Author Archives: Will Cochrane

Social media, patient privacy and COVID-19

mass protection of citizens. Track and trace systems have also been linked to phones allowing the spread of the virus to be monitored and informing those who may have come into contact with something to stay at home. This proving to a slowed the spread of the virus, certainly in the UK. However, in order to obtain this information personal details must be shared to a database leading to potential issues surrounding ethics and privacy. Where is the line drawn between how much information is too much?

The critical issue that having and spreading this information causes is that it leads to blaming and shaming. It is in our nature to blame others for problems so that we ourselves can keep our moral compasses on track. Along with this and spoken about in the article is the potential for misidentification of the “perpetrator” leading to unnecessary hate being put onto those who did nothing wrong. Not only this, but social media acts as a shield to hide behind where you can make comments with no repercussions. Relating this to COVID-19 and the track and trace system it provides a perfect opportunity to know the areas in which someone has had COVID-19 allowing the door to be opened and hateful comments to come in. From an ethical perspective it is a fine line between protecting patient privacy whilst at the same time protecting those around us. How much information is worth giving up? The violation of patient privacy in the short term could protect many but in the longer term could it cause more harm? It is a very difficult line to balance on.

Personally, I believe that this mass spreading of information is useful to some degree if certain parts of information are protected such as name, job and any other identification details. When it comes to COVID-19 it is only important if they are positive or not. Nothing else. I do think that these systems are crucial in slowing the rates of COVID-19 but even so, breaking patient privacy is not worth the cause. Up until now we have dealt with other issues and kept patient information private so why does it now change? As with social media, it is a fine line of what is helpful and what is not. It is difficult to limit what goes on. It is harder to control. Is it worth risking long term issues to protect people in the short term? Is social media helpful as a means of protection? Should patient privacy ever be broken?

Violation of Human Rights Issues – Worth Saving Lives?

In the article “How China Controlled the Coronavirus,” author Peter Hessler, an English professor working in the city of Chengdu, gives a first-hand account of his experiences of the methods put in place to help control the virus. China, more specifically Wuhan, was the known zoonotic origin of the coronavirus – spreading throughout China in early 2020. Now as 2020 comes to a close, however, China has a total death toll of 4,634 in comparison with the United States which has seen 245,514 and the UK with 49,770 (still counting). It is evident from this that China has dealt with the virus better than western powers but at what ethical costs? From the article Hessler sparks a big ethical question for me which is; to what extent are the violation of basic human ethics justified in the protection of lives?

Hessler states that the Chinese response to Coronavirus was more intense and stricter than anywhere else with the government imposing strict rules on how often members were allowed to leave their households and have any form of freedom. Examples even being given of people’s doors being taped shut from the outside preventing any inhabitants from leaving. From any perspective this would be seen as a violation of basic human rights and it raises many ethical issues – mainly of which being a right to freedom. However, we live in different times right now and are experiencing an event like never before. A true global pandemic. Looking logically at these issues with the idea that saving lives is the only true goal then it would appear China’s violations of human ethics are justified as they have achieved their goal and saved lives. But it is never that simple. From these long periods of lockdown other issues have arisen relating to mental and physical health. It is difficult to come to a set outcome on the matter as, like most things, it is purely subjective.

One particular challenge raised by the blanket response seen in China and a lesser extent in the UK is that it fails adequately to address the differing impact of the virus on different groups within society and risks unduly affecting groups whose risks may be less. For example; the needs of the younger generations with regards to mental health and education need to be adequately balanced to the risks posed by the virus to the old. This a major element spoken about in Hesslers article, the use of online platforms and their effectiveness to teach.  Arguably nationwide lockdowns do not sufficiently achieve this balance. A more targeted approach may be a more ethical positive way of looking at it.

Taking a look at the UK and its fight against Coronavirus, I believe it sits nicely in the middle of the US and China’s response with a bit of both worlds. The UK government similarly to China enforced an almost two-month lockdown in March which kept people in their homes and the spreading of the virus down. However, unlike the Chinese it was done in a more relaxed manner. Other than potential fines there were no official punishments for breaking the rules. Consider it to be advice. The ownership of health was put on the people not on the government or state. No real ethical issues were therefore violated, and it seemed a good system. The UK too sits between the US and China on total death toll, this a coincidence? – I’ll let you decide. However, with the UK about to go into another month faze of lockdown from now until early December was it harsh enough?

China’s response to the Coronavirus pandemic was a clear violation of basic human ethics but it was effective in saving lives. The United States on the other hand, maybe not so much. It is a difficult balance to achieve as there will always be backlash on either side. Is a short period of violation worth the lives saved? China now sitting proud with almost no cases whilst the US battles with 100,000s per day. It is a subjective matter difficult to answer, but this is certainly a different world than we one we lived in just 12 months ago.

The Hierarchy of Priority

“A COVID-19 Vaccine Reality Check,” is an article recently published in The Atlantic by Sarah Zhang. In this article, Zhang looks at the current COVID-19 vaccine development that is taking place as well as the distribution plans to the public that are currently being assessed. Elements that most of the public is not involved in or that does not cross their minds. Zhang makes it evident that just because there is a high requirement for the vaccine due to the casualties, it does not change the fact that the vaccine needs to be rigorously tested before it can be mass-produced to try and save the lives of thousands. Despite the media giving regular updates claiming that the vaccine could be here as early as next month, Zhang believes it is going to be much longer. As well as this, Zhang creates a large ethical issue relating to the distribution of the vaccine, which is; who is given the vaccine first? When produced, it is still going to take time for the vaccine to be produced in numbers large enough that everyone is going to be able to receive it. Personally, when I think about this issue, I would look to a more logical and utilitarian method for distribution.

Taking this logical and utilitarian view on this issue, the best method would be to save the most lives possible and give to those that have the highest risk of contracting the virus. This would be the best possible scenario. In this case, those working on the frontlines as medical workers would be prioritized first. They are currently in the most danger by working with those who have COVID-19 every day, and because of their bravery and hard work, they should receive the safety of a vaccine first. This fits the utilitarian viewpoint as the person at higher risk has been saved first, and so the risk of life loss has decreased. This seems to be the most logical idea. Alongside this, the medical worker group fighting on the frontlines is not a large group of people meaning that the likelihood of being able to vaccinate all is high and even the possibility of still having vaccines left is also high. It seems simple for now.

Still keeping this utilitarian viewpoint, the next stage of distribution would be to give the vaccine to the group of people who are the most vulnerable of the rest. This would include those with underlying health conditions as well as the very young and old members of our society. Through research, it has proved that those groups have the highest percentage fatality rates from COVID-19; therefore, it is those whom we must protect next. From a purely utilitarian viewpoint, this argues stands, however, some arguments can arise when it comes to vaccinating the older generations. Due to the limited supply of vaccine, we must use them wisely – some research has been published that indicates that many of those older people dying of COVID-19 already had a high chance of dying through other causes by the end of 2020. Because of this research, some have argued that it is not worth vaccinating these people as they still have a high chance of dying soon after administration and so the vaccine could have been put to good elsewhere. This is extremely difficult to decide, though, as it based primarily on statistics.

The real issues, however, arises after these two groups have received the vaccine. Who should receive it next? It comes down to a decision between teenagers and the middle-aged—research proving that neither is at a very high risk of dying from COVID-19. As a 19-year-old, I feel confident in being able to fight the virus and opt for vaccinating the middle-aged first; however; some disagree with my viewpoint as they are less confident in their safety. On top of this should the vaccine be mandatory for all or are people allowed to choose whether they want it at all. This comes back to the anti-vax arguments. This distribution of the vaccine is a complicated matter from an ethical standpoint as to who gets it first due to the limited supply. It appears to be more subjective than objective. How safe do you feel without one? If given the opportunity to be vaccinated over someone at higher risk would you take it? What is your hierarchy of priority?

Views on The Immortal Life of Henrietta Lacks: Part II

Two main things struck me within this part of the biography. First of which is the subject surrounding the requirement of consent after her death in comparison to before. I found this an especially difficult subject to get my head around. Thinking from a logical viewpoint, it would appear to make more sense that consent would be required whilst the person is still alive and then not required when dead. However, here this is not the case. This subject falls under autonomy – surely it a person has the right to self-govern there-own body, and therefore consent is required for the harvesting of their cells? On the back of this, does someone dead still have autonomy? After thinking about this, I could see more clearly why Henrietta’s family were unsure about giving consent to the doctors.

Another area that causes concern in this part of the biography was numerous articles that were published or going to be. In these articles, it was common that Henrietta’s name was mistaken for another name or that her name was not included at all for privacy. I have less strong feelings towards her name being left because I agree with privacy for the family. However, when relating to the changing of her name, personal issues begin to arise. Primarily of these is that in doing so it feels that the humanistic nature of the case it was taken out. It feels that there is no care given towards Henrietta or the sacrifice that she gave. It makes her seem like a nobody because the writers could not take the small amount of time to correct themselves. I find it merely disappointing. It makes me think about the medical system as a whole. How much do they care, or are you simply another task that they must complete? Another potential warehouse of parts.

The second part of The Immortal Life of Henrietta Lacks focusses primarily on the time and events that take place after the passing of Henrietta – including the mass production of her cells, the news article written about the cells and the discoveries that came as a result of her cells. In this part, it talks about a polio outbreak that Henrietta’s cells helped to find a vaccine for as well as the discovery that humans have forty-six chromosomes. It also shows the interaction between Henrietta’s family and the doctors, who due to her passing now required consent to harvest more cells.

In conclusion, the second part of the biography is one that sparks personal issues for me over the treatment of Henrietta’s name as well as arguments surrounding patient autonomy. Should consent always be required when a person is alive? Should it be when dead if it is deemed to be for the greater good of humanity? In the eyes of medical professionals, are we just a warehouse of potential parts they can use to fix others? These are just questions that came to my mind when reading The Immortal Life of Henrietta Lacks part II

Daniels on Healthcare

There has always been and will always be arguments surrounding the need for the more socialist style of healthcare. Healthcare where the discrepancies between wealth and education do not matter- the only priority is making someone better, no matter the cost. Norman Daniels argues for this equal opportunity rights. The backbone of his argument dictating that; disease and disabilities restrict a person’s range of opportunities, and healthcare’s job is to maintain the “normal” functioning of people so that they too can have access to all of life’s opportunities. He argues that prior education status or wealth should in no way affect this right to healthcare as it is the basis of our functioning society.

Arguments arise surrounding this topic. Questions such as; too what extent should “free treatments,” be given out to people? From Daniels argument, it can be said that any issues considered to affect someone’s range of opportunities should be treated fairly with healthcare; however, assessing what affects this is difficult. How much treatment is too much? How much is too little? It is entirely subjective. Being from the UK this is an area of significant interest for me. In the UK, we have the NHS, considered as the first real socialist form of healthcare. From an outsider’s perspective, it seems excellent and fair for all, but under the shell, it is the cause for numerous issues. If you spoke to a Briton, most would say that the NHS is dying and is an awful system, altogether. There is a lack of care in all aspects. The NHS is spending large quantities of its budget on the treatment of just a few diseases, those relating to; smoking; obesity and type 2 diabetes. These three alone consuming around 85% of the NHS budget. Now, as a patient in the system, these lack of funds show in the quality of the hospitals (most are relatively small and look not far off a prison. Nothing compared to Emory.) As well as, in the wait times (at minimum 2 hours) and even in the parking (costing not far off $10 an hour). The whole experience of healthcare is awful. Not only as patients but also as doctors because this lack of money finds its way to them, most getting paid just over minimum wage to work long and tiring shifts. Everyone in the NHS system is overworked on the whole. So, from afar healthcare for everyone seems fair and just, however, once put into reality, some may argue it worsens care as a whole. In theory, it works, in practicality maybe not so much.

Now Daniels does make some arguments surrounding what he deems to be a limit on “necessary treatment.” Using his principle that healthcare’s job is to improve a person’s functionality and allow them to have fair opportunities to everyone else- Daniels claims that anything outside of this does not warrant healthcare. An example of this being plastic surgery or cosmetic surgery. These surgeries are there to enhance your appearance only and that by doing them it does not improve your equal opportunity rights. They do not enhance or improve functionality or ability. It is in areas such as this that Daniels draws his line. Healthcare, according to him, has one purpose, keep people functioning at the best they can so that they too can have equal opportunities.

Daniels does present a well-argued view on healthcare and the need for it. He presents a good argument as to what is considered “necessary treatment,” and what should be covered under healthcare. However, looking at a first-hand example of healthcare, it is easy to see where cracks begin to open in his argument and the practicalities of a healthcare system. Questions indeed arise in the UK and my family in terms of the weighing of costs vs quality of care. Is free healthcare worth it despite the quality of care being poor? Is it worth just paying for private healthcare which gives faster results and better overall care? These are questions I am thankful enough to ask due to my position and ability to answer them; however, for some, these questions can never be answered as they cannot afford private healthcare. Healthcare as a topic is complicated, and there is no single solution. However, using Daniels theories, it is easier to quantify what treatments fall under the healthcare bracket of care.

Goldman’s Principles of Medical Paternalism

Goldman’s principal argument against the standardised view of paternalism dictates that paternalism relies on there being an objective way to order certain values – such that the preservation of life is always the highest possible value in any medical situation. He argues that paternalists take that view that, in any context, if it is possible to preserve being, then this should be the primary goal, above all other things. This argument appears to agree, in premise, with the instinctive nature of doctors who are trained to use all possible skills to preserve the lives of their patients. Looking at this solely from the perspective of a medical physician this argument seems valid and transparent. Why would there ever come a situation in which saving the life of an individual is the wrong thing to do?

However, Goldman challenges this argument from a wider perspective, it is evident there are some arguments.  His main argument is that the ranking of these values is not objective and is in fact subjective – personal to each being. Some patients may have higher values than the simple act of preserving their own life. I have experienced this subjectivity first-hand with my 97-year-old great- grand-mother who, for many years had signed a DNR because she felt that she had lived her life and felt no need to be resuscitated. Late in her life she was diagnosed with aggressive throat cancer, given only 3 weeks to live she asked to be given no treatment. She asked to be left alone because the pain of the treatment was not worth the short lengthening of her life. Despite going against the view of preservation being the aim and the passing of my family member, personally I am more content with this outcome because as a viewer seeing someone close to you suffer for a long period is almost as bad as their passing.

While Goldman’s argument about the importance of subjective value ordering seems reasonable (and accords with my own personal experiences), there are a number of situations where it becomes harder to sustain.  In short, it relies upon the ability of the patient to make an informed decision about their relative value ordering.   There are a number of circumstances where this might be brought into question.  First,  an individual who is diagnosed with depression or is considered psychologically unstable may have a tainted view on their own ranking of values. Further, patients may be suffering emotional coercion (from family members for example).  In such circumstances, paternalistic values may be seen as having an appropriate role in protecting the individual from his/her self.  The position is further complicated in individuals who are unable (physically or legally) to give an informed view on their hierarchy of values (minors, for example, as they do not have the ability to decide for themselves). In these circumstances it is difficult to draw the distinction as to who should make the decisions; the parents; the medical professional; the state. In these specific scenarios some may consider it easier to move back to the paternalistic view that life should always be preserved at the main priority.

Goldman does present a well-argued attack on paternalism by focussing on the issue of objective value ordering.  However, the societal pressure to preserve life (ingrained in the medical professional’s training) and the numerous circumstances where real objectivity cannot be assured, means that relying solely on a doctrine of objective value ordering to supplant paternalism is likely to be dangerous.  By focussing solely on the rights of ‘an’ individual, rather than considering the wider good (the impact on family, the medical profession, healthcare costs etc.) objective value ordering perhaps represents an overly narrow avenue of attack on medical paternalism.