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December
13
  11:27:00 PM

Ontario doctors preparing for battle over conscience rights

A draft policy of the College of Physicians and Surgeons of Ontario demands that physicians must provide services to prevent imminent “harm, suffering and/or deterioration,” even if doing so is contrary to their moral beliefs. Critics of the new policy fear that they will be forced to violate their conscience.

The draft policy says:

The Canadian Charter of Rights and Freedoms (the “Charter”) protects the right to freedom of conscience and religion. Although physicians have this freedom under the Charter, the Supreme Court of Canada has determined that no rights are absolute. The right to freedom of conscience and religion can be limited, as necessary, to protect public safety, order, health, morals, or the fundamental rights and freedoms of others. Where physicians choose to limit the health services they provide for moral or religious reasons, this may impede access to care resulting in a violation of patient rights under the Charter and the Code.

Although euthanasia is not legal in Canada at the moment, should the Supreme Court legalize it, the policy will require objecting physicians to lethally inject patients themselves if a delay would result in “harm” or “suffering.” In less urgent circumstances, the policy will require physicians unwilling to kill patients to promptly refer them to “a non-objecting, available physician or other health-care provider.”

However, many physicians who object to abortion or euthanasia for reasons of conscience would also object to referral. Dr Charles Bernard, President of Quebec’s Collège des médecins, has explained that mandatory referral effectively nullifies freedom of conscience: “It is as if you did it anyway.”

Prominent academics and activists want to force objecting physicians to provide or refer for abortion and contraception. They and others have led increasingly strident campaigns to suppress freedom of conscience among physicians to achieve that goal. The College’s draft policy clearly reflects their influence.

The Protection of Conscience Project, a lobby group, insists that “it is incoherent and contrary to sound public policy to include a requirement to do what one believes to be wrong in a professional code of ethics. It is also an affront to the best traditions of liberal democracy, and, ultimately, dangerous”.

The College Council has tentatively approved the policy, but will accept public input until February 20 before imposing it on Ontario physicians.

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December
13
  9:48:00 PM

A transhumanist in conversation

Zoltan Istvan is an American writer, futurist and philosopher. He is also perhaps the best-known proponent of transhumanism movement. He spoke with BioEdge earlier this week. 

Q. The latest news in transhumanist circles, I gather, is that you will be running for President of the United States in 2016. What do you have to offer that the other candidates don’t?

A: Transhumanists are often seen as a strange group of people, and despite some of my radical ideas, I manage to remain very normal in daily life. I'm married, have two sweet kids, am an entrepreneur, and have worked for notable companies before, such as National Geographic. I think I can share the positive possibilities of transhumanism with the general public quite well. I think that's my greatest asset as a candidate--being a normal guy with futurist ideas. 

Q. If elected, what are some key policies you would implement? 

A: The first policy I'd implement is creating a national framework for all citizens to live longer and healthier. America spends trillions of dollars on far off wars, but very little on actual science and longevity research. That must change. I would like to change America's military industrial complex into a longevity industrial complex. If we're going to be spending so much money at all, let's spend it directly on our health and well being. 

Q. Transhumanism promises a lot -- but can it solve all political problems? For instance, what is its policy on the Islamic State and radical Islam? Or how will it bring prosperity to the Democratic Republic of Congo? 

A: The Transhumanist Party is relatively new, so it's still working out a lot of those positions on various political concerns, like foreign policy. But it stands behind sharing technologies and creating joint enterprises to lift all groups and nations out of poverty, war, and injustice. 

Q. Christians are generally suspicious of the transhumanist ideology. How would you go about winning over Christian voters? 

A: This is perhaps the toughest mission of transhumanism, to convince a mostly religious world that the rapid advance of technology isn't against faith. Transhumanists must focus on doing good works and showing how technology can improve lives and health. If they do that, Christians and other religious people will befriend us and count us as allies in the making the world a better place.

Q. Bioethicist Wesley Smith recently argued that transhumanism undermines the notion of individual human dignity. He was also concerned about your statements regarding the legitimacy of war to promote the transhumanist cause. What do you say? 

A: Wesley is a friend and powerful thinker, but I disagree that transhumanism undermines anything, expect perhaps death and poor health. Transhumanism strengthens all of us in myriad ways.  

Regarding war and transhumanism, surely many life-changing movements and their supporters would fight for their beliefs if threatened. Transhumanism aims to provide far better lives to our families and people everywhere, and we believe that is worth standing up for. 

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December
06
  4:40:00 PM

UK may offer free weight-loss surgery to fight epidemic

The UK government should offer free weight loss surgery to thousands more people in order to tackle an epidemic of type 2 diabetes, according to expert advice.

A quarter of Britons are obese, fuelling a rise in cases of type 2 diabetes, as well as heart disease, fatty liver disease and cancer. Last year, 6,500 weight loss procedures were performed. Another 5,000 weight loss surgeries will be carried out each year if the government accepts the advice of the National Institute for Health and Care Excellence (NICE).

Dr Rachel Batterham, Head of Obesity and Bariatric Services at University College London Hospital Trust, says “The health benefits of weight loss surgery are so great that it should be considered as part of the treatment for obese diabetics. The earlier you have the surgery in your diabetes course, then the more likely you are to have remission or a really good improvement.”

NICE says that 10% of the budget of the National Health Service is currently spent on diabetes and its complications. Surgery could pay for itself in two or three years. According to a report from McKinsey consultants, obesity now costs the UK nearly £47bn a year, more than armed violence, war and terrorism.

Weight-loss surgery is a drastic, but necessary, remedy, says Professor Jane Ogden, of the University of Surrey.

“In an ideal world people would eat less, do more and stay a healthy weight. Grab bags, takeaways, fizzy drinks and fast food would never have been invented and well lit cycle paths and wide pavements would make getting in the car a treat reserved for special occasions. But those days are gone and today’s world makes it so hard to eat less and so easy to do nothing that even with the greatest will in the world many people struggle with their weight.”

However, NICE and media reports skirted around the traditional bioethical discussion of bariatric surgery, especially for adolescents. In 2010 the American Journal of Bioethics had a special issue on the challenge of obesity and noted:

“Bariatric surgery is particularly interesting because it uses surgical methods to modify healthy organs, is not curative, but offers symptoms relief for a condition that it is considered to result from lack of self-control and is subject to significant prejudice. Taking the reviewed ethical issues into account is important when meeting persons eligible for bariatric surgery, as well as in the assessment of and decision making on surgery for obesity.”

Interestingly, the NICE guidelines do not discuss obesity as an ethical issue, but only its economic benefits.  

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December
06
  3:41:00 PM

Remembering the dark story of Peru’s population control campaign

The Quipu Project is an interactive documentary about women and men who were sterilised in Peru in the mid-1990s by population controllers, often without informed consent. Using VOIP telephone lines and a web interface, researchers are gathering testimony from women in isolated communities high in the Andes. Many are illiterate and speak only Quechua, the principal indigenous language.

In the video above Francisca Quispe Pontenciano recalls the circumstances which led to her sterilisation. It makes painful listening.

This horrific story is hardly known outside of Peru. “I was working for Amnesty International in Peru in the 1990s and nobody knew this was going on,” Matthew Brown, of the University of Bristol, in the UK, told Prospect. “Awareness has been growing in the last three years, partly because of our project and partly because of the efforts of victims groups. These women were sterilised at 20 and now they are coming up to 45 with no one to look after them in old age. That was the community welfare safety net.”

An estimated 300,000 women were sterilised by officials while Alberto Fujimori was president of Peru. He is now serving a 25 year sentence for crimes against humanity, although he has been exonerated of the abuses committed during the population control campaign. Prosecutors failed to prove that Fujimori was criminally responsible for the sterilisation campaign because “no one can force a doctor to do something against their will.”

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December
06
  2:35:00 PM

Should severely disabled infants be euthanased?

Two of the leading voices in bioethics have a fascinating head-to-head confrontation on the euthanasia of severely disabled infants in an upcoming issue of the Journal of Thoracic and Cardiovascular Surgery. Udo Schuklenk, of  Queen's University, in Canada, the  co-editor of the journal Bioethics, and Gilbert Meilaender, of Valparaiso University, in Indiana, discuss the ethics of, in Schuklenk’s words, “what would amount to postnatal abortion”.

The arguments of both men are familiar, but succinct and quotable.

Arguing from a quality-of-life standpoint, Schuklenk writes that “Once we have concluded that death is what is in the best interest of the infant, it is unreasonable not to bring about this death as painlessly and as much controlled in terms of timing by the parents as is feasible.”

After dismissing arguments drawn from human dignity, sanctity-of-life, and the principle of double effect, Schuklenk still has to explain why a suffering infant could not be simply sedated so that it would not suffer, thus avoiding the need for euthanasia. The answer he says, is that parents and doctors and nurses would suffer unnecessarily.

The unnecessarily prolonged dying of their infant son would extend a severely distressing situation for the parents. They would have to witness the deterioration of their infant son over a period of days, possibly weeks. Some of the attending health care professionals would undoubtedly also find it psychologically difficult to watch the child die foreseeably an unnecessarily slow death. …. Given that a terminally sedated infant would have no surviving interests to speak of, the interests of these other parties matter. If his prolonged dying is harmful to them, a further quality-of-life based argument in favor of terminating the infant's life is established.

Meilaender’s argument is less closely argued in academic terms. First he appeals to compassion, the traditional duty of a physician to accompany a patient in his suffering, “ neither abandoning them by imposing treatments that are useless or excessively burdensome, nor abandoning them by deliberately aiming at their death”.

His second argument is more political than bioethical. He appeals to the liberal tradition of human equality:

If I seek to give ultimate authority over my life to others, I become something less than their equal. I join what John Locke called the “inferior ranks of Creatures,” and I make my person an object to be possessed and controlled by others. And the same is true when I give such authority over this child's life to others. Likewise, the person who carries out the euthanizing deed pulls rank and, in effect, exercises a more-than-human authority over the life of one who is, in fact, his moral and political equal. For us to try to exercise such authority is to pretend to be what we in truth are not: something other than beings of equal dignity. And that would be to lose one of the greatest achievements of our political tradition: an affirmation of equal dignity laboriously gained at great cost over centuries.
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December
06
  11:26:00 AM

Thai parliament votes to ban the surrogacy trade

Thailand’s interim parliament has voted in support of a bill to ban commercial surrogacy in the country.

National Legislative Assembly member Chet Siratharanon said the parliament approved the draft bill after a preliminary reading on Thursday. A finalised version of the bill is expected within the next 30 days.

The decision comes in the wake of a number of international scandals involving Thai surrogate mothers paid to carry the babies of foreigners.

In August, a Thai mother who carried twin babies for an Australian couple accused them of abandoning a baby boy with Down's syndrome while taking his healthy sister.

Following this scandal, a separate police investigation began into a Japanese man who authorities believe fathered at least 15 babies with different surrogate mothers.

Commercial surrogacy was technically restricted in Thailand in 1997 after the Medical Council of Thailand introduced strict regulations. However, these regulations have remained largely unenforced. It is only now that the government has begun to take action on the issue.  

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December
06
  11:07:00 AM

An eloquent defense of euthanasia by organ removal

The notion of death by organ removal is sullied by its association with Aztec human sacrifices and the pleasant little English practice of hanging, drawing and quartering for treason. But the practice may make a come back, albeit in a more humane and respectable form.

In an influential article published in the journal Bioethics, Oxford bioethicists Julian Savulescu and Dominic Wilkinson present a rational defence of what they label ‘organ donation euthanasia’. The practice, as they describe in the article, involves the steady removal of a patients’ organs after they have been put under anaesthetic. “Death”, the authors write, “follows the removal of the heart”.

In contrast to previous precedents, the process is – in theory – relatively pain free. Patients are under a total anaesthetic while their vital organs are harvested. And furthermore, it would only take place with informed consent of the patient, which Guy Fawkes and William Wallace never gave.

Savulescu and Wilkinson offer a few other caveats. The procedure should only be performed on patients whose death is already imminent. And they suggest that it may be wise to explore other more palatable options first: “we do not claim that the alternatives discussed here are the only ways to address the organ shortfall.” 

In the end, though, it may prove to be our only option to combating the organ shortage: “We have to decide whether it is worthwhile upholding the principles that currently govern organ transplantation, or whether the unmet needs of patients with organ failure warrant their revision or rejection.”

Community consent, the authors observe, may be an issue.  

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December
06
  10:47:00 AM

Harvesting of executed prisoners’ organs will cease by 2015 - Chinese government

The head of China’s organ donation committee, Dr. Huang Jiefu, has announced that the harvesting of executed prisoners’ organs will end at the start of next year.

Speaking at a conference in the southern city of Kunming on Wednesday, Dr. Huang said that only voluntary donation of organs will continue:

"From the 1st of January 2015, there will be a cessation in the use of organs from executed prisoners; voluntary donation following the death of citizens will be the only means used for organ procurement”.

Dr. Huang said that an organ shortage would ensue following the end of this controversial practice. China currently has one of the lowest rates of voluntary organ donation in the world – a mere 0.6 per 1 million people.

Nevertheless, the rate of donation has increased in the past year. “I believe the organ donation situation will get better and better”, Huang said.

International human rights groups welcomed the announcement, but said that China still has many other grave abuses to address. In an interview with the BBC, Amnesty International's William Nee expressed concern about the extensive use capital punishment in the country:

"It will be worth seeing not only how effective a new voluntary organ donation system is, but it will also be crucial that the government becomes fully transparent about the number of people sentenced to death, the number of executions per year, and how the executions are carried out,".
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December
05
  5:04:00 PM

Raise your hand if you are a courageous, individualistic thinker

A couple of years ago, one of the stories in BioEdge was titled: “Conservatives more likely to be psychopaths, says Florida prof”. It was a terrific, popular and completely accurate headline. The academic’s message was that conservative political views were associated with Machiavellianism, narcissism and psychopathy. There was only a 1 in 100,000 chance that his findings are wrong, he said.

What about conservatives applying for positions in universities, then? If the interviewing panel regards them as psychopaths, they are unlikely to land a job. Universities have enough problems without filling desks with wannabe Hannibal Lecters.

While the Florida prof’s findings might seem absurdly exaggerated, it appears that his view of conservatives is widely shared by social psychologists. And this, says the famous liberal social psychologist Jonathan Haidt, is a serious problem.

In the journal Behavioral and Brain Sciences (pre-print PDF), Haidt and several colleagues, none of them conservatives, warn that lack of diverse opinions is undermining their discipline. Over the past few years, it has been plagued by scandals and failures, “including a few high-profile replication failures, a handful of fraud cases, and several articles on questionable research practices and inflated effect sizes”. One reason for this, they suggest, is lack of political diversity and openness to dissenting viewpoints.

Haidt relates that in 2011 he asked 1000 social psychologists at a conference how many identified as “liberal”. About 80% raised their hands. Only 20 people in the room admitted to being “moderate or centrist”, 12 to being “libertarian” and 3 to being “conservative or on the right”. That is a liberal-conservative ratio of 267:1. More serious surveys find that that the ratio is about 10:1 – but among American voters it is about 0.5: 1.

Ooops, say Haidt and his colleagues. “If left unchecked, an academic field can become a cohesive moral community, creating a shared reality that subsequently blinds its members to morally or ideologically undesirable hypotheses and unanswered but important scientific questions.”

They conclude that:

“1) Academic psychology once had considerable political diversity, but has lost nearly all of it in the last 50 years; 2) This lack of political diversity can undermine the validity of social psychological science via mechanisms such as the embedding of liberal values into research questions and methods, steering researchers away from important but politically unpalatable research topics, and producing conclusions that mischaracterize liberals and conservatives alike; 3) Increased political diversity would improve social psychological science by reducing the impact of bias mechanisms such as confirmation bias, and by empowering dissenting minorities to improve the quality of the majority’s thinking; and 4) The underrepresentation of non- liberals in social psychology is most likely due to a combination of self-selection, hostile climate, and discrimination.”

Whether you are liberal or conservative, this very stimulating article is worth reading. Could it explain the “consensus” which is so often invoked in controversial issues? 

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November
30
  12:42:00 AM

Super surgeon who uses stem cells accused of unethical conduct

Has the stem cell jinx struck again? A world-famous Italian researcher has been accused of failing to obtain ethical approval for operations and misleading medical journals about the success of his research. Paolo Macchiarini, an Italian with a global reputation for building new windpipes with scaffolding constructed with stem cells, appears to be facing serious allegations.

“Since the accusations against Dr Macchiarini are serious and detailed, I considered that they should be thoroughly investigated,” said Anders Hamsten, vice chancellor of Sweden’s famous Karolinska Institute.

Dr Macchiarini denies the allegations. “We have never ever manipulated data,” he told the New York Times, nor did he ignore regulations about informed consent. ,

Dr Macciarini is a colourful character whose experimental windpipe operations have been on the front page of major newspapers around the world over the past few years. “I'm like a wild animal that does not need to be in a cage, I need to express my convictions that I can help a patient with innovative things,” he told The Lancet.

However, other issues have been raised about his research. In 2012 he was placed under house arrest in Italy, charged with attempted fraud and extortion. He was accused of offering a higher place in the transplant queue for money. One of  his papers had to be retracted in 2012.

Dr Macciarini has operated on at least three patients and replaced their windpipe with a structure made of stem cells. However, it appears that none of the operations was subjected to an ethical review. In one case a patient signed a consent form, but two weeks after the surgery. 

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