In a recent article in The Conversation, Two academics at Emory University in Georgia have proposed a novel solution to problem of providing healthcare for the burgeoning elderly population in Western nations.
Rather than merely advocating an increase in the number of geriatricians, Dr. Jonathan Flacker and Rebecca Dillard argue for “new models of care” that focus on “better coordination of care for older adults”.
“If we want care for older adults that is more than just “good enough,” we need more boots on the ground to provide that care. We don’t just need more geriatricians. We need more pharmacists, nurses, nurse practitioners and physician assistants trained in the special needs of the older patient.”
As an example the authors discuss Acute Care for the Elderly (ACE) units – teams of nurses and nurse practitioners, physicians, social workers and other health-care professionals. They use coordinated care principles to ensure better patient outcomes with a relatively small investment of geriatrician time.
They also refer to the Nurses Improving Care for Healthsystem Elders (NICHE) program, an initiative designed to help nurses stimulate culture change and make healthcare systems more senior friendly.
“In each case, the geriatrician’s expertise is amplified throughout health-care organizations through care systems, better use of resources, technology, financial incentives and teamwork.”
The authors acknowledge that there is also a need for new geriatricians. But too often is this put forward as the only solution:
“What older adults need in order to optimize function and quality of life transcends simply the medical issues and extends to policies and infrastructure of our health-care systems and communities.”
About 70 people accompanied Belgian euthanasia doctor Wim Distelmans on his tour of Auschwitz, the Nazi extermination camp in German-occupied Poland, last month. The German magazine Der Spiegel ran a long, reflective feature which attempted to explain why he dared to link euthanasia to Nazi atrocities .
The tour was highly controversial. In Antwerp ultraorthodox Jews were outraged that Dr Distelmans had described Auschwitz as “an inspiring venue”. They called him “a professional killer”. The deputy director of the Auschwitz memorial commented: "We feel that the attempt to link the history of Auschwitz with the current debate about euthanasia is inappropriate."
Distelmans was not deterred by the protests. His point was that the Nazis violated autonomy while he esteems it. He is killing patients out of humility and love. "What does this mean to us?", Distelmans asked the tour group.
"Many of us are doctors. We have power over other people. We know everything better. We were taught to preserve life. But we have to make sure that we do not continue to treat our patients, against their wills, when they actually want to die. Nobody should assume that they have the power to judge what a life is worth. We must become the servants of our patients, and when it comes to the end, we have to accept our failure as physicians."
A doctor on the tour shared an interesting case. One of his patients is an unrepentant former member of the Waffen SS who had hung a picture of Hitler over his bed. He is paralysed on one side and now be wants to be euthanased. He refused because he felt that the patient did not deserve a gentle, painless death. Another said that he would refuse because “If I killed him, I would feel like a murderer."
And Distelmans? He told Der Spiegel that he would perform the euthanasia out of respect for the man's pain and humanity and as an act of unconditional love.
Assisted suicide is an idea which keeps evolving. Who could have foreseen the development of groups of non-doctors which help hundreds of people to die in Switzerland? Now a bioethicist from the University of Tübingen in Germany has proposed what he calls “commercially assisted suicide” (CAS) – paying a non-doctor to kill patients.
Roland Kipke argues in the journal Bioethics that there are no ethical arguments against CAS which cannot also be deployed against physician-assisted suicide (as in Oregon). It is not a popular cause, as the thought of CAS horrifies both supporters and opponents of assisted suicide.
Kipke rolls out several arguments in favour of CAS. It is not a breach of medical ethics because no doctor is involved. A for-profit provider will be more readily available than a doctor, who may have qualms of conscience.
He takes a very sceptical view of the competence of doctors. A commercial provider may not be skilled at detecting depression, but neither are doctors:
“The most common psychiatric disorder, and, at the same time, the disease that is most commonly associated with suicidal intentions, is depression. Several studies clearly show that a large number of physicians fail to recognize the depressive disorders of their patients. This is particularly remarkable because people with depression account for about 10% of a GP's patients…. Therefore, it is not justified to say that doctors are in general particularly able to assess the conditions for an autonomous decision for suicide.”
Nor are doctors particularly competent at prescribing adequate doses of drugs to commit suicide.
“a doctor does not normally learn (in education and medical practice) how many grams of sodium pentobarbital cause a quick death. Above all, the necessary knowledge about the correct dosage is limited and can easily be acquired by non-physicians.”
Kipke feels that patients would have more autonomy in making their final decision if they use a commercial provider.
“Studies have shown that doctors' assessment of the quality of life and of the suicidal wishes of seriously ill patients depends significantly on the psychological situation of the doctors themselves, and that they systematically underestimate the quality of life of their patients. Quite a few doctors also advocate directive counselling, even on morally controversial issues. It is probable that this is not fundamentally different with regard to their decisions for or against suicide.”
Finally, would CAS be another step forward in the insidious commercialisation of human life? No, says Kipke. “Doctors always earn their living from the needs of their patients: no one takes offence.” Why not a commercial provider?
The situation of civilians under siege by the Assad regime in Syria is even worse than under ISIS, the Islamic extremists, say Syrian doctors. In an op-ed in the New York Times, two doctors claim that at least 560 doctors and nurses have been killed and 155 medical facilities have been attacked since the war began.
Much of the destruction is due to barrel bombs, 44-gallon drums filled with explosives and shrapnel launched from helicopters. “The bombs explode with terrific force and breadth, amputating limbs and driving shrapnel throughout the body. One doctor we interviewed was still horrified by the indelible image of a mother and daughter whose bodies were blown apart while their hands remained clasped together.”
The doctors, Leonard S. Rubenstein, of Johns Hopkins University, and M. Zaher Sahloul, president of the Syrian American Medical Society, claim that the regime’s military is deliberately targeting clinics, field hospitals and ambulances. “When work in a field hospital becomes like death, it is difficult to imagine how life has any chance at all,” they write.
They have called upon the Obama administration to set up humanitarian buffer zones in northern and southern Syria so that civilians can be cared for.
Their words are echoed by a Syrian doctor writing on the blog Syria Deeply:
“We are doctors. We live to help and heal people – not to watch them die. Every one of us living in opposition-held territory of Syria has made a conscious decision: despite all the risks, we will stay and treat whoever needs us… As bombers tear across the sky on their way to dropping their deadly cargo, I wish that the urgency that moved the U.S. and other governments to bomb ISIS was matched by an urgency to save the lives of civilians. Please do not wait until there is no one left to save.”
A gay couple in Britain made history recently when all three of their surrogate mothers presented them with babies within seven months of each other. Daryl Lee, 41, and Luke Harris, 50, had been in a civil partnership for years and had always dreamed of having a family. Mr Harris told The Sun:
“When we told our families we are having our first surrogate baby, they were so excited for us, as they know for the past 15 years we've dreamed of having a family of our own. When we told them we were having a second baby they were amazed. And then, when we announced we're actually having three babies of our own they were stunned but overjoyed."
They had considered adoption, but after learning that singer Elton John and his partner David Furnish had acquired a child with a surrogate mother in 2010, they opted for surrogacy. They found the first surrogate, Becky Ellis, on the internet and she recruited two other women.
“I absolutely love being pregnant,” said Becky, who was a surrogate for the third time. In fact, she told ITV earlier this year that she had wanted to be a surrogate since she was 11 years old. The practice seems to be culturally embedded. The show interviewed her and three other surrogate mothers, Bex Harris, Viktoria Ellis and Jemma King, along with Bex’s mother, who cares for them during their pregnancies. (See photo above.)
The first doctor to be tried in Egypt for performing female genital mutilation has been acquitted, dashing activists’ hopes that a conviction would send a stern message parents and doctors.
Raslan Fadl, a medical doctor and Islamic preacher in the village of Agga, northern Egypt, was on trial for manslaughter after 12-year-old Sohair al-Bata’a died in June 2013 after an operation. He denied that the procedure was FGM and said that his accusers were “on drugs”.
“Of course there will be no stopping any doctor after this. Any doctor can do any FGM he wants now,” Atef Aboelenein, a lawyer for the Women’s Centre for Guidance and Legal Awareness, told The Guardian. Suad Abu-Dayyeh, of Equality Now, said: “It’s a very unjust verdict from the judge. It sends a very negative message. It was the first case in the country and we were hoping we could build on it.”
Made illegal in 2008, FGM still has popular support, especially in rural areas. The Guardian reports:
“According to surveys by Unicef, an estimated 91% of married Egyptian women aged between 15 and 49 have been subjected to FGM, 72% of them by doctors. Unicef’s research suggests support for the practice is gradually falling: 63% of women in the same age bracket supported it in 2008, compared with 82% in 1995.”
“We circumcise all our children – they say it’s good for our girls,” one housewife, told the Guardian earlier this year. “The law won’t stop anything – the villagers will carry on. Our grandfathers did it and so shall we.”
People who say Yes say often explain why by invoking the greatest good for the greatest number so critics have called these fat-man-sacrificers typical utilitarian thinkers. Digging deeper, several researchers have found a correlation between this decision and Machiavellian, egotistic or even psychopathic personalities. Utilitarian=Psychopath has never been a good marketing slogan.
Responding to this interpretation, a leading utilitarian bioethicist, Julian Savulescu, of Oxford University, and colleagues argue in the journal Cognition that this slur is based on a mistake. They looked more closely at people's reactions and found that these “utilitarians” were really motivated by “the more modest, unremarkable, and ordinary thought that it is, ceteris paribus, morally better to save a greater number”. In fact, they were more likely to be moral egotists, whose only motivation is to maximize their own selfish welfare. They were faux utilitarians.
The true utilitarianism, says Savulescu, is a lofty, cerebral and exacting doctrine which is diametrically opposed to egotism:
“Utilitarianism is a radically impartial view: it tells us to consider things as if ‘from the point of view of the universe, without giving any special priority to ourselves, or to those dear or near to us. Instead, we should transcend our narrow, natural sympathies and aim to promote the greater good of humanity as a whole, or even the good of all sentient beings. Needless to say, this view of morality is strongly at odds with traditional ethical views and common intuitions. It is also a highly demanding moral view, requiring us, on some views, to make very great personal sacrifices, such as giving most of our income to help needy strangers in distant countries.”
“Few people if any have ever been anything like a perfect utilitarian. It would require donating one of your kidneys to a perfect stranger. It would require sacrificing your life, family and sleep to the level that enabled you to maximise the well-being of others. Because you could improve the lives of so many, so much, utilitarianism requires enormous sacrifices.”
And then he makes an extraordinary confession:
“People think I am a utilitarian but I am not. I, like nearly everyone else, find Utilitarianism to be too demanding. I try to live my life according to ‘easy rescue consequentialism’ – you should perform those acts which are at small cost to you and which benefit others greatly.”
Which leaves his readers perplexed. If utilitarian sinners are psychopaths and utilitarian saints are non-existent, is utilitarianism a moral philosophy for ordinary human beings or only for the authors of obscure journal articles?
One of the most famous advertisements in history was supposedly written by South Pole explorer Ernest Shackleton: “Men wanted for hazardous journey. Low wages, bitter cold, long hours of complete darkness. Safe return doubtful. Honour and recognition in event of success.”
Perhaps egg freezing doctors have learned from Shackleton that highlighting the risks and dangers of cold places need not discourage clients. The video above suggests that it may actually inspire them. It features “The Egg-Whisperer” (aka Dr Aimee Eyvazzadeh at eggfreezingparty.com) and her “Tupperware parties” for fertility-conscious professional women working in and around Silicon Valley. “After you attend a party, we welcome you to become one of Dr. Aimee’s patients so that she can help guide you further. Join the party!” says her website. (Hat tip to the Center for Genetics and Society.)
Pope Francis has condemned euthanasia, calling it “a sin against God the creator”. The Roman Pontiff made the statement in an address to the Association of Italian Catholic Doctors . The Pope – who may be the single most influential bioethical voice in the world -- criticised the logic of what he termed “false compassion”. He also applied the notion to arguments for abortion and IVF.
“The dominant thinking sometimes suggests a ‘false compassion’, that which believes that it is: helpful to women to promote abortion; an act of dignity to obtain euthanasia; a scientific breakthrough to ‘produce’ a child and to consider it to be a right rather than a gift to welcome”.
Summarising his scepticism about contemporary trends, the Pope said:
“We are living in a time of experimentation with life. But a bad experiment. Making children rather than accepting them as a gift, as I said. Playing with life.”
In another recent address, Francis stressed the need to promote what he calls a new “human ecology”. This relatively novel idea draws together the Zeitgeist of the environmentalist movement with the natural law ethos of Catholic bioethics. The Pope is set to release a statement (possibly an encyclical) next year on “human ecology”, and the United Nations has suggested it will support the document.
The new publication is bound to be controversial. The idea of “human ecology” has its roots in Benedict XVI’s understanding of male-female complementarity, and the unethical nature of artificial reproductive methods.
An Australian academic has prompted spirited debate after suggesting that denying euthanasia to the mentally ill could be a form of unjust discrimination.
In a recent article in The Conversation, Dr Sascha Callaghan of the University of New South Wales suggested that mental illness in itself may be insufficient grounds to deny an individual euthanasia:
“The idea that euthanasia should not be offered for mental suffering is not universally agreed, and requires some further consideration… too stringent an approach risks locking people with mental illnesses out of the right to make decisions about the end of their lives – and this might be discriminatory.”
Callaghan referred to a case in the UK in 2012 in which a court ruled that an anorexic woman be force-fed despite her request that the treatment stop. “The implication of the decision was that, by definition, people with anorexia cannot make an end-of-life decision, no matter how harrowing and intractable their illness becomes.”
Whilst not committing to a particular viewpoint on the issue, Callaghan concludes that “certainly there are a range of defensible views on what is a good life and when assisted dying is acceptable.”
The Australian Medical Association recently suspended the medical license of euthanasia advocate Phillip Nitzchke, after he failed to dissuade a mentally ill man, 45-year-old Nigel Brayley, from taking his own life with a lethal barbiturate.