News

Briefing Note: Nuffield Council on Bioethics: Ethical challenges in bioscience and health policy for the UK Parliament

 

This briefing document sets out four key ethical challenges in bioscience and health policy for the UK Parliament and suggests how these challenges can be addressed.

Four challenges, explored in greater detail in this document, include:

 

  1. Build and maintain trust in medical research and the life sciences

  2. Ensure research and innovation address the needs of society

  3. Promote responsible health policy and research

  4. Promote international leadership in bioethics

 

These challenges draw on current and previous projects including their work on genome editing, cosmetic procedures, non-invasive prenatal testing, biological and health data, the culture of scientific research, children and clinical research, donor conception, emerging biotechnologies, mitochondrial DNA disorders, solidarity, naturalness, organ donation, biofuels, personalised healthcare, dementia, public health and forensic bioinformation.

 

The briefing document, along with short summaries of the Council’s recent reports, policy briefing papers and responses to policy consultations are available here.

 

 

 

 

 



NEW BOOK: D. Jones, C. Gastmans, C. MacKellar (Eds.) Euthanasia and Assisted Suicide: Lessons from Belgium. Cambridge University Press. 2017

 

 

 

Euthanasia in Belgium – one of the only five countries where euthanasia is practiced legally – is the subject of a large body of empirical research. However, until the present volume no study has sought to draw this research together into a coherent narrative and present it to an English-speaking readership. The book includes fourteen contributions from academics and clinicians in Belgium and six from international academics. Looking at the implications of legalized euthanasia and assisted suicide from an international and interdisciplinary perspective, this panel of experts has written an in-depth analysis of the ethical aspects of this complex area, appealing to law, philosophy and medical disciplines. The discussion forms a foundation for informed debate about assisted dying and provides a useful guide to similar choices faced by other jurisdictions.

 

 

 

Click here for more information

 



2018 National Student Debate Competition

Topic: Pre-natal and pre-conception genetic screening will lead to a better society.

Deadline for uploading videos: Monday 11 December 2017.

Final to take place Saturday 17 March 2018. Venue tbc.

 

2018 Student Debate Competition - Student information sheet



Call for Abstracts - ICCEC 2018

The Organising Committee of the 14th International Conference on Clinical Ethics Consultation (ICCEC) invites you to submit abstracts that address the conference main theme or any of the sub-themes.

Abstract Guidelines

1. General Conditions

  • The deadline to submit abstracts is Friday 15th December. Abstracts received after this date will not be accepted.
  • Only abstracts submitted in English will be reviewed.
  • Abstracts should be original work that has not been previously submitted for publication or presented at another conference
  • A maximum of two (2) abstracts may be submitted per presenting author (including symposium presenters).
  • Abstracts must not exceed the word limit stated below for the respective presentation type.
  • All abbreviations must be spelled out on first use.
  • To be formally accepted, the presenter (or all presenters for a symposium) must be registered and have paid to attend ICCEC 2018 by 31st March 2018

2. Abstract Themes

Each submission should be classified into one of the following themes: Within these themes the committee will consider a broad range of content. We have provided some examples of areas that might fit within each theme for general guidance only –we encourage you to submit abstracts outside of these examples.

A. Ethical challenges in the clinic: impetus for research and learning

Example

  1. Innovation at the boundary of treatment and research What counts as innovation, and which ethical models and values should apply.
  2. Rationing in clinical practice. How resource limitations influence practice and the ethical implications of different coping

 

B.Theoretical foundations and conceptual frameworks

Example

  1. Different models of CES arising from different philosophical positions and traditions
  2. (How) can ethical theory improve CESS? Is theoretical knowledge a prerequisitefor quality in CESS?


C. Empirical ethics emerging from and informing practice

 

Example

    1. i.Evaluation of CES
    2. ii.Research on ethical challenges in specific clinical areas
    3. iii.Does clinical ethics mitigate moral distress?


D. Translating across global contexts

Example

  1. Can/should curriculums and models of CES be transferred to different global settings and cultures?
  2. Medical research in low income settings creating clinical ethical dilemmas?
  3. Does autonomy engender bioethical imperialism?

E. Translating to advocacy and policy

Example

    1. Developing/influencing policy on treatment of asylum seekers and other migrants
    2. The role of clinical ethics in national policy debates eg Physician Assisted Suicide, Organ transplantation, use of gene therapy

 

3. Types of Presentation

The preferred mode of presentation can be selected during abstract submission. The final mode of presentation for the accepted abstracts will be determined by the Scientific Committee.

Oral Presentations and case studies

  • Presenters will be allocated 20 minutes to present and engage in discussion
  • Abstract Word limit: 300 words

Case studies

  • Presenters will be allocated 30 minutes to present and engage in discussion
  • Abstract Word limit: 300 words

Symposium

  • Presenters will be allocated 1 hour for a panel discussion
  • Up to 4 panellists, in addition to the Chair, are permitted for the symposium.
  • Abstract Word limit: 500 words (inclusive of a summary of each panellist’s topic)

Poster Presentation

  • There will be a dedicated area and timeslot for poster presentations and interactions with delegates
  • Abstract Word limit: 300 words

Registration for Abstract Submission

 

When following the link to submit an abstract you will be re-directed to a site that is Institute of Medical Ethics branded.  If you have not used this site previously you will be required to register before being able to enter an abstract.  One you have registered you will be able to log back in to add more to your abstract and/or edit existing content up until the point where you click to submit.

IMPORTANT – When submitting an abstract please start the title with the letter associated with the theme that you are submitting under ie:
A – Ethical challenges in the clinic: impetus for research and learning
B – Theoretical foundations and conceptual frameworks
C – Empirical ethics emerging from and informing practice
D – Translating across global contexts
E –Translating to advocacy and policy

 

Please have the following details of the Author and Co-Authors ready for the abstract submission

  1. First Name
  2. Last Name
  3. Country
  4. Institution/ Organisation
  5. Profession

Abstract Receipt Confirmation

Upon successful submission, the main author will receive an automated acknowledgement via email.  No further action is required. 

Following the conference accepted abstracts will be published in the Journal of Hospital Ethics with the authors consent.


 

Bursaries

 

The organisers of ICCEC 2018 are delighted to be able to provide a number of bursaries to attend the conference for delegates from both the UK and overseas.

The Institute of Medical Ethics (IME) are extending their Conference Grant Scheme to cover UK based undergraduate medical students and UK based postgraduate students studying for their MA, MPhil or PhD in medical ethics or bioethics (and includes F1 & 2 doctors). 

Important Dates

Important dates

Closing of abstract submissions

Friday 15th December 2017

Notification of acceptance

Friday 23rd February 2018

Confirmation of acceptance

Friday 9th March 2018

Launch of early bird registration rate

Friday 5th January 2018

Deadline for bursary applications

Friday 23rd February 2018

Deadline for early bird registration rate

Friday 20th April 2018

Deadline for standard registration rate

Friday 15th June 2018



IME Elective Bursaries: Transitional round of bursaries to be awarded for 2018

DEADLINE EXTENDED!

Closing date extended to: 00.59 pm Sunday 22 October 2017

Students to be informed of outcome by: Tuesday 5 December 2017

This is for elective bursaries to be awarded for 2018.

The latest application form and guidelines for this round are available on the awards page of the website, along with an additional document entitled Research methods in medical ethics - IME guidance for Elective Bursary Projects which we would encourage applicants to read. Please use only these documents for this round.

(Please note: If you are already in receipt of an IME bursary, this notice does not apply to you.)



PET Report: Basic Understanding of Genome Editing

 

The Progress Educational Trust has just published their report entitled Basic Understanding of Genome Editing. The report summarises the findings of a project they carried out with their fellow charity Genetic Alliance UK, funded by the Wellcome Trust. The project explored what patients and laypeople think and know about genome editing and its implications, and developed recommendations for how best to discuss genome editing in public.

Click here

 



Speaker slides & delegate handbook now available to view: Ethics Education after Medical School 5 June 2017, St Catherine's College, Oxford

Click on Resource centre to view.



Undergraduate conference report by IME grant recipient, Simrit Kudhail

KUDHAIL Image_presentationSimrit is a 4th year student at University of Birmingham who was awarded IME funding to enable him to attend & present at the UNESCO 12th World Conference in Bioethics on 21-23 March in Limassol, Cyprus

The UNESCO Bioethics conference was established to provide academics and healthcare professionals from a wide range of fields with a forum to discuss prevalent and emergent issues of bioethics, healthcare ethics and medical law. Conference attendees represented many different countries and professions, allowing cross-disciplinary and cross-cultural presentations and discussions of these issues, with the aims of raising awareness and presenting novel ideas or possible solutions to a range of ethical issues.

I attended the conference to present the research I conducted during my Healthcare Ethics and Law intercalation year at the University of Birmingham, in which I discussed whether religious patients should be considered autonomous in their decision-making. I hoped that by discussing my research with experts in the field, I would gain a valuable insight into the strengths and limitations of my work, allowing me to develop it further before aiming for a publication. I also hoped to hear others' research on autonomy and see whether my notions of autonomy were similar that of the other presenters, and also whether my research was applicable to their presentations. In this report I reflect on the presentations concerning patients' autonomy and their implications on my own research.

My main area of reflection concerned the difference in the use of autonomy between myself and the other presenters; where my research intended to provide a theoretical revision of autonomy as a rational concept, others' presentations concerned autonomy as a practical principle that all patients ought to have. One such presentation by a Sudanese doctor discussed the rights of adolescents in decision-making in Sudan (Ebtihal Eltyeb, Saudi Arabia). Her presentation eluded to the use of something similar to Gillick-Fraser competence, but it was interesting to hear her attempts to establish a criteria by which adolescents could be given the right to their own healthcare decisions whilst also managing complex cultural traditions (for example examination by doctors of the opposite sex). Another presentation by a British academic discussed the use of a new toolkit (the Mental Capacity Assessment Support Tool, M Jayes, University of Sheffield) which allows healthcare professionals to ensure patients have the capacity to make their decisions. Once again this used autonomy as a practical principle, using Beauchamp and Childress' concept of autonomy as freedom from external influence, achievable through capacity and informed consent.

In this respect, my research was significantly different. I felt a to think theoretically to determine if religious and cultural beliefs were philosophically compatible with autonomy by critiquing whether philosophical accounts of autonomy allowed external influences on decision-making. To do this, I had to move away from the use of autonomy as freedom from external influence, as religion and cultural traditions are themselves external influences. All of these accounts suggested autonomy needed some rational aspect in the decision-making process, whether it is hierarchical desires, coherence with other beliefs, or normative competency. Therefore my research concluded that theoretically, religious or cultural beliefs that have undergone some rational critique can be considered autonomous – a process which I called rational consideration. Thus my presentation was theoretical instead of practical, and concerned autonomy itself rather than the practicalities of decision-making.

The difference in definition was made clear after my presentation, as the first questioner asked "but is autonomy actually rational?" To me, this made it clear that many people do not see autonomy as a property in its philosophical sense, and instead use the word autonomy as a synonym for the patient's own choice which does not necessarily involve a rational component. Thus my reply to the question had to make it clear that I felt our current view of autonomy has moved too far from its philosophical origin, as autonomy is necessarily rational, and I therefore felt non-rational decision-making cannot be considered autonomous. Replying to this question sensitively was one of the hardest aspects of the presentation, and this stressed the importance of making this ethical distinction clearer in my development of this research.

Alongside talks on autonomy, I also attended the sessions run on medical ethics education, disaster ethics, and ethical implications of end of life treatment. One of these presentations - 'Mediating Religious Objections to End-Of-Life Care' (Kartina Choong, University of Central Lancashire) - explored the use of mediation between families and medics as a way to overcome possible conflicts between the religious beliefs of the patient or the patient's family and the medical team. Interestingly this research reached a similar conclusion to my own, in suggesting accepting dissent of treatment on the grounds of their perceptions of their religious belief is not necessarily the right option. Instead, the process of mediation allows the medical team and the patient's family to explore the beliefs in question, and discuss the best outcomes for the patient. This process is in essence similar to the process of rational consideration which I suggested was necessary to ensure decision-making based on religious influence can be considered autonomous; the difference being that the rational process in Choong's research is done by a group on behalf of an individual, whereas rational consideration as I described it is done by the individual themselves.

Whilst this report focuses on autonomy and religious belief, it was inspiring to see a wide range of people discussing a variety of topics concerning medical ethics. Attending a conference with the primary aim of exploring issues in bioethics, healthcare ethics and law across the world has made it clear that medical ethics is incredibly relevant in today's society, and it is becoming more significant globally Yet the cultural diversity we see means that one solution for a given problem isn't always possible, and cultural beliefs and practices affect the ethical issues we will face. Thus it is important we discuss these issues globally in an attempt to find the best solutions possible at that time, and plan for future developments in medical ethics.



Postgraduate conference report by IME grant recipient, Helen Smith

Helen is a PhD student, University of Bristol, who was awarded IME funding to enable her to attend CEPE/ETHICOMP 2017: Values in Emerging Science & Technology on 5-8 June in Turin, Italy

Ethicomp is a series of conferences which consider computer ethics conceived broadly to include philosophical, professional, and practical aspects. It has held conferences since 1995 in Europe and Asia. CEPE (Computer Ethics and Philosophical Enquiry) has been running since 1997 and is more narrowly focussed on the philosophical aspects of computer and information ethics. The CEPE/Ethicomp 2017 was the third joint event which they have held, this time kindly hosted by the Department of Law at the University of Turin, Italy, from 5-8 June 2017.

Around 100 delegates attended; I met professionals, students and academics from Europe, Asia, Australia and North America. The interdisciplinary ethos meant that there were contributions brought from a variety of sectors such as computer scientists, policy makers, lawyers, ethicists, philosophers, social scientists, gaming as well as health technology. The warm, friendly and supportive attitude within the attending community encouraged space for constructive feedback after presentation of each contributor's paper.

Those presentations which were specifically relevant to the medical ethics community included:

Katleen Gabriel's presentation "Between 'Entertainment Medicine' and Professionalization of Healthcare: An Interview Study of Belgian Doctors" identified the rise in enhanced selfcare utilising new technology e.g. blood pressure monitoring, blood sugar monitoring. Her study asked Belgian GPs and Cardiologists how they'd felt about the rise of the use of digital tracking. Patients wanted more dialogue with their doctors and did not wish for the technology to surpass their physician's expertise. Unreliable tech had made one cardiologist angry as it was taking his time away from people who had genuine needs. Drs did not feel that they were losing their authority to tech, but were afraid of the data overload and loss of context. Overall, with data gathered, one can have a clear and more accurate conversation with patients. But the time saved will probably get used to see extra patients rather than spending more time with the individual patient.

Frances Shaw's presentation of "Ethics in the design, research, and evaluation of mHealth and eHealth solutions for mental health: a qualitative study of a research institute" reported on the ethical development she has been doing for the Socialize App (a smartphone app which associates changes in social networks over days/weeks may indicate mental health problems developing) which is in early prototyping. There is concern for the maintenance of privacy as GPS data discloses the home and workplace of individuals and that this data creation is passive and opposite to the act of active and willing disclosure of illness; that disclosure is made on behalf of the individual rather than by the individual which interferes with the person's agency. She identified that Big Data is shaping our state of being and that we should anticipate the development and then theorise the ethics before application rather. For example; there is no identification of the responsibility of initiating the intervention for the person who has been identified as being at risk of being mentally unwell- who should respond once the app has raised the alarm?

David Krep's and Oliver Burmeister's presentation of "I am a Person" spoke of how we are both radically contingent and unique, that in age related cognitive decline the physical motor accompaniment to our mental and emotional lives begins to deteriorate. Value Sensitive Design (VSD) seeks to explicitly support human values in assistive technologies. Through this, power can be identified in an intentional way which will help with the realisation of a society in which technology is a force for empowerment rather than for domination.

I would like to take this opportunity to thank the Institute of Medical Ethics for making it possible for me to attend this event.



National Student Debate Final 2017

A huge well doneto Queen's University Belfast, who battled it out against University of Warwick to emerge the winners of the National Student Debate Final on Saturday 25 March in Manchester.The motion was: UK medical graduates should either work for the NHS for four years or pay back the cost of their education after graduation.

Congratulations Queen's! ... and well done to Warwick for being worthy opponents.

Thank youtoall the teamswho entered and reached the final: Queen's University Belfast, University of Exeter, University of Manchester, University of Leeds, University of Warwick, Hull York Medical School, St George's University London & University of Sheffield.

Huge thanks too to our panel of judges: Georgia Testa, Bryan Vernon, Pirashanthie Vivekananda-Schmidt, Andrew Papanikitas, Demian Whiting, Sarah Carter, Anne Slowther & Vivienne Crawford.

Details of next year's National Student Debate Competition will be announced later this year.

Queens Belfast_winning_team

Winners! Queen's University Belfast

Exeter runners_up

Runners-up, University of Exeter



Posters by Titilopemi Oladosu, King's College London

Titi is a past recipient of an IME Elective Bursary which enabled her to travel to Nigeria in 2013 for her project entitled: Ethico-Legal Issues and Nigeria's Mental Health Act: Health Workers' Perspectives. This was a qualitative study focusing on health workers' perspectives of the 'lunacy act' in Nigeria, and the ethico-legal issues which arising from implementation (or lack) of the act. Titi's work involved one-to-one interviews with members of the Ministry of Public Health, health practitioners, and NGOs focusing on mental health.

Take a look at her excellent posters below highlightingthe project.

Titi orally presentedat The World Psychiatry Association International Congress, November 2016 in Cape Town, South Africa.

In poster form,her work has been presented at the Royal College of Psychiatry International Conference 2014 and the Royal College of General Practitioners National Conference 2016.

Pathway to Care - Exploring Accessibility & Delivery of Mental Healthcare in South West Nigeria

Mental Health Ethics & Law in South West Nigeria



Elective Report by Laura Shorthouse, 4th Year Medical Student, University of Liverpool

Below is Laura's report following her recentIME elective in Zambia earlier this year ......

A personal reflection of ethical dilemmas encountered, and the cost-benefit analysis to Livingstone Central Hospital in Zambia for hosting my elective in maternal, neonatal and child health.

During my five-week elective I gained hands-on experience in maternal, neonatal and child health at Livingstone Central Hospital, and in three local community districts served by the hospital - Linda, Maramba and Mwandi. Working days contained rich and varied learning opportunities to accomplish my goals and professionally develop, but also, provided powerful ethical dilemmas and lessons in people, life and myself, forever shaping my future medical career and character.

Ethical dilemmas

I was introduced to the labour ward on my first day, which was an unforgettable first impression. From the initial ethical 'horror' I felt and not wanting to return to the ward, to the in-depth personal and professional thinking it evoked, to finally overcoming it- it was a life changing experience in growing as a future doctor and person. In a large curtain-less room three women were giving birth in silence and shouted at when they made a noise. The first delivery I witnessed in Africa was stillborn twins.

They were left for over five minutes unwrapped on their mother's lap while the midwives cleaned the floor. They were then disposed, without any opportunity to say goodbye. I wanted to comfort the mother but felt it an inappropriate first impression. Instead, I stood there shocked holding back tears. I found this opening hour to 'obstetrics in Africa' cruel, insensitive, detached and degrading with no patient empowerment. I did not want to go back and play any further part.

As the initial shock of witnessing a different cultural and geographical approach to labour eased, I shamefully realised I was being judgemental. I was impinging my ideology of ethical practice onto others, disregarding their culture and traditions as though the ' west' approach was best. I was determined to overcome this dilemma by returning to the ward and learning more about their culture and ideology. I came to understand that Zambian women have adopted a tough 'carry on' exterior because sadly losing a baby is more of the 'norm' in their culture than mine, as well as them feeing grateful to still be alive post childbirth- to them it is the best way of moving forward. They prefer silence because it is important for them to introduce their baby into a calm environment. Being silent is their personal, empowering and autonomous choice, rather than the oppressive, degrading and paternalistic one I wrongly assumed. Subsequently whilst this was foreign to me, I had chosen to work here and believed it important to respect their wishes and culture moving forward. I therefore felt I was subconsciously empowering my patients and respecting their autonomy thus providing good medical practice; albeit in a very different way to home.

The English language, whilst the official language of Zambia and that of medicine, was predominately limited to wealthy well-educated families, or young children benefiting from international volunteering projects teaching English. Consequently there were several occasions, notably obstetrics and gynaecology, where I needed translators. These were not third party impartial translators like in the UK, but either other doctors, the patient's family or their own children. Where possible I would have preferred doctors, however I did not want to ethically burden my overworked and understaffed host, so relied mostly on the latter two. Taking obstetric and gynaecology histories involve asking many sensitive, intimate and personal questions, which I found not only uncomfortable asking others but took longer. I overcame this discomfort by remembering it was necessary to gather information to treat effectively. In paediatrics, I tried to obtain the history from the child which given their good level of English was more possible and I preferred.

Zambian doctors rarely introduced themselves to the patient, asked how the woman or child was, or sought consent appropriately. No curtains separated the beds and handwritten patient notes were left on makeshift tables often next to the wrong person visible for all to see. Doctors would discuss patients loudly for others to hear and examine them in full view on the ward. Whilst I could not change this practice, I conducted myself in the manner I would back home with some improvisation where necessary. I always introduced myself especially explaining why I was working in the hospital, spoke quietly so only the patient could hear, and asked a colleague to hold a sheet up around the patient's bed when I wanted to examine them privately.

Medical tourism: cost-benefit analysis

I believe my elective benefited the hospital and population it served. Livingstone Central is adjusting to a significant time in its history and facing added pressures that come with a tertiary status. I was an enthusiastic and highly active team player getting involved, and providing teaching opportunities for clinicians to undergo professional development especially on ward rounds. I also impacted my knowledge and experience, which having just completed and passed my medical school finals was of a high standard, and therefore, I believe I facilitated a mutual learning environment. I worked within my competency independently clerking and monitoring patients with minor complaints, so senior clinicians could attend to major complaints and emergencies. I therefore crucially alleviated staffing problems safely without compromising reputations or the work of other staff members.

However, despite only asking the doctors to translate when no-one could speak English I felt guilty for creating extra work for them. Subsequently, if patients could speak some English I preferred to spend longer taking a history than asking the doctors. I would advise medical students to act this way, learn some local/ tribal language where possible, and be acquainted with a place's culture/ customs before arriving.

Conclusion

A complex relationship exists between medical ethics and external influences. Successfully navigating cross-cultural medical ethics requires sensitivity, non-judgemental attitude, and enhanced communication and clinical skills. Through a rich and enjoyable personal elective experience, this study supports the evidence-base 8-10 that electives in developing countries can be beneficial to all.

Word count (997- excluding title, acknowledgement, references)

Acknowledgement

Thank you to the 'Institute of Medical Ethics' for a Medical Elective Bursary.

References

The CIA world fact book (2016) 'Zambia' https://www.cia.gov/library/publications/the-world-factbook/geos/za.html. (Accessed 26th August 2016)

World Health Organisation (2012) 'Country cooperation strategy at a glance: Zambia'. http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_zmb_en.pdf (Accessed 26th August 2016)

World Health Organisation (2016) ' Zambia' http://www.who.int/countries/zmb/en/ (Accessed 26th August 2016)

World Health Organisation (2015) 'Zambia: WHO statistical profile' http://www.who.int/gho/countries/zmb.pdf?ua=1 (Accessed 26th August 2016)

Unicef (2016) ' Zambia: HIV and Aids' http://www.unicef.org/zambia/5109_8459.html (Accessed 26th August 2016)

Our Africa (2016) 'Poverty and Healthcare' http://www.our-africa.org/zambia/poverty-healthcare (Accessed 26th August 2016)

Post Zambia ( 2015) 'L/stone hospital starts operating as tertiary medical institution' http://www.postzambia.com/print.php?id=3441 (Accessed 10th November 2015)

Ackerman LK. The ethics of short-term international health electives in developing countries. Ann Behav Sci Med Educ2010;16:403

Hanson L, Harms S, Plamondon K. Undergraduate international medical electives: some ethical and pedagogical considerations. J Stud Int Educ 2011;15 (2):17185.

Banerjee A et al, Medical student electives: potential for global health?Lancet 2011;377 (9765):555.



Report of Intercalated Project by Toni Saad, MA in Bioethics and Medical Law, St Mary's University, Twickenham

Iam grateful to the IME for their awarding me the intercalated degree grant for my research project into euthanasia in Belgium. Below is a summary of my dissertation, which, I am pleased to report, received the highest mark ever awarded a dissertation on the MA programme at St Mary's (91%).

THE PATH OF LEAST RESISTANCE? HISTORICAL, POLITICAL AND PHILOSOPHICAL CONTEXT OF THE BELGIAN EUTHANASIA EXPERIENCE

Abstract

Following the Netherlands by a few months, Belgium is the second nation worldwide to decriminalise voluntary euthanasia. It did so in 2002 with the passing of the Act on Euthanasia, though euthanasia was relatively widely practiced in Belgium beforehand. Moreover, the Act did not put an end to illegal practices in regard to euthanasia: much euthanasia remains unreported, and non-voluntary euthanasia and physician-assisted suicide, both of which are illegal, continue to occur. Chapter One of this dissertation considers the state of affairs concerning euthanasia prior to and after the 2002 Act, and traces its development and influences. It shows that the process which preceded the decriminalisation of euthanasia was expedited by political motive, and that the Act itself suffers from conceptual flaws. Chapter Two places this Belgian euthanasia experience in its historical-philosophical and political context. It begins by outlining one influential ethical tradition, Aristotelian-Thomism, and describing how departure from it has radically changed the nature of moral philosophy, and, consequently, the fabric of moral debate. Furthermore, it argues that in the social context of political liberalism, the Belgian euthanasia experience and similar phenomena are somewhat inevitable developments. Analysis of the changing nature of moral debate confirms that, though it is very difficult to achieve moral consensus today, trends in moral philosophical thought nevertheless run in definite directions. It is concluded, therefore, that the Belgian euthanasia experience is a single symptom of broad and powerful changes in moral and political philosophy.

Chapter One: The Belgian Euthanasia Experience: Historical and Political Review of a Law unto Itself

In this first chapter I considered the historical and political development of the Belgian law on euthanasia, beginning with the practice of euthanasia before the 2002 law was passed. I examined this law in detail, and traced its evolution, and compared euthanasia practiced before and after its passing into law. Here is a quote from my conclusion of chapter one: "The 2002 Act on Euthanasia was a rushed and deficient piece of legislation which served to justify a pre-existent practice. In a sense, it was a mere formality, though one strongly influenced by the political climate, rather than interested parties. The Act suffers from conceptual and practical shortcomings and remains significantly under-enforcedonly half of all cases of euthanasia are reported. The later amendments it has undergone, particularly that of 2014 concerning the repeal of an age restriction on access to euthanasia, reflect the existence of a strong political will to liberalise euthanasia. And, as in 2002, calls to amend the law did not come from interested parties. At present, euthanasia in Belgium remains a concern because physicians do not abide by the law in terms of reporting euthanasia, continue to practise physician-assisted suicide and, most worryingly, non-voluntary euthanasia."

Chapter Two: The Moral and Political Context of the Metamorphosis of Bioethics

The second chapter takes a broader look at the phenomenon of the Belgian euthanasia experience (BEE), and sets it in its philosophical context. I consider one significant ethical tradition (that embodied by Aristotle, Thomas Aquinas and John Finnis) and describe how departure from it leads almost inevitably to the multiplication of phenomena like the BEE. I consider thin theories of good in the light of this, and explain them in the context of a concurrent evolution in political theory. These changes are then considered in terms of how they bear on contemporary bioethical discourse and debate.

Here is the conclusion to which I come: "the BEE is not an isolated or even a surprising phenomenon. It is the product of an anaemic moral philosophy which has abandoned a substantive notion of human goods. Into the resulting vacuum has entered a conceptually-thin formally rational debate, coupled with shifts in political ideology which seek to place morality in the hands of individuals rather than the State. Ethical discourse is changed unrecognisably as a result...The fact that euthanasia was relatively widely practised before it became legal, and before any significant public debate occurred on the subject, is evidence of the psychological influence of this moral evolution. It is only a society with a very narrowly redefined axiology which can tolerate such widespread transgression of the basic good of life. And it is only a formally rational terrain of debate which can allow such actions to be rationalised in law in order to maximise individual autonomy. That euthanasia continues to go unreported in Belgium, and that there was such a strong political will for its passing into law, is additional evidence of Belgian society's desire for something which was once unthinkable. And the decision to extend the scope of euthanasia to include children is due to the projection of paper-thin axiological values onto the youngest and most vulnerable members of society..."



Conference Report: Centre for Ethics in Medicine, University of Bristol

Below isa post-conference report by two recent Institutional Grant recipients, Rachel Gallagher & Charlotte Mills, University of Bristol, following their Bioethics Conference on 13 April 2016.

Well worth a read as it focusses on a very interesting topic which is not often discussed.

Centre for Ethics in Medicine, School of Social and Community Medicine

University of Bristol

Bioethics conference 2016: Gender, Relationships and Equality

Report for the Institute of Medical Ethics

The conference 'Gender, Relationships and Equality' was an exploration of how medical and social notions of gender affect our relationships. The topic covered a broad range of areas: intersex, fatherhood, prenatal testing, surrogacy and the future of medicine. The audience was mostly students, including bioethics students from the University of Bristol and University of Birmingham, and nursing students from the University of West England.

Dr Sorcha Ui Chonnachtaigh (Keele) presented the first talk on 'the parent-child relationship and decision-making regarding surgeries on intersex children.' This taught us to modernise our conception of gender, as we learnt that it is not a binary notion. This increased our awareness of related issues, and gave us insight into how to address such situations that may arise in our future careers with sensitivity.

Next, Dr Jonathan Ives (Bristol) gave a presentation on 'fathers and reproduction: rights, interests and relevance.' He discussed the different approaches taken by different European countries with regards to abortion and reproductive technologies, and highlighted some key issues about potential inequalities. This encouraged us to analyse the current healthcare approach to pregnancy with more consideration of the father.

Dr Sandi Dheensa (Southampton) continued with the theme of the role of the father, speaking on 'men's involvement in prenatal genetic/genomic testing.' This highlighted conflicts between a need to include fathers in prenatal healthcare, and protection of mothers in instances with potential domestic abuse. Interestingly, 30% of domestic violence starts during pregnancy.

Our final speaker was Dr Katherine Wade (King's College London) who discussed 'improving the surrogacy framework in the UK: a children's rights perspective.' This was especially interesting as it provided an alternative perspective on a topic that the majority of the audience had been studying throughout this year. Dr Wade highlighted how the current law on surrogacy is ineffective as it conflicts with the best interests of the potential children that are brought about in this way.

To finish we were joined by Professor Lois Bibbings (Bristol), for a panel discussion on why bioethics should be concerned about gender, chaired by Dr Zuzana Deans (University of Bristol). Discussion focused on feminist approaches to bioethics, and how these could shed light on issues around gender that may arise in our future careers as doctors and nurses. There was active participation from the audience, including group discussion, which raised some key issues about gendered pay structures and (in)equality of opportunities.

Overall, the discussions throughout the day displayed diverse opinions and disciplinary perspectives on a variety of issues regarding 'Gender, Relationships, and Equality.' The conference was thoroughly enjoyable, and beneficial to all. We would like to express our gratitude to the Institute of Medical Ethics for making this valuable learning opportunity possible.

Rachel Gallagher and Charlotte Mills

Student Representatives, Bristol BSc Bioethics programme



The Messiness of Medicine by Daniel Sokol

Written with medical ethics educators in mind, this BMJ blog piece by Daniel Sokol, Barrister & Medical Ethicist, can be found in our Resource centre.



IME Education Conference 11 March 2016 Speaker Presentations

Presentation slides by Dr David Molyneux & Prof Susan Bewley are available in our Resource Centre.Pleasedo not use or copy without author attribution.



100 Cases in Clinical Ethics and Law, Second Edition

Carolyn Johnston, Penelope Bradbury

Available from 14 January 2016: Paperback 22.99 eBook 16.09 eBook Rental 10.00

Summary

A 30-year-old Polish lady is admitted in labour. This is her first pregnancy and she is full term. She is in a lot of pain, her liquor is stained with meconium and the trace of her baby's heart is classified as pathological. Her grasp of English is limited. You have been asked to obtain her consent for a caesarean section

100 Cases in Clinical Ethics and Law explores legal and ethical dilemmas through 100 clinical scenarios typical of those encountered by medical students and junior doctors in the emergency or outpatient department, on the ward or in a community setting. Covering issues such as consent, capacity, withdrawal of treatment, confidentiality and whistle-blowing, each scenario has a practical problem-solving element, encouraging readers to explore their own beliefs and values including those that arise as a result of differing cultural and religious backgrounds. Answer pages highlight key points in each case, providing advice on how to deal with the emotive issues that occur when practising medicine and guidance on appropriate behaviour.

  • Covers all the topics of the IME core content of learning (2010)

  • Contains input from consultants, lawyers, religious leaders and healthcare professionals

http://www.amazon.co.uk/Cases-Clinical-Ethics-Second-Edition/dp/1498739334