Nearly 80% of RCGP members who submitted individual responses to the consultation expressed the opinion that the College should remain opposed to a change in the law to permit assisted dying. In addition, of the 28 RCGP bodies that took part in the consultation, 20 reported a majority view against a change in the law.
Although a minority of respondents put forward cases to shift the College’s collective position to ‘neutral’ or ‘in favour’ of a change in law on assisted dying, most respondents were against a change in the law. These are a few of their reasons:
change would damage the doctor-patient relationship
it puts the most vulnerable groups in society at risk
It is impossible to eliminate the possibility of coercion.
A change would shift the focus away from investing in palliative care and treatments for terminal illnesses
New laws would instigate a ‘slippery slope’ whereby it would only be a matter of time before assisted dying was extended to those who could not consent due to reasons of incapacity and the severely disabled.
Some doctors thought that the possibility of a wrong decision being made was too high to take the risk. The GP-patient relationship, with GPs often attending patients in the final days and hours of their lives, means that GPs would be one of the professional groups most affected by any change in the law on assisted dying.
Dr Maureen Baker, Chair of the RCGP, said: "This was one of the most comprehensive consultations the College has ever undertaken and the quality of the responses on this extremely important issue has been very high. GPs will continue, as they have always done, to provide excellent care to patients in the final days and hours of their lives."
Peruvian state prosecutors have cleared former president Alberto Fujimori of crimes against humanity relating to his government’s sterilization campaign in the 1990s. Fujimori had been accused of authorizing the forced sterilization of thousands of indigenous Peruvian women. Prosecutor Marco Guzman concluded that there was no systemic forced sterilization, though coercion may have been used in isolated cases: “The women would come to the clinic, agree to the procedure, and undergo sterilization. That was the regular, the normal process,” he said.
2,074 women have given statements to local and international rights groups saying that they had their tubes tied without their knowledge or consent. At least 18 women died as a result of the surgery, the groups claim.
Peruvian women’s rights group Demus have appealed the ruling. “We reject the decision of the public prosecutor that the public policy (under Fujimori) was not systematic and therefore not a crime against humanity”, said Demus lawyer Rossy Salazar. “This was not a common crime but a crime against humanity because so many women were involved”.
In September 1995 the Peruvian parliament passed a bill that revised the “General Law of Population” in order to allow for sterilization. In the following three years over 210,000 women were sterilized, the vast majority in poor indigenous communities.
A study in the journal Fertility and Sterility has found that children born from assisted reproduction are as healthy and well-educated as their naturally conceived peers. Lead researcher Jane Halliday, of the Murdoch Children’s Research Institute in Melbourne, Australia, wrote about her work in The Conversation. She said that: “most IVF offspring have grown into healthy young adults with a quality of life and educational achievement comparable to those of non-IVF conceived peers.”
Questions hover over the long-term safety of IVF because of the great differences in the early environment. Hormonal stimulation, fertilisation outside the body and living in a Petri dish for a couple days are not the way that most people begin life.
IVF children clearly have an increased risk of preterm birth and lower birth weight compared to other children. They are also more susceptible to some birth defects. However, little research has been done on the effect of IVF upon the health of older children. Dr Halliday and her colleagues studied the health of young adults aged 18 to 28, and reached generally positive conclusions. The only caveat was that
“We did find that IVF children had a slightly higher chance of asthma and other respiratory allergies, such as hay fever, which are common conditions in the whole community. But the difference was small with 30% for IVF children and 23% for others.”
There were some limitations to the research. First of all, the good news was self-reported by mothers and children and was not based upon medical examinations. In fact, the information was gathered over the phone. There may have been a degree of selection bias, as a high percentage of couples fail to tell their children that they were conceived through IVF. Mothers were excluded if their child had died (which is the ultimate confirmation of bad health). And only singletons were studied, but much of the ill-health for IVF babies is linked to multiple births.
What the study may show is that if women have singleton IVF babies, it is unlikely that they will be less healthy as young adults. But the question of whether they have a lower life expectancy due to health problems in middle age remains unanswered.
Concern is mounting about widespread surveillance of patients and staff in US hospitals. In an article published in this New York Times, US bioethicist Tim Lahey wrote of the “proliferation” of surveillance, ranging from the monitoring of fragile elderly patients to the recording of staff washrooms to ensure patients are washing their hands.
Lahey recounted various controversial cases of surveillance in hospitals, including the installation of secret security cameras in the nurse locker rooms of a Los Angeles hospital in 2004. In a hospital where Lahey chairs the bioethics committee there was spirited debate over whether to install a video camera in the room of an infant suspected of being routinely abused by his mother.
In the US video surveillance is legal except where patients have a valid expectation of privacy, such as in bathrooms and locker rooms. Where there is reason for surveillance within patient’s rooms, hospital ethics committees need to balance their commitment to patient privacy against the need to ensure the safety of the vulnerable.
“Hidden cameras should be a last resort”, Lahey argues. “Hospitals should notify patients that covert video monitoring may be used in unusual circumstances, and only with the oversight of a hospital ethics committee.”
The British Defence Force may introduce mandatory pregnancy testing for female soldiers before tours of service, after it was revealed that over 200 women returned from combat between 2003 and 2013 because they were pregnant. One woman, lance bombardier Lynette Pierce, gave birth at a base in Afghanistan in 2013. She claims she was unaware of her pregnancy.
Currently the British defence force does not enforce pregnancy tests for female soldiers, believing that it would be an ‘invasion of privacy’. However, the prospect of a woman having to be suddenly evacuated from the front line, putting the lives of other soldiers at risk, may prompt a change in policy. According to the Ministry of Defence most of the babies would have been conceived before the mother left the UK.
After 2,500 years, one of the most hotly debated issues in philosophy is whether we have free will. We may feel that we are free, but it is very difficult to demonstrate. It’s a bit like love: you know it when you experience it and it's hard to convince others.
And it still has many opponents. A novel argument against it from experimental philosophy is that a naïve belief in free will is founded upon a desire to blame and punish others. A number of researchers from the US recently collaborated to study just how our beliefs about free will vary in response to different moral scenarios.
In a paper entitled ‘A Motivated Account of Free Will Belief’, (reported in Oxford University’s bioethics blog, Practical Ethics) five researchers completed a series of studies designed to test the influence of the misconduct of others on our belief in free-will. The researchers concluded:
“Taken together, our results provide a potential explanation for the strength and prevalence of belief in free will: it is functional for holding others morally responsible and facilitates justifiably punishing harmful members of society.”
In one of the studies conducted, university students were informed of their classmates using cheat sheets, and then asked to complete a survey on free will and the moral responsibility of the offenders. The results were that as students were informed of other students using cheat sheets, their belief in moral responsibility increased. Students who were informed of the specific case of cheating gave more positive scores on the Free Will and Determinism (FAD) test, and advocated for harsher penalties for the offenders.
Another study showed that countries with higher murder rates and crime rates have higher levels of belief in free will. “These findings are consistent with our contention that belief in free will is stimulated in part by exposure to others’ harmful behaviours and the associated impulse to punish”, the researchers wrote.
Under the right conditions, full informed consent is not ethically required for some types of health research, according to leading bioethics experts. In the February 20 issue of the New England Journal of Medicine Ruth R. Faden and Tom L. Beauchamp, and Nancy E. Kass, argue that in some cases a time-consuming consent process is not only unnecessary from the standpoint of protecting patients, but also potentially harmful to patients when it functions as an obstacle to gaining new knowledge that can improve the quality of the care patients receive.
The position is a considerable break from ethics principles that have guided research ethics and regulation for decades.
The commentary addresses two concepts generating debate in the healthcare and bioethics fields: the idea of learning healthcare systems, as articulated by the Institute of Medicine (IOM), in which “continuous learning” from clinical practice feeds directly into improving future patient care; and randomized comparative effectiveness research (CER), in which patients are randomly assigned to different, widely used treatments for their condition – all of which are thought to be effective and safe – to determine which treatments work best for which patients.
“In a mature learning healthcare system with ethically robust oversight policies and practices, some randomized CER studies may justifiably proceed with a streamlined consent process and others may not require patient consent at all,” the commentary states.
However, the authors note that no such system exists today with fully developed ethical safeguards, including patient engagement, to allow a study impacting patient care to be ethically acceptable.
The sequencing of DNA from a 2-year-old boy who was buried 12,600 years ago in Montana has been accompanied by great attempts to deal ethically with the remains.
A paper in Nature demonstrated that most Native Americans of North and South America are probably descended from a single population which crossed an ancient land bridge across the Bering Strait. The remains of the “Clovis boy” also suggests that the Clovis people diverged from a second group, which survived in Canada and Greenland.
This came as stunning news for many Native Americans, but behind the publication were complicated negotiations with tribes about how to deal with the relics. In the 1990s, the discovery of a 9,000-year-old human skeleton, so-called Kennewick Man, in Washington state, ended up in years of litigation with tribes who said that the remains belonged to them.
The Umatilla tribe, in whose area the skeleton was found, contended that the skeleton belong to their people and that denying that Kennewick Man was not Native American offended their religious beliefs. The courts, however, determined that they were not genetically related and consequently could be studied by anthropologists.
The authors of the paper in Nature did not want to engage in another bruising battle, so they contacted several tribes in Montana to seek their approval.
“That place is very special to me, that’s my ancestral homeland,” Sean Doyle, a member of the Crow tribe who was a consultant to the project. His advice to the scientists was that they boys should be reburied where he had been found. “I think you need to put the little boy back where his parents left him,” he said. The reinterral will probably take place later this year.
More adventures in artificial reproduction. A British woman has given birth to her third triplet five years after twin boys arrived in 2008. Nicola Brightey and her husband Kevin turned to IVF after they were unable to conceive naturally. An illness in her teen years had blocked her fallopian tubes.
During the treatment, Mrs Brightey produced 14 eggs from which eight embryos were created. Two were placed successfully in her womb in 2008, resulting in twin boys, Daniel and James. The remaining six were cryopreserved.
After a few years, they wanted another child. One embryo failed to develop, but a second did, resulting in the birth of Elizabeth. Mrs Brightey told the Daily Mail: “For years I never thought that we would ever be parents, and it has been such a long battle to have our triplets. It has taken 15 years and nearly £20,000 but it has been worth every penny. I feel like the luckiest mum in the world.”
Presumably another four embryos remain in the freezer.
A brain-dead woman in British Columbia has delivered a baby, more than six weeks after she suffered a devastating brain haemorrhage. Robyn Benson, 32, collapsed on December 28 when she was 5 months pregnant. Her husband Dylan asked that she be kept alive on a ventilator long enough so that her son Iver could be safely delivered.
This contrasts with a parallel case in Texas in which a 33-year-old pregnant woman was declared brain-dead in November. However, the family of Marlise Muñoz sued to have her taken off life support. They alleged that it was against her wishes to survive on life support and that the foetus was not viable.
On February 8, Iver was delivered by Caesarean section 12 weeks prematurely. Robyn was taken off life support and her heart stopped functioning the next day.
Mr Benson kept the world posted on the state of his wife and son in a series of emotional blog posts. He also asked friends and readers for donations to cover the enormous cost of medical care. His goal was C$36,000, but he has raised at least $160,000.
According to media reports, there have been about 30 cases of “posthumous motherhood”. Caring for a brain-dead patient on a ventilator is not easy, a specialist told the New York Times. A complex mix of drugs and hormones is needed to maintain blood pressure and keep the heart beating.