Why do bioethical dilemmas flourish in
Florida? After the right-to-die case of Terri Schiavo rivetted the nation in
2004, another unusual and far-reaching case has surfaced in the courts. This
time the issue is a woman's right over her own body.
Last year a Tallahassee hospital secured a
court order to confine a pregnant woman to her bed to protect her baby.
Samantha Burton, a 29-year-old mother of two,
was 25 weeks pregnant. Her membranes had ruptured, she had contractions and the
foetus was in breech position. Her doctor, Jana Bures-Foresthoefel, thought
that there was a danger of infection or miscarriage. She ordered Ms Burton to
stop smoking and to stay in bed. Ms Burton demurred. She was unhappy with
Tallahassee Memorial Hospital and wanted to go home.
Instead, hospital lawyers showed up and handed
Ms Burton a phone. She found herself defending her plans with Circuit Judge
John Cooper. Judge Cooper supported the hospital and ordered her to stay. Under
Florida law, he declared, a child's welfare overrides its parent's. He even barred
her from seeing another doctor.
In the end, the court order did not save the
baby. Ms Burton had an emergency caesarean three days later but the baby was
still-born. Then she was allowed to go home.
This was not the end of the story. Ms Burton
was very angry. In the words of her lawyer, "She wound up basically
nothing more than an incubator for the state. The court order made only the
fetus a patient." As a matter of principle, she wants the judge's order
retrospectively rescinded. Otherwise, says her lawyer, "Any time a woman
gets pregnant the state could come in and run her life."
The
American Civil Liberties Union says that the court order was unconstitutional.
"Ms. Burton's bodily integrity, privacy, and autonomous decision-making
were given no consideration, let alone respected," wrote the ACLU in a
brief. "The state failed to consider the fallibility of the single medical
opinion presented in this case or the reality, unfortunately demonstrated in
this case, that forced medical interventions cannot guarantee the preservation
of fetal life."
The
First District Court of Appeal is still considering the case, which is
beginning to attract nation-wide attention. Writing in the Huffington Post,
freelance bioethicist Jacob M. Appel described it as one of the “most egregious
abuses perpetrated against a patient by her caregiver since the triumph of the
patients' rights movement in the 1970s.” ~ Tallahassee
Democrat, Jan 18; Huffington Post, Jan 24
The UK’s controversial fertility regulator is again in the hot seat
over its decision to allow clinics to destroy embryos with relatively minor
genetic defects. The Human Fertilisation and Embryology Authority (HFEA), has
published a list of 116 inherited conditions which fertility clinics can screen
out without requiring special permission, says the London Times. These include
conditions carried by successful people without great difficulty such as
thalassaemia (tennis great Pete Sampras) and Marfan syndrome (Abraham Lincoln).
It is considering adding another 24 conditions to the list.
If a condition is on the list, UK fertility clinics will be able to
screen embryos for it and destroy it, if the parents ask them to do so.
The head of the HFEA, Professor Lisa Jardine, was indignant at how the news
was reported. In a letter she complained that the London Times
article was “inaccurate and misleading and could cause confusion and distress
for… families”. She insisted that parents did not make such decisions lightly
and that the embryos were “just three days old and made up of about eight
cells”. ~ London Times, Jan 24
A Scottish MP has introduced a bill for assisted suicide. Margo
MacDonald, a campaigner for euthanasia who suffers from Parkinson’s disease,
claims that her End of Life Choices Bill would allow Scots who wanted to end
their lives to die at home, rather than travel to a suicide clinic in
Switzerland. "Dying is part of living, it's the last act of your life, and
if we accept the responsibility of how we live our lives, then I really fail to
see where there is any demarcation of how we should die," she told
Parliament.
Ms MacDonald says that her bill has a number of safeguards to ensure
that it will not be abused. People must have resided in Scotland for at least
18 months; they have to consult a doctor and have a psychiatrist confirm that
they were not suffering from depression; their decision has to be confirmed
after two weeks and they cannot die until two days after that.
However, Wesley J. Smith, a veteran critic of euthanasia
who scrutinised the bill, claims that it has serious flaws. A 16-year-old could
take advantage of it without parental consent; as no method is specified, a gun
could be used; and anyone, not necessarily a doctor, could dispatch the person
requesting death. ~ Scotsman, Jan 29
In a twist on the old adage that you can’t escape death and taxes, the
Swiss are to vote on a “death tax” on foreigners who visit the country to take
advantage of its liberal assisted suicide law.
Dignitas, a Zurich-based group, helps foreigners commit suicide. They
normally arrive 2 or 3 days before their demise. Apart from ethical
considerations, many Swiss see this as bad public relations.
So opponents of this so-called “suicide tourism” propose imposing a
fine of 50,000 Swiss francs (US$47,000) on Dignitas if it helps kill a person who
has not lived in Switzerland for at least a year. A referendum on the proposal
is scheduled for November 28.
Daniel Suter, Zurich president of the Swiss Federal Democratic Union
party, which is behind the vote, says: “we believe this will cut down the
number of suicides dramatically. There needs to be an end to death tourism. We
anticipate the fine will be passed on to the person committing suicide by the
suicide organisation. Effectively foreigners will be discouraged from coming to
Zurich to die.''
However, Ludwig Minelli, the founder of Dignitas, seems unconcerned by
the move. Even if the referendum proposal passes it will be challenged in the
Swiss courts and in the European Court of Human Rights. ~ Irish Independent, Jan 23
In a interview on the weekend, British
novelist Martin Amis proposed that “euthanasia booths” be placed on “every
corner” where the elderly and the demented can go out quietly, with dignity,
receiving a “martini and a medal”.
England would soon face a “civil war” in
Britain between the younger and older generations in 10 or 15 years' time, he
believes. “They'll be a population of demented very old people, like an
invasion of terrible immigrants, stinking out the restaurants and cafes and
shops," he told the Guardian.
His solution?
"There should be a booth on every corner where you could get a martini and
a medal.”
Critics have labelled Amis’ comments ‘glib’
and ‘offensive’.
Alistair Thompson, of the Care Not Killing
Alliance, described Amis’ comments as “very worrying”. "How on earth can
we pretend to be a civilised society if people are giving the oxygen of
publicity to such proposals?"
Fellow novelist Joan Brady told the Guardian on Monday that she viewed Amis’
comments as ‘flippancy’ and ‘prostitution’, questioning Amis’ ‘trivialising’ of
“a subject of enormous magnitude just to flog a book”. Her husband was killed
by a degenerative disease.
Amis contends that his comments were more ‘satirical’ than ‘glib’. He also
told the Guardian, “What we need to
recognise is that certain lives fall into the negative, where pain hugely
dwarfs those remaining pleasures that you may be left with. Geriatric science
has been allowed to take over and, really, decency roars for some sort of
correction." ~ Guardian Jan 24, Jan 25
A Canadian baby on a life-supporting
ventilator has become the centre of the latest controversy over futile medical
treatment. Isaiah May, the first child of Isaac and Rebecka, was born in
Alberta on October 24. His umbilical cord had been wrapped around his neck and
his brain was starved of oxygen. Doctors said that he had “irreversible brain
damage.” But, although he is silent and mostly unresponsive, he began to put on
weight and move. “He looks like a normal baby," says his mother.
However, his doctors felt that continuing
treatment was not in Isaiah’s best interests. They told the young parents that
their child was brain dead and would always need a ventilator. On January 13
they sent the Mays a letter stating that they intended to remove Isaiah from
the ventilator on January 20.
“Your treating
physicians regretfully have come to the conclusion that withdrawal of active
treatment is medically reasonable, ethically responsible and appropriate. We
must put the interests of your son foremost and it is in his best interests to
discontinue mechanical ventilation support,” the letter states.
However, the Mays are determined to fight for the life of their son and
want to exhaust every chance ofsurvival. This week they succeeded in getting an
injunction to delay the removal until February 19. They plan to seek more
medical advice and to have more tests done. ~ Global Edmonton, Jan 27; CNNews, Jan 20
Just over two weeks ago, CNN's celebrity
doctor and one-time dandidate for surgeon-general in the Obama administration, Dr
Sanjay Gupta, joined the flock of journalists converging upon Haiti. Upon arrival,
Dr Gupta examined a 12-year-old girl suffering from a head injury. The incident
was filmed and made into a four-minute clip that immediately became the lead
item on the CNN website.
Dr Gupta’s fame and popularity have caused
some to question his motives in filming this piece of medical work.
On his way to Haiti two weeks ago, Dr Gupta
clarified in a Twitter post that although journalistic aims drove his work in
Haiti, he would provide medical assistance if necessary. He said, “Many have
asked: of course, if needed, I will help people with my neurosurgical skills.
Yes, I am a reporter, but a doctor first.”
Bioethicists were not impressed. "The reporters who have
been practicing well-televised drive-by medical care in Haiti are demonstrating
an appalling abuse of medical and journalistic ethics,” said Dr Steve Miles, of
the University of Minnesota Center for Bioethics. And Dr Carl Elliott, from the
same centre, was even more scathing. “It's worse than self-promotion. It's
exploiting the suffering of Haitians for the PR goals of their employers. They
should not be reporting on their own work. That's a classic PR tactic: using
humanitarian aid as a public relations device, in order to drive up ratings for
their network.” ~ MinnPost,
Jan 22; LA Times, Jan 14
“Heartbreak mums facing a baby crisis over low
sperm levels” was the headline in the Mirror, a London tabloid. According to figures
supplied by the British Fertility Society, there is such a shortfall of sperm
donors in the UK that women are being forced to go overseas to fertility
clinics or to resort to mail-order fresh sperm. The Society says that UK
clinics require 500 sperm donors to service their patients, but at present
there are only 400. Supply has shrunk since the recent abolition of donor
anonymity.
Dr Pacey is aghast at the use of fresh sperm because there are no
guarantees that it is free of HIV or other STDs. “These fresh sperm delivery
services just full me with horror,” he told the London Telegraph. “There is no
way on earth that they can guarantee they are infection free when they do not
quarantine sperm at all.”
The UK’s fertility regulator, the Human Fertilisation and Embryology
Authority is now considering allowing payment for sperm to overcome the
shortage. ~ London Telegraph, Jan 22
The UK National Health Service (NHS) has
apologised to a man who was mistakenly told that he would likely suffer with a
hereditary brain disease. Mr C was told in his early 30s that he had the
incurable Huntington’s disease, and that it would likely be passed on to his
daughters.
Huntington’s disease (HD) is a
neurodegenerative condition, usually with onset at middle age. Classic symptoms
include mental decline, difficulty with speech, loss of motor function and
shifts in personality. Despite extensive research, it remains incurable.
Mr C lodged a complaint with the Scottish
Public Services Ombudsman, who investigated this case from the NHS Lothian
area. The ombudsman discovered that Mr C and his family all suffered a great
deal of anxiety as a result of the diagnosis, and that this caused them to make
“certain life choices”. Mr C’s wife and one of their two daughters terminated
pregnancies, and one daughter was unable to finish her university degree after
the HD diagnosis.
The technology available for retesting when Mr
C was diagnosed with HD carried a 4% probability for misdiagnosis. Newer and
more accurate testing technology was introduced in 1993, but Mr C was not
retested until 2007. This later test showed up negative, meaning that Mr C
never had the disease at all. It also shows that he fell into the 4% of cases
in which the original tests provided incorrect diagnoses.
The nursing director for NHS Lothian, Melanie Hornett, said that the board
was “deeply sorry” for the hardship that the incident caused Mr C and his
family. "This was an exceptional case and we have implemented the
recommendations of the report to prevent a repeat of a similar incident."
~ BBC News Jan 21
Discouraging news for women over 30 who want
to have a child comes from the UK. According to a study in the journal PLOS
One, by the time a woman reaches 30, she has used up nearly 90% of her reserves
of eggs. By the time she is 40, only 3% remains. Scientists at the University
of St Andrews and Edinburgh in Scotland tracked the growth of the ovarian
reserve from conception to 50. They found that the number of eggs declines far
more rapidly than most women realise. "Our research shows that they are
generally over-estimating their fertility prospects,” says Dr Hamish Wallace,
one of the authors.
The study also dumps cold water on the intriguing theory that new eggs are
produced in adults when germline stem cells in bone marrow reach the ovaries.
Research on mice suggested that this might happen in humans, but the study is
sceptical: “our model provides no supporting evidence of neo-oogenesis in
normal human physiological ageing”. ~ London Telegraph, Jan 27; PLOS One, Jan 27