April
17
 

Euthanasia fails again in Colombian congress

The Colombian legislature has once again failed to pass a law legalising euthanasia. Earlier this week a bill proposed by representative Juan Fernando Reyes Kuri needed to reach 85 votes in favour, but fell two votes short.

Although Colombia is often described as a country where euthanasia is legal, the actual situation is complicated. In 1997 the country’s Constitutional Court ruled that that "the State cannot oppose the decision of an individual who does not wish to continue living and who requests help to die when suffering from a terminal illness that causes unbearable pain, incompatible with his idea of dignity". It directed the legislature to pass a law regulating the right to die.

However, more than 20 years have passed and one bill after another has failed.

Supporters of the right to die are frustrated. Reyes Kuri says that he understands that some of his colleagues in this majority Catholic country are opposed for religious or ethical reasons of their own, "but we cannot allow them to continue imposing their beliefs on everyone".

Another politician supporting a right-to-die law, Senator Armando Benedetti, argues that euthanasia already exists in Colombia; it only needs to be regulated: "Why should those who do not believe in God be limited in their desire to stop living in the face of so much suffering?”

From their point of view, legislative deadlock creates uncertainty for doctors. Few are willing to offer euthanasia because, technically, it is still illegal. "There is still legal insecurity for people who decide to access this procedure and for the doctors who carry it out," says Reyes Kuri.

Opponents give the 1997 ruling a different twist. Angela Sanchez, a representative in the legislature, says that the Court declared that the right to a dignified life implies dying with dignity -- which is why Colombia needs more support for palliative care. Representative Edwin Arias says that the Court only sought to create an exception to the crime of mercy killing and not the legalisation of euthanasia.

Michael Cook is editor of BioEdge



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April
17
 

Biden undoing pro-life ruling by his predecessor

The Biden Administration is quickly dismantling pro-life initiatives of the Trump Administration. This week Health and Human Services Secretary Xavier Becerra green-lighted the use of human foetal tissue for medical research.

Government scientists can now resume research that uses tissue from elective abortions. No special ethical approval will be needed for federally-funded research at universities.

The use of foetal tissue is extremely controversial.

The American Society of Reproductive Medicine applauded the change. “The United States government has developed a robust system of oversight. .... Ideologically driven politicians must not be allowed to interfere with this system on a whim. Whether it’s foetal tissue, embryonic stem cells or CRISPR, we have an unfortunate tendency to politicize scientific advances if they in any way touch on reproduction,” it declared.

However, the Charlotte Lozier Institute, a pro-life think-tank, responded that “Secretary Becerra will open the floodgates to federal taxpayer funding and trafficking of baby body parts. His actions are reckless, dangerous and harmful to innocent unborn life.”

In its report, NPR set this decision in context.

“This action is part of something larger - the anti-abortion rights movement is finding itself on the losing side of a lot of policy battles at the federal level. Just this week, the Biden administration announced steps to reverse changes to the Title X family planning program that had effectively cut significant funding to groups like Planned Parenthood. That news came after the FDA announced it will temporarily loosen restrictions on abortion pills, during the pandemic.

“So, expect many more political fights over issues related to abortion rights in the years to come; at the same time that Biden is taking these actions at the federal level, conservatives still hold a lot of power - in state legislatures and the U.S. Supreme Court.”

Michael Cook is editor of BioEdge



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April
17
 

Human-monkey chimaeras grown for up to 20 days

Researchers in China and the United States have injected human stem cells into primate embryos and grown chimeric embryos for up to 20 days. Despite ethical concerns, the scientists says that the procedure has potential for providing insights into developmental biology and evolution, into disease and transplants, and into drug development.

"As we are unable to conduct certain types of experiments in humans, it is essential that we have better models to more accurately study and understand human biology and disease," says senior author Juan Carlos Izpisua Belmonte, of the Salk Institute, in California.

In the current study, six days after the monkey embryos had been created, each was injected with 25 human cells. The cells were from an induced pluripotent cell line which has the potential to contribute to both embryonic and extra-embryonic tissues.

After one day, human cells were detected in 132 embryos. After 10 days, 103 of the chimeric embryos were still developing. Survival soon began declining, and by day 19, only three chimeras were still alive. Importantly, though, the percentage of human cells in the embryos remained high throughout the time they continued to grow.

Clearly there are ethical issues involved in creating hybrid embryos. What if the hybrid embryos grew into hybrid human-monkeys? As The Economist noted: “Experiments involving human cells can break deep-seated taboos about human dignity, human exceptionalism and—among the religious—stir up worries about interfering with God’s creation.”

“The complicated thing is that we need better models of human disease, but the better those models are, the closer they bring us to the ethical issues we were trying to avoid by not doing experiments in humans,” Nita Farahany, of Duke University School of Law, told STAT. “Remarkable steps forward require urgent public engagement.”

The International Society for Stem Cell Research will soon publish revised guidelines for stem-cell research, including nonhuman-primate and human chimaeras.

Human-monkey chimeras do raise worries, addressed in a report released last week by the National Academies of Sciences, Engineering, and Medicine: “In the specific case of neural transplantation and chimera research, the slippery slope concern is that if small increments in mental capacities develop in transplants or chimeras, there will be no logical point at which the research should be stopped, or it may not be possible later to institute policies to block research that could result in nonhuman animals with unacceptable human capabilities.”

However, the chimeras in this study do not have a nervous system. They “can’t experience pain and aren’t conscious,” bioethicist Katrien Devolder of the University of Oxford, told Science magazine. “If the human-monkey chimeras were allowed to develop further,” she says, “that would be a very different story.”

Michael Cook is editor of BioEdge



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April
17
 

Resisting legalised euthanasia in New South Wales is looking problematic

One state which appears to be high and dry as a movement for “dignity in dying” floods Australia is New South Wales. The Premier, Gladys Berejiklian, bruised by a bitter debate over the decriminalisation of abortion in 2019, wants to avoid another potentially divisive issue. It’s probably not moral qualms which explain her reluctance, because she is a social progressive. Rather, her coalition only has a wafer-thin margin and survives with the support of three independents.

Problem is, two of the independents are strong supporters of euthanasia, Alex Greenwich and Greg Piper. Greenwich plans to introduce a voluntary assisted dying bill in September. The state political editor of the Sydney Morning Herald, Alexandra Smith, says that the timing could not be better. “The NSW upper house debated a voluntary assisted dying bill in 2017,” she writes. “It was defeated 20 votes to 19. Greenwich is confident that second time around it will succeed.” He also plans to make it a key issue in an upcoming byelection to replace a Liberal MP who was ousted after a sordid scandal.

Smith writes: “Greenwich and Piper respect that an issue such as assisted dying is a matter of conscience. However, just as Berejiklian anticipated two years ago, the independents have emerged as kingmakers, with a policy on which they are resolute. When the government is hanging by a thread, the Coalition cannot tear itself apart on an issue voters support and much of the country has already adopted. Coalition MPs opposed to assisted dying may have to accept the world is moving on. Yes, this is a conscience issue, but it always has been – for people on both sides of the debate.”

Michael Cook is editor of BioEdge



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April
17
 

US needs a vaccine mandate, says Ezechiel Emanuel

Vaccine mandates are extremely controversial but bioethicist Ezekiel Emanuel, a veteran of the Obama Administration who is an advisor to Joe Biden, is definitely an enthusiastic and unequivocal  supporter. In an op-ed in the New York Times, he says that vaccinations are essential to curb Covid-19 infections. “How can we increase vaccinations?”, he asks. “Mandates.”

Vaccines should be required for health care workers and for all students who plan to attend in-person classes this fall — including younger children once the vaccine is authorized for them by the Food and Drug Administration.

Employers should also be prepared to make vaccines mandatory for prison guards, E.M.T.s, police officers, firefighters and teachers if overall vaccinations do not reach the level required for herd immunity

He says that mandates are the quickest way to reach herd immunity.

None of us likes being told what to do. But getting vaccinated is not just about our personal health, but the health of our communities and country. Health care workers are professionals whose primary obligation is to their patients’ health and well-being. Except in extreme cases, their personal preferences are secondary.

When they decline to be vaccinated, they put their own preferences above the health and safety of their patients. No patient should worry whether her doctor, nurse or blood draw technician is vaccinated. Health care facilities should require all their workers to be vaccinated for the coronavirus, just as many do for the flu.

Writing in the National Review, bioethics writer Wesley J. Smith said that the proposal was absurd, even if it seemed to be the received wisdom of the “elites”.

Has Emanuel been asleep the last few months? Doesn’t he know that the erratic performance of public-health officials has cost them the confidence of a large percentage of the population? Does he want greater discord than we are already experiencing? I can think of nothing likely to breed greater distrust in the vaccines … than coercing people to take them.

Michael Cook is editor of BioEdge



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April
17
 

New York parent and child want to wed

Nothing beats the New York Post for coverage of the more exciting corners of the Reproductive Revolution. This week it had an exclusive: a lawsuit in Manhattan Federal Court to permit incest. It appears that a parent and his or her child want legal ratification of their romantic attachment, even though they recognise that “a large segment of society views [this] as morally, socially and biologically repugnant”.

According to court papers filed in the matter of Doe v. McSweeney, No. 1:21-cv-2806 in the US District Court for the Southern District of New York, the parent argues that “Through the enduring bond of marriage, two persons, whatever relationship they might otherwise have with one another, can find a greater level of expression, intimacy and spirituality.”

Very few details are given in the publicly-available papers – not even their gender, ages, residence or the nature of their relationship.

“The proposed spouses are adults,” the filing says. “The proposed spouses are biological parent and child. The proposed spouses are unable to procreate together.”

The parent wants to tie the knot in New York City, and is asking the court to declare the laws unconstitutional and unenforceable in their case, which the lawsuit dubs “PAACNP” for “Parent and Adult Child Non-Procreationable” couples.

“Parent-and-adult-child couples for whom procreation is either virtually or literally impossible can aspire to the transcendent purposes of marriage and seek fulfillment in its highest meaning,” the parent argues, claiming it would “diminish their humanity” if they were unable to tie the knot with their own child.

Manhattan family law specialist Eric Wrubel told the Post, “It’s never gonna fly. The closest you can come is Woody Allen, and that wasn’t his daughter, it was an adopted child whom he never adopted and it still turns people’s stomachs.”

Michael Cook is editor of BioEdge



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April
17
 

Prepare for ectogenesis, says bioethicist

Ectogenesis – gestation in an artificial womb – is coming closer, according to a bioethicist writing in BioNews. Professor John D. Loike, of New York Medical College, says that three recent papers in Nature suggest that it may be possible. In two of them, researchers managed to generate human blastocyst-like structures, called blastoids. This heralds the creation of embryos without sperm or eggs.

In the third paper, an Israeli lab developed an artificial womb in which mouse embryos grew into a foetus which contained fully formed organs.

We need to prepare, says Dr Loike, for “a revolution in human gestation”.

But there will be ethical, psychological and financial issues.

the cultural ethical challenges arising from this technology can be daunting. How will people feel if women don't need to become pregnant in order to produce children? Many women feel biologically and psychologically connected to the fetus they are gestating. Moreover, the absence of human pregnancy may impact epigenetic processes and change the mother-child bonding. One could argue, however, that pregnancy may not be a critical process for human development and bonding, since normal human development occurs post-gestationally, in many families that have adopted children. In addition, the burden of medical responsibility for maintaining these embryos in an artificial placenta would fall on our overloaded hospital system. Should health insurance fund this technology?

As is customary with such taboo-smashing developments, he suggests a report is needed to decide whether there should be limits on ectogenesis and to propose policies.

Michael Cook is editor of BioEdge



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April
17
 

Is China forcibly sterilizing Uyghur women?

Reports of bioethical atrocities against Uyghurs in China’s Xinjiang territory are hard to verify, but consistent and persistent. The latest comes from a recent interview in the Japanese newspaper Sankei Shimbun with a female gynaecologist who is an ethnic Uyghur.

The woman, identified only as Gülgine, spoke to the newspaper in Istanbul. She has not been in Xinjiang since 2011. She alleges that at some state-run detention centres for Uyghurs as many as 80 women a day were forcibly sterilised.

“A lot of women were put on the back of a truck and sent to the hospital,” Gülgine said. “The [sterilization] procedure took about five minutes each, but the women were crying because they did not know what was happening to them.”

Gülgine, who is now 47, said she collaborated in these sterilizations at a hospital in Xinjiang’s capital, Urumqi. “I understood the meaning of the surgery, but I later learned that it was a policy for the Uyghur,” she said, “and I too was sterilized.”

Gülgine estimated that forced sterilization began around 1980 when China was implementing its one-child policy. This was decades before the revelation that the Chinese Communist Party was building concentration camps for Uyghur and other Muslim ethnic minority people.

About 50,000 Uyghur have fled Xinjiang for Turkey in recent years. (They are a Turkic people and are welcomed there.) Gülgine said some Uyghur women have visited her in Istanbul, “complaining that they cannot have children. She has examined more than 150 so far, but many don’t know they have been sterilized, and some women start crying in anger when she explains what has happened to them,” according to the Shankei Shimbun.

In the meantime, China is conducting a charm offensive about its treatment of the Uyghurs. As the government video below shows, everything is hunky-dory in the wonderful land of Xinjiang.

Michael Cook is editor of BioEdge



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April
11
 

New Mexico legalises assisted suicide

New Mexico has become the 11th American jurisdiction with assisted suicide.

On Thursday, Governor Michelle Lujan Grisham signed the Elizabeth Whitefield End-of-Life Options Act. “Dignity in dying — making the clear-eyed choice to prevent suffering at the end of a terminal illness — is a self-evidently humane policy,” said Lujan Grisham.

The new law takes effect on June 18. It will permit terminally ill patients with six months or less to live to request lethal medication. The diagnosis must be agreed upon by two medical experts, and the patient must pass a mental competency screening. After a 48-hour waiting period, they could take their own lives. They must take the lethal prescription themselves.

The US jurisdictions where assisted suicide is now legal are: California, Colorado, District of Columbia, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont and Washington. In Montana, a state supreme court decision permits doctors to assist suicides with impunity, but it has not been legalised by statute.

According to AP, New Mexico is the second state after New Jersey with a third or more of its population identifying as Catholic which has chosen to legalise assisted suicide.

Compassion & Choices, one of the leading lobby groups for assisted suicide, was exultant. On its website, it described how hard it had lobbied for change since 2016. “We organized hearings, conducted paid, earned and social media; and inspired strong and robust grassroots efforts. Volunteer advocates shared their stories and support through emails, phone calls, lobby days, social media, videos, and a collection of stories in our storybook.”

The Covid-19 pandemic threatened to derail efforts to pass a bill but Compassion & Choices was determined. “We quickly adapted our approach to account for the new reality and took our campaign virtual, using the power of our storytellers (see New Mexico Storybook) to put a human face on the issue. We flooded news outlets with story after story that demonstrated the importance of passing medical aid in dying legislation this session.”

“Together,” it concluded, “we made history.”

Michael Cook is editor of BioEdge



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April
11
 

Vaccine passports spark controversy

Next stop in the coronavirus pandemic: vaccine passports. Rutgers University, the largest public college in New Jersey, recently announced it would require all its students to be vaccinated as a condition of enrolment beginning in September. The New York Mets are allowing their fans to attend games as long as they provide proof of a vaccine or a negative test for Covid-19.

Some businesses believe that their customers will return if they believe that they will be in a safe environment.

But passport boosters haven’t got a lot of company. The notion of requiring a certificate of vaccination dismays many doctors, bioethicists, business people -- and Republican governors.

Even the Federal government is distancing itself from the idea. “We expect …. a vaccine passport, or whatever you want to call it, will be driven by the private sector,” Jen Psaki, the White House press secretary, said recently. “There will be no centralized, universal federal vaccinations database and no federal mandate requiring everyone to obtain a single vaccination credential.”

Opinions vary so widely that BioEdge can only give an idea of the issues in the debate.

New York Times. Respected journalists Sheryl Gay Stolberg and Adam Liptak treat the issue as another chapter in America’s culture wars. They write that “conservative politicians have turned vaccine passports into a cultural flash point”. However, they point out, there are long-standing legal precedents for requiring them. “A community has the right to protect itself against an epidemic of disease which threatens the safety of its members,” US Supreme Court Justice John Marshall Harlan wrote in 1905.

Stat News. Journalist Lev Facher interviewed Georges Benjamin, the executive director of the American Public Health Association. He says that a “passport” could politicize the rollout of vaccines, worsen health inequities, and even lull vaccinated people into a false sense of security.

JAMA. Lawrence O. Gostin, Glenn Cohen and Jana Shaw argue that “digital health passes” are a can of worms. While they could help the nation make a rapid return to commerce, recreation, and travel, they could be inequitable. What about people who do not have access to the internet? What about people who cannot get access to the vaccine? “Requiring proof of vaccination as a condition of travel would unfairly burden most low- and middle-income countries.”

BMJ. An editorial concludes: “While the merits of vaccine passports may be undeniable, implementation will require ethical justifications and practical solutions that do not discriminate against the poor, the less technically literate, and people from low and middle income countries. Without mitigation strategies and alternative solutions, the hardships experienced by marginalised and vulnerable groups will be intensified through the perpetuation of discrimination.”

The Lancet Microbe. An editorial raises similar questions about equity. But it also points out that there is insufficient scientific proof backing idea of a “passport”. “Preliminary reports from Israel, the UK, and the USA suggest that the Moderna and Pfizer-BioNTech vaccines could reduce SARS-CoV-2 transmission either by lowering the viral load in post-vaccination infections or by preventing asymptomatic infections as well as disease. But until these data have been peer-reviewed and their validity confirmed, uncertainty will remain around the epidemiological utility of relying on vaccine certificates to re-open economies.”

NEJM. A “Perspective” article takes such a balanced view of the situation that it fails to make a strong stand. However, it does offer a good summary of the ethical issues involved:

“First, while vaccine supply remains limited, privileging people who are fortunate enough to have gained early access is morally questionable. Second, even after supply constraints ease, rates of vaccination among racial minorities and low-income populations seem likely to remain disproportionately low; relatedly, if history is a guide, programs that confer social privilege on the basis of “fitness” can lead to invidious discrimination. Third, the extent of protection conferred by vaccination, particularly against new variants, is not yet well understood, nor is the potential for viral transmission by people who have been vaccinated. Fourth, privileging the vaccinated will penalize people with religious or philosophical objections to vaccination. Finally, we lack a consensus approach to accurately certifying vaccination.”

Michael Cook is editor of BioEdge



This article is published by and BioEdge.org under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

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April
11
 

UK research review is sceptical of medical treatment for gender dysphoria

The biggest controversy in medicine at the moment is the appropriate treatment of children with gender dysphoria. Trans advocates claim that puberty blockers are important for their mental health and that they are reversible.

However, a preliminary study by the UK’s National Institute of Health and Care Excellence (NICE) has found that the science supporting this view is of low quality.

In relation to body image and psychosocial impact, says NICE, the results “are of very low certainty”. “Studies that found differences in outcomes could represent changes that are either of questionable clinical value, or the studies themselves are not reliable and changes could be due to confounding, bias or chance.”

Another study asked what is the clinical effectiveness of gender-affirming hormones compared with one or a combination of psychological support, social transitioning to the desired gender or no intervention.

The answer was astonishingly negative, considering the pressure from transgender supporters.

The aim of employing gender-affirming hormones is to induce the development of the physical sex characteristics congruent with the individual’s gender expression while aiming to improve mental health and quality of life outcomes.

However, the NICE study found that certainty of their impact on gender dysphoria, on depression, on anxiety, on quality of life, on suicidality and self-injury was all “very low”.

Why? All of the studies in the review of the literature were flawed. They were all uncontrolled observational studies, which are subject to bias and confounding; they had relatively short follow-up; most of them did not report comorbidities (physical or mental health); most of the studies were poorly reported and used a confusing variety of scoring tools and methods.

The study concluded that “Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria.”

These documents will help inform an independent review into gender identity services for children and young people.

Michael Cook is editor of BioEdge



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April
11
 

Is abortion a global public health emergency?

Around the world, public health measures to cope with Covid-19 -- like social distancing and lockdowns -- have set an extraordinary precedent. It appears that to save thousands, even millions, of lives, people are prepared to accept serious limitations on their traditional freedoms.

The journal Bioethics has published an extraordinarily controversial article which explores whether this precedent could be applicable to abortion.

The direct target of the authors is Judith Jarvis Thompson’s famous argument in support of abortion. Most contemporary philosophers do not regard the foetus as a person; if this is the case, then abortion seems unproblematic. But Jarvis Thompson asked people to imagine that a famous violinist was tethered to a woman for nine months without her consent, depending for his life on her blood supply. Surely she would be justified in cutting herself loose. Similarly, she said, even if a foetus is a human person, a woman is not obliged to bring it to term.

Two British philosophers, Bruce P. Blackshaw and Daniel Rodger, ask their readers to accept Jarvis Thompson’s view for a moment. They argue that the utilitarian public health ethics which have justified severe curtailing of human rights in the pandemic will also justify a prohibition of all abortions.

Their argument works like this. If the foetus is a human person, abortion must be regarded as a global health emergency which is even more serious than Covid-19. There are an estimated 50 million abortions every year -- about the total number of deaths of infants, children and adults from all causes. Deaths from Covid are far lower. They speculate:

… if fetuses were legally recognized as persons by the state, abortion would have to be considered a far more significant public health crisis than the COVID‐19 pandemic in terms of the harm fetuses suffer by being killed. It would justify drastic action to protect this huge and very vulnerable population.

This is quite thought-provoking. If falling fertility rates threatened the viability of a nation (and some already are on track to disappear, like Armenia or South Korea), population decline might be regarded as a public health problem. If so, with the precedent of Covid-19 restrictions, would governments be justified in banning abortion?

Naturally, this line of reasoning is open to many objections: a possible increase in illegal abortions, the failure of prohibitions, an increase in the number of unwanted children, and so on. They respond to each of them in turn.

However, there is one novel recent argument against a pro-life view. Toby Ord believes that the global number of miscarriages could be as high as 200 million every year. Yet opponents of abortion seem unworried by this. This is said to show the inconsistency, even the hypocrisy, of the pro-life view. However, the authors’ riposte is that if miscarriages are a public health crisis, then abortions are as well.

They conclude that “if fetuses are persons, public health considerations require that abortion is prohibited. Abortion can only be tolerated in a society that values public health if fetuses are not regarded as persons.”

Michael Cook is editor of BioEdge



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April
11
 

‘Dignity in dying’ legislation fails in France and Latvia

France: A bill to legalise euthanasia was smothered by delaying tactics in the French Parliament this week.

The bill was a personal initiative of Olivier Falorni, a deputy for the parliamentary splinter group Libertes et Territoires ("Freedom and Territories"). He says that the law would put a stop to a national "hypocrisy" because French residents often travelled to Belgium or Switzerland for assisted suicide. He claims that French doctors are already performing 2,000 to 4,000 euthanasia every year – but secretly.

The bill’s opponents filed about 3,000 amendments ahead of the debate which slowed down proceedings and made a vote in the allotted time impossible.

If it had passed, France would have become the fifth European Union country to permit euthanasia after the Netherlands, Belgium, Luxembourg and Spain. (Switzerland allows assisted suicide, but not euthanasia.)

Neither President Emanuel Macron nor his government have taken sides, although the president said in 2017: "I myself wish to choose the end of my life".

The Minister of Health, Olivier Véran, said he was not convinced that France should have a large-scale debate during the Covid-19 pandemic.

Latvia. On March 25, after a long debate, the Latvian Parliament (Saeima) rejected a public petition which had called for the legalisation of euthanasia. A total of 49 members voted for rejection, 38 voted against, and two abstained.

Opponents emphasised that Latvia needed to get its palliative care system in order first, before considering right-to-die initiatives. Deputy Vitālijs Orlovs, who is a doctor, declared in the debate: “I was taught to fight for patients’ lives to the end. I cannot imagine injecting a person with some substance to help them die – not for any amount of money.”

Supporters stressed a need to do away with end-of-life misery. “People think this will open a can of worms,” said Pēteris Buks, the author of the petition, “but Holland has 17 million inhabitants and 6,000 euthanasia cases. This means that in Latvia these could be about 600 cases. We have ten times fewer people.”

Hat tip to Alex Schadenberg.

Michael Cook is editor of BioEdge



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April
11
 

Brain organoids give rise to novel ethical complications

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Stem cell research has allowed medicine to go places that were once science fiction. Using stem cells, scientists have manufactured heart cells, brain cells and other cell types that they are now transplanting as a form of cell therapy. Eventually, the field anticipates the same will be possible with organs.

A new paper in AJOB Neuroscience by a group led by Tsutomu Sawai, of Kyoto University, reviews the ethical implications of research on brain organoids.

"Organoids" are organ-like structures. By recapitulating normal development, organoids have proven to be invaluable tools for understanding how organs grow and how diseases develop. Organoids have been reported for an assortment of organs, including the liver, kidney and, most controversially, the brain.

The brain is considered the source of our consciousness. Therefore, if brain organoids do mimic the brain, they could develop consciousness, which, involves all sorts of moral implications.

"Consciousness is a very difficult property to define. We do not have very good experimental techniques that confirm consciousness. But even if we cannot prove consciousness, we should set guidelines, because scientific advancements demand it," says Sawai.

With some people imagining a future where our brains are uploaded and kept on the cloud well after our bodies die, organoids bring an opportunity to test consciousness and morality in artificial environments, the article contends.

Ethicists have broken consciousness down into many types. Phenomenal consciousness assumes the awareness of pain, pleasure and distress. Sawai and his colleagues argue that even though restraints on experiments using brain organoids would be needed, phenomenal consciousness would not outright prohibit experiments, since animals commonly used in science, such as rodents and monkeys, also display phenomenal consciousness. Self-consciousness would add to the ethical conflicts, since this status bestows a higher morality.

However, Sawai says that there is a more pressing issue.

"One of the biggest problems is transplants. Should we put brain organoids into animals to observe how the brain behaves?"

While growing whole human brains inside animals is not under any serious consideration, transplanting brain organoids could give crucial insight on how diseases like dementia or schizophrenia form and treatments to cure them.

"This is still too futuristic, but that does not mean we should wait to decide on ethical guidelines. The concern is not so much a biological humanization of the animal, which can happen with any organoid, but a moral humanization, which is exclusive to the brain," said Sawai.

Other concerns, he added, include enhanced abilities -- think Planet of the Apes. Furthermore, if the animal developed humanized traits, then treating it sub-humanely would violate human dignity, a core tenet of ethical practice.

The paper notes that some people do not consider these outcomes unethical. Enhanced abilities without a change in self-consciousness is equivalent to using a higher animal in experiments, like shifting from mouse to monkey. And a change in dignity does not mean a change to human dignity. Instead, the change could result in a new type of dignity.

Regardless, the authors believe that the possibility of unintended connections between the transplanted brain organoid to the animal brain deserves precautionary consideration.

The biggest concern regarding brain organoid transplantation, however, does not involve animals. There is good reason to believe that as research proceeds, the future will bring the possibility of transplanting these structures into patients who suffered from sudden trauma, stroke or other injury to the brain.

There are already a number of clinical trials that involve the transplantation of brain cells as a cell therapy in patients with such injury or neurodegenerative diseases. Sawai said that the ethics behind these therapies could act as a paradigm for brain organoids.

"Cell transplantations change the way brain cells function. If something goes wrong, we can't just take them out and start over. But right now, cell transplantation is usually in just one location. Brain organoids would be expected to interact more deeply with the brain, risking more unexpected changes," he believes.

Michael Cook is editor of BioEdge



This article is published by and BioEdge.org under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

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April
11
 

Knock-on effects of same-sex marriage continue

The legal consequences of same-sex marriage are still working themselves out. Now that sex is not relevant, what constitutes adultery? It is an important issue in some divorce cases.

Last week, in the United States, the New Hampshire Supreme Court unanimously ruled that same-sex extramarital affairs are adulterous.

The case arose in 2019. Robert Blaisdell claimed that because his wife Molly had a sexual relationship with another woman, he was entitled to seek divorce on fault-based grounds. However, a lower court took a narrow view of the law which declared that adultery was “sexual intercourse between persons of the opposite sex”.

But after the 2009 legalisation of same-sex marriage in New Hampshire and the US Supreme Court ruling that such unions were constitutional, the state Supreme Court decided to update the definition.

“It defies logic to suggest that our legislature and the US Supreme Court recognised the rights of same-sex couples to enter into legally valid marriages without also intending that same-sex couples be endowed with all of the responsibilities, protections, and grounds for divorce that are associated with the legal status of marriage,” wrote Justice Patrick Donovan.

Thus, the New Hampshire Supreme Court has redefined adultery as “voluntary sexual intercourse between a married person and someone other than that person’s spouse, regardless of the sex or gender of either person.”

This definition requires some further legal legerdemain in the form of redefining sexual intercourse as “genital contact”.

The implications of developments like this – which are happening in courts across the United States – need to be teased out. For instance adultery used to be defined as “intercourse from which spurious issue may arise.” This suggests that the fundamental issue in marital fidelity used to be protecting the child’s right to know his biological father. But the advent of same-sex marriage leaves children as an optional extra in a romantic union.

Michael Cook is editor of BioEdge



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March
27
 

Mum and dad lite: parenting without sex, romance, co-habitation or marriage

A first date in 'Strangers Making Babies'

Amongst the myriad new family forms springing up as traditional marriage loses popularity is platonic co-parenting. This is not co-parenting after divorce, with all of its acrimony and competition for a child’s affection. Instead this involves two strangers making plans to conceive children (naturally or artificially) and taking joint responsibility for raising them -- but without marriage or living together.

According to Susan Golombok, director of the University of Cambridge’s Centre for Family Research and author of We Are Family, a book examining novel family structures, this is a “new phenomenon picking up speed”.

Of which one straw in the wind is a new reality TV show on Channel 4 in the United Kingdom, “Strangers Making Babies”. In Episode 1, which screened earlier this week, “A group of single, would-be parents look for a platonic partner to have a baby with, without the complication of finding love first”.

The Daily Mail admits that this sounds “bonkers” but it does reflect a growing trend:

For in the past few years, there has been a huge rise in the number of internet sites and forums claiming to match potential co-parents. An estimated 70,000 people in the UK are signed up to such sites, seeking platonic parenting partners.

These sites are unregulated, however, and negotiating them is to tiptoe through a legal, moral and ethical minefield. One of the men who has already been on Facebook co-parenting matching groups sums it up thus: '****ing hell. There are some nutters on there.'

Channel 4’s professional matchmakers have paired up three men with three women deafened by the ticking of their biological clock. First, there’s a getting-to-know-you over drinks, then a weekend together, then a contract, then an attempt at conception.

Channel 4 also recruited an IVF expert, Dr Marie Wren, of the Lister Fertility Clinic, to act as a consultant. “Society has changed so much,” she told the Daily Mail.

“People seem to struggle to meet someone to have a child with. Anonymous sperm donation is not ideal for all single women and surrogacy with egg donation might be an appropriate option for some men seeking to be parents, but co-parenting is for some a far better option.”

One of the three men is 50 and already has children from a failed marriage, but he would like a few more. He explains the advantages of co-parenting. “Romance is lovely but it has a way of making people lose their minds. In this process, they are thinking quite clearly.”

However, Harry Benson, research director of the Marriage Foundation, was much less positive. He commented:

“US studies show that cooperative co-parenting arrangements like this have much less benefit for children than most people assume. This programme appears to be treating children as secondary consumer goods rather than as the product of a loving relationship. UK and US evidence shows that children tend to fare best with both parents under the same roof. That's most likely to happen if the parents are married.”

There are a number of websites which cater for people -- gays, lesbians and heterosexuals -- interested in co-parenting arrangements. Their clients want to become parents and have a family, but unencumbered by romance and commitment. As the website Modamily puts it, their clients are keenly aware that the biological clock is ticking: "There’s plenty of time to find Mr. or Mrs. Right, but only a limited time to find Mommy or Daddy Right. Maybe the person you raise children with is not the same person that you grow old with?"

Dr Golombok says that social scientists still have very little data on platonic co-parenting. "We don’t yet know how children will feel about their family situation, and how it will play out over time," she writes in her book. But, as she told The Guardian last year, “It is possible, though, that taking away romantic baggage could even make for a more stable environment.” 

* This article has been corrected in response to comments by Dr Susan Golombok. 

Michael Cook is editor of BioEdge



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March
27
 

Tasmania becomes third Australian state to pass euthanasia

Cradle Mountain National Park, in Tasmania  

Tasmania has passed euthanasia, or voluntary assisted dying (VAD), legislation, making it the third state in Australia, after Victoria and Western Australia.

The new law will come into effect by the middle of 2022. There is an 18-month implementation period during which a Commission of Voluntary Assisted Dying will be set up. This will oversee the legal administration of VAD and will work out the finer details of how the legislation will be implemented. Doctors will need to complete a special training course.

"It's going to take a while to make this bill operational and also for GPs to do the training and get credentialed," Tim Jackson, head of the Royal Australian College of GPs. "I don't want to get patients' hopes up that they'll be able to go down to their GP next week and access voluntary assisted dying. It's going to take some months."

The implementation period began on December 4, which means the legislation should be operational by the middle of next year.

To be eligible to access voluntary assisted dying, someone must be 18, have decision-making capacity, be acting voluntarily and be suffering intolerably from a medical condition that is advanced, incurable, irreversible and will cause the person's death in the next six months, or 12 months for neurodegenerative disorders.

They must also be an Australian citizen or have resided there for at least three continuous years, and for at least 12 months in Tasmania immediately before making the first request to access VAD. People with mental illness or disability will not have access to VAD.

The architect of the legislation, independent upper house MP Mike Gaffney, said that only 10 people a year were likely to take advantage of the new law.

“At an estimated cost of $240,000 per person, Tas VAD will be arguably the most expensive system in the world, when these funds could be used to provide Tasmanians with a world-class standard palliative care,” said Ben Smith, of Live and Die Well.

Mr Smith also criticised the safeguards. “The use of audiovisual links for VAD consultations (allowed for in the state law) is legally -- defective, medically compromised and open to elder abuse. Vulnerable Tasmanians will be at a significantly increased risk of a wrongful death due to misdiagnosis or undue influence from relatives off-camera.”

Michael Cook is editor of BioEdge   



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March
27
 

Dutch euthanasia criticised in leading medical journal

JAMA Internal Medicine hosted a fiery debate about Dutch euthanasia this week. Geriatrician Diane Meier, of the Icahn School of Medicine, New York, responded feistily to critics of an editorial which she had written in December, headlined “The Treatment of Patients With Unbearable Suffering—The Slippery Slope Is Real”.

Two teams of Dutch physicians responded with reassurances that “all of these Dutch cases of physician-assisted suicide are characterized by a vital patient-physician relationship and that all these requests are voluntary and well considered” and that “instances of physician-assisted suicide always follow the letter of the law and never involve family, financial, or other pressures.”

These contentions are “based on hope, not on research”, says Meier.

Her stinging analysis of Dutch euthanasia must be one of the strongest critiques ever published in a major medical journal. (Sorry, but BioEdge missed it at the time.)

Here are some excerpts:

  • American assisted suicide laws, she says, are fairly strict. “In contrast, countries where PAD has been legal for considerably longer than the US have revised their original laws to remove prognostic requirements, eliminate psychiatric exclusions, broadly define unbearable suffering (to include such conditions as geriatric syndromes and existential distress), and reduce reporting requirements.”
  • “Will legal access to PAD serve as a quick, easy, and inexpensive means of handling the needs of an increasing aging population here and around the globe?”
  • “Permissive access to PAD in this social context comes close to societal validation, supported by policy, that some lives are no longer worth the investment required to preserve them— the implicit belief that both the individual and the society would be better off if the patient were dead.”
  • “This is precisely the type of thinking that led first to the 1927 US Supreme Court’s 8 to 1 decision to uphold a state’s right to forcibly sterilize persons considered unfit to procreate, then to the German physicians’ advocacy of and participation in the eugenic sterilization policies of the early 1930s, and finally to Germany’s involuntary euthanasia of those “lives unworthy of life”— children with disabilities beginning in 1939 and aged people and people with disabilities beginning in 1940.”
  • “Indeed, surveys consistently demonstrate that physicians consider profound debility or cognitive impairment to be fates worse than death. In contrast, diverse older people living with age-related disability rate their own quality of life as fair to very good and point to preservation of dignity and a sense of control as key enabling factors. Physicians’ fear of their own futures, as exemplified by the patients they treat, may result in the unconscious projection of support for a hastened death.”
  • “Meaningful and committed human connection—not 2g of secobarbital—is the right prescription.”

Michael Cook is editor of BioEdge



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March
27
 

New Chinese law bans alteration of human genome

He Jiankui speaking at the Second International Summit on Human Genome Editing

China has updated its criminal code to include a ban on changing the human genome.

“Illegal medical practices” were added to Article 336, which includes “the implantation of genetically edited or cloned human embryos into human or animal bodies, or the implantation of genetically edited or cloned animal embryos into human bodies.”

No doubt this is a retrospective response to China’s gene-editing scandal. On November 26, 2018, He Jiankui, a researcher at the Southern University of Science and Technology (SUSTech) in Shenzhen, announced that his team had helped a Chinese couple give birth to genetically-edited twin girls. The father was HIV-positive, and the embryos’ genomes had been edited in an effort to confer genetic resistance to HIV.

There was an uproar in China and abroad. More than 300 Chinese scientists signed an open letter denouncing He’s experiment. The organising committee for the Second International Summit on Human Genome Editing said that He’s project was unreasonably designed, medically unnecessary, and unethical.

The government acted swiftly and He disappeared. When he surfaced, he was in court, where he was found guilty of “illegal genetic editing of human embryos for reproductive purposes and reproductive medical treatment activities, and disturbing the order of medical management, with serious consequences.”

According to Shao Bowen, writing in Sixth Tone, an English-language magazine about China, this stretched the law. No statute had actually forbidden what He did, only 2003 regulations from China’s Ministry of Science and Technology and the then-Ministry of Health.

The author of the article, Shao Bowen, comments: “Although the new law clears up some of these questions, it was not in effect at the time of He’s experiment. Rather, the prosecutors’ insistence that He be prosecuted seemed less a purely legal decision and more one made to send a clear message of zero tolerance for unethical human embryo experiments.”

Michael Cook is editor of BioEdge



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March
27
 

‘Armenia is facing a demographic catastrophe’

Monumental statue of Mother Armenia in Yeveran

"Armenia is facing a demographic catastrophe," Nune Pashayan, a health department official, told a news conference this week. The government plans to triple funding for reproductive programs.

Mr Pashayan cited a number of statistics. The fertility rate is 1.6 (and needs to be 2.1 to maintain the population). According to the latest data, 14.9% of women and 9.5% of men are infertile.

Eduard Hambardzumyan, founder of the Fertility Center and president of the Reproductive Health Association, told local media that Armenia is caught between high infertility and low rate of fertility. The Armenian population is currently about 2.9 million. By the end of the 21st century, its population could be halved – 1.5 million fewer Armenians. This is a “creeping genocide”, he said ominously.

The figures could be even worse. Apparently the official statistics include hundreds of thousands who have emigrated for work and live in the country only for a few weeks a year.

There is another problem. According to UNICEF, “Armenia has one of the highest rates of gender-biased sex selection in the world.” In 2018, 111 boys were born in Armenia for every 100 girls.

In a fascinating overview of Armenia’s demographic woes in Eurasia Daily Monitor last year, Armen Grigoryan noted that previous presidents had predicted a vibrant and growing population. Former president Serzh Sargsyan (2008–2018) declared in 2017 that by 2040 the population could be 4 million. His successor, Nikol Pashinyan, suggested in 2019 that by 2050 it could be 5 million.

Immediately after the catastrophic explosion in Beirut in August last year, a thousand Lebanese Armenians moved to Armenia. But immigration from the large Armenian diaspora in Russia, the United States, France, Canada, Argentina, Belgium, Germany, Poland, Spain and Syria is unrealistic if there is high unemployment.

In 2018, an editorial in Armenian Weekly, an English-language publication declared sombrely:

“The first 30 years of independence set in motion a demographic crisis so deep and lasting that it is unclear whether anything can be done today to rectify it. The resulting national security issues for Armenia are so serious as to jeopardize the viability of the country for the next 30 years.”

Michael Cook is editor of BioEdge



This article is published by and BioEdge.org under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

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March
27
 

Commissioning parents panicking over surrogate mothers’ vaccinations

The intersection of the Covid-19 pandemic and surrogacy has not been a happy one. After international border lockdowns, hundreds, perhaps thousands, of couples found that they were separated from babies gestating in women in countries like Ukraine.

The rollout of vaccines is proving to be another stumbling block. A fascinating feature in Vice says that many commissioning parents do not want their surrogate to be vaccinated before or during the pregnancy. “Surrogacy agencies have been fielding so many requests for unvaccinated women that several have started specifically matching vaccine-averse prospective parents with surrogates who are willing to stay unvaccinated,” Vice says.

“The intended mother was going so far as to ask me if the surrogate actually got the vaccine, could she then turn around and request a termination of the pregnancy,” one surrogacy manager said. “It just really exemplified, for me, that severe level of anxiety that some people have.”

“I’m not an anti-vaxxer or a pro,” said one prospective father. But he still has reservations. “I think it’s too new of a vaccine. Even if studies are coming out right now, it would be physically impossible for them to have any long-term data that could be valid, in my opinion.”

And many of the surrogate mothers themselves are opposed to getting a vaccine. At a California agency, Surrogate First, about 35% of surrogates have declared that they will refuse. Another 10 to 15% say that they would get vaccinated before, but not during, their pregnancy.

Michael Cook is editor of BioEdge



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March
27
 

Amitai Etzioni wants Biden to form bioethics commission

The eminent communitarian scholar Amitai Etzioni has called upon President Biden to re-establish a bioethics commission to deal with the ethical and social consequence of genetic engineering. Since this can lead to germline modification, this is too important to be left to doctors and scientists, he says.

President Bush created the President’s Council on Bioethics. Although it was highly praised for its deep and humane philosophical analysis of major bioethical issues, it was also criticised as being unreasonably conservative. President Obama disbanded it and created The Presidential Commission for the Study of Bioethical Issues (the Bioethics Commission), which offered more technical advice.

Etzioni says, however, that: “While this commission offers a much-needed perspective of the medical profession, it is also important to explore other moral, ethical, political and sociological implications of genetic engineering.”

He fears that genetic engineering could lead to social inequality, decrease genetic diversity, and “threaten the entire evolutionary process”. He even foresees the danger of government-mandated genetic changes.

“There should be a strong morally shared understanding and constitutional prohibitions against such government policies as they would indeed entail a return to eugenics and could permanently affect the gene pool due to the size and scope of such interventions.”

All of these scenarios call for robust debate amongst people from a variety of professional backgrounds within a bioethics commission.  

Michael Cook is editor of BioEdge



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March
21
 

Mouse embryos grown in vitro by Israeli researchers

Another step in “an explosion of new techniques and ideas for studying early development” of human embryos comes from Israel, where researchers have successfully grown mouse embryos for 12 days, which is about half the animal’s natural gestation period. The rough equivalent for a human would be a first-trimestre baby. They published an article in Nature this week.

It seems that ectogenesis is coming closer – the Brave New World vision of hatcheries in gestating artificially conceived babies. 

The lead author, Jacob Hanna, of the Weizmann Institute of Science, was interviewed about his work in MIT Technology Review. He acknowledge that there are ethical issues.

“I do understand the difficulties. I understand. You are entering the domain of abortions,” says Hanna. However, he says that researchers are already experimenting on and destroying surplus embryos from IVF clinics.

“So I would advocate growing it until day 40 and then disposing of it,” Hanna said. “Instead of getting tissue from abortions, let’s take a blastocyst and grow it.”

At the moment, the mouse embryos only develop if they have been attached to the uterus wall, at least briefly. But Hanna says that his team would like to grow the embryo entirely in vitro.

And if the 14-day limit for growing human embryos is scrapped, he looks forward to doing similar research on human embryos.

“Once the guidelines are updated, I can apply, and it will be approved. It’s a very important experiment,” says Hanna. “We need to see human embryos gastrulate and form organs and start perturbing it. The benefit of growing human embryos to week three, week four, week five is invaluable. I think those experiments should at least be considered. If we can get to an advanced human embryo, we can learn so much.”

Eventually it might be possible to grow embryos for their organs, according to William Hurlbut, a doctor and bioethicist at Stanford University. “I don’t think that organ harvesting is so far-fetched. It could eventually get there. But it’s very fraught, because one person’s boundary is not another person’s boundary.”

Michael Cook is editor of BioEdge   



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March
21
 

Several research groups create ‘artificial’ embryos

An artificial blastocyst created from human stem cells.Credit: UT Southwestern

Four lab groups have almost simultaneously published research showing that it is possible to create structures which are nearly identical to human embryos.

According to Nature, “Two teams published their results in Nature on 17 March; last week, two other groups reported similar results on the bioRxiv preprint server that have not been peer reviewed. These experiments offer a window into a crucial time in human development, and an opportunity to better understand pregnancy loss and infertility without experimenting on human embryos.”

Most of what scientists know about the early development comes from studying human embryos up to 14 days – the legal limit in most countries. The research groups have created structures they call blastoids or iBlastoids which could bypass the need for stopping research at 14 days.

Two of the scientists involved in an Australia-based study explain in The Conversation that: “While iBlastoids and blastoids both seem to be structurally and functionally similar to real blastocysts, it is not yet clear exactly how closely they resemble true embryos formed by a sperm and an egg. While the models were shown to share gene patterns and respond in culture in ways characteristic of actual embryos, researchers also saw significant anomalies, such as unsynchronised growth and cells that are not usually present in an embryo.”

"I'm sure it makes anyone who is morally serious nervous when people start creating structures in a petri dish that are this close to being early human beings," Daniel Sulmasy, a bioethicist at Georgetown University, told NPR. "They're not quite there yet, and so that's good. But the more they press the envelope, the more nervous I think anybody would get that people are trying to sort of create human beings in a test tube."

These developments, linked to pressures from bioethicists to scrap the 14-day rule, suggest that a Second Great Stem Cell War is just over the horizon. The first began when scientists demanded around 2001 that they be allowed to experiment on human embryos but it subsided after 2007 with the discovery of induced pluripotent stem cells. At the time, it seemed impossible to grow embryos in labs beyond 14 days. Now that it looks feasible, there will be another push to grow embryos in Petri dishes up to a new limit.

The Catholic Archbishop of Sydney, Anthony Fisher, a bioethicist with a doctorate from Oxford, was one of the first to comment on the news. In an op-ed in The Australian, he was scathing.

“Remember when embryonic stem-cells were going to cure almost anything, as long as enough restrictions on human embryo experimentation were removed, and enough government money was thrown at them? Two decades later, there are no such cures. Indeed, the majority of the licences granted went not to those institutions researching cures for disease or spinal cord injuries, as promised, but to the IVF industry that pulls in revenues of half a billion dollars each year in Australia alone,” he wrote.

“Some people evidently think Ethics is a place in England. Or that ethics are optional when results, profits or prizes are in view. Or that everything that can be done should be done and inevitably will be done.”

Michael Cook is editor of BioEdge



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March
21
 

Spain becomes the fifth country to legalise euthanasia

Javier Bardem in Mar Adentro

Spain became the fifth country in the world to legalise euthanasia and assisted suicide this week. It joins the Netherlands, Belgium, Luxembourg and Canada.

The vote in the lower house of the Spanish parliament was decisive, 202 in favour, 141 against and 2 abstentions.

"Today we are a more humane, just and freer country. The euthanasia law, widely demanded by society, finally becomes a reality," Spain's Prime Minister Pedro Sanchez announced on Twitter. A 2019 poll showed that a majority of people surveyed supported decriminalizing assisted suicide. Previously, assisted suicide carried a penalty of 10 years in jail.

The law will begin operating in three months. In the meantime regional control committees will be set up to review and authorise requests.

A person requesting euthanasia must be “suffering from a serious or incurable disease or a serious, chronic and incapacitating condition,” which causes them “intolerable suffering.”

The law is certain to be challenged in Spain’s constitutional court. It was promoted by the Socialist Party (PSOE), which is governing in coalition with another left-leaning party, Unidas Podemos. Vox, a conservative opponent, says that it will repeal the law if it is elected.

Spain has the world's fourth-highest life expectancy and one of the world’s lowest birth rates.

Euthanasia has also been a battleground for Spain’s acrimonious politics, with left-leaning progressives using it as a stick to beat the country’s traditional Catholic values.

The film industry helped the pro-euthanasia lobby with Mar Adentro (The Sea Inside), a lightly fictionalised version of the death of quadriplegic Ramon Sampedro in 1998. It won an Oscar in 2004.

Michael Cook is editor of BioEdge   



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March
21
 

Portugal’s high court rejects euthanasia law

Portugal’s Parliament voted to legalise euthanasia and assisted suicide in January. But this week, the Constitutional overturned the law because it was “imprecise”.

Last month, President Marcelo Rebelo de Sousa asked the court to evaluate the law – a step which he can take under Portugal’s constitution.

On Monday, a split court agreed that the bill lacked "the necessary rigour" and rejected it. The vote was 7 to 5. It ruled that the bill was imprecise in identifying the circumstances under which assisted suicide procedures can occur and defining "extreme suffering".

The rules on when euthanasia can be granted must be "clear, precise, clearly envisioned and controllable," the judges added. However, it left the door open to euthanasia provided that the legislation was better drafted. The governing Socialist Party will probably redraft and resubmit the bill.

In fact, this development does not look like a victory for opponents of euthanasia and assisted suicide.

The Article 24 (1) of the Portuguese constitution declares that the inviolability of human life. Nonetheless, the judges said, this “does not constitutes an insurmountable obstacle”.

"The right to life cannot be transfigured into a duty to live under any circumstances," said the president of the court, João Pedro Caupers.

A press release explained: “The conception of a person in a democratic society, which is secular and plural from the ethical, moral and philosophical points of view, is the one that the Constitution of the Portuguese Republic embraces. This gives legitimacy to the tension between a duty to protect life and a respect for personal autonomy and in extreme situations of suffering it can be resolved by means of political-legislative options … such as the anticipation of medically assisted death at the request of the person himself.”

As Yogi Berra used to say, "It ain't over 'til it's over". For better or for worse, it is likely that Portugal is still steaming ahead towards legalised euthanasia.

Michael Cook is editor of BioEdge   



This article is published by and BioEdge.org under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

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March
21
 

Russia’s liberal surrogacy laws under threat

“Russia’s liberal surrogacy rules are under threat,” reports The Economist. The country has become a haven for foreigners seeking cheap surrogate mothers. A woman’s services can be purchased for about US$20,000, much less expensive than the United States.

But after bad publicity over the death of a baby who was intended for a Filipino couple, the practice could be banned for foreigners. “Russia is not an incubator,” says Irina Yarovaya, a deputy speaker of the Duma, Russia’s parliament.

The Economist interprets hostility towards surrogacy as hostility towards commissioning parents who are single men or gay and hostility towards a woman’s right to choose surrogacy as an employment option.

It is true that Russia is not a haven for gay couples. Last year, President Vladimir Putin pushed through a new constitution which included a ban on same-sex marriage. “As far as ‘parent number one’ and ‘parent number two’ go…as long as I’m president this will not happen. There will be dad and mum,” he said.

The invaluable London-based newsletter BioNews recently featured a comment on the situation in Russia by Christina Weis, of De Monfort University, which echoes the concerns of The Economist:

“Amongst the authors of the Russian bills, and in discussion surrounding them, there is a striking absence of focus on the well-being of surrogates in Russia and the impact the bills would have on them. Instead, what is foregrounded in the debate in Russia is firstly, the concern to protect the national interest by ceasing the export of children, and secondly, the protection of traditional Russian family values …

“It is impossible to escape the impression that the potential restriction of surrogacy in Russia is less about moving towards a ban of surrogacy, and more about reserving surrogacy for childbirth that is in the national interest, where only the right kind of people are allowed to become parents.”

Naturally, the issue is a matter of controversy in the Duma, the Russian parliament.

“Denying one the opportunity to become a mom or dad is a crime. A huge number of children are raised by only one parent. If we follow the logic of the authors of the bill, then such children should be taken away from single parents, because this is an ‘unconventional family’,” said says one deputy in favour of surrogacy which is open to different family types.

One another responded by saying that “it is better for a child to grow up in a complete family,” noting that the bill would also prevent same-sex couples from having children with a surrogate. “It is assumed that parents make this decision together and go in search of a surrogate mother, and not just the so-called single fathers who live together and have the resources to have a child, as if they are getting a puppy,” he told Russian media. 

Michael Cook is editor of BioEdge



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March
21
 

Britain’s first birth control clinic opened 100 years ago

Marie Stopes House in Whitfield Street near Tottenham Court Road was Britain's first family planning clinic after moving from its initial location in Holloway in 1925. / Kim Traynor, Wikimedia

The centenary of the opening of Britain’s first birth control clinic has been more an occasion for introspection than for celebration. On March 17, 1921 Dr Marie Stopes and her husband, Humphrey Roe, opened the “Mothers’ Clinic” at 61 Marlborough Road in Holloway, a suburb of London.

Her work quickly expanded and she established a network of clinics throughout Britain. When she died in 1958 she bequeathed the clinics to the Eugenics Society. This organisation was aware that eugenics was regarded with suspicion after the Nazi atrocities before and after World War II. It decided that “the Society should pursue eugenic ends by less obvious means, that is by a policy of crypto-eugenics, which was apparently proving successful with the US Eugenics Society”.

This meshed neatly with family planning. In 1960, the Council of the Eugenics Society resolved that: “The Society’s activities in crypto-eugenics should be pursued vigorously, and specifically that the Society should increase its monetary support of the FPA [Family Planning Association] and the IPPF [International Planned Parenthood Federation] … ”. A critic of Stopes recently pointed out that: “at precisely the moment the Council decided to adopt a policy of crypto-eugenics, it increased funding of the FPA and the IPPF”.

By the mid-70s the clinics ran into financial difficulties and in 1976 they were taken over by a doctor, Tim Black, who was passionate about population control. He turned it into a multinational NGO, Marie Stopes International, one of the world’s largest supplier of abortion services.

A 1992 biography by June Rose uncovered the ugly eugenicist side of the famed birth control pioneer. There was no disputing the historical record, which showed that she was a fervent eugenicist who wanted the “hopelessly rotten and racially diseased” to be sterilised. She was also racist. In 1934, an interview in the Australian Women's Weekly disclosed her views on mixed-race marriages. All half-castes should be sterilised at birth, she said, "thus painlessly and in no way interfering with the individual's life, the unhappy fate of he who is neither black nor white is prevented from being passed on to yet unborn babes."

So last year Marie Stopes International reinvented itself as MSI Reproductive Choices in an effort to distance itself from its eugenicist origins in a time of strident anti-racist activism.

An article in The Conversation points out that: “The historical details about her life and beliefs suggest that birth control activism had inequalities and cruelty baked into it from the very start. They show how dependent supposedly progressive ideals in the early 20th century were on eugenics and social Darwinism … And they reveal how feminist activism undertaken by middle-class white women has so frequently taken place at the expense of their poor, minority ethnic, queer, disabled and trans sisters.”

Michael Cook is editor of BioEdge



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March
21
 

What do Quebec doctors think of organ donation euthanasia?

Euthanasia, or Medical assistance in dying (MAID) as it is called in Canada, has been legal in Québec since December 2015 and elsewhere since July 2016. Since then, more than 60 people have donated their organs after euthanasia.

This is ethically contentious for many reasons: ensuring the autonomy of patients, possible pressure to choose euthanasia, information given to donors, the possibility of directed donations, and the option of death by donation.

A recent article in BMC Medical Ethics presented the results of an in-depth survey of 21 doctors, nurses and coordinators involved in this procedure to see what they thought about organ donation after euthanasia. It found that “Organ donation after MAID was widely accepted among the participants, based on the principle of respect for the donor’s autonomy.”

Below are a few comments made by the participants in the survey:

Respect for autonomy

If the MAID request is well founded and granted, and on top of it, clearly what the patient wants (…) then it should be even more straightforward, if the patient is truly free to make the decision, I don’t see why he should be refused.

Yes, I’m not uncomfortable because the MAID decision has been made and it’s nothing to do with me. It’s not that I’m washing my hands of it, but it’s, like, make your decisions among adults, you are adults, now you want to hear about organ donations and I can help you with that …

Informing patients requesting euthanasia about organ donation

… it’s garbage, it’s wrong to think like that because that’s like saying that it’s only the patients who know organs can be donated who can, who have access to that. You can’t … you can’t only be entitled to that when you know that it exists. How can you decide to give to this organization or the other when you don’t know such an organization exists?

Assessment of motivations for euthanasia

… the purpose of medical assistance for dying is to ease the suffering. Um … that is how it has to stay, it can’t become a way of giving my organs to my neighbour or a friend. It must … ease the suffering. Organ donation can be considered after that, if everything is in place.

Directed donation

It would be very sad if someone you knew or someone you wanted to benefit... could not benefit from your own donation. At that point, it’s also justice for the person who wants to donate.

Organ donation and euthanasia for people with mental illness

For her, to die this way and donate her organs, that’s probably the only way for her to die with dignity, that’s probably the only positive thing in her life and in her passing, both for herself and for her family.

This is difficult, because on the one hand the person will die anyway, and on the other we’re missing out on organs.

Death by donation

It’s the same thing, there’s no moral difference between killing a patient, then taking their organs, and killing a patient by taking their organs (laughs). No, there’s no difference, they’re dead either way.

Is there a big difference, morally speaking? Perhaps not so much, except for, once again, the image that it projects, that it’s the organ retrieval that’s killing him…honestly. (…) ultimately, this doesn’t change anything for the patient, because he won’t suffer, won’t feel anything. 

Michael Cook is editor of BioEdge



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March
14
 

Does plastic threaten the survival of the human race?

You might remember the novelist and celebrity Norman Mailer, the crazy uncle of the American literary scene. He had A Thing about plastic. In 1983 he confided to an interviewer: “I sometimes think there is a malign force loose in the universe that is the social equivalent of cancer, and it’s plastic. It infiltrates everything. It’s metastasis. It gets into every single pore of productive life. I mean there won’t be anything that isn’t made of plastic before long. They’ll be paving the roads with plastic before they’re done. Our bodies, our skeletons, will be replaced with plastic.”

Well, by golly, maybe the crazy uncle was right after all.

The existential danger of plastic (and other environmental contaminants) is the theme of a new book, “Count Down: How Our Modern World Is Altering Male and Female Reproductive Development, Threatening Sperm Counts, and Imperiling the Future of the Human Race”.

In 2017 the author, Dr Shanna Swan, of the Icahn School of Medicine at Mount Sinai in New York City, published research that claimed that sperm levels among men in Western countries had plummeted by more than 50% over the past 40 years. It turns out that sexual development is also changing broadly, for both men and women, and that the modern world is on pace to become infertile. The scenario she paints is a bit like the novel and movie Children of Men, in which no babies have born around the globe for about 20 years.

"If you look at the curve on sperm count and project it forward — which is always risky — it reaches zero in 2045," says Swan. This dismal statistic implies that an average male would have no viable sperm in 25 years’ time. "That's a little concerning, to say the least."

Even more dramatically she claims that homo sapiens already fits the US Fish and Wildlife Service’s standard to be considered an endangered species.

It’s not just sperm counts which concern her. She also notes that while sperm counts drop by 1% a year, miscarriages are also rising by 1% a year. In some parts of the world a 20-something woman today is less fertile than her grandmother was at 35. Other species are struggling with fertility as well. Dr Swan attributes this to endocrine-disrupting chemicals in plastics and other man-made materials.

If these trends persist, she contends, IVF and other and other artificial reproductive technologies will become a widely needed tool for conceiving children. As the New York Times notes in a book review, this book is: “a wake-up call that increases understanding of fertility, its challenges and the recognition that both partners play a role.”

Michael Cook is editor of BioEdge



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March
14
 

IVF dramatically increases twins around the world

More human twins are being born than ever before, largely because of an increase in IVF and other techniques and a rise in average age of mothers.

According to the first comprehensive global overview, published in Human Reproduction, since the 1980s the twinning rate has increased by a third from 9 to 12 per 1000 deliveries. This means that about 1.6 million twins are born each year worldwide. One in every 42 children born nowadays is a twin.

Professor Christiaan Monden, the first author of the study, says: "The relative and absolute numbers of twins in the world are higher than they have ever been since the mid-twentieth century and this is likely to be an all-time high. This is important as twin deliveries are associated with higher death rates among babies and children and more complications for mothers and children during pregnancy, and during and after delivery."

A major cause of this increase is the growth in medically assisted reproduction (MAR), which includes not only IVF techniques, but also ovarian stimulation and artificial insemination. Another cause is delay in childbearing since the twinning rate increases with the mother's age.

We may have reached the peak in twinning rates, particularly in high income countries such as Europe and North America, because of increasing emphasis amongst fertility doctors on the importance of trying to achieve singleton pregnancies.

Prof Monden and his colleagues collected information on twinning rates for the 2010-2015 period from 165 countries, covering 99% of the world's population. For 112 countries, they were also able to obtain information on twinning rates for the period 1980-1985.

They found substantial increases in twinning rates in many European countries, in North America and in Asia. For 74% out of the 112 countries the increase was more than 10%. There was a 32% increase in Asia and a 71% increase in North America. A decrease of more than 10% was found in only seven countries.

Prof Monden said: "The twinning rate in Africa is so high because of the high number of dizygotic twins born there - twins born from two separate eggs. This is most likely to be due to genetic differences between the African population and other populations. The absolute number of twin deliveries has increased everywhere except in South America. In North America and Africa, the numbers have increased by more than 80%, and in Africa this increase is almost entirely caused by population growth."

Most of the increase in twinning rates comes from dizygotic twins, while there has been little change in the rate of monozygotic twins (twins from the same egg), which has remained stable at about 4 per 1000 deliveries worldwide.

"Because infant mortality rates among twins have been going down, many more of the twins born in the second period of our study will grow up as twins compared to those born in the early 80s. However, more attention needs to be paid to the fate of twins in low and middle income countries. In sub-Saharan Africa in particular, many twins will lose their co-twin in their first year of life, some two to three hundred thousand each year according to our earlier research. While twinning rates in many rich Western countries are now getting close to those in sub-Saharan Africa, there is a huge difference in the survival chances."

Michael Cook is editor of BioEdge



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March
14
 

Canada on verge of permitting euthanasia for mental illness

Canada’s House of Commons has passed a revised bill which expands access to euthanasia, eventually including people suffering solely from mental illnesses.

The bill is intended to amend the current law so that it will comply with a 2019 Quebec Superior Court ruling which struck down a provision that allows assisted dying only for intolerably suffering individuals whose natural death is "reasonably foreseeable."

The revised version of Bill C-7 passed by a vote of 180-149. Now the bill returns to the Senate for approval. Justice Minister David Lametti said that he is confident that senators will accept the modifications the government has made to the Senate amendments.

The upshot of the vote is that Canada is one step closer to euthanasia for people who are suffering from mental illness, not from physical pain.

The revised law is under fire for ignoring the opposition of the disability lobby. Writing in The Toronto Star, a psychiatrist and three law professors declared that it would blot Canada’s human rights record:

In under five years, Canada has reneged on the compromise reached to limit MAID to those at the end of life. It will now extend MAID to those with mental illness with almost no legislative study or debate. All this has happened during a global pandemic, when people with disabilities are fighting to stay alive. If Bill C-7 is adopted, Canada can no longer claim to be a progressive country committed to protecting the rights of all its members when it devalues disabled Canadians so profoundly.

Michael Cook is editor of BioEdge    



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March
14
 

Another team of researchers call for the 14-day limit on embryo experimentation to be scrapped

An international team of bioethicists and scientists has advised scrapping the 14-day limit that restricts how long researchers can study human embryos in a dish. Going beyond this policy limit could lead to potential health and fertility benefits, they contend in an article in Science.

This is not a novel suggestion. Scientists and bioethicists have been chafing at the bit for years to extend this widely-accepted limit. This time around, Insoo Hyun, of Case Western Reserve University, and colleagues urge policymakers and the International Society for Stem Cell Research (ISSCR) to consider "a cautious, stepwise approach" to scientific exploration beyond the 14-day limit.

ISSCR is expected to soon release updated guidelines for stem cell and embryo research.

Among the potential benefits of studying human embryos beyond the 14-day limit, they claim, are better understanding of how early development disorders originate and developing therapies for infertility and miscarriages.

Since the first successful birth from in vitro fertilization in the late 1970s, human embryo research has been subject to limits of time and developmental benchmarks. The general rationale for imposing those limits was that, although considered acceptable to benefit human health and improve reproduction, in vitro research should conclude 14 days after fertilization -- about when implantation in the womb is normally completed.

National guidelines, laws and international norms have prohibited scientists from culturing human embryos for research after 14 days. When this limit was put in place, there were no methods to culture embryos in a dish for anywhere close to two weeks. But research since 2016 shows that it is likely possible to culture human research embryos past the two-week limit.

The contribution of the proposal by Hyun and colleagues is six principles that can be used to weigh whether research on human embryos can move beyond the 14-day limit, in incremental, measured steps. They note that their principles apply not only for extending the 14-day limit, but also for other complex research.

"Realistically," they conclude, "an incremental approach seems to be our only path forward, both from a scientific and a policy standpoint."

The “14-day rule” was invention of the UK’s 1984 Warnock Report and it was incorporated into the UK’s legislation in 1990. It limits research on intact human embryos to this period. Why 14 days? The late Dame Mary Warnock freely admitted that it was arbitrary. But a clear limit was needed to regulate IVF and “everyone can count up to 14, and everyone can keep and examine records.”

“The number 14 was not arbitrary in the sense that we drew it out of a hat,” she argued. “But it was arbitrary in the sense that it might have been a different number, though not very greatly different. At any rate, a workable law demanded a degree of invariability.”

Some bioethicists ask whether this is a wise move. David Albert Jones, of the Anscombe Bioethics Centre, in the UK, wrote in 2016: “In the future this may even be seen as the first step towards culturing babies outside the womb, where the child is not only conceived outside the protection of his or her mother's body but no such human connection is envisaged at any stage. Human life and human pregnancy should not be separated in this way.”

Michael Cook is editor of BioEdge



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March
14
 

American bioethicists call for a Covid-19 commission

In the wake of the Warren Commission about the assassination of President Kennedy (1963), the Kerner Commission about the 1967 riots (1968), the Three Mile Island Commission (1979), the 9/11 commission (2002), and the recent commission to investigate the riot on January 6 on Capitol Hill, two bioethicists have called for a Covid-19 commission.

Writing in the blog of The Hastings Center, M. Sara Rosenthal and Art Caplan, say that “Nearly half of the U.S. Covid-19 deaths were unnecessary and can be traced to both acts of commission and acts of omission by the U.S. government.”

They point out that the death toll of the pandemic has nearly exceeded the total toll of battle deaths in most of America’s major wars. “For much of the fall of 2020 through February 2021, the United States has experienced either a Pearl Harbor or 9/11 every day.”

The authors recall that the Holocaust was enabled by campaigns of “disinformation and propaganda”. Similarly, they allege, the Trump Administration should be held responsible for the deaths of 500,000 Americans because of its incompetent and perverse policies.

In responding to Covid-19, deliberate acts of commission by the Trump Administration included a coordinated misinformation campaign; pressuring states to forego science-based mitigation efforts; bullying public health experts and other officials trying to enforce public health measures, such as social distancing or mask-wearing, ultimately turning mask-wearing into a partisan issue; interfering with the independence of the CDC; and causing biological harm by seeding the virus in maskless mass gatherings organized by the President of the United States. Such concerns are echoed in a report by the Lancet Commission on Public Health Policy and Health in the Trump Era. Acts of omission include the failure to enact the Defense Production Act to increase critical supply of medical equipment and tests, including personal protective equipment. Additionally, abandoning Covid-19 management to individual states was reportedly a decision based on politics rather than public health, which created enormous supply scarcity and disparities.

Michael Cook is editor of BioEdge    



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March
14
 

Older motherhood may not be such a great idea

Mauricia with her babies / Newsflash/Australscope

In 2010 at the age of about 58 Spanish woman Mauricia Ibañez gave birth to a baby with the help of IVF. In 2014 she was ruled unfit to care for her daughter, who is now being fostered by a niece in Canada.

She tried again.

In 2017 at the age of 64 Ms Ibañez gave birth to twins, with the help of an American IVF clinic. A few weeks ago she was ruled unfit to care for them as well. They have been taken into foster care by Spanish authorities.

According to the ABC newspaper, a court found that the twins were “in a clear situation of vulnerability” because of Ms Ibañez’s inability to care for them properly. But it stressed that the decision to remove them was not because of her age or mental health. The children were not living in "optimal conditions" and Ms Ibañez did not have a social support network or a family who could help her negotiate the difficulties of sexagenarian parenting.

It appears that Ms Ibañez, who lives in a small town outside of the northern city of Burgos, suffers from a personality disorder -- so it is puzzling why American doctors allowed her to become pregnant at her advanced age.

She told El Pais after the birth of the twins: “I decided to become a mum again because the experience with my first daughter Blanca was so wonderful that I thought, ‘And if I could have more!’ My age doesn’t worry me at all. It’s true I’m old but it’s been possible to fall pregnant. Science and medicine are the last opportunity we have as older people. A man aged 65 can have children without any problem so why do we question things when a woman does it?”

Michael Cook is editor of BioEdge    



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March
14
 

Call for commercial surrogacy to be legalized in Australia

An Australian surrogacy lobby has called for commercial surrogacy to be legalised in Australia. It is currently banned in all of the country’s states.

However, in 2019-20 275 babies born overseas to surrogate mothers were granted Australian citizenship, the highest number on record. Thailand and India, formerly popular destinations, no longer allow foreigners to employ surrogate mothers, so Australians have been going elsewhere.

According to figures from the Department of Home Affairs for the year 2019-20, 120 children were born in the United States, the most popular destination, followed by Ukraine, with 50.

The figures for altruistic surrogacy within Australia are not clear. In 2018, 87 babies were born in Australia and New Zealand via surrogacy, but this only includes births organised through IVF clinics.

Melbourne surrogacy lawyer Sarah Jefford told The Australian newspaper that surrogacy was much safer in Australia, with its superior health system and better legal framework. In other countries surrogacy was like “baby farming” where clinics exploited poor women.

Local laws should be relaxed, she said, including a ban on advertising for surrogates, so that more Australians could be altruistic surrogates. “We have good frameworks here. The rights of the child and the bodily autonomy of the surrogate are protected,” she said.

Michael Cook is editor of BioEdge   



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March
06
 

Poor things! Britain’s aristocrats left behind by assisted reproduction reforms

The Marchioness of Bath and her sons John and Henry 

The Tatler, Britain’s lifestyle and gossip magazine for the upper crust, does not moonlight as a bioethics journal. In any case, its subscribers are probably more into pictures of private jets, jewellery and costume parties than text. Readers of the digital edition have an average household income of US$250,000.

But the latest issue highlights an interesting wrinkle in laws on assisted reproduction. IVF and surrogacy are not compatible with the British system of peerages.

The Marchioness of Bath, married to the 8th Marquess of Bath, is the chatelaine of Longleat, in Wiltshire, the ancestral seat of the Marquesses of Bath with 9,000 acres and its own safari park. It dates back to 1580. She is a media star and the United Kingdom’s first black Marchioness. Their wealth notwithstanding, the couple has had trouble having children. Their second child was born with the assistance of a surrogate mother in California.

For barons and peers of the realm, this poses a problem. As the Tatler points out: “While in the last half a century of family law has seen reforms designed to remove barriers to inheritance or status based on illegitimacy, sex, adoption, donor conception, or being carried by a surrogate, these reforms have mostly excluded succession to titles.”

For the purposes of succession, such children are regarded as “illegitimate”. This means that they will not succeed to the title or even rights of inheritance. In this respect they are worse off than commoners.

“As there are approximately 3,000 hereditary peers and baronets collectively entered on their respective Rolls, given the increasing prevalence of surrogacy or assisted reproduction in family building, it is likely that some of those families will be taken by surprise on the ramifications upon their title. It is equally plausible that these ramifications may not be appreciated for some time, perhaps after a number of generations.”

This is not hypothetical. In 2016, Simon Pringle was deprived of his claim to be baronet of Stichill in favour of his second cousin, Murray Pringle. The case was argued before the Privy Council. On the basis of DNA evidence, it determined that the eldest of the three sons of the 8th baronet, who died in 1919, was not ac heredibus masculis de suo corpore, a male heir from his body, as specified in Charles II’s grant in the 17th century. Therefore, the title should go to a descendant of the second son. (No land or property is attached to the title.)

The judges of the Privy Council sympathised with “the late Sir Steuart Pringle, a distinguished officer, who faced an unwelcome challenge in his autumnal years, and also Simon Robert Pringle, the heir presumptive, who had grown up in the belief that his father was rightfully the 10th baronet and that he would in time succeed to the baronetcy”.

The authors of the Tatler’s analysis conclude: “When titled families resort to surrogacy and assisted reproduction, there is a real risk that some heirs may well be caught out and displaced by the ‘distant cousin from South Africa’, particularly where scientific evidence may well be conclusive.”

Michael Cook is editor of BioEdge  



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March
06
 

Euthanasia moves ahead in Australia

Legalised euthanasia is only a few weeks away in the Australian state of Tasmania. The End-of-Life Choices bill passed through the lower house of the Tasmania Parliament this week and moved to the upper house, where it is expected to pass easily.

It will be the third of Australia’s six states to pass a euthanasia law. It will probably come into effect from mid-2022.

Opponents of the bill criticised the quality of the debate, as MPs appeared determined to pass the bill to avoid sitting on a Friday. It sailed through on a conscience vote, 16-6.

“The short time period … did not provide adequate time for these reports to be digested and fully considered,” said Ben Smith, a spokesman for Live and Die Well, which has opposed the bill. “As a result, the debate … was far from fully informed and lacked the level of due diligence appropriate for a bill dealing with life and death issues. It became clear that a majority of members were more interested in enabling access to assisted suicide and euthanasia rather than strengthening the safeguards.

“The use of telehealth consultations has been maintained in the bill, despite its inconsistency with commonwealth law. The duty to inform the coroner has been removed … Wrongful deaths will be inevitable.”

As momentum grows for legalisation amongst the states – Queensland is close to legalisation as well – activists in the Northern Territory and the Australian Capital Territory are complaining that they cannot pass similar legislation. Constitutionally, the federal government has the power to override Territory laws. It did this in 1996 when the Northern Territory briefly legalised it.

ACT Human Rights Minister Tara Cheyne that it was embarrassing that the federal government allowed human rights to be limited in its own country.

Meanwhile, statistics on “voluntary assisted dying” in Victoria, the first jurisdiction in Australia to legalise euthanasia ,have been released. The numbers are surprisingly high.

According to an analysis of the figures by the Australian Care Alliance:

The total number of deaths by euthanasia or assistance to suicide in July to December 2020 was 94 -- almost double the 49 deaths by these means in July to December 2019. This represents 0.45% of all deaths in Victoria in July-December 2020. It took Oregon twenty years for deaths from legalised assistance to suicide to reach that rate.

A total of 175 people were assisted to suicide or euthanised in 2020 - already above the 100 to 150 deaths per year Premier Daniel Andrews projected the rate would stabilise at after only 12 such deaths he anticipated in the first 12 months (it was 1083% of that figure - 130 deaths).

Michael Cook is editor of BioEdge



This article is published by and BioEdge.org under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

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March
06
 

Shuffling off this mortal coil is not always pleasant

The dying process is an under-examined aspect of euthanasia and assisted suicide. Most people assume that it is swift and painless, but this is not always the case. In Oregon, for instance, which publishes very informative statistics about its “Death with Dignity Act”, the longest reported time to die was 104 hours – 4 days and 8 eight hours.

Known complications over the years include regurgitation and seizures, although in more than half the cases, no record was kept even if anything had happened. In eight instances, since 1998, the patient recovered consciousness – which must have been terrifying.

A letter to the BMJ last month from an Irish pharmacist reviewed the literature on complications with the dying process of euthanasia and made some surprising observations. In the Netherlands, it seems, the rate of non-reporting of euthanasia is strongly related to the type of drugs used. Standard drugs were mostly reported; opioids were mostly not reported.

As far as assisted suicide goes, it is potentially very unpleasant. The author, Bernadette Flood, writes:

There is currently an international scarcity of lethal drugs suitable for oral administration during an assisted suicide. On occasions when oral barbiturate drugs are administered there are reports of patients being unable to self-administer a complex cocktail of lethal medicines. Family members have reported having to scrape powder from 100 plus capsules with toothpicks to produce bitter powder to be mixed with sugar syrup. Medication for nausea and vomiting must be consumed before and during the process. In some countries, lethal cocktails have been ‘experimented’ with due to difficulties sourcing licensed medicines for the purpose of assisted suicide and/or euthanasia.

As she points out, there is also a puzzling disconnect between lethal injections for executions in the United States and lethal injections for euthanasia. “A number of medicines used in assisted suicide and/or euthanasia were previously used in executions. Use of medicines during executions has been described as ‘inhumane’ with reports of people feeling ‘burning’ sensations throughout their bodies prior to death.”

Perhaps because euthanasia cases are shielded from intense media scrutiny, there is less information about how euthanised people actually die.

Dr Flood concludes: “The process of assisted suicide and/or euthanasia cannot guarantee a peaceful, pain-free, dignified death.”

Michael Cook is editor of BioEdge



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March
06
 

Is ‘transphobia’ a kind of eugenics?

These things come and go, but the current benchmark for evil in public bioethics is eugenics. Even heroes of reproductive freedoms have been toppled because they are said to have been fans of eugenics, like Margaret Sanger and Marie Stopes. If you can make the slur “eugenicist” stick, you’ve deplatformed your opponent.

So it comes as no surprise to hear that transgender activists are accusing their opponents of being eugenicists. ACLU lawyer and trans activist Chase Strangio wrote in 2016 in the CUNY Law Review about a visit to a gynaecologist whose first question was “I assume you’re here about a hysterectomy.” He (or she) wasn’t. The remark was perceived to be insulting, even though the doctor was reputedly “trans-friendly”. It sent two messages: that transmasculine people do not need preventative care and that they don’t want children. “Both messages have strong eugenic undertones contributing to the negative health outcomes for the trans community and the coerced sterilization of trans people,” Strangio wrote.

And Slate columnist Evan Urquhart also detects in a raft of anti-trans legislation in state capitols in the US at the moment a eugenic motivation: “These are bills aimed at cleansing society of the ‘wrong’ sort of people as soon as their difference makes itself visible, and promoting the right sort in their place.” He goes on to argue:

The current youth-focused anti-trans legislative push is about protecting society from undesirable people by suppressing and punishing those people as early as possible, ensuring that future generations aren’t contaminated by their ability to thrive. This should sound very similar to the goals of eugenics movements, which seek to encourage the right people to reproduce while discouraging the wrong sort of people from contaminating others with their inferior genes. In the past, eugenics was often pursued through actual sterilization of undesirables, and I should note that many anti-trans activists want to ensure that the only adult trans people legally recognized as their gender are those who have undergone sterilizing genital surgeries. It’s not precisely eugenics … but it certainly rhymes.

Michael Cook is editor of BioEdge



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March
06
 

Confronting the frozen embryo dilemma

Sometimes one gets more insight into the ethical stakes of assisted reproduction through stories rather than through argument. In Today, an NBC News show, Erica Levens, one of its associate directors, discusses her painful history of infertility, her IVF cycles, and her surplus embryos. After having two sons, she still had 14 frozen embryos in an IVF clinic in Long Island. One day, when her sons were in their early 20s, she received a letter from the clinic. Her embryos were already 25 years old. Her options were to use them, donate them, destroy them, or pay storage fees.

Obviously I’m not going to use them, but emotionally it is still difficult to let go. I’ve thought about taking the embryos home and giving them a burial of some sorts. I can donate them to the lab for research or I could donate them somewhere else. I’m waiting to hear from several stem cell research facilities. But I just feel paralyzed. I can’t believe how difficult it is to come to a decision. What if I just do nothing again?

When I think about those embryos now, I’m surprised at how emotional I am. And I just cannot stop thinking about them. Maybe it’s because I’m so proud of who my boys have turned out to be. Maybe I’m just now taking a breath and realizing how traumatic it all was.

Whatever I do, they’re gone. And I guess I have to make that final decision. It brings up a lot of sadness, though.

There may be millions of surplus frozen embryos in the United States. Ms Levens’s dilemma suggests that deciding what to do with them will not be solved easily.

Michael Cook is editor of BioEdge   



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February
28
 

Home is where the heart is for Dutch euthanasia

There’s always something new that you can learn about euthanasia practices. An indignant letter to JAMA Surgery by two surgeons from a hospital in the Netherlands led BioEdge back to a 2017 letter in Transplant International about home-based euthanasia + organ donation. It’s not one of  the better publicised features of Dutch euthanasia.

Apparently many people are interested in organ donation after euthanasia, but they would still prefer to die at home. This cuts off a useful source of organs. These resourceful doctors, Johan P. C. Sonneveld and Johannes Mulder, from Isala Hospital, developed domestic organ donation after euthanasia as a “newly introduced, donor-friendly donation procedure”. It even has its own acronym, DODE. 

The key point is “separating the experience of dying at home from subsequent biological death and organ donation in hospital using an anaesthesia bridge.” The patient is sedated and intubated at home where he lapses from consciousness surrounded by his family. Then he is taken, unconscious, to the hospital in an ambulance, euthanised, and operated on. 

Commencing the euthanasia procedure at home is much more humane, they argue. “Suggesting that euthanasia must take place in the hospital disregards the deepest wishes of these donors: sick, hospital-weary human beings who have decided to end their pain in the comfort and privacy of their own home,” write the doctors.

It’s not clear how often this happens – probably only in a handful of cases every year at the moment.    

Ah yes, why were they indignant? Because a 2020 article in JAMA Surgery had suggested that the best-practice location for organ donor euthanasia is the hospital. Not so, they say. “Advocating the necessity for a hospital stay will alienate many potential donors.”

Michael Cook is editor of BioEdge   



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February
28
 

For teenagers from hell, “compulsory moral neurorehabilitation” might be needed

Transgender issues for teenagers rank very high amongst the (very few) bioethical issues covered by newspapers. In one development, anti “conversion therapy” are being laws are being enacted in many jurisdictions, making it a crime to dissuade young people from expressing a sexual orientation or changing gender. In another, the shibboleth in transgender medicine is “believe the children” about their feelings on gender transition.

The message, therefore, is consistent: respect children’s autonomy. Do not direct their sexuality.

It comes as a surprise, then, to read an article in the leading journal Bioethics which proposes that young people with serious misbehaviour problems like delinquency, aggression, and antisocial behaviour should be compelled to undergo “moral neurorehabilitation”. Some adolescents are “devoid of any culpability, boasting satisfaction at having perpetrated calculated acts of harm”.

How should we deal with this kind of anti-social behaviour? Some of them are “so difficult to treat as to be next to untreatable”. A number of psychologists and bioethicists contend that there are “instances where a compulsory moral enhancement might actually be more responsible of the state than leaving such interventions up to individual choice”.

What kind of interventions? Drugs, the “love drug” oxytocin, and brain stimulation are all mentioned.

On what ethical basis can this be justified? The authors cite several. Psychologist Carol Gilligan’s care ethics is one of them: “A care ethics approach would justify case‐specific compulsory treatment when an individual’s dysfunctional behaviour negatively impacts other family members, significant others, or community members within the individual’s sphere of interaction and influence.”.

What about the adolescents’ autonomy? It must be respected, but “when antisocial behaviours result in school suspension/expulsion, work discharge, interpersonal strife, legal trouble and even incarceration, it can be argued that moral neurohabilitation would potentially increase individual autonomy and options for improved educational, employment, and relationship opportunities.”

They conclude: “Perhaps one day in the not too distant future, adolescents and adults diagnosed with [conduct disorder] and [antisocial personality disorder] may finally be helped to care about others, enjoying the rewards that come with healthy interpersonal interactions, empathic concern, and social affiliation. And the people with whom they interact will no longer have to live in fear.”

Michael Cook is editor of BioEdge    



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February
28
 

Who are more moral: the God-botherers or the nothing-botherers?

A new study in PLOS ONE suggests that, while atheists and theists share moral values related to protecting vulnerable individuals, atheists are less likely to endorse values that promote group cohesion and more inclined to judge the morality of actions based on their consequences.

In many countries, including the United States, it is widely believed that atheists lack a moral compass.

To test this, Tomas Ståhl of the University of Illinois at Chicago, conducted two small internet-based surveys examining the moral values of 429 American atheists and theists and two larger surveys involving 4,193 atheists and theists from the US (a predominantly religious country) and Sweden (a predominantly irreligious country).

He found that theists are more inclined than atheists to endorse moral values that promote group cohesion. Atheists are more likely to judge the morality of an action based on its consequences.

However, both atheists and theists appear to align on moral values related to protecting vulnerable individuals, liberty versus oppression, and being epistemically rational, i.e.: believing in claims when they are evidence-based and being sceptical about claims not backed by evidence.

So why do they reason differently? Ståhl believes that theists are more affected by their community, while atheists work ethical issues out on their own.

Ståhl sums up the message of his findings as follows: "The most general take-home message from these studies is that people who do not believe in God do have a moral compass. In fact, they share many of the same moral concerns that religious believers have, such as concerns about fairness, and about protecting vulnerable individuals from harm. However, disbelievers are less inclined than believers to endorse moral values that serve group cohesion, such as having respect for authorities, ingroup loyalty, and sanctity... It is possible that the negative stereotype of atheists as immoral may stem in part from the fact that they are less inclined than religious people to view respect for authority, ingroup loyalty, and sanctity as relevant for morality, and they are more likely to make moral judgments about harm on a consequentialist, case by case basis."

Michael Cook is editor of BioEdge



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February
28
 

The Hasting Center calls for civics education to protect democratic values

A new report released by the leading bioethics centre in the United States, The Hastings Center, concludes that civic learning in the United States is breaking down and threatening democratic values. It’s another sign of bioethics shifting away from autonomy-oriented discourse about medical issues toward social justice.

As policymakers and educators consider how to strengthen civic learning and democracy in the aftermath of challenges such as the assault on the U.S. Capitol, the report, “Democracy in Crisis: Civic Learning and the Reconstruction of Common Purpose,” proposes four ways that Americans can help combat polarization and increase public engagement:

  1. Address justice as a basis for civic participation: Develop solutions to the vast material inequalities in American life, encourage solidarity and care for one another, and a shared commitment to community life.
  1. Understand the interplay of facts and values: Recover the ideas of critical thinking and scientific fact, along with the recognition that the public should weigh in on the values at stake in science policy.
  1. Enhance schools’ commitments to advancing scientific literacy and preparing students for active civic engagement. Schools should help students develop the knowledge, skills, and habits of mind, essential to self-governance and policy debate.
  1. Talk to each other. Boost participation in local government and nonviolent social movements and create opportunities for citizens to engage with each other in deliberative forums, especially at the community level, where the immediacy of shared concerns may offset national political polarization.

The report’s authors say participating in civic life, conversation, debate, and consensus-building are keys for effective government, though these types of engagement are on the decline.

Informed public debate has broken down because:

  • Government has moved away from efforts to encourage civic participation;
  • The rise of authoritarian, anti-democratic sentiments undercuts efforts to create innovative civic organizations that encourage and build democratic participation;
  • Geographic clustering of citizens weakens citizens’ ability to see those who differ from them as legitimate equals, creating distrust and political polarization;
  • Long-standing social, economic, and racial inequalities in American society undermine citizens’ concern for the common good;
  • Collective reluctance to talk about class and race prevent citizens from understanding each other;
  • Untrustworthy sources of information perpetuate misinformation and reinforce citizens in their pre-existing views, rather than exposing them to the views of others.

“From vaccine policy to climate change, we are facing major challenges that require collective problem solving. We can’t succeed unless we reinvigorate our ability to access trustworthy information, evaluate options, and deliberate together,” said Mildred Solomon, president of The Hastings Center.

Michael Cook is editor of BioEdge



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February
28
 

Beware of unscrupulous cosmetic surgery providers, says UK association

Demand for cosmetic surgery in the United Kingdom has shot up during Covid-19 lockdowns. People attending online meetings week after week are becoming distressed about their appearance.

A long feature in Esquire – not normally a treasure trove of bioethics information – says that “Meetings are conducted over video calls in which we spend the duration assessing the little window of our flaws, every blemish and hint of a receding hairline, while Laura’s connection drops in and out and Martin’s cat climbs onto his keyboard. In our harshly lit bedrooms, kitchens and home offices, insecurities and facial dislikes are laid bare.”

The British Association of Aesthetic Plastic Surgeons (BAAPS) has warned that unscrupulous cosmetic surgery providers are cashing in on a post-pandemic “Zoom boom” by coercing vulnerable patients into panic buying procedures.

“People couldn’t go on holiday, they couldn’t do much, really,” says London plastic surgeon Patrick Mallucci. “So, many instead decided to spend that money on themselves. To treat something.”

The association, which reported seeing a “massive upswing” of 100% in demand for virtual consultations during lockdown, has issued Triple Lock Guidelines to help safeguard patients in these challenging times. However the BAAPS has been extremely concerned to find that some cosmetic surgery clinics are not following safety guidelines.

In a survey of 20 non-BAAPS cosmetic surgery clinics, 75% did not insist on a face to face consult with an adequate cooling off period and 85% did not insist on a cooling off period at all, despite this being a mandatory requirement of good medical practice by the GMC. Concerningly, some clinics even advocated no face to face with a surgeon before surgery.

The association is cautioning the public not to fall prey to unethical tactics and marketing deals luring them to “panic buy”, as they do not give them the required “cooling off” period of at least 14 days between a face-to-face consultation and the procedure being done.

BAAPS president Mary O’Brien said that the “reality of surgery and aftercare that should not be lost in a virtual world. It's about delivering real care to real people to improve psychological and physical wellbeing. Surgery is not a pandemic pick me up."

Michael Cook is editor of BioEdge



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February
28
 

Is happiness a psychiatric disorder?

Photo by Mindspace Studio on Unsplash

At the bottom of web pages at the Journal of Medical Ethics are displayed six Altmetric attention scores – basically the JME’s most popular articles. The highest, with a score of 2948, is a 2012 article about “after-birth abortion”, ie, infanticide. But the second, dating back to 1992, has the intriguing title: “A proposal to classify happiness as a psychiatric disorder”.

Admittedly, its miserabilism was satirical. The point of the author, Richard Bentall, now of the University of Sheffield in the UK, was to show the difficulties of defining a mental disorder.

Happiness, he observes, is a statistically abnormal psychological phenomenon which is associated with a range of risky pathologies like obesity and alcoholism. Future editions of major diagnostic manuals should include happiness under the name “major affective disorder, pleasant type.” There is some evidence that happiness is a disturbance of the central nervous system, as brain stimulation can result in happy feelings. Happy people are also cognitively impaired, as they are consistently unable to retrieve unpleasant events from long-term memory.

Bental concludes: “We can expect the emergence of happiness clinics and anti-happiness medications in the not too distant future.”

An amusing tour de force in an arch, faux-academic style. But also thought-provoking. Without a consensus on the basis elements of philosophical anthropology, is it possible even to agree on what being healthy means? After 30 or so years, we are still at loggerheads. 

Michael Cook is editor of BioEdge    



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February
21
 

A Russian woman wants 105 surrogate babies – and has the money to pay for them

from batumi_mama on Instagram

The Russian media has been abuzz with the news that a 23-year-old woman from Moscow named Christina Ozturk and her husband have embarked upon the ambitious project of having 105 of their own biological children. They already have 11 in their household – one which Christina had herself, and 10 in the last two years with surrogate mothers.

Mrs Ozturk met her 56-year-old husband, Galip, a Turkish businessman living in Georgia, at a resort in Batumi, where there is a well-established surrogacy industry. Each child costs about 8,000 Euros, but Mr Ozturk, who owns a chain of hotels, says that he can handle it easily. The Turkish media describes him as a billionaire, although he denies this. The project seems to have been his idea.

“I don’t know how many they will eventually be, but we certainly don’t plan to stop at 10,” says Christina. “We just not ready to talk about the final number. Everything has its time.” She did mention 105 as an upper limit on her Instagram account, although she back-pedalled in a recent post.

The family situation is quite odd. The facts are difficult to confirm when they have to be filtered through Russian, Georgian and Turkish, but it seems that Mr Ozturk made a fortune in Turkey in the bus industry, was constantly involved in financial scandals and fled the country after being sentenced to life imprisonment over a murder, apparently leaving his wife and eight children behind.

Christina was a single mum when she met the love of her life, who already had eight children, aged 12 to 34. So it will not be just a blended family, but a saturated family. Taking care of 11 small children requires an army of helpers and constant oversight of the surrogate mothers.

“The clinic in Batumi chooses surrogate mothers for us and takes full responsibility for the process,” Christina told the Russian website woman.ru. We are not personally acquainted with surrogate mothers and do not have direct contacts with them in order to avoid problems after pregnancy. All communication takes place through the clinic, we only monitor health indicators.”

Some surrogate mothers become attached to the child and refuse to give him up, even though they must under Georgian law. Christina hints that she has already compelled one woman to hand the baby over.

Weird? Absolutely.

But quite legal. Christina and Galip are loving parents who are zealous for their offspring’s’ welfare; their kids will never be poor. The surrogate mothers are happy (most of them, at least). What’s not to like?

Michael Cook is editor of BioEdge   



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February
21
 

UK to begin first challenge trials for Covid-19

The first Covid-19 human challenge study has received ethical approval in the United Kingdom. Up to 90 healthy volunteers aged between 18 and 30 will be exposed to Covid-19 in a safe and controlled environment to increase understanding of how the virus affects people. It is due to begin in a few weeks.

The first-of-its-kind study for this virus will involve establishing the smallest amount of virus needed to cause infection, which will give doctors greater understanding of Covid-19 and help support the pandemic response by aiding vaccine and treatment development.

The safety of volunteers is paramount, says the government, which means this virus characterisation study will initially use the version of the virus that has been circulating in the UK since March 2020 and has been shown to be of low risk in young healthy adults.

Medics and scientists will closely monitor the effect of the virus on volunteers and will be on hand to look after them 24 hours a day.

Clive Dix, of the Vaccines Taskforce, said: “We have secured a number of safe and effective vaccines for the UK, but it is essential that we continue to develop new vaccines and treatments for Covid-19. We expect these studies to offer unique insights into how the virus works and help us understand which promising vaccines offer the best chance of preventing the infection.”

Human challenge trials are used to develop vaccines and treatments across multiple diseases including malaria, typhoid, norovirus, common cold and Influenza. Volunteers will be compensated for their time, to the tune of around £4,500 over the course of a year, which will include follow-up tests.

Human challenge trials for Covid-19 have been discussed from the time that the virus emerged and they have always been controversial. For a negative view, here are some comments from William Haseltine, a columnist for Forbes who used to be a professor at Harvard Medical School:

The risk to the 90 healthy volunteers who will be recruited for this trial is very real. The press release announcing the challenge claims that “the safety of volunteers is paramount” and highlights how only healthy young adults will be chosen. Yet it ignores the mounting evidence that even a mild case of Covid in a healthy young adult can lead to long term lung damage and other potentially serious lifelong symptoms. To make it worthwhile to put 90 healthy young people at risk for lifelong illness, the benefits have to be very real. But the reality is that this trial is likely to prove relatively meaningless.

Since the issue of human challenge trials for Covid-19 was first introduced last year, our understanding of the virus has evolved dramatically. We now know that the virus can change, and it can change quickly. One of the primary purposes of this vaccine challenge, at least according to the release, is to establish “the smallest amount of virus needed to cause infection, which will give doctors greater understanding of Covid-19 and help support the pandemic response by aiding vaccine and treatment development.” Yet given what we know of SARS-CoV-2 today, it is highly likely that the virus used in the challenge expected to begin in just a few weeks will be markedly different than the virus that the world will be dealing with when the results are released.

Michael Cook is editor of BioEdge



This article is published by and BioEdge.org under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

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February
21
 

‘Chest is best’ is the new slogan in trans-friendly maternity wards

Gender-inclusive language created a stir in the UK media recently when the maternity services department at Brighton and Sussex University Hospitals NHS Trust rechristened itself “peri-natal” services. The changes in terminology were widely ridiculed as extreme wokery:

Staff were suggested to use terms like “pregnant women and people”, “breastfeeding and chestfeeding“, “mothers and birthing parents”. Patients would become “mothers or birthing parents”; “fathers” would become “parent”, “co-parent” or “second biological parent”.

In fact, the term “chestfeeding” is not new. Snopes tracked down a 2018 document from La Leche League Canada and La Leche League USA which encouraged its use for trans and non-binary parents.

Language is always evolving, in the breastfeeding and lactation world as elsewhere. Many of the terms used 20 or 30 years ago would be unfamiliar to parents today, and La Leche League must continue to adapt and evolve as language in the lactation area does as well.

However, as long ago as 2016, two academics from the University of Pennsylvania medical school, criticised the term “breastfeeding” as “ethically problematic” and “stigmatizing” in an opinion piece in the leading journal Pediatrics.

we are concerned about breastfeeding promotion that praises breastfeeding as the “natural” way to feed infants. This messaging plays into a powerful perspective that “natural” approaches to health are better, a view examined in a recent report by the Nuffield Council on Bioethics. Promoting breastfeeding as “natural” may be ethically problematic, and, even more troublingly, it may bolster this belief that “natural” approaches are presumptively healthier. This may ultimately challenge public health’s aims in other contexts, particularly childhood vaccination.

Interestingly, although this article was published only five years ago, it did not allude to transgender issues. Its focus was squarely on the word “natural”.

Coupling nature with motherhood, however, can inadvertently support biologically deterministic arguments about the roles of men and women in the family (for example, that women should be the primary caretakers of children). Referencing the “natural” in breastfeeding promotion, then, may inadvertently endorse a controversial set of values about family life and gender roles, which would be ethically inappropriate.

Michael Cook is editor of BioEdge



This article is published by and BioEdge.org under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

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February
21
 

What about the welfare of the baby in a surrogacy transaction?

"Ad for surrogate mothers, Burbank, California, USA" by gruntzooki is licensed under CC BY-SA 2.0

In debates over surrogacy, most of the battles are fought over the rights of the commissioning parents or the welfare of the surrogate mother. But what about the welfare of the baby? This is an area investigated by a Singaporean legal academic in the journal Public Discourse.

Seow Hon Tan, of Singapore Management University, says that surrogacy must not be legalised as it is not in the best interests of the child. She advances several reasons.

Epigenetics. Life in the womb can affect the foetus. Since surrogate mothers often have, and are always encouraged to have, weak emotional attachments to the child they are gestating, this could somehow be communicated to the foetus. Furthermore, surrogacy places unpredictable stresses on the surrogate mother. “Evidence of poorer attachment in surrogate pregnancies should make us uneasy, as it can lead to problems for the children later on,” she writes.

Separation from the Gestational Mother. The baby could suffer trauma when it is separated from its mother. This is well documented in cases of adoption. What gives commissioning parents the right to impose this trauma on surrogate children?

Bonding to Commissioning Parents. “After being separated from their surrogate mothers, newborns may face problems in reattaching to new parents,” Dr Tan writes. The commissioning mother lacks a genetic link to the baby, which could lead to difficulties in bonding. “Disconnecting childbirth from child-raising means commissioning mothers must raise their infants without being able to draw upon the benefit of maternal–fetal sensitivity and attachments in pregnancy.”

The desires of adult children. Children who want to meet their gestational mother in later life will probably be frustrated in that desire. “Surrogacy leaves a child wondering about the gestational, and possibly genetic, environment that so deeply formed the person he or she became.”

Michael Cook is editor of BioEdge   



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February
21
 

Portuguese president passes euthanasia bill to the Constitutional Court

President Marcelo Rebelo de Sousa

Portugal’s president has sidestepped the country’s controversial euthanasia legislation by asking for it to be reviewed by the Constitutional Court.

President Marcelo Rebelo de Sousa declared that the legislation appears "excessively imprecise," potentially creating a situation of "legal uncertainty" (see PDF).

Three weeks ago the bill passed easily in the legislature after a year of discussion.

The President, a former law professor who helped draft the 1976 constitution, also has some misgivings about whether the bill is consistent with the Portuguese constitution which says that human life is “sacrosanct” – even though abortion has been legal since 2007.

The bill permits terminally ill adults with “unbearable suffering” to end their lives. Rebelo de Sousa noted that this “seems to inculcate a strong dimension of subjectivity” and asked how physicians were expected to assess pain as “intolerable.”

The question is not, apparently, whether or not euthanasia is constitutional but whether the law has been framed properly.

“It does not seem that the legislator provides the physician involved in the procedure with a minimally secure legislative framework that can guide his performance,” Rebelo de Sousa wrote. “This insufficient normative densification does not seem to comply with the constitutional requirement regarding the right to life and human dignity, nor with the certainty of the Law.”

In Portugal’s legal system, the head of state can approve a bill, veto it, or send it to the Constitutional Court for review. The court must give its decision within 25 days.

If the bill is signed into law, Portugal will become the fourth country in Europe to legalize euthanasia, alongside the Netherlands, Belgium, and Luxembourg.

Michael Cook is editor of BioEdge



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February
21
 

Will human germline editing promote equality?

The topic of heritable genome editing is still very much alive, as Australia’s move towards legalising replacement mitochondrial therapy shows. An article in The New Bioethics argues that it is not only forbidden by a variety of international agreements, but it is always going to be “incompatible with the concept of equality in value and in worth of all human beings in a genuinely inclusive society”.

The classic expression of the opposite point of view comes from Australian bioethicist Julian Savulescu. He once wrote: “To say that X is bad, or not desired by me, is not say that John or Julie with X has few rights. Selecting embryos for certain characteristics or treating diseases are both entirely independent of the equality of persons.”

This is mistaken, contends Calum MacKellar, of the Scottish Council on Human Bioethics. Drawing on several strands of analysis, he points out that “a clear inconsistency exists in ensuring that certain individuals are not brought into existence while encouraging the unconditional acceptance of all individuals, irrespective of their genetic characteristics”.

He concludes, that in the absence of extenuating circumstances:

(1) Choosing between possible future persons is an outward expression (revelation) of a discriminatory value system of a person or a whole society already in the real existing world. Such as system accepts an inequality in the inherent value and worth of existing persons with, for example, a disability and

(2) Such a choice may give a real negative message to persons with a condition, such as a disability, who already exist, that they should not have existed.

In short, human germline editing is incompatible with an equal, inclusive society. Instead of seeking to destroy children who may have disabilities, it should try to provide a supportive environment in which they can flourish despite their disability. His argument comes into focus when he applies it sex-selection. A society which permits sex-selection against girl babies is hardly going to be a society which promotes equality between the sexes. Similarly, a society which allows germline editing to eliminate certain types of people is not a society which would take equality seriously.

It is an interesting perspective on an increasingly heated topic.

Michael Cook is editor of BioEdge



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February
14
 

Amendments to Canada’s euthanasia law threaten traditional ‘standard of care’

The Canadian Parliament is debating a major expansion of the country’s 2016 euthanasia act. Critics say that the amendments will make Canada’s law the most permissive in the world.

Bill C-7 intends to give access to “Medical Assistance in Dying” (MAiD) to people whose natural death is not reasonably foreseeable. It establishes more relaxed eligibility rules for those who are near death, including a form of advance directives, and more stringent rules for those who are not.

Writing in Policy Options, Trudo Lemmens, Mary Shariff and Leonie Herx contend that C-7 endorses an ablist prejudice that life with a disability has less dignity or is less worth living. It transforms MAiD “from a procedure to facilitate dying into a terminal therapy for life’s suffering”.

The particular effect they zero in on is that the Bill abrogates a doctor’s traditional “standard of care”, which obliges “physicians to apply their skills and intricate knowledge to a patient’s particular clinical circumstances.” Instead patient choice becomes the criterion for deciding whether or not he or she is eligible for MAiD.

That physicians need to obtain “informed” consent from the patient before engaging in MAiD is obviously key. But they must also generally act according to the “standard of care” which is based on evidence-informed standards, shared among professionals and in line with their acquired clinical expertise.

The fact that a patient ultimately consents to a treatment proposed by a physician does not dislodge this a priori standard. It is part of medical practice that physicians can present only those medical treatment options that are reasonably and objectively indicated based on the “standard of care.”

They use the example of a hip replacement to illustrate the problem. Before surgery, which is risky and painful, a doctor will advise a patient to modify his lifestyle or to use pain medication. He doesn’t reach for a scalpel immediately.

But C-7 effectively allows a patient to self-diagnose his “enduring and intolerable suffering” and to prescribe the remedy, death. This is obviously a very tricky problem for patients with mental disorders.

This is a stunning reversal of the central role of the medical and legal concept of the standard of care. It lifts “informed consent” up to the status of the sole arbiter of what constitutes proper medical practice. This development is also internationally unprecedented. Even the three most permissive MAiD regimes in the world -- Belgium, the Netherlands, Luxembourg, the only ones that currently permit physician-provided ending of life outside the end-of-life context -- treat MAiD rightly as the last resort, available when no other options are seen to remain.

The authors caustically observe that Canadian doctors have surrendered their professional integrity.

By supporting Bill C-7, medical organizations are handing over to patients the determination of professional standards. They are thereby also abandoning their commitment to patients to provide the best evidence-informed care, based on the concept of “informed consent” that we also know is rarely if ever fully realized in practice.

Parliamentary critics are also alarmed at the haste with which the law is changing. “Colleagues, how did we get to this point, where we are debating an overhaul of our entire regime a few short years after its enactment and before we have even undertaken a parliamentary review?” asked Opposition Senate leader Don Plett this week. “As has been said before, we are here because of a lower court decision made by one judge, in one province and because the government chose not to defend its own legislation.”

Michael Cook is editor of BioEdge    



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February
14
 

Planned Parenthood offering transgender service to teens

Planned Parenthood is moving into transgender treatment for teenagers, according to a report by journalist Abigail Shrier.

On her SubStack blog, Shrier, a Wall Street Journal journalist and author of the 2020 book Irreversible Damage, interviewed a former Planned Parenthood employee who used to provide treatment for children who wanted to change their gender.

The employee, who wished to remain anonymous, insisted that she agreed wholeheartedly with PP’s core mission of providing abortions, but she had serious misgivings about providing transgender treatment. She worked in a small American city of about 30,000 people and says that one or two natal female girls would arrive as new clients every day requesting testosterone. “A few reasonable assumptions and some arithmetic reveal that a shocking percentage of the town’s teen girls came through the clinic over just a few years,” writes Shrier.

The girls did not receive top-drawer medical attention:

There were no doctors at the clinic where she worked. Nurse practitioners were the professionals with the highest medical training, she said. The clinic employed a gender counselor who had “no actual professional credentials or formal training other than being MtF” (that is, a male-to-female transgender person). Adolescents would come and speak to this gender counselor and Planned Parenthood would then forward the counselor’s “notes to an actual licensed mental health professional somewhere off-site, and rubber stamp approve the patients to begin their transition. This is basically how they circumvented the requirement to speak to an actual counselor,” according to the employee’s Twitter post.

Embarking upon testosterone treatment is risky. Shrier’s whistleblower was supposed to get them to sign an informed consent form before commencing treatment. “I can say anecdotally that I never saw anybody read it,” she said.

Shrier concludes: “According to the Planned Parenthood employee’s testimony, in affirmative care clinics like this one, for teens seeking fast medical transition -- the medicine cabinet is fully stocked, the customer is always right, and the light is always green.”

Michael Cook is editor of BioEdge



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February
14
 

Should smokers be prioritised for the vaccine?

Should smokers be prioritised for a Covid-19 vaccine? Several American states have decided that they should be. In Massachusetts, New Jersey, Mississippi, Pennsylvania and Virginia, they can receive the vaccine ahead of low-risk groups.

“The goal is to get people at greatest risk,” said Jennifer Tolbert, director of state health reform at the California-based Kaiser Family Foundation. “By targeting those individuals, you can hopefully reduce the chance of them ending up in the hospital with more severe cases of COVID and at greater risk of dying.”

“The coronavirus is a respiratory disease, so a smoker is at higher risk,” says Dr Albert Rizzo, of the American Lung Association. “We know that smoking causes inflammation of the airways. When the virus affects us, it causes inflammation as well. Vaccinating smokers will help stem the tide of more and more people being hospitalized and help prevent the health-care system from being overwhelmed.”

But to many people this seems odd, if not unfair. Aren’t smokers being rewarded for not taking care of their health?

In an interview in the Bill of Health blog, the director of Harvard’s Petrie-Flom Center, Carmel Shachar, explains that smoking “smoking is often the result of structural and biological factors that make it more prevalent in historically marginalized communities, and that denying priority access for smokers would reinforce existing inequities”.

What about the argument that smoking is a matter of choice?

Echoing the arguments of critical race theorists, Dr Shachar contends that this would burden “the health of communities of color and lower socioeconomic communities. There’s an equity argument to acknowledge that not everybody grows up in a community that is supportive of avoiding smoking and avoiding the peer pressure that leads to it, and that hasn’t been targeted as aggressively by advertisements to encourage people to smoke.”

Michael Cook is editor of BioEdge  



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February
14
 

China continues on a demographic slide

The number of registered births in China has dropped for the fourth consecutive year, despite the nation’s new two-child policy.

Figures from the Public Security Ministry released this week showed 10.04 million births were registered in 2020, a staggering 15% drop from 2019. The sex ratio was 1.11 boys for every girl, which suggests that sex selection in favour of boys is still occurring. The natural sex ratio is about 1.06.

The number of registered births is typically lower than the actual number of births, as some parents do not register children immediately. The official birth data will be released in April.

“China has fallen into a low-fertility trap,” Liang Jianzhang, an economics professor at Peking University’s Guanghua School of Management, wrote in an article last week. “Although the number of births in 2020 was the lowest in recent decades, it seems likely to be the highest figure for the next few decades.”

According to Sixth Tone, in the past month, several cities — including Guangzhou in the south, Yinchuan in the northwest, and Wenzhou and Weifang in the east — have released their own data showing birth rate declines ranging from 9% to a jaw-dropping 26%. “The new data adds fuel to concerns about an impending demographic crisis. Birth rates have been declining in China since 2016, with the country in 2019 recording its lowest birth rate — 10.5 newborns per 1,000 people — since the founding of the People’s Republic over 70 years ago.”

In a gloomy article in Caixin, demographers Liang Jianzhang and Huang Wenzhang, do not foresee a recovery in the birth rates:

“China’s fertility rate has been lower than the replacement rate — the rate required to maintain a new generation being as populous as an older one — for over 27 years. In the future, the fertility rate will face further downward pressure. Even if family planning is liberalized immediately, as long as births are not vigorously encouraged by policies, the number of births will continue to decline after a short rebound, and the population will age profoundly. Excluding technological advancement, the scale of China’s economy will continue to shrink, lowering the economies of scale. Ultimately, China will lose its advantage of maintaining a comprehensive collection of all industries, see a fall in per capita income and a decline in national strength.”

Michael Cook is editor of BioEdge



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February
14
 

Another call to abolish the 14-day rule for human embryo research

It's time to extend the legal limit on human embryo research from 14 to 28 days, because technology and knowledge have moved on during the 40 years since it was introduced, urges a bioethicist in the Journal of Medical Ethics.

The “14-day rule” was invention of the UK’s 1984 Warnock Report and it became part of the law in 1990. It limits research on intact human embryos to this period. Why 14 days? The late Dame Mary Warnock freely admitted that it was arbitrary. But a clear limit was needed to regulate IVF and “everyone can count up to 14, and everyone can keep and examine records.”

“The number 14 was not arbitrary in the sense that we drew it out of a hat,” she argued. “But it was arbitrary in the sense that it might have been a different number, though not very greatly different. At any rate, a workable law demanded a degree of invariability.”

"For the past 40 years, the 14-day rule has both governed and enabled embryo research and therapeutic innovation globally. It has been a piece of legislation and a rule of good practice, defining a clear boundary in which valuable research has been able to proceed against some considerable opposition," writes Sophia McCully of King's College, London.

But it is now safe and timely to make a policy change and extend the rule without fear of any "moral and regulatory slippery slope," she says.

Many studies suggest that important changes in the embryo that occur before 14 days are likely to affect subsequent development. But without the ability to go further, their real significance will be hard to understand, she argues. And as the embryo only starts to develop after 14 days, "how are we to learn about our beginnings if we cannot study them?" she asks.

There are also ethical and philosophical reasons why the 14-day rule needs to be amended, she says. It is legal to abort an embryo or foetus substantially 'older' than 14 days, and, with appropriate consent, to do research on its tissues, yet it is illegal to experiment on an embryo beyond 14 days that was never intended for implantation.

With the ability to uncover why an embryo might have abnormalities through experiments on intact embryos maintained beyond 14 days, and then use new technologies to avoid or correct the problem, the frequency of selective abortion and therefore embryo and “foetal wastage” might be reduced, she suggests.

Michael Cook is editor of BioEdge



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February
14
 

Australians spending A$1 billion on cosmetic surgery

Australia’s spending on cosmetic procedures topped A$1 billion in 2020 for the first time, according to the Cosmetic Physicians College of Australasia.

And a clinical psychologist has warned of the dangers of normalising cosmetic procedures. Dr Ben Buchanan, a specialist in body dysmorphia, told news.com.au that people are getting procedures which they might not need.

Cosmetic surgery is becoming as commonplace as getting braces, said Dr Buchanan, who runs a body image clinic in Melbourne.

He says that many people benefit from cosmetic procedures; they become happier and have more self-esteem. However, people with body dysmorphia disorder (BDD) are often very dissatisfied and step onto a treadmill of having procedure after procedure. In fact, 84% of cosmetic surgery patients who have BDD will be disappointed with the results.

“Cosmetic procedures can be a reasonable thing for most people to do, unfortunately it’s very risky for someone with body dysmorphia disorder, to the extent where they think their surgery made them look worse or even that their surgeon did a botched job.”

Dr Buchanan said people with BDD have an “exceptionally detailed visual perception compared to most people” and are far more likely to see so-called flaws that others don’t see.

“People with BDD often think if only they looked better they’d be in a better job, they’d have a better relationship, they’d be richer, that everything would fall into line. There’s this false idea that looking good leads to a good life.”

People with BDD can be thinking about their appearance “every moment of the day”. Their illness has high comorbidity with depression and obsessive-compulsive disorder.

There are risks, too, for the surgeons. A 2002 study indicated that a third of cosmetic surgeons had been threatened with legal action. About 10% said that patients with BDD had threatened them both legally and physically.

Risks for both surgeons and patients notwithstanding, only 30% of the surgeons believed that BDD was a contraindication for their handiwork. It must be a lucrative business!

Michael Cook is editor of BioEdge  



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February
14
 

Arkansas Senate passes expanded medical conscience law

The Arkansas Senate has passed Senate Bill 289, the "Medical Ethics and Diversity Act" which enlarges the scope for conscientious objection for healthcare workers. Arkansas’s current conscience protections are narrowly focused on abortion, abortifacients, and end of life decisions, and they protect only a limited number of people.

The bill is modelled on laws in Illinois and Mississippi. SB 289 effectively extends them to cover LGBTQ+ medicine. The bill has passed the Arkansas Senate and is currently before the House Public Health Committee. The text of the bill frames the issue as a civilisational crisis:

The right of conscience was central to the founding of the United States, has been deeply rooted in the history and tradition of the United States for centuries, and has been central to the practice of medicine through the Hippocratic oath for millennia … The swift pace of scientific advancement and the expansion, of medical capabilities, along with the notion that medical practitioners, healthcare institutions, and healthcare payers are mere public utilities, promise only to exacerbate the current crisis unless something is done to restore the importance of the right of conscience.

The bill “is a blatantly discriminatory attempt to strip LGBTQ people of basic rights,” said a spokesman for the Human Rights Campaign, an LGBTQ+ lobby group. “Health care should be available to all who need it, not withheld by providers because of hate and fear.”

Similar legislation was filed in Arkansas in 2017 and 2019, but neither bill made it out of committee.

Michael Cook is editor of BioEdge   



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February
06
 

Bioethicists call for active advocacy to combat institutional racism

For a discipline which was only born about 50 years, bioethics has reimagined itself time and time again. A number of articles in the latest issue of the American Journal of Bioethics argue that it needs to change again.

The authors, three academics from Harvard Medical School, sum up their aims in the target article, “Race, Power, and COVID-19: A Call for Advocacy within Bioethics”. They argue that “Ultimately, we advocate for a proactive form of bioethics that actively resists and denounces injustice and which considers a much wider variety of voices about justice than bioethics has historically considered.”

The architects of the once dominant paradigm in bioethics in recent years, Beauchamp and Childress, are mentioned once, compared to the French theorist Foucault, who is mentioned 12 times – which gives you an idea of which direction the wind is blowing from.

The authors target white normativity and advocate for a bioethics which is not merely more sensitive to racism, but laser-focused on it.

This may involve novel reconceptualization of how the notion of racism works.

For instance, the notorious Tuskegee syphilis experiments are often used as a touchstone of racist scholarship in the principalist framework promoted by Beauchamp and Childress. But the authors contend that “fascination with Tuskegee and other horrific events have truncated our awareness of the history, depth, and systemic character of American racism”.

They also deal with “implicit bias” in a way which may surprise readers who have discovered the concept only recently. It is already superannuated. “Limiting discussions of racism in bioethics to the problem of bias reduces our conception of justice into imagining how the other who is excluded might feel. While this is important, we must also address the structural factors at play on why one is made to feel that way.”

The first resolve of this new iteration of bioethics is political engagement: “It is not enough to simply acknowledge or believe that something is unjust. Such a feeling needs to be coupled with verbalizing—overtly speaking—the injustice.”

A second is purging the bioethics establishment: “bioethics is embedded within the same power relationships that are mirrored throughout health, research and politics and will require us to ask who holds power and why in order to begin to rectify the displacements that have been perpetuated.”

A third, is “counter story-telling” – highlighting the experiences of the marginalised. “The way we understand, teach, and write within and about bioethics should involve an audit of what is not included within current ethical discourse.”

A fourth, is a move away from “bedside issues” – because “bioethics has gone too small”. So, “Going forward, bioethicists need to focus on more creative ways to address systemic societal issues and incorporate advocacy in a meaningful way within their ethical work.”

As the authors note in their concluding remarks, they believe that the road ahead for bioethics will be painful as old ideas are unlearned and relearned. Bioethicists need to embrace “an ethic of discomfort”. Upcoming bioethics conferences will be interesting affairs. 

Michael Cook is editor of BioEdge



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February
06
 

NEJM backs transgender turn in US govt policy

On the evening of his inauguration President Joe Biden made it his business to send strong signals about the trans-friendly policies of his Administration. He signed an executive order to ban discrimination on the basis of gender identity and sexual orientation which wound back some of the trans-unfriendly policies of his predecessor.

Gender has clearly become a political battleground in the United States. How did this happen?

The New England Journal of Medicine this week gave Norwegian medical historian and bioethicist Ketil Slagstad a platform to help normalise transgenderism and to contest the notion of “naturalness” in medicine.

In the history of medicine Dr Slagstad sees five “‘anomalous’ forms of embodiment and identities” the hermaphrodite, the homosexual, the intersex body, the transsexual, and the transgender person. There never has been an uncontested binary notion of sex, he argues, even as far back as Hippocrates and Galen. And in the 19th and 20th centuries doctors and writers like Richard von Krafft-Ebing, Magnus Hirschfeld, John Money and Robert Stoller illuminated the idea that gender is a spectrum and that sex is plastic and malleable.

His underlying idea is that the idea of “naturalness” has been tossed into the dustbin of history:

These examples demonstrate how transgender rights trigger discussions about the nature of sex. But that effect is nothing new: repeatedly throughout the history of Western thought, “nature” has provided a rich resource for shaping norms, settling categories, and stabilizing concepts of normality. What counts as natural and what role nature plays in the order of things, however, are historically contingent.

The lesson for America is that its political battles over transgender issues are part of a painful historical evolution of understanding of sex and gender which began as far back as ancient Greece.

The history of medicine offers an antidote to the notion that we are simply looking at “nature” when we see sex and gender: what counts as sex and gender is historically changeable, morally infused, and politically loaded.

Ultimately, then, Dr Slagstad seems to argue, defining what is natural is a political, not an ontological, question.

The NEJM is probably the world’s most prestigious medical journal and this contribution nails the transgender flag to its mast. So the article is bound to be controversial. Not long ago Theodore Dalrymple published a scathing critique of the NEJM’s editorial policy, False Positive. No doubt its critics will quote his central complaint:

When it pronounces on social philosophy, as it often does, it reads like Pravda, not in the sense that it is Marxist-Leninist, of course, but in the sense that it takes its own attitudes so much for granted, as being so indisputably virtuous and true, that other viewpoints are rarely if ever expressed in its pages.

Michael Cook is editor of BioEdge



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February
06
 

Spreading genes far and wide

A feature in the New York Times this week shows a very dark side of contemporary sperm donation. It examines the case of Jonathan Jacob Meijer, a Dutch musician in his 30s, who may have fathered 200 children – so far. Through donations to IVF clinics in the Netherlands, he has about 100; through private arrangements, another 80.

Even the New York Times suggests that at least more regulation is needed:

As an industry, however, it is poorly regulated. A patchwork of laws ostensibly addresses who can donate, where and how often, in part to avoid introducing or amplifying genetic disabilities in a population. In Germany, a sperm-clinic donor may not produce more than 15 children; in the United Kingdom the cap is 10 families of unlimited children. In the Netherlands, Dutch law prohibits donating anonymously, and nonbinding guidelines limit clinic donors to 25 children and from donating at more than one clinic in the country. In the United States there are no legal limits, only guidelines from the American Society for Reproductive Medicine: 25 children per donor in a population of 800,000.

The dismal truth is that some males get a kick out of spreading their genes far and wide. A member of Donor Offspring Europe told the Times that some men travel around Europe trying to have as many children as possible.

“It’s kind of disgusting in a narcissistic way,” she said. “No sane person would want 100 children or more. The big question is why? These men want confirmation that they’re a great guy and everybody wants them.”

Mr Meijer, it seems, has been donating to a number of sperm banks outside the Netherlands as well. Ties van der Meer, the director of the Dutch Donor Child Foundation, told the Times that his offspring could number several hundred or even 1,000.

Mr Meijer says that this is “ridiculous” and invokes an ersatz, mystical, flower-power interpretation of love. “I am disappointed by the obsession of the numbers,” he says. “I became a donor not for any numbers but out of love to help parents with realizing their dream. I cannot understand how anyone can only focus on numbers and see my donor children as a number.”

Michael Cook is editor of BioEdge



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February
06
 

Australian parliament to vote on 3-parent babies

For the first time since the same-sex marriage debate, Australian politicians are to have a conscience vote – this time on the controversial issue of “three-parent babies”.

At least 60 babies are born every year in Australia with mitochondrial disease. Scientists say that this could be prevented by replacing the mother’s defective mitochondrial DNA with healthy mitochondrial DNA from a donor egg.

This was approved in the UK in 2015 for “specific circumstances where inheritance of the disease is likely to cause death or serious disease” after a stormy public debate. Critics claim that it could open the door to genome editing – which is currently banned nearly everywhere in the world.

The Prime Minister, Scott Morrison, has declared that he will support the reforms.

“I do hope we can go forward here where science allows us to do this. And as you know, I’m a person who has strong religious beliefs as well but it presents no difficulty for me on this issue. And I think the compassionate thing to do here is to find a way where if we can avoid that horrific, horrific suffering then I believe we should.”

Michael Cook is editor of BioEdge



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February
06
 

Euthanasia round-up

Germany: Legislation was tabled in the German parliament last week which would permit assisted suicide for terminally ill adults after they have received counselling. Germany’s high court has ruled that assisted suicide groups may help people die, but legal guidelines still do not exist. “Everyone who is able to make decisions for themselves should also be able to decide when they want to die,” Katrin Helling-Plahr, of the liberal Free Democrats, says.

According to her bill, only people who have decided autonomously that they want to die will be eligible. They must be able to "weigh the pros and cons on a sufficient basis of assessment in a realistic manner" and "the suicide-willing person must be aware of alternative courses of action to suicide."

Portugal. Euthanasia could become legal soon in Portugal if its President signs legislation. Legislators have already passed a law decriminalising euthanasia and assisted suicide for terminally ill people over 18 who do not suffer from a mental illness who are suffering from unbearable pain and an incurable disease. The President, Marcelo Rebelo de Sousa, has not indicated his intentions. It is possible that he will veto the bill and send it to the constitutional court. Article 24 of the country’s basic law states that human life is inviolable.

Australia. A veteran politician in the governing Liberal Party, Kevin Andrews, has lost preselection and will not be standing in the next election. Back in 1996 and 1997 Andrews became the Parliamentary leader of opposition to euthanasia after the Northern Territory legalised it. Taking advantage of the Top End’s constitutional status as a territory, the Federal Parliament quashed the legislation in a conscience vote. Ever since, Andrews has been in the cross-hairs of euthanasia activists, notably Dr Philip Nitschke, who campaigned against him twice in his safe Liberal seat of Menzies. On his website, Nitschke reflected on the event which launched his career:

“In retrospect, it was little wonder the ‘Euthanasia Yes’ campaign was defeated. Not only was the Commonwealth–Territory power not on our side but the media, the Church and a whole network of powerful and wealthy people pulled out all the stops to defeat the landmark legislation.”

Things are different now in Australia.

Michael Cook is editor of BioEdge



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February
06
 

Should politicians be held to account for mishandling the pandemic?

Politicians around the world must be held to account for mishandling the Covid-19 pandemic, argues the executive editor of the BMJ, Dr Kamran Abbasi. At the very least, mishandling Covid-19 might be classified as ‘social murder’.

When politicians and experts say that they are willing to allow tens of thousands of premature deaths, for the sake of population immunity or in the hope of propping up the economy, is that not premeditated and reckless indifference to human life, he asks.

“If policy failures lead to recurrent and mistimed lockdowns, who is responsible for the resulting non-Covid excess deaths? And when politicians wilfully neglect scientific advice, international and historical experience, and their own alarming statistics and modelling, because to act goes against their political strategy or ideology, is that lawful?”

He acknowledges that any nation’s laws on political misconduct or negligence are complex, and not designed to react to unprecedented events, but says after more than 2 million people have died, “we must not look on impotently as elected representatives around the world remain unaccountable and unrepentant.”

If citizens feel disempowered, who might hold negligent politicians to account, he asks?

He points out that official scientific advisers have often struggled to convince politicians to act until it is too late or kept silent to avoid public criticism, while much of the media is complicit too, “worried about telling pandemic truths to their readers and viewers, owners, and political friends.”

It is this environment that has allowed Covid denial to flourish, for unaccountability to prevail, and for the great lies of ‘world-beating’ pandemic responses to be spun, argues Abbasi.

In a linked editorial, Clare Wenham, of the London School of Economics, asks what went wrong.

Looking at the latest report from the Independent Panel for Pandemic Preparedness and Response, she argues that the system we have established for global health security cannot respond adequately to a health emergency.

She calls for collaborative action to fix the identified weaknesses, but acknowledges that given the politicisation of responses globally, any efforts to develop a standardised response to health emergencies will have to overcome serious challenges to secure agreement among all member states.

"We need a targeted review that names and shames governments, rather than obscuring them with generalisations,” she writes. “I look forward to bolder reports from the independent panel that consider not only the economic and social effect of the pandemic but the failure of Western governments too.”

Michael Cook is editor of BioEdge



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February
06
 

Ultrasound used to jump-start brains of patients with severe brain injuries  

In 2016, a team led by UCLA's Martin Monti reported that a 25-year-old man recovering from a coma had made remarkable progress following a treatment to jump-start his brain using ultrasound.

Now, Monti and colleagues report in the journal Brain Stimulation that two more patients with severe brain injuries -- both had been in what scientists call a long-term "minimally conscious state" -- have made impressive progress thanks to the same technique.

"I consider this new result much more significant because these chronic patients were much less likely to recover spontaneously than the acute patient we treated in 2016 -- and any recovery typically occurs slowly over several months and more typically years, not over days and weeks, as we show," said Monti, a UCLA professor of professor of psychology and neurosurgery and co-senior author of the new paper. "It's very unlikely that our findings are simply due to spontaneous recovery."

The paper notes that, of three people who received the treatment, one did not benefit. However, the other two did.

The first is a 56-year-old man who had suffered a stroke and had been in a minimally conscious state, unable to communicate, for more than 14 months. After the first of two treatments, he demonstrated, for the first time, the ability to consistently respond to two distinct commands -- the ability to drop or grasp a ball, and the ability to look toward separate photographs of two of his relatives when their names were mentioned.

He also could nod or shake his head to indicate "yes" or "no" when asked questions such as "Is X your name?" and "Is Y your wife's name?"

In the days following the second treatment, he also demonstrated, for the first time since the stroke, the ability to use a pen on paper and to raise a bottle to his mouth, as well as to communicate and answer questions.

The other patient who improved is a 50-year-old woman who had been in even less of a conscious state for more than two-and-a-half years following cardiac arrest. In the days after the first treatment, she was able, for the first time in years, according to her family, to recognize a pencil, a comb and other objects.

Both patients showed the ability to understand speech.

"What is remarkable is that both exhibited meaningful responses within just a few days of the intervention," Monti said. "This is what we hoped for, but it is stunning to see it with your own eyes. Seeing two of our three patients who had been in a chronic condition improve very significantly within days of the treatment is an extremely promising result."

The scientists used a technique called low-intensity focused ultrasound, which uses sonic stimulation to excite the neurons in the thalamus, an egg-shaped structure that serves as the brain's central hub for processing. After a coma, thalamus function is typically weakened, Monti said.

Doctors used a device about the size of a saucer to create a small sphere of acoustic energy they can aim at different brain regions to excite brain tissue. The researchers placed the device by the side of each patient's head and activated it 10 times for 30 seconds each in a 10-minute period. Each patient underwent two sessions, one week apart.

Monti hopes to eventually translate the technology into an inexpensive, portable device so the treatment could even be delivered at patients' homes. While the scientists are excited by the results, they emphasize that the technique is still experimental and likely will not be available to the public for at least a few years.

For now, there is little that can be done to help patients recover from a severe brain injury that results in either a chronic vegetative state or a minimally conscious state, Monti said.

Thanks to UCLA Newsroom.

Michael Cook is editor of BioEdge  



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February
06
 

Tunisia is a Mecca for African IVF

Tunisia seems an unlikely place for IVF clinics, but according to a feature in Jeune Afrique, it has become “a destination of choice on the continent for assisted reproduction”. But since Tunisia pioneered family planning and abortion rights in the 1960s, perhaps it was predictable. Most foreign clients come from Libya, Algeria and sub-Saharan Africa.

IVF is not un-Islamic, according to one of the leaders of assisted reproduction in Tunisia, Professor Béchir Hamza. He liked to quote a hadith of the Prophet: "On the day of the Resurrection, the Prophet will be proud of the numerical importance of his community and believers are encouraged to reproduce".

Tunisians, however, do not appear to have been following the Prophet’s advice. The birth rate has fallen steeply, from 6.9 in 1962 to 2.1 today. That may be the reason why IVF has become so popular.

Tunisia only permits IVF for married couples and it bans sperm or oocyte donations. It also discourages the production of surplus embryos. Some doctors want these restrictions to be loosened. But there are no changes on the horizon. "We have found a balance between modernity, scientific advances and religious respect, there is no need to turn everything upside down," one lawyer told Jeune Afrique. "Being less permissive reassures future parents about the attribution of filiation and avoids problems of inheritance," says a family judge.

Excluding accommodation for the couple, the average cost of IVF in Tunisia is 4,500 dinars, or 1,300 euros. The government will cover the cost for Tunisian women under the age of 40 who have been married for three years benefit.

Over the years demand has been increasing, notes gynaecologist Faouzi Ariane. "Even if some infertility is psychological, or even inexplicable, more and more couples are taking the plunge and beginning an IVF process that will enable them to start a family -- and to avoid divorce, of which infertility is one of the most frequent causes.”

Hat tip to Gènéthique.

Michael Cook is editor of BioEdge



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January
31
 

Belgian euthanasia is broken, says academic study

Every once in a while, a bioethics article appears which is so powerful an indictment of injustice that it sends shivers up the spines of its readers. In 1949 Leo Alexander published “Medical Science under Dictatorship” in the New England Journal of Medicine, about Nazi medicine. In 1966 Henry K. Beecher published “Ethics and Clinical Research”, also in the NEJM, whose bland title belied its searing message about ethical catastrophes in contemporary American medicine.

Euthanasia in Belgium: Shortcomings of the Law and Its Application and of the Monitoring of Practice” just published in the The Journal of Medicine and Philosophy may not be as sensational as these landmark articles, but it gives them a run for their money.

Since 2002 euthanasia in Belgium and the Netherlands have been models for legal reform. Canada has followed it. Portugal is about to. In Belgium it accounts for an estimated 2.4% of all deaths, and much more in Flanders, the Dutch-speaking section of the country.

Yet the authors of the JMP article basically argue that Belgian euthanasia is broken ethically, administratively and legally. Its scope is ever-widening and the safeguards are failing. The commission in charge of overseeing doctors’ compliance with the law is ineffective or even complicit in a pro-euthanasia agenda. To document its stunning claims, it draws not on newspaper scandals but on thoroughly researched academic research over the past 20 years and the reports of the control commission itself.

The authors, Kasper Raus, Bert Vanderhaegen, and Sigrid Sterckx, all associated with Ghent University, make three main assertions.

First, the scope of the Euthanasia Law has been stretched from being used for serious and incurable illnesses to being used to cover tiredness of life.” Under the 2002 Belgian law, euthanasia for “tiredness of life” is not permitted. But doctors can circumvent the law by diagnosing “polypathology”– a jumble of ailments which nearly every elderly person has. – and this is sufficient for euthanasia. This represented 19.4% of all reported euthanasia cases in 2019 and a “staggering” 47% of all reported nonterminal cases.

Second, the obligatory consultation of one or two independent physicians may fail to provide a real safeguard. Their tasks are quite limited, and, more importantly, their advice is not binding anyway. The final authority to perform euthanasia lies with the attending physician who can perform it even against the (negative) advice of the consulted physicians.”

Here is one example of how the system can be gamed. If euthanasia is requested for a psychiatric condition, a psychiatrist should be consulted. However, if the patient has another condition, it can be redefined as “polypathology” and a GP can approve it, eliminating the need for a psychiatric consultation.

Third, “The Commission is unable to check the fulfilment of various legal criteria, and it has substantial authority to (re) interpret the Euthanasia Law as it sees fit.” In fact, “the Commission does not seem to act as a filter between physicians who perform euthanasia and the Public Prosecutor, but instead as a shield that prevents potentially problematic cases from being referred.”

Conflict of interest is baked into the composition of the 16-member evaluation committee. Eight of them must be doctors and many of them, including the chairman, Wim Distelmans, perform euthanasia regularly. So they end up checking each other’s files for irregularities. They are supposed to recuse themselves if one of their own cases comes up – but they don’t.

Nothing illustrates the ineffectiveness -- or connivance -- of the Commission better than its track record. In the 18 years since legalisation, it has only referred one case to the Public Prosecutor. And this case had been filmed by an Australian broadcaster and was so obviously in breach of the law that referral was needed to keep up appearances. The doctor was acquitted.

The Commission consistently defends the smooth operation of the law, asserting that despite glitches here and there regarding “non-essential’ features, the “essential conditions” are being upheld. But the authors point that there is no legal ground for this distinction. The Commission is arrogating to itself legislative powers which it does not have.

Policy-makers and politicians in Belgium ought to be horrified by the abysmal working of their country’s euthanasia law documented by these academics. But the authors are not optimistic. They conclude by saying that whether anyone will take them seriously remains to be seen.

Michael Cook is editor of BioEdge   



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January
31
 

Michigan doctor may have fathered ‘thousands’ of children

Dr Philip Peven with one of his donor sperm children, Jamie Hall / Jaime Hall/SWNS

Another dispatch from the Reproductive Revolution. BioEdge has been tracking the generosity of sperm donor dads for several years. Some men have fathered dozens of children, a few may have fathered hundreds. But in the case of Detroit gynaecologist and obstetrician Dr Philip Peven the word “thousands” is being used. It will be impossible to know, but he delivered some 9,000 babies in his 40-year career. Some proportion of those carry his genes. 

Dr Peven is now 105 years old, but is still in reasonably good health. Online DNA tests have united several of his offspring. Two of them confronted him early last year before the Covid-19 pandemic cut off personal contact. He explained to them in the late 40s that medical students and young doctors often donated or sold sperm. When he set up his own practice, he continued to use his own sperm to help women whose husbands had infertility problems. At least once he was given a vial of sperm from a patient’s friend, but discarded it and used his own. He has no idea how many offspring he has, although he told his visitors that “My daughter thinks I could have fathered thousands of children.'”

Some of the offspring have noted that Dr Peven is an Ashkenazi Jew and people with that genetic heritage are prone to Gaucher disease, Tay-Sachs disease and cystic fibrosis. Many of his patients belonged to Detroit’s Jewish community, complicating matters still further.

The Jewish News newspaper has covered this story extensively and found that other doctors were involved. One of the offspring of these other doctors made comments which apply to Dr Peven as well.

“I now realize that it was a different time, a time when doctors were not questioned, but I still consider the doctor’s behaviour unprincipled, unethical and possibly dangerous,” the person said. “The possibility was certainly there that half-siblings could meet, marry and have children. I do realize the doctor was trying to be helpful in enabling couples to have a child, but he should have told the mother he was using his own sperm. I doubt most women would have said yes to that scenario.”

As The Jewish News sought more information about Dr Peven, it unearthed deceptive donor sperm practices by other fertility doctors in Detroit. Dr Sylvester Trythall, who died in 1970, told one patient in the late 50s that he was going to mix her husband’s sperm with a medical student’s. But online geneology sleuthing by a woman named Lynne Weiner Spencer showed that she was really the daughter of Dr Trythall’s handyman, Hank Heemsoth, who died in 2006. Now it appears that Mr Heemsoth was the biological father of about 60 children – not many compared to Dr Peven, of course -- but still noteworthy.

Michael Cook is editor of BioEdge   



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January
31
 

NEJM study questions conventional wisdom on dying process

A new international study in New England Journal of Medicine, documents the physiology of the dying process. More than 600 families were asked to allow their loved ones in the ICU to have vital signs monitored during the dying process.

The researchers found that the classic "flatline" of death is not so straightforward. The study showed that cardiac activity often stops and re-starts several times during the dying process before it finally stops completely - although no one in the study regained sustained circulation or consciousness.

Amongst 480 patients, 67 (14%) of them resumed cardiac activity after a period of pulselessness. The longest duration after pulselessness before resumption of cardiac activity was 4 minutes, 20 seconds.

The study provides evidence to support the current standard to wait for 5 minutes after the heart stops before determining death and proceeding to organ donation.

Confirmation of the current standard is important. For families to choose organ donation when a loved one has died, they must be able to trust that death has really happened and that it is irreversible. Trust allows people to decide to donate at a time of grief and allows the medical community to feel comfortable opening a dialogue about donation.

For donation after circulatory-determined death to be medically possible, death must be declared within a window of time after life sustaining measures are withdrawn. Yet stories persist about people "coming back to life" following a declaration of death, and up to now there has been little evidence to inform the medical understanding of dying.

Further work using the study data will allow donation and transplant teams to predict how long it will take patients to die after removing life-sustaining measures. Predicting a time of death would be immensely useful to coordinate donations and to improve how organs are allocated.

Michael Cook is editor of BioEdge



This article is published by and BioEdge.org under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation. Commercial media must contact us for permission and fees. Some articles on this site are published under different terms.

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January
31