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June
20
  11:56:00 AM

One Child Policy an attack on the common good - Chinese bioethicist

In a provocative new article in the Cambridge Quarterly of Healthcare Ethics, Chinese bioethicist Jing-Bao Nie attacks the one child-policy for having “a hugely negative effect on the common good”. Nie criticises the government’s claim that the policy has benefited society through raising living standards and reducing overcrowding:

“The greatest irony of all is that, while originally designed to improve living standards and help relieve poverty and underdevelopment, the one-child policy has inflicted massive suffering and state-directed violence on Chinese people, especially women.”

Nie has conducted extensive research into the impacts of the coercive policy. He was horrified by the results:

“[It has] grave negative impacts on women undergoing reproductive interventions, including the side effects of contraceptive use, mental and physical problems caused by the uninformed selection of contraceptive methods, conflict between a couple’s wishes and the state’s population goals, and the permanent distress entailed in the failure to produce a male child.”

He discusses in particular the harrowing stories of two women forced to have abortions after failing to meet the criteria for a ‘birth permit’:

“Women have had to endure suffering on a massive scale.”

Nie was initially a supporter of the one-child policy, but changed his views after a close study of these cases.

In late 2013 the Chinese government altered the policy so that parents who themselves were only children could have more than one child. Nie is sceptical about the actual impact of the change:

“It is far from clear when and how the promised modification will be implemented in practice. And the government does not plan to further relax current restrictions to include couples in which neither partner is a single child.” 

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June
14
  11:28:00 PM

Psychiatrist heaps fuel on fiery transgender debate

Denee Mallon     

Denee Mallon is a 73-year-old Army veteran and male-to-female transsexual, who has just won a stunning legal victory. No longer can Medicare refuse to pay Mallon’s medical expenses for sex reassignment surgery. A Department of Health and Human Services (HHS) review board has ruled that it is no longer reasonable to exclude such surgeries because they were experimental or risked serious complications.

"Sometimes I'm asked aren't I too old to have surgery. My answer is how old is too old?" Mallon told the Associated Press. "When people ask if I am too old, it feels like they are implying that it's a 'waste of money' to operate at my age. But I could have an active life ahead of me for another 20 years. And I want to spend those years in congruence and not distress."

However, writing in the Wall Street Journal, a leading psychiatrist, Dr Paul McHugh, challenged the trend of transgender acceptance. He believes that it is seriously mistaken.

“This intensely felt sense of being transgendered constitutes a mental disorder in two respects. The first is that the idea of sex misalignment is simply mistaken—it does not correspond with physical reality. The second is that it can lead to grim psychological outcomes … “

Dr McHugh, a member of President Bush’s bioethics commission, says that his university, Johns Hopkins, stopped doing transgender surgery, even though most patients reported that they were “satisfied” with the surgery. “Producing a "satisfied" but still troubled patient seemed an inadequate reason for surgically amputating normal organs.” He cited a Swedish study which found that the suicide rate among people who had sex-reassignment surgery was 20 times higher than the non-transgendered population.

At the heart of the problem is confusion over the nature of the transgendered. "Sex change" is biologically impossible. People who undergo sex-reassignment surgery do not change from men to women or vice versa. Rather, they become feminized men or masculinized women. Claiming that this is civil-rights matter and encouraging surgical intervention is in reality to collaborate with and promote a mental disorder.
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June
14
  11:21:00 PM

The ethics of tracking Taliban detainees

Attaching chips to dementia patients is becoming a common way of ensuring that their carers know where they are and whether they are safe. In the UK, patients can wear tracking systems which allow them to speak to an operator in a call centre run by local authorities. Welfare agencies have expressed concerns about the patients’ informed consent and privacy.

But the ethical issues are far more tangled if spy agencies are chipping released prisoners, US bioethicist Art Caplan points out.

The American government recently traded five Taliban members detained at Guantanamo Bay for Sgt Bowe Bergdahl, a soldier held by the Taliban. Is it possible that the CIA may have “chipped” the detainees so that they can track them?

Such ‘chipping’ is common for pets and becoming more common for persons with dementia at high risk of wandering from nursing homes.  It might allow surveillance of where the exchanged Taliban prisoners go in terms of enforcing their exile in Qatar for a year or making them inadvertent, unwitting assets for intelligence purposes when they finally do return home.
I don’t want to get into the issue of how sophisticated a surgically implanted chip might be or where is the best place to insert such a device to ensure undetectability or long-term functionality.  I do want to raise the issue of whether this form of secret chipping would be ethical since whether it was done with these men or not it is very likely it could be done in the future.

What are the ethics of surgery without informed consent to protect national security? It’s a thought-provoking question for, as Caplan points out, surgical implants to track enemies is all but inevitable.

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June
14
  11:16:00 PM

Assisted suicides in Washington state up by 43%

Legal assisted suicide deaths in Washington state rose by 43% in 2013, according to an official report. Under the state’s 2008 Death with Dignity Act, adult residents in the state with six months or less to live may request lethal doses of medication from physicians.

In 2013, medication was dispensed to 173 individuals of whom 159 are known to have died, 119 of them, after ingesting the medication. (Sometimes people keep the medication without using it.) The cause of death of another 14 is unknown. The lethal prescriptions were written by 89 different physicians and dispensed by 23 different pharmacists.

Of the 151 participants in 2013 who died, 97% were white and non-Hispanic; 525 were married; and 76% had at least some college education.

Most requests for a lethal prescription were motivated by fear of losing autonomy, dignity or the ability to participate in activities that made life enjoyable. Pain was not mentioned as an issue in the official report. 

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June
14
  11:08:00 PM

Were Irish orphans of the 30s used in clinical trials?

Once again the Catholic Church in Ireland is in the middle of a media firestorm about past abuse, this time about clinical trials in the 1930s. In the wake of lurid reports about a septic tank containing nearly 800 skeletons of babies near the site of a home for unmarried mothers come allegations that orphans were used as guinea pigs for untested vaccines.

A researcher at Cork University, Michael Dwyer, has uncovered records which appear to show that 2,051 children and babies at orphanages were given a one-shot diphtheria vaccine between 1930 and 1936, as part of a drug trial for the drug company Burroughs Wellcome. It appears that no consent was sought. Mr Dwyer told the Daily Mail:

'What I have found is just the tip of a very large and submerged iceberg. The fact that no record of these trials can be found in the files relating to the Department of Local Government and Public Health, the Municipal Health Reports relating to Cork and Dublin, or the Wellcome Archives in London, suggests that vaccine trials would not have been acceptable to government, municipal authorities, or the general public..

'However, the fact that reports of these trials were published in the most prestigious medical journals suggests that this type of human experimentation was largely accepted by medical practitioners and facilitated by authorities in charge of children’s residential institutions.'

A spokesman for GlaxoSmithKline, the drug conglomerate which has absorbed Burroughs Wellcome, said: “The activities that have been described to us date back over 70 years and, if true, are clearly very distressing. We would need further details to investigate what actually took place, but the practices outlined certainly don’t reflect how modern clinical trials are carried out. We conduct our trials to the same high scientific and ethical standards, no matter where in the world they are run.”

The revelations have added fuel to a firestorm of criticism of the Catholic Church’s role in Irish society. However, the truth of the allegations remains to be established. Headlines about 800 baby corpses have provided fodder for the speeches of hostile politicians, but the more that is known about it, the less sinister it appears.

Something similar could be said about Mr Dwyer’s iceberg. Drug tests like this were not illegal at the time in Ireland. And they were conducted before World War II and the Nuremberg code for human experimentation, when governments and doctors were less sensitive to the need for informed consent. The notorious Willowbrook hepatitis trials in the US in the 1950s and 1960s were conducted on hundreds of intellectually disabled children, an even more vulnerable population, long after the Nuremberg code. 

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June
14
  6:28:00 PM

Investigation finds half of Down syndrome abortions missing from register

An investigation into terminations of Down’s Syndrome foetuses in the UK has revealed that half of these abortions go unrecorded.

The probe was conducted by the independent National Down’s Syndrome Cytogenetic Register (NDCR), an organisation that is notified of any Down’s Syndrome diagnoses and can track the progress of pregnancies.

They found that out of 994 terminations, only 496 were properly recorded. Out of the 498 missing cases, around 50 had been recorded but alternative reasons given. It is unclear whether the other 450 were recorded in some capacity, or simply conducted off the register.  

Tory MP Fiona Bruce, chairman of the recent independent parliamentary inquiry into abortion for disability, said it was clear doctors had broken the law: “Worryingly, the department appears to have made no attempt to see that the law is properly enforced,” she said.

“We now know that nearly half of abortions for Down’s Syndrome were incorrectly recorded. How many doctors were referred for investigation? None.”

A spokesman for the Department of Health said they were working with the Royal College of Obstetricians and Gynaecologists to tighten up the system.

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June
14
  12:11:00 PM

Inducing death to give life – without patient consent

A new emergency procedure being trialled in a US hospital has bioethicists feeling nervous. The procedure – known as Emergency Preservation and Resuscitation - involves stopping the heart and lowering the body temperature of trauma patients experiencing cardiac arrest and severe blood loss. 

Doctors replace the patient’s blood with freezing saltwater that stops the heart and lowers body temperature to 10 degrees Celsius. At this temperature doctors have one to two hours to operate before brain damage occurs.

The procedure stops rapid blood loss and dramatically slows the onset of brain damage. At normal body temperatures, surgeons typically have less than five minutes to restore blood flow before brain damage occurs.

Doctors – not the patients – will decide whether the procedure will be performed. Only patients who have obtained a hospital bracelet saying “No EPR” will be omitted from candidature. Some ethicists have expressed reservations about the lack of informed consent, but they recognize the difficulties of obtaining such patient approval. 

Arthur Caplan of the Berman Bioethics Centre says the procedure will often be the only option to keep patients alive. He is, however, nervous about possible brain damage:

“If this works, what they’ve done is suspended people when they are dead and then brought them back to life…there’s a grave risk that they won’t bring the person back to cognitive life but in a vegetative state.”

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June
14
  12:05:00 PM

Expert warns of misuse of genetic evidence in courtroom

Prominent medical law commentator Paul S. Appelbaum has warned of the misuse of genetic evidence in courtrooms. In an article published in Neuron earlier this month, Appelbaum noted that there has been a modest increase in the use of ‘genetic arguments’ in US jurisdictions in the past twenty years. He challenged the view that genetic evidence provides a ‘genuinely excusing condition’:

“Many defendants experience pressures to commit criminal acts—from peer encouragement to the disinhibiting effect of intoxicating substances—but in general we expect them to resist the urge to act illegally or suffer the consequences. Unless a defendant’s genetic endowment substantially impairs her ability to appreciate the wrongfulness of her conduct or to obey the requirements of the law, genetic influences may simply be one more pressure that she is expected to resist.” 

Appelbaum warned that judges could presume a genetic basis for criminal action even when no reliable evidence has been provided (he cites the case of U.S. v. Cossey, 632 F.3d 82, 2d Cir. 2011). A more common occurrence would be for judges or juries to overestimate the conclusions that can be drawn from genetic evidence.

“It will be an ongoing challenge for both legal and genetic experts to monitor the use of genetic data in the courts to ensure that the conclusions drawn validly reflect the science.”

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June
14
  11:53:00 AM

Canadian court declares patient specimen the “personal property” of a hospital

A Canadian court has ruled that a medical specimen taken from a patient in a pathology clinic is the ‘personal property’ of a hospital

The specimen of liver tissue was taken from Ms. Snezana Piljak in Toronto’s Sunnybrook Hospital in 2009. Ms. Piljak passed away from cancer in 2011, and her family sued her doctor for failing to identify the cancer.

That doctor petitioned Sunnybrook hospital for access to Mrs. Piljak’s specimen, but under the rules of evidence for the case the court needed to rule that the liver was the “personal property” of the hospital.

Ontario Superior Court Master Ronald Dash ruled that the tissue belonged to the hospital in which it was being stored:

“Ms. Piljak’s excised tissue is … owned by Sunnybrook hospital, whose pathology department performed the diagnostic tests and in whose archives the tissue is kept,” he wrote. “As the excised tissue is subject to the rights of ownership… I conclude that it is personal property.”

The issue of specimen ownership has until now remained unaddressed in Canadian courts. The case is expected to have a significant influence on future cases. Tim Caulfield, a Canada Research Chair in health law and policy at the University of Alberta, sees the decision as highly important:

“It is Canadian case law that calls human tissue personal property,” Mr. Caulfield said. “And I think that’s significant.”

The decision may have implications for the ownership of data obtained from stem-cell lines:

“You have all these cell lines that are going to become increasingly valuable,” Mr. Caulfield said. “And there’s going to be increasing interest in who controls them”.

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June
13
  11:42:00 PM

US lawmakers protest against incinerating foetuses with medical waste

Is the practice of incinerating aborted foetuses as part of waste-to-energy programs a common practice in the United States? Marion County, Oregon, halted shipments from a leading medical waste company, Stericycle, after claims that aborted babies from Canada had been imported with other waste products and used to power electricity plants. How many other facilities do the same? 

"We thought our ordinance excluded this type of material at the waste-to-energy facility," said a city spokesman. "We will take immediate action to ensure a process is developed to prohibit human tissue from future deliveries."

Stericycle has been under fire for years over the way it disposes of human fetuses from abortion clinics. In 2011 it was fined more than $42,000 for illegally dumping aborted babies together with household and commercial garbage into a municipal landfill in Austin, Texas. Pro-life groups claim that it disposed of the foetuses aborted at the notorious abortion mill in Philadelphia run by Kermit Gosnell.

After reading about the Oregon scandal, a New York lawmaker introduced a bill to make it illegal to burn "human biological matter, remains, or fetuses [for] the purpose of producing energy."

"I think people have a right to have a say in [the disposal of] their remains and the remains of their aborted children, and they have a right to know what happens with them and a right to not be made into some corporate energy profit," Assemblyman Joseph Borelli told the New York Daily News. "I believe many New Yorkers have an objection to energy production that uses human biological matter. This is something you’d find in Brave New World or Soylent Green, not in modern energy production.”

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