Happy Christmas!


Happy Christmas! The staff of BioEdge will be taking a break over the holiday. Our next newsletter will be on January 8.

Thanks for all your support and suggestions during the year. We hope that BioEdge will continue to grow in 2016. 

Cheers,

Michael Cook  
Editor 

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What’s life worth, anyway?


Now that Australian euthanasia activist Philip Nitschke has burned his medical registration rather than give up promoting the right to die, he is tackling his Big Idea: rational suicide.

He is planning to hold a seminar in Melbourne next September to show that people do not have to be depressed or terminally ill to want to die. “The reality is, a portion of our population will suicide and I don’t think we should make it so hard,” Nitschke told The Guardian. He believes that bereaved spouses, long-term prisoners, and all old people should have access to lethal medications so that they can kill themselves.

Australia’s National Mental Health Commissioner, Professor Ian Hickie was appalled by Nitschke’s remarks and spoke out with unusual frankness:

“Nitschke has no understanding of mental health and related issues, and absolutely no empathy. He has demonstrated a lack of humanity and a lack of concern for those who find themselves in these situations and their families, and a complete lack of compassion for those who are socially isolated and trying to connect with their world. I find it a totally unacceptable and appalling idea that age is a proxy for the end of your useful life. To reinforce that is an abhorrent idea.”

However, Nitschke has raised – or rather revived, for the Greeks and Romans discussed the same topic – a good question. If life is really a good, can it ever be rational to take it? If it is not unconditionally good, why can’t we take it? What gives life any value? I can’t say that I have ever admired Nitschke’s ideas or his work, but without people like him, would we be asking these big questions? 

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Debating the word “naturalness”


I’m not surprised that a new report from the Nuffield Council on Bioethics, an influential independent British bioethics think tank, has received no publicity. “Ideas about naturalness in public and political debates about science, technology and medicine” is not a title which sets the pulse racing. Perhaps they should have christened it “Unnatural Acts”. That would have guaranteed it blanket coverage in the London tabloids.

But this study of why people call some things “natural” or “unnatural” could be one of the most important position papers of the decade. It is fundamentally an attempt to undermine what US bioethicist Leon Kass called “the wisdom of repugnance”. Most objections to issues like cloning or mitochondrial transfer or surrogacy are based on that hard-to-define queasy feeling in Bob and Betty’s stomachs: they just don’t pass the smell test.

And this is important.

As the Nuffield Council points out: “People’s ideas about naturalness may influence the degree to which advances in science, technology and medicine are embraced or opposed by the UK public.” So, as I read it, the report sets out to deconstruct the word, to make it meaningless, and so to bury it as a term of intellectual discourse. If people can be taught to mistrust their own intuitions, securing regulatory approval for the most far-fetched projects will be a snap.

No matter where you stand on bioethical issues, this is required reading. It could frame debates for years to come. 

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Taking moral bioenhancement seriously


Oxford’s utilitarian bioethicist Julian Savulescu, with others, has proposed what they call moral bioenhancement – achieving moral outcomes with the help of drugs, genetic engineering and other technologies. As he wrote in 2012

“Our moral shortcomings are preventing our political institutions from acting effectively. Enhancing our moral motivation would enable us to act better for distant people, future generations, and non-human animals.”

While this idea has not been greeted with great enthusiasm by most governments, there is one which may be taking it seriously – the Islamic State. Obviously, though, these gentlemen have a somewhat different view of what constitutes “acting better”.

According to reports in the French media, the terrorists who killed 130 people in Paris on November 13 were high on Captagon, a black-market amphetamine. Witnesses said that the killers were almost zombie-like. "I saw a man shoot," one witness told French TV. "I saw a man who was peaceful, composed, with a face that was almost serene, contemplative, advance towards the bar. He sprayed the terrace [with bullets] as anyone else would spray their lawn with a garden hose."

The main market for captagon is the Middle East, where organised crime, ISIS and other players manage a market worth hundreds of millions of dollars. A Saudi prince was arrested in Beirut this month after he was caught smuggling 40 suitcases of Captagon and cocaine back to Riyadh.

Masood Karimipour, of the United Nations' office for drugs and crime, says that the drug gives fighters “chemical courage”, making them feel invincible. “Certainly it is not consistent with any interpretation of Islam,” he says. However, the Islamic State seem “to be reading a different book from other Muslims in the world .. so I don’t think they’re going to draw the line at the use or distribution of drugs.”

Moral bioenhancement to achieve a global caliphate: it’s an ambitious goal, but if anyone can do, it’s these guys. It’s probably not the vision of a better world that Professor Savulescu had in mind.

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Pink Viagra sales tank


A few weeks ago "pink Viagra", more properly known as Addyi, got a green light from the FDA. The drug purports to treat “hypoactive sexual desire disorder” in women. The day after the approval, Sprout Pharmaceuticals, a small company with the patent, was sold for US$1 billion in cash to Valeant Pharmaceuticals International. Valeant obviously thought it had a winner. 

It turns out that it has backed the wrong horse. In the first few weeks, only 227 prescriptions have been filled. “I thought there was going to be this huge onslaught,” the director of the Women’s Health Clinic at the Mayo Clinic told Bloomberg Business

Addyi has a lot of drawbacks; it has potentially deadly side effects, women can't drink alcohol while using it; it costs US$780 a month; and it must be taken daily. But the biggest problem might be that Valeant believed Sprout's canny public relations campaign which promoted sex as "a basic human right" and one of the FDA's "priority areas of unmet medical need". Perhaps women are more interested in commitment than a Viagra they can call their own. 

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Paris attacked by terrorists


As I write, at least 127 people have died after coordinated attacks on several venues in Paris. President Hollande has declared a state of emergency, imposed border controls and called out hundreds of troops. It appears to be the handiwork of ISIS.

President Hollande has declared defiantly that his nation would be “merciless” in responding to “the barbarians of ISIS”.

The aftermath will test the mettle of France – as it would any nation. Hostility towards the large Muslim population will grow, some French Muslims may become more radicalised, refugees will be unwelcome, and the government could be provoked into putting boots on the ground in the heartland of ISIS, in Syria.

Terrorism depersonalises people, turning innocent men and women into faceless, infrahuman enemies. Islamic terrorism does this in the name of Allah, using God as an ideological pretext for bloodlust and savagery.  

The temptation for France – and other Western nations – will be to depersonalise its enemies and to smite them with the same depersonalised, ideological rage. That, of course, is exactly what ISIS want them to do. But the nation must respond forcefully to this atrocity without losing its liberté, égalité, y fraternité. It will be difficult. 

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An excursion into time machine ethics


We missed this, sorry, but October 21 was #BackToTheFutureDay, the day Marty McFly travelled to in Back to the Future II. The internet was abuzz with the kind of stuff the internet buzzes about better than anyone else and even POTUS tweeted “Ever think about the fact that we live in the future we dreamed of then? That's heavy, man.”

But with all the palaver about time travel, the only person who studied the bioethical conundrums of time travel was Dr Janet D. Stemwedel, a columnist for Forbes who specialises in time machine ethics. She took seriously a question posed on Twitter by the New York Times Magazine: “If you could go back and kill Hitler as a baby, would you do it?” (Only 42% said yes!)

First of all, she notes that this is question that only a utilitarian will take seriously. Killing an innocent child now is deemed right because it will prevent great evils later. But she counters:  “Given all the moving parts in a world of many people who raised, nurtured, enabled, and assisted Adolf Hitler, why is baby Hitler the moving part to eliminate? If you gamble on killing this baby, who has done nothing wrong and for whom there is no guarantee yet of eventually committing the horrors you hope to prevent, aren’t you using the kind of logic that could justify mass exterminations of other people?"

Furthermore, given the large number of people who shared Hitler’s depraved ideas, someone else would probably step into the gap left by his non-existence. She concludes: “In the process of trying to avoid a great harm that, at the stage of Hitler’s infancy, is in no way inevitable, you’ve made yourself a baby killer, which is surely a harm to baby Hitler, to his survivors, and (if you have any kind of conscience) to you.”

Sound advice, readers, if you ever get your hands on a reliable time machine. 

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Are there limits to informed consent?


If you don’t have a strong stomach, you are allowed to skip what follows and proceed directly to the article links below.

Earlier this month the New York Post, a great source of bioethical conundrums, reported the strange case of 30-year-old North Carolina woman Jewel Shuping.

Ms Shuping is convinced that she was always meant to be blind. But by some terrible accident at birth, she had normal eyesight. “I really feel this is the way I was supposed to be born, that I should have been blind from birth,” Shuping explained. Doctors say that she has Body Integrity Identity Disorder.

Finally she found an obliging psychologist in 2006. After giving her some counselling, he gave her some eye-numbing drops and then washed her pupils with drain cleaner. “It hurt, let me tell you,” she says in a YouTube video. “My eyes were screaming and I had some drain cleaner going down my cheek burning my skin,” she said. “But all I could think was, ‘I am going blind, it is going to be okay.”

So here is the bioethical conundrum: was the psychologist right to destroy his patient’s eyesight if she freely requested it, was happy with the treatment, and was living in psychological torment because she could see?

And if he was wrong and unethical, why is participating in gender reassignment surgery or euthanasia right and ethical? 

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Supervision of euthanasia breaking down in Belgium


The theme of control is at the heart of debates about assisted suicide and euthanasia. For the patients, it’s control of their own lives. For legislatures, it’s control of doctors who end lives. Wherever legalisation has failed, it is due to fears about whether people who have been authorised to kill without police supervision will be adequately monitored. Wherever it has succeeded, those fears have been allayed. 

At the moment euthanasia in Belgium, where it is legal, is not being adequately monitored even by the loose local standards. Its parliament has delegated oversight to a commission of 16 professionals who are supposed to review the file for each case of euthanasia. That system is breaking down. Members are resigning, perhaps because of the huge workload, and the vacancies have been mounting. Legally speaking, the commission has lost its mandate. 

But even though control has manifestly broken down, doctors continue to euthanise their patients at the rate of at least five a day. Is this the system that Belgians voted for in 2002?

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More gendercide


We overlooked an amazing story three years ago -- a study of abortion rates in Nepal. Lately Nepal has been in the news as a hotspot for surrgacy. But it is also a natural experiment in sex-selection.

Abortion was legalised in Nepal in 2002. Almost immediately the sex-ratio in the country began to change. Around 2002 the ratio of girls born to boys born was 942 to 1000 for second-born children. By this ratio had fallen to 742. Amongst the richest urban women, just 325 girls were born for every 1000 boys.

In other words, the legalisation of abortion has been a death warrant for Nepalese girls. Abortion provider Marie Stopes International calls Nepal a "unusual success story" because fertilty there has fallen from 4.1 to 2.6 in just 10 years, one of the most dramatic declines in history. But this was achieved by allowing gendercide to flourish. 

PS -- apologies to our readers. We mixed up mailing lists last week and some of you may have received a daily newsletter meant for subscribers to MercatorNet. We have fixed the issue and I hope that it will not happen again. 

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