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August
12
  11:40:00 PM

A Quebec ‘mercy killing’ prompts a rethink on euthanasia law

Michel Cadotte, his sister and his sister-in-law entering court

The ink was hardly dry on Canada’s right-to-die legislation before lawsuits began to expand eligibility for euthanasia to those who are not terminally ill. And now a high-profile case in Quebec could lead to euthanising patients with dementia.

On February 20 Michel Cadotte was arrested by Montreal police after a post appeared on his Facebook page: “I’ve cracked, nobody asked how I’m doing, but now you know, I’ve consented to her request of assistance in dying, I’m waiting for the police.”

Cadotte, 56, was paying a visit to his wife, Jocelyne Lizotte, 60, who had Alzheimer’s disease and was living in a nursing home. He took a pillow and smothered her to death. He had been caring for her since 2006 and was exhausted.

She had reportedly wanted to be euthanised. However, even though Canada allows euthanasia (and Quebec also has its own law), a patient has to be legally competent in order to lodge a request for “medical aid-in-dying”. Jocelyne did not qualify.

Touched by the drama of this case, Quebec legislators are considering a change in legislation to allow people to make binding advance directives for euthanasia before they slip into dementia. This is a feature which was rejected by both the Federal and Quebec governments when they drafted their legislation. Quebec’s came into force in December 2015 and the Federal law in June 2016.

Dr Catherine Ferrier, the president of the Physicians’ Alliance against Euthanasia, told STAT that she was surprised that the Cadotte case was being used to broaden the scope of eligibility for euthanasia. “When I heard this story, I thought, ‘This has nothing to do with my euthanasia work, it has to do with my geriatrics work,’” she said. “It has to do with providing proper care, it has to do with providing proper support for caregivers so they don’t flip out. … How come the whole world isn’t saying, ‘Let’s look after people properly?’”

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August
12
  11:29:00 PM

German interest in racial theories foreshadowed in WWI

Although the interest of some German scientists in now-discredited racial theories is best known as a World War II phenomenon, archivists have discovered that at least one POW camp in World War I was also a centre for racial research. According to a feature on Australia’s ABC, an Aboriginal soldier, Douglas Grant, was captured at Battle of Bullecourt in April 1917. Eventually he ended up at Wünsdorf, a POW camp south of Berlin.

The POWs of Wünsdorf were an extraordinary bunch, for they were mostly Muslims. One of the more bizarre schemes of their German captors was to whip up fervour for jihad among Muslim POWs and send them back to India and the Middle East to stir up trouble for the Allies. The 5000 POWs were given luxurious treatment and an elaborate mosque was built in the camp. It was Germany’s first.

With captives from around the world, German researchers also realised that this was a golden opportunity to investigate racial differences. Grant was a full-blood Aboriginal from the Atherton Tablelands in Queensland who had been adopted by a white couple from Sydney.  "He was measured all over, and upside down and inside out," Grant told an historian later.  According to the ABC:

While the scientists argued there was a scientific basis to these studies, there was also a clear agenda to create a picture of German superiority and racial purity. It was the beginnings of attempting to prove that Germans were the "master race". One German scientist argued that the POW camps were "a Völkerschau [people show] without comparison"...

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August
12
  11:25:00 PM

A cool idea for an afterlife

“To die in order to live” is one of the commonplaces of Christian piety. So it was a bit jarring to stumble across a similar sentiment in an article in the journal Bioethics by utilitarian bioethicists. In discussing the ethics of cryopreservation, Francesca Minerva, of the University of Ghent, and Anders Sandberg, of the University of Oxford, recall that two cryopreserved people “wanted to die in order to live”.

It is in this spirit that they defend the possibility of euthanasia followed by cryopreservation, a procedure they call “cryothanasia”:

It achieves the positive goal of euthanasia (ending suffering) without its negative instrumental side-effect (permanent cessation of life). Even if it turns out to cause information-theoretic death, the intention is clearly to extend life.

They argue that objections to euthanasia should not apply to cryothanasia. The first objection is the “weirdness argument”. Weird it is, they admit, but we already allow weird practices like circumcision or refusing blood transfusions.

The most powerful objection, however, is that cryopreservation simply will not work. The likelihood of success is probably very low, Minerva and Sandberg acknowledge, but a tiny chance of extending one’s lifespan for many years sometime in the future would make it worthwhile.

Essentially, cryothanasia for a person near death is a gamble of a small number of Quality Adjusted Life Years (QALYs) versus a low-probability gain of many QALYs. Traditional cryonics is a gamble of zero QALYs versus a potential gain. Whether cryothanasia is rational depends on whether the ratio (remaining QALYs)/(potential QALYs) is less than the estimated probability of success.

The ethics of cryopreservation reprises Pascal’s Wager about the existence of God, as bioethicist David Shaw argued a few years ago. Ultimately, he contended, it makes sense because "for atheists who don't believe in an afterlife, cryonics represents the only chance of life after 'death'".

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August
12
  6:46:00 PM

Scientists one step closer to interspecies organ transplants

A landmark study has reopened the door for xenotransplantation research (research into interspecies transplants).

A team of Chinese and US scientists have created gene-edited piglets that are free of harmful viruses that cause disease in humans. Scientists now believe that pig organs can be edited to prevent rejection when transplanted into the human body.

In a paper published in the journal Science on Thursday, researchers reported that they had successfully used CRISPR technology to “splice out” 25 porcine endogenous retroviruses (PERVs) from the genetic code of 37 piglets. The viruses are scattered throughout the pig genome and have the potential to cause bizarre and harmful retroviral infections in humans.

While safe and effective pig-to-human organ transplants are a long way off, the researchers are optimistic.

"We recognise we are still at the early stages of research and development”, Dr Luhan Yang, a coauthor of the paper, told the BBC. "We know we have an audacious vision of a world with no shortage of organs, that is very challenging, but that is also our motivation to remove mountains."

The next stage of the research, Yang says, will be to essentially “humanize” the pigs—modifying them enough that their organs can function in the human body. This involves immunological changes as well as making the tissues compatible and fixing blood-clotting issues.

Animal rights groups have expressed concern at the research, saying that xenotransplantation may eventually lead to astronomical numbers of pigs being exploited to grow human-like organs. 

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August
12
  6:41:00 PM

US Senate passes ‘right to try’ law

The US Senate has passed a Right To Try bill that will allow terminally patients to bypass FDA approval when seeking access to experimental medication.

The bill, which expands on compassionate-use legislation passed in states across the country, will give patients the right to request trial drugs directly from pharmaceutical companies. Currently patients must submit an application to the FDA before approaching manufacturers.

The bill also ensures that patients are charged no more than the production cost for the drug, while providing pharmaceutical companies with a degree of legal protection if the patient experiences harm from the treatment. Safety issues that occur in compassionate-use cases must be reported to the FDA, the proposed legislation states.

“Patients with terminal diseases ought to have a right to access treatments that have demonstrated a level of safety and could potentially save their lives,” Senator Ron Johnson of Wisconsin, the author of the bill, said in a statement after the unanimous Senate vote.

Bioethicists are sceptical.  Alison Bateman-House, of NYU Langone Medical Center, called the bill “inherently deceptive” because it simply says patients can ask drug companies for the treatments. Companies often are reluctant to provide unapproved products for a variety of reasons, and the FDA has an efficient system to handle requests for experimental drugs, she told the Washington Post.

In a scathing blog post, bioethicist Craig Klugman criticised Right To Try advocates for bypassing “logical arguments, reason, and good facts”:  

“...A pure market approach to pharmaceutical distribution sacrifices safety, accurate labeling, scientific approaches to treatment, and protecting the public from harm. In their winner-takes-all arena, there must be winners and losers. If right-to-try wins, then we all lose”. 
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August
12
  6:37:00 PM

Artificial womb keeps lambs alive, raising hope for preemies

Researchers have successfully used an artificial womb to incubate premature lambs, with experts saying the technology may one day be used for extremely premature babies.

In a paper published this week in the American Journal of Obstetrics and Gynecology, researchers affiliated with the University of Western Australia (UWA) report that they have incubated premature baby lambs in a uterus-like environment for seven days, allowing the lambs to grow without the adverse effects of a preterm birth.

The researchers call their technique ex-vivo uterine environment (EVE) therapy, and it involves placing the infant specimen in a high-tech amniotic fluid bath with an artificial placenta that allows for gas exchange and nutrient delivery.

“By providing an alternative means of gas exchange for the fetus, we hoped to spare the extremely preterm cardiopulmonary system from ventilation-derived injury, and save the lives of those babies whose lungs are too immature to breathe properly”, UWA Associate Professor Matt Kemp said. “...Although significant development is required, a life support system based around EVE therapy may provide an avenue to improve outcomes for extremely preterm infants”, he said.

The study comes in the wake of research published earlier this year by the Center for Fetal Research in Philadelphia. In that study, researchers developed a womb-like environment in which premature lambs lived for over four weeks before being delivered.

The idea of artificial wombs raising interesting bioethical questions about the morality of abortion and the ethics of ectogenesis, or pregnancy outside the womb. 

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August
12
  6:33:00 PM

New York doctor told to stop marketing 3-person IVF technique

A New York IVF clinic has been told by the US Food and Drug Administration to stop marketing Mitochondrial Replacement Therapy (MRT) – an experimental procedure that aims to prevent defective mitochondrial-DNA from being passed on to children.

New Hope Fertility Clinic – a business of Dr John Zhang, an American clinician who last year delivered the first “three parent baby” – has been advertising the procedures on its website for months. It is described MRT as a "revolutionary technology designed to reverse the effects of age on human oocytes and repair certain cellular defects”, and “the first proven treatment for certain genetic disorders”.

While MRT is prohibited in the US, Dr. Zhang and colleagues have set up a clinic in Guadalajara, Mexico. For roughly US$80,000, New Hope was offering to take women to the Mexican clinic to receive the procedure.  

But in a letter sent to the clinic last week, the FDA ordered Zhang to stop advertising the procedure. FDA officials listed several claims made on the New Hope website that needed to be removed immediately.

The procedure is not approved in the U.S., and Congress has barred the FDA from even reviewing proposals to conduct MRT trials.

Defective mitochondrial DNA can cause a variety of serious and sometimes fatal conditions, such as Leigh Syndrome. The new technique involves removing some of the mother’s DNA from an egg, and leaving the disease-causing DNA behind. The healthy DNA is implanted in a donor’s egg, which is then fertilised. The baby inherits DNA from both of the parents as well as the egg donor, though the DNA contribution of the donor is very small. 

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August
05
  9:29:00 PM

Human embryos modified to eliminate a single-gene disease

American and Korean scientists have published in Nature the details of how they successfully edited a single gene in human embryos. A team of American, Chinese and Korean scientists led by Shoukhrat Mitalipov of Oregon Health and Science University used gene-editing CRISPR/Cas9 technology to eliminate a gene, MYBPC3, linked to a heart disorder.  

Stem cell scientist Paul Knoepfler said that the highly-anticipated paper was technically strong, innovative and rigorous – which suggests that other scientists will soon be building on Mitalipov’s achievements. Perhaps one of the most significant of these was its safety. The paper claims that there were no off-target mutations and no mosaic embryos.

The potential for the technique is immense. The article focuses on curing diseases. About 10,000 harmful single-gene mutations have been identified from breast cancer to Tay-Sachs. Interest in eliminating these will be intense.

However, when other less competent, less experienced and less ethical scientists scale up the number of embryos, safety could obviously suffer.

Nearly every observer stated the obvious: a technique for safely and effectively editing the human genome has significant ethical implications. It can be used not only for curing diseases but for “enhancing” embryos with “better genes”.

Therefore, Mitalipov’s team took great care to dot their ethical is and cross their ts. “Even though this preliminary effort was found to be safe and effective, it is crucial that we continue to proceed with the utmost caution, paying the highest attention to ethical considerations," said corresponding author Juan Carlos Izpisua Belmonte.

As Vivek Wadhwa, a technology expert from Carnegie-Mellon, wrote in the Washington Post, “CRISPR’s seductiveness is beginning to overtake the calls for caution.” For some scientists and bioethicists, the danger of haste can be averted with more reports and more ethics committees.

For others, creating and destroying human embryos for research is itself anathema. In this experiment, dozens of embryos were created, and all were destroyed before they had grown beyond a few days. But everyone recognised the potential for a new generation of eugenics, which has so long been under the shadow of the Nazis’ discredited ideology.

David Albert Jones, of the UK’s Anscombe Institute, penned a withering critique, “Unethical research with eugenic goals”. “The whole rationale for this experiment is to take a step towards genetic modification as an assisted reproductive technology,” he writes. “We are manufacturing new human beings for manipulation and quality control, and experimenting on them with the aim of forging greater eugenic control over human reproduction. This is not a case of using bad means for a good end, but of bad means to a worse end.” 

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August
05
  9:04:00 PM

Commercial surrogacy still thriving in India

Some of the 47 women in a Hyderabad clinic / NDTV 

Efforts to ban commercial surrogacy in India are hitting one speed bump after another. At the moment, despite lobbying from IVF clinics, the government has banned the practice for overseas clients. However, there is still a thriving business in local surrogacy.

A Surrogacy Regulation Bill was introduced into the national parliament last November, but little progress has been made. In fact, it might be killed altogether by combining it with another bill for regulating assisted reproduction.

Surrogacy scandals about "baby factories" are still making headlines in India. In mid-June police raided a fertility clinic in an up-market suburb in Hyderabad and found 47 pregnant women living a two-storey dwelling. The clinic did not allow them to leave the building until they had delivered their babies. “The women were all huddled in one large room and had access to just one bathroom,” a police officer told the Thomson Reuters Foundation.

A few days later, police raided several buildings in another city in Telangana state and found, according to the local media, 120 pregnant women. The managing director of Padmaja Fertility Centre -- who apparently had engaged all the women -- declared that all the rules for surrogacy had been followed. Police did not lay charges.

Pinki Virani, an activist who recently wrote a book on assisted reproduction, has urged the government to speed up regulation:

... the government of India, and the states, awaiting a comprehensive surrogacy law, cannot afford to be sitting around while more surrogacy rackets come to light, like the recent one in Hyderabad's upmarket Banjara Hills, where multiples of pregnant women were being held. Since scant records were being maintained at these so-called surrogacy centres, we don't even know if some of the intending babies from those victims of human trafficking were actually meant to be sold for the internet-infant-porn market.

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August
05
  8:11:00 PM

New kid on the block: the bioethics of ageing

There is ever-multiplying number of sub-specialties in bioethics -- procreative ethics, intergenerational ethics, neuroethics, robot ethics, animal ethics, environmental ethics and so on. But, despite constant doom-mongering in the media about greying populations, chatter about ageing ethics is subdued.

This might change if Christopher Simon Wareham, of the University of the Witwatersrand, has his way. In an online-first article in the Journal of Medical Ethics, he proposes “ageing ethics”, which is “arguably even more fundamental and ubiquitous than procreation”.

The great drawback of ageing ethics is that it will inevitably be viewed as negataive and depressing, “with a narrow focus on issues concerning healthcare costs, end-of-life decisions, and increasing decrepitude and dementia”. But Wareham points out that ageing is a life-long process and includes issues like mid-life crises.

He also makes an interesting distinction between “right ageing” and “good ageing”. 

Ethical dilemmas related to right ageing concern questions about our duties and rights as ageing persons. What ought the ageing person to do in response to ageing-related dilemmas? For instance, the theorist may ask whether it is sometimes morally obligatory for an older person to refuse a treatment so that a younger person may have it. As a further example, ethicists of ageing may address the question of whether forced retirement violates societies’ obligations towards ageing persons.9

Rather than focusing on rights and duties qua ageing persons, ethical questions related to good ageing focus on well-being. How can we age well or meaningfully? For instance, the theorist may ask which ethical theories allow us to cope best with our status as ageing beings. Which values, goods and harms are most relevant to the ageing person, and which virtues are most relevant to flourishing as one ages? 

The definition of ageing matters as well. Transhumanist writers and their allies amongst bioethicists tend to regard ageing as a disease which need to be cured. Others, like Leon Kass, former head of the US bioethics commission under President George W. Bush, believe that ageing is a valuable part of human flourishing. 

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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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