The present and future rapid increase in the hospital population of geriatric patients is discussed with particular reference to the problem of advanced brain degeneration. The consequences of various clinical management options are outlined and it is suggested that extreme attempts either to preserve or terminate life are medically, morally and socially unacceptable. The preservation of life in senile patients has important economic consequences. In achieving a decision on the medical management of patients with advanced brain decay it is suggested (...) that substantial help would be derived from: knowledge of the previously declared wishes of individual patients; improvements in geriatric assessments; broader consultation with relatives, and greater use of inter-disciplinary discussion in the preparation of criteria for terminating medical efforts to maintain survival. (shrink)

During the 1970s, prenatal screening technologies were in their infancy, but were being swiftly harnessed to uncover and prevent spina bifida. The historical rise of this screening process and prevention programme is analysed in this paper, and the role of ethical debates in key studies, editorials and letters reported in the Lancet, and other related texts and governmental documents between 1972 and 1983, is considered. The silence that surrounded rigorous ethical debate served to highlight where discussion lay—namely, within the justifications (...) offered for the prevention of spina bifida, and the efficacy and benefits of screening. In other words, the ethical justification for screening and prevention of spina bifida, when the authors are not explicitly interested in ethics, is considered. These justifications held certain notions of disability as costly to society, with an imperative to screen and prevent spina bifida for the good of the society. (shrink)

In January 2012, the Journal of Medical Ethics published online Giubilini and Minerva's paper, ‘After-birth abortion. Why should the baby live?’.1 The Journal publishes articles based on the quality of their argument, their contribution to the existing literature, and relevance to current medicine. This article met those criteria. It created unprecedented global outrage for a paper published in an academic medical ethics journal. In this special issue of the Journal, Giubilini and Minerva's paper comes to print along with 31 articles (...) from some of the best scholars in the world, from the broadest range of perspectives on abortion and infanticide, including those strongly critical of Giubilini and Minerva.The killing of a baby is among the most shocking of human practices. I am strongly opposed to the legalisation of infanticide along the lines discussed by Giubilini and Minerva. But I would like to explain why a journal of medical ethics published an article examining infanticide and now devotes a special issue to bringing a wide range of perspectives for further examination of these issues.Infanticide has been practised throughout human history for various reasons and continues to be practised today throughout the world. In rare cases, infanticide can be practised openly and legally—for example, as specified under the ‘Groningen Protocol’, in the Netherlands. The Groningen Protocol allows doctors to end the life of neonates at the request of their parents if the infant is experiencing hopeless and unbearable suffering.2But medical infanticide arguably occurs elsewhere other than in the Netherlands today.In neonatal intensive care, it is not uncommon for a doctor to withdraw artificial ventilation with the consequence that a baby dies.3 If anyone else performed that act, including the parents of the child, it would be viewed as an act of homicide, in some cases …. (shrink)

A study of 78 parents of Down's syndrome children shows that, while most were in favour of abortion for a handicapped fetus, they were divided equally on whether euthanasia (no distinction made between active and passive euthanasia) was an acceptable practice. Only a third considered an average Down's syndrome child could be a suitable candidate for euthanasia. While parents argued that the degree of handicap of the child was the crucial factor in making this decision, in fact the social class (...) of the parents themselves was the only variable which was statistically significantly related to their opinions. Differences arose from the parents' lack of agreement on what constituted a sufficiently severe handicap. (shrink)

It is often argued that the continuity of the processes of embryo development precludes the establishment of morally significant boundaries, once development is under way. These arguments typically claim that marking out any moral boundaries requires identifying particular significant events, and that in such circumstances this is either impossible or arbitrary. In this paper it is argued that arguments of this kind are not cogent. The paper concludes by indicating where the real problems lie.

Helga Kuhse and Peter Singer recently examined the view expressed by John Lorber that whereas at times it is permissible to allow severely handicapped infants to die, killing them must never be allowed. In attempting to demonstrate the mistaken nature of Lorber's fear that allowing active infanticide would lead us onto a slippery slope Kuhse and Singer make much use of John Harris's paper in the Journal of Medical Ethics in which he criticised Lorber's views. This paper examines some aspects (...) of the case advanced by Kuhse and Singer and of the earlier paper by Harris. (shrink)

This paper examines some of the issues related to the distinction between acts and omissions. It discusses the difficulties involved in deciding whether there is any moral significance in this distinction, particularly when it is applied to cases which involve killing or allowing to die. The paper shows how this problem relates to some of the current issues in medical ethics. It examines the issues raised by the widely publicised cases of selective treatment of handicapped children and argues that such (...) decisions are taken and have to be taken in the context of wider ethical theories. (shrink)

Utilitarianism is commonly assumed to be the most appropriate sub-structure for medical ethics. This view is challenged. It is suggested that the utilitarian approach to euthanasia works against the patient's individual advantage and is a corrupting influence in the relationship between the physician and society. Dignity for the individual patient is not easily achieved by assessing that person's worth against the yardstick of others' needs and wishes.

In this paper we clarify some issues related to our previous article ‘After-birth abortion: why should the baby live?’.