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Sunday, February 26, 2017

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FROM THE EDITOR

We’ve often blamed the pharmaceutical industry for medicalising the normal ups and downs of life. But journalists are not above disease-mongering. I’ve just noticed a promising new ailment to which members of the Fourth Estte themselves are particularly susceptible: post-election stress disorder.  

According to columnist in Psychology Today, “Countless Americans are reporting feeling triggered, traumatized, on edge, anxious, sleepless, angry, hopeless, avoidant of connection, alone, and suddenly haunted by past traumas they believed they had buried” because of the Trump election.

As of now, no pharmaceutical company is marketing a drug to cure these anxieties. Instead, therapists are recommending a range of behavioural strategies for dealing with the stress. “I advise my clients and friends affected by the election and its aftermath to reach out, connect, affiliate and show compassion for those similarly affected,” wrote Steven Stosny in the Washington Post.

Some people are indignant that Post-Traumatic Stress Disorder after battle is being compared to discouragement after an election loss. Republican Congressman Brian Mast lost both legs in Iraq because of a roadside bomb. Let him have the last word:

There was a big missed opportunity in naming it ‘Post-Election Stress Disorder,'” he says. “I would have preferred they name it ‘Post-Inauguration Stress Disorder,’ that way they could have called it ‘PISD.’ There’s a big difference between being pissed off about things and what happens on the battlefield.”

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Michael Cook
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2017-02-20 12:22 AM
Bariatric surgery for teenagers?
by | Feb 25, 2017
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tags: adolescents, bariatric surgery, pediatrics, usa

American doctors are debating whether to offer bariatric surgery for severely obese young people. The market is huge: about 3 to 4 million teenagers are eligible, but only about 1000 a year have the operation. The proportion of adolescents who are severely obese has doubled nearly doubled between 1999 and 2014 – from  5.2% to 10.2 % of all people  aged 12 to 19.  But most doctors are deeply sceptical of the health benefits of the operation.

On the other hand, it is sometime the only thing that seems to work. “We’re at a point in this field where surgery is the only thing that works for these kids but we don’t know the long term outcomes,” Aaron Kelly, an expert in pediatric obesity at the University of Minnesota told the New York Times.

For many teens severe obesity is medically, socially and psychologically challenging. It is associated with type 2 diabetes, high blood pressure, sleep apnea, acid reflux, fatty liver and high cholesterol levels and depression. “I’ve had many patients tell me they’d rather be dead,” than remain fat, one doctor told the Times. .

On the other hand, it is not spectacularly successful. According to the most recent studies, most participants shed about one-third of their weight and kept it off for at least five years. But two-thirds remained severely obese and some developed vitamin deficiencies.

So doctors are thinking of offering the operation at an even younger age, since diets, exercise and behavioural therapy just do not work. The longer doctors wait, the more likely it is that the obese teenager will become an obese adult. “It obviously is a controversial area,” says Dr Marc P. Michalsky, of the Ohio State University College of Medicine.

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Terrorism and triage
by | Feb 25, 2017
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tags: human dignity, israel, terrorism, triage

Imagine that you are a doctor responding to an emergency in Israel. A terrorist has attacked people in a shopping mall with a knife, stabbing some old women and children. A policeman has shot and seriously wounded the terrorist. Whom should you treat first?

This is a classical triage situation in which the worst are to be treated first. The conventional view is that doctors must be “colour-blind” in treating victims. If the terrorist is the worst injured, he should be treated first.

In an article in the Journal of Medical Ethics, two Israeli doctors question this. Value-neutrality can lead to injustice, they contend, even if “ the virtuous euphoria that accompanies the subjective neutrality-maintenance effort” seems ethically pure.

In any case, “value-neutrality” is a myth, they claim. Deciding which organ to treat is a neutral decision; deciding which person to treat always involves the invocation of values. In fact, a strict “no exceptions” rule could easily be “a manifestation of conservative stagnation, induced by fear of change, or even masked political-correctness.”

In their analysis they argue that on three counts, victims deserve to be treated first:

• “Terrorists do not deserve the right of higher priority in the terror-triage dilemma (retributive justice).

• “The higher societal merit of the victims makes them eligible for higher priority (distributive justice).

• “The terrorist, who intentionally caused the victims' injury, should be of lower priority than the victims (corrective justice).

In a commentary on this controversial view, Michael Ardagh, of Christchurch Hospital, in New Zealand, disagreed with the Israelis’ analysis. His point is simple: there is too much uncertainty in an emergency: 

to make a judgement about relative worthiness for care is a moral stab in a dark uncertainty. In the shadows of that darkness are rumours about what happened and who did what, opinions about why and what for, and impressions in the patients' dress, appearance and speech which might be consistent with a certain stereotype. Even if the moral arguments for triaging terrorists lower than victims were to be accepted, the potential for getting it wrong is enormous.

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Trump under fire from scientists
by | Feb 25, 2017
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tags: donald trump, politicization of science, science policy, usa

This week hundreds of scientists rallied in Boston’s Copley Square to protest against the anti-science forces which have allegedly captured Washington. Nearby, at the annual meeting of the American Association for the Advancement of Science, a talk titled “Defending Science and Scientific Integrity in the Age of Trump” attracted so many listeners that it had to be live-streamed into a spill-over room.

Although the organisers of the rally downplayed criticism of the President, stressed that reason and science were under threat. "It feels like there's been a breakdown of trust between science and the public, and so it's time for scientists to step up and start communicating directly to the public," an MIT post-graduate student said. Scepticism towards climate change is what most of the scientists had in mind.

Some medical professionals and scientists are more direct. The Union of Concerned Scientists published an article in the leading journal Science warning colleagues of the dangers that Trump’s Administration poses for them. Early indications that the Administration plans to distort or disregard science and evidence, coupled with the chaos and confusion occurring within federal agencies, now imperil the effectiveness of our government.”

Psychologist John Gartner has gathered 25,000 signatures on a petition to US Senator Chuck Schmer to demand Trump’s impeachment. It states that “Donald Trump manifests a serious mental illness that renders him psychologically incapable of competently discharging the duties of President of the United States.” Needless to say, none of the signatories have examined Mr Trump.

While most scientists do seem uncomfortable with Trump, he does have some supporters. Richard Lindzen, a former meteorology professor at MIT, told The Atlantic: “I have the feeling that there is Trump derangement syndrome,” he said. “People are reacting to anything he does and going on a rampage.” He welcomes freedom from the oppression of political correctness.

Two names have been mentioned in the media as candidates for Trump’s science advisor – Princeton physicist William Happer and Yale computer scientist David Gelernter. Both of them are described as climate change sceptics. Without endorsing all of Trump’s policies, Gelernter was scornful of protests by scientists:

“Trump is not walking around pontificating on science. He has no science policy. The idea that he’s anti-science is bigoted. I think it’s the worst kind of bigotry. It’s the kind of bigotry that says, non-Ivy League–PhDs—ordinary human beings who haven’t won any science awards and don’t come from Harvard—are probably too stupid to be interested in science. I’ve seen that attitude all over. I think it’s disgusting, as bigotry generally is disgusting.”

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Should Quebec’s Alzheimer’s patients be eligible for euthanasia?
by | Feb 25, 2017
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tags: assisted suicide, canada, euthanasia, quebec

Quebec is about to embark upon a debate on the involuntary euthanasia of demented elderly after a  55-year-old man in Montreal allegedly smothered his Alzheimer’s stricken wife and posted what he had done on Facebook. Michel Cadotte was charged with second-degree murder after his 60-year-old wife died in an assisted care facility.

He said on Facebook that he had "cracked" and "consented to her demands to help her die." Although the facts are not clear yet, the media has reported that the woman requested medical aid in dying but was refused.

Under Quebec’s 2015 law, euthanasia for the demented is specifically excluded. “A person who makes a request for medical assistance in dying must be capable of consent,” Jean-Pierre Ménard, a Montreal medical lawyer, told the Montreal Gazette. “This means the patient must understand their state of health and can express their will. A patient with advanced Alzheimer’s no longer has the capacity to consent, no longer has the cognitive capacity to understand.”

The Gazette reports that Quebec parliamentarians now want to open a public debate on legalizing euthanasia for persons unable to give informed consent. This debate about extending eligibility for euthanasia is happening just a bit more than a year after the law came into effect.

The Quebec Alzheimer’s Society contends that demented patients need to be protected. "It's very difficult with the complexity of dementia to know for sure what a person with dementia would want today," April Hayward, of the Society told CTV News. "They may have expressed a wish ten years ago and do we know for certain that's what they would want today?"

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Peter Singer interviewed about, well, everything
by | Feb 25, 2017
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tags: interviews, peter singer

The Journal of Practical Ethics recently posed 20 hardball questions to Peter Singer about his philosophy. It is a terrific insight into his thinking as his long career draws to a close.

About utilitarianism: Why do many intelligent and sophisticated people reject utilitarianism? Some people give more weight to their intuitions than I do—and less weight to arguments for debunking intuitions. Does that reduce my confidence in utilitarianism? Yes, to some extent, but I still remain reasonably confident that it is the most defensible view of ethics. I don’t know if everyone will accept utilitarianism in 100 years, but I don’t find the prospect frightening. It would only be frightening if people misapplied it, and I do not assume that they will.

On critics: There have been many critics of my views about euthanasia for severely disabled infants. I had some good discussions with the late Harriet McBryde Johnson, who was not a philosopher but a lawyer who had a rich and full life despite being born with a very disabling condition. As long as she was alive, when I wrote anything on that topic, I wrote with her potentially critical response in mind.

The objective truth of morality: You could just say “these are my normative views, and I’m going to treat them as if they were true, without thinking about whether moral judgments really can be objectively true.” If you do that, then in practice your decisions will be the same whether or not moral judgments can be objectively true. But given that I think morality is highly demanding, it becomes easier to say that, since morality is so highly demanding, and there is nothing irrational about not doing what morality demands, I’m not going to bother doing what I know to be right. If there are objective reasons for doing what morality demands, it’s more troubling to go against them.

On absolute moral standards: There are still absolutists. Some are proponents of the “new natural law” tradition, which has its roots in Catholic moral theology, even though it is presented as a secular position. Others are Kantians, many of them outside English-speaking philosophy. In Germany, for example, you would find wide support for the idea that we should not torture a child, even if (as in Dostoevsky’s example in The Brothers Karamazov) that would produce peace on earth forever. To me it seems obvious that if by torturing one child you could prevent a vast number of children (and adults) suffering as much or more than the child you have to torture, it would be wrong not to torture that child. 

On inconsistency: The view that I take in Practical Ethics and some other writings is not that not aiding is the same as harming in all respects... [So why not donate a spare kidney?]  don’t think I’m weak-willed, but I do give greater weight to my own interests, and to those of my family and others close to me, than I should. Most people do that, in fact they do it to a greater extent than I do (because they do not give as much money to good causes as I do). That fact makes me feel less bad about my failure to give a kidney than I otherwise would. But I know that I am not doing what I ought to do.

On adopting out a [hypthetical] Down syndrome child: For me, the knowledge that my [hypothetical] child would not be likely to develop into a person whom I could treat as an equal, in every sense of the word, who would never be able to have children of his or her own, who I could not expect to grow up to be a fully independent adult, and with whom I could expect to have conversations about only a limited range of topics would greatly reduce my joy in raising my child and watching him or her develop.

On dogs, pigs, and disabled babies: Most people think that the life of a dog or a pig is of less value than the life of a normal human being. On what basis, then, could they hold that the life of a profoundly intellectually disabled human being with intellectual capacities inferior to those of a dog or a pig is of equal value to the life of a normal human being? This sounds like speciesism to me, and as I said earlier, I have yet to see a plausible defence of speciesism. After looking for more than forty years, I doubt that there is one.

On bestiality and infanticide: I don’t put forward provocative views for the sake of doing so. I put them forward where I think they have a basis in sound argument, and where it serves a purpose to have them discussed. I hope that other philosophers will do the same.

On the future:  I worry that if people who think a lot about others and act altruistically decide not to have children, while those who do not care about others continue to have children, the future isn’t going to be good.

On moral bioenhancement: I have some practical concerns: will it work? Will there be unexpected negative side-effects? But suppose that we can put aside those worries and can be highly confident that the proposed bioenhancement will reduce suffering and increase happiness for all affected—then I have no problem with human bioenhancement. Indeed, it would be a very positive thing. As for moral bioenhancement specifically, I doubt that it will happen quickly enough, or spread widely enough, to solve the global moral problems like climate change that we face right now. But once again, if we could do it, that would be very good.

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The gene-editing debate just got more complicated
by Xavier Symons | Feb 25, 2017
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tags: crispr, gene editing, law, patents, us

As the debate over gene-editing intensifies, elite US universities are now fighting over a patent for CRISPR-Cas9 technology.

Last Wednesday the The US Patent and Trademark Office ruled that a CRISPR patent application from a researcher based at the Harvard-MIT Broad Institute ‘did not conflict’ with an earlier application by researchers from UC Berkeley.

The researchers who first discovered CRISPR technology, Emmanuelle Charpentier (Max Plank Institute) and Jennifer Doudna (Berkeley), filed a patent on behalf of UC Berkeley in 2012. That application covered the basic contours of the technology. Yet Chinese-American researcher Feng Zhang had filed a patent application shortly afterward, which described in further detail how to use the technology in the cells of higher organisms, i.e., "eukaryotic" cells.

The Patent and Trademark Office ruled that The Broad patent is “sufficiently distinct as to be separately patentable from the claims of the Doudna/Charpentier group’s patent application, which cover the use of CRISPR-Cas9 in any setting, including eukaryotic cells and other cell types”.

Legal experts have expressed surprise at the decision, which implies that some researchers will need to obtain licenses from both institutes. “Anyone wishing to use CRISPR [eg, including agro uses], will need a license from Berkeley, while only uses involving eukaryotes will require both Berkeley and Broad”, said Jorge Contreras, an expert in genetics and intellectual property at the University of Utah.

Some observers argue that the technology should not be patented at all, but rather should be available to any researchers wishing to use it. This Thursday the non-profit group Knowledge Ecology International plans to file a request to the Department of Health and Human Services asking the federal government to step in and ensure that CRISPR is not patented.

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Australian surrogacy booms after SEA crackdown
by Xavier Symons | Feb 25, 2017
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tags: australia, cambodia, commercial surrogacy, surrogacy

Surrogacy in Australia is experiencing a quiet boom, after yet another South-East Asian nation cracked down on the practice.

Last November Cambodia announced a ban on commercial surrogacy, and arrested an Australian nurse who was running a surrogacy clinic in Phnom Penh. Around ten Australian couples are currently stranded in the capital as the government drafts new legislation to regulate the practice.

Meanwhile in Australia, there has been a significant increase in the number of couples looking for surrogates, according to IVF experts.

Dr Glenn Stirling, the medical director of Brisbane IVF clinic Life Fertility, told the ABC that the number of patients they see has risen dramatically, and that new patients arrive almost daily.

"We'd be doing at least, two or three couples a week that are doing surrogacy," he said.

Commercial surrogacy is illegal in Australia, yet reports suggest that in some cases surrogates are secretly remunerated. Payments can be close to $30,000, according to an ABC report.

“It's a very much do-it-yourself model in Australia in terms of finding a surrogate and managing the journey,”  said Sam Everingham from the international advocacy and support group Families Through Surrogacy.

"There's lots of hush-hush around finding a surrogate. It's a really tough thing to manage and pull all the pieces together for a couple who just wants to have a family."

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Anorexic and bulimic woman dies after court orders end to force-feeding
by Xavier Symons | Feb 25, 2017
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tags: consent, force-feeding, law, palliative care

A 30-year-old anorexic and bulimic woman has died in a New Jersey hospital just three months after a court denied a request that she be force-fed.  

The women, identified as “Ashley G” in court papers, had suffered from anorexia nervosa for well over a decade, and had been in hospital since 2014. She had also been diagnosed with chronic depression, according to the state attorney general’s office.

Last year state Department of Human Health Services staff took her to court requesting that she be force-fed, yet Morris County Superior Court Judge Paul Armstrong ruled that she instead be moved to palliative care.

“Whether grounded in common law or constitutional law, our courts have uniformly recognized a patient’s right to refuse medical treatment as a fundamental tenet of respect for patient autonomy, dignity and self-determination,” Armstrong ruled last November.

The woman told the judge that she would resist force-feedings, which are administered through a tube inserted through the nose and pushed down the throat.

The woman was represented by Edward D'Alessandro Jr., an attorney who in the 1970s successfully fought to have 21-year-old Karen Ann Quinlan -- who was in a persistent vegetative state after mixing alcohol with Valium at a party -- removed from life-support so that she could die.

“It [force feeding] would have amounted to torture and we would have been at the same result,” D’Alessandro told the New York Post. “The court chose the correct and compassionate path.”

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A quick look at immortality
by | Feb 24, 2017
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tags: immortality, zoltan istvan

Is immortality a good idea? This video from The Atlantic takes a brief look at a familiar figure for BioEdge readers, Zoltan Istvan. 

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