FROM THE EDITOR
During his campaign, President Trump promised pro-life voters that he would support their agenda. And he has delivered. He reinstated the Mexico City policy; he has cut funding to Planned Parenthood; he has rolledl back Obamacare's birth control mandate. And now a new strategic plan for the Department of Health and Human Services has definitely taken a pro-life turn, with references to protecting life from conception to natural death. "We are on track to seeing the most pro-life president this country has ever seen," says Tony Perkins, of the Family Research Council.
Not everyone is happy about this. “This is a license to discriminate,” Susan Berke Fogel, director of reproductive health at the National Health Law Program, told Politico. “All of that language brings back all of these things that we’ve seen in the past that are just incongruous with really protecting health care and really improving people’s lives.”
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The new strategic plan for the US Department of Health and Human Services has accomplished the impossible -- getting progressives to hanker for the good old days of the Bush Administration.
Every four years the HHS publishes its plan for comment. This one, if approved, will run from 2018 to 2022.
What caught the eye of journalists was a revision of the HHS mission statement. This now reads “HHS accomplishes its mission through programs and initiatives that cover a wide spectrum of activities, serving and protecting Americans at every stage of life, beginning at conception.” It also uses phrases like respecting “the inherent dignity of persons from conception to natural death” and “the value of healthy marriages”. “Birth control” and “contraception” are not mentioned at all. These have set off alarm bells for progressive policy wonks. “This is [a] preamble to the Handmaid’s Tale,” wrote Dr Jen Gunter, an OB/GYN and a pain medicine physician, on her blog.
Even the Bush Administration was tamer and did not use “such overt anti-abortion language,” according to Think Progress.
“Conception and natural death — that’s not the legal standard for anybody,” Kathleen Sebelius, the former head of HHS under Obama, told Vox. “There are states that allow assisted suicide. This does not seem to recognize the law.”
The strategic plan does not have the force of law, but it will guide policies at government agencies. It is obviously being used to reward the President’s pro-life supporters.
“The argument that life begins at conception has long been used by socially conservative activists to attack birth control access,” said Adam Sonfield, of the Guttmacher Institute, an abortion rights group. “It could now form the basis of a new wave of attacks against publicly funded family planning services, for instance, by attempting to redirect funding to entities that do not offer the full array of birth control methods.”
The draft strategic plan is open for public comment through October 27.
Few concepts are more disputed in bioethics than “human dignity”. Ruth Macklin wrote a very short but very famous demolition of the notion in 2003, asserting that “Dignity is a useless concept”. The broad consensus amongst bioethicists is that she was right.
However, in the Journal of Medical Ethics, Linda Barclay, of Monash University, in Melbourne, takes a second look at her argument and concludes that while “human dignity” may be disputed and unclear, it is not altogether useless. For even though it has become a punching bag for bioethicists, there survives an “enormous practical concern for dignity in healthcare settings”.
She makes sense of this by accepting the traditional distinction between intrinsic dignity and extrinsic dignity. As for the former, she agrees with Macklin that it is a useless concept. But external dignity is far from useless; whether it is articulated or not, it is fundamental to healthcare. She interprets “dignity” as “status”.
On my conception of dignity, dignity is conferred in social relations where we follow social norms for treating people as sharing equal status. When we do so, we communicate to others that we consider them our social equals ... Conversely, people do not enjoy dignity when they are routinely treated in a way that relegates them to a lower social status.
Patients are often treated as social inferiors and their privacy, decorum and respect are disregarded. She cites one researcher who found that “the day-to-day exchanges of the sick, homeless and poor are characterised by rudeness, indifference, condescension, contempt, exclusion and vilification”.
This is not only a violation of their dignity, but poses a danger for their physical well-being. “Specifically, when people are regularly treated as social inferiors, they can be particularly vulnerable to maltreatment and abuse.” This danger is particularly acute for people with cognitive impairment, who become victims of dehumanising stigma.
Barclay concludes: “We are now in a position to see that Macklin is wrong to claim that dignity is a useless concept. Respecting persons and respecting their autonomy are not coextensive with treating them with dignity.”
Today is October 14. Two hundred and sixty-seven days have passed since President Trump was inaugurated. And the United States still has no bioethics commission. Is that a problem in a year when CRISPR has generated controversy after controversy? A series of articles in the Hastings Center Report addressed this problem a few months ago.
Alexander Capron, a former president of the International Association of Bioethics, believes that a new commission should be created, but not necessarily a carbon copy of its predecessors, the first of which was created by the Nixon Administration in 1974.
Capron insists that a commission should try to achieve a “consensus”, the model for all previous commissions apart from the one created by George W. Bush. “A commission's only true power—the power of persuasion—is stronger with unanimity,” he writes. Its most valuable work is hammering out a consensus when none currently exists.
He also suggests that a commission should be created by Congress and appointed by the President, giving both the executive and the legislative branch a stake in its outcomes. The deliberations of a commission are meant to result in changes and these links will give it more authority.
A very different view was taken by Rebecca Dresser, who served on the President's Council on Bioethics under President Bush, which promoted discussion rather than consensus. “Although the search for consensus may be the most suitable approach for policy activities,” she writes, “it can lead to a bland and anemic version of bioethics.”
After her experience on the firing line, she regards herself as battle-hardened because bioethics sometimes became “fodder for partisan political debates”.
She raised some interesting questions about the bioethics establishment in the wake of her experience:
I learned that some people won't like it if you deviate from “the Great Bioethics Compromise.” This is the term Jonathan Moreno uses to describe the prevailing approach to United States’ oversight of science and medicine, which is to “[k]eep a close eye on scientific innovation for its societal implications, apply the brakes now and then as needed through regulations or guidelines or just the glare of public discussion, and let the bioethicists be the ones to analyze how all this is going.” Those comfortable with the Great Bioethics Compromise were vocal critics of a politically diverse Council that dared to depart from the status quo.
Her suggestion for the next commission – if one is ever appointed – are to be more inclusive, welcoming new voices, including “members with a range of backgrounds and political views” and people with practical knowledge of some of the issues under consideration.
Although experimentation on human embryos is tightly controlled in the United States. American scientists may have found a way around this restriction. According to the MIT Technology Review, some scientists are creating embryo-like structures from stem cells.
Journalist Antonio Regalado says that there is a boom in “organoid” research. Stem cells are being used to create “clumps of cells that increasingly resemble bits of brain, lungs, or intestine” or even embryos. This emerging technology has been dubbed “synthetic embryology”.
Research on true embryos is enmeshed in America’s bitter disputes over abortion and is largely limited to surplus embryos from IVF clinics. This new technology will allow scientists to investigate embryo development and test drugs without overstepping any legal limits. Regalado writes”
Scientists at Michigan now have plans to manufacture embryoids by the hundreds. These could be used to screen drugs to see which cause birth defects, find others to increase the chance of pregnancy, or to create starting material for lab-generated organs. But ethical and political quarrels may not be far behind. “This is a hot new frontier in both science and bioethics. And it seems likely to remain contested for the coming years,” says Jonathan Kimmelman, a member of the bioethics unit at McGill University, in Montreal, and a leader of an international organization of stem-cell scientists.
At the moment, scientists are observing a 14-day limit; any embryos must be destroyed before 14 days. But this has always been an arbitrary constraint and some scientists complain if that if “synthetic embryos” are not embryos, they should be allowed to drop the time limit.
Divorce does seem to run in families. Children whose parents were divorced have a higher risk of divorcing than those from stable families. The standard explanation is that the children absorbed attitudes towards marital commitment which normalised divorce for them.
So couples with rocky relationships are counselled to strengthen commitment and development weak interpersonal skills.
But all this could be a waste of time. Researchers from Virginia Commonwealth University (VCU) and Lund University in Sweden believe that there is a genetic component to divorce. In a study published in the journal Psychological Science, they claim that while biological children were more prone to divorce if their parents were divorce, this was not the case with adopted children.
"I see this as a quite significant finding. Nearly all the prior literature emphasized that divorce was transmitted across generations psychologically," Kenneth S. Kendler, of VCU, says. "Our results contradict that, suggesting that genetic factors are more important."
By recognizing the role that genetics plays in the intergenerational transmission of divorce, therapists may be able to better identify more appropriate targets when helping distressed couples.
"Previous studies haven't adequately controlled for or examined something else in addition to the environment that divorcing parents transmit to their children: genes," says lead author Jessica Salvatore, of VCU. "And our study is, at present, the largest to do this. And what we find is strong, consistent evidence that genetic factors account for the intergenerational transmission of divorce. For this reason, focusing on increasing commitment or strengthening interpersonal skills may not be a particularly good use of time for a therapist working with a distressed couple."
A new study claims that nine out of ten Quebec caregivers want to extend the province’s Medical Assistance in Dying (MAiD) law to patients with dementia.
The study, presented by Université de Sherbrooke epidemiologist Gina Bravo at World Alzheimer’s Day conference in Montreal this week, involved 302 caregivers from across Quebec and a dozen Alzheimer’s chapters of the Fédération Québécoise des Sociétés Alzheimer. Bravo asked respondents if they support the idea of assisted dying for individuals suffering from dementia who are at the terminal state of their illness, who are showing signs of distress and who have an advance written directive.
According to Bravo, 91% of respondents supported extending the law to patients with dementia, while 72% of respondents said they were favourable to it even in the absence of a written directive.
Currently, MAiD is not permitted for patients who cannot make a request in a “free and informed manner”, thus excluding patients with dementia. In March, however, Quebec Health Minister Gaétan Barrette announced that a parliamentary commission will consider the merits of allowing patients with dementia to give “advanced consent” to medically assisted death.
Bravo said that that the purpose of the study was not “to vote for or against [the issue]”, and she acknowledged that “the difficulties of applying such a law [i.e. one that permits MAiD for demented patients] cannot be ignored.”
A 40-year-old Michigan woman has been sentenced to seven days jail after disobeying a court order to have her son vaccinated.
Rebecca Bredow, who describes herself as an “educated vaccine-choice mother”, was ordered by Oakland County Circuit Judge Karen McDonald in late September to have her child immunised; she had been taken to court by her ex-husband and the child’s father, James Horne, who told the court that Bredow had reneged on a previous agreement to have the child vaccinated.
Bredow deliberately ignored Judge McDonald’s order to have the child immunised, and was soon back in the County courthouse declaring that, "I would rather sit behind bars standing up for what I believe in, than giving in to something I strongly don't believe in”.
Judge McDonald ordered that parents be given equal custody of the child, and that the boy should be vaccinated while Bredow was in jail.
Bredow has since served her short sentence (she was released after five days, under special Oakland Country Jail rules). “It was the worst five days of my life pretty much,” she told reporters on Wednesday, “except for the fact that I just found out that he was vaccinated and I'm not going to get him back today.”
The Bredow case is the latest of a string of high-profile anti-vaxxer cases in America that have resulted in strong punitive measures against objecting parents.