Research Fellow and Manager of Visitors Programmes
Jonathan Pugh is a Postdoctoral Research Fellow in Applied Moral Philosophy at The University of Oxford, and Manager of Visitors Programmes for the Oxford Uehiro Centre. He is currently leading a Wellcome Trust funded project entitled "The Ethics of Novel Therapeutic Applications of Deep Brain Stimulation". His research interests lie primarily in issues concerning personal autonomy in practical ethics, particularly topics pertaining to informed consent. He has also written on the ethics of human embryonic stem cell research, criminal justice, human enhancement, and gene-editing.
Brainjacking in deep brain stimulation and autonomy
Pugh, J, Pycroft, L, Sandberg, A, Aziz, T, Savulescu, J
ETHICS AND INFORMATION TECHNOLOGY
Brainjacking, Deep brain stimulation, Autonomy, Security, Responsibility
When is coercive methadone therapy justified?
D'Hotman, D, Pugh, J, Douglas, T
Heroin use poses a significant health and economic burden to society, and individuals with heroin dependence are responsible for a significant amount of crime. Owing to its efficacy and cost-effectiveness, methadone maintenance therapy (MMT) is offered as an optional alternative to imprisonment for drug offenders in several jurisdictions. Some object to such 'MMT offers' on the basis that they involve coercion and thus invalidate the offender's consent to MMT. While we find these arguments unpersuasive, we do not attempt to build a case against them here. Instead, we explore whether administration of MMT following acceptance of an MMT offer might be permissible even on the assumption that MMT offers are coercive, and in such a way that the resulting MMT is non-consensual. We argue that non-consensual MMT following an MMT offer is typically permissible. We first offer empirical evidence to demonstrate the substantial benefits to the offender and society of implementing non-consensual MMT in the criminal justice system. We then explore and respond to potential objections to such uses of MMT. These appeal respectively to harm, autonomy, bodily and mental interference, and penal theoretic considerations. Finally, we introduce and dismiss a potential response to our argument that takes a revisionist position, rejecting prevailing incarceration practices.
Unexpected Complications of Novel Deep Brain Stimulation Treatments: Ethical Issues and Clinical Recommendations.
Neuromodulation : journal of the International Neuromodulation Society
Innovative neurosurgical treatments present a number of known risks, the natures and probabilities of which can be adequately communicated to patients via the standard procedures governing obtaining informed consent. However, due to their novelty, these treatments also come with unknown risks, which require an augmented approach to obtaining informed consent.This paper aims to discuss and provide concrete procedural guidance on the ethical issues raised by serious unexpected complications of novel deep brain stimulation treatments.We illustrate our analysis using a case study of the unexpected development of recurrent stereotyped events in patients following the use of deep brain stimulation (DBS) to treat severe chronic pain. Examining these unexpected complications in light of medical ethical principles, we argue that serious complications of novel DBS treatments do not necessarily make it unethical to offer the intervention to eligible patients. However, the difficulty the clinician faces in determining whether the intervention is in the patient's best interests generates reasons to take extra steps to promote the autonomous decision making of these patients.We conclude with clinical recommendations, including details of an augmented consent process for novel DBS treatment.
Humans, Deep Brain Stimulation, Decision Making, Chronic Pain