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  2:25:00 PM

Euthanasia could be option for poor, says Lithuanian health minister

The new Lithuanian Health Minister, Rimantė Šalaševičiūtė

Euthanasia might be needed for poor people who cannot access palliative care, the new Lithuanian Health Minister has suggested. Rimantė Šalaševičiūtė was sworn earlier this month, but already she has made waves by backing an open discussion of the legalisation of euthanasia.

Without making any specific proposals, she told local media that Lithuania was not a welfare state with palliative care available for all and that euthanasia might be an option for people who did not want to torment relatives with the spectacle of their suffering.  

The minister has also raised the idea of euthanasia for children. She noted that this option had been approved for Belgian children after a long public debate. It was an option which might be appropriate in Lithuania as well after public debate.

Ms Šalaševičiūtė will face an uphill battle in her campaign to introduce Lithuanians to euthanasia. Many doctors and the Catholic Church oppose it. Dr Andrius Narbekovas, who is both a priest and a doctor, and a member of the Health Ministry’s bioethics commission, told the media:

“The Ministry of Health should protect health and life, instead of looking for ways to take life away. It goes without saying that it is … profitable and cost effective … But a democratic society should very clearly understand that we have to take care of the sick, not kill them."
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  11:48:00 PM

The IVF industry must go green

Free fertility treatment should be banned for those making lifestyle reproductive choices, such as  sterilisation reversal or single motherhood for fertile women. And fertility clinics should be subject to carbon capping schemes, in a bid to help curb climate change, argues a theologian in the Journal of Medical Ethics.

Only those who are medically infertile through no fault of their own should be eligible for government  funded treatment, suggests Cristina Richie, a theology PhD candidate at Boston College, Massachusetts.  

Richie singles out fertility treatments because  they not only produce a carbon footprint as a result of the resource they consume, but also create a  carbon legacy.

And she points out in an accompanying podcast: “Assisted reproductive technologies are typically  given in places with enormously large carbon footprints.” The US, for example, is the world’s second largest carbon emitter, producing 20 metric tonnes of  carbon dioxide per person per year, which multiplies by a factor of 5, with the birth of a child, she explains.

In her paper she argues that the environmental impact of medicine and health has largely been  ignored, and that the ecosystem is already overtaxed.

While ART is not the most pressing environmental issue, nonetheless, it has created 5 million new  lives since the late 1970s, and the number of babies born using these methods is rising steeply, she  argues.

“It is therefore the obligation of environmental policymakers, the ethical and medical communities, and  even society to carefully weigh the interests of our shared planet with a business that intentionally  creates more humans when we must reduce our carbon impact.”

She advocates that the fertility industry adopt a carbon capping scheme, either by making a voluntary but legally  binding commitment to meet emissions targets or by working to cut its total emissions, rather like the  UK National Health Service has done, she suggests.

And it ought to make free fertility treatment available only to those who are medically infertile, not to those who are making “lifestyle” choices, such as people who have voluntarily undergone sterilisation, single fertile women and fertile same-sex couples.

She insists that she is definitely not saying these groups should not have  children, but they could go green and adopt.

The adoption process needs to be made easier, and society also needs to change its attitude to  childlessness, she says. “Retrenchment in all areas of life is the key to slowing down or halting carbon emissions that lead to  climate change. For each child made through medical intervention, a carbon legacy results,” she  concludes.

Commenting on the paper, Iain Brassington, of University of Manchester, agrees that all areas of life should  be assessed for their ecological impact.

“if I wanted to frack for shale gas under Manchester, there’d be questions about sustainability, and about whether we should be looking for more and cheaper hydrocarbons given what we know about the environment.  So why not ask analogous questions about reproduction, its environmental impact, and its legacy to the future?”

Ms Richie’s headline-grabbing article builds on her interest in the ethics of “bodies that do not bear fruit”. After finishing her PhD, she plans to research the value of a child-free life from an evangelical, feminist and ecological perspective. After that, she plans on working on the connections between meat eating and the sexual oppression of women and consumption and the morality of obesity.

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  11:07:00 PM

A psychiatrist who saved lives?


Is this one of those “only in America” stories? On Thursday afternoon in a Philadelphia, a man brandishing a pistol stormed the psychiatric ward of Mercy Fitzgerald Hospital. He shot dead his caseworker, 53-year-old Theresa Hunt and fired at his psychiatrist, Dr Lee Silverman, grazing his head. The doctor ducked for cover behind a desk.

But this was not going to be another mass shooting. Dr Silverman was ready for this. He pulled his own pistol out of a desk drawer and returned fire. He shot the patient, Richard Plotts, twice in the torso and once in the arm. Plotts collapsed and bystanders disarmed him.

It was like a script written by the National Rifle Association. The local police chief told the media: “without a doubt, I believe the doctor saved lives. Without that firearm, this guy (the patient) could have went out in the hallway and just walked down the offices until he ran out of ammunition.” 

Plotts is in a critical condition at a local hospital and Dr Silverman was treated for a slight head wound. What no one has been able to figure out is why a psychiatrist had a loaded gun at work, especially when it was against the hospital’s policy. Perhaps the American Psychiatric Association will change its tune on gun control and adopt as its motto the bumper-sticker slogan, "the answer to stopping a bad guy with a gun is a good guy with a gun". 

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  10:29:00 PM

Does dress matter in medicine?

An ongoing debate amongst physicians has broken into academic discourse – should doctors dress formally for clinical practice?

Microbiologist Stephanie Dancer says ‘yes’.  In an article in the British Medical Journal Dancer asserts that  ‘dressing down’ diminishes the dignitas of the medical profession and could be see as an indication of carelessness: 

“Doctors are members of a distinguished profession and should dress accordingly. Untidiness erodes the image of doctors as responsible and competent…[it] might be taken as a flashing neon sign that says “I don’t care.”

Dancer also claims that scruffy dress could contribute to low hygiene standards in hospitals: “scruffiness, however defined, also intimates a lack of personal hygiene and correspondingly lower standards of hygienic behavior.”

Two Manchester University medical ethicists, Cesar Palacios-Gonzalez and David R Lawrence, have written a scathing critique of Dancer’s claims. Gonzalez and Lawrence assert that scruffy dress has no effect on the ‘intrinsic dignity’ of the medical profession:

“doctors’ attire has no bearing on the inherent dignitas of the medical profession. Even where the doctor’s appearance is, for whatever reason disagreeable to the patient, this does not change the value of the medical intervention to the health of that patient…To state otherwise would be the same as to state that the value of a doctor’s medical practice fluctuates with each patients’ perception of the physicians’ attire.”

They argue on libertarian grounds that doctors should be allowed to dress how they wish.

They also contest Dancer’s claim that casual dress contributes to poor hygiene. Even if particular kinds of casual clothes lead to infection, “this would not mean that there is a case against scruffiness in general; but it would mean that doctors should refrain from using certain types of fabrics in regard for their patients’ safety”. 

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  5:39:00 PM

Botched execution sparks outcry in US

Another botched execution in the USA has reignited debate over the death penalty. Arizona man Joseph Rudolph Wood took almost two hours to die after being injected with the drugs midazolam and hydromorphone. The two drugs are a new barbiturate combination being trialled in a number of US states.

According to witnesses, Wood gasped for air hundreds of times before succumbed to the drugs. “It was very disturbing to watch…like a fish on shore gulping for air”, said reporter Troy Hayden. “I counted 660 times that he gasped,” said Arizona Republic journalist Michael Kiefer.

Just two months ago BioEdge reported on a similar botched execution in Oklahoma.

Shortly after the execution, Arizona governor Jan Brewer issued a statement in which she ordered a full review of the execution process.

She was nevertheless adamant that the execution had been lawful and did not involve undue pain: “One thing is certain, however, inmate Wood died in a lawful manner and by eyewitness and medical accounts he did not suffer” her statement said.

The American Civil Liberties Union of Arizona issued a statement calling for a moratorium on executions. "What happened today to Mr. Wood was an experiment that the state did its best to hide," Executive Director Alessandra Soler said. 

The new drugs being used are intended to replace others that pharmaceutical companies now refuse to sell to US correctional facilities. The drug midazolam causes unconsciousness in a patient, while hydromorphone shuts down breathing and induces cardiac arrest.  

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  3:16:00 PM

Nitschke suspended from medical register

Australian euthanasia advocate Philip Nitschke has been suspended from the medical register as an investigation continues into his involvement in the death of a 45 year old Australian man.  

The Medical Board of Australia decided to suspend Nitschke after he admitted to supporting Nigel Brayley in his decision to commit suicide, despite not being terminally ill. The board said that Nitschke “presented a serious risk to the health and safety of the public”. 

The suspension, which came into effect at midnight on Thursday, prevents him from practicing anywhere in Australia and is an interim measure pending the outcome of the inquiry.

Nitschke called the decision “political“ and “a dirty little midnight assassination“ aimed at silencing him.  He has vowed to fight the suspension.

Beyond Blue spokesperson Jeff Kennett welcomed the decision, saying, "We cannot allow the debate to start that it's alright for a 16-year-old, or a 45-year-old, simply because they're having an off day, to attempt to take their own life. It is not acceptable."

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  2:38:00 PM

Veterans Affairs scandal stems from a crisis of ethics: bioethicist

The crisis in the the US Veterans Affairs Department is fundamentally a crisis of ethics, according to the former hospital ethicist at the Philadelphia Veterans Affairs Medical Center, Evelyne Shuster.

The VA’s director, Eric Shinseki, was forced to resign after it was discovered that employees were generating fraudulent statistics to improve their performance reports. The problem was particularly acute in Phoenix.

The New York Times decried “poor management, a history of retaliation toward employees, cumbersome and outdated technology, and a shortage of doctors and nurses and physical space to treat patients.” The Wall Street Journal lamented a “corrosive culture” which had damaged patient care.

But not long ago, VA was at the forefront of quality care and patient safety. It had identified weaknesses in its ethical culture and had set up a multi-million dollar program to deal with it called Integrated Ethics. How did things go so wrong?

The fundamental reason, Shuster writes in Bioethics Forum, a blog at The Hastings Center, is that ethics was an also-ran behind statistics and key performance indicators:

“Ironically, the very programs that made it possible for the VA to outpace other health care institutions in quality care, efficiency, and accountability also seem to have contributed to ethics failure in actual performance. The VA’s focus on quantifiable performance measures and accountability took a life of its own and helped foster the creation of a culture where ethics, integrity, and responsibility were simply overlooked or perceived as an impediment to achieving quality care.”

The Integrated Ethics program was supposed to promote ethical behaviour. Instead, she says, it “quickly became overwhelmed by a vast and rigid organization that valued documentation over action and reduced ethics to compliance and risk management. As a result, ethics in the VA became bureaucratized, an exercise of filling out forms and managerial compliance.” 

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  3:05:00 PM

‘Informed consent has become a fetish’ – American bioethicist

In a recent Hastings Centre Report article, bioethicist Barbara A. Koenig argues stridently against traditional informed consent models for genetic testing:

"My view is that the focus on consent in contemporary biomedical research has become the modern equivalent of a fetish".

Koenig believes that the ‘full disclosure’ model of informed consent is impracticable. She recounts her experience developing genetic testing protocol after the mapping of the human genome in the 1990s:

“Even then, we recognized that the ideal of full disclosure of all risks and benefits of a particular genetic test, ideally by a trained genetic counselor,would collapse once the volume of genomic data increased. If it took an hour to counsel a patient about one condition, what would happen if panels of test could simultaneously offer multiple findings?”

Koenig proposes a model of consent whereby decision-making is outsourced to a ‘representative citizens group’ educated in basics of genetic testing. This group would be able to make informed decisions on behalf of patients, saving time, money and significant patient distress:

“The focus turns away from a ceremony of individual control and choice. Instead, consent is about giving up control, agreeing to accept a set of procedures and practices created and interpreted by a group of fellow citizens; it is ‘consent to be governed.’”

Koenig argues that this model preserves rather than undermines individual freedom:

“Personal sovereignty is not violated when research participants who will share in the benefits of genomics knowledge are given the opportunity to consent to be governed.”

The article is an interesting complement to the other recent, more extreme challenges to informed consent regulations

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  2:55:00 PM

Nasal growth found on woman’s back after stem-cell treatment

An experimental Portuguese stem cell trial has resulted in a woman developing a nasal growth on her back.

In 2006 the anonymous woman attended a Portuguese hospital where tissue containing olfactory stem cells were taken from her nose and implanted in her spine. The hope was that these cells would develop into neural cells and help repair nerve damage in the woman's spine.

Eight years later she had a spinal growth removed in a US hospital. Doctors investigated the growth and discovered it to be composed of “mostly of cysts lined by respiratory epithelium, submucosal glands with goblet cells, and intervening nerve twigs”.

The cells had continued to grow as olfactory cells rather than morph into neural tissue. The growth was secreting a “thick, copious mucous-like material” which seems to have been pressing against the patient’s spine, causing considerable discomfort.

“It is sobering,” says George Daley, a stem cell researcher at Harvard Medical School who has helped write guidelines for people considering stem cell treatments. “It speaks directly to how primitive our state of knowledge is about how cells integrate and divide and expand.”

The case shows that experimental stem-cell treatment remains risky even when carried out in respectable hospitals.

The findings of the investigation were published online the month in the Journal of Neurosurgery. 

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  2:45:00 PM

Top scientists call for restrictions on pathogen creation

Anthrax growing in a petri dish

A prestigious international group of scientists has called for a limit on the creation of potential pandemic pathogens (PPPs). The scientists, calling themselves the Cambridge Working Group (CWG), drafted a statement earlier this month warning of “fallibility” of even the safest virology laboratories:

“Recent incidents involving smallpox, anthrax and bird flu in some of the top US laboratories remind us of the fallibility of even the most secure laboratories, reinforcing the urgent need for a thorough reassessment of biosafety.”

In the past two months three separate incidents have occurred in the US alone, involving smallpox, anthrax and avian influenza.

The CWG suggested PPP researchers convene and establish stricter guidelines, just as in the Asilomar process:

“A modern version of the Asilomar process, which engaged scientists in proposing rules to manage research on recombinant DNA, could be a starting point to identify the best approaches to achieve the global public health goals of defeating pandemic disease and assuring the highest level of safety.”

Many more academics, including three Nobel laureates, have signed the CWG statement since its publication on the 14th

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 Recent Posts
Euthanasia could be option for poor, says Lithuanian health minister
26 Jul 2014
The IVF industry must go green
25 Jul 2014
A psychiatrist who saved lives?
25 Jul 2014
Does dress matter in medicine?
25 Jul 2014
Botched execution sparks outcry in US
25 Jul 2014

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