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December
08
  11:48:00 PM

Are plants intelligent?

In 2008, a Swiss ethics commission published a discussion paper which suggested that plants had “dignity” which should be respected. Since Article 120 of the Swiss constitution says that “the Confederation … shall take account of the dignity of living beings”, this created both consternation and mockery in the media.

Nothing daunted, some members of the commission went on to formulate the Rheinauer Theses on the Rights of Plants. These proposals guaranteed plants reproductive rights, a right to be independent, a right to evolution, a right to survival as a species, a right to respectful research and development, and a right not to be patented.

The authors of the theses were realistic about the practical difficulties of implementing these on behalf of plants. However, it was a good start towards a bioethics of plants.

The persuasiveness of their initiative is being reinforced by a controversial movement in plant biology which asserts that plants are intelligent – and if this is the case, then perhaps they deserve rights.

Monica Gagliano is an Australian botanist who is a leader in plant intelligence. “Plant cognition is a new and exciting field of research directed at experimentally testing the cognitive abilities of plants, including perception, learning processes, memory and consciousness,” she says on her website. “The emerging framework holds considerable implications for the way we perceive plants as it redefines the traditionally held boundary between animals and plants.”

The idea that intelligence is not unique to animals goes back at least to Darwin, who observed that plants interacted with their environment. Scientists like Gagliano and Stefano Mancuso, an Italian plant physiologist, believe that they have evidence that plants have memory and consciousness – although not in a way that humans can comprehend. They contend that “that we must stop regarding plants as passive objects—the mute, immobile furniture of our world—and begin to treat them as protagonists in their own dramas, highly skilled in the ways of contending in nature.”

“I agree that humans are special,” Mancuso told The New Yorker in a 2013 interview. “We are the first species able to argue about what intelligence is. But it’s the quantity, not the quality” of intelligence that sets us apart. We exist (The New Yorker observed) on a continuum with the redwood, the carrot, and the amoeba. 

What will happen when plants find their advocate for Plant Rights, a new Peter Singer? No more florist shops? No more salads? No more wooden houses? No more lawn-mowing? Time will  tell.

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December
08
  11:42:00 PM

Class action suit against leading Australian cosmetic surgery company

A class action lawsuit has been launched against an Australian cosmetic surgery company specialising in breast augmentations. According to lawyers for the women, The Cosmetic Institute (TCI) performed more than 5,000 cosmetic procedures each year, most of them breast augmentations. A lawyer with Turner Freeman, the firm representing them, claims that as many as 1,000 women may have had botched surgery.

TCI was founded in 2012 by businessman David Segal and surgeon Dr Eddy Dona to compete with cheap cosmetic surgery overseas in countries like Thailand and Vietnam. It was able to lower fees by creating its own in-house operating theatre. “We wanted to show the medical industry was no different to anyone else,” Segal told a business magazine in 2014. “Whether you’re selling T-shirts or boobs or whatever the case may be, it’s about value and service.” 

The TCI website still spruiks its product as “Breast implants for the price of a coffee a day”.

The business model worked well for a while. After only 18 months TCI was described as one of the 20 fastest growing companies in Australia. But then complaints started to roll in.

Turner Freeman’s lawyers claim that the negligence of TCI’s doctors left a number of patients with serious complications, ranging from cardiac arrests to physical disfigurement.

A whistleblower nurse who worked at TCI for three years told a Parliamentary inquiry in New South Wales: "You're talking about a low socio-economic group who are taking on a loan for $20 a week and getting a boob job for the cost of a coffee a day, that's how it was advertised."

The lawyer leading the class action, Sally Gleeson, told The Australian: “We’ll allege the cosmetic industry and Dr Eddy Dona breached their duty of care,” she said. “They essentially created a one-size-fits-all approach akin to the McDonald’s of the fast-food chain or a cookie-cutter approach to surgery, irrespective of the different anatomies or needs of the individual.

“We’ll allege the whole approach to surgery didn’t comply with reasonable medical practice and those deficiencies led to horrific outcomes ranging from clients who suffered cardiac arrest, seizures, lung punctures and very poor aesthetic outcomes including deformities and ongoing … psychological consequences.”

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December
08
  11:34:00 PM

Indiana could create new crime of ‘fertility fraud’ after painful scandals

A string of scandals about IVF doctors who have used their own sperm to impregnate their patients has led to an Indiana bill penalising “fertility fraud”. The proposed law would punish doctors with up to 2½ years in prison.

Sean Tipton, of the American Society for Reproductive Medicine, opposes the legislation. He told the Washington Post that “errors and fraud in the industry are rare, and are easily addressed under existing laws.” He assured the Post that “Clinics maintain rigorous safety protocols to ensure that the correct genetic material is transferred, that donors are properly screened and that medical workers adhere to stringent ethical standards”.

However, this does not take into account the anger and anguish experienced by people who discover late in life that their real father was someone else.

More than 30 years after she was born, Indiana woman Jacoba Ballard discovered that her real father was fertility doctor Donald Cline. “My mother was violated. He took advantage of her in one of the most vulnerable moments of her life,” Ballard says.

Cline was found guilty, but Ballard believes that he should have been punished more harshly. He may have used his own sperm as many as 50 times without telling his female patients. But he was only deregistered (he was already in his late 70s) and fined US$500, plus put on a year’s probation. The sentence was “not enough to send a message”, says Ballard.   

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December
01
  9:45:00 PM

He did it: uproar over Chinese gene-edited babies

He Jiankui  

A Chinese scientist has faced widespread condemnation for editing the genome of two babies at his lab in the Southern University of Science and Technology in Shenzhen, together with an American colleague.

The researcher, He Jiankui, outlined his work at the Second International Summit on Human Genome Editing in Hong Kong. His experiments have not been peer reviewed or published so it is impossible for other scientists to verify his claims. In a Q&A session, He came under heavy fire from other scientists.

The summit’s closing message declared that “the procedure was irresponsible and failed to conform with international norms.” 

The ostensible purpose of the experiment was to give "lifetime protection" against HIV, the virus that causes AIDS. Using the powerful gene-editing technology CRISPR, Dr He modified the DNA of embryos belonging to eight couples. All the fathers had HIV; none of the mothers did. Five of the embryos were implanted but only one woman gave birth -- to twin girls.

If what Dr He says is true – and it’s a big if -- this is a milestone in genetic technology. For the first time a scientist has created designer babies. His purpose was not to prevent the children from having a disease by editing a gene, but to improve their genetic profile by modifying it. In this case, he disabled a gene called CCR5 that creates a doorway for the HIV virus to enter a cell and cause AIDS.

Around the world scientists were furious. He's university declared that it had known nothing about his work and described it as a "serious violation of academic ethics and standards". “China has banned reproductive use of gene editing in human embryos,” said a government minister. “The experiment has violated laws and regulations in China.” Embarrassing the Chinese government is not a career-boosting idea, especially if you are a Chinese citizen. He might be punished severely. 

He’s American colleague, Michael Deem, a bioengineering professor, is being investigated by Rice University.

An Australian researcher, Greg Neely, summed up the reaction of scientists: “Before we start editing human embryos to try and control disease, we first need to better understand the safety issues involved, and importantly we need to identify the most appropriate disease to target, in this case prophylactic editing to control future HIV infection was not justified. In the end the motivation here seems to be one of personal glory for the scientists involved, and there may be a horrific cost to pay for this hubris."

Even “progressive” bioethicists slammed He’s leap into the future. Julian Savulescu, an Oxford professor who supports genome modification, cried that it was “monstrous”. “This experiment exposes healthy normal children to risks of gene editing for no real necessary benefit,” he wrote. “It contravenes decades on ethical consensus and guidelines on the protection of human participants in research. In many other places in the world, this would be illegal and punishable by imprisonment.” Gene editing was worth considering in cases where it was life-saving, he declared. But He’s experiment was “life-risking”.

Is this tsunami of indignation sincere? After all, the summit endorsed a statement which both condemned He and declared that “germline genome editing could become acceptable in the future”. In other words, most of the angry scientists have no ethical qualms about germline engineering in principle – only in practice. As a journalist for MIT’s Technology review, Antonio Regalado, tweeted, “The babies are a ‘misstep’. That's it. Not the last step."

He had not played the game by the rules. His experiment had not been passed by an institutional review board; it was announced in the media before it appeared in a scientific journal; and the ensuing scandal put a cloud over similar research.

In fact, modifying the human genome is already happening legally in the United Kingdom, where Parliament approved three-parent babies not long ago.

As Dr David King, of the British lobby group Human Genetics Alert, commented: "Although some scientists have condemned He Jiankui's criminal eugenic experiments, the truth is that they have themselves provided cover for him. Although there is no medical need whatever for genetic engineering of human beings, scientists' organisations always oppose a global ban.”

Only a few months ago the Nuffield Council on Bioethics, an influential British think tank, cautiously endorsed human genome editing. As long as it was safe and regulated, “the potential use of heritable genome editing interventions to influence the characteristics of future generations could be ethically acceptable in some circumstances.”

However, Dr He insists that he has acted ethically. In the YouTube video produced by his laboratory, he explains why. 

If you take the trouble to listen, you might even agree with him. All of the reasons sound very familiar -- they are boilerplate from the IVF industry. 

Family is society’s bedrock. Our children are the centre of family life. If we can protect a little girl or boy from certain diseases, if we can help more loving couples start families, gene surgery is a wholesome development for medicine.

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December
01
  9:39:00 PM

Harvard profs defend ‘rogue scientist’

George Q. Daley  

Despite the hullabaloo over He Jiankui’s treatment of two babies, two of Harvard University’s most prominent scientists have defended him.

George Q. Daley, dean of Harvard Medical School, told the summit “Just because the first steps into a new technology are missteps, it doesn't mean we shouldn't step back, restart and think about a plausible and responsible pathway for clinical translation."

He is in favour of moving ahead with germline editing. “I do think it’s time to move forward from the prospects of ethical permissibility to start outlining what an actual pathway to clinical applications would look like.” Apart from curing serious genetic diseases, he pointed out, the survival of the human race might be at stake. “There have even been discussions that we as a species need to maintain the flexibility in the face of future threats to take the control of our own heredity.” 

George Church, one of Harvard’s star researchers, described the criticism heaped on He as “bullying”. In an interview with Science magazine Church said

“The most serious thing I’ve heard is that he didn’t do the paperwork right. He wouldn’t be the first person who got the paperwork wrong. It’s just that the stakes are higher. If it had gone south and someone had been damaged, maybe there would be some point. Like what happened with Jesse Gelsinger [who died in a 1999 gene therapy experiment]. But is this a Jesse Gelsinger or a Louise Brown [the first baby born through in vitro fertilization] event? That’s probably what it boils down to.”

Church refused to describe the experiment as “unethical”. True, he said, there is a global moratorium on human germline editing, “but a moratorium is not a permanent ban forever. It’s a checklist of what you have to do. It really seems like he was checking off the published list [see p. 132] by the National Academy of Sciences and added a few things of his own.”

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December
01
  9:28:00 PM

Architects of Victoria’s right-to-die law publish ‘manual’ on how to push legislation through

The Victorian Parliament by night  

One year ago, in December 2017, the Australian state of Victoria legalised euthanasia and assisted suicide. This has given new heart to supporters in other states who have been lobbying for years for the “right-to-die”.

Helpfully, the Australian Healthcare Review has just published a review of how supporters were able to break the log-jam in Victoria – essentially a how-to manual for activists written by the government’s former Ministerial Advisory Panel, the brains trust for the process.

Here are a few of the elements which the authors highlight in their article.

1. Victoria passed a Charter of Human Rights in 2006. Its emphasis on autonomy helped to enable passage of a law decriminalising abortion in 2008 and then last year’s euthanasia legislation.

2. Victoria’s Labor government, headed by Premier Daniel Andrews, supported the legislation, although it was eventually decided on a conscience vote. A report from the parliament’s Legal and Social Issues Committee endorsed it. “Government support was essential,” report the authors.

3. As members of its Ministerial Advisory Panel (MAP), the government appointed seven men and women with distinguished professional qualifications, all supporters of a change in the law. The chair, Brian Owler, was a former federal president of the Australian Medical Association.

4. The MAP had extensive discussions with stakeholders in legalised euthanasia, such as health professionals and administrators, legal groups, medical colleges, nursing and allied health groups, consumer and carer groups and mental health providers. Consultative workshops were held throughout Victoria.

5. The support of the Department of Health and Human Services was essential to the process. It provided expert legal and political advice, and administrative support. The Health Minister dedicated “significant departmental resources required, for the process of consultation to develop a high-quality bill.”

6. Skilful media management ensured that messaging was “consistent and accurate”. The members of the MAP were given media training. Journalists were given extensive briefings at each major step “to ensure that the public messaging of a complex model containing strict criteria was clear and that the work was reported accurately. In addition, different lobby groups undertook public campaigns to engage the media and the general public, as well as to directly lobby politicians, which was helpful in balancing the differing arguments.”

The authors conclude that “This process has been a tangible example of democracy at work at a time when many may feel cynical about political processes.”

It would be interesting to read an account of how the legislation passed from the point of view of its opponents. 

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December
01
  9:24:00 PM

‘Ah, look at all the lonely people’

Loneliness is a serious, if unrecognised, public health problem. And not just psychological health. Former US Surgeon General Vivek Murthy believes that it is as toxic as smoking 15 cigarettes a day. Loneliness can literally kill. Murthy has described it as an “epidemic”.

According to a survey conducted by the Kaiser Family Foundation with The Economist, more than 20% of adults in the UK and the US and 9% in Japan  report that they often or always feel lonely or isolated.

With this in mind, bioethicist Craig Klugman, of DePaul University, asks whether we need a “bioethics of loneliness”.

It’s a complex issue, because loneliness is, in some cases, a result of past choices and dealing with it might mean sacrificing the individualism characteristic of many Western countries. With respect to women, for instance, Klugman notes that “With more opportunities for financial independence and self support, women may be choosing to live alone, marry later, and have smaller families. Thus combatting a perceived epidemic in loneliness might actually result in reinstating restrictive social mores that repress women and reduce their choices.”

Klugman concludes:

I suggest that a bioethics of loneliness would take an interdisciplinary approach to examining what questions one should be asking, and to determining whether the change represents an exercise in autonomy or is in fact causing real harm. The fact that older measures of engagement are not met, does not mean that social engagement is at risk. We should not simply accept the headlines but rather should take a critical eye to analyzing the data, examine the change in technologies and how people interact, and then offer an informed, ethical perspective on our brave new world.

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December
01
  9:18:00 PM

Internet scammers target people seeking to die

Internet scammers are using fake endorsements from well-known euthanasia campaigners to bilk gullible people. According to Derek Humphry, founder of the Hemlock Society:

“At any one time there are at least 40 web sites offering to sell the drug Nembutal without the need for a doctor’s prescription. None are known to be reliable. Not only are they fraudulent but sometimes pretend to be part of genuine right-to-die organizations like ERGO or EXIT.

“The latest impersonator has stolen the colored banner and logo from ERGO’s web site. They repeat the words ‘Euthanasia World Directory – Web Site of Hemlock Society Founder Derek Humphry at the top of their web site.”

Mr Humphry says that the scammers charge US$500 to $700 for enough Nembutal to end life painlessly. “A favorite trick of some thieves is to deliver honestly on a couple of orders, gain a good reputation, then when thousands of dollars roll in, fail to respond and close down the web site.” However, says Mr Humphry, whose blog describes him as “serving the rights of competent, terminally ill adults for 30 years”, neither ERGO nor EXIT sells drugs. They only offer “quality advice” on how to kill people who want to die.

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December
01
  9:11:00 PM

Are IVF embryos persons? A mum and dad who lost theirs say they are

On March 3 a liquid nitrogen storage tank at the University Hospitals Fertility Center in Cleveland failed. More than 950 patients lost over 4,000 frozen eggs and embryos. The hospital attributed the tragic incident to “human error”.

More than 70 aggrieved patients have brought over 40 lawsuits against University Hospitals of Cleveland, although most of these claims have been consolidated into a single case. But one couple, Wendy and Rick Penniman, has attempted to sue on the basis of “wrongful death”. Their lawsuit seeks to establish that embryos should be treated as legal persons and that the life of a person begins at conception.

The "chain of profound implications for other families" dismays three bioethicists and lawyers writing in Annals of Internal Medicine, Eli Adashi, of Brown University; I. Glenn Cohen, of Harvard; and Dov Fox, of the University of San Diego. They believe that a ruling in favour of the plaintiffs could lead to limits on abortion, stem cell research and in vitro fertilization (IVF).

"It would be a sad irony if a legal claim aimed at protecting the rights of those who lost their ability to reproduce had the effect of limiting the reproductive rights of countless others," the authors write.

A ruling that embryos are persons could be used as grounds to limit abortion rights, the authors point out, as well as to potentially restrict research on embryonic stem cells. There could be implications for the future of IVF as well.

"IVF would be significantly compromised," Adashi says. "If a clinician were to freeze embryos, and some do not survive the process, how would that be dealt with? Would that be manslaughter? One needs to view this suit in that context. The implications are of national interest. They go beyond the pro-life / pro-choice debate and reach into the very conduct of IVF and other fertility promotion techniques."

The authors also discuss the limitations of conventional legal strategies tried in similar cases, including breach of contract, medical malpractice, negligent infliction of emotional distress, and loss of property.

Many fertility clinics require patients to sign waivers that explicitly excuse liability for storage failures due to negligence, limiting breach of contract suits. Medical malpractice also doesn't apply in a case such as this, because the egg-harvesting procedures were performed properly. And in Ohio, negligent infliction of emotional distress requires the plaintiffs to be "bystanders" to a physical threat to another person; in this case, they did not witness the tank failure.

The last strategy, loss of property and medical costs, doesn't fully capture the painful disruption of "family-building plans," Adashi says. However, these are the legal grounds the other 70 other patients affected by the accident are pursing in their class-action lawsuit.

The legal system hasn't established appropriate venues for seeking damages for the destruction of eggs or embryos, he adds. "At this point, there's no clarity in the courts as to how to deal with cases like this."

Accidents happen, but more needs to be done to limit and track them, Adashi says. "It was a wake-up call for a lot of people in the field," he said. "How do we deal with something like this? How do we prevent something like this? Who should be in charge?"

This is not the first time that embryos, eggs and sperm have been unintentionally discarded, destroyed, or otherwise harmed in the US. But there is no public or private system for tracking incidents like this, so “the incidence of professional lapses in matters of procreation in this country is unknown”.

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December
01
  9:07:00 PM

Croatia debates conscientious objection for pharmacists

Rows over conscientious objection (CO) in medicine are not unique to the English-speaking world. This example comes from Croatia, where a pharmacist invoked CO and refused to supply contraceptive tablets to a customer. She asked the woman to return the following day when a more cooperative colleague would be on duty.

The customer complained and the case was referred to the  The Croatian Chamber of Pharmacists' (CPP) ethics commission. This week the CPP ruled that the pharmacist had not violated its code of ethics. It declared that according to the code, pharmacists have a right to CO as long as they do not endanger a patient's health and life.

The commission, however, used the case to remind pharmacists of the importance of organising work so that all patients can be catered for.

The case has divided public opinion in the Balkan nation. The president of the CPP, Ana Soldo, told the media said that the rights of one group cannot be prioritised over the rights of another. Doctors have a right to conscientious objection in the same way, she said, that women have the right to decide what happens to their bodies.

Health Minister Milan Kujundžić disagreed. A pharmacist “has the right to conscientious objection but not in their workplace,” he said.

The gender equality ombudsperson, Višnja Ljubičić, contended out that the right to conscientious objection is individual. Pharmacies must ensure that all patients can be serviced. In her opinion, refusal was a clear violation of the code of ethics: “In this particular case, if a pharmacy as an institution as a whole is unable to issue a medicine due to the conscientious objection of its employees, I consider this to be a threat to the user’s health.”

The debate has been fuelled by similar disputes over provision of abortion, which is legal in Croatia. 

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 upcoming events

Passport to Parenthood: Evidence and Ethics behind Cross-Border Reproductive Care
November 24, 2010, London
Progress Educational Trust asks whether fertility tourism is a problem or a solution.

10th World Congress of Bioethics
July 28-31, 2010, Singapore
Bioethics in a Globalised World

Created in the Image of God: realities and challenges in caring for the human person
April 30 - May 2, 2010, Montreal
AGM of Canadian Federation of Catholic Physicians’ Societies; featured speakers include Edmund Pellegrino and Margaret Somerville.

Consequences of the Bio-Medical Revolution
May 1, 2010, Biola University, La Mirada, CA
Helping nurses understand technological advances in health care and their ethical consequences.

Fertility, Infertility and Gender
June 16-18, 2010, Maynooth, Ireland (near Dublin)
Sponsored by the Linacre Centre for Healthcare Ethics, Oxford.


 upcoming events

Passport to Parenthood: Evidence and Ethics behind Cross-Border Reproductive Care
November 24, 2010, London
Progress Educational Trust asks whether fertility tourism is a problem or a solution.

10th World Congress of Bioethics
July 28-31, 2010, Singapore
Bioethics in a Globalised World

Created in the Image of God: realities and challenges in caring for the human person
April 30 - May 2, 2010, Montreal
AGM of Canadian Federation of Catholic Physicians’ Societies; featured speakers include Edmund Pellegrino and Margaret Somerville.

Consequences of the Bio-Medical Revolution
May 1, 2010, Biola University, La Mirada, CA
Helping nurses understand technological advances in health care and their ethical consequences.

Fertility, Infertility and Gender
June 16-18, 2010, Maynooth, Ireland (near Dublin)
Sponsored by the Linacre Centre for Healthcare Ethics, Oxford.


 upcoming events

Passport to Parenthood: Evidence and Ethics behind Cross-Border Reproductive Care
November 24, 2010, London
Progress Educational Trust asks whether fertility tourism is a problem or a solution.

10th World Congress of Bioethics
July 28-31, 2010, Singapore
Bioethics in a Globalised World

Created in the Image of God: realities and challenges in caring for the human person
April 30 - May 2, 2010, Montreal
AGM of Canadian Federation of Catholic Physicians’ Societies; featured speakers include Edmund Pellegrino and Margaret Somerville.

Consequences of the Bio-Medical Revolution
May 1, 2010, Biola University, La Mirada, CA
Helping nurses understand technological advances in health care and their ethical consequences.

Fertility, Infertility and Gender
June 16-18, 2010, Maynooth, Ireland (near Dublin)
Sponsored by the Linacre Centre for Healthcare Ethics, Oxford.


 upcoming events

Passport to Parenthood: Evidence and Ethics behind Cross-Border Reproductive Care
November 24, 2010, London
Progress Educational Trust asks whether fertility tourism is a problem or a solution.

10th World Congress of Bioethics
July 28-31, 2010, Singapore
Bioethics in a Globalised World

Created in the Image of God: realities and challenges in caring for the human person
April 30 - May 2, 2010, Montreal
AGM of Canadian Federation of Catholic Physicians’ Societies; featured speakers include Edmund Pellegrino and Margaret Somerville.

Consequences of the Bio-Medical Revolution
May 1, 2010, Biola University, La Mirada, CA
Helping nurses understand technological advances in health care and their ethical consequences.

Fertility, Infertility and Gender
June 16-18, 2010, Maynooth, Ireland (near Dublin)
Sponsored by the Linacre Centre for Healthcare Ethics, Oxford.


 upcoming events

Passport to Parenthood: Evidence and Ethics behind Cross-Border Reproductive Care
November 24, 2010, London
Progress Educational Trust asks whether fertility tourism is a problem or a solution.

10th World Congress of Bioethics
July 28-31, 2010, Singapore
Bioethics in a Globalised World

Created in the Image of God: realities and challenges in caring for the human person
April 30 - May 2, 2010, Montreal
AGM of Canadian Federation of Catholic Physicians’ Societies; featured speakers include Edmund Pellegrino and Margaret Somerville.

Consequences of the Bio-Medical Revolution
May 1, 2010, Biola University, La Mirada, CA
Helping nurses understand technological advances in health care and their ethical consequences.

Fertility, Infertility and Gender
June 16-18, 2010, Maynooth, Ireland (near Dublin)
Sponsored by the Linacre Centre for Healthcare Ethics, Oxford.


 upcoming events

Passport to Parenthood: Evidence and Ethics behind Cross-Border Reproductive Care
November 24, 2010, London
Progress Educational Trust asks whether fertility tourism is a problem or a solution.

10th World Congress of Bioethics
July 28-31, 2010, Singapore
Bioethics in a Globalised World

Created in the Image of God: realities and challenges in caring for the human person
April 30 - May 2, 2010, Montreal
AGM of Canadian Federation of Catholic Physicians’ Societies; featured speakers include Edmund Pellegrino and Margaret Somerville.

Consequences of the Bio-Medical Revolution
May 1, 2010, Biola University, La Mirada, CA
Helping nurses understand technological advances in health care and their ethical consequences.

Fertility, Infertility and Gender
June 16-18, 2010, Maynooth, Ireland (near Dublin)
Sponsored by the Linacre Centre for Healthcare Ethics, Oxford.



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