Developing a simple test to identify swiftly neonates with sepsis who carry the genetic variant which means that one dose of the recommended antibiotic, gentamicin, will cause the child to become profoundly deaf looks like an admirable objective. The baby needs antibiotics and needs them within 1 hour of admission to the neonatal intensive care unit (NICU). Conventional genetic tests take much longer to yield results. The test being trialled produces results in 25 min; a baby who carries the variant (...) can be treated with a different antibiotic. All the test requires is a gentle swab of the baby’s inner cheek. Babies can be treated for potentially fatal sepsis without the risk that the drugs designed to save their lives will cost them their hearing. Parents and healthcare staff are relieved of worry—a great idea? PALOH is not a trial of the safety or efficacy of the test, only to assess how feasible it will be to carry out this test in a busy NICU, without disrupting the care of the baby. A tiny painless ‘scrape’ will take a sample of DNA—what’s the fuss about? Several other invasive and painful procedures will be carried out without a fuss.1 The problem is DNA. Genetic information must be safeguarded from falling into the wrong hands. In section 45 of Human Tissue Act 2004 (HTA), Parliament legislated to prohibit non-consensual DNA testing.1 It fits uncomfortably in a statute designed to regulate retention and uses of human material, after revelations that organs and tissue from the …. (shrink)

Modern medicine is built on a long history of medical experimentation. Experiments in the past often exploited more vulnerable patients. Questionable ethics litter the history of medicine. Without such experiments, however, millions of lives would be forfeited. This paper asks whether all the ``unethical'' experiments of the past were unjustifiable, and do we still exploit the poorer members of the community today? It concludes by wondering if Harris is right in his advocacy of a moral duty to participate in medical (...) research. (shrink)

This paper is an examination of the Christology and Pneumatology that C. S. Lewis read from the apparent prefiguring of elements of the Incarnation‐Resurrection narrative in religious myths, and also his assertion that the incarnation‐resurrection narrative operates on us both as fact and myth. After an initial examination of the term myth and mythopoeia, Lewis' writings on the myth that became reality are discussed along with examples of prefigurement. Through his understanding of natural theology and his cautious respect for human (...) imagination and in contrast to his earlier deference for the conclusions of the Victorian religionist and social anthropologist James George Frazer, Lewis came to regard these prefigurements as the work of the Holy Spirit – intimations of God's salvific action in Christ – though Lewis' orthodoxy saw human imagination as flawed through original sin. This leads us to ask three questions: first, how do these prefigured ideas come to be in these myths and how do these intimations, splintered fragments of the true light, relate to Lewis' understanding of Christ as the light of the world; second, how does the Incarnation‐Resurrection narrative act/operate on us as a myth, whether spoken or read ; and third, is there internal evidence for a mythopoeic interpretation within the Incarnation‐Resurrection narrative? Our conclusions can be illustrated by a brief examination of Lewis' own Christian myth – Aslan from The Chronicles of Narnia– originally written for a Christian audience but now read by mainly non‐Christian/post‐Christian children and adults. (shrink)

"A potent source of inspiration for anyone interested in the therapeutic potential of Buddhism. David Brazier writes with clarity and authority about the Zen way."—Mark Epstein, M.D. author of Thoughts Without a Thinker: Psychotherapy from a Buddhist Perspective. "Comprehensive and readable... should appeal to anyone broadly interested in Buddhism."—Helen Sieroda psychosynthesis psychotherapist. In this book, psychotherapist David Brazier offers readers in the West a fresh perspective on Buddhist psychology and demonstrates how Zen Buddhist techniques are integrated into psychotherapy. (...) Writing from the viewpoint of a Western psychotherapist, Dr. Brazier successfully demystifies Buddhist psychology, explains the conceptual foundations of Buddhist thought, and with the help of vivid case studies, clearly demonstrates how a Buddhist approach can provide a practical path to personal growth. (shrink)

This paper explores difficulties around consent in the context of organ retention and return. It addresses the proposals of the Independent Review Group in Scotland on the Retention of Organs at Post Mortem to speak of authorisation rather than consent. Practical problems about whose consent determines disputes in relation to organ retention are explored. If a young child dies and his mother refuses consent but his father agrees what should ensue? Should the expressed wishes of a deceased adult override the (...) objections of surviving relatives? The paper suggests much broader understanding of the issues embedded in organ retention is needed to provide solutions which truly meet families' and society's needs. (shrink)

The proposition that Jesus was ‘Bad, Mad or God’ is central to C.S. Lewis's popular apologetics. It is fêted by American Evangelicals, cautiously endorsed by Roman Catholics and Protestants, but often scorned by philosophers of religion. Most, mistakenly, regard Lewis's trilemma as unique. This paper examines the roots of this proposition in a two thousand year old theological and philosophical tradition (that is, aut Deus aut malus homo), grounded in the Johannine trilemma (‘unbalanced liar’, or ‘demonically possessed’, or ‘the God (...) of Israel come amongst his people’). Jesus can only be understood in the context of the Jewish religious categories he was born into; therefore, for Lewis, Jesus is who he reveals himself to be. Jesus' self-understanding reflects his identity, his triune salvific role; this is for Lewis, the transposed reality of divine Sonship. Reason and logic are paramount here, reflected in the structure of Lewis's argument. Lewis's trilemma is not so much a proof of God's existence, but a question, a dilemma, where each and every person must come to a decision. For all its perceived faults, its simplistic language, Lewis's trilemma still is a very successful piece of Christian apologetic, grounded in a serious philosophical and theological tradition. (shrink)

Volume 1. The Anscombe-Lewis debate : from analogia entis to analogia fidei -- "God ... or a Bad, or Mad, Man" : C.S. Lewis's argument for Christ's divinity--a systematic theological, historical, and philosophical analysis of aut Deus aut malus homo -- Atonement : a unified model and event, the drama of redemption - understanding and rationalizing the tradition -- Scripture and the Christ, the Word of God : C.S. Lewis and Karl Barth--Convergence and Divergence -- The Pittenger-Lewis Debate : fundamentals (...) of an ontological Christology -- The question of multiple incarnations : imagination and paradox, reality and salvation. (shrink)

The Human Tissue Act 2004 is designed to regulate the storage and use of organs and tissues from the living, and the removal, storage and use of the same material from the deceased. It repeals much criticized legislation, including the Human Tissue Act 1961, and establishes a Human Tissue Authority to ensure compliance with the Act via a licensing and monitoring regime. When the Act comes into force, probably in April 2006, it will be a criminal offence not to comply (...) with certain provisions of the Act, and a new offence of DNA 'theft' will be introduced. Importantly, the Act places consent at the centre of the system, both from the living and from or on behalf of the deceased. (shrink)

Prolonging neonatal lifeThe paradox that medicine’s success breeds medicine’s problems is well known to readers of the Journal of Medical Ethics. Advances in neonatal medicine have worked wonders. Not long ago, extremely premature birth babies, or those born with very serious health problems, would inevitably have died. Today, neonatologists can resuscitate babies born at ever-earlier stages of gestation. And very ill babies also benefit from advances in neonatal intensive care. Infant lives can be prolonged. Unfortunately, several such babies will not (...) survive for long whatever is done for them. Others will live to leave hospital, but face severe health problems. Doctors have gained the ability to prolong neonatal life. But should they always do so? This question is central to the recent report of the Nuffield Council on Bioethics, Critical care decisions in fetal and neonatal medicine.1 In many quarters, the report received a very positive response, commended in The Lancet as “thoughtful, sensitive and sensible” and welcomed by the premature baby charity BLISS. Critics attacked on both flanks. The report goes too far—ushering in a culture of “throw away babies”. Or it does not go far enough—failing to endorse the Dutch precedent to sanction active neonatal euthanasia.TOO FAR?One of the key recommendations of the report is that guidelines be developed in relation to the institution of intensive neonatal care. It is these guidelines, which have been savaged by some parts of the media. The BMA called them “blanket rules” smothering clinical discretion. The guidelines on resuscitation at birth apply to babies born at the borderline of viability, that is, at or before a gestational age of 25 weeks 6 days. The earlier the baby is born, the lower are the chances that he/she will survive to leave hospital. Before 21 weeks 6 days, none of …. (shrink)

The aim of this paper is to explore in the light of recent scientific discoveries, coupled with a return to biblical orthodoxy, the question of the Fall, and the apparent intergenerational conditions of original sin. This is the human condition – East of Eden. Invoking Darwin's theory of evolution through natural selection from random mutation as a means of repudiating the existence of original sin can no longer be sustained, scientifically; the biology of horizontal gene transfer, transgenerational epigenetics, accelerated evolution (...) and biological plasticity has rendered Darwinism grounded in a Naturalistic methodology an inadequate explanation. If humanity is ‘born this way’ – mired in sin – have we condemned ourselves and our children to this status? How does this affect the relationship between biology and free will, between a form of predestination and decision-making? Therefore, this paper is towards an understanding of the ontology of the original, or first, sin, and is a biblical and scientific exploration of postlapsarian humanity's self-willed state, ‘East of Eden.’. (shrink)

Formulated by Aquinas, commented on by post-Copernican philosophers and theologians, analysed in depth by C.S. Lewis, and deliberated by some contemporary writers, the question of multiple incarnations either within humanity or amongst extra-terrestrial sentient species is all too intermittently examined: ‘Can the Christ be incarnated more than once in our reality, or somewhere else in the universe, or another reality?’ In this paper, we examine the debate and the conclusions: that is, Lewis’s position within his philosophical theology and his analogical (...) narratives; also, some contemporary philosophers of religion and theologians (Karl Rahner, with Christopher L. Fisher and David Fergusson; Sjoerd L. Bonting and William B. Drees; E.L. Mascall and Brian Hebblethwaite; Oliver Crisp and Keith Ward). How do they relate to Aquinas’s handling of the question and how do they compare with Lewis’s approach based on a theology of the imagination (grounded in Augustine and Alice Meynell)? Can Lewis resolve the argument? Could alien species have witnessed wholly different acts, equally unique, costly to God, and necessary to the process of salvation? Any answer or explanation relates to the function and purpose of the incarnation: the Fall, original sin—therefore, how we define the boundaries, limits, of atonement. (shrink)

The right of adults with sound mind to consent to treatment or risk their own health for the benefit of the community in a clinical trial is unequivocally recognised by the law. But what about those vulnerable by virtue of their age, nature or position in society? Experts from the fields of medicine, philosophy, theology and law, explore the ethical and legal principles which seek to reconcile the individual's right to autonomy with the need to protect vulnerable groups. Discussions refer (...) both to specific groups and specific issues. (shrink)

The High Court ruling that a premature baby should be not be resuscitatedLate in the afternoon of Thursday, 7 October 2004, Mr Justice Hedley ruled in a highly publicised dispute between parents and doctors about the future care of a severely disabled infant.1 With sadness, and some reluctance, the judge held that Charlotte Wyatt should not be subjected to any further invasive or aggressive treatment to prolong her life, despite her parents’ insistence that she be given every chance to survive (...) a little longer. The judgment was limited in scope. The judge did no more than authorise Charlotte’s doctors “in the event of a disagreement between the parents and themselves, not to send the child for artificial ventilation or similar aggressive treatment”.The fate of baby Charlotte attracted massive media coverage. Just a week later another dispute between a mother and her child’s doctors hit the headlines.2 A third dispute about the care of an older child also looks likely to end up in court.3 However, Charlotte’s case is unusual only in that the case was heard in open court and because it attracted such publicity. For at least 23 years,4 the Family Division of the High Court in England has heard a series of cases when parents and professionals have profoundly disagreed about how best to treat, or not to treat, a very sick baby. As happened in Charlotte’s case, the courts have usually,5 in the end, endorsed the professionals’ judgment about the best interests of the infant. The coincidence of three such high profile cases has prompted speculation that parents will …. (shrink)

Jansen expresses concern as to the legal implications of both selective reduction of pregnancy and unsuccessful attempts at termination of pregnancy using mifepristone. This commentary examines the legality of both procedures and concludes that Jansen is over-optimistic in his belief that neither procedure is likely to fall foul of the criminal laws on induced abortion. By contrast his anxieties about civil liability arising from the subsequent live birth of a damaged infant are, it is suggested, unnecessarily pessimistic. Such an action (...) is most unlikely to succeed if brought by the infant herself and any claim on the part of the mother will normally be dependent on proof of negligence. The commentary focusses on the law in England with relevant references to other common law jurisdictions. (shrink)

An increasing number of scientists and doctors are concerned that new laws are inhibiting ethical research. This paper argues that this is not the case. Laws do not inhibit medical progress. Misunderstanding the law may do so.

We wish to describe and acknowledge the exceptional contributions to medical ethics, both in the UK and internationally, made by Edward Shotter1 who died at home on 3 July 2019. He was founder of the London Medical Group2 3 and instigator of similar student-led medical ethics groups throughout the UK; founder of the Institute of Medical Ethics4 and founder of the Journal of Medical Ethics. Ted Shotter transformed the study of medical ethics in the UK in the interests of patients (...) and professionals alike. In 1963, he established the pioneering ‘Medical Group’ model, an innovative bottom-up method whereby students in the health professions could gain a grounding in ethics that had previously been denied to the profession.5 It was with these Medical Groups that many of the leading figures in contemporary UK medical ethics and law began their careers in the subject including Sir Kenneth Calman, Sir Ian Kennedy, Professor Margaret Brazier OBE, Professor John Harris and Professor Sir Jonathan Montgomery to name but …. (shrink)

Medical Ethics has many unsung heros and heroines. Here we celebrate one of these and on telling part of her story hope to place modern medical ethics and bioethics in the UK more centrally within its historical and human contex.

Why should we respect the wishes which individuals may have about how their body is treated after death? Reflecting on how and why the law respects the bodies of the living, we argue that we must also respect the ‘dead’. We contest the relevance of the argument ‘the dead have no interests’, rather we think that the pertinent argument is ‘the living have interests in what happens to their dead bodies’. And, we advance arguments why we should also respect the (...) wishes of the relatives of the deceased regarding what happens to the bodies of their loved ones. In our analysis, we use objections to organ and tissue donation for conscientious reasons (often presented as religious reasons) to show why the living can have interests in their dead bodies, and those of their dead relatives, and why these interests should be respected. (shrink)

In the United Kingdom, the debate about how best to meet the shortfall of organs for transplantation has persisted on and off for many years. It is often presumed that the answer is simply to alter the law to a system of presumed consent. Acting perhaps on that presumption in his annual report launched in July, the Chief Medical Officer, Sir Liam Donaldson, advocated a system of organ donation based on presumed consent, the so-called “opt-out” system.1 He is calling for (...) a change in the law in England and Wales whereby consent to organ donation is presumed, making a person’s organs automatically available for transplantation after death, unless they registered objections to this while alive. Subsequently, the British Medical Association lent its support to the introduction of such a system.2 The BMA contends that “the practice of presumed consent legislation has had a significant effect on the number of cadaveric donors per million population.”2It is often taken for granted that there must be a correlation between the enactment of legislation on presumed consent and an increase in organ donation and procurement. However, the correlation is not as straightforward as it might seem. It may be that other practical measures to encourage organ donation could be implemented without changing the Human Tissue Act 2004, an Act which has been in force for barely a year.An analysis by Abadie and Gay demonstrated that “presumed consent legislation has a positive and sizeable effect on organ donation rates”,3 but they themselves admitted that the correlation between rates of donation and presumed consent legislation is “not completely unequivocal”.3 It is true that among the most successful cases in procurement rates are countries with presumed consent legislation . However, since some of the …. (shrink)