June
20
 

Bioethicists debate as curtains close on Casey Kasem

The passing of disc jokey Casey Kasem has generated a remarkable volume of bioethical commentary. Artificial nutrition was withdrawn from an unconscious Kasem in light of an advance directive he had written. The directive was vague, and some of Kasem’s family objected to move.

Nancy Berlinger, lead author of the Hastings Centre Guidelines, says that the specifics of one’s end-of-life preferences must be discussed with family.

Kasem’s directive stated that he would not want to be kept alive if it "would result in a mere biological existence, devoid of cognitive function, with no reasonable hope for normal functioning." 

"What does it mean to have 'no cognitive functioning'?" asked Berlinger. 

Daniel Johnson of Permanent Care Management Institute agreed: "When people take time to have discussions with family to ask the right questions with all important parties, you almost never see this," he said.

Bioethicist Wesley Smith proposed… click here to read whole article and make comments




 
June
20
 

One Child Policy an attack on the common good - Chinese bioethicist

In a provocative new article in the Cambridge Quarterly of Healthcare Ethics, Chinese bioethicist Jing-Bao Nie attacks the one child-policy for having “a hugely negative effect on the common good”. Nie criticises the government’s claim that the policy has benefited society through raising living standards and reducing overcrowding:

“The greatest irony of all is that, while originally designed to improve living standards and help relieve poverty and underdevelopment, the one-child policy has inflicted massive suffering and state-directed violence on Chinese people, especially women.”

Nie has conducted extensive research into the impacts of the coercive policy. He was horrified by the results:

“[It has] grave negative impacts on women undergoing reproductive interventions, including the side effects of contraceptive use, mental and physical problems caused by the uninformed selection of contraceptive methods, conflict between a couple’s wishes and the state’s population goals, and the permanent distress entailed in the failure to produce a male child.”

click here to read whole article and make comments



 
June
14
 

Psychiatrist heaps fuel on fiery transgender debate

Denee Mallon     

Denee Mallon is a 73-year-old Army veteran and male-to-female transsexual, who has just won a stunning legal victory. No longer can Medicare refuse to pay Mallon’s medical expenses for sex reassignment surgery. A Department of Health and Human Services (HHS) review board has ruled that it is no longer reasonable to exclude such surgeries because they were experimental or risked serious complications.

"Sometimes I'm asked aren't I too old to have surgery. My answer is how old is too old?" Mallon told the Associated Press. "When people ask if I am too old, it feels like they are implying that it's a 'waste of money' to operate at my age. But I could have an active life ahead of me for another 20 years. And I want to spend those years in congruence and not distress."

However, writing in the Wall… click here to read whole article and make comments




 
June
14
 

The ethics of tracking Taliban detainees

Attaching chips to dementia patients is becoming a common way of ensuring that their carers know where they are and whether they are safe. In the UK, patients can wear tracking systems which allow them to speak to an operator in a call centre run by local authorities. Welfare agencies have expressed concerns about the patients’ informed consent and privacy.

But the ethical issues are far more tangled if spy agencies are chipping released prisoners, US bioethicist Art Caplan points out.

The American government recently traded five Taliban members detained at Guantanamo Bay for Sgt Bowe Bergdahl, a soldier held by the Taliban. Is it possible that the CIA may have “chipped” the detainees so that they can track them?

Such ‘chipping’ is common for pets and becoming more common for persons with dementia at high risk of wandering from nursing homes.  It might allow surveillance of… click here to read whole article and make comments



 
June
14
 

Assisted suicides in Washington state up by 43%

Legal assisted suicide deaths in Washington state rose by 43% in 2013, according to an official report. Under the state’s 2008 Death with Dignity Act, adult residents in the state with six months or less to live may request lethal doses of medication from physicians.

In 2013, medication was dispensed to 173 individuals of whom 159 are known to have died, 119 of them, after ingesting the medication. (Sometimes people keep the medication without using it.) The cause of death of another 14 is unknown. The lethal prescriptions were written by 89 different physicians and dispensed by 23 different pharmacists.

Of the 151 participants in 2013 who died, 97% were white and non-Hispanic; 525 were married; and 76% had at least some college education.

Most requests for a lethal prescription were motivated by fear of losing autonomy, dignity or the ability to participate in activities that… click here to read whole article and make comments




 
June
14
 

Were Irish orphans of the 30s used in clinical trials?

Once again the Catholic Church in Ireland is in the middle of a media firestorm about past abuse, this time about clinical trials in the 1930s. In the wake of lurid reports about a septic tank containing nearly 800 skeletons of babies near the site of a home for unmarried mothers come allegations that orphans were used as guinea pigs for untested vaccines.

A researcher at Cork University, Michael Dwyer, has uncovered records which appear to show that 2,051 children and babies at orphanages were given a one-shot diphtheria vaccine between 1930 and 1936, as part of a drug trial for the drug company Burroughs Wellcome. It appears that no consent was sought. Mr Dwyer told the Daily Mail:

'What I have found is just the tip of a very large and submerged iceberg. The fact that no record of these trials can be found in… click here to read whole article and make comments



 
June
14
 

Investigation finds half of Down syndrome abortions missing from register

An investigation into terminations of Down’s Syndrome foetuses in the UK has revealed that half of these abortions go unrecorded.

The probe was conducted by the independent National Down’s Syndrome Cytogenetic Register (NDCR), an organisation that is notified of any Down’s Syndrome diagnoses and can track the progress of pregnancies.

They found that out of 994 terminations, only 496 were properly recorded. Out of the 498 missing cases, around 50 had been recorded but alternative reasons given. It is unclear whether the other 450 were recorded in some capacity, or simply conducted off the register.  

Tory MP Fiona Bruce, chairman of the recent independent parliamentary inquiry into abortion for disability, said it was clear doctors had broken the law: “Worryingly, the department appears to have made no attempt to see that the law is properly enforced,” she said.

“We now know that nearly half of abortions for Down’s Syndrome were incorrectly recorded. How… click here to read whole article and make comments




 
June
14
 

Inducing death to give life – without patient consent

A new emergency procedure being trialled in a US hospital has bioethicists feeling nervous. The procedure – known as Emergency Preservation and Resuscitation - involves stopping the heart and lowering the body temperature of trauma patients experiencing cardiac arrest and severe blood loss. 

Doctors replace the patient’s blood with freezing saltwater that stops the heart and lowers body temperature to 10 degrees Celsius. At this temperature doctors have one to two hours to operate before brain damage occurs.

The procedure stops rapid blood loss and dramatically slows the onset of brain damage. At normal body temperatures, surgeons typically have less than five minutes to restore blood flow before brain damage occurs.

Doctors – not the patients – will decide whether the procedure will be performed. Only patients who have obtained a hospital bracelet saying “No EPR” will be omitted from candidature. Some ethicists have expressed reservations about the lack of informed consent, but they… click here to read whole article and make comments




 
June
14
 

Expert warns of misuse of genetic evidence in courtroom

Prominent medical law commentator Paul S. Appelbaum has warned of the misuse of genetic evidence in courtrooms. In an article published in Neuron earlier this month, Appelbaum noted that there has been a modest increase in the use of ‘genetic arguments’ in US jurisdictions in the past twenty years. He challenged the view that genetic evidence provides a ‘genuinely excusing condition’:

“Many defendants experience pressures to commit criminal acts—from peer encouragement to the disinhibiting effect of intoxicating substances—but in general we expect them to resist the urge to act illegally or suffer the consequences. Unless a defendant’s genetic endowment substantially impairs her ability to appreciate the wrongfulness of her conduct or to obey the requirements of the law, genetic influences may simply be one more pressure that she is expected to resist.” 

Appelbaum warned that judges could presume a genetic basis for criminal action even when no reliable evidence has been provided (he cites… click here to read whole article and make comments




 
June
14
 

Canadian court declares patient specimen the “personal property” of a hospital

A Canadian court has ruled that a medical specimen taken from a patient in a pathology clinic is the ‘personal property’ of a hospital

The specimen of liver tissue was taken from Ms. Snezana Piljak in Toronto’s Sunnybrook Hospital in 2009. Ms. Piljak passed away from cancer in 2011, and her family sued her doctor for failing to identify the cancer.

That doctor petitioned Sunnybrook hospital for access to Mrs. Piljak’s specimen, but under the rules of evidence for the case the court needed to rule that the liver was the “personal property” of the hospital.

Ontario Superior Court Master Ronald Dash ruled that the tissue belonged to the hospital in which it was being stored:

“Ms. Piljak’s excised tissue is … owned by Sunnybrook hospital, whose pathology department performed the diagnostic tests and in whose archives the tissue is kept,” he wrote. “As the excised tissue is subject to the rights of ownership…… click here to read whole article and make comments




 

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