Sunday, July 10, 2011

Short and Sharp - Limitiation of Liberty

I know I’ve been on a kind of ‘ethical bender’ of late, so I promise this will be my last post on ethics for a while (isn’t that what all addicts say?). However, I wish to have a final quick exploration of the topic of limiting the liberty of individuals in a society. I think that by being a member of society, we  agree (explicitly in some cases, implicitly in most) to give up certain rights, such as the right to murder each other, for the safety and benefits that living in a society offers (yes, I am a fan Hobbes, if you can’t tell; at least in regard to social contract theory). The point of this post is to explore what constitutes the line between what can and cannot be limited by society.

While this is related to my last post on bone marrow donation, I’m going to use the example of vaccination to draw out the potential points of disagreement. We all (well, the significant majority) accept the limit that we cannot kill (either intentionally or through recklessness on our part). The same is true for causing harm to others that falls short of killing them (again, both intentionally and through recklessness). So, given these two fair uncontroversial points, why do we allow people, be they adults or children by the choice of their parents, to opt out of vaccination?

For those of you not familiar with herd immunity, this is the phenomenon where when a certain portion of the population is immune to a certain disease, their immunity acts to protect those who are not immune. The percentage of immunity required to reach this threshold varies for every contagion and is based on factors like the route of infection (airborne, food etc.) and the virulence of the pathogen. Within any given population, there are a certain proportion of individuals that, for medical reasons, cannot be given vaccinations (effectively, anyone with impaired immune functions, often due to age, genetic conditions or other factors). So, with an already reduced population to work with, allowing others to opt out of vaccinations further reduces the amount that are immunised, putting everyone at an increased risk of infection.

My point is not that vaccination should be mandatory (I do think that, but that is not the case I am making here), but what reasons are there that we don’t make them mandatory? I’ve heard people suggest that it is to do with liberty, but as I’ve already said, we given up liberties all the time to benefit from living in a society. Does doing something to people rather than asking them not to do something change the issue (positive vs. negative liberty)? Does removing the option to opt out change anything for people who would have chosen to be vaccinated regardless? What is the threshold for what constitutes a significant harm of an action to the public as to reduce the liberty of individuals to undertake said action?

Thursday, July 7, 2011

Is Donating Bone Marrow A Charitable Act?

A few weeks ago, the Australian Bone Marrow Donor Registry contacted and informed me that I have matched with a person who may require a bone marrow transplantation. I told them that I was interested and went in last week for some confirmatory testing. An interesting thing that I have noticed is that a significant number of people who I have told about this have responded with “that is so generous; I could never do that”. This is the idea that I wish to explore. I’d like to begin with an apparently unrelated hypothetical:
A man is out for a late night walk down a country road and he notices a car stopped on the side of the road with its hazard lights on. Upon investigation, he finds a woman breathing heavily and clutching her chest. She tells him she believes she is having a heart attack. Unfortunately, neither of them have a mobile phone on them. She asks him to use her car to drive her to the hospital, as she is in too much pain to do so. The man does have a license. After a few seconds, the man says that he rather not, as the potential risk of crashing the car is too high.
While I cannot say for certain, I think most people would find the justification for not offering help to be quite weak; no one sees driving a car as being too risky as to not offer help to someone who may die without it. To get an idea of the risk associated with driving a car, the world death rate for motor vehicle accidents is 20.8 per 100,000 people (from the Wikipedia page, which quotes WHO statistics).

The point of this hypothetical is to highlight a contradiction in with the way that the people who I spoke of at the beginning think about bone marrow donation. Statistically speaking, donating bone marrow is safer than driving a car. For clarification, there are two procedures used to harvest bone marrow. The first and most common is a peripheral bone marrow harvest’; this is where the donor is given a drug to stimulate their blood marrow to grow and then they give blood and the bone marrow cells are harvested (in the same way as white blood cells are harvested for donation). As such, the risk associated with donating bone marrow by this method has the similar risk to donating blood; that is, a negligible risk. When most people think of a bone marrow donation, they think of extraction from the hip bone. This requires a general anaesthetic in most cases and it is this that presents the only risk of death (in that, no deaths have ever been recorded due to the actual extraction process). However, using even the most conservative figures (i.e. the ones that show the highest mortality rate), the death rate for general anaesthesia is around 14 per 100,000 people (from this study).

So, statistically speaking, it would be safer to give bone marrow to someone that to drive them to the hospital. However, I do not think that the people that I spoke of would change their view of not wanting to donate bone marrow because of this (I specifically did express this point to one of them and they did indeed not change their view). I am not entirely sure why. I see only minor differences in the scenarios and nothing to make them categorically different (well, as far as I can tell). So I throw it open to my highly intelligent audience; is there anything that would make not donating bone marrow more justifiable than not driving someone to a hospital?

[One potential criticism I could see is that I have used the world data motor vehicle accident death rates and, as such, will be much higher than any given country (for example,  the death rate in Australia is around 5 per 100,000; much lower than the world figure). However, the same is true of general anaesthesia figure; the study used data from any published study (excluding only those that were not in English). As such, it would probably be much lower in any given first world country (as is the case with the death rate from motor vehicle accidents).]