The most senior Sierra Leone doctor helping to fight the Ebola epidemic has died after contracting the virus from patients. Dr. Sheikh Umar Khan was a virologist in charge of a hospital unit treating Ebola patients in Kenema – a major city in the most effected area of the country. Dr. Khan was credited with treating over 100 patients since the outbreak began in February.
He passed away on Sunday in a Doctors without Borders clinic, just a few days after being diagnosed.
"It is a big and irreparable loss to Sierra Leone as he was the only specialist the country had in viral haemorrhagic fevers," Chief Medical Officer Dr. Brimba Kargbo said on Tuesday.
By genengineering, Savulescu is referring to large-scale interventions by which we can alter the structure of the environment, making it more conducive to human inhabitation. He used as an example the introduction of ants, iron sulphide, and artificial trees to combat global warming.
Savulescu suggests that genengineering is already occurring in the form of massive carbon omissions. Insofar as it is already happening we shouldn’t be concerned to engage in large-scale geoengineering to bring the world back to normal.
He also challenges the claim that the ‘natural’ climate is the best. We should rely less on assessing how things naturally are, and more on deciding how they should be:
“We cannot avoid asking and answering the question: what is a good human life? Likewise, we cannot avoid the ethical question: what is a good climate?”
Savulescu argues for a kind of long-term genengineering, as this will have less immediate negative effects (if any):
“We should prefer interventions that slowly modify climate over generations, rather than rapid interventions that carry risk within a single generation, if we wish to adopt a person-affecting precautionary approach.”
After the flurry of criticism for the now infamous Facebook ‘social contagion’ study, bioethicists are defending its authors.
The paper, co-authored by a data manager from Facebook and two researchers from Cornell, examined how users’ emotions changed when confronted with manipulated newsfeeds. Based on carefully written algorithm, researchers omitted certain ‘positive’ and ‘negative’ posts from users’ feeds when they logged on to the website (read the abstract here).
The experiment was conducted without the direct consent of its 310,000 participants.
The authors argued that the study was no different from Facebook’s usual practice:
“It is true that Facebook altered its algorithm for the study, but it does that all the time, and this alteration was not known at the time to increase risk to anyone involved.”
They were divided on the question of informed consent:
“Some [of us] think that the procedures were consistent with users’ reasonable expectations of Facebook and that no explicit consent was required. Others argue that the research imposed little or no incremental risk and that informed consent might have biased the results; in those circumstances, ethical guidelines, such as the US regulations for research involving humans, permits researchers to forgo or at least substantially alter the elements of informed consent.”
They are concerned about the impact of intense criticism on further research:
“The extreme response to this study, some of which seems to have been made without full understanding of what it entailed or what legal and ethical standards require, could result in such research being done in secret or not at all.”
Without making any specific proposals, she told local media that Lithuania was not a welfare state with palliative care available for all and that euthanasia might be an option for people who did not want to torment relatives with the spectacle of their suffering.
The minister has also raised the idea of euthanasia for children. She noted that this option had been approved for Belgian children after a long public debate. It was an option which might be appropriate in Lithuania as well after public debate.
Ms Šalaševičiūtė will face an uphill battle in her campaign to introduce Lithuanians to euthanasia. Many doctors and the Catholic Church oppose it. Dr Andrius Narbekovas, who is both a priest and a doctor, and a member of the Health Ministry’s bioethics commission, told the media:
“The Ministry of Health should protect health and life, instead of looking for ways to take life away. It goes without saying that it is … profitable and cost effective … But a democratic society should very clearly understand that we have to take care of the sick, not kill them."
The incident is thought to be the first case of 'conscientious objection' to force-feeding at Guantánamo since a mass hunger-strike began at the prison last year. Cleared Syrian Abu Wa’el Dhiab related the news on a phone call last week with his Reprieve lawyer, Cori Crider. Dhiab explained that a military nurse recently told him he would no longer participate in force-feedings, saying: “I have come to the decision that I refuse to participate in this criminal act.”
A Department of Defense spokesperson confirmed this to the Miami Herald: “There was a recent instance of a medical provider not willing to carry out the enteral feeding of a detainee.” The nurse in question has apparently been assigned elsewhere; Mr. Dhiab said that after the man made his decision known, he never saw him again.
The nurse also related to Mr Dhiab the discrepancy between military descriptions of force-feeding and the reality: “before we came here, we were told a different story. The story we were told was completely the opposite of what I saw.” Other nurses have voiced their concern about the practice, according to Mr Dhiab, but said they had no power to object. Mr. Dhiab says he often heard comments to the effect of: “Listen, we have no choice. We are worried about our job, our rank.”
Force-feeding has been ongoing at the prison since men started hunger striking in peaceful protest at their detention without charge or trial. Last year more than 100 men participated in a mass hunger strike at worsening conditions and indefinite detention after President Obama closed the office charged with closing the prison. That office has since reopened but 149 men, the majority of whom have been cleared for release, remain imprisoned.
Cori Crider commented: “This is a historic stand by this nurse, who recognized the basic humanity of the detainees and the inhumanity of what he was being asked to do. He should be commended. He should also be permitted to continue to give medical care to prisoners on the base but exempted from a practice he rightly sees as a violation of medical ethics.”
And in a comment piece in The Guardian, she added:
"Since it isn't technically a disciplinary matter – and frankly, even if it were – the rest of the doctors and nurses at Gitmo ought to join their colleague’s boycott. They should return to first principle of medicine, which is patient autonomy. They should insist on using force-feeding only when absolutely necessary and in ways that minimize, not maximize, the suffering it causes – a compromise my client would accept. In so doing, they would have the support of the American medical community, which has already condemned force-feeding and urged health professionals not to participate."
Free fertility treatment should be banned for those making lifestyle reproductive choices, such as sterilisation reversal or single motherhood for fertile women. And fertility clinics should be subject to carbon capping schemes, in a bid to help curb climate change, argues a theologian in the Journal of Medical Ethics.
Only those who are medically infertile through no fault of their own should be eligible for government funded treatment, suggests Cristina Richie, a theology PhD candidate at Boston College, Massachusetts.
Richie singles out fertility treatments because they not only produce a carbon footprint as a result of the resource they consume, but also create a carbon legacy.
And she points out in an accompanying podcast: “Assisted reproductive technologies are typically given in places with enormously large carbon footprints.” The US, for example, is the world’s second largest carbon emitter, producing 20 metric tonnes of carbon dioxide per person per year, which multiplies by a factor of 5, with the birth of a child, she explains.
In her paper she argues that the environmental impact of medicine and health has largely been ignored, and that the ecosystem is already overtaxed.
While ART is not the most pressing environmental issue, nonetheless, it has created 5 million new lives since the late 1970s, and the number of babies born using these methods is rising steeply, she argues.
“It is therefore the obligation of environmental policymakers, the ethical and medical communities, and even society to carefully weigh the interests of our shared planet with a business that intentionally creates more humans when we must reduce our carbon impact.”
She advocates that the fertility industry adopt a carbon capping scheme, either by making a voluntary but legally binding commitment to meet emissions targets or by working to cut its total emissions, rather like the UK National Health Service has done, she suggests.
And it ought to make free fertility treatment available only to those who are medically infertile, not to those who are making “lifestyle” choices, such as people who have voluntarily undergone sterilisation, single fertile women and fertile same-sex couples.
She insists that she is definitely not saying these groups should not have children, but they could go green and adopt.
The adoption process needs to be made easier, and society also needs to change its attitude to childlessness, she says. “Retrenchment in all areas of life is the key to slowing down or halting carbon emissions that lead to climate change. For each child made through medical intervention, a carbon legacy results,” she concludes.
Commenting on the paper, Iain Brassington, of University of Manchester, agrees that all areas of life should be assessed for their ecological impact.
“if I wanted to frack for shale gas under Manchester, there’d be questions about sustainability, and about whether we should be looking for more and cheaper hydrocarbons given what we know about the environment. So why not ask analogous questions about reproduction, its environmental impact, and its legacy to the future?”
Ms Richie’s headline-grabbing article builds on her interest in the ethics of “bodies that do not bear fruit”. After finishing her PhD, she plans to research the value of a child-free life from an evangelical, feminist and ecological perspective. After that, she plans on working on the connections between meat eating and the sexual oppression of women and consumption and the morality of obesity.
Is this one of those “only in America” stories? On Thursday afternoon in a Philadelphia, a man brandishing a pistol stormed the psychiatric ward of Mercy Fitzgerald Hospital. He shot dead his caseworker, 53-year-old Theresa Hunt and fired at his psychiatrist, Dr Lee Silverman, grazing his head. The doctor ducked for cover behind a desk.
But this was not going to be another mass shooting. Dr Silverman was ready for this. He pulled his own pistol out of a desk drawer and returned fire. He shot the patient, Richard Plotts, twice in the torso and once in the arm. Plotts collapsed and bystanders disarmed him.
It was like a script written by the National Rifle Association. The local police chief told the media: “without a doubt, I believe the doctor saved lives. Without that firearm, this guy (the patient) could have went out in the hallway and just walked down the offices until he ran out of ammunition.”
Plotts is in a critical condition at a local hospital and Dr Silverman was treated for a slight head wound. What no one has been able to figure out is why a psychiatrist had a loaded gun at work, especially when it was against the hospital’s policy. Perhaps the American Psychiatric Association will change its tune on gun control and adopt as its motto the bumper-sticker slogan, "the answer to stopping a bad guy with a gun is a good guy with a gun".
An ongoing debate amongst physicians has broken into academic discourse – should doctors dress formally for clinical practice?
Microbiologist Stephanie Dancer says ‘yes’. In an article in the British Medical Journal Dancer asserts that ‘dressing down’ diminishes the dignitas of the medical profession and could be see as an indication of carelessness:
“Doctors are members of a distinguished profession and should dress accordingly. Untidiness erodes the image of doctors as responsible and competent…[it] might be taken as a flashing neon sign that says “I don’t care.”
Dancer also claims that scruffy dress could contribute to low hygiene standards in hospitals: “scruffiness, however defined, also intimates a lack of personal hygiene and correspondingly lower standards of hygienic behavior.”
Two Manchester University medical ethicists, Cesar Palacios-Gonzalez and David R Lawrence, have written a scathing critique of Dancer’s claims. Gonzalez and Lawrence assert that scruffy dress has no effect on the ‘intrinsic dignity’ of the medical profession:
“doctors’ attire has no bearing on the inherent dignitas of the medical profession. Even where the doctor’s appearance is, for whatever reason disagreeable to the patient, this does not change the value of the medical intervention to the health of that patient…To state otherwise would be the same as to state that the value of a doctor’s medical practice fluctuates with each patients’ perception of the physicians’ attire.”
They argue on libertarian grounds that doctors should be allowed to dress how they wish.
They also contest Dancer’s claim that casual dress contributes to poor hygiene. Even if particular kinds of casual clothes lead to infection, “this would not mean that there is a case against scruffiness in general; but it would mean that doctors should refrain from using certain types of fabrics in regard for their patients’ safety”.
Another botched execution in the USA has reignited debate over the death penalty. Arizona man Joseph Rudolph Wood took almost two hours to die after being injected with the drugs midazolam and hydromorphone. The two drugs are a new barbiturate combination being trialled in a number of US states.
According to witnesses, Wood gasped for air hundreds of times before succumbed to the drugs. “It was very disturbing to watch…like a fish on shore gulping for air”, said reporter Troy Hayden. “I counted 660 times that he gasped,” said Arizona Republic journalist Michael Kiefer.
Just two months ago BioEdge reported on a similar botched execution in Oklahoma.
Shortly after the execution, Arizona governor Jan Brewer issued a statement in which she ordered a full review of the execution process.
She was nevertheless adamant that the execution had been lawful and did not involve undue pain: “One thing is certain, however, inmate Wood died in a lawful manner and by eyewitness and medical accounts he did not suffer” her statement said.
The American Civil Liberties Union of Arizona issued a statement calling for a moratorium on executions. "What happened today to Mr. Wood was an experiment that the state did its best to hide," Executive Director Alessandra Soler said.
The new drugs being used are intended to replace others that pharmaceutical companies now refuse to sell to US correctional facilities. The drug midazolam causes unconsciousness in a patient, while hydromorphone shuts down breathing and induces cardiac arrest.