Sunday, December 11, 2016

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When there’s talk of border crossings and illegal Mexican migrants, my thoughts used to turn to the ugliness of Donald Trump’s dream: "I will build a great wall -- and nobody builds walls better than me, believe me --and I'll build them very inexpensively. I will build a great, great wall on our southern border.”

But after reading a remarkable feature in California Sunday Magazine, I’m trying to think about 66 Garage instead. The name of Mr 66 Garage may not ring a bell with you, but to be fair, it doesn't ring one with him either. He is an undocumented migrant whose truck overturned on a border crossing in June 1999. He hit his head and never woke up.

Ever since, 66 Garage has lived in a persistent vegetative state in a San Diego nursing home where he is given round-the-clock care. What a country America is! It produces a politician who treats illegal migrants as if they were cockroaches and nurses who treat them as if they were their own family.

Anyhow, this 18-20-year-old man had taken the “undocumented” part of his journey seriously. He could not be identified and the nursing home christened him 66 Garage, although some of the staff protested that it was undignified. A wonderful woman named Paula visited him every week for 15 years and wondered who he was.

There are thousands upon thousands of missing migrants and their relatives are desperate to find them. A photo of 66 Garage has been shared more than 300,000 times on Facebook. Earlier this year a friend of Paula’s took an interest in the case and 66 Garage was finally fingerprinted. A match led to his sister in the southern state of Oaxaca. Now she can wave at him over Skype on his birthday.

It’s a remarkable story about vulnerability, dignity, blood ties, and American generosity. Read it.

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Michael Cook
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This week in BioEdge

2016-12-05 12:12 AM
Is ‘financial abortion’ an idea whose time has come?
by | Dec 10, 2016
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tags: abortion, feminism

If women have a right to get right of a baby, why shouldn’t men? This radical idea has been kicking around for about 20 years, but seems to becoming more popular. In 1998 Brown University sociologist Frances K. Goldscheider floated the idea of a “financial abortion” in order to achieve true gender equality.

Earlier this year the youth wing of the Liberal Party in Sweden adopted the idea. Up until 18 weeks of pregnancy, it argued, men should have the right to relinquish all rights and responsibilities for their partner’s child. Unsurprisingly, the proposal went to the same place as the Young Liberals' proposals for legalizing necrophilia and consensual incest -- nowhere at all -- as it sounded absurdly sexist and anti-feminist.

But dyed-in-the-wool Australian feminist, comedian and author Catherine Deveney has revived the idea. The litmus test is simple:

Is it fair for people to be forced to become parents against their wishes? If it's not fair for a woman to be forced to bear a child or have an abortion, it follows it's not fair for a man to be forced to become a parent.

The idea becomes slightly more plausible in the light of the slogan “every child a wanted child”. What if a man does not want a child? How can you force him to love his wee sprog?

“I believe every baby should be wanted, and every parent should be willing,” writes Deveney. “When we consent to having sex, we do not automatically consent to becoming a parent. If, when a cis male and cis female have vaginal sex, their contraception fails, it doesn't mean both people have to become parents. The options are abortion, adoption, parenting together or sole parenting.”

The most obvious objection is that a man should be financially responsible for the child. But, says Deveney, “this kind of thinking is founded in oppressive heteronormative values and belongs in the 1950s.”

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The battle continues over the A-List embryos
by | Dec 10, 2016
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tags: embryo custody, ivf, nick loeb, sofia vergara

In happier times   

What began as soap opera is turning into a master class in metaphysics. “Modern Families” TV star Sofia Vergara, 44, and her former partner, entrepreneur and Hollywood producer Nick Loeb, 41, have been at war over two frozen embryos in a California IVF clinic. Vergara, now married to "True Blood" star Joe Manganiello, refuses to allow the embryos to be brought to term with a surrogate mother; Loeb insists that they have a right to life.

Both of them have deep pockets and wily lawyers. With 600,000 supernumerary embryos in deep freeze in the US, the outcome could set legal precedents in a number of areas. However, the dispute is not theoretical, but passionate and sometimes vindictive.  

The latest moves are as follows.


In mid-November Vergara’s lawyers demanded that Loeb disclose the names of two former girl friends who had abortions. They want to show that his belief that life begins at conception is insincere. “Oddly, Loeb wants us to believe that he supports a woman’s right to privacy, and to make a choice concerning reproduction. However, he seems to believe that his celebrity ex-fiancé, Sofia Vergara, does not have those same rights,” said her lawyer.

Loeb, who now has strong pro-life views, was adamant in his refusal. “Could you imagine if you had moved on with your life, gotten married and had children and kept this a secret from your family, then all of a sudden 15 years later (you were) made to reveal your abortion to the world. Maybe your parents never knew, maybe your husband never knew, nor your children,” he told The New York Daily News. “For the California court to make these women wear a scarlet letter in today’s world is shocking.”

Emma and Isabella sue their mother

This week a suit was filed in Louisiana, a state where frozen embryos are recognized as “juridical persons”, on behalf of Emma and Isabella, the two embryos. The plaintiff was someone named James Charbonnet, not Loeb, and he is the trustee of a fund for their health care and education. By not being born, he argues, the embryos have been deprived of their inheritance. It is an ingenious argument, although whether it will succeed in California, where the embryos are located, is problematic. 

Last year Loeb outlined why he wants to protect the embryos in a New York Times op-ed. Obviously he is pleading for his own cause, but his points he makes are not just soap opera theatrics:

When we create embryos for the purpose of life, should we not define them as life, rather than as property? Does one person’s desire to avoid biological parenthood (free of any legal obligations) outweigh another’s religious beliefs in the sanctity of life and desire to be a parent? A woman is entitled to bring a pregnancy to term even if the man objects. Shouldn’t a man who is willing to take on all parental responsibilities be similarly entitled to bring his embryos to term even if the woman objects?

A number of issues are emerging in the snowballing war between the two celebrities: whether embryos are human life or property; whether men and women have equal rights over unborn children; whether embryos are human beings; what should be done with the hundreds of thousands of surplus IVF embryos; and whether contracts for the disposal of embryos are binding. Where will it end? Will Emma and Isabella still be in the refrigerator in 50 years' time?

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Nitschke ramps up campaign for unrestricted suicide
by | Dec 10, 2016
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tags: assisted suicide, euthanasia, netherlands, philip nitschke, suicide machine

Philip Nitschke is one of the world’s most famous Australians, although he has recently moved to the Netherlands. He helps people to kill themselves, mostly by directing them to lethal drugs or supplying them with bottled gas. He has also written a book on DIY suicide, the Peaceful Pill Handbook, which is available over the internet.

In his view, legal euthanasia is passé, with its rules for who is eligible and who is not, with its paperwork, and with its prissy restrictions on who can administer the injections. That is a medical model of suicide, he argues. His life’s work is achieving unrestricted access to the means for painless, quick suicide. Suicide, in his view, is not a benefit to be granted by the state, but a fundamental human right for people who are in pain or who simply are tired of life.

This week he announced that the organisation which he heads, Exit International, was forming a subsidiary, Exit Action, which will take “a militant pro-euthanasia position”. He said that many members of Exit International were angry after the defeat of assisted suicide in South Australia last month and wanted to be more active in promoting the right to die.

“Exit Action is critical of the ‘medical model’ that sees voluntary euthanasia as a privilege given to the very sick by the medical profession. The standard approach for years has been to get the very sick to tell their stories of suffering to the public and politicians, in the hope that politicians might take pity and change the law. Exit Action believes that a peaceful death, and access to the best euthanasia drugs, is a right of all competent adults, regardless of sickness or permission from the medical profession.”

How Exit Action will operate is unclear, but it seems to involve supplying people of all ages with drugs purchased on the internet, possibly in defiance of the law.

He told AAP that members of Exit Action will form "buyers clubs" and create distribution networks for the preferred euthanasia drug Nembutal, although it is illegal in Australia. They will also network about how to source lethal drugs and to test their purity.

Dr Nitschke spoke this week at a right to die conference in Amsterdam where he described his latest suicide machine, “Sarko”. He told BioEdge that it was well received by the Dutch and that he hopes to begin constructing them in January. 

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Victoria to debate assisted suicide
by | Dec 10, 2016
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tags: assisted suicide, australia, victoria

The Labor Government of the Australian state of Victoria will introduce legislation into the Parliament next year to legalise assisted suicide. The Labor Party will allow its MPs a conscience vote.

Assisted suicide recently failed in the South Australian Parliament, but only after the Speaker cast the deciding vote. Supporters of change have been buoyed up by their near miss in Adelaide and by a widely publicized campaign orchestrated by media personality Andrew Denton.

Victorian Premier Daniel Andrews is a late convert to the cause of assisted suicide after his father died of cancer earlier this year. “Community sentiment on this issue is changing” he says, “and I know many in Victoria think it’s time we have this debate – a debate that respects people’s views and respects people’s lives.”

A discussion paper will be released for public comment early next year, followed by consultations with stakeholders. The Government expects to introduce the legislation in the second half of 2017.

Victorian Sex Party MP Fiona Patten welcomed the Government's "bold" move. "Allowing terminally ill people the right to die when they choose with dignity, is not only compassionate but common sense," she said.

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UK scientists to push for 28-day limit on cultivation of embryos
by | Dec 10, 2016
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tags: 14 day rule, embryo research, uk

British scientists want to extend the amount of time that they can cultivate human embryos in Petri dishes from 14 to 28 days. This is a highly controversial move, but scientists believe that it will result in great medical advances.

The 14-day limit has stood for 25 years, since the early days of IVF in the UK. After Baronness Mary Warnock issued an influential report on IVF legislation in 1984, the figure was enshrined in legislation in 1990. It was always an arbitrary number, but no one questioned it, mostly because it proved so difficult to keep the embryos alive more than a few days anyway. However, this year, Cambridge University scientist Magdalena Zernicka-Goetz cultivated human embryos for 13 days, opening up the possibility of extending the limit even further.

“Extending the rule would have benefits for our understanding of our own development, in explaining why it goes wrong and in finding ways to put those errors right,” Zernicka-Goetz told The Guardian. “However, I don’t think that we should make any change without there being a consensus among the public, ethicists and scientists. We need to set limits within which most of us are comfortable.”

Other scientists are also touting the great benefits of such research. “I think if we could extend the limit for embryo research to around 28 days, the benefits for medical research would be enormous,” says IVF expert Simon Fishel. “It would give us 20 years of research that would transform our understanding of ourselves. There is only so much we can learn from animal experiments, from other species, after all. Certain tumours, developmental abnormalities, miscarriage: there is a whole raft of issues in medical science that we could start to understand.”

Opponents of the move are crying “slippery slope” and so, surprisingly, is Baroness Warnock. She believes that if the limit is shifted, opponents of embryo research will assert that their fears have been vindicated.

As indeed they are. Professor David Jones, director of the Anscombe Bioethics Centre in Oxford told The Observer:

“In the original act, a lot of things were prohibited – the creation of hybrid embryos, the cloning of embryos and the genetic modification of embryos. These have all been swept away, so I wouldn’t be surprised if they did shift the 14-day limit. In any case the 14-day limit is not philosophically defensible. I don’t think there is a difference between a 10-day-old embryo and a 20-day embryo in terms of its moral status.”

However, leading stem cell scientist Robin Lovell-Badge, of the Francis Crick Institute in London, insists that misgivings about a slippery slope are unfounded. The 28-day mark will be “an inflexible barrier” which “would not be changed in future”.  

In the United States, scientists and ethicists are also pushing for an extension. At a conference at Harvard University in November, most of them wanted an even more permissive regime than envisaged in the UK. “My view is the 14-day rule should be looked at as a public-policy tool and not as a strict moral distinction between right and wrong,” said Insoo Hyun, associate professor of bioethics and philosophy at Case Western Reserve University. “Is it time to get rid of such lines in the sand and rely solely on clear ethical principles?”

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Murky picture of IVF complications in UK
by | Dec 09, 2016
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tags: ivf, ovarian hyperstimulation syndrome, uk

Five years ago, a paper published in the BMJ came to the startling conclusion that IVF was more dangerous than abortion in the UK. The 2007 UK Confidential Enquiry into Maternal Death recorded four deaths directly related to IVF via ovarian hyperstimulation syndrome and three deaths related to multiple pregnancy after IVF. Thus, more deaths were related to OHSS than to abortion (two) despite many fewer IVF procedures (for example, there were 48,829 IVF cycles v 198,500 abortions in the UK in 2007).

Has the situation improved since then?

UK authorities are making it very difficult to find out, suggests Dr Geeta Nargund in BioNews. She points out that the UK’s fertility watchdog, the Human Fertilisation and Embryology Authority, reported a “slight increase” in severe OHSS incidents in 2015. However, at 40%, the increase was far from slight. She writes indignantly:

The HFEA should be putting this alarming statistic on the front page and discussing methods to reverse this trend. Yet the very opposite appears to be the case. It is impossible to extract the number of OHSS cases from this report and it has only come to light thanks to the persistence of Guardian science reporter Hannah Devlin… there remain questions about whether any maternal deaths that may be linked to OHSS have been reported.

She argues that the HFEA should expose OHSS complications and should make renewal of the licences of IVF clinics conditional upon the incidence of OHSS. “By this means, the welfare and safety of women undergoing IVF treatment would be more effectively protected. The time has now come for firm action to reverse the trend of severe OHSS.”

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US Senate committee wants to ban ‘concurrent surgeries’
by | Dec 09, 2016
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tags: clinical ethics, concurrent surgeries, patient care

Late last year, the Boston Globe’s Spotlight team, which won a Pulitzer prize in 2003 for exposing sex abuse in the Catholic Church and was celebrated in the Best Picture in this year’s Oscars, turned its guns on the state’s most famous medical centre, Massachusetts General Hospital.

The issue was “concurrent surgeries,’’ two operations, managed by the same surgeon, whose critical parts occur at the same time. The Spotlight team raised alarming questions about the safety, quality of patient care, and transparency of the practice.

The existence of concurrent surgeries was startling news to nearly all lay people and politicians reacted immediately.

Now the powerful Senate Finance Committee has issued a report which calls upon government-funded hospitals to “develop a concurrent and overlapping surgical policy that clearly prohibits the former and regulates the practice of the latter”.  

According to the Globe’s report:

The committee also called on hospitals to clarify when it is safe for surgeons to schedule operations that overlap even for a short time. Critics of overlapping surgeries say it is hard for surgeons to divide their attention between two patients and that operations don’t always go as planned.

The federal government already bars surgeons at teaching hospitals from billing Medicare for procedures if the critical parts overlap. But those rules are seldom enforced, and internal critics at hospitals across the United States have cited cases in which surgeons shuttled back and forth between two operating rooms for hours, often without the patients’ knowledge.

Advocates of concurrent surgeries argue that this longstanding practice enables timelier access to highly skilled, in-demand surgeons by freeing up their time to perform more specialized operations, helps train medical professionals by pairing senior doctors with residents or fellows, and improves the utilization of operating facilities.

The Senate Committee staff found little data to support either positive or negative views of the practice, although a Mayo Clinic study which appeared recently compared the outcomes of thousands of such overlapping surgeries with non-overlapping operations at its Rochester campus and found no difference in the rates of postoperative complications or deaths within a month after surgery between the two groups.

Patient consent is an important issue. Dr Jim Rickert, president of The Society for Patient Centered Orthopedics, told Medscape Medical News, that sometimes patients learn that their surgeon will not be giving them his full and undivided attention as they are being wheeled into theatre. He says there will be resistance: "The practice that occurs now is lucrative. Hospitals get to squeeze more out of their [operating rooms] every day and it's lucrative for the surgeons.”

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Doctor and nurse turn killers in Italian hospital
by | Dec 09, 2016
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tags: angels of mercy, crime, euthanasia, italy


Doctors and nurses are the most trusted professionals, according to a UK poll earlier this year, just ahead of hairdressers and teachers, but absolutely thrashing politicians, real estate agents and journalists. This may account for the confidence with which supporters of euthanasia and assisted suicide entrust them with the lives of the elderly and terminally ill.

However, this week’s news from Italy is a reminder that not all medicos are worthy of that trust. An anaesthetist and his nurse lover have been arrested near Milan over the deaths of at least five patients and possibly dozens more between 2011 and 2014. The deaths took place at Saronno Hospital, about 30 km north-west of Milan.

Leonardo Cazzaniga, 60, and nurse Laura Taroni, 40, are also suspected of having killed his father and her husband and her mother. It appears that they tricked Ms Taroni’s spouse into believing that he had diabetes and then poisoned him with some hospital drugs.

Police wiretapped the couple’s phones and presented excerpts from disturbing conversations. At one stage Taroni told Cazzaniga she could kill her son and her eight-year-old daughter. "Every now and again I have this urge to kill someone - I need to," Taroni allegedly told Cazzaniga. According to one of Cazzaniga's colleagues, he frequently referred to himself as an "angel of death". It appears that he also used cocaine.

Also relevant to potential euthanasia laws, it appears that colleagues and hospital administrators may have turned a blind eye to the deaths. One doctor allegedly blackmailed the hospital into hiring her in exchange for keeping quiet about the murders. She may have also helped Ms Taroni falsify her husband’s tests for diabetes.

The police are not treating the deaths as euthanasia, or mercy killing, but as homicides. 

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Michael Cook
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