In the wake of the recent Thai surrogacy scandals, commentators are debating how the practice of surrogacy should be reformed.
Many say that we should make commercial surrogacy legal in Western countries. In Australia, researchers from Surrogacy Australia, the Canberra Fertility Centre and Monash University are campaigning for compensation for Australia surrogates.
Fertility specialist Dr. Martyn Stafford-Bell says that overseas surrogacy arrangements expose both surrogates and babies to serious health risks. “Such adverse outcomes could be avoided if access to surrogacy was facilitated within Australia”, he commented in a recent interview.
Australian Surrogacy lawyer Stephen Page agrees with Dr. Stafford-Bell.
“The reality is if Australians are going in such great numbers to developing countries, such as India and Thailand, with the possibility of exploitation, sure it’s much better to have it here, where it can be regulated”.
But others are questioning the very practice of commercial surrogacy.
The debate surrounding Canada’s marijuana laws has intensified, with the president of the Canadian Medical Association (CMA) labeling medicinal marijuana “bad medicine”.
Dr. Louis Hugo Francescutti is skeptical about the benefits of the controversial treatment. He voiced his concerns at the CMA’s annual meeting in Ottawa on the 18th of August: “It’s just plain bad medicine to prescribe a product when we don’t know how it works, we don’t know when it works, who it works for, how it interacts or how much to prescribe….”.
Under current Canadian law, patients wishing to purchase medicinal marijuana need to obtain a prescription from a doctor. Many doctors are unsure about the treatment and hence reluctant to issue a prescription.
Dr. Francescutti is concerned about the effect of current legislation on doctor-patient relations: “It puts physicians in a very awkward situation and it strains the physician-patient relationship”.
“Even if wrongdoing was not suspected, however, (and even the parents of abused individuals did not believe them, in the case of some celebrities who have now been exposed), patients should have a right to protection from the intrusion of non-healthcare personnel.”
Chadwick suggests that the aura of Savile’s celebrity impaired the judgement of hospital staff:
“The whole sorry episode suggests a need to pay attention to something I have touched on before in editorials, the question of what people ‘see’. Do we have here a case of knowingly turning a blind eye, or simply not seeing what is in front of one?”
The academic conversation over brain death continues, with the American journal of Bioethics publishing a special issue on the status of death determined by neurological criteria (DDNC).
The issue contains 20 articles offering different perspectives brain death. Most of the papers refer a recent legal battle in Texas over Marlise Munoz, a brain dead woman carrying a second trimester foetus.
The papers are highly technical and difficult to summarize in a short post. There are, however, a number of clear themes:
Doctors who failed to raise concerns about colleagues could be struck off, under new guidance being considered by the UK’s General Medical Council (GMC).
The GMC has launched a public consultation on the proposed changes. Current guidance for the fitness to practice panels of the Medical Practioner Tribunal Service (MPTS) states “it may be appropriate to remove a doctor from the medical register when their behaviour is fundamentally incompatible with being a doctor.”
The proposed changes would augment the MPTS’s scope for disciplinary action. New scenarios covered include cases where a doctor has “failed to raise concerns where there is a reason to believe a colleague’s fitness to practice is impaired” and cases where a doctor has failed to raise concerns “where a patient is not receiving basic care to meet their needs”.
Germans and British make up the bulk of the numbers, with neurological conditions, such paralysis, motor neurone disease, Parkinson’s, and multiple sclerosis, accounting for almost half of the cases, the findings show.
611 non-residents had been helped to die between 2008 and 2012, all but four of whom had gone to Dignitas. Their ages ranged from 23 to 97, with the average being 69; over half (58.5%) of the ‘tourists’ were women, who were 40% more likely to choose assisted suicide in Switzerland than men.
How to deal with the Ebola outbreak in West Africa seems to be splitting bioethicists. Some applaud the World Health Organisation's recent decision to allow experimental drugs to be released "for compassionate use". For Arthur Caplan, of New York University Langone Medical Center, this seems to be the right decision:
"In a plague that kills 90% of its African victims complaints about unwarranted exploitative research seem a bit ridiculous even against a long history of misuse and abuse of poor desperate persons in poor African nations."
However, bioethicists Ezekiel Emanuel, of the University of Pennsylvania, and Annette Rid, of King's College London, want to be a bit more restrictive about "compassionate use" and believe that experimental drugs are not the main way to beat the disease. In an article in The Lancet, they write:
The war between Hamas in Gaza and Israel has been treated very gingerly by most of the major medical journals. Except The Lancet. This prestigious British publication ran an incendiary letter from a score and more of academics and doctors with Palestinian sympathies and subsequently a strong defence of its editorial policy.
“It is surely the duty of doctors to have informed views, even strong views, about these matters; to give a voice to those who have no voice; and to invite society to address the actions and injustices that have led to this conflict. Our responsibility is to promote an open and diverse discussion about the effects of this war on civilian health.”
There are currently over 123,000 people in the US on the organ donation waiting list. Only 29,000 organ transplants took place in 2013 – a consequence of the dire shortage of organ donors.
A number of healthcare commentators are now calling for ‘compensation’ for donors.
Sally Satel of the American Enterprise Institute believes that some form of monetary incentive is the only way to address the donor shortage: “altruism, as a strategy, is simply not producing enough organs. It needs to be supplemented with compensated donation”.
Alan Langnas of the University of Nebraska and Daniel R. Solomon of the Scripps Research Institute make a similar argument.
“Organ donors, and in particular the live kidney donor, are being asked to altruistically support a system with sizable financial costs to themselves. These costs represent a considerable disincentive to organ donation. To begin to move the dial on this we…
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An revealing new study in the Journal of Medical Ethics examines the attitudes of medical students towards conscientious objection. The study, conducted by a group of researchers from the University of Oslo, canvased the views of 531 fifth and sixth year medical students in Norway. Students were asked about a range of procedures including abortion, euthanasia, ultrasound in the setting of prenatal diagnosis and assisted reproduction for same sex-couples. Students views varied significantly depending on the issue.
62% of respondents said they would object to participating in euthanasia – a surprisingly high proportion considering that the majority of Norwegians are said to support legalising euthanasia.
A far smaller number said they would object to participating in abortions (between 12.5% and 19%, depending on the stage of pregnancy and whether the foetus had disabilities).