Just when you thought that surrogate motherhood could not get more bizarre and complicated, a news flash comes from Hyderabad, the centre of the Indian surrogacy industry. This story concerns J. Pearl Linda Van Buren Green, a 35-year-old New Yorker, and her son Emperor Kaioyus Van Buren Green, who are caught in a Bermuda Triangle of "red tapism" somewhere between the Big Apple, Jamaica and the Subcontinent. 

More than 18 months ago Ms Green flew to India with seven vials of frozen semen. Her husband, Eric Dalton Green, lives in Jamaica and could not come to India because he has a fear of flying. Ms Green visited clinics in Goa and Mumbai before hitting the jackpot in Hyderabad. There she found a clinic which provided donor eggs and a surrogate mother, both anonymous. Her son was born on December 7.

Then began her battle with Indian bureaucracy. Because she could not prove that her husband was the biological father, the government turned down her request for the baby's passport. in a huff, Ms Green stormed out of the passport office, leaving her bundle of joy on a bench. The police reviewed CCTV footage and after some inquiries, found Ms Green and returned the baby to her. They decided not to charge her with abandonment. Ms Green is still waiting for identity papers for the baby.

Fertility has become a significant industry in Hyderabad. The Calcutta Telegraph reports that “Many women from Andhra Pradesh’s drought-hit districts choose to become surrogate mothers to earn a few extra bucks for their impoverished families.” One clinic claimed that it has a list of “nearly 400 surrogate mothers” who can be contacted at short notice.

There are 50 or 100 surrogate births a month, although only a handful of these come from overseas. “Most of the clients are women from well-to-do Indian families who want to avoid childbirth so that their lifestyle, or body shape, is not affected,” said IVF specialist Srinivas Prasad. ~ Calcutta Telegraph, Jan 29

New figures show that 75 patients are dying in UK hospitals and care homes each day with conditions potentially caused by neglect. In 2010, over 27,000 people died with bedsores or infected wounds – an increase by more than 50% in a decade. Bedsores occur when patients are not turned regularly, or are left in poor hygiene. They may become infected if not spotted and tended to quickly. While in many cases the sores and infections were not the cause of death, experts said their presence demonstrated that thousands of patients were receiving poor treatment during the last days and weeks of their lives.

The Daily Mail reports that figures from the Office for National Statistics show that in 2010, 155 patients died in hospital from dehydration and a further 48 died from malnutrition. Another 812 died with dehydration and another 301 with malnutrition, although the conditions did not directly cause death.

While some attribute these deaths to poor care, officials who compiled the statistics noted that some illnesses such as Alzheimer’s or certain forms of cancer make it very difficult for patients to eat or drink. However, Katherine Murphy of the Patients Association said: “These figures are a terrible indictment of our precious National Health Service. They represent avoidable deaths. These people needed our care when they were at their most vulnerable.”

A Department of Health spokesman said: “Many patients who suffer or die from malnutrition and dehydration are admitted to hospital with these conditions and have underlying health conditions like cancer that make them more susceptible to these problems. However, every NHS patient has the right to expect that they are looked after properly in hospital.”

A series of scandals over care of the elderly prompted the discovery, and led to an intervention from UK Prime Minister David Cameron this month ordering nurses to attend to patients more often. Last year, a report by the Health Service Ombudsman berated the National Health Service for treating the elderly inhumanely. ~ Daily Mail, Jan 22; Telegraph, Jan 29

Last year, Taiwanese health authorities moved to crack down on illegal abortions, warning that doctors found guilty of the practice could have their licenses revoked. They announced on Tuesday that tougher oversight on illegal gender-selective abortions prevented almost 1,000 terminations of female foetuses last year.

Chiu Shu-ti, director-general of the Bureau of Health Promotion, attributed the improvement to government measures aimed at curbing sex-selective abortions and public-private campaigns promoting gender equality awareness. “To improve the country’s imbalanced sex ratio, the DOH has been publishing birth statistics on a regular basis and monitoring hospitals with irregular numbers since May 2010,” Chiu said. “Thanks to these efforts, 993 baby girls were saved in 2011.”

“The strict measures have paid off,” said Lee Tsui-feng, an official at Bureau of the Health Promotion of Taiwan’s Department of Health. According to government figures, 108 male babies were born for every 100 female babies in 2011, down from 109 to 100 in 2010. The normal sex ratio at birth worldwide I 104-106 to every 100 females.

While sex-selective abortions have always been illegal in Taiwan, the practice is believed to have become widespread, due to a traditional preference for male offspring. Despite last year’s improvement, Lee said it might take another 4 or 5 years to root out illegal abortions entirely. ~ AFP, Feb 1; Taiwan Today, Jan 30

Jesus Navarro needs a new kidney.  He has a willing donor and private insurance -- but he has been denied the transplant because he is an illegal immigrant. Administrators at the University of California San Francisco Medical Center are refusing to transplant a kidney from Navarro’s wife, saying he may not receive sufficient follow-up care, due to his uncertain status.

The decision highlights the tension between immigration policy and health care, and underlines the difficult role medical professionals play in attempts to save the lives of illegal immigrants. Mercury News reports there is anecdotal evidence to suggest that clinics often perform organ transplants on undocumented residents, even when the patients are young. In one case, UCLA Medical Center gave an illegal immigrant woman 3 liver transplants before she turned 21.

Health administrators also reject patients because of their immigration status, but that usually happens when patients lack insurance. “It puts the doctors in a very awkward and torn position,” said University of Pennsylvania bioethicist Art Caplan. “You come into this trying to do good and find yourself stuck in the middle of a fight about immigration.” ~ San Jose Mercury News, Jan 31

 

The North Carolina legislature has recommended that surviving victims of the State’s forced sterilization program be paid US$50,000 each. About 7,600 people were sterilized between 1929 and 1974 in North Carolina to prevent the feckless poor and the mentally handicapped from bearing children. About 2,000 are still alive. In the YouTube video above Elaine Riddick laments her experience. She was sterilized at 14 when she gave birth after being raped.

In a 1950 pamphlet, the Human Betterment League of North Carolina said that the program was necessary to protect "the children of future generations and the community at large.” "You wouldn't expect a moron to run a train or a feebleminded woman to teach school," it said. ~ Los Angeles Times, Jan 25

After losing a case for damages for the birth of their severely disabled son based on a “wrongful life” claim, a Sydney couple has returned to the courts with a “wrongful birth” claim for A$10 million.

Keeden Waller was born in August 2000 with a rare blood clotting condition. This caused a massive stroke soon after his birth which left him unable to walk, talk or use a toilet. His parents are suing the IVF specialist under whose care he was conceived. Lawrence Waller, the father, suffered from the same condition but somehow the doctor failed to link the parents up with a genetic counsellor.

''There was a duty of care on the part of Dr James to ensure that both he and the Wallers understood that this problem could be passed on and for there to be proper counselling and discussion about the other options they had, including the option of an anonymous sperm donor,'' the Wallers’ lawyer argues.

The doctor’s lawyer contends that he was not responsible for finding out whether a rare genetic condition could be inherited. ‘‘There is no question that Debbie and Lawrence Waller have experienced a tragic event and that the Keeden Waller situation is extremely sad,’’ said their lawyer. ‘‘But they are intelligent adults who were advised to speak to a genetic counsellor. They chose not to take up that advice.’’

The outcome of the case – which is far from certain – is sure to influence compensation to parents of other disabled children.

In 2006 the couple failed in the High Court of Australia when their lawyers argued that the birth was a “wrongful life”. At that time, the court ruled that the IVF specialist did not cause Keeden’s disabilities and that the couple could not claim that it would have been better if Keeden had never been born. ~ Sydney Morning Herald, Feb 1; skepticlawyer, Feb 1

Bioethics is playing a walk-on role in the drama of the Republican primaries. Newt Gingrich has expressed his opposition to abortion and embryonic stem cell research and has called for an investigation of practices in IVF clinics. He believes that human life begins at conception.

Gingrich’s stand on embryonic stem cell research has shifted over the years but he now says that he would ban all embryonic stem-cell research, including research done on surplus embryos created by IVF clinics. In his words, it amounts to “the use of science to desensitize society over the killing of babies.”

He also plans to form a commission to study the ethics of in vitro fertilization. “I believe life begins at conception, and the question I was raising was what happens to embryos in fertility clinics, and I would favor a commission to look seriously at the ethics of how we manage fertility clinics,” Gingrich said at a news conference at a Baptist church in Florida. “If you have in vitro fertilization, you are creating life; therefore, we should look seriously at what the rules should be for clinics that are doing that, because they are creating life.”

Predictably, the notion of questioning IVF was ridiculed. The liberal website ThinkProgress ran the news under the headline: “Gingrich Suggests It’s Immoral For Couples To Conceive Children Through In Vitro Fertilization”. But in Time magazine, columnist Bonnie Rochman thought it had some merit. What is going to be done with the hundred of thousands of embryos in frozen in the storage tanks of IVF clinics?

After his failure to overtake frontrunner Mitt Romney in Tuesday’s Florida primary, Gingrinch’s star seems to be fading. But his effort to back restrictions on tinkering with embryos could influence policy in a Romney Administration. ~ Washington Post, Jan 30

The left-wing candidate in the French presidential election has strongly endorsed the legalisation of euthanasia if he is elected. François Hollande, a Socialist, who will face the incumbent Nicolas Sarkozy, recently revived France’s simmering  euthanasia debate.

"I propose that all adults in an advanced or terminal phase of an incurable disease, which is causing unbearable physical or psychological suffering and cannot be treated, may request, under specific and strict conditions, medical assistance to end their life with dignity. "

A spokesman told Reuters that the exact protocols had not been worked out yet. "We believe that a person who is terminally ill and experiencing intense physical and psychological suffering must receive active assistance to die, but it must be very strictly regulated," she said.

Euthanasia has been fiercely debated in France. In January last year the Senate rejected a bill put forward by M. Hollande. President Sarkozy is firmly opposed. The current Prime Minister, François Fillon, pointed out in last year's debate that working out the exact protocols was devilishly difficult:

“This scheme does not offer the necessary guarantees. The proliferation of definitions of the end of life and procedures introduces ambiguities and sources of legal uncertainty. The implementation of the act of euthanasia is itself surrounded by conditions that are imprecise.”

The first round of the French election will take place on April 22.  Le Monde, Jan 27

Princeton bioethicist Peter Singer and a research assistant, Agata Sagan, proposed a “morality pill” in a column in the New York Times this week. They speculate that moral behaviour is at least in part biochemically determined. Hence, it should be possible to engineer moral behaviour with drugs. Here is the scenario that they paint:

“If continuing brain research does in fact show biochemical differences between the brains of those who help others and the brains of those who do not, could this lead to a “morality pill” — a drug that makes us more likely to help? Given the many other studies linking biochemical conditions to mood and behavior, and the proliferation of drugs to modify them that have followed, the idea is not far-fetched. If so, would people choose to take it?

“Could criminals be given the option, as an alternative to prison, of a drug-releasing implant that would make them less likely to harm others? Might governments begin screening people to discover those most likely to commit crimes? Those who are at much greater risk of committing a crime might be offered the morality pill; if they refused, they might be required to wear a tracking device that would show where they had been at any given time, so that they would know that if they did commit a crime, they would be detected.”

They foresee some objections to their idea. Some people will argue that depriving someone of free will can never be justified. But Singer and Sagan are sceptical of the existence of free will, so they suspect that this is not a sound objection.

Morality pills are not a novel idea. Another Australian utilitarian, Oxford bioethicist Julian Savulescu, believes that it would be a crime not to “enhance” people to act more morally. A couple of years ago he and Ingmar Persson contended that:

“If safe moral enhancements are ever developed, there are strong reasons to believe that their use should be obligatory, like education or fluoride in the water, since those who should take them are least likely to be inclined to use them. That is, safe, effective moral enhancement would be compulsory.”

A very specialised morality pill is already being used in some jurisdictions: chemical castration. This is meant to turn repeat sex offenders into harmless eunuchs. Dmitri Medvedev, the president of Russia, has backed the idea. And an editorial in the BMJ in 2010 gave it cautious approval:

"Given the transparency of benefits and risks, there is no obvious reason why an offender should not be able to make an informed choice about drugs… Physical castration as part of a rehabilitative strategy may even have a place."

Church-affiliated institutions must cover free contraception for their employees, the Obama administration has announced. As a concession to outraged religious groups, Health and Human Services Secretary Kathleen Sebelius said their hospitals, colleges and social service agencies will have an additional year to comply with regulations under President Barack Obama’s health care overhaul. The plan takes effect on August 1, but institutions who have sought an exemption will not have to comply until August 1, 2013 – after the election in November.

Ms Sebelius said that access to contraception was a fundamental part of healthcare: “Scientists have abundant evidence that birth control has significant health benefits for women and their families, it is documented to significantly reduce health costs, and is the most commonly taken drug in America by young and middle-aged women.”

Despite protests, the Obama Administration seems confident that this will not become a religious liberty issue. “This decision was made after very careful consideration, including the important concerns some have raised about religious liberty. I believe this proposal strikes the appropriate balance between respecting religious freedom and increasing access to important preventive services,” Sebelius said in a statement.

A number of important religious groups disagree strongly. A spokesman for an Orthodox Jewish group, Nathan Diament, complained about the “underlying rationale for its decision, which appears to be a view that if a religious entity is not insular, but engaged with broader society, it loses its 'religious' character and liberties.”

The National Association of Evangelicals said that employers with religious objections to contraception will be forced to pay for services and procedures they believe are morally wrong. “No government has the right to compel its citizens to violate their conscience.  The HHS rules trample on our most cherished freedoms and set a dangerous precedent.”

"In effect, the president is saying we have a year to figure out how to violate our consciences," said Archbishop Timothy M. Dolan, president of the US Conference of Catholic Bishops. "To force American citizens to choose between violating their consciences and forgoing their health care is literally unconscionable. It is as much an attack on access to health care as on religious freedom. Historically this represents a challenge and a compromise of our religious liberty."

Politically, the move is puzzling. America, a leading Catholic magazine, observed that “the exemption will surely prove an election year headache for the Obama administration as it adds powerful fuel to the fire for those alleging that the administration's policies and practices often trample religious liberty… Clearly a lose-lose proposition in an election year.”

On the other hand, supporters of the measure insist that it is a women's rights issue. Louise Melling, deputy legal director of the American Civil Liberties Union, pointed out in the Washington Post that nearly all women, including many Catholics, use contraceptives at some stage. Furthermore, religious institutions employ many who do not share their faith and many states already require contraceptive coverage. Religious freedom “does not give religious groups the right to impose their beliefs on others,” she said.

In the first published results from a clinical trial using human embryonic stem cells (hESCs), 2 legally blind patients with macular degeneration who had been given an injection in one eye have suffered no harmful side effects and appear to have slightly better vision. The trial was sponsored by a Massachusetts biotech, Advanced Cell Technology.

This is a rare piece of good news for the stagnating hESC field and ACT’s share price rose 23%. Two months ago another company, Geron, aborted the only other human trial with hESCs – a potential cure for spinal cord trauma – and announced that it was abandoning the field entirely. ACT is now the only company working with hESCs.

The results were widely reported, based on a study published in The Lancet. However, the author of the paper, Steven D. Schwartz, a retina specialist at UCLA, conceded that it was “extremely unusual” to publish a paper with data based on only 2 patients --without a control group. He said that it was justified by public’s huge interest in stem cells.

Since they were discovered 13 years ago, hESCs have shown promise for treating diseases, but they have also been shadowed by safety issues and ethical concerns, as the process destroys human embryos. ~ New York Times, Jan 23

The controversial practice known as “three-parent IVF” has drawn one step closer in the UK with the government’s announcement of public consultation into its acceptability. The Wellcome Trust has also announced that it would allocate extra funds to expand research into the technique, which uses genetic material from 3 parents – 2 women and a man – to build a baby. The procedure, which currently banned, is a response to mitochondrial disease – defects in the small frameworks called mitochondria which surround the cell nucleus.

Mitochondrial diseases are inherited from the mother. They are rare – only about 100 affected children are born each year in the UK – but often very disabling. The proposed procedure involves extracting the nucleus from an affected woman’s egg, transferring it to the shell of an egg supplied by a donor with healthy mitochondria, then fertilising it with the sperm of the affected woman’s partner.

The ensuing baby would have genetic characteristics mainly from its mother and father, and some from the third parent – the donor. In another method, the woman’s egg is fertilised with her partner’s sperm and then transferred into the donor egg.

Strictly speaking, the procedure does not cure the disease at all and it will be of no help to current sufferers. Instead, it creates an embryo which lacks the disease. It is not clear whether the procedure itself is safe.

The Society for the Protection of Unborn Children said: “These macabre experiments are both destructive and dangerous and therefore unethical. Scientists should abandon the spurious field of destructive embryo experimentation and instead promote the ethical alternative of adult stem-cell research, which is already providing cures and treatments for the same conditions.” ~ Independent, Jan 20

Leading plastic surgeons in the UK have responded to the current crisis in cosmetic surgery by calling for a ban on advertisements for all types of cosmetic surgery, including breast enlargements and tummy tucks. They say the industry is an under-regulated “wild west”.

The surgeons are members of the British Association of Aesthetic and Plastic Surgeons (BAAPS), who work on reconstruction in the National Health Service and regularly perform cosmetic surgery in private hospitals. The group, based at the Royal College of Surgeons, has been concerned in recent years about standards in private cosmetic chains, which advertise aggressively in tabloids and women’s magazines.

They have called for a ban as part of a six-point-plan with proposals for tighter regulation of the industry, including registration and audit of surgeons. “Over the last decade the BAAPS has worked tirelessly to educate the public on the many aggressive marketing gimmicks that not only trivialise surgery but endanger the patient,” said the organisation's president Fazal Fatah.

“We have warned against the unrealistic expectations set by reality 'makeover' shows and against crass competition prizes promising 'mummy makeovers' and body overhauls. In no other area of surgery would one encounter Christmas vouchers and 2-for-1 offers – the pendulum has swung too far, and it is time for change.”

According to the BAAPS, nose straightening and breast enlargement are medical procedures, and advertising should be banned as for prescription medicines. BAAPS says there should be a register for all types of implants, not simply those used to enlarge breasts but also those inserted into the buttocks, calves, pectoral muscles and other areas. Widespread calls for a breast implant register followed the scandal of the PIP implants, which were made with industrial-grade silicone designed for mattresses. ~ Guardian, Jan 22; BioEdge, Jan 21

Former News International CEO Rebekah Brooks and her husband have become parents through surrogacy. Once the editor of the now-defunct tabloid News of the World, the 43-year-old Ms Brooks was in the business of headlining celebrities’ private lives. Now her own 5-year battle with infertility is fodder for her colleagues, along with her arrest on charges of alleged phone hacking and corruption. The surrogate mother of Scarlett Anne Mary Brooks, whose name has not been released, was pregnant with twins, but one of them died early in the pregnancy. The story is likely to boost the profile of surrogacy in the UK. ~ BBC, Jan 26; BioEdge, Nov 19

“Dishonesty is common and institutionalized in medicine and medical research,” says a UK cardiologist, Peter Wilsmhurst, who has spent years trying to expose research misconduct and has reported more than 20 doctors to the General Medical Council.

Apparently the UK scientific establishment agrees with him. Earlier this month the British Medical Journal and the international Committee on Publication Ethics organised a meeting with representatives from universities, funding groups, journals and lobby groups to discuss the problem.

According to Nature News, Elizabeth Wager, of the international Committee on Publication Ethics, said that one American editor had told her that UK institutions were the worst to deal with if misconduct were suspected. “Our reputation in the world is not looking good.”

A number of factors are at work. The UK government, unlike the US, does not have an effective watchdog for research fraud. There can be conflicts of interest if a university detects fraud by one of its employees. It is much easier to dismiss an erring academic than to publicise his misdeeds. Whistleblowers can be sued for defamation. 

The issue is serious enough for Nature to devote an editorial to it. It proposed more government oversight, collaboration between funders and universities, and reform of the English libel laws. “Sounds ambitious? If the solutions were easy, there wouldn't be a problem to discuss,” says Nature. “But there is, so we must face it.” ~ Nature, Jan 13

The Parliamentary Assembly of the Council of Europe (PACE) has given a big boost to opponents of legalised euthanasia. This body, which (somewhat confusingly) is not part of the European Union, is an advisory body in Strasbourg with more than 300 delegates whose pronouncements on human rights are highly influential in the EU.

This week PACE passed a resolution on living wills (or advance directives) which  states as a fundamental principal: “Euthanasia, in the sense of the intentional killing by act or omission of a dependent human being for his or her alleged benefit, must always be prohibited.”

Furthermore, an amendment was passed stating that “surrogate decisions that rely on general value judgements present in society should not be admissible and, in case of doubt, the decision must always be pro-life and the prolongation of life”.

The resolution is not legally binding on members of the EU, but it may put hamper efforts of euthanasia campaigners to pass legislation like the Netherlands and Belgium. The Italian delegate who proposed the amendment was jubilant: “last year we have obtained a great victory reaffirming the right of medical practitioners to conscientious objection; today we have also fought a good battle and we have won, thanks God, against a real ideological tyranny of culture of death…  now euthanasia is completely banned from PACE”. ~ European Dignity Watch, Jan 26

Is it morally wrong to kill people? Not really, argue two eminent American bioethicists in an early online article in the Journal of Medical Ethics. Walter Sinnott-Armstrong, of Duke University, and Franklin G. Miller, of the National Institutes of Health believe that “killing by itself is not morally wrong, although it is still morally wrong to cause total disability”.

Ultimately their aim is to justify organ donation after cardiac death (DCD). This is a state in which a patient is neurologically damaged and cannot function without a respirator. Within minutes of withdrawing this, the organs are removed. However, the authors state frankly that the patient is not dead at that point because it is possible that the patient’s heart could start beating again. (Other bioethicists disagree, vehemently.)

“[T]he criterion of irreversibility has not been satisfied; hence, these patients are not known to be dead at the time of organ procurement.”

In view of well-publicised organ shortages, transplant surgeons are eager to increase the number of available organs. DCD is an important avenue. However, a nagging suspicion that these patients might not be dead is still a substantial stumbling block because the medical profession insists that donors must always be dead. But Sinnott-Armstrong and Miller have an solution:

“[T]he dead donor rule is routinely violated in the contemporary practice of vital organ donation. Consistency with traditional medical ethics would entail that this kind of vital organ donation must cease immediately. This outcome would, however, be extremely harmful and unreasonable from an ethical point of view [because patients who could be saved will die]. Luckily, it is easily obviated by abandoning the norm against killing.”

This radical conclusion may shock some readers, but the authors are not murderers. They want to bring greater precision to what we mean by killing. Rendering someone totally and permanently incapacitated is just as bad as taking a life, or so they contend. Killing totally disabled patients does them no harm.

“Then killing her cannot disrespect her autonomy, because she has no autonomy left. It also cannot be unfair to kill her if it does her no harm.”

Nor, they say, is life “sacred”. The only relevant difference between life and death is the existence of abilities – and a brain-damaged person no longer has these.

“[I]f killing were wrong just because it is causing death or the loss of life, then the same principle would apply with the same strength to pulling weeds out of a garden. If it is not immoral to weed a garden, then life as such cannot really be sacred, and killing as such cannot be morally wrong.”

Journal of Medical Ethics, Jan 19

Is that rustling in the bushes a deer or is it my brother? What the hell. We’ll sort it out later… BANG! Most people would regard moral reasoning like this as potentially indicative of a deficit of ethical reflectiveness. Several paediatricians writing in the latest issue of Philosophy, Ethics, and Humanities in Medicine apparently agree. They have called for a moratorium on donating organs after cardiac death (DCD) until a number of troubling issues have been resolved. The pre-press, peer-reviewed article offers a good summary of the ethical issues.

“We have argued that DCD donors are not dead, and therefore that organ donation during DCD violates the dead donor rule.  Our concerns with DCD include the following: irreversibility of absent circulation has not occurred and the many attempts to claim it has all fail; conflicts of interest at all steps in the DCD process are simply unavoidable; premortem interventions to preserve organ utility are not justifiable; and consensus statements by respected medical groups do not change these arguments. 

“The truth, we believe, is that honesty requires that we face these problems instead of avoiding them.  Until the concerns we describe are seriously considered, full public disclosure occurs, and fully informed consent is obtained from donors, there should be a moratorium on the practice of DCD.  We believe that DCD is not ethically allowable because it abandons the dead donor rule, has unavoidable conflicts of interests, and implements premortem interventions which can hasten death.  These important points have not been, but need to be fully disclosed to the public and incorporated into fully informed consent.  These are tall orders, and require open public debate.  Until this debate occurs, we call for a moratorium on the practice of DCD.”

Philosophy, Ethics, and Humanities in Medicine, Dec 29, 2011

It is difficult to imagine a case better scripted for a discussion of informed consent than Mary Moe’s Massachusetts abortion.

When Mary Moe, a pseudonym for a 32-year-old woman with schizophrenia and bi-polar disorder, visited a hospital emergency room in October, it was discovered that she was pregnant. This meant that she could not take her psychiatric medication as it would harm the foetus. So the state Department of Mental Health applied to have the woman’s parents named as guardians so they could give consent for an abortion.

However, Mary did not want to have an abortion. Although she was not completely coherent, she insisted that she was “very Catholic” and would never do such a thing. She knew what abortions were, as her first pregnancy had been aborted. (She subsequently gave birth to a son, whom her parents are caring for.)

The case went before Judge Christina Harms, a Harvard Law School graduate and a former lawyer in the State’s welfare services. Judge Harms ordered Mary Moe to have an abortion. If she were intransigent, she could be “coaxed, bribed, or even enticed’’ into the hospital. Furthermore, the judge wanted to put an end to these distressing pregnancies. She ordered Mary More to be sterilized “to avoid this painful situation from recurring in the future.’’ Harms reasoned that Mary Moe was not competent to make a decision about an abortion, because of her “substantial delusional beliefs.” But if she were competent, she would choose to abort the child.

In the event, Judge Harms was overruled. “The personal decision whether to bear or beget a child is a right so fundamental that it must be extended to all persons, including those who are incompetent,’’ said the state appeals court. As for the sterilization, said one of the appeals judges, “The judge appears to have simply produced the requirement out of thin air.”

The publicity given to this unusual case has led mental health advocates to wonder how often women are forcibly aborted and sterilised. “I didn’t realize that forced sterilizations were going on anywhere,” said Howard Trachtman of the National Alliance on Mental Illness Massachusetts, told the Boston Globe. “If a precedent were set for that, then you could see a whole slew of people filing for it, or trying to get judges to order it.” “Simply having a diagnosis of schizophrenia or any other mental illness is not a basis for sterilization in and of itself. It’s just sheer prejudice,” Elyn Saks, of the University of Southern California, told the Boston Herald. ~ Boston Globe, Jan 18

 

The UK’s cosmetic surgery industry is under fire in the wake of the liquidation of a French company which made faulty breast implants. For a number of years Poly Implant Prothese had been manufacturing breast implants with industrial grade silicon instead of medical grade. Now the implants are rupturing at a higher than normal rate and a woman has died in France of a rare cancer which appears to be related to the leakage.

Earlier in the month, a few dozen women with PIP implants marched in London's medical specialist district to protest against clinics which are refusing to remove and replace the devices. Danni Starr, 33, an accounts clerk, told the Guardian: “We feel totally fobbed off. I feel so angry that these companies can make all this money from doing this surgery, and then when there is a problem, they can’t afford to help us.”

Regulators in Venezuela, the Czech Republic and France have recommended removal, but other countries, including the UK, say that this is unnecessary. However, a British Parliamentary committee is to investigate the scandal and to ask whether lax regulation has led to a “cowboy” market amongst British clinics.

Dr Daniel Poulter, a member of the committee, told the Guardian: "We have an industry which has grown at a great pace over the last 10 years or so and the breast implants scandal has helped to shine a light on wider issues about the way the cosmetic surgery industry works. The current system leaves too much potential for cowboy surgery, and for women to be exploited."

Some of the issue to be considered are whether private clinics should be required to provide counselling for those seeking cosmetic changes, so that doctors do not take advantage of the vulnerability of women with deep-seated psychological problems. A culture which celebrates body image creates huge pressure on some women to conform to beauty stereotypes, he warned.

"Programmes like [reality TV show]'The Only Way is Essex' and celebrity culture and glossy magazines have glamorised cosmetic procedures and the body beautiful - but in the same way that they have had an impact on anorexia, they are also linked with psychological problems, and obsessions about appearance and body dysmorphia."

According to the British Association of Aesthetic Plastic Surgeons the number of operations has more than doubled in six years, to more than 38,000 operations.

Dr Poulter said: "One of the major concerns that has emerged is about record keeping in the private sector, and about the attitude of the companies, about the responsibility they hold to look after the women they treated. We are also concerned about whether the regulators have fallen behind the industry they are regulating." ~ Guardian, Jan 14

Here is contrarian bioethics at its best. Pregnancy and childbirth are so painful, risky and socially restrictive for women that public funding should urgently be directed to the development of artificial wombs. This is the only way to achieve true equality between men and women for then neither women nor men would then be limited by having children and the burdens of reproducing the species would be shared equally.

This is the radical suggestion made by a leading British bioethicist, Anna Smajdor, of the University of East Anglia.

Artificcial gestation, or ectogenesis,  is currently science fiction, but it may be possible. Dr Smajdor believes that in a truly liberal society pregnancy and childbirth should not be tolerated:

Changes to financial and social structures may improve things marginally, but a better solution needs to be found. Either we view women as baby carriers who must subjugate their other interests to the well-being of their children or we acknowledge that our social values and level of medical expertise are no longer compatible with “natural” reproduction.

Pregnancy is barbaric, Dr Smajdor contends – an illness so serious that it is comparable to measles, which is also occasionally fatal, but does not last nine months.

I suggest that there is a strong case for prioritizing research into ectogenesis as an alternative to pregnancy. I conclude by asking the reader the following: if you did not know whether you would be a man or a woman, would you prefer to be born into Society A, in which women bear all the burdens and risks of pregnancy, or Society B, in which ectogenesis has been perfected.

Her article in the Cambridge Quarterly of Healthcare Ethics is a reply to a critique of an article which she published in 2007, “The moral imperative for ectogenesis”. ~ Cambridge Quarterly of Healthcare Ethics, January

More from the booming surrogate mother industry. A Philadelphia company is raising eyebrows by describing gestational surrogacy as a paying job. An email from Surrogate Services International says that "In this economy and particularly around the holiday season one would think a local business would not have any trouble filling job openings."  It is offering "well paid, part-time positions" as egg donors and surrogate mothers.

The company’s website explains: “We understand that for many women assisting parents achieve their dream of parenthood is payment enough, however since we know this is a real job with immense responsibilities we believe the gestational carrier should be paid accordingly as such.” The “wages” [sic] range from US$20,000 to $35,000.

Like similar companies in the US, SSI’s services include a phalanx of lawyers to ensure that the mother relinquishes the child and that the intending parents, from both the US and overseas, can adopt the baby. It is an LGBT-friendly agency.

Professor Art Caplan, of the University of Pennsylvania, was incensed:

"I thought it was most outrageous. What they are saying is that having a baby is the same as working at the perfume counter at Macy's or Bloomingdales for a part-time job. I don't know what planet these people are operating on but i don't think it is one that is distinguished by its ethics. These are major decisions and they shouldn't be treated in this trivial way.” ~ NBC National News, Jan 4

A 3-year-old girl who was allegedly denied an opportunity for a kidney transplant because she was “mentally retarded” has sparked a debate in the US media. Amelia Rivera has a rare genetic disease known as Wolf-Hirschhorn Syndrome that can cause mental impairment, seizures and kidney failure. However, her parents were told by doctors at Children's Hospital of Philadelphia that there would be no transplant. Her mother, Chrissy Rivera, was enraged and posted her version of a conversation with the doctor and a social worker on a blog.

 “So you mean to tell me that as a doctor, you are not recommending the transplant, and when her kidneys fail in six months to a year, you want me to let her die because she is mentally retarded? There is no other medical reason for her not to have this transplant other than she is MENTALLY RETARDED!”

“Yes, [said the doctor]. This is hard for me, you know.”

Mrs Rivera says that she offered to find a matching kidney in her large extended family, but the doctor flatly refused: “She is not eligible  because of her quality  of life. Because of her mental delays.”

The hospital refused to comment on the incident but insists that it “does not disqualify potential transplant candidates on the basis of intellectual abilities." However, children with developmental delays are complicated to care for and may have a greatly reduced life expectancy. Hence, hospitals may prefer to allocate scarce organs to children who have a greater chance of survival. The Washington Post found that American hospitals had no consistent policy on allocating organs to children who are intellectually disabled.

The story went viral  and prompted a column by leading bioethicist Art Caplan, of the University of Pennsylvania. He pointed out that:

“There are reasons why anyone with an intellectual or physical disability might not be considered a good candidate for a transplant.  But those reasons, to be ethical, have to be linked to the chance of making the transplant succeed. Otherwise they are not reasons, they are only biases.”

The issue is still not settled. The Riveras are to meet officials from the Children's Hospital of Philadelphia next week. ~ cbsnews.com, Jan 17

After a long legal and political debate leading up to a decision by its Supreme Court in 1988, Canada has ended up as one of the few nations in the world without an abortion law. About 100,000 abortion are performed each year. But now the Canadian Medical Association Journal is calling for strict limits on abortion – if the mother wants to abortion a child simply because it is a girl.

Gendercide has been imported into Canada with Asian migration. Census data show that there is an unusually high number of male births to women who are South and East Asian immigrants despite vastly improved socio-economic prospects. Most Canadians regard sex-selection as “odious”, says the CMAJ, but the practice persists.

In a ringing editorial, the CMAJ says:

“Should female feticide in Canada be ignored because it is a small problem localized to minority ethnic groups? No. Small numbers cannot be ignored when the issue is about discrimination against women in its most extreme form. This evil devalues women.”

Its solution for eliminating this “repugnant practice” is “to postpone the disclosure of medically irrelevant information to women until after about 30 weeks of pregnancy”. The assumption is that almost no one would have an abortion at 30 weeks.

However, the widely-discussed proposal has been criticised on several counts. From a practical point of view, it will soon be easy for women to test the sex of their unborn child at home, with commercially-available kits. Can a doctor refuse to perform an abortion even if he suspects the patient’s motivation? He might get in legal hot water.

In fact, one of the papers on which the journal’s stand was based was more realistic. “Our [30-week] proposal, then, would not prevent sex selection. Rather, we suggest that it would permit health care providers to navigate ethically the meaningful application of the SOGC policy of not supporting sex selection while maintaining patients’ rights to full disclosure of medical information.” In other words, the 30-week rule is just a sop for doctors’ consciences.

And both pro-life and pro-choice supporters attacked the proposal as illogical. Why should doctors discourage aborting girls and acquiesce in aborting children with Down syndrome? “Either the fetus has rights or not,” said Marni Soupcoff, of the National Post. “If not, then sorry, no ‘good’ reason is necessary for an abortion. If yes, it gets complex.” ~ CMAJ, Jan 16

The UK should legalise assisted suicide, says a report by a private group headed by former lord chancellor Lord Falconer. The Commission on Assisted Dying, which, despite its official-sounding name, was funded by a right-to-die activist, argues that it is possible to craft a law which will allow people with terminal illness to die without danger of coercion, provided that strict safeguards were observed.

The main provisions of the Falconer commission’s scheme are:

The controversial commission began its investigations a year ago. Its members included some well-known doctors, four politicians, and a former Metropolitan police commissioner. They were supposed to approach the topic with an open mind, but they were recruited by the lobby group Dignity in Dying (formerly the Voluntary Euthanasia Society) and nearly all of them were known to support assisted suicide.

Sarah Wootton, chief executive of Dignity in Dying, described the 400-page report as "comprehensive and robust" and hoped it would "form the foundation of future legislative change".

However, Dr Peter Saunders, of Care Not Killing, an alliance of faith and disability groups and doctors, said: "This investigation was unnecessary, biased and lacking in transparency, and its report is seriously flawed. It is being spun as a comprehensive, objective and independent review into this complicated issue. It is anything but."

The British Medical Association had refused to give evidence to the commission. It maintained its opposition to assisted suicide. A spokesman said: "While there is a spectrum of views on assisted dying within the medical profession, the BMA believes that the majority of doctors do not want to legalise assisted dying." ~ BBC, Jan 5

Remember the Avis Rent-a-Car commercials from the 1960s? Maybe not. Anyhow, they tripled the company’s market share with the slogan, “Avis Is Only No. 2, We Try Harder.” The Belgian right-to-die lobby seems to have the same can-do attitude. In the journal Health Policy, researchers associated with the End-of-Life Care Research Group at Ghent University and the Vrije Universiteit Brussels have lamented the low take-up of the services of doctors specialising in facilitating euthanasia.

A group called the Life End Information Forum (LEIF) was formed in 2002 in Belgium as soon as euthanasia was legalised. Since the new law required a second, confirming opinion if someone requested euthanasia, there was a need for experienced doctors. “Consulting a LEIF physician contributes to the careful practice of euthanasia,” say the researchers. Disappointingly only 35% of those who had received a euthanasia request since LEIF became active had made use of LEIF.

They recommend that the government and medical associations actively promote LEIF, that the LEIF specialists be paid for consultations, and that LEIF promote its services “as widely as possible”.

Although LEIF has been “relatively successful”, it seems apparent that the Belgian researchers were a wee bit dejected by the contrast with a very active end-of-life consultation service in the neighbouring Netherlands. There, nearly two-thirds of euthanasia requests involve SCEN, a consultation service was set up by the Royal Dutch Medical Association and the Association of General Practitioners. SCEN’s doctors receive standard financial compensation from the patient’s insurance company after writing a consultation. The Belgian researchers note that the Dutch have had nearly 40 years of experience with euthanasia (even though it was legalised only 10 years ago). But if Dutch doctors are #1 in euthanasia, Belgian doctors are going to try harder! 

 

Hey, this is pretty cool: an annotated list of dramas and documentaries about bioethical topics at the Scottish Council on Human Bioethics (SCHB). It was launched this week.

My test for the completeness of a such a list is whether it includes the film with the desperate line, “I am not an animal. I am not an animal. I am a human being!”. Give up? That’s from David Lynch’s haunting film The Elephant Man. And yes, the SCHB has listed it. At the moment, there are 118 documentaries and 165 dramas on the list. It even has some famous foreign titles, like the German classic Homunculus (1916) and the Nazi voluntary euthanasia film Ich Klage An (I accuse, 1941).

I was pretty keen to check out a 1952 drama listed under “Human-Nonhuman Hybrids and Chimeras” -- Bela Lugosi Meets a Brooklyn Gorilla. I looked at the trailer on YouTube: it richly deserves the SCHB’s warning that it is among the 50 worst films ever made. Do yourself a favour: check it out now. 

Given that chimpanzees are so closely related to us, American researchers should hardly ever allow them to be used in biomedical research, says a report from the Institute of Medicine and National Research Council. These include the absence of suitable models and inability to ethically perform the research on people. 

In addition, these animals should be used only if forgoing their use will prevent or significantly hinder advances necessary to prevent or treat life-threatening or debilitating conditions. In short, chimpanzees are obsolete in most biomedical research.

The report attracted a huge amount of public attention and the committee was swamped with public comments and emails.

NIH also should limit the use of chimpanzees in behavioral research to studies that provide otherwise unattainable insights into normal and abnormal behavior, mental health, emotion, or cognition, the report says.  They should be performed only on acquiescent animals using techniques that are minimally invasive and are applied in a manner that minimizes pain and distress.

Advances in the development of other research tools, including cell-based tests and other animal models, have rendered chimpanzees largely nonessential as research subjects, the committee noted.  It acknowledged two possible ongoing uses: the development of a limited number of monoclonal antibody therapies already in the pipeline, and development of a vaccine that would prevent infection by hepatitis C virus (HCV).

The committee did not reach a consensus decision on whether chimpanzees are essential to the development of a prophylactic Hepatitis C vaccine and if or how much the use of chimpanzees would accelerate or improve this work.  Roughly 3.2 million Americans are chronically infected with HCV, and about 17,000 new infections occur each year in the United States alone.  Persistent infection can lead to liver disease and cancer; it is the most common cause of liver failure and transplantation in the United States.

Chimpanzees and humans are the only two species that are susceptible to HCV infection, and no other suitable animal models currently exist to test a prophylactic vaccine.  However, chimpanzees' immune systems clear HCV from their bodies more effectively, and they are less likely to develop liver damage.  The committee members agreed that it would be possible and ethical to test a prophylactic vaccine candidate in humans without prior testing in chimpanzees, provided that it was first shown to be safe and to stimulate an immune response in other animals.  However, the committee was evenly split on the necessity of testing various HCV vaccine candidates in chimpanzees before proceeding to human trials.

The committee would not close the door on the possibility that chimpanzees may be needed in future research to develop treatments or preventive tools against as yet unknown diseases or disorders.  It is impossible to say in advance whether other animal models or research tools will always serve effectively and quickly enough in the face of a novel health threat.

As of May this year, 937 chimpanzees, ranging in age from less than 1 year old to greater than 41, were available for biomedical and behavioral research in government and private labs. About 600 are owned or supported by the NIH. At the moment, the government has imposed a moratorium on breeding chimpanzees in captivity and it is illegal to import them. As a result, by 2037 the federally funded chimpanzee research population will “largely cease to exist” in the United States. ~ National Academy of Science, Dec 15; Science Insider, Dec 15

A New South Wales government proposal to prevent families from overturning their deceased relatives’ wishes on organ donation has garnered mixed reactions. Some lauded the government for trying to tackle the low transplant rate, others expressed concern that denying the wishes of family members could be fruitless. A government discussion paper released on Tuesday revealed about 50% of potential organ donors in NSW were vetoed by family members when their loved ones died.

NSW Health Minister Jillian Skinner said a low donation rate is partly due to families using their power of veto over a loved one’s request to donate organs. “Perhaps it is time to look at ensuring patients have the final say,” Ms Skinner told reporters at the Royal Prince Alfred Hospital in Sydney. NSW’s donation rate was only 12.4 people per million, compared with 19.7 per million in Tasmania.

Chris Thomas, of advocacy group Transplant Australia, said the individual’s wishes to donate organs should be respected. “In the instances where donors have made an informed decision and then the family comes and overrules it, that's a tragedy when you've got 1600 people waiting for a life-saving transplant,” Mr Thomas told AAP. ~ Sydney Morning Herald, Dec 6

From the outside, it’s a two-room apartment. However, within its walls, it’s a barn for 15 surrogate mothers, all at various stages of pregnancy. The mini-surrogacy hub is located in Prabhadevi, which is just around the corner from the famous Siddhivinayak temple. 

This small commune of women have been kept in the rented room by the Rotunda clinic in Bandra. Rotunda, which markets itself on the internet as www.iwannagetpregnant.com, is India’s first “first Lesbian, Gay, Bi-sexual, Trans-gender friendly clinic”, mostly for overseas couples.

In the tiny apartments, the 15 women sleep on mattresses on the floor and spend a good portion of their pregnancies together. The dense population and high oestrogen levels result in some intense arguments – but they are given proper meals, regular medication and a resident maid to clean.

“In most cases, there is no regular source of income as their husbands are either not working or have left them," said Anita Soni, a gynaecologist at Hiranandani hospital who deals with patients from Rotunda. "Some of these women have never seen more than 50 rupees in their entire lives. Now they're earning in lakhs [100,000 rupees/US$1800] and providing better education to their own children," she added.

Some of the women are so desperate for money that they sign up under false pretences. Soni noted a recent case in which a 38-year-old woman, considered too old for surrogacy, pretended to be 32. Complications arose during the pregnancy, and the delivery was premature. The baby had to spend time in neonatal intensive care but survived. “The woman had lied to us because she desperately needed money. Her son-in-law had thrown out her 19-year-old daughter because they had been unable to pay dowry,” Soni said. ~ Times of India, Dec 12

This ran between 1933 and 1977 as a means of keeping welfare low, preventing poverty and enhancing the gene pool. Thirty-one other states had eugenics programs, and Virginia and California each sterilised more people than North Carolina. However, their programs were not as aggressive as North Carolina’s. While the state officially apologised in 2002, Governor Bev Perdue is grappling with the state’s obligation to the victims of the program.

A New York Times feature recounts the story of one man, 62-year-old Charles Holt, who was sterilised as a young adult. Government records state that after he showed violent behaviour at school as a teenager, he was sent to a state home for people with mental and emotional problems. In 1968, when he was ready to leave and begin life as an adult, the Eugenics Board of North Carolina decided that he should have a vasectomy. A social worker persuaded his mother.

Many others were selected for sterilisation, such as people with epilepsy and those too “feeble-minded” to raise children. They are now waiting to see the state’s decision on how much his lost fertility is worth. How much should they be paid? Is $20,000 per victim, as some have suggested, enough? North Carolina gave social workers the power to select people for sterilisation. The selection often depended on IQ tests, such as in Mr Holt’s case. About 70% of the North Carolina operations occurred after 1945, and many involved poor young women and racial minorities. 

“The state owes something to the victims,” said Governor Perdue, who campaigned on the issue. Her five-member task force has been discussing the issue since May. A final report is due in February. ~ New York Times, Dec 9

Do we need to change the name of persistent vegetative state? A feature in the St Louis Post-Dispatch argues that the term is applied “sloppily” and that studies have “undermined the validity of the PVS diagnosis.” Colleen Carroll Campbell, an author and former presidential speechwriter, points out that when American neurologist Fred Plum and Scottish neurosurgeon Bryan Jennett picked the term “vegetative”, they wanted a jargon-free term that could classify severely brain-damaged patients whom they considered awake but unaware. Campbell writes that families of those described as “vegetative” have “long chafed at the dehumanizing and bleak overtones of the label, not to mention the high rates of misdiagnosis among PVS patients.

Campbell also points out two recent cases which have added weight to the complaints and raised concerns about how often patients are written off – when there may be hope. A report was published in The Lancet last month by neuroscientists at the University of Western Ontario in Canada. The researchers used a portable electroencephalography machine, or EEG, to test the awareness of PVS patients at their bedside. Researchers discovered that almost 20% of the “vegetative” patients they tested were actually aware. 

The second was reported in BioEdge last week – a New York Times feature recounted the story of Chris Cox, a man from Tennessee who fell into minimal consciousness after a vehicle accident and subsequent overdose of Oxycontin. While on the prescription sleeping drug Ambien, he is able to respond to his environment, respond to basic commands, and smile and speak on cue. This remedy grabbed a lot of attention in 2006 when the medical journal NeuroRehabilitation published a study of 3 patients who were supposedly vegetative who experienced periods of wakefulness and responsiveness every day with the help of Ambien’s generic counterpart zolpidem. ~ St Louis Today, Dec 8

The British body for regulating doctors, the General Medical Council, has announced that it is working on guidelines for telling doctors what they should do if a patient asks for help in committing suicide. There is an increasing number of Britons seeking to go to Switzerland to seek death at suicide clinics. There will be a public consultation early next year. Niall Dickson, the Chief Executive of the General Medical Council, said:

“The issue of assisted suicide is complex and sensitive. We already have clear guidance for doctors that they must always act within the law and assisting or encouraging suicide remains a criminal offence. This guidance will not in any way change the legal position for doctors. It is not our role to take a position on whether or not the law should be changed; that is a matter for the relevant legislature.

“We recognise however that there are a range of actions which could be considered as assisting in a suicide, such as providing information to a patient about suicide or providing practical assistance for someone to travel to a clinic such as Dignitas. Some of these actions may not lead to criminal charges but may still lead to complaints to us about a doctor’s fitness to practise.”

The guidance considers factors that might be relevant in determining the seriousness of each case, in the context of the different actions doctors may take in assisting patients who wish to end their lives. The new guidance will not cover euthanasia (in which a doctor’s actions have directly led to a patient’s death), as standards on this are clear.

The legal position of assisted suicide in England and Wales is unclear. It is clearly illegal, but there are doubts about whether charges would be brought against a doctor who assisted someone in a suicide. In 2010 Keir Starmer, the public prosecutor, issued liberalised guidelines which focused on the intention of the person assisting. There is a case currently in the courts which could raise the issue of whether doctors could help with impunity. ~ GMC, Dec 14, Guardian, Dec 15

Current rules and regulations provide adequate safeguards to mitigate risk in clinical trial, says the Presidential Commission for the Study of Bioethical Issues. After a survey of federally-sponsored research involving human volunteers after a scandal over highly unethical treatment of Guatemalan patients in the late 1940s by doctors in the Public Health Service, Commission basically gave American research a clean bill of health.

The report, Moral Science: Protecting Participants in Human Subjects Research, recommends 14 changes to current practices to better protect research subjects, and calls on the federal government to improve its tracking of research programs.

“The Commission is confident that what happened in Guatemala in the 1940s could not happen today,” Commission Chair, Amy Gutmann. said.  “However, it is also clear that improvements can be made to protect human subjects going forward.”

“Many of the most important advances today are driven by research that involves human participants,” Commission Vice Chair, James W. Wagner, said. “We must ensure that the way we conduct research involving human subjects protects, encourages, and makes fruitful the selfless practice of allowing oneself to become the subject of a medical or social study intended for the benefit of another.”

While there is no way to eradicate all risk of harm, particularly in some types of medical and translational research, Gutmann noted that “our nation vigorously and rigorously protects people who volunteer for research studies.  However, the Guatemala experiments remind us never to take ethics for granted. We must never confuse ethical principles with burdensome obstacles to be overcome or evaded. Good science requires good ethics, and vice versa.” 

As same-sex marriage gains traction in the legal sphere, what about in bioethics? Two bioethicists at the University of Pennsylvania have issued a stirring call for a “queer bioethics” in the leading journal Bioethics. Lance Wahlert and Autumn Fiester point out that many of their colleagues have been insisting that bioethics has to be reimagined to include the powerless and to challenge the status quo. If so, they say, the time has certainly come for bioethical analysis which accommodates LGBTQI (lesbian, gay, bisexual, transgender, queer, and intersex) persons.

“Queer bioethics requires us to take a two-fold approach: (1) We must pay greater attention to the topics, identities, and issues that are blatantly queer, for the service of queer persons; and, (2) We must examine the most common, the most pedestrian, and the most germane of universal health issues (those we wouldn’t even instinctively think of as ‘queer’) and imagine how they might be complicated or rendered troubling by the injection of queer personhood.”

Their proposal does not give concrete proposals or identify areas which would need to change. But they point out until now LGBTQI issues have been studied in isolation from each other – the response to the AIDS epidemic, blood donation by homosexuals, treatment of intersex children and so on. These all ghettoised LGBTQI persons, shunting them into a corner far from normality. In fact, their existence should lead bioethicists to embark upon a radical journey of redefining the self and the person. “The time for queer bioethics is now,” they conclude.

Wahlert and Fiester are already hard at work putting this in train. They have set up a “Project on Bioethics, Sexuality, and Gender Identity” at Penn and have organised a Queer Bioethics symposium in March and a conference in September. ~ Bioethics, Dec 14

 

Sex selection is one of the few bioethical issues which are opposed by both progressives and conservatives. As evidence of how unnatural the practice is, its opponents cite increasingly skewed “sex ratios”. The natural ratio of girls to boys at birth is about 105, so ratios of up to 130 in parts of China are described as perverse.

However, bioethicist Timothy F. Murphy, at the University of Illinois College of Medicine at Chicago, argues in the journal Bioethics, that “the natural sex ratio cannot be a sound moral basis for prohibiting parents from selecting the sex of their children”. What he objects to is the notion that there exists a natural state of affairs which should not be changed.

“If we move away from the view that a divine, or semi-divine, or even just a superior-to-human intelligence undergirds the operations of nature as a whole, human beings are free to choose the kinds of futures that are important to us relative to the calculations we make about the options ahead.”

Furthermore, there is more ambiguity than first meets the eye about the natural sex ratio. It varies from country to country; it varies before birth and after birth. And it varies anatomically: “The presumption that people are unequivocally male or female is not true to the facts of genetic traits, intersex conditions, and transgender identities, which is another reason that we can only know the ‘natural’ sex ratio in an approximate way.”

A rough equivalence of the sexes might be socially desirable, he acknowledges, but not because it deviates from a natural state of affairs. He concludes: “By itself, the idea of nature offers no material support for opposition to the selection of children’s sex, let alone criminalization of that practice.” ~ Bioethics, Dec 13

A new scheme launched by the British Pregnancy Advisory Service has made getting the morning after pill as easy as ordering a pizza – but unlike pizza, it will be free.

The BPAS says that after a brief telephone consultation, it will home-deliver supplies of Levonelle and condoms to help girls from falling pregnant over the Christmas and New Year period. The BPAS website explains:

“The thing is, we see more women with an unplanned pregnancy in January than any other time of the year. We don't want you to be one of them. Getting hold of the 'Morning After Pill' over Christmas can be difficult so it's useful to have it before you need it.”

Under-16s need a prescription for this product, but the BPAS cheerfully admits that some girls “will not be completely honest about their age”.

The scheme is being heaped with criticism, but appears to be going ahead. The Health Secretary, Andrew Lansley, said that he preferred that girls have a face-to-face consultation, but he declined to intervene.

Josephine Quintavalle, of the Pro-life Alliance, told the London Telegraph: “BPAS won’t have any idea about what is really going on with the caller. She could be having underage sex. She could sell it to a friend.”

The BPAS is marketing the scheme at the website santacomes.org and a poster which reads: “He's hot, he lights you up inside, you can't switch it off and before you know it, the sparks are flying.” Pro-abortion Daily Mail columnist Sandra Parsons groaned. “The words on the posters are as hackneyed as they are patronising — indeed, you’d struggle to find lines even half as bad in the most tawdry romantic novel. As for the message they convey, I can’t tell you how depressing I found it.” ~ London Telegraph, Dec 5

 

In a surprise move, the Obama Administration has overruled a decision by the Federal Food and Drug Adminisration to allow girls under 17 to buy the morning-after pill without a prescription.

The head of the FDA had determined that “the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted disease.” But Health and Human Services Secretarary Kathleen Sibelius told the media that she felt uncomfortable with 11-year-olds accessing the pill.

President Obama supported the decision. “[Secretary Sibelius] could not be confident that a 10-year-old or an 11-year-old going to a drugstore should be able — alongside bubble gum or batteries — be able to buy a medication that potentially, if not used properly, could have an adverse effect,” he said. “And I think most parents would probably feel the same way.”

The move seems nakedly political. Facing an uphill battle to retake the White House in next year’s election campaign, the President clearly did not want to antagonise conservative voters.

But progressives are dismayed at a return to Bush Administration policies. “We are outraged that this administration has let politics trump science,” Kirsten Moore, president of the Reproductive Health Technologies Project told the New York Times. ~ New York Times, Dec 7; 

China has admitted that it harvests organs from condemned prisoners, but very little information about the practice has emerged in the press. Executed prisoners are believed to account for two-thirds of all transplants, although the government apparently wants to promote a voluntary scheme.

But who are these prisoners? Even less information is available about this, although the Falun Gong, a persecuted indigenous group, claims that its members are being killed for their organs.

A frightening article in the Weekly Standard sheds some light on the situation. Investigative journalist Ethan Gutmann interviewed several Uighur refugees now living in the West who had witnessed the process of organ transplantation. They tell stories of ghastly abuses of political prisoners.

The Uighur ethnic minority live in Xinjiang, the vast, arid Western province of China. They are not Chinese but Turkic; most are Muslims and a few have joined terrorist groups. To smother the possibility of revolt, the government has been encouraging Han Chinese to migrate there. In the 1990s there were riots which resulted in hundreds of deaths and arrests. “When it comes to the first organ harvesting of political prisoners, Xinjiang was ground zero,” says Gutmann.

From what they told him, it appears that prisoners are injected with an anticoagulant. Then they are dispatched with a bullet in the right side of the chest. This leaves them unconscious but still alive. Organs are quickly removed, without anaesthetic, to ensure that they are fresh. They are immediately transplanted to patients, who appear to be mostly Communist Party officials.

Although most articles on the topic have depicted the prisoners as hardened criminals, Gutmann interviewed an Uighur policeman who told him that organs were harvested from young men arrested in political demonstrations. In the late 1990s, a young Uighur doctor was told “harvesting political prisoners was normal. A growing export. High volume. The military hospitals are leading the way.”

When political unrest died down in Xinjiang, harvesting organs from Falun Gong started.

“By my estimate up to three million Falun Gong practitioners would pass through the Chinese corrections system. Approximately 65,000 would be harvested, hearts still beating, before the 2008 Olympics. An unspecified, significantly smaller, number of House Christians and Tibetans likely met the same fate. By Holocaust standards these are piddling numbers, so let’s be clear: China is not the land of the final solution. But it is the land of the expedient solution.”

After riots in 2009, harvesting from Uighur political prisoners has resumed. Gutmann concludes:

“China, a state rapidly approaching superpower status, has not just committed human rights abuses—that’s old news—but has, for over a decade, perverted the most trusted area of human expertise into performing what is, in the legal parlance of human rights, targeted elimination of a specific group.”

Weekly Standard, Dec 5

The keenness of British journalists to score exclusives and to run down the last details of stories are legendary – or at least they are now, after the News of the World phone hacking scandal.

Which is what makes the ho-hum coverage of this week’s report on mental health and abortion in the UK so puzzling. Commissioned by the Academy of Medical Royal Colleges and funded by the Department of Health, it is said to be “the world’s largest, most comprehensive and systematic review into the mental health outcomes of induced abortion”, although it does not appear to have been peer-reviewed. Its message is that

“…having an abortion does not increase the risk of mental health problems. The best current evidence suggests that it makes no difference to a woman’s mental health whether she chooses to have an abortion or to continue with the pregnancy.”

But if abortion is not a mental health risk, why are there so many of them? In England and Wales there are seven grounds for an induced abortion. According to readily available statistics for 2010, 98 percent of the 196,109 abortions in England and Wales were performed on “Ground C”, fear of injury to the “physical or mental health of the pregnant woman”. Of this 98 percent, according to the government, “The vast majority (99.96%) of ground C only terminations were reported as being performed because of a risk to the woman’s mental health”.

As Peter Saunders, CEO of the Christian Medical Fellowship points out:

“This means that when doctors authorise abortions in order to protect a woman’s mental health they are doing it so on the basis of a false belief not supported by the medical evidence. In other words the vast majority of abortions in this country are technically illegal.”

However, the report itself fails to allude to this problem. It found that having an unwanted pregnancy is associated with an increased risk of mental health problems. However, the rates of mental health problems for women with an unwanted pregnancy are the same, whether they have an abortion or give birth. The most reliable predictor of post-abortion mental health problems is having a history of mental health problems. ~ Guardian, Dec 9 

Scientists at Weill Cornell Medical College have used genetic methods to successfully repair cleft lips in mice embryos. The research breakthrough may show the way to prevent or treat the conditions in humans.

Cleft lip and cleft palate are among the most common birth defects, with treatment requiring multiple cycles of surgery, speech therapy and orthodontics. It is sometimes used to justify abortions.

To date, there have been very few pre-clinical methods that allow researchers to study the molecular causes of these malformations, especially with animal models.

In a report in a recent issue of the journal Developmental Cell, Licia Selleri and her co-authors report the first multigenic mouse model of cleft lip with or without cleft palate. The researchers uncovered how certain genes contribute to the development of these abnormalities. They also discovered that altering one type of molecule within the Wnt signaling pathway (that comprises a network of proteins best known for their roles in embryogenesis) is sufficient to correct the defects.

"To my knowledge, this is the first time that anyone has corrected this defect in embryos, and we really show here that Wnt is a critical factor," Dr. Selleri says. "This is a very provocative result because it opens a completely new avenue of strategies for tissue repair." ~ Eurekalert, Nov 28

The “slippery slope” is often derided as a logical fallacy. But when one of the leading advocacy groups for euthanasia in Belgium posts an article entitled “Euthanasie: tijd voor de volgende stap, Euthanasia, time for the next step”, it’s hard not to think that it may not be so illogical after all.

The Humanistisch-Vrijzinnige Vereniging (Humanist-Liberal Association) complains that eligibility for euthanasia is far too restrictive. At the moment, only people with unbearable suffering can be euthanased. This leaves out people in irreversible comas, people with dementia, people with irreversible brain diseases and people who are under 18. This is manifestly unfair, the HVV contends.

However, this is not just a private initiative. In November Wim Distelmans, the chairman of the official Federal Committee on Euthanasia, released an open letter to Prime Minister Elio Di Rupo asking him to re-open a national debate on euthanasia. (At the time, Di Rupo was pulling a government together (this took 589 days) but now he is officially prime minister.) He and eight colleagues, like the HVV, have asked the Belgian government to update its 2002 euthanasia law. The proposed changes include these provisions:

Institut Européen de Bioéthique, Dec 6; 

The 23,000 members of the Massachusetts Medical Society have voted against physician-assisted suicide. Its House of Delegates voted by a large majority for maintaining a policy the Society has had since 1996. According to the MMS press release: “Opposition to physician-assisted suicide was part of a larger policy statement that includes recognition of patient dignity at the end of life and the physician’s role in caring for terminally-ill patients.”

Lynda Young president of the Society, said: “Physicians of our Society have clearly declared that physician-assisted suicide is inconsistent with the physician’s role as healer and health care provider. At the same time we recognize the importance of patient dignity and the critical role that physicians have in end-of-life care.” 

Dr Young said the policy exceeds a single statement of opposition to physician-assisted suicide to include “support for patient dignity and the alleviation of pain and suffering at the end of life.” She also said it includes the Society’s dedication to “provide physicians treating terminally-ill patients with the ethical, medical, social, and legal education, training, and resources to enable them to contribute to the comfort and dignity of the patient and the patient’s family.”

While the Medical Society has rejected physician-assisted suicide, the right of terminally ill patients to self-administer life-ending drugs may have moved closer to getting a place on the state ballot next year. Sponsors of proposals for self-administering these drugs claim they have enough signatures to get the issue on the ballot. ~ Massachusetts Medical Society, Dec 3; CBS Boston, Nov 22

The recent past of Korea’s cloning research is best described as dubious. Disgraced Seoul University professor Hwang Woo-suk claimed in 2004 to have