Indian IVF clinics are glad to showcase their bevies of happy surrogate mothers who have become pregnant for foreign couples, heterosexual and homosexual, and singles, male and female, who want children. But not necessarily the surrogates who die.
This week 30-year-old Premila Vaghela, who took on the job to support her own two children, died in the eighth month of her pregnancy of unexplained complications. She had come to her IVF clinic, Pulse Women's Hospital, in Ahmedabad, in the state of Gujarat, for a routine check-up when she had a convulsion and collapsed. The doctors at Pulse quickly did an emergency caesarean. As the Times of India noted, "she completed her job" and a baby was delivered. Pulse then shipped her off to another hospital where she died. The child is intended for an American woman named Helen.
In the quaint lingo of the Indian media, it was noted that "Premila paid the price of offering herself as surrogate with her life. Dr Manish Banker of Pulse Hospital… said that they are clueless as to why Premila developed a fatal health incident."
Pulse has an Australian connection, as it is described as an "international collaboration" with Melbourne IVF, one of Australia's best-known clinics. Its website describes it as "a modern hospital whose mission is to provide high quality international standard health care that meets the needs and exceeds the expectation of the people."
The fate of Mrs Vaghela is a stark reminder that death is one of the hazards of being a surrogate mother in India. Had this happened in a developed country like the US or Australia, a major investigation would be launched. But this is unlikely to happen in Ahmedabad, where the police have already described the incident as an accidental death, pending a post-mortem.
The pro-forma contract displayed by Pulse on its website is loaded in favour of the genetic parents and the hospital against the surrogate mother -- who may not understand the legalese or the dangers involved. The woman has to agree to the most intrusive limitation of her lifestyle and even to accept foetal reduction (see Pulse's video) if necessary. Since up to three embyros are transferred at a time -- not international best practice -- this is quite possible.
The contract also states that "the Surrogate and her Husband agree to assume all medical, financial, and psychological risks and to release, the Genetic Parents, their attorney(s), the Treating Doctor, other professionals contemplated herein and/or involved in any aspect of the surrogacy arrangement, and each said person's agents and employees from any legal liability except professional malpractice (malfeasance or negligence)." In short, Mrs Varghela's impoverished husband can only seek compensation if he can prove negligence on the doctor's part. His chances of success are vanishingly small.
In a chilling section of the contract headed "life support", the surrogate and her husband agree that "if she is seriously injured or suffers a life-‐threatening instance during her third trimester of pregnancy", then she "will be sustained with life support equipment to protect the fetus' viability and insure [sic] a healthy birth on the Genetic Parents' behalf". It is the mirror image of abortion, with the interests of the clients' baby trumping the mother's.
"Surrogacy has picked up majorly all over Gujarat," notes the Times. "The decent money offered by couples, majority of who are NRGs and foreigners, attracts many women from poor socio-economic backgrounds." Mrs Vaghela’s husband Karsan is a manual labourer. Her sister told the Indian Express, “She was precious to us. Now we cannot do anything about it. Please leave.” ~ Times of India, May 17
Below is a news item from TV9 in Gujarat (in Gujarati)
Another adventure in the Wild West of assisted reproduction, this time from Israel. An Israeli woman who is undergoing sex reassignment surgery wants to freeze her ovarian tissue before she has her hysterectomy. Egg freezing would have been easier, but she had already started hormone therapy and this has disabled her ovarian function.
Although an ethics committee has approved the procedure for the unnamed woman, the Israeli Ministry of Health has denied permission because "it is not, to date, a standard procedure in Israel". Cryopreservation is allowed only for young women who are to be treated for cancer. The Ministry also argues that cryopreservation is meant for "self-use" under current regulations and since the woman will no longer have a womb, she can no longer become pregnant.
The wo/man has appealed to the Israeli Supreme Court, arguing that s/he is being discriminated against and that denying access to cryopreservation to a person undergoing sex reassignment violates a right to healthcare and the right to procreate.
In the latest issue of BioNews, Vardit Ravitsky, of the University of Montreal and Professor David Heyd, of the Hebrew University of Jerusalem, argue that the Ministry of Health is ethically wrong. What if the transgender person, now functioning as a man, were to partner with a woman who could act as a surrogate with the help of donated sperm? They would form a family, or rather, a "reproductive unit":
"Rather than considering each individual in this scenario separately, which leads to the framing of the female partner as a surrogate, we should consider this through the lens of the couple's reproductive project. The couple, as the 'reproductive unit', already has the required egg and uterus; all they are missing is donated sperm."
What about the effect upon the child of this complicated parentage? Things are already quite complicated in the world of assisted reproduction, Ravitsky and Heyd argue. Another step forward is unlikely to make much difference. In any case, the paramount consideration is "reproductive autonomy":
"Although the situation might seem confusing, it is not necessarily more problematic than numerous others. Many children are born today to two mothers or two fathers; to a genetic mother who is not the birth mother (in surrogacy); to a birth mother who is not the genetic mother (in egg donation), and more. We doubt that this scenario would raise substantially new challenges to the child's identity."
As a postscript, the world's first "pregnant man", Thomas Beattie, who had three children before completing gender reassignment surgery, is divorcing his/her wife and alleging serious emotional and physical abuse at her hands. S/he became briefly famous in 2007 posing for a photo which portrayed him/her as heavily pregnant but with facial hair. ~ BioNews, May 15; Daily Mail, April 26
South African supporters of physician-assisted suicide and euthanasia launched a campaign for legalisation this week. The leading figure in the movement, Sean Davison, has recently returned from New Zealand after being convicted of helping his aged mother commit suicide in 2006. He spent five months under house arrest.
Davison, a professor of forensics at the University of the Western Cape, says that “This is one of the greatest challenges facing humanity. It takes brave thinking and brave decisions”.
Two organisations are behind the campaign, Ethics South Africa and Dignity South Africa. The former has just released a position paper, "End of life decisions, ethics and the law", calling for “statutory legal clarity and reform” for terminal pain management, life-sustaining treatment and assisted dying.
“Competent persons have a moral right to make their own choices, including choices about their own continued life in clearly defined conditions, and to act upon these choices. We have an ethical obligation to respect that right,” says the author, Professor Willem Landman.
The issue is sure to generate much opposition, says the Mail & Guardian. The former president of Pro-Life SA, Dr Claude Newbury, said "Our mandate [as medical practitioners] is to control pain. Once the medical profession thinks it is permissible to kill anyone, then that society is on a slippery slope to Auschwitz… Killing is not part of our Constitution."
The number of Washington state residents who died of physician-assisted suicide rose to 70 last year, up from 51 in 2010 and 36 in 2009, when the state’s Death With Dignity Act took effect. The numbers are small, but the increase each year has been about 40% on the previous year.
According to a government report released this month, 103 patients requested and received lethal doses of medications from 80 different physicians in 2011. Of these, 70 died after taking the medication. Another 5 died, but may not have taken the medication.
The statistics suggest that image of patients slumping almost immediately into unconsciousness and death after taking a lethal barbiturate is not true in all cases. Of the 70, at least 7 took 11 minutes or more before lapsing into unconsciousness. One or more took 2 hours. About 20% took an hour and a half to die, but one or more took 13 hours.
A psychiatric or psychological evaluation is not required under the law and only 5% had one. Most of the patients said that loss of autonomy, dignity and ability to participate in activities that make life enjoyable were the reasons for choosing to end their lives. Only about 38% worried about inadequate pain control. More than 90% were white, and 75% had at least some college education. Nearly 80% of the patients had cancer. ~ amednews.com, May 14
More and more baby-boomers, desperate to have grandchildren, are pushing daughters to freeze their eggs, the New York Times reports. Dr William Schoolcraft, of the Colorado Center for Reproductive Medicine, says patients consult him with parents in tow. “I see these patients come in, and they’re with two elderly people, and I’m like, ‘What the hey?’ ” Dr. Schoolcraft said. Parent give emotional and financial support, as their daughters dive into the emerging industry of egg freezing to boost their chances of starting a family later on.
The procedure is costly -- between USD$8,000 and $18,000. It is still considered experimental by the American Society for Reproductive Medicine, and there are no guarantees. However, would-be grandparents seem happy to roll the dice. “By the time Allison was 35, I felt the clock was tick-tick-ticking,” said Candace Kramer, 61, whose daughter took her up on the suggestion to freeze her eggs -- and her offer to pay half the bill. “I viewed it as opening up an opportunity for her.”
Thirty-seven-year-old Colorado woman Jennifer Hayes now blogs about the experience at RetrieveFreezeRelax.com. She told the local TV station: "I was really tired of making decisions based on the pressure of my biological clock… My parents said to me, 'You know, do you think we'd rather have this money sitting in a bank account or a grandchild some day?'" Now she is writing a humorous book about her egg freezing experience. ~ New York Times, May 13
The US Senate's Finance Committee has asked seven organisations, including the well-known Center for Practical Bioethics, in Kansas City, for information about financial ties to the pharmaceutical industry. This inquiry is part of the committee's investigation of links between manufacturers, doctors and organisations which have advocated increased use of narcotic painkillers.
The Committee claims that the US is suffering from "an epidemic of accidental deaths and addiction resulting from the increased sale and use of powerful narcotic painkillers" and that opioid-based prescription painkillers kill more people than heroin and cocaine combined. It is concerned about "extensive ties between companies that manufacture and market opioids and non-profit organisations".
The Centre for Practical Bioethics also received a letter demanding information about financial ties because Purdue Pharma, the manufacturer of OxyContin and other pain drugs, is a substantial donor. Myra Christopher, its founder and former president, is an outspoken advocate of pain relief, especially in palliative care. She has always insisted that funds came with no strings attached. The Center says that it will cooperate fully in the investigation.
Because the American Journal of Bioethics is linked to the Center through Glen McGee, the founding editor of AJOB and a former ethicist at the Center, some bioethicists have alleged that AJOB will be drawn into the investigation. AJOB has vigorously denied this. "No financial relationship exists or ever existed between AJOB and Purdue Pharmaceuticals or any pharmaceutical company. AJOB received no financial support from the Center for Practical Bioethics," it says on its blog.
Five or six years ago the ethical dilemmas in human embryonic stem cell research were the hottest story in bioethics. One of the many celebrities promoting funding for it was Michael J. Fox, an actor whose career has been severely curtailed by Parkinson's disease. As an extremely effective patient advocate, he claimed that opponents were enemies of hope.
"I'm glad that I put the effort into promoting it. My quest in that regard was really about research freedom and not shutting down avenues of research because of ideological reasons that were countered by the majority opinion of whether it was worthwhile doing. Hopefully stem cell research will result in something. I'm glad we found for it and the right to do it but there's other areas that we are pursuing...
“Stem cells are an avenue of research that we’ve pursued and continue to pursue but it’s part of a broad portfolio of things that we look at. There have been some issues with stem cells, some problems along the way...
“It’s not so much that [stem cell research has] diminished in its prospects for breakthroughs as much as it’s the other avenues of research have grown and multiplied and become as much or more promising. So, an answer may come from stem cell research but it’s more than likely to come from another area."
Fox's foundation, the Michael J. Fox Foundation for Parkinson’s Research, is the largest private funder of Parkinson’s disease research in the world. It recently launched an on-line initiative to encourage participation in clinical trials of drugs, not stem cells.
Here is an advertisement he made in support of Missouri US Senate candidate Clare McCaskill in 2006. Nowadays the hope lies with other therapies.
Aggressive IVF treatments at clinics in the UK are putting women and babies at risk, experts say. Unnecessary procedures, high doses of potent drugs and risky interventions are being used as couples spend a fortune trying to conceive. According to experts, a safer and milder approach to IVF is available that could give patients equivalent success rates over a longer period and at a lower cost.
Professor Geeta Nargund, of St George's Hospital in south London, expressed her concerns at a conference in Copenhagen. She said there was mounting evidence that the usual method of IVF used in the UK, in which ovaries are stimulated with high doses of drugs to produce large quantities of eggs for harvesting, was harmful to women's health and caused chromosomal abnormalities to resulting embryos. "High-dose stimulation can have distressing side effects on the woman, the most serious of which is called ovarian hyper-stimulation syndrome," she said. "There is no doubt that women subjected to this kind of stimulation are at serious health risk." ~ London Telegraph, May 14
Misty Baker turned to a surrogate after ten years of fighting with infertility - and now Baker and her surrogate are both pregnant with twins. After getting married, Baker and her husband Brian Baker tried unsuccessfully both natural conception and IVF. The Washington couple's final course of action was surrogacy. While they piled up their savings and continued to get their finances in order, Misty's friend Amber offered to be the baby's gestational carrier.
Six of Misty's eggs were fertilised with Brian's sperm, and two of those were implanted inside Amber. In a last-ditch effort to get pregnant, they implanted the 4 remaining embryos into Misty. After several days, the doctor called to tell them they had 4 babies on the way. "We tried for 10 years," Misty said. "I truly believe I would not have gotten pregnant if Amber had not been a part of this. Unconsciously, it just took that pressure off me." Brian added: "Somehow that reduced her stress level and anxiety and made it possible for her body to accept the embryos." ~ Los Angeles Times, May 13
Despite diagnoses of infertility, some couples who have sought fertility treatments find that they later have a baby naturally, according to a new French study. In some cases the parents conceived another child beforehand using IVF, while in other cases the couple conceived even following a failed attempt at IVF.
"Most infertile couples think that they are unable to conceive spontaneously whereas our study shows (this) remains possible," Dr. Pénélope Troude at the French national medical research institute, INSERM, told Reuters Health. "Our results should give hope to couples who have been unsuccessfully treated by IVF," Troude and her research team wrote in the report, published in the journal Fertility and Sterility. Troude said unexplained infertility could be a good sign for couples who want to get pregnant, compared to those who have a clear reason for not conceiving initially. ~ Fox News, May 4
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| michael@bioedge.org
2:27:44 PM
South African supporters of physician-assisted suicide and euthanasia launched a campaign for legalisation this week. The leading figure in the movement, 
The number of Washington state residents who died of physician-assisted suicide rose to 70 last year, up from 51 in 2010 and 36 in 2009, when the state’s Death With Dignity Act took effect. The numbers are small, but the increase each year has been about 40% on the previous year. 
