FROM THE EDITOR
I just finished reading the obituary of an American scholar of Persian studies – who had nothing whatsoever to do with bioethics, as far as I know. What caught my eye was the fact that he spoke fluent Russian, German, Arabic, Persian, Pashto, French, Uzbek, and Turkish, as well as being able to cipher out ancient languages like Avestan, Pahlavi and Sogdian. Pretty good for a boy from Birmingham, Alabama.
Being a polyglot would be a big help in reporting on bioethics. Unfortunately, the only languages your editor is fluent in are English, American, Kiwi and Australian. Developments in countries where English is not the lingua franca are underreported. Google Translate is a treacherous guide -- traduttore, traditore, as they say in Italian. So, for the most part, we are stuck with reporting what happens in English-speaking countries, even if significant developments occur elsewhere.
Perhaps that is why this week’s lead story has flown under the radar, even though it did appear in the English-language Journal of Critical Care. It seems, as far as I understand it, that intensive care doctors in Belgium have decided (decreed may be a better word) that it is acceptable medical practice to euthanase their patients, even if they are not suffering, even if they are not elderly, even if their relatives have not requested it, even if they have not requested it and even if it is not legal.
The lead author, Dr Jean-Louis Vincent, of the Free University of Brussels, attempted to justify this policy in a leading Belgian newspaper, Le Soir, in February but the news must have ground to a halt at the language barrier.
I do hope that critical care physicians in other countries protest this development. Surely it cannot be good for their specialty. How many Belgians will trust their mother’s doctor when she is seriously ill if he has the power to decide whether she lives or dies?
An administrative note: BioEdge will not be published next week because of the Easter holiday.
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|This week in BioEdge|
Involuntary euthanasia is acceptable medical treatment, according to a recent official statement by the Belgian Society of Intensive Care Medicine. Although voluntary euthanasia is legal is Belgium under some circumstances, involuntary euthanasia is basically illegal. But the Society wants to be able to euthanase patients who do not appear to have long to live.
The Society spells out its policy very carefully. It is not about grey areas like withdrawing burdensome or futile treatment or balancing pain relief against shortening a patient’s life. It clearly states that “shortening the dying process by administering sedatives beyond what is needed for patient comfort can be not only acceptable but in many cases desirable”.
“Shortening the dying process” is a euphemism for administering a lethal injection.
Most dying patients in intensive care have not made advance directives and “are usually not in a position to request euthanasia”. Therefore, “difficulty can arise when the purpose of the drugs used for comfort and pain relief in end-of-life management is misconstrued as deliberate use to speed the dying process.” The Society’s solution to this difficulty is to allow its members to kill the patients.
Effectively the Society has declared itself to be above the law. However, with the backing of the Society, it is unlikely that Belgian doctors would be prosecuted. It will be interesting to see how the government reacts.
The Society also says that intensive care doctors should inform relatives of a decision to euthanase a patient, but it does not instruct them to ask for the relatives’ permission. The policy applies to both adults and children. Furthermore, patients do not have to be suffering; “Shortening the dying process” can actually enhance death, the statement says.
The statement concludes by reassuring intensive care doctors that what they are doing is “not be interpreted as killing but as a humane act to accompany the patient at the end of his/her life.”
In February the lead author of the policy, Jean-Louis Vincent, a former president of the Society, published an op-ed in the leading Belgian newspaper Le Soir explaining the Society’s position. He complained that intensive care doctors were working in a “legal no man’s land” and that Belgium needs a law which bans overly aggressive therapy. He believes that advance directives are worse than useless and that doctors need to be able to give lethal injections to shorten lives which are no longer worth living, even if the patients have not given their consent. “The first purpose of medicine is to restore or maintain health, that is, the well-being of the individual, not life at all costs,” he wrote.
Thanks for the tip from Wesley J. Smith at NRO's Human Exceptionalism blog.
Cryonics is the branch of cryogenics that concerns the freezing and preservation of deceased human beings in the hope that healing and resuscitation will be possible in the future. The cryogenics 'movement' is more widespread than most would think. The number of cryogenically frozen human bodies worldwide was estimated at 270 in 2013. There are seven major cryonics companies around the world - the majority in the US - and some of these companies are growing rapidly. The process is illegal in some countries, for example France, but authorities generally allow for bodies to be transported to other countries where corpse disposal laws are not as strict. Cryonicists claim that frozen persons are not actually dead, but rather in a temporary quiescent state. The video above provides an interesting insight into the process, as well as some of the bioethical issues.
A retired British art teacher has had herself euthanased in Switzerland, citing weariness of the modern world. The woman, asking to be identified only by her Christian name Anne, made use of the assisted suicide service offered by Dignitas, in Zurich, after deciding that it was futile to “struggle against the current” of modern life.
Anne was gravely concerned about the commercialisation and dehumanisation of society. She felt that computers and social media had taken humanity out of our interactions, and was appalled at comfort-seeking short-cuts that people took in modern life. In an interview with the Sunday Times shortly before her death, Anne said:
“They say adapt or die. At my age, I feel that I can’t adapt, because the new age is not an age that I grew up to understand. I see everything as cutting corners. All the old-fashioned ways of doing things have gone.”
She was also anxious about overcrowding and pollution in cities.
Anne's application to Dignitas was overseen by de-registered doctor Michael Irwin, the founder of the Society for Old Age Rational Suicide (Soars).
The Lancet has published an alarming editorial about the pressure on healthcare systems from an growing elderly population. The article examines the various factors that are contributing to an 'elderly care crisis'. The key issue is demographic -- the proportion of people aged over 60 years will double from about 11% to 22% between 2000 and 2050. In addition, Western nations such as Britain have significantly cut funding to elderly care in recent years. As noted in the Age UK report Crisis in Care 2014, public funding for older people's social care fell by a massive £1·2 billion (15·4% in real terms) between 2010—11 and 2013—14, even though it had been stagnant between 2005 and 2010.
The authors are concerned particularly for middle to low income countries such as China, which face the same issues as the US and the UK, but with less funding to address it. They conclude:
A more age-friendly approach is needed to ensure healthy ageing with dignity. To meet this goal, more investment—financial and human resources—is, without doubt an urgent necessity. In a climate of austerity, efforts can also be exerted in other areas, especially disease prevention and health promotion for older people, together with interventions to reduce smoking, alcohol consumption, and obesity. Additionally, better coordination is needed between health care, long-term care, and social services to enhance capacities and ensure sustainable services.”
Human rights activist Leonard Rubenstein has called for the release of the report on CIA torture of detainees compiled by the US Senate Select Committee on Intelligence (SSCI). The report, a 6000-page account of the use of 'enhanced torture techniques' under the Bush administration, was completed in 2012, but has so far been withheld from the public due to CIA claims of factual inaccuracy.
Rubenstein, a former president of Physicians for Human Rights, believes it imperative that a revised version be released. It will enable Congress and the medical community to address the participation of medical personnel in torture:
“The Senate’s report probably will shed more light on the CIA’s shameful enlistment of doctors in the torture of detainees, a profound violation of the doctors’ duty to do no harm. By doing so, it can awaken the medical community and Congress to the need to devise mechanisms to ensure respect for what turn out to be very fragile norms.”
Rubenstein served on an independent task force that identified the roles played by psychologists and physicians in 'enhanced torture'. The involved medical personnel developed and promoted interrogation methods such as sensory deprivation, isolation, sleep deprivation and waterboarding.
America’s best-known practitioner of euthanasia, Jack Kevorkian, was also an artist. After his death in 2011, the ownership of his painting was disputed. However, the legal wrangling is over and 11 of his canvases are for sale at a West Hollywood art gallery. "He was a talented amateur," curator Lee Bowers told CNN. "He painted throughout much of his life."
His “thanatron” is also for sale – the machine which he used to help people to die. The asking price is US$25,000.
The paintings may give some insight into the mind of Kevorkian, a doctor who claimed that he had helped 130 people to die over 20 years. In 1999 he was finally convicted of second-degree murder in Michigan and jailed for eight years.
Kevorkian’s style is bold and expressionistic, with garish colours and dramatic, nightmarish images. “Coma” depicts a prone patient being sucked into a death mask which resembles a CAT scan machine. It is typical of Kevorkian’s obsession with death.
Euthanasia may be off the legislative agenda in Quebec for a while. In the April 7 election, the Parti Quebecois (PQ), which had championed it, was thrashed. It lost 24 seats and has been reduced to a distant second place. The Liberals, led by Philippe Couillard, now have 70 seats and a comfortable majority.
The PQ, led by Pauline Marois (who lost her seat), was backing euthanasia, a secularist charter of values, stricter language legislation and sovereignty. Its defiantly separatist agenda now appears to have been a mistake. As Couillard said in March, the PQ “continues to present Quebecers as weak, besieged, threatened people. When it’s not the federal government, it’s the other provinces. When it’s not the federal government or the other provinces, it is foreigners who come to live here. And when it’s not the foreigners living here, it is us, Quebecers who don’t think like them. I’m fed up with that, and it’s going to end with this election.”
However, euthanasia will not go away. The PQ MP who introduced Quebec’s euthanasia bill, Veronique Hiron, has already told the media that she hopes it will not disappear. Couillard, a former neurosurgeon, says that his party is split on the issue. He thought that the PQ’s euthanasia bill was too broad, but he does not seem to be opposed in principle.
An American businesswoman and an Ivy League scientist have teamed up to create a sophisticated service for reducing genetic diseases for lesbian couples and single women. Anne Morriss and Lee Silver, of Princeton, have founded Genepeeks, a company which will identify the sperm donors who have the best chance of producing a disease-free baby.
Using Silver’s patented gene analysis technology, Matchright, Genepeeks will create "virtual babies" for the woman and a range of possible sperm donors and screen out donors with a flawed genetic profile. Matchright screens for hundreds of diseases, but also other features, like eye colour and height. Morriss and Silver insist, however, that the technology will not be used to create genetically engineered children.
However, Silver, the author of pop science books like Remaking Eden: How Genetic Engineering and Cloning Will Transform the American Family (1998) and Challenging Nature: The Clash of Science and Spirituality at the New Frontiers of Life (2006) is an apostle of genetic engineering and even human cloning.
Genepeeks will have to be prepared for stiff opposition.
Marcy Darnovsky, executive director of the Center for Genetics and Society, in California, told BBC News that its service was "highly irresponsible".
"It amounts to shopping for designer donors in an effort to produce designer babies. We believe the patent office made a serious mistake in allowing a patent that includes drop-down menus for which to choose a future child's traits. A project like this would also be ethically and socially treacherous."
Nikkan Sports' coverage of stem cells / Kotaku
The Japanese woman at the centre of the latest stem cell scandal, Haruko Obokata, apologised tearfully for her “carelessness, ignorance and immaturity” at a press conference this week. But she insists that her “stimulus-triggered activation of pluripotency” (STAP) cells do exist. She claims that she had created them 200 times before publishing a paper in Nature which has come under fire for its flawed data.
Her employer, the world-famous RIKEN Institute has accused her of academic misconduct after an internal investigation. But Obokata is seeking a new investigation by outsiders. “I would also like to emphasize there was no deceptive motive in my completing these articles, given that legitimate experiments were conducted, and that there exists solid data as a direct result,” she told the press conference.
The Japanese media has been having a field day with this story. The press conference was carried live on national TV networks and Obokata’s face blanketed newsstands.