The bitter debate over President Obama’s healthcare plan can be baffling. With a finite supply of money, surely the cost of treatment has to be taken into account, one side argues. The other side contends passionately that lives cannot be measured with dollars.

Most of the time, the battle rages over grey areas. However, the controversial freelance bioethicist Jacob M. Appel, writing in the Huffington Post, helpfully discusses a case which makes the issue black and white. This involves a dispute over a New Jersey man, Ruben Betancourt. Mr Betancourt was in a vegetative state, after his brain had been starved of oxygen. His relatives wanted him kept alive; the Catholic hospital wanted to withdraw his respirator and other care because they were merely prolonging his death.

Mr Betancourt passed away before New Jersey's Superior Court was able to issue an order. However, it may soon clarify whether hospitals can discontinue care in such cases. Mr Appel believes they should.

He says: “[the] court [should] decide that physicians and taxpayers only have a duty to provide unlimited care to patients who have a meaningful chance of returning to consciousness. Let us make no mistake about what this would mean: It would mean declaring that the lives of PVS patients are worth less than those of others. Rather than shying away from this outcome, progressive bioethicists should have the courage to acknowledge and to embrace this proposition.”

There you have it: an example of “healthcare rationing” in its starkest form. If care of the estimated 25,000 PVS patients in the US were withdrawn all at once, the system would save US$6 billion a year, according to futility law expert Thaddeus Mason Pope.

In response, on Bioethics Forum, at the Hastings Center Report, L. Syd M Johnson says it’s not that simple – even the Betancourt case. Johnson points out that Betancourt was not actively dying, that some PVS patients recover; that some PVS patients are misdiagnosed; and that other patients are unlikely to benefit from the savings. Besides, Johnson continues, “There are substantial social costs to declaring an entire class of patients ‘worthless’.” ~ Bioethics Forum, July 2; Huffington Post, June 23  

A leading Scottish health campaigner has implored the Scottish Government to urgently address the problem of malnutrition of the elderly and vulnerable in National Health Service hospitals in Scotland.

Dr Jean Turner, executive director of Scotland Patients Association, warned that hundreds of patients, especially the elderly, are undernourished and deteriorating in hospital beds because they are not receiving help with feeding. She says that it is “a form of euthanasia”.

She says nursing staff rarely express their concerns about patient welfare for fear of repercussions from senior management.

A recent report estimated 50,000 patients die annually in NHS hospitals in an undernourished state, which may have hastened their deaths. The warning by the SPA follows a Scottish Public Services Ombudsman report that severely criticised a Lanarkshire hospital’s care of a 66-year old patient.

The woman’s death was attributed to kidney failure after a 14-week stay in Wishaw General Hospital, and her family says poor standards of care, especially in nutrition, hastened her end. One family member told the Sunday Herald: “Staff would tell me, ‘It takes an hour to feed your mother and we don’t have an hour’.” ~ Herald Scotland, Jul 7

The archeologists of a 2,000-year-old Roman villa in the Thames Valley are puzzled by the discovery of a mass burial of 97 new-born infants. Forensic examination of the skeletons found at the Yewden villa in Buckinghamshire suggests the inhabitants must have been systematically killing the children. Archaeologist Jill Evers believes that the villa may have been a brothel. She says that without contraception or abortion, the Romans would have had to kill newborns.

While shocking to modern sensibilities, researchers told the BBC that infants were not considered to be human beings in the fullest sense until they were about two years old. Children younger than this were seldom buried in cemeteries, but in the grounds of domestic sites.

The bones were actually unearthed and catalogued in 1921 and stored in cigarette and cartridge boxes in the Buckinghamshire County Museum. However they were lost until recently. Now archaeologists  plan to carry out DNA tests to establish the sex of the infants and whether they were related. ~ BBC, June 25

Recent media coverage of a blood test for Down’s syndrome suggests that children with the condition are being depicted as non-persons. The Daily Mail, Britain’s second-largest newspaper, announced that “A quick inexpensive blood test for Down's syndrome that could save the lives of hundreds of unborn babies each year is being developed by scientists”. However, the main result of the test would to terminate hundreds of unborn babies with Down’s syndrome.

The lives of unaffected babies could be considered “saved” only in the sense that they would not be miscarried as a result of invasive investigations to detect and destroy Down’s syndrome babies.

Despite the publicity given to this preliminary report of research by Dutch scientists at the annual conference of the European Society of Human Reproduction and Embryology, a successful test is still several years away. Professor Stephen Robson, a spokesman for the Royal College of Obstetrics and Gynaecology, described it as the “holy grail” of pre-natal testing. ~ Daily Mail, June 30

Embryos produced using IVF can be screened for genetic defects before implantation into the womb, a German high court ruled on Tuesday. Leipzig’s Federal Supreme Court ruled in favour of a Berlin gynaecologist who carried out pre-implantation genetic diagnosis (PGD) for three couples and implanted only the healthy embryos. The other embryos, which possessed hereditary defects, were left to die off.

The doctor, 47, unidentified by the court, brought the case to court himself in 2006 to clarify the legal situation. He was acquitted by a Berlin regional court, but the city’s state prosecutor appealed.

Judge Clemens Basdorf told German news agency DAPD that IVF embryo screening should be legal "if there is a danger of grave genetic defects for the desired children of the patients." ~ AP, Jul 7

It’s expensive to treat the dead with dignity. This seems to be the message from a bizarre story from Lagos, Nigeria’s largest city. A waste disposal contractor for Lagos University Teaching Hospital has been  arrested after he was caught looking for a burial spot in the bush for about 70 dead babies. He claimed that he was employed to bury them in a cemetery but was not given enough money. A hospital official said that the incident was “embarrassing” and declared that the hospital was investigating the incident.

According to the BBC, many families are too distraught or too indigent  to care for dead babies and they abandon them outside hosptitals. It seems to be a case of gross mismanagment, but police are inquiring whether ritual ceremonies or organ trafficking was involved. ~ BBC,  July 7

Two recent neuroscience articles in important journals claim to undermine free will and “human exceptionalism”.

In the journal Science Dutch researchers claim that an overview of the literature shows that conscious decisions are deeply affected by the “unconscious will”.

"People often act in order to realize desired outcomes, and they assume that consciousness drives that behavior. But the field now challenges the idea that there is only a conscious will. Our actions are very often initiated even though we are unaware of what we are seeking or why," says Ruud Custers, of Utrecht University.

Custers told Time magazine that our conscious selves not really in charge, but that this is not necessarily a problem. "We have to trust that our unconscious sense of what we want and what is good for us is strong, and will lead us largely in the right direction."

In a similar vein, a study in the Journal of Neuroscience claims that brain scans can predict behaviour better than the people whose brains were scanned. Scientists at UCLA were able to predict whether subjects would use suntan lotion more accurately than the people themselves.

This could be a major finding for advertisers. While advertising agencies often use focus groups to test commercials and movie trailers, in the future they and public health officials perhaps should add "neural focus groups" to test which messages will be effective while monitoring the brain activity of their subjects. “We're just at the beginning,” says Matthew Lieberman, a UCLA professor. ~ Science Daily, June 23; Time, July 2

The US is poorly prepared to care for the growing number of aged with intellectual disabilities, according to a commentary in the Journal of the American Medical Association. Nowadays these adults live nearly as long as the general population. “Consequently, the relatively rapid increase in a new population of aging adults with complex medical and mental health problems has resulted in inadequate geriatric health care provision,” say Elizabeth A. Perkins and Julie A. Moran.

The problem is not new. A 2002 report by the US Surgeon General complained about problems with health status, access to care and lack of training for doctors. “Nearly a decade later,” say Perkins and Moran, “progress is slow, and efforts affecting the well-being of older adults are even more marginal.” Stigmas and stereotypes persist, hampering attempts to treat these people with dignity. ~ JAMA, July 7

An interesting example of politicised science has emerged during Senate hearings on Elena Kagan's nomination to the Supreme Court. Documents reveal that she doctored a draft statement on partial-birth abortion by the American Council of Obstetricians and Gynaecologists (ACOG) while she was an associate White House counsel for the Clinton administration in 1996. The documents, released by the Clinton Library, include a memo, a draft ACOG statement on partial-birth abortions, and a set of undated notes in Kagan’s handwriting.

At the time, the Clinton Administration opposed any restrictions on partial-birth abortions which did not include health exceptions. ACOG asked the White House for advice about how to describe its positions. Its draft statement said that it “could identify no circumstances under which this procedure . . .  would be the only option to save the life or preserve the health of the woman.” This clearly undermined Clinton's stand.

Kagan helpfully rephrased the statement. It then read: "A select panel convened by ACOG could identify no circumstances under which this procedure, as defined above, would be the only option to save the life or preserve the health of the woman. An intact D&X, however, may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of a woman, and only the doctor, in consultation with the patient, based upon the woman's particular circumstances can make this decision."

Unsurprisingly, the discovery of the documents has enraged the pro-life lobby. But Slate columnist William Saletan said what concerned him most was that ACOG consented to Kagan's editorial assistance, and that subsequently her additions were cited by the Supreme Court to allow partial-birth abortions to continue. ~ Slate, Jul 3; National Review Online, Jun 29; CNSNews, Jun 29

We missed this story when it broke, but it is too good to pass up. British serial surrogate Louise Pollard has announced that she is giving birth to the grandchild of Osama bin Laden.

Omar bin Laden, 29, fourth son of the world’s most wanted man, hired Louise via a website, and offered her £30,000 for her services. Omar is the sixth husband of 54-year-old Jane, who took the name Zaina Mohamad al-Sabah bin Laden after converting to Islam. She is a grandmother who suffers from MS and has three adult children from previous relationships.

Ms Pollard, a previously married single mother with one son of her own, has given birth twice to other people’s children. She became a surrogate mother for the first time at 21 and may be the youngest surrogate mother in the UK. She aspires to eclipse Carol Horlock, who has had 12 babies for other couples and is believed to be the UK’s most prolific surrogate mother.

A relative of Pollard told The Sun: "It doesn't matter to her who she's doing it for. All she's interested in is the money. She is a single mum with her own three-year-old son." Mr bin Laden says he “hates” his father and that he has had no contact with him for nearly 10 years. But if anything is likely to bring Osama bin Laden into the open, surely it is his grandchild-to-be. ~ Daily Mail, May 20, Jun 11; The Sun, Jun 12