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|This week in BioEdge|
Like voters everywhere, Americans like healthy leaders. So the reassuring news that their President is "excellent health" was headline news this week. After a three-hour exam with military doctors at the Walter Reed Military Medical Centre, the White House physician, Ronny Jackson, said that it had gone “exceptionally well”. He will give a media briefing on Tuesday.
On the other hand, the news is not surprising. During the 2016 election campaign, Hillary Clinton’s fainting fit at a 9/11 ceremony in New York became another rod for her back, while Trump’s personal doctor declared that he would be "the healthiest individual ever elected to the presidency".
The idea of releasing personal health data raises some interesting bioethical questions. Does a President have a right to medical privacy, like other citizens?
A lot could ride on this. If Mr Trump were deemed unfit to carry out his weighty responsibilities, he could be removed from office under the 25th Amendment to the Constitution.
The “excellent health” which he is said to enjoy presumably covers only his physical health. Trump’s foes find excuses on a weekly basis to question his mental health. This week he allegedly asked at a meeting of US lawmakers “What do we want Haitians here for? Why do we want all these people from Africa here? Why do we want all these people from shithole countries?”
The President denied saying this, although he admitted that he used “strong” words.
The characteristically impulsive and provocative language have stirred some psychiatrists to denounce him as psychologically unstable, possibly in the early stage of dementia, and unfit for office. However, Mr Trump is unlikely appear in any of their consulting rooms for a psych check.
How utilitarian are you? Leading bioethicists at Oxford University, including Julian Savulescu, have published a nine-question survey which allows you to identify whether “You’re not very utilitarian at all.” or whether “You might be Peter Singer”. )Click here to take the survey at the Practical Ethics blog.)
The team at Oxford’s Uehiro Centre developed the survey, which is called “the Oxford Utilitarianism Scale”, in part, to help restore the badly dinted image of utilitarian thinking amongst ordinary people (although the proportion of those who have opinions on utilitarianism tout court is likely to be very small).
The philosophy of Jeremy Bentham and John Stuart Mill has come in for a battering in recent years. It is associated with university assignment about “trolley problems” which involve killing people tied to railway tracks, with psychopaths and Macchiavellian thinking. The Oxford team admits in an article published in the journal Psychological Review that:
Utilitarianism tells us to impartially maximize the aggregate well-being of everyone—and that we must severely harm or even kill innocent people if doing so is needed to achieve this overarching moral ideal.
This seems rather harsh, not to say inhuman, to the protesters at some of Peter Singer’s public lectures. As Savulescu reports, John Paul II’s devastating put-down was: “Utilitarianism is a civilization of production and of use, a civilization of ‘things’ and not of ‘persons,’ a civilization in which persons are used in the same way as things are used.”
However, in recent years, Singer has been promoting another face to utilitarianism: “impartial beneficence”, which leads to “effective altruism”.
In a blog post on Practical Ethics, Savulescu draws upon the traditional language of Christian morality to describe the positive altruistic core at the heart of his philosophy:
There are two other features of utilitarianism that are often neglected. First, it compels us to do as much good as we can in the world—a much more positively oriented aim—while treating each of us in exactly the same way. So when I ask, “What is the right thing for me to do?”, my own wellbeing counts no more (or less) than anyone else’s. So, if I could give a kidney and save someone else’s life without putting my own life at equal or greater risk, I should give a kidney. This is very demanding. And if I do it, admirable—maybe saintly.
An overwhelming majority of registered nurses working in Quebec nursing homes support euthanasia for dementia patients who have left a living will, researchers from Canada and the Netherlands. In an article in the journal Geriatric Nursing.
Euthanasia is legal in Canada, but only for patients who are competent, even if they had expressed a request for “medical aid in dying” in their lucid moments. However, this restriction is under pressure. After a man killed his demented wife, the Quebec Minister of Health and Social Services asked experts to study whether MAiD could be provided for patients with advance directives.
Although only doctors are able to euthanize patients, the researchers point out that “Given their unique experience and expertise, nurses' voice must be taken into account in deciding whether or not to modify the current legislation to give incompetent patients access to MAiD.”
Five hundred and fourteen nurses were surveyed; 219 responded. Of these, “83.5% agreed with the current legislation that allows physicians to administer aid in dying to competent patients who are at the end of life and suffer unbearably. A similar proportion (83%) were in favor of extending medical aid in dying to incompetent patients who are at the terminal stage of Alzheimer disease, show signs of distress, and have made a written request before losing capacity.”
Just as interesting as the nurses’ attitudes towards incompetent patients was their feelings about how they would like to be treated themselves should they become demented. If diagnosed with Alzheimer’s, 79% said that they would make a formal request to die. If a love-ones were diagnosed, 65% would call a doctor to euthanise them (provided they had left a request).
Canada legalised euthanasia and assisted suicide less than two years ago, but already there are complaints that the legislation is not flexible enough and allows faith-based facilities to stymie the intent of the legislation.
In Quebec, the Superior Court will begin hearing a constitutional challenge to the federal law by two patients, Jean Truchon, 49, and Nicole Gladu, 71, who suffer from incurable degenerative diseases.
According to CTV News Montreal, “Both are dependent on others and say they are miserable and want control of their end of lives. [But] Neither qualifies for the act under federal or provincial law, because their deaths are not ‘reasonably foreseeable’ and they are not at the end of their lives.”
They content that eligibility requirements for euthanasia are overly restrictive.
And in British Columbia, a doctor has been accused of sneaking into a nursing home which does not permit euthanasia on its premises in order to euthanase a patient. Louis Brier Nursing Home in Vancouver, a Jewish facility, has protested to the BC College of Physicians and Surgeons about Dr Ellen Wiebe, who has admitted participating in the death of 83-year-old Barry Hyman.
In another case, also in Vancouver, 64-year-old Ian Pope had to move out of St. Paul's Hospital, a Catholic facility, to obtain “medical aid in dying”, also from Dr Wiebe, because the hospital will not allow it on its premises. "I thought it was ridiculous," Mr. Pope's daughter said, "because it's a publicly funded hospital."
The Globe and Mail commented:
Mr. Pope's experience underlines the challenges that patients across the country still face if they end up near the end of their lives in a hospital, nursing home or hospice that objects to assisted dying – a procedure that has now been legal in Canada for more than 18 months.
Women who have sex change surgery to become men should still be able to have babies, according to the British Fertility Society.
Dr James Barrett, lead clinician at the Gender Identity Clinic at Tavistock and Portman NHS Foundation Trust, complains that: “The number of people coming forward with gender dysphoria has increased rapidly over the past decade. But the consistent provision of [National Health Service] funding for fertility preservation for this group is yet to catch up.
“This is medical. It's people whose fertility is impaired as a result of actually NHS mandated treatment for a well-established condition that has been treated by the NHS for the last 50 years.”
Powerful hormone treatment and surgery could make women who are becoming men infertile. This “is a real disease,” says Dr Barrett, “and it is hugely frustrating that the whole NHS is not always able to help our patients with that part of their lives.
Another problem faced by British women who want to become men is that some NHS Trusts use eleigibility criteria for women seeking fertility preservation about weight and age. For IVF, women have to be 23, but it seems that ‘transfolk’ are often younger.
Josephine Quintavalle, from Comment on Reproductive Ethics, told The Telegraph (London): “The cash-strapped NHS should be concentrating on offering good basic healthcare to women or helping them beat their cancer, and not get side-tracked with these kinds of novelties. Egg freezing is an invasive procedure and the outcomes are far from clear.”
Fueled by high demand and high rewards, black-market surrogacy is booming in China, The Times (London) reports. Its source is The Paper, a state-run news website, which carried out a two-month-long investigation.
Agents charge commissioning couples anywhere between US$55,000 and $155,000 for a baby, gender guaranteed. It is also risky, especially if there are problems with the pregnancy or if the baby is disabled.
Everything about the transactions is illegal, from the surrogacy to gender selection. But couples are desperate. IVF is often unavailable. And after the relaxation of the one-child policy, many women want to have a second child, but they are too old. Other have lost an only child and they want to replace him.
And the money is welcomed by poor villagers. The Times reports:
“My little daughter has done it several times. My older daughter just delivered twins for others. My daughter-in-law is now pregnant. I helped her for a few months until she was settled,” a middle-aged woman said. “If you can bring home hundreds of thousands of yuan, which mother-in-law would pick quarrels with her daughter-in-law?”
Residents in one village told undercover journalists that more than 100 local women were working as surrogate mothers. “Sometimes mother-in-law and daughter-in-law are doing it together. One villager would introduce another to the business, just like introducing each other to factory jobs,” one villager said. “They return home with branded bags, and they go out for another [surrogacy] when they spend all the money.”