Characterization of health issues in young first-time blood donors.

BACKGROUND AND OBJECTIVES: Blood donors, especially young donors, are considered a healthy segment of the population. We sought to identify medical issues that may warrant medical referral in young first-time blood donors. MATERIALS AND METHODS: A retrospective cohort study was performed in first-time donors ages 16-22 who presented in a system of nineteen regional United States blood centres over 10 years. Donor health attributes characterized include body mass index, blood pressure, total cholesterol and pre-donation haemoglobin. Using standardized definitions, overweight and obese body mass, hypertension, elevated cholesterol and anaemia were identified and characterized in this donor population. RESULTS: Among 825 041 young first-time donors presenting between January 2009 and December 2018, with available measurements, 46·9% were either overweight or obese, 59·8% demonstrated high blood pressure (22·2% elevated blood pressure, 37·6% stage 1 or 2 hypertension), elevated cholesterol was identified among 6·3% of males and 8·8% of females, and anaemia was present in 3·5% of males and 5·2% of females. During the study period, all unfavourable health outcomes significantly increased in prevalence (P < 0·0001) when comparing 2009 vs. 2018 rates. CONCLUSION: Elevated weight and obesity are common in young first-time allogeneic United States blood donors, with fewer donors having elevated total cholesterol or anaemia. Such medical issues may have significant importance for future health and well-being as well as continued donor eligibility. Blood centres may be able to help support the identification and mitigation of important medical issues in donors and provide a public health benefit.

Does the heterogeneity of autism undermine the neurodiversity paradigm?

The neurodiversity paradigm is presented by its proponents as providing a philosophical foundation for the activism of the neurodiversity movement. Its central claims are that autism and other neurodivergent conditions are not disorders because they are not intrinsically harmful, and that they are valuable, natural and/or normal parts of human neurocognitive variation. This paper: (a) identifies the non-disorder claim as the most central of these, based on its prominence in the literature and connections with the practical policy claims that the paradigm is supposed to support; (b) describes the heterogeneity of autism at the behavioural and causal levels, and argues that at the behavioural level this encompasses ways of being autistic that are harmful in ways that cannot be not wholly attributed to discrimination or unjust social arrangements, challenging the claim that autism is not a disorder; (c) considers and rejects responses to this challenge based on separation of high- and low-functioning autism, separation of autism from co-occurring conditions, and viewing autism as part of an individual's identity. Two of these responses fail for reasons that are themselves connected with the behavioural and/or causal heterogeneity of autism.

Lockdown and levelling down: why Savulescu and Cameron are mistaken about selective isolation of the elderly.

In their recent article, 'Why lockdown of the elderly is not ageist and why levelling down equality is wrong', Savulescu and Cameron argue for selective isolation of the elderly as an alternative to general lockdown. An important part of their argument is the claim that the latter amounts to 'levelling down equality' and that this is 'unethical' or even 'morally repugnant'. This response argues that they fail to justify either part of this claim: the claim that levelling down is always morally wrong is subject to challenges that Savulescu and Cameron do not consider; and a policy of maintaining general lockdown does not constitute levelling down, as it provides absolute benefits to those who would be worse off under selective isolation.

Advance euthanasia directives and the Dutch prosecution.

In a recent Dutch euthanasia case, a woman underwent euthanasia on the basis of an advance directive, having first been sedated without her knowledge and then restrained by members of her family while the euthanasia was administered. This article considers some implications of the criminal court's acquittal of the doctor who performed the euthanasia. Supporters of advance euthanasia directives have welcomed the judgement as providing a clarification of the law, especially with regard to the admissibility of contextual evidence in interpreting advance euthanasia directives, but suggested that the law regarding advance euthanasia directives should be further relaxed to remove the requirement of current suffering and that an unfortunate consequence of the prosecution is that it is likely to deter doctors from performing euthanasia even in more straightforward cases. This article argues that the court's endorsement of the use of contextual evidence is problematic, that the case for prioritising prior decisions over current interests has not been advanced by the discussion surrounding this case and that worries about the alleged deterrent effect are not well founded.

Conscientious objection, professional duty and compromise: A response to Savulescu and Schuklenk.

In a recent article in this journal, Savulescu and Schuklenk defend and extend their earlier arguments against a right to medical conscientious objection in response to criticisms raised by Cowley. I argue that while it would be preferable to be less accommodating of medical conscientious than many countries currently are, Savulescu and Schuklenk's argument that conscientious objection is 'simply unprofessional' is mistaken. The professional duties of doctors should be defined in relation to the interests of patients and society, and for reasons set out in this article, these may support limited accommodation of conscientious objection on condition that it does not impede access to services. Moreover, the fact that conscientious objection appears to involve unjustifiable compromise from the objector's point of view is not a reason for society not to offer that compromise. Arguing for robust enforcement of the no-impediment condition, rather than opposing conscientious objection in principle, may be a more effective way of addressing the harms resulting from an over-permissive conscientious objection policy.

Conscientious objection in healthcare: why tribunals might be the answer.

A recent focus of the debate on conscientious objection in healthcare is the question of whether practitioners should have to justify their refusal to perform certain functions. A recent article by Cowley addresses a practical aspect of this controversy, namely the question of whether doctors claiming conscientious objector status in relation to abortion should be required, like their counterparts claiming exemption from military conscription, to defend their claim before a tribunal. Cowley argues against the use of tribunals in the medical case, on the grounds that there are likely to be fewer unjustified claims to conscientious objection in this context than in the military, and that in any case tribunals will not be an effective way of distinguishing genuine and false cases. I reject these arguments and propose a different conception of the role of a medical conscientious objection tribunal.

Case report of a transfusion-associated hepatitis A infection.

BACKGROUND: Documented transfusion-associated hepatitis A (TAHA) is rare, and blood donors in the United States are not routinely screened for this infection. We report a case of TAHA associated with a donation made 8 days after a donor returned from a trip to South America. STUDY DESIGN AND METHODS: This is a review of donor and recipient records and a review of the literature. RESULTS: A donor developed symptoms of hepatitis 20 days after donation (28 days after returning from South America). The donor reported the illness 56 days after donation when contacted to schedule another visit. By this time, the red blood cell and frozen plasma components had been transfused. The recipient of the plasma, a 15-month-old female, tested positive for immunoglobulin M antibody to hepatitis A virus 43 days after transfusion. The recipient had displayed mild, nonspecific symptoms approximately 2 weeks after transfusion. Hospital infection control investigated the potential for further spread within the hospital because the recipient had been an inpatient for most of the posttransfusion period. The risk of transmission to other patients was determined to be negligible because the patient had been in isolation for other reasons. Family members, who included a health care professional, were counseled and offered prophylaxis. CONCLUSION: TAHA may be underrecognized. This case was identified only because of a donor report at the time of recruitment. Asymptomatic donor viremia has been documented in plasma donors. Although TAHA rarely results in severe disease, the risk it creates of secondary transmission especially within the hospital setting is not inconsequential.