Assyrian pre-nups

Several of our stories this week deal with end-of-life issues. For a bit of a change, how about an historical diversion?

“And when Rachel saw that she bare Jacob no children, Rachel envied her sister; and said unto Jacob, Give me children, or else I die.” You might recognise this quote from the Bible. It is often used to illustrate the pain of infertility, which hurts no less 4,000 years later.  

Jacob was a wandering pastoralist. But Turkish archaeologists announced this month that they had uncovered evidence of urban infertility in Kültepe, an Assyrian site in the centre of modern Turkey. It is a clay tablet with cuneiform script with a prenuptial agreement – also 4,000 years old. It may be the first pre-nup in recorded history.

If, after two years, the bride has still not borne a child, the tablet says, the wife will allow her husband to use a female slave as a surrogate mother to produce an heir. The slave would be freed after giving birth to a son.

Many ethical issues in the Reproductive Revolution have precedents, but it’s amazing to see that today’s surrogate mothers were anticipated by Assyrian slave girls four millennia ago. 

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The bioethics of social media

Autonomy being the central theme of contemporary bioethics, shouldn't bioethicists be concerned about the growing presence of social media, especially Facebook, in our lives? As we report below, what Facebook (and other social media) want is to "consume as much of your time and conscious attention as possible." This involves dulling consumers' willpower with tricks learned from the gambling industry and psychology, ie, making people less autonomous. 

The debate about Facebook at the moment revolves around nefarious schemes by Russia to hack American elections. Social media executives are being hauled before Congressional committees to explain why their products should not be considered threats to democracy. But isn't the addictive nature of Facebook an even greater threat?

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Are you lonely tonight?

Songs about loneliness are legion and range from the soppy and sentimental, like Roy Orbison’s “Only the Lonely” to the irony of the Beatles’ “Eleanor Rigby”. I’ve always been a sucker for Ralph McTell’s “The Streets of London”, with its piercing lyrics about homeless people in a big city. 

Perhaps the reason loneliness is such a potent theme is that we instinctively realise how dangerous it is. 

It turns out that loneliness is (a) a major social and health issue and (b) a widespread phenomenon. One US researcher has even estimated that it affects as many as 45% of retired Americans. This seems far too much, but the levels are certainly high. And since it increases the odds of an early death by 26%, I’d call it a challenge for bioethics. How can we heal the frayed and broken bonds of social cohesion?

A feature in this week’s JAMA examines the cost of loneliness – and the lack of solutions. We report on it below

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Stories like this have surfaced in BioEdge before, but I have always found them quite touching. We report below that researchers have found that a Neanderthal who lived in a large cave in Iraq about 50,000 years ago was terribly handicapped. Not only was he blind in one eye, missing a forearm, and crippled, but he was also profoundly deaf. With Pleistocene lions and tigers prowling in the neighbourhood, this was a big handicap for a forager.

How did he survive? His clan cared for him, tended to his needs, healed his wounds and protected him. He died at the ripe old age of 40 or 50 (equivalent to about 80 nowadays). Obviously Thomas Hobbes' infamous maxim -- that the life of man outside society is "solitary, poor, nasty, brutish, and short" -- needs to be revised. Primitive as they were, these Neanderthals had their own family-based version of Obamacare. 

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Blazing Australia

If you are not inclined to be disputatious, don’t visit Australia at the moment. Across the country is a heated debate about same-sex marriage. According to the bookies, the Yes vote is set to win, although the No vote is giving its opponents a good run for the money. Newspapers are full of op-eds for and against; the broadcast media seems to be only “for”; and Twitter is going wild.

But something equally important is being debated: assisted suicide. The lower house of the state of Victoria yesterday voted for a bill which will legalise it. If it passes, other states will almost certainly follow. It will mark a dramatic turn in Australia’s law and medicine. But – compared to same-sex marriage – almost no one is talking about it.

What accounts for the difference? Oxford bioethicist Professor Julian Savulescu, writing in The Conversation, says that people fear death and like talking about sex and that in evolutionary terms, death is less important than reproduction. 

It’s an interesting question. I don’t believe that I agree with his answer. I think that people intuitively understand that control of marriage is the hinge of social life and are reluctant to redefine it.

But what do you think? Why is the debate over same-sex marriage so much more engaging than the equally important debate over euthanasia?

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President Trump rewards pro-life supporters

During his campaign, President Trump promised pro-life voters that he would support their agenda. And he has delivered. He reinstated the Mexico City policy; he has cut funding to Planned Parenthood; he has rolledl back Obamacare's birth control mandate. And now a new strategic plan for the Department of Health and Human Services has definitely taken a pro-life turn, with references to protecting life from conception to natural death. "We are on track to seeing the most pro-life president this country has ever seen," says Tony Perkins, of the Family Research Council. 

Not everyone is happy about this. “This is a license to discriminate,” Susan Berke Fogel, director of reproductive health at the National Health Law Program, told Politico. “All of that language brings back all of these things that we’ve seen in the past that are just incongruous with really protecting health care and really improving people’s lives.”

What do you think? 

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Go gentle?

The drugs used for executing American prisoners and the drugs used for assisting suicide are more or less the same. Do they guarantee that patients will, as in Keats' poem, "cease upon the midnight with no pain". 

Um, no, or at least no guarantees. Just as some prisoners are tormented in botched executions, some patients in the state of Oregon have taken the lethal drug, gone unconscious, and awakened -- sometimes days later. Read all about it in our lead article. 

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Is drug addiction an illness?

Most of us have an ambivalent attitude towards drug addicts. Can they stop? No, their will power is shot to pieces. Will you invite one home to dinner? No, he’s a drug addict. However inconsistent it might be, we manage to dismiss addiction as morally serious and stigmatize them at the same time.

The Massachusetts Supreme Court is due to hear a case on drug addiction which could have wide-ranging consequences. Julie Eldred, an addict, relapsed while on parole and was jailed. (See story below.) But jailing her was wrong, according to the Massachusetts Medical Society, because opioid use is a chronic illness, not a character defect.

The opposite point of view is represented by 11 addiction experts in an amicus curiae brief. They argue that “Most addicts quit and do so on their own. Addiction seems to be among the most spontaneously ‘remitting’ of all the conditions termed major mental disorders, which is a very inconvenient fact for the position that addiction is a ‘chronic and relapsing brain disease.’”

The outcome of the argument will have immense legal and social consequences. If the addict is helpless in the grip of his or her disease, punishment makes no sense. The whole criminal law would change. To be continued....

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A Nobel Prize for bioethics?

There is a gap in the Nobel Prizes: there's no award for bioethics. There is the Nobel Peace Prize and the Nobel Prize for Medicine or Physiology. Both of them touch on bioethical issues in some fashion, but only tangentially.

True, some Nobel laureates have provoked bioethical controversies. The 1918 laureate in chemistry, Fritz Haber, was “the father of chemical warfare”. The 1956 laureate in Physics, William Shockley, was interested in eugenics and sterilizing people with IQs under 100. The 2010 laureate in Medicine, Robert Edwards, developed IVF. James Watson, the 1962 laureate in Medicine, was interested in designer babies. António Egas Moniz, the 1949 laureate in Medicine, developed the frontal lobotomy.

However, the time has come. As reported below, the 2018 Dan David Prize, worth US$1 million will be awarded “to an outstanding individual or organization in any field of the humanities or social sciences who have transformed our understanding of the moral and ethical significance of biological and medical innovations in our times.”

It appears that this will be the last time that the Dan David Prize will be awarded for bioethics. So it’s a great opportunity. Send us your nomination, with a brief explanation. If we get enough entries, we will publish them next week. 

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Belgian euthanasia under the microscope

For better or worse, this week’s newsletter seems largely dedicated to topics revolving around euthanasia. Belgium’s system is finally getting the close critical scrutiny it deserves in a new collection of essays from Cambridge University Press.

Coincidentally, the doyen of euthanasia there, Dr Wim Distelmans, has just released statistics about child euthanasia. “Nothing to see here; please move along,” seems to be his message. In three years, only two children have been euthanised. Perhaps that is an index of how normal euthanasia has become in his country.

Assisted dying is a hot topic, too, in Australia, in the states of Victoria and New South Wales. BioEdge has organised a free forum on NSW’s Voluntary Assisted Dying Bill on this coming Thursday in Sydney. It will be held at Parliament House, on Macquarie Street, from 9.30am to 12.30pm. A number of medical and legal experts will be discussing the possibility of legal euthanasia in New South Wales. For more details, please check our Facebook page.

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