January
24
 

Chinese actress dumped by Prada after she dumped her two surrogate babies

Chinese actress Zheng Shuang in her brief time as a Prada ambassador

Bioethical standards are loose and murky in China, but there are things which do provoke outrage. No, we are not talking about the alleged genocide of Xinjiang's Uyghurs. The issue du jour is that a popular model and actress, Zheng Shuang, has been accused by her estranged former partner of abandoning two children whom she commissioned from two surrogate mothers in the United States.

A wave of outrage swept through Chinese social media. As a result, she was immediately dumped by the luxury goods firm Prada as a brand ambassador. Government regulators have blacklisted her.

Zhang Heng, her former partner, says that he has been stranded in the US for over a year because he “must take care of and protect two young and innocent lives”. Ms Zheng is reportedly listed as the children’s mother on the children’s birth certificates.

A leaked tape of a conversation helpfully emerged in which Zheng, Zhang and their parents were discussing what to do with the then-unborn children, after the celebrity couple had broken up.

Zheng’s father suggested that they abandon the children at the hospital, while Zhang’s father said it would be illegal. Zheng’s family then suggested giving the children up “for adoption”, while Zheng expressed annoyance that they could not be aborted.

The government is not pleased with these developments. The Central Political and Legal Affairs Commission of the Communist Party of China said: “Surrogacy is banned in China as it uses women’s uteruses as a tool and sells life as a commercial product. As a Chinese citizen, the act of travelling to the US on a legal loophole is not abiding the law.”

The state broadcaster CCTV also commented that “surrogacy is banned in China because it overlooks life”, and even called it “trampling the bottom line [of human morality]”.

While surrogacy is effectively banned in China, an article last year in International Journal of Law, Policy and the Family said that: “Driven by high demands from society, the surrogacy industry has flourished in recent years in China with an estimate of 10,000 resulting children born every year.”

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.

comments powered by Disqus
 
January
24
 

How many embryos are frozen in China’s IVF clinics?

Over 200,000 IVF babies are born in China every year. This means that millions of embryos may be frozen in storage – even though most couples do not pay the annual fee.

This is creating a conflict of values for IVF clinics. On the one hand, keeping the embryos is expensive and takes up medical resources. On the other, they are very reluctant to destroy them. "At present, there are about 100,000 frozen embryos stored in the reproductive centre of our hospital that have not had the preservation fee paid. The fees of about 80,000 frozen embryos have not been renewed for more than a year," a doctor in Zhengzhou, the capital city of Central China's Henan Province, told the Global Times. "Most hospitals, not only hospitals in Zhengzhou, but also reproductive centres in other places in China, chose to preserve overdue embryos," she said. Zhengzhou is a city of 10 million, but that is just 1% of China’s population.

There are several factors involved in the clinics’ reluctance to dispose of the embryos. Hospitals are permitted to discard the embryos if they have the parents’ consent – but most parents neither consent nor pay for storage. “I don’t think any hospitals in China really discard embryos,” a Beijing doctor told CGTN. “From a doctor’s perspective, an embryo has the potential to grow into a baby. We feel uncomfortable destroying it.” But, he added, “We have some patients who haven’t visited our centre for more than a decade, but we still keep their embryos. But now our centre is running out of place storing the growing number of nitrogen tanks. What are we supposed to do?”

He said that they are also afraid of legal consequences. “No existing laws clearly define if embryos are humans or substances. Even if we sign contracts with patients that state we can discard embryos, what if a future law says embryos are actually human? Then we would face serious consequences."

As in other countries, the dilemma of China’s frozen embryos seems insoluble.

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.

comments powered by Disqus
 
January
24
 

Why do euthanasia rates vary across the Netherlands?

There is a seven-fold unexplained variation in rates of euthanasia across The Netherlands, reveals an analysis of health insurance claims data, published online in the journal BMJ Supportive & Palliative Care.

It's not clear if these differences relate to underuse, overuse, or even misuse, say the researchers.

Official data show that the number of euthanasia cases has risen more or less continuously since 2006, reaching 6361 in 2019. These cases make up just a small proportion of all deaths, but they have doubled from just under 2% in 2002 to just over 4% in 2019.

To explore this further, the researchers analysed national insurance data, covering all healthcare claims for the 12 months preceding the deaths of Dutch residents between 2013 and 2017.

They focused on euthanasia carried out by family doctors, which comprised 85% of all euthanasia cases, to calculate rates for 90 regions, 388 municipalities, and 196 districts in the three largest Dutch cities: Amsterdam; Rotterdam; and The Hague.

Some 25,979 claims for euthanasia were made between 2013 and 2017, with slightly more men than women opting for the procedure every year. The average age increased from 71 in 2013 to 73 in 2017.

The numbers of procedures varied widely across the country. The regions with the highest proportion of euthanasia cases as a proportion of all deaths, referred to as the euthanasia ratio, had roughly five times more euthanasia deaths than in the regions with the lowest.

There were also striking differences between the three largest cities in the Netherlands.

In Amsterdam, in the three districts with highest rates of euthanasia, the proportion of these deaths was between nearly 12% and around 14.5% higher than in Rotterdam, where the proportion remained more or less static at around 6%. In The Hague the rate of euthanasia in the three districts with the highest rates of euthanasia, the proportion of these deaths rose from nearly 7.5% to more than 11%.

Throughout the five years, the rate in the top three municipalities was 25 times higher than that of the bottom three.

Age, church attendance, political orientation, income, subjectively assessed health, and availability of community volunteers all emerged as potentially influential factors.

For example, in regions with relatively high numbers of 45-64 year olds, people were more likely to opt for euthanasia while in regions with a high proportion of church goers, they were less likely to do so.

Similarly, progressive political views were associated with higher rates of euthanasia while a higher percentage of community volunteers was linked to lower rates.

Higher rates of euthanasia were also associated with higher household income and good self-reported mental and physical health, possibly because the well off and the healthy may be more inclined to ask for assistance in dying when they do suffer, suggest the researchers.

After accounting for these factors, there was still a 7-fold geographical difference in rates of euthanasia across the country, for which there was no obvious explanation.

"The unexplained part of the variation may include the possibility that part of the euthanasia practice may have to be understood in terms of underuse, overuse or misuse," suggest the researchers.

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.

comments powered by Disqus
 
January
24
 

Radical right-to-die activists arrested in France

Ten members of the Ultime Liberté association, which campaigns in France for the legalization of assisted suicide, have been arrested for trafficking in the banned suicide drug pentobarbital.

Founded in 2009, Ultime Liberté is the radical wing of the right-to-die movement in France. It claims to have 3,000 members scattered throughout the country.

"Our goal is that euthanasia can legally have the right of citizenship in France " the magazine Marianne was told by one of its members. Ultime Liberté wishes to " obtain for any capable person the legal recognition of the freedom to choose the time, place and terms of his death recognized by a law including assisted suicide, or voluntary euthanasia when the person is in a state where he can no longer communicate and he has written his advance directives."

The activists, aged between 60 and 80, are accused of having helped other members of the association to obtain pentobarbital. Does Ultime Liberté buy it and resell it to its members? Not officially, but it appears that the arrested members of the association had sent encrypted messages giving information about how to obtain the drug.

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.

comments powered by Disqus
 
January
24
 

Family splits over fate of unresponsive man in England 

The Catholic Church in England has protested strongly against a decision to withdraw hydration and nutrition from a man who became permanently comatose after a heart attack in November.

Mr RS, a Polish citizen who lived in Britain for many years, has been in a hospital in Plymouth. Doctors there felt that he was completely unresponsive and would have no “quality of life”. If given food and water, he would probably live another five years. Without them, he would die within a few weeks. So, with the agreement of his wife, they applied to withdraw food and water so that he would die. On December 15, the Court of Protection granted their request.

The prognosis for RS was not in dispute. But his wife and his family were at loggerheads over what should be done.

RS was, everyone agrees, a staunch Catholic (although he attended Mass only about once a month) and consistently supported a “pro-life” perspective on abortion and euthanasia. However, he was distant towards a sister, who lives in the UK, and other relatives in Poland, perhaps because he had married a divorcee outside the Catholic Church.

His wife testified that he would not want to live in a comatose state and be a burden to others; his family said that he would oppose the course of action recommended by the Court of Protection because of his Catholic beliefs.

English law allows doctors to withdraw nutrition and hydration if it is deemed to be in the “best interests” of a patient. In RS’s case, Mr Justice Cohen found that the wife’s testimony was more persuasive and ruled that the course that he would want to be taken is the course which in this case is that which is in his best interests.”

In their letter to the Health Secretary, Matt Hancock, Catholic bishops stated: ‘

“The Catholic Church continues to oppose the definition of assisted nutrition and hydration as medical treatment which has now become the basis of medical and legal decisions to withdraw assisted nutrition and hydration from patients. Providing food and water to very sick patients, even by assisted means, is a basic level of care. This care must be given whenever possible unless it is medically indicated as being overly burdensome or failing to attain its purpose.”

The director of the Anscombe Bioethics Centre, David Albert Jones, wrote a lengthy comment on the case of RS. He pointed out that “The grave danger of this judgement is that committed Catholics and those who hold a similar view about the human significance of food and drink may be starved and dehydrated to death against their will.”

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.

comments powered by Disqus
 
January
24
 

A new Swiss group caters for Dutch who are not eligible for euthanasia

You might think that the Dutch, who live in a country where euthanasia is legal, would have no need for the schemes of Dr Philip Nitschke, Australia’s rogue right-to-die campaigner. You would be wrong.

The Dutch magazine Trouw profiled an 87-year-old man, Kees Kentie, who went to Switzerland to die with the help of a new assisted suicide organisation, Pegasos, which is affiliated with Nitschke’s Exit International. As he explained in a recent tweet:

"The Swiss have not medicalised their end-of-life laws. Those tired of life can be helped, and couples can die together. Pegasos makes this possible. This pisses off the Dutch, where you MUST be sick, from NL, and a doctor makes the decisions, not you."

Kentie, who is not terminally ill, but frail and tired of life, wanted to die. But no Dutch doctors would help him as he did not fulfil the euthanasia law’s criteria.

So he looked into dying in Switzerland and found Pegasos which promises shorter waiting times and less red tape and conducts business in English.

Kentie went to Switzerland with two Dutch friends who made sure that he was comfortable and accompanied him in his last days. The paperwork was minimal. He had a brief chat with one of the officials of Pegasos. According to Trouw:

That Kentie is ‘tired of life’ is explained in the context of the conversation and from the supporting documents. It does not need to be explicitly asked. It was important that [his friend] Hooimeijer had earlier helped Kentie put his thoughts down on paper.

Half an A4 page long, Kees explained that he was at a time when he felt that his life was increasingly completed and that he had a fear of further decline. He wanted to stay in control until the very end.

Nitschke – who now resides in the Netherlands -- keeps Pegasos at arm’s length, but he promotes it on the website of Exit International, his organisation. The Swiss Medical Association regards it as unethical, although it seems to act within the law. According to Trouw, it “is the only one of the six Swiss death aid organizations to also provide assisted suicide to those who are 'tired of life', older than 'around 70 to 75 years' and not seriously ill.” It seems that it has less red tape because it by-passes the Swiss requirement for “unbearable suffering”. Instead of asking a doctor to certify this, it takes the word of the patient himself. However, the head of the ethics department of the Association, Thomas Gruberski, told Trouw, “We do not agree with that interpretation.”

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.

comments powered by Disqus
 
January
24
 

Australians launch class action suit against IVF clinic over faulty embryo test

More than 100 – and potentially 1,000 -- patients of Monash IVF, a major Australian fertility company, have launched a class action suit. They claim that potentially viable embryos were destroyed because a pre-implantation genetic test was faulty.

Lawyers contend that the non-invasive preimplantation genetic test is now known to be significantly less reliable than first thought. Their clients are seeking compensation for economic loss as well as pain and suffering. Some of the women and couples believe that they may never be able to have children.

The non-invasive test was rolled out in Monash IVF clinics in May 2019. However, it appears that it returned false positives, indicating that some embryos were defective when they were not. The test has been withdrawn. The company says that it will “vigorously” contest the lawsuit.

“IVF is such a long and difficult road. The emotional impact of going through treatment is hard enough alone and then to have something like this happen has just compounded everything that we were already dealing with,” 43-year-old Danielle Bopping told The Australian.

"Every week and month counts when you're in your 40s," one of the lawyers explained. "Some people fear that they've lost their last chance to produce their own genetically-related children."

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.

comments powered by Disqus
 
January
24
 

Classics scholar slams transhumanism in new book

Books about transhumanism seem to fall into two categories: glowing with enthusiasm and glowering with indignation. Posthuman Bliss? The Failed Promise of Transhumanism, by Susan B. Levin, an expert in classical philosophy at Smith College falls into the latter camp.

Advocates of transhumanism are on a quest to raise human IQ so high that beings with these higher cognitive capacities would exist on a higher ontological plane. Some even believe that humanity's self-transcendence through advancements in science and technology may even be morally required. Consequently, Levin believes, the stakes of how we respond to transhumanism are immeasurably high.

She argues that transhumanism will undercut liberal democracy, promote eugenics, and undermine personal autonomy – claims which are warmly disputed by transhumanists.

Transhumanism is legitimately critiqued for proponents’ insistence that nothing short of humanity’s self-transcendence is a rational aim … In liberal democracy, fostering public health and welfare without jeopardizing the pillar of personal liberty requires ongoing navigation and reflection.

If we took our marching orders from transhumanists, and were able to produce humanity’s “godlike” successors, the question of how to foster overall welfare without devitalizing autonomy would be moot. For posthumanity would have supplanted us, the very beings for whom this matter is of urgent concern.

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.

comments powered by Disqus
 
January
24
 

After all, what is really wrong with apotemnophilia?

Long John Silver managed pretty well 

Apotemnophilia is one of those words which may be useful in Scrabble© but seldom come up in day-to-day discourse, let alone medical practice. However, it is an increasingly contested issue in bioethics, though better known as BIID, Bodily Integrity Identity Disorder, or the amputation of healthy limbs.

BIID is a rare psychiatric condition in which people know that their leg (for instance) is normal and healthy, but still feel that it is not part of their identity; they want it cut off, even though they realise that they will become disabled. Oddly enough, however, they often do not seem to mind wearing a prosthesis to recover some of the limb’s functionality.

In a provocative article in The New Bioethics, Richard Gibson, of the University of Manchester Law School, in the UK, asks whether ultimately there would be anything wrong with BIID if a prosthesis provided equal or better functionality. “If these cause an amputee no additional hardships or place in their way no discriminative barriers, then they would not experience any disabling effects of their atypical bodily construction. They would have a mere-difference from the majority of other people, not a bad-difference.”

Prostheses are rapidly becoming better, providing not only support, but sensation; they can even be controlled by the brain. At some point they might even be better in some respects than a natural limb. If that happens, Gibson asks, can we really say that BIID is ethically wrong? It would no longer be an instance of “maleficence” – which doctors are enjoined from doing.

once such neuroprosthetics can function at a level equivalent to that of their biological counterparts, the arguments against providing healthy limb amputation in cases of BIID that rest upon the supposed harms of disability generation will begin to lose their persuasive power.

In other words, the universal condemnation of BIID rests on “shaky foundations”.

Although Gibson does not mention this, his argument is an example of the crisis of “naturalness” in bioethics. Once having abandoned the idea of a human nature, and of a natural state of health, it is hard to withstand pressure to reconfigure the human body. The debate over transgenderism is another good example.

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.

comments powered by Disqus
 
January
24
 

Do amazement, wonder, and awe have a place in bioethics?

If it were to be written The Varieties of Bioethical Experience would be a book as big as a telephone directory. There is Islamic bioethics, feminist bioethics, utilitarian bioethics, indigenous bioethics, principalist bioethics, Catholic bioethics, Marxist bioethics, conservative bioethics, black bioethics, progressive bioethics, queer bioethics, and so on and on.

Writing in the journal Ethics & Behavior, Australian bioethicist Margaret Somerville has outlined another variety – the bioethics of wonder. The article is a personal reflection on her 40 years in bioethics and medical law in Canada and Australia which distils the main themes of her research. She writes:

The main new proposition that I derive from this very broad overview, which will need much further in-depth research, is that experiences of “amazement, wonder, and awe”, combined with healthy scepticism, that is, without cynicism or nihilism, can lead to deep gratitude and hope, which, in turn can lead to a stronger commitment to act ethically. I call this proposal “The Wonder Equation”.

Much of her writing has been concerned with deeply controversial issues like euthanasia, abortion, reproductive technologies and same-sex marriage, in which she has defended positions which are often labelled “conservative”.

However, Somerville contends that they are not conservative in the sense of protecting superannuated and superfluous moral positions, but rather of incorporating “the learning and wisdom we have accrued as communities and societies throughout millennia and that each of us has accrued as individuals as we live our lives.”

As a first step toward that goal, I propose that in relation to formulating our values, we should be open to experiencing “amazement, wonder and awe” in as many situations and as often as possible. By way of example, “if we perceive a foetus as a unique new human being and regard it, and subsequently the newborn child, with “amazement, wonder and awe”, we are likely to see it as involving a mystery that we must respect, which will usually exclude abortion and certainly excludes infanticide.”

Is she on to something? Aristotle famously declared that “It is through wonder that men now begin and originally began to philosophize.” Should we add “and do bioethics”?

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.

comments powered by Disqus
 
January
24
 

Covid could be a Waterloo for the leading bioethical theory

Napoleon gallops towards Waterloo 

Covid-19 is providing a stress test for bioethical theories. And it seems that not all varieties will succeed. Writing from a utilitarian perspective, the co-editor of the journal Bioethics, Udo Schüklenk, and an Irish bioethicist, John Lawrence, have delivered a stinging critique of the dominant paradigm in contemporary bioethics, principlism.

They examined a number of Covid-19 policy documents to see whether they provided useful guidance for doctors and policy makers. The answer, they believe, is No.:

On each occasion a number of well‐sounding principles, that most reasonable people would have great difficulty finding fault with, are added—as a kind of preface—to what would otherwise be highly controversial policy documents. These principles are typically in conflict (think autonomy and beneficence, or utility and equity). It is unclear how they relate to each other. And, in cases where two or more principles result in conflicting action guidance, we are no clearer about which of them ought to be prioritized. Most importantly, such principles do not, when specified to the degree that they tend to be in ethical guidelines, provide a clear‐cut and conclusive answer to the question of who, in the here and now, should be offered treatment or a vaccine when it is not possible to treat or vaccinate all those who could benefit.

As a result of the conceptual chaos, Covid-era bioethics is returning to the bad old days of “doctor knows best”.

In the absence of explicit criteria for weighing and balancing competing ethical demands, one ends up with a guidance document that is unable to provide any explicitly justifiable ethical guidance to begin with. The result is that health care providers and practitioners are left to make adjudications and trade‐offs on their own.

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.

comments powered by Disqus
 
January
16
 

If fake medical news is dangerous, its authors should be jailed, says Polish lawyer

As vaccines for Covid-19 are rolled out across the world, fake medical news is becoming a bigger issue than ever. Disseminating false information could lead to vaccine hesitancy, lower levels of vaccination, less protection for the general population, and the deaths of vulnerable people.

A Polish legal expert, Kamil Mamak, of Jagiellonian University, has suggested in the journal Medicine, Health Care and Philosophy that it may be necessary to criminalise fake medical news. “Whoever publicly disseminates information evidently discrepant with medical knowledge [will be] subject to a penalty,” is his proposal.

Criminal sanctions for spreading false and mischievous information are already on the books in Poland. There, as in other European countries, Holocaust denial is a crime. Free speech, he says, is never absolute.

Mamak says that criminal penalties have to be a last resort, after resorting to measures like education, making accurate information readily available on the internet, and self-regulation by companies like Twitter, Facebook and Google.

There are definitional problems, Mamak admits. Who determines what is true and what is false? He says that it has to be “discrepant with medical knowledge” – in other words, differing from the consensus of experts. “The status of medical information must be clear for the representative body of scientists. It cannot be applied to a situation in which scientists have polarized opinions. For example, it is possible to publish positive results while others publish negative results on the same issue based on the same data.”

What about medical breakthroughs which are not accepted by the consensus? Mamak points out that the offense would have to include “public dissemination”, so divergence from a consensus would be not be an offence if it were in professional circles – submitting an article to a journal, for instance.

Public dissemination is not limited to creating fake news – in Mamak’s view, it could also include sharing and liking articles on Facebook or liking and reposting on Twitter.

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.

comments powered by Disqus
 
January
16
 

Doctors need to study the lessons of the Holocaust, says ethics journal

The illustration for the editorial of the January issue of the AMA Journal of Ethics comes from the “doctor’s trials” at Nuremburg in 1947. A young and sullen-looking young woman wearing earphones stands between two helmeted soldier in the dock. She is Dr Herta Oberhauser, the only woman in the trials, and she was being sentenced to 20 years imprisonment (of which she served only five) for crimes against humanity. She experimented on women at the Ravensbruck concentration camp – deliberately creating gangrenous wounds to test the efficacy of sulpha drugs. She also gave lethal injections to several of her patients.

Oberhauser was one of the small fry amongst the Nazi doctors and nurses who committed medical atrocities before and during World War II.

The journal’s special issue is intended to help doctors not to forget what can happen if healthcare workers misuse their special skills and status. Surprisingly, the editors say that many American doctors are unaware that bioethics arose from the experience of the Nuremburg trials.

the historical impact or resonance of the Holocaust in bioethics has generally been at a low frequency in the United States. This painful history has largely been overlooked in American medical education, perhaps because to examine it closely one must first disturb the comfortable view of our nation and our profession as entirely heroic actors in the Second World War.

They argue that the year 2020, with the Covid pandemic and the Black Lives Matter demonstrations, has shown American doctors that they, too, need to be aware of dark corners of medicine in their own country.

it became widely recognized as problematic—and not just in the United States—to view medical professionals as purely altruistic, color-blind healers, blameless in creating and sustaining health care systems that predictably and consistently generate racial and ethnic health disparities.

The medical history of the Holocaust remains relevant – and essential – in a sound medical education.

[P]erhaps the year 2021 will become the year in which every health professional training program awakens to the fact that health sciences students (and practitioners) must learn about and reflect upon the historical roles of health professionals in creating both the atrocities of the Second World War and the different but related atrocities of racial injustice that we witness today. After all, these legacies are deeply entwined. Our profession’s involvement in providing the pseudoscientific foundations that supported ethnic and racial violence during the Second World War cannot be disentangled from the history of scientific racism and its ongoing, powerful, and pervasive influence on the world today.

This fascinating issue of the journal contains several articles about aspects of the Holocaust and medical education. It is well worth reading.

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.

comments powered by Disqus
 
January
16
 

London newspaper reveals ‘shocking evidence’ about transgender treatments

After a legal battle The Mail on Sunday has published what it called “shocking evidence” about transgender medicine which led a High Court judge to ban a government gender clinic from prescribing puberty-blockers.

The Gender Identity Development Service (GIDS) clinic in London, also known as the Tavistock Centre, began prescribing these for children under 16 in 2011. In December the clinic was forced to stop after the Court ruled that it was “very doubtful” that youngsters could give informed consent.

Swedish psychiatrist Christopher Gillberg testified that the use of puberty blockers is basically “a live experiment” on vulnerable children. “In my years as a physician,” he wrote, “I cannot remember an issue of greater significance for the practice of medicine. We have left established evidence-based clinical practice and are using powerful life-altering medication for a vulnerable group of adolescents and children based upon a belief.”

According to the newspaper, the evidence of Gillberg and other experts was that:

  • Puberty-halting drugs can harm a patient's brain and bone development;
  • Clinics are urging gender-changing teen girls to choose sperm donors to fertilise eggs before freezing them;
  • Medics are failing to warn about the infertility risks posed by puberty blockers;
  • Children who regret treatment find themselves “locked” into new bodies;
  • Internet sites persuade autistic children that they are transgender when they simply have “identity issues”.

The Tavistock centre has had a 60-fold increase in requests for its services over the past 15 years. Judges were told that there had been a steep rise in the number of girls aged 12 to 17 requesting help and that they outnumbered biological males wanting to transition by two to one.

Doctors also testified that there was a “disproportionate number” of children across the world claiming trans identities who were in care, adopted, autistic, anorexic or had psychiatric or mental illnesses.

The evidence included testimony from dozens of young women who claimed that their lives had been ruined by sex change treatments.

Lucy, a woman who underwent sex change surgery, described herself as “mutilated”. “I'm horrified that when I went for the hysterectomy they didn't emphasise to me how important these organs are. Now it's too late. I'm 23 and I am basically in menopause and all the health implications that come with that. I can't comprehend how doctors could let this happen.”

Professor Stephen Levine, an American expert in the field of gender treatment, testified that “there was no other field of medicine where such radical interventions are offered to children with such a poor evidence base”.

He also claimed that treatment was taking place in such a “toxic and febrile context that critical and cautious voices are shouted down as transphobic, hateful and engaging in conversion therapy.

“Such a climate has created an intimidating and hostile environment where silence and acquiescence are the inevitable consequence. It is left to those of us at the end of our careers, who have nothing to lose, to voice our concerns.'

“Scientific requirements for establishing an intervention's utility are well known in medicine,” he said. “Advances are undertaken through carefully controlled clinical trials. Why should gender problems be considered an exception?”

The director of GIDS, Dr Polly Carmichael, insisted in her submission to the High Court that all the potential side effects and impacts were explained to young people by clinicians before referring them for puberty blockers. She submitted that the primary purpose of puberty blockers was to give a young person time “to think about their gender identity”.

Conservative peer Baroness Nicholson, a former director of Save The Children, told Mail on Sunday: “Puberty blockers are... a harrowing, physical destructive experiment on immature boys and girls. It closes normal development in favour of a painful life and a curtailed barren future – the NHS should never have allowed such unresearched use of public money on irremediable surgery on healthy bodies.”

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.

comments powered by Disqus
 
January
16
 

Examining the thorny moral problem of foetal reduction

It is a truth universally acknowledged that defending an opinion on abortion will make at least half of one’s readers unhappy. But Joona Räsänen, a Finnish bioethicist at the University of Oslo, defends an opinion on abortion in the Journal of Medical Ethics which is bound to make all of them unhappy.

He tackles the controversial question of foetal reduction: killing one or more foetuses in a multiple pregnancy. This may happen when one of them is diseased or has a birth defect or when the mother feels incapable of caring for more than one child. It often happens after IVF when a woman ends up with triplets or quadruplets – or even octuplets. Some doctors have refused to “reduce” the pregnancies because they regard it as immoral.

Räsänen points out that most people nowadays have two contradictory intuitions: that abortion is permissible and that killing one of two foetuses is not. This seems to imply that killing twin foetuses is moral while killing one is not – which seems counterintuitive.

He is not questioning a woman’s right to abortion. Abortion is always a woman’s decision, he says, but the woman still must face up to the ethical conundrum: save both, terminate one, or terminate both.

What is Räsänen’s proposal? It’s an unexpected blend of pro-life and pro-choice elements, which is bound to upset both:

So here is a suggestion: gestate both fetuses and give the other one for adoption. This conclusion might disturb some—it certainly disturbs me. I admit that separating twins raises their own set of ethical issues but it cannot possibly be worse for the child to become separated from her twin sibling than to have the sibling killed

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.

comments powered by Disqus
 
January
16
 

NEJM proposes change in birth certificates to accommodate transgender concerns

The Australian census will begin asking questions this year about gender diversity. It plans to ask people what is their "sex recorded at birth" as well as their declared gender. Changing the information recorded on birth certificates is even more radical – but that was proposed recently in a commentary article in the New England Journal of Medicine (December 17).

American birth certificates should be revised to make ticking a box for male or female optional. Legally identifying information should be reported “above the line” because that is publicly available. To avoid stigma and allow self-identification, fields like race, parental marital status and sex or gender should be below the line.

The birth certificate is a document which evolves with time, argue the authors, who come from Brown University Medical School and Vanderbilt Law School: “it is time for another up- date: sex designations should move below the line of demarcation.”

They argue that “Designating sex as male or female on birth certificates suggests that sex is simple and binary when, biologically, it is not … Assigning sex at birth also doesn’t capture the diversity of people’s experiences. About 6 in 1000 people identify as transgender … Sex designations on birth certificates offer no clinical utility; they serve only legal -- not medical -- goals.”

Assigning sex at birth is unfair and even dangerous, they contend. “Assigning sex at birth perpetuates a view that sex as defined by a binary variable is natural, essential, and immutable … Imposing such a categorization system risks stifling self- expression and self-identification.

The comments of the NEJM’s readers were initially glowing, but rapidly became hostile. “The suggestion that sex is not binary because intersex disorders exist is ludicrous. … spare us the trip down this anti-science, ideological rabbit hole,” was a typical response.

Evolutionary biology Colin Wright, who is also the editor of Quillette, analysed the article in more detail. He pointed out that as recently as August last year, The Lancet published a survey article which concluded that: “The combination of all genetic and hormonal causes of sex differences [yield] two different biological systems in men and women that translate into differences in disease predisposition, manifestation, and response to treatment.”

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.

comments powered by Disqus
 
January
16
 

Retiring Scottish politician links IVF with euthanasia

Perhaps we should update that proverbial expression for brutal honesty, “out of the mouths of babes and sucklings”, to include “and retiring politicians”. After ten years in the Scottish Parliament, Conservative leader Ruth Davidson is moving to the British House of Lords as a Life Peer.

She used the occasion to write an op-ed for The Telegraph (London) in support of assisted suicide.

In ten years of elected politics, I have made more mistakes than I can ever hope to remember some through overreach, some by omission, others by nothing more than blunder. But the mistake that eats away, demanding redress, is voting against assisted dying. Sometimes, amid complex arguments and conflicting evidence, you know – simply know in the essence of your being – that something is plain wrong. It’s time to change the law.

This is not an uncommon sentiment, but her reasoning is out of the ordinary. She advances two reasons. First, a common one: that a gradual decline into dementia is humiliating and demeaning for an elderly person and a torture for their loved ones.

Second, and not so common, is IVF.

What has that to do with assisted dying?

Davidson explains that going through IVF herself stripped away all of her illusions about the special nature of the beginning of life, and thus, as well, about the end of life:

It may seem odd to say that medical intervention to help create life has hewn away inhibitions about a more planned or even medicalised end of life, but it has. The systems and processes of egg retrieval; choosing donors through any number of characteristics from height to family medical history; embryo implant and even being able to guarantee against twins, makes a mockery of the mystique of kismet surrounding birth. And if birth can be so demystified (for the over 50,000 people who undergo IVF treatments in the UK every single year) then what rule of fate exists for death and why is there such imbalance?

This makes sense, in a way. In both IVF and assisted suicide or euthanasia, human life is commodified, dominated by technology, and de-sanctified. Is socially-acceptable IVF, then, a distant precondition for the emergence of legalised euthanasia? If a pro-life campaigner had made this argument, she would have been mobbed on Twitter. But Ruth Davidson's valedictory candour has a ring of truth to it. Out of the mouths of babes, sucklings and retiring politicians…

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.

comments powered by Disqus
 
January
16
 

The number of Down syndrome births in Europe has been halved

The growth of prenatal screening in Europe has reduced the number of babies being born per year with Down syndrome (DS) by an average of 54%, according to a new study published in the European Journal of Human Genetics.

The same researchers, from Massachusetts General Hospital, found in 2016 that 33% fewer babies with DS per year were born in the United States as a result of pregnancy terminations.

"People with DS were being counted sporadically, inconsistently, or not at all, depending on the country," says Brian G. Skotko, senior author of the study. "But without an accurate estimate, it's impossible for policymakers and advocacy organizations to determine how many resources and support services are needed for its Down syndrome population." Their data are laid out in both the study and a fact sheet.

The researchers also wanted to establish a baseline of DS birth rates and pregnancy termination rates ahead of widespread adoption of new non-invasive prenatal screenings (NIPS). The new screening tests can detect the likelihood of a chromosomal condition in a foetus as early as nine weeks of gestation, after which an expectant couple can elect to pursue definitive genetic testing. As NIPS becomes widely available, fewer babies with DS are expected to be born.

NIPS was introduced in the US in 2011 but has yet to be widely covered by national health care systems in European countries. "Countries that are grappling with funding decisions for NIPS should certainly be having deep discussions about its impact on the country's Down syndrome population," says Skotko, who has a 40-year-old sister with DS. Countries also must create an adequate infrastructure of support and information so that expectant couples can make informed decisions about NIPS and subsequent pregnancies.

The researchers discovered a wide variation in DS birth rates among European regions. From 2011 to 2015, Southern Europe had the highest reduction in DS births due to pregnancy terminations (71%), followed by Northern Europe (51%) and Eastern Europe (38%). There were, however, considerable differences among countries, ranging from no reduction in the percentage of babies being born with DS in Malta, where pregnancy termination is highly restricted, to an 83% reduction in Spain.

Pregnancy terminations related to DS are influenced by multiple factors. Some nations, such as Denmark, provide free access to prenatal screening, whereas there may be cost barriers for couples in other countries. A country's religious and cultural mores also play a role, as do a country's policies about the way expectant couples are counselled about prenatal screening and DS. Parents' decisions might also be influenced by the opportunities that exist for people with DS to live fulfilling, productive lives. "In the US, people with Down syndrome have great opportunities to get an education, to fall in love, and to find satisfying jobs," says Skotko.

The modelling study also estimated the number of people with DS currently living in each country. The decreasing number of DS births is offset by people with DS living longer than ever -- to an average age of around 60 in countries with resource-rich health care systems. In Europe there were 27% fewer people living with DS in the overall population in 2015 (and 21% fewer people with DS in the US) as a consequence of elective pregnancy termination from previous 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.

comments powered by Disqus
 
January
16
 

The Pope’s homeland, Argentina, has legalized abortion

Abortion activists celebrate in Buenos Aires

After a marathon debate, on December 30, the Argentine Senate voted to decriminalise abortion in the first 14 weeks of pregnancy. The dramatic legal change could have a domino effect on abortion access in South and Central America.

The law sailed through, with 38 votes for, 29 votes against, and one abstention.

The new law legalises abortion for any reason during the first 14 weeks of a pregnancy. Thereafter it will be allowed if the pregnancy is the result of a rape or if the mental health of the mother is at risk, although it does not define the term. In cases of rape, the only legal requirement is an affidavit presented to the doctor performing the abortion.

In a nod to the transgender lobby, the law applies to “women and other identities with the capacity to gestate”.

No judicial authorisation is required and the procedure must be done within five days after a request.

Unnecessarily delaying or creating obstacles to abortion access or refusing to perform one, has become an offence punishable by up to a year in prison.

Abortion was already legal in Argentina, but only after rape or if the life or health of the mother were in danger. However, critics said that doctors still stymied women’s interest in abortions by demanding too much paperwork. According to Crux, recent polls showed that between 50 and 60% of people are opposed to more liberal laws.

Conscientious objection will be a tricky issue in Argentina, where many Catholic doctors are bound to refuse requests. Under the new law, doctors can refuse, but they must immediately refer the woman to a compliant doctor.

Abortion is already legal in Uruguay, Guyana, and Cuba, as well as parts of Mexico, but in El Salvador, the Dominican Republic, Nicaragua, and Honduras abortions are banned entirely.

International Planned Parenthood was cock-a-hoop over legalisation. It declared that it had lobbied hard for the victory. “IPPFWHR has nurtured an ecosystem of feminist organizations and activists for more than 15 years that contributed to make today possible,” it declared in a press release. “IPPFWHR directly supports seven partners in Argentina, who in turn sub-grant funds to 20 other grassroots organizations from around the country.”

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.

comments powered by Disqus
 
December
13
 

Ethicists propose standards for Covid-19 triage

With a second wave of Covid-19 sweeping through Europe and the United States, threatening to overwhelm hospital ICUs, discussion of triage is again coming to the fore.

"A lack of intensive care ventilation units owing to rapidly increasing infection rates numbers among the most significant nightmare scenarios of the corona pandemic," says Mathias Wirth, of the University of Bern (Switzerland), because: "Shortages of supply can result in triage of patients suffering from severe cases of COVID-19 and thus force a life or death decision."

Together with experts from Yale University, King's College London, Charité Berlin and Essen University Hospital, Wirth has prepared a statement on these difficult decisions in the American Journal of Bioethics (AJOB).

The experts warn against prematurely implementing triage; even though triage allows for decisions based on fairness in extreme situations, it leads to significant strain on the affected parties, relatives and medical personnel. They write:

It is unbearably difficult for a patient and their families and friends not to interpret a classification based on specific triage criteria as a moral judgment about the worth of an individual life. How can the unsubstitutable dignity of each and every individual be affirmed even as resources are given to some people and not to others?

In order to avoid it, every effort must be made to transfer seriously ill patients to other hospitals without shortages of supply - across country borders in case of emergency, according to the authors.

The authors recommend increased regional, national and even international collaboration in intensive care for Covid-19 patients in preparation for future waves of infection. "Just because triage is correct under some circumstances does not mean that it is correct under all circumstances," says Wirth. "There is no real and legitimate triage situation as long as treatment spaces are available elsewhere."

Secondly, a negative triage decision for individual people should not under any circumstances mean that their medical and psychological care is neglected. Quite the opposite: If they are deprived of a ventilator, maximum effort is required for their care and treatment, both for them and for their relatives.

Decisions about triage give too little consideration to moral problems, according to the authors. "The suffering that triage decisions involved for patients, relatives and medical personnel in the epicenters of the first wave attests to this," says Wirth. With these recommendations, triage planning can be classified more clearly as a last resort, meaning that alternatives must be afforded greater attention.

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.

comments powered by Disqus
 
December
13
 

Triage according to standard tests of frailty, says Oxford bioethicist

If triage becomes necessary, what criteria should be used? Bioethicists seem reluctant to put a finger on a particular characteristic which exclude people from potentially life-saving treatment. It shouldn’t be age, or disability, or mental capacity, or social status, or race, or ability to pay…. What, then?

Dominic Wilkinson, of the University of Oxford, argues in the American Journal of Bioethics, that it should be frailty. “Frailty is relevant to resource allocation in at least three separate ways, through its impact on probability of survival, longevity and quality of life (though not a fourth—length of intensive care stay)”.

Frailty is normally associated with old people, but not all old people are frail and not all frail people are old. There are a number of scales of frailty, so that an assessment of frailty is (theoretically) objective.

Wilkinson states firmly that “Frailty is ethical to use in ICU triage” and is not discriminatory. Indeed, he argues, “frailty might be almost a perfect ICU rationing criterion—potentially attractive according to multiple different theories of rationing, and in combination identifying patients who are less likely to survive, likely to survive for a shorter period, and with greater functional impairment (as well as having potentially already experienced more life).”

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.

comments powered by Disqus
 
December
13
 

Why do the elderly request euthanasia in the Netherlands?

Most requests for euthanasia in the Netherlands come from people suffering from cancer. But the number of patients who have dementia, psychiatric disorders, or multiple geriatric syndromes (MGS) is growing steadily.

An article by Dutch physicians in JAMA Internal Medicine examines the kind of geriatric syndromes which motivate a person to ask for euthanasia.

They found that an accumulation of geriatric syndromes alone is insufficient to explain the unbearableness of suffering that leads to a request for euthanasia. All of the patients they studied had been suffering from MGS for several years. But then came a tipping point – a fall, an infection, a hospitalization, or the loss of a close relative. Falls can often prompt a reflection on life, warning of a future of decline, dependence and isolation.

It was this combination of aches and pains in conjunction with the medical history, life history, personality, and values that gave rise to what the patient experienced as unbearable suffering. 

Their finding also may also explain why, in some exceptional cases, the medical dimension of the suffering can also be based on a single geriatric syndrome that, in combination with social and existential problems associated with that syndrome, may result in unbearable suffering.

In summary, experiences in the social and existential dimensions are intertwined with the medical dimension of suffering.

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.

comments powered by Disqus
 
December
13
 

Did Neanderthals bury their dead?

Was burial of the dead practiced by Neanderthals? It’s an important issue, as the existence of funerary rites would suggest that, like us, the Neanderthals had spiritual intuitions.

For the first time in Europe, scientists have found strong evidence of burial around 41,000 years ago, at the Ferrassie rock shelter in the Dordogne. Their study is published in Scientific Reports.

Dozens of buried Neanderthal skeletons have been discovered in Eurasia, leading some scientists to deduce that they buried their dead. But most of the best-preserved skeletons were not excavated using modern archaeological techniques.

After six Neanderthal skeletons were discovered at the Ferrassie site at the beginning of the 20th century, a seventh, of to a child of around two years old, was found between 1970 and 1973, For almost half a century, the collections associated with this specimen were in the archives of the Musée d'archéologie nationale.

Recent research revealed 47 new human bones not identified during excavation and undoubtedly belonging to the same skeleton. This new information proves that the body of this two-year-old Neandertal child was purposefully deposited in a pit dug in a sedimentary layer around 41,000 years ago. However, further discoveries will be necessary to understand the chronology and geographical extension of Neanderthal burial practices.

Another article earlier this year about excavations in the Shandihar cave in Iraqi Kurdistan  also reported what appeared to be an intentionally buried individual. In the 1950s an American archaeologist, Ralph Solecki, claimed that he had found evidence that Neanderthals had scattered flowers at a burial at the Shandihar site. “The association of flowers with Neanderthals adds a whole new dimension to our knowledge of his humanness, indicating he had a ‘soul,’” Dr Solecki wrote.

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.

comments powered by Disqus
 
December
13
 

Could surrogacy contracts work?

The complications involved in commercial surrogacy are leading lawyers and legislators to considering regulating what they cannot forbid. As a Dutch minister cited put it:

Surrogacy is a legal twilight zone; I think we have to end that. This also means that we have to come to a neat arrangement, managing surrogacy in a decent way. So no more abuses in faraway countries that we don’t want, but surrogacy in the Netherlands on a non-commercial basis.

So  pre-conception authorization of surrogacy agreements (PASA) is being studied in the Netherland and the UK. Two Dutch researchers critique this in a very interesting article in a special issue of The New Bioethics on surrogacy.

Bans on surrogacy are meant to protect women and children against commodification and exploitation. But they are easily evaded by resorting to the black market or by going overseas.

But PASA may not protect them effectively either, they argue.

PASA legislation is supposed to discourage intending parents from going overseas where the dangers of exploitation and commodification are normally much greater. 

However, our analysis suggests that both promises will prove to be false. First, proposals for PASA contradict themselves, by defending PASA as a way to discourage surrogacy tourism, while, at the same time, not only refusing to close off ‘the foreign route’, but even making it more attractive.

Second, although PASA is presented by its advocates as a more effective way of safeguarding human rights and human dignity in surrogacy arrangements, a novel normative outlook is silently being introduced, which offers less protection to surrogate mothers and surrogacy-born children.

Finally, although the assessment that is supposed to take place under PASA contains standards to make sure that surrogacy arrangements are not commercial, commodifying or exploitative in nature, the experience in Greece and South Africa suggests that authorities will nevertheless rubber-stamp arrangements of such nature.

In fact, the authors are so convinced that this system will fail that they predict that: “children born from such practices might, in the future, sue the state for failing to protect their human rights and dignity. Such lawsuits are already taking place in the context of adoption and donor-conception, and are likely to follow in the context of surrogacy as well if PASA is introduced.”

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.

comments powered by Disqus
 
December
13
 

New doco chronicles sperm donor abuse by US doctor

Dr Quincy Fortier, the subject of Baby God. Photograph: HBO

Another revelation of a super-stud doctor, this time in Nevada. Dr Quincy Fortier was named Nevada’s doctor of the year in 1991. Practicing as an obstetrician and fertility doctor for 40 years, he may have impregnated hundreds of women. So far only 26 people have been confirmed as his offspring from his patients.

His career is sketched in a just-released HBO documentary, “Baby God”. The director, “Hannah Olson, told The New York Post that Fortier was an “extreme” example of a “widespread phenomenon” in the fertility industry that may have continued into the 1980s.

“With or without the patients’ knowledge or consent, doctors would use their own sperm to ‘help’ a woman conceive,” she said. “They couldn’t predict the future and the ease with which people are now able to analyse their DNA.”

Fortier died in 2006, He had his eight children with his wife.

Fortier began his perverse practice as early as 1948. The documentary features a newly-wed who sought his help for an infection and never even requested artificial insemination. Her son discovered the deception in 2017.

“It bothers me to think that these doctors thought they were smarter than their patients,” says one of his offspring, 54-year-old Wendi Babst. “It was a case of: ‘Don’t look behind the curtain, little lady, while I make a baby for you.’ My mother wanted a family with the man she loved.”

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.

comments powered by Disqus
 
December
13
 

Japan tries AI matchmaking

The phrases “artificial intelligence” and “high hopes” are yoked together in many headlines. AI promises a bright future in nearly everything, from medicine to manufacturing to transport to public services.

And now the Japanese government plans to use it for matchmaking. According to a BBC report, it will subsidise local government projects that use AI to pair people up.

Last year the number of births in Japan fell below 865,000, a record low. The population is projected to decline from a peak of 128 million in 2017 to under 53 million by the end of the century. Its fertility rate of 1.36 is one of the lowest in the world.

Reversing the steady decline in fertility has become a national priority. Boosting the use of AI tech is one of its latest initiatives.

Many local governments already offer conventional matchmaking services. Some are using AI systems to produce a more sophisticated analysis of the standardised forms where people submit their details.

"We are especially planning to offer subsidies to local governments operating or starting up matchmaking projects that use AI," a cabinet official told AFP. "We hope this support will help reverse the decline in the nation's birth rate."

There are sceptics.

Sachiko Horiguchi, an anthropologist at Japan's Temple University, says that the government should help young people earn more.

She pointed to a recent report which suggests a link between lower income levels and lack of interest in romantic relationships among young Japanese adults.

"If they're not interested in dating, the matchmaking would likely be ineffective," Dr Horiguchi told the BBC. "If we are to rely on technologies, affordable AI robots taking over household or childcare tasks may be more effective."

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.

comments powered by Disqus
 
December
13
 

China uses AI to create facial recognition surveillance of Uyghurs

According to leaked documents revealed in the Washington Post, Huawei, China’s giant telecom, has helped to develop an AI system to identify Uyghurs, its oppressed Turkic minority in the province of Xinjiang.

Allegedly the facial recognition system is programmed to send “Uyghur alarms” to the police when Uyghurs are spotted by security cameras.

The documents say that Huawei worked with a company called Megvii in 2018 to develop a facial recognition system that could determine the ethnicity of all the people in a crowd, with special flags for Uyghur faces.

A Huawei spokesman told WaPo that the document was authentic but said that it was “simply a test” of a product that never became a “real-world application”.

Megvii is one of eight Chinese companies sanctioned by the Trump administration for involvement in  China’s persecution of the Uyghurs and other minorities. Another blacklisted company, Hikvision, which is currently the largest global provider of video surveillance equipment has also developed a Uyghur identification system.

According to CNet.com “Facial recognition tech raises privacy concerns because of its ability to track and identify people on a mass scale. Police in the US have used it to track and identify protesters, despite the United Nations' human rights chief calling for a moratorium against the practice.”

The PRC's Foreign Ministry denounced the report as “slander”. “Legal use of facial recognition in public areas in some parts of China is to improve social management, effectively prevent and attack criminal acts,” said a spokesman in a statement to CNBC. “China doesn’t go any further than countries in America and Europe. And the measures are not targeting any particular ethnic groups. The measures strengthen social security, thus earn support from people of all ethnic groups.”

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.

comments powered by Disqus
 
December
13
 

The California Institute for Regenerative Medicine gets a second lease on life

California, the state of sun, sand, surf, Botox, tech and stem cells.

Like the tense national election, the stem cell field also saw deep divisions among Californians. Proposition 14, the Stem Cell Research Institute Bond Initiative (Prop 14), was on the ballot in an initiated state statute. This ballot initiative the California Institute for Regenerative Medicine (CIRM) to borrow US$5.5 billion. Taxpayers will repay this with interest over the next 30 years. Not surprisingly, Californians were divided on the measure. But, on the day, it passed, 51 to 49 percent.

The funds will be allocated to research, clinical trials, programmes and start-up costs for facilities. A portion of the money will be spent researching illnesses affecting the brain and central nervous system.

Some will also be allocated to the Shared Labs Program, state-funded facilities dedicated to conducting studies on human embryonic stem cells. In 2004, when the CIRM was created, a fierce debate centred on the ethics of experimenting with human embryos. But this time it was barely mentioned in the media.

The CIRM has a long back story.

The Bush Administration effectively stopped experimentation on human embryonic stem cells by cutting off federal funding for it in 2001. In 2004, Prop 71 was initiated by Robert Klein, a real estate developer and investor. It was designed to bypass Bush’s ban by establishing a state constitutional right to perform stem cell research. It was believed then that Prop 71 would make California a stem cell Mecca.

CIRM became the only state-funded stem cell research agency in the United States. But its record was mixed. It has granted research funds to various institutions and companies. It has funded some human clinical trials for a broad range of diseases. But its record was mixed:

As the San Francisco Chronicle said in an editorial opposing the initiative:

“While state funds helped support the research that led to two approved cancer drugs and a host of prospective therapies in various stages of development, far-reaching breakthroughs attributed to the stem cell agency have been scarce so far, as a Chronicle investigation found. More than half the original funding went to buildings and other infrastructure, education and training, and the sort of basic research that, while scientifically valuable, is a long way from medical application. There’s nothing inherently wrong with that, but it is at odds with the vision of dramatic advancements put to voters.”

During Obama’s administration, restrictions on embryonic stem cell research were removed, a position left unchanged by the Trump administration. Technically, this would mean that California scientists can apply for federal research grants to perform their research -- but these grants are very competitive. 

By 2019 the CIRM was running out of money, leading to the suspension of new projects except for emergency funding put aside for Covid-19 related research. This prompted the Californians for Stem Cell Research, Treatments and Cures political action committee (PAC) to run another campaign.

Surprisingly, most of the state’s media opposed extending the life of the CIRM. The Desert Sun wrote in its editorial:

“It remains to be seen whether Prop 14 will deliver this time. In times of crisis, there is a multitude of pressing matters like job creation and housing. The pandemic has worsened the housing crisis and unemployment in some parts of the state, very obvious in large cities. Indeed this initiative will stretch California's huge budget deficits.”

Dr Patrick Foong is a law lecturer at Western Sydney University. His research interest lies in bioethics and health law.



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.

comments powered by Disqus
 
December
06
 

The 27-year-old infant

Molly Gibson / National Embryo Donation Center

When Molly Gibson celebrates her first birthday on October 26 next year, she will be 28 years old. That’s nearly the age of her mother, Tina.

She was adopted as an embryo by her parents, Tina and Ben, through the National Embryo Donation Center (NEDC), in Knoxville, Tennessee. Her genetic sibling Emma was born three years ago.

Molly now holds the record for the longest life as a frozen embryo, 27 years. Her sister was the previous record-holder, at 24 years.

According to the NEDC one million human embryos are in cold storage in the United States at the moment. Often after an IVF procedure, there are “surplus” embryos. They can be donated to research, destroyed, or “adopted out” to another couple. A final option, which many take, is to do nothing and leave them frozen.

There is a handful of embryo adoption agencies in the US. Founded in 2003, the NEDC has organised about 1,000 embryo adoptions and births. It conducts around 200 transfers each year. As in traditional adoption, couples can decide if they would like a "closed" or "open" adoption. The latter allows some form of contact with the donor family. This ranges from an occasional email to a cousin-like relationship, the NEDC told the BBC.

The NEDC has a strongly Christian ethos and “firmly believes in the sanctity of life beginning at conception and recognizes marriage as a sacred union between man and woman as defined by scriptures of the Holy Bible”. It has received more than US$3.9 million in federal funding.

The concept of embryo adoption poses thorny ethical problems, especially for Christians. The Vatican published a document which discussed the issue, Dignitatis Personae, in 2008. It took a dim view of initiatives like the NEDC. Embryo adoption, like surrogate motherhood, though “praiseworthy with regard to the intention of respecting and defending human life” would lead to “other problems of a medical, psychological and legal nature”.

But the Vatican recognised that the existence of millions of frozen embryos is also a perplexing challenge to human rights.

All things considered, it needs to be recognized that the thousands of abandoned embryos represent a situation of injustice which in fact cannot be resolved. Therefore John Paul II made an “appeal to the conscience of the world’s scientific authorities and in particular to doctors, that the production of human embryos be halted, taking into account that there seems to be no morally licit solution regarding the human destiny of the thousands and thousands of ‘frozen’ embryos which are and remain the subjects of essential rights and should therefore be protected by law as human persons”

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.

comments powered by Disqus
 
December
06
 

UK High Court bans transgender puberty blockers for under-16s

Keira Bell, a 23-year-old activist, has won a stunning victory in the English courts over the conventional wisdom on gender dysphoria.

Keira had a very bad start in life. Her father walked out when she was four, leaving her and her sister in the care of her alcoholic mother. At 14 she was a miserable tomboy who didn’t fit in with the girls or the guys.

“I just stayed at home, locked in my room, playing video games,” she told the London Times. “And on the internet I read lesbian bloggers, but felt something else was wrong with me because I was so uncomfortable with my body and puberty and becoming a woman.” Then she discovered American trans activists on YouTube. “I thought, ‘That’s me. I need to do this, to medically transition to make myself better and live my life as I’m supposed to.’”

At 16 she sought help from the only gender-identity development service (GIDS) in the United Kingdom, the government-funded Tavistock Centre.

She says that after just three 60-minute appointments she was given puberty blockers. A year later she was prescribed testosterone and developed male facial hair and a deep voice. A couple of years after that she had a double mastectomy to remove both of her breasts. She changed her name to “Quincy” and had her birth certificate altered to make her legally a man.

It was a typical trajectory for teenage girls with gender dysphoria.

But Keira’s initial satisfaction quickly turned sour and she realised that she had made a big mistake. Or, rather, the Tavistock clinic had made a big mistake. “I should have been challenged on the proposals or the claims that I was making for myself,” she said. “And I think that would have made a big difference as well. If I was just challenged on the things I was saying.”

She sued Tavistock.

And this week she won her case in Britain’s High Court. It was a stunning victory which will cause ripples around the world. Over the past ten years, as in most other Western countries, the number of teenage girls referred to Tavistock rose by more than 5,000 percent.

Since many of these girls will endure infertility, surgical mutilation, psychological distress, and lifetime dependence upon medication, this is a very big deal.

The court ruled that it was highly unlikely that children under 16 could understand and give consent to puberty blockers.

Advocates of the transition process claim that the puberty blockers give children time to overcome the emotional turmoil of puberty and to give them time to make a considered decision. If this were the case, surely some patients would decide that they were better off in their birth sex. But in fact, the court observed, there is “a very high likelihood” that children who start on puberty blockers will move on to the next step of taking cross-sex hormones, which cause “irreversible changes”, especially loss of fertility. 

Although a child may understand the concept of the loss of fertility for example, this is not the same as understanding how this will affect their adult life. A child’s attitude to having biological children and their understanding of what this really means, is likely to change between childhood and adulthood. For many children, certainly younger children, and some as young as 10 and just entering puberty, it will not be possible to conceptualise what not being able to give birth to children (or conceive children with their own sperm) would mean in adult life. Similarly, the meaning of sexual fulfilment, and what the implications of treatment may be for this in the future, will be impossible for many children to comprehend.

One aspect of the ruling which escaped comment in the media was the number of times that the justices used the word “surprising” in their judgement.

Tavistock made assertions about its transgender treatment for which they had failed to collect data. “We find it surprising that such data was not collated in previous years given the young age of the patient group, the experimental nature of the treatment and the profound impact that it has … we have found this lack of data analysis – and the apparent lack of investigation of this issue – surprising … We find it surprising that GIDS did not obtain full data showing the figures and the proportion of those on puberty blockers who remain within GIDS and move on to cross- sex hormones.”

Originally, Tavistock only provided puberty blockers for children over 16. But in 2011 it began treating children as young as 12 with puberty blockers in an approved research study. Nine years later, Tavistock still has not published the results of the study.

The court understated sarcasm makes it appear likely that doctors were basing their treatment more on ideology than on science.

The result of the High Court’s decision – which is sure to be appealed – is modest. It does not ban transgender treatment. It simply declares that it is highly doubtful that children under 16 should be given puberty blockers because they cannot give informed consent. In the UK, children over 16 are deemed to be competent to consent to treatment. However, given that the treatment is innovative and experimental, the Court suggested that doctors should seek court approval first.

Mermaids, a group which lobbies for transgender children, was furious. The ruling “nods towards a future where the right to abortion and pro-choice decisions are restricted for all, destroying freedoms long fought for by women’s rights activists.”

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.

comments powered by Disqus
 
December
06
 

Some ‘Do Not Resuscitate’ orders were wrongly assigned in UK nursing homes

The UK’s Quality Care Commission is investigating how “do not resuscitate” (DNR) orders were used in the Covid-19 pandemic.

The principle was very clear. According to an April 3 QCC memorandum, “It is unacceptable for advance care plans, with or without DNAR form completion to be applied to groups of people of any description. These decisions must continue to be made on an individual basis according to need.”

However, an interim report published this week declared that some DNR orders were wrongly given to some residents in nursing homes.

According to a report in The Guardian, about 40 members of the public complained that DNR orders had been given without consultation with the patients or their families. In one nursing home all of the residents had been given a DNR notice. There were complaints that DNR orders were given to anyone infected with the coronavirus.

However, as news this week showed, age does not necessarily condemn a coronavirus victim. Angelina Friedman, a 102-year-old New Yorker, lived through the Spanish Flu epidemic in the 1920s and survived two bouts of Covid-19 infection this year.

Some people reported that they did not even know an order was in place for their relatives until they were quite sick.

Alarmingly, Rosie Benneyworth, of the QCC, admitted that the principle is still not clear for some doctors. “We have also highlighted the fact that it is possible in some cases that inappropriate DNACPRs [do not attempt cardiopulmonary resuscitation] remain in place – and made it clear that all care providers have a responsibility to assure themselves that any DNACPR decisions have been made appropriately, in discussion with the person and in line with legal requirements.”

The final report is due early next year.

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.

comments powered by Disqus
 
December
06
 

Should bioethicists look more closely at cosmetic leg-lengthening?

Cosmetic leg-lengthening is an orthopaedic procedure which is not for the faint of heart. Although it is well-established, it is very painful and has up to a 100% rate of minor complications.

However, it is becoming more and more popular. Short men often feel inferior professionally and romantically and believe that a few more inches will give them greater stature. "I always thought that being tall and being successful were linked,” a New York man told the BBC. He had an operation which added 3 inches (8 cm) to his height.

"After I had the operation I was in physical therapy maybe three or four times a week for a few hours each day. I did that for probably six months. It was a very humbling experience. It is kind of crazy… breaking both of your legs and learning to walk again. It's seen as a cosmetic surgery, but I did it a lot more personally for my mental health."

At leading centres in the US, Germany and South Korea the procedure is carried out between 100 and 200 times a year. Clinics in Spain, India, Turkey and Italy perform between 20 and 40 operations a year. In the UK there are only about 15. All clinics report growing interest.

Dr David Goodier, a British orthopaedic surgeon told the BBC that some of his patients "have psychological problems", including body dysmorphia. And as more people opt for the procedure, he is worried that patients will choose the cheapest option – leading to serious complications.

The ethics of the procedure have not been discussed in any depth, but as one site pointed out, there are “risks in other aesthetic procedures such as breast augmentation, breast implants, and even gender re-assignment surgery, and say ‘Why not legs?’”

In 2017 an Australian surgeon wrote an editorial which was very critical of cosmetic lengthening in the Journal of Limb Lengthening & Reconstruction.

cosmetic limb lengthening is a misuse of limb lengthening surgery. We are, rightly, worried about the potential complications of limb reconstruction surgery. While there may be tones of self-righteousness underpinning this position, many of us are seeing an unacceptable increase in severe limb-threatening complications, especially among medical tourists, returning to their home countries and cities. The burden of managing these complications then falls on the health systems of these countries.

International medical tourism has meant that in many places it is a booming but unregulated industry. Like with many new technologies, ethics and regulation have not kept pace with speed of change. The arrival of motorized distraction intramedullary nails has made cosmetic lengthening “easier” and thus more “acceptable” to patients. Yet there has been little to no debate about the ethics of cosmetic limb lengthening.

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.

comments powered by Disqus
 
December
06
 

Activists promoting new way to overcome abortion stigma

An op-ed in the New York Times has promoted a new type of contraception for women who fear the stigma of abortion. Called the Missed Period Pill, or MPP, it was inspired by a service offered in Bangladesh during its brief but bloody war of independence with Pakistan.

It is believed that hundreds of thousands of women were raped during the conflict. Since abortion was illegal, the Bangladeshi government allowed evacuation of the uterus for a limited period -- as long as women did not have a pregnancy test. It was called “menstrual regulation”.

US researchers have published a survey in the journal Contraception seeking the views of American “people” (women, presumably). The people were asked whether they would be interested in a pill which would bring on bleeding like a menstrual period, and which would terminate the pregnancy for nearly all people who were pregnant. The key point is that they would never know whether or not they had been pregnant. They found that 42% of all participants and 70% of those who would be unhappy if they were pregnant, would be interested in the MPP.

In the opinion of the researchers, this raises an interesting psychological issue.

It appears that after decades of feminism, culminating in groups like Shout Your Abortion, many women still appear to be ashamed of having an abortion. A dark stigma still hangs over the procedure. According to the NYTimes:

One participant said that such a service would be “a psychological cushion” for those women “who may be unsure of their own feelings on abortion.” Another said that she thought it would result “in less moral conflict,” and a third that she would feel “less guilty of my choice.”

The results of the survey were, therefore, a bit disconcerting, according to the NYTimes.

The notion behind M.R. — that a person wouldn’t know if she had an abortion and therefore no one else could know if she did, either — is, in one sense, the antithesis of what many in the reproductive rights movement hope to achieve.

Some abortion activists call the MPP “Plan C”: “it could be positioned between emergency contraception and abortion (which is the termination of a confirmed pregnancy), filling the gaping hole in the continuum of options available to those trying to manage their fertility.”

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.

comments powered by Disqus
 
December
06
 

What ethical principles do we need in the Covid-19 pandemic?

Back in February the World Health Organisation held a meeting in Geneva about the gathering coronavirus epidemic. Several bioethicists have summarised the discussions about ethical principles in an article in the journal Public Health Ethics. Amongst the five authors is Ezekiel Emanuel, a former Obama adviser whom President-elect Joe Biden has named to his Covid-19 task force.

The principles are not the four familiar ones taught in medical schools: respect for autonomy, beneficence, non-maleficence, and justice. Here are the main concerns which emerged from the meeting:

Solidarity, “the practice of standing up together and acting in common”. “Just as infection spreads through connection, our ethical response requires us to act together to ensure recognition of our common nature, needs and value.”

Equal Moral Respect. “There can be no room for disagreement regarding the equal moral respect that is owed to every individual. In short, equal moral respect serves as a fundamental precondition for fair and equitable treatment.”

Equity. “Treating people equitably means treating like cases alike, e.g. treating people in accordance with their unique needs.”

Autonomy. “An autonomous individual is able to control what happens to their bodies and lives. Autonomous people may also forego making choices.”

Vulnerability. “Its core ethical function is to mark out the need for additional ethical consideration—or, heightened ethical scrutiny in the context of research—towards the risks and threats faced by a person or group regarded as potentially vulnerable.”

Trust. “During public health emergencies, such as COVID-19, action is required to ensure the maintenance of trustworthiness in those given responsibility for the response.”

Interestingly, solidarity is the first cab off the rank, not autonomy, which has been the default principle in most contemporary ethical discourse. Does this reflect a growing feeling that – in the words of Craig Klugman -- that “Bioethics has pushed too far in the direction of the individual and needs to have a turn toward the importance of the community and the common good”?

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.

comments powered by Disqus
 
December
06
 

Catholic bioethicists form coalition to lobby against hard lockdowns

Catholic and pro-life groups have formed a coalition to lobby for the right of patients to have “reasonable” access to family and clergy during the Covid-19 pandemic. The Health Care Civil Rights Task Force bases its criticism of hard lockdowns on constitutional rights.

The right to religious freedom and the right to visitation intersect in health care when clergy visit patients to provide spiritual care. Denial of visitation from clergy is a violation of both the right to religious freedom and the right of visitation. To prohibit a patient from receiving spiritual healing from clergy and from receiving the sacraments of eternal life during their last moments on this earth is a cruelty completely unjustified by the pandemic and is symptomatic of the radical secularization of modern society.

In its manifesto, the Task Force cites the First Amendment, which guarantees freedom of religious exercise. The Attorney-General of the Trump Administration, William Barr, declared in April that: “even in times of emergency, when reasonable and temporary restrictions are placed on rights, the First Amendment and federal statutory law prohibit discrimination against religious institutions and religious believers.”

Catholic discourse about medical ethics has a long history. Based on this experience, the Task Force says: “Morally we are called to use ordinary means and reasonable precautions to preserve our lives without ceasing to fulfill our daily responsibilities. It is vitally important to reiterate this almost self-evident point because a desire to reduce the risk of disease transmission to almost zero has led to fundamental rights being violated.”

The Task Force’s members include National Catholic Bioethics Center president Joseph Meaney, Bobby Schindler (the brother of Terri Schiavo), and officials at the Christ Medicus Foundation and Healthcare Advocacy Leadership Organization.

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.

comments powered by Disqus
 
December
06
 

Japan suicides spike during pandemic

More Japanese have died from suicide in October than from Covid-19 in the whole year.

"We didn't even have a lockdown, and the impact of Covid is very minimal compared to other countries ... but still we see this big increase in the number of suicides," said Michiko Ueda, a suicide expert at Waseda University in Tokyo. "That suggests other countries might see a similar or even bigger increase in the number of suicides in the future."

Japan keeps timely statistics on suicide, which is a major public health problem. So the figures for October have already been tabulated: 2,153 suicides and 2,087 Covid-19 deaths so far this year.

According to a CNN report, experts had anticipated that the pandemic would spark a mental health crisis, on top of the pressures of mass unemployment, social isolation, and anxiety.

Women have been disproportionately affected, although they represent a smaller share of the number of suicides. In October, the number of women who killed themselves rose nearly 83% compared to the same month last year; for men it rose nearly 22%.

"Japan has been ignoring women," said one woman interviewed by CNN. "This is a society where the weakest people are cut off first when something bad happens."

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.

comments powered by Disqus
 
November
29
 

Belgian authorities investigating allegedly illegal euthanasia deaths

Officials in the Belgian city of Leuven are investigating about ten euthanasia cases which may not have been done legally.

The public prosecutor was tipped off by an anonymous letter to the De Standaard newspaper. Until the investigation has been completed, police are keeping mum.

The letter says: “Our family member passed away two years ago, and we were told that euthanasia was presumed to have been carried out without the doctors informing us or following the necessary procedure. This is a very traumatic experience for us.”

Doctors are not required to notify the family if a person wants to be euthanised, but various medical associations strongly recommend it.

Two doctors were named in the letter, both of them associated with nursing homes in the Emmaus group. The head of the group, a former federal minister, Inge Vervotte, confirmed that the two doctors work with the homes, but she insisted that stressed that the cases being investigated involved patients in their private practice, and not residents of the nursing homes.

Professor Wim Distelmans, Belgium’s chief euthanasia overseer, said that his committee is supposed to be informed about every case of euthanasia, but it doesn’t always happen. “Some doctors are happy to admit that,” he admitted.

“What doctors write down, we naturally take for granted as true,” he said. “Apart from that, and rightly so, everyone is free to file a complaint with the public prosecutor’s office if they think they have reason to.”"

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.

comments powered by Disqus
 
November
29
 

European Parliament condemns Poland’s conservative stand on abortion

Europe is ganging up on Poland to get it to support legal abortion. On Thursday the European Parliament strongly condemned a recent decision by the country’s supreme court and urged its government to stop restricting women's sexual and reproductive health rights.

A total of 455 MEPs voted in favour of the non-binding resolution, with 145 opposing and 17 abstentions.

In October Poland’s Constitutional Tribunal ruled that abortions for reasons of foetal abnormality violate the Polish constitution. Since 1,074 of the 1,110 legal abortions in Poland in 2019 were done for this reason (many of them for conditions like Down syndrome), this effectively banned most abortions. Ever since, the country has been in turmoil, with demonstrations in support of abortion and against the Catholic Church and the government.

The 4,500-word non-binding resolution echoes the long list of demands by the protesters and reaches far beyond the decision of the constitutional tribunal. It calls for ready access to “emergency contraception”, age-appropriate sexuality education, a review of appointments to the constitutional tribunal, and more funding for sexual and gender equality. It affirms as a matter of fact that “access to abortion constitutes a human right, while the delaying and denying thereof constitute forms of gender-based violence and may amount to torture and/or cruel, inhuman and degrading treatment”.

It also deplores the fact that many Polish doctors invoke a right to conscientious objection if they refuse to do abortions or supply contraceptives.

There is a strongly political element in the resolution, as Poland’s current conservative government is determined resisted EU encroachment on its sovereignty. The resolution claimed that the ruling was made by “judges who are elected by and are fully dependent on politicians from the ruling coalition led by the Law and Justice Party (PiS)” and that it was “yet another example of the political takeover of the judiciary and the systemic collapse of the rule of law in Poland”.

The president of the Constitutional Tribunal, Julia Przylebska, angrily rejected the demands.

"The European Parliament's resolution constitutes an unprecedented attempt to interfere with internal systemic issues of the Republic of Poland not covered by European treaties,” she said. “MEPs have trespassed on the independence of the Constitutional Tribunal of the Republic of Poland, which is a breach of the tri-partite separation of powers, and therefore the fundamentals of democracy, which cannot be justified.”

She went on to say that "the European Parliament deputies have undermined one of the foundations of a democratic state based on the rule of law, which is judicial independence. Additionally, the Constitutional Tribunal ruled solely on the eugenic premise as a justification for a termination of pregnancy." She pointed out that Poland still allows terminations if pregnancy poses a threat to the woman's health or life and when the pregnancy results from a crime.

"The European Union constitutes a community of values,” she explained. “Let me remind all of you of Article 4 of the Treaty on the European Union which states that, in line with the principle of sincere cooperation, the EU and its Member States show respect for one another. I appeal to all European Parliament deputies for respect and to stop discrediting the Republic of Poland by undermining the legitimacy of its constitutional bodies, including the Constitutional Tribunal."

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.

comments powered by Disqus
 
November
29
 

Marie Stopes’s most famous memorial scrubs her name off the brand 

Just as slavery is the Achilles heel of 19th century institutions, eugenics is the weak point of abortion providers. The Black Lives Matter movement has unearthed links to slavery in public statuary and founders of American universities. Similarly, Planned Parenthood has had to distance itself from Margaret Sanger and the name of a former president of the University of Southern California has been expunged from its buildings.

But nobody has a bigger public relations challenge than Marie Stopes International. This is a British outfit with 13,000 employees which claims to be “one of the world’s largest providers of high quality, affordable contraception and safe abortion services”. Last year it helped around 5 million women with their abortions. It has clinics in 37 countries around the world.

Problem is, there are grubby eugenic fingerprints all over the brand. Marie Stopes, the pioneering birth control provider after whom the group was named, was an ardent eugenicist who even advocated compulsory sterilisation.

So the organisation is changing its name to MSI Reproductive Choices. Problem gone.

But is it?

Stopes was a prolific writer and describing her as a eugenicist is entirely uncontroversial.

How about the N-word? Yes, that too. In 1935, she attended a Nazi Congress for Population Science in Berlin. Zoe Williams, a columnist for The Guardian, mused that “Her eugenics programme was actually slightly to the right of Hitler’s.” Stopes admired Adolf. A month before World War II broke out she sent him a note along with a volume of her ghastly love poems: ‘Dear Herr Hitler, love is the greatest thing in the world: so will you accept from me these that you may allow the young people of your nation to have them?‘

If there had been any doubt about where her sympathies lay, she bequeathed her birth control clinic to the Eugenics Society when she died in 1958. Stopes’s birth control segued into controlling births.

All this was well known. June Rose’s 1992 widely-reviewed biography, Marie Stopes and the Sexual Revolution, paints a picture of an unpleasant woman whose brain was boiling with poisonous ideas and documents her devotion to eugenics, her social Darwinism, and her admiration of Hitler. (Rose suppressed evidence of anti-Semitism as “too distasteful”.)

But nobody seems to have cared too much. Until now. In the age of cancel culture, the eugenics taint became too dangerous. Anticipating attacks from the ravening wolves of wokery, the managers of Marie Stopes International acted before their business was destroyed. They cancelled their patron saint. Marie Stopes has been whitewashed from the organisation’s history.

Simon Cooke, the CEO, explained: “Marie Stopes was a pioneer of family planning; however, she was also a supporter of the eugenics movement and expressed many opinions which are in stark contrast to MSI’s core values and principles.”

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.

comments powered by Disqus
 
November
29
 

Will Covid-19 dethrone ‘autonomy’ as the dominant principle of bioethics?

What will bioethics look like after Covid-19? The experience of lockdowns, social isolation, fear of an invisible enemy, deference to experts, and dependence could change perceptions of how we approach ethical dilemmas.

Ruth Chadwick, co-editor of the journal Bioethics, muses in a recent editorial on the vehemence of public opinion about lockdown. “A survey undertaken by the UK think tank Demos found that 12% of mask wearers said they ‘hate’ those who do not wear face coverings, while 14% of lockdown respecters expressed the same emotion towards rule breakers.”

What does this suggest about the principles of bioethics? “Hatred is several steps beyond social disapproval. It suggests that there may be something more here than concerns about the free rider problem, or even worries about direct threats to one’s personal safety, if people are being regarded as ‘bad’ regardless of the relative riskiness of their behaviour in particular situations.”

Perhaps more reflection on solidarity is called for and less on autonomy. “Perhaps most striking, however, in the light of the Demos findings, is the question of what the conditions for the possibility of social solidarity might be,” she writes, “and the implications for the applicability and usefulness of the principle of solidarity in bioethics.”

Chadwick is the latest of a number of bioethicists – from very diverse schools of thought – who are questioning the dominant paradigm of autonomy. Carter Snead argues that autonomy presents “an incomplete and false vision of human identity and flourishing” which defines a human being “as an atomized and solitary will”. Laura Williamson contended recently that autonomy is of little use in ethical discussions about substance abusers. And Craig Klugman pointed out that “Bioethics has pushed too far in the direction of the individual and needs to have a turn toward the importance of the community and the common good.”

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.

comments powered by Disqus
 
November
29
 

Have the Swiss smuggled religion into their constitution?

Switzerland has some of the strictest laws in the world for care of animals. Goldfish, for instance, being social animals, must have companions in their bowls. This concern for animals and even plants stems from a 1992 referendum to amend the Swiss constitution to protect “human dignity” (Article 119) and the dignity of creatures (Article 120).

These amendments have been unpopular in some circles as they hamper the development of human reproductive technology and biotechnology.

An American lawyer, James Toomey, has published “the first English-language study of the Swiss constitutional concept of dignity as a coherent, unified concept that restrains biotechnology in both humans and other species” in the Journal of Law and the Biosciences.

He argues that “Because this theory speaks directly to contested questions of the good life, Switzerland’s adoption of it as a constitutional principle is analogous to the adoption of a religious theory in a constitution.”

The restrictions have very practical implications, as the rapid development of CRISPR gene editing technology will inevitably conflict with Swiss law.

Toomey, however, attacks the Swiss constitutional amendments not because they hamper the development of business and technology, but on philosophical grounds. “This worldview is meaningfully indistinguishable from traditionally religious ones. It is not one that liberal states should endeavor to adopt because liberal states should not adopt any one.”

His argument is an original one: that the Swiss have imposed a religious doctrine upon their citizens.

There is no doubt that for many Swiss people, nature has a moral value. It matters for its own sake, and they live their lives keeping that in mind. They enacted their worldview by majority vote into the Swiss constitution. In some sense, this is direct democracy in action, and more power to the activists able to convince a majority of citizens and cantons. But where democracy clashes with liberalism (and there is little more foundational to the liberal promise than individual freedom of belief), it is the majority and not the foundational principles of liberalism that ought to bend. As Steven Pinker put it, ‘[a] free society disempowers the state from enforcing a conception of dignity on its citizens’.

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.

comments powered by Disqus
 
November
29
 

China breaks up organ-donor racket

Four high-ranking doctors have been jailed in China after they were found guilty of illegally harvesting human organs. A court in the eastern city of Bengpu passed a sentence of between 10 and 28 months in jail on the charge of “insulting a body”.

Organ donation is a sensitive topic in China. Five years ago the government officially ended its policy of retrieving organs from executed prisoners and established a voluntary donation system. However, there are constant allegations that prisoners, even political prisoners, are used as sources for organ transplants. Now it appears that a black market in organs has sprung up to meet a shortfall.

This case is likely to lead to tighter rules on organ donations.

It appears that the defendants had failed to obtain legal consent for 11 organ-harvesting procedures between 2017 and 2018 in the county of Huaiyuan in the east province of Anhui. They also forged documents to make the procedures appear to be legal.

The scam worked like this. The former head of intensive care at the county’s People’s Hospital, Yang Suxun, asked families of dying patients, usually victims of car crashes or those suffering from cerebral haemorrhage, if they would like to donate the organs.

If they agreed Dr Yang would ask Huang Xinli, a doctor in Nanjing, if he needed the organs. Then Dr Yang would get family members to sign forged consent forms, without the presence of officials from the Red Cross Society of China as is required by organ transfer rules.

Dr Huang was an organ procurement official and was familiar with organ transplant rules. He forged signatures, altered medical records and manipulated the entry of organ transplants in the national system to “legalise” his acts.

Two other doctors participated. An ambulance driver and a businessman who helped to deliver the organs were also jailed.

The scheme was discovered when a man was promised 200,000 Yuan in “government subsidies” for his mother’s organs. But then he learned that the government did not offer financial incentives.

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.

comments powered by Disqus
 
November
29
 

Unknown hackers break into database of fertility clinics

Data security at U.S. Fertility, the largest network of fertility clinics in the United States, with 55 clinics in 10 states, was attacked by cybercriminals in August and September. First, some files containing names, addresses, dates of birth and, in some cases, a Social Security number were copied. Then, the hacker engaged in a ransomware attack.

This is an attack in which hackers lock users out and then demand payment to allow restoration of the system. If the ransom is not paid, hackers often threaten to publish the stolen data.

U.S. Fertility said the attack may have included private health data that could contain patient's medical histories, test results or medical records.

There is no evidence that any of the information was misused.

As a result of the incident the company has fortified its firewall, is monitoring its computer network for suspicious activity and is adapting employee security training on data security and recognizing phishing emails.

US Fertility was formed in May as a partnership between Shady Grove Fertility, which has dozens of locations across the East Coast of the US and Amulet Capital Partners, a private equity firm that invests in the healthcare space.

Data security is a not just a commercial problem for IVF clinics. The American government regards it as a national security issue. A CNBC report in October revealed that a Chinese company had been blocked from buying an IVF clinic in San Diego at some stage during the Trump Administration.

CNBC asked John Demers, a security expert in the Department of Justice, to explain why the government had bothered with IVF clinics.

“Your genetic material, your biological material, is among the most intimate information about you, who you are, what your vulnerabilities may be, what your illnesses have been in the past, what your family medical history is,” he responded. “The Chinese approach is to gather it now, and then figure out what to do with it later.”

This leads to two important worries. First, China could use fertility clinic data to accumulate a database of biological information about Americans.

“That can be used from a counterintelligence perspective to either coerce you or convince you to help the Chinese,” Demers said. “I’d be worried that the Chinese were going to get sensitive personal information about individual Americans, whether it’s their financial information, their health-care information, their genetic information, all of which they could use, from an intelligence perspective, to target that person.”

Second, the information could be weaponised. “I’m not saying that we’ve seen this, but the worst case would be the development of some kind of biological weapon,” Demers said. “If you had all of the data of a population, you might be able to see what the population is most vulnerable to,” he said, “and then develop something that’s taking advantage of that vulnerability.”

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.

comments powered by Disqus
 
November
29
 

Can we synthesise Christianity moral theology with secular bioethics?

A thought-provoking target article in the latest edition of The American Journal of Bioethics considers how Christian theological concepts might enrich secular bioethical discourse. Authors Michael McCarthy (Loyola University), Mary Homan (Medical College of Wisconsin) and Michael Rozier (Saint Louis University) argue that the Christian concepts of human dignity, sin, and the common good can bring analytical depth and clarity to discussions in a range of bioethical subfields, including debates clinical ethics, research ethics and public health ethics.

In essence, they claim that: “a Christian approach to bioethics can augment bioethical discourse by providing a thick theological description of the human person.” 

The authors begin their article with a comment on the decline of dialogue between Christian moral theologians and secular bioethicists. Christian theologians had a significant impact on bioethics in its inception, though the influence of religious thought on bioethics has waned in recent years. The authors argue that this is due to both increasing secularism in society as well as a failure on the part of Christian ethicists to illustrate the relevance of Christian concepts for contemporary bioethics. This "communication breakdown" is regrettable, and the authors express a desire to establish a new dialogue between Christian moral thought and secular bioethics. 

To demonstrate the importance of Christian moral concepts, the authors provide a series of ethical vignettes from different subspecialties of bioethics, and consider how Christian moral thought might enrich our thinking about these issues. In research ethics, the authors argue that issues of injustice arise regularly, including problems with minorities either being excluded from research or being exploited in research. Theology, they contend, can enrich our understanding of the effects of structural injustice in the context of research ethics:   

“theological bioethics argues for a critical reflection on what alternative choices need to be made to upset the power dynamic and disrupt the social sin embedded within the practice of biomedical research”. 

In public health ethics, the authors note that public health experts often become preoccupied with utilitarian health goals, while failing to make space for individual interests in their framework. Related to this, they fail to prosecute the case for civic virtue and compliance with public health campaigns or orders: 

“[Public health ethics] makes no claim as to why it is significant that human beings share lives together or why we create communities. This lack of a compelling reason for community leads to a variety of problems, including the challenges in the United States around vaccination”.

What is needed in public health ethics is a robust conception of the common good, whereby the good of individuals is conceptually linked to the good of society. 

The authors conclude their article by noting that Christian view of humanity can provide a richer lens than standard bioethical principles through which to view contemporary issues: 

“...a Christian anthropological vision of the human person centered on an understanding of human dignity, sin, and the common good provide a unique perspective to pursue the social ethics concerns raised by many secular bioethicists”. 

The article is certainly a stimulating read, and it is admirable in its attempt to make Christian ethical thought compatible with the concerns of contemporary bioethics. Its diplomatic style, however, leads to certain glaring oversights -- be they intentional or unintentional -- in the discussion. The devil is in the details, as Wake Forest University bioethicist Nicholas Colgrove writes in a commentary

“...Securing agreement on general claims (like “respect human beings”) is easy but securing agreement on the meaning of these claims is not. For instance, Christians who insist that all humans have dignity cannot accept that access to safe abortion is a matter of justice or means of protecting the vulnerable... Reflection on the actual Christian concept of “human dignity,” therefore, leaves secular bioethicists with two choices: Accept the Christian concept and revise dominant secular moral norms or deprive the Christian concept of its core content.”   

Xavier Symons is deputy editor of BioEdge 



comments powered by Disqus
 
November
22
 

Dutch doctors cleared to euthanise dementia patients who have advance directives

Dutch doctors will be able to sedate demented patients and then euthanise them, if they have made advance directives, according to new official guidelines. This follows a Supreme Court ruling earlier this year which quashed the conviction of a retired nursing home doctor for murder.

The doctor, Marinou Arends, euthanised a 74-year-old woman, even though she was resisting, on the basis of advance care directives which she had written before she entered the nursing home. Although the doctor had secretly sedated her, the woman still had to be held down by her son-in-law so that she could be given the lethal injection. The patient had said she wanted euthanasia “when the time was ripe”, but she had not been clear about what she regarded as unbearable suffering.

Dr Arends was the only doctor to have been prosecuted since euthanasia was legalised in the Netherlands in 2002.

The court exonerated her, ruling that she had acted legally. It declared that if a demented patient is incapable of giving consent, doctors may proceed in accordance with prior written request even if they seem happy or even if they resist.

The regional euthanasia review committees (RTE) now advise giving doctors more leeway to follow their own judgement in practice.

“In giving euthanasia to a patient who is no longer mentally competent as a result of advanced dementia, it is not necessary for the doctor to agree with the patient the time or manner in which euthanasia will be given,” says the new RTE guideline. “This kind of discussion is pointless because such a patient will not understand the subject.”

Jacob Kohnstamm, chairman of the RTE, said the clarification stressed doctors’ reasonable, professional judgement and could relieve fears of prosecution in these rare cases.

"It’s only two or three cases a year but this might help doctors to have less fear of a penal case," he said in the Telegraph (London).   

“Doctors can now worry less that they are putting a noose around their own necks with euthanasia,” he said. “They can be less afraid of the justice system and the review committees.”

According to Dutch media, the new guidelines will affect very few people each year, as most doctors advise that patients with dementia should go at “five to 12” while they are still compos mentis. Last year there were 6,361 cases of euthanasia, representing 4.2% of deaths. Of these, 160 people had early stage dementia and just two were at an advanced or very advanced stage. These, of course, are the reported deaths – a good proportion of euthanasia cases are not reported.

So far this year, the RTE has approved one euthanasia for a woman between 70 and 80 with advanced Alzheimer’s, based on her advance directive, at the request of her husband.  

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.

comments powered by Disqus
 
November
22
 

Euthanasia as an option for Canadian nursing home patients who are sick of lockdowns

A final family get-together with Nancy Russell / ctvnews.ca  

This is just one story amongst many but it raises serious questions. A 90-year-old woman, Nancy Russell, chose euthanasia last month in Toronto. She was not suffering unbearable pain. She was just sick and tired of lockdown isolation in her nursing home.

According to a report in CTVNews, “Residents eat meals in their rooms, have activities and social gatherings cancelled, family visits curtailed or eliminated. Sometimes they are in isolation in their small rooms for days. These measures, aimed at saving lives, can sometimes be detrimental enough to the overall health of residents that they find themselves looking into other options.” 

“She, almost overnight, went from a very active lifestyle to a very limited life, and they had, very early on, a complete two-week confinement just to her room,” said her daughter. “She was just drooping. It was contact with people that was like food to her, it was like, oxygen. She would be just tired all the time because she was under-stimulated.”

Ms Russell supported Canada’s medically assisted dying but the first doctor to whom she applied refused because she had “too much to live for”. She applied again after “more concrete medical health” issues emerged. This time, the doctors gave her the tick of approval.

“She just truly did not believe that she wanted to try another one of those two-week confinements into her room,” her daughter said.

“When you stick someone alone and deprive them of the usual things that bring them interest in joy, that can be an incredibly isolating, lonely, depressing experience,” Samir Sinha, a geriatric specialist at Mount Sinai Hospital told CTV News.

“And frankly, when you can't look forward to getting out of your room, to having meals or doing activities with others, to even seeing your own families and loved ones, you can imagine for a person in the last few years of their life where these are the basic things that actually bring them joy and really defined what they would call their own quality of life, when you actually deprive a human being of these things, you can imagine that that can have significant psychological consequences that can really give people no real will to live anymore.”

Even to die, Ms Russell had to leave her nursing home. She spent a week with one of her children before she was given a lethal injection surrounded by her relatives on October 20. “She was able to direct a peaceful, pain free death on her own time and avoid a great fear of hers, which was to endure winter and lockdowns,” her daughter said.

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.

comments powered by Disqus
 
November
22
 

Bioethicist speaks about his own clash with Covid restrictions

Numerous articles have been published in bioethics journals about aspects of the Covid-19 pandemic. But bioethicist Joseph Meaney, the president of the National Catholic Bioethics Center, speaks from personal experience. He was hospitalised for four days with a near-fatal heart problem and had to cope with Covid-19 restrictions on visiting. He reflected on his experience with a journalist at Crux.

Hospitals should recognise a right not to die alone:

Certain hospitals and health care facilities, particularly nursing homes for the elderly, put into place draconian visitation restrictions as a reaction to the COVID-19 pandemic. The result of these policies was the prevention of family members or clergy from being able to come to the bedside of many dying persons as they wished. Large numbers of people had only medical staff around them when they died. These were preventable tragedies and especially serious from a spiritual perspective since the last rites can only be given in person and can be essential for preparing a person for death and their souls for eternal life through the forgiveness of sins.

Many institutions have a mistaken hierarchy of values.

What I believe is lacking is a compassionate understanding of human rights. For some secular humanists it could be indeed true that there is no higher value than preserving person’s physical life and they do not believe in life after death. It is their right to hold this belief, but they do not have the right to impose it on others. For Catholics and many other believers there are things worse than death or more important than reducing the risk of death.

Utilitarian considerations are not enough

What is frightening is the blindness to the pain and suffering being imposed unreasonably on patients and families. Empathy requires us to try and understand the feelings and beliefs of others. If what is being requested is impossible or clearly harmful, it can be refused. If a person values something tremendously, it should be given great weight. No one should be forced to cooperate with evil and violate their well-formed consciences, but what I see happening with the dying is a cold calculation. It is cheaper and easier to simply deny visitation and it can reduce the risk of contagion. 

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.

comments powered by Disqus
 
November
22
 

Leading British surgeon allegedly hoarded body parts

(Sorry, we missed this significant story which broke in September and October.) A pioneering orthopaedic surgeon has been officially censured for illegally keeping the bones of 5,224 of his patients without their consent for his private research. On October 22 conditions were placed on the medical licence of 67-year-old Derek McMinn.

Patients travelled from all over the world to have McMinn operate on their hips and knees at the BMI Edgbaston Hospital in Birmingham. He developed the first technique for successful metal-on-metal hip resurfacing and is an acknowledged authority in the field. His patients included politicians, sports stars and celebrities.

McMinn said that he had been storing bone samples in his private residence for 25 years with the verbal consent of his patients. However, consent is supposed to be documented in writing and there does not appear to be any evidence of discussions with his patients. His collection apparently included patient notes and X-rays. He claims that he acted with the full knowledge of his colleagues and employer.

The Independent was told by an anonymous source at the hospital: “It’s all been kept quiet, they have covered it up. There are lots of patients who haven’t been told and who don’t know he has their body parts. He was the goose that laid the golden egg. He generated an enormous amount of income for the hospital. He had been there a long time; it was almost his hospital really. It is shocking how was this allowed to happen for so long.”

Commenting on the scandal in The lndependent, Dr Alexis Paton, an ethicist with the Royal College of Physicians, blamed “tunnel vision”.

If McMinn failed to recognise his research was crossing a line, it also speaks to a very real, very modern and very persistent problem in healthcare that almost always results in harm to patients: tunnel vision.  

Tunnel vision occurs when healthcare staff focus on only one aspect of care, losing awareness of the situation and appropriate steps they should be taking to avoid harm. …

If McMinn was clandestinely hoarding human tissue, what he hoped to gain is unclear. Speaking as someone who reads a lot of these, a sound and well-written research proposal and ethics application would very likely have been approved. That he allegedly ignored the conventions of research ethics and patient rights for so long, talking his co-workers into colluding with him leaves one important and unanswered question: was it worth the risk?  

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.

comments powered by Disqus
 
November
22
 

Sex robots can offer the intimacy that the elderly disabled crave, says bioethicist

Sex robots are needed for older people, especially older people with disabilities, according to an article in the Journal of Medical Ethics. Nancy S. Jecker, a bioethicist at the University of Washington, in Seattle, contends that “the non-voluntary absence of sex from someone’s life is not just a bad thing but also a threat to a person’s identity and dignity” and sex robots can fill this gap in the lives of the elderly. Society should make “reasonable efforts” to help them as a way of promoting human dignity.

Jecker, who has written extensively about ethical issues associated with ageing societies, cites a number of other writers who believe that robots are the answer to the affective needs of lonely elderly and disabled people. “Almost everyone wants someone to love, but many people have no one. If this natural human desire can be satisfied for everyone… surely the world will be a much happier place,” writes David Levy, an authority on computer chess.

Michael Hauskeller, a philosopher at the University of Exeter, in the UK, points out that some people actually believe that the advantage of sex robots is their reliability compared to human partners, who are unreliable and thereby inferior. “The problem with entering into relationships with other people,” he says, “is that, although they certainly can be a source of pleasure, more often than not they stand in the way of it. Moreover, even when they give us pleasure and happiness…this pleasure can always be taken away.” (It's not a point of view that he shares.) 

Trusting that sex toys will become more and more sophisticated, Jecker contends that “Unlike sex devices that function merely to enhance sexual pleasure, people bond to sex robots and feel close to them. Sex robots create the possibility not just of sexual pleasure but also of sexual relationships and interpersonal intimacy.”

While acknowledging that many people are sceptical about the idea that a robot can ever substitute for the affection of a human being, she argues that “sex robots are not a perversion but a way to enhance dignity by shoring up capability shortfalls.”

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.

comments powered by Disqus
 
November
22
 

Serbian govt and media attack bioethicist

Prof. Vojin Rakić 

A leading Serbian bioethicist is being attacked by the government and media in his country, prompting an open letter supporting him signed by some of the most prominent bioethicists in the US, the UK and across Europe.

Professor Vojin Rakić is the founder and head of the Center for the Study of Bioethics  in Belgrade. His research focus is moral bioenhancement and he has debated the issue in the Journal of Medical Ethics with Julian Savulescu and Ingmar Persson. The letter describes him as “an internationally well-known and highly respected scholar, who is a man of integrity and courage and a much-valued colleague”.

It appears that Rakić fell foul of the Serbian President,  Aleksandar Vučić, after criticising him for being an autocrat who was using pandemic measures to consolidate his power. Since then, says the letter:

Prof. Rakić has been persecuted by the current Serbian authorities through the use of false accusations and has been regularly victimised on TV programs and on the front pages of regime-run media in Serbia. This campaign includes having been wrongly accused of misrepresenting himself in his professional role in the International Network of the UNESCO Chair in Bioethics (Haifa), a gross misrepresentation of elements of his academic work, as well as an onslaught of defamation of his person and his family, with blatant lies about his private life and the private lives of his underage children.

One of the bullets used by the government’s media stooges is an article which Rakić published in the journal Sexuality & Culture earlier this year. In “Prostitutes, Sex Surrogates and Sugar Babies” he argued for the basic morality of prostitution. This was used by the web portal Republika to insinuate that he was an immoral fraud.  

Amongst the signatories are Art Caplan, of NYU Grossman School of Medicine; Peter Singer, of Princeton University; John Harris, of the University of Manchester; Erik Parens, of The Hastings Center; and Udo Schuklenk, co-editor of Bioethics.

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.

comments powered by Disqus
 
November
22
 

Your mission, should you choose to accept it, is to blow up the universe

Euthanasia is usually viewed as a personal experience. But there are movements and philosophers who believe that it would be a good idea if the whole human race were to perish. South African philosopher David Benatar, for instance, argues that bringing people into existence always does them harm. And the Voluntary Human Extinction Movement advocates the gradual disappearance of mankind.

However, as Thomas Moynihan, of the University of Oxford, writes in The Conversation, these guys are amateurs compared to a nearly forgotten German philosopher, Eduard von Hartmann (1842-1906).

A disciple of Schopenhauer, von Hartmann believed that all life is suffering and all existence is pain. Therefore, the less life the better. If humanity managed to go extinct, evolution would eventually give rise to another intelligent species which would also experience great suffering. This would “perpetuate the misery of existence”.

Moynihan writes:

Hartmann thought that, as intelligent beings, we are obligated to find a way to eliminate suffering, permanently and universally. He believed that it is up to humanity to “annihilate” the universe: it is our duty, he wrote, to “cause the whole kosmos to disappear”.

In other words, the moral duty of humanity is to find a way to euthanise the universe.

Hartmann was convinced this was the purpose of creation: that our universe exists in order to evolve beings compassionate and clever enough to decide to abolish existence itself. He imagined this final moment as a shockwave of deadly euthanasia rippling outwards from Earth, blotting out the “existence of this cosmos” until “all its world-lenses and nebulae have been abolished”.

Von Hartmann was vague about how humanity could comply with its destined task, although he was confident that sooner or later appropriate technology would be developed.

Moynihan believes that von Hartmann was mistaken:

Hartmann’s philosophy is fascinating. It is also unimaginably wrong. This is because he confuses the eradication of suffering with the eradication of sufferers. Conflating this distinction leads to crazy visions of omnicide. To get rid of suffering you don’t need to get rid of sufferers: you could instead try removing the causes of pain. We should eliminate suffering, not the sufferer.

Moynihan has just published a book on the history of human extinction projects, X-Risk: how humanity discovered its own extinction.

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.

comments powered by Disqus
 
November
18
 

Biden announces expert team for planning Covid-19 fight

In one of his first initiatives after the election – which continues to be disputed by the incumbent -- US President-elect Joe Biden set up a Transition Covid-19 Advisory Board.

There is little doubt that the US is facing a crisis. New cases are rising in at least 40 states, with more than 9.3 million total infections and more than 236,000 deaths. According to exit polls, 73% of Biden voters felt that this pandemic was the most serious issue facing the country.

Mr Biden has appointed David Kessler, Vivek Murthy, and Marcella Nunez-Smith as his lead advisers. His policy is outlined on his campaign website.

“Dealing with the coronavirus pandemic is one of the most important battles our administration will face, and I will be informed by science and by experts,” said Mr Biden. “The advisory board will help shape my approach to managing the surge in reported infections; ensuring vaccines are safe, effective, and distributed efficiently, equitably, and free; and protecting at-risk populations.” 

The first part of his plan is to fix Trump's test-and-tracing policy. He will make testing free and widely available. He plans to double the number of drive-through testing sites, invest in home tests and instant tests, set up a “Pandemic Testing Board” to produce and distribute tens of millions of tests, and hire 100,000 contact tracers.

He also plans to use the Defense Production Act to ramp up production of masks, face shields, and other PPE so that the national stockpiles are fully replenished.

He will provide expert advice on how to apply lockdowns, on the notion that “Social distancing is not a lightswitch; it is a dial.”

When vaccines are available, he will “invest US$25 billion in a vaccine manufacturing and distribution plan that will guarantee it gets to every American, cost-free.”

And to protect older minority Americans he will “establish a Covid-19 Racial and Ethnic Disparities Task Force, as proposed by Senator Harris, to provide recommendations and oversight on disparities in the public health and economic response. At the end of this health crisis, it will transition to a permanent Infectious Disease Racial Disparities Task Force.”

On the controversial issue of masks, Biden says that he wants “every American to wear a mask when they are around people outside their household”. This is not a Federal responsibility so he has called upon governors and local authorities to make it mandatory in each state.

Reaction to his initiatives was subdued. At the libertarian site Reason, Ronald Bailey was supportive but suspicious of the ability of Obama-era bureaucrats to deliver the goods. A former head of Planned Parenthood and public health expert, Leanna Wen, said in the Washington Post that Biden’s team of advisors was top-heavy with medicos. She suggested adding economists, businessmen, celebrities who had experienced Covid-19, religious leaders, and Republicans. Wesley J. Smith pointed out in National Review that Biden’s task force Ezekiel Emanuel, of the University of Pennsylvania. He reminded readers that Emanuel wrote not long ago that “living too long is also a loss” – a dangerous sentiment at a time when the elderly are at serious risk.

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.

comments powered by Disqus
 
November
18
 

Eugenics policies are part of China’s five-year plan, says expert

An expert on women’s issues has rung alarm bells about the potential for eugenics in China’s latest “five-year plan”. Columbia professor Leta Hong Fincher told a panel of China watchers at a virtual conference by the Center for International and Strategic Studies last week.

“What caught my eye was that they actually use specific language saying that China needs to ‘upgrade population quality,’” she said. “They need to ‘optimize their birth policy.’ They even use a term … which is effectively emphasizing the role of eugenics in population planning in China.”

She told the conference that this also has an impact upon a serious human rights issue – the treatment of Uyghur Muslims in the northwest province of Xinjiang. The government is using draconian methods to limit births of the Uyghurs and to dilute Uyghur culture by encouraging intermarriage.

“We see it happening in Xinjiang with the forced sterilization of particularly Uyghur Muslim women. And the language in the plan suggests to me that the government is going to continue with that,” she said.

“You have seen a huge reduction in birth rates in Xinjiang and, on the flip side, the government is also trying to coopt and persuade Han Chinese women who are college-educated into having more babies.”

Birth rates fell by nearly a third in Xinjiang in 2018. A good part of this was attributed to the sinister-sounding term “better implementation of family planning policy.”

Back in 2018 Dr Hong Fincher criticised China’s population control policies in the New York Times. She claimed then that the government was treating women “as the reproductive agents of the state, as instruments of implementation for its eugenic development agenda.”

“The approach’s eugenic undertones are unmistakable. Even as officials urge college-educated, Han Chinese women to marry and get pregnant, they are discouraging, sometimes through coercion, ethnic minorities with high birthrates — particularly Uighurs in the northwestern region of Xinjiang — from having more children.”

There are financial incentives for intermarriage. The Guardian reported in 2014 that at least some local governments will pay 10,000 yuan (US$1500) to mixed-race couples during the first five years of their marriage, on top of housing, medical and education subsidies. This does not appear to have changed.

The government is even making bizarre match-making videos.   

On Hong Fincher’s Twitter feed she cites the despairing words of a Uyghur activist published on the Bitter Winter website:

“Uyghur women are also forced into marriages with Han Chinese men, a part of China’s strategy to force assimilation of the Uyghurs, colonize the region and take its resources while promoting the Belt and Road Initiative. There is no other way to view this other than as government-sponsored mass rape of an entire race of women with the express purpose of “breeding” the Uyghurs bloodline away. Uyghur women are unable to give birth to Uyghur babies anymore. Thus, there are no more new Uyghur generations and the Chinese government’s systematic genocide is set on the rails with an autopilot mode.”

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.

comments powered by Disqus
 
November
18
 

Does the autonomy principle work for substance abusers? 

Autonomy is the fundamental principle of contemporary bioethics – or most of it. In moral dilemmas, the path leading to greater autonomy is normally the right one. But are there exceptions?

In a fascinating article in the Journal of Medical Ethics, Laura Williamson, of Augusta University, in Georgia, argues that substance abuse is a disorder for which therapies based on autonomy are of little use. Far more important are relationships and empathy.

a simple focus on self-determination, while intended to empower, does not provide sufficient support to help us move beyond seeing people as solely responsible for what is a complex biopsychosocial condition. The focus remains on the person seeking treatment, not the professionals providing it. It also gives inadequate decision-making support to help people work through what is the best course of action for them: independence has been linked to abandonment. Finally, a focus on self-determination lacks the ability to highlight that what a person-centred approach requires is not leaving people to their own devices (by being less paternalistic), but actively engaging with and supporting them to make informed choices about their recovery options.

Promoting separateness over relatedness does not help addicts, she argues. “Healthcare professionals can continue to operate with misconceived and outdated concepts of autonomy that prioritise non-interference to such an extent that clients are left isolated.”

In fact, she says, privileging autonomy can promote stigma, as the fundamental reality of addiction is precisely impaired autonomy. “Without a stronger relational or social component, an individual focus can fuel a vicious circle which sees people with [substance use disorders] as responsible for their condition, blameworthy and the justifiable target of stigma.”

It’s a very thought-provoking article. The cost of alcoholism, illicit drug use and prescription opioid abuse is an estimated US$440 billion a year in the United States. A more liberal estimate which includes a quantification of society harm is $1.45 trillion. About 160,000 Americans died of drug or alcohol abuse in 2017. If autonomy is the fundamental principle inspiring treatment programs, it doesn’t seem to be working.

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.

comments powered by Disqus
 
November
18
 

Disabled groups attack liberalizing euthanasia in Canada

Lobby groups for Canadians with disabilities are working hard to defeat a bill broadening the scope of euthanasia legislation.

Under the current legislation, although some people with chronic illness want “medical aid in dying” (MAiD), they may not be eligible because their death is not “reasonably foreseeable”, in the words of the legislation.

A new proposal, Bill C-7, retains all of the existing eligibility criteria, but removes the requirement for "reasonable foreseeability of natural death". It would also expressly exclude persons suffering solely from mental illness.

But disability advocates believe that Bill C-7 sends a message that their lives are not worth living. “Our biggest fear has always been that having a disability would become an acceptable reason for state-provided suicide,” Krista Carr, of Inclusion Canada, told the House of Commons justice committee this week. “Bill C-7 is our worst nightmare.”

Catherine Frazee, of Ryerson University’s School of Disability Studies, says that the government is making it possible for people with disabilities to kill themselves while doing whatever it can to prevent suicide for everyone else.

“Why only us?” she asked. “Why only people whose bodies are altered or painful or in decline? Why not everyone who lives outside the margin?”

Roger Foley, a 45-year-old with a neurodegenerative disease that has left him hospitalized, unable to move or care for himself, recounted how he’s been denied home care and allegedly been pressured by hospital staff to seek an assisted death. “My life has been devalued. I have been coerced into an assisted death by abuse, neglect, lack of care and threats,” said Foley.

He has launched a court challenge based on his right to an “assisted life.”

Carr told the committee that “every national disability organization is opposed” to Bill C-7 but their voices are “are getting drowned out by people who do not experience the systemic marginalization, the poverty and the very difficult lack of supports and life circumstances that people with disabilities experience that lead them into situations where MAID is either promoted to them or they feel like it’s their only option.”

Unsurprisingly, not everyone with a serious disability is opposed to the amendments. Steven Fletcher, a former federal MP and cabinet minister said that the notion of protecting the vulnerable is “insulting” and “condescending.”

Fletcher, who became a quadriplegic at 23 after his car hit a moose, believes people with disabilities should have right to decide when their suffering has become intolerable, just like everyone else.

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.

comments powered by Disqus
 
November
18
 

Mother blocks – temporarily – transgender treatment in BC

A Supreme Court judge in British Columbia stopped doctors from performing a “gender-affirming” double mastectomy on a 17-year-old Vancouver girl. The girl’s mother had appealed to the court for an injunction, which Justice Shelley C. Fitzpatrick granted for three weeks.

The teenager began hormone treatment in July as part of her transition and was scheduled to have her breasts removed.

Her mother, A.M., believes that her daughter has been "caught up in a fad". She criticised a BC school program, SOGI 123, for "pushing depressed and anxiety-ridden girls to gender-change clinics when what they need is psychiatric care."

A.M. also wants the court to prevent her daughter’s doctor from administering puberty blockers.

"Worst of all, the law lets it all be kept secret from parents. Why is the College of Physicians and Surgeons of British Columbia permitting this?"

A.M.’s lawyer, Carey Linde, told CTV News that "The right of the parent to be in charge of their children is the core of Western civilization."

Trans rights activist Morgane Oger disagreed. She said that the judge should not have granted an injunction of even three weeks given that a similar case last year failed. "The laws don't have exceptions for parents with strong feelings," Oger said. "The Supreme Court has decided this, the Appeals Court has decided this – we're not going to let a parent veto a child's medical care, whether it's an abortion, or transgender-specific care, or access to a prescription, or access to a transplant."

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.

comments powered by Disqus
 
November
18
 

Military doctors who treated Trump are caught in a web of dilemmas

President Donald Trump’s brush with Covid-19 raised a number of questions related to medical ethics. He received a cocktail of drugs, including experimental treatments which are not normally available to the public. He had to receive emergency approval from the US Food and Drug Administration. His doctor, Navy Commander Sean Conley, told the public only what the President wanted him to say.

Without mentioning Mr Trump’s name, Elliott J. Crigger, an ethicist at the American Medical Association, has published a scathing commentary on the ethics of the President’s highly public treatment in the Hastings Center Bioethics Forum.

First, he acknowledges that POTUS is a most unusual patient. Everyone has a right to confidentiality, but the public – the whole world – has a stake in his health.

Similarly, the physician of POTUS may easily have divided loyalties. As a doctor, he should respect the patient’s interests; as a military officer, he has to follow the orders of his Commander-in-chief.

not respecting the president-patient’s preferences for care when they do not coincide with the physician’s best professional judgment is to decline a direct order from the commander-in-chief; providing treatment that the physician believes will not achieve the desired goals of care contravenes the ethics of medicine.

So should Commander Conley have prescribed Regeneron's REGN-COV2, an experimental and unproven drug? In part, says Crigger, it depends on the circumstances – its likely benefit, its urgency, the risks, and the alternatives.

But he concludes, “As a matter of professional ethics, physicians are not required to offer or provide treatment they cannot be reasonably certain will benefit the patient nor to accede to a patient’s request for unproven treatment—even a patient who has the power, authority, and public significance of the president.”

In any case, making an experimental drug available to POTUS sends bad messages to the public. It encourages reckless use of untested drugs and it undermines a doctor’s obligation to ensure that all patients receive the same quality of care.

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.

comments powered by Disqus
 
November
14
 

Tasmanian politicians defer vote on euthanasia

A euthanasia bill passed in the upper house of the Australian state of Tasmania this week. Both sides of the contentious issue believe that it could also pass in the lower house, but Premier Peter Gutwein stepped in and requested a report from a committee of experts before a final vote.

According to The Australian, it now seems that the fate of the bill will not be decided before February or March next year.

“Should this legislation become law, it is incumbent on all of us to ensure that it is the best law possible and affords real protections for the most vulnerable in our community,” Mr Gutwein told parliament.

“Just as other jurisdictions have utilised independent processes to ensure such legislation is the most robust it can be, I have requested the University of Tasmania to establish an independent review panel to … provide their view regarding how this legislation compares to similar laws in other states and around the world.

“I have also requested UTAS to provide a view from the review panel in terms of end of life considerations, such as palliative care and advanced care directives … and what other steps could be considered prior to this legislation taking effect.”

The inquiry was backed by an independent member of the lower house, Madeleine Ogilvie, who has called for a study of how euthanasia will affect faith-based hospitals and nursing homes. She holds the balance of power.

The bill’s sponsor, upper house member Mike Gaffney, insisted earlier in the week that the bill should be passed as soon as possible. “In Tasmania, we’ve had bills in 2009, 2013, 2017 (all voted down) and now 2020. The bill should progress as quickly as it can downstairs and I’m sure the Premier will do that.”

Mr Gaffney said that his bill would force faith-based institutions to host euthanasia deaths. “They shouldn’t be able to (stop assisted dying) in a secular society,” he said. “I’d be concerned that any organisation, where you’ve had a person resident for years, would then at their time of need, say, ‘well, you’ve got to get up and go because it’s not part of our policy’.

“If this becomes law, it is … a legal choice, so why would any institution deny a person access to adequate or correct medical assistance? VAD is not suicide; it’s a legal, medical option.”

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.

comments powered by Disqus
 
November
07
 

Polish government backs down over abortion

In the face of massive protests, the government of Poland has delayed indefinitely the implementation of a law banning abortions of children with birth defects. The country’s supreme court ruled last month that this was unconstitutional, sparking huge demonstrations every day across the country.

The government, led by the conservative Law and Justice Party (PiS), is faced with a dilemma. A significant number of voters are passionate supporters of liberalising its abortion laws. The government supports the court, but it is under enormous pressure domestically and internationally to be more “progressive”. The New York Times described the protests as  “the most intense in the country since the 1989 collapse of communism”.

"The verdict made me feel like my country was spitting in my face. I broke down in tears, powerless," Natalia Broniarczyk, of a group called the Abortion Dream Team, told AFP.

The nightly demonstrations reflect fault lines in Polish society. “I think it is a whole backlash against a patriarchal culture, against the patriarchal state, against the fundamentalist religious state, against the state that treats women really badly,” Marta Lempart, one of the organisers of the demonstrations, said in The Guardian.

The leader of PiS, Jarosław Kaczyński, last week urged members to call for a defence of the Catholic Church “at all costs”. He also declared that the protests were “intended to destroy Poland”, and urged his supporters to fight for “Poland and patriotism” in order to avert “the end of … the Polish nation as we know it”.

Ewa Letowska, of the Polish Academy of Sciences and a former judge at the Constitutional Tribunal, the country’s highest court, told the NYTimes that the government’s delay was illegal. “The publication of the tribunal’s rulings is mandatory,” she said. “Although there were objections to the ruling, some of them legitimate, delaying the publication is unconstitutional.”

The Polish president, Andrzej Duda, once a supporter of severely restricted access, has backtracked a bit. He now favouring and exception for fetuses with “lethal” abnormalities. But this would still ban abortions in case of other conditions such as Down syndrome. This compromise does not appear to satisfy either side.    

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.

comments powered by Disqus
 
November
07
 

Election takeaways

The result of America’s 2020 presidential election is still unknown. It seems that Joe Biden has defeated President Donald Trump but weeks of recounts and lawsuits could lie ahead. However, a few bioethical developments have emerged from the fog of Tumultuous Tuesday.

It appears that the number of pro-life women in the House of Representatives will double. All 11 pro-life women incumbents were re-elected, and at least 13 new pro-life women will join them. At least seven of them flipped Democrat-held seats. Other pro-life gains are possible, because winners have not been declared in some seats. At least six pro-life women will serve in the US Senate. “We expect when all votes are counted and the races are called, we will have a record number of pro-life women serving in the next Congress,” declared Marjorie Dannenfelser, of Susan B. Anthony List. “These gains are a repudiation of abortion extremism and further evidence that life is a winning issue in politics.”

Louisiana voters approved an amendment to the state’s constitution which declares that there is no constitutional right to an abortion: “To protect human life, nothing in this constitution shall be construed to secure or protect a right to abortion or require the funding of abortion.” This measure is toothless and largely symbolic at the moment, however, under Roe v. Wade. There are only three abortion clinics currently operating in Louisiana. Tennessee, Alabama and West Virginia already have similar provisions in their constitutions.

California voters appear to have given a thumbs-up to Proposition 14, to refinance the California Institute for Regenerative Medicine. This authorises a bond issue for US$5.5 billion over the next 10 to 15 years. Although counting has not finished yet, officials reported that 51.1% of voters backed it.

Nature reports that most American scientists are dismayed by the results of the election. “Some scientists saw the deadlocked election as a sign of their own failure to communicate the importance of science, evidence and truth to the general population,” writes Jeff Tollefson. “Distrust of Trump within the scientific community stems from his rejection of climate science, his rollback of numerous environmental regulations and his mishandling of the COVID-19 pandemic, which has now killed more than 230,000 people in the United States. Nature’s own survey of its scientist readers demonstrated their condemnation for these actions: of the approximately 580 respondents eligible to vote, 87% said they would be doing so for Biden.”

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.

comments powered by Disqus
 
November
07
 

We need to move beyond vertebrate-centric bioethics, scholars argue

A long-standing prejudice based on feelings of disgust and speciesism has excluded non-vertebrate animals like octopuses and insects from moral consideration. But invertebrate brains comprise upwards of 99% of the brains on the planet, argue two philosophers in the journal Animal Sentience, and we need to treat them accordingly. It is time to end the “vertebrate dogma”.

Their contentions are supported by a good number of comments from other academics in a commentary section of the journal.

Part of the problem is that anachronistic views of evolution, which regard invertebrates as “lower” beings, continue to influence public policy and common morality, contend Irina Mikhalevich, of Rochester Institute of Technology, and Russell Powell, of, Boston University. But studies of invertebrate behaviour, especially of bees, suggest that they may have a rich inner life. They may deserve moral status.

“Honeybees can be taught addition and subtraction procedures, appear to have the concept of ‘zero’ and can learn to attend to global or local features of objects ... Bees and wasps can recognize human faces... One study suggests that ants can pass the mirror self-recognition test which human infants only pass at around 20 months of age. There is even tantalizing evidence of causal reasoning and means-end rationality in bees and transitive inference in paper wasps.”

They may even have feelings. “For example, bumblebees tend to interpret ambiguous stimuli more optimistically after exposure to a pleasant stimulus, just as humans tend to do when they are happy or calm. Conversely, vigorously shaking bees appears to induce a pessimistic bias in odor discrimination tests.” 

Obviously, the evidence that non-vertebrates have inner states is controversial and ambiguous, but isn’t it better for policy-makers to play it safe, the authors ask. “If the costs of falsely attributing sentience to animals are minor while the costs of false negatives are high (because, for instance, they result in a great deal of unnecessary suffering), then erring on the side of false positives is prima facie ethically preferable.”

But wouldn’t including invertebrates in the moral community impose ridiculous demands upon humans? Mikhalevich and Powell are adamant. “The fact that living up to our moral obligations is hard is a patently inadequate reason for failing to meet those obligations.” Besides, this does not mean that we must give equal moral consideration to all beings; it would probably be proportionate to their sentience.

There would be sticky situations, they acknowledge. “Whether harm to a small number of vertebrate subjects is morally preferable to harm to a large number of invertebrate subjects is unclear. But such questions should be resolved through an analysis of interest conflicts, not by according some legitimate interests no weight at all.”

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.

comments powered by Disqus
 
November
07
 

Assisted suicide is a reasonable excuse for overseas travel for locked-down Britons

Britain has entered a second period of hard lockdown to avert a wave of Covid-19 patients swamping hospitals. Holiday travel overseas is banned. However, Health Secretary Matt Hancock has said that visiting the Swiss assisted suicide clinic Dignitas will be permitted, as an exception.  

This follows consternation in the media over a woman with terminal breast cancer who advanced her booking with Dignitas because she feared that a travel ban would make it impossible. Under the lockdown regulations, travellers are only exempted for work, education or other legally permitted reasons.

Mr Hancock told Parliament: “The new coronavirus regulations place restrictions on leaving the home without a reasonable excuse. Travelling abroad for the purpose of assisted dying is a reasonable excuse, and so anyone doing so would not be breaking the law. The question of how we best support people in their choices at the end of their life is a complex moral issue that, when considered, weighs heavily upon us all.”

Mr Hancock has rejected calls for a review of current legislation which bans assisted suicide. However, he has agreed to have an online meeting with Noel Conway, a 71-year-old with motor neurone disease who has become a symbol of the movement for legalising it.

Mr Conway’s local MP, Daniel Kawczynski told Parliament: “As a Roman Catholic, I have recently changed my mind on this issue because of my constituent Mr Noel Conway who lives near Shrewsbury. I said to him, 'Why don't you go to Switzerland?' And his answer will stay with me forever: 'No, I'm an Englishman, I want to die in England.' And I think it's extremely important that our citizens have this right.”

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.

comments powered by Disqus
 
November
07
 

Welcome to the world of ‘platonic co-parenting’

Another chapter in the history of the reproductive revolution: platonic co-parenting. This involves two people conceiving (naturally or artificially) children 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”.

The Guardian interviewed an American woman and a Canadian man who had discovered each other on a co-parenting website. “I really didn’t want a romantic connection; I thought it would convolute things,” says Jenica Anderson, who is co-parenting with Stephan DuVal. “I’d seen the traditional recipe not work out. We had a shared sense of direction – raising a happy child who makes it through life OK.”

“Unlike surrogacy … platonic co-parenting remains little understood and less spoken about,” says The Guardian. “Sites are overrepresented by members working in the media, senior civil service, law, medicine and banking, where privacy is prized, says Patrick Harrison, founder of PollenTree.com. ‘There are a lot of people in this country who probably don’t share a view that it’s a great thing, and they can be vocal,’ he says. ‘Our members keep a low profile because it’s nobody else’s business. They don’t need the rest of society to tell them it’s a good or bad thing.’”

Another woman told The Guardian that she wanted a child and she was running out of time on her biological clock: “For years, I wanted the big love. I ended up with a very broken heart, but still wanted a baby. I could have paid $500 at the sperm bank, but I was pretty sure I could do it for free. If I couldn’t have the big dream, this felt like the next best thing.”

Professor Golombok and her colleagues are tracking 50 of these arrangements in a study considering the impact on children. She thinks that they can work, despite the unusual difficulties. “Taking away romantic baggage could even make for a more stable environment,” she says.

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.

comments powered by Disqus
 
November
07
 

Al Jonsen, bioethics pioneer, dies

A pioneer in the novel field of bioethics, Al Jonsen, died on October 21, at the age of 89. According to one reviewer, he was the first person to be titled “professor of bioethics”.

From 1969 to 1972, Jonsen was president of the University of San Francisco. From 1974 to 1978 he served as a member of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. He co-authored the Belmont Report, published in 1979, which articulated ethical principles of beneficence, justice, and respect to govern human-subjects research. In 1980, he was elected to the National Academy of Sciences Institute of Medicine.

He also taught at the University of Washington, School of Medicine, from 1987 to 1999. After retiring he co-founded the Program in Medicine and Human Values at Sutter Health's California Pacific Medical Center in 2003.

Jonsen co-authored a classic text, “Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine,” published in 1982. Its toolkit included the "four-box method" to help clinicians make difficult ethical decisions.  

Like a surprising number of pioneer bioethicists, Jonsen’s career began in theology. He was ordained as a Jesuit Catholic priest in 1962. He left the priesthood in 1976 to marry.

However, he supported legalised abortion and helped the Kennedys reach an accommodation of their Catholic faith with growing public support for abortion. According to his book The Birth of Bioethics, he attended a meeting of notable Catholic dissident theologians in Hyannisport with Robert and Ted Kennedy in 1964: “The Kennedys hoped to formulate a political stance on abortion that would be compatible both with Catholic teaching and the political climate of the country.” Their advice after two days of palaver, he recalled later, threaded abortion through the eye of the Catholic needle:

“Catholic politicians in a democratic polity might advocate legal restriction on abortion, but in so doing might tolerate legislation that would permit abortion under certain circumstances, if political efforts to repress this moral error led to greater perils to social peace and order

This wise counsel probably helped to frame culture war debates for the next half century.

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.

comments powered by Disqus
 
November
07
 

Updating the Hippocratic Oath

The Hippocratic Oath seems to be evolving faster than the coronavirus. NPR highlighted a class oath written by incoming first-year medical students at the University of Pittsburgh School of Medicine during their orientation week.

“Their class oath, the first of its kind in our program’s history, speaks to the power and importance of clinical care and research in creating a more inclusive and just society,” said the school’s dean, Anantha Shekhar. The students also took the traditional oath, or a version of it.

What’s remarkable is the difference between the students’ oath and the traditional oath. The former addresses championing diversity in medicine and society, being an ally with the poor and marginalised and restoring trust in the health care community. Traditional bioethics concerns like abortion, conscience, euthanasia, confidentiality or sexual abuse are not mentioned.

“We start our medical journey amidst the COVID-19 pandemic and a national civil rights movement reinvigorated by the killings of Breonna Taylor, George Floyd and Ahmaud Arbery,” the oath begins. “We honor the 700,000+ lives lost to COVID-19, despite the sacrifices of health care workers.” And it continues:

I will support and collaborate with my colleagues across disciplines and professions, while respecting the patient’s vital role on the health care team.

I will honor my physical, mental and emotional health so as to not lessen the quality of care I provide. 

I will carry on the legacy of my predecessors by mentoring the next generation of diverse physicians.

I will recognize the pivotal role of ethical research in the advancement of medicine and commit myself to endless scholarship with the ultimate goal of improving patient care.

I will care for my patients’ holistic well-being, not solely their pathology. With empathy, compassion and humility, I will prioritize understanding each patient’s narrative, background and experiences while protecting privacy and autonomy.

I will champion diversity in both medicine and society, and promote an inclusive environment by respecting the perspectives of others and relentlessly seeking to identify and eliminate my personal biases.

I will be an ally to those of low socioeconomic status, the BIPOC community, the LGBTQIA+ community, womxn/women, differently-abled individuals and other underserved groups in order to dismantle the systemic racism and prejudice that medical professionals and society have perpetuated.

I will educate myself on social determinants of health in order to use my voice as a physician to advocate for a more equitable health care system from the local to the global level.

I will restore trust between the health care community and the population in which I serve by holding myself and others accountable, and by combating misinformation in order to improve health literacy.

In making this oath, I embrace the ever-changing responsibilities of being a physician and pledge to uphold the integrity of the profession in the clinic and beyond.

The growing trend of taking oaths composed by medical students themselves may indicate that they are taking their ethical commitment to the profession seriously. However, as an article in Academic Medicine pointed out: “if students at the same school are swearing to different oaths year-to-year, are those schools sending mixed messages to their students—that medical oaths are ultimately flexible documents that can be shaped in whatever manner the swearer wishes?” 

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.

comments powered by Disqus
 
October
31
 

New Zealand will soon have legal voluntary euthanasia

New Zealand has become the latest jurisdiction to legalise euthanasia. The issue appeared as a referendum question in the October 17 general election which swept popular Prime Minister Jacinda Ardern back into office with a clear majority.

The results have taken two weeks to count and the final result will not be known until November 6. However preliminary results released by the electoral commission on Friday indicated that 65.2% of eligible voters backed the legalisation of euthanasia, with only 33.8% opposed.

Although some 480,000 special votes remain to be counted, the margin is so great that they cannot affect the final outcome. The act will come into effect exactly one year after the final results are announced – November 6, 2021.

A second referendum question on the legalisation of cannabis did not succeed.

The new law has had a complicated gestation. New Zealand’ unicameral parliament passed an End of Life Choice Act in 2019, but then it had to be ratified by a national referendum.

The act outlines criteria for who can apply to end their life. The patient must be 18 or over, New Zealand citizens, suffering from a terminal illness that will end their life within six months, “have a significant and ongoing decline in physical capability”, “enduring unbearable suffering that cannot be eased” and in a position to make an “informed decision” about their death.

Those suffering mental illness or decline would not be eligible, nor would those applying solely on the basis of “advanced age” or a disability. Two doctors – one independent – would have to sign off on the decision, with a psychiatrist called in if either doctor has any doubts.

MP David Seymour, who sponsored the bill, said that New Zealand has fallen “decades” behind the most progressive countries in the world. “I think it’s time New Zealand moved towards being a more compassionate and tolerant society,” he told the Guardian.

Euthanasia-Free NZ, which campaigned against the law, was disappointed and said that most voters misunderstood the Act. A poll before the referendum suggested that only 20% of voters understood that the Act would not make it legal to turn off machines that are keeping people alive. “It seems that most New Zealanders voted for an end-of-life choice that is in fact already legal,” said Renée Joubert, of Euthanasia-Free NZ.

Only 35% knew that euthanasia would be available to terminally ill people who had no physical pain. Only 29% were aware that terminally ill people who meet all the eligibility criteria, but also have depression or another mental illness, would be allowed euthanasia. Only 13% realised that the Act does not require independent witnesses.

Unlike US, Canadian and Australian laws, the New Zealand legislation requires no independent witnesses when a person signs their euthanasia request in front of the doctor and no cooling-off period before the lethal dose is prescribed. It doesn’t require a competency test at the time of receiving the lethal dose.

New Zealand has become the fifth country to legalise euthanasia, along with the Netherlands, Belgium, Luxembourg, and Canada. Several American states, two Australian states, and Switzerland permit assisted suicide.

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.

comments powered by Disqus
 
October
31
 

Poland still racked by protests over abortion

The fury on the streets about Poland’s tougher restrictions on abortion has not subsided.

Tens of thousands of protesters took part in rallies in Warsaw and other cities on Friday. The streets have been filled with demonstrators every day since last Thursday when the nation’s highest court banned abortions for unborn children who have congenital defects. According to official statistics, this is the most common reason for the 1,110 legal abortions recorded last year.

Marta Lempart, co-founder of Women's Strike, and one of the principal organisers of the protests, told Deutsche Welle: "We're prepared to fight till the end." Her goal is to force the resignation of the government. She also wants the Constitutional Tribunal's ruling declared invalid due to what is perceived as the court's fealty to the executive branch.

The protests have ugly ideological overtones. In this predominantly Catholic country, the demonstrators’ rage has been directed at the Church. Protesters have disrupted Masses, verbally abused priests, graffitied churches, and defaced memorials to John Paul II. Right-wing groups have responded by defending churches and disrupting some demonstrations. We are "in the middle of a neo-Bolshevik revolution," said head of a radical nationalist association named Marsz Niepodleglosci (Independence March) in front of a church in Warsaw. "The time for peace and tolerance for barbarians is over."

Poland's president, Andrzej Duda, who supported the ban on abortion for foetal abnormality, now appears to have changed his mind. Now he believes that women should have the right to abortion in some cases. “It cannot be that the law requires this kind of heroism from a woman,” he said in an interview with radio RMF FM. The president said he still favours outlawing abortion if a foetus has a non-lethal congenital defect.

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.

comments powered by Disqus
 
October
31
 

Ombudsman slams euthanasia in Canada’s prisons

Canada’s prison ombudsman has recommended an absolute moratorium on providing “assisted dying” inside a federal penitentiary.

In his annual report, Ivan Zinger acknowledged there have been three known cases of doctor-assisted death in federal prisons, two of them in the 2019-20 reporting period. His office found a series of errors and delays and the misapplication of law and policy in both.

The first case involved a “a non-violent recidivist” serving a two-year sentence. A decision to deny him full-day parole was almost certainly a factor in his request for MAiD, as medical assistance in dying is termed in Canada. “The decisions to deny parole and then provide MAiD in a prison setting seem out of step with the gravity, nature and length of this man’s sentence,” said Zinger.

Prison authorities took a very detached view of the prisoner. They were bound to respect a request from a competent patient, they told the ombudsman.

But Zinger was sceptical. “It would seem that this man ‘chose’ MAiD not because that was his ‘wish,’ but rather because every other option had been denied, extinguished or not even contemplated. This is a practical demonstration of how individual choice and autonomy, even consent, work in corrections,” he wrote.

The second case involved a dangerous offender who was mentally ill, terminally ill and suicidal. There was no prospect of his release. Zinger points out that he lived in a different world from other citizens:

Hopelessness, despair, lack of choice and alternatives, conditions imposed by the fact and consequence of incarceration, are issues magnified in the correctional setting. As the Government considers extending MAiD beyond physical illness to intolerable psychic pain, there must be careful deliberation of the mental health profile of Canada’s prison population. For prisoners, matters of free choice are mediated through the exercise of coercive administrative state powers. There is simply no equivalency between seeking MAiD in the community and providing MAiD behind prison walls

Mr Zinger says the government should set up an expert committee to consider the ethical and practical concerns in providing medically assisted death in prisons and suggest policy and law changes.

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.

comments powered by Disqus
 
October
31
 

High cancer risk for IVF babies

Children conceived with IVF have a higher risk of developing cancer than those conceived naturally, according to a study published in the journal JAMA Network Open this week. “The increased risk was 2-fold higher for children conceived via in vitro fertilization than for children conceived naturally,” say the authors.

"IVF-conceived children are at about one-third greater risk of birth defects compared to their naturally-conceived counterparts, as well as at higher risk of childhood cancer, although in absolute terms these numbers are small," the lead author, Barbara Luke, of Michigan State University, East Lansing, told MedPage Today.

"An unresolved question in assisted reproduction research remains the contribution of parental versus treatment factors to adverse outcomes," Luke said..

The researchers used birth data from Massachusetts, New York, Texas and North Carolina between 2004 and 2016. They cross-referenced them with birth defect registries, cancer registries, and reported clinical results from the Society for Assisted Reproductive Technology. They only considered babies conceived with their parents' gametes, excluding frozen gametes, to get as close as possible to the conditions of natural conception.

Finally, they ruled out babies born before 22 weeks of pregnancy or weighing less than 300 grams. The study thus covered more than a million children conceived naturally and approximately 53,000 conceived by in-vitro fertilization.

The researchers found several notable differences between the two groups.

  • 1.8% of babies conceived naturally have congenital malformations, compared to 2.4% in the group of babies conceived by IVF,
  • All babies with non-chromosomal abnormalities have a higher risk of cancer. The risk is multiplied by 2.07 for babies conceived naturally and by 4.04 for IVF babies.

“With IVF births rising worldwide, further investigations into these associations are warranted,” the authors write.

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.

comments powered by Disqus
 
October
31
 

Brains in a dish pose ethical problems

A recent feature in Nature opens with the following sentence: “In Alysson Muotri’s laboratory, hundreds of miniature human brains, the size of sesame seeds, float in Petri dishes, sparking with electrical activity.”

Dr Muotri, a Brazilian researcher working at the University of California, San Diego, is investigating what makes us uniquely human. The obvious answer is the brain, so he is studying it from an evolutionary and developmental perspective and differentiating stem cells to recreate "brain organoids" in his lab.

His research is quite innovative. For instance, he has compared the DNA of Neanderthals (taken from the fossil record and DNA samples from bones) with our DNA. This could give clues about why Neanderthal social, cultural and technological development was more limited and why they became extinct. This might lead to insights into mental health.

However, what his website blurb skates over is the difficult ethical questions arising from creating brain organoids. Nature points out that some scientists and ethicists argue that some experiments with organoids should not be allowed.

It appears that most researchers believe that it would be unethical to create organoids which have some degree of consciousness – disembodied brains floating in a petri dish. However, there’s very little agreement about what consciousness is. Philosophers have clashed over this for centuries; neuroscientists have been no more fortunate in reaching a conclusion. In the meantime, researchers like Muotri are forging ahead. He believes that he might need to create consciousness as part of his research.

In his view, brain organoid research offers no special difficulties. “We work with animal models that are conscious and there are no problems,” Muotri told Nature. “We need to move forward and if it turns out they become conscious, to be honest I don’t see it as a big deal.”

This horrified Wesley J. Smith, bioethics writer at National Review: “That crass attitude illustrates the huge peril biotech could pose to human decency. As the great moral philosopher Leon Kass once wrote, ‘shallow are the souls that have forgotten how to shudder.’”

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.

comments powered by Disqus
 
October
31
 

Japan’s new PM promotes IVF to boost birth rate

Japan's biggest long-term problems are a low birth rate and a shrinking population. Incoming Prime Minister Yoshihide Suga has pledged to provide insurance coverage for infertility treatments.

He will also promote paternity leave for working fathers to ease the burden on working mothers. He has promised more help for single-parent households, more than half of which are living in poverty.

Japan’s total fertility rate — the average number of children born per woman during reproductive years — was 1.36 in 2019. The government hopes to raise the rate to 1.8.

However, experts say that the policy will not be a panacea for reversing the nation’s declining birth rate, especially in the middle of the Covid-19 pandemic when many people are suffering financially.

Suga’s precedessor, Shinzo Abe, regarded the rapidly ageing population and falling number of births as a “national crisis,” and introduced free preschool education and day-care services.

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.

comments powered by Disqus
 
October
31
 

Artificial reproduct