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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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November
29
  6:35:00 PM

Russian politicians propose universal DNA profiling

Politicians from a minor nationalist party, the Liberal Democratic Party of Russia, want the government to file fingerprints and DNA profiles of every Russian citizen. While the proposal appears to have little chance of success, it does suggest that some law-makers lack sensitivity about issues of genetic privacy.

According to the bill’s sponsor, Roman Khudyakov, the information would be stored safely in a special agency of the Interior Minister or the FSB (the successor to the KGB). He told the popular daily Izvestia that the information could be stored on citizens’ ID cards. He dismissed concerns about the safety of their personal data.

“All information will be protected. It is like a bank card. We will also toughen the criminal responsibility for officials who have access to the data. When people face three years in prison for leaking the data no one would be tempted to do this.”

The data would be stored for 150 years after the date of collection, and then destroyed.

Under Mr Khudyakov’s proposal, registration would be voluntary for ordinary citizens, who would have to pay a fee for the privilege of allowing the state to know everything about their genetic information. But it would be both free and compulsory for all civil servants, law enforcers, military and security personnel, convicts, firemen, rescuers and applicants for a driving license or gun permit. Which, of course, captures just about everyone.

Mr Khudyakov has also proposed universal fingerprinting of all travellers, both foreign and Russian, and all people with dangerous diseases, especially AIDS

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November
29
  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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November
29
  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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November
29
  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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November
29
  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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November
29
  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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