Uehiro Oxford Institute

A New St Cross Special Ethics Seminar, with Professor Maureen Kelley. Much of global health research occurs against the backdrop of severe, intersectional and structural vulnerabilities, where susceptibility to disease and early death are driven by poverty, and related factors such as political conflict and climate change. Global health research priorities over the last two decades have been shaped by a small number of high income country institutions, with political commitments informed largely by the ‘global burden of disease’ model. On this model, international research has primarily targeted infectious diseases and other causes of high morbidity and premature, preventable mortality, but has ignored the structural determinants of those diseases. An unintended consequence is that researchers at the frontlines of data collection and interaction with participants and communities come face-to-face with the daily suffering of participants and family members. They often face heart-rending dilemmas in responding to complex health, social, and economic needs that far outstrip the resources and expertise of most research projects or clinical trials. In this presentation, I will share findings from a longitudinal research ethics study, where local ethics teams were embedded within ongoing clinical and social science research studies in contexts of severe poverty, food shortages, droughts and flooding, gender-based violence and political conflict—typical of many global health research sites. Based on our empirical ethics findings, including experiences of research participants, community members and researchers, I will offer critical reflections on the limitations of current accounts of researcher responsibility (ancillary care or duty of care), and suggest we rethink the ways that current global health research institutions and funders engage the underlying structural drivers of disease and suffering.

A New St Cross Special Ethics Seminar with Dr David M Lyreskog. It is no exaggeration that the philosophical and ethical dimensions of age-related cognitive decline and dementia have been discussed for millennia, nor is it without reason. To this day, we struggle with understanding and dealing with the conceptual and ethical complexities which these conditions give rise to. And yet, we keep encountering new problems, challenging us to again rethink our relationship with neurodegenerative disease, cognitive impairment, and personhood.

In this presentation I highlight phenomena in dementia care, prevention, and treatment, which have recently gained attention in dementia care and in the literature of the same – including relational identity adoption, paradoxical lucidity, and transformative experience – and discuss their ethical, philosophical, and practical implications. I argue that, to tackle the problems that arise, we may need to adjust our way of thinking about the human mind, to better make sense of what is at stake in dementia care and to deal with the consequences. I suggest that a framework allowing a spacial and temporal “plasticity of the mind” of sorts may help us in this endeavour, and inform our decision-making in care, prevention and treatment of dementia. I also address some of the potential issues with adopting such an approach, and discuss how to move on from here.

Professor Morten L. Kringlebach explains how recent advances in neuroimaging offer an insight into hedonia and eudaimonia, and draws out implications for neuropsychiatric disorders. Recent advances in whole-brain modelling have helped stratify the heterogeneity of anhedonia across neuropsychiatric disorders, and the key underlying components of the pleasure network. I will show how modelling of neuroimaging data from diverse hedonic routes such as psychedelics, meditation and music could potentially offer new insights not only into hedonia but potentially also eudaimonia. To this end, we have recently demonstrated the hierarchical organisation of consciousness in over thousand people, and the crucial role played by rare long-range exceptions to a fundamental exponential distance rule of brain connectivity. These processes are controlling the information cascade in the turbulent-like brain dynamics necessary for optimal orchestration of behaviour necessary a life well-lived. This has direct implications for getting a handle on eudaimonia and well-being which are difficult to study empirically, as well as the diagnosis and treatment of anhedonia in neuropsychiatric disorders.

Professor Morten L. Kringlebach (Aarhus University, Denmark; University of Oxford)

THE NEW ST CROSS SPECIAL ETHICS SEMINARS ARE JOINTLY ARRANGED BY THE OXFORD UEHIRO CENTRE AND THE WELLCOME CENTRE FOR ETHICS AND HUMANITIES (WEH).

MT20 New St Cross Special Ethics Seminar with Assoc. Professor Jennifer Hawkins Valid informed consent to treatment requires that the person giving consent have decision-making capacity or (what amounts to the same thing) must be mentally competent. To date the most influential model for both conceptualizing what capacity is, and for assessing it clinically, is the “four abilities model” developed by Thomas Grisso and Paul Appelbaum. Despite its popularity, however, this framework is flawed. It not infrequently delivers the wrong verdict in certain kinds of cases involving strong emotions and/or problematic values. Given that we want to (a) avoid objectionable forms of paternalism (b) avoid labeling as incompetent those who simply have unusual values and (c) avoid assuming that mental illness entails lack of capacity, it can seem as if there is no good solution to the problems posed by these cases. Nonetheless, there is a way we can proceed while avoiding these moral pitfalls. In this paper I first offer a better way of conceptualizing what it is we are trying to determine in capacity assessments, and then sketch an alternative way to assess capacity that avoids the moral pitfalls while yielding better, more plausible results in the problem cases.

MT20 New St Cross Special Ethics Seminar with Assoc. Professor Jennifer Hawkins Valid informed consent to treatment requires that the person giving consent have decision-making capacity or (what amounts to the same thing) must be mentally competent. To date the most influential model for both conceptualizing what capacity is, and for assessing it clinically, is the “four abilities model” developed by Thomas Grisso and Paul Appelbaum. Despite its popularity, however, this framework is flawed. It not infrequently delivers the wrong verdict in certain kinds of cases involving strong emotions and/or problematic values. Given that we want to (a) avoid objectionable forms of paternalism (b) avoid labeling as incompetent those who simply have unusual values and (c) avoid assuming that mental illness entails lack of capacity, it can seem as if there is no good solution to the problems posed by these cases. Nonetheless, there is a way we can proceed while avoiding these moral pitfalls. In this paper I first offer a better way of conceptualizing what it is we are trying to determine in capacity assessments, and then sketch an alternative way to assess capacity that avoids the moral pitfalls while yielding better, more plausible results in the problem cases. Creative Commons Attribution-Non-Commercial-Share Alike 2.0 UK: England & Wales; http://creativecommons.org/licenses/by-nc-sa/2.0/uk/

Alberto Giubilini and David Jones trade views and argue each other's position on conscientious objection in healthcare In this unusual online debate, Alberto Guibilini (Oxford Uehiro Centre for Practical Ethics) and David Jones (The Anscombe Bioethics Centre) adopt each other's position on conscientious objection, arguing for the opposing view in an attempt to explore not only the subject, but the very nature of disagreement and discussion.

Recording of the New St Cross Special Ethics Seminar on surrogate decision-making after severe brain injury. Patients with ‘covert awareness’ may continue to have values and an authentic sense of self, which may differ from their past values and wishes, despite lacking decision-making capacity in the present. Accordingly, surrogate decision-makers should make decisions based on how the patient is likely to experience their condition in the present, rather than their past wishes and values.

Recording of the New St Cross Special Ethics Seminar on surrogate decision-making after severe brain injury. Patients with ‘covert awareness’ may continue to have values and an authentic sense of self, which may differ from their past values and wishes, despite lacking decision-making capacity in the present. Accordingly, surrogate decision-makers should make decisions based on how the patient is likely to experience their condition in the present, rather than their past wishes and values.

In this New St Cross Special Ethics Seminar, Professor Arthur Schafer outlines the current contours of the Canadian euthanasia debate. In June of 2016 the Canadian Parliament passed legislation (Bill-14) legalizing MAiD: medical assistance in dying. Subject to various restrictions, both mercy killing and medically assisted suicide are now legal in Canada. The contours of the Canadian euthanasia debate will be described, with special focus on the ethical issues that remain most controversial. Two salient Canadian Supreme Court decisions will be analysed: Rodriguez (1993) and Carter (2015), as well as more recent constitutional challenges. The presentation will conclude by outlining the further legal changes that are likely to (or that should) occur in the reasonably near future.

In this New St Cross Special Ethics Seminar, Professor Arthur Schafer outlines the current contours of the Canadian euthanasia debate. In June of 2016 the Canadian Parliament passed legislation (Bill-14) legalizing MAiD: medical assistance in dying. Subject to various restrictions, both mercy killing and medically assisted suicide are now legal in Canada. The contours of the Canadian euthanasia debate will be described, with special focus on the ethical issues that remain most controversial. Two salient Canadian Supreme Court decisions will be analysed: Rodriguez (1993) and Carter (2015), as well as more recent constitutional challenges. The presentation will conclude by outlining the further legal changes that are likely to (or that should) occur in the reasonably near future.