Morals and ethics and medicine

A subtext floats below the surface of this week's BMJ, illustrating how morals and ethics are woven throughout health care.

Problem: there is a worldwide shortage of organ donors, leading to long waiting lists and unneeded suffering and deaths. No one would argue against publicity that might motivate people to donate. Does that justify a recent Dutch game show that claimed to portray a real-life kidney donor interviewing potential recipients, which turned out to be a hoax to garner ratings and publicity for the cause (doi: 10.1136/bmj.39237.609132.59)? Ethicists Inez de Beaufort and Frans Meulenberg felt soiled by the whole thing.

Or how about the question of whether health insurers should have access to your genetic history? Søren Holm says it's no different from their knowing other risk related information, such as age and medical history (doi: 10.1136/bmj.39216.468495.AD). Richard Ashcroft disagrees (doi: 10.1136/bmj.39216.425231.AD), saying that predicting risk from genetics not an exact science yet and could result in unfair discrimination against those who need insurance the most.

Even in “straightforward” scientific trials there is often an ethical twist. Ian Jones and colleagues studied schoolchildren to determine at what age they can reliably deliver the chest compressions required for cardiopulmonary resuscitation (CPR) (doi: 10.1136/bmj.39167.459028.DE). The answer, it turns out, is about age 13. So should we be training kids to do CPR? In a related editorial, Ian Maconochie et al discuss this question. Though they say that teachers felt students' self esteem would be increased by such training, no one mentions how the children might feel when they pump on a chest and the person dies.

Finally, international health and health care disparities are prime sources of moral outrage. Selina Banu and associates conducted a randomized trial comparing the behavioral side effects of phenobarbital and carbamazepine in the treatment of childhood epilepsy (doi: 10.1136/bmj.39022.436389.BE). They were about the same, which is good news because phenobarbital is cheaper. But the outrageous finding is buried both in the research report and in an accompanying editorial by Emilio Perucca (doi: 10.1136/bmj.39065.460208.80): about 80% or 85% of people with epilepsy in developing countries receive no treatment at all.