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  11:32:00 PM

Nitschke loses legal battle to practice as a doctor

Australian euthanasia activist Dr Philip Nitschke remains deregistered after a ruling that his activities would undermine public confidence in the medical profession and posed a serious risk to public safety. Nitschke says that he will appeal the decision by the Northern Territory Health Professional Review Tribunal.

The controversial doctor has been in the limelight ever since he killed four patients when euthanasia was legal in the Northern Territory for several months in the mid-90s. The Medical Board of Australia disapproved of his activism, but failed to restrain him. However last year a Perth man asked Nitschke for advice about suicide. He obliged and the man later killed himself. The MBA contends that Nitschke should have referred him to a medical practitioner, while Nitschke has argued that the man had a right to rational suicide even though he was not terminally ill.

Nitschke's lawyer says it is an error of law for the tribunal not to consider the "enormous body of medical literature addressing the issue of rational suicide". However the tribunal insisted that the only legal issue is whether his actions are consistent with the code of conduct for Australian doctors.

The evidence cited in the Tribunal’s judgement gives an insight into the mind of the man who is probably the world’s best known apologist for an unrestricted right to suicide:

Nitschke is a qualified medical doctor but devotes nearly all his time to promoting euthanasia in Australia and around the world. He sees only a few patients a year on trips back to his home in the Northern Territory. He failed to fulfil his compulsory professional development requirements as a doctor. Instead he devoted his time to keeping abreast of developments in euthanasia.

Nitschke admitted in his testimony that that had become rather nonchalant about requests for help in committing suicide: “So in that sense, I suppose I’m hardened to them. I’m not surprised when I get them and I behave to them perhaps on a way which some would see as insensitive.”

Depression, even clinical depression, is not a contraindication for euthanasia. The only criterion is whether a client is rational. “I've met people that are well and say they want to end their lives. Are they depressed? Probably a bit. … everyone’s a bit depressed. The question is: have they lost the ability to give insightful rational decisions? No. … So we’re seeing all sorts of people come along. Tired of life people.”

As long as people have a reason short of phobias about invading Martians, suicide is an acceptable option for Nitschke. “Now financial concerns are one such example of what we would describe  as a non-medical reason for wanting to engage in the act of suicide. Now in terms of whether I would engage with them further, I would probably say ‘are you certain?', ‘are you sure?' And if the person said ‘yes I’m certain. I’m sure because this is such a catastrophe that this is the only way I can see out of it and I have thought it all through’, I would say that’s entirely a reasonable course for you to take if it's a course that you decide is in your best interests. It’s not for me to come along and second judge.”

Dr – or Mr – Nitschke is not letting the grass grow under his feet while he appeals his deregistration. He is scheduled to appear as a stand-up comedian at the Edinburgh Fringe Festival in August. He expects to be criticised for “trivialising” the topic, but he has been planning a new career in comedy for some time.

Nitschke was invited by a British comedian, Mel Moon, who has a terminal illness and is the youngest member of his suicide promotion group, Exit International. “Despite his notorious reputation, he’s actually quite funny,” she says. “Not as natural as a stand-up, but more like a witty after-dinner speaker.” 

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  3:49:00 PM

No contraception, no govt handouts, says Aussie politician

A tragic murder in the Australian state of Queensland has provoked a controversial solution by a former Federal government minister: no contraception, no dole.

“If a person’s sole source of income is the taxpayer, the person, as a condition of benefit, must have contraception. No contraception, no benefit,” Gary Johns, a Labor minister in the Keating government, wrote in The Australian, where he is currently a columnist. 

Mr Johns was responding to the news that a 34-year-old woman had stabbed to death all of her seven children, aged 2 to 14, and her niece as they lay sleeping in the north Queensland city of Cairns. Her children had been fathered by five different men.

Mr Johns framed his proposal as a solution to the problem of state-sponsored sexual irresponsibility.

Therefore, there should be no taxpayer inducement to have children. Potential parents of poor means, poor skills or bad character will choose to have children. So be it. But no one should enter parenthood while on a benefit.

It is better to avoid having children until such time as parents can afford them. No amount of “intervention” after the fact can make up for the strife that many parents bring down on their children.

As commissioner Tim Carmody wrote in the Queensland Child Protection Commission of Inquiry report in 2013, “some families will never rise to the challenge or have the capacity or commitment needed to take responsibility for the children they bring into the world”.

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  10:45:00 PM

Are chimpanzees persons?

The argument about non-human personhood has surfaced once again – this time in a New York State Supreme Court.

The court was hearing the case of Tommy – a 26-year-old chimp allegedly being kept in a shed by a neglectful owner. The animal rights group The Nonhuman Rights Project were petitioning the court to extend personhood rights to Tommy, and prosecute the owner accordingly.  

Despite their characterisation of Tommy as an autonomous individual, the five-member judicial panel ruled that personhood didn’t extend to non-humans. The judges stated:

“Unlike human beings, chimpanzees cannot bear any legal duties, submit to societal responsibilities or be held legally accountable for their actions. In our view it is this incapability to bear any legal responsibilities and societal duties that renders it inappropriate to confer upon chimpanzees the legal rights... that have been afforded to human beings.”

The case is by no means the end of the animal rights movement’s push to have non-human animals recognized as legal persons. Non-Human Rights Project attorney Stephen Wise was very happy to have his argument taken seriously. 

“Can you imagine: I’m in a courtroom, and we’re having a dialogue about what a chimpanzee wants?”

Indeed, the growing body of research into animal sentience is bound to contribute to the impetus to change the system and give greater legal standing to higher sentient beings.  

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  10:26:00 PM

What did Udo Schuklenk really say about neonatal euthanasia?

Bioethicist Udo Schuklenk has come under fire following the publication of a conference paper in which he advocated neonatal euthanasia in certain extreme circumstances. A number of commentators have attacked Schuklenk for his ‘dangerous’ remarks and ‘eugenic ideology’. Schuklenk has hit back, arguing that one particular critic misrepresented his argument, and, to quote, “made stuff up”.

So, what did Dr. Schuklenk actually write? I’ll just try to state the facts.

The paper, entitled ‘Physicians can justifiably euthanize certain severely impaired neonates’, was originally read at the Annual Meeting of the American Association for Thoracic Surgery. The stimulus for the article was real life case of a baby suffering from severe heterotaxy syndrome – a condition in which the heart or other organs are misarranged in the body. The association were seeking insight on whether it would be permissible in such cases to euthanise a baby. Shucklenk responded:  

“There appear to be some cases, then, where continuing existence is not in a severely impaired neonate’s best interest. Terminating its life, based on parent choice, seems a prima facie reasonable option.”

Schuklenk has gone to pains to point out that he didn’t write ‘severe deformities’, but rather ‘severely impaired’. Schuklenk goes on to consider various arguments for and against this procedure. He argues that there is a good case to allow parents of the neonate to go proxy for him or her.

He also criticises the notion of human dignity as question begging.

“[Such claims] are question-begging; they typically assume the truth of what they need to demonstrate. Human dignity has no clear, universally agreed-upon meaning. A quality-of-life proponent could just as well argue that respect for human dignity demands that the infant’s life be terminated on compassionate grounds.”

He considers terminal sedation as an alternative to euthanising the ‘severely impaired’ child; in the end, he argues that parental distress and the unnecessary drain on health care resources make euthanasia an acceptable option.

“Health care resources ought to be deployed where they can actually benefit patients by improving their quality of life. This cannot be achieved in the scenario under consideration.”

For those of you who can’t access the article itself, the above will hopefully serve as a useful summary. I’ll leave it up to commenters to editorialize. 

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  9:15:00 PM

Book closes on stem cell saga

RIKEN officials announce failure to replicate STAP cells.    

Yet another stem cell dream has been shattered for ever. At a news conference yesterday, officials at Japan’s prestigious RIKEN Institute announced that attempts to replicate STAP cells, or stimulus-triggered acquisition of pluripotency cells, are over.

When Nature published a paper by 31-year-old researcher Haruko Obokata in January, the scientific world was electrified. Using her method it was going to be possible to create pluripotent stem cells easily and quickly. Or so it seemed.

Very quickly her results began to unravel. Other scientists failed to replicate her astonishing claims and found that some of her illustrations and data were misleading or even fraudulent. By April her employer had accused her of misconduct. By July the papers had been retracted. In August one of her co-authors committed suicide.

RIKEN gave Dr Obokata three months to replicate her own results. She has failed. “I’m just totally shattered and very perplexed by the results,” she said. She has submitted her resignation.

Somewhat ironically, two days before, Nature – which had published Obokata’s article despite serious reservations on the part of anonymous reviewers -- ran an editorial about media hype

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  5:22:00 PM

Is this guru dead or meditating?

For an interesting twist on the determination of death, we turn to the Punjab, in northern India. A court there has ordered that the body of Ashutosh Maharaj, who died of a heart attack on January 29, be cremated.

But Maharaj was (or is) a the leader of  Divya Jyoti Jagrati Sansthan (Divine Light Awakening Mission) movement and his followers are convinced that he is not dead but meditating. They believe that he has reached the state of "samadhi," the highest level of meditation which only the holiest of India’s holy men reach. In this state they can control the beating of their heart and may even appear to be dead.

"Maharaj has been in deep meditation," according to one of his followers. "He has spent many years meditating in sub-zero temperatures in the Himalayas, there is nothing unusual in it. He will return to life as soon as he feels and we will ensure his body is preserved until then."

The body of Maharaj, who was in his 70s when he apparently passed away, has been refrigerated and local authorities are reluctant to enforce the court order. A December deadline has now been pushed back to February 9, more than a year after his medical death.

In India meddling with the affairs of religious leaders can be dangerous. When a guru died in West Bengal in 1993, secular-minded authorities who were trying cremate the body had to battle their way through thousands of his followers. When police arrested another guru in Haryana state last month on charges of murder and incitement to violence, there was a riot and six of his followers died. 

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  4:00:00 PM

The Optimist: I have lived in a golden age, says US bioethicist

Arthur Caplan’s canter through the history of bioethics in a special 40th anniversary issue of the Journal of Medical Ethics is decidedly upbeat. “Bioethics today is riding high in the saddle; shaping public health policy, exercising oversight of biomedical research, consulted by powerful organisations for ethical help and setting normative rules for the diagnosis and treatment of patients. It has spread worldwide, from a few small think tanks and medical school programmes located in the USA.”

How did this happen?

Caplan, who launched his career in the 70s and now teaches at New York University’s Langone Medical Center, is probably the most quoted bioethicist on the planet. He attributes the good fortune of his vision of bioethics to public engagement. Bioethicists provided answers to unsettling questions raised by novel technology at the exact time when the public needed them.

“It was a field whose timing was impeccable—new problems and challenges emerged one after another in rapid succession fuelled by technological advances creating a demand for somebody, anybody, to provide thoughtful input into their management. It was a field that, notably, attracted few, but among the thin ranks were many intellectual giants.”

Many reasons have been put forward to explain the glamour of bioethics, including the “intellectual bamboozlement” of the medical profession, the chaotic state of philosophy departments, and the abdication of moral authority by the medical establishment. But Caplan has a different explanation: bioethicists like himself were not afraid of the media. “Bioethics gained social legitimacy by not following the British analytical philosophy tradition into the ivory tower, but, rather, the Socratic tradition of engaging the public in the ‘marketplace’.”

He worked hard to engage journalists, by teaching at Columbia University’ journalism school and then by serving on the board of a journalism think tank, the Poynter Institute. He has always tried to teach the media that “bioethics [is] not simply an after-dinner mint but often the core subject of interest to those following stories about healthcare and the biomedical sciences”.

Later on he began to write a syndicated newspaper column. “By the time social media burst on to the scene in the mid-2000s, opening a new world of blogs and websites and somewhat diminishing the authority and impact of the mainstream media, bioethics’ responsibility to engage in public discourse was taken for granted and even extolled by national commissions and panels.”

Other academics were not always impressed and grizzled about celebrity bioethicists and oversimplification. But, for Caplan, the proof is in the pudding. “By using the media to move into the public arena, the field engaged the public imagination, provoked dialogue and debate, and contributed to policy changes that benefitted patients and healthcare providers.” Bioethics did well by doing good. 

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  2:56:00 PM

The Pessimist: Editor of leading bioethics journal mourns “failure” of bioethics

“Both bioethics and medical ethics together have, in many ways, failed as fields,” laments the editor of the Journal of Medical Ethics, Oxford’s Julian Savulescu. His diagnosis is that an illogical moralism dominates nearly all bioethical issues and that debates are conducted in philosophical darkness. He concludes gloomily that “From time to time, we ought to ask how well we are doing. In my own career, apart from promoting people's careers, I am only aware of two instances where my work did some good.” He even says that he feels, at least sometimes, that “there is no future for medical ethics”. 

His disappointment is particularly poignant because the issue in which his reflections appear is a special 40th anniversary splash of the JME. 

One example of the moral ignorance which pains Professor Savulescu is the moral obligation that people have to donate their organs after their death. To him, this is almost a self-evident ethical precept:

“Why? Because this is not just an easy rescue, it is a zero cost rescue. Organs are of no use to us when we are dead, but they are literally lifesaving to others. Nonetheless, most people choose to bury or burn these lifesaving resources, and are allowed to. Yet the state extracts death duties and inheritance taxes, but not the most important of their previous assets—their organs. The failure to meet even our most minimal moral obligations is damning. It represents the failure of modern practical ethics.”

At some points in his essay, Savulescu seems almost despondent:

“I left a promising career in medicine to do bioethics because I had done philosophy in 1982 and attended Peter Singer's lectures in practical ethics. The field was new and exciting and there were original proposals and arguments. Singer, Glover, Lockwood, Parfit and others were breaking new ground, giving new analyses and arguments. Now medical ethics is more like a religion, with positions based on faith not argument, and imperiously imposed in a simple-minded way, often by committees or groups of people with no training in ethics, or even an understanding of the nature of ethics.
“What medical ethics needs is more and better philosophy—and a return to the adventurousness and originality of its pioneering days. There have been successes—euthanasia and better treatment of animals to mention just two. But the field has in many ways dried up or become dominated by moralists bent on protecting privacy and confidentiality at great cost and ‘getting consent’, and in other ways ‘protecting basic human rights and dignity’. Medical ethics isn't sufficiently philosophical, and when it is philosophical, it's the bad arguments or a narrow range of arguments that often seem to make a difference. And there is the attempted scientification of ethics in empirical ethics, a kind of sociological ethics, surveying people's opinions and practice. But this can never directly lead to answering the question: what should we do?”

From this, it appears that Professor Savulescu believes that Singer’s “practical ethics” is ethics and that being “philosophical” is being utilitarian. He concludes with the lapidary maxim, “Good ethics requires good philosophy.” No doubt philosophers of every stripe will agree with him there. The question which the article fails to address is whether Singer and Savulescu’s utilitarianism is good philosophy. 

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  10:10:00 AM

Swiss bioethicist backs organ donor euthanasia

The idea of using patients as organ donors if they request assisted suicide or euthanasia seems to be catching on. This is reasonably common in Belgium and in the Netherlands an official protocol is being drawn up to regulate such cases.

Now, in an interview with the Swiss news service, bioethicist David Shaw, of the University of Basel, in Switzerland, has backed the idea. He says that it is shame for life-preserving organs to be wasted.

I'm not saying that we should be killing people to take their organs. But Switzerland is one of the few countries in the world where several hundred people use assisted suicide every year. This is a situation where you have people who want to die, you know when they're going to die, and many of them are probably registered organ donors. So it's also more respectful to the people to let them do this final kind of parting gift to humanity.
The trouble when you have an idea like this is that some people might get a hold of it and say, 'These crazy ethicists. They want to kill everyone and take their organs out.' Not the case at all. I'm just saying, people are dying because we don't have enough organs.

Will this put pressure on sick patients to die to donate because they believe that it is the only way that their lives can have meaning? No, says Dr Shaw. “The burden argument is used a lot in assisted suicide debates, and it's not really very convincing. The bioethics literature is quite clear on that.”

Dr Shaw, a Scot, also serves on the UK Donations Ethics Committee, so his views may have some influence in shaping legislation if the UK legalises assisted suicide.

HT to Wesley J. Smith.

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  11:09:00 AM

Psychologists criticised in CIA torture report

Two psychologists contracted by the CIA to create enhanced interrogation techniques for al-Qaeda detainees have come under fire for violating human rights and medical ethics. Although pseudonyms were used in the 480-page report published this week by the Senate Select Committee on Intelligence, it was clearly referring to Bruce Jessen and James Mitchell, who were paid US$81 million for their work.

Both Jessen and Mitchell had worked on  the military’s Survival, Evasion, Resistance, and Escape (SERE) program in which soldiers are trained to endure brutal mock interrogations, including waterboarding. After 9/11 they were asked to design an interrogation program.

Despite the opprobrium heaped on them, the two men cannot respond directly to the criticisms in the report because they have signed non-disclosure agreements. “I’m in a box -- I’m caught in some Kafka novel,” Mitchell, who is now retired and living in Florida, told Bloomberg. “Everyone is assuming it is me, but I can’t confirm or deny it. It is frustrating because you can’t defend yourself.”

But he defended the broad aims of the program he helped to design.

“The people who think the men and woman in the CIA are doing the heavy lifting for them so they can sleep safe at night, those people I get a lot of positive comments from. Then there are the people who think it would be better that 3,000 people die than that KSM [Khalid Sheikh Mohammed] get slapped and they don’t care because it isn’t going to be them who is dying. They just don’t care.”

The techniques they designed were based on the notion of “learned helplessness”, which was developed in the 1960s with dogs by Martin Seligman (who is mortified by his indirect link with torture). People who face unending adversity eventually become depressed and give up attempts to improve their situation. The CIA's psychologists thought that this state would encourage detainees to become cooperative and volunteer information.

Physicians for Human Rights was highly critical of the participation of health professionals in all stages of the CIA’s program. Their involvement in monitoring the torture techniques was central to providing legal protection to interrogators, said PHR, as torture could them be described as “safe, legal, and effective”.

"They were complicit at every step, including designing the torture techniques, monitoring the infliction of severe physical and mental pain, and failing to document clear evidence of harm,” said Dr Vincent Iacopino, PHR’s senior medical advisor. “What happened was unethical, unlawful, and immoral, and we must ensure it never happens again."

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