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  5:24:00 PM

Near enough is not good enough

The phrase “not completely brain dead”, like “not completely pregnant”, has a Monty Python-esque ring to it. But it is the way the Daily Mail described an alarming organ transplant incident in the German city of Bremen.

Doctors in a hospital in Bremen had already made an incision in the abdomen of a man who was presumed to be dead when they discovered that the deceased donor was still alive according to organ transplant protocols. The operation was immediately terminated – and the brain-damaged patient died. The incident is being investigated by the German Medical Association.

The Süddeutsche Zeitung (the source for the Daily Mail) was told that "it is quite possible that the man's brain was so damaged that he would not have been able to return to a normal life, but as long as he was not properly diagnosed as brain dead, nobody knows."

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  5:01:00 PM

After half an hour, it all feels totally normal in Hollywood

Hollywood tittle-tattle is not the most reliable source, but, like all tittle-tattle, it’s fascinating. And possibly true. Hollywood Reporter is running a story about “23 Hollywood moms with same sperm donor and one crazy vacation”. Its upshot is that 15 children in and around Hollywood have the same sperm-donor father whom they cannot possibly meet until they are 18, at the earliest.

The article focuses on Sarah Fain, a TV writer-producer for The Shield and The Vampire Diaries. She decided to become a single mother and bought sperm from a clinic. "It's like online dating, only you don't have to have a relationship with the person," she said. "It's not: 'What if this is the love of my life?' It's: 'This person doesn't have Alzheimer's in their genetic history.' "

Later on, when she brought two-year-old Violet to day care, she discovered that at least two of the other children looked remarkably like her. She went to her sperm donor Facebook group and discovered that they were two of the 15 offspring of Mr X.

Now they all have dinner every Sunday. "They're my family," says Fain. In September, the Facebook group rented a vacation house. "Talk about crazy — there were 12 2-year-olds," says Fain, who adds: "It's one of those things that feels incredibly bizarre for half an hour. Then it feels totally normal."

Presumably the 23 moms are 11 lesbian couples and Ms Fain, a single mother. 

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  4:06:00 PM

A new kind of diplomacy

Gerardo Hernandez and Adriana Pérez before the birth of their child.  

 Artificial insemination has become part of international diplomacy. Cubans were scandalised when Gerardo Hernandez, a spy who had been in a US jail for 16 years, greeted his very pregnant wife in Havana after he was released as part of a prisoner swap.

Hernandez was arrested in 1998, found guilty, sentenced in 2001 to two life terms and held in a maximum security prison in California where he was not allowed conjugal visits. However, it turns out that the Obama Administration had agreed for Hernandez’s sperm to be shipped to Cuba as part of the negotiations over restoring ties between the two countries. “One of the first things accomplished by this process was this,” Hernández told the media. “I had to do it by ‘remote control’ but everything turned out well.”

Hernandez’s wife, Adriana Pérez, had pleaded that she would not be able to have a family. The deal was brokered by Vermont Senator Patrick Leahy. “The expectation was that this man would die in prison. This was her only chance of having a child,” one of his aides told CNN. Earlier this month Ms Pérez gave birth to a girl. 

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  3:39:00 PM

PBS investigates Belgian euthanasia

This PBS video gives an insight into the issues and personalities behind Belgium’s euthanasia regime. It does not take sides (in the view of bioethics blogger Wesley J. Smith, it is “terminally nonjudgmental”), but it does give some idea of the tangled moral issues.

Some viewers might find the optimism of the co-chair of Belgium’s euthanasia commission, Gilles Genicot, questionable. He defends the fact that not one of the 8,000 case of euthanasia has ever been prosecuted. “I can understand it might sound surprising, but the way our law works is– based on– trust we give to doctors,” he says. “Because they know their patients far better than anyone else.” Outside of Belgium, that is often called paternalism. 

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  12:25:00 AM

Mario Cuomo, bioethicist

Three-term New York governor Mario Cuomo was a skilled politician who almost ran for President and almost sat on the Supreme Court. He was an eloquent spokesman for the liberal strain of American politics, defending the little guy and big government. But he also exerted a great influence on US bioethics debates.

On abortion. Although he was proud to be a Catholic, he supported a woman’s right to choose. In 1984 he gave a speech at Notre Dame University in which he argued that a politician who was personally opposed to abortion could, in good conscience, vote for a law which permitted it. “Approval or rejection of legal restrictions on abortion should not be the exclusive litmus test of Catholic loyalty,” Cuomo stated in his address at Notre Dame. “We should understand that whether abortion is outlawed or not, our work has barely begun: the work of creating a society where the right to life doesn’t end at the moment of birth; where an infant isn’t helped into a world that doesn’t care if it’s fed properly, housed decently, educated adequately.”

On the death penalty. He was a resolute opponent of capital punishment, a stand which nearly cost him the governorship.

On end-of-life issues. In 1985 Cuomo set up the New York state biomedical Task Force on Life and the Law,  23 experts who assist the State in developing public policy on issues arising at the interface of medicine, law, and ethics. Its reports have been cited in a number of important federal and state court decisions. One report eventually established irreversible brain stem damage as the criterion for death. It also opposed the legalisation of euthanasia.

“No matter how carefully any guidelines are framed, assisted suicide and euthanasia will be practiced through the prism of social inequality and bias that characterizes the delivery of services in all segments of our society, including health care. The practices will pose the greatest risks to those who are poor, elderly, members of a minority group, or without access to good medical care. The growing concern about health care costs increases the risks presented by legalizing assisted suicide and euthanasia. This cost consciousness will not be diminished, and may well be exacerbated, by health care reform.”

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  12:17:00 AM

Connecticut teen forced onto chemotherapy

The state of Connecticut is forcing a 17-year-old to undergo chemotherapy to treat her Hodgkins lymphoma. Officials say that this is the only way to save her life; she and her mother contend that the treatment is vile and intrusive. In October after much argument, police and the Department of Children and Families, removed her from her mother’s care and placed her with a foster family. She returned home in November after promising to undergo chemotherapy, but after two days of treatment, she ran away and disappeared for a week. In December she was strapped to a bed, sedated and given chemotherapy.

Cassandra felt violated, she wrote in the Hartford Courant: “I want the right to make my medical decisions. It's disgusting that I'm fighting for a right that I and anyone in my situation should already have. This is my life and my body, not DCF's and not the state's. I am a human — I should be able to decide if I do or don't want chemotherapy. Whether I live 17 years or 100 years should not be anyone's choice but mine. How long is a person actually supposed to live, and why? Who determines that? I care about the quality of my life, not just the quantity.”

The case has been reported across the US. The DCF says that it had no choice. “When experts — such as the several physicians involved in this case — tell us with certainty that a child will die as a result of leaving a decision up to a parent,” the statement said, “then the Department has a responsibility to take action.”

Bioethicist Arthur Caplan supported the officials. “Respecting choice is important. Not burying a young teenage girl who would have lived is far more important,” he wrote in a column.

Cassandra and her mother, Jackie Fortin, wanted the state supreme court to recognise the “mature minor” doctrine, because she is nearly 18, the age when she could legally refuse consent. However, the court was not impressed by her week in hiding.

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  11:42:00 PM

Euthanasia of convicted Belgian murderer cancelled

The Belgian justice minister has refused to allow convicted rapist Frank Van den Bleeken to undergo euthanasia. The 52-year-old convict is serving a life sentence for one murder and several rapes committed in the 1980s. He says that he cannot control his sexual impulses and that life in prison is such a torment that he would prefer to be dead. "I'm in my cell 24 hours a day. That's my life. I don't feel human here. What do I have to do? Do I have to sit here and waste away? What's the point in that?" he told a television journalist in 2013.

In fact, euthanasia was not his first choice for his future. He first applied to be treated at a specialist unit for sex offenders in The Netherlands. However that meant going to a foreign country and the Belgian government refused. This left Mr Van den Bleeken with euthanasia as his only way out, at least in his opinion. La Ligue des droits de l'Homme (the Belgian League of Human Rights) described the government’s indifference as barbaric.

About 15 other Belgian prisoners have also applied for euthanasia.

Mr Van den Bleeken was scheduled to die on Sunday, January 11. However, this week the justice minister, Koen Geens, capitulated to pressure from human rights groups and declared that he would allow the prisoner to be moved to the Netherlands. Thereupon the Belgian doctor who had agreed to carry out the euthanasia procedure withdrew for “confidential personal reasons”.

Mr Van Den Bleeken’s lawyer, Jos Vander Velpen, says that his client was shocked by the news. "He's upset because that he was prepared for euthanasia on Sunday. He had said goodbye to everyone, the funeral was organised, the memorial cards were written up. But in the end it is always the physician who must decide in all conscience. His freedom of conscience must be respected," he said.

The justice minister has also responded to criticism of Belgium’s treatment of mentally ill prisoners. He announced that the government will set up its own specialist unit.  

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  11:37:00 PM

German nurse may have killed 178 patients

A German male nurse has admitted to a psychiatrist that he killed 30 patients to show off his “excellent” resuscitation skills – but he may have been responsible for as many as 178. The nurse, who was convicted in 2008 of attempted murder, injected patients with a cardiovascular drug at a hospital in Delmenhorst hospital, near Bremen, in northern Germany, between 2003 and 2005.

By orchestrating an emergency, he then stepped in to save the patients. Prosecutors say that the nurse, who has only been identified as Neils H, hoped to win the admiration and gratitude of staff and relatives. Until now he has not admitted responsibility and investigations have only linked him clearly to 12 deaths.

The psychiatrist said that Mr H told him that he injected about 90 patients, 30 of whom died. He is aware that he had caused many people “huge damage, suffering and anxiety” and he was not “basking in the limelight” of his notoriety. “This is not so. He is deeply ashamed,” he told a court.

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  11:32:00 PM

Nitschke loses legal battle to practice as a doctor

Australian euthanasia activist Dr Philip Nitschke remains deregistered after a ruling that his activities would undermine public confidence in the medical profession and posed a serious risk to public safety. Nitschke says that he will appeal the decision by the Northern Territory Health Professional Review Tribunal.

The controversial doctor has been in the limelight ever since he killed four patients when euthanasia was legal in the Northern Territory for several months in the mid-90s. The Medical Board of Australia disapproved of his activism, but failed to restrain him. However last year a Perth man asked Nitschke for advice about suicide. He obliged and the man later killed himself. The MBA contends that Nitschke should have referred him to a medical practitioner, while Nitschke has argued that the man had a right to rational suicide even though he was not terminally ill.

Nitschke's lawyer says it is an error of law for the tribunal not to consider the "enormous body of medical literature addressing the issue of rational suicide". However the tribunal insisted that the only legal issue is whether his actions are consistent with the code of conduct for Australian doctors.

The evidence cited in the Tribunal’s judgement gives an insight into the mind of the man who is probably the world’s best known apologist for an unrestricted right to suicide:

Nitschke is a qualified medical doctor but devotes nearly all his time to promoting euthanasia in Australia and around the world. He sees only a few patients a year on trips back to his home in the Northern Territory. He failed to fulfil his compulsory professional development requirements as a doctor. Instead he devoted his time to keeping abreast of developments in euthanasia.

Nitschke admitted in his testimony that that had become rather nonchalant about requests for help in committing suicide: “So in that sense, I suppose I’m hardened to them. I’m not surprised when I get them and I behave to them perhaps on a way which some would see as insensitive.”

Depression, even clinical depression, is not a contraindication for euthanasia. The only criterion is whether a client is rational. “I've met people that are well and say they want to end their lives. Are they depressed? Probably a bit. … everyone’s a bit depressed. The question is: have they lost the ability to give insightful rational decisions? No. … So we’re seeing all sorts of people come along. Tired of life people.”

As long as people have a reason short of phobias about invading Martians, suicide is an acceptable option for Nitschke. “Now financial concerns are one such example of what we would describe  as a non-medical reason for wanting to engage in the act of suicide. Now in terms of whether I would engage with them further, I would probably say ‘are you certain?', ‘are you sure?' And if the person said ‘yes I’m certain. I’m sure because this is such a catastrophe that this is the only way I can see out of it and I have thought it all through’, I would say that’s entirely a reasonable course for you to take if it's a course that you decide is in your best interests. It’s not for me to come along and second judge.”

Dr – or Mr – Nitschke is not letting the grass grow under his feet while he appeals his deregistration. He is scheduled to appear as a stand-up comedian at the Edinburgh Fringe Festival in August. He expects to be criticised for “trivialising” the topic, but he has been planning a new career in comedy for some time.

Nitschke was invited by a British comedian, Mel Moon, who has a terminal illness and is the youngest member of his suicide promotion group, Exit International. “Despite his notorious reputation, he’s actually quite funny,” she says. “Not as natural as a stand-up, but more like a witty after-dinner speaker.” 

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  3:49:00 PM

No contraception, no govt handouts, says Aussie politician

A tragic murder in the Australian state of Queensland has provoked a controversial solution by a former Federal government minister: no contraception, no dole.

“If a person’s sole source of income is the taxpayer, the person, as a condition of benefit, must have contraception. No contraception, no benefit,” Gary Johns, a Labor minister in the Keating government, wrote in The Australian, where he is currently a columnist. 

Mr Johns was responding to the news that a 34-year-old woman had stabbed to death all of her seven children, aged 2 to 14, and her niece as they lay sleeping in the north Queensland city of Cairns. Her children had been fathered by five different men.

Mr Johns framed his proposal as a solution to the problem of state-sponsored sexual irresponsibility.

Therefore, there should be no taxpayer inducement to have children. Potential parents of poor means, poor skills or bad character will choose to have children. So be it. But no one should enter parenthood while on a benefit.

It is better to avoid having children until such time as parents can afford them. No amount of “intervention” after the fact can make up for the strife that many parents bring down on their children.

As commissioner Tim Carmody wrote in the Queensland Child Protection Commission of Inquiry report in 2013, “some families will never rise to the challenge or have the capacity or commitment needed to take responsibility for the children they bring into the world”.

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