Some bioethicists who feel at home in the utilitarian common room of the Journal of Medical Ethics described the imbroglio as an attack on academic freedom. Udo Schüklenk, of Queen’s University, in Ontario, who is also the editor of Bioethics, a distinguished international journal, complained bitterly that “bioethics journals are under increasing and sustained fire from political activists” of all stripes, from “the left, feminists, disability activists [to] religious conservatives”.
He singles out two gadflies who “busily scan bioethics journals for evidence of the secular liberal bias they claim exists … and also attack, pretty much immediately, papers—and by extension the journals that publish them—that they disagree with.”
The first is Wesley J. Smith, the editor of the Human Exceptionalism blog on the website of the US magazine National Review Online. The other is the editor of BioEdge, whose “outputs are routinely picked up by search engines such as Google's news service, thereby arguably providing the site with a larger real-world impact than most bioethics journals could dream of”.
Of the two, although he regards both as “agitprop”, Dr Schüklenk prefers BioEdge which, he says, “is less caught up in the US culture wars, so there is less of a permanent doomsday flavour to its outputs”.
But the controversy also brought to light a difficult issue for editors of bioethics journals. How should they deal with inflammatory theories and articles? Infanticide is not the only topic which is taboo in the media. No doubt an article defending non-voluntary euthanasia for patients in a permanent vegetative state would provoke a similar response. “When all is said and done, this is an academic freedom issue. It has to do with ensuring both that we are able to ask difficult questions, and that we are able to defend conclusions that most people will disagree with.”
Malcolm Oswald, of the University of Manchester, made a novel suggestion. He proposed that bioethics papers be tagged “green papers” or “white papers”. The latter would be purely theoretical discussions; the former practical policy proposals. “Had it been labelled as ‘green’, readers could have understood what Giubilini and Minerva explained later: that it was a discussion of philosophical ideas, and not a policy proposal advocating infanticide.”
Giubilina and Minerva subsequently explained that their article was published as a thought-experiment, not a serious public policy proposal. Schüklenk says that this loss of nerve is a serious failing.
“Bioethics analyses offering practical conclusions are not theoretical games,” he writes. Peter Singer and Michael Tooley, two bioethicists who have defended the moral legitimacy of infanticide, have never asked not to be taken seriously. “Respect for free speech has a flipside, requiring of us to take responsibility for the views that we defend. On what other grounds could we expect our views to be taken seriously. What kind of debate could we reasonably have with discussants who—when cornered—will say ‘I didn't really mean it’?”
Not everyone in the “pro-life” camp is singing from the same song sheet in the controversy over infanticide. In this month's Journal of Medical Ethics two leading foes of abortion debate the reasonableness of arguments for infanticide.
One, the well known American legal philosopher Robert P. George, of Princeton University, describes Giublini and Minerva's argument as “moral madness”. The other, controversial Catholic theologian Charles Camosy, of Fordham University, argues that the authors make not only reasonable but strong arguments. He dismisses George's claim as “unchristian”. The debate was sparked by George's comments in the blog Mirror of Justice last year.
In his article, “Infanticide and Madness”, George appeals to a fundamental intuition that killing an unwanted newborn is evil. To argue against this intuition, is outrageous.
"Whatever errors of fact and judgment are made possible by the complexities of human development or a prenatal child’s hiddenness in the womb—though in the age of the sonogram, the child is hidden only from those who wish to avert their gaze—it should be plain to see that killing an infant because he or she is unwanted is evil. The advocacy of that, or of its moral permissibility, is what should take one aback, not a declaration by me or anyone else that such advocacy should be denounced as moral madness."
George goes on to condemn those who sent threatening mail to the authors following the publication of the article.
Charles Camosy, author of the 2012 book, Peter Singer and Christian Ethics: Beyond Polarization, takes a more conciliatory approach. Camosy contends that without a Judeo-Christian ethical background it is difficult to see that pre-rational human beings are still persons. It is not unreasonable for secularists to argue for infanticide:
"if it is not madness to claim that ‘a non-rational human being is a non-person’ before birth, then neither is it madness to make the same claim about human beings after birth." (See 'Concern for our vulnerable pre-natal and neo-natal children' in the same JME issue).
Interestingly, Camosy does not engage with George's appeal to a fundamental human, rather than simply Christian intuition, namely that the killing of an unwanted infant is morally depraved. Camosy is perhaps aiming only at a theological critique of the matter.
The infanticide debate in the Journal of Medical Ethics has garnered comments from the grand old men of infanticide, the Australian Peter Singer and the American Michael Tooley. They have been defending it for decades.
Singer and Tooley attack the "anti-abortion mindset", claiming that the irrationality of "pro-life" groups caused the aggressive reaction to the Giubilini-Minerva article. They are philosophically illiterate. Singer rather condescendingly analyses the aggression of opponents:
"Their problem, apparently, is that most of them do not know how to argue against anyone who agrees with them that the fetus and newborn infant have the same moral status, but then denies that merely existing as an innocent living human being is enough to give a being a right to life."
Similarly, Tooley regards most people who disagree with his views as irrational:
"...in the case of many people, their views on the moral status of abortion are part of a ‘package deal’, part of some very general point of view to which they are deeply committed... In such cases, the person may find it very difficult to consider, dispassionately, arguments dealing with abortion, since he or she may view such arguments as threatening his or her general worldview".
For those suffering from this psychosis Tooley prescribes a dose of Socrates and self-reflection:
"My hope is that readers who find the conclusions for which Giubilini and Minerva argue problematic will ask themselves whether their own views may not be connected, for example, to deeply held religious beliefs that make it very difficult to take seriously the Socratic challenge in this case."
The so-called Groningen Protocol (GP) in the Netherlands allows euthanasia of newborns under strict conditions if there is “hopeless and unbearable suffering” and both parents give “informed consent”. Dr Verhagen claims that there were fewer instances of newborn euthanasia after the publication of the GP – but for reasons not connected with it. With more prenatal screening, more women opted for terminations of pregnancy in difficult cases like spinal bifida. The number of newborn euthanasia cases actually fell from 15 in 2005 to 2 in 2010.
The GP is, of course, very controversial. In an article in The Lancet in 2008, a paediatric oncologist and bioethicist at the Cleveland Clinic, Erik Kodish, angrily repudiated it. “The very notion that there is an ‘accepted medical standard’ for infanticide calls for resistance in the form of civil disobedience,” he wrote.
However, in some cases, “after-birth abortion” might be the most sensible treatment, Verhagen believes, as it allows the parents and the doctors to make a more accurate diagnosis and to discuss treatment opinions. “If all stakeholders conclude that the prognosis is very grim, the babies condition is judged as one with sustained and intolerable suffering, and the parents request for euthanasia, why should that not be permissible as an alternative to second trimester termination?”
In any case, Dr Verhagen points out, the official opinion of the American Academy of Pediatrics is that it is morally permissible to withdraw or withhold hydration and nutrition from newborns in some cases. These include ”children in a persistent vegetative state or children with anencephaly”. This is a form of euthanasia, but the child lingers for a long time while it starves to death. “If the parents wish to shorten that course, and organise their child's death more in the way they have envisioned it, shouldn't euthanasia be available for them?”
Of course, bioethicists writing in the Journal of Medical Ethics are not the only people who have suffered for their views on abortion. A new Australian university group, Life Choice, has struggled to get approved because of its opposition to abortion.
Life Choice’s aims are “to promote the dignity of human life from conception to natural death, through reasonable and informed discussion on the issues of abortion and euthanasia in Australian society."
But it has faced fierce opposition at the major universities in Sydney. The group was almost disaffiliated by the University of Sydney Union. The president of the Student Representative Council declared that "a woman's right to chose comes before freedom of speech". For similar reasons the student union at the University of NSW refused to endorse the society.
The issue has generated a storm of media coverage, including several articles in The Australian and the Sydney Morning Herald.
Surprisingly, the group has found a supporter in Peter Singer. "I have been an advocate of legal abortion since I was an undergraduate myself, when abortion was illegal; but I am also a strong supporter of freedom of speech," Professor Singer said. "A university, in particular, should be a place where ideas are able to be freely expressed. Students should be challenged to defend the ideas they take for granted."
Five people have been convicted of organ trafficking in Kosovo by the European Union court which runs the legal system in the quasi-independent territory. The controversial case ended with a jail term of 8 years for a prominent urologist in Pristina, Lutfi Dervishi, for "organised crime and human trafficking".
His son Arban was sentenced to seven years and three months. The other three received terms of between one and three years. EU prosecutors hope to charge 8 more suspects with organ trafficking.
The charges all relate to transplants done in 2008. The donors were recruited from eastern European and Central Asian countries with fees of about 15,000 Euros. The recipients, mostly Israelis, paid 100,000 Euros. The donors "were cast adrift after the removal of organs without proper medical care or any medical attention, like waste," EU prosecutor Johnathan Ratel told the media.
The case has international ramifications. The EU prosecutors were unable to extradite two of the main suspects in the Medicus case (named after the clinic where transplants took place), a Turkish transplant surgeon, Yusuf Sonmez, and the alleged mastermind, an Israeli named Moshe Harel.
The Serbian media has covered the case closely and has highlighted sensational allegations that Kosovar gangsters with links to high government officials sold organs from Serb prisoners of war during the 1990s. Kosovo and Albania have hotly denied these claims.
This is not the way the era of assisted reproduction was supposed to work. An unnamed woman in the UK has been jailed for five years after artificially inseminating her 14-year-old adopted daughter in order to get another child.
The harrowing case came to light after the secretive Court of Protection released a judgement by Mr Justice Jackson. He said that he had "an abiding sense of disbelief that a parent could behave in such a wicked and selfish way towards a vulnerable child".
The case came to light when the 48-year-old mother behaved strangely in the hospital after her daughter had given birth. She tried to prevent her from breastfeeding, saying, "we don't want any of that attachment thing". The staff noticed how reluctant the daughter was to hand the baby to her mother and when she attempted to remove the baby from the ward they contacted child protection workers.
The mother was clearly a strange and domineering woman. Her divorced husband had not seen her for 10 years. The woman did not want to give birth herself because she had diabetes and did not want to pass on the disease to her children. So she had herself sterilized and adopted three children, two before her divorce and one afterwards as a single mother. She home-schooled them and raised them in seclusion, or as the judge put in, in a “toxic cocoon”.
However, the woman was not happy with only three children and applied to adopt a fourth. When her application was denied she ordered her 14-year-old virgin daughter to bear a child for her. The girl told the court:
‘Mum said to me, “A, the only way I can have a fourth child is for you to get pregnant”. ‘I was shocked, pretty shocked at first. And then I suddenly thought, “Maybe if I do this then everything will be over. Mum will be happy like she was before”. ‘And I also thought from a selfish point of view, “If I do this . . . maybe she will love me more”.’
The woman’s system was crude. She forced the girl to inseminate herself "alone in her bedroom, using syringes of semen and douches prepared by the mother". This happened seven times. Once she bought semen from a casual visitor, but the other time it came via post from the Danish sperm bank Cryos.
Mr Justice Jackson said there were "no effective checks on a person's ability to obtain sperm from Cryos" and that no "meaningful medical involvement is demanded", except for the approval of a doctor (which the mother forged).
The girl may have miscarried once at 14, the judge believes, but finally, at the age of 16, she gave birth to a boy.
The case was a clear failure of adoption procedures and child welfare authorities. The woman was reported several times to the authorities, but no effective action was taken. The local Safeguarding Children Board said in a statement, "Nothing can change what has happened to the children in this truly terrible case. It is clear that public bodies must highlight the major public policy issues which arise from this case."
Here’s the bioethical angle on the Boston Marathon bombing: should the brain of Tamerlan Tsarnaev be autopsied to see if boxing-induced brain trauma was responsible for the violence? Experts in chronic traumatic encephalopathy (CTE) at Boston University believe that it could have been a significant factor, if not the only one, in sparking the atrocity. “I hope to God they do the special testing,” said Dr. Robert Cantu, a clinical professor of neurosurgery.
Among the effects of CTE are emotional instability and lack of impulse control. Media accounts of Tsarnaev’s life suggest that his personality changed radically in the last few years. Dr Cantu and his colleague, Dr Robert Stern, who run the Center for the Study of Chronic Traumatic Encephalopathy at BU, were careful to stress that it was unlikely that his personality change, leading to a complex, highly planned operation like the bombing was the result of CTE. However, an autopsy might give a better picture of his motivation.
“Am I suggesting it because I think he has the disease? No,” Stern told the Boston Globe. “But would it lead to a complete picture [of his brain]? Yes.” Cantu added, “If they don’t do it, something could be missed.”
As Boston grieves after recent terrorist attack, charity workers have flown in “comfort dogs” to console residents. The Lutheran Church Charities Comfort Dogs are a team of canines that “sense the sadness” of people and work on cheering them up. “People talk to dogs -- They are like furry consolers,” said Tim Hetzner, president of the charity.
These comfort dogs are a good example of what doctors call Emotional Support Animals (ESAs). ESAs are a novel psychological therapy. Doctors prescribe them for patients suffering from depression and social withdrawal in the belief that the unconditional affection of the pet can ameliorate the effects of these illness. And in some countries, such as the US, the law exempts ESAs from standard domestic pet regulations.
One case is that of Petey the pig, a 40-pound domestic pet of New Yorker Danielle Forgione. Ms Forgione purchased the pet to help deal with the death of her brother in a motorcycle accident. (Here is a link to Petey's Facebook page.) The New York City Department of Health has ordered Ms Forgione to remove the pet following complaints from neighbours.
American bioethicist Maurice Bernstein has posed some relevant questions in his blog:
“A question can be asked as to why in our society it is necessary to turn to lower animals to provide emotional comfort: Is there no adequate benefit available from inter-personal relationships? Or is a common denominator of the discomforted patient the lack of personal ability to develop a helpful relationship with another person who could provide needed emotional support?”.
The Americans with Disabilities Act was amended in 2011 to state that creatures which are not trained to perform specific services to a patient are no longer considered "service animals" and are no longer permitted in environments where they pose problems with regard to safety, sanitation or disturbance.
Two IVF stories from opposite ends of the globe are a sobering reminder that “foetal reduction” remains a failsafe position in clinical practice. In the UK, Sharon Turner gave birth to quadruplets last month -- two sets of identical twins – a one in 70 million occurrence. She and her husband Julian were married in 2007 and turned to IVF after they failed to have children. She became pregnant on her fourth attempt – luckily, because the couple had spent 40,000 pounds, all their savings, on the IVF cycles.
News of the quads came as a shock, but the Turners were delighted. But specialists at John Radcliffe Hospital in Oxford warned that there were dangers in the birth. Mrs Turner told the Daily Mail: “They gave us three options: get rid of all of them, get rid of two of them or keep them. There was no way we could get rid of them. We were happy to let nature take its course.” The quads were born 11 weeks premature on March 30. They are still in hospital but are in relatively good health and will go home soon.
On the other side of the world, in Surat, India, doctors at the Newbirth IVF Gujarat Institute of Reproductive Medicine implanted five embryos in a 40-year-old woman, in the hope that one or two would survive. All of them did.
Then the specialists performed what the Times of India described, somewhat bizarrely, as a “rare IVF experiment”, or foetal reduction: “In this procedure, potassium chloride is injected into the fetal heart to make it stop functioning.” Three of the five foetuses were killed in this fashion. After 37 weeks of pregnancy the mother delivered healthy twins.