Time to Defend Human Exceptionalism in the Professional Journals!

Many of the chances we see in society today, were gestated decades ago in professional journals and law review articles, which from what I have seen, tend to be pretty uniformly pushing society in one direction. Example: Today pulling feeding tubes from cognitively disabled patients is routine. I doubt this would have happened--because it was once unthinkable, but for the many professional journal articles written in the 1980s that promoted the policy.

Case in point, a 2007 article in the Tulsa Law Review (no link, have copy) promoting Futile Care Theory: As readers of SHS know, I believe that medical futility is part of an overarching attempt to shift society's fundamental value away from being focused primarily on individual worth, to a more collectivist approach of the kind warned against so vividly in the old sci-fi flick, Logan's Run. Be that as it may, I think it is very dangerous because it turns over determining when a life is worth living from patients and families to doctors and bioethicists.

The author makes this point chillingly explicit:

Physicians, because of their expertise and thorough education, are best able to determine when a patient is no longer benefiting from life-sustaining measures. A survey shows that ninety percent of patients feel that doctors are accurate decision-makers as to end-of-life care. n332 After a physician makes a judgment, an ethics committee further examines the futility determination. Because a concrete, and agreed upon definition for the term "futile" appears to be unattainable, physicians should be the primary, if not sole, judges, and decide when continued treatment is unnecessary, unethical, and no longer serves any purpose. Their judgments and decisions should be recognized and respected as legitimate, thoughtful, and final.

Nothing new here, of course. I bring it up because a judge might one day rely on this article (among others) in determining that medical futility is constitutional. Indeed, that is why it was written.

Articles published in intellectual and professional journals that receive little or no public discussion, are very important as they become the intellectual ammunition (if you will) for the guns that seek to destroy human exceptionalism, particularly in the courts. Thus, as I have occasionally remarked about here, we see journal articles pushing assisted suicide, a radical constitutional right to conduct scientific research, for animal moral and legal equality, etc. etc., all of which are written in the hope that they will one day influence courts or policy makers to go along. And if there is a dearth of material on the other side--which seems to be the case--that influence can be greatly magnified.

And I worry that those with the expertise and ability to counter these arguments in the intellectual spheres tend not to man the ramparts defending the sanctity and equality of human life. Perhaps this is based on the blithe assumption that "It can't happen here." But anyone who thinks that today is just not paying attention. Indeed, given that a Swiss ethics panel has promoted what could be called plant rights, things are becoming so extreme that you can't even engage in parody because they catch up to you.

Law students, doctors, lawyers, Ph.D.s and others who wish to maintain a society based on human exceptionalism need to be just as active in the "learned journals" as are those who support policies that would destroy it. And believe me, they are active. Are we?

Sarah Palin's Real Claim to Fame:

She's made SHS!

Lincoln, King, Garrison, Douglas, Stanton, and So Many Others are Smiling Tonight

This is not a political endorsement: But it is a celebration of the culmination and success of an earlier fight on behalf of human exceptionalism--Abolitionism and racial equality.

Abraham Lincoln who grew into abolitionism during his presidency, is smiling tonight as the first African-American in history accepts his party's nomination to be its candidate for President of the United States. So is the great William Lloyd Garrison, who not only stood for abolition, but full equal moral worth between blacks and whites--and men and women--at a time when only a very few did either.

Ditto the great Frederick Douglas, who escaped slavery and became a clarion beacon for equality.

And Elizabeth Cady Stanton, who before she was a feminist, cut her teeth in the abolitionist movement.

Also, Booker T. Washington, whose great granddaughter I met a few weeks ago--living history--who at a time of vicious Jim Crow oppression, led the country toward a better time.

And of course, Martin Luther King, who on this day 45 years ago, gave us a dream we could all embrace.

It took hundreds of years and hundreds of thousands of deaths to get here. But perhaps the time has come when those incredible words can at last be spoken without reservation: "Free at last, free at last, thank God Almighty, we are free at last!"

What Passes for Animal Rights Credibility:Pretending a Child Has Cancer Due to Eating Hotdogs.

The animal rights movement's strongest claim promoting vegetarianism is ethical, as in "If it has a face, don't eat it." But that isn't good enough. Too often they go into odious comparisons between the worst human evils and barbecuing a steak (PETA's infamous Holocaust on Your Plate Campaign), or engage in outright distortion and propagandist manipulation. Case in point, pretending a child eating a hot dog has colon cancer. From the story:

A new TV commercial shows kids eating hot dogs in a school cafeteria and one little boy's haunting lament: "I was dumbfounded when the doctor told me I have late-stage colon cancer." It's a startling revelation in an ad that vilifies one of America's most beloved, if maligned, foods, while stoking fears about a dreaded disease.

But the boy doesn't have cancer. Neither do two other kids in the ad who claim to be afflicted. The commercial's pro-vegetarian sponsors say it's a dramatization that highlights research linking processed meats, including hot dogs, with higher odds of getting colon cancer. But that connection is based on studies of adults, not children, and the increased risk is slight, even if you ate a hot dog a day

Without reading the whole story, I thought this will be the Physicians Committee for Responsible Medicine, a PETA creature, as mendacious a group as you will find. Yup:

Dr. Neal Barnard, president of the Physicians Committee for Responsible Medicine, called the ad "a way to raise appropriate concern about a deadly concern." Barnard also heads The Cancer Project, an offshoot of his anti-meat advocacy group.

Never believe anything the PCRM or the Cancer Project say. Less than 5% of the committee are physicians. They are quacks in this field, their assertions products of their ideology rather than objective science. If in doubt about what they claim, turn to a credible source.

The Harsh Values of Health Care Rationing

The Oregonian is trying to defend the Oregon Medicaid rationing scheme and its offer to pay for the assisted suicides of patients for whom it denied life-extending chemotherapy. The idea behind the Oregon scheme was to expand coverage to people who were not the poorest of the poor, but at the cost of restricting treatment to certain patients. Politics came into the system early as late stage AIDS patients--who would have been opted out in the early iteration of the plan--were opted in because of the political clout of their community. But some cancer patients don't have such clout, so they are out of luck.

From the editorial:

The money Oregon can spend on health care is limited. Currently, 576,000 Oregonians have no health insurance coverage whatsoever. Many are people formerly on the Oregon Health Plan whom the state can no longer cover because of the ever-rising cost of medical care. Some of these Oregonians will develop cancer but, unlike those still on the state's health plan, they will not have coverage for even a first round of chemotherapy, or for potentially curative surgery.

The reality is that if we pay for marginally effective, expensive, second-line treatments for one person, we would be denying access to well-established, first-line treatments for others

So socialized health care, leads to rationing, which leads to patient groups vying against each other for coverage.

And get this crass reaction of the Oregonian toward Medicaid telling patients "we won't pay for you to live but we will to kill you:"

Weighing the cost of end-of-life treatment against the voter-approved Death with Dignity Act was never a part of those discussions. No treatment has ever been denied because death would be more "cost effective." The very idea is both abhorrent and a blatant distortion of the facts.

The Oregon Health Plan is charged with prioritizing services that reflect the values of Oregonians, who have made it clear--twice--through their ballots that physician aid in dying is an option they want at the end of life. But the fact that it is covered by the health plan has no bearing on the decision in this or any other case.

It's deeply regrettable that insensitive wording in a letter caused a patient distress

That's it? It is "regrettable" that the patients were caused "distress?" What compassion!

Moreover, the editorial is factually wrong. The threat of the state or HMOs paying for killing but not for caring has been repeatedly raised by opponents of assisted suicide. Indeed, reflecting my Naderite roots, I began warning about this potential as soon as I entered the fray about the issue in 1993. We were called alarmists by the likes of the Oregonian, of course. But we were clearly right.

Which raises another point: The Oregonian--which once opposed PAS--has predictably fallen in line to march to the logic of the culture of death. Once its values are accepted by a society, every time an abuse comes to light it is shrugged off or justified--just like the Oregonian did about this travesty.

If this keeps up, in thirty years Oregon will be precisely where the Netherlands is today, if not sooner.

The Manuscript is Turned In!

Finally. It was several years in the making, but I have just electronically turned in my manuscript of the animal rights book to the publisher. It came in at between 90,000 and 100,000 words, not surprising given that "short-winded" is not exactly my strong suit.

I can't tell you what a relief it is to be done. Much work remains, of course. Editing can be a cruel and painful process. But most of it now is in the hands of the publisher.

I am going to take a week off, except for SHS, rest, and paint the bedroom. And then I will get back to the lecture circuit, writing articles, and return to recording Brave New Bioethics podcasts, which I sorely neglected in the press of the looming book deadline.

"Stunning" Adult Stem Cell Success

When the MSM declares an adult stem cell success "stunning," as the Washington Post headline does, you know it is a new day. In mice, scientists were able to transform adult cells into stem cells--from within the body! From the story:

Scientists have transformed one type of fully developed adult cell directly into another inside a living animal, a startling advance that could lead to cures for a plethora of illnesses and sidestep the political and ethical quagmires that have plagued embryonic stem cell research.

Through a series of painstaking experiments involving mice, the Harvard biologists pinpointed three crucial molecular switches that, when flipped, completely convert a common cell in the pancreas into the more precious insulin-producing ones that diabetics need to survive.

The feat, published online today by the journal Nature, raises the tantalizing prospect that patients suffering from not only diabetes but also heart disease, strokes and many other ailments could eventually have some of their cells reprogrammed to cure their afflictions without the need for drugs, transplants or other therapies.

There is a long way to go before this can be used in humans, if ever. But my, how the world has changed from less than a year ago. ESCR has lost its political potency as an issue. The newest and most hopeful areas of advancement are coming from morally uncontentious areas of biotechnology. The drive to push human cloning has been staggered by IPSCs.

Perhaps we will be able to have everything that scientists wanted from ESCRs, without the moral baggage. And you know what: I believe that some people would be extremely unhappy about that because they saw this field of scientific inquiry as a way not only to improve health care, but also to change the culture in a less sanctity of life direction. Looks now like that might not happen.

And for our friends in the animal rights movement: One more proof of the efficacy of using animals in research.

SHS Funnies

The transhumanist psychologist's last words, uttered moments before he suddenly realized that he had been chasing the literally impossible dream:

New Federal Regulation Favoring "Conscience?"

The Department of Health and Human Services has a proposed regulation up for public comment that would apparently provide protection for doctors who do not wish to perform abortions. From the story:

The proposed rule, which applies to institutions receiving government money, would require as many as 584,000 employers ranging from major hospitals to doctors' offices and nursing homes to certify in writing that they are complying with several federal laws that protect the conscience rights of health care workers. Violations could lead to a loss of government funding and legal action to recoup federal money already paid.

Abortion foes called it a victory for the First Amendment, but abortion rights supporters said they feared the rule could stretch the definition of abortion to include birth control, and served notice that they intend to challenge the administration.

What about the birth control fear? Secretary Leavitt says no, it won't apply. As I quickly read this, this seems right, but I think there is some room for doubt. From page 34-35 of the Notice of Proposed Rule Making:

Section 88.4 Requirements and Prohibitions
(a) Entities to whom this subsection 88.4 (a) applies shall not:
(1) subject any institutional or individual health care entity to discrimination for refusing: (A) to undergo training in the performance of abortions, or to require, provide, refer for, or make arrangements for training in the performance of abortions; (B) to perform, refer for, or make other arrangements for, abortions; or (C) to refer for abortions;
(2) subject any institutional or individual health care entity to discrimination for attending or having attended a post-graduate physician training program, or any other program of training in the health professions, that does not or did not require attendees to perform induced abortions or require, provide, or refer for training in the performance of induced abortions, or make arrangements for the provision of such training.

It seems clear that the proposal would not protect a health care worker who refused to participate in providing barrier-type birth control methods. And it would also appear that the term "perform abortions" would not apply to birth control since the dispenser of birth control doesn't "perform" an abortion even if the method of birth control is an abortofacient. However, this analysis would also cover dispensing RU 486, which causes an abortion but which the health care provider does not perform. What about that? And if that form of abortion would be covered by the regulation, then why wouldn't abortofacient forms of birth control? This is particularly germane since, in my quick reading, I didn't see a definition of the term abortion (although that might exist in referenced laws, regulations, or court rulings). So, I think Leavitt is right, but I can see how it might be construed otherwise.

But this is where we are: When a culture is divided about what is right and what is wrong as ours is, and indeed, in which the very concepts seem to becoming relativized, we end up with such proposed regulations.

SHS Political Funnies

This isn't presented as a political statement, but I love good political cartoons. This one from The Times of London is tops. Enjoy.

Science Helps Paralyzed People Walk

So much good is happening in science that has nothing to do with controversial areas such as human cloning--that lest we forget that most scientific research is not controversial--I feel duty-bound to bring it to the attention of SHSers. Case in wonderful point: An engineer, who is himself paralyzed, has invented an "exoskeleton" that permits paraplegics to walk. From the story:

HAIFA, Israel (Reuters)--paralyzed for the past 20 years, former Israeli paratrooper Radi Kaiof now walks down the street with a dim mechanical hum.

That is the sound of an electronic exoskeleton moving the 41-year-old's legs and propelling him forward--with a proud expression on his face--as passersby stare in surprise. "I never dreamed I would walk again. After I was wounded, I forgot what it's like," said Kaiof, who was injured while serving in the Israeli military in 1988. "Only when standing up can I feel how tall I really am and speak to people eye to eye, not from below."

The device, called ReWalk, is the brainchild of engineer Amit Goffer, founder of Argo Medical Technologies, a small Israeli high-tech company. Something of a mix between the exoskeleton of a crustacean and the suit worn by comic hero Iron Man, ReWalk helps paraplegics--people paralyzed below the waist--to stand, walk and climb stairs...

The ReWalk is now in clinical trials in Tel Aviv's Sheba Medical Centre and Goffer said it will soon be used in trials at the Moss Rehabilitation Research Institute in Pennsylvania

It's also healthy for people to be able to get up on their feet:

Kate Parkin, director of physical and occupational therapy at NYU Medical Centre, said it has the potential to improve a user's health in two ways.

"Physically, the body works differently when upright. You can challenge different muscles and allow full expansion of the lungs," Parkin said. "Psychologically, it lets people live at the upright level and make eye contact."

Iuly Treger, deputy director of Israel's Loewenstein Rehabilitation Centre, said: "It may be a burdensome device, but it will be very helpful and important for those who choose to use it."

So, let us never forget: Good ethics and good science are a powerful combination that offer a cornucopia of benefits to humankind.

SHS Funnies

Another early transhumanist experiment goes awry.

NHS Meltdown: Doctors Withhold Information on Treatments from Patients

So now some UK doctors are withholding information from patients about possible cancer treatments due to NHS funding polices. From the story:

Cancer patients are being denied information about treatments that could help them live longer by their own doctors, a new survey has disclosed. A quarter of specialists in myeloma, a bone marrow cancer that claims 2,600 lives in the UK each year, admitted keeping their patients in the dark about possible therapies.

They believed it was better not to talk about certain treatments not yet approved by the health service's rationing watchdog to avoid raising false hope. Primary care trusts are generally reluctant to pay for drugs not already passed by the National Institute for Health and Clinical Excellence (Nice).

NICE is the Orwellian-named utilitarian bioethics "advisory" board that continues to push policies that promote utilitarianism at the expense of Hippocratic values.

This is what happens when rationing convinces doctors to assume a "dual mandate," that is to both treat patients and to adhere to funding policies. It destroys their ability to provide optimal care and it destroys trust of patients in their doctors.

The right thing to do is to tell the patient about the treatments. That is their job. If the NHS won't pay for it, the patient might be able to find out other means of obtaining the care. Keeping patients in ignorance is inexcusable.

Animal Rights Leader Slams HSUS for Offering Reward to Catch Terrorists

I believe that the Humane Society of the United States (HSUS) is an animal rights group as committed to the agenda as PETA. But it is far more clever. Rather than engage in PETA-style antics, and rather than push the meme that animals are people too, intead, it implacably files lawsuits against animal industries, pushes voter initiatives like the one that put pregnant pigs in Florida's Constitution and Proposition 2 this year in California, and otherwise spends a fortune trying to make animal husbandry more difficult.

As a tactic, it is brilliant: If you keep chewing at the edges long enough, the entire pie will be consumed.

Some animal rightists hate this approach because, to them, it reeks of animal welfare advocacy that validates animal husbandry and increases public support for it by eliminating the worst practices. And so, radical animal rights leader Stephen Best has exploded in rage against HSUS. And what seems to have really set him off is HSUS's token reward offer of $2500 (from a non profit with more than $200 million in assets) for the capture and conviction of the terrorists who exploded an incendiary bomb on the porch of a Santa Cruz animal researcher. From Best's wildly ranting blog:

[W]hen three years ago HSUS seemed content to merely "applaud" the state for breaking into activists’ homes – armed and angry men breaking down their doors, stealing and destroying their possessions, separating them from their human and nonhuman families, and locking them away in federal prisons for years--now it seems that HSUS has taken its treachery and complicity one step further, by actually offering a $2,500 reward, in cooperation with the FBI and state and local law enforcement officials, to capture the person(s) who set off firebombs at the homes of two vivisector in Santa Cruz, California in August 2008.

As one bomb exploded when the researchers and their families were here and someone could have been injured of killed, these actions were clearly not the work of the ALF, which adheres to a strict nonviolent policy that targets the property of animal exploiters but never the exploiters themselves.

Best, being a complete wacko, suggests that the terrorist bomb was actually planted by the state. But his real point seems to be to money:

I encourage people to send HSUS a polemic not a check, and to donate their hard-earned money not to robotic raconteurs but rather to ardent activists who fight on the front lines of the emerging war over nature with substantial results. I'm talking, for instance, about small groups such as the Sea Shepherd Conservation Society; amazing activists like Anthony Marr or Gary Yourofsky, who foment revolutionary change on a shoestring budget; and stellar local animal rescue groups.

The head of the Sea Shepherd's, Paul Watson, has called human beings an AIDS virus afflicting the earth and Yourofsky has wished rape upon any woman who wears fur, while yearning for researchers to die slowly of cancer--in the "compassionate" name of animal rights.

It is tempting to think of this as a fight within the family. I applaud HSUS's opposition--albeit tepid, as I see it--to violence and terrorism. The animal rights movement as a whole would do itself a huge favor if it united in opposing terrorism and cooperated with law enforcement to purge the movement of these criminals. But with rare exceptions, mostly what we get is the sound of crickets chirping. Meanwhile, fanatics like Best reveal the depth of rage and misanthropic radicalism that is part--not the whole, but part--of the DNA of animal rights.

The Hard, Cold, Awful Reality of Euthanasia/Assisted Suicide

A story just published in the UK's Guardian is a diary account of the euthanasia death of Mieneke Weide-Boelkes, a woman with brain cancer, written by her son Marc Weide, who made it public. As such, and because it is so awful, it seemed to me that frank comment was warranted. I sent it off to First Things, and they put it up on the site.

But I want to reproduce my comments here, too. The story of Weide-Boelkes' euthanasia amply demonstrates the abandonment that assisted suicide/euthanasia consciousness generates in society, within medicine, and among families. And it proves clearly that the "protective guidelines" are utterly meaningless. It also demonstrates that once mercy killing is sanctioned, families become almost remote bystanders.

To cases: One of the supposed requirements of Dutch euthanasia is that there can be no other way to alleviate suffering other than killing the patient. Yet, in this actual case, the woman who would soon be dead wants to die for fear of going bald during life-extending chemotherapy: From the story:

The prognosis is she could live another year if she undergoes chemotherapy. But she won't. "I'm not going to go bald," she says. "I don't want people saying, 'How sad, that beautiful hair all gone.' Never."

Despite the ability to extend Weide-Boelkes' life, and the driving motives of worries that she will not be pretty (and hence not worthy of being loved?), and fears about losing the ability to engage in enjoyable activities as the reasons for wanting euthanasia, the doctor agrees to kill.

And here are two things so often seen in euthanasia/assisted suicide cases that are reported publicly: We have created a "choice" culture so pervasive that even in the face of impending killing families feel they are not entitled to resist their loved one's desire to be made dead. Second, the fear of the future from the patient--precisely what happens in Oregon with assisted suicide--is what most often leads to the killing, not the actual experience of unalleviable pain and suffering:

The doctor says euthanasia can take place next week. Another doctor first needs to verify, though, that Mum cannot be cured, that her wish to die has been consistent, and that her suffering is unbearable.

Martin is convinced of the first two conditions but not of the third. If Mum is too energetic to stay in bed, then how is her suffering unbearable? Mum puts her coffee down. "Well, I have to die anyway, don't I?" Then she asks us what we think.

I interrupt: "It should be your own decision. None of us is to say anything." But Mum struggles to say she wants to die. Eventually I say, "I think what she finds unbearable is not so much her pain and sickness, but the fear of it getting worse and of losing control." When Martin is finally satisfied that Mum wants to end it, he agrees to contact the second doctor. He leaves with an empathetic nod to us all.

None of us is to say anything! And yet he did! I couldn't believe my eyes: Weide, not his mother, found the words to justify the euthanasia. When she asked what the family thought, where were their kisses? Where were the assurances of always being there for her? Where were the phone calls to doctors to assure the patient her suffering could be alleviated through palliative care. Where were the efforts to obtain proper mental health interventions to help alleviate the woman's terror of the future? Instead, a terrified woman was left to sink or swim in the midst of an emotional crisis! I know we are not supposed to "judge" in these matters, but what an abdication of a son's responsibility to his mother--what I call terminal nonjudgmentalism in action.

On the day she dies, she vacuums the house!

I can hear she is hoisting the vacuum cleaner up to the attic. It is just after 6am. It is the start of an increasingly mad day, during which Mum hoovers the whole house and does six loads of washing (one of which consists of a single white shirt). She scrapes all the woodwork on the outside of the house clear of moss and cleans the windows.

After breakfast, I find Dad fuming after Mum has given him grief for not ironing fast enough. I ask him if it helps to see her as a mental patient instead of his wife. He grumbles. I think of what was said the night before, about Mum's relative physical fitness and her obsession with material objects and cleanliness. I feel an increasing tension as the day progresses and I still don't know whether it is going to be Mum's last.

Even the doctor pushes through hesitancy on the part of the patient.6.15pm:

The doctor arrives shortly after the scene with the toilets. Mum greets him, then disappears upstairs, saying, "Best let me potter for a bit." Nobody sees her for another 20 minutes.

"Does it happen at all that people pull out at the last minute?" I ask. "Yes," Martin says. "Quite often I go home again and a new appointment is made. But in many cases the patient passes away between visits."

When Mum comes back, listing things she has put in bags and boxes, Martin gently interrupts her: "Can I just ask you something? Is there still a lot you feel you need to do?"

"Yes," she says, "I mean no. I'm just nervous."

"I can always come back later if you are not ready," says the doctor.

Mum sits down and listens to the doctor. Then she takes a deep breath and says, "OK. I am ready." At 7pm, with my father, brother and me around her bed as well as Martin, who has given her the injection, Mum goes to sleep.

This is beyond awful. Euthanasia leads to the most profound abandonment of frightened and suffering people.

Pluripotent Stem Cells From Wisdom Teeth?

Spending the money and scientific talent to perfect human cloning (SCNT) is becoming very hard to justify--if that is, all that is wanted are tailor made, patient specific stem cells for study of diseases and/or eventual therapeutic purposes. (Of course, therapeutic cloning is not the real goal, it is the pretext.) From the story:

Researchers at the government-backed National Institute of Advanced Industrial Science and Technology said they created stem cells of the type found in human embryos using the removed wisdom teeth of a 10-year-old girl.

"This is significant in two ways," team leader Hajime Ogushi told AFP. "One is that we can avoid the ethical issues of stem cells because wisdom teeth are destined to be thrown away anyway.

"Also, we used teeth that had been extracted three years ago and had been preserved in a freezer. That means that it's easy for us to stock this source of stem cells."

President Bush said he had confidence that scientists would be able to find ethical means of obtaining pluripotent stem cells. He was right.

UPDATE: Mea culpa. This appears to have been another IPSC experiment. The teeth do not appear to have had pluripotent cells within them without injection of genes. Good catch by Lydia.

I Am Not a Chimp--And Neither Are You

As promised, I have a more extended piece up at the Weekly Standard Website demonstrating that the case for granting equal rights to chimpanzees with humans is not justified scientifically. First, I describe the ideological agenda behind the effort to reduce humans to the status of apes. From my column:

THERE IS A CONCERTED advocacy campaign underway across several disciplines aimed at knocking human beings off our pedestal of moral exceptionalism and redefining us as merely another animal in the forest. Toward this end, elements of the natural world are being personalized by public intellectuals, even as they seek to strip personhood from some people. The point of this ideological drive is to degrade our perceived self-worth so much that we will readily sacrifice human prosperity and welfare "to save the planet" or "for the animals," while undercutting the power of theistic religion in general, and Judeo-Christian moral teaching in particular, to influence public policies.

But what about our alleged close genetic relationship with chimpanzees?

[T]he purported 94-98 percent [genetic]similarity [between humans and chimps]--whichever it is--doesn't compare total genetic makeup, but only the DNA that "encodes proteins," that is, that stimulates the production of the building blocks of our physical bodies and functions...

[R]ecent studies have surprised scientists, showing that [non coding]junk DNA isn't really junk, but has a function. Research continues as to its exact purposes, but given the significant differences between human and chimp non-coding DNA, even if the purported 98 percent similarity of coding-DNA is true, it actually applies to only a small percentage of our total functional genetic makeup.

But what about the similarity between humans and chimps at the protein coding level? First, as Bill Hurlbut explains, even identical genes express differently across species, and hence, may produce different outcomes. Beyond that the "98%" identical meme masks tremendous biological differences, at least 40 million of which have been identified:

Forty million biological differences at the most fundamental biological level of life from whence our form and function spring is no mere crack in the pavement, as the likes of Goodall, Dawkins, and Singer would have us believe. No wonder geneticist Svante Paabo, a chimp consortium member based at Max Planck Institute for Evolutionary Anthropology, told Science, "I don't think there's any way to calculate a number [of similarities between chimps and humans]. In the end," he said, "it's a political and social and cultural thing about how we see our differences."

Which gets us back to what is really going on:

Ideology--not science--is the nub of the matter, reflecting a fervent desire among the "all we are is apes" crowd to destroy the cultural values explicitly upholding the highest moral worth of human beings. Society may choose to go the ape route, of course. But it is perfectly clear that the proposed radical changes in morality and law are not justified by current scientific understanding.

Out of necessity, the piece is a bit arcane, but I think it is important for those of us fighting off the assaults on human exceptionalism to know that the science supports our position, not that of the "all we are is apes" crowd.

Dogs Prove Human Exceptionalism

Everyone knows that dogs did not evolve, they were (and are still, technically) wolves that were intelligently designed by us.

The tight bond between humans and our best friends, and more particularly their exposure to our love and our genetic and behavioral manipulation has created special traits not often seen in the natural world. From the story:

Dogs are becoming more intelligent and are even learning morals from human contact, scientists claim. They say the fact that dogs' play rarely escalates into a fight shows the animals abide by social rules...

Dr Peter Pongracz from Eotvos Lorand University, Budapest, and colleagues have produced evidence dog barks contain information that people can understand. They found even people who have never owned a dog can recognise the emotional 'meaning' of barks produced in various situations, such as when playing, left alone and confronted by a stranger.

His team has now developed a computer program that can aggregate hundreds of barks recorded in various settings and boil them down to their basic acoustic ingredients. They found each of the different types of bark has distinct patterns of frequency, tonality and pulsing, and that an artificial neural network can use these features to correctly identify a bark it has never encountered before.

This is further evidence that barking conveys information about a dog's mental state, reports New Scientist magazine. They also discovered people can correctly identify aggregated barks as conveying happiness, loneliness or aggression.

'Even children from the age of six who have never had a dog recognise these patterns,' says Dr Pongracz.Dogs are not just able to 'speak' to us--they can also understand some aspects of human communication.

Still, we shouldn't make too much out of this:

Dr Alexandra Horowitz from Barnard College in New York prefers the term "theory of behaviour" to describe dogs' apparent insight. She said: 'I think there is a massive territory between a theory of mind and a theory of behaviour.' Her own recent study illustrates the point--when dogs play together, they use appropriate signals for grabbing attention or signalling the desire to play depending on their playmate's apparent level of attention, such as whether it is facing them or side-on.

That could be interpreted as mind reading, she admits, but a simpler explanation is that dogs are reading body language and reacting in stereotyped ways.

This much is clear: It took the exceptional species--us--to change what were only 10,000 years ago gray wolves and intentionally transform them into the multitudinous breeds of dogs that are not only noble--and at times delightfully goofy--but also protectors, wonderful companions, and the givers and receivers of tremendous love and joy.

I- 1000 Propganda Clearly Untrue

Pro assisted suicide advocates are expert spin artists who specialize in ignoring the forest for the trees. But this bit of cow manure is so obviously false that if the media weren't generally totally in the tank, the campaign would become a laughing stock. From "The Oregon Experience" on the Yes on 1-000 Web site:

The poor, disabled or minority populations were not adversely impacted in any manner because all of the patients who chose the option had health care coverage.

Oh really? Better tell that to Oregon lung cancer patient Barbara Wagner, who was told by Oregon Medicaid that it would not pay for chemotherapy to extend her life, but would pay for her assisted suicide. The same thing happened to Randy Stroup when he wanted chemo for his recurrent prostate cancer.

If refusing to pay for treatment but paying for killing isn't an "adverse impact," then what is?

Here's another whopper:

Approximately 88% or more over the years were in hospice, and all of them were at the very end of their dying process.

First, the annual statistics published by the State of Oregon can't tell us that. Moreover, we know for a fact that the assertion is flat out false. As described in the Journal of the American Psychiatric Association, Michael Freeland received a lethal prescription nearly 2 years before he died a natural death--meaning that he clearly was not at the last stages of his disease.

And here's another abuse in that case: When Freeland became psychotic, his psychiatrist left the lethal prescription "safely at home" even as he recommended hospitalization and then court oversight over the ill man's affairs.

Assisted suicide in Oregon is rife with abuse. With the exceptions of the "no funds for care but will pay for killing" stories, the media just won't cover it.

Embryonic Stem Cells Stimulate Immune Rejection in Mice

This shouldn't be a surprise because scientists have worried about it all along, but ES cells injected in mice clearly stimulated the kind of immune rejection seen with transplanted organs. From the Scientific American story:

The much-ballyhooed human embryonic stem cell apparently may share a problem with transplanted organs: a high probability of rejection.

Researchers at Stanford University School of Medicine found that mice mounted an immune response after being injected with human embryonic stem cells (hESCs). The result: all the transplanted stem cells--which hold the promise of maturing into several different types of tissue--were dead within a week.

Wu says that the fact that the hESCs could not survive in the mouse, coupled with previous work showing that the animals also reject mice ESCs, suggests that if human stem cells were transplanted to a patient, they would very likely provoke an immune response. The U.S. Food and Drug Administration, however, has not approved the injection of hESCs into patients because the raw cells have the potential to become cancerous...

The new study not only showed that these cells are not invisible to the immune system, but using a noninvasive molecular imaging technique, the scientists could see when exactly the cells were dying off. The finding means that people who may one day be treated using pools of stem cells taken from many lines could reject them, making the therapy useless.

This is a real problem for proponents of ESCR as a therapy that will make it difficult to permit human trials. Moreover, when added to the tumor problem, the very pronounced difficulties with ESCR should color our thinking about where we want to put public money in research--even without cosidering the ethical objections that have raised such a fuss for the last ten years. It seems clear to me that based on the emerging science alone, public funding should favor IPSCs--which will not have the immune response problem (but as pluripotent cells, still have tumor issues)--and adult/umbilical cord blood stem cells.

Embryonic Stem Cell Success: Morphed into Blood

An interesting ESCR success was published in the journal Blood. ES cells were morphed into blood, offering the potential of greatly easing blood shortages and making transfusions safer for patients. From the story:

In the new study, researchers were able to make as many as 100 billion red blood cells--enough to fill two or three collection tubes--from a single plate of embryonic stem cells.

After allowing the stem cells to begin the earliest stages of embryonic development, the researchers prompted some of them to grow into red blood cells by exposing them to a variety of proteins. Up to 65% of the resulting cells matured to the point at which they shed their nucleus, which allows them to take on the distinctive doughnut shape of circulating red blood cells, said Dr. Robert Lanza, chief scientific officer at Advanced Cell Technology Inc. and the study's senior author.

The team, which also included researchers from the University of Illinois at Chicago and the Mayo Clinic in Rochester, Minn., produced blood of types A-positive, A-negative, B-positive, B-negative and O-positive. The method was 100 times more efficient than previous efforts, said Eric Bouhassira, a professor of stem cell biology and regenerative medicine at Albert Einstein College of Medicine in New York. But most of the cells had embryonic or fetal versions of globin, the compound in red blood cells that carries oxygen. Only a relative few appeared to contain the adult globin that would be needed by patients, he said.

"Whether they would be good enough for transfusion is very unclear," said Bouhassira, who wasn't involved in the study. Lanza said the research team was conducting more experiments to see whether the stem cells would produce more adult globin if given more time to mature in the lab.

Even with substantial improvements, the method faces another big hurdle. Roger Dodd, director of the American Red Cross' Holland Laboratory in Rockville, Md., said that producing blood in the lab could cost thousands of dollars per unit--far too expensive to replace the 14 million pints of red blood cells that are transfused every year. "It's a rather ambitious goal," Dodd said.

A few points:

This is from Advanced Cell Technology, along with others. With ACT, it is always wise to trust but verify, since the hype is often a bigger deal than the actual experiment. However, Blood is certainly a reputable journal.

Second, while the story says that adult stem cells are not as efficient in this process, it is interesting to note that the change to blood cells came from embryonic stem cells that were not then truly stem cells but had begun differentiation.

Third, I wonder if IPSCs would work as well.

Fourth, the cost factor could easily prevent this from ever going into clinical application even if the existing kinks are solved.

Fifth: I will bet the cells used were Bush approved, since ACT is bankrupt and thus, these researchers probably received an NIH grant.

Finally, if ESCR/blood ever became widely acceptable, would it have to be labeled so that those with ethical objections could refuse it?

UPDATE: Re Bush-approved lines, I checked with my sources. One of the ESC lines was indeed Bush-approved . Another line was one that Harvard had established privately, and two from lines created at ACT.

A Coming McCain Change in ESCR Federal Funding?

The stem cell issue sure didn't turn out to be as potent--or as important--as people expected this time last year. With the IPSC breakthrough, President Bush's funding limitations ceased to be a cutting edge issue in the presidential campaign. That won't matter to Senator Obama, since smashing everything Bush is a Democratic driving force. But apparently some involved with the issue think that Senator McCain may be softening in his opposition to the current policy. From the story:

McCain's campaign did not respond to The Hill's questions or numerous attempts to obtain a comment for this article. In February, the campaign issued a statement to the Wisconsin State Journal standing behind his record but containing the language O'Steen quoted as evidence of McCain's flexibility on the issue.

"John McCain does support federal funding for embryonic stem cell research," the February statement says in part. "[H]e believes that recent scientific breakthroughs [IPSCs] may render this debate academic," according to the statement.

Oh, that is piquant isn't it? I noticed that he made the same kind of statement during the candidates' forum hosted by Pastor Rich Warren on Saturday.

The Bush policy--which has still resulted in at least $160 million in NIH funding for human ESCR--may survive after all. Stay tuned.

Gay Twist on Medical Conscience Issue

This is a new angle on the right of patients to demand treatment and when doctors can say no. This time it involves a religious objection to providing artificial insemination for a lesbian.

The doctor believed it was immoral to help a homosexual get pregnant and refused to participate, but referred her to someone else for the services. The new doctor was not covered by health insurance. The woman in question sued the original doctor and the California Supreme Court ruled unanimously that anti discrimination laws trump religious objections. From the story:

The ruling, based on a state law prohibiting businesses from discriminating against customers because of their sexual orientation, comes three months after the court struck down California's ban on same-sex marriage. "This isn't just a win for me personally and for other lesbian women," said the plaintiff, Guadalupe Benitez. "Anyone could be the next target if doctors are allowed to pick and choose their patients based on religious views about other groups of people."

The ruling is the first in the nation to address doctors' religious objections to treating gay or lesbian patients and should make health care more accessible, said Benitez's lawyer, Jennifer Pizer, of the Lambda Legal Defense and Education Fund.

Lawyers for the clinic and two of its doctors said they were considering an appeal to the U.S. Supreme Court. One supporter of the physicians called the ruling a strike against religious freedom. "This court is allowing two lesbians to force these individuals to choose between being doctors in the state of California or being able to practice their faith," said attorney Brad Dacus of the conservative Pacific Justice Institute, which filed arguments backing the doctors...The law "furthers California's compelling interest in ensuring full and equal access to medical treatment irrespective of sexual orientation," said Justice Joyce Kennard.

So this seems to be the state of the situation in law and as I perceive the mainstream view within bioethics:

- Doctors refusing to sustain lives based on quality of life determinations, still to be determined in the courts, explicitly legal in Texas and perhaps in other states, generally although not unanimously, supported in bioethics.
- Doctors and pharmacists refusing to supply contraception services based on conscience, under concerted attack throughout the nation in legislatures and courts, bioethicists almost all against permitting conscience to control in this circumstance.
- Doctor refusing elective fertility treatment based on religious views, outlawed in California, a ruling I suspect will be recieved happily within mainstream bioethics.

None of this is consistent if the actual issue is the consciences of doctors and other medical professionals. But that isn't what is really going on. Rather, these and other bioethical issues, at least partially, serve as a canvas for broader cultural struggles that are roiling society.

Looked at it that way, and the consistency becomes clear. The ethics of medicine and health care come about as close as we get to expressing the general core values of a society. The current societal trend is to subsume actual or deemed to be religiously-based views to secular values and tolerance of individual choices in the public sphere--a trend moving swiftly into the ethics of medicine. But individual or professional values actually or perceived to be based primarily on secular or "rational" analyses, such as in medical futility, are more likely to be honored in the courts and among public intellectuals, and individual conscience of patients or professionals required to take a back seat.

How these play out as we go along will thus tell us a lot about where we are as a society and where we are going.

SHS Poll: When Should Human Rights First Apply?

Killing for Organs: More on Attempt to Kill the Dead Donor Rule

Last week I posted two criticisms of the NEJM article advocating the dismantling of the dead donor rule (here and here) that requires death before the taking of vital organs. I got some backstage blowback that I painted with too broad a brush about the kind of support such proposals have within bioethics. I don't think I did that, given that the attempt to kill the dead donor rule is being mounted in the most Establishment medical and bioethics journals by some of the most respected thinkers in their fields, but there is no question that "killing for organs" is far from the unanimous view--for example Art Caplan's good work in this area--a point that I could perhaps have made more clear. (The URL for the NEJM article is also now available, which can be accessed here.)

Still, it seems to me that the issue is gaining traction, particularly within the field of organ transplant medicine, in part because the idea has been "in play" for some time. This was perhaps most vividly illustrated in a very disturbing article written by Robert M. Arnold and Stuart J. Youngner in the prestigious Kennedy Institute of Ethics Journal way back in June 1993, "The Dead Donor Rule: Should we Stretch It, Bend It, or Abandon It?" (no link). They claim in the piece that "the production of body parts will increasingly be linked to the intentional ending of some lives with the salvaging of others." And they give a hypothetical that would seem to be the product of a nightmare:

Machine dependent patients could give consent for organ removal before they are dead. For example, a ventilator-dependent ALS patient could request life support to be removed at 5:00 p.m., but that at 9:00 a.m. the same day he be taken to the operating room, put under general anesthesia, and his kidneys, liver, and pancreas removed. Bleeding vessels would be tied off or cauterized. The patient's heart would not be removed and would continue to beat throughout the surgery, perfusing the other organs with warm, oxygen-and nutrient rich blood until they were removed. The heart would stop, and the patient would be pronounced dead only after the ventilator was removed at 5:00 p.m, according to plan, and long before the patient could die from renal, hepatic, or pancreatic failure.

If "choice" becomes the issue in organ donation instead of being dead, how do we avoid ultimately sinking to that scenario? Indeed, the authors seem to support moving in that direction--while using the usual "on one hand, on the other" hedge that is a hallmark of bioethical discourse, writing:

Given the difficulties our society is likely to experience in trying to openly adjudicate these disparate views [pro and con dead donor], why not simply go along with the quieter strategy of policy creep. It seems to be getting us where we seem to want to go, albeit slowly. Besides, total candor is not always compatible with the moral compromises that inevitably accompany the formulation of public policy.

Calling a spade a spade has at least one advantage however. By framing our choice in stark rather than obfuscated terms, we may be able to choose our path more clearly and be less surprised where it takes us.

This is precisely how I see my role: I strive to bring these controversies out of the ivory tower and into the public square in ways that prevent the obfuscation that leads to stealth policy creep.

And on this issue, the stakes could not be more stark. We turn our heads away and let "the experts" sort it all out at society's peril.

Gwynith Paltrow Endorses Company that Uses The Skins of Animals: Predictably, the Fur Flies

Oh, oh. A-list movie star Gwyneth Paltrow has endorsed a clothing company that uses animal skin in some of its products, and predictably, the animal rights ideologues are coming unglued. From the story:

The Hollywood star has been signed up by Italian designer Tod's and is pictured draped in fox fur and wearing fur-lined boots feature in the company's latest advertising campaign.

Miss Paltrow, 35, who is married to the Coldplay singer and vegetarian Chris Martin has won praise for her impeccable green credentials and is a fan of holistic practices and yoga. The decision to endorse Tod's, a luxury goods company which also uses ostrich and snakeskin in its products, and describes itself as "refined, understated luxury, impeccable taste and enviable quality", has come as a shock to animal rights campaigners.

Mark Glover, director of Respect for Animals, said: "Gwyneth Paltrow should be ashamed. I can only assume that Paltrow either is ignorant of the facts or lacks human decency and compassion."

No, the people who are responsible for Darfur lack human decency and compassion. Those who block a solution politically should be ashamed

What one wears hardly rises to that level of importance. Assuming the clothing is not made of endangered species, I don't see the problem. We have been wearing animal skins as long as we have been human. Indeed, wearing fur or ostrich hide is no more immoral in my view than wearing leather shoes made from the cattle we eat as steak.

Besides, fur is green. It is all natural. There are no petroleum or synthetics involved in its manufacture. Negligible carbon footprint. It is biodegradable. Heck, fur fits right in to the new global paradigm!

I certainly respect those who disagree, and laud them for living out their ethics--which is an aspect of human exceptionalism since only we refrain from or take actions based on purely ethical concerns.

So leave the poor, I mean rich, woman alone and find something more worthy of complaining about than a big time movie star being overpaid to permit her name to be associated with a line of ludicrously priced prestige clothing.

Will San Francisco Voters Protect Human Traffickers?

Usually my wife Debra J. Saunders--better known as Secondhand Smokette--and I plow different fields in our writing. But once in a while, our interests converge, as in a few weeks ago when she wrote a splendid column about animal rights violence directed against researchers in Santa Cruz, the issue of assisted suicide--which she first criticized before I was ever onto the issue--and today in her vivid take down of a proposed San Francisco initiative that, if passed, could have the effect of taking the legal heat off of human traffickers and those who exploit children in commercial sex. From her column in today's San Francisco Chrnonicle:

Yet the San Francisco ballot measure completely ignores the prostitution of children. The measure simply states, "Law enforcement agencies shall not allocate any resources for the investigation and prosecution of prostitutes for prostitution." Astonishingly, there's no exemption that encourages police to enforce the law for minors.

If the measure passes, the city is likely to become an international haven for pimps who peddle girls and boys, and perverts seeking sex with minors. And where does that leave Bay Area youth? "They want new and young," Jasmine, a former teen prostitute from Oakland who now volunteers for the nonprofit Sage Project, which fights sexual exploitation, explained to me.

And get this, which would clearly indicate the intent behind the measure:

The other big problem: The measure prohibits city law enforcement from applying for grants to prosecute human traffickers. That's right, this measure gives a free pass to the human sex-slave trade--a city that is a central stop for international sex-trade rings.

So, we'll see if voters in liberal and libertine San Francisco will have the wisdom to reject this measure--regardless of what they might think about legalizing prostitution generally.

If, as I fear, voters can't see that this measure isn't just about being "sex positive" (as one proponent called the measure), it will be another chunk taken out of the hide of human exceptionalism. When any human being is permitted to be treated as a mere commodity--whether as a sex slave, a source of vital organs while living, or an embryo or fetus created and developed or gestated to be used in destructive research--our quest to achieve universal human equality is undermined. And that hurts each and every one of us.

Monty Python Predicts the Future of "Live Organ Transplants"

This bit from Monty Python's THE MEANING OF LIFE, PART 1, is terribly gross and over the top, but it has the germ of a point and came to mind in our discussion of the growing advocacy within bioethics and organ transplant medicine to do away with the dead donor rule and allow living patients to be harvested.

This is definitely NOT for the squeamish!

Killing the Dead Donor Rule: Why Should We Trust the Promises of Regulatory Control?

This is Part 2 of my deconstruction of an article in the NEJM proposing to end the dead donor rule in organ transplantation. Hit this link to read Part 1:

In the end, since the authors of "The Dead Donor Rule and Organ Transplantation" apparently believe we can't really get many viable organs from truly dead patients, they seek to shift the ethical ground. Restricting donation of vital organs to the truly dead is to be discarded, and in its place they propose that old catchall--"choice:"

Whether death occurs as the result of ventilator withdrawal or organ procurement, the ethically relevant precondition is valid consent by the patient or surrogate. With such consent, there is no harm or wrong done in retrieving vital organs before death, provided that anesthesia is administered. With proper safeguards, no patient will die from vital organ donation who would not otherwise die as a result of the withdrawal of life support.

No. No. No. First, not all patients whose life support is removed necessarily die, for example the terrible case in California where the surgeon was charged with trying to hasten the death of a prospective donor (charges that now appear likely to be dropped) when the patient did not go into cardiac arrest after cessation of life support. More to the point, why should we trust bioethicists and organ transplant professionals to enforce "proper safeguards" when this article claims that the current safeguards aren't adequate despite being told for years that they are? And if the only thing that matters is consent, why not let any seriously ill patient be killed for their organs? Yes, this has been seriously proposed, as I discussed in Culture of Death.

Besides, "the bioethicists" have a terrible record overall of keeping to their solemn promises about control, guidelines, and limitations, to wit:

- Dehydration of the cognitively devastated, as originally packaged, was only to be permitted in cases of patients unquestionably in PVS. Now, conscious patients are dehydrated all the time.

- When ESCR broke on the scene, we were told that "all" the biotechnologists wanted were the "leftover" IVF embryos. Now, the National Academy of Sciences has given its ethical imprimatur to creating embryos for research whether through fertilization or cloning, and cloning is pursued at Harvard, Stanford, and other facilities.

- Assisted suicide is supposed to be limited to the terminally ill for whom nothing else can be done to alleviate suffering. We have seen in Oregon and elsewhere that that promise has certainly not been kept. Indeed, they kill babies in their cribs in the Netherlands based on eugenic criteria.

And now, we are urged to move from taking vital organs from the dead, to taking them from the living who will die anyway.

This is the ultimate point: Across a broad front we are being pushed toward objectifying and instrumentalizing human life by treating some of us as mere resources to benefit those whose lives are deemed to have better quality, and hence, greater moral worth. That is not only unethical, it is profoundly immoral. And if it continues, it will lead to a collapse in the public's trust in medicine, bioethics, and bioscience.

Killing the Dead Donor Rule: Undermining the Ethics of Organ Donation in the New England Journal of Medicine

I have now read "The Dead Donor Rule and Organ Transplantation" in the NEJM (359:7, August 14, 2008), by Robert D. Troug, MD, a physician at Harvard Medical School, and Franklin D. Miller, a bioethicist at the NIH. It makes for frightening reading. My comments will of necessity be long, so I will do this in two posts for ease of reader digestion.

The authors claim that brain dead isn't really dead, since, as one example, some patients declared dead by neurological criteria secrete certain hormones. Nor, they argue, is heart death under the organ procurement protocols death because the patients could perhaps be resuscitated.

Their answer to this alleged ethical problem is to just explode the dead donor rule entirely. (I don't know about Miller, but Troug has been mining this particular vein for several years.) There is no link (have copy), but here is the gist of the argument:

The uncomfortable conclusion to be drawn from this literature is that although it may be perfectly ethical to remove vital organs for transplantation from patients who satisfy the diagnostic criteria of brain death, the reason it is ethical cannot be that we are convinced they are really dead.

No. If we are convinced that the patients are not really dead--and be clear, I don't accept this premise--then there is no ethical way to take their organs and we will have to wait until death is unquestionable. Otherwise, medical ethics becomes mere medical expediency.

The authors resurrect the old false equivalence between removing life support as an action causing death and active killing--which bioethicists spent years arguing was not the case--and correctly so. When life support is removed, the death is natural. If you take someone's heart before they are dead, the person died from their heart being removed! Distinction huge, difference monumental.

In the next post I will ask why we should trust their new proposed paradigm of killing for organs to be properly supervised.

Pushing Back Against Futility: Rejecting "Professional Autonomy" as a Justification

The drive to instill Futile Care Theory is back in high gear after a bit of a respite. But here's a pleasant surprise: One Eric Gampel, a bioethicist from California State University, Chico, pushes back against the concept of imposing "professional autonomy" in the futile care controversy in the journal Bioethics (no link). From the abstract:

Despite substantial controversy, the use of futility judgments in medicine is quite common, and has been backed by the implementation of hospital policies and professional guidelines on medical futility.

The controversy arises when health care professionals (HCPs) consider a treatment futile which patients or families believe to be worthwhile: should HCPs be free to refuse treatments in such a case, or be required to provide them? Most physicians seem convinced that professional autonomy protects them from being forced to provide treatments they judge medically futile, given the lack of patient benefit as well as the waste of medical resources involved.

The argument from professional autonomy has been presented in a number of articles, but it has not been subjected to much critical scrutiny. In this paper I distinguish three versions of the argument:
1) that each physician should be free to exercise his or her own medical judgment; 2) that the medical profession as a whole may provide futility standards to govern the practice of its members; and 3) that the moral integrity of each physician serves as a limit to treatment demands.

I maintain that none of these versions succeeds in overcoming the standard objection that futility determinations involve value judgments best left to the patients, their designated surrogates, or their families. Nor do resource considerations change this fact, since they should not influence the properly patient centered judgment about futility.

He's right. And for those who disagree, if "professional autonomy" applies, then there are no grounds for opposing the so-called "conscience laws" that would permit physicians to refuse to prescribe birth control and pharmacists to dispense Plan B day after pills.

Gampel is fighting against medical paternalism coming full circle. In the bad old days, doctor autonomy forced patients to remain on machines they did not want. Today, futilitarians want to decide that patients whose lives they don't think worth living can't have the treatment even if they want it.

Futile Care Theory is really about denying human exceptionalism by imposing utilitarian bioethical moral values upon all of us.

(I have the article for those who wish it.)

Spain Preparing to Legalize Euthanasia?

I have been waiting for this: Spain's government may be the most radical in the free world, controlled as it is by Socialists and Greens. It is personalizing fauna by preparing to legalize the Great Ape Project, and has pursued other agendas on the progressive agenda with vigor. Yet, so far, no legalization of euthanasia. That appears poised to change. From a brief story from the Catholic News Agency:

The Minister of Justice in Spain, Mario Fernandez Bermejo, received the members of the organization, Right to Die with Dignity, in a meeting and vowed to meet the demands of their group dedicated to promoting euthanasia and suicide.

Although the meeting did not end with a concrete agreement, the Minister published a statement in which he remarked that the board is concerned that those with terminal illnesses have a dignified end to their lives and assured that the government is in "a period of deep thought" regarding palliative care.

In the meeting, the coordinator of the association, César Caballero requested the government of Spain "make euthanasia and assisted suicide possible to those with terminal illnesses who have made the requests in advance."

The irony, of course, is that euthanasia are decidedly illiberal and anti-progressive--as the splendid book Liberalism's Troubled Search for Equality, by Robert P. Jones makes very clear.

Swiss Values Come to San Francisco

With the Swiss declaring "plant rights" and castigating the "decapitation" of wild flowers, it was only a matter of time before these ideas came to San Francisco. I can't prove it yet, but the evidence is beginning to come in. In this morning's Leah Garchick "Public Eavesdropping" feature, a favorite of mine that repeats funny statements overheard on the street:

"Go back over there and apologize to those flowers!"

Woman to child at Palomino's restaurant, after child ripped flowers from planter and threw them on floor, overheard by Michael Callanan

Get them while they're young!

Undermining Public Trust in Organ Donation

There is a story out today that I find very disturbing, for it both reflects the apparent urge among some organ professionals to cross crucial ethical boundaries and promotes public confusion about when someone can be properly declared dead. It involves heart transplants from babies and implies strongly that ethical rules were ignored in the organ procurement procedure. From the AP story:

The Denver cases are detailed in Thursday's New England Journal of Medicine. The editors, noting the report is likely to be controversial, said they published it to promote discussion of cardiac-death donation, especially for infant heart transplants.

They also included three commentaries and assembled a panel discussion with doctors and ethicists. Many of the remarks related to the widely accepted "dead donor rule" and the waiting time between when the heart stops and when it is removed to make sure that it doesn't start again on its own.

In two of the Denver cases, doctors waited only 75 seconds; the Institute of Medicine has suggested five minutes, and other surgeons use two minutes.

State laws stipulate that donors must be declared dead before donation, based on either total loss of brain function or heart function that is irreversible. Some commentators contended that the Denver cases didn't meet the rule since it was possible to restart the transplanted hearts in the recipients. "In my opinion, it's an open-and-shut case. They don't have irreversibility, and they don't have death," said Robert Veatch, a professor of medical ethics at Georgetown University.

When I agree with Robert Veatch, it is a rare day! I support "heart death" procurements with the 5 minute waiting period, and still support brain death as dead, despite some admittedly important issues being brought up about that matter--which we will not discuss here.

Alas, some wish to push boundaries beyond even brain and heart death protocols to people unquestionably alive. From the story:

But others argue the definition of death is flawed, and that more emphasis should be on informed consent and the chances of survival in cases of severe brain damage.

That sentence should have been explored more fully because it strongly implies advocacy to dismantle the dead donor rule, which I suspect (being me) that the editors of the NEJM would support. Be that is it might or might not be, there are many voices writing in the most prestigious and bioethics and medical journals in the world arguing to follow the Siren song of utilitarianism by dismantling of the dead donor rule--either by redefining death as a diagnosis of PVS, or just permitting procurement from the unquestionably living. We have discussed these matters here at SHS often (for example, this post) and I have covered it extensively in my other writing (for example, this NRO piece) and in Culture of Death.

If organ professionals and bioethicists want to destroy all public faith in organ transplant medicine, I can't think of a better way than taking organs before true irreversible cardiac arrest and pushing for procurement rights before actual death. The impulse to help sick people is laudable, but principles and standards that apply to transplant medicine exist for a reason. The time is now to stop pushing at the boundaries, otherwise that sound you will hear will be people tearing up their organ donor cards. And that would be a tragedy.

And for goodness sake people, create uniform rules for organ procurement to apply throughout the country so we don't have such varying procedures being followed in different hospitals!

FOLLOW UP: I have been told by someone I trust--but have not yet read it myself--that at least one of the NEJM articles referenced in the AP story does indeed advocate for doing away with the dead donor rule on the basis that both heart death and brain death diagnoses allow organs to be procured from people who are not really dead, so let's open it up some more. That's a disastrous opinion on many levels, assuming it was accurately represented to me. I am loaded with work at the moment but will read these articles as soon as I am able. More then.

Lead Into Gold: More Scientists Eschew ESCR and Cloning for IPSC Research

It may not yet be a full fledged exodus, but it would appear that the tide has changed dramatically. Where just a few years ago the clamor to overturn the Bush policy was touted throughout the media and among the politicians of the Science Establishment, it now appears that many of the world's top scientists are moving away from ESCR/Cloning and toward IPSC research.

At least that is the take of the splendid bioethics newsletter Bioedge. In the latest edition, for example, it tells of George Q. Daly, the former president of the International Society for Stem Cell Research turning to IPSC research--even though only a little while ago he testified that cloning offered the best hope for obtaining patient specific pluripotent stem cells. From the story:

Like a number of other leading stem cell scientists, Dr Daley seems to be quietly abandoning human embryonic stem cells, which are obtained by destroying human embryos. This represents a radical about-face. Back in 2005 he testified before the US Senate that: "Although [reprogramming] is worth pursuing, it is extremely high-risk, and may take years to perfect, and may never work as well as nuclear transfer [cloning], which we know we can practice today." [Me: Of course, that was, shall we say, a misstatement. Scientists couldn't practice human nuclear transfer then, and as far as we know still cannot today.]

He was certain then that therapeutic cloning was the only sure path and demanded a change in legislation. "Already proven routes to obtaining embryonic stem cells from excess IVF embryos or through the use of somatic cell nuclear transfer," he continued, "should not be put on hold pending the outcomes of the more speculative methods.

As it turns out, by using these "more speculative methods" Dr Daley and his colleagues have made more progress in six months than he had in years toiling over embryonic stem cells.

Bioedge notes a similar change in California:

Until August, all press releases from the CIRM described it as "the largest source of funding for human embryonic stem cell research in the world". In January it scolded President Bush for not realising that "human embryonic stem cells clearly remain the gold standard for research into pluripotent cells". It firmly squelched hopes about reprogramming: "it will not, for the foreseeable future, be suitable for clinical studies in human because of safety concerns".

In May it stated that it was funding new facilities to allow human embryonic stem cell research "and other stem cell approaches”. The latest press release, dated August 13, however, contains a small but significant change in the CIRM's self-description: "in the world". It appears that the CIRM's love affair with slow, inefficient, expensive, ethically fraught and legally complex human embryonic stem cells may be drawing to a close. In the very near future the CIRM could be boasting that it is the "the largest source of funding for pluripotent stem cell research in the world, as well as other stem cell approaches".

If this continues, and it becomes clear that the tide is irreversibly flowing toward IPSCs, the political ability to create an international ban on human cloning without the catcalls of CURES! CURES! CURES! to distract leaders from doing the right thing will increase. We may actually be able to throttle human cloning before it gets too far out of the test tube.

Drudge Report: "Whites No Longer Majority by 2042"

Whites will cease being the majority by 2042, the Census Bureau reported, to which I reply, "So what?" Human life is what matters, not the fiction of racial differences. From the story:

In a new report out Thursday, the U.S. Census Bureau projects the nation will become much more diverse by midcentury, with minorities forecast to become the majority population by 2042, experts said.

We will also be aging:

Census officials also expect the nation's population to grow older, projecting that by 2050 one in five Americans will be age 65 and older

Yea, well I'll be there long before that.

I may be getting older, but I still hope to live to see the day when we stop keeping track of race because it simply doesn't matter.

What Applies to Field Mice Killed in Plant Agriculture Should Apply to Animals Accidentally Killed by Tuna Fishing

A little while back I wrote a piece for National Review Online called "Veganism is Murder." The thesis of the piece was that while many animal rights activists claim that "meat is murder," vegans also live off the deaths of animals due to the perhaps billions of mice, snakes, gophers, and other field fauna killed by mechanized farming methods each year.

Well, you could hear the screaming in Timbuktu! The primary theme of those objecting to my point was that food animals are killed on purpose, while the field animals' deaths (which are far more painful than those that occur in slaughterhouses) are incidental and accidental--and hence, vegans bear no moral responsibility for the killing that occurs during harvests and field burnings.

If that is true, what are to make of this story that reveals "dolphin friendly" tuna--that is fish caught without accidentally also trapping and killing dolphin--are about as friendly to other animals as the combines are to voles. From the story:

David Ritter, from Greenpeace, said: "Thousands of turtles and sharks are killed every year while catching tuna to be put in tins... "Whilst the label on the tin may say 'dolphin-friendly', some tuna fishing methods can be hugely destructive."

Clearly the activists at Greenpeace haven't been reading the vegans posting at SHS! If they had, they would know that incidental deaths of animals, which are foreseen but not intended, don't count as cruelty.

Yes, yes: I know that vegans object to killing tuna, too. But the point is still valid: If consumers of tuna bear moral responsibility for the deaths of the other animals, then vegans do for the deaths of those field animals gruesomely killed by the combines, poisons, and other methods of modern agriculture.

Diminishing Value of Human Life: Kill Your Wife Get Banned From the Pub

Who says that the value of human life is on the wane? In Scotland, a man murdered his wife, and because he has dementia, the judge has banned him from pubs rather than sending him to jail. From the story:

Lord Matthews told the defendant: "You were found guilty of the culpable homicide of your wife, who you were together with for many years.

"In normal circumstances this would attract a prison sentence in double figures. I have read and considered a number of reports from experts. It is plain to me that if I were to impose that sort of sentence you would be released in a very short time because prison would not be able to cope with your condition.

"Sentencing you would just be a token gesture. I am anxious to impose a sentence that restricts your liberty. You still go to the pub where you went with your wife. That must annoy her relatives. Not being able to go there will be a more meaningful disposal than a prison sentence which will not last long."

The defendant should have stayed in prison until he required nursing care, and then received that in an appropriate facility. But banning from the pub for murder? (Maybe if it was a "death with dignity" case!) You just can't make this stuff up.

Dorothy Livadas--New Futile Care Case in New York: Overruling Patient Advance Directives

This is the future that Futile Care theorists hold for us. If you sign an advance medical directive granting a proxy the right to make your health decisions on your behalf in the event of incapacity--and that proxy wants life support ceased--that decision is sacrosanct, and woe betide the outsider (even other family members) who try to interfere. But, if doctors decide that the proxy's decision to maintain life support is "inappropriate," well then, to hell with the advance directive, and indeed, to hell with the proxy.

Just such a scenario is unfolding today in Rochester. Dorothy Livadas named her daughter Ianthe to be her proxy. But Ianthe is exercising independent judgment requiring life support to continue that the hospital doesn't want to provide, and so the hospital has sued to have her replaced by a proxy more malleable to the hospital's desires. From the story:

Dorothy Livadas, 97, lives with the aid of life support. She has not left her hospital bed for seven months.

In healthier times, she signed documents giving her daughter, Ianthe Livadas, the power to make medical, legal, and financial decisions for her. Before entering the hospital in 2005, Dorothy Livadas also signed documents instructing that she be taken off life support if she lapsed into a state where there was no reasonable expectation of recovery.

Now, a dispute over her mother's condition has forced Ianthe Livadas into a five-month legal battle against doctors, attorneys, and the Catholic Family Center. "You don't expect a hospital to be threatening you that they're going to put aside your mother's choice of health care proxy and power of attorney, and replace you," Ianthe said.

The usual meme that "cure" is point, not life, was trotted out by the hospital:

Although not wishing to comment on the specifics of this case, the head of Intensive Care at Strong Memorial Hospital testified in a courtroom that there is no chance Dorothy will awaken or communicate. A doctor from Rochester General who was called in for a second opinion concurred.

So what, even if true? (And, as we have seen, such categorical pronouncements have often proved false, as in the Jesse Ramirez and Haleigh Poutre cases.) The proxy believes the life of Dorothy is what matters.

Surely courts would not agree! Please. Proxies and family members who value their loved ones lives aren't capable of making "objective decisions," don't you know:

However, the courts have ruled that Ianthe Livadas no longer has a say in her mother's care as Justice Harold Galloway awarded custody to Catholic Family Center. He said that Ianthe "fails to appreciate her mother's true medical condition," and that she "lacks the objectivity and insight to make necessary decisions."

Here's proof of a warning I have frequently made: Under Futile Care Theory, patient autonomy is one way street. Advance directives only matter if the proxy makes the "approved" decision. This is the beginning of the creation of a duty to die in which those with the power to decide push aside patients and duly appointed proxies who disagree in order to impose their own bioethical values on the rest of us. There's a term for that; medical tyranny.

One final point: If we are going to have futile care theory imposed on us, this scenario is preferable to star chamber decision making by bioethics committees meeting in private session. At least here, there's a right to appeal and a public proceeding so that the public can be appraised of what is happening. So, if a patient's continued treatment is really torture, this is how it should be handled. But boy, this is a dangerous road that can only threaten the most vulnerable among us. And something should be done about the inequality of funds for lawyers in cases such as this. If a hospital wants to forcibly pull the plug, it should have to pay the legal fees of the family so they don't go bankrupt trying to save their loved one's life.