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.
The Medical Board of Australia decided to suspend Nitschke after he admitted to supporting Nigel Brayley in his decision to commit suicide, despite not being terminally ill. The board said that Nitschke “presented a serious risk to the health and safety of the public”.
The suspension, which came into effect at midnight on Thursday, prevents him from practicing anywhere in Australia and is an interim measure pending the outcome of the inquiry.
Nitschke called the decision “political“ and “a dirty little midnight assassination“ aimed at silencing him. He has vowed to fight the suspension.
Beyond Blue spokesperson Jeff Kennett welcomed the decision, saying, "We cannot allow the debate to start that it's alright for a 16-year-old, or a 45-year-old, simply because they're having an off day, to attempt to take their own life. It is not acceptable."
At the conclusion of the debate on his Assisted Dying bill in the House of Lords last Friday (July 18), Lord Falconer said, “I express my gratitude for the total lack of venom and the constructiveness with which they have approached the issue.” After passing a second reading, the bill passes to a Parliamentary committee which will scrutinise it and propose amendments. Here are some excerpts from speeches of opponents of the bill, beginning with Lord Robert Winston, one of the pioneers of IVF.
Lord Winston (Labour): Perhaps I might indulge myself briefly to tell noble Lords about my mother's death. For the last two or three years of her life we decided absolutely, given that there was modest and not inadequate medical care, that we would leave her at home and see to her ourselves and rotate regularly being with her. There was a 40-minute moment before her death when my mobile phone rang and it was my youngest son, Benjamin, who was with my mother in her bedroom. He said, “Dad, I don't think Granny is very well”. “Tell me what is wrong”, I said. He said, “She’s not speaking”. I said, “It’s possible, Ben, that she might have died”. He said, “What do I do?”. I said, “Stay there. I will drive as fast as I can and will be with you in the next 30 to 40 minutes. Just stay with her. You’ve been immensely privileged and so has she because she loved you very much and you are the last person she saw and she is the first person you have seen in this situation”.
I got there, and my point is that we have been talking intensively in this debate about the dignity of a planned death. I do not believe in that planned death being dignified. There is much more dignity in many ways in being able to ensure that people wherever possible die with their relatives around them in an unplanned death in the way that my mother died, with her youngest grandson present.
Baroness Campbell of Surbiton (a crossbencher who is seriously disabled and confined to a wheelchair). Supporters of the Bill argue that there is a hard and fast distinction between terminal illness and disability. I can tell you absolutely that there is not. We, the folk this Bill claims to serve, know that. The Bill purports to offer choice—the option of premature death instead of pain, suffering and disempowerment—but it is a false choice. It is that of the burglar who offers to mug you instead. That is not choice. Pain, suffering and disempowerment are treatable—I have to believe that—and they should always be treated. My long experience of progressive deterioration has taught me that there is no situation that cannot be improved.
I have spent my life developing ways to prevent people in vulnerable situations feeling powerless and burdensome. They do get cajoled and do feel a burden, especially when they are at home with no one to come and assist them to go to the toilet and to have dignity. I have seen this transformation when people have been helped. Those whom society once saw as totally dependent have become active and valued human beings. I am afraid that assisted dying will bring back outdated beliefs that devalue disabled and terminally ill people, when we have tried so hard to get away from them. Small wonder then if some succumb to those beliefs and see premature death as the only answer. Small wonder if family, friends, doctors and others see it as their duty to support that goal. It appears easier, cheaper and quicker—and it is.
Lord Ribiero (Conservative and a former president of the Royal College of Surgeons): “the Assisted Dying Bill would fundamentally alter the role of the doctor-patient relationship. Doctors should preserve and improve life. If they are also involved in taking life, a damaging conflict of interest will occur, which patients will not understand. My noble friend Lord Sheikh stressed that there is a danger that a right to die may become a responsibility to die, making vulnerable people more vulnerable … The debate highlights the need for better and more widespread palliative care with a focus on individual patients’ needs rather than a focus on assisting a few to die.”
The debate on the Assisted Dying bill in the House of Lords last Friday (July 18) was a remarkable display of eloquence, knowledge and passion. Here are some excerpts from speeches of supporters of the proposed legislation, beginning with Lord Falconer, a former Lord Chancellor, who proposed it.
A record number of Lords spoke, more than 130, in a debate which lasted 10 hours. However, this did not resolve the issue. After passing a second reading, the bill passes to a Parliamentary committee which will scrutinise it and propose amendments.
Lord Falconer of Thoroton (Labour): My Lords, in the last stages of a terminal illness, there are people who wish to end their life rather than struggle for the last few months, weeks, days or hours. Often it is not the pain that motivates such a wish, but the loss of independence and dignity. Those who love them often try to help, sometimes by going with them to Switzerland. Nobody wants assisters who are motivated by compassion to be prosecuted. The courts and the prosecution authorities recognise this impulse and have tried to steer a course between Section 2 of the Suicide Act 1961 and the desire not to enforce it. But the current situation leaves the rich able to go to Switzerland, the majority reliant on amateur assistance, the compassionate treated like criminals and no safeguards in respect of undue pressure. Many people, caring so much for those they leave behind, are dying earlier and alone because they fear implicating their loved ones in a criminal enterprise. They horde pills or put a plastic bag over their head when they are alone.
The Earl of Glasgow (Liberal Democrat): I get very angry when those who oppose the Bill misrepresent what it is actually proposing and fail to mention how limited its aims intentionally are. It applies only to those who are already terminally ill yet still in sound mind who want, as we all surely do, some control or say in the manner of their own death. It has nothing to do with coercing vulnerable old people into killing themselves. Yet our opponents use emotive words such as “legalised killing” or “euthanasia” and talk about this being a slippery slope that could lead to the eventual demise of the frail, disabled or mentally ill. No, it does not. No, it is not. The Bill is about personal choice and the alleviation of unnecessary suffering—the choice to decide how, where and, to a small extent, when you want to die.
Lord Avebury (Liberal Democrat): As a Buddhist, I recognise that this Bill contravenes fundamental Buddhist beliefs in the inviolability of human life, but there is also the Buddhist principle of compassion, which I think applies in the extreme circumstances of distressing terminal illness. That, it seems to me, weighs heavily in consideration of this Bill and is partly what has persuaded me to support it. I believe that the same is true of many other people of strong religious faith, both Buddhists and Christians. They believe, as I do, that helping people who are suffering from distressing terminal illnesses outweighs the principle of inviolability of human life.
Baroness Murphy (crossbench): My Lords, I am afraid that the noble Lord, Lord Gordon, will be disappointed that I am one of those members of the medical profession who would be proud to be associated with the Bill. I certainly would not desist from becoming an expert under a code of practice to administer medication to those who had requested it, if the Bill was passed. Many members of the medical profession feel, as I do, that at the moment the provisions are fudged, the system does not work and it depends on regular, 24-hour hypocrisy to deliver the care that we are currently obliged to pretend that we give.
Last time we debated this topic in the House, I rather lost my temper—egged on, I have to say, by the noble Baroness, Lady Boothroyd—so I have promised myself that I will not do so this time. However, one of the things that trouble me about debates in this House is that we go endlessly for emotional anecdote, talking about our experience, or talking about other jurisdictions as if we have looked at the evidence. I have sat here as a simple medical scientist—I was a practising psychiatrist and academic for 30 years, working with elderly people in the most deprived community in south-east London—and I have to tell noble Lords that I do not recognise any of the fears from evidence.
The crisis in the the US Veterans Affairs Department is fundamentally a crisis of ethics, according to the former hospital ethicist at the Philadelphia Veterans Affairs Medical Center, Evelyne Shuster.
The VA’s director, Eric Shinseki, was forced to resign after it was discovered that employees were generating fraudulent statistics to improve their performance reports. The problem was particularly acute in Phoenix.
The New York Times decried “poor management, a history of retaliation toward employees, cumbersome and outdated technology, and a shortage of doctors and nurses and physical space to treat patients.” The Wall Street Journal lamented a “corrosive culture” which had damaged patient care.
But not long ago, VA was at the forefront of quality care and patient safety. It had identified weaknesses in its ethical culture and had set up a multi-million dollar program to deal with it called Integrated Ethics. How did things go so wrong?
The fundamental reason, Shuster writes in Bioethics Forum, a blog at The Hastings Center, is that ethics was an also-ran behind statistics and key performance indicators:
“Ironically, the very programs that made it possible for the VA to outpace other health care institutions in quality care, efficiency, and accountability also seem to have contributed to ethics failure in actual performance. The VA’s focus on quantifiable performance measures and accountability took a life of its own and helped foster the creation of a culture where ethics, integrity, and responsibility were simply overlooked or perceived as an impediment to achieving quality care.”
The Integrated Ethics program was supposed to promote ethical behaviour. Instead, she says, it “quickly became overwhelmed by a vast and rigid organization that valued documentation over action and reduced ethics to compliance and risk management. As a result, ethics in the VA became bureaucratized, an exercise of filling out forms and managerial compliance.”
"My view is that the focus on consent in contemporary biomedical research has become the modern equivalent of a fetish".
Koenig believes that the ‘full disclosure’ model of informed consent is impracticable. She recounts her experience developing genetic testing protocol after the mapping of the human genome in the 1990s:
“Even then, we recognized that the ideal of full disclosure of all risks and benefits of a particular genetic test, ideally by a trained genetic counselor,would collapse once the volume of genomic data increased. If it took an hour to counsel a patient about one condition, what would happen if panels of test could simultaneously offer multiple findings?”
Koenig proposes a model of consent whereby decision-making is outsourced to a ‘representative citizens group’ educated in basics of genetic testing. This group would be able to make informed decisions on behalf of patients, saving time, money and significant patient distress:
“The focus turns away from a ceremony of individual control and choice. Instead, consent is about giving up control, agreeing to accept a set of procedures and practices created and interpreted by a group of fellow citizens; it is ‘consent to be governed.’”
Koenig argues that this model preserves rather than undermines individual freedom:
“Personal sovereignty is not violated when research participants who will share in the benefits of genomics knowledge are given the opportunity to consent to be governed.”
In 2006 the anonymous woman attended a Portuguese hospital where tissue containing olfactory stem cells were taken from her nose and implanted in her spine. The hope was that these cells would develop into neural cells and help repair nerve damage in the woman's spine.
Eight years later she had a spinal growth removed in a US hospital. Doctors investigated the growth and discovered it to be composed of “mostly of cysts lined by respiratory epithelium, submucosal glands with goblet cells, and intervening nerve twigs”.
The cells had continued to grow as olfactory cells rather than morph into neural tissue. The growth was secreting a “thick, copious mucous-like material” which seems to have been pressing against the patient’s spine, causing considerable discomfort.
“It is sobering,” says George Daley, a stem cell researcher at Harvard Medical School who has helped write guidelines for people considering stem cell treatments. “It speaks directly to how primitive our state of knowledge is about how cells integrate and divide and expand.”
The case shows that experimental stem-cell treatment remains risky even when carried out in respectable hospitals.