Towards Belmont 2.0


In a recent article in the American Journal of Bioethics, bioethicist Art Caplan and three colleagues call for a complete overhaul of the venerable Belmont Report (see below). This is the 1979 US government report which set out three famous principles which have governed human research ever since: respect for persons, beneficence, and justice.

Most government reports are already gathering dust within a few months after their publication. But the Belmont Report’s influence has been enormous, as it shaped the bioethical framework for clinical and research decision-making in the US and many other countries as well.

Caplan & Co make a good case for revising the standards in the light of experience and changing times. But it comes at an awkward moment: the Trump Presidency.  What kind of commission would Mr Trump create to study this issue? Perhaps a noisy and truculent one, a bull in the bioethics china shop. Be careful what you wish for? 

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Shameless self promotion


We have a number of very important stories this week: a paper in Nature about gene-editing human embryos, a rise in euthanasia figures in the Netherlands, some appalling news about commercial surrogacy in India... plus a great interview with Yale bioethicist Lydia S. Dugdale about death and dying. 

But, for better or worse, this is a day for shameless self-promotion. Sorry. I have just published a book, The Great Human Dignity Heist, a collection of short essays on topics ranging from IVF to paleo-archaeology to polio epidemics to euthanasia and cannibalism. Its lurid sub-title is How bioethicists are trashing the foundations of Western civilization

If you live in Sydney, you are invited to a book launch at 1pm on this coming Thursday, August 10, at Parliament House, Macquarie Street, Sydney. Professor Margaret Somerville will be the main speaker. (RSVP to mcook@mercatornet.com.) 

And of course, if you cannot make it, feel free to order a book online

In Australia from the publisher, Connor Court
https://goo.gl/V1vF8V 

In the US and Canada from Amazon (feel free to leave a review of the book!)   
https://www.amazon.com/Great-Human-Dignity-Heist-Bioethicists/dp/1925501469/ 

Cheers

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The drama of little Charlie Gard


We're back! And although the northern hemisphere summer is normally a slow-news season, bioethics has been on the front page of world newspapers.

The drama of the dying British baby Charlie Gard, his loving parents, the doctors at Great Ormond Street hospital in central London, and the English law has captured the imagination of people everywhere.

To be honest, I am not sure whose "side" I should be on. Parents should normally make healthcare decisions for their children.

But there are cases in which their choices are plainly wrong -- as a Swedish doctor suggests below in his version of the mysterious resdignation syndrome among refugee children -- and the advice of doctors should be heeded.

Which was the case here? We'd love to hear from you. 

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BioEdge on holidays


There is plenty of variety in this week’s BioEdge: a euthanasia pioneer surveys its progress in the Netherlands; a neuroethicist despairs over ‘fake news’; a legal expert assesses the chances of Noel Conway’s assisted dying request in the UK; an important new paper asks whether puberty suppression for transgender kids is ethical...

But the big news is that BioEdge (and its editor) are taking a solstitial holiday for a few weeks. The next issue will arrive on about July 21.

Cheers,

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Michelle Carter found guilty


A Massachusetts woman has been found guilty of involuntary manslaughter in a case which was reported across the United States and could affect the debate about assisted suicide.

In 2014 Michelle Carter, then 17, used phone calls and text messages to bully her boyfriend, Conrad Roy III, 18, into asphyxiating himself in his car.

Their relationship was a bizarre one. Although they lived only an hour away from each other, they met in Florida on family holidays. Thereafter they only met each other a handful of times. But they texted each other incessantly, especially about Roy’s desire to kill himself. Ms Carter encouraged him.

However, when he was sitting in his car and the fumes were building up, he got out, clearly wanting to live. She instructed him to get back in. He did and he died.

There are two schools of thought about Ms Carter’s bullying. Most people would agree with the judge that she had a duty to try to save Roy’s life and acted in a “wanton and reckless” manner.

But others, while acknowledging that her words were reprehensible, point out that Massachusetts has no law against assisted suicide and that words are not bullets. They argue that her incitement was protected free speech.  

The American Civil Liberties Union has yet another reason why Ms Carter should have been acquitted: “If allowed to stand, Ms. Carter’s conviction could chill important and worthwhile end-of-life discussions between loved ones.” In other words, this throws sand in the gears of legalising assisted suicide.

What do you think? 

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Not a happy camper


We may have over-egged today’s newsletter with stories about surrogacy, but they all appeared this week with a common theme: what about the mothers? The accepted wisdom is that most mothers are well compensated and give up the child happily.

Not always.

Take the case in England of a surrogate mother who has just been jailed for 22 weeks for stalking a judge and a court welfare officer. The terrified family court judge had awarded the child she bore to the commissioning gay couple even though Lian Harris had changed her mind and wanted to keep it.

Ms Harris snapped.

Over a year she harassed the judge, protested outside the house of politicians and lawyers, unfurled a banner on Westminister Cathedral saying “Family courts do evil”, attempted to fasten herself to the second-floor balcony of the social worker’s home, and tried to organised harassment on Facebook, amongst other stunts.

Not a happy camper.

Ms Harris is said to be an exceptional case. But how do we know? Where are the longitudinal studies to prove that surrogate mothers live happily ever after once they surrender the child they carried for nine months?

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Bioethicists: dust off your resumes


Now that President Donald Trump has backed out of the Paris Climate Change agreement, employment prospects for bioethicists may pick up. Let me explain.

The boundaries of bioethics are very elastic, and on some maps they include care for the natural environment. I would predict that in the measure that scientists lose faith in a political solution to global warming, some will back geoengineering projects to cool the planet.

These include tactics such as injecting aerosols into the upper atmosphere, dumping iron filings into the sea to promote algal blooms, and machines to capture carbon dioxide. These involve significant risk and place great power in the calculations of technocrats. They need to be studied very carefully. As University of Chicago climate scientist Raymond Pierrehumbert said a few years ago, “I see lots [of geoengineering ideas] that are feasible but they all terrify me.”

A 2010 conference on the ethics of climate intervention at Asilomar, in California, addressed some of these issues using principles drawn from the famous Belmont principles of autonomy, beneficence, non-malificence and justice. And who knows more about these than bioethicists? Dust off those resumés. 

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Sorry for the delay


I can't say that I agree with Nietzsche on everything, but he was onto something when he wrote, "what does not kill a database makes it stronger". 

We were hit by a bug over the weekend and this mini-Götterdämmerung  has delayed the newsletter. But soon, touch wood, it will be stronger than ever. Thanks, Friedrich. 

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If there is a market, let’s legalise and regulate it


The Economist is the world’s best news magazine. Its stylish, intelligent and well-informed coverage has made it the Bible of the global elite. “I used to think. Now I just read The Economist,” the former CEO of Oracle, Larry Ellison, once said.

Part of its appeal is its ideological consistency. Ever since 1843 The Economist has argued that aim of public policy should be to promote the market economy as the best way of achieving prosperity and democracy. A light touch of government regulation is needed only to ensure fairness and legal certainty. Thus it embodies the “classical 19th-century Liberal ideas” which made Britain, and later the United States, a bulwark of capitalism.

Whatever the merits of this ideology in framing public policy for economics and finance, it is ill-suited to questions of personal behaviour.

In principle The Economist supports all autonomous action which is either harmless (in its view) or profitable. Hence, in recent years it has thrown its considerable prestige behind campaigns for the legalisation and regulation of drugs, pornography, prostitution, euthanasia, and same-sex marriage.

And this month it has taken up cudgels in favour of an international market in surrogate mothers and babies. “Carrying a child for someone else should be celebrated—and paid”, is the defiant headline of its editorial. Given the magazine’s influence, this is a significant development. What do you think of it? 

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Ooops! Sorry about that


I'm afraid that we are having a few issues with the software behind BioEdge. We've upgraded it, largely to ensure security -- which seems like a Very Very Good Idea in the light of what happened this week to Britain's National Health Service.

Unfortunately upgrades always have a few bugs. We are slowly working through them, but as we prepared this issue of the newsletter, we discovered a few glitches that we hadn't anticipated. So we ask for your patience. Hopefully we'll have them fixed up by next week. 

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