http://www.bioethicscaribe.org.jm/forum/index.php Sun, 20 May 2012 09:03:22 -0400 Phorum 5.2.15a http://www.bioethicscaribe.org.jm/forum/read.php?2,252,252#msg-252 http://www.bioethicscaribe.org.jm/forum/read.php?2,252,252#msg-252
Sunday, July 10, 2011, 11:31 PM
Wesley J. Smith


My friend H. Tristram Engelhardt was one of the pioneers in the field that came to become to be known as bioethics. Over the years, he has been mining an intellectual vein of analysis that could be called libertarian bioethics, that is (in a nutshell), he believes that with the decline of traditional religion and calls to authority governing our ethics, our moral views have become so pluralistic that no overarching view can prevail throughout society. In such milieu, he believes that ways must be found for conflicting moralities to peacefully co-exist.

He also asserts that this lack of societal unity should induce bioethicists to take a humbler approach to their work than they might have hoped for the field in its formative years. In this regard, E has an article in the current Journal of Medicine and Philosophy, in which he discusses different approaches to morality that are seen in the real world, e.g. religious, Rawls liberalism, Confucian, etc., doing his usual splendid job of explaining different perspectives. Obviously in a blog length post, I can’t do justice to all that E writes, but can only pick out a few cherries.

E discusses how the plurality of views about moral issues materially impacts bioethics. From “Confronting Moral Pluralism in Posttraditional Western Society: Bioethics Reassessed:”

A plurality of moralities produces a plurality of bioethics. Across the world, different persons and groups affirming different bioethics support moral dis-agreement by advancing substantively different views as to what is proper inhealth care and the biomedical sciences (Engelhardt, 2006). For example, a Confucian literature has developed, embracing a bioethics quite different from those dominant in America and Europe (Fan, 2007,2010;Qiu, 2004). Among the differences is the commitment of Confucian bioethics to family consent, rather than to individual patient consent.

True enough. But in the West, while I admittedly don’t know of any polling of bioethicists, I think there is an orthodoxy in the field that does have a predominate approach to morality and bioethical public policy, based on a decidedly politically liberal viewpoint. Oh, people may come to their conclusions from differing philosophical angles, but unless one has a modifier in front of the word “bioethicist”–e.g. “conservative bioethicist,” or “Catholic bioethicist”–professional bioethicists in the West predominately take the liberal line, including with regard to the following issues:

Oppose human exceptionalism, by asserting that the capacities of the individual determine his or her moral value, not membership in the human race, (for example, by embracing the concept of “specieism” or “personhood theory”);
Support a very robust view of abortion rights;
Support government funding of embryonic stem cell research;
Support human cloning research;
Oppose reproductive cloning, not based on moral qualms (again, generally), but primarily safety concerns. Once safe, reproductive cloning would be viewed by most as merely one aspect of a near absolute procreative liberty;
Support legalizing assisted suicide (more mixed here than the right to an abortion);
Support Futile Care Theory or the right to unilaterally stop life-sustaining treatment after some procedural process is first engaged;
Oppose medical conscience clauses that would permit medical personnel to opt out of procedures they find morally objectionable, such as abortion (other than medical futility);
With a few notable exceptions (such as Art Caplan), support redefining death or doing away with the dead donor rule for purposes of organ procurement. Also, support presumed consent with regard to organ donation.
Support explicit health care rationing;

Of course, there are exceptions to these general rules. But I think the above fairly depicts where most of the bioethicists who teach in the major universities in the USA, UK, Australia, Canada, and elsewhere in the West, along with their graduates who work in hospitals, consultancies, government agencies, etc., are coming from. (That said, I do think there is respect for moral views of patients/families in hospital bioethics committees.)

Moreover, bioethics isn’t merely a discourse, if it ever truly was. It is, again in my view, a movement that seeks to persuade society to adopt and apply its views on these and other matters. Not that there is anything wrong with that, but I do grow weary of those who pretend otherwise.

Engelhardt thinks that because there are so many competing moral views, bioethicists should willingly play a more humble role in society than perhaps was hoped at the field’s genesis (as in Joseph Fletcher writing that “we mean business” about establishing “criteria for humanhood” in the first issue of the Hastings Center Report.) E writes:

Academic bioethicists can:(1) Analyze ideas, concepts, and claims cardinal to an understanding of the moral issues raised by health care and the biomedical sciences,(2) Assess the soundness of arguments bearing on these issues, and (3) Provide geographies of different moral and moral–philosophical positions regarding bioethical issues; bioethicists can accomplish the last by showing how, given different initial premises and rules of evidence, different positions support different moral norms and viewpoints, as when bioethicists show that act-utilitarians of a certain sort will affirm as appropriate choices what Kantians will reject.

I have no problem with Engelhardt’s prescription. But I think those currently working in the field will not want to pull back from what I see as their goal of having their way on these difficult moral issues, mostly in terms of public policy, but also with regard to individual outcomes.

Yes, there are certainly different bioethics approaches that may preclude a universal bioethics (although I am not as pessimistic as Englehardt about one based in universal human rights). But as to the West: I think the movement has invested too much time, energy, and brain power into becoming “players” in politics and the public square to willingly take a back seat now.


Comments (59)


59 Comments
Blake
July 11th, 2011 | 6:24 am
“Yes, there are certainly different bioethics approaches that may preclude a universal bioethics (although I am not as pessimistic as Englehardt about one based in universal human rights)”

Well, you know what I think, but I’ll say it anyway.

America – and really the Western world since the Enlightenment – was founded on two self-contradictory pillars: the ideals that lead us to believe in things like “equality” and “self-governance”, and the beliefs that some people are “elite” and are more qualified than others to make the decisions that impact society.

Both ideas come to us directly from the Enlightenment, and ever since the Enlightenment, they have been in conflict. Utopias have not only not worked, but have been nightmare-scenarios filled with violence and conspicuous human rights violations. Imperialism and slavery got bigger and more vicious after the point where we embraced the ideal of “self-governance”.

This is what the whole idea of civil rights is all about: using the legitimacy of truth as a shield against cognitive dissonance, double standards, and justifications.

Will we as a people choose ethics, or will we choose cognitive dissonance, double standards, and justifications? We’re all of us voting right now, with our actions and our beliefs, with what we will put up with and what we will forgive, and what we will or won’t go along with.

Sooner or later we’ll either accept ethical progress or we’ll die. The question is whether we need to bring down another of history’s great terrors on our own heads before we see that ethics really does matter, and really can’t be treated as relative, optional, elective, or “one for me, another for you”.

[Reply]

Robert
July 11th, 2011 | 6:58 am
The “liberal” position sounds like facism to me, but I wonder if E’s libertarian approach
is robust enough to mount a solid defense.

Robert at bioethike.com

[Reply]


HCM
Reply:
July 11th, 2011 at 12:00 pm

@Robert, Actually, fascism is religious in nature. Ever hear of paternalistic tyranny?

I’m currently trudging through Liberal Fascism by Jonah Goldberg.

[Reply]

Joe DeVet
July 11th, 2011 | 8:33 am
I’m gonna cast a vote for the work of Dr John Haas and the National Catholic Bioethics Center which he heads.

No other source I know of has such clear and principled analyses based on the one criterion which should be at the heart of any bioethics worth considering: the dignity of the human person.

[Reply]

HCM
July 11th, 2011 | 9:20 am
The sooner we get rid of society’s religious baggage, the better.

Christianity encourages the following:

- Irresponsibility (god punishes innocent Jesus for everyone else’s sins)
- Cop-outs (a temporary sacrifice is not a sacrifice).
- A hypocritical, nonsensical differentiation between “causing death,” “hastening death” and “letting people die.” The result is the same in all three cases.
- A complete ignorance of the scientific method (e.g. contraception in Africa).
- Glorification of suffering (Mother Teresa and “suffering with” people).

Religious approaches to bioethics end up causing more suffering than any other approach.

[Reply]


holyterror
Reply:
July 11th, 2011 at 3:12 pm

@HCM, LOL.

The “nonsensical” differentiations in ethical considerations of medical care (or non-care) are only that if you do not know how to think very clearly. The “end result” for every single one of us is the same: We all shall die.

Will we die on the side of the road, “hastened” to our death by an inattentive driver who clipped us as we changed a tire? Will we die at the hands of a gangbanger who “caused” our death to fulfill an initiation requirement into his crew? Will we be “allowed to die” by EMTs who find us passed out in a filthy apartment, suffering from dementia and forgotten by everybody?

HCM, you really have to reach for reasons to dismiss the distinctions that some religious bioethicists make in attempting to lay out moral actions. You really have to start with the premise that religion is stupid. Which, if you do, that is fine. But you can’t honestly claim that you are offering a rational argument. You are just casting about insults.

Eventually, the result of life is always the same, yes, for every one of us. It is always physical death. But then, what? What will we have left behind? An increase in goodness and compassion? Or an increase in apathy and despair? I’d say that a failure to truly consider the consequences of one action over another will always lead to the latter. (No religious language needed there, to see it.)

[Reply]


holyterror
Reply:
July 11th, 2011 at 3:14 pm

@holyterror, (The rest of your statements are utter miscontruals of religious thought and not appropriate to the blog ,I don’t think. And probably not worth the attempt to change your understanding of, but feel free to ask Wesley for my email if you want to get into it with me.)

[Reply]


HCM
Reply:
July 11th, 2011 at 6:34 pm

@holyterror, So you’ll violate free will (a religious concept, not in the bible) to preserve the “sanctity” of life?

Funny how you want to choose to die naturally, but not allow others the right to choose to die painlessly and quickly.

[Reply]


holyterror
Reply:
July 11th, 2011 at 7:40 pm

@HCM, Er, I can’t follow your straw man here. Could you be more specific which one?

[Reply]


holyterror
Reply:
July 11th, 2011 at 8:48 pm

@holyterror, OK after reading your post below, I think I am cluing in to your crusade. Are we talking religious opposition to assisted suicide?

Listen, I am resisting the temptation to do a religion 101 with you. If you care that you know don’t seem to know anything about real religious thought, feel free to email me.

In case you are confused on the law, I remind you that *all* laws curb free will in some way. We acknowledge that all people are in essence free to choose but there are some things that society will, for one reason or another –hopefully really good ones — NOT allow to go unpunished and, by threatening punishment, hopefully communicate the disapproval of such choices and even stop some from making them. NOT a curb on free will (eg, you are free to hang yourself; there is no eye of Big Brother watching you to keep you from it if you begin), but society around you has sufficient concerns about such an act that there are laws ans social expectations to discourage it.

(But I think you are aware of all this. I still say you have just decided to pick a fight with Religion, the straw man you have in your mind who is the perfect scapegoat for the ritual and philosophical system that you practice.)

In answer to the rest of your post, I guess it depends on what you call “dying naturally.” I would much rather be beheaded by a crusading pagan than die from breast cancer. The first is much less of a natural death. But as of yet harder to come by. Sigh.

[Reply]


HistoryWriter
Reply:
July 12th, 2011 at 1:33 pm

@holyterror,

“You really have to start with the premise that religion is stupid.”

NOW we’re finally getting somewhere.

[Reply]


Avdotya
Reply:
July 11th, 2011 at 9:42 pm

@HCM, True story. Some 20 years ago two friends of mine were working in Nepal and got word that Mother Theresa was in one of her clinics (one was reluctant as he is a staunch anti-theist while she is Catholic). As they were walking in there stood Mother Theresa and she was furious (it’s worth mentioning that it was not announced and hence was not a staged or public event). Apparently she was enraged that money had been spent on making a reception area, complete with a desk, rugs and chairs (described to me as very simple furniture at that). She was telling some of the workers to get rid of them because every penny spent on decoration, every space needlessly used up, was one less bed to help heal a child, one less bed to let the poor die with dignity etc.

This is what it means to “suffer” with the poor. Human beings, not religion, bear both the ability to make men suffer, and to mitigate their suffering through love and care — two principles that extend from religious moral teachings. Deny religion its worthy place in our history, and you deny your own humanity.

[Reply]

JustChris
July 11th, 2011 | 10:18 am
HCM,

I’d be really interested to see your opinion of the world you so desperately want and have such religious zeal in demanding we convert to after having to live in it for 10 years.

[Reply]


HCM
Reply:
July 11th, 2011 at 4:11 pm

@JustChris, A world without legal torture and without terminal sedation without consent is a world I think even you would wish to reside in.

[Reply]


holyterror
Reply:
July 11th, 2011 at 7:41 pm

@HCM, Wait– did you just cast your vote for terminal sedation with no consent?

[Reply]


HCM
Reply:
July 12th, 2011 at 11:39 am

@holyterror, Certainly not. Terminal sedation should never be permitted without patient consent.

Unfortunately, in Australia and some other jurisdictions, it’s easy to dope the patient up on morphine without consent.

This makes it easy to make a murder look like an accident.

[Reply]

Dblade
July 11th, 2011 | 10:44 am
Yeah, as opposed to say a utillitarian approach which promotes euthanasia as a cost-saving measure, or even worse, a population control one.

We tried the whole post-religious approach to bio-ethics with the whole concept of pro-choice. We’ve wound up with near demographic collapse, skewed sex ratios, and first children at age 35+. Religion acts as a bulwark against the worst excesses of secularism by resisting it. Without it, you are at the mercy of the technician and the bureaucrat, and I think we all know how tender those mercies are.

[Reply]


HCM
Reply:
July 11th, 2011 at 2:08 pm

@Dblade, What’s wrong with responsible family sizes and responsible family planning?

You make it sound like everyone over 35 who doesn’t have at least 3 kids is a selfish [jerk--watch your language, please HCM].

[Reply]


Dblade
Reply:
July 11th, 2011 at 4:32 pm

@HCM,
Having a kid out of bioclock panic at 35 isn’t responsible planning. People aren’t being responsible at all, they are just relying on magic bullets while expecting to be able to suddenly have children on demand.

And honestly, I think if we as a society were all to have 3 kids at 35, we might find ourselves tolerating a lot less of the abuses capitalism likes to throw at us. “Responsible family planning” shouldn’t really mean “give the best years of your life to some crappy web start-up because it’s more important than kids.”

[Reply]


HCM
Reply:
July 11th, 2011 at 5:51 pm

@Dblade, Having children at all in this day and age of over 7 billion humans is selfish, irresponsible and egotistical in the extreme.

Yet another reason to discard religious ethics – they only advocate caring for one’s own in-group.

Do you also believe in converting poor people before feeding them?

[Reply]


holyterror
Reply:
July 11th, 2011 at 3:55 pm

@Dblade, Eh, DBlade, don’t let HCM shift the discussion on you. He is doing a bait-and-switch with the family-size thing.

Note also the fuzzy, yet value-laden, language of secular moralizers: “responsible”

[Reply]


HCM
Reply:
July 11th, 2011 at 5:50 pm

@holyterror, Oh, so you think putting 33 million people into permanent comas until palliative care is perfected (which still hasn’t happened) is acceptable?

You disgust me.

Anyone who takes that attitude, or believes that “suffering with” someone is compassion does not deserve to be working in the healthcare sector.

Period. It’s defeatist and callous at best.

[Reply]


holyterror
Reply:
July 11th, 2011 at 8:14 pm

@HCM, OK, I seriously underestimated the level of nasty feelings you have about this. For that, I am sorry for seeming so dismissive. But I truly am not sure against whom you are arguing. And I am not sure what topic we are discussing, except I have an inkling that it relates to assisted suicide and euthanasia?

Above, I called you out for tearing down philosophical inquiry into the nature of action and inaction regarding the death of another person. You were speaking out of your previously-formed prejudices about it.

If you actually want to discuss it, then fine. But, look, seriously, you just jumped in here on the attack and have been trying to steer the conversation into your attack since.
(Is that the definition of trolling? I really haven’t figured out what it means yet other than a word to call people that you don’t like. Help me, somebody.)

[Reply]


HistoryWriter
Reply:
July 12th, 2011 at 1:39 pm

@holyterror,

Didn’t you know? A troll is someone who disagrees with Wesley.

HW

[Reply]


Wesley J. Smith
Reply:
July 12th, 2011 at 2:03 pm

No, a troll is someone here to primarily rattle the cages and to taunt those to whom he feels morally superior. He is not really intersted in exchanging views. In particular the smuigness is unearned. Example: Raven isn’t a troll. Too often, you are.

[Reply]


holyterror
Reply:
July 11th, 2011 at 8:58 pm

@HCM, Also, even though I still have no idea what the heck you are talking about, I remind you that anyone who thinks suffering is *avoidable* is completely freaking deluded, and possible dangerous.

This does not mean we can’t have a civilized conversation about the extent of suffering and what measures can be ethically taken to alleviate it while maintaining respect for persons. That is, if you are able.

[Reply]


HCM
Reply:
July 11th, 2011 at 11:16 pm

@holyterror Thank you. I accept your understanding.

I am indignant because pro-lifers continually and repeatedly insist that there is some profound Rubicon between assisted suicide and terminal/palliative sedation.

The law in Australia, as it stands, allows nurses and doctors to perform terminal sedation without patient consent.

And because that’s the law, it’s easy to cover up murders as “palliation.”

And isn’t terminal sedation an attempt to evade all suffering? Or am I still missing something here?

[Reply]


holyterror
Reply:
July 12th, 2011 at 2:28 pm

@HCM, HCM, I think you are hitting on exactly *why* terminal sedation is considered immoral by many ethical philosophers– including in my own religion. I do not think that the distinction is a good one and I am not sure why you think religion makes it, saying one is ok and the other is not. Could you give me examples?

RE: Suffering: Any philosophy or ethics based on doing whatever it takes to prevent or avoid suffering is as out-to-lunch as one based on alien overlords returning to take us all back to the homeland. It is compeltely out of synch with reality and can ultimately really result in a lot of misery and a good number of people dead by their own hand (or that of a kindly helper, if they balk at the last minute.)

[Reply]

Blake
July 12th, 2011 | 6:12 am
The sooner we get rid of society’s religious baggage, the better.

Unfortunately, there is no way to “get rid of society’s religious baggage”. The idea that humanism is somehow “different” from other beliefs – because they are “myth”, whereas humanism is “the truth” – is a belief that contradicts itself: it is irrational, requires a leap of faith, and looks like superstition from the “outside”.

But, hey, maybe when your religion grows up, it will apologize for its Inquisitions, crusades, and zealot-based bloodshed, and maybe you’ll learn how to co-exist (as opposed to simply demanding everyone else learn to co-exist with you….)

I am indignant because pro-lifers continually and repeatedly insist that there is some profound Rubicon between assisted suicide and terminal/palliative sedation.

Did you ever come up with answers to the questions I keep asking?

How do you propose establishing the line between suicides – and deaths in general – that should be encouraged, vs. those that should be opposed?

How come you never answer?

[Reply]


HCM
Reply:
July 12th, 2011 at 12:38 pm

@Blake,

Humanism isn’t based on paranoid or power-hungry superstition. Humanism is based on respect for people as individuals, and also their right to make choices, and have free will.

As for your other point, I have answered. More than once, in fact.

Informed consent and unrelievable suffering are my criteria. I suggest you research the difference between transient and clinical depression.

[Reply]


Blake
Reply:
July 12th, 2011 at 2:30 pm

@HCM,

As for your other point, I have answered. More than once, in fact.

Informed consent and unrelievable suffering are my criteria

So your answer to the problem of what constitutes informed consent is … informed consent?

You’ll just decide which types of consent are and are not informed? You can just tell that this person is capable of consenting, but that one over there isn’t, and requires intervention?

And your answer to the problem of having to use value judgments to determine which types of suffering should be ruled “this person’s life is worthless” is … to use your own judgment?

You have dodged the question entirely.

You do seem to be suggesting that you want to hand the power of life and death over to psychiatrists and psychologists….men and women who claim the power of science but really use a process that has virtually no science in it – one that relies almost exclusively on voting, committee decisions, and politics – to determine categories that are subjective, involving moral judgments couched in the language of science.

Psychologists and psychiatrists can’t even do better than a dartboard at saving a troubled marriage, and you want them to be in charge of deciding which categories of people will be deemed expendable?

The facts on psychologists and psychiatrists don’t really suggest they are reliable, or can be counted on to have anything resembling “judgment”.

I reject psychologists or psychiatrists as a source of authority. Maybe if their “science” ever becomes reliable enough to be useful, that will change. But for right now, they are simply not trustworthy, and can’t be counted on to take care of their own patients, or to even show a reasonable degree of concern for the responsibilities they’ve already got.

[Reply]


HCM
Reply:
July 12th, 2011 at 3:13 pm

@Blake, Blake, do you give informed consent when you choose what foods constitute your diet? Of course you do.

The same applies when dealing with medical treatment and end-of-life issues (including assisted dying).

[Reply]


Blake
Reply:
July 13th, 2011 at 9:50 am

@HCM,

@Blake, Blake, do you give informed consent when you choose what foods constitute your diet? Of course you do.

The same applies when dealing with medical treatment and end-of-life issues (including assisted dying).

Oh, so you’re saying we shouldn’t intervene in anyone’s suicide.

Or any other situation where there might be a question whether a person is or is not “in their right mind”.

The ability to communicate = the ability to consent, in your view?

[Reply]

Blake
July 12th, 2011 | 6:20 am
Anyone who takes that attitude, or believes that “suffering with” someone is compassion does not deserve to be working in the healthcare sector.

Yes, we absolutely prefer health care workers who can decide for themselves which patients would be better off dead.

[Reply]


HCM
Reply:
July 12th, 2011 at 11:46 am

@Blake, So the patient gets no say as to when, where and how to die?

[That's disgusting. HCM: Let's not get too personal. It solves nothing and persuades no one. Thanks.]

[Reply]


HCM
Reply:
July 12th, 2011 at 3:12 pm

@HCM, My apologies, Wesley.

But under the current system of end-of-life choices, doctors and nurses have more say than the individual patients themselves.

[Reply]


Blake
Reply:
July 14th, 2011 at 6:57 am

@HCM,

But under the current system of end-of-life choices, doctors and nurses have more say than the individual patients themselves.

What a peculiarly humanist belief – that a patient should have the right to decide when he dies.

[Reply]

Blake
July 12th, 2011 | 2:16 pm
Humanism isn’t based on paranoid or power-hungry superstition.

The belief that man can and should control nature – despite all evidence demonstrating that this is impossible, involves denial and cognitive dissonance, and results in immense destruction – is the opposite of “paranoid”; it involves delusions of grandeur.

But humanists are, as a group, as paranoid as anything produced by any religion. Their superstitions are every bit as ridiculous to ‘outsiders’ as anything from fifth-century Christianity.

[Reply]


Wesley J. Smith
Reply:
July 12th, 2011 at 2:27 pm

What’s more, humanism is mutating into anti humanism.

[Reply]

HCM
July 12th, 2011 | 6:41 pm
I just read an excellent, elucidating, erudite article about death, dying and how callous religious leaders can be (minor coarse language):

[12tuesday.com]

“An older priest approached the podium and gave a sad tale about a minister who had lost a child in a car accident. The catalyst in the story is when a guest visited the minister’s house and said she didn’t understand what kind of god would take a child so suddenly, so unexpectedly, and at such a young age. The minister in the story became furious and declared that, when someone passes, God is the first to grieve.”

[Reply]

Blake
July 13th, 2011 | 9:28 am
how callous religious leaders can be

As opposed to atheist leaders, who are always exquisitely sensitive to the needs of others (especially those who challenge their beliefs).

I hope you get over the anger at God. I was angry for many years because of something insensitive a church person said at the death of someone I loved very dearly, when I was a teenager. But that church person is not God – in fact, there is no promise at all that all church people will be good and loving and kind. Many church people try to be, but fail. Others are only at church for show.

[Reply]


HCM
Reply:
July 14th, 2011 at 12:50 am

@Blake, [HCM: Too vituperative.]

[Reply]

Blake
July 13th, 2011 | 9:48 am
- Irresponsibility (god punishes innocent Jesus for everyone else’s sins)
- Cop-outs (a temporary sacrifice is not a sacrifice).
- A hypocritical, nonsensical differentiation between “causing death,” “hastening death” and “letting people die.” The result is the same in all three cases.
- A complete ignorance of the scientific method (e.g. contraception in Africa).
- Glorification of suffering (Mother Teresa and “suffering with” people).

Let’s go over this.

1. Irresponsibility (god punishes innocent Jesus for everyone else’s sins)

You don’t understand what’s going on here. Try reading Erotism: Death and Sensuality for a more sophisticated level of discussion re: scapegoating.

Or go and read both Greek tragedy (Aeschylus) and Norse sagas, until you come to the part where the blood feuds start escalating out of control. The ancient Greeks “solved” the problem through Athena simply passing judgment, which everyone accepted, and turning the Furies into happy little benevolent creatures. The Norse, on the other hand, got a more satisfying ending to their blood feud problem: a voluntary scapegoat – someone who was willing to be the one to accept the injustice, so that the downward spiral could be broken.

Cop-outs (a temporary sacrifice is not a sacrifice).

Again, you are setting Christian beliefs against humanist assumptions. If there is no God, and all the things the humanists believe is true, then this statement might make sense – except that, even then, under those circumstances, Christianity calls for everyone to live according to the same set of rules, following both the teachings and the example of Jesus. So in that sense, it’s not a temporary sacrifice. It calls us all to not only remember Jesus’ sacrifice, but also to do as he did – to be the one who will accept the injustice, so that what could spiral into something ugly can instead end.

Recent scientific studies have confirmed that forgiveness and “letting things go” can in fact be a healthier lifestyle than the endless pursuit of “justice”. It is an interesting thing I have noticed that Christians believe in rules, but also teach that one must forgive those who lapse, whereas humanist profess to believe in no rules, but are very intolerant and unforgiving of those who don’t obey those rules-that-supposedly-don’t-exist.

- A hypocritical, nonsensical differentiation between “causing death,” “hastening death” and “letting people die.” The result is the same in all three cases.

Humanists seem to have extreme difficulty with and a tendency to confuse the concept of active vs. passive verbs. But there is a difference, and it is significant.

- A complete ignorance of the scientific method (e.g. contraception in Africa).

The problem here is not “complete ignorance”. The problem here is that your mental model overestimates the lives that will supposedly be saved or improved through the use of contraception in Africa, while you minimize or completely deny that contraception has any negative impact.

The Church, on the other hand, has a different mental model – one that is more aware of the negative consequences of contraception.

If contraceptives were as harmless and as effective as your mental model assumes, we wouldn’t have any more social problems here in the USA. We have been teaching sex ed and distributing condoms for decades, but the rates of unintended pregnancy and disease are not lower than before we started doing this.

So it cannot be assumed that your way is self-evidently right and the Church’s way is obviously ignorant. It is not “obvious”.

- Glorification of suffering (Mother Teresa and “suffering with” people).

Humanism glorifies pleasure, while Christianity calls us to remember suffering.

You might argue that the Church “glorifies” suffering, but I don’t know what that means – I have not seen it personally. What I have seen is that the church wants us to enjoy our pleasure when it is time for pleasure, but also to experience the other aspects of life in their time and place as well.

For me, the results in my own life have been paradoxical: the attempt to chase pleasure leads to suffering, while the attempt to not focus on my own selfish pleasure has lead to greater enjoyment of life.

There are many reasons why this is so. I believe it can ultimately be described simply by saying the Christian prescription for how to live (and/or my interpretation of it) comes closer to the way we were meant to live.

The pursuit of pleasure taken to excess is a destructive force. It delivers diminishing returns, exacerbates conflict, hurts loved ones, and sets up unrealistic expectations.

It leads us to seek to control that which is not ours to control, and as we focus on trying to force our life to be what it isn’t, we skip past and fail to find the joy in that which our life is.

[Reply]


HCM
Reply:
July 14th, 2011 at 12:58 am

@Blake, 1. So we should punish an innocent human being (Jesus) to let everyone else off the hook? That is the polar opposite of justice. It’s ludicrous. It’s inhumane. And it’s evil.

2. The “rules” you follow are based on fiat. “Do this, or burn forever.” That’s blackmail, period.

3. Do you also agree that refusing life support for neonatal babies is OK? Because that’s what you seem to be implying. “We can let people die from want of treatment, but we can’t grant them a painless death.”

Ridiculous.

4. Wow. Do you really think telling kids not to have sex is going to work? No, it’s not, and you have yourselves to blame for it. The only thing resulting in high rates of STDs and abortion is abstinence-only “education.”

5. What’s wrong with pleasure in moderation? It’s certainly better than doing nothing but spout platitudes to those dying (‘Jesus is embracing you in love!’).

If the whole world believed that “suffering with” someone was good enough, we wouldn’t even have aspirin in the world today.

[Reply]

Blake
July 14th, 2011 | 6:48 am
If the whole world believed that “suffering with” someone was good enough, we wouldn’t even have aspirin in the world today.

Go tell that to the people who run all those Catholic hospitals.

[Reply]

Blake
July 14th, 2011 | 6:50 am
2. The “rules” you follow are based on fiat. “Do this, or burn forever.” That’s blackmail, period.

I don’t know what religion you’re talking about, but that’s not what my church teaches.

It’s more like this:

Imagine that someone creates a world for you and puts you in it.

They love you, so they make the world nice. They give you a boat to sail, or a mountain to climb, or a car to drive.

All you have to do is take what is offered, and you will be happy. But you want to have your own way, so you try to sail your boat against the wind, and end up capsizing it. You end up trying to defy the laws of gravity, and end up hurt. You drive the car the wrong way, and end up causing a huge pile-up.

Now whose fault is it that you chose to do that? “It’s God’s, because he should have made the world in a way that I could have every thing I wanted, in the way I wanted, when I wanted!”

Now stamp your little feetsies when you say that.

[Reply]


HCM
Reply:
July 14th, 2011 at 7:39 pm

@Blake, No, your god created two people, Adam and Eve, without even the knowledge of good and evil.

So they couldn’t know that god was good and Satan was evil, could they?

[Reply]

Blake
July 14th, 2011 | 6:57 am
4. Wow. Do you really think telling kids not to have sex is going to work? No, it’s not

Actually, some abstinence-only programs do work.

Sorry to burst your bubble – I know the MSM goes out of its way to try to reinforce the weird idea that somehow all that sex education we’re doing is “working” (??).

But it turns out that abstinence-only education can work even in this culture that openly glorifies premature sexualization of children, and openly mocks parents and others who resist or object. The key appears to be motive: an abstinence-only education that is primarily religious won’t work, but an abstinence-only education that focuses on what kids really care about comes up with very different results.

See, the problem with your little deceit is that you’re lying when you say sex ed is “just about telling kids the truth”. It is a heavily edited truth. The real truth is, sex really isn’t “fun” for a lot of kids. It’s not “fun” to be pressured into something you’re not ready for. It’s not “fun” to feel you have to do this – even though you’re scared or you’re not sure your partner is the right one – because you’re afraid your partner won’t love you, or you’ll look immature and unsophisticated, or any of the real reasons girls get into relationships at a too-young age.

It’s not “fun” to be afraid that photos of your naked body might end up on everyone’s cel phone.

It’s not “fun” to be terrified of diseases, or to be afraid that you might have gotten pregnant.

What’s so “fun” about sex? Well, it depends on why you do it, how you do it, who does it with you, and so on.

All of that – and more – is information that has to be left out of traditional pro-sex “sex ed”, because the truth interferes with your agenda.

The truth is, the only thing that enables so many humanists to successfully persuade other peoples’ kids that it’s normal, natural, healthy, safe, and fun to be promiscuous at the age of 12, is that humanists have done a good job painting religious people as uncool, and kids at the age where they naturally need to “differentiate” themselves and their identity from their parents’ are very responsive to that message.

It isn’t that they really want sex. It’s that you really want them to have sex.

[Reply]


HCM
Reply:
July 14th, 2011 at 6:36 pm

@Blake, I would really like to see some sources that show a reduction in teen pregnancy and STDs after abstinence-only education was instigated. Please, enlighten me.

And yes, sexting is a violation of privacy. That doesn’t mean 15-year-olds should be thrown into prison for taking erotic photos of each other and sending them to each other.

[Reply]

Blake
July 14th, 2011 | 7:09 am
1. So we should punish an innocent human being (Jesus) to let everyone else off the hook? That is the polar opposite of justice. It’s ludicrous. It’s inhumane. And it’s evil.

Just like saying an ape turns into a man obviously makes no sense…if you take one aspect of a thing and pull it out of context, it’s not going to make any sense. Not because it’s nonsensical, but because pulling something out of its context guarantees ignorance.

You need the whole history of the Covenant in order to evaluate whether or not it’s “inhumane” or “evil”.

[Reply]


HCM
Reply:
July 14th, 2011 at 5:58 pm

@Blake, Then, pray tell, what is this whole context that justifies human torture and sacrifice?

[Reply]

Thomas Aquinas
July 14th, 2011 | 6:52 pm
“So we should punish an innocent human being (Jesus) to let everyone else off the hook? That is the polar opposite of justice. It’s ludicrous. It’s inhumane. And it’s evil.”

He gave his life willingly out of love. That is the Christian position. Just as an innocent person steps in front a child to take a bullet from a criminal, Jesus died in our stead. “No greater love than this than one who gives his life for a friend.”

Perhaps it is time to read the theology you loathe.

[Reply]


HCM
Reply:
July 14th, 2011 at 7:45 pm

@Thomas Aquinas, So what? It’s not a real sacrifice if it’s temporary.

Jesus is still the co-ruler of the universe. That’s no sacrifice.

If I could die and be resurrected, I’d do it in a heartbeat.

[Reply]


HCM
Reply:
July 14th, 2011 at 9:01 pm

@Thomas Aquinas, Also, if he gave his life willingly, he committed suicide. That’s what suicide is (killing one’s own self).

The fact that other people nailed him to a cross doesn’t change things in the least. Suicide by cop is still suicide.

[Reply]

Blake
July 15th, 2011 | 5:20 am
@Blake, Then, pray tell, what is this whole context that justifies human torture and sacrifice?

If you ever decide to stop trolling, go talk to religious people until you find one who ‘feels right’ to you,and ask your questions with sincerity.

You will get the answer you need when you are ready for it.

[Reply]


HCM
Reply:
July 15th, 2011 at 10:16 am

@Blake, Oh, please.

If you’re going to dismiss the torture and cruelty (not to mention genocide) depicted in the OT as the “justified will of God,” then the least you can do is give us a real reason, rather than simply spouting platitudes like “trust god” or “listen to Ravi Zacharias.”

[Reply]

Blake
July 15th, 2011 | 2:36 pm
Oh, please.

If you’re going to dismiss the torture and cruelty (not to mention genocide) depicted in the OT as the “justified will of God,” then the least you can do is give us a real reason, rather than simply spouting platitudes like “trust god” or “listen to Ravi Zacharias.”

As I said, if you ever get sincere, it’s not like you’re the first ever Clever Atheist to notice that some things in the Bible don’t make sense to atheist sensibilities.

All those questions are already addressed, and are readily available, as soon as you feel like doing the work.

[Reply]


HCM
Reply:
July 17th, 2011 at 2:36 pm

@Blake, That’s a dodge/cop-out all in one.

When you rely on faith, you abandon empiricism, and you use a system (religion and fiat) that has caused more death and suffering than any other.

When you blame the African AIDS crisis and overpopulation on “lack of self-control,” you have abandoned, utterly, any moral ground you had to stand on.

If you want gay children and teenagers to commit suicide, then Utah would be your cup of tea.

Here’s the per-capita suicide rate for Utah vs. other states and countries:

[www.suicide.org] (Utah is 9th, but this is for all suicides, not specifically youth suicides)

[www.spottedeagle.com]

[www.sltrib.com]

Don’t forget that this only include obvious suicides – most police will rule it as a homicide if there is no note, or as an accident if it’s a car crash, etc.

[Reply]

Ianthe
July 18th, 2011 | 3:04 pm
I call the very existence — and the very notion — of “bioethics” immoral — and it wouldn’t exist if there weren’t too many people who aren’t even good enough to work with their hands who think that they are too good for that kind of thing but entitled to make a good living even though they aren’t fit to make a living with their minds. In other words, too little civilization. Bioethics — what a travesty. People who have ethics don’t discuss ethics, any more than it’s polite to talk about money or talk about or do a lot of other things that are rife today in the same world in which “bioethics” is. SHEESH! It’s like entering conversation with a salesperson — the battle is lost as soon as it starts. The unconscionable is happens now at the same time it’s become a matter of discussion. It shouldn’t be, there shouldn’t be any discussion about it, and the people who don’t deserve the sustenance of life are taking it away from those who do and getting paid to do it. Condemn “bioethics,” don’t participate in the “field”!

[Reply]


Leave a Comment
Name (required)

Mail (will not be published) (required)

Website

Comment (All comments are held for moderation.)]]> daarons BSEC Public Forum Wed, 27 Jul 2011 08:43:29 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,249,249#msg-249 http://www.bioethicscaribe.org.jm/forum/read.php?2,249,249#msg-249 by Jared Yee | 14 May 2011

tags: Germany, stem cells

In a case which is a veritable cocktail of bioethical issues, Europe’s biggest stem cell clinic has been shut down. The controversial practices of the XCell-Center in Düsseldorf, currently at the heart of a scandal over the death of a baby after a brain injection, were exposed by an undercover investigation from the London Sunday Telegraph. The clinic had been charging patients up to more than US$30,000 for stem cell injections into the brain and back despite a lack of scientific proof that the treatments actually worked.

Stem cell research experts had accused XCell of exploiting vulnerable patients who desperately sought cures for illnesses and diseases such as Parkinson’s, cerebral palsy, multiple sclerosis, autism and spinal cord injuries. Most other European countries – as well as the US, Canada and Australia – have outlawed stem cell treatments unless shown to be effective and safe. XCell had exploited a loophole in German legislation allowing it to charge for the experimental treatments.

In the past fortnight, however, XCell announced suddenly that it had stopped carrying out operations because of what it called legal changes in Germany. A posting on its website in the last two weeks declared:

“Due to a new development in German law, stem cell therapy is currently not possible to perform at the XCell-Center. Regretfullyfor this reason, we must cancel your appointment until further notice. We will notify you for further updates about the matter.”

The clinic had come under intensifying scrutiny after the death of an 18-month-old Romanian boy last August. Three months before, a 10-year-old Azerbaijani boy almost died after a similar procedure. Criminal charges may be laid against the doctor.

Ira Hermann, who manages the German stem cell network which funds scientific research projects, said: “XCell was offering unproven treatments and taking a lot of money from very vulnerable people.” Professor Chris Mason, of the University College London, said: “This is excellent news for the European cell therapy industry. XCell had failed to demonstrate itstreatments were either safe and effective or had scientific rationale.” ~ London Telegraph, May 8



Follow the discussion
Comment (1)

Brenda Grabast · 1 day ago
This really irritates me. I have SEEN with my own eyes the success that the XCell Center had on 5 children. Before and after videos, and meeting the children in person. To say there is no scientific rationale, well, is just plain jibberish. Unless these children, that went to the same place, for the same procedure, all suddenly were miraculously blessed with abilities they have never had before, isn't proof enough, then prove how the human race came to be. Prove that! Actual proof! You can't do it. Some things have to be relied on by pure faith. And to strip these families with handicapped children of that hope, is morally wrong. At least with this proceudre, there was hope. Now, there is none.
Report]]> daarons BSEC Public Forum Tue, 17 May 2011 11:24:30 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,248,248#msg-248 http://www.bioethicscaribe.org.jm/forum/read.php?2,248,248#msg-248
Doctors Loath to Pay for Unbiased Education: Survey

By Frederik Joelving


NEW YORK (Reuters Health) May 09 -

While doctors believe industry funding may bias their continuing medical education, they are unwilling to pay for impartial information, a new survey finds.

Drugmakers and medical device companies sponsor up to 60% of the billion-dollar CME industry, stoking widespread worries that financial interests might be warping the way doctors treat their patients.

"It's definitely a concern," said Dr. Jeffrey Tabas, an emergency physician at the University of California, San Francisco, who also helps oversee the university's CME. "This is what we are doing to maintain our lifetime learning and improve our practice."

While some institutions have already taken steps to remove themselves from commercial influences, both UCSF and many others remain dependent on industry money.

Little is known about what individual physicians think about this relationship, so Dr. Tabas and his team decided to survey attendees at five CME courses delivered by the International AIDS Society-USA, which also receives industry funding.

They found 88% of 770 doctors who answered their questionnaire believed commercial support could bias CME presentations.

Less than half thought paying higher registration fees for CME activities would make sense, however, and only 15% would like to see industry funding completely removed.

According the report, published online today in the Archives of Internal Medicine, physicians spend an estimated $1,400 a year on CME. That would climb to $3,500 without support from pharmaceutical companies and device makers.

Although it's not clear from the survey, Dr. Tabas said most physicians probably believe the extent of industry bias is fairly limited.

"Because they feel in general there is not a lot of bias, they are not willing to pay to reduce it," he told Reuters Health.

Another possibility, he said, is that they think they themselves are immune to such bias, while their colleagues are not.

"We need new models of funding CME that minimize conflicts," Dr. Tabas said. "The best approach at this point is to create barriers between the money and the delivery."

Such barriers could include making sure industry money isn't earmarked for specific purposes, such as lectures about a particular drug. But Dr. Tabas acknowledged that might make companies more reluctant to pick up the considerable tab for CME.

He said he was especially worried about support to individual faculty members, who may receive CME credits for joining a company's speakers' bureau. This practice was eliminated last year at UCSF.

Other institutions have taken more radical steps and now don't accept any industry funding for their CME. But an editorial on the findings say eliminating commercial sponsorship across the board is impossible.

"Most do not want to see it eliminated, presumably because of the resulting increased costs for registration," Dr. Todd Dorman of Johns Hopkins University in Baltimore and Dr. Ivan Silver of the University of Toronto write.

"For large groups, reducing costs and maintaining separation between commercial CME funders and providers seem essential," they add.

SOURCE: [bit.ly]

Arch Intern Med 2011.]]> daarons BSEC Public Forum Wed, 11 May 2011 07:44:12 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,247,247#msg-247 http://www.bioethicscaribe.org.jm/forum/read.php?2,247,247#msg-247
An Abertay University academic has branded homeopathy "ethically unacceptable" and called for it to be rejected by healthcare professionals.

By Grant Smith
Published in the Courier : 09.05.11


Dr Kevin Smith, who is a senior lecturer specialising in genetics and bioethics, has said the NHS should not spend £4 million a year supporting homeopathy, which involves treating patients with highly diluted substances.

There is a homeopathic hospital in Glasgow, one of four in Britain.

Writing in the journal Bioethics, Dr Smith said scarce NHS resources should not be allocated to them.

He said, "Homeopathic preparations are so diluted that they contain no significant amounts of active ingredients, and thus can have no effect on the patient's body.

"Those who believe it works either do not understand the science or are simply deluded.

"Homeopathy is not ethically neutral — it is wasteful and potentially dangerous."

Ethical perspective:

In his article, Dr Smith said he had looked at the positive and negative features of homeopathy from an ethical perspective.

The potential benefits included its non-invasiveness, cost-effectiveness and the placebo effect — in which a patient's condition improves even though they have been given no genuine medicine.

The negative effects were patients' failure to seek effective healthcare, wastage of resources, promulgation of false beliefs and a weakening of commitment to scientific medicine.

Dr Smith said he had reached the conclusion "homeopathy is ethically unacceptable and ought to be actively rejected by healthcare professionals."

In his biography on Abertay's website, Dr Smith describes himself as "committed to the principles of science-based medicine, and strongly opposed to psuedo-science and quackery."

Cristal Sumner, the chief executive of the British Homeopathic Association, said treatments at the Glasgow hospital were provided by fully-qualified doctors who often specialised in treating people whose conditions had not responded to conventional medicine.

She said it was "patently absurd" to argue that homeopathy was unethical or a waste of money, adding that given the "remarkable results" of studies at the NHS homeopathic hospitals, the further use of the treatment should be explored.



Click for more on these topics:

People: Kevin Smith | Organisations: NHS, Abertay University, British Homeopathic Association | Concepts: Homeopathy, Healthcare, Medicine, Treatment, Homeopathic, Conventional medicine]]> daarons BSEC Public Forum Wed, 11 May 2011 07:24:20 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,246,246#msg-246 http://www.bioethicscaribe.org.jm/forum/read.php?2,246,246#msg-246
The race to develop biofuels is on, and an article in the current issue of Global Change Biology Bioenergy is taking a look at ethical issues and questions surrounding the rapid rise of this emerging energy.

Professor Joyce Tait, Chair of the Nuffield Council on Bioethics Working Party on Biofuels, and Scientific Adviser to the Innogen Centre at Edinburgh University, reports on the Council's proposed development of a comprehensive ethical standard for biofuels.
The standard would address six ethical principles surrounding production of biofuels, including the protection of human rights, environmental sustainability, greenhouse gas reduction, and fair trade.

Without these principles, there is concern that rushing to meet aggressive biofuel targets could harm the environment and violate human rights.
"Biofuels are one of the only renewable alternatives we have for transport fuels such as petrol and diesel, but current policies and targets that encourage their uptake have backfired badly. The rapid expansion of biofuels production in the developing world has led to problems such as deforestation and the displacement of indigenous people. We want a more sophisticated strategy that considers the wider consequences of biofuel production,” says Tait.

These ethical guideline standards could be adopted worldwide and enforced via a certification program, and could be used as a benchmark for other products and developing technologies.

For more information and discussion regarding the ethics of biofuel development, visit www.gcbbioenergy.org
Advances in Biofuel Technology
Sorghum Grass for Biofuel?
Biomass Research and Development]]> daarons BSEC Public Forum Wed, 11 May 2011 07:17:20 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,244,244#msg-244 http://www.bioethicscaribe.org.jm/forum/read.php?2,244,244#msg-244 by Michael Cook | 16 Apr 2011l

tags: Arthur Caplan, bioethics, Robert P. George

It’s difficult to think of bioethicists who differ on more issues than Robert P. George, of Princeton (yes, there is a bioethicist at Princeton who is not Peter Singer) and Arthur Caplan of the University of Pennsylvania. George, a former member of President Bush’s Council on Bioethics, is a leading conservative who opposes embryonic stem cell research and abortion. Caplan is the unofficial dean of progressive bioethics and perhaps the most quoted bioethicist in the American media. But at a meeting organised by the Witherspoon Institute, a think tank at Princeton, they agreed on one thing: stem cell scientists told porkies about the promise of their research.

Caplan complained:

“Embryonic stem-cell research was completely overhyped, in terms of its promise. And people knew it at the time. I tried to say so myself at different times myself, even though I support embryonic stem-cell research. But this notion that people would be out of their wheelchairs within a year if we could just get embryonic stem-cell research funded was just ludicrous…

“Here’s an assertion that you hear all the time: ‘Stem-cell research will help Alzheimer’s.’ But stem cell research has no possibility of helping Alzheimer’s. Alzheimer’s is a gunk-up-the-brain disease, where every cell is affected. You can’t fix it by any sort of stem cell research. Model it? Maybe. Cure it? Never.”

Twisting the truth could backfire, George warned:

“…that’s the kind of dishonesty that threatens to alienate the public from science. Because even if the public buys it in the beginning, and the scientists win the political debate, when they can’t deliver on the promises they made, people’s faith in scientists—crucial for the funding of science—is placed in jeopardy.”

The key point on which the two celebrity bioethicists agreed was that facts do not speak for themselves and that science is not ethics. Ethical norms have to govern scientific inquiry and medical practice. As Caplan put it, “You can pile up evidence to the size of the Jungfrau, but if you don’t have norms, evidence does you no good. But some out there believe that the evidence speaks for itself.”

The dialogue between the two men is fascinating reading. It is a great contribution to the bioethics debate by Public Discourse, the Witherspoon Institute’s online journal. ~ Public Discourse, April 13]]> daarons BSEC Public Forum Tue, 19 Apr 2011 15:35:09 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,241,241#msg-241 http://www.bioethicscaribe.org.jm/forum/read.php?2,241,241#msg-241
Allison Gandey


INFORMATION FROM INDUSTRY


March 4, 2011 — Mothers with Alzheimer's may be more likely to pass the disease down to their children, a new study suggests.

The work is preliminary, but investigators identified twice as much gray matter volume reduction in disease-vulnerable areas of the brain in people with a maternal history of late-onset Alzheimer's than those with a father with the disease or those with no family history.

"It is estimated that people who have first-degree relatives with Alzheimer's disease are 4 to 10 times more likely to develop the disease themselves compared to people with no family history," lead investigator Robyn Honea, DPhil, from the University of Kansas School of Medicine in Kansas City, said in a news release.

"Using 3-D mapping methods, we were able to look at the different regions of the brain affected in people with maternal or paternal ties to Alzheimer's disease," Dr. Honea explained. "In people with a maternal family history of the disease, we found differences in the breakdown processes in specific areas of the brain that are also affected by Alzheimer's disease leading to shrinkage."

Asked by Medscape Medical News to comment, Debra Fleischman, PhD, from the Rush Alzheimer's Disease Center in Chicago, Illinois, said, "Neurologists should know that a pattern of regional cortical thinning has been demonstrated in persons at risk for Alzheimer's disease and that this pattern may be influenced by maternal family history."

The results are published in the March 1 issue of Neurology.

Regional Cortical Thinning:

There are several studies showing that individuals without dementia who have mothers with Alzheimer's disease experience changes in memory performance, reductions in brain glucose metabolism in parietotemporal cortices and posterior cingulate, and increased β-amyloid load.

The researchers studied 53 dementia-free people 60 years and older. Of these, 11 reported having a mother with Alzheimer’s disease, 10 had a father with the disease, and 32 had no family history of dementia. Investigators administered magnetic resonance imaging and cognitive tests at baseline and then after 2 years.

They used a custom voxel-based morphometry processing stream to examine regional differences in atrophy between groups.

Investigators found that cognitively healthy people with a mother with Alzheimer's had significantly increased whole-brain gray matter atrophy and cerebral spinal fluid expansion compared with the other groups.

Consistent with other studies.
The voxel-based analysis revealed these subjects also had significantly greater atrophy in the precuneus, parahippocampal, and hippocampus regions compared with people with fathers with Alzheimer's disease or those with no family history, independent of APOE4 status, sex, and age.

They also analyzed APOE4-related atrophy and found those with the risk allele ε4 showed more regional atrophy in the frontal cortex compared with non-ε4 carriers.

"What we saw is consistent with other studies," senior study author Jeffrey Burns, MD, from the University of Kansas, said during an interview. "We cannot yet extrapolate this to individuals in clinical practice. We will need larger studies for that."

However, Dr. Burns said, "There seems to be something different in what people are inheriting from their mothers than their fathers. We expect this study will change some perceptions about familial history."

The genetic basis for the transmission of Alzheimer's disease is unknown. The investigators suggest mitochondrial DNA may play a role. "Given both its maternal transmission and evidence supporting a role for mitochondrial DNA abnormalities in Alzheimer's disease," they write.

Step Forward:

Dr. Fleischman points out that although the study is limited by a small sample size, it represents another step forward in identifying a unique imaging endotype for people at risk for Alzheimer's disease.

"The next step would be to directly examine the association of regional cortical thinning with amyloid burden in maternal family history, which this study does not do. It will also be important to examine this pattern of cortical thinning in maternal family history with other, potentially treatable, risk factors for Alzheimer’s disease."

Dr. Fleischman points out, "Other work has suggested that regional cortical thinning, particularly in precuneus, is associated with systemic inflammation in older persons without dementia. It would be of interest to examine whether those persons with maternal family history and regional cortical thinning are more likely to have systemic inflammation and/or neuroinflammation."

The investigators say they hope that understanding how the disease may be inherited could lead to better prevention and treatment strategies.

This study was funded by the National Institute on Aging and the National Institute of Neurological Disorders and Stroke. Dr. Burns has received funding from Pfizer, Novartis, Medacorp Consulting, Johnson County Clinical Trials, PRA International, Elan, Janssen, Wyeth, Danone, and the Dana Foundation. He has served as an expert witness in legal proceedings regarding competency. Dr. Honea and Dr. Fleischman have disclosed no relevant financial relationships.

Neurology. 2011;76:822-829.]]> daarons BSEC Public Forum Fri, 18 Mar 2011 16:55:38 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,240,240#msg-240 http://www.bioethicscaribe.org.jm/forum/read.php?2,240,240#msg-240
David Aaron Troy
By RFI

France's official ethics group has given the green light to embryo transfer for assisted childbirth after the death of the father. But it remains opposed to artificial insemination post-mortem.

The Comité consultative national d’éthique (CCNE) announced its decision on Wednesday, as bioethics laws come under the spotlight at the Senate in the next month.

After months of reflection, the CCNE said that embryo transfer – a process of assisted reproduction in which an embryo is placed in the uterus of a female – should be authorised in certain cases after the death of the father.

The father must have given his consent for the procedure before his death, his paternity must be certain and time limits must be observed.

Artificial insemination remains unauthorised, as it is harder to confirm how the father wished to use his sperm. Following his death, a man's donated sperm is automatically destroyed in France.

MPs in the French lower house voted through a draft law which approved embryo transplants, against the advice of the government, in January and it will go to the upper house in April.

TAGS: HUMAN RIGHTS - SCIENCE]]> daarons BSEC Public Forum Fri, 18 Mar 2011 16:44:39 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,239,239#msg-239 http://www.bioethicscaribe.org.jm/forum/read.php?2,239,239#msg-239 Ron Zimmerman


March 10, 2011 — A nonprofit physicians organization came out hard against updated dietary guidelines recently issued by the US Department of Agriculture (UDSA), suing the government to force the USDA to change its recommendations.

The Physicians Committee for Responsible Medicine (PCRM) alleges that the USDA knowingly hides harmful foods behind obscure language in the report.

The guidelines are published jointly every 5 years by the USDA and the US Department of Health and Human Services and are supposed to represent the most current and sound scientific information available. The dietary guidelines are the blueprint for all federal nutrition programs, including school meals.

However, PCRM says in its lawsuit, rather than giving Americans nutritional advice that would help them fight obesity, the government instead bowed to conflicts of interest with agribusiness and blurred the message about foods Americans should eat less of.

PCRM President Neal Barnard, MD, was clear in his criticism of the USDA. "The dietary guidelines are the best they've ever been, but we're pushing to make them better," he said in an interview with Medscape Medical News.

"It's critically important yet fundamentally dishonest when they have an explicit message of what foods to eat more of, but when it comes to foods to eat less of, they hide behind biochemical codes," he said. "It's intentional. And it doesn't help the school nutritionist designing school lunch menus or a food planner in a rural town."

The physicians' committee, which says it represents more than 10,000 physicians and 100,000 other healthcare professionals, is a nonprofit public health organization advocating preventive medicine through proper nutrition. It took particular aim at the familiar food pyramid diagram.

The USDA's MyPyramid diagram is ineffective and confusing to the general public, says the PCRM lawsuit. The physicians say it conveys abstract messages that must be translated into concrete food choices with a computer program that is not available to Americans who do not have access to a computer.

Dr. Barnard explained his organization's opposition: "Last March we petitioned them to scrap the food pyramid. In 2005 they took away food groupings and just made it colored stripes, which is completely useless to the population the food pyramid is designed to teach: disadvantaged Americans who have no way of decoding the pyramid. It became totally useless."

The PCRM argues that "there is no scientific basis for including meat or dairy groups in dietary guidance material" because people who avoid those foods have lower rates of diabetes, cancer, and cardiovascular disease.

Foods to Avoid Not Named:

The dietary guidelines specify foods to eat more often such as fruits and vegetables, but when it comes to foods to eat less often, such as meat and cheese, the guidelines use "biochemical terms unfamiliar to the general public," says the lawsuit. The PCRM finds it nonsensical that the guidelines call for limiting cholesterol, saturated fats, and solid fats "without clearly explaining that meat, dairy products and eggs are the only sources of cholesterol in the diet."

Within the lawsuit petition, the PCRM reports that at the press conference for the release of the guidelines, Marian Burros, a journalist with Politico, asked defendant Secretary of Agriculture Tom Vilsack, "Why do you call it solid fat, instead of porterhouse steak? Or why do you call it solid fat, and then...the guidelines on dairy include cheese?"

Vilsack's answer was vague, alleges the lawsuit: "Vilsack admitted that the dietary guidelines 'essentially' have a 'way' of listing foods that one should avoid, by 'suggesting other foods.' "

PCRM Nutrition Education Director Susan Levin, MS, RD, addressed what the organization feels is Vilsack's doublespeak: "Americans need straightforward health advice, not bureaucratic mumbo jumbo designed to protect agribusiness."

Arthur Caplan, PhD, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia, agrees with the intent of the lawsuit, saying he does not know whether the USDA's confusing language is purposeful, "but informed consent for consumers demands easy to understand, simple, straightforward language — that is not what it should be in this set of guidelines. The lawsuit seems to me," he continued, "to be correct in demanding clearer language and less technical and food insider talk."

The USDA did not respond to the PCRM's written comments to the proposed dietary guidelines, so when the final recommendations were published at the end of January, Dr. Barnard felt his group had no choice but to file their lawsuit.

"We filed the lawsuit as our way of saying, 'You will listen to us; the court will make you listen,' " said Dr. Barnard. "Our lawsuit guarantees that we will have their attention. We're finally saying, enough is enough."

The PCRM's lawsuit also notches up its war against the USDA by alleging conflicts of interest. The lawsuit argues that the dietary guidelines are meant to be read by the general public, not scientists, yet it uses "inconsistent language, ambiguous phrases and biochemical terminology to avoid providing clear dietary information due to Defendants' conflicts of interest."

Those conflicts of interest include the Secretary of Agriculture's statutory duty to foster "new or expanded markets" and to move "larger quantities of agricultural products through the private marketing system to consumers." In addition, the lawsuit points to the fact that advisory committee members for the dietary guidelines have ties to meat and dairy food product industries, such as Dannon, Kraft Foods, and MacDonald's Corp, which creates direct conflicts of interest.

"The Secretary of Agriculture has an impossible job when it comes to health," said Dr. Barnard, "because his job is simply to make agribusiness richer."

Dr. Caplan believes the USDA has a broader mandate, but that they are focused on a narrow part of their statutory authority. "The mandate to promote agriculture is the one that has dominated American government food policy forever, and that mandate often trumps health worries," he told Medscape Medical News.

The PCRM wants a trial court to send its lawsuit to a full jury trial to declare that the defendants have violated the Administrative Procedure section of the US Code by issuing dietary guidelines not based on the preponderance of the medical knowledge, and to order defendants to withdraw portions of the dietary guidelines. The group also wants the USDA to rewrite and reissue the official dietary guidelines based on proper medical knowledge. That medical knowledge, according the PCRM, would specifically mention meat and dairy products as a major source of saturated fat in Americans' diets.

It particularly galls the PCRM that although dairy products account for more than 30% of the saturated fat in the American diet, the guidelines disguise this fact by splitting dairy products into many categories, including cheese (8.5%), butter (2.9%), whole milk (3.4%), reduced-fat milk (3.9%), dairy desserts (5.6%), and pizza (5.9%), so that dairy products' contribution to the diet is harder to see.

"Look, in 5 years, when the next dietary guidelines are written," said Dr. Barnard, "diabetes will be the worst it's ever been, obesity will be worse, if that's even possible, and the government treats all this as if it doesn't matter. In 2010, $128 billion was spent on diabetes treatment alone. Every state is having budget troubles. Is that because they spent too much on school buses? No, it's healthcare. As a doctor, I can't fathom why it isn't taken seriously."

When contacted by Medscape Medical News, a spokesman for the USDA, John Webster, replied: "Since this is now in litigation, we have no comment."

Dr. Caplan thinks the USDA is ignoring its responsibility to the public by refusing to comment. "I think the criticisms merit a serious response," he said.]]> daarons BSEC Public Forum Fri, 18 Mar 2011 16:36:07 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,238,238#msg-238 http://www.bioethicscaribe.org.jm/forum/read.php?2,238,238#msg-238
Ira Mellman February 28, 2011



High Costs Drive Americans Overseas for Medical Help

Much has been reported about the rapidly expanding Asian economy. Perhaps one of the fastest growing aspects of many Asian economies is medical tourism, with India, South Korea and Thailand leading the way.

“Medical tourism is the travel of individuals from a home country like the U.S., Britain, even Singapore, Thailand in the region to a destination for the primary purpose of seeking medical care," said Glenn Cohen, the Co-director of the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at the Harvard University law school.

He said medical tourism comes in what he terms "three flavors".

“The first flavor ,especially in the U.S., is uninsured or underinsured individuals who are doing price shopping. By one estimate, getting angioplasty out of pocket in the United States would cost about $98,000. If you’re getting it in Thailand or Singapore you’re looking at $13,000. So huge cost saving is one aspect of looking for medical travel abroad. A second group of people are people who have insurance coverage that gives them an incentive to go abroad. We have a little bit of that in the U.S. And then a third category are individuals who are seeking to avoid domestic prohibition or unavailability of a service. For example, a lot of Irish engage in what could be called 'abortion tourism', [where] people travel to Switzerland for assisted suicide and people travel elsewhere for stem cell therapy and the like, and of course to India for surrogacy tourism and the like," he said.

Cohen says this has translated into big businesses around the world.

“Cuba in 2004 made about $20 million on medical tours and Jordan made about $500 million. It's estimated that by 2012, India will be looking at about $2.2 billion in revenue. This is a very fast growing industry and a number of countries are making a very concerted effort to corner at least the regional market. There is some division as to the kind of services they offer. But it’s a very lucrative industry and there are also all kinds of other players who we call intermediaries or facilitators who try to arrange travel for you and kind of act as concierges in some way in the industry," he said.

Asia is a particularly fast growing market for medical tourism. A recent report from the Indian market research company RNCOS predicts a growth rate of over 17.5 percent in Asia by next year.

Among the leaders in Asian medical tourism are India, South Korea and Thailand. China wants to be part of that group.

According to Dr. David Vequist, who heads the Center for Medical Tourism Research in San Antonio, Texas, they are doing just that.

"China is interested in developing a medical tourism specialty and in fact there are efforts going on in places like Shanghai in order to develop a medical hub. It would be similar to what the Koreans have done or the Japanese have done or Thailand, or some of these other countries that have been active in medical tourism, India, for example," he said.

According to Vequist, China, due to its huge population, may have an edge over other countries.

“China, as a country has quite a few people who travel within the country for health care and increasingly have people who travel outside the country for health care. The majority of the health care facilities inside the country don’t necessarily have a great global reputation for health care. Gallup recently released a study that shows that 15 percent of Chinese citizens are travelling within the country to find better health care. And what we’re finding is as Chinese tourism picks up around the world, we’re seeing more and more Chinese nationals going to other countries and receiving surgeries and pharmaceuticals and other types of health care outside of China," he said.

Vequist says a growing medical tourism reputation inside China might lead to those people seeking treatment in their own country.

While the expanding world of medical tourism is undoubtedly good for economies, there are some major concerns that need to be addressed.]]> daarons BSEC Public Forum Thu, 17 Mar 2011 14:08:51 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,236,236#msg-236 http://www.bioethicscaribe.org.jm/forum/read.php?2,236,236#msg-236
Published February 21, 2011 | By Francesca Minerva


The “news” is that a 61 year old from Illinois served as a surrogate mother for her daughter’s son, carrying in her womb the embryo created using her daughter’s and her son-in-law’s egg and sperm.

Anyone shocked?

I guess no, and this is instead a (nice) surprise to me.

When I started my first class in Bioethics, in 2001, surrogate motherhood was still a very controversial topic, at least in Italy. People were passionately debating about the moral legitimacy of such kind of “unnatural” practice. Also, people were really worried about the fact that women who had already passed menopause could procreate.

Ten years later, (almost) no one complains. I could not even find the news on Italian newspapers, as no one noticed or considered the news relevant enough to put it on newspapers (OK, it can be that Italian journalists are all focussed on another topic right now, but still it surprises me that the news is not mentioned on the most important newspapers).

I read the comments of people from different countries on this news, but I could hardly find someone claiming it was wrong, for any reason, to serve as a surrogate mother for a daughter. People were keen on judging this choice as sweet, lovely, but not immoral.

But still ten years ago, and even more in the 80s when this kind of practice started to spread in the Sates, people considered it somehow shocking and especially religious and/or conservatives people thundered at such a misuse of reproductive technologies.

A few years later, it seems that many of the objections and of the worries left place to a serene and benevolent acceptance of surrogate motherhood.

Now, it would be interesting to understand whether the common opinion about this practice has changed because people just have become used to this practice, or if it is because they have really changed their mind about the moral legitimacy of the practice.

It seems more plausible to think that people realized that, at the end of the day, if no one is harmed and all the people involved are happy, there is no good reason to be against this kind of practice.

Other practices, as abortion, for instance, are still controversial after centuries of debates and analysis of the issue, and this shows that people just do not get used to practices they (really) believe to be immoral also after centuries of debating (and practicing).

If we think of other medical or legal practices like euthanasia, divorce, same sex marriage, in vitro fertilization etc., we realize that the common perception of these practices has changed radically in the last 30 years. And this shift of values took place even if the practices were illegal or forbidden. For instance, surrogate motherhood is fully legal just in Ukraine, illegal in most of the European countries and accepted just in its altruistic (but not commercial) form in countries where it is allowed, being anyway illegal in most countries all over the world.

This suggest, at least to me, that citizens are quicker than the laws that regulate their conducts to become familiar with novelties.

If we think of smart drugs, for instance, it seems that the stubborn a-priori prohibition to start experimentations on these drugs for enhancing goal, is symptomatic of a short-sightedness of legislators. As many people already use smart drugs to enhance their performances, the attempt to prevent them from doing so (banning the experimentation) instead of regulating the use of these enhancers, seems to be doomed.

The point is that if people think that a certain practice, or drug, or option in general is good to them, and if they will easily find someone who will help them to achieve their goal, they will probably ignore the legal ban. At the end of the day, abortion has been legalized in order to avoid back-street termination of pregnancies that caused the death in many women.

Prohibitions and bans, far from discouraging people to do something, end up encouraging a black market, with all the related dangers to health.

It would be much better if legislators had the finger on the pulse of the real situation and adapt laws to a continuously changing society, banning practices that are seriously dangerous to citizens, but regulating non harmful practices in a way that they will be safe to anyone using them under medical and public control.


Posted in Francesca Minerva's Posts, Health, Public Health, Reproductive Technologies, Uncategorized]]> daarons BSEC Public Forum Tue, 15 Mar 2011 17:32:37 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,235,235#msg-235 http://www.bioethicscaribe.org.jm/forum/read.php?2,235,235#msg-235 By Arthur Caplan/Guest columnist

The MetroWest Daily News
Posted Jan 14, 2011 @ 08:06 AM


Last July former Vice President Dick Cheney had a left ventricular assist device (LVAD) put into his chest to assist his failing heart. Cheney is now resuming his public life in politics. News reports note that he is more than willing to talk about his new life-saving implant. It is not so clear that he fully understands what he needs to say about it.

There is a lot to talk about regarding LVADs. As Cheney resumes his active role in GOP politics, is he aware that the only reason he is alive is as a result of taxpayer-supported government research at the National Institutes of Health? He might want to mention that the private sector did not do the basic research that led to the invention of the LVAD, public money played the crucial role.

The left ventricular assist devices are used when a heart is no longer capable of pumping blood on its own and cannot recover. Those who receive them will die with them. Which leads to another topic Cheney should be talking about: how he will die.

LVADs are the direct legacy of the program to build a total artificial heart that was instituted at NIH more than 50 years ago. While a total artificial heart proved difficult to create, partial artificial hearts were designed and actively used in government-financed research trials by the late 1990s. While the newly empowered GOP is saber-rattling about huge cuts in government spending, without federal funding for NIH, Cheney would be very unlikely to be alive to join that chorus.

While Cheney's LVAD is clearly keeping him alive and active, things will not always be so positive. LVADs have a lot of frequent complications including a high risk of infection, device failure, and blood clots. Any of these can cause mental impairment in addition to a high risk of death.

So it is important that the former vice president and anyone else with an LVAD have a conversation with their doctor about end-of-life planning. While politically it has proven difficult to keep a financial incentive in place in Obamacare to encourage this conversation, it is crucial that those who are dependent upon a last ditch technology like an LVAD talk about their wishes and values with their doctors and their families.

Dick Cheney has spent his life combating the untoward influence of big government on individual freedom and as a critic of many nondefense federal programs. Ironically, it is federal spending that created the machine that allows him to continue to push his point of view. And it is the very program he and the GOP have condemned as death panels that provides the best hope that he will enjoy the kind of death he chooses. He and the rest of us must do whatever we can to encourage advance care planning as part of our routine medical care.

- ARTHUR CAPLAN

Arthur Caplan, PhD, is the Director of the Center for Bioethics and the Sidney D. Caplan Professor of Bioethics at the University of Pennsylvania.
Copyright 2011 The MetroWest Daily News. Some rights reserved]]> daarons BSEC Public Forum Mon, 14 Mar 2011 15:09:29 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,233,233#msg-233 http://www.bioethicscaribe.org.jm/forum/read.php?2,233,233#msg-233
Published: Sunday, January 09, 2011, 5:42 AM
Special to The Birmingham News By Special to The Birmingham News


By GREG PENCE


Few jobs exist where you might function while losing your mind. Few families exist where a mother's losing her mind wouldn't be devastating.

For decades, bioethicists have pondered whether patients should be told about a future disease. Each year, more accurate pre-symptomatic tests arrive, but do we want to know their results?

Previously, we knew that patients with one copy of a gene-variant called APOE4 develop Alzheimer's three times more than normal, and if they have two copies, twelve times more. Although 40 percent of Alzheimer's patients have this gene-variant, having it does not mean one gets Alzheimer's.

Recently, a California neurologist used MRI scans, combined with information from spinal taps, to better predict Alzheimer's. Right now, these tests still lack certainty, but soon we'll get there. But do we want to know?

Huntington's disease is like Alzheimer's in that it has no cure, but unlike Alzheimer's, it has a single gene that we can test for. Nevertheless, its ethical issues may presage those of testing for Alzheimer's.

First, getting the news is irreversible. You can't take it back. Once you know you have Huntington's, you cannot return to blissful ignorance.

Second, many people take the test to learn they lack the disease. That means that about half find out the opposite and are not emotionally prepared. Although people say they test to find out "my condition, either way," no one wants to hear bad news. Before clients take the test, genetic counselors try to make them feel if they can handle bad news, but most people don't get such counseling.

Third, testing is a family affair, and this is tricky. Medical and legal ethics emphasize a patient's autonomy, i.e., her right to know and to make decisions about her life and body. But, for better or worse, we are not atomistic individuals. We are spouses, parents, children and siblings. If we develop Alzheimer's, others must care for us. Don't they have the right to know, too?

Testing is a family affair in another way. Because Alzheimer's looks to be in part gene-based, testing one family member tells others about his or her risk.

Perhaps a lesson can be drawn from psychologist Nancy Wexler, whose mother died of Huntington's and who led the team that discovered tests for Huntington's. Convinced for decades that she would take the test when she could, instead, she later declined to take the test that she helped develop. She then advocated not taking it.

"If you have the gene," Wexler said, "it's not whether you will find out, but when."

So Wexler argued that, until the disease strikes, people should live robustly in ignorance. Otherwise, they may develop a sick identity. The news that they will develop Alzheimer's may overshadow everything, making them change long-term plans and do foolish things.

A fourth lesson from the history of bioethics is that, in our capitalistic society, companies will try to make money selling presymptomatic tests for Alzheimer's -- the way they do now for breast cancer and other multi-factorial diseases.

Such testing may convey inaccurate information and lead to further ethical problems, such as unnecessary suicides or people testing positive and then purchasing long-term coverage without disclosing it, bankrupting insurance companies. This is especially true when tests merely reveal increased risk of getting Alzheimer's, not certainty.

A final lesson from the history of bioethics is the consensus that if you can't offer a patient anything to prevent or to ameliorate a terrible disease, why test for it? For newborns with diseases such as Phenylketonuria (PKU), we can test, intervene and prevent bad effects, but as of now, this is not true for Alzheimer's or Huntington's.

There are many myths about Alzheimer's. It is likely to be caused both by genes and environmental factors, and to have variable courses. As someone who, with his wife, for a decade cared for a relative with dementia, I know that the benign portrait of dementia depicted in many movies and TV shows is inaccurate.

The federal government recently announced a commission to plan for the overwhelming number of future Alzheimer's patients. Unfortunately, this commission merely hopes to prevent or delay Alzheimer's, rather than plan for the care of those afflicted.

As a matter of intergenerational justice, can we expect our kids to pay for (the predicted) 13 million Alzheimer's patients in 2050, each of whom after diagnosis will probably live eight years? What about the elderly singleton without a living family? Clearly, we need a plan.

One little-noticed part of President Barack Obama's new national medical plan is the ability to purchase long-term health coverage from the government (patients must pay five years before they can use it). Given how few Americans have such coverage, and given how Medicare does not provide it, most of us should buy it.

Discussing Alzheimer's with a relative of mine, he replied, "I'm in the Hemlock Society. Just kill me when I get it." Would that it were so simple. In all states, killing-with-consent is a crime, even if the loved one has a terminal illness.

Another friend says, "If I'm getting Alzheimer's, I'll kill myself." Maybe. But people in the early stages mask and deny their disease. It can take years for the disease to cripple a mind, and by that time, the person who would have killed himself is, quite simply, gone, replaced by a different being with half his former IQ who now wants to live.

It may seem I'm completely against testing by individuals, because knowledge has few benefits for them. But families also matter. It will be hard for them to stand by passively, watching a relative dissolve a good marriage, squandering retirement funds or making a bad will. Practically speaking, because the family must take responsibility for care, at some point, it must intervene to protect assets, both social and financial. But here it's a matter not of advance, presymptomatic testing, but of diagnosis of a disease. That's the right time to force testing, especially because drugs such as donepezil may then delay progression of the disease for six months.

So this bioethical issue is not merely philosophical, but deeply personal for millions of us, both as individuals and as responsible members of our families.

Gregory Pence, Ph.D., has taught bioethics in the medical school and philosophy department at UAB for 35 years. E-mail: pence@uab.edu.]]> daarons BSEC Public Forum Fri, 11 Mar 2011 16:36:52 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,228,228#msg-228 http://www.bioethicscaribe.org.jm/forum/read.php?2,228,228#msg-228 In Ethical Dilemma, What Would Your Doctor Do? Frank Answers From Real MDs
By Daniel J. DeNoon


WebMD Health News
Reviewed by Michael W. Smith, MD

Nov. 10, 2010 -- Would doctors help patients die if they asked? Would they have sex with a patient? Would they cover up a mistake that harmed a patient?

These are three of 21 tough ethical questions answered by more than 10,000 doctors in a Medscape survey released today. Medscape is WebMD's web site for medical professionals.

"What came through loud and clear in the survey is that by and large, doctors try to do what they believe is right," Steven Zatz, MD, executive vice president for WebMD Professional Services, says in a news release.
What's also clear is that doctors don't all agree on what is right.
For example, when asked if doctor-assisted suicide should ever be allowed, 41% gave a definitive "no" while 59% said "yes" or "it depends."
The survey kicks off Medscape's special series on medical ethics. Leading bioethics experts will weigh in on why the doctors answered the way they did -- and what this means for the future of medicine.

"Today's doctors face more frequent and more complex bioethical dilemmas than in former times," Thomas H. Murray, PhD, says in the news release. Murray is president of The Hastings Center, a bioethical research center in Garrison, N.Y.
The poll sampled doctors from a broad range of medical specialties, including pediatrics, internal medicine, psychiatry, surgery, oncology, women's health, and family medicine.
Below is a sample of the survey results, with some typical -- and conflicting -- comments from doctors who answered the poll. You can see The full survey results here.

Should physician-assisted suicide be allowed in some cases?
Answers:
• Yes, 45.8%
• No, 40.7%
• It depends, 13.5%
Doctors said:
• "I'd want it for me when the need arises."
• "Assisted suicide is murder."

Could you become involved in a romantic/sexual relationship with a patient?
Answers:
• Yes, while that patient is still a patient, 0.8%
• Yes, but not until at least 6 months after they stopped being a patient, 11.7%
• It depends, 4.5%
• No, 83.1%
Doctors said:
• "It is totally exploitative and wrong."
• "I did, and 30 years later we are together and happy."

Would you ever recommend or give life-sustaining therapy when you judged that it was futile?
Answers:
• Yes, 23.6%
• No, 37.0%
• It depends, 39.4%
Doctors said:
• "Why waste money and time when results are nil?"
• "I would do this if I felt it would give the family time to accept the inevitability of death."

Are there times when it's acceptable to cover up or avoid revealing a mistake if that mistake would not cause harm to the patient?
Answers:
• Yes, 19.0%
• No, 60.1%
• It depends, 20.9%
Doctors said:
• "Cover-ups are never OK."
• "Why make a mountain out of a molehill if it will cause the patient more emotionally upset than simply not saying anything, as long as no physical harm has occurred?"

Are there times when it's acceptable to cover up or avoid revealing a mistake if that mistake would potentially or likely harm the patient?
Answers:
• Yes, 1.6%
• No, 94.9%
• It depends, 3.5%
Doctors said:
• "I would, but I would contact an attorney first."
• "We take an oath to do no harm. Covering up is a form of lying."

Would you ever undertreat a patient's pain because you’re concerned about repercussions or because you believe that a patient -- even a terminal patient -- might become addicted?
Answers:
• Yes, 5.6%
• No, 84.1%
• It depends, 10.3%
Doctors said:
• "Pain should not be undertreated, and what's the problem with a terminal patient being addicted and comfortable?"
• "Having been sanctioned by an out-of-control, vindictive state medical board, such things aren't even in the purview of ethics, but rather a survival mechanism for my ability to continue practicing."

Would you ever hide information from a patient about a terminal or preterminal diagnosis in an effort to bolster their spirit or attitude?
Answers:
• Yes, I soften it and give hope even if there's little chance, 14.6%
• Yes, unless someone is going to die imminently, I don't tell them how bad it is, 1.7%
• No, I tell it exactly as I see it, 59.8%
• It depends, 23.8%
Doctors said:
• "Most of the time, I tell them exactly as it is; they need to know the truth, and who am I to judge what they should or shouldn't know? If the patient is very frail emotionally and physically and has a very supportive family, I may not."
• "The truth, delivered with compassion, is a gift."

Is it ever acceptable to break patient confidentiality if you know that a patient's health status may be harming others?
Answers:
• Yes, 53.2%
• No, 20.2%
• It depends, 26.6%
Doctors said:
• "As per Mr. Spock, 'The needs of the many outweigh the needs of the few or the one.' This applies in highly specific circumstances, however, and would be the exception, not the rule."
• "Owing to ethics and HIPAA, I don't believe that it should or can be done. I would certainly attempt to convince the patient to disclose the information to his or her spouse or partner."

Would you agree that you should refuse gifts or perks from pharmaceutical companies because they may influence your medical judgment?
Answers:
• Yes, 46.8%
• No, 36.8%
• It depends, 16.4%
Doctors said:
• "If by 'gifts' you mean items of value (e.g., expensive pens or outings) then my answer is yes."
• "I am not so shallow that I can be bought off by a slice of pizza."

Should it be legal for people to buy organs for transplant, if they would not be able to receive an organ by waiting their turn through the national database?
Answers:
• Yes, 19.9%
• No, 66.5%
• It depends, 13.6%
Doctors said:
• "The ability to pay determines a lot of accessibility to medical care. I'm not sure why organ transplants are different."
• "The sale of human body parts is immoral."

Would you perform an abortion in certain situations, even if it were against your own beliefs?
Answers:
• Yes, 34.1%
• No, 53.5%
• It depends, 12.4%
Doctors said:
• "If I were against it, I would not perform it; there is something called integrity, you know."
• "It's about the patient, not about me."]]> daarons BSEC Public Forum Thu, 09 Dec 2010 14:17:57 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,226,226#msg-226 http://www.bioethicscaribe.org.jm/forum/read.php?2,226,226#msg-226 Further Education By Meredith Cohn and Andrea K. Walker, The Baltimore Sun

October 24, 2010

Hundreds of Maryland doctors have accepted fees, some exceeding six figures, from pharmaceutical companies in the past two years to promote their drugs to other doctors — a practice that is not illegal but raises ethical questions about the industry's influence over patient care.

Large companies such as Merck and Eli Lilly have disclosed $258 million in payments nationwide in 2009 and the first half of 2010, with about $6 million going to Maryland physicians and a handful of nurses. There were more than 450 Maryland recipients from Johns Hopkins, the University of Maryland, a half-dozen Baltimore-area community hospitals, private practices and other institutions around the state.

The disclosures come as medical institutions and lawmakers have worked to rein in potential conflicts of interest, curbing these payouts as well as company-funded dinners and cruises. Ethicists and consumer groups say industry wouldn't pay if it weren't getting a return, like a boost in sales. And patients don't usually know that their doctors might have a monetary incentive to prescribe certain drugs.

"The more money you take, the more likely you are to present their drugs in a positive light, and the more likely you are to do research that is favorable to the drugs," said Dr. Carl Elliott, a professor in the University of Minnesota Center for Bioethics and the author of a book on ethics in medicine. "For whatever reason, doctors like to pretend the money has no effect on them."

But doctors who have received the money defend the paid speeches as educational for fellow physicians. And they say they are not influenced in caring for patients.

Gene Ransom, chief executive of MedChi, the Maryland State Medical Society, which represents more than 22,000 Maryland physicians, said: "Doctors take an oath to do no harm. Doctors, for a couple of hundred or a couple of thousand dollars, aren't going to risk their livelihoods or the lives of their patients."

The extra pay doctors collect for speeches and consulting from seven drug companies — whose sales make up about a third of the market — were compiled in a database by reporters at ProPublica, an independent investigative journalism organization that partnered with several media outlets. But there are more than 70 other companies that have not disclosed whether they are making payments to doctors. Those totals and recipients could remain a secret until 2014, when the federal health care reform law will require such disclosure.

The known payout to Maryland doctors constitutes just over 2 percent of the nationwide total in ProPublica's database. Seven doctors in the state joined 384 nationwide in earning more than $100,000; Most earned substantially less.

Since the database became available in recent days, officials at the University of Maryland School of Medicine and elsewhere say they are reviewing information to see if new guidelines are warranted.

The university's conflict-of-interest policy, just 18 months old, seeks to address speaking fees at industry events that aren't certified as continuing medical education. Doctors are allowed to participate if they get approval from their department chairs, but they can't read speeches or put their names on journal articles written by the industry. Their own talks must not be considered promotional. And drug company pay must be "fair market value."

"We're still learning how well the policy is working," said Dr. Nancy Lowitt, Maryland's associate dean for faculty affairs and professional development, who helped develop the policy. "What we need to do now is be aware of the data coming out and respond more to what we're learning. There's still risk, and we have to be aware of it and respectful of it."

Lowitt said she believes doctors regularly turn down paid speaking invitations, more often since the policy became effective. And she said chairs take their oversight role "very seriously." Still, at least two dozen university doctors accepted money, according to the database.

Of the seven doctors in Maryland who accepted six-figure payouts, five did not respond to efforts to contact them, couldn't be reached or declined to comment.

Dr. Robert DiBianco, a Rockville cardiologist who earned $142,436 from GlaxoSmithKline and Pfizer during the time period, said he declines to speak if products are not backed by proper studies or if companies want him to use their slides and talking points. He says money doesn't influence him when he does speak — recently about GlaxoSmithKline's Lovaza, an FDA-approved drug made with omega-3 fish oil to reduce triglyceride levels.

"People are worried that if the physician is being paid they will lean toward that drug," said DiBianco of Cardiovascular Consultants. "But I don't think physicians are influenced that much by that."

Dr. Jerald Insel, chief of the division of cardiology at Good Samaritan Hospital, won't usually talk about drugs in his lectures, which means he doesn't always get invited back by drug companies — including GlaxoSmithKline and Eli Lilly, which paid him $184,834 to talk about drugs including Avandia, a diabetes drug restricted recently because it appears to increase risk of heart attacks.

He said he frequently talks for free, but there's not enough university and hospital-backed continuing education, and education is a "mission" to him. He said he only takes industry money, which largely goes to charity, so he can get access to more doctors who will go to nice restaurants for a talk but will no longer come to the once-routine grand rounds where specific patients' problems and treatments are discussed.

"The company thinks they're getting someone jumping up and down about their drug, but I talk about diabetes," said Insel, adding that he doesn't prescribe drugs for diabetes, a risk factor for heart disease. "If I had my way, hospitals and universities would pay for more education, or everyone would give away the money and talks would be in less fancy restaurants. But we live in the real world, and we need more education of doctors."

The ProPublica database shows that Maryland doctors and nurses accepted 650 payments, ranging from a few hundred dollars to more than $200,000. Many doctors received more than one fee, and the biggest recipients were internists, oncologists and psychiatrists. At least one doctor works in bioethics.]]> daarons BSEC Public Forum Sat, 20 Nov 2010 08:33:23 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,224,224#msg-224 http://www.bioethicscaribe.org.jm/forum/read.php?2,224,224#msg-224 By Susan Perry | Published Thu, Oct 14 2010 10:23 am


This week, the directors of the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) joined President Obama and other administration officials in condemning a human syphilis/gonorrhea experiment conducted by U.S. researchers on unsuspecting Guatemalan prisoners, soldiers and mentally ill patients in the late 1940s.

Writing in the Journal of the American Medical Association (JAMA), Dr. Thomas Frieden, director of the CDC, and Dr. Francis Collins, director of NIH, called the Guatemalan experiment “regrettable and deeply saddening.”

The two men also insisted that such unethical studies could not be done today because of the myriad safeguards that have been put in place during the past 60 years to protect study participants, especially those drawn from vulnerable populations, such as the poor, the imprisoned and the mentally ill.

Is that true? Are there enough protections in place?

No, says Dr. Carl Elliott, a professor of bioethics at the University of Minnesota and author of the just-published “White Coat, Black Hat: Adventures on the Dark Side of Medicine.” (Last month, Elliott also published a Mother Jones article that focused on the 2004 suicide of a young mentally ill man who was enrolled at the time in a U of M industry-funded clinical trial of the antipsychotic drug Seroquel.)

Clinical trials can still exploit study subjects, only the exploitation has taken a different form, Elliott told me in a phone interview earlier this week. Medical researchers may no longer be going out and intentionally making people sick, as they did in the Guatemala study (and in the infamous Tuskegee syphilis study), but they still can — and do — recruit vulnerable people (the uninsured, the poor) and often fail to give them adequate treatment while the subjects are in the trial.

“In a lot of ways, what’s going on now is even worse,” said Elliott. No one apparently died in the Guatemalan trial, he noted, but that wasn’t the case in a clinical trial conducted by the pharmaceutical giant Pfizer during a meningitis outbreak in Nigeria in 1996. Pfizer tested an experimental antibiotic, Trovan, on 200 children during that epidemic without, according to the children’s families, proper consent. (The families say they didn’t realize their children were receiving an experimental treatment.) Eleven children died and many more were permanently disabled. (Trovan has been banned in Europe and can be prescribed in the United States only to adults and in limited medical situations.)

The Trovan study is an example of the increasing number of clinical trials being conducted solely for marketing rather than for scientific purposes (to advance our knowledge about a disease or a treatment), said Elliott. “They’re being done to make a drug look good so it can be approved and marketed. … It’s totally driven by the market.”

To beat the competition to market, drug companies need to get their studies completed quickly.

“The thing that slows them down is recruiting subjects,” said Elliott. The faster a company can recruit people to participate in a clinical trial, he said, the faster it can do the study, get the drugs approved, stay on the market — and make money.

“It all starts with patients,” said Elliott. And the easiest patients to recruit, he added, are those without health insurance and/or who are poor. They need the money.

For Phase I trials, which are conducted to determine if a drug is safe, researchers must recruit healthy people. Yet what healthy person is going to volunteer to be the first to take an experimental drug? The unemployed and the poor, said Elliott.

Later-Phase trials, which test a drug's effectiveness, need to recruit sick people. “A lot of those patients are in America because we don’t have universal health coverage,” he said, “but it also means people in the developing world. There are a lot of sick people in the developing world who are happy to sign up for a trial.”

“We rich people with health insurance in the developing world can depend on poor people without health care to test our drugs for us, and nobody sees that as a problem,” he added.

As for safeguards, Elliott pointed out that many of the 6,000-plus institutional review boards (IRBs) that are supposed to oversee the methodology, safety and ethics of clinical trials in the United States are for-profit entities whose existence depends on the drug companies that they’re evaluating — a troubling conflict of interest.

“IRBs essentially have extremely little oversight in this country,” said Elliott. Indeed, just last year, a sting operation conducted by a congressional committee and the General Accountability Office uncovered a Colorado IRB that was willing to rubberstamp a clinical trial for a fake and unproven medical product from a fake company. The IRB hadn’t checked anything.

“What depresses me more than anything else is that I can see so little avenue for action, for striking back on the part of the people who are bearing the burden of this,” said Elliott. “Unlike, for example, the civil rights movement where you actually had a community that could organize and strike back for power, sick people and poor people are so vulnerable and so easily exploited that there is little opportunity for some kind of collective action.”

Health | Thu, Oct 14 2010 10:23 am]]> daarons BSEC Public Forum Thu, 18 Nov 2010 16:34:14 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,223,223#msg-223 http://www.bioethicscaribe.org.jm/forum/read.php?2,223,223#msg-223
Ethics Group Says Tighter Rules Needed for Online Medical Sites


Online tools and services that promote personalized health care need to have tighter government regulation to ensure that they do not mislead or misinform consumers, British medical ethics researchers say in a report issued on Tuesday by the Nuffield Council on Bioethics, Reuters reports (Kelland, Reuters, 10/12).

Such tools and services include:

■Health information resources; and
■Vendors of private screening kits and other medical products.
For the report, researchers examined:

■How individuals can make sure that the information they find online is accurate and unbiased;
■The sale of medications and other health care products online;
■Tools for creating personal health records, such as Google Health and Microsoft HealthVault;
■The use of telemedicine; and
■Body imaging and genetic profiling test services (Press Association/Google News, 10/11).
Report's Findings

The researchers note that some websites should raise a red flag particularly when they do not indicate who provided the information and what the purpose of sharing the information might be.

They also write that some private DNA tests, which are marketed with the promise of predicting the user's risks of developing certain diseases, can be "medically or therapeutically meaningless" and could provide results that are "unclear, unreliable or inaccurate" (Moss, Scotsman, 10/12).

In addition, the researchers note that some private, direct-to-consumer CT or MRI scans are falsely marketed as a form of a "health checkup" to individuals who do not have symptoms for any conditions.

As a result, the readings might be difficult to interpret and suggest "abnormalities" that actually are harmless, which might prompt some people to seek unnecessary treatments or other procedures, Reuters reports (Reuters, 10/12).

Recommendations

The report urges government regulators to assume a larger role in monitoring the sale of scans, tests and drugs that are marketed directly to consumers.

It also recommends that firms provide additional information to consumers on:


■How an "excess risk" of a disease relates to the general population; and
■Giving personal information to companies (Press Association/Google News, 10/11).]]> daarons BSEC Public Forum Thu, 18 Nov 2010 15:47:32 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,222,222#msg-222 http://www.bioethicscaribe.org.jm/forum/read.php?2,222,222#msg-222 Posted by Jennifer Miller, Bioethicist October 11, 2010


[NYT] Several years ago, I learned that a physician in a town not too far from where I was practicing had committed suicide. Neither I nor my hospital colleagues knew him, but according to the story we heard, he was the father of young children, was respected by doctors and patients alike and had struggled privately with mental illness since medical school.
But it was not the details of his life that haunted us; it was the details of his death. He had locked himself in a room in the hospital, placed a large needle in his vein and injected himself with a drug that so effectively paralyzed his muscles he was unable to breathe. Or call for help.
For days afterward, the doctor’s death came up repeatedly in conversations. We talked about the grief his family must have been experiencing and speculated on the extent of depression and self-loathing he must have experienced, but we dared not speak of, let alone imagine, the agony of his final moments.

Always, we ended up asking one another the same question: How could a doctor — who most likely knew about what he was suffering from and about the treatments available — never seek help?

For several decades now, studies have consistently shown that physicians have higher rates of suicide than the general population — 40 percent higher for male doctors and a staggering 130 percent higher for female doctors. While research has traced the beginning of this tragic difference to the years spent in medical school, the contributing factors remain murky. Students enter medical school with mental health profiles similar to those of their peers but end up experiencing depression, burnout and other mental illnesses at higher rates. Despite better access to health care, they are more likely to cope by resorting to dysfunctional behaviors like excessive drinking and are less likely to receive the right care or even recognize that they need some kind of intervention.

Researchers have offered several theories to explain these seemingly paradoxical findings. Some have faulted the increasing social isolation of medical education, training and practice. Others have pointed to the tendency for doctors to be highly critical of themselves and to blame themselves for their own illnesses. Still others, in light of the particularly high rates of suicide among female doctors, have suggested that workplace harassment may have a role.

Despite the many studies, theories and, more recently, student wellness programs and confidential mental health services offered by more and more medical schools, the grim statistics for medical students have hardly budged over the last generation. Up to a quarter of young doctors-to-be suffer from depression, more than half may be experiencing burnout, and a just more than 10 percent may be harboring thoughts of suicide.

These sobering numbers have remained unchanged in large part because our understanding of this issue has been hampered by inadequate research methodologies and insufficient financial support. We haven’t had the sophisticated tools needed to analyze the causes or appropriate interventions; and even if we did, we haven’t had the money to do anything with them.

Now two groups of researchers, using innovative methods and financed by medical school programs and departments with a keen interest in physician well-being, have published separate studies in The Journal of the American Medical Association that go beyond incidence statistics and theoretical considerations. Each study offers new findings about medical student distress and how the learning environment both fosters and exacerbates it. Read together, they offer disquieting views of the world in which tomorrow’s doctors are formed.

“There’s no arguing anymore over whether there’s a high prevalence of distress,” said Dr. Liselotte N. Dyrbye, lead author of one of the studies and an associate professor of medicine at the Mayo Clinic in Rochester, Minn. “What’s important now is that we hold a mirror up to ourselves and ask why this is happening, because it is clearly not what we medical educators have intended.”

Previous studies have linked medical student distress to unprofessional behavior. But, as Dr. Dyrbye and her colleagues show in their research, different types of distress — professional versus personal — can have very different effects on a young doctor’s sense of what is right and wrong.

Surveying more than 2,500 medical students across the country, the researchers found that students who suffered from professional distress, more commonly referred to as burnout, a constellation of emotional exhaustion, detachment and a low sense of accomplishment, were more likely to admit to cheating on tests, lying about the status of a patient’s laboratory tests or physical exam and espousing less altruistic views regarding their role as physicians. Conversely, students who suffered from personal distress, defined as poor mental or physical quality of life or depression, were not more susceptible to these unprofessional behaviors and self-centered beliefs.

“There certainly is some overlap,” Dr. Dyrbye said. “But depression and burnout are two separate entities.”

One result of erroneously conflating the two types of distress is stigmatization of mental illness. According to the second study, conducted by researchers from the University of Michigan in Ann Arbor, medical students who are depressed or prone to depression often believe they are viewed as inadequate and incompetent by those around them.

“They feel this from every direction — from other medical students, faculty members, counselors, and even in their applications for residency training,” said the study’s lead author, Dr. Thomas L. Schwenk, a professor of family medicine at the University of Michigan. While depression can cause individuals to have negative and distorted views of their surroundings, “the culture of medical school makes these students also feel like they can’t be vulnerable or less than perfect.”

Given that students must compete with one another throughout medical school for postgraduate training positions, many have a difficult time admitting to any perceived weakness. For those who do and want help, there are more obstacles: with the sense that peers, faculty members and others are likely to judge distressed students as less competent, it is nearly impossible to find somewhere truly safe to turn.

But this “survival of the fittest” mentality can affect all medical students, not just those who are depressed or burned out. And it can affect patients by wearing away at a young doctor’s sense of empathy.

“If this is the way that students view each other,” Dr. Schwenk said, “how do they view their patients who are depressed or struggling with mental illness?”

More long-term studies are needed to test interventions and analyze the factors contributing to student distress. “We have to assume that starting in medical school, there’s a pipeline of experiences that leads to an increased risk of suicide,” Dr. Schwenk said. But without more evidence-based interventions, even the best intentions of medical educators will continue to do little to stem the tide of medical student distress and physician suicides.

That failure has already and will continue to come at a tremendous cost to doctors and patients. “I still believe that the people who are the most vulnerable are often the most empathic,” Dr. Dyrbye said. “They are the ones who get most attached and put the needs of the patient first.”

Dr. Dyrbye continued, “Until we know what really helps them and what works best, our learning environment will continue to eat away at our students’ empathy and altruism.”]]> daarons BSEC Public Forum Wed, 17 Nov 2010 14:07:52 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,221,221#msg-221 http://www.bioethicscaribe.org.jm/forum/read.php?2,221,221#msg-221

American academic Professor Glenn Cohen has been investigating some ignored legal aspects of medical tourism from the USA. 'Medical tourism: the view from 10,000 feet' is a short paper in leading bioethics journal the Hastings Center Report. A longer just-published paper in the Iowa Law Review is 'Protecting patients with passports: medical tourism and the patient protective argument'.

In the longer paper Cohen looks at the motivations and demographics of medical tourists:
• Some are uninsured or underinsured patients seeking cost savings (in some cases upwards of 80% savings compared to U.S. prices) on procedures like hip replacements or cardiac bypass by seeking them in countries like India or Thailand.
• Some are part of a growing industry of insurer-prompted medical tourism — individuals who have insurance but whose insurers incentivise or allow treatment abroad.
• And failed attempts (a bill that died in the West Virginia legislature) to have government prompted medical tourism where state health insurance schemes incentivise (or much less plausibly require) travel abroad for health care.

Cohen argues that these types of medical tourism raise significant legal and ethical issues:
• "Domestically we treat advance contractual waivers of medical malpractice rights as unenforceable, such that you cannot bargain for a better price with your doctor by waiving those rights, even in the extreme case where you might not be able to afford the surgery without that price discount. How should we feel about the way in which medical tourists will (due to several interlocking facets of American civil procedure, and sharply less remunerative foreign law) essentially waive medical malpractice recovery rights by seeking care abroad in order to achieve costs savings? How should we regulate the insurer-prompted medical tourism market? Does the existing state insurance architecture of regulation suffice? What about self-insured plans? What are the dynamic effects on U.S. health care markets of competition from medical tourism centers? What are the effects of medical tourism on health care access in the destination country and should they matter to us? How will the recent Obama health care reform initiatives change the playing field?"

So far, much of what Cohen investigates is not new to the medical tourism world. But then he ventures into an area that few in the business like to consider,
• "There is medical tourism for services illegal in the home country but legal in the destination country (abortion tourism, reproductive technology tourism, euthanasia tourism, stem cell therapy tourism) and for services illegal in both places but with grey or black markets in the destination country (organ tourism). Here we face questions of whether the USA should extend its domestic criminal prohibition extraterritorially in the model of the Protect Act (child sex tourism) There are also hard questions about the obligations of doctors in the home country as to patients who have returned with illegally purchased organs, as well as their obligations to inform or not inform patients about the option of going abroad."

'Medical tourism: the view from 10,000 feet' highlights concerns on the single/dual illegality matter,
• If a foreign country criminalizes organ sales but has a lax enforcement regime, that effectively tolerates a grey market. Should the USA use its criminal law against citizens that purchase organs abroad? US laws on child sex tourism are the nearest equivalent where the law can be applied to the acts of a US citizen outside the USA.
• Another approach on such organ tourism is to extend Medicare regulations that require doctors to tell patients that if they buy illegal organs abroad, the doctor could refuse to supply aftercare or drugs.
• Should US law default to what is legal in the USA or what is legal in the destination country?

Cohen says, ‘If we try to reign in the activities of US citizens abroad, then we face legal challenges in designing regulation and detecting it where the activities are legal or illegal and not policed in destination countries. He mentions the dilemma of making Americans into criminals when US laws, government interference in research, and inadequacies of the system have created the US demand for organ and fertility tourism.

An area that Cohen touches on but ultimately skates over is whether or not the USA has any right to impose its views and laws on US citizens just because other countries have different legal ethical and medical views on areas such as same sex fertility tourism, organ transplants, surrogacy and assisted suicide. David Young-Cheol Jeong comments, "As for the legality of certain treatments, it might be interesting to think about overseas manufacturing activities at lower wage, lower occupational safety and health standards, or lower environmental regulations and enforcement. US multi-nationals run factories in China, Guatemala or Cambodia, so if you can establish the basis on criminal liabilities for rendering medical services, it might be applicable to multi-nationals who buy labour in violation of their home country laws. The punishment should come from the home country."

Cohen’s next paper will be a longer piece that looks at normative justifications for extending a state’s criminal law outside the USA, and what they can tell about medical tourism for services legal in the destination country but not the home country of the patient. Another area Cohen has investigated is whether medical tourism hurts access to medical care in destination countries by driving up costs and using resources in the country. He presented a paper at a conference in June but has yet to get it published in an academic journal. Cohen comments, "While one can specify triggering circumstances that would make a negative effects from medical tourism on destination country access to healthcare more likely, and while one can find authors making these claims and some anecdotal evidence for the effect, I have yet to find any empirically rigorous demonstrations of the effect. Even if the effect was demonstrated, there are interesting questions of whether this should create an obligation on the part of home countries or international organizations to prevent some forms of medical tourism due to this negative effect."

Medical tourism news08 October 2010]]> daarons BSEC Public Forum Wed, 17 Nov 2010 13:54:36 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,220,220#msg-220 http://www.bioethicscaribe.org.jm/forum/read.php?2,220,220#msg-220
Contact: Susan Gilbert
gilberts@thehastingscenter.org
845-424-4040 x244
The Hastings Center

Author who revealed unethical Guatemala syphilis study writes for Bioethics Forum
Findings from the past have implications for research in the future
(Garrison, NY)


The researcher whose revelations about unethical U.S. studies on syphilis in Guatemala in the 1940's led to apologies from the Obama administration last week has written a commentary for Bioethics Forum, the Hastings Center's online publication. She calls for the need to learn from history to better protect human subjects in the developing world.

Susan M. Reverby, a professor at Wellesley College, describes how she unearthed documents about the study by accident while doing research for a book on the Tuskegee syphilis study. The documents, hidden in the University of Pittsburgh archives, revealed that doctors from the U.S. Public Health Service infected prisoners, soldiers, and psychiatric patients with syphilis to find out if penicillin could prevent the disease from taking hold. "They knew this was on the ethical edge," she writes in Bioethics Forum.

Reverby describes the media frenzy that followed the announcement last week. "The press coverage and reaction has been overwhelming, crossing the world in just more than a nanosecond," she writes, adding that "it has been difficult to do what historians do best: explain details and context." She concludes her Bioethics Forum piece with her hope that the Guatemala findings can serve as a guide to strengthen human subjects protections, especially in trials conducted abroad. "The debate on the necessity for protections in the developing world continues and perhaps this will be a reminder of why they matter," she writes. Nearly half of all U.S.-based clinical trials are conducted overseas.


###]]> daarons BSEC Public Forum Wed, 17 Nov 2010 13:33:57 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,219,219#msg-219 http://www.bioethicscaribe.org.jm/forum/read.php?2,219,219#msg-219
By Ed Silverman // October 4th, 2010 // 10:00 am


The last several years have seen increasing concern over ethics in the pharmaceutical industry – from the way clinical trials are run and trial data is disclosed to promotional activities aimed at consumers and interactions with the medical community and universities. Among the many observers who make a living by witnessing this unfolding morass is Carl Elliott, a professor at the Center for Bioethics at the University of Minnesota, who has published a book called “White Coat, Black Hat: Adventures on the Dark Side of Medicine.” We spoke with him about his observations and insights…

Pharmalot: Do we live in unethical times?

Elliott: You could definitely make that argument, although the nature of what’s going on is not really new. When I was writing about the drug reps, I asked them about scams and manipulations that are used with doctors and asked is it new? This one rep laughed and said there’s nothing new under the sun, there’s just more of it. I tend to agree with that. But it got a whole lot worse in the 90’s and we’re still living with that. As an ethicist, I don’t like being a self-righteous, finger-wagging, self-appointed expert trying to point out to the world what other people are doing wrong. I don’t think I have any moral expertise more than anybody else. I do think ethics speaks for itself.

Pharmalot: What’s the biggest problem?

Elliott: They all point to the same thing, which is undermining trust in medical knowledge and the profession. The difficulty with the way things are done now is that you don’t know if you can believe what’s in the medical literature anymore. After product-liability litigation, you learn evidence has been faked or ghostwritten and that doctors are getting payments from pharma. You see things on television you may not believe because the news is being spun. Research subjects feel they have been exploited.


Pharmalot: That’s a pretty gloomy picture you paint. Is it really that bad?

Elliott: That’s the problem. You don’t know. Once your trust is undermined, it’s very easy to become paranoid. It’s not all gloom and doom…I do think there are gleams of sunshine peaking through the clouds. One of them is trial lawyers. I think that what has emerged in litigation has opened a lot of eyes – also doctor and expert witnesses are making information available, which is pretty remarkable. I think you can sense a change, as a result, in medicine. It’s a very conservative profession and very hierarchical. And there are lot of people who worked their way up to top by virtue of collaborating with industry. But there are also fairly outspoken ones and when they have that sort of platform and reputation, others take note. And I think medical students, such as the American Medical Students Association, has been encouragingly on the right side of the issue.

Pharmalot: Okay, so let me ask you this: Does the pharmaceutical industry do anything right?

Elliott: Whenever any administrator at my university says something negative about the industry, they paraphrase it by saying how wonderful the industry is at saving lives, etc., as if they’re afraid of the mob. They can’t say anything without prefacing it with all these compliments. I’m not sure if it’s a matter of a tin ear or an effort to defuse suspicion, but it happens everywhere. It’s like the Democrats. Before they criticize a government or a policy, they have to go into this long shpiel about how patriotic they are and love their country. But look, I don’t disagree with the idea that industry does make good drugs. But I don’t need to preface my remarks with such comments.

Pharmalot: You’ve also complained that the bioethics field isn’t always transparent. How so?

Elliott: The whole issue of bioethics working for industry grates on me. It’s a small thing in the scheme of things and there isn’t that much money compared with academic medicine thought leaders. But bioethicists shouldn’t be paid consultants…How can I tell my students, ‘Oh, I make $100,000 a year from a company, but don’t worry you can trust me.’ On a larger level, you could say the same thing about for-profit institutional review boards, because the industry needs to have trials done. So they just pay a fee to an ethics board to approve a trial. If turned down, they just go to another. It’s a crazy way to regulate clinical trials, but that’s the system we have.

Pharmalot: A recent study found that some doctors seem to believe they’re entitled to certain freebies. Yet there’s certainly been a lot of publicity about concerns over such things. Why does the issue persist?

Elliott: Medicine is hard and medical training is hard and medical school is miserable and by the time people are out of residency training, in a lot of ways, they’re kind of angry. And a lot of people have the sense that the work is not what I thought it would be like and somebody owes me something. So the finding is totally believealbe, although I don’t want to justify it.

Do ordinary doctors get it? I’ve been involved in this stuff awhile and worked at a lot of different hospitals. At every hospital, there’s always some small group of doctors worried about industry influence and what they always get worked up about are the pizzas and pens and little gifts. ‘We gotta get the reps out of the hospitals,’ they say. I don’t’ disagree with that, but what they never say is we need to get rid of the department chair who is making a half million a year from the industry, which to me is more outrageous than the pens and pizzas. If it were up to me, there’d be no more pizzas and pens, but there’s something self serving about them getting worked up about what students and residents are getting without paying attention to what their colleagues are getting..

Pharmalot: Okay, but on a practical level, does transparency matter? How many people do you think might really take action if they find their doctor has a tight relationship?

Elliott: Suppose you find out the doctor you’re going to gets all this money from a company. What do you do with that? Talk? Get another doctor? Try to figure out how it relates to the treatment? In the end, it undermines trust and maybe it deserves to be undermined. I don’t think disclosure is all that helpful unless you say you’re not willing to go to any doctor that takes money from industry. But then you have choices to make. Which doctors will you be able to see? What if all the specialists in your town are on somebody’s payroll? Then what do you do? I don’t think disclosure solves the problem. That seems to be the approach and I think it’s totally misguided. The more doctors who do it and the more widely known people know about it, the more widely it will be done and the practice will become normalized and nobody will feel any compunction about taking money from industry anymore.

October 4th, 2010
10:26 am


Link to this comment
Probably redundant, but outside R&D and their medical departments, which answer questions for other physicians, there are very few MDs in pharma.

The industry is primarily led by MBAs, lawyers and sales people at the highest levels. This presents a priority issue, as it usually places cash over patient well being.

It will not change anytime soon, if ever. The incentives for executives to exceed sales goals drives a “win at all cost” mindset for far too many at the top and those who dream of getting to the top.
Rep

October 6th, 2010
10:28 pm

Link to this comment
Hey doc,

It is already changing in some campanies (ie. patients first). I’m not as pessimistic as you appear to be but I’m still skeptical and not sure what to make of it yet. I can only guess that the old “profit first” models will not survive and hope they will be replaced by “patients first, profit will follow”.
Salient point]]> daarons BSEC Public Forum Tue, 16 Nov 2010 14:21:41 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,218,218#msg-218 http://www.bioethicscaribe.org.jm/forum/read.php?2,218,218#msg-218 October 4, 2010

NPR's Robert Siegel talks to Jeff Kahn, director of the Center for Bioethics at the University of Minnesota Medical School, about the ethics of in vitro fertilization.
Copyright © 2010 National Public Radio®.


ROBERT SIEGEL, host:

In 1978, the phrase in-vitro fertilization was something the experts said.�The rest of the world spoke of test-tube babies. Newspaper columnists and editorial writers invoked Aldous Huxley's image of baby hatcheries in his dystopian novel "Brave New World."

Jeffrey Kahn directs the Center for Bioethics at the University of Minnesota Medical School. And, Jeffrey Kahn, have four million births through IVF trumped all the moral and ethical questions that were posed by the procedure?

Dr. JEFFREY KAHN (Director, Center for Bioethics): I think at the outset there was such concern about the new and uncertain technology that this proposed that people were quite afraid. But four million births later, those early issues went away, but new ones certainly came in the aftermath.

SIEGEL: As for the old issues, though, I mean, there were concerns of the potential eugenic consequences of IVF, that it wouldn't just help people who couldn't conceive, but it would help people who couldn't conceive with the kind of mate they would like to conceive. That, I guess, is part of life today.

Dr. KAHN: Absolutely. And I think that technology has evolved in ways that have brought some of those concerns to light so we can now test embryos outside of the body and make decisions about which ones to implant based upon the results of those tests. And that's what people were fearful of in 1978. The technology just didn't exist until well into the 1990s.

SIEGEL: You spoke, though, of concerns that were anticipated back in 1978 that have developed. What would place in that category?

Dr. KAHN: Well, I think things around new combinations of parents, effectively. So now we have the ability to combine sperm from one man, egg from one woman, that resulting embryo can be implanted into a third woman. And then the child born from that pregnancy can be raised by a separate couple.

So we have, in that case, five different people involved in the creation and eventual rearing of a single child. And that, I think, wasn't thought about in prospect quite in the way that it turned out to be a reality.

SIEGEL: There is another area of concern, which is the notion that embryos that are not implanted are frozen and whatever we do with them, are we doing that with human life? Is disposing of them disposing of human life?�That problem persists.

Dr. KAHN: Absolutely. And I think it's something that was foreseen in some respect. But the numbers at which we create and now store the excess embryos has really gotten to the point where we need a societal conversation and maybe a policy decision about what to do with those leftover embryos. The estimates are something like a million frozen embryos left in the United States alone. And we don't really have good plans for what ought to be done with them.

SIEGEL: What about the ethical and moral issues for doctors? That is, should they facilitate multiple births for a woman who has no apparent means of support of sextuplets or octuplets? Or is it the doctor's job to honor the patient's wishes and let the chips fall where they may?

Dr. KAHN: Well, it may be even a more fundamental conflict than that, in that we think about the right to have children as a basic fundamental liberty that we recognize. And so, when an individual says I'd like to have children, we don't usually ask why or how many or what techniques do you propose to use.

And so we have the technology that allows us to create these high multiple birth pregnancies bumping up against what we think of as a quite fundamental liberty. And we really haven't wrestled that to the ground either. And that's an issue that started in 1978, and then certainly persists today.

SIEGEL: There's another level of discussion of medicine, which is what do we think are the normal needs of making people well that should be covered by insurance plans - public and private. Have we settled that one when it comes to fertility treatments and IVF? Do we understand what it is that every woman or every couple is entitled to?

Dr. KAHN: No, absolutely not. In fact, in the United States there's quite a variety of coverage when it comes to reproductive medicine techniques. So some policies will cover a few cycles of in-vitro fertilization for any one individual. Many, many policies don't cover it at all, viewing it not as treatment of an illness or a disease but something that is rather more optional than that.

So it is far from being a settled issue when it comes to who pays and if they pay for it, how much.

SIEGEL: Jeffrey Kahn, thank you very much for talking with us today.

Dr. KAHN: My pleasure.

SIEGEL: So Jeffery Kahn, who is director of the Center for Bioethics at the University of Minnesota Medical School.

Copyright © 2010 National Public Radio®. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to National Public Radio. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.]]> daarons BSEC Public Forum Tue, 16 Nov 2010 13:37:43 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,214,214#msg-214 http://www.bioethicscaribe.org.jm/forum/read.php?2,214,214#msg-214 Julia Medew
August 27, 2010


NON-RELIGIOUS doctors are more likely to make decisions that could hasten a terminally ill patient's death than are religious doctors, a new study suggests.

A survey of 4000 British doctors found that those who described themselves as ''very'' or ''extremely'' non-religious were twice as likely as religious doctors to have provided deep sedation until death, even if it could speed up the patient's dying process.

The results of the survey, published in the Journal of Medical Ethics, also showed that non-religious doctors were more likely to have discussed life-shortening measures with patients.

Monash University Centre for Human Bioethics director Justin Oakley said the results suggested religious doctors might not be having frank and open discussions with patients and that some patients might be denied access to care such as deep sedation because of doctors' religious beliefs.

Associate Professor Oakley said the study should prompt similar research in Australia. He felt doctors should disclose their views to patients so they could make informed decisions about who cared for them.

''I think doctors owe it to patients to tell them up front what they are prepared to do for them and what they are not,'' he said.

In Australia, it is illegal for doctors to give drugs with the deliberate intention of ending someone's life, but they can administer morphine or other medication to relieve pain or distress that may shorten life.

Australian Medical Association president Andrew Pesce said if doctors were morally opposed to particular procedures, such as abortion or sedation for the dying, they should refer patients wanting those procedures to someone else who could help them.]]> daarons BSEC Public Forum Fri, 05 Nov 2010 21:20:55 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,212,212#msg-212 http://www.bioethicscaribe.org.jm/forum/read.php?2,212,212#msg-212 By NATASHA SINGER

Mother Jones Takes on Clinical Trial Ethics


Carl Elliott, a professor of bioethics at the University of Minnesota, dissects his own institution — and its conduct in a clinical trial of antipsychotic drugs — in an article in the September issue of Mother Jones.

The narrative centers on the case of Dan Weiss, 26, who was enrolled by university researchers in an antipsychotic drug study without his consent. Mr Weiss, who later changed his last name to Markingson, committed suicide during the study.

Dr. Elliott uses the case to examine the general state of the clinical trial industry, delivering a withering critique.

People, including patients who volunteer to be guinea pigs for medical research, generally assume that the purpose of clinical trials is to produce scientific knowledge, he writes. But some drug trials my be little more than marketing exercises for drug makers, he writes, raising ethical questions about whether it is appropriate to expose participants to the health risks involved in such research.

“What if a research study is not really aimed at producing genuine scientific knowledge at all? The documents emerging in litigation suggest that pharmaceutical companies are designing, analyzing, and publishing trials primarily as a way of positioning their drugs in the marketplace. This raises a question unconsidered in any current code of research ethics. How much risk to human subjects is justified in a study whose principal aim is to ‘generate commercially attractive messages?’ ”

And universities can be complicit, he writes, when their own panels of independent experts — called institutional review boards, or I.R.B.’s — whose mandate is to protect study participants, fail to do so. When lawyers in the Weiss case deposed board officials at the University of Minnesota, for example, the officials said that protecting research subjects was not their responsibility, according to the article.

Instead, Minnesota’s I.R.B. director said that the role of her oversight group was to ensure that a researcher overseeing the drug trial and the drug maker sponsoring the study had a plan to protect patients, Dr. Elliott writes:

“If this were true, it would render I.R.B.’s worthless: The sponsor and investigators are the ones that the I.R.B. is supposed to protect subjects from.”

A university official, quoted in the article, said: “To date, there has been no finding of wrongdoing from any of the investigations or reviews done by the university on this issue.”]]> daarons BSEC Public Forum Fri, 05 Nov 2010 20:53:48 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,210,210#msg-210 http://www.bioethicscaribe.org.jm/forum/read.php?2,210,210#msg-210 A New Jersey case raises pressing policy questions.

By Arthur Caplan


Ruben Betancourt died on May 29, 2009. Last week, a New Jersey appellate court declined to rule on the heated dispute that had broken out between his family and a North Jersey hospital over stopping his medical care prior to his death.

It's not often that the nonruling of a court holds national significance, but the state Appellate Division's punt in this case merits our attention.

Betancourt, 73, had undergone surgery at Trinitas Regional Medical Center in Elizabeth to remove a tumor from his thymus gland. The surgery went well, but during his postoperative recovery, Betancourt's breathing tube somehow became disconnected, and he suffered severe, irreversible brain damage.

As a result, Betancourt wound up needing a ventilator, kidney dialysis, and a feeding tube. He soon developed terrible skin ulcers and infections.

The doctors at Trinitas believed it was pointless to continue treating Betancourt. His brain was permanently and severely damaged, his kidneys would never work again, and his skin would only continue to fall apart.

Betancourt's daughter and the rest of his family did not agree. They wanted all treatment to continue.

The hospital unilaterally imposed a do-not-resuscitate order, meaning the staff would not try to revive Betancourt if his heart stopped. The family went to court and persuaded a judge to have the order rescinded. Then the hospital went to court to have it restored.

In the midst of all this fighting, Ruben Betancourt died.

Should doctors ever be able to decide that medical care is futile and stop treatment regardless of the wishes of a patient's family, friends, or guardians? It's a huge question, and it will only become more pressing in the years to come, as more and more patients' lives are prolonged with expensive medical technology.

Today these cases are almost always worked out quietly, without lawsuits. In my experience, the hospital usually backs down, and care goes on.

But that may not be the right answer in every case. And doctors, who often feel frustrated by situations they deem futile, don't press to end care for a variety of reasons, including the risk of adverse publicity and the money to be made providing more care.

In its 26-page opinion, the New Jersey court said it would not rule on the Betancourt case because the facts were in dispute, a malpractice charge might be brought against the hospital, and the hospital and family are fighting over Betancourt's bills. The court held that the contentious nature of the case did not make it useful for resolving broader issues of public policy concerning medical futility and decisions to stop care against families' wishes.

The court did, nevertheless, understand the importance of the matter, saying: "The issues presented are profound and universal in application. They warrant thoughtful study and debate not in the context of overheated rhetoric in the battlefield of active litigation, such as marked the [Terri] Schiavo debate, but in thoughtful consideration by the Legislature as well as executive agencies and commissions charged with developing the policies that impact on the lives of all."

State legislatures, bioethics commissions, religious groups, think tanks, and the federal government would do well to heed those words.

Although few cases involving medical futility reach court, that doesn't mean doctors don't grapple with them regularly in hospitals and intensive care units. Although nearly every such case is resolved in favor of continuing care, that doesn't mean this is the best use of medical resources or public money. And although this nation is likely to encounter more cases like Ruben Betancourt's, that doesn't mean we should resolve them all in the courts.

What these facts do mean is that it's time to openly and publicly examine what should happen when medical professionals feel they can do no more for patients, but their families, partners, and friends vehemently disagree.

--------------------------------------------------------------------------------
Arthur Caplan is director of the Center for Bioethics at the University of Pennsylvania. He can be reached at caplan@mail.med.upenn.edu.]]> daarons BSEC Public Forum Fri, 05 Nov 2010 20:34:56 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,209,209#msg-209 http://www.bioethicscaribe.org.jm/forum/read.php?2,209,209#msg-209 Tuesday, August 17, 2010

Two interesting issues in the news recently. One. should a Turkish pop singer with HIV who knowingly had unprotected sex with others and without informing them of her illness be sent to jail? Two, should the treatment for a genetic malformation which, while making surgery unnecessary, also reduces the possiblity that the female infant will grow up to become a lesbian be allowed? Should gay rights trump parental rights and the best interests of the child?

In the first case, this from the BBC:

A singer from German girl band No Angels has admitted to having unprotected sex with several partners without warning them she was HIV-positive.

Nadja Benaissa, 28, was speaking at the opening of her trial in the German city of Darmstadt. . . .

She faces a charge of grievous bodily harm for allegedly infecting one man.

She has also been charged with attempted bodily harm for allegedly having sex with two other men who were not infected.

The charges carry a prison sentence ranging from six months to 10 years.

The issue of whether someone with HIV or AIDS is duty bound, morally and legally, to warn their partners of their infection prior to engaging in sex of any sort, let alone unprotected sex, would seemingly be a no-brainer. Indeed, for the protection of society at large, not merely should there be punishment for such acts, it should be severe indeed. It is a criminally reckless act that portends to destroy innocent people's lives and spread HIV throughout society.

Amazingly, some groups see it otherwise. Earlier this year, the International Planned Parenthood took the position that "each person has a right to a 'fun, happy and sexually fulfilling lives' and that, within the penumbra of that right, those with AIDS or HIV have a right to engage in sex without informing their partner that they are infected. And it would seem that is the tack being taken by at least some AIDS "activists." Back to the case of Ms. Nadja Benaissa, this also from the BBC:

Aids campaigners have been critical of the authorities' handling of Ms Benaissa's case, and warned against a rush to criminalise the transmission of HIV, the BBC's Tristana Moore reports from Berlin.

Edwin Bernard, a writer and advocate specialising in HIV prosecutions, believes that prosecutions and laws on HIV transmission may do more harm than good in terms of reducing the spread of infections.

He told BBC World Service that studies in the US had found that they have had no real impact on new infections.

When the 24 US states which have disclosure laws were compared with those that do not, there was no impact on the rate of transmission or the level of unprotected sex people engage in, he said.

"By singling out HIV, it really promotes fear and stigma," Mr Bernard added.

"Many of these cases, and in particular the media reporting of these cases, perpetuate an awful lot of myths about how HIV is transmitted, as well as things like the life expectancy, which is pretty close to normal now in the developed world."

The campaigner noted that prosecutions were relatively rare compared with the number of HIV transmissions that happen each year.

He estimated that there had been at least 600 prosecutions in more than 40 countries with prison sentences handed down in most cases, ranging from a few months to life.

Very few people, he said, had been prosecuted for intentionally transmitting HIV sexually.

This really is insanity, it seems to me. They are advocating that a person with HIV/AIDS who knowingly engage in sex without telling their partners should be allowed to freely continue that conduct because: they might be stigmatized; it promotes fear, and; with extensive treatment it is not now an automatic death sentence. Hey, its the new common cold. Right?

Oh, and do note, the Obama DOJ is taking a similar position. They are advocating that people with HIV and AIDS be taken out of a special holding facility in South Carolina prisons where they receive daily treatment. The DOJ wants South Carolina to disperse these individuals throughout the general prison population.

What do you think?

In the second case, this from the LA Times about a rare medical condition and a new treatment for the disease that might lessen the child's predisposition to lesbianism:

Each year in the United States, perhaps a few dozen pregnant women learn they are carrying a fetus at risk for a rare disorder known as congenital adrenal hyperplasia. The condition causes an accumulation of male hormones and can, in females, lead to genitals so masculinized that it can be difficult at birth to determine the baby's gender.

A hormonal treatment to prevent ambiguous genitalia can now be offered to women who may be carrying such infants. It's not without health risks, but to its critics those are of small consequence compared with this notable side effect: The treatment might reduce the likelihood that a female with the condition will be homosexual. Further, it seems to increase the chances that she will have what are considered more feminine behavioral traits.

That such a treatment would ever be considered, even to prevent genital abnormalities, has outraged gay and lesbian groups, troubled some doctors and fueled bioethicists' debate about the nature of human sexuality.

The treatment is a step toward "engineering in the womb for sexual orientation," said Alice Dreger, a professor of clinical medical humanities and bioethics at Northwestern University and an outspoken opponent of the treatment.

The ability to chemically steer a child's sexual orientation has become increasingly possible in recent years, with evidence building that homosexuality has biological roots and with advances in the treatment of babies in utero. Prenatal treatment for congenital adrenal hyperplasia is the first to test — unintentionally or not — that potential.

The hormonal treatment "theoretically can influence postnatal behavior, not just genital differentiation," said Ken Zucker, psychologist in chief of the Center for Addiction and Mental Health in Toronto, who studies gender identity. "Some people refer to girls with CAH as experiments of nature because you've got this condition and you can take advantage of studying it."

Complicating the situation is the fact that the daily hormone pill does nothing to treat or cure the underlying condition, caused in this case by a defective enzyme in the adrenal gland.

Dreger and critics — which include the National Center for Lesbian Rights, Advocates for Informed Choice (an organization that works to protect the rights of people with intersex conditions), and some pediatric endocrinologists and parents of children with the condition — say far too little is known about the safety of the hormone, the steroid dexamethasone, when used prenatally. They say it should be used sparingly, in closely monitored clinical trials, or not at all. They're even more concerned that some doctors might tell parents that a reduced chance of homosexuality is one of the therapy's benefits. . . .

Congenital adrenal hyperplasia, caused by a defect in an enzyme called 21-hydroxylase, affects about 1 in 15,000 infants, and almost all newborns are screened for it. Undetected, the abnormality can make both male and female infants critically ill within a few weeks of birth because of an associated salt loss through the urine. The defective enzyme also causes a deficiency of the hormone cortisol, which can affect heart function, and an increase in androgens produced by the adrenal glands. . . .

Is anyone else offended by the fact that gay rights groups are weighing in on this medical treatment to advance their own special interests? One, this treatment may prove beneficial to the child. Two, the people who should determine whether to go forward with this treatment seems to me to be solely an issue of parental rights. Lastly, since reducing the tendency towards homosexuality is not an option, but a side effect of this treatment, is there any moral or ethical reason for withholding this information from the parents - besides the facts that it upsets gay rights activists? Should gay rights ever trump parental rights? Those are questions for you. Feel free to weigh in.


Posted by GW at Tuesday, August 17, 2010

Labels: Aids, bioethics, crime, ethics, gay rights, genetic disorder, HIV, Nadja Benaissa, parental rights, stigma]]> daarons BSEC Public Forum Fri, 05 Nov 2010 20:26:49 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,207,207#msg-207 http://www.bioethicscaribe.org.jm/forum/read.php?2,207,207#msg-207 August 15, 2010|By Shari Roan, Los Angeles Times

A prenatal pill for congenital adrenal hyperplasia to prevent ambiguous genitalia may reduce the chance that a female with the disorder will be gay. Critics call it engineering for sexual orientation.
Each year in the United States, perhaps a few dozen pregnant women learn they are carrying a fetus at risk for a rare disorder known as congenital adrenal hyperplasia. The condition causes an accumulation of male hormones and can, in females, lead to genitals so masculinized that it can be difficult at birth to determine the baby's gender.

A hormonal treatment to prevent ambiguous genitalia can now be offered to women who may be carrying such infants. It's not without health risks, but to its critics those are of small consequence compared with this notable side effect: The treatment might reduce the likelihood that a female with the condition will be homosexual. Further, it seems to increase the chances that she will have what are considered more feminine behavioral traits.

That such a treatment would ever be considered, even to prevent genital abnormalities, has outraged gay and lesbian groups, troubled some doctors and fueled bioethicists' debate about the nature of human sexuality.

The treatment is a step toward "engineering in the womb for sexual orientation," said Alice Dreger, a professor of clinical medical humanities and bioethics at Northwestern University and an outspoken opponent of the treatment.

The ability to chemically steer a child's sexual orientation has become increasingly possible in recent years, with evidence building that homosexuality has biological roots and with advances in the treatment of babies in utero. Prenatal treatment for congenital adrenal hyperplasia is the first to test — unintentionally or not — that potential.

The hormonal treatment "theoretically can influence postnatal behavior, not just genital differentiation," said Ken Zucker, psychologist in chief of the Center for Addiction and Mental Health in Toronto, who studies gender identity. "Some people refer to girls with CAH as experiments of nature because you've got this condition and you can take advantage of studying it."

Complicating the situation is the fact that the daily hormone pill does nothing to treat or cure the underlying condition, caused in this case by a defective enzyme in the adrenal gland.]]> daarons BSEC Public Forum Fri, 05 Nov 2010 20:05:21 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,204,204#msg-204 http://www.bioethicscaribe.org.jm/forum/read.php?2,204,204#msg-204
Published: Thu, May 20, 2010 @ 12:00 a.m.
By Arthur Caplan

Philadelphia Inquirer

Type “genetic testing” on an Internet search engine and then hang on. You will be in for quite a ride. There is an endless parade of companies touting genetic tests for everything, including determining whether your kid has the potential to be a star athlete, finding out whether your ancestors were kings or ne’er-do-wells, finding a date, optimizing your diet, or knowing what diet to use if your intake is not optimal. Apparently, there is more self-discovery to be had by spitting your saliva into a cup and sending it off to be genetically analyzed than in a whole month of Dr. Drew.

The push to get you to spend money on genetic testing has also reached your local drugstore.

Walgreens is entering into an agreement with Pathway Genomics to sell Pathway’s Insight genetic test kit. If you send your saliva to Pathway, it promises to tell you what risks you have for developing Alzheimer’s, breast cancer, diabetes, obesity, psoriasis and blindness. In addition, the company says you can find out how caffeine, cholesterol-lowering drugs, and blood-thinners might affect you.

Crude forms:

Unfortunately, these crude forms of genetic testing cannot do any of these things. The reality is that Internet offers and home-testing kits are not ready for prime time. Not enough Americans have had their genes analyzed so as to know what risks they face, particularly if you are in a minority ethnic group. Nor do genetic scientists know, except for a small number of rare diseases, enough to foretell how different genes will interact with different environments and lifestyles to produce health or illness. And not having a gene for a disease does not mean you won’t get that disease. If your house is full of radioactive radon gas leaking up from underlying rocks, your risk for lung cancer is high no matter what genes you do or don’t have.

Right now no government agency regulates the accuracy of genetic tests. There is no requirement that competent counseling be available to answer questions about the information you will get back. And for most risks there is nothing you can do except maintain a healthy lifestyle, which you can do without spending hundreds of dollars for genetic testing.

If you do have patterns of disease in your family, then seek out testing from a well-established, hospital-based, human genetics program. If you don’t, join a gym.

Arthur Caplan is director of the Center for Bioethics at the University of Pennsylvania. Distributed by McClatchy-Tribune Information Services.

Copyright 2010 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.]]> daarons BSEC Public Forum Fri, 05 Nov 2010 13:56:58 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,203,203#msg-203 http://www.bioethicscaribe.org.jm/forum/read.php?2,203,203#msg-203
Scientists create 'synthetic life,' fuel debate over bioethics
Scientists have created an artificial genome and inserted it into a bacteria cell, creating the first synthetic life. The goal of the project is to design microbes for energy or health applications.
________________________________________
________________________________________
By Pete Spotts, Staff writer / May 20, 2010

Scientists have taken a significant step toward creating artificial life by transplanting computer-designed genetic material into a bacteria cell, forming a new strain of the bacteria.
The work, while a significant scientific breakthrough, touches on profound questions regarding the origins and nature of life, some analysts say.

One of the ultimate goals of the project, the scientists say, is to develop the ability to design microbes from scratch to perform functions ranging from converting carbon-dioxide into oil and cleaning up pollution to serving as tiny machines for speeding the manufacture of vaccines.

The effort, reported in Friday's issue of the journal Science, does not represent a complete from-scratch organism.
Instead, the team used computer data on an existing bacterial genome as a template. Then they digitally modified the genome, adding their own formulations – including genetic material that encoded the researchers' names and three literary quotes in a kind of artist's signature that verified the genetic material the bacterial cell took up was the synthetic form.
So the effort remains a proof of principle, says J. Craig Venter, who heads the J. Craig Venter Institute in Rockville, Md., and led the research effort. Much work remains before researchers attain the ability to design and make fully custom microbes.
Still, the first colony of synthetic cells represents a biological and philosophical watershed.

"This is the first self-replicating species on the planet whose parent is a computer," Dr. Venter said during a press briefing Thursday announcing the results. "The cell started with a digital code in a computer."
The team used that information to build a bacterial chromosome essentially from four bottles of chemicals. They used yeast as a factory for assembling smaller segments of the chromosome into ever-larger segments. Then they transferred the entire new chromosome into a recipient cell, whose internal chemistry activated this assembly of genes.

Beyond the technical accomplishment – and the inevitable concerns about the safety and ethics of this fledgling technology – lies what may be a more profound implication of the work, according to University of Pennsylvania bioethicist Arthur Caplan.
Since Aristotle, he explains, scientists, philosophers, and theologians have argued over whether life involves more than chemical components – some have called it a "soul," others élan vital, a vital force that distinguishes the living from the nonliving.
Venter's team has shown that with the right mix of inanimate chemicals to build DNA sequences, and the right soup within the cell receiving the DNA, the result is a living organism, Dr. Caplan says.

The concept isn't alien to biologists, particularly those probing the origins of life on Earth. Yet Venter's work could be seen as the "final word in favor of mechanistic reductionism" of organic life, he says. "That's the enormous significance of this work."
Indeed, the work highlights a broad trend in the physical and biological sciences – one that over the past several decades has evolved to give humanity the ability to manipulate inanimate, and now animate, matter at its most fundamental levels and in forms of uniquely human design.

Even as the science of synthetic biology has evolved, so has the discussion of implications of this field, notes Gregory Kaebnick, an research scholar at the Hastings Center, a bioethics think tank in Garrison, N.Y.
Yet at this stage, he says, the nascent technology may raise hackles unnecessarily.

"I'm very sympathetic about concerns over how biotechnology may change the human relationship with nature," he says. "Synthetic biology can look like the culmination of the threat biotechnology can pose" to this relationship.
"But to my lights it doesn't pose a serious threat," he adds. Up to now, synthetic biology has focused on microbes, not complex organisms like plants or cows. "And the things we are doing to them are restricted to industrial uses," he adds.
Moreover, the aim is to simplify the genomes so that organisms spend most of their energy on producing the products -- fuels, pharmaceuticals, pollution-clean-up agents, for instance. Removing all but the most essential genes makes the organisms less adaptable to stress, and so less able to survive outside of a carefully controlled environment, Dr. Kaebnick says.

Still, taking advantage of any benefits from crossing the threshold from swapping "natural" genes among living organisms to designing synthetic genomes will require that scientists pay close attention to public concerns, according to David Ropeik, a risk-management consultant and former instructor on risk at the Harvard School of Public Health.

Because many of the developments leading to Thursday's announcement have remained fairly low on the public's radar screen, he says he anticipates that Venter's latest results could trigger the kind of public outcry that led researchers in the 1970s to place a temporary moratorium on gene-splicing research, then in its infancy. Leaders in the field met to work out a set of "how we need to be careful" protocols for conducting the work, Mr. Ropeik recalls.
That act alone, he says, signaled that researchers recognized and respected public concerns about the work they were undertaking.
The same is needed today, he says.
"What's really important for all the progress this work promises is that people's concerns be taken seriously and get factored in to how scientists behave and proceed," he says.

Venter notes that his group has been briefing politicians and regulators along the way, and the work has been reviewed by ethicists, including Dr. Caplan.
But the efforts may now have to be played out on a larger stage, and the work may need some self-imposed limits.
A report on synthetic biology produced by the University of Nottngham's Institute for Science and Society in Britain noted that "it must be recognised that ... some ethically problematic scientific projects and potentially controversial technologies may have to be abandoned in order to maintain trust."]]> daarons BSEC Public Forum Fri, 05 Nov 2010 13:15:20 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,173,173#msg-173 http://www.bioethicscaribe.org.jm/forum/read.php?2,173,173#msg-173 Published: 21 May 2010


A US biologist has stepped into the shoes of Baron Frankenstein by breathing life into a bacterium using genes assembled in the laboratory.
The creation of the "synthetic cell", described as a "landmark" by one British expert, is a 15-year dream come true for maverick genetics entrepreneur Dr Craig Venter.

It has major implications for genomics, including the manufacture of artificial organisms designed for specific tasks such as making vaccines or cleaning up pollution.

But experts recognise that as Mary Shelley demonstrated in her famous novel, there are potential dangers too. Synthetic life could, for instance, pave the way to terrifying biological weapons.

Dr Venter's researchers explain in the journal Science how they effectively "re-booted" a simple microbe by transplanting into it a set of genetic code sequences that were built from scratch.

The genome was copied from the blueprint contained in Mycoplasma mycoides, a simple bacterium that infects cattle and goats.

After first constructing short strands of DNA, the scientists used yeast cells as natural factory assembly lines.

The sequence was built in a step-by-step process. DNA repair systems in the yeast attached the pieces together, gradually lengthening the strands to finish up with a chromosome more than a million "letters" of genetic code long.

The final test came when the completed chromosome was transplanted into another bacterium, Mycoplasma capricolum, replacing its native DNA.

After a failed first attempt, the scientists brought the cells to life. Driven by the new genome, the bacteria took on the appearance and behaviour of M.mycoides, generating different proteins and multiplying.

Describing the achievement, Dr Venter said: "This is the first synthetic cell that's been made, and we call it synthetic because the cell is totally derived from a synthetic chromosome.

"This is an important step we think, both scientifically and philosophically.
It's certainly changed my views of the definitions of life and how life works."

To prove the recipient bacteria contained the synthetic genome, the scientists effectively signed their names in DNA.

Four of the DNA sequences included coded "watermarks" - strings of "letters" corresponding to the names of people involved in the project, an e-mail address, and some famous quotations.

Commenting on the breakthrough in Science, Professor Mark Bedau, editor of the journal Artificial Life, called it "a defining moment in the history of biology and technology".

US biologist Dr Jef Boeke, from Johns Hopkins University in Baltimore, Maryland, told the journal: "It represents an important technical milestone in the new field of synthetic genomics".

British expert Professor Paul Freemont, co-director of the EPSEC Centre for Synthetic Biology at Imperial College London, said: "The paper... is a landmark study that represents a major advance in synthetic biology.

"The applications of this enabling technology are enormous and one might argue this is a key step in the industrialisation of synthetic biology leading to a new era of biotechnology."

Dr Venter, who runs the J. Craig Venter Institute in Rockville, Maryland, came to fame when he controversially challenged publicly-funded scientists working on the international Human Genome Project, the first attempt to produce a complete map of the human genetic code.

He set out to construct his own private version of the human genome, using a different "short cut" method, and succeeded. The race ended in a dead heat when both versions were published simultaneously in Science in 2001.

Even before the human genome milestone, Dr Venter was working towards the creation of synthetic life.

The research published today marks the culmination of 15 years' effort at a total cost of around ]]> daarons BSEC Public Forum Thu, 20 May 2010 15:10:10 -0400