64 found
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  1.  13
    Withdrawal Aversion and the Equivalence Test.Julian Savulescu, Ella Butcherine & Dominic Wilkinson - 2019 - American Journal of Bioethics 19 (3):21-28.
    If a doctor is trying to decide whether or not to provide a medical treatment, does it matter ethically whether that treatment has already been started? Health professionals sometimes find it harder to stop a treatment than to refrain from starting the treatment. But does that feeling correspond to an ethical difference? In this article, we defend equivalence—the view that withholding and withdrawal of treatment are ethically equivalent when all other factors are equal. We argue that preference for withholding over (...)
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  2.  6
    Worth Living or Worth Dying? The Views of the General Public About Allowing Disabled Children to Die.Claudia Brick, Guy Kahane, Dominic Wilkinson, Lucius Caviola & Julian Savulescu - 2020 - Journal of Medical Ethics 46 (1):7-15.
    BackgroundDecisions about withdrawal of life support for infants have given rise to legal battles between physicians and parents creating intense media attention. It is unclear how we should evaluate when life is no longer worth living for an infant. Public attitudes towards treatment withdrawal and the role of parents in situations of disagreement have not previously been assessed.MethodsAn online survey was conducted with a sample of the UK public to assess public views about the benefit of life in hypothetical cases (...)
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  3.  7
    Moral Uncertainty and the Farming of Human-Pig Chimeras.Julian Koplin & Dominic Wilkinson - 2019 - Journal of Medical Ethics 45 (7):440-446.
    It may soon be possible to generate human organs inside of human-pig chimeras via a process called interspecies blastocyst complementation. This paper discusses what arguably the central ethical concern is raised by this potential source of transplantable organs: that farming human-pig chimeras for their organs risks perpetrating a serious moral wrong because the moral status of human-pig chimeras is uncertain, and potentially significant. Those who raise this concern usually take it to be unique to the creation of chimeric animals with (...)
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  4.  6
    ICU Triage in an Impending Crisis: Uncertainty, Pre-Emption and Preparation.Dominic Wilkinson - 2020 - Journal of Medical Ethics 46 (5):287-288.
    The COVID-19 coronavirus pandemic raises a host of challenging ethical questions at every level of society. However, some of the most acute questions relate to decision making in intensive care. The problem is that a small but significant proportion of patients develop severe viral pneumonitis and respiratory failure. It now seems likely that the number of critically ill patients will overwhelm the capacity of intensive care units within many health systems, including the National Health Service in the UK. The experience (...)
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  5.  29
    Harm Isn't All You Need: Parental Discretion and Medical Decisions for a Child: Table 1.Dominic Wilkinson & Tara Nair - 2016 - Journal of Medical Ethics 42 (2):116-118.
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  6.  19
    Utilitarianism and the Pandemic.Julian Savulescu, Ingmar Persson & Dominic Wilkinson - forthcoming - Bioethics.
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  7. Should We Allow Organ Donation Euthanasia? Alternatives for Maximizing the Number and Quality of Organs for Transplantation.Dominic Wilkinson & Julian Savulescu - 2012 - Bioethics 26 (1):32-48.
    There are not enough solid organs available to meet the needs of patients with organ failure. Thousands of patients every year die on the waiting lists for transplantation. Yet there is one currently available, underutilized, potential source of organs. Many patients die in intensive care following withdrawal of life-sustaining treatment whose organs could be used to save the lives of others. At present the majority of these organs go to waste.In this paper we consider and evaluate a range of ways (...)
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  8.  57
    A Life Worth Giving? The Threshold for Permissible Withdrawal of Life Support From Disabled Newborn Infants.Dominic James Wilkinson - 2011 - American Journal of Bioethics 11 (2):20 - 32.
    When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of well-being. I (...)
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  9. A Costly Separation Between Withdrawing and Withholding Treatment in Intensive Care.Dominic Wilkinson & Julian Savulescu - 2014 - Bioethics 28 (3):127-137.
    Ethical analyses, professional guidelines and legal decisions support the equivalence thesis for life-sustaining treatment: if it is ethical to withhold treatment, it would be ethical to withdraw the same treatment. In this paper we explore reasons why the majority of medical professionals disagree with the conclusions of ethical analysis. Resource allocation is considered by clinicians to be a legitimate reason to withhold but not to withdraw intensive care treatment. We analyse five arguments in favour of non-equivalence, and find only relatively (...)
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  10.  50
    Hard Lessons: Learning From the Charlie Gard Case.Dominic Wilkinson & Julian Savulescu - 2018 - Journal of Medical Ethics 44 (7):438-442.
    On 24 July 2017, the long-running, deeply tragic and emotionally fraught case of Charlie Gard reached its sad conclusion. Following further medical assessment of the infant, Charlie’s parents and doctors finally reached agreement that continuing medical treatment was not in Charlie’s best interests. Life support was subsequently withdrawn and Charlie died on 28 July 2017.Box 1 ### Case summary and timeline21–23 Charlie Gard was born at full term, apparently healthy, in August 2016. At a few weeks of age his parents (...)
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  11.  34
    Philosophical Medical Ethics: More Necessary Than Ever.Julian Savulescu, Thomas Douglas & Dominic Wilkinson - 2018 - Journal of Medical Ethics 44 (7):434-435.
    When we applied for the editorship of the JME 7 years ago, we said that we considered the JME to be the most important journal in medicine. The most profound questions that health professionals face are not scientific or technical, but ethical. Our enormous scientific and medical progress already outstrips our capability to provide treatment. Life can be prolonged at enormous cost, sometimes far beyond the point that the individual appears to be gaining a net benefit from that life. Science (...)
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  12.  58
    In Favour of Medical Dissensus: Why We Should Agree to Disagree About End‐of‐Life Decisions.Dominic Wilkinson, Robert Truog & Julian Savulescu - 2016 - Bioethics 30 (2):109-118.
    End-of-life decision-making is controversial. There are different views about when it is appropriate to limit life-sustaining treatment, and about what palliative options are permissible. One approach to decisions of this nature sees consensus as crucial. Decisions to limit treatment are made only if all or a majority of caregivers agree. We argue, however, that it is a mistake to require professional consensus in end-of-life decisions. In the first part of the article we explore practical, ethical, and legal factors that support (...)
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  13.  37
    Death or Disability?: The 'Carmentis Machine' and Decision-Making for Critically Ill Children.Dominic Wilkinson - 2013 - Oxford University Press UK.
    Death and grief in the ancient world -- Predictions and disability in Rome.
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  14.  25
    Conscientious Non-Objection in Intensive Care.Dominic Wilkinson - 2017 - Cambridge Quarterly of Healthcare Ethics 26 (1):132-142.
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  15.  22
    Settling for Second Best: When Should Doctors Agree to Parental Demands for Suboptimal Medical Treatment?Tara Nair, Julian Savulescu, Jim Everett, Ryan Tonkens & Dominic Wilkinson - 2017 - Journal of Medical Ethics 43 (12):831-840.
    Background Doctors sometimes encounter parents who object to prescribed treatment for their children, and request suboptimal substitutes be administered instead. Previous studies have focused on parental refusal of treatment and when this should be permitted, but the ethics of requests for suboptimal treatment has not been explored. Methods The paper consists of two parts: an empirical analysis and an ethical analysis. We performed an online survey with a sample of the general public to assess respondents’ thresholds for acceptable harm and (...)
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  16.  66
    The Self-Fulfilling Prophecy in Intensive Care.Dominic Wilkinson - 2009 - Theoretical Medicine and Bioethics 30 (6):401-410.
    Predictions of poor prognosis for critically ill patients may become self-fulfilling if life-sustaining treatment or resuscitation is subsequently withheld on the basis of that prediction. This paper outlines the epistemic and normative problems raised by self-fulfilling prophecies (SFPs) in intensive care. Where predictions affect outcome, it can be extremely difficult to ascertain the mortality rate for patients if all treatment were provided. SFPs may lead to an increase in mortality for cohorts of patients predicted to have poor prognosis, they may (...)
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  17.  7
    Commentary: Treating Ambiguity in the Clinical Context: Is What You Hear the Doctor Say What the Doctor Means?Vicki Xafis & Dominic Wilkinson - 2019 - Cambridge Quarterly of Healthcare Ethics 28 (3):422-432.
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  18. Consequentialism and the Death Penalty.Dominic J. Wilkinson & Thomas Douglas - 2008 - American Journal of Bioethics 8 (10):56-58.
    Comment on "The ethical 'elephant' in the death penalty 'room'". Arguments in defense of the death penalty typically fall into one of two groups. Consequentialist arguments point out beneficial aspects of capital punishment, normally focusing on deterrence, while non-consequentialist arguments seek to justify execution independently of its effects, for example, by appealing to the concept of retribution. Michael Keane's target article "The ethical 'elephant' in the death penalty 'room'" should, we believe, be read as an interesting new consequentialist defense of (...)
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  19. Double Trouble: Should Double Embryo Transfer Be Banned?Dominic Wilkinson, G. Owen Schaefer, Kelton Tremellen & Julian Savulescu - 2015 - Theoretical Medicine and Bioethics 36 (2):121-139.
    What role should legislation or policy play in avoiding the complications of in-vitro fertilization? In this article, we focus on single versus double embryo transfer, and assess three arguments in favour of mandatory single embryo transfer: risks to the mother, risks to resultant children, and costs to society. We highlight significant ethical concerns about each of these. Reproductive autonomy and non-paternalism are strong enough to outweigh the health concerns for the woman. Complications due to non-identity cast doubt on the extent (...)
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  20.  14
    The Relational Threshold: A Life That is Valued, or a Life of Value?Dominic Wilkinson, Claudia Brick, Guy Kahane & Julian Savulescu - 2020 - Journal of Medical Ethics 46 (1):24-25.
    The four thoughtful commentaries on our feature article draw out interesting empirical and normative questions. The aim of our study was to examine the views of a sample of the general public about a set of cases of disputed treatment for severely impaired infants.1 We compared those views with legal determinations that treatment was or was not in the infants’ best interests, and with some published ethical frameworks for decisions. We deliberately did not draw explicit ethical conclusions from our survey (...)
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  21.  27
    Cost-Equivalence and Pluralism in Publicly-Funded Health-Care Systems.Dominic Wilkinson & Julian Savulescu - 2018 - Health Care Analysis 26 (4):287-309.
    Clinical guidelines summarise available evidence on medical treatment, and provide recommendations about the most effective and cost-effective options for patients with a given condition. However, sometimes patients do not desire the best available treatment. Should doctors in a publicly-funded healthcare system ever provide sub-optimal medical treatment? On one view, it would be wrong to do so, since this would violate the ethical principle of beneficence, and predictably lead to harm for patients. It would also, potentially, be a misuse of finite (...)
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  22.  55
    Protecting Future Children From In‐Utero Harm.Dominic Wilkinson, Loane Skene, Lachlan de Crespigny & Julian Savulescu - 2016 - Bioethics 30 (6):425-432.
    The actions of pregnant women can cause harm to their future children. However, even if the possible harm is serious and likely to occur, the law will generally not intervene. A pregnant woman is an autonomous person who is entitled to make her own decisions. A fetus in-utero has no legal right to protection. In striking contrast, the child, if born alive, may sue for injury in-utero; and the child is entitled to be protected by being removed from her parents (...)
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  23.  9
    Ethical Complexity and Precaution When Parents and Doctors Disagree About Treatment.Marnie Manning & Dominic Wilkinson - 2018 - American Journal of Bioethics 18 (8):49-55.
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  24.  45
    How Much Weight Should We Give to Parental Interests in Decisions About Life Support for Newborn Infants?Dominic Wilkinson - 2010 - Monash Bioethics Review 29 (2):13-1.
    Life-sustaining treatment is sometimes withdrawn or withheld from critically ill newborn infants with poor prognosis. Guidelines relating to such decisions place emphasis on the best interests of the infant. However, in practice, parental views and parental interests are often taken into consideration.In this paper I draw on the example of newborn infants with severe muscle weakness. I provide two arguments that parental interests should be given some weight in decisions about treatment, and that they should be given somewhat more weight (...)
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  25.  42
    The Window of Opportunity: Decision Theory and the Timing of Prognostic Tests for Newborn Infants.Dominic Wilkinson - 2009 - Bioethics 23 (9):503-514.
    In many forms of severe acute brain injury there is an early phase when prognosis is uncertain, followed later by physiological recovery and the possibility of more certain predictions of future impairment. There may be a window of opportunity for withdrawal of life support early, but if decisions are delayed there is the risk that the patient will survive with severe impairment. In this paper I focus on the example of neonatal encephalopathy and the question of the timing of prognostic (...)
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  26.  65
    “Neglected Personhood” and Neglected Questions: Remarks on the Moral Significance of Consciousness.Dominic Wilkinson, Guy Kahane & Julian Savulescu - 2008 - American Journal of Bioethics 8 (9):31 – 33.
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  27.  36
    Balancing Obligations: Should Written Information About Life-Sustaining Treatment Be Neutral?Vicki Xafis, Dominic Wilkinson, Lynn Gillam & Jane Sullivan - 2015 - Journal of Medical Ethics 41 (3):234-239.
    Parents who are facing decisions about life-sustaining treatment for their seriously ill or dying child are supported by their child's doctors and nurses. They also frequently seek other information sources to help them deal with the medical and ethical questions that arise. This might include written or web-based information. As part of a project involving the development of such a resource to support parents facing difficult decisions, some ethical questions emerged. Should this information be presented in a strictly neutral fashion? (...)
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  28.  29
    Zika, Contraception and the Non‐Identity Problem.Keyur Doolabh, Lucius Caviola, Julian Savulescu, Michael Selgelid & Dominic J. C. Wilkinson - 2017 - Developing World Bioethics 17 (3):173-204.
    The 2016 outbreak of the Zika arbovirus was associated with large numbers of cases of the newly-recognised Congenital Zika Syndrome. This novel teratogenic epidemic raises significant ethical and practical issues. Many of these arise from strategies used to avoid cases of CZS, with contraception in particular being one proposed strategy that is atypical in epidemic control. Using contraception to reduce the burden of CZS has an ethical complication: interventions that impact the timing of conception alter which people will exist in (...)
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  29.  3
    Is Withdrawing Treatment Really More Problematic Than Withholding Treatment?James Cameron, Julian Savulescu & Dominic Wilkinson - forthcoming - Journal of Medical Ethics:medethics-2020-106330.
    There is a concern that as a result of COVID-19 there will be a shortage of ventilators for patients requiring respiratory support. This concern has resulted in significant debate about whether it is appropriate to withdraw ventilation from one patient in order to provide it to another patient who may benefit more. The current advice available to doctors appears to be inconsistent, with some suggesting withdrawal of treatment is more serious than withholding, while others suggest that this distinction should not (...)
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  30.  26
    Schrodinger's Fetus.Dominic Wilkinson - 2017 - Journal of Medical Ethics 43 (1):1-1.
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  31.  8
    Safeguarding Choice at the End of Life.Dominic Wilkinson - 2015 - Journal of Medical Ethics 41 (8):575-576.
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  32.  21
    Rationing Conscience.Dominic Wilkinson - 2017 - Journal of Medical Ethics 43 (4):226-229.
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  33.  51
    Antenatal Diagnosis of Trisomy 18, Harm and Parental Choice.Dominic J. C. Wilkinson - 2010 - Journal of Medical Ethics 36 (11):644-645.
    In this commentary I assess the possible harms to a fetus with trisomy 18 of continued life. I argue that, although there is good reason to avoid subjecting infants to major surgery and prolonged intensive care where there is little chance of benefit, doctors should support and engage honestly with parents who decide to continue their pregnancies. We should ensure that infants with trisomy 18 have access to high quality palliative care.
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  34.  15
    How Can You Be Transparent About Labeling the Living as Dead?David Rodríguez-Arias, Dominic Wilkinson & Stuart Youngner - 2017 - American Journal of Bioethics 17 (5):24-25.
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  35.  7
    Asymmetrical Reasons, Newborn Infants, and Resource Allocation.Dominic Wilkinson & Dean Hayden - 2017 - American Journal of Bioethics 17 (8):13-15.
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  36.  2
    ‘Your Country Needs You’: The Ethics of Allocating Staff to High-Risk Clinical Roles in the Management of Patients with COVID-19.Michael Dunn, Mark Sheehan, Joshua Hordern, Helen Lynne Turnham & Dominic Wilkinson - forthcoming - Journal of Medical Ethics:medethics-2020-106284.
    As the COVID-19 pandemic impacts on health service delivery, health providers are modifying care pathways and staffing models in ways that require health professionals to be reallocated to work in critical care settings. Many of the roles that staff are being allocated to in the intensive care unit and emergency department pose additional risks to themselves, and new policies for staff reallocation are causing distress and uncertainty to the professionals concerned. In this paper, we analyse a range of ethical issues (...)
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  37.  66
    Precision and the Rules of Prioritization.John Mcmillan, Tony Hope & Dominic Wilkinson - 2013 - Cambridge Quarterly of Healthcare Ethics 22 (4):336-345.
  38.  30
    Disability, Discrimination and Death: Is It Justified to Ration Life Saving Treatment for Disabled Newborn Infants?Dominic Wilkinson & Julian Savulescu - unknown
    Disability might be relevant to decisions about life support in intensive care in several ways. It might affect the chance of treatment being successful, or a patient’s life expectancy with treatment. It may affect whether treatment is in a patient’s best interests. However, even if treatment would be of overall benefit it may be unaffordable and consequently unable to be provided. In this paper we will draw on the example of neonatal intensive care, and ask whether or when it is (...)
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  39.  60
    Three Myths in End-of-Life Care.Dominic Wilkinson - 2013 - Journal of Medical Ethics 39 (6):389-390.
    Huang and colleagues provide some intriguing insights into the attitudes about end of life care of practising Taiwanese neonatal doctors and nurses.1 There are some similarities with surveys from other parts of the world. Most Taiwanese neonatologists and nurses agreed that it was potentially appropriate to withhold or limit treatment for infants who were dying. A very high proportion was opposed to active euthanasia of such infants. But there were also some striking differences. Only 21% of Taiwanese doctors ‘agreed’ with (...)
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  40.  25
    Making the Cut: Analytical and Empirical Bioethics.Dominic Wilkinson - 2014 - Journal of Medical Ethics 40 (9):581-582.
    This issue of the journal includes papers across both analytical and empirical schools within bioethics.In his feature article, ‘The kindest cut? Surgical castration, sex offenders and coercive offers’, John McMillan asks whether surgical castration can be ethically provided as medical treatment for sex offenders . While surgical castration has previously been available in a number of European countries, in recent years it has only been available in the Czech Republic and in Germany. The European Committee for the Prevention of Torture (...)
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  41.  6
    Ectogestation Ethics: The Implications of Artificially Extending Gestation for Viability, Newborn Resuscitation and Abortion.Lydia Di Stefano, Catherine Mills, Andrew Watkins & Dominic Wilkinson - 2020 - Bioethics 34 (4):371-384.
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  42.  26
    Ethical Language and Decision-Making for Prenatally Diagnosed Lethal Malformations.Dominic Wilkinson, Lachlan De Crespigny & Vicki Xafis - unknown
    In clinical practice, and in the medical literature, severe congenital malformations such as trisomy 18, anencephaly, and renal agenesis are frequently referred to as ‘lethal’ or as ‘incompatible with life’. However, there is no agreement about a definition of lethal malformations, nor which conditions should be included in this category. Review of outcomes for malformations commonly designated ‘lethal’ reveals that prolonged survival is possible, even if rare. This article analyses the concept of lethal malformations and compares it to the problematic (...)
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  43.  8
    How Should We Treat Human–Pig Chimeras, Non-Chimeric Pigs and Other Beings of Uncertain Moral Status?Julian Koplin & Dominic Wilkinson - 2019 - Journal of Medical Ethics 45 (7):457-458.
    Our recent article begins by describing a new technique for creating human–animal chimeras. This technique—known as interspecies blastocyst complementation—may enable us to generate human organs inside of human–pig chimeras. One central concern about farming human–pig chimeras for their organs is that their moral status would be uncertain and potentially significant. Our article is partly, but not only, about such concerns. At the heart of our paper are two broader questions. First, how should we treat beings of uncertain moral status? And (...)
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  44.  34
    Should We Replace Disabled Newborn Infants?Dominic Wilkinson - 2011 - Journal of Moral Philosophy 8 (3):390-414.
    If a disabled newborn infant dies, her parents may be able to conceive another child without impairment. This is sometimes referred to as 'replacement'. Some philosophers have argued that replacement provides a strong reason for disabled newborns to be killed or allowed to die. In this paper I focus on the case for replacement as it relates to decisions about life support in newborn intensive care. I argue (following Jeff McMahan) that the impersonal reason to replace is weak and easily (...)
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  45.  10
    The Equivalence Thesis: Why Timers Do Not Successfully Resuscitate the Acts/Omissions and Withdrawal/Withholding Debate.Dominic Wilkinson, Ella Butcherine & Julian Savulescu - 2019 - American Journal of Bioethics 19 (4):W6-W9.
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  46.  32
    What has Philosophy Got to Do It? Conflicting Views and Values in End-of-Life Care.Dominic Wilkinson - 2017 - Journal of Medical Ethics 43 (9):591-592.
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  47.  55
    Challenging the Status Quo.Dominic Wilkinson - 2009 - Journal of Bioethical Inquiry 6 (2):235-237.
    Harold Jaffe argues that we should adopt opt-out testing for HIV. There are paternalistic and utilitarian arguments for such an approach. In this commentary I draw attention to some similarities between his arguments and debates about opt-out systems of organ donation. I argue that the status quo bias provides both part of the reason that opt-out approaches work, and an explanation for why such approaches are sometimes resisted.
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  48.  6
    Current Controversies and Irresolvable Disagreement: The Case of Vincent Lambert and the Role of ‘Dissensus’.Dominic Wilkinson & Julian Savulescu - 2019 - Journal of Medical Ethics 45 (10):631-635.
    Controversial cases in medical ethics are, by their very nature, divisive. There are disagreements that revolve around questions of fact or of value. Ethical debate may help in resolving those disagreements. However, sometimes in such cases, there are opposing reasonable views arising from deep-seated differences in ethical values. It is unclear that agreement and consensus will ever be possible. In this paper, we discuss the recent controversial case of Vincent Lambert, a French man, diagnosed with a vegetative state, for whom (...)
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  49.  6
    Is the Non-Identity Problem Relevant to Public Health and Policy? An Online Survey.Keyur Doolabh, Lucius Caviola, Julian Savulescu, Michael J. Selgelid & Dominic Wilkinson - 2019 - BMC Medical Ethics 20 (1):46.
    The non-identity problem arises when our actions in the present could change which people will exist in the future, for better or worse. Is it morally better to improve the lives of specific future people, as compared to changing which people exist for the better? Affecting the timing of fetuses being conceived is one case where present actions change the identity of future people. This is relevant to questions of public health policy, as exemplified in some responses to the Zika (...)
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  50.  10
    Newborns in Crisis: An Outline of Neonatal Ethical Dilemmas in Humanitarian Medicine.Jesse Schnall, Dean Hayden & Dominic Wilkinson - 2019 - Developing World Bioethics 19 (4):196-205.
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