German scientists and doctors are still coming to grips with the grim story of how their colleagues collaborated with the Nazis. A recent issue of the journal Science sketches the link between German anatomists and the regime. Before Hitler came to power, about 20 civilians were executed each year in Germany and their bodies were made available to anatomists. Between 1933 and 1945, however, at least 16,000 civilians were executed – apart the death camps. By 1942, all the bodies of prisoners executed for high treason were being turned over to anatomists.

With the emergence of more historical data, Germany’s Anatomical Society plans to hold its first meeting on “Anatomy in the Third Reich” on September 29. “We hope that this will contribute to a global debate on ethical standards for the use of human cadavers in research and teaching,” Andreas Winkelmann, an anatomist at Charité Medical University in Berlin, told Science. Indeed, it is still an issue, as there have many allegations that the plastinated bodies in some travelling exhibitions come from executed prisoners.

Historians have uncovered abundant information about how callous the anatomists of the Third Reich became. In Vienna, for instance, a special streetcar ran between the place of execution and the medical school morgue. If the morgue was full, executions were delayed. At least 1,337 bodies were delivered in this way.

In another distressing example, the director of the Berlin Institute of Anatomy from 1935 to 1952, Hermann Sieve, dissected the bodies of 200 female prisoners to understand how their reproductive system was affected by the stress of learning the date of their execution. “The picture is one of a very gradual slippage in moral values among anatomists,” says Christoph Redies, a professor of anatomy at the Jena University Hospital. ~ Science, July 16

Even though many US states demand that doctors report colleagues whose performance is impaired by alcohol or drug use or by physical or mental illness, a survey in a recent issue of JAMA suggests that a third of them would not do it.

Catherine M. DesRoches, of Massachusetts General Hospital, in Boston, found that only 64% of American physicians agreed with the professional commitment to report physicians who are significantly impaired or otherwise incompetent to practice.  About 17% of the physicians surveyed had dealt with an impaired colleague, but on 67% of these had blown the whistle.

Overseas doctors and underrepresented minority physicians were significantly less likely than other physicians to report. The most frequently cited excuses included the belief that someone else was taking care of the problem; the belief that nothing would happen as a result of the report; fear of retribution; the belief that reporting was not their responsibility; or that the physician would be excessively punished.

"These… raise important questions about the ability of medicine to self-regulate,” say Dr DesRoches and her colleagues. “More than one-third of physicians do not completely support the fundamental belief that physicians should report colleagues who are impaired or incompetent in their medical practice. This finding is troubling, because peer monitoring and reporting are the prime mechanisms for identifying physicians whose knowledge, skills, or attitudes are compromised…

“Reliance on the current process results in patients being exposed to unacceptable levels of risk and impaired and incompetent physicians possibly not receiving the help they need." ~ JAMA, July 14

An 11-year-old UK schoolgirl, with the approval of her parents, has decided to have her leg amputated so that she can become a para-olympian. Danielle Bradshaw, of Newton, near Manchester, has no medical need of an amputation, but would like to have one so that she can follow her dream of being a world-class disabled athlete.

Danielle was born with congenital dislocation of both hips and the right knee. She has a healthy left leg but she does not want to spend the rest of her life “dragging the other one” behind her.  

Surgeons have told her that a number of operations and skin grafts could be performed on the right leg, which has been damaged since birth. However, they also told her that while she could keep the leg, she would not be able to use it. Her parents were astounded by her decision, but soon agreed. The operation has been scheduled for August.

This raises some thorny ethical issues. Can an 11-year old make an informed decision about a procedure of this gravity? Should parents allow their children to do so?

Her mother Debbie Quigley, 36, said: “Danielle suggested it to the doctors. They could have done reconstructive surgery but she said: ‘What’s the point of dragging around something that doesn’t work?’” Stepfather Darren Quigley, 49, said: “We couldn’t get our heads around it at first. But when we heard the options it makes sense.”

Danielle will be fitted with a prosthetic replacement leg once the wound heals. Her friends have begun raising funds to buy her a running blade and sports wheelchair. “I’m not scared, I’m excited. I can’t wait for it to be done so I can start running and training,” she said. “I just want to be a normal kid. I see people running and I want to know how that feels.” ~ Manchester Evening News, Jul 15

The fertility doctor for “Octomom” Nadya Suleman implanted too many embryos in yet another patient, resulting in the death of a fetus, the California state licensing board alleges. The Medical Board of California says that Dr Michael Kamrava acted negligently in implanting seven embryos in a 48-year-old woman, identified as “L.C.”

Four of these embryos became viable, but the woman lost one during pregnancy and gave birth to triplets, one of whom is profoundly developmentally delayed, the board said.

For a patient over 35, the US fertility industry recommends implanting only one or two embryos. However the medical board found that Kamrava "placed L.C. at great risk for high order gestation, which was confirmed by a quadruplet pregnancy that ended with catastrophic results".

The Beverly Hills doctor has been under investigation since Suleman gave birth to octuplets in January last year. He was expelled from the American Society for Reproductive Medicine last September.

Dr Kamrava faces another complaint – that he failed to refer another patient, H.L., for cancer screening, despite a history of cancer and her ovarian cysts. Allegedly he ruled out cancer on his own “rather than refer H.L. to a specialist for further evaluation”. In April 2009 she was diagnosed with cancer and had to have her ovaries, cervix, uterus and fallopian tubes removed. ~ AP, Jul 13

Stem cells derived from reprogramming adult cells may have limited usefulness as an alternative to embryonic stem cells, leading researchers said this week.

The study found that induced pluripotent stem cells, which have been the darling of stem cell scientists for the past couple of years, retain a “memory” of their original adult tissue. This may make it difficult to convert them to other cell types for medical treatment, say researchers from Harvard and Johns Hopkins. The findings were published online in Nature. Similar results from other Harvard researchers were published in Nature Biotechnology.

This could be a setback for regenerative medicine because iPS cells are a promising and ethical uncontroversial alternative for embryonic stem cells. However, researchers have already begun finding ways around the limits that the study has identified, so that the iPS cells could still be used for treating illnesses such as diabetes and Parkinson’s disease.

“It’s a challenge to be understood and overcome,” George Daley, a researcher at the Harvard Stem Cell Institute and Children’s Hospital in Boston and lead author of the Nature study, told Bloomberg Businessweek. “We already have strategies for overcoming this.” ~Bloomberg Businessweek, Jul 19

A Norwegian woman who engaged an Indian woman to be a surrogate mother of twins may not be able to bring them back home because they are not genetically hers.

Andras Bell (name changed), 31, commissioned a surrogacy at India’s Rotunda fertility clinic. She was suffering from premature ovarian failure, so she chose a Scandinavian sperm donor and an Indian egg donor. Twin boys were born in April.

Ms Bell did not anticipate a mandatory DNA test, which is demanded by many European consulates following a string of recent surrogacy controversies. This revealed that there was no biological link between her and the boys. Her only claim on them was that she had commissioned the surrogacy and signed a few forms at the IVF clinic stating that she would be their “legal mother”. The consulate refused to grant them citizenship.

“We provided all the relevant documents and two to three informed consent papers that she had signed,” said medical director of Rotunda, Dr Gautam Allahabadia. He added that the clinic had done nothing illegal or unethical. “Embryo adoption is a well-accepted choice, and probably the only option for women who are unable to conceive naturally,” he said. Dr Allahabadia helped to draft India’s proposed guidelines for surrogacy, which stipulate that fertility clinics should ensure that foreign clients liaise with their consulates to avoid visa problems. But these were framed only this year, months after Bell had commissioned the surrogacy.

Why didn’t Ms Bell just adopt a child rather than going through the surrogacy process? One IVF expert surmises that “One reason could be that she wanted to avoid the stringent adoption laws and believed that surrogacy was an easier path.” ~Times of India, Jul 21

October 6 is "Stem Cell Awareness Day". But where are the celebrations? Extensive googling failed to yield news of festivities. The California Institute for Regenerative Medicine, which was set up to promote research on human embryonic stem cells, has a section on its website dedicated to “Stem Cell Awareness Day 2010”.  But if you click on the link, you come to a half-finished site, without graphics or information, a scientific Marie Celeste bobbing on the internet.

The only feature that works is a video made for Stem Cell Awareness Day last year in which a high school teacher tells his students that stem cell research is more important than health care, that stem cell research is health care. “Hopefully, in the future, we’ll see everybody rejoicing about stem cell awareness because it has a fantastic potential to play a very important part in our lives,” said the CIRM’s director, Australian scientist Alan Trounson, in the 2009 video. Has the helium leaked out of the balloon?

Two Melbourne couples are suing hospitals because doctors failed to diagnose Down Syndrome in their unborn children, thus denying them the choice to have an abortion.

In the first case, at Royal Women’s Hospital, a four-year-old girl has heart, kidney and thyroid problems, needs help to eat and cannot talk. The parents want compensation for their trauma and specialist care costs.

In the second, at Sunshine Hospital, the parents complain that doctors failed to "exercise reasonable care" of the mother, "advise (her) in relation to the risks of Down syndrome given her age" and "provide (her) with the option of ante-natal screening. "In the event that Down Syndrome had been detected, (she) would have elected to undergo a termination of her pregnancy," say documents presented to the court. The parents claim to have suffered "depression, shock and anxiety" and "pain and suffering during pregnancy and delivery".

In the Australian state of Victoria, parents are able to sue for compensation to cover the costs of raising a child until they are 18 if the child was born as a result of negligent care.

Wrongful birth lawsuits are uncommon in Australia, but not unprecedented. In 2003 the Australian High Court's found, in Cattanach v Melchior, that parents could claim damages for raising an unplanned child. However, in 2006 the High Court rejected two claims for “wrongful life” by disabled children whose lawyers argued that they would be better off had they never been born. “Life with disabilities, like life, is not actionable,” the court declared. ~ ABC, July 21; Herald-Sun, July 21; Medical Journal of Australia 2006

A Canadian Army officer has been found guilty over the “mercy killing” of a wounded Taliban insurgent in Afghanistan. Captain Robert Semrau could face up to five years in jail for “disgraceful conduct”. However, the jury of fellow officers found him not guilty of second-degree murder and attempted murder.

The incident occurred in 2008 in the Afghan province of Helmand. The prosecution alleged that Captain felt bound by a “soldier’s pact” to end the suffering of a gravely wounded man. “He told us that he shot the Taliban, he put him out of his misery and if anything came of it, he would wear it,” a corporal told the court. However, with no body, no autopsy, and conflicting witnesses, it was difficult for the prosecution to establish a case for murder. There is no defence for mercy killing in Canadian law.

In 2004 an American soldier tried to excuse a battlefield execution in Baghdad's Sadr City suburb as “mercy killing”. However, he was found guilty of unpremeditated murder and sentenced to three years in jail. ~ Globe and Mail, July 19

Here is a startling case from the UK. A severely brain-damaged 43-year-old father of two, Richard Rudd, became a quadriplegic, unable to move or communicate after a motorcycle accident last October. He had left no advance directives, but his family clearly recalled remarks about a friend who had become a paraplegic. "If ever this happens to me, I don't wanna go on. I don't wanna be like him," he told them.

So after his situation stabilised, his family felt that doctors should withdraw his life support system.

However, Mr Rudd’s doctor noticed that he could move his eyes. This meant that even though he was “locked in”, it was possible to communicate with him. After six months, the doctor asked him if he wanted to continue living. The answer was an unequivocal Yes. “I asked him again and on three occasions he made it clear, just with yes/no answers, that this was a consistent response," said Professor David Menon of the Neuro Critical Care Unit (NCCU) in Addenbrooke's Hospital in Cambridge..

Since them Mr Rudd has made steady improvement. He can smile and his long-term memory is intact.  

His father, also named Richard Rudd, told the BBC: "We all sit round and talk in the pub or at work and say 'if this happened to me, turn the machine off'. It's all hypothetical and you don't know until it happens to yourself. As a family and friends, if that person can't decide for themselves, sometimes you feel that you can decide for them…

"But now Richard's in the situation where that's actually happened. It's real life - it's not pretend. He is in that situation. The will to live takes over… For my part, I'm glad he's alive and didn't make a living will." ~ BBC, July 13