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December
09
  10:08:00 PM

How long should women’s eggs remain frozen for social purposes?

The British Fertility Society has recommended that the time limit on freezing eggs for social reasons be changed from 10 years to 55 years, thus potentially allowing women to have children when they are in their 80s.

Freezing eggs for medical purposes is already permitted for 55 years. This allows girls made infertile by cancer treatments as toddlers, for instance, to possibly have children as adults. Backers of a higher limit for women who freeze their eggs for social reasons, like wanting to delay childbirth until they find a suitable partner or complete a satisfying professional career, say that 10 years is inadequate.

The British Fertility Society says the limit is “arbitrary” and does not take into account new technology. Its Chair, Professor Adam Balen, told The Daily Telegraph: “There is no justification for the 10-year time limit for eggs or sperm. It has no rationale and I think they just plucked the number out of thin air. Practice changes and life moves on, that’s the danger of enshrining these things in an act of Parliament.”

This not the first time that the 10-year limit has been criticised. Last year Professor Emily Jackson, of the London School of Economics, wrote about the issue in the Journal of Medical Ethics. She concluded:

"Because social egg freezing is in its infancy, we do not know what practical impact the 10-year time limit will have upon women who have frozen their eggs. If a woman has 3 years of storage left, at what point should she give up on meeting a suitable partner and attempt IVF with donor sperm, for example? It seems likely that women faced with the imminent destruction of their eggs will feel under pressure to use their eggs before time runs out for them, ironically perhaps creating a newly ticking non-biological clock.” 

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December
09
  9:46:00 PM

After 70 years, lessons from the Nuremberg Code

Karl Brandt, Hitler's personal doctor, on trial at Nuremberg 

On August 20, 1947, an international tribunal which investigated the crimes of 23 Nazi doctors and bureaucrats involved in concentration camp medical experiments issued its verdict. As part of its judgment (seven of the men were sentenced to death) the tribunal also set a 10-point set of rules now known as the Nuremberg Code.

This called for the “voluntary consent” of the human research subject, an assessment of risks and benefits, and assurances of competent investigators. As an essay in JAMA by experts from the US and the UK points out, “These concepts have become an important reference point for the ethical conduct of medical research.”

The message of the authors is that rules do not necessarily lead to compliance. Surprisingly, at least for readers unversed in the history of medical ethics, both in Germany and in the Communist Eastern Bloc the protection of patients and respect for their autonomy were topics with which doctors were very familiar.

In Poland, for instance, Teodor Heiman published Etyka Lekarska (“Medical Ethics”) in 1917 denouncing the exploitation of patients. In 1967 the Polish Medical Association published “Deontological Ethical Rules” (Deontologiczno-Etyczne Zasady) with clear and strict discussion of the standards embodied in the Nuremberg Code. Even in East Germany, medical ethicists worked with government commissions to create safety standards for experimental research subjects. Nonetheless, East German doctors were notorious for their participation in doping Olympic athletes.

There was obviously a gap, they argue, between the law and medical practice. The Nuremberg Code, despite its official-sounding name, has not been enshrined in any national legislation. This has permitted scandals like the participation of American psychologists in CIA “enhanced interrogation” during President Bush’s “War on Terror”.

So who must be responsible for ensuring that doctors act ethically? Other doctors, the authors argue:

The story of the Nuremberg Code is not one of ethical norms taking on the force of law. Rather, its legacy shows the fundamental importance of a robust organized medical profession that protects its independence from political interests and its ability to chart its own moral course, yet is at the same time open to the essential role of nations and government agencies that respect broadly defined and agreed-upon rules to protect the rights and well-being of human research participants.

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December
02
  10:49:00 PM

Help us turbocharge bioethics debates

Dear BioEdge reader, 

First of all, thank you for being one of those more than 20,000 people who read our articles every month. When we started BioEdge more than 15 years ago, we never thought that it would have such a huge impact around the world.

Like everyone else, we do have a bias. We are trying to promote human dignity as a foundation for bioethics. With issues like euthanasia, surrogacy, gene editing, and organ markets in the headlines, we cannot afford to forget the ethical dimension of medical decisions. 

The mainstream media don't have enough time or patience to dig behind significant stories and to identify global trends. That's where BioEdge comes in, bringing you cutting-edge bioethical issues every week.

In our last survey we discovered that a considerable number of our readers do not agree with our views. Perhaps you are one of them. However, they told us that they like BioEdge because we make a positive contribution to debates and that we often spot things that they have missed.

For this reason we would like to ask for your support. Your donation willcontinue to enhance a fruitful debate on bioethics, keeping BioEdge a place where people with different views can work together for the future of humanity. 

 

With your help, we will raise the US$30,000 needed to continue being a light for the mysterious and fascinating black holes of biology and medicine that technology is opening up for us.

BioEdge is an initiative promoted by New Media Foundation and The WaterStone Group, which relies solely on support from generous volunteers and donors. We aren't supported by a university, a think tank, or a drug company.

The WaterStone Group is a publicly supported, tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code. Contributions to WaterStone are tax-deductible in the United States to the extent permitted by law.

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December
02
  10:38:00 PM

If you get a ‘do not resuscitate’ tattoo, will doctors pay attention?

Doctors at a Florida hospital’s emergency department were startled to discover the words “do not resuscitate”, together with a signature, tattooed to an unconscious man’s chest. Should they respect the request or not?

The 70-year-old man had no identification and no next-of-kin could be found. His blood alcohol was high. His health was very bad, with a history of chronic obstructive pulmonary disease, diabetes, and an irregular heart rate.

The doctors decided to keep him alive, invoking the principle of not choosing an irreversible path when faced with uncertainty. In a case report in the New England Journal of Medicine, they say that “He was placed on empirical antibiotics, received intravenous fluid resuscitation and vasopressors, and was treated with bilevel positive airway pressure.”

However, the hospital’s ethics consultants advised the medical team to honour the patient’s request. They contended that “it was most reasonable to infer that the tattoo expressed an authentic preference, that what might be seen as caution could also be seen as standing on ceremony, and that the law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interests.”

The patient died without recovering consciousness.

The issue of DNR tattoos has not received an extraordinary amount of attention in the scholarly literature. There are counter-examples. For instance, in 2012, California doctors reported in the Journal of General Internal Medicine that a 59-year-old man was admitted to hospital for a below-the-knee amputation due to chronic ulcers. He wanted to be resuscitated in the event of heart or lung failure.

Noting that he had a DNR tattoo, hospital staff queried the conflicting signals. “He explained that he had lost a bet playing poker with fellow ancillary hospital staffers while inebriated in his younger years; the loser had to tattoo ‘D.N.R.’ across his chest.” Understandably, the doctors suggested that he have the tattoo removed to avoid confusion in the future. “He stated he did not think anyone would take his tattoo seriously and declined tattoo removal.”

So the question of whether you should get a DNR tattoo remains open. Perhaps you could write, “Do not resuscitate (and I got this tattoo when I was sober)”.

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December
02
  10:29:00 PM

Rohingya face population control pressure on both sides of the border

One strand in the persecution of the Rohingya Muslims by the Myanmar government is population control. Since 2005, the government has tried to enforce a two-child policy. Back in 2015, Physicians for Human Rights complained that Millennium Development Goals were being used by the government to force the Rohingya to have fewer children.

And now, in the squalid camps across the border in Bangladesh which are now home to more than 600,000 Rohingya, the Bangladesh government is trying to sell the same message -- with no more luck than their Myanmar counterparts. Public health official Dr Pintu Bhattacharya told Australia’s ABC that a Bangladeshi incentive scheme should be extended to the refugees. They are paid a small amount for voluntary sterilisation. "If we do not have this program among refugees then we will have more pregnancies, more newborns and more population," he says.

Rohingya families are large and some men have several wives. Most couples have six or seven children and family planning workers have met families with 19 children. Many told AFP that a large family will help them survive in the camps. Many also believe that contraception is against Islam.

In the light of the fact that the Myanmar government weaponised contraception to control the Rohingya, perhaps it is understandable that these desperate refugees believe that large families represent freedom. 

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December
02
  10:20:00 PM

Some Canadian doctors are refusing to treat attempted suicides

Canada’s new euthanasia laws are perplexing doctors who have to deal with suicide attempts. According to the National Post, there have been a number of reports of doctors who refused to treat people who had tried to kill themselves. In the case of poisons, remedies were readily available.

Quebec’s College of Physicians has issued an ethics bulletin which says that last year, “in some Quebec hospitals, some people who had attempted to end their lives through poisoning were not resuscitated when, in the opinion of certain experts, a treatment spread out over a few days could have saved them with no, or almost no, after-effects.”

However, the bulletin says that this approach is mistaken: “If there is a life-threatening situation, you have to do whatever is possible to save a life, then you treat the underlying cause ... From a moral point of view, this duty to act to save the patient’s life, or to prevent him from living with the effects of a too-late intervention, rests on principles of doing good and not doing harm, as well as of solidarity. It would be negligent not to act.”

Bernard Mathieu, president of the 500-member Association of Quebec Emergency Physicians, said that the new euthanasia law had probably confused some doctors. “It’s possible it has confused doctors a little bit,” he said. “Patients are being given the right to no longer live, and doctors are even being asked to help them in certain cases.”

Bioethics writer Wesley J. Smith was scathing in his comments about the news. “How many of those people would have been glad their lives were saved, as sometimes happens when suicides fail? We’ll never know because they are dead.”

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December
02
  10:14:00 PM

Should doctors comply with all patient requests?

American doctors are increasingly being paid according to patient satisfaction. According to a report in Forbes, 2% of primary care physicians’ pay is now based on “patient satisfaction metrics” and 1% of specialist physicians’ pay.

Does this mean that doctors should agree with every request from a patient? The authors of a recent article in JAMA Internal Medicine respond with a qualified No. “Clinician denial of some types of requests was associated with worse patient satisfaction with the clinician, but not for others, when compared with fulfillment of the requests. In an era of patient satisfaction-driven compensation, the findings suggest the need to train clinicians to deal effectively with requests, potentially enhancing patient and clinician experiences.”

They found that 68% of requests included an explicit request by the patient. But the doctors only complied with only 85% of these.

Did refusal to comply upset patients?

Yes, if it involved physician referral, pain medication prescription, or laboratory test referral and the doctors received a lower satisfaction rating. However, when they refused to supply antibiotic prescriptions or imaging test referral patients accepted their decision without protest.

When doctors did refuse, their satisfaction ratings could be 10 to 20 percentiles lower. “The sizes of the associations suggest that clinicians who are less likely than their colleagues to fulfill patient requests for these services could face a penalty in satisfaction ratings, potentially affecting clinician career satisfaction, compensation, and handling of subsequent requests for these services.”

Doctors probably do not need scholarly research to realise that they will suffer financially if they refuse patients requests. So one down side, the authors note, is that “clinicians may be tempted to adopt a default approach of simply acquiescing to patient requests, including requests for low-value care, in an effort to maintain both favorable patient satisfaction ratings and clinical productivity targets.”

What doctors need, they suggest, is “Training ... to provide clinicians with communication approaches that foster a positive patient experience without simply acquiescing to requests for low-value care, thereby avoiding the harms of unnecessary evaluation and treatment, maintaining good stewardship of resources, and potentially enhancing clinician career satisfaction.

This research seems to have a certain relevance to the debate over the morality of conscientious objection. Some bioethicists, like Julian Savulescu, contend that refusal of services based on conscientious objection has no place in modern medicine. These findings suggest that the elimination of conscientious objection might be financially beneficial for doctors and medical health companies. Second, it might be associated with “low-value care”. Third, refusal of services like abortion and contraception could be turned into a positive patient experience if clinicians had better communication skills. 

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December
02
  9:41:00 PM

This is what happens when no one says No to a patient with anorexia nervosa

The death of a young Australian wife and mother raises the question of whether healthcare workers should always comply with the wishes of their patients.

A coronial inquiry is investigating the death in 2014 of a 28-year-old Adelaide woman, Claudia La Bella. It turns out that she was spending A$500 a week on laxatives, sometimes consuming as many as 800 tablets a day.

Mrs La Bella was a complicated woman. Skeletal and weak from the laxatives, she concocted a story for her family and friends that she was suffering from ovarian cancer. She had also embezzled $374,000 from her employer over five years, which no doubt created a great deal of tension.

However, a psychiatrist declared that it was incomprehensible that the staff at a local pharmacy would order 25 to 30 boxes of Dulcolax for her every week, each containing 200 laxative tablets.

"I still cannot comprehend how they morally and ethically sold someone up to $500 a week worth of laxatives," Dr Maria Naso said. "Just because they are not a regulated item does not mean we can forfeit our moral and ethical responsibility."

“Most people know that laxatives are abused by teenagers — girls talk about it in school, it’s on the internet. Selling that amount is beyond words,” she told the coroner.

Dr Naso said that a letter should have been requested from the woman's doctor. "It is hard to not see this as a purely financial transaction that was of benefit to the owner," she said.

Reluctance to deny patient demands also emerged when she was admitted to hospital, weighing only 35 kilos. A CT scan showed dozens of tablets in her stomach. Nonetheless, she decided to leave the hospital nine days before her death. The doctor in charge advised against it but was reluctant to press the issue because she did not appear to have a mental illness.

The psychiatrist questioned the doctor’s judgement. "She was willing to place herself at risk and leave her daughter potentially motherless — this itself should have raised grave concerns for her mental state." Other doctors had raised the possibility of anorexia nervosa. The doctor could have legally required her to remain in hospital for 24 hours in order to get a psychiatric assessment.

It appears that too many people, including her family, said Yes to Mrs La Bella. Now she is dead. 

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December
02
  9:35:00 PM

South Korea debates the privacy of a patient’s intestines

Dr Lee Cook-jong during a press conference about the wounded soldier  

The escape of a defector from North Korea has ignited a bioethics controversy in South Korea.

Earlier this month, a low-ranking soldier posted in the border truce town of Panmunjom commandeered a jeep and rushed toward the heavily guarded border. He crashed the vehicle and ran through a park towards South Korea. North Korean soldiers shot at him, hitting him several times. South Korean soldiers pulled him over the border and he was rushed to a hospital.

Defections across the demilitarised zone are rare, so the defection was hot news in South Korea. The trauma surgeon who treated the defector, Lee Cook-jong, is a flamboyant figure who has often been in the news. He gave a press conference on November 15 in which he described some of the unnamed defector’s medical ailments.Dr Lee said he had found dozens of flesh-coloured parasitic worms, some as long as 27 centimetres, in the man's intestines, along with kernels of corn. This gave some insight into the health standards of North Korean soldiers. "In my over-20-year-long career as a surgeon, I have only seen something like this in a textbook," he said.

The controversy erupted when a member of the South Korean national assembly accused Dr Lee of violating the country medical privacy law and declared that he had committed a "terrorist act against someone's personality".

Kim Jong-dae, who represents a small opposition party, criticized him for disclosing personal information about patients. "Shootings at Panmunjom are well-known so it's natural the people and media pay a lot of attention but it is enough for the doctor to explain the process of the operation and the patient's condition," he wrote on Facebook. 

"The drastic image of a person's body contaminated by excrement and parasites shocked our society, and the people's fear and aversion went out of control," he said. "It's not only against courtesy for the patient but also a possible violation of the Medical Law." 

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November
25
  9:48:00 PM

Cephalosomatic anastomosis forges ahead

Ren Xiaoping and Sergio Canavero

Head transplantation is back in the news again. Controversial Italian neurosurgeon Sergio Canavero has claimed at a press conference in Vienna that a team from Harbin Medical University led by Dr Ren Xiaoping has carried out the world's first head transplant (aka Cephalosomatic anastomosis) experiment.

During an 18-hour operation, the surgeons transplanted a head onto a corpse. Dr Canavero says that the Chinese team would soon use this experience to move to a living human paralysed from the neck down.

The announcement was greeted with great scepticism by other scientists. “If someone’s making grand scientific claims but hasn’t provided robust evidence for them, yet they have done a TED talk, alarm bells should be ringing,” wrote Dean Burnett in The Guardian.

A debate was carried on in a special section in the latest issue of AJOB Neuroscience. Bioethicists queued up to attack the plans of Canavero and Ren as unfeasible and unethical. Two bioethicists were so exasperated by the attention paid to the overhyped and under-documented experiment that they asked: “why are we still talking about this?” Paul Root Wolfe wrote that while a “head transplant” was theoretically defensible, “attempts of Ren and Canavero to rush this primitive technology to a first-in-human trial is ethically indefensible and irresponsible.”

But more interesting is Canavero and Ren’s defence of their project, which they call – provocatively -- HEAVEN. They argue strongly that it is feasible and they point out three promising uses for it: life extension, gender reassignment, and cosmetic body swaps.

They hint that they have received many emails from desperate transsexuals who are interested in head transplants. “Imagine the parents of the brain dead body donor who are racked with sorrow and despair for their loss but are told that once the new being will start reproducing, his or her offspring will actually be the donor's parents’ descendants!”

The two neurosurgeons are defiant: “Yes, we forced the debate on the academe. But the future of hopeless people is in the balance. We would have dared no less.”

They also dismiss bioethics and bioethicists: “bioethics is mere opinion, more or less (dis)informed, at times with a heavy political streak... that hinges on supposed ‘authorities’ as ‘polestars’ of the present debate.”

And rather than modifying their ambitions in the face of nearly unanimous criticism, they reveal that Canavero has even more daring plans. He is making plans for brain transplantation. This project’s name is .... BRAVE. 

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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)
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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.


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