The wake up pill

I've been tracking the use of this blog with Google Analytics and was interested to see that several people stumbling across it had been looking for information on the ethics of coma. As I've mentioned before ethics is about how we look after the vulnerable - and those in comas are vulnerable because they are unable to tell us about themselves and their wishes.

One recent coma story covered here was the women whose family fought for her not to be given Zolpidem to wake her up. Today the Telegraph reports on a story of a young woman who has been woken by Zolpidem and seems to be recovering.

Looking at the pictures of this young woman, slumped in a wheel chair, it strikes me that we move on to a second area of ethics - care of the disabled and issues around quality of life. What does it mean to have quality of life? How can it be defined and measured? Is it enough not to suffer or should there be more to it than that?

This ties in, too, to the debate on abortion. Some abortions are carried out because the child will be disabled. How badly disabled must one be in order for life not to be worth living? I think of the range of cases - from the young girl in Ireland and was carrying a anencephalic child (that's a child with most of its head missing, in lay terms) to the vicar who asked the police to prosecute in a case where a child was aborted after 24 weeks for cleft palate.

Abortion is a complex issue. The BBC provides a page on ethical issues around abortion. Organisations on different sides of the debate include the Society for the Protection of Unborn Children , British Pregnancy Advisory Service the Catholic Church in England and Wales and Marie Stopes International.

A question of ethics

The library current awareness page now has a section on ethics. Recently I've been adding a lot of stories on the abortion debate to it. It struck me that many of the stories on ethics seem to be about preserving and protecting life, or meeting in a dignified way with death, at the beginning or end of life. If you were asked to give two examples of ethical debates in health what would you come up with? The two that leap to my mind are abortion and euthanasia.

This made me wonder what was the definition of ethics. My Shorter Oxford helpfully defines it as the science of morals...and then defines the science of morals as being to do with ethics.

I think it has to do with protecting the weak and vulnerable. Ethics are always interesting, perhaps it is also that we were all once born and will all eventually die so that cerebral debate on the rights of the terminally ill to die with dignity will one day become a very real set of decisions about your parent, or sibling, or you.

The other area of ethics in health is around animal welfare. Is it right that we should use animals to test drugs, shampoos, lipsticks, to ensure that we can use medicines and other products safely? Again, this seems to be to be an issue of protecting the vulnerable.

Beyond that, ethical questions arise when we learn how to do something new, and immediately we ask should we do it? I presume that in the past that impulse was a safety net. I have discovered that I can pull this animal's tail, put my hand in this fire or jump down this ravine. But are those actions wise? Will they harm me?

We teach children very early on that there are many things they can do but should not. Some of these are definite rules to avoid harm - don't touch that hot mug of tea! Don't put that pea in your ear! Don't hit your sister! Others are rules to help us fit into the rest of society - Don't pick your nose! Don't put your elbows on the table! Don't say that rude word!

Sometimes humankind learns how to do things and then finds they are harmful. We discover thalidomide and damage many babies. We discover that cows will eat other animals, and end up with BSE and vCJD. We discover tobacco and give ourselves lung cancer. Humankind has no parent to advise us, so we must think things out for ourselves. Sometimes we have to learn things through experience. Sometimes it takes many years for the harm to become apparent - hence the current debate on whether or not mobile phones cause brain tumours.

So it seems to me that ethics is about whether we should do those things we can do. It is about ensuring that we do not harm ourselves as individuals, communities or a species. It is about protecting others, too. Above all, ethics is about thinking before we act. There are more topics for ethical debate on the website of the Nuffield Council on Bioethics and on Intute's Bioethics Web. There are also ethical issues around you every day that should make you think.

Improving Google

Can you improve on perfection? Google is wonderful - simple to use and always (well, almost always) finds the answers. It seems rather churlish to grumble, but really, who has time to go through all those results it finds? Luckily there are ways of using Google that are still simple, but get you less results and more relevant results.

From your Google search box look to the side for the link to Google Advanced Search. This has the benefit of being a fill-in-the-boxes type search, so you don't need to remember any fancy codes - you just type the words you want where you want them. Among other things it allows you to specify that you want two or more words to appear as a phrase or to exclude words you don't want.

If you prefer to stick to the Google search box you know and love then there are ways of telling Google that you want something as a phrase or you want to exclude a particular word. If you want medical ethics to appear as a phrase then put it in quote marks - "medical ethics". If you don't necessarily want words side by side, but would like them near to each other, put an asterisk * between the words - medical * ethics.

Some words Google takes for granted. If you type two words (aspirin stroke) it will assume you want both of those things, so there is no need to type aspirin and stroke. Google also thinks about plurals, so if you ask for cake it will also look for cakes.

As with any other search engine the more specific you are the less you will retrieve. So diabetes retrieved for me, just now, 78,800,800 hits. Diabetes recipes gives 2,260,000. Diabetes recipes cake 1,260,000 and diabetes recipes "carrot cake" just 34,600. Conversely, if you aren't finding enough information then take words out of your search and be more general.

Finally, Google comes in different flavours, as it were. There is an image search, a maps search and a news search - click the links above the search box to find these.

Google has a page of tips on searching and a "cheat sheet" listing all the various ways of making Google even better.

Mother knows best

Hitting the headlines this weekend was the story of the mother who wants her daughter to have a hysterectomy. There is no medical need for this operation, but the girl has cerebral palsy and her mother is concerned that her daughter will be "confused" by menstruation and that it will cause her "indignity".

Presumably the mother speaks from her own experience when she speaks of menstruation involving "tears...pain...embarrassment". Menstruation is a very personal issue. Janet Street Porter, writing in The Independent about a new pill that will prevent periods talks of the "horror of menstruation." For other women it's no more than a minor inconvenience. Is it right to force you own view of menstruation on to someone else. Why assume that it will cause pain and embarrassment to the daughter when many women experience no such thing?

And why undergo surgery - which always carries some risk - when there is a handy pill that will do the same job? Pills have safety issues, too, and who knows how preventing part of a woman's normal biology will affect her health? The experts, as ever, are divided.

This story has echoes of the "pillow angel" story. Who benefits from the hysterectomy - the child, or the mother? If the mother is the primary carer is it necessarily wrong to do something that is "just" in her interest? Surely it's in the child's best interest to have her mother feel she can cope with caring for her? Without care at home this girl would need to be cared for by the state, costing money that could be spent elsewhere. Carers save the NHS billions of pounds each year.

As ever, although the mother says this is all about her child, any court decision on whether or not doctors can carry out the hysterectomy will have wider implications. Disability groups perhaps fear the thin end of the wedge, that having gone this far society will ask why not give hysterectomies to women with Downs, with MS, with ADHD, with any nasty antisocial habits we'd rather not perpetuate. How many steps is it from one hysterectomy to mass sterilisation of "life unworthy of life"?

As with many ethical debates our personal views and experiences colour our reactions. We perhaps react more strongly where a child is involved. We have our own views on the right and proper way for a mother to treat her child. Should we accept these emotions as part of the evidence in considering an ethical case, or is ethics an absolute, like a mathematical problem where it is possible to come to the right answer?

I don't have the answers. We have books in the library to help you think through ethical issues. You'll also find stories on ethical issue to get you thinking on our current awareness page.