A world of paradox

Being just a bleachers bioethicist, I don't have anything original to contribute to the debates. I just watch from the sidelines. However, one thing that does strike me is the number of situations in which the received wisdom leads to contradictory or paradoxical conclusions.

For instance, some doctors argue that the use of performance-enhancing drugs is wrong because it gives athletes an unfair advantage over "natural" athletes. But South African Olympic champion Caster Semenya has been ordered to take performance-reducing drugs because her natural endowment makes her too fast. 

As you can read below, an Ontario appeals court says that doctors who refuse to refer for voluntary euthanasia (killing their patients) should be drummed out of medicine. In the UK, meanwhile, a tattooist has been jailed for 40 months for voluntary tongue-splitting

And last week a judge in the UK gave his blessing to an unnamed couple who are allowing their 4-year-old son to socially transition to a girl. Four years old seems a bit young to make up one's mind about gender. On the other hand, the Belgian medical association has demanded that parents who give their 4-year-olds a vegan diet be prosecuted.

It's all a bit bewildering. 

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Is it possible to wind back euthanasia in Belgium?

In our lead story today we focus on an apparent, and surprising, rift over euthanasia in Belgium. On the one hand the medical association recently issued guidelines which tell doctors to be more cautious about granting euthanasia for psychiatric reasons. On the other, the country’s leading right-to-die association is campaigning vigorously to grant euthanasia to patients with dementia. Apparently, even supporters of the country’s euthanasia law differ on the wisdom of making a liberal law even more liberal.

My feeling, however, for what it's worth, is that Belgium will keep relaxing its 2002 law until it becomes effectively euthanasia on demand. Doctors will become mere suicide enablers.

There may be one way to stop this process, or at least to slow it down. And that is to fire the chairman of the Federal Euthanasia Commission, Dr Wim Distelmans. This gentleman is not only the senior regulator of euthanasia in Belgium. He is also a media star as the chief spokesman for the right to die and one of the main practitioners of euthanasia. In other countries, this would be regarded as an egregious conflict of interest.

A new chairman who is not immersed in the world of Belgian euthanasia politics would be in a better position to identify abuses and refer doctors who fail to comply with the law to the public prosecutor. 

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New stats on Dutch euthanasia

The government's statistics for euthanasia in the Netherlands were released recently. They show that the number of people who took advantage of legal assisted suicide and euthanasia declined slightly -- about 7% -- for the first time since 2006.

To be completely candid, I regard a decline in the number of euthanasia cases as good news. That is, if it is true. It is possible that more cases were simply not reported to the authorities. Fewer euthanasia cases means fewer people in desperate pain and fewer people who feel that their lives are meaningless.

However, this is not the way that euthanasia supporters see it. For them it was bad news because fewer people had taken advantage of the blessing of a peaceful death. From their point of view, good news is an ever-increasing, upward-sloping line on a graph. 

Euthanasia already accounts for at least 4% of all deaths in the Netherlands. What proportion are its supporters aiming at? 5%? 10%? 40%? I have never read any projections of this figure. It would be interesting to know what the future holds for the Dutch. 

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Legal, yes, but not safe and rare

The latest figures for euthanasia deaths in Canada have just been published. Allowing for some deficiencies in the data, an astonishing 1.12% of deaths are attributable to what the Canadians call "Medical Aid in Dying" (MAiD). I say "astonishing" because, like many others, I thought that euthanasia would be "safe, legal and rare". Instead, between one in a hundred and one in fifty people die at the hands of a doctor. 

The Ministry of Health explains that "The percentage of deaths ... continues to remain within the percentage of medically assisted deaths provided in other countries where 0.4% (Oregon, USA, 2017) to 4% (Netherlands, 2017) of total deaths has been attributed to a medically assisted death". Somehow this is meant to be reassuring, but comparing two figures which differ by a factor of ten and relate to two different practices (assisted suicide and euthanasia) is meaningless. 

What should alarm all Canadians is that in a mere two years since legalisation, euthanasia has become so widespread. Is it going to stop at 4%? There's no reason to say that it will. 

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The interplay of euthanasia and anatomy donations in Canada

HEADS UP! BioEdge will be taking a break over Easter. The next newsletter will be published on April 27. 

In the meantime, there's plenty of thought-provking reading in this week's edition. If you have the time, give us some feedback on how we're going and how we can improve our coverage. 


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Modern marriage in Nebraska. Hate and public health.

With hate crimes like the recent murders of 50 Muslims in Christchurch, New Zealand, by a white nationalist, some bioethicists are asking whether bigotry is a disease. And, if so, whether it can be prevented (or cured) with the tools in the armoury of public health professionals. In an article below, public health experts suggest four ways that doctors can push back against hatred. 

It's an interesting line of thought. Clearly some forms of bigotry and hatred lead to deadly crimes. But defining hatred is often deeply political. The members of  the KKK and ISIS are clearly dangerous "haters". But how about foes of Muslim immigration or same-sex marriage? Are they "haters" or just political opponents? I must confess that I feel that the bioethics of hatred is off to a shaky start, conceptually. But I believe that it will become more prominent as time goes on. The Christchurch gunman let a genie out of the bottle.

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‘I feel much younger than I look’

This is not an appropriate venue for a discussion of my age, but I think that most readers will sympathise with my occasional interest in turning the clock back a few years. What if the hoary adage, "you're only as old as you feel", could have the force of law? 

Last year, a flamboyant positivity guru tested this theory in a Dutch court by applying to have his legal age changed from 69 to 49. To no one's surprise, he lost, but the reasoning for the adverse judgement was peculiar (as reported in the media, anyway). The court declared that too much government paperwork depends upon an agreed biological age. At a time when self-identification for gender is widely accepted, this line of reasoning is surprisingly weak. 

Which brings me to an intriguing article in the Journal of Medical Ethics (see below) which supports the notion of self-defining age. The author bases it on the need to prevent discrimination on the basis of age, or ageism. I wonder how the courts will respond to this argument. 

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Will there be a moratorium on gene-editing?

A California family was outraged recently when their grandfather was told that he had very little time to live by a "robot", or rather, what the media described as a robot. In fact, it was a teleconference screen mounted on a robot lectern. I don't suppose that the distinction makes much difference. The elderly man's children and grandchildren were horrified by the cold detachment of the procedure. 

The hospital apologised, of course, but the incident is symptomatic of the impersonality which pervades our culture. Prodded on by our love affair with technology, human relations are being reduced to formal interactions. It may be overstating it to say that competence in face-to-face contact is a dying art -- but something is changing. To have a dozen Facebook "friends", for instance, is hardly the same as having a dozen friends. 

But an even more -- I was thinking of inserting the word "sinister"  but I won't -- application is the reduction of human sexuality to the twin and separable functions of recreation and reproduction. In an article below, British IVF pioneer Simon Fishel predicts that robots will handle the whole process of conception, from harvesting gametes to transferring embryos. 

It seems to me that defending humane relationships will be one of the key challenges to bioethics in the coming decades. 

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Parents request sperm retrieval from West Point cadet

It often takes a newsworthy tragedy to make us think deeply about difficult ethical issues. One example is our lead story this week. The parents of a brain-damaged West Point cadet, Peter Zhu, asked a court to order a hospital to retrieve his sperm so that the family name can be carried on. No sooner said than done. Justice John P. Colangelo, of the New York Supreme Court, Ninth Judicial District, directed Westchester Medical Center to collect the sperm and have it stored. A court hearing will be held on March 21.

The outcome of this case will be interesting, partly because it pits ethics based on family ties against ethics based on personal autonomy. Peter’s parents know that they cannot get their son back, but they believe that they have a right to a possible child to carry on the family name. But bioethicists point out that grandparents do not have a right to a grandchild and that Peter never consented to such a procedure. A family's tragic loss is shaping up as a clash of cultures, collective versus individualistic, Asian versus Western. 

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Womb transplants. Euthanasia

Colombia is a country that flies under the radar as far as euthanasia goes. But it has one of the most progressive legal frameworks for euthanasia anywhere. (See article below.) Children over the age of 6 can request the right to die (with the approval of their parents). It may also be one of the jurisdictions where it is least used. Euthanasia has been permitted since 2015, but only 40 people have taken advantage of it -- according to official records. Unofficially, there may be many more. As in other countries, activist doctors who are impatient with red tape take the law into their own hands. 

And bizarrely, Colombian voters have had no say in this momentous legal change.  “We have not had a big national debate about this, and I’m not very happy about it," says a former Colombian health minister. “We need a public debate: We are not Belgium or Holland – this is at odds with people’s beliefs and mode of thought.” It would be good for a team of bioethcists to study the situation in Colombia with the same rigour as they have in Belgium, the Netherlands, or Canada. 

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