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May
13
  10:34:00 PM

“God complex” UK surgeon injured hundreds of women

Ian Paterson 

A British surgeon with a “God complex” carried out unnecessary breast cancer surgery on hundreds of women, leaving them disfigured or at risk of cancer. Ian Paterson, of Manchester, was convicted in late April of intentionally wounding patients and is awaiting sentence. Although he was on trial for a handful of cases, he appears to have done hundreds of unnecessary operations between 1997 and 2011 at two privately-run hospitals in the West Midlands.

Paterson exaggerated or invented cancer risks and sometimes claimed payments for more expensive procedures. The prosecution said that he carried out "extensive, life-changing operations for no medically-justifiable reason".

The National Health Service has dealt with 250 claims but it is feared that the total number of his victims at private and NHS hospitals may exceed 1,000. One of the rogue operations was “a cleavage-sparing mastectomy”, which removed only part of a breast. This meant that cancerous tissue may have been left behind, leaving women at risk. He was asked to stop this procedure, but continued with for several years.

Paterson’s motives are obscure, although he probably needed to fund his expensive lifestyle. A police spokeswoman told the BBC: "Some of his victims said he wanted to play God with their lives or he got some perverse satisfaction from these procedures. We will probably never know."

One patient, on whom Paterson operated nine times, said bitterly: “I think he’s a psychopath. Why would anyone in their right mind do operations to people knowing that they didn’t need them?”

Paterson projected two personalities. To his patients, he was charming and reassuring. One woman said: “You felt that he was genuine and caring, and he just wasn’t like a normal consultant. He was very down to earth. He’d be very caring and would put you at ease. There wasn’t any reason to distrust what he was telling us.”

But with colleagues, he could be a bully. One former colleague said he had “a very aggressive, bullying sort of personality, which allowed him to get his way. People would generally go around him, they were afraid of him.” 

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May
13
  10:25:00 PM

More Ubuntu, less autonomy, says South African bioethicist

The dominant philosophy in bioethics in the West is respect for autonomy. Although there is an extensive backstory to this, it has become enshrined in the “principalist” approach promoted by Tom Beauchamp and James Childress in their 1979 text Principles of Biomedical Ethics. But is respect for autonomy a good foundation for bioethics in all cultures?

Writing in Developing World Bioethics, South African bioethicist Kevin Behrens says No. He claims that sub-Saharan cultures have a communitarian approach which finds the radical individualism of principalism almost incomprehensible:

In essence, it is concerned only with individual decision-making, with the purported right of individuals to make choices about their health and life entirely on their own. On many African accounts this notion of autonomy is problematic. A pervasive notion is that it is central to the worldview of most Africans that community is prized and that individuals are bound up with their communities. Decisions about one's body and life are, therefore, not to be taken by individuals acting alone, but in engagement with their families and communities.

This “strong sense of interdependence and mutual care” is widely known as Ubuntu, which means that “we cannot truly be persons outside of community with others. Human flourishing is dependent upon being in relationships, and sharing a way of life with others.” Behrens claims that this view is supported by communitarian theorists like Daniel Callahan and Amitai Etzioni. He even asserts that Western societies have lost an important dimension of their humanity by over-emphasing individualism.

Asserting is one thing; proving is another. Behrens tries to argue that “respect for persons” works better in bioethics than “respect for autonomy”.

When pressed to reflect honestly on what is important in their lives, even those who have been raised in strongly individualist communities must acknowledge that they do not really think that autonomy is all that matters; they also seek the support and participation of their loved ones in their decisions; they too take very seriously the impact of their choices on those who are important to them

Of course, this line of thinking quickly hits a speed bump: what is a person? If infants and disabled humans are persons, what about dolphins and chimpanzees? To accommodate humans who do not have autonomy, Behrens contends that we should distinguish between “persons with agency” whose right to self-determination should be respected, and “persons without agency” who need to be protected.

This article is a fascinating look at bioethics from a very different cultural perspective.

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May
13
  10:21:00 PM

‘Nature’ has buyer’s regret after March for Science endorsement

The leading science journal Nature seems to have experienced a case of buyer’s regret after a whole-hearted endorsement of the March for Science. An April 11 editorial said that the journal was “delighted” to endorse the march. Although some scientists might be concerned that the march would be highjacked by lobby groups, this had a “straightforward” solution, according to Nature: “turn up and shout louder about what you think matters more”.

Those who insist that the march will reinforce political positions and make the situation worse overestimate the potential of alternative approaches to change the mindset of committed ideologues in the White House and elsewhere.

A month later, however, Nature toned down its hostility to those “committed ideologues”. A May 10 editorial argues that “Presenting science as a battle for truth against ignorance is an unhelpful exaggeration.” The journal calls for a bit of humble self-examination:

Those who claim persecution in their pursuit of science would do well to consider whether the pursuit is as pure as they might wish. Science is ripe with problems: irreproducible results, manipulation of statistics, widespread sexual harassment and gender discrimination, and conflicts — or at least what seem to be conflicts — of financial interest, to name but a few. Stepping back to see how all this comes across to non-scientists could be educational.

Furthermore, scientists are a diverse lot:

Plenty of politicians, particularly in recent years, have made a habit of choosing certain inconvenient facts and dismissing them entirely. But to claim that this constitutes a strategic war on science is to argue that science is a single, unified entity: that if you are not with science on any given issue, you are against science.

Science does not speak with a single voice. Sit at a hotel bar during any conference and you will hear impassioned debate over what the data have to say about a certain question. Equally credentialled researchers fall out on whether carbon dioxide levels in the atmosphere have passed a tipping point, or on the health risks of sugar.

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May
13
  9:56:00 PM

Canadian car crash victim gets compensation to pay for a surrogate mother

After the tragic accident 

A Canadian woman who barely survived a car crash in which her fiancé was killed has been awarded C$100,000 by a court to cover the cost of hiring a surrogate to bear a child for her. It is believed to be the first payment of this kind in Canada.

The money was a component of a payout of $3.83 million from the Insurance Corporation of British Columbia (ICBC) to Mikaela Wilhelmson by the BC Supreme Court.

In 2011 Ms Wilhelmson was a passenger in the back seat of a car when it was hit head-on by a vehicle speeding on the wrong side of the road. She sustained serious damage to her spine and internal organs, making a birth dangerous and painful.

In her judgement, Justice Neena Sharma relied upon an IVF expert who said that Ms Wilhelmson was prone to adhesions and could easily have an ectopic pregnancy.  

Based on the medical evidence presented, I find on a balance of probabilities that Ms. Wilhelmson will have significant difficulties conceiving a child in the future as a direct result of her abdominal injuries from the accident. I also find as a fact that Ms. Wilhelmson would be putting her health and welfare at great risk, to an unreasonable degree, if she were to carry a baby. I have no doubt that the best option for Ms. Wilhelmson to have a biological child would be to hire a surrogate.

From a layman’s perspective, this case has some very odd features.

First, commercial surrogacy is illegal in Canada. However, across the border in the United States, it is not, so the $100,000 will be used to pay for an American surrogate. According to the judge, this will not contravene Canadian law.

Second, although Ms Wilhelmson desperately wants a child, she has already had two abortions, one before her accident and one afterwards.

Third, the judge awarded the maximum for pain and suffering not because she lost her fertility, but because she retained it. She had an abortion after the accident because doctors said it would endanger her health, a decision which caused her great emotional pain. “Ms. Wilhelmson faces a future where she might be fertile and might be able to get pregnant again, but cannot safely carry a child,” the judge argued. “Other than abstinence, no method of birth control is 100% effective. She therefore faces a possibility at the young age of 26 of again, getting pregnant and having to abort a child that she desperately wants to have.”

Fourth, the judge made no consideration whatsoever to the welfare of the child. The unfortunate woman had been in two relationships before the accident and two afterwards. She is so physically and psychologically damaged that marriage is now only a remote possibility. The child would probably be raised without a father by her and her mother. 

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May
13
  9:47:00 PM

UK Gay dads go into international surrogacy business

Britain’s most famous gay dads are at the centre of a controversy over their surrogate mother business. Tony and Barrie Drewitt-Barlow were the first same-sex couple in Europe to have their names on the birth certificates of their children. Now they have four sons and a daughter created with the help of a variety of egg donors and surrogates.

Barrie Drewitt-Barlow owns a company called the British Surrogacy Centre (BSC) which organises commercial surrogacy for international clients, including people from the UK. Despite the name, however, commercial surrogacy is illegal in Britain, so the company is actually based on the other side of the Atlantic. Britiish surrogates may only be reimbursed for “reasonable expenses”.

A report by investigative reporters from the Daily Mail claims that the BSC is operating in a legal grey area. Baroness Mary Warnock, an ethicist who was the architect the UK’s policies on fertility, is outraged by the company’s activities:

‘It seems pretty clear that they are breaking the law. I think their motive is to get around the law and they should be investigated by the authorities on that basis alone. I would like to know the details of their financial profits and I think certainly the Human Fertilisation and Embryology Authority should investigate their activities. This is a plain case of exploitation.’

The Drewitt-Barlows have courted controversy for years. They made a fortune from Euroderm Research, now insolvent, which ran clinical trials. They also had their own reality-TV show, “The Parent Makers”, about their unusual family. A website advertises their extravagant family life. Now they appear to have moved into US-based commercial surrogacy, with two centres and 15 full-time staff. London papers have often run articles about their sometimes-stormy relationships with clients or the surrogate mothers.

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May
13
  9:10:00 PM

Beware of IVF incest, ethicists warn clinics

Oedipus led from Thebes by his daughter (and sister) Antigone

IVF clinics must prepare for “intrafamilial reproductive arrangements”, according to a new document published by the ethics committee of the American Society for Reproductive Medicine (ASRM).

While “collaborative reproduction” typically involves anonymous or unrelated individuals (such as family friends), legal experts say that it is increasingly common, in North America at least, for first-degree relatives to share egg, sperm or wombs. The new ASRM document addresses the ethical and legal issues arising from these familial arrangements.

The document states that there are some combinations that should be rejected outright because they are consanguineous (such as the pairing of a sister’s eggs with a brother’s sperm). Others should be rejected as they “simulate incestuous unions”, such as a father providing sperm to a daughter, who is using a donated egg to fall pregnant.

The committee is less opposed to arrangements such as a father giving sperm to his son’s wife. The ethical acceptability of this procedure will depend on the “attitude of [the] female partner”, the document states.

Some concerns about intrafamilial arrangements include whether consent is possible where a donor or surrogate is closely tied to and perhaps dependent on the recipient couple, and whether the novel arrangements will have negative implications for family dynamics.

The National Post recently reported a case involving a mother attempting to use her daughter’s eggs and her new partner’s sperm to fall pregnant.

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May
13
  8:12:00 PM

Conscience wars intensify in the US

Ezekiel J. Emanuel

An article on conscientious objection in the New England Journal of Medicine has sparked outcry among conservative bioethicists. University of Pennsylvania bioethicists Ronit Y. Stahl and Ezekiel J. Emanuel argue that medical societies should “declare conscientious objection unethical” and remove conscience clauses from their codes of ethics.   

According to the authors, “objection to providing patients interventions...that the profession deems to be effective, ethical, and standard treatments...is unjustifiable”. Stahl and Emanuel argue that doctors, in entering the medical profession, agree to abide by the ethical and professional standards of the profession: “By entering a health care profession, the person assumes a professional obligation to place the well-being and rights of patients at the center of professional practice.” Regardless of their personal religious objections, they “must provide the appropriate interventions as specified by the medical profession”.

Doctors who object to standard practice should choose between the following two options, the authors suggest: “select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession.”

Bioethicist Wesley Smith slammed the article, suggesting that opponents of conscientious objection want to “weaponize medicine to impose secular individualistic and utilitarian values on all of society.” As Smith emphasises, Emanuel is a highly respected figure in American bioethics, and has been described as the “chief architect of Obamacare”. Smith suggested that the article is indicative of a concerted campaign to “cleanse health care of all those who would dare to practice medicine in accord with sanctity-of-life moral viewpoints.”

The argument advanced by Stahl and Emanuel is remarkably similar to the overarching thesis of a recent special edition of the Journal of Medical Ethics on conscientious objection.

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May
13
  8:04:00 PM

Do Australian Christians support euthanasia?

A recent episode of Australian television show Q&A sparked debate about the level of Christian support for assisted dying in Australia. Author and journalist Nikki Gemmell, a panelist on the show, claimed that “80% of Australians and up to 70% of Catholics and Anglicans” support euthanasia laws.

Audience members were sceptical, and requested that the claim be verified.

According to a Fact-Check published in The Conversation, Gemmell’s statement “is backed up by a number of surveys – but not all.” Southern Cross University Aged Services Professor Colleen Cartwright wrote that “public support can drop significantly depending on the questions asked, how the survey was conducted and who conducted it”. Cartwright discussed a variety of polls, some of which suggested that up to 74% of Catholics and 81% of Anglicans supported euthanasia, while others reported that only 28% of Catholics and 25% of Anglicans supported euthanasia.

“Support for voluntary euthanasia is generally higher when the question asks about patients with “unrelievable suffering” who have “absolutely no chance of recovering””, Cartwright said. “Support falls when patients do not have a terminal illness”.

In a review of the article, University of Newcastle legal academic Charles Douglas observed that “support might be lower if a model of assisted death is specified”. 

[One] study reported 73% approval for unspecified assistance, 64% support for a doctor “administering life-ending medication” and 55% support for a doctor “prescribing life-ending medication that the patient could take””, Douglas said.

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May
06
  10:57:00 PM

Two doctors charged with FGM in US-first

In a US first, two Detroit-based Muslim doctors have been charged with carrying out female genital mutilation – a crime under federal law that carries a sentence of up life imprisonment. The doctors, identified by authorities as Jumana Nagarwala and Fakhruddin Attar, allegedly carried out FGM on two young girls at a small private medical clinic in Livonia, Michigan, this February.

Investigators say that Ms. Nagarwala, a 44 year old emergency room doctor, performed the procedure on the girls after hours. Mr. Attar, who works at the clinic, is alleged to have given Mrs. Nagarwala access to the facility. Both Nagarwala and Attar are members of an Indian-Muslim community known as Dawoodi Bohra, a group that is known to practice FGM.

Nagarawala denies the accusations, but authorities say the girls sustained severe injuries including scarring and lacerations to the genitalia. The girls said that they were told by Nagarawala they were receiving treatment for “tummy aches”.

Both Attar and Nagarawala are being held in a county jail after being refused bail at their bond hearings.  

Authorities have been questioning other young girls who belong to the sect to ascertain if the practice is widespread.

“Female genital mutilation constitutes a particularly brutal form of violence against women and girls. It is also a serious federal felony in the United States,” acting US attorney Daniel Lemisch said in a statement. “The practice has no place in modern society and those who perform FGM on minors will be held accountable under federal law.”

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May
06
  7:40:00 PM

National Academies respond to conflict of interest claims

The National Academies of Sciences, Engineering and Medicine are strengthening their conflict of interest policy after it was revealed that the authors of two major reports failed to disclose industry links. Independent reviews into two studies, one on genetically engineered crops and another on chronic pain management, revealed that authors had substantial connections to industry.

A 2016 review published in Plos One found that 6 out of 20 panel members of a report into genetically engineered crops had "had one or more reportable" financial conflicts of interest, none of which were disclosed in the report.

This followed a 2014 analysis by the Milwaukee Journal Sentinel and MedPage Today of a 2011 study by the Institute of Medicine (now the National Academy of Medicine) on managing chronic pain. The investigation found that nine members of the institute’s 19-expert panel had current or recent connections to companies that manufacture narcotic painkillers.

In response to the damning reviews, The National Academies are revising their conflict-of-interest policy that were last updated in 2003.

Academies spokesmen William Kearney claimed the review was part of a routine process, and that the organisation stood by the reports in question. “We fully stand behind that committee and its report which we are very proud of and our decision to review our procedures had nothing to do with that.”

Yet the changes already made by the review appear to be directly related to the two reports. The Academies said it will now publish disclosures of conflicts of interest (COIs) of the scientists who author academy reports in the documents themselves.

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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.


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