Generally, when their first child is under a month old, the most profound thought new fathers can manage is "sleep". But most new fathers aren't medical ethicists. Richard Ashcroft may have one eye on his pillow, but the other is still locked firmly on his work. "Having a son has changed the way I think," he says. "I've given lectures on the ethical issues arising in childbirth in the past, but I now realise that until you've seen it for yourself you've no real idea what you're talking about. This isn't to say that it makes abortion any more clear cut; what it does mean is that you know what a nine-week-old foetus looks like on ultrasound, and you understand what you're asking a woman to go through if she's being made to continue a pregnancy she doesn't want."
His recent experiences have given him a different take on other contentious parenting issues. While the tabloids that didn't manage to buy the serial rights to the story have been tut-tutting about the wrongs of a 62-year-old woman having a baby, Ashcroft takes a rather more pragmatic approach. "I don't think there can be any real objections to a doctor helping a post-menopausal woman get pregnant," he says. "I simply wonder where a woman that age finds the energy to raise a child to adulthood. I certainly feel knackered and I'm only 37. There again, maybe we do have to rethink what we mean by early old age; people are living a great deal longer and are capable of much more than they used to be."
Queen Mary, University of London, will no doubt be thrilled that their newly appointed successor to Len Doyal as professor of biomedical ethics remains focused on the job. Doyal was always going to be a tough act to follow - he was one of the architects of the study of medical ethics and still has plenty to say - but Ashcroft is very much his own man.
In recent weeks, Doyal has been involved in a public spat about assisted euthanasia, having come out in favour of a system similar to those used in Belgium, Switzerland and the Netherlands, where doctors can - subject to rigid guidelines - prescribe drugs to hasten the death of both the mentally competent and incompetent. Ashcroft feels that may be a step too far, for the moment.
"As a philosopher, my natural instinct is to believe we should be able to reach the correct decision through logic. By asking ourselves questions such as what is living, what is dying, and when is someone not a person, society ought to be able to find some common ground. But it is clear there is no real consensus at the moment in this country, so the decision has to be political. Maybe if we reached the point where many doctors were being taken to court for assisting suicide, society would decide that something had to change."
Drug trials
Medical ethics has rarely been off the front pages in the past six months. Questions were raised about the drug trials at Northwick Park hospital that went so badly wrong, leaving the volunteers suffering from multiple organ failure. Ashcroft is hedging his bets somewhat before the outcome of the official inquiry, but he reckons that a first glance at the evidence suggests the drug company ran the trials pretty much by the book.
"You could maybe argue that the company shouldn't have trialled the drug on so many patients at once," he says, "and that it should have given the dose to one patient first to see if there was an adverse reaction. But that is a comparatively minor matter. All the previous tests on animals appear to have been conducted properly, and a much lesser dosage was used on the human volunteers. So it's hard to see what else they could have done.
"Some people criticise the whole process of human drug trials, but I find it hard to think of any viable alternative. The only really problematic area is just how voluntary some of the volunteering may be. Offering money to take part is inevitably going to be more attractive to the less well-off members of society, and young people people are also likely to take a different attitude towards their mortality. But these ethical dilemmas run through society as a whole, and are not confined to medical ethics."
It's the grey areas that fascinate Ashcroft. There may be a number of ethical issues on which everyone agrees - such as not killing people in the process of scientific research - but there are many where the boundaries are blurred. Is a 10-day-old embryo really a human being? Should George Best have been given his liver transplant?
"Society has no easy answers. In my view, a 10-day-old embryo is not human life, but for many people it definitely is. The question of transplantation is also tricky. Best was a high-profile patient getting the very best of private medicine, and you have to wonder whether someone else with his known history of alcoholism and short record of sobriety would have been treated preferentially. But, there again, doctors have to make a quick judgment call and it is possible there was no other suitable patient for the donor liver at the time.
"There was a similar moral debate surrounding the first heart transplants in the late 1960s. Undoubtedly, there was a race to become the first person to perform the operation, and perhaps a UK ethics committee might have taken a different view on experimental surgery on the very ill from that taken by Christiaan Barnard's Cape Town hospital. Yet, because they went ahead and took the risks, you could say that they accelerated our understanding of both the techniques and problems concerning rejection, and that thousands of lives have been saved as a result."
There are now similar ethical problems concerning pioneering arm and face transplants and, in all of Ashcroft's work, there is a trade off between the scientific and the philosophical. It's a battle he's been fighting for most of his life. He was born in Newcastle, but grew up in the south of England after his father, a legal civil servant, and mother, a housewife, moved to Guildford. "I was always a bit of a generalist, as I was good at both the arts and sciences," he says. "So I never quite knew what I wanted to do. I took a modular degree at Cambridge which enabled me to switch between maths and philosophy."
But, while the physicists appeared to be willing to discuss only the rather sterile and familiar topic of Oppenheimer and the atomic bomb, the social constructionists were getting their teeth into arguments about whether scientific facts were real or made - and it was philosophy that won the day. Not that that made life any easier in the short term. "My PhD was an utterly miserable experience," Ashcroft says. "It took me the best part of five years, and I found it incredibly difficult to narrow down what argument I wanted to make. I used to live in dread of anyone asking me what I was doing, because I just didn't have a clue."
Things didn't look up when Ashcroft completed his doctorate, as jobs for philosophers were thin on the ground. Then Liverpool University offered him a place researching ethics and clinical trials and - after a brief tutorial in methodology - he's never looked back. He has always aimed to ensure that his logic is backed by fact. Complementary medicine, for instance. "I'm in favour of funding alternative therapies on the NHS if there's clear evidence that they work, " he says. "There are all sorts of bogus theories about acupuncture, but the bottom line is that it appears to work.
Placebo effect on a cat
"Homeopathy is another matter. There's no research to show there's any difference between it and the placebo effect. I once had a landlady who was obsessed by homeopathy, and it was one of the conditions of my lease that I gave her cat some kind of homeopathic pill to treat its ailments. I'm not sure how you measure the placebo effect on a cat but, from all I could observe, it wasn't the slightest bit grateful. In any case, it soon died."
Ashcroft says the landscape has changed a great deal in 20 years. "People used to be much more deferential towards doctors, and there was a greater acceptance of the limitations of medical provision," he points out. "Under these circumstances, it was right that the profession should be subject to tight ethical scrutiny. Now, though, I think there are sound arguments for relaxing some of the constraints on doctors.
"After various scandals, such as the collection of children's body parts at Bristol Royal Infirmary and Alder Hey hospital, people are much more wary of what's going on, and more vocal about asking for what they need. And it's here that many of the new ethical battles are being fought. As more treatments become available, society has to ask itself what it wants to afford, while at the same time ensuring that it's not just those patient groups and pharma companies with the loudest voices that get priority.
"But neither should we necessarily expect any consistency. Different people can come to different conclusions about the same issue, and both decisions can be perfectly reasonable. What patients really need is a clear explanation of how any decision is made; if people can follow the logic, it's much easier to accept not getting their own way. Much as I understand that many people's principles can dissolve when it becomes personal, and that it's important individuals don't get pushed around, we can't lose sight of a public-spiritedness."
After his stint at Liverpool, Ashcroft headed back south to Imperial College, where he continued his ethical research. You get the feeling, though, that Imperial was just a little too scientific for his liking and that his new post at Queen Mary suits him rather better. "Much of the work will be the same," he says, "but I think I'm going to get rather more space for day dreaming, for thinking about the big issues."
So what are these big issues? "There's the ethics of epidemiological research," he says. "People are now beginning to understand that environmental factors may be as important in some illnesses as the genetic. And then there's the equality of distribution. Healthcare provision for HIV/Aids is completely distorted around the globe. People tend to give me an odd look when I tell them I'm writing a book on medicine and utopia. But if we don't deal with Aids, we're heading for dystopia."
Ashcroft pauses. "God, I hate myself when I start to sound pious."
Curriculum vitae
Name: Richard Ashcroft
Age: 37
Job: Professor of biomedical ethics, Queen Mary, University of London
Dislikes Dance remixes of 70s pop songs
Likes: American crime and medical TV shows
Dislikes Dance remixes of 70s pop songs
Married: with one child
