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June
09
  10:44:00 PM

Will IVF turn around Japan’s declining population?

Five percent of Japanese babies are due to IVF – one of the highest rates in the world. Still, according to The Economist, “No country resorts to IVF more than Japan—or has less success”.

Japan’s population is less than half of the US, but it has a third more fertility clinics.

Fewer than 10% of IVF treatments succeed, says Yoshimasa Asada, a fertility specialist, and the proportion is falling. “We have the world’s highest IVF numbers and the lowest success rate,” he told The Economist. “It’s an embarrassment.”

Many factors are at play. Japan’s unique social standards play a role. Both men and women work punishing hours; women marry late; few have babies out of wedlock. About 40% of women who undergo IVF do so in their 40s, twice as many as in Britain or France.

The woes of IVF treatment have to be seen against the crisis of an ageing society. The number of Japanese babies born each year fell below 1 million for the first time in 2016. The total fertility rate was 1.44, far below replacement level, and far from the goal of 1.8 by 2026 set by Prime Minister Shinzo Abe. This already assumes that Japan’s population will decline by one-fifth, from 127 million to 100 million by 2060.

The government offers subsidies for IVF, although it is not available under the public health system. The IVF industry is trying to sell the idea that a better-run IVF system could arrest population decline. The head of a Danish company which sells IVF products told The Economist that “with better guidelines and more financial aid Japan could produce an extra 300,000 babies a year. That is roughly the number by which deaths currently outstrip births”.

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June
09
  10:37:00 PM

3-parent babies: Singapore and Ukraine

Singapore could become the second country after the United Kingdom to legalize three-parent babies, a technique for giving birth to children who would otherwise have a genetic disease. Technically known as mitochondrial replacement therapy (MRT), the procedure was legalised in 2016 in Britain after a long and intense debate in the media and Parliament.

Singapore is trying to foster cutting-edge biological science and follows developments elsewhere carefully. “Our position is to keep a close watch on what happens in the UK, to track the UK experience, and to learn from what they have done,” geneticist Oi Lian Kon told Science magazine. He is leading a review panel for the government’s Bioethics Advisory Committee.

According to Science, “No other countries have adopted laws specifically about MRT. Many have a blanket ban on changing the human germline that includes the technique. Thailand is the only country that does not explicitly prohibit altering the human genome, whereas Italy and Israel permit it under certain conditions.”

Meanwhile, a clinic in Ukraine is already performing the technique and marketing it internationally. One MRT baby has already been born after the mother was treated at The Nadiya (hope) Clinic in Kiev, three more are pregnant, and several others are undergoing treatment. The director, Valery Zukin, was not flustered when a journalist from National Public Radio (US) quizzed him about the ethical issues. "As a doctor I understand only one thing: We have parents who couldn't have children and now they have their own biological child. That's all," he told NPR.

However, MTR is currently illegal in the US – a wise move, according to Marcy Darnovsky, of the Center for Genetics and Society, in California. "What we're seeing is a fast slide down a very slippery slope toward designer babies," Darnovsky told NPR. "We could see parents feeling eager to give their children traits like greater strength, needs less sleep. Some people are saying that, 'Yes, there are genes for IQ and we could have smarter babies.' "

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June
09
  9:54:00 PM

What are the five best arguments against euthanasia?

As medical societies around the world consider changes to their position on euthanasia, several influential doctors and ethicists have co-published a commentary in the Journal of Palliative Care opposing any policy change.

Among the authors of the article, entitled “Physician-Assisted Suicide and Euthanasia: Emerging Issues From a Global Perspective”, are Georgetown University’s Daniel Sulmasy, who served on President Obama’s Commission for the Study of Bioethical Issues, Margaret Somerville, a legal scholar and one of the most vocal opponents of the legalisation of euthanasia in Canada, and influential palliative care specialist Lukas Radbruch.

The authors summarise what they take to be the five strongest reasons to oppose euthanasia. They include:

1) “slippery slopes”: The authors assert that “despite safeguards for euthanasia in the Netherlands and Belgium, there are data that safeguards are ineffective and violated...Allowing voluntary euthanasia has led to nonvoluntary euthanasia”.

2) “lack of self-determination”: The authors note that many expressions of a desire for death do not mean that a patient wants to euthanasia or assisted suicide; “As individual requests for PAS-E are often labile, complex in origin, and subject to the individual’s changing priorities, such requests require careful and repetitive attention”.

3) “inadequate palliative care”: “Holistic knowledge of palliative care”, they state, “is the most urgent ethical obligation of jurisdictions worldwide rather than legalizing PAS-E

4) “medical professionalism”: doctors assisting in PAS-E, the authors argue, threaten the moral integrity of the medical profession.

5) “difference between means and ends”: the push for PAS-E confuses the problem of suffering with the life of the person: “we must kill the pain and suffering, not the person with the pain and suffering”.

Coincidentally, a completely different vision of euthanasia emerges from a recent article in the Belgian Tijdschrift voor Geneeskunde (Journal of Medicine). J.L. Bernheim, a researcher at the End-of-life Care Research Group, 
flatly denies that critics of Belgian euthanasia know what they are talking about. He divides criticisms into pragmatic (factual) and essentialist (moral and legal).

On the first score, Bernheim denies that there was or is a “slippery slope” or that vulnerable patients are not protected adequately. On the second, he argues that euthanasia is a genuinely compassionate supplement to end-of-life care. It’s an interesting to see how different euthanasia looks inside the borders of Belgium. Unfortunately, the article is available only in Dutch at the moment.

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June
09
  9:51:00 PM

Is China raising its animal ethics standards?

Gene-editing research has developed at a much faster rate in China compared to Western nations, and many attribute this to the lack of bioethics regulation in the country. Yet are things changing?

A new feature article in The Atlantic gives insight into the ethical considerations that enter into the research processes of leading genetics and animal research teams in mainland China.

It would appear from some of the more controversial research projects conducting in the country -- such as the cloning of monkeys -- that very little ethics oversight takes place. Yet according to Robert Desimone, head of the McGovern Institute for Brain Research at MIT, “the situation [in China] is changing radically”. Researchers at the Shenzhen Institutes of Advanced Technology (SIAT), for example, must have relevant research projects reviewed by committee similar to the Institutional Animal Care and Use Committees (IACUC). The IACUC is a body that oversees federally funded animal research in the United States, including scientific and ethical assessment of projects. Some Chinese facilities doing research on non-human animals have been accredited by the Association for Accreditation of Laboratory Animal Care, an international nonprofit that oversees animal welfare in labs.

Still, reports routinely arise from China of research projects that would not seem to meet the sorts of ethical standards set by Western research ethics oversight bodies.

According to The Atlantic, researchers from SIAT -- with the assistance of leading US genetics researchers -- have deliberately created chimpanzees with genetic defects designed to simulate autism, in an effort to study the causes of autism and relevant drug treatments. Other recent research projects to emerge from China include gene-edited rabbits with muscular dystrophy symptoms, and piglet model of Huntington's disease.

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June
02
  10:05:00 PM

Is euthanasia the next step for Ireland after abortion?

Hard on the heels of Ireland’s historic approval of abortion in a constitutional referendum last week comes a bill to legalise euthanasia. Junior minister John Halligan is working on draft legislation which will be introduced Dáil by a Government on his behalf.

It’s not clear whether the bill would sanction euthanasia or only assisted suicide.

Mr Halligan has been heartened by the public’s response to the abortion debate. They showed "courage and compassion" and polls indicate that they would endorse a “right-to-die”. He also believes that a Citizen’s Assembly, similar to the one preceding the recent referendum, is needed.

Another member of the Dáil, Gino Kenny, a socialist, told the Irish Independent that he would back a Citizens’ Assembly.

"When all the dust settles on this issue [abortion], I think the vast majority would see the logic in some way in some sort of legislation change for people, particularly with a terminal illness. There is compassion. This happens in Ireland. Some people go to Switzerland and some have taken medicine they bought on the internet. "

Euthanasia is still not a burning issue in Ireland, but some observers see it as the next natural step. Before the referendum Ian O’Doherty, a columnist at the Irish Independent wrote:

... euthanasia is the next big social issue we will have to tackle, even if the political appetite is not there. We have an ageing population, a failing health care system and while Irish hospices do genuinely humbling, incredible work (some of the greatest, most decent people I have ever met were those who staff hospices in this country), we are facing into a demographic time bomb which is only going to get worse ...

'My body, my choice' doesn't apply only to abortion, it applies to all of us and anyone who has ever watched a loved one struggle through the last few months of their life, when they would rather be dead, knows that it is obscene to keep someone alive against their will.

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June
02
  9:59:00 PM

Is it immoral to love your kids because they are related to you?

There is a slow-moving debate over at the Journal of Medical Ethics on whether it is moral or immoral to desire to be biologically related to one’s children. While many might find this preposterous, it appears more sensible if it is compared to racism. People nowadays are troubled by the notion that we should have more affection for people who look like us. Why should parental affection be treated differently?

The question seems to be sparked by uneasiness over the legal and moral status of reproductive technologies. IVF, for instance, makes it possible to raise children whose link to at least one of their biological parents is non-existent. Does this matter?

Rebecca Roache, a lecturer in Philosophy at Royal Holloway, University of London, argued a couple of years ago that:

the wish to be biologically related to one's children—like the wish to associate only within one's racial group—can have harmful effects. The wish to associate only with members of one's own race can (and does) result in people being denied important opportunities on account of their race. And the wish to be biologically related to one's children means that the vast majority of aspiring parents create new babies, despite there being millions of existing children without families in need of adoption or foster care; as a result, aspiring parents' preference for biological relatedness to their children leads to existing parentless children being denied the opportunity of a family.

Another scholar, J. David Velleman, countered in Philosophical Papers that “it is immoral to create children with the intention that they be alienated from their biological relatives—for example, by donor conception” – an assertion that Roache dismissed as “ unhelpful armchair philosophy”.

Attacking the problem from a different angle, Ezio Di Nucci, of the University of Copenhagen, argues in JME that the racism angle doesn’t hold water, but the desire for biologically related children is still “morally illegitimate”, although it is just a “moral vice” which does not call out for government regulation. He argued elsewhere a couple of years ago that this desire is obnoxiously patriarchal. “Liberation [from the patriarchy] requires the establishment of fair and equal parental projects where biological ties do not play any role in the distribution of roles, responsibility, and ultimately power.”

Footnote: One example of the desire for biological relatedness comes from the Australian media. Max Delmege, a 72-year-old millionaire and his 34-year-old wife Sam, have laid open their personal lives on television as they struggle to have an IVF child. Over the past three years they have had three miscarriages, 11 IVF cycles and spent more than A$100,000. “I just do it because I have to, if I want to have a baby, I just have to do it,” Sam told the media.

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June
02
  5:33:00 PM

Portugal: Communists firmly oppose euthanasia

A demonstration opposing euthanasia in Portugal / Morning Star 

A footnote to last week’s story about the narrow defeat of euthanasia in Portugal’s parliament. The vote was 115-110 and failed because the Communist Party opposes euthanasia. Communist MP Antonio Filipe explained why in the Morning Star, a British socialist newspaper (once known as the Daily Worker):

[Euthanasia is] “not as a sign of progress but a step towards civilisational retrogression with profound social, behavioural and ethical implications.

“In a context in which the value of human life is frequently made conditional on criteria of social utility, economic interest, family responsibilities and burdens or public spending, legalisation of early death would add a new dimension of problems.

“First of all accelerating the deaths of those to whom society refuses to respond and support in situations of fragility and need. Faced with human suffering, the solution is not to divest society of responsibility by promoting early death but to ensure conditions for a dignified life.”

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June
02
  5:24:00 PM

Most Americans support some form of the ‘right to die’: Gallup poll

The latest Gallup poll shows that a broad majority of Americans, 72%, continue to believe that a doctor should be legally allowed, at a patient's and a family's request, to end a terminally ill patient's life using painless means.

The level of support depends on the wording of the question. The Gallup poll describes euthanasia, but does not use the word.

Men, young adults, Democrats and liberals are especially likely to approve of legally and painlessly ending a terminally ill patient's life. Support drops below a majority only among weekly churchgoers.

Opinions have changed dramatically since Gallup first gauged the public's attitudes about euthanasia in 1947 and 1950. At that point, 37% supported legally and painlessly ending a terminally ill patient's life. But by 1973, when the question was next asked, a 53% majority were in favour.

Since 1990, support, at least for Gallup’s wording of the question, has not dipped below 64% and has been as high as 75%.

Gallup asks a separate question about doctor-assisted suicide. And although this has legal backing in some states, it receives less public support in Gallup's polling than euthanasia, possibly because the question contains the phrase "commit suicide." The euthanasia question uses the language "end the patient's life by some painless means," which is less confronting and more ambiguous.

Gallup has measured Americans' views of doctor-assisted suicide since 1996, and in most years, support for it has been slightly lower than for euthanasia, though it has never fallen below 51%. Currently, 65% of Americans think doctors should be legally allowed to assist a patient in dying by suicide.

Support for doctor-assisted suicide varies less by subgroup than support for euthanasia. The most notable subgroup differences for physician-assisted suicide are by ideology and frequency of church attendance.

A slim majority of self-identified conservatives (51%) think assisted suicide should be legal, compared with 79% of liberals. As is the case with euthanasia, less than half of weekly churchgoers (41%) support assisted suicide.

Again, liberals (71%) and infrequent churchgoers (69%) are much more likely than their conservative (39%) and weekly churchgoing (26%) counterparts to say doctor-assisted suicide is morally acceptable. Catholics and Protestants are evenly divided.

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June
02
  12:59:00 PM

What will happen to California’s assisted suicide law?

Last month BioEdge reported on the decision by a California county court judge to overturn the state’s assisted suicide law. Since then, state Attorney General Xavier Becerra filed an appeal to the county court, and asked the 4th District Court of Appeal to allow the law to stay in place while the “appeals process” took place. But the district court refused, and on Friday Riverside County Superior Court judge Daniel A. Ottolia issued a formal judgement that deemed the law to be “unconstitutional”. Legal experts say that this means the law has been overturned -- for now.

“Until and unless the law is reinstated by action of the court of appeal or California Supreme Court, it has been ruled unconstitutional and is therefore void,” Stephen Larson, an attorney for the group suing to invalidate the law, said in an email to The Los Angeles Times.

Becerra is expected to file appeal to a higher court, but he is yet to do so.

Experts say that it is unlikely that the decision will affect assisted suicide in California in the long term. Even if the appeals court upholds Ottolia’s decision, the state Legislature could pass a similar law, perhaps with additional safeguards. The law has strong support in the Legislature and among the public. A 2015 survey conducted by UC Berkeley found that 76% of Californians supported allowing terminally ill patients to take their own lives.

“I’d be surprised if the law doesn’t stand in the long term,” Nelson told The Times.

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June
02
  12:56:00 PM

Lookism, and what we should do about it

There are many “isms” that pop up in debates about discrimination -- “racism”, “sexism”, “ageism”, “ableism”, and so on. But in addition to these, a new “ism” has surfaced in the literature on discrimination -- “lookism”.

“Lookism” refers to discrimination against people who are unattractive, or, to use a technical term, “aesthetically unfortunate”. On the basis of “lookist” prejudice, ugly people may be barred from certain jobs and paid less by their employers, in addition to being less likely to make friends and find a partner. While “lookism” is not usually included within analyses of social bias, bioethicists say that lookism is as “widespread and pervasive”.

In her 2010 book The Beauty Bias: the Injustice of Appearance in Life and Law, legal scholar Deborah Rhode observed that “anywhere from 12 to 16 percent of workers believe that they have been subject to such bias, a percentage that is in the same vicinity, or greater, than those reporting gender, racial, ethnic, age, or religious prejudice”. Bioethicist Francesca Minerva stated in a 2017 paper that lookism affected between 3% and 18% of the population. In a recent interview, Minerva said that “it has been estimated that this bias’s cost to society is pretty much as much as the racist bias”.

There may be some disagreement about these claims. But presuming “lookism” is a problem to some extent, what, if anything, should we do to address it? Minerva has a few suggestions:

“we should get rid of fictional beauty models that exist just on heavily photoshopped cover pages of fashion magazines, and we should use legal measures at least to make people aware of the fact that lookism is a problem and to disincentive them from indulging in lookist practices”.

She also suggests that we might provide “social support” to ugly persons if they “want to surgically intervene on socially induced aesthetic problems”.

Yet these suggestions are controversial. In a 2005 Journal of Libertarian Studies paper “Is lookism unjust?”, US-based academics Louis Tietje and Steven Crisp argued on libertarian grounds that we should not outlaw lookist prejudice:

“In the absence of an uncontested standard of justice, individuals should be free to discriminate on the basis of their own values. This means that institutions are free to enact policies that prohibit discrimination against or benefit in some way those who are aesthetically less fortunate. Institutions may also engage in aesthetic discrimination or refrain from enacting any policies related to beauty discrimination. It also means that we should not enlist the coercive power of the state to try to eradicate beauty discrimination”.  
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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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