A complex custody dispute has come before an Israeli court, raising questions about the limits of legal parenthood as well as the rights of parents with disabilities. A disabled woman is taking state social services to court after being denied custody of a child she had conceived by surrogacy.
In 2009 wheelchair-bound Ora Mor Yosef organised the insemination of a volunteer surrogate mother with sperm from an Israeli father. Mor Yosef's intention was to take custody of the child once born. However, when the surrogate gave birth to healthy girl, Jewish social security services immediately took custody of the child on the grounds that Mor Yosef was not a legal parent. The child was handed over to adoption services.
Mor Yosef appealed to the Israeli High Court of Justice, which has halted the adoption procedures until the end of a court case assessing the woman's rights to raise the child.
According to the woman's attorneys, the seizing of the child from the surrogate mother is due, in large part, to Mor Yosef’s perceived inability to care for a child due to her disability. Mor Yosef has muscular dystrophy.
However, she insists that her disability does not prevent her from leading a full life. If granted custody, Mor Yosef will seek out the adaptive tools and assistance she needs to help make certain the healthy little girl would enjoy “the best possible upbringing.”
Of the 166 detainees at Guantanamo Bay, about 100 are on a hunger strike. About 20 are being force-fed, according to the New York Times. About 40 medical staff have arrived to ensure that the detainees are fed.
The men want their cases heard before a court. Many of them have been at Guantanamo for 12 years without being charged.
What are the medical ethics of force-feeding? It seems to violate the norms of informed consent and refusing burdensome treatment. The American Medical Association sent a letter to Secretary of Defense Chuck Hagel on April 25. It quoted the 1975 Tokyo Declaration of the World Medical Association which takes an unambiguous stand on the issue: “Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially”.
It is not clear how many doctors, if any, are involved in the force-feeding.
However, President Obama has ignored the niceties of medical ethics for the hunger strikers. He simply told the media, “I don’t want these individuals to die.” Politically it is impossible to release the detainees; legally it is hard to try them. So they remain in limbo, frustrated and angry.
The military has not released much information about the force-feeding regimen. But in The Daily Beast, infectious diseases expert Kent Sepkowitz, of Memorial Sloan-Kettering Cancer Center, makes it sound excruciating:
“Without question, it is the most painful procedure doctors routinely inflict on conscious patients. The nose—as anyone knows who ever has received a stinger from an errant baseball—has countless pain fibers. Some patients may scream and gasp as the tube is introduced; the tear ducts well up and overflow; the urge to sneeze or cough or vomit is often uncontrollable… The procedure is, in a word, barbaric. And that’s when we are trying to be nice.”
However, he also is unsure what is to be done.
“In this debate individual doctors are stuck at a crossroads of unusual complexity. Sworn to alleviate pain and prevent death where possible, we also are sworn to respect the wishes of the individual. For us, there is no simple way out. Though sharing some similarities, the situation is distinct from respecting the wishes of a patient dying from an untreatable illness—starvation has a remedy.”
India and China are not the only countries with lop-sided sex ratios due to sex-selective abortions. Georgia, a former member of the USSR in the Caucasus with a population of about 4.5 million, has a distorted sex ratio at birth of 114 boys to 100 girls. One-third of the 36,000 abortion performed last year in Georgia were for sex selection. The natural ratio is about 105 to 100.
"Those figures really took demographers by surprise. No one had expected sex selection to spread to that area, but as in much of East Asia, the abortion rate is quite high," Mara Hvistendahl, author of Unnatural Selection: Choosing Boys over Girls, and the Consequences of a World Full of Men, told Radio Free Europe.
"The new prenatal diagnostic technologies have come in as these countries develop. And the birth rates have also fallen very rapidly in these areas. These are the same trends that we saw decades earlier in East Asia and now they are hitting the Caucasus region."
Most Georgians are nominally Christian. The head of the Orthodox Church, Patriarch Ilia II, put the topic of gendercide on the national agenda by proposing a ban on most abortions in his Easter homily. “When the country is in such a difficult demographic situation, I think that the government must pass a law banning abortions, with just a small number of exceptions, of course."
While everyone seems to agree that sex selection is undesirable, solutions get bogged in the abortion debate. None of the officials interviewed by RFE would support a ban on abortion. Prime Minister Bidzina Ivanishvili opposes it, saying that greater prosperity is the best way to reduce sex selective abortion.
However, Mara Hvistendahl is sceptical. "What is actually happening is that sex selection is something that hits first in urban areas, in rapidly developing countries, not in the poorest places in the world. That is why it hit China, that's why it hit India. And that is why it is now hitting parts of Eastern Europe. And when it hits those countries, it is the elite that takes up the practice first."
The Caucasus is one of the world’s most volatile regions and demography is a weighty geopolitical issue, especially since Georgia and neighbouring Armenia, whose cultural backgrounds are Christian Orthodox, border on Muslim states. As the English-language Georgia Times points out, “if the trend continues, by 2050 the population of Georgia and Armenia will be approximately equal (and this despite the fact that the demographics in Armenia also leave much to be desired), and the population of Azerbaijan will be 3 times larger than Georgia's population.”
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".
There are very few academic studies of Keynes’s views on eugenics. An overview is offered in John Laurant and John Nightingale's Darwinism and Evolutionary Economics. An alternative account can be found in John Toye's Keynes on Population.
An Australian health tourism company is offering a new package for couples seeking a sex-selective IVF. Sex selective treatment is banned in Australia, but couples can now holiday in Thailand whilst having the procedure done.
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.
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| michael@bioedge.org
11:23:24 PM
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Poland's Justice Minster was sacked this week
A media firestorm broke out last week