Dominic Wilkinson
Biographic Data
| ID | 4499661 |
|---|---|
| NAME | Dominic Wilkinson |
| GIVEN NAMES | Dominic |
| FAMILY NAME | Wilkinson |
| SIGNATURE | WILKINSON D |
| AFFILIATIONS | University of Oxford |
| ORCID | 0000-0003-3958-8633 |
| VERIFIED | Yes |
| TOTAL WORKS | 53 |
| TOTAL CITATIONS | 5 |
| AUTHOR COUNT | 52 |
| EDITOR COUNT | 1 |
| FIRST PUBLICATION YEAR | 1996 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 1 |
AI-assisted consent in paediatric medicine
Obtaining informed consent in paediatrics is an essential yet ethically complex aspect of clinical practice. Children have varying levels of autonomy and understanding based on their age and developmental maturity, with parents traditionally playing a central role in decision-making. However, there is increasing recognition of children’s evolving capacities and their right to be involved in care decisions, raising questions about facilitating mea…
Which AI doctor would you like to see? Emulating healthcare provider–patient communication models with GPT-4
Large language models (LLMs) have demonstrated potential in enhancing various aspects of healthcare, including health provider–patient communication. However, some have raised the concern that such communication may adopt implicit communication norms that deviate from what patients want or need from talking with their healthcare provider. This paper explores the possibility of using LLMs to enable patients to choose their preferred communication …
Should Terminal Sedation Be Expanded to Individuals Who Choose to Die Via the Voluntary Stopping of Eating and Drinking
The voluntary stopping of eating and drinking (VSED) is a phenomenon whereby an individual with decision‐making capacity chooses to cease eating and drinking with the intention of ending their own life. This is widely acknowledged as a lawful, albeit uncommon, end‐of‐life decision. It is now generally accepted that patients undertaking VSED should have access to appropriate palliative care, as per any other form of dying. However, it remains uncl…
Empowering Patient Autonomy
The principle of (respect for) patient autonomy has traditionally emphasized independence in medical decision‐making, reflecting a broader commitment to epistemic individualism. However, recent philosophical work has challenged this view, suggesting that autonomous decisions are inherently dependent on epistemic and social supports. Wilkinson and Levy's “scaffolded model” of autonomy demonstrates how our everyday decisions rely on distributed cog…
When Is It Safe to Introduce an AI System Into Healthcare? A Practical Decision Algorithm for the Ethical Implementation of Black‐Box AI in Medicine
There is mounting global interest in the revolutionary potential of AI tools. However, its use in healthcare carries certain risks. Some argue that opaque (‘black box’) AI systems in particular undermine patients' informed consent. While interpretable models offer an alternative, this approach may be impossible with generative AI and large language models (LLMs). Thus, we propose that AI tools should be evaluated for clinical use based on their i…
Is Consent-GPT valid? Public attitudes to generative AI use in surgical consent
Healthcare systems often delegate surgical consent-seeking to members of the treating team other than the surgeon (e.g., junior doctors in the UK and Australia). Yet, little is known about public attitudes toward this practice compared to emerging AI-supported options. This first large-scale empirical study examines how laypeople evaluate the validity and liability risks of using an AI-supported surgical consent system ( Consent-GPT ). We randoml…
Effective altruism in global health
The effective altruism (EA) movement has seen explosive growth within the last decade, resulting in the allocation of hundreds of millions of dollars in funding towards altruistic causes. The movement aims to maximise good and has identified global health initiatives as especially promising. In this paper, we first present a brief overview of the philosophy behind EA and concede the importance of efficacy in the context of the scarcity of resourc…
Augmenting research consent
The integration of artificial intelligence (AI), particularly large language models (LLMs) like OpenAI’s ChatGPT, into clinical research could significantly enhance the informed consent process. This paper critically examines the ethical implications of employing LLMs to facilitate consent in clinical research. LLMs could offer considerable benefits, such as improving participant understanding and engagement, broadening participants’ access to th…
Self-censorship
A virologist recently made headlines after successfully using an experimental form of oncolytic virotherapy to treat her own recurrent breast cancer. This case has come at a time when regulators are increasingly having to grapple with the proliferation of self-experimentation outside of accredited research institutions. There is, therefore, a pressing need to outline the key ethical dimensions of self-experimentation and to develop ethical guidan…
Hope pluralism in antenatal palliative care
When parents face the distressing news during pregnancy that their baby is affected by a serious medical condition that will likely lead to the baby’s death before or soon after birth, they experience a range of complex emotions. Perhaps paradoxically, one common response is that of hope. Navigating such hope in antenatal interactions with parents can be difficult for healthcare professionals. That can stem from a desire to accurately communicate…
Should We Use Behavioural Predictions in Organ Allocation
Medical predictions, for example, concerning a patient's likelihood of survival, can be used to efficiently allocate scarce resources. Predictions of patient behaviour can also be used—for example, patients on the liver transplant waiting list could receive lower priority based on a high likelihood of non‐adherence to their immunosuppressant medication regimen or of drinking excessively. But is this ethically acceptable? In this paper, we will ex…
Misaligned hope and conviction in health care
It is often said that it is important for patients to possess hope that their treatment will be successful. We agree, but a widely appealed to type of hope—hope based on conviction (religious or otherwise), renders this assertion problematic. If conviction‐based hope influences patient decisions to undergo medical procedures, then questions are raised about the scope of patient autonomy. Libertarians permit patients to make decisions to undergo m…
Consent-GPT
Obtaining informed consent from patients prior to a medical or surgical procedure is a fundamental part of safe and ethical clinical practice. Currently, it is routine for a significant part of the consent process to be delegated to members of the clinical team not performing the procedure (eg, junior doctors). However, it is common for consent-taking delegates to lack sufficient time and clinical knowledge to adequately promote patient autonomy …
As low as reasonably practicable (Alarp)
Children dependent on life-prolonging medical technology are often subject to a constant background risk of sudden death or catastrophic complications. Such children can be cared for in hospital, in an intensive care environment with highly trained nurses and doctors able to deliver specialised, life-saving care immediately. However, remaining in hospital, when life expectancy is limited, can considered to be a harm in of itself. Discharge home o…
Ethics round table
Decisions about how and where they deliver their baby are extremely important to pregnant women. There are very strong ethical norms that women’s autonomy should be respected, and that plans around birth should be personalised. However, there appear to be profound challenges in practice to respecting women’s choices in pregnancy and labour. Choices carry risks and consequences—to the woman and her child; also potentially to her caregivers and to …
Wish to die trying to live
The recent legal dispute about medical treatment for a 19-year-old patient, Sudiksha Thirumalesh, (known initially by the Court of Protection as ‘ST’) in A NHS Trust versus ST & Ors (2023) raised several challenging ethical issues. While Sudiksha’s case bears similarities to other high-profile cases in England and Wales, there are key differences. Crucially, Sudiksha herself was part of the disagreement. She was alert, communicative and sought to…
Scaffolding informed consent
The principle of respecting patient autonomy underpins the concept and practice of informed consent. Yet current approaches to consent often ignore the ways in which the exercise of autonomy is deeply epistemically dependent. In this paper, we draw on philosophical descriptions of autonomy ‘scaffolding’ and apply them to informed consent in medicine. We examine how this relates to other models of the doctor–patient relationship and other theories…
The ethics of natural immunity exemptions to vaccine mandates
The Supreme Court of the United States has recently been petitioned to revisit legal issues pertaining to the lawfulness of imposing a vaccine mandate on individuals with proof of natural immunity during the COVID-19 pandemic. While the petition accepts that the protection of public health during COVID-19 was an important governmental interest, the petitioners maintain that the imposition of a vaccine mandate on individuals with natural immunity …
Vaccine mandates for healthcare workers beyond Covid-19
We provide ethical criteria to establish when vaccine mandates for healthcare workers are ethically justifiable. The relevant criteria are the utility of the vaccine for healthcare workers, the utility for patients (both in terms of prevention of transmission of infection and reduction in staff shortage), and the existence of less restrictive alternatives that can achieve comparable benefits. Healthcare workers have professional obligations to pr…
Implications of identity-relative paternalism
The harm principle, personal identity and identity-relative paternalism
Is it ethical for doctors or courts to prevent patients from making choices that will cause significant harm to themselves in the future? According to an important liberal principle the only justification for infringing the liberty of an individual is to prevent harm to others; harm to the self does not suffice. In this paper, I explore Derek Parfit’s arguments that blur the sharp line between harm to self and others. I analyse cases of treatment…
Expanding choice at the end of life
Expanded terminal sedation in end-of-life care
Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term ‘Expanded TS’ (ETS) can be used to describe the use of …
Religious accommodation, agonism, agnosticism in healthcare
Space competition. A publicly funded hospital is finalising plans for its new building. There is intense pressure and competition between departments for the finite physical space and budget. One question relates to how much space is set aside within the new building for a ‘prayer space’. Should there be separate spaces for different religions or a common space for those of different religions? Should the allocation of this space come out of that…
Grief and the Inconsolation of Philosophy
Can metaphysics yield the consolations of philosophy? One possibility, defended by Derek Parfit, is that reflection on the nature of identity and time could diminish both fear of death and grief. In this paper, I assess the prospect of such consolation, focussing especially on attempts to console a grieving third party. A shift to a reductionist view of personal identity might mean that death is less threatening. However, there is some evidence t…
Directly observed therapy for tuberculosis in rural South Africa, 1991 through 1994
OBJECTIVES. This paper describes an audit of a community-based tuberculosis treatment program involving directly observed therapy in South Africa. METHODS. A program audit of 2473 consecutive tuberculosis patients in Hlabisa Health District, KwaZulu/Natal, South Africa, was conducted between 1991 and 1994. RESULTS. Monthly admissions increased from 34 per month in 1991 to 66 in 1994. Of 2186 patients managed in Hlabisa, 1903 (87%) received direct…
Directly observed therapy for tuberculosis in rural South Africa, 1991 through 1994
OBJECTIVES. This paper describes an audit of a community-based tuberculosis treatment program involving directly observed therapy in South Africa. METHODS. A program audit of 2473 consecutive tuberculosis patients in Hlabisa Health District, KwaZulu/Natal, South Africa, was conducted between 1991 and 1994. RESULTS. Monthly admissions increased from 34 per month in 1991 to 66 in 1994. Of 2186 patients managed in Hlabisa, 1903 (87%) received direct…
Is mandating elective single embryo transfer ethically justifiable in young women
Zika, contraception and the non‐identity problem
The 2016 outbreak of the Zika arbovirus was associated with large numbers of cases of the newly‐recognised Congenital Zika Syndrome ( CZS ). 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 c…
Newborns in crisis
Newborn infants are among those most severely affected by humanitarian crises. Aid organisations increasingly recognise the necessity to provide for the medical needs of newborns, however, this may generate distinctive ethical questions for those providing humanitarian medical care. Medical ethical approaches to neonatal care familiar in other settings may not be appropriate given the diversity and volatility of humanitarian disasters, and the ex…
Valuing life and evaluating suffering in infants with life-limiting illness
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? Thir…
ICU triage in an impending crisis
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 (ICUs) within m…
Consent in the time of Covid-19
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 t…
‘Your country needs you’
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 prof…
Passport to freedom? Immunity passports for Covid-19
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 tra…
Minority report
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,…
Utilitarianism and the pandemic
There are no egalitarians in a pandemic. The scale of the challenge for health systems and public policy means that there is an ineluctable need to prioritize the needs of the many. It is impossible to treat all citizens equally, and a failure to carefully consider the consequences of actions could lead to massive preventable loss of life. In a pandemic there is a strong ethical need to consider how to do most good overall. Utilitarianism is an i…
Compensation and hazard pay for key workers during an epidemic
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 mad…
Is withdrawing treatment really more problematic than withholding treatment
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…
Dissonance and consonance about death
In their three thoughtful commentaries on my essay, Prentice, Mahoney and Moore and Lantos reflect on the challenges that I set out: can we make sense of the notion of a good death, and can we use art and music to provide any insights into it?1–3 I was thinking about these questions again while reading this week of yet another UK legal dispute relating to life-sustaining treatment for a child. In January, the High Court heard the case of Pippa Kn…
Sleep softly
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 that, I call on philosophy and o…
Queue questions
The rapid development of vaccines against COVID‐19 represents a huge achievement, and offers hope of ending the global pandemic. At least three COVID‐19 vaccines have been approved or are about to be approved for distribution in many countries. However, with very limited initial availability, only a minority of the population will be able to receive vaccines this winter. Urgent decisions will have to be made about who should receive priority for …
A conscious choice
One of the most commonly referenced ethical principles when it comes to the management of dying patients is the doctrine of double effect (DDE). The DDE affirms that it is acceptable to cause side effects (e.g. respiratory depression) as a consequence of symptom‐focused treatment. Much discussion of the ethics of end of life care focuses on the question of whether actions (or omissions) would hasten (or cause) death, and whether that is permissib…
An empirical bioethical examination of Norwegian and British doctors' views of responsibility and (de)prioritization in healthcare
In a world with limited resources, allocation of resources to certain individuals and conditions inevitably means fewer resources allocated to other individuals and conditions. Should a patient's personal responsibility be relevant to decisions regarding allocation? In this project we combine the normative and the descriptive, conducting an empirical bioethical examination of how both Norwegian and British doctors think about principles of respon…
Proportionality, wrongs and equipoise for natural immunity exemptions
We would like to thank each of the commentators on our feature article for their thoughtful engagement with our arguments. All the commentaries raise important questions about our proposed justification for natural immunity exemptions to COVID-19 vaccine mandates. Thankfully, for some of the points raised, we can simply signal our agreement. For instance, Reiss is correct to highlight that our article did not address the important US-centric cons…
The unnaturalistic fallacy
COVID-19 vaccine requirements have generated significant debate. Here, we argue that, on the evidence available, such policies should have recognised proof of natural immunity as a sufficient basis for exemption to vaccination requirements. We begin by distinguishing our argument from two implausible claims about natural immunity: (1) natural immunity is superior to ‘artificial’ vaccine-induced immunity simply because it is ‘natural’ and (2) it i…
Surrogate decision making in crisis
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 wh…
Surrogate uncertainty
In the case that triggered this round-table discussion there are three separate factors that contribute to moral uncertainty.1 First, the infant, baby T, is extremely premature with suspected brain injury and potentially poor prognosis. Second, the gestational mother is critically unwell herself and her outlook is guarded. Third, as linked commentaries make clear, the legal status of the intended parents (IP) is complex and ambiguous.2 3 Any of t…
Sense and sensitivity
The UK government has put lateral flow antigen tests (LFATs) at the forefront of its strategy to scale-up testing in the coronavirus pandemic. However, evidence from a pilot trial using an LFAT to identify asymptomatic infections in the community suggested that the test missed over half of the positive cases in the tested population. This raises the question of whether it can be ethical to use an inaccurate test to guide public health measures. W…
Wabi-sabi
Affirmative action in healthcare resource allocation
This article is about the potential justification for deploying some form of affirmative action (AA) in the context of healthcare, and in particular in relation to the pandemic. We call this Affirmative Action in healthcare Resource Allocation (AARA). Specifically, we aim to investigate whether the rationale and justifications for using prioritization policies based on race in education and employment apply in a healthcare setting, and in particu…
Medicine (36 works) · Psychology (32 works) · Political science (31 works) · Law (28 works) · Computer Science (19 works) · Ethics and Legal Issues in Pediatric Healthcare (18 works) · Social Psychology (17 works) · Ethics in medical practice (16 works) · Palliative Care and End-of-Life Issues (16 works) · Business (13 works)