eLetters

498 e-Letters

  • In Defense of Instrumental Value

    The authors argue that when we prioritize healthcare workers for ventilators because of their instrumental value as healthcare workers, we fail to value human lives equally. While they suggest that “it may be ethically justifiable for healthcare workers to receive priority for some scarce healthcare resources” and argue that healthcare workers should have sufficient personal protective equipment (PPE), they do little to explain why granting priority for these resources isn’t also, as they argue with ventilators, a case of failing to attribute equal value to human lives. Indeed, it is not clear that they think prioritizing healthcare workers for vaccines was the right thing to do: “. . . our social fabric has shown signs of unravelling as vaccine roll-outs have pulled on loose threads” and prioritizing vaccines has resulted “in unanticipated frustration, mistrust and strife.” The authors are right in their conclusion about ventilators, but we should reject the concerns their article raises about vaccines and PPE. If saving the most lives is the goal, it is consistent with valuing each person’s life equally to prioritize healthcare workers for preventive measures, particularly at the outset of a pandemic.
    The authors mention three reasons ventilators are different from preventive measures like PPE and vaccines: 1) Efficacy: Those who require a ventilator will not return to work quickly. 2) Lifesaving: While ventilators rescue endangered lives, preventive measures only...

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  • Placebos can still work when patients are told, honestly, that they are placebos

    This study, https://doi.org/10.1126/scitranslmed.3006175, showed that the placebo effect still worked when patients were informed that they were receiving the placebo.

    If this is generally true, there is no need to move from honesty.

  • I’ve got a few questions.,..,,

    Tell me now, what would the Doctors and staff do in this situation if there wasn’t a supposed Covid diagnosis?
    What is SOP ?
    Why couldn’t they just follow that procedure with any and all PPE precautions?
    I wouldn’t think they would just throw someone in that condition into a room full of equally suffering patients ?

    Do they?

    Somebody please explain this to me in Layman’s terms.

    If these questions were already answered in the article then let me know, and I’ll do a closer read, but until then.....

    Thank You

  • Critique of Good Reasons to Vaccinate: Mandatory or Payment for Risk?

    The author asserts that coercion to vaccinate is ethically analogous to mandatory seatbelts or the use of physical force to remove a dangerous substance from a child. This is a false analogy. Wearing seatbelts while driving or removing a dangerous toy from a child does not alter anyone’s individual constitution, but vaccines do, permanently, and with largely unknown long-term consequences. Vaccination is an intimate, deeply invasive and permanent medical procedure, not just a behavioural preference. The same flawed comparison could be used to support mandatory abortion or coercive organ harvesting if these procedures were deemed in the interest of public health: a repugnant conclusion.

    Regarding seriousness of Covid-19 as a public health issue, the author ignores the fact that Covid-19 deaths are recorded in a non-standard way which precludes meaningful assessment of the true public health impact of this disease in comparison to other respiratory infections. Acording to the WHO https://www.who.int/classifications/icd/Guidelines_Cause_of_Death_COVID-... guidelines, “A death due to COVID-19 is defined for surveillance purposes as a death resulting from a clinically compatible illness [...] COVID-19 should be recorded on the medical certificate of cause of death for ALL decedents where the disease caused, or is assumed to have caused, or contributed to death.” The Office of Nat...

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  • Mandatory Vaccination by a philosopher?

    Dear Editor,
    having scanned the article by Julian S, philosopher in Oxford no less, in your journal's edition from Nov 2020 , I feel I need to comment: The mandate to prevent harm from others requires a reasonable amount of knowledge what the risk to self is. To use a narrative extract from an autoethnographic case study as example:
    ... what those people who experienced serious reaction to the covid vaccine are believed to have reacted to is an emulsifier called PEG -
    polyethylenglycol which sounds harmless enough. I was tested for allergies comprehensively by a very thorough specialist in Ger in 1996
    and that because of a series of very light reactions. I dare to assert that in the UK where I have lived for 20 years and worked in
    multidisciplinary health settings, the first thing people would know about such an allergy would be if they suffered an anaphylactic shock.
    Prior to that most people would only/at best have been prescribed cortisone.
    I believe here enters what M. Fricker, UK philosopher in NY, calls epistemic injustice inherent in a system of health inequalities as prevalent in the UK and an approach to behaviourism in clinical practice I politely call blinkered. - So far my initial reaction to the article.
    Coincidentally I then after I found the video interview where Dr Mary Ramsey for PHE declares the safety of vaccines, I felt prompted to do a little research and - surprise, surpri...

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  • Older people deserve better than paternalistic lockdown

    The opinion piece by Savulescu and Cameron[1] is a good reminder of why multidisciplinarity is so important for clinical ethics,[2] and even more so where decisions for older people are concerned. There are so many problematic aspects to this paper it is genuinely difficult to know where to start.

    Taking language first, the authors write in a reductionist manner about “the aged” and “the elderly”. These terms are repugnant to older people and the United Nations Human Rights Commission,[3] and ignore the diversity of the older population and the need for individual, and individualised, recommendations. The authors’ comment about not defining “an appropriate cut-off to identify ‘the elderly’” also misses this point. While acknowledging that ethnicity is a proxy for other factors that contribute to poorer outcomes, the authors fail to recognise that age is also such a proxy.

    The erroneous and nihilistic “inevitable association between age and deterioration of physical health” seems to be a foundation for flawed arguments. Some older people are in poor health and may be well-advised – not coerced - to stay mainly indoors, avoid unnecessary social contact, and to take outdoor exercise at a safe distance. Others will have a different risk profile or will balance the potential benefits and risks of isolation differently. The assertion that “coercion is used in standard quarantine on the basis of risk of harm to others” does not recognise that people without any com...

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  • Selective isolation of older adults is ageist and unhealthy

    In response to the article by Savulescu & Cameron [1] “Why lockdown of the elderly is not ageist and why levelling down equality is wrong,” we claim that the article presents an ageist approach that may be as harmful or more than the actual virus. In their work, the authors make reference to philosophical, legal, and practical aspects of locking down older adults, as they make the case for the merits of what they refer to as selective isolation. It is our position, as psychologists and gerontologists, that this approach is ageist, and is a disservice to older adults and society at large.
    In the initial response to this article, O'Hanlon, O'Keeffe & O'Neill [2], have done a comprehensive job of refuting these claims based on the science that has been coming in regarding the effects of the lockdown on older adults. We wish to contribute another angle – that of the actual preferences and values of older adults themselves. No discourse about any group in society is complete without including this group. Thus, we attempt to abide by the old adage: "Nothing About Us Without Us".
    In a recent qualitative study, we explored the personal experiences and preferences of older adults living in CCRCs (continuing care communities) in Israel during the height of the novel Coronavirus pandemic [3]. We were surprised to discover that CCRC residents in different locations in Israel were subjected to significant restrictions, and in many cases were...

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  • NIPT is the only ethical test

    Medethics-2020-106709 – see decision 23-July-2020

    NIPT is the only ethical test

    Abstract
    Bunnik et al and Schmitz interchange about the public funding of NIPT surprisingly lacks consideration of Wilson’s and Jungner’s classic principles of screening as well as broader issues relating to women’s autonomy. In addition, overall healthcare costs must be considered no matter the system of their financing (public purse, private insurance or direct cost to families).

    I have followed the interchange between Bunnik et al and Schmitz [1 – 3] because NIPT is a topic I have published on for 5 years now, most recently in English [4].
    The most important reason for making NIPT publicly funded and for it to replace First Trimester Combined (FTC) in screening is that NIPT is a much better test than FTC [4]. According to the principles laid down by Wilson and Jungner in their classic essay [5], in this situation screening should be done with a test with as low a false negativity as possible so that the pregnant can truly trust the message that she does not carry a foetus with a genetic abnormality. NIPT misses far fewer cases than FTC and is a classic rule-out test.
    Where it has been studied, the biggest unease with NIPT among pregnant women is the risk of sex-selection, that is that female foetuses are selectively aborted only because they are female [4, 6, 7]. Notwithstanding, Schmitz raises the spectre of “unease with NIPT causing discriminatory mes...

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  • Why a selective lockdown of the elderly would be unjust: A response to Savulescu and Cameron

    On the grounds that the elderly are more likely than the non-elderly to become severely unwell, require intensive, scarce and expensive and thereby put the NHS at risk of being overwhelmed, if they catch COVID-19, Savulescu and Cameron make two dubious claims. Firstly, they say that a selective, legally compulsory, lockdown of the elderly to stem a resurgence of the pandemic could be morally justifiable. Secondly, they say that such a selective lockdown would be just. They write: ‘Ethically, selective isolation is permissible. It is not unjust discrimination. It is analogous to only screening women for breast cancer: selecting those at a higher probability of suffering from a disease.’1
    I shall focus here on a response to the latter claim. To justify a particular allocation of benefits or burdens as a just allocation is different from justifying a particular allocation – whether or not it is just – in terms of its morally desirable consequences. I do not believe that a lockdown of the elderly would be morally justified by its consequences but, whether or not it would so be, it would be unjust discrimination.
    ARISTOTLE ON DISTRIBUTIVE JUSTICE AND WOMEN
    Under the heading of ‘THE IDEAL OF EQUALITY AND THE CONCEPT OF UNJUST DISCRIMINATION.’, Savulescu and Cameron write:
    ‘Aristotle described the principle of equality as treating like cases alike, unless there is a morally relevant difference. For example, if men are allowed to vote, and women are not, th...

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  • Healthcare staff wanted. No one with a conscientious objection need apply?

    Help 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.

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