More on conscientious objection

Conscientious objection to procedures like abortion and euthanasia often features in BioEdge. There is a growing consensus that CO has no place in modern medicine. It’s often argued nowadays that a doctor’s duty is to carry out the wishes of patients, regardless of whether they agree with them or not.

I stumbled across an interesting hypothetical on the American Medical Association Journal of Ethics which makes me question this consensus. In it, three bioethicists analyse a situation involving a difficult patient with deep Christian convictions. He is refusing post-operative pain medication because he believes that he needs to suffer in order to atone for his life as an alcoholic. What should the physician do?

The bioethicists conclude that he should neither acquiesce nor refer the patient to another doctor who will acquiesce. Instead, the physician should “refuse to offer this course of action, regardless of the religious rationale for such a request”.

They go on to assert that “Indeed, as part of their professional commitment to the patient’s health, physicians have some obligation to respectfully challenge patients' refusals of medical care that the physician believes is needed. A sincere discussion—even a respectful debate—in no way denigrates [his] religious beliefs.”

Indeed, this makes good sense. But, viewed from another angle, the bioethicists are advising the physician to conscientiously object to a course of action determined by a lucid patient after serious consideration. They even counsel him to argue (respectfully) with the patient to convince him that he is wrong.

If this is so obviously the case, why is it wrong for a doctor to refuse to perform an abortion? I’m having trouble reconciling the ethical reasoning of the two situations. Can anyone help? 

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Septuagenarian mothers

Below is an article about a 73-year-old Indian woman who has just given birth to twin boys. This is a story which used to fly onto the front page, but is now a bit ho-hum. To stir media interest, we need to break through the next barrier. “Centenarian gives birth to twins, say Indian doctors” – now that would be newsworthy, I think. At least the first centenarian would.

The ho-hum factor may account for the fact that few questions were raised about obvious ethical issues involved in septuagenarians giving birth.

First of all, it is obviously reinforcing a sexist stereotype – that a woman is useless unless she has children. Furthermore, despite reassuring words from the doctors, it is a serious risk to the mother’s health.

Second, the children of a 73-year-old mother will soon be orphans. In fact, their father had a stroke on the day after they were born. No one seems to be thinking about their welfare and their future. They are just status symbols for their parents and the doctors.

Why did the doctors cooperate? For the money? For the fame? It strikes me as completely unethical.

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The latest news about the ‘gay gene’

Nearly every week, it seems, you read about the discovery of a new gene explaining inexplicable behaviour -- internet addiction, obesity, voting conservative, voting liberal, infidelity, divorce, chocaholism, alcoholism, whatever.

I recall that a few years ago a New York judge even handed down a harsher-than-usual sentence because a defendant had a gene for viewing child pornography. The fact that the gene had not been discovered did not deter him. Someday it would be.

In short, the notion of genetic determinism seems to have a full nelson on the American imagination. So it comes as no surprise that homosexuality is believed, from North to South, and East to West, to be genetically determined. The most influential voice on this score is probably Lady Gaga, whose mega-hit “Born This Way” has been viewed about 300 million times on YouTube.

Fortunately or unfortunately, it’s looking like Lady Gaga was wrong. Researchers at MIT and Harvard’s Broad Institute have found that “it is impossible to meaningfully predict an individual’s same-sex sexual behavior from genetics”. If this study holds up, it is bound to shift the goal posts in the debate over homosexuality. Read about it below and post your comments.

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‘Reproductive freedom’ at risk

Sorry, guys, late again. There's a good variety of topics below -- we'd love to get your comments. 

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Transgender inquiry in Australia

Sorry, guys. We're running a bit late with this week's newsletter. I'd love to get your comments on our two lead stories on transgender treatment ethics and on the fertility industry. 

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India could ban commercial surrogacy

Probably no country knows more about the dangers of commercial surrogacy than India. And at the moment, it looks as though it could be banned completely. A bill upending India's surrogacy industry has passed the lower house. What happens next is anyone's guess. Similar bills have died of exhaustion before reaching a vote in the upper house. But at least it shows that it is not necessarily a good way to give needy women extra pocket money. 

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Exporting ethics

The ever-volatile issue of stem cell research is back on the boil. Earlier this week a Japanese researcher announced that he would be creating human-mouse chimeras -- and bringing them to term. This is controversial stuff, but at least the researcher waited until he had obtained a thumbs-up from Japanese authorities. 

Not to be outdone, a Spanish researcher announced soon afterwards this week that she and her colleagues in Spain and the United States are going to create human-monkey chimeras.

Monkeys? Isn't this even more controversial? Yes, of course it is, she told the media. But it's OK: we're doing it in China where ethical standards are lower. 

How do you classify that sort of attitude toward ethics? Arrogant? Undemocratic? Secretive? Publicity-hungry? Immoral? Take your pick. 

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Modern eugenics

What's in a name? Does it make a difference if (by way of example) the widespread abortion of unborn children with Down syndrome is called "eugenics"? A number of bioethicists deny that it is, even though the rates of termination reach 90% if a diagnosis is made before birth. From their point of view, "eugenics" is a word reserved for Nazi atrocities. The destruction of children with Down syndrome is not being carried out by Nazis, ergo, it is not eugenics. 

A number of bioethicists writing from a disability perspective disagree. We have presented some of their arguments in a special issue of the Journal of Policy and Practice in Intellectual Disabilities. They have a refreshingly different opinion on this contentious topic. 

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Cutting the Gordian knot

Surrogacy is where bioethics, President Trump’s war on “illegals”, US-China hostility, California weirdness, IVF profitability, and constitutional law all meet. Here’s the drill.

Unlike many other states and countries, California permits surrogacy. So it has become a Mecca for gay couples, couples who want gender-balanced families, and couples from jurisdictions where surrogacy is illegal. Since surrogacy is illegal in China, many Chinese couples are California-dreaming, as well. Using an American surrogate has the added attraction for them of giving birth to a baby who automatically becomes a citizen under the 14th Amendment. This also makes it easier for its parents to stay in the US.

Mr Trump has said that he wants to end birthright citizenship. "We're the only country in the world where a person comes in and has a baby, and the baby is essentially a citizen of the United States...with all of those benefits,” he said last year. “It's ridiculous. It's ridiculous. And it has to end."

The President has almost no chance of bypassing the 14th Amendment with an executive order, as he has threatened, and still less of repealing it. But why not ban commercial surrogacy? That will close a very big loophole in the law.

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Solidarity with Vincent Lambert

Michel Houellebecq and Pope Francis are two names seldom found in the same sentence. Yet they are united in decrying the death of Vincent Lambert, the disabled French nurse who died this week after having his food and water removed.

Being the head of the Catholic Church, Pope Francis’s views are, and are supposed to be, predictable. But Houellebecq, France’s most acclaimed and controversial novelist, is hardly a spokesman for traditional values. His novels are grotesque, nihilistic, pornographic, vulgar, cynical, and misogynistic. But, with the unsparing honesty of a true artist, he sees exactly what was going on:

"Vincent Lambert was in no way prey to unbearable suffering, he was not suffering any pain at all (...) He was not even at the end of life. He lived in a particular mental state, the most honest of which would be to say that we know almost nothing …

As he points out, it is ironic that France’s minister for health is called the “Minister of Health and Solidarity”. Solidarity with whom?

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