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  10:45:00 PM

Ebola outbreak prompts ethical questions

The worst-ever Ebola outbreak has prompted bioethical discussion on two fronts. The viral disease has killed about 1,000 people in West Africa, mostly in Guinea, Sierra Leone and Liberia. A few cases have been diagnosed in Nigeria. The chances of dying in this outbreak are about 50%. Newspapers in Western countries like the US, the UK and Australia are highlighting the possibility of their own epidemics. The World Health Organisation has declared it an international public health emergency, although it has not suggested general bans on travel or trade.

The first issue, as bioethicist Arthur Caplan points out, is that developed countries only worry about exotic diseases like Ebola when it threatens them:

“The harsh ethical truth is the Ebola epidemic happened because few people in the wealthy nations of the world cared enough to do anything about it. We do need headlines about Ebola. They should ask how did this incurable plague get out of control in Africa when medicine knows how to contain it? What are we going to do to fund research to find vaccines and treatments for diseases that don’t immediately threaten us, but kill a lot of people in far away lands? A public health policy that ends at our borders is not fair, just or even smart.”

The second is equitable distribution of a vaccine. There is no approved vaccine at the moment. A small American company, Mapp Biopharmaceutical, has been testing a vaccine called ZMapp on animals. But no one knows whether it is safe or effective on humans. Only a handful of doses at the moment and scaling up production to thousands of doses would take months.

However, two white American medical missionaries, Kent Brantly and Nancy Writebol, who contracted the disease in Africa have been given two precious doses of ZMapp and seem to be improving. Why were they chosen instead of Africans? Apparently it is regarded as good practice to treat "first responders" first because of a social responsibility to help those who help others.

"These were people who had volunteered to put themselves in harm's way to help people who were affected by this," bioethicist G. Kevin Donovan, of Georgetown University Medical Center in Washington told USA Today. "It's not unreasonable for them to have the expectation that we would try to help them."

But bioethicists are chary of manufacturing an untested drug to distribute in West Africa. ZMapp is unproven. The partial recovery of the two missionaries may have had nothing to do with the drug. Instead of curing people, it might make them worse.

The WHO has convoked a gathering to discuss the ethics of providing an untested vaccine. “We are in an unusual situation in this outbreak. We have a disease with a high fatality rate without any proven treatment or vaccine,” says Dr Marie-Paule Kieny, of the WHO. "We need to ask the medical ethicists to give us guidance on what the responsible thing to do is.”

Some doctors have argued that African governments should make up their own minds on the ethics. Writing in the Wall Street Journal, three doctors contended that “African governments should be allowed to make informed decisions about whether or not to use these products, for example to protect and treat health-care workers who run especially high risks of infection.”

Arthur Caplan takes another tack. He favours boosting public health response in West Africa which so far has been chaotic and underfunded. “Morally, everyone is keenly interested in who should get the drug,” he told the New York Times. “But the most important moral question is, ‘What is the best thing to do to bring that outbreak to a close? And I don’t think it’s drugs.’”

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  9:13:00 PM

The world of Chinese surrogacy

This New York Times video sketches the burgeoning Chinese surrogacy industry. Although it is technically illegal, there are many loopholes and the country now has an estimated 1,000 surrogate mother brokers. The Times interviews the CEO of Baby Plan Medical Technology Company who says that his business has four branches and a track record of 300 babies.

The children are expensive: US$240,000. The Times features a surrogate from the impoverished countryside who hopes to solve her financial problems with the pregnancy. Baby Plan provides her with good medical care but sequesters her in a flat for the duration of her pregnancy. “Our liaison staff tells them every day that the baby in your stomach isn’t your baby,” says the CEO. “A nice way of putting it is emotional comfort; less nice is brainwashing.”

An extraordinarily thought-provoking article. 

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  8:58:00 PM

Should governments pay for sex for the disabled?

Most social work students probably do not imagine that their career might require them to play the pander. But finding prostitutes for disabled clients is sometimes part of the job description, even though both the legality and morality of this practice are disputed. Another voice was added this week to long-simmering debate in the pages of the Journal of Medical Ethics over this issue.

Back in 2009 Dr Jacob M. Appel, a New York psychiatrist with a flair for controversy, argued that “sexual pleasure as a fundamental right that should be available to all”. Hence, if the disabled were unable to experience this, the government should step in and provide subsidised prostitution. “As a society, we also provide food for those who cannot feed themselves—even delivering it to their homes, when required. Sexual pleasure ought not be viewed any differently.”

Dr Appel acknowledged that he supports neonatal euthanasia for severely disabled infants. However, he contends, if society has erred in allowing these children to life, it is a matter of justice to offer them the possibility of sexual pleasure.

In 2011 Dr Ezio Di Nucci, of the University of Duisburg-Essen weighed in. He agreed that severely disabled individuals should be helped to satisfy their sexual interests. But he questioned whether this should happen at the public expense. He proposed instead that “the sexual interests and needs of the severely disabled be met by charitable non-profit organisations, whose members would voluntarily and freely provide sexual pleasure to the severely disabled”. He thinks that this is superior to Appel’s proposal because, amongst other reasons, it would not require the legalisation of prostitution.

A powerful argument against providing the disabled with sexual services is that it assumes a regime of legalised prostitution – which many feel is demeaning and harmful to women. The most recent contributor to the debate, Dr Frej Klem Thomsen, of Roskilde University, in Denmark, tackles this problem. He says that the issue is complex and unclear, but that there seems to be sufficient justification for allowed a legal exception. In other words, prostitutes could service the disabled, but only the disabled. 

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  5:24:00 PM

Should we eliminate all suffering in the world?

Many sci-fi novels consider what life would be like without suffering. Philosopher David Pearce believes we can have such a life - and indeed, that we have a moral imperative to pursue it.

Pearce calls himself a negative utilitarian. Our moral calculus should be informed by a desire to limit as much as possible the suffering of all sentient beings. Pearce adopts a similar position to Peter Singer regarding the moral status of animals. Animals can suffer just like human beings, and this biological similarity gives them moral standing.

Pearce takes this hedonistic ethic to its extreme conclusions. In a recent interview with the futurist magazine IO8, Pearce spoke of our “headonistic imperative” to genetically alter all sentient life such that there is no suffering on earth. “Human and nonhuman animals are alike in an ethically critical respect...No sentient being wants to be harmed — to be asphyxiated, dismembered, or eaten alive.”

Pearce argues that we should “get rid of predation” through “genetically re-engineering” the biosphere. Pearce believes that technologies such as CRISPR will allow us to selectively edit out undesirable genes from the genetic code of all kinds of sentient life.

“Even sober-minded scientists describe the CRISPR revolution as "jaw-dropping". Gene drives can spread genetic changes to the rest of the population.”

Pearce believes that we could get to a point where there was no suffering whatsover on the earth:

“there is nothing to stop intelligent agents from identifying the molecular signature of experience below hedonic zero and eliminating it altogether — even in insects...I tentatively predict that the world's last unpleasant experience in our forward light-cone will be a precisely datable event — perhaps some micro-pain in an obscure marine invertebrate a few centuries hence.”

Pearce believes that such a life would be a near utopia:

“If we get things right, the future of life in the universe can be wonderful beyond the bounds of human imagination: a "triple S" civilisation of superlongevity, superintelligence and superhappiness.”

Pearce claims that we can create a more engaging world than the dull existence of the characters of Brave New World. Many are sceptical.

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  9:25:00 AM

Japanese stem cell scientist found dead after retracted papers

A leading Japanese stem cell researcher has committed suicide in the wake of retractions of papers which he co-authored. Yoshiki Sasai, 52, deputy director of the Riken Center for Developmental Biology, was discovered by a security guard and died in hospital about two hours later. Suicide notes were apparently found but the contents have not been disclosed.

Dr Sasai was a colleague of lead author Haruko Obokata on two stem-cell papers published in Nature earlier this year. The papers claimed that bathing cells in a mild acid could make them revert to a pluripotent, or even totipotent state. But the resutls were challenged after other scientists could not replicate them. It was soon discovered that some of the data was fatally flawed.

An investigation by the Riken Centre found that Ms Obokata was guilty of research misconduct, but not Dr Sasai. However, the scandal badly damaged Riken’s reputation and Dr Sasai told the Wall Street Journal earlier this year that he was "overwhelmed with shame" over his failure to supervise the research project adequately. 

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  4:30:00 PM

New Thai laws leave hundreds of babies in limbo

New surrogacy regulations introduced by the Thai junta government have placed hundreds of surrogate newborns and fetuses in legal limbo.

Yesterday the National Council of Peace and Order - the current Thai interim government - announced a blanket ban on commercial surrogacy arrangements, strictly limiting surrogacy to altruistic arrangements involving blood relatives. The regulations are a ratification of extant restrictions in the code of ethics of the Thai Medical Council.

It is unclear what effect the new ban will have on ongoing surrogacy arrangements involving couples from other countries.

NCPO spokesman Colonel Winthai Suvaree said yesterday the law would allow infants who have just been born to be suckled by their birth mothers for six months, but then would allow the baby to be taken home by parents.

Health Ministry general-secretary Samphan Komrit did not give a definitive answer to questions about fetuses of foreign biological parents currently being carried by surrogates. He only said that such cases would be dealt with “according to morality”.

Australian couples are concerned about the fate of their children being carried by surrogates.

Talking with The Australian, an anonymous Australian woman spoke of her concern of her surrogate “going underground” to avoid prosecution.

“We are due to go there in eight weeks but we are really worried about whether we will be able to leave with the baby.”

The regulations come in the wake of the controversy surrounding a down syndrome child left by her Australian parents with a surrogate mother in Thailand.

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  4:20:00 PM

Controversy over Canadian fertility clinic’s mixed-race IVF prohibition

A Canadian fertility clinic has come under intense scrutiny for refusing to provide IVF for parents of different races. The Regional Fertility Program, which until recently had an official policy of not creating mixed-race babies, garnered media attention after one of its doctors told a single caucasian women she could only be inseminated with sperm from a white male. 

Dr. Calvin Green, the clinic’s administrative director, claimed that mixed-race IVF promotes a designer baby culture: “I’m not sure that we should be creating rainbow families just because some single woman decides that that’s what she wants”. 

In a statement last last month the clinic announced that it now provides mixed-race IVF, and that Dr. Greene’s comments merely indicate his own personal opinion.

Commentators have slammed the clinic former policy.

“This is not something that’s ethical”, said Gloria Poirier, executive director of the Infertility Awareness Association of Canada. “We certainly don’t support that”.

"If the assumption is that it is not in the best interest to be in a racially mixed family, that's very bizarre”, said bioethicist Kerry Bowman from the University of Toronto. "Women will decide for themselves how they want their family to be constructed."

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  4:04:00 PM

#Repligate: Social priming research in crisis

Debate over social priming research has intensified following an inquiry into the replicability of priming experiments. In a special issue of the journal Social Psychology a team of researchers conlcuded that out of seven “important findings” in the field of social priming, only one could be replicated.

The replication experiments were conducted by research groups such as the Many Labs Replication Project. Each study was reviewed in multiple research labs. 

Some of unreproducible studies included Simone Schall’s cleanliness and morality investigation and a widely publicized study into the effects of flag priming on conservative values

The grim findings, say those involved in the replication attempts, indicate the need for “crowdsourcing dozens of laboratories” to achieve accuracy and reliability.

The authors of the original studies think otherwise. Simone Schall has accused the editors of Social Psychology of “defamation”. Schall claimed that the method of the replication was flawed and has published a scathing response in the June edition of the journal. 

The replication trend is likely to continue, with the Journal of Personality and Social Psychology recently announcing it will allow for the publication of replication studies - a groundbreaking shift from their previous editorial moratorium on such papers.  

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  3:44:00 PM

Calls for regulation as Iran’s kidney trade spirals out of control

Street art in Tehran depicting an organ auction

Street art in Tehran depicting an organ auction / The Guardian

The peak body overseeing Iran’s kidney trade is lobbying the government for tighter regulation on foreign nationals procuring kidney transplants. According to Mostafa Qasemi, the head of the Charity Association for the Support of Kidney Patients (CASKP), many foreigners are entering the country with false documentation and procuring transplants in from unscrupulous doctors.

“These patients enter the country with false documents; doctors do not examine their documents and are paid millions to carry out a kidney transplant for them”, Quasemi said.

Quasemi referred to the case of two Saudi men who recently travelled to Iran and bribed doctors and patients for transplants. One of the Saudi men died, and an ensuing investigation led to the arrest of medical staff and group of people smugglers.

The government has hit back, accusing the CASKP of negligence. Ministry of Health representative Katayoon Najafizadeh said that the CASKP is responsible for issuing permits for all non-familial transplant arrangements. They have failed to ensure fake permits aren’t produced and accepted. “The Charity Association for the Support of Kidney Patients is responsible for this situation and must be held accountable”, he said.

Iran is the only nation in which the buying and selling of kidneys is legal. The market is regulated by two organisations - the CASKP, an NGO,  and the Ministry of Health’s Charity Foundation for Special Diseases. More than 2,300 kidney transplants are carried out in the country each year.

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  11:12:00 PM

Thailand cracks down on surrogacy

An Australian couple who commissioned a surrogate mother in rural Thailand abandoned a Down syndrome twin and left him with his impoverished mother, according to the Sydney Morning Herald.

The story of 21-year-old Pattharamon Janbua, who is married with a three-year-old and a six-year-old in Chonburi province in northern Thailand, emerged as the Thai military government begins to crack down on Thailand’s burgeoning surrogacy industry.

The couple asked her to abort the Down syndrome boy, named Gammy, but she refused. After the birth, the surrogacy agent took the girl twin and left the boy with the surrogate. Now Ms Pattharamon realises that she had been terribly naïve. Gammy has serious heart problems and without an operation, he will probably die. The agent cheated Ms Pattharamon of a good chunk of her fee; she never met the commissioning couple. 

“I asked the agency, ‘Did I have to sleep with the man?’ I was an innocent young girl and I don’t know about this business," she told the SMH. "The agent told me, ‘We are going to make a glass tube baby,’ but I didn’t understand. “My husband agreed because we didn’t have money to pay our debt and I didn’t need to have sex with another man.”

The case has been widely publicised in Australia. This is "an incredibly sad story," said Prime Minister Tony Abbott. "I guess it illustrates some of the pitfalls involved in this particular business. It's a very, very sad story and I hate to think that a child could be abandoned like that." 

To put a stop to abuses like this, the military government plans to ban commercial surrogacy. From now on, the intended parents have to be married, heterosexual and medically infertile, the transaction must be altruistic, and the surrogate must be related to the intended parents. If the law is enforced, it will end a booming industry.

“The recent change in law in Thailand is likely to particularly impact upon same-sex couples, with many of the popular ‘low-cost’ destinations for surrogacy restricting surrogacy to married heterosexual couples," says Anne-Marie Hutchinson, of Dawson Cornwell, a UK family law firm.

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