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Tuesday, March 28, 2017

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FROM THE EDITOR

A number of the eminences of Silicon Valley are besotted with immortality. Google, PayPal co-founder Peter Thiel, and Facebook’s Mark Zuckerberg are a just a few names amongst the many who want to do away with death, or at least add a few decades, or even a few hundred years, to their lifespans.

Even if this is achievable, is this desirable?

British sci-fi author and futurist Paul Graham Raven has written a blistering demolition of the transhumanist project. (Hat-tip to Wired.) It is basically a philosophy for selfish (and mostly white) rich guys, he suggests.

it turns out that technologies which extend, augment or otherwise improve human life are already here! You may have heard of some of them: clean water; urban sanitation; smokeless cooking facilities; free access to healthcare; a guaranteed minimum income; a good, free education. There are more – and you’d be surprised how many of them have been around in one form or another for decades, even centuries! But they’re unevenly distributed at the moment, so the first agenda item for all transhumanists should be looking for ways to get these technologies to everyone on the planet as soon as possible

But that is unlikely to happen. In their single-minded focus on maximising their own welfare, dedicated transhumanists are deaf to the needs of the society: “You look after yourself, I’ll look after me; what could be fairer than that?” Raven writes caustically. Come to think of it, this critique of personal autonomy could be applied to a number of other areas in bioethics. 

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Michael Cook
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2017-03-20 11:21 PM
Canadian surgeons harvesting organs from euthanised patients
by | Mar 25, 2017
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tags: canada, euthanasia, organ donation euthanasia

Taking advantage of the country’s new law, Canadian transplant surgeons have harvested organs from dozens of euthanasia patients. According to the National Post, 26 people in Ontario who died by lethal injection have donated tissue or organs. This involved mostly corneas, skin, heart valves, bones and tendons.

The National Post’s report only covered Ontario. Bioethicists, Transplant Quebec and an ethics committee of the Quebec government in Quebec argued last year that euthanasia could be a good source of organs, so it is quite possible that similar procedures have been carried out in that province as well.

“If we accept people can make decisions to end life, and we accept the idea of cardiac death being sufficient for organ donation, this should be acceptable,” Dr James Downar, of Dying with Dignity Canada, told the Post, to allay fears that patients could be pressured into donating organs.

Oddly enough, this is a topic which did not emerge in discussions about euthanasia before the Supreme Court legalised it in 2015. An influential report by a Royal Society of Canada Expert Panel did not even mention it, for instance, nor the Supreme Court’s decision in Carter vs Canada.

Coordinating organ transplants with euthanised donors has been going on for several years in Belgium and the Netherlands. About 40 cases in the two countries have been reported. Last year Dutch physicians at the Maastricht University Medical Center and the Erasmus University Medical Center Rotterdam published a multidisciplinary manual for the complex procedure.

A recent article in the Impact Ethics blog by Professor Jennifer A. Chandler, of the University of Ottawa, pointed out that combining organ donation with euthanasia could lead to some tricky issues in ethics, law and conscientious objection:

• What if a patient seeks euthanasia to direct his donation to a family member? The potential for abuse is obvious.

• What if a next-of-kin is asked to approve organ donation after a person has been euthanised but has left no instructions?

• What if the transplant surgeon has a conscientious objection to the procedure? Should he be forced to do it?

• What if a recipient objects to receiving an organ from a euthanised patient? 

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Is the 14-day limit on growing embryos out of date?
by | Mar 25, 2017
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tags: embryo experimentation, embryo research, sheefs

Both in the US and UK, growing human embryos more than 14 days in a laboratory is banned. Recent developments suggest that it may be possible to grow them for longer and a number of scientists are lobbying to extend the limit. They contend that the limit is out-of-date and too restrictive.

But what if they could create embryo-like structures without creating complete embryos? This possibility is completely unregulated.

This is why John D. Aach and George Church and others from Harvard Medical School say that ethical guidelines for synthetic human entities with embryo-like features (SHEEFs) are needed. It might be possible to create a human heart and a rudimentary human brain, for instance. What if the brain is conscious, or could feel pain?

Research limits designed for embryos will not work for SHEEFs because “it will soon become possible to generate SHEEFs that can bypass canonical embryonic stages through the use of completely different laboratory operations”.

The 14-day rule was a hard-fought compromise between different ethical views of the embryos but at least the participants in the debate understood what an embryo was. “SHEEFs might present novel combinations of such features that are very unlike those of embryos, and are so new and unfamiliar that traditions may be puzzled and unable to offer articulated opinions about them.”

In an article in the journal eLife, Aach and his colleagues call for a wide-ranging discussion about the ethics of creating SHEEFs. They compare the 14-day rule to a stop sign at the end of a research road. What scientists need now is a perimeter fence surrounding experiments on SHEEFs to prevent researchers from straying into unethical territory.

“I absolutely support this,” Cambridge University biologist Magdalena Zernicka-Goetz told NPR’s Shots. “The time is right to begin discussion of these issues in a forum that includes scientists and has a wide representation of society.”

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Cambodia bans exports of breast milk to US
by | Mar 25, 2017
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tags: breast milk, breast milk market, cambodia, commercialization

Cambodia has banned exports of breast milk to the United States. Ambrosia, a Utah company, has been shipping breast milk to American mothers (and possibly some body builders). Cambodian authorities say that the business endangers the health of babies.  

UNICEF is adamantly opposed to the sale of breastmilk by poor women in developing countries. “Breast milk banks should never be operated by exploiting vulnerable and poor women for profit and commercial purposes,” Iman Morooka, of UNICEF in Cambodia, told The Guardian.

“Breast milk could be considered as human tissue, the same as blood, and as such its commercialisation should be banned. Malnutrition remains a threat to children’s wellbeing in Cambodia, and proper breastfeeding is one of the key factors contributing to a child’s good health and nutrition.”

There are ethical objections, as well. "It treats the women as a tool for producing things for other people who have more opportunity," says Ros Sopheap, the director of NGO Gender and Development for Cambodia. "Even if the women do it voluntarily, there is financial pressure."

Ambrosia Milk—known in Cambodia as Khun Meada, which means “gratitude of mothers” in Khmer – has exported the milk of about 90 women since 2015. “We believe in empowering the mothers of Cambodia with a way to make money while nurturing their families, as well as others, through the donation of their excess milk,” says its website.

A co-founder of the company, Ryan Newell, defended his business to The Guardian: “We’ve been able to offer these women work where they are earning two to three times what they would be making elsewhere. They’re able to stay home with their kids more because they are not working the insane hours.”

For poor women, it must seem like an attractive proposition. One woman told the Cambodian Daily that the minimum wage in a garment factory is US$144 per month, while she could earn $120 a week by selling her breast milk. Ambrosia has exported about 500 kg of frozen breast milk every two to three months since it began operations. 

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Redefining gender roles: hubbie gives birth
by | Mar 25, 2017
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tags: male pregnancies, transgender pregnancies, transgenderism

Another dispatch from the Wild West of assisted reproduction. “Husband Gave Birth To His First Child After Wife Was Unable To Fall Pregnant” was the irresistible headline in the Huffington Post UK.

However, it turns out that instead of being a pregnant truck driver, a bit like Arnold Schwarzenegger’s 1994 film Junior, the husband is a transgender man. The couple are actually lesbians, who married in 2013 in Ohio: Chris Rehs-Dupin and Amy.

After Amy’s five failed attempts at artificial insemination, Chris volunteered to carry the baby. Although she was living as a man, she had not had sex-change surgery and still had her reproductive organs. “We were fortunate enough to have two uteruses,” they told the Daily Mail. Their daughter Hayden was born in December 2014. (No mention was made of the biological father.)

The pregnancy shook Chris’s decision to live as a man. “Being pregnant is such a female thing and that's when I started to question that it was not what I was.” Amy tried to breastfeed their daughter, but Chris eventually had to. However, she persevered with her male identity after the birth. She is thinking of having a double mastectomy but not “bottom surgery” as she does not want to rule out the possibility of bearing another child.

In the meantime, Amy fell pregnant after another attempt at artificial insemination. They would like to have a third child. 

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Making eugenics acceptable again
by | Mar 25, 2017
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tags: eugenics

Gene editing technology will inevitably lead to eugenics – and that’s a good thing, says Adam Cohen, the author of ”Imbeciles: The Supreme Court, American Eugenics, and the Sterilization of Carrie Buck”.

Cohen’s book relates the tragic story of a young woman from Virginia who was forcibly sterilised. Her case went all the way to the US Supreme Court, which concluded, in the notorious words of Justice Oliver Wendell Holmes, “Three generations of imbeciles are enough.” That case marked the highwater mark of the American eugenics movement. But Nazi atrocities almost completely discredited the idea.

However, writing in an op-ed for the Los Angeles Times, Cohen, like an increasing number of bioethicists, distinguishes between “bad eugenics” and “good eugenics”. The former is totalitarian and involuntary; the latter is individual and discretionary. He strongly supports the idea of “embryo editing”: “This time around, eugenics could be a force for good.”

... we should also recognize that there is a crucial difference between the old eugenics and the new. Rather than demonizing “unfit” people and working to sterilize them, the new eugenics regards their inherited disabilities as treatable medical conditions and seeks to help them have healthy children.

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Experts alarmed by MD suicide rate in Australia
by Xavier Symons | Mar 25, 2017
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tags: mental illness, professional conduct, suicide

Australian doctors are calling for a campaign to fight mental illness in the medical profession, after it was revealed that four junior clinicians had taken their lives in the past six months.

Writing in The Guardian this week, doctor and author Ranjana Srivastava described the heart wrenching experience of attending the funeral of a colleague who took her own life. Srivastava called on doctors to make a concerted effort to support colleagues who were suffering:

“As a profession, we must do more than lament our dead colleagues. Dealing effectively with mental illness and halting suicide among doctors requires curiosity, compassion and practical support.”

In addition to four deaths across the country in the past half year, New South Wales Coroner Michael Barnes revealed that 20 doctors have committed suicide in his State alone in the past decade.

AMA NSW president Brad Frankum said it was time the industry “faced facts” on suicides. Frankum told the Daily Telegraph that junior doctors were under extreme pressure, and that hospital culture fostered a competitive environment and placed young people under intense scrutiny with extremely long work hours.

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Should a human-pig chimera be treated as a person?
by Xavier Symons | Mar 25, 2017
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tags: chimera embryos, chimeras, personhood, xenotransplantation

Earlier this year US researchers reporting that they have successfully created human-pig chimera embryos. Ethicists are debating the moral issues surrounding this research, and, in particular, the moral status given to human-nonhuman chimeras.

In an article published in Quartz this week, Oxford ethicist Julian Savulescu noted that human-pig chimeras may be capable of feeling pain, and, indeed, could potentially engage in higher cognitive functions and social activity. We should take a precautionary approach with chimeras, Savulescu suggests.

“Any human-pig chimera should ... be assessed against the criteria of personhood... If there is a chance a new lifeform could experience pain or might not be able to interact socially, and we don’t know, it should be treated as if it does experience pain and will have problems of social adaptation. Likewise, if it could plausibly have higher cognitive functions, it should be treated as if it would have them.”

Case Western Reserve University bioethicist Insoo Hyun is critical of the assumptions underpinning the idea of “chimera personhood”. In an influential article published in Plos Biology last year, Hyun wrote:

“It it is entirely unclear what types of new psychological characteristics could count to elevate the moral status of a research animal above where it currently is, such that its scientific use would no longer be morally acceptable. In my view, the only characteristic that might qualify doing this heavy moral lifting is the appearance of human-like self-consciousness, defined as an existential awareness and concern for oneself as a temporally extended agent with higher-order beliefs about one’s own mental experiences. But this unique psychological characteristic is not likely to emerge in a chimeric animal’s brain”.

Lori Matthews, executive director of the Kimmela Center for Animal Advocacy and a neuroscientist, argues that we should place these ethical questions within the context of ongoing animal rights “abuses”. Writing in STAT, she said:

“These concerns about chimeric research add to the already potent ethical issues associated with mainstream invasive animal research. Tens of millions of animals are sickened, injured, genetically manipulated, and killed in biomedical labs every year, even as a robust body of evidence shows that some animals are more self-aware and emotionally and cognitively complex than we previously thought. That leads to the inescapable conclusion that we have already crossed a number of moral lines.”

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Texans debate ‘therapeutic privilege’ for ob-gyn doctors
by Xavier Symons | Mar 25, 2017
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tags: abortion, law, texas, us, wrongful birth

A controversial bill protecting doctors against ‘wrongful birth’ claims has passed the Texas Senate, garnering strong criticism from pro-choice groups.

The Physician Liability Bill allows doctors to withhold information about fetal abnormalities or disabilities from mothers when the disclosure of the information is deemed harmful. This will in turn prevent parents from suing doctors for what is known as ‘wrongful birth’ – according to which the doctor can be held accountable for preventing parents from making an informed decision about whether to have the child.

Pro-choice advocates argue that the bill is a veiled attempt to limit abortion rights.

“This bill places an unreasonable restriction on the constitutional right of a woman to make an informed decision about whether or not to have an abortion,” said Margaret Johnson, a member of the League of Women Voters of Texas, after the bill cleared the Senate on Monday.

De Paul University bioethicist Craig Klugman was similarly critical of the proposed law. “The bill would permit doctors to purposefully mislead the patient with no regard for the patient’s autonomy or best interest in an attempt to make a particular decision favored by the physician—to choose against abortion”, he wrote in a blog post.

But Republican Senator Brandon Creighton, the sponsor of the bill, described the current legal situation as “deeply disturbing”, and said that he would “fight to protect the value and dignity of every life including those born with disabilities”.

The bill will now be debated by Texas’s House of Representatives, where it is expected to meet strong resistance.

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Catholic social teaching and the duty to vaccinate
by Xavier Symons | Mar 25, 2017
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tags: catholicism, conscientious objection, paternalism, vaccination

What does Catholicism say about vaccination?

In a target article in the latest edition of the American Journal of Bioethics, two ethicists argue from the perspective of Catholic Social Teaching (CST) that parents have a duty to vaccinate their children.

Paul J. Carson and Anthony T. Flood of North Dakota State University invoke principles of CST such as “solidarity” and “the common good” to justify mandatory immunisation, arguing that adherents of Roman Catholicism have a social duty to help society achieve herd immunity.

“In the context of vaccination, these principles and values entail a duty to vaccinate. By not vaccinating ourselves and our children, we forsake solidarity with our neighbors and commitment to the common good...refusing vaccination violates the requirements of personal justice insofar as the act fails to give others their due...if a minimal risk on our part greatly decreases the health risks of the vulnerable, we owe it to them to do so.”

Flood and Carson also suggest that the requirements of “distributive justice” demand that Catholics have their children vaccinated.

“The protection against serious infectious diseases constitutes a good that requires a just distribution across society. The vulnerable have a just claim to this good and that entails that those who can receive vaccines should do so.”

Several response articles to the paper discuss the importance of trust in the Christian tradition and in the doctor-patient relationship.

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