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October
25
  10:07:00 AM

Radical measures to prevent the spread of Ebola in hospitals

At least three US hospital systems are currently considering whether they withhold certain treatments from Ebola patients, in a bid to protect their doctors and nurses.  

The move comes after two nurses from Dallas were infected with the virus whilst treating a patient who had recently returned from West Africa.

Executives at University of Chicago Medicine are considering whether procedures such as inserting a breathing tube or putting a ventilator on a patient should be avoided due to the potential of exposure to the virus.  

“We have very little experience with [those procedures] except for Mr Thomas Duncan, who didn’t do well,” said Dr Emily Landon, a bioethicist and epidemiologist from the hospital. 

Pennsylvania’s Geisinger Health System is also considering whether certain ‘risky’ procedures could be avoided, as are managers from Intermountain Healthcare, which runs facilities in Utah. 

Geisinger is paying close attention to directives from the Centre for Disease Control and Prevention (CDC), and has set up an Ebola Response Team to deal with the new viral threat.

Dr G. Kevin Donovan, director of the bioethics centre at Georgetown University, told hospitals to proceed with caution: “To have a blanket refusal to offer these procedures is not ethically acceptable”.

Dr Nancy Kass, a bioethicist at Johns Hopkins Bloomberg School of Public Health, said healthcare workers should not hesitate to perform a medically necessary procedure so long as they have robust personal protective gear.

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October
24
  5:37:00 PM

Assisted suicide debate intensifies in Scotland

British Anti-euthanasia group Care Not Killing (CNK) has launched a major online campaign intended to derail a new assisted-suicide (AS) bill being debated in the Scottish parliament.

The proposed legislation, due to be discussed by the parliamentary justice committee next Tuesday, would make assisted suicide legal for people as young as 16 who suffering from “a terminal or life shortening illness”. 

The bill was originally moved by Margo MacDonald, an MSP who died in April following a long battle with Parkinson’s disease. 

CNK’s online petition labels the proposed changes “unnecessary, unethical and uncontrollable”. Extant penalties, the petition states, “act as a strong deterrent to exploitation and abuse whilst giving prosecutorial discretion in hard cases.”

CNK spokesperson Dr Gordon MacDonald said that a change to the law would “place pressure on vulnerable people to end their lives for fear of being a financial, emotional or care burden upon others.”

Earlier in the year influential Scottish journalist Kevin McKenna wrote a scathing critique of the bill, criticising the “twisted morality” and “bizarre…deathly obsession” that underpinned it.  

Patrick Harvie MSP, and ardent supporter of the bill, accused CNK of providing a distorted picture of proposed changes:  “I hope that MSPs will judge this bill on its own merits before reaching their decision.” 

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October
24
  10:31:00 AM

The enormous potential of adult stem cell treatments

Scientists who developed a treatment to allow a paralysed man to walk again have spoken of the possibility of healing other debilitating nervous system conditions.  

Prof Geoffrey Raisman, of University College London’s Institute of Neurology, said the successful operation on paralysed fire-fighter Darek Fidyka opened the door to treating nervous system damage throughout the body.  

38 year old Mr. Fidyka has regained feeling in his lower limbs after doctors transplanted olfactory ensheating cells (OECs) from his nose into his spinal cord. OECs are what allow the sense of smell to return when nerve cells in the nose are damaged.

A few months after the transplant, Fidyka’s thigh muscles began to grow, and two years on he can walk with the help of a Zimmer frame. 

The ability to trigger nervous system repair has massive implications, says Professor Raisman. “There’s no reason to restrict this to spinal cord. We have opened the door to a future which is terrifyingly large.”

John Haycock, a Professor of Bioengineering at the University of Sheffield, said: “It paves the way for cell-based therapies in conditions of the nervous system previously thought impossible to treat, not just spinal cord injuries but other conditions such as stroke. 

Certain scientists are sceptical of what the study shows. “One case of a patient improving neurological impairment after spinal cord knife injury following nerve and olfactory cell transplantation is simply anecdotal and cannot represent any solid scientific evidence to elaborate upon”, said Dr Simone Di Giovanni, Chair in Restorative Neuroscience, Imperial College London.

But others say the technique is quite promising: “I think there’s good reason to be optimistic” wrote Dr Paul Zachary Myers of the University of Minnesota Morris. “It has to be a realistic hope — progress has been made. A cure does not exist. But that’s still some pretty good news.”

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October
18
  11:37:00 PM

Italian nurse may have killed 38 nursing home patients

A 42-year-old Italian nurse has been arrested over one death in a nursing home in the northern city of Lugo. But she is suspected of killing as many as 38 because they annoyed her. According to Italian media Daniela Poggioli even took selfies with some of the dead patients. “In all my professional years of seeing shocking photos, there have been few like these,” said Alessandro Mancini, the chief prosecutor of Ravenna.

The police investigation will be difficult, as the alleged method was an injection of potassium chloride, which is undetectable after a few days.

Some of Ms Poggioli’s colleagues suspected that something was wrong because so many patients were dying, far more above the average. She was also uncooperative and gave some patients laxatives just before the next shift to inconvenience other nurses. She also used to give patients sedatives to ensure that they would be quiet. 

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October
18
  11:31:00 PM

Swedes succeed in first womb transplant

Doctors at the University of Gothenburg, in Sweden, have delivered the first baby to have been gestated in a transplanted womb. The child, a boy, is healthy and normally developed.

The goal of the Gothenburg project, headed by Professor Mats Brännström, is to enable women who were born without a womb or who have lost their wombs in cancer surgery to give birth to their own children.

Nine women in the project have received a womb from live donors – in most cases the recipient’s mother but also other family members and close friends. The transplanted uterus was removed in two cases, in one case due to a serious infection and in the other due to blood clots in the transplanted blood vessels.

The other women have in 2014 tried to become pregnant through a process where their own embryos, produced through IVF, are reintroduced to the transplanted uterus. Professor Brännström hopes that the remaining six women will also have successful pregnancies.

The successful delivery is considered a major step forward. “It gives us scientific evidence that the concept of uterus transplantation can be used to treat uterine factor infertility, which up to now has remained the last untreatable form of female infertility. It also shows that transplants with a live donor are possible, including if the donor is past menopause,” says Brännström.

Richard Smith, a gynaecological surgeon at Queen Charlotte's Hospital in London, has already applied to perform the procedure on five women. He says that he has a waiting list of 60 women.

As Dr Amel Alghrani, a law lecturer at the University of Liverpool, points out in BioNews, success could open up some ethical issues. What will happen when a male to female transgendered person asks for a womb transplant? “Once this occurs, by default, will we have discovered the science to achieve male pregnancy and the prospect of unisex gestation?” she asks. 

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October
18
  11:25:00 PM

Swedish feminists condemn surrogacy

Swedish feminists have issued a policy paper condemning commercial surrogacy and calling upon their government to ban the practice. The Swedish Women’s Lobby (Sveriges Kvinnolobby) argues that surrogacy is a health risk and violates poor women’s human rights.

“Allowing surrogacy is to make use of women’s bodies and reproductive organs for the enjoyment of someone else, to the detriment of the woman herself. We premiere the right to bodily integrity and fundamental human rights over the right to children, which is in fact not a human right, but has been treated as such in the discourse on surrogacy. We renounce the view of a liberal market- approach to surrogacy and the right of the paying buyers which are [privileged] whilst women’s rights are negotiated.
“ … we are seeing a trend towards a dismantling of these fundamental rights in favor of the will and want of individuals to become parents in the name of their individual fulfillment. The issue of surrogacy has been treated within the discourse of reproductive rights and the means of childless parents to have a baby, when the human rights perspective is the only plausible in dealing with this issue. We find that the current investigation in Sweden is being issued on the wrong grounds and that the set of voices that are asking for an investigation are lacking a human rights perspective. We therefore call on the Swedish government to forbid surrogacy motherhood.
“An end needs to be put to the industry of surrogacy that reduces the female body to a container! Having a feminist approach to surrogacy means rejecting the idea that women can be used as containers and their reproductive capabilities can be bought. The right to bodily integrity is a right which should not be able to be negotiated by any form of contract. No matter the regulation or the nature of the contract, it still remains a trade with women’s bodies and with children. The rights of women and children, not the interest of the buyer, must be the focus of the debate surrounding surrogacy.”
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October
18
  6:42:00 PM

What do we do when biohazards are human?

Bioethicists are debating the ethics of quarantine as governments around the world move to contain the spread of Ebola. The UN announced on Thursday that it is drafting guidelines to prevent human rights violations against people suspected of having Ebola. UN High Commissioner for Human Rights Zeid Raad al-Hussein cautioned against imposing criminal punishments on those who refuse isolation, saying that it might have the opposite effect.

A number of leading American bioethicists have defended the practice, arguing that it “takes precedence” over certain rights of the individual.

In a recent article in Time magazine, Art Caplan and Alison Bateman-House of NYU argued that freedom of movement must at times be restricted: “in the face of a threat of death, liberty can and should be, as we are watching in Dallas, limited so that you can’t move around freely and infect others.”

They did, however, stress the need to provide for the particular needs of different persons quarantined:  “If you are poor you are going to need more resources to get you through then if you are rich.”

Craig Klugman of De Paul University criticised the individualism of those who fail to voluntarily isolate themselves: “Why can’t people be trusted to do the right thing?...Has our worship at the altar of individualism gone so far that we are willing to spread a deadly disease to simply satisfy our desire for soup?” Klugman asks people to accept a program of voluntary isolation. When this fails duress may be legitimately used. 

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October
18
  6:34:00 PM

US officials try to hose down Ebola fears

As the Ebola outbreak grows in scale – with cases now reported in Spain and the US – experts are becoming increasingly concerned about public hysteria. According to a new Washington Post-ABC News poll, two-thirds of Americans are now worried about an Ebola epidemic in the US, and more than 4 in 10 are "very" or "somewhat worried" that they or a close family member might catch the virus.

Some experts see the next few weeks as crucial to containing mounting anxiety. “Officials will have to be very, very careful,” said Paul Slovic, president of Decision Research, a non-profit that studies public health and perceptions of threat. “Once trust starts to erode, the next time they tell you not to worry — you worry.”

DuPont, a company that manufactures protective suits, said it has more than tripled its production since the start of the outbreak in March. Kimberly-Clark, which also produces protective clothing, said it had seen a 20-30% rise in sales compared with this time last year.

Many elements of the Ebola threat are conducive to public hysteria, experts say. It is invisible and deadly – and this has been graphically illustrated through gruesome pictures reported home from Africa. It’s also a disease that personally we can do little to limit. 

In a speech on Wednesday, US President Barack Obama echoed countless healthcare officials and tried to allay public fears: “If we follow these protocols properly... the likelihood of widespread Ebola outbreaks in this country is very, very low”. 

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October
18
  3:00:00 AM

Bestiality to be banned in Denmark

Denmark plans to ban bestiality – a practice that has long been illegal in other European nations. Danish food and agricultural minister Dan Jorgensen said that the practice was harming animals and damaging the country’s image. Speaking in an interview with Ekstra Bladet, a Danish tabloid, Jorgensen commented: “I have decided that we should ban sex with animals. That is happening for numerous reasons. The most important is that in the vast majority of cases it is an attack against the animals.”

“It is also damaging to our country's reputation to allow this practice to continue here while it is banned elsewhere”, he continued.

There has been a significant rise in underground animal sex tourism in Denmark since its neighbours Norway, Sweden and Germany outlawed bestiality. A recent Gallup poll revealed 76% of Danes supported a ban on animal sex.

Bioethicist Wesley Smith criticised the motivations behind the ban, saying that it failed to acknowledge the impact of the practice on human dignity:  “Bestiality is so very wrong not only because using animals sexually is abusive, but because such behavior is profoundly degrading and utterly subversive to the crucial understanding that human beings are unique, special, and of the highest moral worth in the known universe”. 

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October
17
  8:57:00 PM

A cool, rational analysis of egg freezing

With egg freezing rapidly becoming a fashionable reproductive option, the Harvard Law and Policy Review has published a survey article about the dangers of this form of fertility preservation. Barry University law professor Seema Mohapatra surveys the medico-ethical, legal and social complexities of egg freezing in an impressive literature survey entitled ‘Using Egg Freezing to Extend the Biological Clock: Fertility Insurance or False Hope?’.

Considering all the latest studies, Mohapatra argues that egg freezing needs to be treated with appropriate caution by medical practitioners and the general public.

Mohapatra discusses the scientific risks of freezing, emphasising that significant doubt remains about the safety of the procedure:  

“Although the American Society of Reproductive Medicine ('ASRM') removed the 'experimental' label from egg freezing, ASRM was careful not to endorse the practice. In fact, ASRM actually found a 'lack of data on safety, efficacy, cost-effectiveness, and potential emotional risks' associated with egg freezing. In addition, ASRM warned against the widespread use of egg freezing because it may 'give women false hope and encourage women to delay childbearing.'”

Mohapatra speculates about possible social pressures that could develop as egg freezing becomes more popular:

“I worry that if egg freezing is embraced by employers as a way to delay the 'opting-out' concept, those women who wish to have a child when they are younger may be seen as less committed and this reproductive 'option' may become more of a perceived requirement. To counter this concern, I suggest a more robust informed consent process, similar to the process used in research.”

Her chief recommendation is that doctors be required to provide more detailed information about the risks of the procedure to satisfy informed consent requirements:

“I argue that physicians should approach egg freezing for social reasons more as research than as treatment, and thus should be required to disclose that there are unforeseeable risks associated with the process.”

This is a highly useful resource for those trying to understand the various legal, ethical and sociological issues surrounding a new and increasingly popular form of reproductive technology. 

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Radical measures to prevent the spread of Ebola in hospitals
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24 Oct 2014
The enormous potential of adult stem cell treatments
24 Oct 2014
Italian nurse may have killed 38 nursing home patients
18 Oct 2014
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18 Oct 2014

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