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Biomedical subjects

Julian Savulescu

Publications and source records attributed to Julian Savulescu.

At least 37 records · Page 2Linked to original sources
PubMed2003

An ethical approach to giving couples information about their fetus.

The amount of information available to couples about the health of their fetus is increasing. An important question in prenatal diagnosis is what information should be given to couples, and how best to present it. It has been argued elsewhere that, in the absence of economic constraints on testing, there is no place for limiting the information available to couples about their fetus. However, not every couple wants all available information, and it is not always clear what couples do want to know. Providing unwanted information about the health of a fetus may be harmful in a number of ways. Herein, the potential harms of being given unwanted information about one's fetus are illustrated by using case studies drawn from clinical practice, and a new approach to prenatal diagnosis is suggested. If the harms of being given unwanted information about one's fetus are to be avoided, then couples need an opportunity to limit the data gathered about their fetus at prenatal diagnosis.

Chromosome Aberrations↗
PubMed2003

Prenatal diagnosis for "minor" genetic abnormalities is ethical.

Is it justified to detect minor genetic aberrations before birth and terminate pregnancies based upon such information? We present the case of a woman who wanted Prenatal Diagnosis (PND) to detect whether her female fetus was a Haemophilia mutation carrier. Such carriers are usually healthy. She wished to eradicate the Haemophilia mutation from her family to avoid future generations being affected and to protect her children from having to go through PND themselves. We explore existing guidelines, public attitudes and possible objections to providing PND for minor abnormalities. We argue that in a society where couples have considerable autonomy relating to decisions about the fetus at least until viability, the routine restriction of PND for minor genetic abnormalities would be an unjust infringement of individual liberty.

Abortion, Eugenic↗
PubMed2002

Carers, ethics and dementia: a survey and review of the literature.

BACKGROUND: Much has been written on ethical issues in dementia, but usually from the point of view of the various professionals involved. Whilst there has been an increasing amount of interest in the psychosocial problems that face the carers of people with dementia, the ethical nature of some of these problems has largely been ignored. OBJECTIVE: To review the literature on ethical issues in dementia from the perspective of the main, non-professional carers of people with dementia. METHOD: A systematic literature search using Medline, Clinpsych and CINAHL databases between 1982 and 2000. A pilot study of carers. RESULTS: The lay perspective provides both a wide variety of issues and unique approaches. Although in the literature quantitative research answers some questions, it is qualitative research that deepens our understanding of the issues from the perspective of carers. CONCLUSION: It is particularly qualitative research that brings out the ethical issues for carers, which tend to be more varied than the ethical issues raised in the professional literature. Awareness of such issues could inform and shape the support given to carers.

Aged↗
PubMed2002

Issues and concerns of couples presenting for preimplantation genetic diagnosis (PGD).

BACKGROUND: The use of preimplantation genetic diagnosis (PGD) to select genetically 'normal' human embryos and to transfer them to the uterus of a woman has generated considerable controversy. Debate has occurred over the implications of PGD, sex selection, safety of embryonic manipulation and eugenics. This study evaluates a range of social and moral concerns of couples towards PGD and assisted reproductive technologies (ART) prior to treatment to obtain unbiased authentic attitudes independent of the treatment cycle and the outcome. METHODS: A total of 121 subjects were administered a structured questionnaire after each couple's in vitro fertilization (IVF) or genetic counselling session. Group A consisted of 41 subjects presenting for PGD of single gene disorders (PGD-SG) and group B consisted of 48 subjects undertaking PGD for aneuploidy screening (PGD-AS). A control group consisted of 32 subjects that were about to commence their first IVF cycle. RESULTS AND DISCUSSION: All groups found PGD to be a highly acceptable treatment. They expressed little concern about its extension to testing non-disease states such as sex and they were strongly in favour of a shared decision-making model in which couples have considerable autonomy over decisions about the embryo(s) to transfer. Differences between the groups included issues surrounding the transfer of embryos, restrictions to PGD and the destruction of embryos.

Adult↗
PubMed2002

The embryonic stem cell lottery and the cannibalization of human beings.

One objection to embryonic stem (ES) research is that it 'cannibalizes' human beings, that is, kills some human beings to benefit others. I grant for argument's sake that the embryo is a person. Nonetheless, killing it may be justified. I show this through the Embryonic Stem Cell Lottery. Whether killing a person is justified depends on: (1) whether innocent people at risk of being killed for ES cell research also stand to benefit from the research and (2) whether their overall chances of living are higher in a world in which killing and ES cell research is conducted. I call this kind of killing 'risk reductive.'

Cannibalism↗
PubMed1999

Desire-based and value-based normative reasons.

This paper is a response to John Harris' provocative 'Justice and Equal Opportunities in Health Care'. The aim of this short response is to locate the difference between Harris and me within a broader debate about the nature of reasons for action. I argue that Harris is appealing to a desire-based conception of normative reasons. I highlight some of the deficiencies of a desire-based conception of reasons, and contrast it with a value-based account.

Delivery of Health Care↗
PubMed1998

Consequentialism, reasons, value and justice.

Over the past 10 years, John Harris has made important contributions to thinking about distributive justice in health care. In his latest work, Harris controversially argues that clinicians should stop prioritising patients according to prognosis. He argues that the good or benefit of health care is providing each individual with an opportunity to live the best and longest life possible for him or her. I call this thesis, opportunism. For the purpose of distribution of resources in health care, Harris rejects welfarism (the thesis that the good of health care is well-being) and argues that utilitarianism in general may lead to de facto discrimination against groups of people needing health care. I argue that well-being is a superior theory of the good of health care to Harris' opportunism. Harris' concerns about utilitarianism can be better addressed by: (i) relating justice more closely to reasons for action; (ii) by conceptualising the relationship between reasons for action and the value of the consequences of those actions as a plateau rather than scalar relationship. Justice can be understood as satisfying as many equally rational claims on resources as possible. The rationality of a person's claim on health resources turns on the strength of that person's reasons to promote certain health-related states of affairs. I argue that the strength of that reason does not track the expected value of that state of affairs in a fully scalar fashion. Rather a person can have most reason to promote some state of affairs, even though he or she could promote other more valuable states of affairs. Thus there can be equal reason for a distributor of public resources to save either of two people, even though one will have a better and more valuable life. This approach, while addressing many of Harris' concerns about utilitarianism, does not imply that doctors should give up prioritising patients according to prognosis altogether, but it does allow that patients with lower but reasonable prognosis should have a share of public resources.

Age Factors↗
PubMed1997

Liberal rationalism and medical decision-making.

I contrast Robert Veatch's recent liberal vision of medical decision-making with a more rationalist liberal model. According to Veatch, physicians are biased in their determination of what is in their patient's overall interests in favour of their medical interests. Because of the extent of this bias, we should abandon the practice of physicians offering what they guess to be the best treatment option. Patients should buddy up with physicians who share the same values -- 'deep value pairing'. The goal of choice is maximal promotion of patient values. I argue that if subjectivism about value and valuing is true, this move is plausible. However, if objectivism about value is true -- that there really are states which are good for people regardless of whether they desire to be in them -- then we should accept a more rationalist liberal alternative. According to this alternative, what is required to decide which course is best is rational dialogue between physicians and patients, both about the patient's circumstances and her values, and not the seeking out of people, physicians or others, who share the same values. Rational discussion requires that physicians be reasonable and empathic. I describe one possible account of a reasonable physician.

Coercion↗
PubMed1996

Choosing the best: against paternalistic practice guidelines.

Isobel Ross rightly points out that providing information is not enough to guarantee that patients will choose the best course of action. She argues that to adequately protect patients' interests, we need practice guidelines to 'ensure that dangerous and unnecessarily risky procedures are excluded from practice'. What constitutes an 'unnecessarily risky procedure' is to be determined by a group of reasonable doctors. At one point, Ross suggests that such guidelines are 'presumptive' rather than 'absolute'. But this is really a concession to patient variability. She intends that certain procedures are ruled out on paternalistic grounds. I will argue that practice guidelines are desirable but should not determine practice. We should not rule out procedures on paternalistic grounds.

Communication↗