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Biomedical subjects

J Savulescu

Publications and source records attributed to J Savulescu.

At least 37 records · Page 2Linked to original sources
PubMed2002

"Saviour siblings".

The Victorian Infertility Treatment Authority has given permission to allow tissue typing in combination with preimplantation genetic diagnosis. This is a new application of IVF. Not only will it allow parents to select an embryo free from serious genetic disease it will allow them to simultaneously select for a match so that the umbilical cord blood of the resulting baby can provide stem cells to treat an existing sibling who has a disease.

Child, Preschool↗
PubMed2001

Predictive genetic testing in children.

Predictive genetic testing should only be performed on children if it is in their best interests. "Interests" include psychosocial elements. Predictive testing is performed on children when there are interventions to prevent disease or to detect and treat it early and it is necessary to begin these interventions in childhood. It is also performed for diseases known to commence in childhood. Predictive testing in children for adult-onset conditions for which there is no medical intervention is highly controversial. Competent children and adolescents can consent to predictive genetic testing. Predictive testing can result in harm, such as discrimination (eg, in insurance entitlement or employment) and stigmatisation. Predictive testing can have important non-medical benefits in terms of self-knowledge and life planning.

Australia↗
PubMed2001

Competence and consent.

To perform a medical procedure on a competent patient who is refusing it may constitute battery; but to fail to perform a medical procedure on an incompetent patient who is refusing it may constitute negligence. Competence involves being able to understand the consequences of receiving medical treatment, and not receiving it, and being able to make a decision on the basis of that understanding. Competent people can sometimes make imprudent or irrational decisions. Cognitive impairment and mental illness do not necessarily render a person incompetent to consent to investigation and treatment. The suspicion of cognitive impairment or mental illness should prompt a thorough evaluation of competence and mental state. Treatment of incompetent people should be dictated by their best interests, advance directives or substituted judgement.

Aged↗
PubMed2001

Is there a future for clinical ethics services in Australia?

Clinical ethics refers to the consideration of ethical issues arising directly in the context of patient care. Health professionals are generally adept at effectively and sensitively managing ethical issues in clinical care. However, in some settings, multidisciplinary clinical ethics services may enhance clinical practice by assisting clinicians, patients and others to identify, understand and manage ethical issues. Clinical ethics services may be particularly valuable for situations in which moral perspectives diverge or communication has deteriorated. Such services may facilitate discussion and help the parties find mutually satisfactory solutions. Clinical ethics services may take various forms, including clinical ethics committees, ethics consultants, patient advocates or other mechanisms for responding to complaints and grievances. There is considerable disagreement about key aspects of clinical ethics services, including who should conduct them, how they should be run and what role they should play in decision-making.

Adult↗
PubMed2001

Taking the plunge.

Explore the source record for details and available documents.

Fees and Charges↗
PubMed2001

Is there a case in favour of predictive genetic testing in young children?

Genetic testing has brought the ability to predict the onset of diseases many years before symptoms appear and the use of such predictive testing is now widespread. The medical fraternity has met the application of this practice to children with caution. The justification for their predominantly prohibitive stance has revolved around the lack of a readily identifiable medical benefit in the face of potential psychological harms to the child. We argue that predictive testing can have important psychosocial benefits and that the interests of the child have been construed too narrowly. Proponents of a prohibitive stance also argue that testing in childhood breaches the child's future right to make the same decision as an autonomous adult and to maintain this information as confidential. We argue that predictive genetic testing of children is not necessarily a violation of the child's future autonomy. Indeed, in some cases, such testing may facilitate the development of autonomy in the maturing child. We argue that parents are generally best placed to judge what is in their own child's overall interests, and that parental request for testing after appropriate genetic counselling should be respected unless there is clear evidence that the child will be harmed in an overall sense as a result of testing.

Adolescent↗
PubMed2001

Procreative beneficence: why we should select the best children.

Eugenic selection of embryos is now possible by employing in vitro fertilization (IVF) and preimplantation genetic diagnosis (PGD). While PGD is currently being employed for the purposes of detecting chromosomal abnormalities or inherited genetic abnormalities, it could in principle be used to test any genetic trait such as hair colour or eye colour. Genetic research is rapidly progressing into the genetic basis of complex traits like intelligence and a gene has been identified for criminal behaviour in one family. Once the decision to have IVF is made, PGD has few 'costs' to couples, and people would be more inclined to use it to select less serious medical traits, such as a lower risk of developing Alzheimer Disease, or even for non-medical traits. PGD has already been used to select embryos of a desired gender in the absence of any history of sex-linked genetic disease. I will argue that: (1) some non-disease genes affect the likelihood of us leading the best life; (2) we have a reason to use information which is available about such genes in our reproductive decision-making; (3) couples should select embryos or fetuses which are most likely to have the best life, based on available genetic information, including information about non-disease genes. I will also argue that we should allow selection for non-disease genes even if this maintains or increases social inequality. I will focus on genes for intelligence and sex selection. I will defend a principle which I call Procreative Beneficence: couples (or single reproducers) should select the child, of the possible children they could have, who is expected to have the best life, or at least as good a life as the others, based on the relevant, available information.

Beneficence↗
PubMed2001

Is current practice around late termination of pregnancy eugenic and discriminatory? Maternal interests and abortion.

The attitudes of Australian practitioners working in clinical genetics and obstetrical ultrasound were surveyed on whether termination of pregnancy (TOP) should be available for conditions ranging from mild to severe fetal abnormality and for non-medical reasons. These were compared for terminations at 13 weeks and 24 weeks. It was found that some practitioners would not facilitate TOP at 24 weeks even for lethal or major abnormalities, fewer practitioners support TOP at 24 weeks compared with 13 weeks for any condition, and the difference in attitudes to TOP between 13 weeks and 24 weeks is most marked for pregnancies which are normal or involve a mild disorder. It is argued that a fetal abnormality criterion for late TOP is inconsistently applied, discriminatory and eugenic. Four possible moral justifications for current practice are examined, each of which would require significant changes to current practice. I argue in favour of a maternal interests criterion for any TOP.

Abortion, Eugenic↗
PubMed2001

Why genetic testing for genes for criminality is morally required.

This paper argues for a Principle of Procreative Beneficence, that couples (or single reproducers) should select the child, of the possible children they could have, who is expected to have the best life, or at least as good a life as the others. If there are a number of different variants of a given gene, then we have most reason to select embryos which have those variants which are associated with the best lives, that is, those lives with the highest levels of well-being. It is possible that in the future some genes are identified which make it more likely that a person will engage in criminal behaviour. If that criminal behaviour makes that person's life go worse (as it plausibly would), and if those genes do not have other good effects in terms of promoting well-being, then we have a strong reason to encourage couples to test their embryos with the most favourable genetic profile. This paper was derived from a talk given as a part of the Decamp Seminar Series at the Princeton University Center for Human Values, October 4, 2000.

Beneficence↗
PubMed2000

Determining the validity of advance directives.

We examine the ethical principles underpinning advance directives (ADs) and the legal duties of doctors in determining their validity. A physician attending an incompetent patient with an acute life-threatening illness, and an AD refusing treatment, should ensure that the AD is legally valid before making the treatment decision. Treatment against a patient's wishes, as expressed in a valid AD, compromises patient autonomy and may constitute battery. Conversely, withholding treatment in accordance with an AD that is not legally valid risks substantial harm to the patient and may constitute breach of the duty of care and negligence. Legally valid directives should be respected. If an AD is not legally valid, the patient should be treated in his or her best interests. If uncertain, the physician should treat according to the patient's best interests while seeking legal advice.

Acute Disease↗
PubMed2000

Sex selection and preimplantation diagnosis: a response to the Ethics Committee of the American Society of Reproductive Medicine.

In its recent statement 'Sex Selection and Preimplantation Genetic Diagnosis', the Ethics Committee of the American Society of Reproductive Medicine concluded that preimplantation genetic diagnosis for sex selection for non-medical reasons should be discouraged because it poses a risk of unwarranted gender bias, social harm, and results in the diversion of medical resources from genuine medical need. We critically examine the arguments presented against sex selection using preimplantation genetic diagnosis. We argue that sex selection should be available, at least within privately funded health care.

Ethics, Medical↗
PubMed2000

The ethics of cloning and creating embryonic stem cells as a source of tissue for transplantation: time to change the law in Australia.

Every day, people die because there are insufficient tissues available for transplantation. The development of cloning and embryonic stem (ES) cell line technologies offers real hope for developing better sources of tissues for transplantation. Moreover, these new technologies may mean that damaged tissue (for example, after a stroke or heart attack) can be replaced with normal functioning tissue rather than scar tissue. Research into 'therapeutic cloning' and the development of ES cell lines is illegal in several States in Australia. It is time to review that legislation in order to allow destructive embryo research. My argument is that at least research should be allowed on spare embryos from assisted reproduction; that it is only one moral view (of several plausible ones) of the status of the embryo which precludes producing embryos for research; that this view is mistaken and so it is morally permissible to produce embryos for research into therapeutic cloning.

Australia↗