Simmering away in the pages of the British Medical Journal is a debate over the merits of surgical or chemical castration for convicted sex offenders. The Journal takes a surprisingly positive view of the proposal. On the whole, argue psychiatrist Don Grubin and criminal psychologist Anthony Beech, it may not be a bad idea, if the offender gives his consent:

When drugs work the clinical effect is often dramatic, with offenders reporting great benefit from no longer being preoccupied by sexual thoughts or dominated by sexual drive. These drugs can also allow offenders to participate in psychological treatment programmes where previously they may have been too distracted to take part. Given the transparency of benefits and risks, there is no obvious reason why an offender should not be able to make an informed choice about drugs… Physical castration as part of a rehabilitative strategy may even have a place.

A number of issues arise in considering the wisdom of castration. Is the offender capable of giving informed consent when the alternative may be the rest of his life in prison? Is the doctor acting only in the best interests of his patient, and not of society? Is punitive mutilation consistent with his Hippocratic Oath not to do harm? Apparently the English Department of Health believes that these and other issues can be overcome, as it is supporting the prescription of drugs on a voluntary basis for sex offenders.

However, two Italian doctors from the Gemelli Clinic in Rome, Giuseppe Vetrugno and Fabio De Giorgio, comment in a recent letter to the BMJ that they are “perplexed” to discover that a health department “has approved a stark reversal of what should be the natural outlook in the practice of medicine”. “The physician is never to act against the interests and the wellbeing of the patient. The physician is the trustee of the patient who seeks to be healed, meaning that the healer’s sole professional responsibility is to cure the patient,” they argue.

In the BMJ’s arguments they detect “pseudo-humanitarian alibis that utilise, under a logic of greater or lesser returns, a form of punishment already questionable in its own right, employing it in the name of a indeterminate collective good”. ~ BMJ, Jan 10

Are iPS cells better than embryonic stem cells? For anyone interested in the ethical dimension of regenerative medicine, this is a hot topic. Gretchen Vogel weighs up the latest research in the March 5 issue of the journal Science. Some recent papers suggest that induced pluripotent stem cells – which have less ethical baggage because they do not involve the destruction of embryos – have less medical potential than iPS cells.

In one of these, Robert Lanza, of Advanced Cell Technology, found that iPS cells were capable of producing far fewer cells than human embryonic stem cells (hESCs). In one experiment, the difference was a thousand to one. The iPS cells also aged more quickly and died sooner than hESCs. “These cells are pretty screwed up,” Lanza commented.

However, James Thomson, of the University of Wisconsin, the scientist who first isolated hESCs, is more optimistic. “The differences are real, but one shouldn’t overinterpret them. When you go back and tweak the conditions, [iPS cells] seem to have the same potential” as ES cells, he says. The differences may be due to imperfections in the reprogramming process that morphs a skin cell into an iPS cell. “There’s going to be a lot of noise” in the data as scientists work to diagnose and overcome reprogramming’s weak spots, Thomson says.

He tried to turn both hESCs and iPS cells into neural cells and found that 90% of the hESCs made the transition. Of the iPS cells, 79% of one line and only 15% of another line did. However, another leading stem cell scientist, Hans Schöler, of the Max Planck Institute for Molecular Biomedicine in Münster, Germany, says he has noticed no differences between hESCs and iPS cells when they changed into neural stem cells. But he, too, acknowledges that reprogramming is still an inexact science.

Shinya Yamanaka, of Kyoto University, who was the first to successfully reprogram mature mouse cells into iPS cells, has also observed that iPS and hESCs vary from line to line, thought not systematically. He told Science that adding factors to the reprogramming mix should produce more dependable iPS cells. ~ Science, Mar 5

Most articles on IVF are written from the perspective of an anguished couple longing for a bundle of joy. The other angle is the treatment providers, who are also longing for their bundles of joy, which come in the form of greenbacks. At least this is the impression given by promoters of the Destination Health exhibition in London in mid-April. Here is their blurb, slightly abridged:

* * * * *

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An Australian court has authorised the sterilisation of an 11-year-old Queensland girl who is severely intellectually disabled. The girl, who was identified only as “Angela”, has Rett Syndrome. She cannot speak or even use sign language. Ever since she was born she has had epilectic seizures which have been brought under control with medication. However heavy menstrual periods provoke the seizures.

In March 2009 doctors recommended that she have a hysterectomy, but the Queensland Health Department said a court order was needed because the procedure was irreversible. This week Family Court judge Paul Cronin found that the operation would be "in the child's best interests". In his judgement, he said, "Angela is never going to have the benefits of a normal teenage and adult life. A fundamental consideration is ... the risks to Angela's life as well as her general health."

But Dr Leanne Dowse, from the University of New South Wales, said the decision may have breached international human rights conventions.

"Australia became a signatory to the UN convention on the rights of persons with disabilities in July 2008," Dr Dowse told ABC Radio. "That convention says that individuals with a disability have a right to respect for his or her physical integrity. That sort of idea means that the first position is to protect an individual from these sorts of things." ~ Sydney Morning Herald, Mar 9

This post is not exactly about bioethics, but about the context of bioethics, at least in America. The Obama-appointed head of the National Institutes of Health, Francis S. Collins, has published two books for the general public this year (where does he get the time?). The first outlines his passion to promote the revolutionary potential of personalised medicine, The Language of Life: DNA and the Revolution in Personalized Medicine.

The publisher’s blurb describes it as a very readable book for the layman in which “Collins describes the medical, scientific, and genetic revolution that is currently unlocking the secrets of ‘personalized medicine,’ and offers practical advice on how to utilize these discoveries for you and your family’s current and future health and well-being.” 

Uncontroversial stuff, and quite appropriate for the government’s voice for science. But here’s the controversial book: an anthology of readings about the compatibility of faith and science, Belief: Readings on the Reason for Faith. Bloggers about science and faith are indignant at Collins’s insistence that God exists and religion matters:

Faith and reason are not, as many seem to be arguing today, mutually exclusive.  They never have been… Down through the centuries, humanity’s greatest minds have developed interesting and compelling arguments about faith, based on moral philosophy, arguments about nature, and examination of sacred texts.  But outside of limited academic circles, these deeper perspectives are not heard from much these days. The goal of this anthology is to present some of these points of view, to spur on a more nuanced and intellectually rich discussion of the most profound questions that humanity asks: Is there a God? If so, what is God like? Does God care about me? And what, if anything, is the meaning of life?

Bioethics, medicine and science are often assumed to be dominated by agnostics or atheists. It is interesting to see that the most prominent figure in American science is a believer.

More pressure this week in the UK to legalise assisted suicide. Vicki Wood, a seasoned euthanasia campaigner, committed suicide in the Dignitas clinic in Zurich, Switzerland. The 67-year-old toymaker and artist was suffering from an unspecified illness. More than 130 Britons have died at Dignitas since it opened in 1998.

In 1999 Ms Wood was convicted of attempted murder after she tried to smother her husband. She had described it as “mercy killing”, because her husband was suffering from dementia and Parkinson’s disease. The judge sentenced her to two years’ probation with the provision that she was not to see her husband alone for the rest of his life. Her husband died 9 months later.

And former Health Secretary Patricia Hewitt has called for a Royal Commission into assisted suicide. A patron of the lobby group Dignity in Dying, the Australian-born Ms Hewitt told Parliament this week that one in 500 deaths was the result of illegal voluntary euthanasia.

"Other desperate people find that they have to refuse food and water, a wretched process, in order to exercise some control over when and how they die. And each year, a number of terminally ill people – it is impossible to say how many – resort in desperation to violent, lonely and often botched suicides." ~ Guardian, Mar 11

The Dutch Parliament will debate a proposal to offer euthanasia for anyone over 70, whether or not they are terminally ill or in great pain. A euthanasia lobby group, "Vrijwillig levenseinde", or "Of free will", gathered more than 112,000 signatures on a petition. Only 40,000 signatures are required to force a debate.

The proposal is to train non-medical staff to administer a lethal injection to healthy people over 70 who "consider their lives complete" and want to die. These suicide assistants would receive government accreditation. Their job would be to check whether clients were not temporarily depressed and had a "heartfelt and enduring desire" to die.

Marie-Jose Grotenhuis, the campaign's spokeswoman, said: "We've been overwhelmed by the amount of reactions, especially because people took it so seriously and reactions were mostly positive." Her group will wait until after national elections on June 9 to ask Parliament to open the debate. Euthanasia was legalised in Holland in 2002 in the Netherlands and more than 2,500 cases were reported in 2009. ~ London Telegraph, Mar 10

The gruesome details of 4 assisted suicides with helium bags at the Swiss suicide clinic, Dignitas, are described in the latest issue of the Journal of Medical Ethics. Three researchers – from Canada, the US and the Netherlands, wanted to draw on the experience of Dignitas. Their reason for their interest is not quite clear, but their methocs were approved by an ethics research board at Kwantlen Polytechnic University, in British Columbia.

The researchers watched videos of the demise of 4 people who breathed helium through a mask under the supervision of Dignitas volunteers. (The deaths are taped and given to the police so that they can check that every detail of the demise is legal.) Three of the deaths took place fairly quickly and in about 5 to 8 minutes all gasping had finished. The fourth, however, took  at least 38 minutes and the volunteers were clearly nervous.

Dignitas normally uses a lethal dose of sodium pentobarbital. But in 2008 the Zurich authorities said that the patient had to be seen by a doctor more than once before the suicide. The head of Dignitas, Ludwig Minelli, thought that this unduly restricted his clients’ autonomy, and started using helium, which did not require the intervention of doctors. The authors of the article believe that the use of helium could help demedicalise assisted suicide, although they believe that a bag over the head is superior to a mask, which allows some oxygen to enter.

One of the most useful aspects of the article is a complete breakdown of deaths at Dignitas from May 1998 to December 2009 (click on link). There have been 1041 deaths, with nearly 60% coming from Germany, 14% from Great Britain, 11% from Switzerland and 9% from France. People from about 30 countries have come to die at Dignitas. ~ Journal of Medical Ethics, March

A high school student in Toronto, Lia Mills, became an internet sensation with her YouTube video denouncing abortion. Now she’s back with a speech for her Grade 8 speech project arguing that euthanasia should not be legalised in Canada. Her arguments are off-the-shelf and her research suggests that her parents had more than a little role in her presentation. But, hey, how much originality can you expect from a 13-year-old? What is impressive is her earnestness, intensity and level-headedness. If she represents the new generation of pro-lifers, what will the debate be like in 20 years’ time?

Just over 70% of Swiss voters have rejected a referendum proposal to give animals lawyers who would represent them in court. All 26 cantons voted against the move by animal rights activists. In some cantons, the No vote was more than 80%. Although this system is already in place in Zurich, the Swiss clearly thought that it was too expensive and too bizarre to be extended to the whole country. All of the cantons would have been forced to engage animal advocates.

 The president of the Swiss Farmers' Union, Hansjorg Walter, said: "Voters have taken a pragmatic decision and acknowledged that Switzerland has one of the strictest animal welfare laws. The Union wants proper enforcement of animal welfare. Violations harm the image of farmers. But there are stringent checks and penalties for misconduct are already severe." ~ London Telegraph, Mar 8