AMA spurns assisted suicide


“Death with dignity” or “aid in dying” is gathering pace in the United States, now that Hawaii has joined the list of states which permit it. Some of the most important input in the debate comes from medical associations. The American 
Academy of Hospice and Palliative Medicine 
has adopted a position of “studied neutrality”. But how does the American Medical Association stand?

According to a recent decision by its Council on Ethical and Judicial Affairs, squarely against it. Below we report that in a little-noticed report, it endorses many of the arguments raised against assisted suicide: "dying with dignity" is a misnomer; it is probably not safe; and it could lead to a slippery slope. It's a very interesting read -- along with all of our other articles. Check them out. 

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Thanos inherits the mantle of Paul Ehrlich


Personally, I'm not a big fan of super-hero films. I get a bit tired of the wisecracks and the fake explosions and crumbling buildings. But that's me, I'm afraid. Age. Generational change. Fuddy-duddy etc. 

However, they are interesting thermometers of the culture. Black Panther certainly taps into a revolt against racism. Guardians of the Galaxy revolves around lost fatherhood. And the really, really bad guy in the latest epic, Avengers: Infinity War, is obsessed with population control. He has a plan for eliminating half the population of the earth. It's a reprise of Paul Ehrlich's 1968 damp squib, The Population Bomb, which predicted social collapse and environmental disaster unless the brakes were put on world population. It was a very scary script and it never happened, like most disaster movies. 

What I wonder is this: does this mean that over-population still scares people or that it no longer does? Thanos, after all, is a villain, and the Avengers are out to defend the world, not support his extreme environmentalist creed. My feeling is that very few people are fretting about over-population as such, although the real problem, a shrinking and greying population, isn't attracting much interest either. Any thoughts?

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Dodgy death statistics in Flanders


“Die, my dear Doctor! That's the last thing I shall do,” said the 19th Century British foreign secretary Viscount Palmerston, not long before he slipped his cable. For all of us, dying is the last and perhaps most significant moment of life. Which is why recording the exact cause of death is a matter that calls for scrupulous accuracy – not just for epidemiological purposes, but also as part of our personal and social history.

But our disturbing lead story today – that Flemish doctors under-report euthanasia by a mind-boggling 550% -- throws all this to the winds. The most common practice, at least according to the latest research into the topic, is that most Flemish physicians who practice euthanasia lie on the death certificate.

Perhaps their offence is more understandable than jurisdictions which require doctors to lie. In many, like Oregon, they are told to record the patient’s underlying disease as the cause of death – as if JFK died of Addison’s disease rather than an assassin’s bullet.

Perhaps we should keep in mind the wise words of the author of a study on death certificates: “Death certificates are really important. We owe it to our patients to be able to accurately record why they die” — and thus to “help the living.”

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A more inclusive view of personhood


“Personhood” is a concept that is of great relevance to a range of bioethics debates. These include embryo research, abortion, the withdrawal and withholding of treatment, and euthanasia. Ironically, conservative bioethicists argue for a liberal definition of personhood, while liberal bioethicists tend to defend a more restrictive account of who classifies as a person. The former suggest that personhood pertains to a radical capacity for conscious activity, and all human beings, regardless of whether they have actualised this capacity or not, are persons.

The latter argue that the unborn and the radically incapacitated do not have a capacity for conscious self-awareness, and do not count as persons.

Yet the way in which we define personhood has a relevance that goes beyond debates about human beings. It also has significant bearing on debates about animal rights.

Some bioethicists argue that certain non-human animals, such as chimpanzees, should be recognised as “persons”. NYU animal studies professor Jeff Sebo, for example, says that chimps have many of the traits – self-recognition, use of language, friendships and the pursuit of goals – that we take to be constitutive of personhood. As such, we should include them in our definition of personhood. Sebo has championed a protracted legal campaign in New York State to have two chimpanzees, Kiko and Tommy, recognised as persons.

Here’s what Sebo had to say in a recent New York Times op-ed:

Sometimes when we are overwhelmed by the complexity of an issue, it can help to start by stating a simple truth and going from there. In this case, the simple truth is that Kiko and Tommy are not mere things. Whatever else we say about the nature and limits of moral and legal personhood, we should be willing to say at least that. The only alternative is to continue to accept an arbitrary and exclusionary view about what it takes to merit moral and legal recognition. Kiko and Tommy deserve better than that, and so do the rest of us.

I wonder if these two different debates – the limits of human personhood and the scope of animal personhood – have implications for each other. Perhaps those who defend the rights of the unborn and severely incapacitated humans must also acknowledge the need to afford greater legal recognition to intelligent non-human animals. And perhaps those who advocate for a definition of personhood that includes intelligent animals should also include those at the margins of human life.

XAVIER SYMONS  
Deputy Editor

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Disability and euthanasia


Mahatma Ghandi reputedly said, “A nation’s greatness is measured by how it treats its weakest members.” We could paraphrase this in a contemporary context: a nation’s right-to-die laws are measured by how it treats the disabled.

Our lead story this week deals with the euthanasia of patients with an intellectual disability or autism in the Netherlands. Four bioethicists suggest that the necessary safeguards are lacking in these cases.

That is bad enough. But they go on to point out that the disabled have to deal with nigh-intolerable suffering for their whole lives. How does legal euthanasia make them feel? In the words of another author, “If society endorses the right of a person to seek physician assistance to end his or her life because of increasing loss of functional autonomy, what does that say about how our society values the lives of people who live with comparable limitations every day of their lives for years on end?”

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Hawaii legalises assisted suicide


Hawaii legalised assisted suicide this week. It becomes the seventh American jurisdiction to do so. Since 1997, the legislatures of Hawaii, Oregon, Washington state, California, Colorado, Vermont and the District of Columbia have passed laws permitting assisted suicide. In Montana, a court decision found that it was legal, but there has been no legislation. 

The new law follows the controversial Oregon model. One of the drawbacks of this legislation is its definition of "terminal illness". It is usually understood to be a condition which will lead to death withinn six months or a year. But if a patient decides to spurn all treatment, treatment which could keep them alive for years, his or her illness will automatically become "terminal". This is a flimsy basis for such an important law. 

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Driverless ethics


The tragic death of a Florida woman struck by a driverless Uber has revived public interest in robot ethics. How do these cars make decisions in life and death situations? Are they transparent enough about the standards?

Such questions will be asked more and more as the age of autonomous vehicles approaches. Perhaps you could program it yourself. Highly Ethical Cars would take almost no risks and take two hours to get to work. Minimally Ethical Cars would run red lights and get there in five minutes. It’s going to be an interesting debate.

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A beautiful death


A recent US documentary recounts the story of an Oregon couple who committed suicide together in April 2017. The couple, Charlie and Francie Emerick, had both been diagnosed with terminal illnesses. They felt that, after having been married and together for some sixty odd years, it was only fitting that they exit this world as a couple.

Talk of “fittingness” in the context of death draws our attention to a broader topic, namely, the aesthetics of death. Just as we seek beauty in life, so also do we seek beauty in death.

There is a certain beauty to ending the narrative arc of our lives with a “fitting” poetic flourish. And in the context of euthanasia, it seems that many cases are underpinned by a desire not just for a peaceful death, but a beautiful death.

In 2016, a 41-year-old Californian multi-media and performance artist, Betsy Davis, ended her life with lethal medication. Davis wanted her suicide to be a “final act” in her artistic career, and she organised an elaborate weekend of celebrations and performances before consuming the lethal dose on a canopy bed by a hillside.

I wonder if, in seeking a beautiful death, we should look the wisdom the ages, rather than following our own artistic intuitions. The 15th century Latin tract Ars Moriendi provides persons in extremis with guidance for a good death. It encourages readers to face death bravely, to avoid temptations to despair, impatience or pride, and to surround oneself with those loved ones who, in life, have brought joy to one’s soul.

I’m not sure that the authors of the text had assisted suicide in mind when they outlined the elements of the ars moriendi

XAVIER SYMONS
Deputy Editor
 

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Remembering Proposition 71


In 2004, Californian voters overwhelmingly approved Proposition 71, a ballot initiative which created the US$3 billion California Institute for Regenerative Medicine. This was the apogee of stem cell fundamentalism around the world. Stem cells, especially human embryonic stem cells, were the key to unlock the secrets of human biology. They would lead to cures to dread diseases, perhaps not tomorrow, but the day after tomorrow.

Hollywood stars enthusiastically backed the ballot initiative. Quadriplegic Christopher Reeves told voters in an advertisement, "Stem cells have already cured paralysis in animals. Stem cells are the future of medicine." Parkinson’s victim Michael J. Fox said: "Vote yes on 71, and save the life of someone you love."

Fourteen years on, the CIRM (aka California taxpayers) has received its first royalties – a cheque for US$190,345.87 – a 0.00006% return on investment.  And that’s not for a cure, by the way. It’s for a drug which has only passed a Phase I clinical trial. Clearly, California voters were sold a pup. Is it time for the state to set up a stem cell truth and reconciliation commission? Read the story below. 

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Thailand needs bioethics


BioEdge is a bioethical gadfly, nipping and biting at what we perceive to be bad arguments and unhealthy developments. But the recent story about a Japanese man who fathered 13 children with the help of mothers hired in Thailand suggests that almost any bioethical approach is better than none – and “none” was the position of the Bangkok judge who awarded him custody.

"The petitioner is an heir and president of a well-known company listed in a stock exchange in Japan, owner and shareholder in many companies ... which shows the petitioner has professional stability and an ample income to raise all the children. Therefore, it is ruled that all the 13 children are legal children of the petitioner … and the petitioner is their sole guardian."

Any bioethicist would immediately comment that this decision ignores many important issues. Are children just property? What about the rights of the surrogate mothers? Is it right to raise 13 boys without mothers? Is it right to raise 13 boys together like cattle? Is wealth a substitute for parenting? Is fatherhood simply a matter of sperm donation?

It sounds as though the judge merely wanted to hand the boys over to Japan. In his words (as reported) I can detect no inkling of the fact that the issue is more complicated than a commercial property transaction. It sounds as though Thailand urgently needs bioethics education.

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