Online Seminar: Josh Parker & Matthew Watkins VIDEO RECORDING

Josh Parker (Education Fellow in Ethics and Law, Wythenshawe Hospital): Anaesthetic gases, climate change and ethics: a volatile combination?

Matthew Watkins (Postgraduate Researcher, University of Southampton): Confusing the purpose of the medical relationship in Law: a return to Beneficence-in-trust as the basis of Medicine

Abstracts

Anaesthetic gases, climate change and ethics: a volatile combination?

It is well established that inhaled volatile anaesthetic gases (VGAs) contribute to climate change through their innate greenhouse gas effect, accounting for 5% of the NHS’s total carbon footprint. Whilst The Montreal protocol aims to phase out global chlorofluorocarbon use along with hydrofluorocarbons, VGAs are often excluded from this in light of medical necessity. This paper aims to question the ethics of using VGAs in light of their contribution for anthropogenic climate change and its consequences for humanity.

First, we question whether doctors should use VGAs given their climate effects. It might be assumed that because climate change is bad for humanity and that VGAs cause climate change this provides a moral reason to refrain from using them. However, each individual use of VGAs has a negligible impact on the climate, and it is only through repeated and aggregate use that any harms can be seen. As a collective action problem, it is therefore difficult to establish that any single anaesthetic directly changes the climate or is harmful. Here make the case that a functional climate is both a public good and a common good. Following this, we argue that multiple moral theories converge on a duty to avoid negligible harms to these goods. Given that anaesthesia is an invaluable part of modern healthcare, we discuss why the availability of alternative anaesthetic techniques means that the use of VGAs should be morally avoided. Nevertheless, eliminating VGAs may have burdens and risks to individual patients. We therefore consider such cases and explore when it is ethical for patients to shoulder the burdens of avoiding climate change, and when it is ethical to use VGAs. Ultimately, we conclude that most uses of VGAs are unethical, and that in large part they ought to be abandoned.

Confusing the purpose of the medical relationship in Law: a return to Beneficence-in-trust as the basis of Medicine

“It is nearly 20 years since O’Neil published Autonomy and Trust in Bioethics. This seminal book exposed the relationship between the reduction in public trust and the dramatic increase in both the ethical and legal regulation of medical decision-making. However, rather than fill the void with a coherent set of beneficent principles, as a way to rationalise and structure medical decision-making, certain members of the judiciary have embarked on a campaign to shift power in the medical relationship towards the patient – adopting the mantra: “the patient rather than the doctor must decide.”

This paper will argue that the development of Negligence case-law has led to the piecemeal eradication of medical discretion. Worse, the Law has re-characterised the doctor-patient relationship: from one grounded on moral principles, to one based on servicing the consumer patient. Not only is this alien to the British conception of medicine, but it is also damaging to the essential relationship of trust. First, it legitimises abandoning the potentially inexpert, and vulnerable, patient to complex and potentially harmful decision-making. Second, it forces the doctor to depart from the moral norms, principles, and virtues, which require them to care for the patient, avoid harm, and act in their best interests. Without these inner moral norms to guide her actions a doctor can only act by following rules to avoid sanction. If these rules and standards are decided by a potentially irrational patient, or set abstractly by the law, there is every possibility that the doctor will be forced to do harm. When harm occurs the cycle of scandal, reduction in trust, and over-regulation continues.

Adopting the scholarship of MacIntyre, Pellegrino & Thomasma, this paper advocates that only when patients, and society at large, can trust that all doctors are acting upon shared moral principles will this demoralising cycle end. The first step is the re-adoption of a collective conception of the purpose (telos) of medicine: as Beneficence-in-trust.”