Euthanasia claimed its most famous victim last Saturday. At the age of 95, Belgian Nobel laureate Christian de Duve was killed with a lethal injection. He died in his home, surrounded by his four children.
He had planned his death for weeks and even explained his reasons and his philosophy of life in a long interview with the Belgian newspaper Le Soir. This was published immediately after his demise. Apparently de Duve had cancer, but he had also fallen down on April 1 and spent several humiliating hours on the floor. He took it as a sign of worse to come and decided to set a date for his euthanasia – which is legal in Belgium.
Born in 1917, Dr de Duve was deservedly famous in Belgium as its only living Nobel laureate. He shared the 1974 Nobel in Physiology or Medicine with Albert Claude and George E. Palade. His contribution was describing the structure and function of discovered peroxisomes and lysosomes, small structures within cells. In his very active retirement, he devoted himself to writing about the origin of life.
No doubt de Duve’s death will be used by the euthanasia and assisted suicide lobbies in the UK, the US, Canada, Australia and elsewhere as an advertisement for legalisation. Belgian notables tumbled over themselves to eulogise his memory. Prime Minister Elio Di Rupo praised his exemplary career and public spirit. Leading politician Paul Magnette lauded his conviction and courage. P.Z. Meyers, of the popular blog Pharyngula, exclaimed: “What a dignified and honorable way to go!”
Controversy continues to rage over whether or not to establish a market in organs to shorten steadily growing waiting lists. One objection is that applying a market model will result in exploitation and moral corruption.
Armin Falk, of the University of Bonn, and Nora Szech, of the University of Bamberg, claim that in comparison to non-market decisions, people’s moral standards are significantly lower if they participate in markets.
In a number of different experiments, several hundred subjects were confronted with the moral decision between receiving a monetary amount and killing a laboratory mouse versus saving the life of a mouse and foregoing the monetary amount.
The animals involved in the study were "surplus mice", which had been raised in laboratories outside Germany and were no longer needed for research. Without the experiment, they would have all been killed. If a subject decided to save a mouse, the experimenters bought the animal and housed it in a healthy environment for the rest of its life.
Falk and Szech found that a significantly higher number of participants in their experiments were willing to accept the killing of a mouse in market conditions. "In markets, people face several mechanisms that may lower their feelings of guilt and responsibility," says Szech. In market situations, people focus on competition and profits rather than on moral concerns. Guilt can be shared with other traders. In addition, people see that others violate moral norms as well.
In addition, in markets with many buyers and sellers, subjects may justify their behavior by stressing that their impact on outcomes is negligible. "If I don't buy or sell now, someone else will."
This is certain to provoke heated disagreement, especially in the US, where devotion to the market economy approaches religious fervour in some circles. However, Falk and Szech stress that they recognise the benefits of markets; they simply want to show that markets do tend to erode moral standards. They also acknowledge that the alternative, a command economy or a totalitarian system, does not produce more ethical outcomes.
Like many women, she felt that she was exempt from age-related fertility decline. When she marries in her mid-30s, she was shocked to discover that she had endometrial cysts on her ovaries. Then she turned to IVF treatment. When that failed after four cycles, she turned to two egg donors. These both failed.
Drawing on her own experience, Zoll has written an eye-opening memoir. As a professional human rights and health advocate, she is well-qualified to investigate the fertility industry. It is not a cheerful story. She writes:
“The fact is, in the United States, there is virtually no oversight of any aspect of the industry, and few if any long-term studies tracking the health of women undergoing treatments or the babies born from them. The only requirement is the Fertility Clinic Success Rate and Certification Act of 1992 -- a ‘law’ that loosely mandates clinics to report their annual ‘success rates’ to the Centers for Disease Control.
“In the course of my research I discovered that the vast majority of assisted reproductive technologies fail. Around the globe in 2012, approximately 1.5 million ART cycles were performed, with an estimated 1.1 million failed cycles (76.7 percent). In 2010 in the United States, the most recent data available from the Centers for Disease Control reveals that of the estimated 150,000 ART cycles conducted, approximately 103,000 (68.6 percent) failed.”
The goal of Cracked Open to ignite a consumer-driven public education movement as a counterweight to decades of uncritical media coverage. Zoll would like to see more protection for women undergoing treatment and their children.
The concept of 'wrongful birth' has suffered another defeat, this time in Australia. A New South Wales couple has lost a case in which they sued an IVF specialist for failing to indicate their child's chance of a disability.
Lawrence and Debbie Waller lodged the claim against Dr Christopher James, a gynaecologist who helped them conceive their son by IVF. They claim that Dr. James did not inform them of the 50% chance that their son would inherit a rare blood-clotting condition, antithrombin deficiency.
A few days after birth in August 2000, their son Keeden had a stroke which left him disabled for life. The Wallers claimed the stroke occurred partly because of a blood-clotting condition inherited from his father.
The judge concluded, based on evidence from medical expert called by the defendant, that Keeden's antithrombin condition ''at most was a minor contributing factor and was possibly irrelevant to the outcome''. The Wallers had claimed $10 million in damages.
Courts around the world have been very reluctant to recognise claims of “wrongful birth” as this would require them to admit that non-existence is superior to existence. It is yet to be recognized as a cause of action in 25 US states. However, in some US state courts significant damages have been awarded to parents making such claims.
Poland's Justice Minster was sacked this week after accusing German scientists of importing Polish embryos for experiments. Jaroslaw Gowin, a well-known conservative figure in Poland's centre-right Civic Platform party, was dismissed on Monday by Prime Minister Donald Tusk. In an interview on Polish television last week, Gowin claimed that "German scientists are importing embryos from other countries, probably also from Poland, and conducting experiments on them".
Tusk claimed that he sacked Gowin not for his opposition to IVF but rather because of his abrasive style: 'I have no time to comment every week on a minister's behaviour only because he goes too far in politicising the issues which are in the realm of his public activity', he told Polskie Radio. Gowin has defended his comments, citing information from Polish doctors working in IVF clinics.
Last month the German Embassy in Warsaw asked for clarification on a statement made by Gowin elsewhere, after he claimed that Polish embryos were being sold to German scientists.
Currently IVF is unregulated in Poland and entirely privately financed. However from July state funding will be made available for 15,000 couples as part of a three-year IVF programme.
A media firestorm broke out last week after Harvard’s celebrity economic historian Niall Ferguson offered a crude assessment of the key to Keyesian economics. At a conference in the US last week, he said Keynes did not care about future generations because he was a homosexual and therefore childless. Subsequently Ferguson made an “unqualified apology” on his blog.
Instead of baying about homophobia in the media pack, London columnist Brendan O’Neill ran down a different angle on Keynes: that he was a eugenicist zealot. A number of commentators have recalled that Keynes was director of the British Eugenics Society from 1937 to 1944. Keynes called eugenics "the most important, significant and, I would add, genuine branch of sociology which exists." In one of his unpublished essays, he endorsed the legalisation of birth control because of the irresponsibility of working-class Britons:
“To put difficulties in the way of the use of [contraception] checks increases the proportion of the population born from those who from drunkenness or ignorance or extreme lack of prudence are not only incapable of virtue but incapable also of that degree of prudence which is involved in the use of checks.”
O'Neill provocatively concludes, "it is wrong to say Keynes didn’t care about future generations. He cared about some of them – the well-bred, genetically good ones. And to the extent that he didn’t care about the future offspring of the poor and dumb, well, it wasn’t his gayness that made him feel that way, but rather the mean-spirited Malthusianism".
For A$12,000 Global Health travel is offering 11 days in a luxury Bangkok hotel while couples undergo IVF treatment to choose a baby boy or girl. Cells are taken from the three-day-old embryo for gender screening, and a boy or girl is implanted before the pregnant woman flies home a few days later.
''Some people bring their whole family and make a holiday of it,'' Global Health Travel managing director Cassandra Italia said yesterday. ''It isn't something just the wealthy are doing, and we get 10 to 20 inquiries a month.''
There have been calls for the Australian National Health and Medical Research Council (NHMRC) to revise prohibitions on the use of IVF for sex-selection. A NHMRC spokesperson said that the guidelines won't be reconsidered until 2015. For now, Australian couples will have travel to countries like Thailand, the US or Cyprus where the procedure is legal. Now thanks to advances in travel medicine they can now make a holiday of it.
Remember the battle over what brain-damaged Florida woman Terri Schiavo would have wanted if she were conscious? The case for removing life support rested on the claim that she had said that she would have wanted a feeding tube to be removed. With more cases like hers coming before the courts, lawyers are advising people to make living wills. But how valid are statements, oral or written, made in the past about present preferences?
A recent article in the Journal of Medical Ethics tackles this difficult topic. In “Significance of Past Statements: Speech Act Theory”, Joanne Gordon contends that past utterances do not always express a person’s preferences for how she would like to be treated. They can only be intended to provoke a psychological reaction in her listeners.
Gordon uses speech act theory -- a philosophical theory about the nature and significance of verbal utterances -- to analyse statements about end-of-life care. People may not intend that their statements express a treatment preference. Rather, they want to create a particular impression -- to comfort, to shock, to inspire, and so forth. For example, the statement “I don’t want to be dependent on others” may not necessarily express a treatment preference. Rather, "an individual could conceivably be acting insincerely to generate a perception of himself/herself as a fiercely independent". Gordon also offers the example of comments made to a loved one in residential care:
“'I hope when I’m older I end up somewhere nice like this' or 'I’d love to be waited on hand and foot'...It seems reasonable to suggest that [the speaker] may not possess any such positive thoughts or attitudes about dependency but is using these words purely to bring about a comforting or reassuring effect."
Gordon concludes that "Speech act theory shows us that statements can also be ‘hollow’ groups of
words, which we frequently use with the sole purpose of bringing about psychological effects on our audiences in everyday social interactions." She concludes that greater attention be given to the context in which utterances are made, their consistency of other statements, their overall personal narrative.
In late February last year, two Italian academics working at Monash University in Australia flicked a match into a highly combustible pile of old abortion debates, caricatures of pointy-headed academics, news-hungry journalists and recycled Go-Home-Peter-Singer posters.
Alberto Giubilini and Francesca Minerva’s article in the UK-based Journal of Medical Ethics was “After-birth abortion: why should the baby live?” It wasn’t a very original argument for the morality of infanticide – Peter Singer and Michael Tooley had made the same point decades ago – but the arresting title tossed even more petrol on the blaze. The authors contended that the same reasons which justify abortion are also sufficient to justify killing a child up for an unspecified time after birth.
“If criteria such as the costs (social, psychological, economic) for the potential parents are good enough reasons for having an abortion even when the fetus is healthy, if the moral status of the newborn is the same as that of the foetus and if neither has any moral value by virtue of being a potential person, then the same reasons which justify abortion should also justify the killing of the potential person when it is at the stage of a newborn.”
BioEdge may have been the first to pick up the story, but it went viral when it appeared on The Blaze, the website of American shock-jock Glenn Beck. There it attracted hundreds of comments. Many of these were not supportive -- fairly typical was: “These people are evil. Pure evil. That they feel safe in putting their twisted thoughts into words reveals how far we have fallen as a society.” From there it moved into all the major news media. There were well over 2,000 comments in the London Telegraph. The authors were attacked in the US Congress.
Since it may have been the first time that many readers of The Blaze and even many journalists had ever heard of bioethicists, the publicity may have been a major setback for the public image of bioethics. The controversy continued for weeks. Giubilina and Minerva received hundreds of emails, some of them containing death threats.
Now that the dust has died down, the Journal of Medical Ethics, a redoubt of utilitarian ethics, has responded to the crisis with a special issue containing 31 commentaries from a range of ethicists, some of whom have argued for years that infanticide can be a moral action; others who believe that even suggesting it is a vile stain on academic integrity. Editor Julian Savulescu introduces the issue with these words:
“Infanticide is an important issue and one worthy of scholarly attention because it touches on an area of concern that few societies have had the courage to tackle honestly and openly: euthanasia. We hope that the papers in this issue will stimulate ethical reflection on practices of euthanasia that are occurring and its proper justification and limits.”
Some bioethicists who feel at home in the utilitarian common room of the Journal of Medical Ethics described the imbroglio as an attack on academic freedom. Udo Schüklenk, of Queen’s University, in Ontario, who is also the editor of Bioethics, a distinguished international journal, complained bitterly that “bioethics journals are under increasing and sustained fire from political activists” of all stripes, from “the left, feminists, disability activists [to] religious conservatives”.
He singles out two gadflies who “busily scan bioethics journals for evidence of the secular liberal bias they claim exists … and also attack, pretty much immediately, papers—and by extension the journals that publish them—that they disagree with.”
The first is Wesley J. Smith, the editor of the Human Exceptionalism blog on the website of the US magazine National Review Online. The other is the editor of BioEdge, whose “outputs are routinely picked up by search engines such as Google's news service, thereby arguably providing the site with a larger real-world impact than most bioethics journals could dream of”.
Of the two, although he regards both as “agitprop”, Dr Schüklenk prefers BioEdge which, he says, “is less caught up in the US culture wars, so there is less of a permanent doomsday flavour to its outputs”.
But the controversy also brought to light a difficult issue for editors of bioethics journals. How should they deal with inflammatory theories and articles? Infanticide is not the only topic which is taboo in the media. No doubt an article defending non-voluntary euthanasia for patients in a permanent vegetative state would provoke a similar response. “When all is said and done, this is an academic freedom issue. It has to do with ensuring both that we are able to ask difficult questions, and that we are able to defend conclusions that most people will disagree with.”
Malcolm Oswald, of the University of Manchester, made a novel suggestion. He proposed that bioethics papers be tagged “green papers” or “white papers”. The latter would be purely theoretical discussions; the former practical policy proposals. “Had it been labelled as ‘green’, readers could have understood what Giubilini and Minerva explained later: that it was a discussion of philosophical ideas, and not a policy proposal advocating infanticide.”
Giubilina and Minerva subsequently explained that their article was published as a thought-experiment, not a serious public policy proposal. Schüklenk says that this loss of nerve is a serious failing.
“Bioethics analyses offering practical conclusions are not theoretical games,” he writes. Peter Singer and Michael Tooley, two bioethicists who have defended the moral legitimacy of infanticide, have never asked not to be taken seriously. “Respect for free speech has a flipside, requiring of us to take responsibility for the views that we defend. On what other grounds could we expect our views to be taken seriously. What kind of debate could we reasonably have with discussants who—when cornered—will say ‘I didn't really mean it’?”