News

In memory of The Very Rev'd Edward Shotter, Hon Vice-President, Institute of Medical Ethics

Ted Shotter

(29 June 1933 – 3 July 2019)

We are deeply saddened to inform you of the recent passing of Ted Shotter, Hon Vice-President, IME. Ted was a true pioneer in the field of medical ethics and leaves behind an outstanding legacy, both in the UK and worldwide. Prof Raanan Gillon, President of the IME, has written a tribute which he delivered at Ted's funeral service at Blythburgh Church ('the cathedral of the marshes') in Suffolk on 29 July, and which will give you a flavour of Ted's life and achievements...

Edward Shotter - a true innovator for medical ethics

I was introduced to Ted in the very early 1970s by the Dean for postgraduate students at University College Hospital London, Gerald Stern, who knew I had an interest in medical ethics. 'Ted Shotter is the man you need to meet' – and how right he was. However at that first meeting I told Ted- who had previously been a Student Christian Movement chaplain to medical students- that I very much doubted that I, an atheist Jew- albeit educated at Christ's Hospital-  could be much help in his very Christian – as I then perceived it to be- London Medical Group. He smiled- he might even have winked. 'If you'll forgive my saying so Dr Gillon I think you're a Godsend'. Ted had in fact been assiduously extending  the teaching of medical ethics to medical students of all faiths and none.  Well we were friends ever since and I was appointed another of his 'Assistant Directors' of the  London Medical Group.  The LMG as it was known, along with the similar student-led groups that arose in every UK medical school, was the first of Ted Shotter's three major contributions to medical ethics both in the UK and internationally, for it introduced outside experts into the teaching of medical ethics to medical students, and about subjects chosen by the students themselves. Since Hippocratic times medical ethics had been a zealously guarded doctors-only zone but Ted changed all that!

His second major contribution was the invention of the Institute of Medical Ethics, at first somewhat laboriously named the Society for the Study of Medical Ethics. That Institute is these days a significant UK charity promoting teaching, research and publication in medical ethics, and providing grants for doing so, thanks in large measure to its co-ownership- with the British Medical Association- of the very successful Journal of Medical Ethics. That journal is Ted's third major contribution to the development of national and international medical ethics, for it is now one of the world's leading bioethics journals. Again Ted's encouragement was hardly a hindrance to my application back in 1980, to be, after Alastair Campbell, the  JME's second editor- a post I somewhat greedily held for twenty years.

I was so pleased to have very recently been able to pass on slightly belated birthday greetings from his IME colleagues, friends and admirers and to reminisce with him about  the achievements I've just mentioned; and also to recall his honorary Fellowship of the Royal College of Physicians, as well as  his international recognition by the American Hastings Center in bestowing its prestigious Henry Knowles Beecher Award for  life time contributions to bioethics. The occasion was lunch at Westhall, nobly prepared for the two of us by Jane before she retired to her own sick bed. Ted was in wonderful form and several times said what a fortunate man he was in so many ways, and especially in his lovely and loving wife and family.

It was a terrible shock to learn that he had died the following day- but it remains my strong impression that he died a truly happy man.

Prof Raanan Gillon
President, Institute of Medical Ethics



Dr Abidemi Otaiku, FY1, received an IME conference grant to present a poster at the Neuroethics Network meeting, Paris, June 2019. Read his report below

The Neuroethics of Dreaming? Ethical & Psychological Implications of Lucid Dream 'Immorality'

I recently had the opportunity to attend the Neuroethics Network 2019 Meeting which was held at the Brain and Spine Institute in Paris, an internationally recognised neuroscience research foundation, located on the grounds of the world famous Salpêtrière hospital. 

This was an intimate three day meeting that brought together early career researchers and established academics from around the world working in neurology, psychiatry, philosophy, ethics and neuroscience, to present and discuss the latest research findings in Neuroethics - the academic discipline concerned with the ethical, societal and legal implications raised by advances in neuroscience and neurotechnology.

Over the three days of the meeting, there were seven 'Athenaeum Seminars', which were essentially three to four themed talks grouped together in the programme, each covering a key topic in neuroethics. These ranged from highly pragmatic talks focused on ethical issues arising from treating complex psychiatric patients, in the 'Psychiatric Illness' seminar, all the way to the more esoteric and philosophical, but still fascinating talks, regarding machine consciousness and 'machine moral responsibility' in the 'Other Minds' seminar. Other seminars had a more interdisciplinary nature such as the seminar 'Forensic Psychiatry and Neurolaw' which explored how neuroscience may affect how we determine the legal culpability of offenders, and also, how neuroscience based interventions – such as so-called 'moral bioenhancement' may one day be used to prevent offenders from committing further crimes.

In addition to the talks included in the Athenaeum Seminars, there were also a number of e-poster presentations that were displayed throughout the meeting. I had the privilege of having an abstract for my research on the ethical and psychological implications of "immoral" lucid dream behaviour, accepted for an e-poster presentation at the meeting. I received some very helpful and interesting feedback from the delegates who had read my poster and had come to find me during breaks in the programme to discuss my work further. I am hoping to write up this research for submission to a medical ethics or neuroethics journal in the coming weeks, and I will most certainly be integrated some of the constructive feedback that I received throughout this meeting to improve the final manuscript.

Overall this was a very enjoyable and intellectually stimulating meeting, which introduced me to new areas of neuroethics and also increased my knowledge of areas that I had already been familiar with. Having this opportunity to present my work at an international conference at such an early stage in my career was a greatly informative experience, and has given me the confidence to submit my work to other international medical ethics or neuroethics conferences in the future.

I am very grateful to the IME for awarding me with a Postgraduate Conference Grant, which enabled me to attend and present my work at the Neuroethics Network Meeting, which I highly enjoyed, and which has also deepened my knowledge of the fascinating field of neuroethics.



Sarah Kelly, a medical student at University of Edinburgh received an IME Scholarship for her Master of Bioethics intercalated degree at Harvard University, August 2017. Read the report of her project below:

Handling Medical Error: Lessons to be learned from the US?

Medical error is a leading cause of death in Western nations.1 To address this problem, there have been recent public policy and legal reforms in the UK, including a statutory duty of candour and emphasis on institutional support and responsibility.2 These aim to engender a culture of openness and transparency in order to better prevent, address and learn from medical errors. However, there have been limited concurrent educational or institutional changes to support these statutory and professional obligations. Current practices around institutional handling of medical error continues to fall short of these professed policy and legal standards, as was borne out in the case of Dr. Hadiza Bawa-Garba.3 This case reignited debate around medical errors in the UK and how they ought to be handled and the medical community expressed outrage and fear over the decisions of the Court and General Medical Council.3 It highlighted the tension between the legal tendency to pinpoint blame and the professed aim of the medical community to acknowledge collective responsibility. In particular, many called for new ways to consider how institutions can better support individuals involved in instances of medical error.

Medical practice in the US has gained a reputation for its litigious culture and many individual hospitals are taking steps to avoid medical errors in order to reduce litigation and improve patient care.4 As part of the Masters of Bioethics programme at the Center for Bioethics, Harvard Medical School I interned with the Ethics Committee at Beth Israel Deaconess Medical Center. As part of this I assisted in ethics consultations requested by patients and clinicians and I took particular interest in their proactive approach to handling medical errors. This report considers some of the steps taken by BIDMC to address and reduce “preventable harm” and how they might be applicable to UK medical practice.

One method by which BIDMC aims to promote collective responsibility around medical error is by publishing quarterly reports of “Preventable Harm” online.5 On their publicly available website, the hospital lists the number of reported errors across many contexts, including surgical site infections, falls resulting in injury and disrespectful communication. This allows for ready identification of common errors, which has led to review and improvement in areas such as infection control. It aims to destigmatise error and share responsibility for improving practice between clinicians and management. By encouraging open dialogue around errors, the hospital aims to demonstrate to patients and families that they are actively identifying important contexts where mistakes commonly occur and proactively addressing them. This approach to transparency is relatively unique among Massachusetts hospitals and I could find no record of UK Health Boards doing anything similar. Given that data around numbers of incidents of medical error are commonly recorded by hospital management, it would be feasible to create comparable documentation in the UK—whether available online to the public, to clinicians only, or available upon request. Tracking such numbers might provide the institutions with a certain accountability to ensure that areas of common mistakes are acknowledged and could identify specific areas that require additional support.

Secondly, BIDMC (along with other Massachusetts hospitals) have introduced a Communication, Apology and Resolution (or “CARe”) initiative.6 Clinical staff are provided with training to encourage timely communication with patients and families.5 The “CARe” initiative is offered as means of encouraging collaboration between involved parties to prevent future errors. Meetings between parties following difficult events can provide valuable time for personal and team reflections on the surrounding circumstances and emotions and what might be done in future to improve practice. Decisions regarding whether to pursue litigation are complex and multifactorial but the provision of an alternative, non-adversarial but official pathway for dealing with mistakes is thought to reduce rates of legal action. Data tracking practice since 2001 at the University of Michigan has demonstrated that such a programme as led to a reduction in the number of patient injuries claims, system improvements following investigation of claims, shorter time to claim resolution, and significantly decreased costs for both the claimants and the hospital involved.4 Given that the cost of legal claims is known to be rising around the UK, such a system would not only encourage valuable (and confidential) individual reflection but also serve as a means of allowing funds to be spent on improving care rather than costly compensation.

 

Thirdly, BIDMC Ethics Committee provide consultations at any point of patients’ journeys. They can provide support, guidance and mediation around complex decisions, reducing harms like disrespectful communication. They also offer discussions and debriefs with patients, families, and clinicians after difficult events to ensure all perspectives are considered to improve practice. Ethics committees who provide such contemporaneous advice, actively meet with all stakeholders, and provide care-guiding advice remain rare in the UK;7 in the US, almost every hospital now has some form of committee providing such consultations.8 My experience demonstrated the role of committee members (with appropriate training in communication) being involved early in discussions with the medical teams after an error to advise on the most suitable methods and circumstances to discuss the errors with patient and family. They often worked in conjunction with the hospital legal team to counsel on how to broach the subject with honesty and integrity, while assuaging clinicians’ commonly-held fears around litigation.


In conclusion, medical error is a complex but important issue that must be acknowledged and addressed. My experience with BIDMC Ethics Committee has demonstrated some ways in which mistakes can be identified, tackled and prevented. Transparent record-keeping of numbers and patterns of incidents, explicit programmes to encourage communication and collaboration around medical error, and ethics committees to provide guidance and mediation are all examples of some methods that could be used to improve practice.

 

REFERENCES

 

  1. Makary, M, and Daniel, M. 2016. "Medical Error—The Third Leading Cause of Death in the US". BMJ, p.i2139.
  2. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
  3. Cohen, D. 2017. "Back to Blame: The Bawa-Garba Case and the Patient Safety Agenda". BMJ, j5534.

4.Michigan Medicine. University of Michigan (2019). The Michigan Model: Medical Malpractice and Patient Safety at Michigan Medicine. [online] University of Michigan. Available at: https://www.uofmhealth.org/michigan-model-medical-malpractice-and-patient-safety-umhs [Accessed 16 June 2019].

 

  1. BIDMC. Eliminating Preventable Harm at BIDMC. https://www.bidmc.org/about-bidmc/quality-and-safety/efforts-to-improve-quality-of-care/eliminating-preventable-harm-at-bidmc. [Accessed 16 June 2019]

 

6.Massachusetts Alliance for Communication and Resolution following Medical Injury (2019). MACRMI: About CARe. [online] Available at: https://www.macrmi.info/about-macrmi/about-dao/ [Accessed 16 Jun. 2019].

 

7.  Sokol, D. 2014. "Renewing the Call for Clinical Ethicists". BMJ 349. 2: g5342-g5342.

 

8. Aulisio, M. (2016). “Why Did Hospital Ethics Committees Emerge in the US?”. The AMA Journal of Ethics, 18(5), pp.546-553.

 

REFERENCES

  1. Makary, M, and Daniel, M. 2016. "Medical Error—The Third Leading Cause of Death in the US". BMJ, p.i2139.
  2. Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
  3. Cohen, D. 2017. "Back to Blame: The Bawa-Garba Case and the Patient Safety Agenda". BMJ, j5534.

4.      Michigan Medicine. University of Michigan (2019). The Michigan Model: Medical Malpractice and Patient Safety at Michigan Medicine. [online] University of Michigan. Available at: https://www.uofmhealth.org/michigan-model-medical-malpractice-and-patient-safety-umhs [Accessed 16 June 2019].

  1. BIDMC. Eliminating Preventable Harm at BIDMC. https://www.bidmc.org/about-bidmc/quality-and-safety/efforts-to-improve-quality-of-care/eliminating-preventable-harm-at-bidmc. [Accessed 16 June 2019]

6.      Massachusetts Alliance for Communication and Resolution following Medical Injury (2019). MACRMI: About CARe. [online] Available at: https://www.macrmi.info/about-macrmi/about-dao/ [Accessed 16 Jun. 2019].

7.      Sokol, D. 2014. "Renewing the Call for Clinical Ethicists". BMJ 349. 2: g5342-g5342.

8.      Aulisio, M. (2016). “Why Did Hospital Ethics Committees Emerge in the US?”. The AMA Journal of Ethics, 18(5), pp.546-553.



Lydia Daniels, a medical student at Imperial College London received an IME Scholarship for her BSc in Medical Sciences with Humanities, Philosophy & Law intercalated degree, Sept 2018. Read the report of her project below

Should doctors be the arbiters in decisions to withdraw artificial nutrition and hydration from minimally conscious and vegetative patients?

My project focuses upon the decision to withdrawal artificial nutrition and hydration from patients in a vegetative or minimally conscious state. More specifically, I respond to the ruling in An NHS Trust v Y (2018) (hereafter, NHS v Y), by asking, should doctors be the ultimate arbiters of these decisions, according to the nature of the decision and the doctor's role?

The landmark case of Airedale NHS Trust v Bland (1993) (hereafter, Bland) ruled that indefinitely prolonging a life in a vegetative or minimally conscious state may not always be in the patient's best interests and hence that withdrawing ANH can be legal. The question of 'who decides' was granted legal clarity in NHS v Y, a Supreme Court ruling which confirmed that doctors can withdraw ANH from patients in permanent vegetative and minimally conscious states (PVS and MCS) without recourse to the courts, providing there is agreement between the doctor and the family that this is in the patient's best interests.

Making this decision in the clinical setting has clear practical and economic benefits. Halliday et al. (2015) states that NHS economists estimate the average court referral process costs around £122,000, and Holland et al. (2014) highlight the emotional distress that delays in withdrawal can cause families.

Beyond its practical implications, the ruling in NHS v Y prompts us to reflect on the critical question of whether doctors should be entrusted with decision-making power in these cases. Wicks (2019) claims this ruling threatens the patient's right to life by removing a neutral advocate in the court, and Foster (2018) argues the ruling could lead to paternalistic decision-making orientated around biomedical need rather than patient wishes. However, in order to make a more robust evaluation of this ruling we must take a broader view. As Lord Browne-Wilkinson states in Bland, 'behind the questions of law lie moral, ethical, medical and practical issues of fundamental importance to society' (p877). These issues need to be evaluated in order to test whether the ruling in NHS v Y reflects a fair balance of perspectives. My project uses a multidisciplinary approach by looking at the sociological background, legal context and professional implications of the ruling in NHS v Y to assess whether doctors are well-placed as arbiters of these decisions.

Firstly, I track the court's deference to the medical profession, particularly following the shift towards greater respect for patient autonomy demonstrated in the Mental Capacity Act (2005). Looking forward to NHS v Y, I have identified the element of deference in the ruling's assertion of doctors as arbiters of these decisions and its reliance upon professional regulation. However, I argue that this deference can be dissociated from traditional, paternalistic notions of the term, in light of how the profession and its guidance has evolved to become more patient-centred, as suggested by Devaney and Holm (2018).

I also investigate the nature of the decision doctors are being asked to make: firstly how the concept of best interests has evolved to become more holistic, and secondly whether withdrawal of ANH from PVS/MCS cases ought be to categorised as 'special cases'. My project considers that viewing PVS/MCS patients as deserving of a higher safeguarding standard than other patients is unjustified, and that the technicalities of diagnosis should not overshadow consideration of the patient's wishes. NHS v Y has rightly aligned these decisions with other life and death best interest decisions, however the significance of ANH and its withdrawal for families should be taken into account by doctors and discussed with sensitivity.

I then focus on whether clinical decision-making in the present day lends itself to withdrawal decisions, including discussion of the broader role of ethical decisions in medicine. Contrary to the concern that this ruling will incite paternalistic decision-making, empowering doctors to be arbiters of these particular decisions allows timely withdrawal of ANH when it is agreed to no longer be in the patient's best interests. I argue, therefore, that this model may demonstrate greater respect for the patient's wishes.

Paternalistic or idiosyncratic decision-making is mitigated against by the rigour of the professional guidance. I have considered that the measures which have been put in place within the guidance have created sufficient safeguards for the patient's right to life: consultation with those concerned for the patient's welfare, the expert 'second opinion' and the option to consult the courts.

My project concludes that the ruling in NHS v Y represents a positive step forward, asserting the doctor as the arbiter of these withdrawal decisions and recognising their ability to develop and exercise sound ethical decision-making, for the ultimate benefit of the profession and its patients.

Although this project has advocated doctors as the appropriate decision-maker in these sensitive and important scenarios, this must correspond with standards in clinical training. I recommend that medical schools ensure that they facilitate the development of sound ethical reflection and knowledge of the law to equip future doctors to face such scenarios. Incorporating this into a broader study of medical humanities would give students an appreciation of the profession's historical and sociological context as well as the narratives brought forwards by patients. This would encourage future doctors to properly evaluate their assumptions alongside patients' personal, religious and cultural values.

With heaviness of heart I recognise that the voices of PVS and MCS patients cannot contribute to this debate. Unless we are able to establish communication with these patients, the decision-maker must rely on second-hand accounts of previously-expressed feelings and values. It has been deeply moving to consider the impact of the decision-making process on the family, many of whom see withdrawing ANH as an impossibly difficult decision, but at the present time, the only feasible option to allow their relatives to die. This project also illuminates the need to encourage patients to draft advance decisions to refuse treatment where appropriate, ensuring these are properly documented and respected by healthcare teams.

I am incredibly grateful for the opportunity to explore this topic and extend particular gratitude to the IME for their financial support.

References

Airedale NHS Trust v Bland (1993) House of Lords, AC 789 (House of Lords)

An NHS Trust & Ors v Y & Anor (2018) Supreme Court, UKSC 46 (Supreme Court)

Mental Capacity Act (2005) (c.9) United Kingdom. London: HMSO. Available at: https://www.legislation.gov.uk/ukpga/2005/9/contents

Devaney, S. & Holm, S., 2018. The Transmutation of Deference in Medicine: An Ethico-Legal Perspective. Medical Law Review, 1 5, 26(2), pp. 202-224.

Foster, C., 2019. The rebirth of medical paternalism: An NHS Trust v Y. Journal of medical ethics, 1 1, 45(1), pp. 3-7.

Halliday, S., Formby, A. & Cookson, R., 2015. An assessment of the court's role in the withdrawal of clinically assisted nutrition and hydration from patients in the permanent vegetative state. Medical Law Review, 23(4), pp. 556-587.

Holland, S., Kitzinger, C. & Kitzinger, J., 2014. Death, treatment decisions and the permanent vegetative state: evidence from families and experts. Medicine, health care, and philosophy, 8, 17(3), pp. 413-23.

Wicks, E., 2019. An NHS Trust and others v Y and another (2018) UKSC 46: Reducing the Role of the Courts in Treatment Withdrawal. Medical Law Review, 15 1



Rachel Burnley, a student at University of Bristol Medical School, recently received an IME Institutional Grant to help fund the BSc Bioethics student-led conference 'Personal Beliefs within Medicine' held March 2019.

Click HERE to read the report which highlights an excellent example of a university involving students from local schools and colleges in ethics conferences as part of their widening participation scheme.



The Nuffield Council on Bioethics has published a bioethics briefing note on disagreements in the care and treatment of critically ill babies and young children.

The briefing note outlines the possible causes of disagreements between parents and healthcare staff, and highlights areas of action for healthcare policy-makers and NHS leaders that could help to prevent prolonged and damaging disagreements developing in future, or to resolve them more quickly.

 

Overall, they suggest the aim should be:

  • good communication between families and staff and an understanding of differing perspectives

  • appropriate involvement of parents in discussions and decisions about the care and treatment of their child

  • timely use of resolution interventions, such as mediation, in cases of disagreement

  • attention to the profound psychological effects that disagreements can have for families and staff.

     

    The briefing note is available at: http://nuffieldbioethics.org/project/disagreements-care-critically-ill-children. 

    Please do not hesitate to get in touch with Nuffield Council on Bioethics if you would like to discuss any aspects of the briefing note:

    020 7681 9622 |

     

T: +44 (0) 20 7681 9622 | E: sgriffiths@nuffieldbioethics.org



Financial support for carers. Had an abstract accepted for the IME Conference 2019?

If you have had an accepted accepted for the IME Conference on 24-26 June 2019 at Cardiff Metropolitan University, you might be eligible for financial support for carers.

The IME recognises that for those of you with caring responsibilities, attending events such as the IME Conference is an important part of developing and maintaining your career.  The IME also understands that attending such events can cause an additional financial burden if you need to make alternative care arrangements.

To help alleviate some of this burden, we are introducing a scheme which may entitle you to a small grant of up to £250 (maximum fund of £2,000) if you have caring responsibilities.  In order to qualify for the grant you must have an abstract accepted for the conference. *Abstract Submissions are now closed*

The grant can be used to fund additional/alternative care arrangements for your dependent* to either stay at home while you travel, or to fund travel and associated care costs allowing the dependant to travel with you.

Note:
A dependant is a partner, child or parent, or someone who lives with you as part of your family. This could be, for example, an elderly aunt or grandparent. It does not include tenants or boarders who may be living in your family home.

You may make an application for this grant if the following conditions apply:

·You have caring responsibilities and nobody else at your home can provide the care.

·No alternative source of funding is available, e.g. from the conference/training etc. organiser or by other means, such as from research grant funding.  Where relevant it is your responsibility to provide evidence that no alternative source of funding is available.

·The grant is to cover costs outside of the routine everyday care costs you normally incur.

The funds will be paid on receipt of an invoice/receipt detailing the costs incurred. Please note that any impact on benefits or HMRC impacts are the responsibility of the applicant.

Click here for an application form.

Click here for guidelines.

 



National Student Debate Final 2019

Winners! The Keele team

Winners! The team from Keele

Congratulations to the team from Keele University who took on the reigning champions Queen's University Belfast at the 2019 National Student Debate Final in Manchester on Saturday 9 March. Queen's won both the 2017 and 2018 finals & proved to be tough opponents during the 2019 final but, in the end, Keele triumphed.The motion was Law & professional guidance should abandon the 'best interests' test in favour of the 'serious harm' test when deciding whether to override the decisions of parents about treatment for their children.

Congratulations once agan to Keele and commiserations to tough opponents Queen's.

Thank you to all the teams who entered, in particular those who reached the final: Keele University - Queen's University Belfast - University of Liverpool - University of Exeter - University of Sheffield - University of Cambridge - University of Cambridge - University of Birmingham.

Thank you also to our guest speaker, Dr Joe Brierley (Consultant Paediatric Intensive Care & Director of Bioethics), Great Ormond Street Hospital who spoke to the students about Paediatric Bioethics, and also to our panel of judges: Georgia Testa, Dr Richard Knox, Dr Joe Brierley, Miss Lorraine Corfield, Dr Vivienne Crawford, Dr Simon Deery, Julie Stone, Jordan Parsons and Dr Daniel Tigard.

Details of next year's competition will be announced later this year.

Runners up Queen's Dr Joe Brierley Runners up Queen's and

Dr Joe Brierley, Great Ormond St Hospital




Calling Medical Undergraduates! The IME Student Council are recruiting!

Click here for details and how to apply.

Join us & help promote interest & awareness of medical ethics.

Deadline for applications: midnight, Sunday 2 June 2019



IME Student Conference 2019: Medical Ethics in a Technologically Advancing World

Click here to read a conference review, by Charlotte Galvin, intercalating medical student, Keele University and IME Student Conference Vice Chair.
 



Dr Richard Shoulder was awarded a full elective bursary 2017/18 for his project entitled 'Elective Ethical Toolkit - an essential for medical students working abroad' whilst in his final year at University of Bristol.

Richard is also the 2018 winner of The Mark Brennan Poster Prize (bursary category) for his poster of the project. Congratulations Richard!

To read Richard's elective report (which includes the Elective Ethical Toolkit), click here.



Progress Educational Trust Annual Conference - Institutional Grant Report

PET conference_2018The IME was pleased to be able to award an Institutional Grant to PET to fund the attendance of eight medical students at their annual conference Make Do or Amend: Should We Update UK Fertility and Embryo Law? on 5 December 2018.

Read their report below ...

The Progress Educational Trust (PET) is an independent registered charity founded in 1992 to advance public understanding of ethics, law and science in the fields of human genetics, assisted reproduction and embryo/stem cell research.

PET works to improve choices for people affected by infertility and genetic conditions, and to promote the responsible application of science through education and debate.

PET's discussion conference Make Do or Amend: Should We Update UK Fertility and Embryo Law?, which was held at Amnesty International in London, on 5 December 2018, explored law and regulation governing fertility treatment and embryo research.

In the PET tradition, following introductory presentations the bulk of each session's running time was devoted to soliciting questions and comments from the audience.

Conference sessions included:

The Human Fertilisation and Embryology Act: Is It Broke and Should We Fix It?

Society Marches On: Key Social Changes

Science Marches On: Key Scientific Developments

New Science, New Families, Old Law: Is the Human Fertilisation and Embryology Act Fit for Purpose?

A Patchwork of Policies: Assisted Conception and Embryo Research in Europe

The Future of Fertility Law: What Must Change and When?

How the Institute of Medical Ethics made a difference

By funding places for eight medical students to attend the conference free of charge, the Institute of Medical Ethics (IME) made the event substantially more accessible. The medical students who made use of these places, contributing to the 220-strong audience, were from the Universities of Birmingham, Sheffield and Liverpool and from Manchester Metropolitan University. One student also attended from Australia's Monash University, currently a visiting student at the Oxford Uehiro Centre for Practical Ethics.

Thanks to the IME, it was possible for these students to participate in an event whose cost would otherwise have been prohibitive – especially when combined with the cost of travel.

Furthermore, association with a body such as the IME gives an imprimatur of quality to the event. Prospective delegates who are unfamiliar with PET's work in bioethics are given confidence that the conference will be of a high standard.

Feedback from attendees:

220 people attended the PET conference, of the attendees who completed feedback forms, 100 per cent rated the conference as either excellent or good overall, and 97 per cent said they were better informed as a result of attending.

Several of the students who received sponsored places gave specific feedback:

Charlotte McDowell (University of Sheffield):

'I'm a third-year medical student planning to intercalate in medical ethics and law next year. I find the topic of surrogacy to be particularly interesting, and I went to the event in the hopes of getting a better understanding of the current ethical and legal issues. The event was very engaging, and I really enjoyed it. All of the speakers were interesting and well selected. The talks given only furthered my interest in intercalating in medical ethics and law. I also have to write an essay for my applications for intercalated degrees, and I decided as a result of the event to write about the ethical issues surrounding commercial surrogacy. I would like to thank the IME for kindly subsidising places, as I could not have attended without this.'

Lucy Benham Whyte (Manchester Metropolitan University and University Hospital Coventry):

'I am extremely grateful for the subsidised place that was available to me, since I would not have been able to afford to come to London on the student budget alone. This particular event was extremely relevant to my studies as a trainee embryologist, and I feel my level of knowledge in regard to embryo and fertility law is much more advanced as a result. I hope I will be able to attend many PET conferences in the future.'

Lydia di Stefano (Monash University):

'I found the conference really interesting and helpful to complement the biomedical perspectives I have heard about assisted reproductive technologies at medical school. I would not have been able to attend the conference without being sponsored.'

Sam Calmonson (University of Birmingham):

'I was able to attend the Progress Educational Trust conference thanks to the IME. It was fantastic opportunity to increase my knowledge about the topic. All the speakers gave an interesting insight into their views, and the short presentations helped to keep the conference moving, whilst generating debate and conversation. As a medical student, this was an interesting day away from the main course that I would highly recommend to anyone interested in ethics.'



Gemma Skilton, a final year medical student at the University of Birmingham, received an IME grant to present her paper at the 13th World Conference on Bioethics, Medical Ethics & Health Law, Jerusalem, Nov 2018

Read her report below as an example of the IME enabling students to participate in an international conference & to hear diverse views on important topics.

In November of this year, I received a conference grant from the IME that allowed me to travel to Jerusalem in order to present my research at the 13th World Conference on Bioethics, Medical Ethics and Health Law. This was a 3-day conference that took place from the 27-29th November 2018. As a medical student at the University of Birmingham I had previously completed an intercalated degree in Healthcare Ethics and Law. It was during this degree that I conducted the research which I was then able to deliver during my oral presentation at this conference. Thus, as a medical student with an intercalated degree in this field, I was incredibly excited and grateful for this opportunity not only to present my own work but also to learn from many other like-minded people presenting their own research on varied topics within the field of healthcare ethics and law.

This conference offered over 500 presentations across more than 60 topics and subtopics, with presenters coming from 63 different countries. The sheer size, variety and international nature of the conference made for an amazing and unique experience. Never before had I had the opportunity to hear from such a diverse group of people about the many different ethical and legal issues affecting them in all different parts of the world. As just one example, the ethics of psychiatric assessment to possess firearms is an ethical issue that seldom requires reflection in the UK, however the application of these issues in the USA was a novel consideration for me. Particularly poignant was the phrase coined by the presenter, a psychiatrist working in the USA, “I cannot take your guns away from you, but I can take you away from your guns”. The enriching opportunity to consider different international perspectives on medical ethics and law served to further my already great interest in this field. Not only this, the conference also presented the opportunity to consider ethical issues within other fields than medical ethics such as immigration ethics and the ethical responsibilities within migration policies.

 

As outlined, this conference really opened my eyes to a diverse range of ethical issues which I had not previously reflected upon. However, given that I was also there to present my own research, my experience of the conference in relation to this cannot go without reflection. The topic of my research was based upon the informed consent process for the implantation of implantable cardioverter defibrillators (ICDs) and whether discussing deactivation ought to make up a part of this. Consequently, I found several of the informed consent themed sessions incredibly engaging and thought provoking in relation to the background of my own research. For example, one delegate delivered her legal analysis of “the hidden paternalism in Montgomery” which was particularly interesting to reflect upon given that an analysis of UK case law on informed consent made up a section of my own research. I was very lucky to have been accepted not only to give an oral presentation but also to co-chair the session in which I was presenting, both of which were new experiences to me. I was one of five presenters in my session themed around informed consent. Two delegates, both from Israel, presented on the topic of the readability standards of informed consent and health literacy level. Another delegate, from South Africa, presented his research regarding informed consent for Biobank research. Finally, the fourth delegate, also from University of Birmingham, presented the ethical issues around gaining informed consent for complex procedures. This experience has been valuable firstly, in assisting the development of my presentation skills. Secondly, in allowing me to share my research with international experts and to hear about their research in turn, using this exposure to further refine my ideas and ethical understanding of the different concepts and issues around informed consent.

The sheer size and variety of this conference made for a truly unforgettable experience. Whilst at times its size and diversity felt a little overwhelming, this was only because there were so many talks to visit that one wished that they could somehow be in several places at once! It was a real inspiration and privilege to be amongst such a wide array of people all so passionate about medical ethics and law and I would thoroughly recommend this conference to all medical students with such an interest like myself. I am incredibly grateful to the IME for the support they have given me which allowed me to do this.

 

 

 



Sam Calmonson, a final year medical student at University of Birmingham, received an IME conference grant to give an oral presentation at the 13th World Conference on Bioethics, Medical Ethics & Health Law, Jerusalem, November 2018. Read his report below

Thanks to the Institute of Medical Ethics Conference Grant programme, I had the opportunity to attend the 13th World Conference on Bioethics, Medical Ethics and Health Law, organised by the UNESCO Chair in Bioethics. The conference took place in the Ramada Hotel in Jerusalem and ran across three days, with over 800 participants discussing more than 60 topics in bioethics and law.

Each day was split into sessions, with the vast majority of each sessions having five 15 minute presentations under a common theme, leaving a short amount of time for general questions at the end. Some operated as a round table discussion between experts in a topic, followed by a generalised discussion involving the audience afterward. Outside these scheduled hours, the set-up of the hotel allowed for fruitful discussion about the ethical topics, as well as an opportunity to ask more detailed questions of the presenters and their work. This is something with which I actively engaged, finding their comments on my own work very helpful. The sheer variety of opportunities to learn about new and developing research was astounding.

Of the topics available, I particularly enjoyed session relating to the ethics of informed consent, ethics in Jewish law, ethical decision-making in psychiatric patients and the other presentations in my own session on 'Death and Dying: Life's Beginning'. In the session about informed consent, there was research published by surgeons describing the ethical implications of consenting patients to surgery carried out by trainees and the degree to which consent for this needed to be gained. This sparked debate about the 'minimally good samaritan' and whether there exists a collective societal obligation to be treated by trainee doctors for the good of the society. This was followed by a philosopher's approach to using the informed consent principle as an argument for euthanasia. The session about Jewish law discussed arguments about abortion based upon the debate between two famous biblical scholars, as well as looking at the religious interpretations about genome editing - something important for future healthcare practices in Israel. After my own presentation about the ethics of withholding resuscitation from extremely premature neonates, there was a presentation about extending Canada's Medical Assistance in Dying (MAiD) programme to those who are under 18 years of age, using case studies of teenage cancer patients who have reached palliative stages but not the age above which MAiD was available. This extended into a wider debate about assisted dying in general. Similarly, a psychiatrist from Harvard Medical School talked the topic of assisted dying in psychiatry the following morning. These topics tended to generate the most conversation during the questions and answer sessions. Another presentation that I found particularly interesting was the question of administering contraception to migrants in expectation of rape. The question posed by the presenter was whether this was ethically justified by preventing pregnancy or complicit by not preventing rape. The consequentialist argument found that contraception was a net good and therefore ethical, but the topic raised the wider topic of migrants from other countries, something that has taken a back seat in the wider news today.

I thoroughly enjoyed the opportunity to present my own research to an audience of about 50 people. It was a new experience, involving dealing with people who vehemently disagreed with my content during my presentation as well as those who actively engaged with my work and sought me out after to continue the discussion. I have been able improve my own work and find helpful people to consult in the future. None of this could have been possible with the generous grant from the Institute of Medical Ethics and it is to them that I am most grateful for allowing me this enriching opportunity.



Paolo Corsico, PhD student, University of Manchester School of Law, received an IME conference grant to present at the American Society for Bioethics & Humanities conf, & the International Neuroethics Society annual meeting 2018. Read his report below

Report on American Society for Bioethics and Humanities (ASBH) annual conference and International Neuroethics Society (INS) annual meeting

California, October – November 2018

Last October, I received an IME conference grant to go to California and attend two of the most important bioethics conferences worldwide. Thanks to the generous support of IME, I was able to take part in the American Society for Bioethics and Humanities (ASBH) annual conference in Anaheim, on October 18-21, 2018. Ten days later, I took part in the annual meeting of the International Neuroethics Society (INS) in San Diego. As a European postgraduate student in bioethics, I was eager to learn about trends, priorities, and novel challenges in medical ethics as they are experienced by colleagues in North America.

It is hard to describe how vast, inclusive, and far-reaching was the array of issues addressed by more than 600 presentations during the four-day ASBH conference. You need a mobile app to navigate the programme at ASBH. Still, it is difficult to decide which sessions to attend. The keynote speakers addressed what I believe to be two overarching themes of the conference: new 'epidemics' and global health challenges, and the relevance of health humanities in contemporary culture and clinical education.

The first keynote speaker Jonathan Metzl, professor of sociology and psychiatry at Vanderbilt University, Tennessee reflected on the relationships between mass shootings and mental illness. In his inspiring lecture, Metzl noted that:

The US gun violence epidemic is made worse by polarized debates, which are fuelled by stereotypes around mental illness and race.

Three stereotypes characterize the problematic narrative according to which 'mental illness is the problem in mass shootings': 1) the mentally ill are disproportionately violent, 2) psychiatric expertise can predict gun violence, and 3) gun violence is the result of 'dangerous loners' or 'violent cultures'.

The way in which we build narratives around mental illness and gun violence is stigmatizing. We must challenge such stereotypes, give up polarized debates, and start working together to build a safer society.

With reference to the health humanities, Despina Kakoudaki, director of the Humanities Lab at the American University in Washington DC engaged the ASBH audience with a fascinating overview of Mary Shelley's Frankenstein. Her keynote shed light on the cultural understanding of artificial bodies and robots. Kakoudaki argued that the discourse on artificial bodies has been ongoing for centuries. This discourse includes the ancient ideas of 'artificial birth' and 'mechanical body', as well as the modern idea of 'mechanical slaves' and that of 'existential cyborgs'. Two key points of her lecture were that:

Real robots are now changing our world. However, real robots are sometimes non-recognizable in everyday life, as embodiment and location of artificial agents influence the perception of their agency.

If robots become self-aware, like Frankenstein, they might demand rights and liberty. This is a real political issue that we ought to address.

The INS annual meeting, entitled "Cutting Edge Neuroscience, Cutting Edge Neuroethics" was held at San Diego Central Library on November 1-2, 2018. Smaller than ASBH, but by no means less engaging, the meeting aimed at rethinking the role of neuroethics for the occasion of the 10th annual conference. Central themes were the growing expansion of digital neuro-technologies in health care domains, and the impact of neuro-technology on individuals' identities and public policies.

I particularly appreciated the opening keynote address, delivered by the president of Mindstrong Health, Tom Insel. Dr Insel highlighted the disruptive potential of digital phenotyping—that is, the measurement of individual cognition, emotion, and behaviour by using data from smartphones and wearables—to address 'disorders of behaviour'. The key messages of his keynote were that:

Digital phenotyping has the potential to revolutionize the way we manage disorders of behaviour, by giving us access to data that are objective, continuous, ecological, and passive.

Ethical challenges emerge within two domains: 1) issues of value, which include the efficacy of novel tools and user engagement, and 2) issues of trust, which include transparency, agency, and responsibility.

Emily Postan from the University of Edinburgh then gave an engaging 'rising star plenary lecture'. Postan argued that access to neuro-information has the potential to affect our identities and that our primary concern should not be with the abuse of neuro-information by others, but with the use that we ourselves make of it. Postan's central claim was that beliefs about the brain and the mind influence our self-narratives in positive and negative ways. We should ensure that access to neuro-information benefits the construction of our self-narratives and the development of our personal identities.

I believe that any student in bioethics and medical humanities would greatly benefit from attending ASBH and INS. Not only for the opportunity to network with fellow ethicists from all over the world, nor for the conferences' cutting-edge approach to ethics and policy debates. Most importantly, I think that early career bioethicists should attend the ASBH and INS annual conferences because they are outstanding opportunities for personal and professional development. I am deeply grateful to the IME for having supported me.

Paolo Corsico, PhD candidate in Bioethics and Medical Jurisprudence, CSEP, School of Law, the University of Manchester

Below: American Society for Bioethics & Humanities Conference, Anaheim

ASBH, Anaheim



IME Intercalated Scholarships available - apply now!

UK medical undergraduates .. Apply here for an IME Intercalated Scholarship 2018/19 - available now! Up to £2,000 each available to support your intercalated degree.

Closing date: 23.59 on 31 March 2019. 

 

 



Call for Papers - 2019 IME Conference

Concept, Classroom and Clinic

24th - 26th June 2019 Cardiff Metropolitan University, Llandaff Campus, Western Avenue, Cardiff, CF2 2YB

The Institute of Medical Ethics invites abstracts for its forthcoming conference in Cardiff, 24th – 26th June 2019. The conference is designed to give opportunities for researchers, educators, clinicians, and students involved in medical ethics, medical law and medical humanities to present their academic work. The conference organisers welcome submissions from a range of disciplines relevant to medical ethics, including bioethics, medicine, healthcare, philosophy, social sciences, law, public policy and the medical humanities.

In addition to submissions from established academics, early career researchers and healthcare professionals, we also encourage submissions from postgraduate and undergraduate students. Contributions to the 2019 conference can take the form of posters, oral presentations, lightning talks or panels. Oral presentations last 20 minutes followed by questions and discussion. Panels will run forÂÂÂÂÂ 90 minutes and should consist of two or three papers with sufficient time for audience discussion. Lightning talks last five minutes.

In addition there is the Fringe focusing on performance art/stories/live medical humanities and a session where participants can make a pitch for funding a research proposal to an expert panel. The abstract submission process is online and open at https://bit.ly/2j41IP0

There are six categories of abstract. Please indicate the categories for which you have submitted your abstract.

Oral presentations: 20 minutes, followed by ten minutes’ discussion to explore the implications for research, teaching clinical practice and critical humanities (to submit under this category please select 'Oral' from the Presentation Format dropdown box and whenÂÂÂÂÂ inputting text in the Abstract Content box please type ORAL).

Poster presentations: there will be a prize for the best poster (to submit under this category please select 'Poster' from the Presentation Format dropdown box).

Panel sessions: 90 minutes: two or three speakers related to a single topic with audience discussion. Abstracts should include a proposed timetable for the session (to submit under this category please select 'Panel' from the Presentation Format dropdown box).

Lightning talks: 5 minutes: a chance to share work in progress on a project – anything from a Master’s dissertation, a PhD, an educational development, a challenging clinical event or a piece of critical research (to submit under this category please select 'Oral' from the Presentation Format dropdown box and whenÂÂÂÂÂ inputting text in the Abstract Content box please type LIGHTNING).

Fringe: 15 minutes (maybe negotiable): something different, imaginative, perhaps provocative: performance, creativity, audience interaction (to submit under this category please select 'Oral' from the Presentation Format dropdown box and whenÂÂÂÂÂ inputting text in the Abstract Content box please type FRINGE).

(Red*) Dragon’s Den: This is a UK version of the popular US show Shark Tank based on a Japanese programme called Money Tigers: an opportunity to pitch an imaginative idea for funding a project or piece of research. Adapted for IME, this will offer constructive criticism to those making a pitch and will avoid the brutal humiliation sometimes associated with these shows (to submit under this category please select 'Oral' from the Presentation Format dropdown box and whenÂÂÂÂÂ inputting text in the Abstract Content box please type DRAGON).

*The Red Dragon is a symbol of Wales and appears on the Welsh flag.

You may submit more than one abstract to this conference. Submissions should be submitted by midnight: 31st January 2019



IME National Student Debate Competition 2019

Student information

The event will take place on Saturday 9th March 2019

 

 

 

The debate final will be held in the City of Manchester. As well as the actual ‘debates’, there will also be a keynote speaker of interest to finalists.

Purpose of the debates

  1. a)Promote engagement on a national level with medical ethics
  2. b)Foster a community of interest in medical ethics
  3. c)To provide new learning opportunities
  4. d)To allow students to enjoy medical ethics and have fun

Recruiting students

Students are responsible for organising their own debate teams. It is likely that you will have an ethics lead in your School but they may not have the time to be involved. Putting the onus on students to organise their teams means that you can still enter the national competition even if your ethics lead is unable to be involved.

Although this event has been primarily organised with medical students in mind, you have the option to include students of allied healthcare professions in your team if you wish, such as nurses or physician associates. At least half of the team members must be medical students. Given the purpose of the debates, you should endeavour to include students who are interested in medical ethics rather than simply debating. This event is part of the IME’s endeavour to engage students in medical ethics and foster a community of interest. While many students are competitive and want to win, the stress should be on taking part, meeting like-minded students, learning and enjoyment. It is the taking part that matters.

Entering the competition

There will be a limit of eight teams that can participate in the final in Manchester, and only one team per Medical School. As there may be more than eight teams interested in taking part, there will be a video-audition process to decide which eight teams will qualify to take part on the 9th March. If there are many interested students in your medical school, it is possible for more than one team to upload an entry for the video audition.

All teams wishing to compete are required to upload a video of themselves undertaking a 10 minute debate which will then be judged by a panel to select the eight finalists.

Teams participating in the national final can have up to six members. But when preparing the video, only four people take part: two on each side of the debate.

The topic for the video audition is:

Too much importance is placed on autonomy in medicine today

Each side should spend five minutes presenting their side of the debate. Format is as follows:

First speaker For the motion: 2 minutes

First speaker Against the motion: 2 minutes

Second speaker For the motion: 2 minutes

Second speaker Against the motion: 2 minutes

For the motion (summing up): 1 minute

Against the motion (summing up): 1 minute

*The person summing up can be either of the two speakers. 

Deadline for videos to be uploaded is 10th December 2018

Please upload to YouTube. You will need to create a channel if you don’t already have one. Upload your video as ‘Unlisted’ which is a drop down option in the centre of the screen at the start of the upload process on https://www.youtube.com/upload

This will ensure that the video won’t be findable by the general public even if they know the name of it.

Then email the URL of your video to Phil Greenwood of the IME philg@instituteofmedicalethics.org; copying in contact@instituteofmedicalethics.org 

Please note: If you do not receive a confirmation of submission email from us within one week of emailing the URL of your video, please telephone us on 01925-299733.




Toni Saad, final year student at Cardiff University, was the recipient of a 2018 IME Elective Bursary. Read his report below ...

Conscientious Objection in Healthcare

April 2018, Anscombe Bioethics Centre, Oxford, UK

For two weeks of my medical elective, after completing six weeks in Neurology, I was the Anscombe Bioethics Centre's Visiting Research Fellow, working on the current controversy of conscientious objection in healthcare. My time consisted of preparing a paper for a half-day symposium on the subject and planning a joint seminar between the Uehiro Centre and the Anscombe Centre.

The seminar took place at the Oxford Martin School and consisted of a discussion of the Consensus Statement on Conscientious Objection (published on the University of Oxford's Practical Ethics blog) and Prof. David Oderberg's Declaration on Conscientious Objection. The merits of these were debated and their implications explored. The overriding goal was for parties to gain a better understanding of the core disagreement(s) about conscientious objection. One of the attendees drafted a dozen points upon which disagreement was agreed, and these were summarised at the end. After the event, the discussion was continued by email. We are hoping to draft some of the work which has come out of the seminar for submission for publication. The value of this exercise was to locate precisely the points of disagreement which underly the respective positions on conscientious objection in healthcare, as well as points upon which parties agreed.

The second major event was the half-day symposium on conscientious objection in law and medicine at which I presented a paper. Dr Mary Neal spoke about some of the legal aspects of conscientious objection in healthcare, while my talk considered the ethical and medical aspects. I argued that some common arguments raised against conscientious objection do no withstand logical scrutiny: arguments about the requirements of autonomy fail to recognise the real difference between positive and negative autonomy; arguments about the duty of a healthcare professionals typically do not consider the goals of medicine or the nature of clinical judgement; and arguments about the inappropottaeness of values in clinical decision-making ignore the ineluctably moral character of healthcare and the inevitability of making clinical decision on the basis of conscience. The second part of the paper explored the question of why hostility to conscientious objection has come about in recent times. I argued that the hostility is not towards conscience per se, although that is often how arguments are presented, but it is to do with concerns over controversial issues relating to sex and reproduction. If these issues were different, I speculated that there would not be such a hostile literature towards conscientious objection. After delivering the paper, I heard Dr Andrew Papanikitas' response to it, and took questions from the attendees. This last part was most challenging, as I was forced to answer questions which I had not previously considered. However, the event was undoubtedly useful for my own learning.

My time in Oxford highlighted the need to continually refine my thinking about conscientious objection in healthcare. Interacting face-to-face with those who take a view opposed to my own showed me that I had misunderstood some of the concerns of those opposed to conscientious objection and failed to answer these adequately. Moreover, I realised that previous work I had done in defence of conscientious objection needed revision in light of very helpful conversations with Prof. David Albert Jones. I had previously argued in a paper in Clinical Ethics that conscientious objection should only be permitted with respect to procedures which do not conform to the goal of medicine defined as healing. In this category I included abortion, contraception, euthanasia and ritual circumcision etc. What I realised is, if medicine really is a moral endeavour which requires conscience to make any clinical decision, then it does not make sense to shut down from the outset conscientious objection to things which are not part of a pre-agreed list of controversial procedures. It is too narrow to talk about conscientious objection only in terms of ends, and not also in terms of means. These two can be distinguished, and doing so shows that, even when there is no conflict about the morality of ends, there can be conflict over means. Hence, thought a cardiologist may not be opposed to treating heart disease with a given drug in principle, he may refuse to do so in practice if he deems it would be ineffective or disproportionally harmful. This is a decision of conscience as much as typical examples, though it is about means rather than ends. This is an area which remains uncharted in the debate over conscientious objection. I now believe the discussion needs to move beyond its focus on lists of controversial procedures and view healthcare holistically as a moral endeavour: conscience is not only for the dilemma and controversy, but for every act where one aims to do good.

I am very grateful to the IME for its generous grant for this medical elective, and would like to thank them for making it possible. I would also like to thank Prof. David Jones of the Anscombe Bioethics Centre for the honour of making me the centre's Visiting Research Fellow and guiding my work in preparation for my elective. I look forward to studying further this surprisingly complex subject.

Toni Saad holds an MA in medical ethics and is the book reviews editor for The New Bioethics.



Below is a report from Lydia Daniels, third year medical student at Imperial College London, who was given an IME grant to attend our Spring Conference: Rights, Access & Entitlement to Healthcare on 9 March 2018

 

daniels finalI was given the opportunity to attend the 12th Annual IME Spring (Education) Conference entitled Rights, Access, and Entitlement to Healthcare, held in Manchester on the 9th March, thanks to support from the IME conference grant. I arrived eager to uncover lesser-known truths about inequalities within our NHS. There is no doubt that I came away from the conference with a heightened awareness of access disparities between UK communities and the existence of stigma and prejudice within our healthcare system, alongside both the ethical tensions and the opportunities that this creates.

One of the most striking sessions of the day was delivered by Anna Miller on the topic of healthcare provision for migrants, refugees and trafficked people, with reference to her policy and advocacy work with Doctors of the World. We focused on the many barriers facing undocumented migrants who need to access healthcare, and the complex of loops undocumented migrants must jump through before they can receive NHS services. Hospitals do not follow this process as closely as it is described within the law, yet a true enforcement would create a huge resource burden. Measuring this beside the comparatively small proportion of NHS money that is spent on undocumented migrants, some would argue the charging process is somewhat futile especially as this group are unable to secure legal, well paid employment.

The current guidelines from NHS England make it clear that no lack of ID or immigration status disclosure should prevent a person from full registration with a GP practice, however when Doctors of the World have made attempts to register migrants on their behalf, only 2 in 5 applicants were successful - the others were rejected on the aforementioned grounds. These statistics were appalling revelations, and show a discrepancy between guidelines and reality.

We were also made aware of migrants' reluctance to access healthcare due to fear that they will be detained and forced to leave the country. Anna described a 2017 agreement (the Memorandum of Understanding) that allows NHS digital to pass information to the Home Office for immigration law enforcement purposes. We were caused to ponder upon the ethical unease this creates, including the obvious impact on trust in the doctor-patient relationship. A reluctance towards full disclosure means clinicians are neither able to safeguard effectively nor pursue a full holistic approach. Migrants are some of the most vulnerable people living in our country, and it is next to impossible for them to freely access healthcare. Therefore, we must ask: what message does this send about the values of our NHS, and does this come into moral conflict with its founding principles?

Fascinating insights into incorporating homeless people into healthcare were delivered by Dr Shaun Jackson, a GP at Urban Village Medical Practice in Manchester and innovator of "needs-led" homeless healthcare clinics. Shaun began his talk by giving us some hard-hitting statistics. Homeless people have a significantly lower average life expectancy than the general population, and many die from treatable conditions – this group, with some of the greatest health needs, often falls outside the NHS's field of vision. Shaun's clinics consist of fully integrated, multidisciplinary services, including mental health support, tissue viability, and drug assessment and treatment, tied together under the concept of 'inclusion health'.

Conference attendees were encouraged to reach out to this group, with Shaun's assurance that homeless people are, in his experience, greatly concerned for their health. Therefore, they are often surprisingly capable of engaging with health interventions. This translates into a clear opportunity for health professionals to expand their services to reach out to those in great need, to more faithfully implement the principle of universal provision: proportional healthcare access for marginalised people. Ingrained attitudes towards people experiencing homelessness were emphasised as a constraining factor, and it was suggested that a lack of exposure within training could hold responsibility for this.

This report is merely a glimpse into the insights that were shared on this day. I, like many others, left the conference better informed, and inspired to join the fight to better serve the health needs of those on the fringes of society.

Lydia Daniels, 3rd Year Medical Student, Imperial College London



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

 



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.



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 highlighting the project. 

Titi orally presented at 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