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  9:20:00 AM

Lord Winston warns of unregulated IVF ‘jungle’

In a recent interview with the Independent Robert Winston warned of deception in the IVF market. Fertility companies, he believes, are exaggerating the effectiveness and safety of new techniques.

Winston, a Labour peer who helped pioneer the development of fertility medicine within the NHS, said the field is now being driven by profit. He criticized the Human Fertilization and Embryology Authority for allowing companies to peddle expensive, unproven techniques.

"I think [the HFEA] is not regulating the clinical treatments, which is what it should be doing. I don't think it is competent. I think it is frightened of being sued"

Lord Winston is concerned about the way prenatal genetic screening is being marketed.

"When you do this technique, instead of improving the pregnancy rate, you reduce it by as much as 50 per cent," Winston said. "So prenatal genetic screening actually decreases the pregnancy rate, but it is still being sold as a way of getting pregnant where there's been a failure. In my view that's not honest.”

Other relatively new developments in artificial reproduction are being used without due regard to their effectiveness or safety, he said. Many clinics for instance offer an eggs freezing service, which is sold as useful for young women undergoing chemotherapy or other treatments that are likely to leave them sterile. "This is now becoming quite a big business. It's really not likely to work," Lord Winston said, quoting figures showing that the overall success rate from egg freezing is less than 10 per cent.

Winston also believes that Mitochondrial Replacement Therapy needs to be studied further before it is carried out on human eggs. 

"The problem is that I don't believe there has been enough work done to make sure mitochondrial replacement is truly safe. There probably needs to be a great deal more research in as many animal models as possible before it's done."

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  8:50:00 AM

Physicians under pressure in conceal-weapon permit process

A new survey of North Carolina doctors has found that many are concerned about the increasing number of requests they are receiving to assess their patients' competency to carry concealed weapons.

In particular, a majority of physicians who responded to the survey said they were worried about the potential ethical consequences in the doctor-patient relationship if they participated in the concealed-weapon permit process. 

"This is not a small problem," said Dr. Adam Goldstein, corresponding author of the study and a professor in the Department of Family Medicine at the University of North Carolina School of Medicine. "More than 20 percent of the physicians we surveyed have been asked to sign competency permits for concealed weapons, and a majority of them do not feel they can adequately assess the physical or mental competence of their patients to safely have a concealed weapons permit."

The study, published as a research letter in the June 29, 2014 issue of the New England Journal of Medicine Involved 600 physicians registered with the North Carolina Medical Board and in active practice in October 2013. Of the 600 surveys sent, 225 completed surveys were returned.

The survey found that physicians involved in concealed-weapon permitting sign off on permits almost 80 percent of the time, despite their uncertainty. "If physicians do not feel that they can adequately assess their patients' competence yet are still giving approval for concealed-weapon permits, then there is something wrong with the system," said John Pierson, a second year medical student and chief author of the study. 

"There are things we can do now to change this," said Kathy Barnhouse, a professor of Family Medicine at UNC. "We discovered that the great majority of physicians feel that assessments for concealed weapons permits should best be done by providers specifically trained in making such assessments, presumably with standards to make assessments about mental and physical competence."

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  9:23:00 AM

The big business of Australian IVF

A second Australian IVF company wil float on the stock exchange today. Investment analysts believe that Monash IVF will have a market capitalisation of about A$427 million. Its rival, Virtus Health, is capitalised at $694 million. This means that Australian IVF is at least a $1 billion business. As capital markets expert Paul Docherty explains in this interview in The Conversation, IVF is an attractive investment for institutional investors in Australia because it helps them to diversify their portfolio. 

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  10:15:00 PM

Virginia’s compulsory vasectomy

A Virginia petty criminal has been sentenced to 20 months in prison, three years supervised probation and two years unsupervised probation – and a vasectomy. Twenty-seven-year-old Jessie Lee Herald pleaded guilty to child endangerment, hit and run driving and driving on a suspended license. But it was for none of these that assistant prosecutor Ilona L. White imposed the condition of a vasectomy as part of the plea bargain.

"It was primarily due to the fact he had seven or eight children, all by different women, and we felt it might be in the commonwealth's interest for that to be part of the plea agreement," she explained.

He has also agreed not to reverse the vasectomy – which is difficult, in any case – as long as he is on probation.

The quirky conditions of Herald’s sentence, which went viral on the internet, provoked much commentary. It was called “temporary negative eugenics” at Jezebel and at Slate “reproductive coercion”.

Perhaps Ms White lacks a sense of history, or she would have sensed the irony of compulsory sterilization in Virginia. In 2002, the 75th anniversary of a notorious Supreme Court decision, Buck v. Bell, Virginia Governor Mark Warner publicly apologized for the state’s past involvement in eugenics. He said, "The eugenics movement was a shameful effort in which state government never should have been involved."

Carrie Buck was a young woman whom the commonwealth of Virginia wanted to sterilise because she came from bad stock. The case went all the way to the US Supreme Court, which ruled, in an 8-1 decision, against Ms Buck. The majority ruling was written in 1927 by the legendary Oliver Wendell Holmes Jr, whose imperishable argument was:

“It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Three generations of imbeciles are enough. "

After nearly a century, perhaps the commonwealth of Virginia has come full circle in its attitude toward eugenics. Except that now, two generations seem to be enough. 

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  12:35:00 PM

US polls send mixed signals on assisted suicide

“Most Americans Are Totally Fine With Euthanasia” was the headline this week in Time magazine over a report on a recent Gallup poll. According to the polling service, “Strong majorities have supported this for more than 20 years.”

However, the question in the survey did not mention the words “euthanasia” or “assisted suicide”. It was:

“When a person has a disease that cannot be cured, do you think doctors should be allowed by law to end the patient's life by some painless means if the patient and his or her family request it?”

Gallup framed the issue in a different way in the same poll with this question:

“When a person has a disease that cannot be cured and is living in severe pain, do you think doctors should or should not he allowed by law to assist the patient to commit suicide if the patient requests it?”

The result was starkly different – a majority, but only of 58%.

As Gallup points out, “Americans are less likely to support euthanasia … when the question does not mention the word suicide.” This suggests that the respondents know very little about the issue and might even be confusing euthanasia with palliative care.

Last November a Pew Forum poll came up with quite different figures. It found that 49% disapproved of laws that would allow a doctor to prescribe lethal doses of drugs which a terminally ill patient could use to commit suicide.

While Americans may be inconsistent and ill-informed on end-of-life issues, the Pew poll also suggests that more and more approve of a moral right to suicide:

“About six-in-ten adults (62%) say that a person suffering a great deal of pain with no hope of improvement has a moral right to commit suicide, up from 55% in 1990. A 56% majority also says this about those who have an incurable disease, up from 49% in 1990. While far fewer (38%) believe there is a moral right to suicide when someone is “ready to die because living has become a burden,” the share saying this is up 11 percentage points, from 27% in 1990. About a third of adults (32%) say a person has a moral right to suicide when he or she “is an extremely heavy burden on his or her family,” roughly the same share as in 1990 (29%).”
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  10:28:00 PM

A test for Alzheimer’s will be very disruptive

In 2009 Judge Karen Williams, chief judge on the US Court of Appeals for the 4th Circuit who was a potential Supreme Court nominee,  discovered that she was one of the 1% of Alzheimer cases which develops before 60. She resigned immediately lest the reasoning of her decisions be questioned.

If an easy diagnostic test for Alzheimer’s Disease is developed, how would this affect people’s lives? Hank Greely, the head of the Stanford Center for Law and the Biosciences and the new Stanford Program in Neuroscience and Society, makes some interesting forecasts in the Neuroethics Blog. He says that such a test is unlikely to become available soon, but sooner or later it could be. We should be prepared.

Insurance discrimination: if a test could predict AD, insurance companies might refuse to cover people for disability. 

Politics: President Ronald Reagan was diagnosed with AD shortly after leaving office. To keep a president with AD from running the country, voters might demand to know candidates’ test results. Candidates for the Supreme Court, which is a life-long appointment, might have to present their test results before they are confirmed.

Family dynamics. If their parents test positive, children might want to get control of their financial affairs. Parents might contemplate suicide long before the disease takes hold.

As Greely points out, these issues already exist with genetic diseases like Huntington’s Disease. But HD is rare and AD will affect between 10 and 15% of the population. A test could be extremely disruptive. 

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  4:52:00 PM

Scottish rights groups back right to die for children

Taking their cue from Belgium, Scottish lobby groups for child welfare have tentatively backed voluntary euthanasia for youngsters with terminal illnesses.

Together (Scottish Alliance for Children's Rights) has submitted a response to proposed legislation in the Scottish Parliament which says that Scotland should learn from Belgium, which extended the right to euthanasia to minors earlier this year. It argues that children have the same rights as adults and that if euthanasia were legalised, Scotland would be in breach of the United Nations Convention on the Rights of the child if it denied children with sufficient maturity the right to die.

“It is important to note that children are prone to and suffer terminal illnesses and extreme physical pain just as adults do … terminal illnesses do not discriminate based on the age of a person and accordingly, neither should health care. The UN Committee on the Rights of the Child is clear that a child who is capable of forming his or her own views should be assured the right to express those views freely in all matters affecting the child. The views of a child must be given due weight in accordance with their age and maturity.”

Campaigners against assisted suicide and euthanasia are outraged. A spokesman for Care Not Killing told the media: “Right-minded people will be baffled that such an idea can be advanced, not least from one organisation purporting to represent the interests of children. Such a monstrous idea should be unthinkable.”

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  3:30:00 PM

Is moral bioehancement even possible?

A new article in Bioethics criticises the moral bioenhancement debate as misguided and founded on gratuitous assumptions. 

The authors – Inmaculada de Melo-Martin (Cornell) and Arleen Sales (St John’s University) – argue that the impact of pharmacological interventions on moral behavior is uncertain and further that bioenhancement is incapable of solving what seem to be massive structural problems (climate change, global poverty, and so forth). 

Bioehancement, they claim, might make people “motivationally or dispositionally enhanced”, but this won’t of necessity terminate in moral action. Moral action requires sophisticated moral reasoning and awareness, and a mere physiological disposition to ‘goodness’ won’t provide this.

Regarding the structural dimension of climate change and global poverty, they write:

“The assumption that humanity’s moral ills are the result of mainly individual moral deficits is highly suspect. The framing of morally complex situations like war, famine, terrorism, lack of access to medicines, or poverty, as the result of certain types of individual moral failings ignores the role played by structural – social, cultural, political, economic – forces in enabling and often promoting these evils”.

It is not even clear that moral bioehancement would achieve the modest goal of promoting support for good political and institutional reforms.

The authors question the empirical science behind the pharmacological bioehancement. We are still uncertain as to the role of regions in the brain, such as the amygdala, in regulating the affective component of the emotions.

The article is a strong attack on a series of widely accepted assumptions, and for this reason will likely receive significant attention in future bioethics discourse. 

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  3:24:00 PM

Israel debates assisted suicide

Israel is in the middle of a heated debate about assisted suicide. A ministerial committee has approved a bill which would allow doctors to prescribe lethal medication to Israeli citizens with less than six months to live and exempts doctors from liability for the death.

The bill is said to be supported by a majority in the Knesset and the Israeli public. However, it is firmly opposed by religious leaders. Chief Ashkenazi Rabbi David Lau expressed his opposition, saying that “a doctor can be a healer, but when he is unable to heal he does not have the authority to kill. He may give pain medication, even in heavy doses, as death nears, but cannot kill.”  

And in the Jerusalem Post Rabbi Shimshon HaKohen Nadel writes:

"Israel is not Belgium, the Netherlands, or the State of Oregon. The State of Israel is the Jewish state, and religious affiliations aside, Judaism values life above all. In Judaism, life has sanctity. A law legalizing physician-assisted suicide threatens to undermine the Jewish character of the Jewish state.
"It’s high time we embrace our status as a “light unto the nations.” As the Shelah bill proceeds to a preliminary reading and is assigned to a committee, the State of Israel, as the Jewish state, has an obligation to articulate a clear message to the world that life has value and sanctity, and must be protected and preserved."
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  3:17:00 PM

Israel’s medical association condemns new force-feeding bill

The Israel Medical Association has announced its opposition to new bill that would legalize the force-feeding of Palestinian prisoners. The bill, currently before the Knesset, has been drafted in response the widespread hunger strikes of Palestinian administrative prisoners. Since April, 125 of the prisoners have gone on hunger strike, and about 70 have been hospitalised.

The medical association’s chairman, Leonid Eidelman, said that the proposed amendment could pose a serious danger to the prisoners’ health and violated the ethical rule of non-maleficence, primum non nocere (“first, do no harm”).

Avinoam Reches, a senior neurologist at Jerusalem’s Hadassah University Medical Center and longtime chairman of the medical association’s ethics bureau, said that the bill treats prisoners worse than animals:

“Israel has a law forbidding the forced feeding of geese to produce better and more pâté de foie gras. If so, why would it allow the force feeding of security prisoners?”.

Reches is also concerned about the consequences for physicians working in prisons: “If they refuse [to force-feed] for ethical reasons, they could be dismissed and lose their income”.

Arnon Afek, Director of Israel’s general health ministry, says that the association's concerns are unfounded:

“The amendment would be just one tool in dealing with many aspects of caring for prisoners. Most of it involves medical treatment and not force-feeding. There are many checks and balances in the amendment.”

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