’ guidance on decisions about clinically-assisted nutrition and hydration (CANH) is dangerous in overlooking the symptomatic benefit that CANH can provide.
Our guidance, which was developed over a period of 18 months, in conjunction with a range of medical, legal, and ethical experts, is professional guidance, setting out the process that needs to be followed in order to comply with the law and good practice. We are clear that the guidance should be read in conjunction with the most up-to-date clinical guidelines when reaching a decision, and that any significant divergence from established practice must be justified. It is the clinical guidance which is the most appropriate home for discussion on assessing and responding to symptomatic distress. For patients who are in a prolonged disorder of consciousness (PDOC), this will be the clinical guidelines on PDOC from the Royal College of Physicians – who were the joint authors of our guidance. (These guidelines are currently under review by the RCP’s PDOC guideline development group following recent changes to the law. The updated version is expected to be published in early 2020.)
We do not, as Dr Anthony-Pillai suggests, only “implicitly acknowledge” that CANH can provide symptomatic benefit. We explicitly state at the outset, in determining the scope of the guidance, that “clinical benefit” encapsulates not just prolonging some...
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