Monday, February 19, 2018

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Last year the London Telegraph ran a travel article about Belgium, “10 reasons why Belgium is not as boring as you think”. A bit patronising, right?

Personally, I’d never call a country which has dared to legalise euthanasia boring. Anything but. This is a defiant poke in the eye to hundreds of years of Western civilisation. Whether you agree with Belgium’s regime of legalised euthanasia or not, it is a wildly exciting experiment in disrupting established social norms.

The latest news is that a whistleblower has accused the country’s euthanasia commission of breaking the law, muzzling dissent, and packing the commission with euthanasia practitioners. In other countries this would be called corruption. The whistleblower's letter to the Belgian Parliament is a searing indictment of a respected institution. You would think that the Belgian media would be baying for blood.

Nope. It was an American news agency, Associated Press, which broke the story. As far as I can see, it has been reported around the world, but not in Belgium. It’s a funny kind of journalism which ignores such a big story.  Perhaps the media there believes that Belgium really is as boring as you think. Or perhaps they are in the pocket of the euthanasia lobby. 

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Michael Cook
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This week in BioEdge

2018-02-12 11:26 PM
Belgium’s euthanasia commission under fire after shock letter by whistleblower
by Xavier Symons | Feb 17, 2018
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tags: belgium, consent, euthanasia, euthanasia for psychological suffering, wim distelmans

Evidence of gross negligence is mounting against Belgium’s peak euthanasia regulatory body, the Federal Commission for Euthanasia Control and Evaluation.

Dr. Ludo Van Opdenbosch, a neurologist who was a Commission member for several years, resigned in September 2017. Associated Press recently obtained the letter of resignation that Dr Van Opdenbosch sent to senior politicians, which details his dissatisfaction with the oversight processes of the Commission. "I do not want to be part of a committee that deliberately violates the law," he wrote. 

According to the letter, the Commission failed to refer to authorities a doctor who Van Opdenbosch says euthanised a demented patient without consent. The letter outlines the basic details of the case the patient, whose identity was not disclosed, was euthanised at the family's request, and there was no record of any prior request for euthanasia from the patient.

Furthermore, Van Opdenbosch states that when he expressed concerns about other potentially problematic cases, he was immediately "silenced" by other members of the Commission. He suggests that because many of the doctors on the commission are leading euthanasia practitioners, they can protect each other from scrutiny, and act with “impunity”. 

"It's not euthanasia because the patient didn't ask, so it's the voluntary taking of a life," said Dr An Haekens, psychiatric director at the Alexianen Psychiatric Hospital in Tienen, Belgium. "I don't know another word other than murder to describe this." 

However, the two co-chairs of the commission, Dr Wim Distelmans and Gilles Genicot, have strongly denied that there has been any negligence. "It can obviously occur that some debate emerges among members but our role is to make sure that the law is observed and certainly not to trespass it," they said. They also denied that Van Opdenbosch had been muzzled. 

Associated Press had already revealed details of a rift between the co-chair of the Commission, Dr. Willem Distelmans, and Lieve Thienpont, an advocate of euthanasia for the mentally ill. Distelmans suggested some of Thienpont's patients might have been killed without meeting all the legal requirements.

More than 360 doctors, academics and others have since signed a petition calling for tighter controls on euthanasia for psychiatric patients.

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Ukraine: a new surrogacy hotspot
by Xavier Symons | Feb 17, 2018
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tags: commercial surrogacy, surrogacy, ukraine

With several Asian countries having outlawed commercial surrogacy, more and more desperate couples are descending on Ukraine in search of surrogate mothers.

Analysts say that demand for surrogacy in Ukraine has increased dramatically in the last two years, with rough estimates suggesting that around 500 surrogate pregnancies are taking place annually.

Ukraine's liberal laws attract people, BBC reporters suggest. The country recognises the "intending parents" as the biological parents from the moment of conception and places no limit on how much a surrogate may be paid - essentially creating an open market where women can demand their chosen price.

Yet the process doesn’t always run smoothly. There are unverified stories of embryos being secretly swapped, poor health screening and operators taking on too many clients to be able to offer the adequate level of care.

"We have seen examples where Ukrainian agencies have refused to pay the surrogate if she doesn't adhere to strict requirements, if she miscarries," says Sam Everingham, director of the Sydney-based charity Families Through Surrogacy.

The Hague Conference on Private International Law is currently drafting an international convention dealing with transnational surrogacy agreements and parentage. Lobbyists have urged that the convention condemn the practice of commercial surrogacy.

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Former NFL players turn to stem-cell therapies for help
by Xavier Symons | Feb 17, 2018
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tags: fda, football concussion, stem cell therapies, stem cell tourism, us

Former NFL players are turning to unapproved stem-cell treatments to deal with chronic pain and neurodegenerative disease.

News services in Texas recently reported that several former members of the Dallas Cowboys had received experimental stem-cell therapy in Mexico to deal with pain and injuries.

Bob Lilly, once a top defensive lineman for the Cowboys, said he had received two separate treatments offered by Texas stem cell company Celltex.

“I have no pain,” Lilly said. “And that's pretty unusual when you've played 24 years of football”.

Several of Celltex’s treatments are yet to be approved by the FDA, and in many cases the company flies clients to Mexico to receive stem cell injections.

Rickey Dixon, who played six seasons in the NFL (1988-1993) took out a loan to receive experimental stem-cell therapy after he was diagnosed with Lou Gehrig’s Disease in 2013. As a result of his neurodegenerative disorder, Dixon is now confined to a wheelchair and requires a feeding tube to eat.  

While many doctors are enthusiastic about the promise of stem cell therapies to treat brain damage, neurologist Michael De Georgia of Cleveland Medical Centre has sounded a note of caution:

“we need to be very cautious about claims and promises to patients who may be under the assumption or the belief that this therapy has been shown to be effective, and it hasn't”.
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Netherlands passes opt-out organ donation law
by Xavier Symons | Feb 17, 2018
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tags: euthanasia, netherlands, organ donation, presumed consent

The Netherlands has joined Belgium and Spain in adopting “opt-out” organ donation legislation.  

Earlier this week the Dutch parliament narrowly passed a bill that requires every person over the age of 18 to notify government officials if they do not want to be an organ donor.

All adults in the country not yet registered as donors will receive a letter asking if they want to donate their organs after death. Those who do not respond to the first letter, or to a second letter six weeks later, will be considered organ donors, although they can amend their status at any time.

The law is intended to reduce pressure on next-of-kin, who are often required to make decisions about organ donation on behalf of the deceased.

Yet critics of the bill complained that it puts too much authority in the hands of the government over what happens to a citizen after their death.

Bioethicist Wesley J Smith suggested that in some cases euthanasia “without request or consent” could be combined with presumed consent for organ donation: “a patient could very conceivably be both killed and harvested without having requested it”.

The law is expected to be implemented in 2020.

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ACLU challenges Ohio’s down syndrome abortion law
by Xavier Symons | Feb 17, 2018
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tags: abortion, aclu, down syndrome, law, us

The ACLU has launched a legal challenge against Ohio’s new down syndrome abortion legislation, which prohibits doctors from aborting pregnancies purely on the basis of a Down syndrome diagnosis.

The ACLU suit was filed on Thursday in a Federal court in Cincinnati on behalf of Preterm in Cleveland, Planned Parenthood and other Ohio abortion providers. "The government cannot deny a woman's right to terminate her pregnancy pre-viability," ACLU legal director Freda Levenson said at a news conference in Columbus announcing the suit.

Republican Ohio Governor John Kasich signed the law in December, and it is scheduled to take effect on March 23. The ACLU has requested both a temporary restraining order and a permanent injunction against the law to keep it from taking effect.

Ohio Right to Life, the state’s oldest pro-life organisation, has dismissed the lawsuit as a political stunt. “[The ACLU’s] blatant and continuous attacks on the dignity and sanctity of human life make it clear that they do not care for the youngest of each new generation: the unborn”, said Mike Gonidakis, the group’s president.

Similar laws have already made their passage through the legislatures of Indiana and North Dakota.

The Indiana law, enacted in 2016, has been blocked by a federal judge, who said the state has no right to limit women's reasons for terminating pregnancies. The state has appealed.

North Dakota's law went into effect in 2013 and has not been challenged.

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Indian husband steals wife’s kidney without her knowledge or consent
by | Feb 16, 2018
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tags: india, organ trafficking

One of the more bizarre stories of the murky work of organ trafficking comes from Kolkata. About two years ago, Rita Sarkar, 28, felt a sharp pain in her abdomen. Her husband took her to a clinic where she quickly had an appendicectomy. But the pain persisted. Her husband refused to take her to see a doctor and told to speak with no one about her operation.

Finally her father’s relatives whisked her away to another clinic. An investigation showed that one of her kidneys had been removed and that other was infected.

Sarkar’s husband was arrested this week and confessed that he had sold the kidney to a to a businessman in the Indian state of Chhattisgarh.

The husband’s justification was that Sarkar’s family had not paid a big enough dowry – although they were married in 2005. “He and his family tortured me during the past 12 years of marriage for dowry and when my family failed to meet their demands, they sold my kidney,” she told the local press. Dowries have been banned in India since 1961, but the practice persists.

According to the report in the Washington Post, “the Voluntary Health Association of India has estimated that about 2,000 Indians sell a kidney every year.”

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Membership rising in Swiss assisted suicide group Exit
by | Feb 16, 2018
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tags: assisted suicide, switzerland

In 2017, 10,078 people joined the Swiss euthanasia organisation Exit and the number of assisted suicides rose slightly. The organisation says that increased interest is due to the ageing population.

At the end of December 2017, the organisation had 110,391 members in German-speaking Switzerland and in Ticino, Only Swiss citizens are eligible for Exit’s services. Its rival, Dignitas, also accepts foreigners. Last year, 734 people ended their lives using Exit’s services, compared with 723 the previous year. Although men are generally much more likely to commit suicide, the majority of people using Exit are women (60%).

As in previous years, the most common underlying illnesses – according to Exit -- for which people sought its help were terminal cancer, age-related multiple illnesses and chronic pain. This is at odds with reports from Oregon and elsewhere that the most frequently reported end-of-life concerns are decreasing ability to participate in activities that made life enjoyable, loss of autonomy, and loss of dignity.

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First case report of transgender woman breastfeeding an infant
by | Feb 16, 2018
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tags: transgender, transgender breastfeeding

In another step forward in the transgender movement, a trans woman (a natal male) has been helped to breast-feed her partner’s baby.

The 30-year-old woman sought help from Mount Sinai’s Center for Transgender Medicine and Surgery in New York City. Her partner did not want to breastfeed and she wanted to assist. Although she had not had gender-reassignment surgery, after years of taking medication, she had well-developed breasts.

From chatter on internet forums, it appears that trans women are experimenting with drugs to help them lactate. This person took an anti-nausea drug called domperidone which is used off-label to trigger breast milk, in combination with feminising hormones oestrogen, progesterone and spironolactone.

As a result she was eventually producing 227 grams of breast milk a day. This is below the 500 grams that babies need so she had to supplement it with formula. The authors of the study in the journal Transgender Health concluded that “modest but functional lactation can be induced in transgender women”.

“This is a very big deal,” says Joshua Safer of Boston Medical Center, told New Scientist. “Many transgender women are looking to have as many of the experiences of non-transgender women as they can, so I can see this will be extremely popular.”

While this development was greeted with great enthusiasm, further studies are needed to ensure that it is safe. Domperidone is associated with cardiac arrhythmias, cardiac arrest, and sudden death when used intravenously. There are reports that spironolactone is associated with tumours in rats. There may be other, long term effects, such influencing the child’s IQ.  

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Michael Cook
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