•  253
    Lessons From the German Organ Scandal
    Journal of the Intensive Care Society 14 (3): 200-1. 2013.
    Doctors at four German hospitals have been suspended from their posts following internal investigations which alleged that they had been manipulating the organ transplant allocation system in order to help their patients get donor livers more quickly. It is alleged that doctors exaggerated the severity of their patients’ conditions so that they would be accorded higher priority for receiving organs, but there may also have been manipulation of medical records, deception of patients and potentia…Read more
  •  42
    Creating human organs in chimaera pigs: an ethical source of immunocompatible organs?
    with Wybo Dondorp, Niels Geijsen, and Guido de Wert
    Journal of Medical Ethics 41 (12): 970-974. 2015.
  •  2
    Evidence-Based Persuasion: An Ethical Imperative
    with Bernice Elger
    Journal of the American Medical Association 309 (16): 1689-90. 2013.
    The primacy in modern medical ethics of the principle of respect for autonomy has led to the widespread assumption that it is unethical to change someone’s beliefs, because doing so would constitute coercion or paternalism., In this Viewpoint we suggest that persuasion is not necessarily paternalistic and is an essential component of modern medical practice.
  •  33
    Prioritising Healthcare Workers for Ebola Treatment: Treating Those at Greatest Risk to Confer Greatest Benefit
    with Priya Satalkar and Bernice E. Elger
    Developing World Bioethics 15 (2): 59-67. 2015.
    The Ebola epidemic in Western Africa has highlighted issues related to weak health systems, the politics of drug and vaccine development and the need for transparent and ethical criteria for use of scarce local and global resources during public health emergency. In this paper we explore two key themes. First, we argue that independent of any use of experimental drugs or vaccine interventions, simultaneous implementation of proven public health principles, community engagement and culturally sen…Read more
  •  134
    Cryoethics
    In Hugh LaFollette (ed.), International Encyclopaedia of Ethics, Blackwell. 2013.
    Cryoethics is a new theme within bioethics (see bioethics) concerned with the ethics of cryonic storage. Cryonics, which is also erroneously referred to as “cryogenic” technology, offers people the option of having their bodies or brain-stems preserved at very low temperatures after death in order to be revived at some point in the future when technology is sufficiently advanced to enable reanimation, and possibly immortality. The main issues in cryoethics center around whether it is ethical to …Read more
  •  28
    Using non-human primates to benefit humans: research and organ transplantation—response to César Palacios-González
    with Wybo Dondorp and Guido de Wert
    Medicine, Health Care and Philosophy 19 (2): 227-228. 2016.
  •  60
    Many ethical issues are posed by public health interventions. Although abstract theorizing about these issues can be useful, it is the application of ethical theory to real cases which will ultimately be of benefit in decision-making. To this end, this paper will analyse the ethical issues involved in Childsmile, a national oral health demonstration programme in Scotland that aims to improve the oral health of the nation's children and reduce dental inequalities through a combination of targeted…Read more
  •  29
    This paper examines the legal justification for water fluoridation (WF) in the United Kingdom. While current legislation clearly permits WF, there is a degree of obfuscation concerning whether the practice amounts to medication, and were it to be acknowledged that fluoridated water constitutes a medicine, the legality of the practice would not be so obvious. It is concluded that an accurate and honest interpretation of the law would result in the conclusion that fluoridation does constitute medi…Read more
  •  143
    Prescribing placebos ethically: the appeal of negatively informed consent
    Journal of Medical Ethics 35 (2): 97-99. 2009.
    Kihlbom has recently argued that a system of seeking negatively informed consent might be preferable in some cases to the ubiquitous informed consent model. Although this theory is perhaps not powerful enough to supplant informed consent in most settings, it lends strength to Evans’ and Hungin’s proposal that it can be ethical to prescribe placebos rather than "active" drugs. This paper presents an argument for using negatively informed consent for the specific purpose of authorising the use of …Read more
  •  28
    In recent years there have been many revelations about ghost authors, who contribute to publications but are not credited, and guest authors, who do not contribute but are credited. Most medical and many other journals adhere to the authorship standards set by the International Committee of Medical Journal Editors (ICMJE), which were designed in part to combat the phenomena of ghost and guest authorship. However, the current criteria set for authorship by the ICMJE have their own problems. This …Read more
  •  110
    This article highlights the often overlooked fact that doctors who respect a bereaved family's veto of a deceased patient's organ donation are complicit in the deaths of those who would have benefited from the organs in question. Respecting the veto violates the dying wish of the patient, is against the spirit of the law and contributes to the deaths of other patients.
  •  1
    Hematopoietic stem cell transplantation is a widely accepted practice in the United Kingdom (UK). The relatively liberal UK law permits donation both within families and from strangers, and even allows the creation of “saviour siblings” who are brought into being with the specific intent of having them donate stem cells to save other members of their family. This chapter describes the regulation of HSCT in the UK and highlights some ethical issues related to discrimination against some categorie…Read more
  •  43
    Continuous consent and dignity in dentistry
    British Dental Journal 203 (11): 569-571. 2007.
    Despite the heavy emphasis on consent in the ethical code of the General Dental Council (GDC), it is often overlooked that communication difficulties between patient and dentist can cause problems in maintaining genuine consent during interventions. Inconsistencies in the GDC's Standards for dental professionals and Principles of patient consent guidelines are examined in this article, and it is concluded that more emphasis must be placed on continuous consent as an ongoing process essential to …Read more
  •  11
    Evidence and Ethics in Occupational Therapy
    with Justine Shaw
    British Journal of Occupational Therapy 74 (5): 254-256. 2011.
    Reagon, Bellin and Boniface argue that traditional models of evidence-based practice focus too much on randomised controlled trials and neglect 'the multiple truths of occupational therapy'. This opinion piece points out several flaws in their argument, and suggests that it is unethical to rely on weaker evidence sources when higher quality evidence exists. Ironically, the evidence that they provide to support their argument regarding different types of evidence is itself very weak.
  •  31
    Autonomy and Fear of Synthetic Biology: How Can Patients’ Autonomy Be Enhanced in the Field of Synthetic Biology? A Qualitative Study with Stable Patients
    with Milenko Rakic, Isabelle Wienand, Rebecca Nast, and Bernice S. Elger
    Science and Engineering Ethics 23 (2): 375-388. 2017.
    We analyzed stable patients’ views regarding synthetic biology in general, the medical application of synthetic biology, and their potential participation in trials of synthetic biology in particular. The aim of the study was to find out whether patients’ views and preferences change after receiving more detailed information about synthetic biology and its clinical applications. The qualitative study was carried out with a purposive sample of 36 stable patients, who suffered from diabetes or gou…Read more
  •  17
    The representation of women as authors, reviewers, editors-in-Chief, and editorial board members at six general medical journals in 2010 and 2011.
    with Thomas Erren, Juliane Groß, and Barbara Selle
    JAMA Internal Medicine 174 (4): 633. 2014.
    Although more women continue to enter the medical profession, disparities between the sexes in academic medicine persist. This “gender gap” has implications for academic advancement. In 2006, Jagsi and colleagues reported that, although the proportion of women among first and last authors in the United States had significantly increased since 1970, women still represented a minority of the authors of original research and guest editorials in six prominent medical journals.1 In a related 2008 stu…Read more
  •  16
    The Vulnerability of the Individual Benefit Argument
    with Domnita O. Badarau and Rebecca L. Nast
    American Journal of Bioethics 14 (12): 17-18. 2014.
  •  181
    Reducing the harmful effects of alcohol misuse: the ethics of sobriety testing in criminal justice
    with Karyn McCluskey, Will Linden, and Christine Goodall
    Journal of Medical Ethics 38 (11): 669-671. 2012.
    Alcohol use and abuse play a major role in both crime and negative health outcomes in Scotland. This paper provides a description and ethical and legal analyses of a novel remote alcohol monitoring scheme for offenders which seeks to reduce alcohol-related harm to both the criminal and the public. It emerges that the prospective benefits of this scheme to health and public order vastly outweigh any potential harms.
  •  47
    Institutional review boards (IRBs) have a reputation for impeding research. This reputation is understandable inasmuch as many studies are poorly designed, exploit participants, or do not ask a relevant question , and it is entirely proper that IRBs should reject such proposals. However, IRBs also frequently reject or tamper with perfectly sound and relevant studies in the name of protecting participants from harm, in accordance with the widely accepted message that “clinical research is justifi…Read more
  •  53
    Genetic Morality
    Peter Lang. 2006.
    This book will attempt to show that these and other problems are ultimately resolvable, given careful and unbiased application of established ethical principles ...
  •  28
    Neuroenhancing Public Health
    Journal of Medical Ethics (6): 2012-101300. 2013.
    One of the most fascinating issues in the emerging field of neuroethics is pharmaceutical cognitive enhancement (CE). The three main ethical concerns around CE were identified in a Nature commentary in 2008 as safety, coercion and fairness; debate has largely focused on the potential to help those who are cognitively disabled, and on the issue of “cosmetic neurology”, where people enhance not because of a medical need, but because they want to (as many as 25% of American students already use no…Read more
  •  46
    Crocodile tiers
    Journal of Medical Ethics 34 (8): 575. 2008.
    It is clearly unethical for the NHS to tell people that they will die sooner unless they pay for private treatment, and then to tell them that if they pay for private treatment they will have to pay the NHS for its insufficient service. This is all the more true if people in other parts of the country are receiving all the drugs they need for the same condition on the NHS. Patients who discover that the NHS care that they have paid for will not keep them alive should be able to supplement their …Read more
  •  34
    Unethical framework: Red Card for the REF
    Times Higher Education. 2012.
    Almost all academics sigh at any mention of the REF. Preparing submissions for the Research Excellence Framework takes up a lot of effort, but is important because the REF determines a department's funding allocation from a finite pot of cash. As such, it is seen as a necessary evil by most staff. However, the REF poses ethical problems in addition to the stress it causes. As it stands, the REF is exacerbating a schism between research and teaching staff, encouraging deceptive attribution of au…Read more
  •  89
    Oncologists frequently have to break bad news to patients. Although they are not normally the ones who tell patients that they have cancer, they are the ones who have to tell patients that treatment is not working, and they are almost always the ones who have to tell them that they are going to die and that nothing more can be done to cure them. Perhaps the most difficult cases are those where further treatment is almost certainly futile, but there remains an extremely slim chance of yet more ag…Read more
  • Biobanks are vital for diagnostic, epidemiological and research purposes following radiation disasters, but there is a history of delays in this type of research and specifically in setting up important resources including tissue repositories following the rare occurrence of these events. Here, we argue that one key lesson from Chernobyl and Fukushima has still not been learned: it is essential to agree on a proactive international plan for a radiation disaster biobank and accompanying data coll…Read more
  •  1
    Confidentiality in Prison Health care – A Practical Guide
    with Bernice Elger
    In Bernice Elger, Catherine Ritter & Heino Stöver (eds.), Emerging Issues in Prison Health, Springer. forthcoming.
    The importance of medical confidentiality is obvious to anyone who has ever been a patient, and protecting private information about patients is one of the key responsibilities of healthcare professionals. However, maintaining the confidentiality of patients who are incarcerated in prisons poses several ethical challenges. In this chapter we explain the importance of confidentiality in general, and the dilemmas that sometimes face doctors with regard to it, before describing some of the specifi…Read more
  •  27
    The Trojan Citation and the “Accidental” Plagiarist
    Journal of Bioethical Inquiry 13 (1): 7-9. 2016.
  • What is a biobank? Differing definitions among biobank stakeholders
    with Bernice Elger and Flora Colledge
    Clinical Genetics 85 (3): 223-7. 2014.
    Aim: While there is widespread agreement on the broad aspects of what constitutes a biobank, there is much disagreement regarding the precise definition. This research aimed to describe and analyse the definitions of the term biobank offered by various stakeholders in biobanking. Methods: Interviews were conducted with 36 biobanking stakeholders with international experience currently working in Switzerland. Results: The results show that, in addition to the core concepts of biological samples…Read more
  •  27
    Permitting patients to pay for participation in clinical trials: the advent of the P4 trial
    with Guido de Wert, Wybo Dondorp, David Townend, Gerard Bos, and Michel van Gelder
    Medicine, Health Care and Philosophy 20 (2): 219-227. 2017.
    In this article we explore the ethical issues raised by permitting patients to pay for participation in clinical trials, and discuss whether there are any categorical objections to this practice. We address key considerations concerning payment for participation in trials, including patient autonomy, risk/benefit and justice, taking account of two previous critiques of the ethics of P4. We conclude that such trials could be ethical under certain strict conditions, but only if other potential sou…Read more
  •  43
    The ethics committee as ghost author
    Journal of Medical Ethics 37 (12): 706-706. 2011.
    Ethics committees have a bad reputation for impeding, rather than facilitating research. Here, I argue that many committees actually improve the quality of the research proposal to such an extent that they deserve credit as authors in any resulting publications, or at least an acknowledgement of the contribution made.