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  11:14:00 PM

Who is most vulnerable?

who is more susceptible to euthanasia or assisted suicide?    

In the on-going debate over euthanasia, there are seldom any new arguments. A favourite of those in favour of legalisation argue that the wishes of people who are competent and able to make a rational choice deserve to have their autonomy respected. A favourite of those against contend that the vulnerable – the poor, the disabled and the elderly – will be victimised.

One strand of evidence favours euthanasia supporters. In Oregon, where assisted suicide is legal, most of the people who take advantage of it, according to the figures for 2013 are white (94%), male (62%) and well-educated (53% with a college degree). There are no estimates of income, but well-educated white males tend to be wealthier than average and, significantly, not vulnerable.

However, a fascinating article in the Journal of Medicine and Philosophy turns this argument on its head. Erik Krag, of Southern Illinois University–Edwardsville, suggests that it may be members of the dominant social group – white men -- who are actually most vulnerable to the temptation to request euthanasia.

Men have been socialised to believe that life is not worth living if they are not dominant, independent and fully in control. When illness or indigence strike, some men will believe that their lives are completely useless, especially if they are not connected to others in a loving family structure or committed to a belief in transcendent values.

“… what happens when, through illness, injury, or simply old age, the rich, well-educated white male’s fragile source of value is broken irretrievably and he loses the ability to conform to the masculine ideals that he has been socialized to attain?”

So, paradoxically, the fact that wealthy white men are the principal “beneficiaries” of physical-assisted suicide shows that they are even more “vulnerable” than many physically disabled people. Dr Krag writes:

“… we should be no less wary of the effects of society’s influence on those who ‘would rather be dead’ than lose their privileged status. When the rich, well-educated, white male loses his privileged status, he finds himself cast suddenly into the role of the one whose life he had deemed not worth living. He is socially humiliated by his failure to measure up and unable to use the tools that he has worked so hard to develop.
“With the loss of his privileged status, the weight of society’s disdain for him hits him all at once; his sense that society sees him as worthless is magnified all the more by the self-aversion that the last remnants of his former identity cause him to feel. He has lost his source of value, and the isolating competitiveness of his upbringing has left him ill-equipped to find value in defiance, persons, or a transcendent reality.
“Certainly, if ever a person was vulnerable to feelings of depression and self-disregard, this is he. We should thus not be surprised that it is well-educated white men who seek and obtain PAS/VAE most often.”
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  10:35:00 PM

Australia could recognise multiple parents

Australian law could be revised to allow more than two parents, if recommendations in a major report are accepted by the government. A “Report On Parentage And The Family Law Act”, was released this week.

Adoption and new reproduction technologies are placing new strains on what “parent” means in contemporary society. Because of “the evidence of family diversity and children’s views about who is a parent”, the Council has recommended that the word “parent” be replaced by “other significant adults” or “other people of significance to the child” and that references to “both” (which implies only two) parents should be omitted.

There are many kinds of parents, the Council points out: legal, adoptive, genetic, intending, psychological, social and surrogate, amongst others.

The report was commissioned by the previous Labor government and was completed last December. The delay meant that it was released when commercial surrogacy is being placed under a microscope.

Although legalising commercial surrogacy – which is currently banned in Australia -- was not included in the report’s terms of reference, the Family Law Council, which produced the report, clearly is in favour. It is “conscious that the number of children conceived as a result of overseas commercial surrogacy arrangements has increased dramatically in the past several years, despite the existence of Australian laws prohibiting such arrangements.” It favours an international convention on surrogacy.

International commercial surrogacy already involves hundreds of children. “According to community group Surrogacy Australia, in 2011 the estimated numbers of births to Australians via surrogacy arrangements were 45 Australian babies born in the US, 45 in Thailand and 315 in India.” (Now that both Thailand and India have closed their doors to international surrogacy, this is bound to change.)

Some of the background unearthed by the Council is thought-provoking. For instance, it says that commercial surrogacy is potentially quite corrupt. In countries like India, Thailand and Malaysia, “The lack of a legal framework in these countries, coupled with the poverty of many of the population, increases the potential for exploitation of the surrogate mother as well as the risks of child trafficking.”

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  8:52:00 PM

Paolo and Francesca’s IVF mix-up

An Italian judge has settled a bitter custody battle for IVF twins by awarding them to the birth mother. The case, which has gripped Italy, is a worst case scenario for IVF clinics. Two women with similar names underwent IVF in Rome’s Sandro Pertini  hospital. The embryos were switched and one couple miscarried.

Three months later the woman bearing the twins had a genetic test which revealed that they were not related to her. The genetic parents claimed the twins but the birth mother, Francesca, and her partner, Paulo, are refusing to give them up. Under Italian law, the birth mother is clearly the legal mother.

The babies were born this week by Caesarean section. "We are happy. Very happy: our children are born, they're very well and we have already registered their birth," says Francesca. "No one will be able to take them from us," she told La Stampa.

Although the law is clearly on the side of the birth parents, the National Bioethics Committee has suggested that the couples somehow collaborate in raising the children.

(Has anyone noted the irony that this 21st Century couple is named Paolo and Francesca? You can't make this sort of thing up. Dante meets another Paolo and Francesca in the second circle of Hell in the Inferno. The heart-rending story of their passionate affair was the theme of many paintings, plays, and operas in the 19th century. Is there a message here about evolving attitudes toward love and fertility?)

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  2:55:00 PM

Thailand moves to ban surrogacy

The new Thai military government is moving swiftly to crush the lucrative surrogacy industry. This week two Australian same-sex couples and two American couples were prevented from leaving Thailand with a baby. The as-yet-unwritten legislation leaves 200 more surrogate mothers and their Australian clients in legal limbo.

Until now, commercial surrogacy was banned in Australia and discouraged in Thailand. However, taking advantage of numerous loopholes, it has become an important feature of Thailand’s booming medical tourism industry.

Under a new law women will be forbidden to carry babies for commercial purposes and surrogacy will be restricted to relatives. The penalties will be severe: 10 years in jail and a fine.

However, Nandana Indananda, a Bangkok-based lawyer who helped draft the new surrogacy law, told Deutsche Welle that surrogacy as such will not be banned.

“Firstly, it prohibits a doctor or surrogacy clinic from performing a surrogacy for commercial purposes. Secondly, no one is allowed to establish or operate a surrogacy agency for commercial purposes. Thirdly, no one can publish any advertisement about surrogacy for any purpose, either commercial or non-commercial …
“As for the parenthood issue, the bill determines that, if certain conditions are met, the intended couple will be considered the parents of the child, even if the intended parents pass away before the birth of the child.

No one knows how this will affect the increasing demand world-wide for surrogate mothers. Both India and Thailand have recently banned international commercial surrogacy. A few other countries, (Russia, Ukraine, Belarus, Georgia, Armenia, and the US), permit it. However, the number of countries with ideal conditions for commercial surrogacy -- enabling legislation, high-quality medical care, and desperately poor women – is shrinking fast. 

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  1:30:00 PM

“Cordon sanitaire” drawn around Ebola victims

Bioethical debates about whether to administer an experimental drug for Ebola victims are interesting and necessary. But only a handful of doses are available anyway and hundreds of people are dying in Guinea, Sierra Leone and Liberia. According to the latest update from the World Health Organisation, 2,127  cases and 1,145 deaths have been reported. But it has also declared that “the numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak”.

“Extraordinary measures,” are needed, it says, “on a massive scale, to contain the outbreak in settings characterized by extreme poverty, dysfunctional health systems, a severe shortage of doctors, and rampant fear.”

In view of the emergency, the three worst affected countries have taken the most drastic step possible – drawing a “cordon sanitaire” around the areas where the outbreak is most virulent. The perimeter is guarded by soldiers and no one is allowed in or out until the plague runs its course. It is a primitive method but in mediaeval times it was the only way to keep infection from multiplying.  

This method was used to control an outbreak of Kitwit, in Zaire (now Democratic Republic of the Congo), a city of half a million in 1995. According to Laurie Garrett, writing in The New Republic, it was “brutally successful, as all trade to the Kikwit region ground to a halt, the desperately poor people were fully isolated to war with Ebola on their own”. She received a Pulitzer Prize for her reporting on the epidemic and the lesson she drew from her experience is tough and utilitarian:

“Despite all the brouhaha here in the United States and Canada about application of experimental drugs and vaccines never clinically tested for safety or effectiveness to the African crisis, this siege will end not with magic bullets, but smart, heroic strategies that find infected people swiftly, place them behind cordoned quarantine barriers, and bury the dead rapidly after their demise without families’ contact or viewing. Yes, it is heartless and can seem cruel, but strategic isolations, coupled with vast urban campaigns of capture of the infected constitute the only hopes for ending the state of siege.”

However, other observers contend that tough love has to supplement tough measures. “It might work,” Dr Martin S. Cetron, of the Centers for Control and Prevention. “But it has a lot of potential to go poorly if it’s not done with an ethical approach. Just letting the disease burn out and considering that the price of controlling it — we don’t live in that era anymore. And as soon as cases are under control, one should dial back the restrictions.”

More probably depends on organisation than vaccines at this stage. “The bottom line with Ebola is we know how to stop it: traditional public health,” says Tom Frieden, Director of the CDC. “Find patients, isolate and care for them; find their contacts; educate people; and strictly follow infection control in hospitals. Do those things with meticulous care and Ebola goes away.

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  11:45:00 AM

A disturbing study of gendercide in India

A major report on sex-ratios and abortion in India gives detailed background information on the scourge of gendercide. Sex Ratios and Gender Biased Sex Selection: History, Debates and Future Directions has been published by UN Women and covers the history, the figures and the debate about the causes of gendercide.

India’s child sex ratio (CSR) – the number of girls for every 1,000 boys under the age of 6 — has deteriorated sharply over the past 20 years, dropping to 918 in 2011 from 945 in 1991, even though levels of education and wealth have risen significantly.

The report emphasises that sex-selective abortion has decreased in traditionally problematic regions, mostly in the north, but increased significantly in other areas. In the northwestern state of Punjab, where the CSR was extremely low, the number of female children per 1,000 male children rose to 846 in 2011 from 798 in 2001.

However, in regions like Manipur, in the northeast, and Andhra Pradesh, in the southeast, the traditionally even CSR has dropped below 940.

Dr. Mary E John, author of the report and senior fellow of New Delhi’s Centre for Women’s Development Studies, argues that the decline reflects a common   gender-biased family plan: “families are actually ‘planning’ to have at least one son and at most one daughter.” Dr. John suggests that parents are concerned about dependent female adults, rather than female children. Women in India are marrying later and tend to stay live at home for longer, she writes in the report.

The trajectory of gendercide is a little-know feature of the problem. When the British colonised India in the 18th century, they were shocked to discover “missing girls”. Some accounts describe villages without a single girl. In that era, the principal causes seem to have been large dowries and hypergamy, the practice of women marrying men of a higher caste. According to census figures in 1901 put the ratio was at 961 women for every 1000 men, which fell to 946 in 1951, 941 in 1961 and 930 in 1971.

Why does the ratio keep falling even as India becomes more “modern”? The report says:

… two broad claims emerge. On the supply side, as we have repeatedly seen, we have medical technologies, granted fullest agency in the hands of the aggressive radiologist who takes his mobile machine into the hinterland of rural India to vend his wares, unmindful of the criminality of such actions. Such unscrupulous practitioners in turn are being ably supported by multinational capital, and several activists have pointed to the role that companies like General Electric are playing in pushing the market for ultrasound machines, further and further, into India’s rural heartland.

On the demand side, what appears with equal frequency is, quite simply, ‘dowry’. “Like a black shadow in the wake of dowry demands, is the spread of sex selection”.

This is an extremely interesting report which sheds much light on a complex problem. 

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  11:34:00 AM

Media ethics 101: How not to report suicide

Two incidents this week show opposing responses to publicising suicides. In the US, comedian Robin Williams committed suicide, leading to an outpouring of grief by the public and horror by experts in media ethics. In Australia, controversial assisted suicide activist Dr Philip Nitschke resumed publicity for his do-it-yourself suicide kits. 

The “sensational headlines” and “unnecessary detail” of media reports -- as exemplified by the New York Post's lurid page -- were slammed around the globe. Dr. Mike Jempson, lecturer at the University of the West of England, called some of the media reports “textbook examples of how not to report a suicide”:

“[Williams death] seems to have given some newspapers a green light to “go off on one” – delving into his psyche with gay abandon, detailing the precise method of his suicide, and indulging in unhelpful speculation about its causes with little regard for the grief of his family, friends and fans.”

Sharon Mallon of the Open University implored newspapers to show restraint when reporting these sensitive issues to prevent copycat suicides by vulnerable people:

“If we are to prevent imitative suicides all reporting must simultaneously provide the public with enough information to understand the death, while providing an image of suicide that is sensitively managed through careful reporting.”

Media ethics lecturer Douglas Chalmers suggested that the issue is systemic, and stems from an obsession with ratings and circulation, as well as a refusal to adopt existing media guidelines:

“I believe the problem cannot be placed solely at the door of the individual journalist, but rather it is due to the increasing work pressure piled upon journalists by their employers’ insistence that it is circulation, rather than consequence, that counts. Most journalists do not receive adequate training from their employers on this or other ethical questions. Many editors are also clearly failing to adopt existing guidelines although these are not new issues, and guidance has existed for many years.” 

Meanwhile in Australia, Dr Nitschke, whose medical registration has been suspended because of his links to a suicide death, is openly promoting ways to commit suicide painlessly -- mostly the barbiturate Nembutol, but also asphyxiation using cylinders of nitrogen gas from a company linked to him.The Medical Board of Australia described him as "a serious risk to public health and safety". 

Dr Nitschke told ABC News that he had been inundated by requests for information about suicide despite the bad publicity. However, most of his clients are just vulnerable elderly rather than vulnerable teenagers. Earlier this week he conducted a public workshop on Queensland's Sunshine Coast detailing methods of how to kill oneself. 

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  5:47:00 PM

UK father of 58 children sentenced

Gennadij Raivich, a professor of perinatal medicine and neuroscience at University College London is the author of publications like “Investigation of cerebral autoregulation in the newborn piglet during anaesthesia and surgery” and “Methyl-isobutyl amiloride reduces brain Lac/NAA, cell death and microglial activation in a perinatal asphyxia mode”. There are 153 of these listed on his website.

But the achievement for which he will go down in history is siring 58 children by women desperate to become pregnant by donor insemination. He was convicted late last month only of the assault of one woman, although two others had laid complaints against him.

Interestingly, 15 satisfied female “customers” from all over the country spoke in his defence, including a police officer, maths teacher and lecturer, some of whom had two and in one case three of his children via what he called “Artificial Insemination Plus”.

The details of Professor Raivich’s extracurricular activities are too seedy to relate here, but the prosecutor’s address to the jury sums up the main issues:

 “You have to ask yourselves what kind of woman agrees to meet a complete stranger for AI when they do not even know his real name. Someone who is desperate and is prepared to put up with the potential embarrassment and humiliation and who have kept the details from their friends and families. A perfect victim for sexual assault, someone unlikely to complain.
“Compare the women to this defendant, someone who has traded on the fact he is a doctor and paraded his scientific knowledge, impressing them with his apparent expertise. What kind of man embarks on a breeding programme to have as many children as possible? You will have to ask yourselves if he knows as much as he claims. You may feel there is a high degree of narcissism in what he has done and is sexually motivated in some of these transactions. He provided a one stop shop for women who wanted semen. All were desperate to have a baby.”

The motivations behind assisted reproduction are often mysterious. Atavistic instincts seem to be at work, unconstrained by the social mores associated with the institution of marriage. Perhaps Professor Raivich’s polyphiloprogenitive proclivities will give a clue to future researchers. 

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  1:25:00 PM

WHO endorses use of untested Ebola treatments

The WHO has endorsed the use of untested Ebola interventions on patients infected with the disease.  

A 12-member panel of bioethicists convened by telephone on Monday to discuss the issue.

In a press conference following the discussion, Marie-Paule Kieny, assistant director-general of the WHO, said there was consensus about the compassionate use of the drug on those infected with the virus:  “[There has been] unanimous agreement among the experts that in the special circumstances of this Ebola outbreak it is ethical to offer unregistered treatments”.

The panel believed that the extent of the outbreak and the high case-fatality rate outweighed concerns about the side effects of untested treatments:

“In the particular circumstances of this outbreak, and provided certain conditions are met, the panel reached consensus that it is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention.”

The two American victims of the virus, as well as Spanish victim Rev. Miguel Pajares, received an experimental anti-ebola drug called ZMapp. Pajares has since died, but the American patients are in a stable condition.

Small shipments of Zmapp have arrived in the Liberia for use on infected doctors.

Nigerian patients will receive an experimental drug called Nano-Silver, produced by an anonymous Nigerian scientist. 

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  1:15:00 PM

Serbian soldiers were killed for organs - EU task force

An EU investigation into criminal activity during the 1999 Kosovo war has found that a “handful” of Serbian soldiers were killed by Albanian militants for the purposes of organ trafficking.

Special Investigative Task Force chief Cliff Williamson announced the findings at a news conference in Brussels late last month.

Williamson said that “less than ten” soldiers were killed and their bodies smuggled to Albania for organ harvesting.

The fact that there were only a few victims, Williamson remarked, does not diminish the savagery of the crime: “even one person was subjected to such a horrific practice, and we believe a small number were, that is a terrible tragedy”.

He did say, however, that accusations of widespread organ harvesting have caused unnecessary trauma for families of missing soldiers.

The investigative committee does not currently have enough evidence to initiate prosecution but will continue its investigation.

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