Vale Noa Pothoven


The news of a 17-year-old Dutch girl suffering from anorexia nervosa who died of 'euthanasia" flew around the world this week. It was an error. The Royal Dutch Medical Association (KNMG) clarified what happened: "She decided to stop eating and drinking to bring her own death. In The Netherlands, this is not considered euthanasia or physician assisted suicide." The media issued corrections and moved on. 

I'm curious to know more about this sad story. In her autobiography, Noa said that she had been raped and that this had provoked a psychological crisis. Sadly, this could easily have been true. No one queried the truth of her story, possibly because sexual abuse is known to trigger anorexia. But without that back story, would the world have been so sympathetic to her decision to starve herself to death?

The KNMG says that stopping eating and drinking under medical supervision is not physician-assisted suicide. Really? She committed suicide and she was assisted by physicians. As Humpty Dumpty said, "When I use a word, it means just what I choose it to mean—neither more nor less." If Noa's death wasn't physician assisted suicide, then I'm a Dutchman.

Isn't the real news here something altogether different? Dutch doctors who were unable or unwilling to treat a 17-year-old rape victim for anorexia nervosa gave up on her and allowed her to kill herself. In her time of greatest need, they abandoned their patient.  

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Black genocide


An interesting group within the American pro-life movement is African-Americans who oppose abortion. The Rev Clenard Childress Jr, for instance, is a New Jersey pastor who runs a website called Black Genocide. Groups like his highlight the fact that African-American women account for a third of abortions in the US. 

This might have been remained a factoid about the US abortion wars, but it was unexpectedly placed on centre stage this week with the Supreme Court's decision in Box v. Planned Parenthood of Indiana and Kentucky. Justice Clarence Thomas, the only African-American on the bench, was seething with anger when he reflected on the fate of black babies (see our story below): 

abortion in the United States is also marked by a considerable racial disparity. The reported nationwide abortion ratio— the number of abortions per 1,000 live births—among black women is nearly 3.5 times the ratio for white women. And there are areas of New York City in which black children are more likely to be aborted than they are to be born alive—and are up to eight times more likely to be aborted than white children in the same area.

Journalists who bothered to report his remarks shook their heads and described him as loopy. He's not. That abortion has a disproportionate impact on the poor and disenfranchised is a blot on American society. For a touching comment on this, check out this rap song from a group called Flipsyde, Happy Birthday. 

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How to make comments


We cover a wide range of issues in this newsletter, ranging from whether brain-damaged Frenchman Vincent Lambert should be allowed to die to whether IVF affects human evolution.

But today I’ll address a nuts-and-bolts issue– how to make comments. We’d like to encourage debate and fresh ideas in the comment box below each article. However we realise that it is a bit clumsy and hard to use.

There are no perfect commenting systems. We use third-party software called Disqus. It works well and allows us to moderate comments. But the best way to make a Disqus comment is to sign up for Disqus. It’s easy and quick.

Unfortunately – and understandably – many of our readers are reluctant to sign up for one more social media system. The solution is to post as a “guest”. But Disqus makes this a bit difficult.

So here’s how to do it. Type your name (or pseudonym) into the “name” box. Then two more boxes appear. Type in your email AND tick the box “I’d rather post as a guest”.

Voilà! You’re all set. Write your comment (be sensible and polite) and click the arrow button.  

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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. 

Cheers 

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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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