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February
14
  10:10:00 PM

Political inaction as minors work tobacco farms

Human rights groups have expressed grave concern about the employment of young children on tobacco farms around the US.

Thousands of children work on plantations in America, despite multiple studies identifying grave risks posed to adolescent health. A report released by Human Rights Watch (HRW) last May that found children who work on tobacco farms are more at risk of getting cancer, living with reproductive health issues and suffering from permanent neurological damage, among other side effects. The children, generally of a Hispanic migrant background, work on the farms to supplement low family incomes.

But State legislatures appear inactive. A bill to regulate the practice recently was debated in Virginia but was voted down.

After significant lobbying, a number of large tobacco companies and associations have implemented policies that ban employing workers under 16.

Anti-tobacco activist Laura Graen believes the move is long overdue. “While any move to improve its business practices is welcome, given its history, it seems the tobacco industry is more focused on doing the right thing for its public image than safeguarding the rights of child workers.”

Later this year Rhode Island Congressman David Cicilline (D) is expected to reintroduce a federal bill that would prohibit children under the age of 18 from working in direct contact with tobacco.

Despite the apparent political inaction up until now, Jo Becker of HRW’s children’s rights division is enthusiastic about the recent attention:

“There’s certainly been a lot of interest [at a national level]”. 

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February
13
  11:30:00 PM

Israeli defence forces under fire for abuses during Gaza War

Independent investigators commissioned by Physicians for Human Rights-Israel have concluded last year’s war in Gaza involved “several serious violations of human rights and international humanitarian law” by the Israeli Army, including attacks on healthcare workers and facilities.  

Most estimates put the Gazans killed in the 50-day war at over 2,100, of whom at least 70% were civilians, including over 500 children. Over 11,000 were wounded and over 100,000 made homeless. Seventy-three Israelis were killed: 67 soldiers and 6 civilians, including one child and one migrant worker. 469 soldiers and 255 civilians were wounded.

In a report, No Safe Place, the investigators – who came from South Africa, Germany, Denmark, USA, Switzerland and Gaza – describe a number of ethically-dubious incidents. These included using civilians as human shields, shelling a civilian convoy, attacking a clinic and interfering with medical evacuations. They were  unable to conclude whether these and other abuses were the policy of the Israeli Army or whether they were the responsibility of individual soldiers.

“The attacks were characterised by heavy and unpredictable bombardments of civilian neighbourhoods in a manner that failed to discriminate between legitimate targets and protected populations and caused widespread destruction of homes and civilian property. Such indiscriminate attacks, by aircraft, drones, artillery, tanks and gunships, were unlikely to have been the result of decisions made by individual soldiers or commanders; they must have entailed approval from top-level decision-makers in the Israeli military and/or government.”

The report broadly corroborated other versions of the conflict by United Nations agencies. In January the International Criminal Court began its own investigation of possible war crimes violations. 

A spokesman for Israel’s foreign ministry dismissed the document as biased and poorly informed. “The report is laced with biased information, based on one sided sources whose credibility is questionable. Had the information in the report been shared with Israeli authorities prior to its publication, our input could have been incorporated. Sadly, this was not the case, and the result is a report bearing a low level of credibility, whose contribution to understanding the conflict between Israel and Hamas this summer is very low.”

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February
13
  10:33:00 PM

Searching for a new word for suicide

A group of right-to-die activists is searching for a new word for suicide by conducting an internet survey.

“Suicide” evokes nooses, bridges, bullets, insecticide and 20-storey buildings, a depressing panorama for the members of the unnamed group. To them, a violent exit is suicide through depression, a clinical condition which can often be treated successfully.

“This is very different from the situation in which suffering, terminally ill individuals choose to hasten their dying,” the survey says. “Such individuals wish to end their life in a peaceful and dignified manner, at home, with family around them. To most people, this is something else, not suicide.”

How is the more dignified way of shuffling off the mortal coil to be called? “Hard as it is to believe, the English language has no word for this different kind of dying, this hastening of death. The purpose of this survey is to find out if there might be a word or phrase that can be widely used to denote this different kind of dying.”

The survey also asks readers what they think of the following terms: self-deliverance, dying/death with dignity, rational suicide, humane, self-chosen death and a freshly-minted euphemism, dignicide.

Make your suggestions here

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February
13
  10:05:00 PM

Bioethicists push “3-parent embryos” in US

After “three-parent embryos” were legalised in Britain last week, some American bioethicists immediately took to the media to promote the technique.

In an article in Wired, “Is It Ethical to Create Babies From Three DNA Sources? Absolutely”, Art Caplan, who is probably the best-known American bioethicist, argues that it will prevent the birth of disabled children. He says that it is almost certainly safe and will not involve three parents. Like many other scientists, he contends that it is not eugenics and will not lead to eugenics. The mitochondria play an insignificant role in determining personality. “Transplanting mitochondria is not going to be the method used to create enhanced babies. Traits like height, intelligence, strength, balance, and vision don’t reside in the battery part of our cells.”

And in the Wall Street Journal, the head of a master’s program in bioethics at Columbia University, Robert Klitzman, argues that “three-parent embryos” are to be welcomed. Its opponents are scaremongering, he argues. It is an ethically straightforward procedure, like organ transplantation. “As biotechnology continues to advance and improve human health, we need to beware of applying frightening metaphors when they do not fit, and only distort and mislead.”

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February
13
  9:38:00 PM

How will conscientious objectors fare in Canada?

Conscientious objection to “physician-assisted dying” is shaping up as a major issue among doctors in Canada after last week’s Supreme Court ruling which legalised it.

As an article in the CMAJ, the journal of the Canadian Medical Association, points out, professional associations will play a major rule in writing the rules in the federal and provincial legislatures. The Court’s decision has been suspended for a year to allow this, so, technically speaking, assisted suicide is still illegal.

The Supreme Court and the CMA president, Dr Chris Simpson, insisted that doctors must be allowed the right to conscientious objection. What this means in practice is fuzzy.

“The core of that reconciliation will be that we respect individual doctors’ rights to conscientiously object,” says Dr Simpson. “That’s in patients’ best interests. Ultimately, no patient is going to want their physician pulled in against their will to help them with such a profound issue.” 

However, Dr James Downar, who wrote a CMAJ Commentary on physician assisted death last year, interpreted these reassurances in a way which is sure to alarm some doctors. He believes that regulations must force doctors with conscientious objection to refer requests for PAD to a more willing colleague. Otherwise some people will not be able to avail themselves of their newly recognised Charter right to assisted death.

Another issue which interests Americans is whether Canada will allow “suicide tourism”, as Switzerland does. Washington Post writer Rachel Feltman points out that there is an obvious case to support it: if “ no one can stop an able-bodied person from ending their life,  so preventing a terminally-ill patient from receiving the help they needed to do so should be considered a discriminatory act”.

On the other hand, “Given the strong emphasis on illness and the patient-doctor relationship in Canada's ruling, it's highly unlikely that the country would adopt such a liberal suicide policy.” But since the regulations are still to be written, no one can be sure. 

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February
07
  11:02:00 PM

UK surgeons call for regulation of cosmetic “cowboys”

Sick and tired of horror stories of botched cosmetic surgery by unqualified doctors, the Royal College of Surgeons in the UK, is calling for a register of approved cosmetic surgeons. The RSC says that patients who have surgery for aesthetic rather than medical reasons should have access to clear, unbiased and credible information about their surgeon, care provider, procedure and likely outcomes.

To obtain certification, surgeons will have to be registered in the area of training that covers the operations they wish to perform.  They will also need to demonstrate they have:

  • undertaken a minimum number of procedures within the relevant region of the body in a facility recognised by the health regulator;
  • the appropriate professional skills to undertake cosmetic surgery; and
  • provide evidence of the quality of their surgical outcomes.
  • Certification will only permit surgeons working in the private sector to undertake cosmetic surgery on the areas of the body that relates to the speciality they trained in.

The cosmetic surgery industry has been under intense scrutiny since thousands of women were fitted with sub-standard breast implants made by a French company, Poly Implant Prothese. UK ministers have criticised it as a "cowboy industry" of "murky practices".

Gary Ross, a consultant cosmetic and welcome but that more needed to be done: "We really need it to be mandatory; we need every plastic surgeon and cosmetic surgeon to be involved in it and be regulated and certified.”

Melanie Latham, a legal academic at Manchester Metropolitan University, was even more critical. She wrote: “90% of patients are women and they are paying a high price in more ways than one: they pay out thousands of pounds for treatments, then can suffer the consequences of scarring, pain, and lack of after-care from sub-standard providers.”

The Medical Defence Union, which insures about half of the doctors in the UK, complained in 2012 the rates of compensation for cosmetic surgery patients was far higher than for other procedures. It said that many clinics that did not offer proper aftercare and ignored patients' complaints. Surgeons sometimes vanished after causing suffering and their staff would undertook cosmetic work without full liability insurance.

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February
07
  11:00:00 PM

US public and scientists see world through different glasses

Despite similar views about the overall place of science in America, the general public and scientists often see science-related issues through a different lens, according to a new pair of surveys by the Pew Research Center and the American Association for the Advancement of Science (AAAS).

The report finds significant differences in views on 13 science-related issues. For instance, there is a:

  • 51-percentage point gap between scientists and the public about the safety of eating genetically modified foods -- 88% of AAAS scientists think eating GM food is safe, while 37% of the public believes that.
  • 42-percentage point gap over the issue of using animals in research -- 89% of scientists favor it, while 47% of the public backs the idea.
  • 40-percentage point gap on the question of whether it is safe to eat foods grown with pesticides -- 68% of scientists say that it is, compared with 28% of citizens.
  • 37-percentage point gap over whether climate change is mostly caused by human activity -- 87% of AAAS scientists say it is, while 50% of the public does.
  • 33-percentage point gap on the question about whether humans have evolved over time -- 98% of scientists say we have, compared with 65% of the public.

There is no single direction of differences between scientists and the public. By a 20-percentage point margin, citizens are more likely than scientists to favor offshore oil drilling. And by a 12-point margin, the public is more likely to say that astronauts are essential for the future of the US space program.

"We were surprised by the size of those differences and how often they occur," said Cary Funk, of Pew.

There is agreement between the public and scientists on one core issue: Both groups believe that science, technology, engineering and math education (STEM) in America's elementary and secondary schools is not performing well. These surveys find that science holds an esteemed place among citizens and professionals, but both groups are less upbeat about the scientific enterprise than they were in 2009 when the Pew Research Center conducted similar surveys.

A majority of adults say science has made life easier for most people (79%) and has had a positive effect on the quality of US health care (79%), food (62%) and the environment (62%). At the same time, the share seeing a negative contribution of science has ticked up across each of these measures compared with 2009.

"While the public is still broadly positive about the contributions of science to society, there has been a slight rise in negative views across a number of measures, suggesting some softening in the perceived value of science to society. These patterns will be important to watch over time," Funk said.

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February
07
  10:45:00 PM

Palliative care and PAD—The Benelux experience

In debates about end of life care, there are many who express concern at the potential impact of physician-assisted death on palliative care. Are there grounds for this worry?

A recent paper in the Journal of Medical Ethics says ‘no’. The paper – published by a team of researchers from Belgium’s End of Life Care Research Group – compares the development of palliative care (PC) in countries where euthanasia is legal to countries where it is not. 

The team considered changes in structural service indicators in EU countries, as well as examining increases in government spending on palliative care in Belgium over the period 2002-2011.

The results, they said, were surprising. The rate of increase in the number of structural PC provisions was highest in the Netherlands and Luxembourg. Belgium stayed on par with the UK in its development of palliative care availability. Furthermore, Belgian government expenditure for PC doubled between 2002 and 2011.

The authors tentatively suggest that concerns about effects on palliative care are unfounded:

“Does adding the ‘antibiotic’ of PAD to the Petri dish of society inhibit growth of PC resources and services? The Benelux data do not verify this concern.”

But while these findings are significant, the authors still note that only one in four of the top countries for palliative care provision in the EU is a country that allows euthanasia (Belgium). In the other three top countries, Iceland, the UK and Sweden, the procedure remains illegal.

The authors of the study also acknowledge that it will be important to examine the long term effects of euthanasia legalization: “A final comment is that the effects of legal PAD may still manifest on the longer term or in other ways.”

Time will tell what other effects euthanasia has on end-of-life care. 

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February
07
  10:34:00 PM

The vexing question of anti-vaxxers

A major outbreak of measles in California has ignited a huge debate over compulsory vaccination in the US.

The outbreak, which appears to have originated in Disneyland theme park at Anaheim, California, led representatives of both major parties to reaffirm a rather vague and non-committal position: there must be a balance between widespread vaccination and the choice of individuals to opt out on the basis of religious or philosophical objections.

"[Vaccinations] are an important part of making sure we protect [kids’] health and public health", said New Jersery governor Chris Christie, a presidential hopeful.  "I also understand that parents need to have some measure of choice in things as well. So that’s the balance that the government has to decide." 

White House spokesman Josh Ernest said, "The president believes it shouldn’t require a law for people to exercise common sense and do the right thing." He continued,  "… This is the right thing for them to do both by their own children, but by also other children in the community. They have a responsibility to do this."

But while federal politicians have stayed at a more theoretical level, state senators have been more zealous in seeking restrictions. California senators Diane Feinstein and Barbara Boxer have sent an open letter to the state’s Health and Human Services department, requesting that only children with medical conditions be exempt from vaccination.

"Parents who refuse to vaccinate their children not only put their own family at risk, but they also endanger other families who choose to vaccinate", the senators asserted.

In an article in the National Law Review, Georgetown University health law expert Lawrence O. Gostin argues that the risks of not vaccinating outweigh the importance of personal choice:

“The ethical question is whether a layman's view of vaccine risk, unsupported by evidence, ought to prevail when the consequence of failure to vaccinate is the spread of dangerous, sometimes lethal, diseases…What has happened is that religious and conscientious objectors cluster in distinct neighborhoods, which leads to outbreaks throughout the community. The tragedy of the commons is that if enough people opt out, everyone becomes at risk.”
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February
07
  2:42:00 PM

Canada’s supreme court strikes down ban on assisted suicide

The Supreme Court of Canada 

In a landmark decision the Supreme Court of Canada ruled on Friday that prohibiting assisted suicide is unconstitutional and a violation of the country’s Charter of Rights and Freedoms.

It unanimously affirmed the decision of the British Columbia Court of Appeal which had struck down the ban and ruled that a woman suffering from ALS, Gloria Taylor, had the right to ask for assistance in dying. Its judgement in what became known as Carter v. Canada stated that it is unconstitutional to deny physician-assisted suicide to:

“a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”

The lengthy judgement reaffirmed the reasoning of Justice Jo-Ann Prowse in the Carter case but still leaves many features of end-of-life decisions undecided. For instance, the Supreme Court declared that “We make no pronouncement on other situations where physician‑assisted dying may be sought”. It therefore refused to decide whether people may legitimately request help to commit suicide if they are simply tired of life or fearful of the future. Nor does it set an age limit for suicide requests.

While the unanimous decision is surprising, it was not unexpected. Canada has been debating assisted suicide and euthanasia for years. In 2011 a report from the Royal Society of Canada, a think tank, strongly recommended the legalisation of assisted suicide and euthanasia. In June Quebec, defying the Federal government, passed legislation which allowed it. In August the Canadian Medical Association declared that it no longer opposed it.  

The reasons underlying the Court’s decision were fundamentally two: personal freedom and security. “An individual’s response to a grievous and irremediable medical condition is a matter critical to their dignity and autonomy. The prohibition denies people in this situation the right to make decisions concerning their bodily integrity and medical care and thus trenches on their liberty. And by leaving them to endure intolerable suffering, it impinges on their security of the person.”

Unending pro-life arguments against assisted suicide, it also declared that a prohibition infringed upon people’s right to life because they might end their lives sooner than they would if they could rely upon assistance: “it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.”

What about conscientious objectors to assisted suicide? The Supreme Court tried to reassure them by declaring that “nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.  The declaration simply renders the criminal prohibition invalid.” This is a matter for legislatures and professional associations. However, it also said that “we underline that the Charter  rights of patients and physicians will need to be reconciled”, thus framing requests as a legitimate right under Canada’s charter. Opponents of assisted suicide are unlikely to be reassured.

The Court’s views on the experience of Belgium, where euthanasia has been legal for more than a decade, were interesting. It studied research by Professor Etienne Montero, a professor in bioethics and an expert on the practice of euthanasia in Belgium. He claimed that safeguards there were flimsy and that there were many abuses. Without contesting this, the Court declared that the experience in Belgium was irrelevant because of the many cultural differences between the two countries.

It will take a while for the consequences of the Carter case to work themselves out. However, it is abundantly clear that bioethicists are divided into two camps. Arthur Schafer, of the University of Manitoba hailed it as "a victory for humanity and justice."

"The fact the Supreme Court decision was unanimous reflects the overwhelming consensus in Canadian society that individuals should have their liberty respected when it comes to such important decisions as when and how we die."

 But Margaret Somerville, of McGill University in Montreal, said that it was a disaster.

 "Canada has fallen over the edge of the abyss in legalizing the intentional infliction of death on our most vulnerable citizens — those who are old, frail, disabled, depressed, mentally, physically, or terminally ill…
"This is not an incremental change, but a seismic shift in one of our most important foundational values — respect for human life at both the individual and societal levels," she said. "I believe that future generations will look back on this decision, in the light of its future consequences, as the most important, harmful and regrettable ethical, legal and public policy decisions of the 21st century."
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