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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The hottest topic around

It’s hard to think of a more volatile topic than transgender transitions for children entering puberty. The number of kids demanding puberty-blockers so that they can transition to the opposite sex is exploding all over the developed world. It’s a mysterious and poorly understood phenomenon which involves a range of bioethical issues.

Is gender dysphoria really a medical issue at all? Or is it just a waystation on a spectrum of sexualities? How do we decide? Is it ethical to offer treatments which have yet to prove their efficacy? Is it ethical to offer treatments which will have negative side-effects? How can children make decisions which will affect their whole lives without understanding the medical, sexual and psychological implications? There is enough here to fill a library with contending points of view.

But this is far from being a theoretical issue. Children with gender dysphoria are suffering now. Who is to decide how can they be best cared for? A bioethicist writing in the American Journal of Bioethics effectively argues that parents are not the best judges. (See article below.) They are in the same position as loving, well-intentioned parents who want to use herbal remedies for their child’s cancer. Doctors, backed by governments, should decide. The state has to step in to save the child from suffering and even death.

It’s a controversial, even incendiary, point of view. But that is the way the debate is heading. We can expect to hear more, much more, in the future.

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Great stories this week

Hi there,

We have a range of interesting and provocative stories this week. In our lead, Australian doctors are in the eye of a political storm over refugees. In a pattern familiar in other countries, conservatives and progressives have been battling for years over immigration policy. To over-simplify: a new law makes two doctors – not government officials or politicians – the gatekeepers who decide whether refugees currently living off-shore in special camps need medical treatment in Australia. It is sure to be an election issue.

Consent is fundamental to contemporary medicine. So why can’t Dr Evil, a British body modification artist, ply his trade on fully-consenting adults? A court in the UK has ruled that there are limits to the kind of harm that can be inflicted, even if people consent. Dr Evil’s case shines a new light on some medical procedures.

And, astonishingly, the involuntary euthanasia of possibly as many as 34 elderly patients in two Catholic hospitals in the city of Columbus has been almost ignored outside of Ohio.

There’s lots more. Just follow the links below.


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We’re back, again!

Hi there,

Apologies for the non-publication of BioEdge last weekend. We're back on track now.

In the meantime, we have managed to create a new mobile site for BioEdge. More and more of our readers are accessing the newsletter with smartphones. The old links were hard, if not impossible, to read. I think that you will find the new links much better. 

We'd appreciate your feedback, though. There are always bugs in every new system and we'd like to identify them as soon as possible. 


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Sorry, guys

Hi there,

Sorry, but the editor (aka me) is still under the weather. There will be no BioEdge this week. Next week we should be back on track. See you then.


Michael Cook

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