The gruesome details of 4 assisted suicides with helium bags at the Swiss suicide clinic, Dignitas, are described in the latest issue of the Journal of Medical Ethics. Three researchers – from Canada, the US and the Netherlands, wanted to draw on the experience of Dignitas. Their reason for their interest is not quite clear, but their methocs were approved by an ethics research board at Kwantlen Polytechnic University, in British Columbia.

The researchers watched videos of the demise of 4 people who breathed helium through a mask under the supervision of Dignitas volunteers. (The deaths are taped and given to the police so that they can check that every detail of the demise is legal.) Three of the deaths took place fairly quickly and in about 5 to 8 minutes all gasping had finished. The fourth, however, took  at least 38 minutes and the volunteers were clearly nervous.

Dignitas normally uses a lethal dose of sodium pentobarbital. But in 2008 the Zurich authorities said that the patient had to be seen by a doctor more than once before the suicide. The head of Dignitas, Ludwig Minelli, thought that this unduly restricted his clients’ autonomy, and started using helium, which did not require the intervention of doctors. The authors of the article believe that the use of helium could help demedicalise assisted suicide, although they believe that a bag over the head is superior to a mask, which allows some oxygen to enter.

One of the most useful aspects of the article is a complete breakdown of deaths at Dignitas from May 1998 to December 2009 (click on link). There have been 1041 deaths, with nearly 60% coming from Germany, 14% from Great Britain, 11% from Switzerland and 9% from France. People from about 30 countries have come to die at Dignitas. ~ Journal of Medical Ethics, March

A high school student in Toronto, Lia Mills, became an internet sensation with her YouTube video denouncing abortion. Now she’s back with a speech for her Grade 8 speech project arguing that euthanasia should not be legalised in Canada. Her arguments are off-the-shelf and her research suggests that her parents had more than a little role in her presentation. But, hey, how much originality can you expect from a 13-year-old? What is impressive is her earnestness, intensity and level-headedness. If she represents the new generation of pro-lifers, what will the debate be like in 20 years’ time?

Just over 70% of Swiss voters have rejected a referendum proposal to give animals lawyers who would represent them in court. All 26 cantons voted against the move by animal rights activists. In some cantons, the No vote was more than 80%. Although this system is already in place in Zurich, the Swiss clearly thought that it was too expensive and too bizarre to be extended to the whole country. All of the cantons would have been forced to engage animal advocates.

 The president of the Swiss Farmers' Union, Hansjorg Walter, said: "Voters have taken a pragmatic decision and acknowledged that Switzerland has one of the strictest animal welfare laws. The Union wants proper enforcement of animal welfare. Violations harm the image of farmers. But there are stringent checks and penalties for misconduct are already severe." ~ London Telegraph, Mar 8

Sixty-three suicide prescriptions were dispensed during the first nine months of Washington state's "death with dignity" act, according to the first official statistics since assisted suicide became legal in March last year. At least 36 people have used their lethal medication to end their lives. This was roughly one in a thousand deaths in the state.

There have been no complaints from the public about doctors and pharmacists and their compliance with the law, said the state health department. "We're very satisfied with the compliance by the health care provider community," said spokesman Donn Moyer.

The statistics, which are available on the department’s website, are a bit difficult to interpret, as not everyone who took out a prescription used it. Of the 63, 47 are now dead. Seven died of their ailment and 36 after taking the lethal dose, but in 4 cases, no death certificate had been received.

Why did they want to die? According to the report, “All were concerned about loss of autonomy, 82 percent about loss of dignity, and 91 percent about losing the ability to participate in activities that made life enjoyable.” Only 25% mentioned inadequate pain control, although 79% had cancer; 23% feared being a burden.

A psychiatric assessment of the patient is not required unless the attending doctor requests one. Only 3 reports were filed. That worried Eileen Geller, president of True Compassion Advocates. "Really, the majority of people who experience a serious or chronic illness have at some point untreated clinical depression," Geller said. "When someone says, 'What's going to happen to me? I'm worried about my finances, I'm worried about my family,' do you really want to treat it differently and say, 'Well, here's some lethal drugs.' "

Former Washington governor Booth Gardner, the man who masterminded the campaign to legalise assisted suicide in his state, is heading to Hollywood this weekend to see if a documentary about the campaign will win an Oscar. ~ Seattle Post-Intelligencer, Mar 4

Conceding that apes are persons could be expensive, says an Australian philosopher, as we would have to police ape societies to prevent assault and murder. Writing in Oxford’s Practical Ethics blog, Dr Steve Clarke says that “If we take the idea that non human great apes have the right to life then surely we have a responsibility to police all ape communities to uphold the right to life, in the same way that we try to ensure that the right to human life is upheld, by policing human societies.”

Two objections immediately arise. First, that it would be too expensive. Chimpanzees and bonobos are a feisty lot and kill each other and other apes. But, writes Dr Clarke, a person is a person, and refusing to protect ape persons against violence would be “highly discriminatory”. One solution would be to “redeploy police from the safest human communities to the more violent ape communities.” Second, apes are wild animals and should not be interfered with. This is understandable, he says, “But animals can only be wild animals if humans don’t attempt to uphold their rights.” ~ Practical Ethics, Feb 26

The UK’s second-largest supermarket chain is slashing the price of IVF fertility drugs to position itself as the most competitive pharmacy in the country. A spokesman for Asda, a WalMart subsidiary, explained: “IVF is extremely expensive and around 40,000 women go through it every year. More than 80% of our customers are women and so naturally we want to help to reduce the cost of IVF by offering the medication on a not for profit basis, saving our customers as much as £820 per cycle of treatment." 

An article in the Daily Mail gives some background on how IVF is becoming a highly competitive commercial business:

“IVF - or in vitro fertilisation - is one of the fastest and most profitable branches of medicine… A single cycle of IVF treatment at a private clinic is believed to cost about £5,000. Infertility is the most common reason for women aged 20 to 45 to see their GP after pregnancy. The failure to conceive during the three NHS cycles has led to the boom in private clinics in the UK offering the service for thousands of pounds. There are currently 115 private clinics licensed to carry out fertility treatment. The fertility industry is worth around £500 million and last year produced more than 13,000 babies in the UK. The huge demand and competition from cheaper clinics abroad has pushed supermarkets to enter the market and push prices down.”

~ Daily Mail, Mar 3

The American Psychological Association has amended its Code of Ethics to make clear that its standards can never be interpreted to justify or defend violating human rights. In 2002 the APA amended its code to say that if a psychologist was confused or doubtful, he could follow his employer’s instructions. But this was used as an excuse to justify psychologists participating in the "enhanced interrogation" of suspects after 9/11.  A new sentence has been added: “Under no circumstances may this standard be used to justify or defend violating human rights.” The change is effective from June 1.

Shortly after the APA’s announcement, Leonard Rubenstein and Stephen N. Xenakis – who are both doctors – reminded the world about the psychologists and doctors who did participate in waterboarding, sleep deprivation, isolation and stress positions. Shouldn’t they be investigated and disciplined for violating human rights?

“No agency — not the Pentagon, the C.I.A., state licensing boards or professional medical societies — has initiated any action to investigate, much less discipline, these individuals,” they complained in a New York Times op-ed. “They have ignored the gross and appalling violations by medical personnel. This is an unconscionable disservice to the thousands of ethical doctors and psychologists in the country’s service. It is not too late to begin investigations. They should start now.” ~ New York Times, Feb 28, APA, Feb 24

Unfairly, perhaps, but the most enduring legacy of bioethicist Leon Kass to his colleagues may be a phrase he used in 1997 to argue against human cloning, “the wisdom of repugnance”. That’s the Saks Fifth Avenue coinage; its CostCo cousin is “the yuck factor”. Both have been ridiculed as a backward and unintellectual attempt to slow technological progress by appealing to irrational feelings of disgust. Public policy should be based on rationality, not evolved responses to the dangers of spiders and copraphilia. More than a decade later the former head of Council on Bioethics under President George W. Bush is still being attacked over the concept’s validity.  

In the journal Bioethics, the Finnish scholar Jussi Niemela fires another salvo at Kass and his supporters. Kass argued that “repugnance is the emotional expression of deep wisdom, beyond reason’s power fully to articulate it”. Niemela counters that it is no such thing. Visceral reactions to IVF, cloning, incest, or even homosexuality are merely “cognitive violations” of “folk biology”. We feel disgusted because we have instinctive, biologically-evolved responses to dangerous foods and pathogens, not because an option is morally wrong. Furthermore, to make sense of the world, human beings use “folk biology” which projects onto living beings conventional structures of behaviour. Because the mechanical and asexual aspects of cloning clearly violate these, it is strange and unfamiliar, ie, a cognitive violation.

What politicians and the public need to grasp, argues Niemela, is that “the yuck factor” is basically the rationalization of superstitions. “If something is not easy to grasp by folk-theoretical reasoning, that doesn’t necessarily mean it is bad or even dangerous: it’s just something that contradicts natural intuitions. It appears that things that are not easily understood by utilizing folk-theoretical thought create a fertile soil for argumentation that strives to cause fear and disgust.”

Niemela’s is merely the latest instalment in the battle of emotivism in bioethics – whether moral judgements are just emotional reactions or acknowledgements of universal laws of human nature. It is a debate as old as the 18th century philosopher David Hume. Stay tuned for further controversy.

Do doctors euthanase cancer-stricken children at their parents’ request? According to a study of the deaths of 141 children in the Archives of Pediatrics & Adolescent Medicine, some parents think they do. However, the authors are sceptical. Lead author Joanne Wolfe, a palliative pain specialist at the Dana-Farber Cancer Institute and the Boston Children’s Hospital, says the doctors probably were more likely to be adminstering morphine in larger and larger doses in order to alleviate the children's worsening pain.

One in eight parents in the study (13%) said that they had considered requesting ending the life of their child, and 9% said that they had that discussion with the caregiver. The parents of five children said that they had explicitly asked their doctor to carry out euthanasia, and the parents of three said that their doctor had carried it out using morphine.

Dr Douglas Diekema, medical ethicist at the Children's Hospital in Seattle, said that the results of the study are not surprising. "I have no doubt that in a small number of cases, some physicians might cooperate with a parent's desire to see a child's suffering ended. This might include giving a drug for sedation or pain control that also suppresses the drive to breathe.” He added, "Most physicians don't intentionally push that drug to the point of stopping a child's breathing, but some may be comfortable not intervening if a child stops breathing in the course of treating him or her for discomfort". ~ AP, Mar 2

Like many other countries, Malaysia has a problem with human trafficking for commercial sexual exploitation and forced labour. Most of the victims come from countries in the region like China, Nepal, Burma, Indonesia and the Philippines. Now the Malaysian Ministry of Home Affairs has added a new twist to this sad story with claims that its citizens have been the victims of organ trafficking activities abroad. Secretary-general Datuk Abdul Rahim Mohd Radzi said that most of the victims were women and children who were kidnapped and taken to a foreign country where their organs were removed and sold. However, he gave no details of the scale of the trafficking, apart from saying that some of those who were deceived into selling their organs abroad were not remunerated as promised. He said, "This organ trade, which may happen by force, conscious or unconsciously, is deemed wrong under the Anti-Human Trafficking Act 2007." Only 186 people have been charged under the Act in the last two years ~ Malaysian National News Agency Mar 2