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  5:23:00 PM

Have Chinese scientists discovered a “singleton gene”?

More evidence that articles about genetic determinism are positively correlated with provocative headlines.

In the Daily Mail, the article was headed, “Were you BORN to be single? Scientists discover a gene that makes certain people bad at relationships”; in the Mirror, “'It's not you, it's my DNA': Are you destined to be alone forever as Singleton gene discovered?”; and in the relatively sober Guardian, ‘Happy gene’ may increase chances of romantic relationships”.

The headlines were summing up a study from Peking University, in Beijing, in the journal Scientific Reports. Researchers found that a single gene, 5-HTA1, which affects levels of the mood hormone, serotonin,  “was significantly associated with the odds of being single both before and after controlling for socioeconomic status, external appearance, religious beliefs, parenting style, and depressive symptoms”.

Fifty percent of university students who had two copies of the C variant of the gene were likely to be in relationships, but only 40% of students with the G variant.

But after the large numbers came the small details. The study admitted that the genetic component explained only 1.4% of the difference in the probability of being single or in a relationship. Furthermore, the researchers only interviewed Han Chinese university students. Results with blue-collar workers or with different ethnic backgrounds might produce different results. 

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  4:43:00 PM

Dutch doctors want to harvest organs of euthanased patients

Doctors in the Netherlands are developing a protocol which will increase the number of organs from people who request euthanasia. Erasmus Medical Centre in Rotterdam and the University Hospital of Maastricht have written national guidelines which are being studied by the Dutch Transplant Foundation.

If the procedures are approved, they would be binding on hospitals and doctors throughout the country.

Spurring on this study is the feeling among transplant surgeons that healthy organs are sometimes wasted when patients are euthanased. In the words of a medical ethics expert with the Royal Dutch Medical Association, Gert van Dijk, “An estimated 5 to 10% of people who are euthanased could be considered for organ donation. Five percent does not seem like much, but this still means 250 to 500 potential organ donors every year.” He believes that Dutch doctors could even double the number of organs available for life-saving procedures. It could also give donors the consolation of knowing that they are saving lives even if they themselves have to die.

Up to now, there have only been six case of organ donation after euthanasia in the Netherlands. More have been done in neighbouring Belgium, where euthanasia is also legal.

While getting euthanasia patients to donate organs might sound easy, in practice there are a number of difficulties. Most euthanasia patients have cancer and so their organs are not suitable for donation. The most suitable patients are those with neurodegenerative diseases like ALS or multiple sclerosis.

There are administrative issues as well. Most hospitals are adverse to allowing doctors to perform euthanasia if they are not staff members. Many euthanasia patients want to die at home, but if they want to donate their organs, they have to die in an operating theatre, away from their loved ones. 

The protocol will probably create some firm guidelines:

  • Procedures for euthanasia and organ donation must be completely separate. Only if a person fulfils all the criteria for euthanasia would he be eligible for organ donation.
  • The idea of donating organs must come from the patient, not the doctor.
  • Only a doctor who is not involved in the organ donation can confirm the patient’s eligibility for euthanasia.
  • The euthanasia doctor must sign a statement indemnifying the hospital against future lawsuits. 
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  10:45:00 AM

I, Gray, beheld a new heaven and a new earth

Some admire futurists for their audacity; others mock them for their frequent and spectacular inaccuracy. The latest predictions of futurist-cum-transhumanist Gray Scott in are certainly daring. But are they accurate?

According to Scott, Human ectogenesis – the growth of an embryo or fetus outside of the human womb – will be possible by 2033. “The debate over ectogenesis”, says Scott, “will heat up around 2020, once scientists are allowed to birth the first full term mammal inside an artificial uterus.” Scott refers to the research of Juntendo University academic Yoshinori Kuwabara, who with his research team has managed to keep goat fetuses growing for ten days.

Scott also claims that ‘age reversal’ in humans will be possible by 2025:

“For the wealthy, reversing age will be common by 2025. It may be extraordinarily expensive and risky, but for people who want to turn back the clock, it will be worth it.”

Scott wrests support for his predication in a recent article on age reversal published in the journal Cell. The study, completed by a group of US and Australian researchers, discusses the successful reversal of ageing in the muscle tissue of mice.

In a more general prediction, Scott claims that transhumanists will outnumber Christians by the year 2035. For this prediction he utilizes a rather controversial definition of a transhumanist – someone with any bio-upgrade or human enhancement (including anyone who has undergone the banal medical process of hip-replacement or dental implants).

Will all or some or none of these predictions come true? Retrofuturist scholars make light of the myriad of failed predictions from the past, but they also note that a number of extremely precise and supposedly ‘crazy’ predictions have come true. Time will tell where these transhumanist visions fall.

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  10:26:00 AM

What does it mean to be a human person?

Concerning the nature of time, Augustine famously wrote:

“What, then, is time? If no one ask of me, I know; if I wish to explain to him who asks, I know not.” (Confessions, Bk XI, ch.XIV).

A recent article on personhood by bioethics writer Virginia Hughes discusses an analogous definition of personhood. Hughes draws upon the work of academics Martha Farah and Andrea Heberlein, who in 2007 argued that personhood “is a concept that everyone feels they understand but no one can satisfactorily define”. 

Hughes surveys the ‘hard science’ of personhood. Much of recent neuroscientific research attempts to explain our intuitions about the ‘personhood’ through reference to features of the brain that structure our experience of the world. It’s a kind of curious hybrid of materialism and Kantianism. 

Hughes discusses a number of neuroscientific discoveries in the past century. Structures like the fusiform face area and the superior temporal sulcus are activated when we are looking at faces or moving bodies. We also can’t help but anthropomorphise inaniminate structures when they display animate characteristics (consider the ‘bullying triangle’ from a famous 1940’s experiment). In addition, babies are able to process facial expressions at an extremely early stage, despite their scant real world experience. All this seems to suggest that personhood, rather than having some objective existence in the world, is a direct product of neurophysiological phenomena in the human brain.

However, even with all the scientific evidence describing the neurophysiological substrate of the concept ‘personhood’, there seems to be something left unexplained. As Farah and Heberlein note, science has been able to offer an objective definition of plants – organisms that get their energy through photosynthesis – but it hasn’t be able to do the same for the category of personhood. 

Some might pounce on the claim and use it to justify a bioethical human exceptionalism. Others may argue the opposite. If personhood is a flaky, undefinable concept, it loses its moral force in bioethical debates.

Whilst not directly engaging in this debate, Hughes suggests that personhood is the categorical foundation of human social life:

“Here’s why I think the personhood notion so valuable. We are people. Our people-centric minds evolved for a reason (namely, our species depends on social interactions) and our people-centric minds dictate how our society works. So maybe personhood is not based in reality. It’s the crux of our reality.”

There are a number of assumptions here, some more controversial than others. Whilst Hughes provides a useful summary of the topic, the need for extended scholarly treatment of the topic is evident.

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  10:10:00 AM

Rethinking care for the elderly

In a recent article in The Conversation, Two academics at Emory University in Georgia have proposed a novel solution to problem of providing healthcare for the burgeoning elderly population in Western nations.

Rather than merely advocating an increase in the number of geriatricians, Dr. Jonathan Flacker and Rebecca Dillard argue for “new models of care” that focus on “better coordination of care for older adults”.

“If we want care for older adults that is more than just “good enough,” we need more boots on the ground to provide that care. We don’t just need more geriatricians. We need more pharmacists, nurses, nurse practitioners and physician assistants trained in the special needs of the older patient.”

As an example the authors discuss Acute Care for the Elderly (ACE) units – teams of nurses and nurse practitioners, physicians, social workers and other health-care professionals. They use coordinated care principles to ensure better patient outcomes with a relatively small investment of geriatrician time.

They also refer to the Nurses Improving Care for Healthsystem Elders (NICHE) program, an initiative designed to help nurses stimulate culture change and make healthcare systems more senior friendly.

“In each case, the geriatrician’s expertise is amplified throughout health-care organizations through care systems, better use of resources, technology, financial incentives and teamwork.”

The authors acknowledge that there is also a need for new geriatricians. But too often is this put forward as the only solution:

“What older adults need in order to optimize function and quality of life transcends simply the medical issues and extends to policies and infrastructure of our health-care systems and communities.”

The sentiments of these academics are echo those of Atul Gawande in his new book Being Mortal: Medicine and What Matters Most in the End

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  11:20:00 PM

Belgian euthanasia group tours Auschwitz

About 70 people accompanied Belgian euthanasia doctor Wim Distelmans on his tour of Auschwitz, the Nazi extermination camp in German-occupied Poland, last month. The German magazine Der Spiegel ran a long, reflective feature which attempted to explain why he dared to link euthanasia to Nazi atrocities .

The tour was highly controversial. In Antwerp ultraorthodox Jews were outraged that Dr Distelmans had described Auschwitz as “an inspiring venue”. They called him “a professional killer”. The deputy director of the Auschwitz memorial commented: "We feel that the attempt to link the history of Auschwitz with the current debate about euthanasia is inappropriate."

Distelmans was not deterred by the protests. His point was that the Nazis violated autonomy while he esteems it. He is killing patients out of humility and love. "What does this mean to us?", Distelmans asked the tour group.

"Many of us are doctors. We have power over other people. We know everything better. We were taught to preserve life. But we have to make sure that we do not continue to treat our patients, against their wills, when they actually want to die. Nobody should assume that they have the power to judge what a life is worth. We must become the servants of our patients, and when it comes to the end, we have to accept our failure as physicians."

A doctor on the tour shared an interesting case. One of his patients is an unrepentant former member of the Waffen SS who had hung a picture of Hitler over his bed. He is paralysed on one side and now be wants to be euthanased. He refused because he felt that the patient did not deserve a gentle, painless death. Another said that he would refuse because “If I killed him, I would feel like a murderer."

And Distelmans? He told Der Spiegel that he would perform the euthanasia out of respect for the man's pain and humanity and as an act of unconditional love.

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  6:14:00 AM

Should we pay commercial providers to assist suicides?

Assisted suicide is an idea which keeps evolving. Who could have foreseen the development of groups of non-doctors which help hundreds of people to die in Switzerland? Now a bioethicist from the University of Tübingen in Germany has proposed what he calls “commercially assisted suicide” (CAS) – paying a non-doctor to kill patients.

Roland Kipke argues in the journal Bioethics that there are no ethical arguments against CAS which cannot also be deployed against physician-assisted suicide (as in Oregon). It is not a popular cause, as the thought of CAS horrifies both supporters and opponents of assisted suicide.

Kipke rolls out several arguments in favour of CAS. It is not a breach of medical ethics because no doctor is involved. A for-profit provider will be more readily available than a doctor, who may have qualms of conscience.

He takes a very sceptical view of the competence of doctors. A commercial provider may not be skilled at detecting depression, but neither are doctors:

“The most common psychiatric disorder, and, at the same time, the disease that is most commonly associated with suicidal intentions, is depression. Several studies clearly show that a large number of physicians fail to recognize the depressive disorders of their patients. This is particularly remarkable because people with depression account for about 10% of a GP's patients…. Therefore, it is not justified to say that doctors are in general particularly able to assess the conditions for an autonomous decision for suicide.”

Nor are doctors particularly competent at prescribing adequate doses of drugs to commit suicide.

“a doctor does not normally learn (in education and medical practice) how many grams of sodium pentobarbital cause a quick death. Above all, the necessary knowledge about the correct dosage is limited and can easily be acquired by non-physicians.”

Kipke feels that patients would have more autonomy in making their final decision if they use a commercial provider.

“Studies have shown that doctors' assessment of the quality of life and of the suicidal wishes of seriously ill patients depends significantly on the psychological situation of the doctors themselves, and that they systematically underestimate the quality of life of their patients. Quite a few doctors also advocate directive counselling, even on morally controversial issues. It is probable that this is not fundamentally different with regard to their decisions for or against suicide.”

Finally, would CAS be another step forward in the insidious commercialisation of human life? No, says Kipke. “Doctors always earn their living from the needs of their patients: no one takes offence.” Why not a commercial provider? 

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  11:58:00 PM

Stop the carnage in Syria, doctors plead

The situation of civilians under siege by the Assad regime in Syria is even worse than under ISIS, the Islamic extremists, say Syrian doctors. In an op-ed in the New York Times, two doctors claim that at least 560 doctors and nurses have been killed and 155 medical facilities have been attacked since the war began.

Much of the destruction is due to barrel bombs, 44-gallon drums filled with explosives and shrapnel launched from helicopters. “The bombs explode with terrific force and breadth, amputating limbs and driving shrapnel throughout the body. One doctor we interviewed was still horrified by the indelible image of a mother and daughter whose bodies were blown apart while their hands remained clasped together.”

The doctors, Leonard S. Rubenstein, of Johns Hopkins University, and M. Zaher Sahloul, president of the Syrian American Medical Society, claim that the regime’s military is deliberately targeting clinics, field hospitals and ambulances. “When work in a field hospital becomes like death, it is difficult to imagine how life has any chance at all,” they write.

They have called upon the Obama administration to set up humanitarian buffer zones in northern and southern Syria so that civilians can be cared for.

Their words are echoed by a Syrian doctor writing on the blog Syria Deeply:

“We are doctors. We live to help and heal people – not to watch them die. Every one of us living in opposition-held territory of Syria has made a conscious decision: despite all the risks, we will stay and treat whoever needs us… As bombers tear across the sky on their way to dropping their deadly cargo, I wish that the urgency that moved the U.S. and other governments to bomb ISIS was matched by an urgency to save the lives of civilians. Please do not wait until there is no one left to save.”
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  11:28:00 PM

UK gay couple acquires 3 kids from 3 surrogates simultaneously

Surrogate mums and a mum discuss the experience   

A gay couple in Britain made history recently when all three of their surrogate mothers presented them with babies within seven months of each other. Daryl Lee, 41, and Luke Harris, 50, had been in a civil partnership for years and had always dreamed of having a family. Mr Harris told The Sun:

“When we told our families we are having our first surrogate baby, they were so excited for us, as they know for the past 15 years we've dreamed of having a family of our own. When we told them we were having a second baby they were amazed. And then, when we announced we're actually having three babies of our own they were stunned but overjoyed."

They had considered adoption, but after learning that singer Elton John and his partner David Furnish had acquired a child with a surrogate mother in 2010, they opted for surrogacy. They found the first surrogate, Becky Ellis, on the internet and she recruited two other women.

“I absolutely love being pregnant,” said Becky, who was a surrogate for the third time. In fact, she told ITV earlier this year that she had wanted to be a surrogate since she was 11 years old. The practice seems to be culturally embedded. The show interviewed her and three other surrogate mothers, Bex Harris, Viktoria Ellis and Jemma King, along with Bex’s mother, who cares for them during their pregnancies. (See photo above.)

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  10:55:00 PM

Hopes of anti-FGM campaigners dashed in Egypt

12-year-old Sohair al-Bata’a    

The first doctor to be tried in Egypt for performing female genital mutilation has been acquitted, dashing activists’ hopes that a conviction would send a stern message parents and doctors.

Raslan Fadl, a medical doctor and Islamic preacher in the village of Agga, northern Egypt, was on trial for manslaughter after 12-year-old Sohair al-Bata’a died in June 2013 after an operation. He denied that the procedure was FGM and said that his accusers were “on drugs”.

“Of course there will be no stopping any doctor after this. Any doctor can do any FGM he wants now,” Atef Aboelenein, a lawyer for the Women’s Centre for Guidance and Legal Awareness, told The Guardian. Suad Abu-Dayyeh, of Equality Now, said: “It’s a very unjust verdict from the judge. It sends a very negative message. It was the first case in the country and we were hoping we could build on it.”

Made illegal in 2008, FGM still has popular support, especially in rural areas. The Guardian reports:

“According to surveys by Unicef, an estimated 91% of married Egyptian women aged between 15 and 49 have been subjected to FGM, 72% of them by doctors. Unicef’s research suggests support for the practice is gradually falling: 63% of women in the same age bracket supported it in 2008, compared with 82% in 1995.”

“We circumcise all our children – they say it’s good for our girls,” one housewife, told the Guardian earlier this year. “The law won’t stop anything – the villagers will carry on. Our grandfathers did it and so shall we.”

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