Blood ties


Csanad Szegedi receiving tuition

One of the recurring themes thrown up by assisted reproduction is the importance of genetic ties. Are we determined by our origins, or can we forge our own identity? Does it matter whether our nearest and dearest are our kith and kin or whether they are just the people we hang around with?

By chance I just stumbled across the astonishing story of a Hungarian politician whose life was transformed when he discovered his true genetic identity.

By the time Csanad Szegedi was 24, he was vice-president of Jobbik, a far-right, nationalist and virulently anti-Semitic party. He was elected to the European Parliament as a Jobbik MEP in 2009 and wrote a book, I Believe in Hungary’s Resurrection.

Then he learned his family’s deepest secret: he was a Jew. His grandfather and grandmother were actually Auschwitz survivors.

Szegedi’s life fell apart. He was forced to resign from Jobbik.

Suddenly he did a complete about-face. Under the tuition of a Lubavitch rabbi from New York who was living in Budapest he became an Orthodox, observant Jew; he had himself circumcised, adopted the name Dovid and burned a thousand copies of his book. Now he is migrating to Israel with his wife and two children. He is interesting in joining the Knesset.

Szegedi is obviously a complex, intense man. He could even be a charlatan. But his astonishing journey does suggest that there is something to the idea that our personal identity is incomplete if it lacks the genetic heritage. 

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Belgian euthanasia and nihilism


Today is a landmark, of sorts. It marks the first time that a child has been euthanised under contemporary euthanasia laws. Of course, euthanising infants is relatively common, but not children who are old enough to be asked if they really want to die. The death occurred last week in the Flemish-speaking part of Belgium, although it was announced today by Belgium's euthanasia supremo, Wim Distelmans. His words were very sober and solemn, as befits the occasion, but I suspect that he and his colleagues are quietly happy to see the boundaries of euthanasia spread even further.

Ultimately this is a triumph for out-and-out nihilism, not just Belgium's inventive euthanasia lobby. Nihilism is a philosophical fad which seems to catching on. Below we feature a report on three American bioethicists who argue the case for population control to fight climate change and a defense of infanticide by a Finnish bioethicist. I've also just discovered a new book by South African philosopher David Benatar. In it he argues that procreation is morally wrong because life's a bitch and then you die (I am over-simplifying, of course.) He concludes his book with these cheerful thoughts: 

Every birth is a future death. Between the birth and the death there is bound to be plenty of unpleasantness ... Inflicting serious harm—or even the risk of it—on one person, without his or her consent, in order to benefit others, is presumptively wrong. 

If I'm right, euthanising a child is not an terminus for Belgian euthanasia, but just a bus stop en route to pure nihilism. What its supporters are trying to eliminate is not just pain, but life itself. What do you think? 

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Excel glitch


I’m not very clever with spreadsheets. Never have been. Never will. My consolation, though, is that some people who use them 24/7 may not be either. A study by Australian researchers in the journal Genome Biology found that 20% of genomic papers contain errors because of a simple conversion error in the popular program Microsoft Excel. You see, if the gene Septin 2 is entered, as it usually is, as SEPT2, Excel automatically converts it to a date, 2-Sept. This is an issue that has been known since 2004, but it keeps increasing.

This raises some questions about the usefulness of the reviewing and editorial process at major journals if they are failing to pick up errors like this. And although this is a relatively minor glitch, it also shows once again that science is not infallible, even if it is backed up by sophisticated statistical analysis and acres of figures. Garbage in, garbage out.

By the way, our deputy editor, Xavier Symons, a post-graduate student in bioethics in Melbourne, has just had an article published in the Journal of Medical Ethics on the thorny topic of conscientious objection. Congratulations, Xav!  

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Investigating IVF


From an ethical point of view, IVF is made of teflon. Just about nothing sticks. It's understandable, since its product line is the joyful experience of cradling a newborn baby. However, there have always been some dark clouds hanging over IVF. What works always seems to have trumped what's safe. But clinicians are beginning to realise that some IVF techniques could be responsible for serious health problems for IVF children decades later. 

As we report below, the editor of the leading journal Human Reproduction warns that changes are needed. “It’s not possible to sell a single drug on the market if you do not give the total composition of the drug, but for such an important thing as culture media, that envelopes the whole embryo, you can sell it without revealing its contents. For me, that’s unacceptable,” he says. “Compared to the rest of medicine, this is such a backward area. We can’t accept it any longer.” 

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The anguish of too few children


I must be getting old. For most of my life, I have been reading about the global need to curb births and the unmet demand for contraception. And then I opened this week’s edition of The Economist and discovered that the main problem facing couples is the unmet demand for children.

The Economist surveyed 19 countries, asking people how many children they wanted and how many they expected to have. The results were astonishing.

“For more and more couples, the greatest source of anguish is that they have fewer children than they want, or none at all. … In every rich country we surveyed, couples expect to be less fertile than they would like, and many in developing countries suffer the same sorrow….

“The pain of having no or fewer children than you desire is often extreme. It can cause depression and in poor countries can be a social catastrophe. Couples impoverish themselves pursuing ineffective treatments; women who are thought to be barren are divorced, ostracised or worse.”

I hope that executives at Marie Stopes International (see article below), the United Nations Population Fund and all the other global agencies dedicated to shrinking family sizes read The Economist’s advice:

"Governments and aid agencies have turned family planning into a wholly one-sided campaign, dedicated to minimising teenage pregnancies and unwanted births; it has come to mean family restriction. Instead, family planning ought to mean helping people to have as many, or as few, children as they want."

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Costa Rica railroaded


Costa Rica is a small Central American republic of about 4.5 million people which is remarkably stable, compared to other countries in the region. It is one of the few countries in the world without a standing army. Its democratic institutions are robust. A higher proportion of people turn out to vote than in the US. The percentage of seats in parliament held by women is nearly double that of the US – about one-third.

Yet Costa Rica has been dragooned by an international court into enacting legislation which violates its Constitution. In 2000 it became the only country in the world to ban IVF, based on a Supreme Court ruling that this violated a constitutional guarantee to the right to life for the unborn. Last year, after many legal battles, Costa Rica was ordered by the Inter-American Court of Human Rights to enact legislation enabling IVF -- against the will of its legislature and Supreme Court. “Seven foreigners are making decisions about human life in Costa Rica,” said one deputy bitterly. After more legal tussles, clinics began offering IVF procedures last month.

Regardless of where one stands on the ethics of IVF, this seems like a low point for respect for democracy. An article in Nature crowed over the victory and said that the next goal must be the legalization of abortion. There’s something quite cynical about this. If the Inter-American Court of Human Rights struck down the death penalty in the US, all Americans would be united in their outrage. Voters in the UK supported Brexit because EU courts were suborning UK legislation, amongst other issues. Yet no one is defending Costa Rica’s right to make up its own mind on controversial bioethical problems.

This is The Mouse That Roared with an unhappy ending.  

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All beauty must die


The death of Ivo Pitanguy in Rio this week was the intersection of bioethics and the Olympics. The world’s best-known cosmetic surgeon and a celebrity in his native Brazil, he carried the Olympic flame on the day before he died of a heart attack at the age of 93.

A member of the Brazilian Academy of Letters, Pitanguy thought deeply about his specialty. “My operations are not just for my patients’ bodies. They are for their souls,” he wrote. He regarded beauty as a human right and he made cosmetic surgery as popular among the poor as among glittering celebrities.

However, his poetic vision of his specialty clashes with the scepticism of some bioethicists. The Nuffield Council on Bioethics, in the UK, is currently conducting an inquiry into cosmetic procedures, in response to concerns that patients are being victimized and that the industry is sustained by sexist stereotypes. Its discussion paper is particularly interesting. We hope to cover this area in more depth in the future.

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The greatest show on earth


The Games of the XXXI Olympiad have just started in Rio de Janeiro. A few thousand young men and women will be sweating in their competitions; a few billion people will be watching them on television screens; and a few bioethicists will be disputing the merits of taking drugs and human enhancement. Stretching the body to its limits, going "Faster, Higher, Stronger", is a thrilling spectacle. But -- this is just a personal crochet -- I've always sought out the human drama in the Olympics, which sometimes has nothing to do with record books. 

My favourite Olympic moment comes from the marathon at the 1968 Games in Mexico. John Stephen Akhwari, of Tanzania, began to cramp up because of the high altitude conditions. And then at the 19 kilometre mark, he fell and badly injured his knee and shoulder. But on he ran, or stumbled, and as dusk was falling, he hobbled into the nearly empty stadium, a bandage flapping around his leg, and crossed the finish line an hour after the winner. When they asked him why he bothered, he replied, "My country did not send me 5,000 miles to start the race; they sent me 5,000 miles to finish the race."

You can enhance stamina and speed, but can you enhance courage and loyalty? 

Have you any favourite Olympic stories? 

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Brexit and English utilitarianism


What does Brexit mean for bioethics?” is our lead story today. Given that the Leavers were not expected to win and that the pundits have widely different views of the future of the politics and economies of the UK and the EU, it is unwise to be dogmatic on the issue.

However, the question highlights the importance of Britain in the world of bioethics. Britain is the home of utilitarianism, which is the dominant philosophy in bioethical discourse at the moment. The medical and scientific establishment is dominated by a utilitarian mindset which has set the agenda for debates on embryo research, stem cell research and assisted dying around the world. As one cynical writer commented, “when it comes to bioethics, Europe might be better off without Britain”.

There is something in this. Although I am handicapped by a big language barrier, my impression is that from Norway to Italy there is much more depth and diversity in bioethical discourse across the Channel. The Greens and the Christian Churches are much more influential, to say nothing of Continental philosophy, which despises utilitarianism as vacuous and naïve. If England (the pundits all agree that Scotland will secede) loses its biomedical industry to the EU, perhaps utilitarian bioethics will lose some of its funding and its influence. That would be no bad thing, I think.

******

Sorry, guys, but BioEdge will be taking a holiday during July. Our next issue will be in the first week of August. 

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Crazy or crafty?


I have no love for Donald Trump, but it does seem unfair that only he is being accused of being crazy in this year’s election for president. It is a truth universally acknowledged that any man (or woman) who hankers after high public office must be in need of a psychiatrist. In 2013 psychologists published an article asserting that most recent presidents have suffered from “grandiose narcissism, which comprises immodesty, boastfulness and interpersonal dominance”. Remember that Hillary Clinton has been accused of all these failings, not just Trump. Perhaps they are crafty, not crazy.

That’s why the Goldwater Rule is a good thing. As Xavier Symons mentions below, this is an informal rule of medical ethics for psychologists and psychiatrists which bans them from commenting on the mental state and stability of public figures. It’s very rash to predict that psychological flaws disqualify a person from holding public office. Winston Churchill was depressive and an alcoholic and became the most admired statesman of the 20th century. Abraham Lincoln probably suffered from depression but is the most revered of all American presidents. Mr Trump may be unsuited to the job of president, but I’d prefer to make up my own mind on the subject without airy speculation from psychiatrists who have never spoken to the man himself. 

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