Which is futile, a patient’s care or his life?

When disaster strikes, a Texas hospital may not be the best place for a seriously ill patient. Under the Texas Advance Directives Act, passed by the legislature in 1999 and signed by then-Governor George W. Bush, doctors can either continue with or withhold life-sustaining treatment if treatment seems futile -- against the wishes of the patient's family, or even of the patient himself. Once the approval of an ethics committee is secured, the patient's family has 10 days to find another hospital or nursing home, if they do not agree. To help them in their search, they are given a list of lawyers and organisations.

Bioethics writer Wesley J. Smith calls Texas "ground zero for futile-care theory". He says that in some cases, at least, patients are being denied care not because further treatment is futile, but because his "life that is deemed futile and, hence, not worthy of being preserved".… click here to read whole article and make comments

New manual drafted by psychiatrists with ties to drug industry

More than half of 28 new contributors to the next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) have ties to the drug industry, according to the website Integrity in Science, a project of the Center for Science in the Public Interest. The DSM is used by mental health professionals to classify mental illnesses.

The conflicts of interests, which ranged from small to extensive, have been posted online by the Association. One member has worked as a consultant for 13 drug companies, over the past last five years, including Pfizer, Eli Lilly, Wyeth, Merck, Astra Zeneca, and Bristol-Myers Squibb. However, the Association's president, Carolyn B. Robinowitz, claimed that "we have made every effort to ensure that DSM-V will be based on the best and latest scientific research, and to eliminate conflicts of interest in its development." The consultants have agreed not to allow their… click here to read whole article and make comments

Finances put ethical pressures on US doctors

Rising financial pressures upon family doctors is the theme of the current issue of the journal Medical Economics. One doctor told the magazine that patients often report that they called numerous offices—one patient claimed to have made 17 calls—before finding a physician who was willing to see them. Part of the problem is the "pay for performance" standard under which many doctors now work in the US. This is meant to encourage high-quality medical care by rewarding doctors who meet certain benchmarks. However, it also tends to penalise doctors who are conscientious enough to care for the sickest and most vulnerable patients and rewards those who select patients likely to yield good results.

Cecil Wilson, of the American Medical Association, comments that, "In an ideal world, physicians wouldn't have to worry about financial considerations." But, he says, "If you can't keep your doors open, you can't provide care for anyone. These… click here to read whole article and make comments

Is human dignity a stupid idea?

Steven PinkerIn the minds of most people, human dignity must surely be a cornerstone of bioethics. But as BioEdge has often pointed out, most bioethicists feel differently about it. In fact, low-intensity academic warfare is sputtering along over a 2003 proposal by bioethicist Ruth Macklin that "human dignity" (scare quotes de rigeur) should be junked. It is either too vague to be meaningful or it simply restates other notions, such as respect for autonomy or capacity for rational thought.

The controversy provoked the President’s Council for Bioethics to respond with a fat book of essays which, for the most part, defend the disputed notion. And this in turn has provoked Steven Pinker, a cognitive psychologist at Harvard, to rebut it in the most influential opinion journal in the US, The New Republic, under the inflammatory headline, "The Stupidity of Dignity". Since Pinker is one of America’s top public intellectuals, his argument is… click here to read whole article and make comments

War on terror in another bioethical fix

The war on terror has thrown up another bioethical conundrum: forcible drugging of foreigners deported from the United States. The Washington Post has learned that hundreds of deportees were injected with dangerous psychotropic drugs to keep them docile until they are delivered to their home country between 2003 and 2007. "Involuntary chemical restraint of detainees, unless there is a medical justification, is a violation of some international human rights codes," says the Post. Federal officials have described the practice as "an act of last resort", but the newspaper alleges that more than 250 people were drugged by the Department of Homeland Security’s new Immigration and Customs Enforcement agency.

Many of the deportees had resisted attempts to deport them in the past, but they did not necessarily do so when they were medicated. In the year to October 2007, 53 people were sedated without a psychiatric reason. Fifty of these were given… click here to read whole article and make comments

Having fun behind closed doors

News that American scientists had created a genetically modified human embryo leaked out over the weekend. Scientists at Cornell University in New York created one from a left-over IVF embryo last year to study how early cells and diseases develop. They presented their findings long ago to a meeting of the American Society of Reproductive Medicine. However the media only caught wind of it when it was mentioned in a report from the UK’s fertility regulator, the Human Fertilisation and Embryology Authority.

The HFEA may have drawn attention to the Cornell experiment to reassure the public over the possibility that British scientists could soon be conducting similar experiments. Provisions in the UK’s proposed new fertility legislation will allow GM embryos for research.

Dr David King, of Human Genetics Alert, an opponent of the legislation commented: "This is the first step on the road that will lead to the nightmare… click here to read whole article and make comments

Hybrid embryos: nice, but not necessary, says expert

Once again, bioethics is on centre stage in the British Parliament as the House of Commons debates a revision of its fertility legislation. This contains a large number of highly controversial proposals. The three best-known would allow the human-animal hybrids for research and the use of saviour siblings in IVF treatment and would abolish the need for a father in eligibility for IVF treatment. On these three government MPs will be allowed a conscience vote. However, there are other troubling proposals, such as the creation of genetically modified human embryos. The transport secretary, Ruth Kelly, has given Prime Minister Gordon Brown notice that she will not support the bill. It is highly unusual for a minister to rebel against her boss.

Labour rebels have been heartened by remarks by Lord Robert Winston, one of the world’s leading figures in IVF, about the bill. He says that he is unhappy about the… click here to read whole article and make comments

American ‘reverend’ enjoys his job of assisting suicide

A disturbing profile in the Guardian of the one leading lights of the right-to-die movement, the Rev. George Exoo, shows that there is a hierarchy of repute even amongst fans of assisted suicide. Exoo is a "a gay, liberal, libertarian Unitarian preacher, cultured, funny, charming", says Jon Ronson, who has just made a documentary about him for British television. He is also an embarrassment for his colleagues.

Exoo surfaced in the media when he helped a woman in Dublin to die. The Irish police unsuccessfully sought his extradition to stand trial for assisting a suicide. Ronson found that when mainstream right-to-die groups are pestered by clients who are not terminally ill, they eventually refer them to Exoo. He claims to have helped 102 people to die. Most of them were not terminally ill, just depressed or suffering from psychosomatic diseases.

The leading figure in Dutch euthanasia, Dr Pieter Admiraal,… click here to read whole article and make comments

Claims by Irish bioethics council attacked

The Irish Council for Bioethics recently recommended by a unanimous vote that frozen IVF embryos could be destroyed for research to generate human embryonic stem cell lines. Now a group of Irish academics and scientists have written an open letter criticising its proposals in order to dispel the impression that they represent the consensus of the academic and biomedical communities. They say that human beings have a unique moral status, regardless of their stage of development

"The embryos are human individuals. The disturbing suggestion... that the value of an embryo might be contingent on the attitude of parents is not consistent with any valid concept of individual human rights. Neither the fact that many embryos die, nor that twinning can occur, changes the fact that destroying IVF embryos is destroying the lives of human individuals," says the letter. It also claims that there is no evidence to suggest that embryonic stem cell… click here to read whole article and make comments

Ava Gardner’s message for would-be suicides

One of the most depressing films you could possibly see is On the Beach, a 1959 Hollywood melodrama with Gregory Peck and Ava Gardner about Melbourne after World War III (which happened in 1964). Fallout from the Northern Hemisphere, where everyone has dropped off the perch, is drifting slowly over Australia, blanketing the continent with death. The enlightened government of the day distributes free suicide pills and injections so that no one need suffer the agony of terminal radiation sickness. This policy was far ahead of its time. Dr Philip Nitschke, an Australian who is one of the world’s leading euthanasia activists, has been trying to legalise his own "peaceful pill" for years, still without success.

Anyhow, to get to the point, Ava Gardner did not enjoy Melbourne. "The perfect place to make a film about the end of the world," she is reputed to have said, a remark often repeated gleefully… click here to read whole article and make comments

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