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Same-sex marriage doesn’t really fall into the bioethics basket. However, the recent earthquakes in Nepal brought to light a link to the biggest social policy debate in the United States and Ireland at the moment.
Kathmandu, it turns out, became a surrogacy hub after India and Thailand imposed restrictions on this racket. According to one clinic operating there, it is a very attractive destination: “Surrogacy in Nepal is very affordable and recommended for same-sex couple like gays and lesbians, for singles and even married couple who are unable to take the chance of surrogacy in India.”
So poor women are renting out their wombs so that gay couples can take babies home. A number of babies commissioned by gay Israelis were airlifted out of the ruins of Kathmandu back to Tel Aviv on a defence force aircraft – but not the mothers.
It's an angle that the justices in far-off Washington will probably not consider, but it deserves to be mentioned: if same-sex marriage is legalised, how will gay couples get children? Will it be by exploiting women in places like Nepal?
The drama of bioethics is coming to light as more novelists and playwrights mine it for their stories. Last week we ran a feature about the world of the medical thriller and authors like Michael Crichton, Robin Cook and Tess Gerritsen. Now I've just discovered that the world premiere of a play about the development of IVF, "The Waiting Room", takes place next week in Melbourne.
The curious thing about this production is that the playwright is Kylie Trounson, the daughter of Alan Trounson. Trounson père is a controversial Australian scientist who was a pioneer of IVF in Australia. He developed a technique for freezing embryos and was an ardent promoter of the use of human embryonic stem cells. Bitter conflicts over the reproductive revolution emerge in the play, although the author -- who has a very good relationship with her dad -- seems to frame him as a new Galileo.
Are there any Melbournians out there who would like to review it for BioEdge?
Our apologies to readers who may have received an unwanted email from New Media Foundation, the publisher of BioEdge, the other day. We manage a few newsletters and one of them, MercatorNet, was inadvertently posted out to BioEdge subscribers. We are contacting the email company to ensure that it won't happen again.
In 2007 an infection swept through the pomegranate trees of Hyderabad-Karnataka in India. Pomegrates are a profitable export crop into countries like Germany, Switzerland, France, and Canada. Farmers had borrowed heavily to invest in pomegranates and the disease brought them to their knees. Then came floods. The banks threatened to foreclose. Politicians promised relief and did nothing.
Three hundred of these despairing farmers have a solution: they have petitioned the local governor for mercy killing, ie, euthanasia: "No yield, no money to repay the loans. The only option before us is to die," they say.
On the other side of the country, in Jharkhand, 130 prisoners have also petitioned the local governor for mercy killing. They claim that they have spent 20 years in jail and have done their time but the authorities have done nothing. They are suffering from extreme mental trauma and say that death is better than the lives they are living now.
Such requests for “mercy killing” are relatively common in the Indian media, believe it or not. Perhaps they are genuine. Perhaps they are calculated to capture the media spotlight. But in any case, no one is going to die. Euthanasia is illegal.
However, it’s easy to see how dangerous it could be for desperate people. Bureaucrats would rubberstamp their application for a lethal needle, for it would be easier to kill the petitioners than to give them jobs. If euthanasia were legal, people would die simply because they were luckless and poor.
Is there a lesson for us in more developed countries? I think so. As a committee of the Scottish Parliament wrote in a thorough report this week about an assisted suicide bill (see below), “there is no way to guarantee the absence of coercion in the context of assisted suicide.”
Now for something completely different because April 25 is Anzac Day, “the one day of the year” , a solemn commemoration of the 1915 Gallipoli landing, the first (and disastrous) battle fought by an independent Australia. Today is the centenary celebration.
The highlight of every Anzac Day is the Dawn Service, a simple ritual which is held in nearly every town and hamlet throughout the country.
For me, the most memorable of these took place in Hobart a few years ago. I walked with hundreds of others through the dark towards the Cenotaph on a frosty morning. There was complete silence as an elderly Protestant minister gave a short and eloquent address about Australia’s fallen heroes which managed to make everyone, both religious and secular, happy.
However, there was something quite eccentric about his delivery. Every couple of paragraphs there was an pause. It only lasted long enough to remind us how cold we were and how dark it was, but it was slightly embarrassing. Then there was another burst before he lapsed into silence again. Finally, he concluded with an Amen.
In a quavering voice he said that this would be his last Anzac Day service. He was 85 now and had done it for 30-odd years. Time to pass the baton to someone else. And then he apologised for those pauses. “It was so cold,” he said, “I had to blow on my fingers so that I could keep on reading.” Suddenly it dawned on me: the old minister was blind and had been reading his Braille text with his frozen fingers. You find heroism in the most unexpected places…
The best-known words of America's World War II hero, General Douglas MacArthur, could be usefully paraphrased for bioethics: old generalizations never die; they just promise to return. Take eugenics. Nowadays coercive eugenics is universally reviled (although the consumer-driven kind probably has a bright future). Nonetheless, as if law-enforcement officials had never heard of the Nazis or compulsory sterilization campaigns in the US, there are constant reports of prosecutors using sterilization in plea bargains.
Or take the notion of "born criminals", people whose biology destines them for a life of social deviance. That is the repudiated theory of Cesare Lombroso and other 19th century criminologists. They detected criminal tendencies in sloping foreheads and left-handedness. But the idea keeps bobbing to the surface, this time (as we report below), repainted as a genetic predisposition to sex-offending.
I suppose that another reason why bioethicists need a clear philosophical framework. Otherwise they will scud before the prevailing breeze.
We are back after the Easter break. I’m afraid that I failed to alert subscribers to the gap in continuity. Apologies.
The coincidence of two anniversaries struck me as I was preparing this week’s newsletter. It is the tenth anniversary of the death of Terri Schiavo on March 31, 2005 – probably the most controversial bioethics case of all time, if measured by column inches in newspapers or the tonnage of court documents. And it is the 40th anniversary of the publication of Animal Ethics, the book which launched Peter Singer’s career as a public philosopher.
The two events have much in common. Terri’s life support was withdrawn because American courts were persuaded that because she no longer had interests which extended over time, she would suffer no harm in dying. And Singer’s main argument for expanding the circle of protection to include pigs and dolphins is that they do have these interests.
From this angle the most important issue in bioethics, then, must be: is there anything special in simply being a human being, regardless of how conscious he or she is, regardless of whether his or her interests extend over time? At the moment the pendulum seems to be swinging towards Singer’s utilitarianism. I wonder whether there will be a reaction as he fades from the scene.
Does anyone else feel that that they are being suckered by the Brittany Maynard videos produced by the assisted suicide group Compassion & Choices? Brittany, you must remember, is the 29-yar-old woman who chose assisted suicide in Oregon last year, rather than suffer a slow decline because of a brain tumour.
She made two videos which went viral on YouTube – no wonder, as they were directed by a New York public relations firm which put together a multi-platform media campaign called Twenty Nine Years for C&C. A professional story-telling consultant was employed to create the video. The celebrity magazines, the glossy women’s magazines and the major newspapers were provided with photos and interviews. Brittany was interviewed on national television. C&C has a lot riding on her story.
This week, Brittany spoke from the grave to California legislators in video testimony about a bill to legalise assisted suicide. While it lacks the professional gloss of the first two, it is poignant and direct – just the thing for fence-sitting legislators.
But I found it a little bit creepy: the poor woman was being ventriloquized by C&C and exploited as a pin-up girl for assisted suicide. Her words add nothing to the debate except the tragedy of premature death.
Let’s be honest. Isn’t this a bit sexist and ageist? If Brittany were 59 instead of 29, would she have become a YouTube sensation? I think not. In fact, Maggie Karner, a Connecticut woman, has exactly the same disease and has no intention of asking for assisted suicide. Take a look at her video. It makes a lot more sense than Brittany’s.
Today, March 21, is World Down Syndrome Day. Down Syndrome, also called Trisomy-21, occurs when people have a third copy of their 21st chromosome – hence the choice of March 21. In 2011 the United Nations passed a resolution supporting the celebration and declaring grandiloquently that:
People with Down syndrome, on an equal basis with other people, must be able to enjoy full and equal rights, both as children and adults with ‘opportunities’ and ‘choices’.
This is the theme of a series of very touching and entertaining YouTube interviews with Down Syndrome people around the world which were released this week. The organisers of the Day, a British charity called Down Syndrome International, say that people with Down Syndrome are discriminated against and are often denied the right to participate in civic life.
What’s odd about this complaint is that the biggest discrimination is not mentioned at all – the right to participate in life, period. Statistics vary, but an estimated 90% of women who know that they are pregnant with a Down Syndrome Child choose to abort it. Increasingly accurate prenatal testing services will ensure that fewer and fewer Down Syndrome Children enter the world, with the connivance of governments and doctors. In practice, the “choice” which Down Syndrome advocates are supporting is, sadly, the choice that adults make when they disabled children.
The generous and self-sacrificing work of Down Syndrome International must be acknowledged. But a bit of realism is in order, too. Why is it so reluctant to mention that Down Syndrome children are being denied their right to life?
Does Ebola have a silver lining? According to the latest figures from the World Health Organization, 9,976 people have died of the disease since last March: 4,162 in Liberia; 3629 in Sierra Leone; 2170 in Guinea; 8 in Nigeria; 6 in Mali; and 1 in the United States.
It may seem cynical, but that single death in the US may be good news. For years, researchers have been studying Ebola, but it was only when some Americans became infected that the bells went off. The developed world realized that this ferocious killer could take root here, instead of over there somewhere. Interest rose exponentially.
Writing in PLoS Neglected Tropical Diseases, a researcher from the University of Kansas, A. Townsend Peterson, points out that scientific and pharmaceutical interest in West Nile virus only took off after it appeared in the US in 1999. Something similar is happening with Ebola.
“How many other neglected diseases must await this process of spread to affluent regions and infection of affluent people, making the transition from neglected tropical disease to emerging infection, before they also will see investment and innovation?” he asks.
Globalization has some unexpectedly positive spin-offs.