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

If you want to hear a passionate of Sarah Palin’s “death panels”, it’s hard to go past the vituperative spray delivered by American news anchor Keith Olberman on his show Countdown. After his father’s colon was removed, he ended up in hospital for six months battling one infection after another. The week before the broadcast, in despair over the treatment, discomfort and pain, he asked his son to kill him.

This made Mr Olberman reflect upon the notion of “death panels” and “these sub-humans who get paid by the insurance companies” to oppose them. In fact, they are “life panels” which give patients and their families control over their treatment. “Nobody gets to say no except the patient and the family. It’s a life panel. And damn those who call it otherwise to hell,” said Mr Olberman.

Whether or not his complaint is fair or accurate, it is excellent television. Have a look. It is an eloquent description of the kind of burdensome treatment which everyone fears. Comments, anyone?

Are memoirs of elderly parents asking for death the Next Big Thing in the mis lit genre? A few years ago misery literature was hailed as the book world's boom sector, but sales have flagged recently, perhaps because stomachs which dine on relentless gloom satiate quickly. However, Imperfect Endings: A Daughter's Tale of Life and Death, to be published this month, could revive its fortunes.

Zoe Carter tells the story of her independent mother Margaret, who is suffering from Parkinson’s disease and thinks that it is time to make an exit – with her three daughters looking on. New York Times blogger Paula Span, of “New Old Age”, says that the book “blends family history with clear-eyed exploration, examining not only [the author’s] mother’s motives but also the complicated responses of her children and grandchildren”. “I could quote from the book all day,” writes Ms Span. In the end, Margaret just starves herself to death.

It does have a certain Humpty-Dumpty feel about it – “When I use a word…  it means just what I choose it to mean neither more nor less”. The US National Institutes of Health is thinking of redefining a human embryonic stem cell (hESC) to make more of them available for Federal funding.

Last year, after President Obama declared that it was time for a new direction in stem cell research in the US, it defined hESCs as cells “derived from the inner cell mass of blastocyst stage human embryos”.  These are 4 to 6 days old and have roughly 100 cells. However, this leaves out hESCs derived from blastomeres, which are only 1 or 2 days old and have only about 8 cells. So the proposed new definition is “pluripotent cells that are derived from early stage human embryos, up to and including the blastocyst stage”.

The reason for the change appears to be to allow Federal funding to flow to Advanced Cell Technology, a company which has derived hESCs from blastomeres. It claims that its technique is even more ethical, as no embryos are destroyed when a cell is removed from a blastomere. (At least IVF doctors say that this is the case when the technique is used in their clinics to test an embryo for genetic defects or its sex.)

 Dr David Prentice, of the Family Research Council, has pointed out that the new rule is more likely to result in the destruction of more embryos. In ACT’s experiments on blastomeres, at least some of them perish. Furthermore, some recent research suggests that removing a single cell does harm an embryo. If this is true, he asks, wouldn’t ACT’s stem cells fall foul of the Dickey Amendment, a Congressional ban on funding destructive embryo research?

Comments on the proposed redefinition close on March 25. Dr Prentice, who is almost alone in making comments in the media, is not impressed: “this redefinition illustrates the willingness of NIH to change the rules to fit their desires for more embryos. Expect more abuses in the future.” ~ Los Angeles Times, Feb 19

When IVF clinics inject sperm directly into an egg as a remedy for male infertility, they may be creating another generation of infertile men, warns the scientist who developed the technique. ICSI, or intracytoplasmic sperm injection, is used in half of IVF in Britain and two-thirds in Europe.

Andre Van Steirteghem, of the Brussels Free University Centre for Reproductive Medicine, is the leader of a research team which developed ICSI nearly 20 years ago. But now he has some misgivings. At a meeting of the American Academy for the Advancement of Science in San Diego, he was asked whether we are creating a generation of children who are more likely to be infertile as a result of using IVF.  He told the media: “Well, yes, the answer to that is maybe yes. There are genetic causes of infertility that you can bypass with assisted reproductive technology, but that may mean that the next generation may be infertile as well. This is something that all clinics should mention to patients."

Other problems associated with ICSI have also emerged in recent  years.  A statistically significant number of children born from the technique have had health problems. Scientists have speculated that sperm which would normally not succeed in fertilizing an egg are responsible.

Nonetheless ICSI is becoming more popular, perhaps because IVF clinics are more confident that the technique will result in a baby for their clients. Prof Van Steirteghem said ruefully, "I have noticed from the beginning that several clinics use ICSI for everyone. I don't think it's necessary when you have methods like conventional IVF which is certainly less invasive, and can help couples with female factor or idiopathic (no known cause) infertility when the sperm count is normal. I don't see any reason why ICSI should be used in these situations. We have to see what will come out in the future, and long term follow up is extremely important, but yes, ICSI has been overused." ~ London Telegraph, Feb 22; Independent, Feb 22

In the Middle Ages, cities used to dispute over the bodies of saints, partly because their relics would ensure a steady stream of devout pilgrims. The latter-day version of this is a dispute in Colorado over the head of 71-year-old Mary Robbins, who died on February 9. The contending parties are her family and the Alcor Life Extension Foundation, an Arizona company which freezes heads and bodies so that they can be restored to life when the technology becomes available.

The bodies or heads of more than 80 people are stored at Alcor’s facilities, and more than 850 people have signed up to be preserved when they die. "Alcor is not a cult and it's not a fly-by-night operation. It's a science-based medical organization," says its attorney. The company insists that “the spiritual status of cryonics patients is the same as frozen human embryos, or unconscious medical patients” and that it is attempting to maintain life, not restore it.

In 2006 Mrs Robbins instructed Alcor to cryogenically preserve her head and brain. She also agreed to give the nonprofit foundation a US$50,000 annuity to cover maintenance costs. Her family says that she changed her mind shortly before she died and refuses to hand the annuity over to Alcor. Until the dispute is settled in probate court, Mrs Robbins’s body has been stored in a mortuary in Colorado Springs.

"I've never tried a case where we're talking about the dismemberment of a body and fighting over pieces of a body," the family’s attorney told AP. But at least he can study some precedents, like the dispute between Venice and Bari over the bones of St Nicolas of Myra (aka Santa Claus). ~ Los Angeles Times, Feb 20

Confused by claims and counter-claims about climate change? Can’t decide whether it’s your patriotic duty to be a sceptic or a true believer? Well, you have it easy. How about deciding whether IVF is good for a baby’s health or not? Three similar, but conflicting stories appeared in the media this week.

“Babies born by in vitro fertilization (IVF) do not face an increased risk of birth defects, nor are they at greater risk of being smaller than normal, according to a study conducted in Japan.” This comes from the American journal Fertility and Sterility. However, it found that 5 percent of IVF developed placenta previa, compared to 1.5 percent of the women who conceived naturally.

Women who have fertility treatment are four times more likely to have a stillborn baby than those who conceive naturally, reported the Guardian about a Danish study.

And Belgian researchers found that IVF children are generally as healthy as naturally conceived children but tend to be lower in birth weight and have slightly more genetic differences. "By and large, the kids are just fine. It's not like the kids have extra arms or extra heads or anything," says Carmen Sapienza, a geneticist at Temple University in Philadelphia.

How is a layman to reconcile these conflicting reports? Any ideas?

Assisted suicide is still a crime which will be prosecuted in Britain, says the Director of Public Prosecutions. Mr Keir Starmer published new guidelines this week at the request of the Law Lords and after a public consultation.

"Nothing in this policy could be taken to amount to an assurance that a person will not be prosecuted if he assists the suicide or attempted suicide of another person," the DPP said.

What the police will assess most carefully is whether a suspect was wholly motivated by compassion. This will be given more weight than whether the victim was terminally ill or in pain. Being related to the victim will not be a condition for mitigation because relatives could be manipulative.

Other conditions for mitigation include whether the victim had made a clear, voluntary decision to commit suicide and whether the suspect had reported the suicide to the police and fully assisted inquiries.

Mr Starmer insisted that it was Parliament’s job to change the legislation, not his. "Only parliament can set out what processes or procedures might be appropriate in the context of encouraging or assisting suicide that may lead to an automatic decision not to prosecute," he said. Mercy killing remains a crime.

Reaction to the new guidelines was mixed.  Richard Hawkes, chief executive of disability charity Scope, said: "Many disabled people are frightened by the consequences of these new guidelines and with good reason. There is a real danger these changes will result in disabled people being pressured to end their lives."

But Debbie Purdy, the woman with multiple sclerosis who forced a decision on the matter by taking her plea for clarity to the House of Lords, was satisfied. She can now travel to Dignitas in Zurich secure in the knowledge that her husband will probably not be prosecuted. "The important thing about the guidelines is they've been able to really clarify the difference between malicious encouragement and compassionate support for somebody's decision," she said.

The day before the guidelines were published, Prime Minister Gordon Brown , published an article in the London Telegraph arguing forcefully against the legalization of euthanasia and assisted suicide.

“The law – together with the values and standards of our caring professions – supports good care, including palliative care for the most difficult of conditions; and also protects the most vulnerable in our society. For let us be clear: death as an option and an entitlement, via whatever bureaucratic processes a change in the law might devise, would fundamentally change the way we think about mortality. The risk of pressures – however subtle – on the frail and the vulnerable, who may feel their existences burdensome to others, cannot ever be entirely excluded. And the inevitable erosion of trust in the caring professions – if they were in a position to end life – would be to lose something very precious.”

~ London Telegraph, Feb 24; Guardian, Feb 25

A number of devastating genetic diseases are slowly disappearing because of genetic testing, according to a report by Associated Press. Tay-Sachs disease, a neurological illness that cropped up among Ashkenazi, or Eastern European Jews, has almost disappeared. Affected children lack a key enzyme and this causes them to decline physically and mentally until death at about the age of 4. But in the last decade, there have only been about a dozen cases of Tay-Sachs each year in the US.

“Now, more women are being tested as part of routine prenatal care, [says AP] and many end pregnancies when diseases are found. One study in California found that prenatal screening reduced by half the number of babies born with the severest form of cystic fibrosis because many parents chose abortion.”

In California, for instance, Kaiser Permanente, a health care group, offers pre-natal screening. From 2006 to 2008, 87 couples were identified as carriers of cystic fibrosis mutations and 23 foetuses were found to have the disease – 20 of them were aborted.  

Another fatal disease associated with Ashkenazi Jews is familial dysautonomia, which affects children psychologically, mentally and physically. It causes faulty nerve development, floppy muscles, digestive and other problems, and kills many by young adulthood. Because of screening only one child is born with the condition a year in the US and geneticists think that the disease may cease to exist.

But is this an unreserved good, asked Columbia University medical historian Barron Lerner in a thoughtful article in the New England Journal of Medicine last year. Is it tantamount to eugenics, with all its horrific baggage? Will the disappearance of the disease make fund-raising for research into alleviating it harder? ''If a society is so willing to screen aggressively to find these genes and then to potentially to have to abort the fetuses, what does that say about the value of the lives of those people living with the diseases?'' he asks. ~ New England Journal of Medicine, Oct 22, 2009; AP, Feb 17

The inaugural annual Conference of the Australasian Association of Bioethics and Health Law [AABHL] will take place in Adelaide from July 1 to 4. (The Australasian Bioethics Association and the Australasian and New Zealand Institute of Health Law and Ethics have recently merged to form the AABHL. This year’s topic is “Choice... do we have any?  Who chooses what is ethical? Who should choose? What shapes choice?”

The invited speakers include Australian human rights activist Julian Burnside, philosopher and neurosurgeon Grant Gillett, legal scholar Ngaire Naffine, and bioethicist Wendy Rogers. For registration details, a draft program and a guidelines for submitting papers, see the conference website.

* * * * *

The Hastings Center Report, one of the world’s leading bioethics journals, is marking its 40th anniversary with an informal essay contest about the future of bioethics. "We'll read anything that any student, graduate fellow, or untenured professor in bioethics send us (current or former Center staff excluded), and we'll publish the best of the lot in the November-December issue," says editor Gregory E. Kaebnick.

Essays might call for new ways of doing bioethics or examine the implications of trends within the general categories that the Center now addresses--clinical care, public health, health policy, new technologies, and medical research. Essays might also identify particular underexamined topics within the generally accepted categories. The ideal essay would be 1600 words long. Essays can be sent to the editorial staff at editorial@thehastingscenter.org by August 15.

Sorry – we missed this one when it was published in December.

A 51-year-old Michigan man estimates that he fathered 400 children after donating sperm to an IVF clinic between 1980 and 1994. At the time Kirk Maxey saw donation as a way to pay his way through medical school and to help infertile women. "You would get a personal phone call from a nurse saying, 'The situation is urgent! We have a woman ovulating this morning. Can you be here in a half hour?',” he told Newsweek.

Now, mindful of the dangers of passing on serious genetic defects or of incestuous relationships amongst his offspring, he has some regrets. He is CEO of Cayman Chemical, a 300-person global pharmaceutical company, and has become a forceful lobbyist for government regulation of the sperm-donor industry.

Mr Maxey has made his genome public through Harvard's Personal Genome Project, and hopes that the information will help his offspring and their mothers. "I think it was quite reckless that sperm banks created so many offspring without keeping track of their or my health status," he told Newsweek. "Since there could be [many families] that could have to know information about my health, this is my effort to correct the wrong." ~ Newsweek, Dec 16

The Catholic Church’s stand on medical ethics has come under attack in the US in recent weeks after American bishops backed the Vatican ban on IVF for fertility treatment and the necessity of providing nutrition and hydration for comatose patients. “It will be a sorry day if American patients seeking the best medical care are forced to avoid Catholic hospitals for fear of having their living wills ignored or their doctors' counsel dictated from Rome. The Church would be wise to focus its energies on theology and to leave the practice of medicine to the professionals,” wrote free lance bioethicist Jacob M. Appel in the Huffington Post.

However, instead of knuckling under, Pope Benedict XVI has been firing up the troops. In a major speech in Rome, he stressed the importance of bioethics as “a particularly crucial battleground in today's cultural struggle between the absolutism of technology and human moral responsibility”. He placed the controversial notion of “human dignity” at the centre of Catholic bioethics:

“Without the foundational principle of human dignity it would be difficult to find a source for the rights of the person and the impossible to arrive at an ethical judgment if the face of the conquests of science that intervene directly in human life. It is thus necessary to repeat with firmness that an understanding of human dignity does not depend on scientific progress, the gradual formation of human life or facile pietism before exceptional situations. When respect for the dignity of the person is invoked it is fundamental that it be complete, total and with no strings attached, except for those of understanding oneself to be before a human life.”

However, he does not ground his bioethics upon Catholic theology but upon the natural moral law which “belongs to the great heritage of human wisdom”. Without an objective standard for forming moral judgements, he stated, human life could become “an object subjugated to the will of the strongest”. ~ Zenit, Feb 14

The origin of plastinated bodies at an exhibit in Birmingham, UK, was controversial enough to serve as the subject of an editorial in The Lancet, one of the world’s leading medical journals. Premier Exhibitions, a company with good connections in China, had displayed its collection of flayed and partially dissected bodies, male and female, in the Custard Factory for 3 months, attracting many visitors, including thousands of schoolchildren.

Where did the bodies come from? In New York the company was forced to display a disclaimer that the bodies could have been those of Chinese prisoners. In the UK no such advice was displayed, as the 2004 Human Tissue Act does not require proof of informed consent for tissues which have been imported.

Human rights activist Dr David Nicholl believes that the bodies were the victims of torture  or execution and accused the organisers of having “blood money” on their hands for charging a £14 entrance fee. The Lancet supported his campaign for the Tissue Act to be amended to include imported tissue. “Assurance that all remains on public display were donated with informed consent of the deceased, is imperative,” it says.

Even if some sort of proof of informed consent were displayed, would the persons have consented to using their remains to stage cocktail parties and banquets? The “festive package” for the Christmas season included mulled wine, a hog roast and a cash bar for only £55 per guest. ~ The Lancet, Feb 20

Neanderthal is a byword for backwardness, but this relative of ours, which disappeared only25,000 or 30,000 years ago, was clearly human. The Neanderthals had burial rites, built fires, probably had language, made tools and even had a larger brain than homo sapiens. Now, according to an article in the journal Archaeology, some scientists want to clone them.

According to George Church, a genetics professor from Harvard Medical School, Neanderthal cells could be significant in the discovery of treatments for largely human-specific diseases such as HIV or smallpox. He says that if they are different enough to modern humans, they may possess genetic immunity to these conditions. Also, differences in their biology could lead to new gene therapy or drug treatments.

A first draft of the Neanderthal genome was released a year ago, but it is likely to contain many errors. Creating an artificial genome is an even greater challenge, but if it can be done, is it ethical to use it to recreate Neanderthals?

The bioethicists interviewed by Archaeology were largely in favour of it. Bernard Rollin, of Colorado State University, has no serious ethical reservations, but warns that it all depends on how they are perceived by others. "I don't think it is fair to put people...into a circumstance where they are going to be mocked and possibly feared," he says. Lori Andrews, of Chicago-Kent College of Law, doesn't see any problem with cloning, but points out that the Neanderthal's legal rights would include the right not to be experimented on. Since experimentation is the main purpose of the exercise, this makes cloning futile.

James Noonan, a geneticist at Yale University, takes a dim view of cloning. "If your experiment succeeds and you generate a Neanderthal who talks, you have violated every ethical rule we have, and if your experiment fails... well. It's a lose-lose," he says.

On the other hand, Dr Church believes that it could be unethical not to clone them.

The Neanderthals' differently shaped brains might give them a different way of thinking that would be useful in problem-solving. They would also expand humanity's genetic diversity, helping protect our genus from future extinction. "Just saying 'no' is not necessarily the safest or most moral path," he says. "It is a very risky decision to do nothing."

John Hawks, a University of Wisconsin paleoanthropologist, says that he does not believe that it is ethical to recreate a Neanderthal, but also that it is inevitable that some people will ignore the ethics of the situation. "In the end,” he says, "we are going to have a cloned Neanderthal, I'm just sure of it." ~Archaeology Vol 63 No. 2 Mar/Apr 2010

What chance have ordinary mortals of finding out the status quo in stem cell research when powerful personalities have the ear of the media and science journals? Currently there are 3 stem cell candidates for cures, drug discovery and genetic research – human embryonic stem cells (hESC), induced pluripotent stem cells (iPS), and adult stem cells. Only hESCs are entangled in ethical controversy because they are obtained by dicing up human embryos. Some kinds of adult stem cells show clinical promise, although none is available for the public. Each kind has its champions, but more and more researchers are turning to iPS cells and adult stem cells. Even though sulphurous debates were held over the ethics of using hESCs and legislation was changed in many countries to allow scientists to use them, their star seems to be fading.

This month, hESC defenders have staged a bare-knuckle public relations fightback.

In the London Times, Thomas Okarma, CEO of Geron, the only listed company doing research in hESCs, told journalist Mark Henderson that iPS cells were vastly over-rated.

“iPS cells have been talked up as therapy by people with no experience of developing therapies. There is simply no business model for getting treatments based on your own cells into your body. The degree of difficulty in getting regulatory approval is just too great when you’re making new therapeutic cells from scratch every time.”

Okarma is a canny operator. A Geron clinical trial with hESCs was given FDA approval within days after President Obama’s inauguration and his repudiation of the Bush policy on stem cells. It turns out that Geron engineered the timing of the approval to create a huge wave of publicity. Geron needs good publicity, as none of its many announcements that human trials are imminent have proved true.

In another public relations coup, Newsweek’s Sharon Begley interviewed Robert Lanza, a leading figure in hESC research. He works for Advanced Cell Technology, a company which claimed to have cloned a human being in 2001. He also rubbished the potential of iPS cells. His experience has been that iPS cells age early and are vastly inferior to hESCs. "This whole population of cells is screwed up,” he said. Cures will be impossible if iPS cells age prematurely, and they will also be useless for drug discovery.

Dr Lanza is an interesting figure. His personal website describes him as “one of the leading scientists in the world” and repeats Discovery magazine’s description of him as “the Bill Gates of science”. He describes his latest book, Biocentrism, as “a simple yet radical idea shakes the very foundations of knowledge”, that “consciousness creates reality”. In an article written with the New Age guru Deepak Chopra, he says that biocentrism makes Darwinism outdated. Yet the media never asks him about his drift into New Age spirituality.

Finally, the head of the California Institute for Regenerative Medicine, Alan Trounson, one of the world’s leading cheerleaders for hESCs, and 2 colleagues have interviewed Stephen Bellamy, an Anglican priest in the latest issue of the journal Stem Cells. Rev Bellamy is a strong defender of hESC research and pre-natal genetic diagnosis. The main point of the interview is to give an overtly Christian theological justification for research on human embryos. It must be the first time that stem cell theology has featured in a science journal:

“As an evangelical Christian, I hold a high view of the authority of scripture. The Bible teaches about the value, in God's eyes, of prenatal life developing in the womb but does not and cannot directly address the situation of our having the remarkable power and responsibility of dealing with preimplantation, or in vitro embryos.”

Ultimately, which type of stem cells will be useful will be thrashed out in laboratories, not in the media. But regulation and government funding probably depend more on the media. This month the supporters of hESC research have showed that they are far from a spent force. They kicked goals.

It seemed too good to be true: a brain-damaged Belgian man in a coma for 23 years began to communicate – and even promised to write a book – after doctors discovered that he was really conscious. The tragic case of 46-year-old Rom Houben was reported around the world. Unfortunately it turns out that it wasn’t true – at least the most dramatic aspects of the story.

The neurologist who examined Mr Houben, Steven Laureys, now acknowledges that his cautious endorsement of the miraculous story was wrong. It turns out that the dramatic comments credited to Mr Houben had been filtered through a speech therapist using a technique called facilitated communication. After more extensive tests, it seems that she had unwittingly been projecting her own story and presenting it as his.

Sceptics of Houben’s incredible story feel vindicated. "It's like using an Ouija board," said bioethicist Arthur Caplan, of the University of Pennsylvania. "It was too good to be true, and we shouldn't have believed it."

However, that is not the end of the story. What has been proved faulty is facilitated communication. According to a long article in Der Spiegel, Houben may be capable of communication, but it is very difficult to examine him because his body is constantly shaken by spasms.

“Researchers are fairly certain that Houben is conscious -- and they find themselves in the desperate position of a rescue team trying to dig out a person from under the rubble…. ‘We'll simply have to find another way to him,’ Laureys says.” ~ Guardian, Feb 19

London’s Daily Mail is a tabloid’s tabloid but its reporters are expert at tracking down and interviewing people with stories to tell, even if they don’t have publicists. Taking its cue from the euthanasia debate over whether people in pain, terminal illness, or severe disability should have the option of assisted suicide, the newspaper interviewed Elisabeth Shepherd. 

Ms Shepherd cares for her 36-year-old son James, her fifth child. At the age of 8 James was struck by a car and hovered between life and death for months. Now he is a quadriplegic, can barely speak and is incontinent. But she cheerfully soldiers on, alone, day after day, caring for him.

She contacted the Daily Mail after another mother, Kay Gilderdale, was acquitted of the attempted murder of her severely disabled daughter. “Your admiration for the mother of Lynn Gilderdale frightens me,” she told the newspaper. “My fear,” she says, “is that if people begin to think of assisted suicide as an option then the balance will change. As a society, we will shift towards a different mindset. A mindset in which people like James begin to appear expendable.”

Ms Shepherd says that her convictions are not religious, but based on her belief in an inalienable human dignity.

“I do believe in a God, but my instinct that life is precious is not just grounded in that. It's partly from watching doctors fight so hard to preserve the least glimmer of life. It's also because I feel we're sold an ideal and people feel that if they don't have it they're not enough. But if we become a tickbox society, where we say no because someone can't have sex or cannot feed themself, where will that leave us?

“What is a human being? Is my son any less of a human being? Am I, because having done a law degree I didn't pursue my legal career and became a carer? Does that make me, or James, any less of a contributor to society? We all want something. But my aspirations and James's are different. Others might long to be an air hostess; we just want to see him flex a finger.”  ~ Daily Mail, Feb 18

A former BBC documentary producer threw petrol on the smouldering euthanasia debate in the UK this week with a public confession that he had committed a mercy killing 20 years ago. Seventy-year-old Ray Gosling, who was well known in the 60s and 70s as a reporter and gay activist, told a BBC TV show that he had smothered a lover dying of AIDS with a pillow. The doctor looking after the man was apparently aware but did nothing.

“In a hospital one hot afternoon, the doctor said ‘There’s nothing we can do’, and he was in terrible, terrible pain. I said to the doctor ‘Leave me just for a bit’ and he went away. I picked up the pillow and smothered him until he was dead. The doctor came back and I said ‘He’s gone’. Nothing more was ever said.”

Shortly after the program was broadcast, police called Mr Gosling in for questioning, but he refused to name the man or to give any details of the incident. He told the media that he had no regrets. “If there’s a heaven and he’s looking down, he’d be proud of me,” he told the BBC.

Mr Gosling’s confession, filmed artfully in a chilly graveyard, was made two months ago, but the BBC did not inform police. This has led to accusations that the UK’s public broadcaster is subtly supporting the cause of assisted suicide.

“It is somewhat bizarre and highly irresponsible that the BBC… made the decision to make it international news just before the [Director of Public Prosecutions] releases his assisted suicide prosecution guidelines,” said the lobby group Care Not Killing. ~ Independent, Feb 17; New York Times, Feb 17

Finally, a key performance indicator for Australian euthanasia activist Dr Philip Nitschke! In Australia, after recent legislation, it is illegal to promote assisted suicide in print or on the internet, so it is hard to measure how successful he has been. However, recent figures from the Victorian Institute of Forensic Medicine show that 51 people throughout the country have died after taking Nembutal, his drug of choice, in the past 10 years.

Somewhat embarrassingly for Dr Nitschke and his organization, Exit International, six people in their 20s and eight in their 30s had died of Nembutal poisoning. Because this drug is illegal in Australia for human consumption, Dr Nitschke has been encouraging people to smuggle it in from overseas, mostly from Mexico, or to manufacture it themselves. The most pessimistic interpretation of the figures is that 14 young people who were not terminally ill discovered how to obtain lethal doses of the poison from Exit members.

However, the figures, which were generated for The Age newspaper in Melbourne, are difficult to interpret, because only 38 of the 51 cases were thoroughly examined by a coroner. And the total could be higher, as it includes only those which emerged from a search of a national database. Of the 38, only 11 were suffering from a serious physical illness. Of the 51, nearly two-thirds were under 60. Without a more detailed knowledge of the cases, the data strongly implies that most of the people who used Nembutal to kill themselves were either mentally ill or just weary of life.

Typically, Dr Nitschke was unapologetic about possible collateral damage from his campaign for euthanasia for people suffering from terminal illness and loss of autonomy. ''There will be some casualties… but this has to be balanced with the growing pool of older people who feel immense well-being from having access to this information,'' he said. ~ The Age, Feb 15  

Should animals residing in Switzerland have the right to be represented by a lawyer? Voters will have their say in a national referendum on March 7. Animals in the canton of Zurich have had an “animal advocate” who represents abused animals in court since 2007. If successful, every canton will be forced to appoint one.

The government is opposed. It feels that existing animal welfare laws are sufficient to protect animals from abuse. Farmers and animal breeders fear being buried under red tape. A group called No to the Useless Animal Lawyers’ Initiative says, “Animal rights advocates are useless to animals. They can’t prevent animal abuse because they only get involved after it has been perpetrated.”

Zurich’s animal advocate, Antoine Goetschel, a 50-year-old vegetarian, is enthusiastic about the initiative. "Humans accused of animal cruelty can hire a lawyer or get one assigned, but animals cannot," he told London's Sunday Times. "Which is where I come in."

In Zurich he helps to enforce a 2008 national law which protects the rights of goldfish, canaries and guinea pigs, amongst other animals. Goldfish, for instance are regarded as “social animals” which should always have a companion. The Swiss take this seriously. Goetschel told the Times of a recent case in which police entered a home to investigate possible domestic violence. They noticed that the couple’s canary was living in a cage all by itself, so animal abuse was added to spouse abuse in the list of charges.

The proposal is a controversial one. Clara Balestra, of a child protection group, the Sarah Oberson Foundation, points out that the advocate will be independent both from the government and the animal’s owner and defend only the interests of the animal. Swiss children are not protected this well, she complains: “The groups [which] enjoy the best advocacy of their rights are the ones with most influence on decision-makers. So, we face a strange case where animal rights advocates seem to be stronger (better organized? better funded? better represented?) than child advocates.” ~ London Sunday Times, Jan 31

New members of the National Academy of Sciences in the US are asked to pen an inaugural article for its journal, the PNAS. Biologist Anthony R. Cashmore, of the University of Pennsylvania, has used the opportunity to set down a sweeping program for the reorganisation of all of society. Professor Cashmore is a plant biologist. Based on his studies of the plant species Arabidopsis thaliana, he has researched photoreceptors and how they drive plant growth and development, including changes in pigmentation and gene expression, seed germination, stem elongation, circadian rhythms and flowering.

Moving boldly out of his area of specialisation he demands that biologists recognise that free will is nonsense, that we are not responsible for our actions and that the criminal law must be fundamentally restructured.

“if we no longer entertain the luxury of a belief in the ‘magic of the soul’, then there is little else to offer in support of the concept of free will. Whereas much is written claiming to provide an explanation for free will, such writings are invariably lacking any hint of molecular details concerning mechanisms. Also, it is often suggested that individuals are free to choose and modify their environment and that, in this respect, they control their destiny. This argument misses the simple but crucial point that any action, as ‘free’ as it may appear, simply reflects the genetics of the organism and the environmental history, right up to some fraction of a microsecond before any action.”

On the whole scientists are sceptical about the claims of religion, but they fail to be equally sceptical about the existence of free will. If they really believed that free will does not exist and that all behaviour is determined by genetics and environment, then society will have to accept radical changes.

“Progress in understanding the chemical basis of behavior will make it increasingly untenable to retain a belief in the concept of free will. To retain any degree of reality, the criminal justice system will need to adjust accordingly.” ~ PNAS, Feb 8 

“Wanted: nurse or spiritual caretaker in possession of a Completed Life Certificate to assist suicides.” If a group of elderly grandees in the Netherlands calling itself “Out of Free Will” succeeds with its plan for decriminalizing assisted suicide, job advertisements like this will be appearing in the newspapers.

They have already begun collecting signatures to lobby for a change in legislation.

In an interview in the NRC Handelsblad, three of them explain why the Netherlands needs to grant anyone sane over the age of 70 the right to die with a professionally-trained expert’s assistance. Under their plan the expert would determine whether they are of sound mind and not depressed. A doctor would  then confirm this assessment. After the death, the expert would write up a report for the local euthanasia committee. Only Dutch citizens would be eligible.

The specialist suicide assistants will need to complete a “Completed Life” training program and to join a professional association which will maintain standards of professional, transparent and safe conduct.

Dick Swaab, the head of the Amsterdam-based Netherlands Institute for Neuroscience, and a leader of the group, explained that “Throughout the animal kingdom, individuals are simply replaced, rather than patched up endlessly.” Human beings are much the same and they should move on when it is time to go.

The age limit of 70 is arbitrary. “Whether it should be 65 or 90 is a good question,” says legal scholar Eugene Sutorius. “We think that once someone has reached old age, he has proved abilities at living. He can then choose to leave this life in a procedural, medicalised manner.”

The three spokesmen told the newspaper that abuse of the law was unlikely to be a problem, especially in view of the country’s positive experience with euthanasia. “It was thought to be the first step on a slippery slope that would lead the medical profession to lose its integrity,” says Mr Sutorius. “But I have seen nothing of the kind happen.” ~ NRC Handelsbad, Feb 8

Two and a half years of controversy and recrimination peaked at the end of January when Andrew Wakefield, the doctor who claimed to have discovered a link between measles virus, bowel diseases and autism and thereby sparked widespread fear of the combined MMR jab, was severely censured by Britain’s General Medical Council. It said that he was “dishonest, irresponsible and showed callous disregard for the distress and pain of children”.

The sad story began in 1998 when Dr Wakefield published a paper in The Lancet claiming that it was unsafe for children to receive a combined measles-mumps-rubella vaccination. The paper was based only on data gathered from 8 children, but there was enough evidence to suggest, he told a press conference, that single doses should be given a year apart. Many parents panicked and immunization rates dropped significantly. Subsequently there were outbreaks of measles in the UK amongst children whose parents refused to give them the vaccine.

The GMC found that Wakefield had flouted ethical rules in the trial. He subjected children to invasive tests such as lumbar punctures and colonoscopies that they did not need and for which he had no ethical approval. He also concealed from The Lancet his financial interest in the outcome of the trial

Dr Shona Hilton, of the Medical Research Council, told the Guardian that the scare had undermined parents’ trust in MMR vaccination. "Thankfully confidence is returning and the uptake of MMR vaccine is increasing," she said. "We need to continue rebuilding trust with parents that MMR vaccination is safe and ensure that those parents caring for children with autism do not blame themselves."

In April the GMC will decide whether Wakefield and his two colleagues have been guilty of serious professional misconduct, which could result in their deregistration. Dr Wakefield told the media that "The allegations against me and against my colleagues are both unfounded and unjust .” Thousands, mainly parents of autistic children, still support him enthusiastically.

The Lancet withdrew the controversial article a few days after the GMC hearing, although it had published a partial retraction in 2004, signed by 10 of the 13 original authors, including the 2 doctors censured by the GMC along with Dr Wakefield. At the time The Lancet continued to insist that publication had not been a mistake because the journal existed to "raise new ideas". ~ Guardian, Jan 28; London Times, Feb 3

Stem cell research may not be as dispassionate and objective as the public thinks, if a complaint by a group of stem cell researchers is taken seriously. In an open letter to journal editors, 14 leaders in the field have taken the unusual step of alleging that good papers are being sabotaged, and mediocre papers are being over-publicised.

Some researchers are abusing the peer-review process by blocking or delaying rival research, they say. "Papers that are scientifically flawed or comprise only modest technical increments often attract undue profile. At the same time publication of truly original findings may be delayed or rejected". The letter is the culmination of rising concerns about the rejection of good research, and the publication of poor research, for personal or political reasons.

Sometimes, they say, reviewers demand further experimentation, which allows another researcher to scoop rivals with a similar paper. "It's hard to believe except you know it's happened to you that papers have been held up for months and months by reviewers asking for experiments that are not fair or relevant," said Professor Austin Smith, of Cambridge University.

One solution is to to publish anonymised comments from referees along with research papers, so that the validity and fairness of the research can be judged by all. Robin Lovell-Badge of the National Institute for Medical Research in London said,  "Because all comments would be published, it would hopefully make biased or careless refereeing less common, and it would embarrass journals if people could spot biased or stupid comments." ~ New Scientist Feb 2; BBC News Feb 2

The first evidence that the fathers of test-tube babies may pass on their fertility problems has been discovered in a new study. It was found that boys conceived by the implantation of a single sperm cell into an egg using IVF were likely to develop shorter fingers, an indicator known to be associated with infertility. This new finding may be an indicator of a generation with less chance of having their own children.

In Britain, almost one in 50 babies is conceived through artificial means. Almost half are conceived using intracytoplasmic sperm injection (ICSI), a process that bypasses the competition that occurs between proportionally healthier and unhealthier sperm in natural fertilisation. Only the healthiest sperm cell will fertilise a given egg during natural fertilisation, whereas ICSI bypasses this process. The result is that unhealthier sperm may be forced into an egg, leading to a higher percentage chance of defects such as infertility. ~ Sunday Times, Feb 7

Two Russian mothers have won the right to rebut a journalist’s argument that handicapped children should be euthanased. Aleksandr Nikonov, of the popular tabloid Speed-Info, wrote a column contending that children with mental retardation and other developmental disabilities should be killed so that they don’t suffer, in what he termed “post-natal abortion”.

Snezhana Mitina, mother of a 10-year-old son with Hunter’s syndrome , and Svetlana Shtarkova, mother of a 3-year-old son with severe brain damage, were outraged. They filed a complaint with the Russian Union of Journalists which decided that Mr Nikonov’s words were extremist.

The two women say that many Russians share his ideas. "The opinion expressed by the author is not unique; statistics show that one-fourth of Russians share similar views," Shtarkova told the journalists’ union on February 2. "Complete strangers come up to me in the street and tell me that I'm depraved and deserve my fate. Doctors and social workers refuse to do their jobs, just because my child is severely disabled."

Mr Nikonov was unrepentant. He told the Radio Liberty “If you want to bring up a child with Down syndrome, you can do it. But if you don’t, you can euthanase him. Why is prenatal abortion legal, and postnatal abortion is not?”

This incident underscores Russia's reluctance to care for its citizens with disabilities who are widely regarded as burdens for society, says Radio Liberty.

“The issue is gaining traction as Russia faces a severe population crisis brought on by a low birthrate and poor pediatric health. Over the next two decades, Russia's population is expected to shrink by 17 million people. Faced with such statistics, advocates of people with disabilities say the country cannot afford to let prejudice stand in the way of caring for the country's estimated 15 million registered "invalids" -- adults and children suffering from a range of physical and mental ailments.” ~ Radio Liberty, Feb 8

 

Catholic healthcare authorities in the United States are coming under fire over revised directives on care for patients in a persistent vegetative state. Back in November, US Catholic bishops updated their health care guidelines after the Vatican declared that such patients should be given nutrition and hydration, except in some exceptional circumstances. The news passed largely unnoticed.

But this week the Chicago Tribune asked whether a Catholic hospital would honour a patient’s advance directives if they stipulated that no food and water should be given. It interviewed elderly Catholics who were horrified at the thought of lingering unconsciousness. "My pleasure is in being part of the human race," said one of them. "If that's gone, if I can't interact with other people, even if they could give me nutrition and keep me hydrated, I'm not interested in being preserved."

However, the view of the bishops is that food and water, like cleanliness and avoiding bedsores, are ordinary care, not exceptional treatment, and they should be provided as long as they are not burdensome for the patient. Pope John Paul II sketched out this principle in a 2004 speech, and the Vatican made further clarifications in 2007. A new edition of the guidelines incorporates those positions in Directive 58 of the US bishops' Ethical and Religious Directives for Catholic Health Care Services. 

The head of Compassion and Choices, a prominent lobby group for assisted suicide, attacked the Church for not respecting patients’ autonomy. In her blog, its president, Barbara Coombs Lee, said that the guidelines were arrogant and authoritarian and hinted that she would fight them. “We must increase public awareness of the threats to their rights in Catholic institutions and take steps to stop the Vatican from unilaterally ignoring legally executed advance directives,” she wrote.

However, Catholic authorities told the Tribune that they did not foresee problems. "I have never seen an advance directive that says, 'If I am in a persistent vegetative state, I ask that you withdraw food and water,'” said Erica Laethem, a director of clinical ethics at Resurrection Health Care, Chicago's largest Catholic health care system. ~ Chicago Tribune, Feb 8; HT to Sheila Liaugminas

On January 29, anti-abortion activist Scott Roeder was found guilty of first-degree murder for murdering abortion doctor George Tiller last May in Wichita, Kansas. Roeder confessed to shooting Tiller during services at the Reformation Lutheran Church, where he was serving as an usher. Roeder admitted that he had killed Tiller but asserted that he was trying to save unborn children. He now faces life in prison.

Tiller had become a controversial figure because he was one of the few doctors in the US who are willing to do late-term abortions.

National Right To Life disavowed the killer and said that it would continue to work in educational, legislative and political activities "to ensure the right to life for unborn children, people with disabilities and older people."

Abortion advocates now want a thorough investigation of whether others had worked with Roeder in planning the murder.

"Our sincere hope now is that with the door thrown wide open by the district attorney and her cross examination of Scott Roeder and by his own testimony of his relationship with other extremists who promote the murder of doctors, that a thorough and rigorous investigation will be conducted into whether or not this murder was part of a conspiracy to kill Dr Tiller and to kill other doctors," said Kathy Spillar, of the Feminist Majority Foundation.  ~ Wichita Eagle, Jan 30

Oscar nominees have often included films which support euthanasia and assisted suicide. This year a documentary short, “The Last Campaign of Booth Gardner”, seems to be the only one. The editor of BioEdge confesses to being a bit mystified at how Oscar nominations work, because the film doesn’t have its own website or a trailer, isn’t even listed on the production company’s website, and hasn’t screened in a single cinema theatre. Apparently it will be screened on HBO, but a date has not been set.

The production company, Denver-based Just Media, specialize in documentaries about social justice issues.

The star of the film is Booth Gardner, governor of Washington from 1985 to 1993, heir to the Weyerhaeuser fortune, and a victim of Parkinson’s disease. He successfully directed the Initiative-1000 campaign to introduce assisted suicide into Washington in 2008 – although ultimately he would like a law which permits physician-assisted suicide for anyone who wants it, whether or not they have a terminal condition. Stay tuned. Oscar hype will help to make the film better known. ~ HT to Derek Humphry

A surprising debate in the US may shed some light on opposition to assisted suicide and euthanasia. Parents of soldiers who have committed suicide on active duty are complaining that their children are not receiving the same recognition for services to their country, although benefits and decorations are basically the same. But they feel wounded by the fact that since the Clinton Administration, the US President does not send condolence letters to families of those who committed suicide.

According to the New York Times, there were more than 300 suicides in 2009, the most since records began in 1980. Most occur in the US, but at least 184 troops have killed themselves in Iraq or Afghanistan since 2001. The Army is taking the troops’ mental health seriously and has set up suicide prevention and emotional resilience programs. But no letters of condolence are arriving from the President.

“The roots of that policy, which has been passed from administration to administration via White House protocol officers, are murky and probably based in the view that suicide is not an honorable way to die,” the Times reports. The White House says that the policy is being reviewed. ~ New York Times, Feb 1   

The ethical debate over embryonic stem cells is looking ever more irrelevant to the science. Scientists at the Stanford University School of Medicine have succeeded in transforming mouse skin cells directly into functional nerve cells with the application of just three genes. The cells make the change without first becoming a pluripotent type of stem cell — a step long thought to be required for cells to acquire new identities.

 

The finding – published in Nature online on January 27 -- could revolutionize the future of human stem cell therapy and recast our understanding of how cells choose and maintain their specialties in the body.

“We actively and directly induced one cell type to become a completely different cell type,” said Marius Wernig, of Stanford’s Institute for Stem Cell Biology and Regenerative Medicine. “These are fully functional neurons. They can do all the principal things that neurons in the brain do.” That includes making connections with and signaling to other nerve cells — critical functions if the cells are eventually to be used as therapy for Parkinson’s disease or other disorders.

 

They found that about 20% of the former skin cells transformed into neural cells in less than a week. That may not, at first, sound like a quick change, but it is vast improvement over iPS cells, which can take weeks. What’s more, the iPS process is very inefficient: Usually only about 1 to 2% of the original cells become pluripotent.

 

“We were very surprised by both the timing and the efficiency,” said Wernig. “This is much more straightforward than going through iPS cells, and it’s likely to be a very viable alternative.

 

The research suggests that the pluripotent stage, rather than being a required touchstone for identity-shifting cells, may simply be another possible cellular state. “It may be hard to prove,” said Wernig, “but I no longer think that the induction of iPS cells is a reversal of development. It’s probably more of a direct conversion like what we’re seeing here, from one cell type to another that just happens to be more embryonic-like.” ~ Stanford University, Jan 27

It’s hard to tell whether it is good news or bad news, but it is exciting news. Researchers in Britain and Belgium reported in the New England Journal of Medicine this week that they were able to communicate with a 29-year-old man in a vegetative state by using an fMRI scan. They asked him to think of tennis when he wanted to answer Yes and to think of his house when he wanted to answer No. Different parts of the brain lit up and he gave correct answers to 5 out of 6 questions.

Dr Adrian Owen, co-author of the research from the Medical Research Council, said: "We were astonished when we saw the results of the patient's scan and that he was able to correctly answer the questions that were asked by simply changing his thoughts. Not only did these scans tell us that the patient was not in a vegetative state but, more importantly, for the first time in five years, it provided the patient with a way of communicating his thoughts to the outside world."

Dr Steven Laureys, co-author from the University of Liège, confirmed: "So far these scans have proven to be the only viable method for this patient to communicate in any way since his accident. It's early days, but in the future we hope to develop this technique to allow some patients to express their feelings and thoughts, control their environment and increase their quality of life."

The implications of this study are far-reaching, as everyone instantly realized. Neurologists are already aware that 40% of diagnosese of patients in a vegetative or minimally conscious state are flawed. Now they have discovered that it may be possible to communicate with a handful of them. In an accompanying editorial in the NEJM, neurologist Allan H. Ropper, of Brigham and Women's Hospital, in Boston, wrote: “brain activation was infrequent, but it occurred often enough that it will now be difficult for physicians to tell families confidently that their unresponsive loved ones are not ‘in there somewhere’”. 

The divide between consciousness and unconsciousness will also become blurred. Dr Ropper also argued that a response through a brain scan does not necessarily imply that there is lively mental activity or awareness of one’s predicament.

Another consequence which occurred to Dr Ropper is the possibility of asking apparently “vegetative” patients whether they would like their life support turned off. Without conscious consent, this would be illegal nearly everywhere. With consent, it would constitute the withdrawal of burdensome treatment, which is legal nearly everywhere. Perhaps Terri Schiavo was just the beginning. ~ New England Journal of Medicine, Feb 3; Los Angeles Times, Feb 4

It’s not difficult for a person with a terminal disease to make an emotionally compelling case for suicide. The loss of autonomy, the burden on loved ones, and the senseless pain make self-deliverance seem not only rational, but quietly beautiful. Making an eloquent case for fighting on is less common, especially when the person has one of the most terrifying of all genetic ailments, Huntington’s disease.

Yet this is what British journalist Charlotte Raven has done in a recent article in the Guardian. In 2006 she learned that she would, sooner or later, develop Huntington’s disease, just as her father had done. Her first thought was to commit suicide before the disease claimed her, although her husband opposed it and she had misgivings about how she could explain her decision to her infant daughter.

She considered travelling to Dignitas, which appealed to “dynamic decision-makers rejecting some second-rung, low-flying version of their being”. This would actually be “an act of self-preservation”, she says. “I wanted Minelli to save me from the embarrassment of finding my self-image as a witty sophisticate no longer ‘matched’ the reality.”

Her research into Huntington’s disease led her to fishing villages along Lake Maracaibo, in Venezuela which have the densest population of Huntington’s disease victims in the world. However, there is also a clinic, Casa Hogar Amor y Fe, founded by a charismatic doctor, Margot de Young. Located in a former bar in the red light district, the staff care for the patients with love and respect.

The visit completely changed Ms Raven’s views on suicide. There she met a woman with Huntington’s disease who went on to have four more children rather than be sterilised. “One peculiarity of HD is that it leaves intact the sufferers' ability to love their family. This is both the best thing about the illness and the worst. It means sufferers are likely to choose life, with all that this implies – and explains why Mariela has chosen a decade of terrible suffering over death. Maternal love pins Mariela to the shore, defiantly producing children.”

And she also realised that one could be a dynamic decision-maker in the midst of illness. She watched one man eating a meal with the concentration of a chess master, as choking to death on food is common amongst Huntington’s sufferers. “Reaching for the spoon and risking death, the man revealed himself as a dynamic decision-maker of the first order.”

She flew home with a new outlook on her life. “I felt worthy of being cherished and knew I'd do whatever it took to survive. Back home, I told my husband he was right. The case for carrying on can't be argued. Suicide is rhetoric. Life is life.”

Curiously, perhaps, Ms Raven has no discernible religious convictions and might best be described as a radical feminist with a turbulent personal life, at least in the past. ~ Guardian, Jan 16

 

Why do bioethical dilemmas flourish in Florida? After the right-to-die case of Terri Schiavo rivetted the nation in 2004, another unusual and far-reaching case has surfaced in the courts. This time the issue is a woman's right over her own body.

Last year a Tallahassee hospital secured a court order to confine a pregnant woman to her bed to protect her baby.

Samantha Burton, a 29-year-old mother of two, was 25 weeks pregnant. Her membranes had ruptured, she had contractions and the foetus was in breech position. Her doctor, Jana Bures-Foresthoefel, thought that there was a danger of infection or miscarriage. She ordered Ms Burton to stop smoking and to stay in bed. Ms Burton demurred. She was unhappy with Tallahassee Memorial Hospital and wanted to go home.

Instead, hospital lawyers showed up and handed Ms Burton a phone. She found herself defending her plans with Circuit Judge John Cooper. Judge Cooper supported the hospital and ordered her to stay. Under Florida law, he declared, a child's welfare overrides its parent's. He even barred her from seeing another doctor.

In the end, the court order did not save the baby. Ms Burton had an emergency caesarean three days later but the baby was still-born. Then she was allowed to go home.

This was not the end of the story. Ms Burton was very angry. In the words of her lawyer, "She wound up basically nothing more than an incubator for the state. The court order made only the fetus a patient." As a matter of principle, she wants the judge's order retrospectively rescinded. Otherwise, says her lawyer, "Any time a woman gets pregnant the state could come in and run her life."

The American Civil Liberties Union says that the court order was unconstitutional. "Ms. Burton's bodily integrity, privacy, and autonomous decision-making were given no consideration, let alone respected," wrote the ACLU in a brief. "The state failed to consider the fallibility of the single medical opinion presented in this case or the reality, unfortunately demonstrated in this case, that forced medical interventions cannot guarantee the preservation of fetal life."

The First District Court of Appeal is still considering the case, which is beginning to attract nation-wide attention. Writing in the Huffington Post, freelance bioethicist Jacob M. Appel described it as one of the “most egregious abuses perpetrated against a patient by her caregiver since the triumph of the patients' rights movement in the 1970s.” ~ Tallahassee Democrat, Jan 18; Huffington Post, Jan 24

The UK’s controversial fertility regulator is again in the hot seat over its decision to allow clinics to destroy embryos with relatively minor genetic defects. The Human Fertilisation and Embryology Authority (HFEA), has published a list of 116 inherited conditions which fertility clinics can screen out without requiring special permission, says the London Times. These include conditions carried by successful people without great difficulty such as thalassaemia (tennis great Pete Sampras) and Marfan syndrome (Abraham Lincoln). It is considering adding another 24 conditions to the list.

If a condition is on the list, UK fertility clinics will be able to screen embryos for it and destroy it, if the parents ask them to do so.

The head of the HFEA, Professor Lisa Jardine, was indignant at how the news was reported. In a letter she complained that the London Times article was “inaccurate and misleading and could cause confusion and distress for… families”. She insisted that parents did not make such decisions lightly and that the embryos were “just three days old and made up of about eight cells”. ~ London Times, Jan 24

A Scottish MP has introduced a bill for assisted suicide. Margo MacDonald, a campaigner for euthanasia who suffers from Parkinson’s disease, claims that her End of Life Choices Bill would allow Scots who wanted to end their lives to die at home, rather than travel to a suicide clinic in Switzerland. "Dying is part of living, it's the last act of your life, and if we accept the responsibility of how we live our lives, then I really fail to see where there is any demarcation of how we should die," she told Parliament.

Ms MacDonald says that her bill has a number of safeguards to ensure that it will not be abused. People must have resided in Scotland for at least 18 months; they have to consult a doctor and have a psychiatrist confirm that they were not suffering from depression; their decision has to be confirmed after two weeks and they cannot die until two days after that.

However, Wesley J. Smith, a veteran critic of euthanasia who scrutinised the bill, claims that it has serious flaws. A 16-year-old could take advantage of it without parental consent; as no method is specified, a gun could be used; and anyone, not necessarily a doctor, could dispatch the person requesting death. ~ Scotsman, Jan 29

In a twist on the old adage that you can’t escape death and taxes, the Swiss are to vote on a “death tax” on foreigners who visit the country to take advantage of its liberal assisted suicide law.

Dignitas, a Zurich-based group, helps foreigners commit suicide. They normally arrive 2 or 3 days before their demise. Apart from ethical considerations, many Swiss see this as bad public relations.

So opponents of this so-called “suicide tourism” propose imposing a fine of 50,000 Swiss francs (US$47,000) on Dignitas if it helps kill a person who has not lived in Switzerland for at least a year. A referendum on the proposal is scheduled for November 28.

Daniel Suter, Zurich president of the Swiss Federal Democratic Union party, which is behind the vote, says: “we believe this will cut down the number of suicides dramatically. There needs to be an end to death tourism. We anticipate the fine will be passed on to the person committing suicide by the suicide organisation. Effectively foreigners will be discouraged from coming to Zurich to die.''

However, Ludwig Minelli, the founder of Dignitas, seems unconcerned by the move. Even if the referendum proposal passes it will be challenged in the Swiss courts and in the European Court of Human Rights. ~ Irish Independent, Jan 23

In a interview on the weekend, British novelist Martin Amis proposed that “euthanasia booths” be placed on “every corner” where the elderly and the demented can go out quietly, with dignity, receiving a “martini and a medal”.

England would soon face a “civil war” in Britain between the younger and older generations in 10 or 15 years' time, he believes. “They'll be a population of demented very old people, like an invasion of terrible immigrants, stinking out the restaurants and cafes and shops," he told the Guardian. His solution? "There should be a booth on every corner where you could get a martini and a medal.”

Critics have labelled Amis’ comments ‘glib’ and ‘offensive’.

Alistair Thompson, of the Care Not Killing Alliance, described Amis’ comments as “very worrying”. "How on earth can we pretend to be a civilised society if people are giving the oxygen of publicity to such proposals?"

Fellow novelist Joan Brady told the Guardian on Monday that she viewed Amis’ comments as ‘flippancy’ and ‘prostitution’, questioning Amis’ ‘trivialising’ of “a subject of enormous magnitude just to flog a book”. Her husband was killed by a degenerative disease.

Amis contends that his comments were more ‘satirical’ than ‘glib’. He also told the Guardian, “What we need to recognise is that certain lives fall into the negative, where pain hugely dwarfs those remaining pleasures that you may be left with. Geriatric science has been allowed to take over and, really, decency roars for some sort of correction." ~ Guardian Jan 24, Jan 25

A Canadian baby on a life-supporting ventilator has become the centre of the latest controversy over futile medical treatment. Isaiah May, the first child of Isaac and Rebecka, was born in Alberta on October 24. His umbilical cord had been wrapped around his neck and his brain was starved of oxygen. Doctors said that he had “irreversible brain damage.” But, although he is silent and mostly unresponsive, he began to put on weight and move. “He looks like a normal baby," says his mother.

However, his doctors felt that continuing treatment was not in Isaiah’s best interests. They told the young parents that their child was brain dead and would always need a ventilator. On January 13 they sent the Mays a letter stating that they intended to remove Isaiah from the ventilator on January 20.

“Your treating physicians regretfully have come to the conclusion that withdrawal of active treatment is medically reasonable, ethically responsible and appropriate. We must put the interests of your son foremost and it is in his best interests to discontinue mechanical ventilation support,” the letter states.

However, the Mays are determined to fight for the life of their son and want to exhaust every chance ofsurvival. This week they succeeded in getting an injunction to delay the removal until February 19. They plan to seek more medical advice and to have more tests done. ~ Global Edmonton, Jan 27; CNNews, Jan 20

Just over two weeks ago, CNN's celebrity doctor and one-time dandidate for surgeon-general in the Obama administration, Dr Sanjay Gupta, joined the flock of journalists converging upon Haiti. Upon arrival, Dr Gupta examined a 12-year-old girl suffering from a head injury. The incident was filmed and made into a four-minute clip that immediately became the lead item on the CNN website.

Dr Gupta’s fame and popularity have caused some to question his motives in filming this piece of medical work.

On his way to Haiti two weeks ago, Dr Gupta clarified in a Twitter post that although journalistic aims drove his work in Haiti, he would provide medical assistance if necessary. He said, “Many have asked: of course, if needed, I will help people with my neurosurgical skills. Yes, I am a reporter, but a doctor first.”

Bioethicists were not impressed. "The reporters who have been practicing well-televised drive-by medical care in Haiti are demonstrating an appalling abuse of medical and journalistic ethics,” said Dr Steve Miles, of the University of Minnesota Center for Bioethics. And Dr Carl Elliott, from the same centre, was even more scathing. “It's worse than self-promotion. It's exploiting the suffering of Haitians for the PR goals of their employers. They should not be reporting on their own work. That's a classic PR tactic: using humanitarian aid as a public relations device, in order to drive up ratings for their network.” ~ MinnPost, Jan 22; LA Times, Jan 14

“Heartbreak mums facing a baby crisis over low sperm levels” was the headline in the Mirror, a London tabloid. According to figures supplied by the British Fertility Society, there is such a shortfall of sperm donors in the UK that women are being forced to go overseas to fertility clinics or to resort to mail-order fresh sperm. The Society says that UK clinics require 500 sperm donors to service their patients, but at present there are only 400. Supply has shrunk since the recent abolition of donor anonymity.

Dr Pacey is aghast at the use of fresh sperm because there are no guarantees that it is free of HIV or other STDs. “These fresh sperm delivery services just full me with horror,” he told the London Telegraph. “There is no way on earth that they can guarantee they are infection free when they do not quarantine sperm at all.”

The UK’s fertility regulator, the Human Fertilisation and Embryology Authority is now considering allowing payment for sperm to overcome the shortage. ~ London Telegraph, Jan 22

The UK National Health Service (NHS) has apologised to a man who was mistakenly told that he would likely suffer with a hereditary brain disease. Mr C was told in his early 30s that he had the incurable Huntington’s disease, and that it would likely be passed on to his daughters.

Huntington’s disease (HD) is a neurodegenerative condition, usually with onset at middle age. Classic symptoms include mental decline, difficulty with speech, loss of motor function and shifts in personality. Despite extensive research, it remains incurable.

Mr C lodged a complaint with the Scottish Public Services Ombudsman, who investigated this case from the NHS Lothian area. The ombudsman discovered that Mr C and his family all suffered a great deal of anxiety as a result of the diagnosis, and that this caused them to make “certain life choices”. Mr C’s wife and one of their two daughters terminated pregnancies, and one daughter was unable to finish her university degree after the HD diagnosis.

The technology available for retesting when Mr C was diagnosed with HD carried a 4% probability for misdiagnosis. Newer and more accurate testing technology was introduced in 1993, but Mr C was not retested until 2007. This later test showed up negative, meaning that Mr C never had the disease at all. It also shows that he fell into the 4% of cases in which the original tests provided incorrect diagnoses.

The nursing director for NHS Lothian, Melanie Hornett, said that the board was “deeply sorry” for the hardship that the incident caused Mr C and his family. "This was an exceptional case and we have implemented the recommendations of the report to prevent a repeat of a similar incident." ~ BBC News Jan 21

 

 

Discouraging news for women over 30 who want to have a child comes from the UK. According to a study in the journal PLOS One, by the time a woman reaches 30, she has used up nearly 90% of her reserves of eggs. By the time she is 40, only 3% remains. Scientists at the University of St Andrews and Edinburgh in Scotland tracked the growth of the ovarian reserve from conception to 50. They found that the number of eggs declines far more rapidly than most women realise. "Our research shows that they are generally over-estimating their fertility prospects,” says Dr Hamish Wallace, one of the authors.

The study also dumps cold water on the intriguing theory that new eggs are produced in adults when germline stem cells in bone marrow reach the ovaries. Research on mice suggested that this might happen in humans, but the study is sceptical: “our model provides no supporting evidence of neo-oogenesis in normal human physiological ageing”. ~ London Telegraph, Jan 27; PLOS One, Jan 27

England is in danger of following the Netherlands down the road of illegal but tolerated euthanasia, according to a London legal expert. In a biting article in the Solicitors Journal Jacqueline Laing declares that " It was precisely the failure to prosecute that gave the Netherlands its status as a progressive state permissive of euthanasia decades ago. This inevitably led to its legalisation". And she points out that Australian euthanasia activist Dr Philip Nitschke has already suggested that his supporters consider travelling to England where they can evade prosecution.

The Director of Public Prosecutions is currently conducting a public consultation about penalties for assisted suicide at the request of the Law Lords. But despite the fig-leaf of democratic consensus-building, Dr Laing claims that the guidance is  "unconstitutional, arbitrary and at odds with human rights law, properly understood".
Effectively, her argument is that the guidance constitutes euthanasia by stealth. Significant changes in legislation are the province of Parliament, not the judiciary, and still less a consultation paper.

She also contends that euthanasia is incompatible with human rights such as non-discrimination and equal dignity and that it will lead to discrimination against the vulnerable and depressed. The future is bleak: "Once this unconstitutional and illegal guidance becomes normalised, financial, scientific and medical interests willincentivise what can only be described as homicidal practice."

The Royal College of Physicians has also weighed into the debate with a stern letter to the DPP. Its registrar, Dr Rodney Burnham, suggests that any doctor who participates in assisted suicide should be prosecuted. The College's position is that “Assisting suicide has been clearly and expressly outside our duty of care since Hippocrates and must remain so for the integrity of these professions and the public good.” ~ Solicitors Journal, Jan 19; London Telegraph, Jan 19

 

Assisted suicide is never long out of the headlines in England, it seems. This week they featured two devoted mothers who killed their disabled children. In the first case, 57-year-old Frances Inglis was sentenced to life imprisonment for giving her brain-damaged 22-year-old son Thomas a lethal dose of heroin in November 2008. She will have to serve a minimum sentence of 9 years.

In 2007 Thomas was injured in a brawl and taken unwillingly to a hospital by ambulance. He jumped out while it was moving and ended up with severe brain damage. She believed that since then he had been living a life of "horror, pain and tragedy'' and she was determined to bring it to an end. In September 2007 she injected her son with heroin, but he was resuscitated. She denied her involvement after she was arrested. While on bail for attempted murder, she obtained 10 packets of heroin for £200, and injected him again.

Mrs Inglish told the court that she had no choice: "The definition of murder is to take someone's life with malice in your heart. I did it with love in my heart for Tom, so I don't see it as murder. I knew what I was doing was against the law." However, prosecuting lawyer Miranda Moore said in her closing statement: "It is a tragic case but it is not a defence to murder to end someone's life to put them out of their misery.''

In a similar case which is still being tried, 55-year-old Kay Gilderdale gave her 31-year-old daughter sleeping pills, anti-depresssants and morphine to help her to commit suicide. Her daughter Lynn had been mute and bed-ridden since she was 14 after contracting myalgic encephalomyelitis.

The two stories have common features. Both women were separated from their husbands, with whom they were still on good terms, but they made the decision alone after working themselves into a frenzy of compassion. And both relied upon the internet for finding information about their children's condition and how to kill them. Mrs Gilderdale was reading about euthanasia campaigner Dr Philip Nitschke as her daughter was dying. -- London Telegraph, Jan 20; BBC, Jan 20

 

Senior fertility specialists in the UK have rejected calls for an age cap on IVF eligibility. After 59-year-old Sue Tollefsen featured in a BBC documentary about her desire to get IVF in Britain so that she could give birth at 60, there were howls of indignation from the public. But doctors backed up Ms Tollefsen's claim that she was fit to be a mother even though she would be 70 when her child was ten. “I agree there should be a cut-off point," she told the London Times. "Perhaps 65 is too old, but I’m still so healthy I don’t see why I shouldn’t be treated.” 

Tony Rutherford, president of the British Fertility Society, said that he saw no need for an arbitrary cut-off point for IVF with donated eggs. “There are concerns about treating women in their fifties because of increased risks to both the mother and baby. Many doctors, myself included, would not treat at that age, but the society’s view is that clinics can take a case-by-case approach. There aren’t any right and wrong answers in this situation.”

Allan Pacey, of the University of Sheffield, said: “I would argue against a need to legislate on this issue. Whatever age limit the Human Fertilisation and Embryology Authority or parliamentarians choose to make, there will always be cases from time to time where women are a few days older than whatever age is chosen and argue that the law has treated them unfairly. If a rigid law is made, then all it takes is a women to get on a budget airline to another country and get around the law that way. This has its own dangers and we seem to be willing to stick out heads in the sand about that.”

Ms Tollefsen had her first child two years ago -- an IVF daughter, Freya, conceived in Moscow with donor eggs. Although she is well aware of the age problem, she says that her husband is 10 years younger than her and will be able to care for the children if she passes away. The Sun's agony aunt, Deidre Sanders, took a more moralistic stand. "Sue talks almost exclusively about her own feelings. This is all about meeting her needs now, not her kids' in the long term. The fact is there is a serious risk that Freya and any sibling could end up carers for their mum while still in their teens." ~ Sun, Jan 19; London Times, Jan 18

 

In a demonstration of how much some couples are willing to suffer to have an IVF child, a British couple has finally taken home twins after 18 cycles of IVF over 25 years costing more than US$200,000. Neil and Monica Ward, of Sussex, are ecstatic now that their ordeal is over. “Every time it didn’t work it took 10 months to get over it and it was like a living hell for both of us,” Neil told the media during the pregnancy. “My wife is desperate for children and if you love a person that much you have to say yes no matter what the consequences.” The couple used both donor sperm and donor eggs.

“What this story shows is that even if you've had lots of failed attempts with more conventional treatment, an older patient can still use donor egg and conceive successfully - sometimes you're just going to need that high tech treatment,” said Dr. Richard Paulson, chief of the division of reproductive endocrinology at the University of Southern California. ~ New York Daily News, Jan 19

In a vote of confidence in the growing fertility market, three of Australia's major IVF groups have merged to create the second-largest IVF company in the world. Melbourne IVF, the Queensland Fertility Group and New South Wales-based Australia IVF have merged under the umbrella of IVF Holdings, which is owned by Quadrant Private Equity. Doctors in all three states own major stakes in the parent company. Quadrant appears to be interested in further growth. It is searching for similar businesses and says that IVF Holdings is realising integration benefits by acquiring and expanding organically as well as through "selective opportunities". ~ Herald Sun, Jan 18

 

Ontario's privacy commissioner has ordered computer security to be strengthened after a nurse lost a USB memory stick containing information about more than 83,000 patients. It had been collected during H1N1 flu vaccination clinics between October 23 and December 15. The data included names, government-issued ID numbers and personal health information. Ann Cavoukian declared that patient records had to be kept safely and ordered the health bureaucracy "to immediately implement procedures to ensure that any personal health information stored on any mobile devices [laptops, memory sticks, etc] is strongly encrypted." The Ontario Ministry of Health will check regularly to ensure that health information is being handled correctly.

"While I accept that custodians may not be able to totally eliminate the loss or theft of mobile devices, what I cannot accept is that the information contained therein is not encrypted," the commissioner said. "Unauthorized access to health information stored on these devices that happen to be lost or stolen may clearly be prevented through the use of encryption technology. However, despite strong incentives to avoid privacy breaches and the availability of encryption to prevent such breaches, unencrypted mobile devices continued to be used. This is both distressing and completely unacceptable." ~ CBC News, Jan 14 

 

A new adult stem cell treatment developed in the UK has restored sight to several patients in a trial. Researchers at the North East England Stem Cell Institute regrew the outside membrane of damaged corneas from stem cells taken from a healthy eye. All of them were suffering from limbal stem cell deficiency, a painful eye disease that pre