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Biomedical subjects

John Harris

Publications and source records attributed to John Harris.

At least 73 records · Page 4Linked to original sources
PubMed2002

Audit of long-term mortality and morbidity outcomes for carotid endarterectomy.

There have been no Australian studies of long-term mortality status and cause of death after carotid endarterectomy (CEA) or, for survivors, quality-of-life. We first determined rate and cause of death for a cohort of patients four years after CEA. Surviving patients were surveyed to ascertain health status, using MOS SF-36. Of 238 patients who underwent CEA in our health service in 1995, 44 (18.5%) had died within four years. The majority of deaths (61.4%) were attributable to vascular causes. Of the surviving 162 patients (survey response fraction 90%), 10 (6.2%) subsequently had suffered a non-fatal stroke in the four years following their CEA. With respect to health status, Physical Functioning scores differed significantly by age (t = 2.65, df = 149, P = 0.01) as did Role Physical scores (t = 2.10, df = 142, P = 0.04). We conclude that patients undergoing CEA are at high risk of dying from vascular causes, inviting concerted efforts in discharge planning to co-ordinate optimal vascular risk factor management.

Aged↗
PubMed2002

Extending human lifespan and the precautionary paradox.

This paper argues that a precautionary approach to scientific progress of the sort advocated by Walter Glannon with respect to life-extending therapies involves both incoherence and irresolvable paradox. This paper demonstrates the incoherence of the precautionary approach in many circumstances and argues that with respect to life-extending therapies we have at present no persuasive reasons for a moratorium on such research.

Aging↗
PubMed2002

Law and regulation of retained organs: the ethical issues.

Organ retention has been with us for millennia. Walk into virtually any cathedral and many a church in Europe and you will find an array of retained organs or tissue, allegedly originally the property of assorted saints, or even of God, and almost certainly collected without proper informed consent and retained in less than secure conditions. In our own time the complexities of organ collection, retention and use have proliferated. The events at Alder Hey Children's Hospital and the debates about the ethics of biobanking all over the world have dramatically highlighted the complexity, the difficulty and the moral importance of these issues. Some of these issues have to do with the question of who can give permission for or consent to such removal and retention. Other issues involve consideration of whose rights or interests are engaged when cadaver organs and tissue are removed and retained, just what in particular is the nature, extent and force of those rights or interests, and how they are to be balanced against other moral considerations. These questions are the subject of this paper. We will not, however, here be concerned with the issues of genetic privacy, the security of genetic information.

Advance Directives↗
PubMed2002

Commentary on Skene and Parker: the role of a church (or other ideologically based interest group) in developing the law--a plea for ethereal intervention.

This paper discusses the provocative views of Skene and Parker as to the role of religious or other ideologically based interest groups in law and policy making. We draw distinctions between doctrine and prejudice and between argument and ideology which we trust take the debate further. Finally we recommend an ethereal, democratic, and populist partial solution.

Abortion, Legal↗
PubMed1999

Restoring natural function: access to infertility treatment using donated gametes.

Fertility services are the only area of medicine in which health professionals are required by law to make social judgements about a person's suitability for treatment. The Human Fertilisation and Embryology Act of 1990 imposes restrictions on access to licensed fertility treatment based on social judgements about the probable welfare of any resulting child. In this paper, it is argued that just as social judgements are inappropriate in other contexts, so they are in the context of fertility treatment. Furthermore, the ambiguous requirement for concern for the welfare of the resulting child simply does not provide a just and ethically defensible solution to the problem of access to licensed fertility treatment. born as a result of the treatment (including the need of that child for a father) and of any other child who may be affected by the birth treatment.

Journal Article↗
PubMed1999

Justice and equal opportunities in health care.

The principle that each individual is entitled to an equal opportunity to benefit from any public health care system, and that this entitlement is proportionate neither to the size of their chance of benefitting, nor to the quality of the benefit, nor to the length of lifetime remaining in which that benefit may be enjoyed, runs counter to most current thinking about the allocation of resources for health care. It is my contention that any system of prioritisation of the resources available for healthcare or of rationing such resources must be governed by this principle. This can have apparently paradoxical conclusions in that it can seem wasteful to give someone with a very slim chance of a lifesaving treatment the same priority as someone with a much better chance. In an important and thoughtful recent paper, Julian Savulescu has concentrated on this apparent weakness and has argued for a particular conception of the good or benefit to be achieved by a healthcare system which purports to demonstrate the inadequacies of an equal opportunities approach to prioritisation and to replace it with an altogether better account. This paper will show that a rational 'reasons based consequentialism' is more in line with the equal opportunities approach, which I defended some time ago in these pages, than with that of Savulescu. I shall then examine more closely the conception of equal opportunities in health care and show that if we give weight to an individual's reasons, and what is expected to be good for them, we will opt for exactly the equality based account of distributive justice that I have recommended.

Delivery of Health Care↗
PubMed1999

The concept of the person and the value of life.

The concept of the person has come to be intimately connected with questions about the value of life. It is applied to those sorts of beings who have some special value or moral importance and where we need to prioritize the needs or claims of different sorts of individuals. "Person" is a concept designating individuals like us in some important respects, but possibly including individuals who are very unlike us in other respects. What are these respects and why are they important? This paper sets out to answer these questions and to develop a coherent and useful concept of the person.

Animal Rights↗
PubMed1996

What is the good of health care?

This paper sets out to discuss what precisely is meant by "benefit" when we talk of the requirement that the health care system concern itself with health gain or with maximising beneficial health care. In particular I argue that in discharging the duty to do what is most beneficial we need to choose between rival conceptions of what is meant by beneficial. One is the patient's conception of benefit and the second is the provider's or funder's conception of benefit. I argue that it is the patient's conception of benefit which is paramount and that if this is followed it commits us to a conception of patient care which must be blind to prognosis in so far as prognosis is thought to bear upon issues of prioritisation or resource allocation.

Altruism↗
PubMed1994

Does justice require that we be ageist?

This paper restates some of the principal arguments against an automatic preference for the young as advocated by Kappel and Sandøe, arguments many of which have been extant for over a decade but which Kappel and Sandøe largely ignore. It then goes on to demonstrate that Kappel and Sandøe's "indifference test" fails to do the work required of it because it can be met by unacceptable conceptions of justice. The paper develops a number of new arguments against what I have called "ageist" preferences for the young or for those with long life expectancy. Finally I show that Kappel and Sandøe must believe that murdering older people is less morally wrong than murdering the young and that people relying on arguments such as theirs will have to accept the moral respectability of killing the innocent in order to maximise units of lifetime.

Adult↗
PubMed1993

Is gene therapy a form of eugenics?

If, as I believe, gene therapy is in principle ethically sound except for its possible connection with eugenics then there are two obvious ways of giving a simple and straightforward answer to a question such as this. The first is to say "yes it is, and so what?" The second is to say "no it isn't so we shouldn't worry". If we accept the first of the above definitions we might well be inclined to give the first of our two answers. If on the other hand, we accept the sort of gloss that Ruth Chadwick gives on Galton's account, "those who are genetically weak should simply be discouraged from reproducing", either by incentives or compulsory measures, we get a somewhat different flavour, and one which might incline a decent person who favours gene therapy towards the second answer.

Persons with Disabilities↗