Helpful hints in the healthcare rationing debate


July 9, 2010 

Hi there,

One of the really cool things about being a journalist is that you need not actually know very much. You just report what other people said and did in a more or less colourful way. In fact, as a famous British war correspondent once pointed out, “tout comprendre, c’est tout pardonner” and “tout pardonner” makes dull copy.

Of course, one needs to comprehend something, especially in bioethics, where some -- all actually -- of the issues are so thorny and controversial. But I frankly confess to being baffled by the angry American debate over healthcare rationing. Is it being thrifty or is it violating human rights?

I am grateful to Jacob M. Appel, who writes for a sterling bioethical journal called The Huffington Post, for enlightening me. In a recent contribution he makes the argument for rationing in the starkest possible terms: let’s unplug patients in a permanent vegetative state. Caring for them costs too much. (See below.)

When it is framed in such black and white terms, it is not difficult for me to make up my mind – at least at the outer margins of the debate. I doubt that the Obama Administration will be using Mr Appel as a consultant, but at least I now see what is at stake. So thanks, Jacob.

What do you think? Make a comment.

Cheers,

Michael Cook

Editor

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Can we please have our laws back?


Hi there,

I hope that you will be generous enough to allow me to indulge one of my pet peeves. Until 2008, for several years, there were fierce debates in the UK, the US, Australia and elsewhere about the morality of research on human embryos.

Eminent scientists around the world appeared on the media and before parliamentary committees demanding funding for their research into human embryonic stem cells. Without it, they declared, sick children will die. Squelch your ethical qualms about destroying human embryos and we will deliver cures and miracle drugs. Most governments listened. They changed the laws.

What has happened? An interview with Harvard scientist George Q. Daley in the latest issue of Nature Medicine gives some insight. In 2007, scientists discovered a new way of creating cells which were functionally equivalent to embryonic stem cells. It was ethically non-controversial because it destroyed no embryos. Within weeks Daley and many others abandoned their embryos and set to work on induced pluripotent stem cells. But the laws still allow them to destroy those embryos.

In other words, governments and the public were scammed. They traded convictions for cures and they lost both. The anguish and desperation were just bargaining chips. I feel that stem cell scientists owe us an apology.

What do you think?

Cheers,

Michael Cook

Editor

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India’s looming commercial surrogacy


Hi there!

One reason to keep tabs on developments in bioethics in the UK, the US and Australia is that arguments which convince us are recycled and used in places like India, Thailand and Singapore. These countries have high-quality medical technology, but unsophisticated bioethics. As a consequence they tend to adopt a utilitarian ethic without a robust debate informed by a more metaphysical tradition and by respect for human rights.

One example of this is a bill being considered by India’s parliament which will legalise commercial surrogacy. The groundwork was laid by a report written by the India Law Commission last year. It was fairly sketchy and very liberal. But the bill ignored its key point – that surrogacy should not be commercialised. If the bill passes in its present form, poor Indian women will be exploited as wombs for hire. The provisions of the bill which protect the rights of these unfortunate women do not inspire confidence.

Judging from comments from Indian IVF clinics, commercial surrogacy will be a bonanza for them. A world-wide market for surrogate mothers, especially for gay couples, is opening up as adoption becomes more and more difficult and they expect many clients. It is hard to describe this as anything other than contemptible colonialism.

I wish bioethicists elsewhere would give this dangerous and ill-conceived legislation a big raspberry.

Cheers,
Michael Cook
Editor

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A bioethical telenovela from Argentina


June 18, 2010 

Hi there!

I realise quite keenly and lament the fact that BioEdge’s coverage of the world of bioethics is biased towards the English-speaking world. I have a smattering of other languages, but it is impossible to scan the media in Czech, or Danish, or Chinese. So, help! If you feel that something is worth reporting outside of the Anglosphere, please pass it on.

At least we managed to pick up a fascinating story from Argentina which mixes power politics, media magnates, a billion-dollar inheritance, human rights, dark secrets and genetic testing. The adopted heirs of a leading Argentine leading media group have been forced to give DNA samples to see if they are the children of los desaparecidos, victims of the military junta which executed left-wing foes and adopted out their babies.

Should they be forced by a specially-tailored law to know the truth about themselves, especially since their obscure origin may have nothing to do with los desaparecidos? Lots of room for discussion here – and for a film script.

Cheers,
Michael Cook
Editor

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abortion by telemedicine


June 11, 2010 

Hi there,

Amongst the intriguing stories this week is one which deals with the incendiary issue of abortion. We don’t cover the abortion debate too often, as it is well covered on dozens, if not hundreds, of newsletters and websites and it tends to polarise readers. However, an initiative of Iowa Planned Parenthood caught my eye. Its doctors are doing abortions by telemedicine by prescribing the drug mifepristone to its rural clients.

This brings to the fore some interesting and quite unexplored issues in medical ethics. Is medicine a personal relationship, or just a service? Is the internet an adequate way of engaging in a doctor-patient relationship? Can patient confidentiality be ensured? How can telemedicine doctors ensure continuity of service?

This seems to be consistent with a growing trend towards depersonalisation in society. Is it really where medicine should go? Any ideas?

Cheers,

Michael Cook

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Website redesign on the way


June 4, 2010 

Hi there,

We are looking forward to a redesign of the BioEdge website in the not-too-distant future. Do you have any suggestions to make it more attractive and useful – for research, study or general interest? Get in there early!

One feature that we are keen to exploit is the Facebook paraphernalia which we have added recently. Try them out. It’s a very easy way to share articles with your friends.

This week’s selection of articles is a bit on the light side, with a YouTube video of a thrash death metal song from Fear Factory about assisted suicide and a bizarre attempted murder in California which might qualify as a “mercy killing”. But there are weighty stories aplenty, as well…

Cheers,

Michael Cook
Editor

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Why isn’t the media across Katie’s Law?


May 28, 2010  

Hi there,

With economic meltdown threatening in Europe and a catastrophic oil spill in the Gulf, the US media still gave wall-to-wall coverage to the controversy over Facebook’s privacy controls. Grandstanding congressmen were demanding that Facebook make its rules simpler.

But when an opportunity came to debate a privacy issue which reaches much further into people’s lives, the House of Representatives hardly paid attention. By a vote of 357 to 32 it approved “Katie’s Law”, a measure that will bribe state governments to help build up a national DNA crime database. This was hugely controversial in the UK’s recent election and one of the first promises made by the new government’s deputy prime minister was to dismantle the country’s vast DNA database as a blot on British liberties.

Why isn’t the US media taking this up? Whether you approve or disapprove of a DNA database, you must admit that it is a major civil liberties issue.

We have a few other stories for you this week as well: reopening the debate over gay blood donors, organ donation in Pakistan, the perils of ancestor testing, adult stem cells which rebuilt a boy’s windpipe, and much more.

Enjoy!

Cheers,
Michael Cook
Editor

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Craig Venter creates synthetic microorganism


Hi there,

May I could share a personal reflection with you? This is a job in which one reads about an astonishing number of fruitcakes. I don’t mean people with strongly held convictions or vaunting ambitions whom I take issue with. No, I’m thinking of Real McCoy fruitcakes.

The big story in bioethics this week is clearly Craig Venter’s announcement that his team has created a synthetic genome. No one greeted this with more enthusiasm than the Raelians, a bizarre cult which believes that humans were created by aliens called the Elohim and wants to clone humans as a path to immortality.

Their leader, Rael, a former French sports journalist, says: "With Venter's achievement, we're witnessing the first step toward the Elohimization of humanity that will bring the creation of the first synthetic human being."

So, if any of our readers have Craig Venter’s ear, perhaps they could tell him that he has a future as a cult figure in addition to his other accomplishments.

Cheers,

Michael Cook
Editor

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The clash of prudence with principle


May 14, 2010

Hi there!

Female genital mutilation is wrong, right? So why has the American Academy of Pediatrics appealed for a relaxation of a government ban on the practice? The AAP thinks that a blanket ban on an ancient cultural practice will not work. Instead parents are going to haul their daughters back to the old country where the procedure will take place without anaesthetics, without hygiene, perhaps with a shard of broken glass.

Absolutely not, say the AAP’s counterparts in the UK. They regard this notion as a shameful concession to repugnant and oppressive gender-based violence.

The conflict of realism with principle is fascinating. Where do you stand on this? Make a comment!

Early next week we will publish an interview with distinguished American bioethicist George J. Annas about his latest book, Worst Case Bioethics. Please visit the BioEdge website to check it out.

Cheers,
Michael Cook
Editor

PS – you may have received a request for donations from us this week. Please consider it carefully.

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Has Jodi Picoult subscribed to BioEdge? She should


May 8, 2010

Hi there,

This week we had to sift through a number of interesting stories and articles in professional journals. It's impossible to fit everything in and some of the most intriguing stories get left out.

I was particularly struck by two stories from Australia. In the first, an Australian traumea surgeon, Craig Jurisevic, has just published his memoirs of his time in the 1999 Kosovo War. He went on patrols, provided intelligence, killed Serb soldiers, and operated in battlefield hospitals run by the Kosovo Liberation Army. Were his battlefield exploits compatible with his Hippocratic Oath? How should the Australian Medical Association respond?

And in the second, an intensive care doctor had to quash suspicions that she kept a convicted child-killer alive so that she could make a deathbed confession to police about other murders. Emma Hothersall told an inquest in Queensland that police had never put pressure on her to keep Valmae Beck alive after she suffered a heart attack. But what if they had? What would be the ethics of extending a lifer's life?

Perhaps some of your friends are novelists – get them to subscribe to BioEdge!

We've linked the BioEdge website to a Facebook page. Why don't you think about becoming a fan?

Cheers,

Michael Cook
Editor

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