84 found
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  1.  79
    Utilitarianism and the Pandemic.Julian Savulescu, Ingmar Persson & Dominic Wilkinson - 2020 - Bioethics 34 (6):620-632.
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  2.  17
    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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  3.  13
    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.  27
    Passport to Freedom? Immunity Passports for COVID-19.Rebecca C. H. Brown, Julian Savulescu, Bridget Williams & Dominic Wilkinson - 2020 - Journal of Medical Ethics 46 (10):652-659.
    The COVID-19 pandemic has led a number of countries to introduce restrictive ‘lockdown’ policies on their citizens in order to control infection spread. Immunity passports have been proposed as a way of easing the harms of such policies, and could be used in conjunction with other strategies for infection control. These passports would permit those who test positive for COVID-19 antibodies to return to some of their normal behaviours, such as travelling more freely and returning to work. The introduction of (...)
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  5. 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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  6. 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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  7.  52
    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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  8.  25
    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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  9.  62
    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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  10.  34
    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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  11.  16
    ‘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 - 2020 - Journal of Medical Ethics 46 (7):436-440.
    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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  12.  60
    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.  6
    Valuing life and evaluating suffering in infants with life-limiting illness.Dominic Wilkinson & Amir Zayegh - 2020 - Theoretical Medicine and Bioethics 41 (4):179-196.
    In this paper, we explore three separate questions that are relevant to assessing the prudential value of life in infants with severe life-limiting illness. First, what is the value or disvalue of a short life? Is it in the interests of a child to save her life if she will nevertheless die in infancy or very early childhood? Second, how does profound cognitive impairment affect the balance of positives and negatives in a child’s future life? Third, if the life of (...)
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  14.  8
    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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  15.  12
    Rationing in a Pandemic: Lessons From Italy.Lucia Craxì, Marco Vergano, Julian Savulescu & Dominic Wilkinson - 2020 - Asian Bioethics Review 12 (3):325-330.
    In late February and early March 2020, Italy became the European epicenter of the COVID-19 pandemic. Despite increasingly stringent containment measures enforced by the government, the health system faced an enormous pressure, and extraordinary efforts were made in order to increase overall hospital beds’ availability and especially ICU capacity. Nevertheless, the hardest-hit hospitals in Northern Italy experienced a shortage of ICU beds and resources that led to hard allocating choices. At the beginning of March 2020, the Italian Society of Anesthesia, (...)
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  16.  13
    Are Generational Welfare Trades Always Unjust?Walter Veit, Julian Savulescu, David Hunter, Brian D. Earp & Dominic Wilkinson - 2020 - American Journal of Bioethics 20 (9):70-72.
    Volume 20, Issue 9, September 2020, Page 70-72.
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  17.  41
    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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  18.  7
    Sleep Softly: Schubert, Ethics and the Value of Dying Well.Dominic Wilkinson - 2021 - Journal of Medical Ethics 47 (4):218-224.
    Ethical discussions about medical treatment for seriously ill babies or children often focus on the ‘value of life’ or on ‘quality of life’ and what that might mean. In this paper, I look at the other side of the coin—on the value of death, and on the quality of dying. In particular, I examine whether there is such a thing as a good way to die, for an infant or an adult, and what that means for medical care. To do (...)
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  19.  36
    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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  20.  68
    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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  21.  3
    Surrogate Decision Making in Crisis.Dominic Wilkinson & Thillagavathie Pillay - forthcoming - Journal of Medical Ethics:medethics-2020-107181.
    Care of the critically ill newborn includes support for the birth mother/parents with regular updates around the clinical condition of the baby, and involvement in discussions around complex decision-making issues. Discussions around continuation or discontinuation of life-sustaining are challenging even in the most straightforward of cases, but what happens when the birth mother is critically unwell? Such cases can lead to uncertainty around who should assume the parental role for these difficult discussions. In this round table discussion, we explore the (...)
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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.  25
    Conscientious Non-Objection in Intensive Care.Dominic Wilkinson - 2017 - Cambridge Quarterly of Healthcare Ethics 26 (1):132-142.
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  24.  24
    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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  25.  12
    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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  26.  28
    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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  27.  16
    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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  28.  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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  29.  8
    Consent in the Time of COVID-19.Helen Lynne Turnham, Michael Dunn, Elaine Hill, Guy T. Thornburn & Dominic Wilkinson - 2020 - Journal of Medical Ethics 46 (9):565-568.
    The COVID-19 pandemic crisis has necessitated widespread adaptation of revised treatment regimens for both urgent and routine medical problems in patients with and without COVID-19. Some of these alternative treatments maybe second-best. Treatments that are known to be superior might not be appropriate to deliver during a pandemic when consideration must be given to distributive justice and protection of patients and their medical teams as well the importance given to individual benefit and autonomy. What is required of the doctor discussing (...)
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  30.  13
    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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  31.  8
    Minority Report: Can Minor Parents Refuse Treatment for Their Child?Helen Lynne Turnham, Ariella Binik & Dominic Wilkinson - 2020 - Journal of Medical Ethics 46 (6):355-359.
    Infants are unable to make their own decisions or express their own wishes about medical procedures and treatments. They rely on surrogates to make decisions for them. Who should be the decision-maker when an infant’s biological parents are also minors? In this paper, we analyse a case in which the biological mother is a child. The central questions raised by the case are whether minor parents should make medical decisions on behalf of an infant, and if so, what are the (...)
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  32.  8
    Compensation and Hazard Pay for Key Workers During an Epidemic: An Argument From Analogy.Doug McConnell & Dominic Wilkinson - forthcoming - Journal of Medical Ethics:medethics-2020-106389.
    The COVID-19 pandemic has created unusually challenging and dangerous workplace conditions for key workers. This has prompted calls for key workers to receive a variety of special benefits over and above their normal pay. Here, we consider whether two such benefits are justified: a no-fault compensation scheme for harm caused by an epidemic and hazard pay for the risks and burdens of working during an epidemic. Both forms of benefit are often made available to members of the armed forces for (...)
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  33.  69
    Is It Better to Be Minimally Conscious Than Vegetative?Dominic Wilkinson & Julian Savulescu - 2013 - Journal of Medical Ethics 39 (9):557-558.
    In the case of Re M, summarised in the paper by Julian Sheather, Justice Baker faced the difficult task of weighing up objectively whether or not it was in Mâs best interests to withdraw artificial feeding and to let her die.1 The judge concluded that M was ârecognisably aliveâ, and that the advantages of continued life outweighed the disadvantages. He compared her minimally conscious state favourably to that of a persistent vegetative state .2 It was clear that artificial feeding would (...)
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  34.  44
    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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  35. 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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  36.  21
    Rationing Conscience.Dominic Wilkinson - 2017 - Journal of Medical Ethics 43 (4):226-229.
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  37.  9
    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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  38.  7
    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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  39.  69
    “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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  40.  26
    Dissent About Assent in Paediatric Research.Dominic Wilkinson - 2012 - Journal of Medical Ethics 38 (1):2-2.
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  41.  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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  42.  11
    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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  43.  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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  44. 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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  45.  30
    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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  46.  54
    Ventilating the Debate: Elective Ventilation Revisited.Dominic Wilkinson - 2013 - Journal of Medical Ethics 39 (3):127-128.
    This issue of the Journal of Medical Ethics features a special symposium on ‘elective ventilation’ . EV ) was originally described in the 1990s by doctors working in Exeter in the UK.1 At that time there was concern about the large shortfall in organs for transplantation. Patients could become organ donors if they were diagnosed as being brain dead, but this only ever occurred in patients on breathing machines in intensive care who developed signs of brainstem failure. Doctors wondered if (...)
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  47.  26
    Schrodinger's Fetus.Dominic Wilkinson - 2017 - Journal of Medical Ethics 43 (1):1-1.
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  48.  8
    Safeguarding Choice at the End of Life.Dominic Wilkinson - 2015 - Journal of Medical Ethics 41 (8):575-576.
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  49.  16
    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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  50.  28
    Which Newborn Infants Are Too Expensive to Treat? Camosy and Rationing in Intensive Care.Dominic Wilkinson - 2013 - Journal of Medical Ethics 39 (8):502-506.
    Are there some newborn infants whose short- and long-term care costs are so great that treatment should not be provided and they should be allowed to die? Public discourse and academic debate about the ethics of newborn intensive care has often shied away from this question. There has been enough ink spilt over whether or when for the infant's sake it might be better not to provide life-saving treatment. The further question of not saving infants because of inadequate resources has (...)
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