Birth of IVF Octuplets Raises Ethical Questions: But Why?

The news wires are buzzing about Nadya Suleman, the woman who had eight babies through IVF. Questions are being raised about the ethics of the case, both because of her circumstances--she already has six children--and the number of children born. From the story:

Fertility experts have raised concerns about the number of embryos implanted and whether the procedure was within medical guidelines. "I cannot see circumstances where any reasonable physician would transfer [so many] embryos into a woman under the age of 35 under any circumstance," said Arthur Wisot, a fertility doctor in Redondo Beach and the author of "Conceptions and Misconceptions."

Doctors probably could not deny treatment to a woman simply because she already has children, he said. However, he added, they should have taken steps to make sure she did not have so many babies at once. "I certainly think you can talk to her about it if you feel like she's making a decision that's not in her best interest or the interest of her children," Wisot said. "You can send her for psychological evaluation, but I honestly don't know if you can say, 'No, I won't take care of you because you have too many children.' "

Dr. Geeta Swamy, an assistant professor of obstetrics and gynecology at Duke University, told The Times this week that the American Society for Reproductive Medicine and the American College of Obstetricians and Gynecologists advise doctors "to curb these higher-order multiple gestations," she said. "But it really is still up to the individual physician. There aren't any laws or legal ramifications to it."

The problem we face as a society can be seen clearly in the above comments.

But when you think about it: How can there even be a question of laws and ramifications in this day and age? The door to realistic norms and binding ethical constraints has not just been unlocked over the last few decades, it has been torn off the hinges. In today's world, doctors are becoming less professionals and more order taking technicians. Want an abortion? Take a number. Want assisted suicide? Take a number. Want to invest $500,000 into your face with cosmetic surgery? Take a number. You want your children genetically tested before deciding whether they are worth having? Take a number. Get pregnant with three IVF embryos and only want one, take a number to "selectively reduce" the two you don't want so you can raise an only child. A single woman, without a job, who already has six kids and wants eight more? Take a number.

A lot of people will be angry about this. Her mother even defended the woman as not being "evil." But I don't see how she or her doctors can be condemned when the watchword of the era is terminal nonjudgmentalism with the only gauge of morality being "choice."

Assisted Suicide in Wyoming: "Neutrality" of Physicians Organizations Promotes the Culture of Death

One of the purposes of professional medical organizations is to stand up for proper ethical policies and laws. Lately, we have seen too many such organizations going "neutral," on assisted suicide. How an organization dedicated to defending doctors and patients can be indifferent to one of the most important ethical and legal controversies that affect their patients' very lives is beyond me. But when a judge in Montana conjured a right to assisted suicide out of her hat, the head of the Montana Medical Association shrugged and sniffed that his group wasn't even discussing the issue because it had "bigger fish to fry."

The latest such abdication of responsibility was in Wyoming, and it resulted in an anti-assisted suicide bill being defeated in a legislative committee. From the story:

The bill would have held defendants who engage in assisted suicide accountable with a 20-year prison term, but members of the panel gutted most of the bill after complaints from the Wyoming Medical Society.

The doctors group, which deviates from the position the American Medical Association takes opposing assisted suicide, told members of the committee it took no position on the bill but asked legislators to remove the section of it effectively prohibiting doctors from giving patients drugs with the intent to kill them.

The bill was eventually pulled from consideration.

Why is this happening? I think part of it is that political types who spend the time and energy to get into positions of leadership in such organizations--I saw this too when I was in the active practice of law--tend to reflect the views of the liberal political Establishment, even in conservative areas (kind of like newspapers, now that I come to think about it). This sometimes leads to a divide between what leadership wants and the rank and file believe. Along this line, when the leadership of the British Medical Association put that august group into the neutral camp on assisted suicide in 2006, there was a grass roots revolt among its members and its opposition to legalization was firmly reestablished. I also think younger physicians have been steeped in the utilitarian/"choice ideology emerging in our times and consequently refuse to man the ramparts against destroying what is left of orthodox Hippocratic medicine.

In addition, the pro assisted suicide movement is abundantly funded by people and foundations of the mindset of George Soros. The easiest way to describe it is that they want the world to look like Amsterdam and they have the money to make it so. One of the tactics taken is to send out high end, well-tailored assisted suicide advocates to these groups, whose leadership tend to be high end and well tailored, and who also share a cultural and political perspective with their visitors. The goal is to neutralize medical opposition to assisted suicide, and it is beginning to work.

The Beginning of the End of Futile Care Theory?

Well, this is very refreshing. An article published two years ago in the journal Chest ( 2007; 132:1987–1993) suggests that coercive medical futility be replaced with a different--and from my perspective, far more positive--approach to handling intractable disputes between a medical team wanting to cease life-sustaining treatment and a family insisting that it continue. (I was pleasantly surprised that one of the authors is Robert D. Troug, MD, whom I have criticized here at SHS for supporting killing the dead donor rule in organ transplatation.) From the article (no link, but I have):

The debate about how to resolve cases in which patients and families demand interventions that clinicians regard as futile has been in evolution over the past 20 years. This debate can be divided into three generations. The first generation was characterized by attempts to define futility in terms of certain clinical criteria. These attempts failed because they proposed limitations to care based on value judgments for which there is no consensus among a significant segment of society.

The second generation was a procedural approach that empowered hospitals, through their ethics committees, to decide whether interventions demanded by families were futile. Many hospitals adopted such policies, and some states incorporated this approach into legislation. This approach has also failed because it gives hospitals authority to decide whether or not to accede to demands that the clinicians regard as unreasonable, when any national consensus on what is a "beneficial treatment" remains under intense debate. Absent such a consensus, procedural mechanisms to resolve futility disputes inevitably confront the same insurmountable barriers as attempts to define futility.

We therefore predict emergence of a third generation, focused on communication and negotiation at the bedside. We present a paradigm that has proven successful in business and law. In the small number of cases in which even the best efforts at communication and negotiation fail, we suggest that clinicians should find ways to better support each other in providing this care, rather than seeking to override the requests of these patients and families.

Excellent! When presented with properly educated facts and emotional support, most families do the right thing by their loved ones. Education and compassionate emotional/spiritual support are the keys here. But in those rare cases where agreement cannot be reached, I agree that the right approach is to stop using coercion and provide the treatment--assuming it is not physiologically futile. That's the way to keep trust in medicine particularly at a time of tight medical resources.

I am not optimistic, however. There doesn't seem to have been much follow up to this article--at least none that I have seen. That would be too bad because by following the "third generation," presents the bioethical community with the opportunity to end a humongous public dispute before it really starts.

Adult Stem Cells Successfully Treat Early MS in Human Trials

Can you imagine the banner headlines if this were an embryonic stem cell success? From the story:

[Adult]Stem cells transplanted into early-phase multiple sclerosis patients stabilised, and in some cases reversed, the debilitating neurological disorder, according to a study published Friday...In clinical trials, a team of scientists led by Richard Burt of Northwestern University in Chicago essentially rebuilt the immune system of 21 adults -- 11 women and 10 men -- who had failed to respond to standard drug treatments. First they removed defective white blood cells that, rather than protecting the body, attacks the fatty sheath, called myelin, that protects the nervous system.

The immune systems were then replenished with so-called haemopoeitic stem cells -- extracted from the patient's bone marrow -- capable of giving rise to any form of mature blood cell. The technique is not new. But this was the first time it had been applied to young and relatively healthy individuals in the early, so-called "relapsing-remitting" phase of the disease. Participants had had MS for roughly five years.

After an average follow-up period of three years, 17 of the 21 patients improved by at least one point on a standard disability scale, and none had a final score lower than before the stem cell transplant. The procedure "not only seems to prevent neurological progression, but also appears to reverse neurological disability," concluded the study, published in the British medical journal The Lancet.

Please note this is not a cure. But from my non scientific reading of various studies, it seems that these treatments usually help improve the conditions of patients rather than eradicate the diseases entirely.

But hey, it beats a kick in the teeth!

Was the FDA's ESCR Human Trial Approval Political Rather Than Scientific?

When the FDA approved Geron's application to conduct human trials of their embryonic stem cell treatment for acute spinal cord injury, some noted that it might be political, coming as it did within days of the change of the presidential guard. I wasn't among those, but perhaps I should have been more cynical. Science has an article about the decision ("Celebration and Concern Over U.S. Trial of Embryonic Stem Cells Jennifer Couzin Science 30 January 2009: Vol. 323. no. 5914, p. 568--no link). This reaction from a stem cell research supporter should set off alarm bells:

Evan Snyder, a neuroscientist who directs the stem cell research center at the nonprofit Burnham Institute for Medical Research in San Diego, California, warns that a shaky start could set the field back enormously. "There's a lot of debate among spinal cord researchers that the preclinical data itself doesn't justify the clinical trial," says Snyder, who is working on using neural stem cells for drug delivery.

Among the concerns he cited: The rodents Geron studied had more moderate injuries than patients expected in the trial, suggesting that the results might not translate, and the therapy has not been tried in larger animals

Really? Why wouldn't the FDA require such work as they usually do in approving new drugs? Indeed, when the FDA said no to Geron last year, I expected successful larger animal work would be a necessary precondition to obtaining the FDA's approval. Here's the company's response from the article:

Keirstead and Okarma assert that, despite the criticisms, they've done everything they can before taking the next step. "There's nothing we can do but go to humans now," says Keirstead. Animal testing has its limitations, he adds--including the fact that there are no large animal models of spinal cord injury.

Perhaps one should have been devised. In any event, the FDA should be above politics. I hope that it was in this case. Otherwise, if things go wrong, the moral consequences will be on the commissioners' heads.

SHS is Truly International

About seven weeks ago I began tracking the locales from which Secondhand Smoke is accessed. In that time,we have been visited by people interested in bioethics and human exceptionalism from 139 countries. Our newest "flag" is Ethiopia. Thanks to all!

Gene Therapy Success in Trial on "Bubble Boy" Disease

Great news from the uncontroversial biotech file: "Bubble Boy" disease, named after David Vetter who became famous because he had to be isolated behind plastic shields to prevent infection from a genetic disease that causes severe defects in the immune system, has been effectively treated in human trials using gene therapy. From the story:

Gene therapy seems to have cured eight of 10 children who had potentially fatal "bubble boy disease," according to a study that followed their progress for about four years after treatment. The eight patients were no longer on medication for the rare disease, which cripples the body's defenses against infection. The successiful treatment is reported in Thursday's issue of the New England Journal of Medcine and offers hope for treating other diseases with a gene therapy approach...

Researchers removed marrow cells from the patients, equipped the cells with working copies of the gene for the enzyme, and injected the cells back into the patients. In most cases, that was done before age 2. The journal article reports the outcome two to eight years later, with an average of four years. All 10 patients were still alive, but two needed further treatment. None showed signs of leukemia or other health problems from the therapy, the researchers said...

The new findings are good news for the idea of using gene therapy to treat some other blood cell disorders, including sickle cell disease, said Kohn, who didn't participate in the new study.

This is good. And it seems a form of adult stem cell therapy since the stem cells in the reinjected bone marrow thereafter produced immune cells that were healthy.

This is a very serious disease: David Vetter died at age 12. Gene therapy is an ethical hope for a more healthy future for humankind.

Wyoming's New Assisted Suicide Bill--To Outlaw It!

Wonder of wonders, Wyoming has stepped up to the plate to outlaw assisted suicide. From HB 120 (no link):

(a) A person who has knowledge that another person intends to commit or attempt to commit suicide and who does either of the following with the intention of enabling or facilitating the suicide commits the offense of assisting suicide:(i) Provides the physical means by which the other person attempts or commits suicide; (ii) Participates in a physical act by which the other person attempts to commit or commits suicide.

The bill ensures that good pain control is not considered assisted suicide and that removing unwanted life-sustaining medical treatment is not threatened. Good for Representatives Davison, Brechtel, Jaggi, McKim and Petersen and Senators Cooper, Meier and Peterson for sponsoring this bill.

Obama Adminstration Puts Politics Above Fight Against AIDS in Africa

Washington Post columnist Michael Gerson has written an important column that shows how Left Wing politics has apparently interfered with the fight against AIDS in Africa.

From the column:

During Obama's transition, Dr. Mark Dybul was initially asked to stay on as the coordinator of the President's Emergency Plan for AIDS Relief (PEPFAR) for several months until a replacement could be found and confirmed. Because Dybul was the main architect of the program and one of its guiding visionaries, few were surprised by the offer. With Ambassador Randall Tobias, Dybul organized the most staggeringly successful foreign assistance effort since the Marshall Plan--eventually helping support lifesaving AIDS therapy for more than 2 million people.

That certainly seems like the right thing to do. But then:

A few radical "reproductive rights" groups--the fringe of a fringe--accused Dybul of advocating "abstinence only" programs in AIDS prevention. It was always a lie. Dybul consistently supported comprehensive prevention efforts that include abstinence, faithfulness and condom use--the approach that African governments themselves developed. In fact, Dybul was sometimes attacked from the right for defending a broad definition of AIDS prevention, including programs to address prostitution and transgenerational sex. Over the years, PEPFAR distributed 2.2 billion condoms -- hardly an "abstinence only" approach...

Then, the day after the inauguration, Dybul received a call asking him to submit his resignation and to leave by the end of the day. There was no chance to reassure demoralized staffers, or PEPFAR teams abroad, or the confused health ministers of other nations. The only people who seemed pleased were a few blogging extremists, one declaring, "Dybul Out: Thank you, Hillary!!!"

Gerson doubts that Hillary's fingerprints are on this, but it is clear that for someone in the Administration, maintaining continuity of a policy that has unquestionably saved saving lives of AIDS patients in Africa meant less that being sexual-politically correct. Let us hope this is not a sign of things to come.

What It Means to be Human Podcast: Here Comes Montana Assisted Suicide

You've read about it, now hear my analysis of the Montana court case creating a constitutional right to "die with dignity." As I state, it is the first time of which I am aware in which an advocacy slogan ("death with dignity") was elevated into a constitutional principle. Talk about overreaching! Check it out.

Devastating Critique of "Heart Death" Organ Donation Protocols

The attempt to increase the organ donation pool has led to an increased use in "heart death" procurement protocols, known as "non heart-beating cadaver donors." Under what has been called the Pittsburgh Protocol, obtaining organs via this method involves, 1) Planned removal of ICU-type life support; 2) Waiting for full cardiac arrest; 3) A time interval, generally 2-5 minutes. 4) Declaration of Death; and, 5) Organ procurement from the cadaver. Death is declared on the basis that there has been an "irreversible" loss of cardio/pulmonary function. (This is known as Donation after Cardiac Death, or DCD.)

There have been problems reported. For example, too short wait--only 75 seconds--between cardiac arrest and procurement, as well as ethical violations of failing to keep the medical team and their treatment of the patient isolated from the transplant team--the latter of which are to have no input whatsoever in the patient's care or the decision to withdraw life support.

Now, an important article in the Journal of Intensive Care Medicine calls into question the entire concept of DCD. For example, withdrawing life support often doesn't lead to immediate cardiac arrest, and some patients don't die at all. From the article:

There is a misconception that withdrawal of ventilatory and hemodynamic support will result in immediate or imminent death in the ICU. A survey of withdrawal of mechanical ventilation in the critically ill adults at 15 ICUs found that 21 of 166 patients (13%) survived to ICU discharge after withdrawal of life support.

Of even more concern, the proper care of such patients may be compromised by concern for protecting organ viability:

In circumstances involving possible organ donation, it can be difficult not to manage patients as potential donors rather than as dying patients. Some institutions have permitted onsite in-house coordinators from procurement organizations to engage in donor surveillance and management in the ICU before donation consent and without families' knowledge to increase donation rate.

Because of the financial interests of health care and health care-related industries the institutional ethos in established transplant centers become subordinate to transplantation practice, which can introduce the risk of unconscious identification with the program.

This can lead to actual compromises in proper end-of-life care:

The need to procure viable organs can undermine the type and quality of EOL care offered to prospective organ donors. DCD requires the transfer of patients before or upon death to the operating room for organ procurement. Opioids and sedatives may be withheld to avoid hastening death before withdrawal of life support and completion of preparation for organ procurement.

Another concern has also been expressed that upon withdrawal of life support, excessive doses of opioids and sedatives may be administered for early onset apnea and pulselessness to shorten the warm ischemia time for organ procurement. Likewise, the administration of heparin to prevent the formation of blood clots in the solid organs of a potential organ donor may precipitate internal hemorrhage and hasten the donor's death. The administration of vasodilators to promote solid organ perfusion can exacerbate hypotension and the onset of cardiocirculatory arrest on withdrawal of life support.

The summary worries that these protocols have compromised the dead donor rule:

There is little evidence to support that the DCD practice complies with the dead donor rule. The likely high false-positive rate of the UW evaluation tool can expose many dying patients to unnecessary perimortem interventions. The use of medications and/or interventions for the sole purpose of making the organs more viable can have unintended negative consequences on the timing and quality of organ donors' EOL care. Recipients of marginal organs from DCD may suffer higher mortality and morbidity than recipients of other types of donated organs.

Beware: Rather than use this information to more carefully manage organ procurement protocols--and we still need nationally uniform rules--some bioethicists and organ professionals will instead use it it as a club to destroy the dead donor rule itself. As I have noted often, there is a drive underway to open the door to explicit killing for organs. We must resist such instrumentalization of human life.

Here Come the Assisted Suicide Bills

Two states have had assisted suicide bills introduced; Hawaii and New Hampshire. Hawaii's law requires a suicide "monitor" to be present at the death--which in practice would often be an assisted suicide ideologue, such as the "counselors" who work with Compassion and Choices:

Monitor required; form. (a) A qualified patient shall designate a competent adult to act as a monitor and who shall be present at the time of actual administration of the medication to the qualified patient and shall witness the event. The monitor shall have the power to act on behalf of the qualified patient to:
(1) Stop the administration of the medication if it has not yet been carried out; or (2) Enlist medical assistance to attempt to reverse the effect of the medication if the medication has already been delivered,if the monitor has reason to believe that the qualified patient has had a change of mind and is not able to effectively express or communicate the wish not to proceed taking the medication.

The New Hampshire bill seeks to expand the law as it exists in Oregon. For example, rather than define terminal illness as a patient reasonably expected to have six months or less to live, the New Hampshire bill uses an expansive definition of "terminal illness" that is wide enough through which to drive a hearse: From the NH bill:

XIII. "Terminal condition" means an incurable and irreversible condition, for the end stage of which there is no known treatment which will alter its course to death, and which, in the opinion of the attending physician and consulting physician competent in that disease category, will result in premature death.

What is a "premature death" anyway? It could be just about anything. Indeed, Jack Kevorkian once infamously said that a terminal illness is one that shortens a life by a single day.

Moreover, read the definition carefully: It this definition of terminal condition could include a broad host of diseases and conditions that are not thought to be terminal illnesses as generally defined in the immediate sense. For example, asymptomatic HIV infection would qualify as a terminal condition since there is now no known treatment that alters its course to death. (It might slow it down, but not alter it.) So would early Alzheimer's disease. Perhaps also cancers not expected to be cured and kidney disease. Indeed, under this definition a disease that could take years to kill the patient could technically qualify as a terminal condition under this definition making the patient qualified for assisted suicide.

But you see, that is the plan. Advocates for mercy killing constantly push the boundaries here, and blur normal definitions there--with the ultimate goal of enacting a very broad license to mercy kill that reaches far beyond terminal illness to the anarchy of death on demand.

Virginia Senate Bill 1142: Paving the Way for Experimenting on the Incapacitated and Dying?

A correspondent--who is a disability rights activist--alerted me to SB 1142, a proposal in Virginia to overhaul its law concerning advance directives. There are several things in the bill that concern me, but she wrote worrying that it would open the door to experimenting on the incapacitated and the dying.

She is right--the bill authorizes signers of advance directives who become incapacitated to be experimented upon if the named surrogate decision maker consents--even if the experiments are not intended to provide them any help at all. From the bill:

Section: 54.12983.1. An advance directive may authorize an agent to approve participation by the declarant in any health care study approved by an institutional review board pursuant to applicable federal regulations, or by a research review committee pursuant to Chapter 5.1 (§ 32.1123 et seq.) of Title 32.1 that (i) offers the prospect of direct therapeutic benefit to the declarant, or (ii) aims to increase scientific understanding of any condition that the declarant may have or otherwise to promote human wellbeing, even though it offers no prospect of direct benefit to the patient.

Adding to the concern, if the patient is terminally ill, an advance directive may be established orally:

Further, any competent adult capable of making an informed decision who has been diagnosed by his attending physician as being in a terminal condition may make an oral advance directive to authorize the providing, withholding or withdrawing of lifeprolonging procedures or to appoint (i) directing the specific health care the declarant does or does not authorize in the event the declarant is incapable of making an informed decision, and (ii) appointing an agent to make health care decisions for the declarant under the circumstances stated in the advance directive if the declarant should be determined to be incapable of making an informed decision.

My correspondent notes that the form language permitting experimentation is the default setting--there isn't a check box to indicate yes or no in the suggested form. Unless the creator scratches the provision out, he or she is authorizing him or herself to be the subject human experimentation. Since some people will surely see the text as mere boilerplate or might not understand the import of the words, they might not know that they had consented to be experimented on while incapable or dying.

This provision explicitly violates the Nuremberg Code that requires subjects of human experimentation be capable of consenting to--and have complete understanding of--the experiment in which they participate. From the Code:

The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice,...and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision. This latter element requires that before the acceptance of an affirmative decision by the experimental subject there should be made known to him the nature, duration, and purpose of the experiment; the method and means by which it is to be conducted; all inconveniences and hazards reasonable to be expected; and the effects upon his health or person which may possibly come from his participation in the experiment.

The Nuremberg Code isn't legally binding, but its precepts are proper guidelines to follow. The substitute decision making to allow experimentation aspect of this bill should be removed since by definition, a person for whom decisions are being made consistent with an advance directive is incapable of giving truly informed consent to participate. A nebulous general assent ahead of time of the kind allowed in the bill doesn't cut it.

Thanks very much to my correspondent for bringing this important matter to my attention.

Do Men Have Any Rights Over Their Unborn Children?

An unusual situation has arisen in Australia involving an ethical complication arising out of IVF. A woman and her fiance` created embryos via IVF. She was impregnated but then died in an auto crash. Now the grandmother of the remaining embryos may sue to prevent the father from bringing his offspring to term. From the story:

A British woman whose pregnant daughter was killed in a car crash is considering legal action to stop her fiancé using her frozen embryos to have their child. Kay Stanley, 32, had undergone IVF treatment and had her eggs fertilised before she died.

Her mother Gwen Bates, a nurse from Rotherham, Yorkshire, claims her fiancé Brett Vogel, 34, may be considering using a female relative as a surrogate for the fertilised embryo. Mrs Bates, 59, insists Kay Stanley would have been opposed to such a move.

Even if that is true, even if the poor dead woman would not want her children gestated by another woman, so what? She is dead. The father is alive. His nascent children can still be born. Why should he be prevented from having his children--if that is his decision--and instead be forced to see them destroyed (or possibly experimented upon)?

Let's consider this: The law generally holds that a woman is entitled to an abortion--regardless of what the father might want--because it is her body that gestates the child. That biological symbiotic relationship fact is seen as trumping whatever rights the father might have in the matter. It is her body and if she doesn't want to gestate, she has the unfettered right, at least in the early months, to terminate the pregnancy.

But in this case, the mother is dead and so her body is not being used for anything. The father may want to have his children brought to birth. If the grandmother can legally prevent her grandchildren from being born, it means that fathers have no rights of any kind over their pre-born children. If so, that is utter sexism. I mean, if he had died, would his parents be able to prevent the fiance from having his children? I think not.

These are the kind of dilemmas that the IVF can of worms has opened. But that is water under the bridge. In this case, I can see no justification for the grandmother's claim. What would be good for the goose should also be good for the gander.

Coming Soon: War Against the Weak the Documentary

The book War Against the Weak is the best history of the eugenics movement ever written. (Here is my take that appeared in National Review.) Now, there is a new documentary about to be released--War Against the Weak--The Movie. (Hit this link to see a trailer

For SHSers in Southern California, it will premier today at the Santa Barbara Film Festival:

WORLD PREMIERE Saturday, January 24th, 4:00pm Santa Barbara Museum of Art * 1130 State St, Santa Barbara, CA(805) 963-4364.

Monday, January 26th, 4:45pm Metro 4 Theatre * 618 State St, Santa Barbara, CA‎ - (805) 963-9503

I haven't previewed the film, but it looks like good stuff.

Extended Q and A With Yours Truly on Bioethics, Human Exceptionalism, and the Coup de Culture

I was pleased to have been interviewed by Daniel Herbster for AdvanceUSA about my views on bioethics and human exceptionalism. I thought I would post a few exerpts here, along with the link, for anyone interested in reading the whole thing. First, I was asked why bioethical issues are so important. From the interview:

Bioethics is a contraction for "biomedical ethics." It is a field that has profound influence over core areas of human endeavor that help establish and define the morality of society, and indeed, the meaning of human life itself. Should elderly people have their health care rationed? Is assisted suicide a proper medical service? Is it right to create cloned human embryos for use in research or to bring to birth? Is it wrong to abort fetuses because they test positive for Down syndrome? Should parents be able to genetically enhance their children? Are there morally relevant differences between humans and animals? What should happen if a nurse refuses to participate in an abortion or a physician wants to cut off wanted life-sustaining medical treatment because the patient has a poor "quality of life?" These and other equally important bioethical issues are much larger than the sum of their parts because they establish philosophical norms that exert tremendous influence upon society beyond the policies themselves. Indeed, I can think of few fields more important than bioethics in determining the kind of society we shall become in the 21st century.

Later, I was asked what I thought are the most important bioethical issues we face. I decided to swim a little deeper, since utilitarian bioethics is a symptom rather than a cause:

Actually, it is bigger even than bioethics. I think humanism is mutating into an explicit and misanthropic anti-humanism. Indeed, I now believe that we are in the midst of what I call a "coup de culture" in which the social order founded in Judeo-Christian/humanistic view that upholds the unique importance of human life is being supplanted by a philosophical system steeped in utilitarianism--which is where bioethics comes in and the potential of creating disposable castes of people--hedonism--by which I mean the presumed right to indulge almost every urge and desire and not be judged--and radical environmentalism. Thus, Ecuador's new constitution just granted "rights" to "nature" that are co-equal to those of people and Spain is about to pass into law the Great Ape Project that creates a "community of equals" among humans, gorillas, chimpanzees, and other apes. The new movie The Day the Earth Stood Still, a remake of a great old science fiction film from the 1950s, has the aliens coming to earth not to save mankind from self destruction, but to obliterate humanity--a complete genocide--in order to save the earth. Think about it! An A-List Hollywood extravaganza explicitly sends the message that we are the vermin species on the living planet, which is the heart of the Deep Ecology ideology. I think the goal is to knock us off the pedestal of human exceptionalism so that we will be so humbled and self-degraded that we will willingly sacrifice our own welfare and prosperity to "save the planet." In this light, the problem of bioethics is a part of a larger overarching threat...

At the end I was asked about the novels Brave New World and 1984:

BNW is probably the most prophetic novel ever written and is more relevant today than it was in 1932 when it was first published. I think we are already on the path to the inhuman society Huxley depicts, which not coincidentally, is utterly utilitarian and hedonistic. The only aspect he missed was the radical environmentalism that has come to the fore in recent years. Huxley's characters believe in nothing. But I don’t think humans can believe in nothing. We seem to be hard wired to seek the transcendent. With theism under attack, a new form of earth religion based on deep ecological principles could well fill the developing belief gap. I also think 1984 is well worth reading because of how vividly Orwell depicted the power of word engineering--a hallmark of the coup de culture today.

That's my story and I'm sticking to it.

Even Many Doctors Want to Force Colleagues to Violate Hippocratic Oath

An op/ed in today's Baltimore Sun has two doctors insisting that physicians refer patients for abortions if they don't wish to do the deed themselves. (The term used is reproductive health, and so it isn't only abortion to which they refer--but it is part of what is meant by the but euphemism.) In complaining about the Bush conscience regulation, that protects health care workers from being discriminated against if they refuse to participate in health procedures they find morally offensive or that is against their religion, the doctors support the must-refer approach. From the column:

As health care providers, we are, at the very least, obligated to provide all patients with appropriate referrals--even if we do not participate in or agree with the care. Our personal morality does not enter into it. For example, we cannot refuse to treat a drug user for his drug-induced heart attack just because we are morally opposed to drug use. Nor can a doctor deny a blood transfusion to a woman who lost blood in a fight, even though he or she is opposed to violence. How, then, can we allow a receptionist, doctor, nurse or janitor to turn away a women seeking birth control at a clinic that provides such services just because the employee thinks premarital sex is wrong?

I wish these kind of columns had the courage to argue the actual issues primarily involved rather than side matters that are either irrelevant or extremely rare. Be that as it may, forcing a doctor refer a patient to a provider that he or she knows will do the abortion or assist the suicide is to force the referring doctor to be complicit in those acts. Thus, while there certainly should be cooperation in transferring records from the original doctor to a replacement if a patient decides to go that route, no dissenting physicians should not be required ethically to participate directly or indirectly in acts that explicitly violate the Hippocratic Oath.

I don't think the Bush guidelines are the perfect answer, and as I have written, a lot more thought needs to go into who is covered and under what circumstances by the conscience issue. And as I have also written, I think a distinction needs to be made between elective and non elective procedures, as well as between offending procedures and patients.

But I do believe that if the culture of death prevails legally, we should not permit dissenting health care providers to be driven out of medicine or force facilities such as Catholic hospitals that follow contrary moral teaching to be forced to choose between violating their beliefs and closing their doors.

HT: Holy Terror

Topsy-Turvy in the Netherlands: Punishing Hate Speech but Applauding Eugenic Infanticide

I only bring this up because it provides a vivid example of how so much of the West has become, in the old Gilbert and Sullivan phrase, topsy-turvy. The Dutch Government is bringing a parliamentarian named Geert Wilders up on charges of hate speech for making incendiary statements about fundamentalist Islam. From a blog opinion article about the event:

"The Freedom Party (PVV)," read yesterday's press release, "is shocked by the Amsterdam Court of Appeal's decision to prosecute Geert Wilders for his statements and opinions. Geert Wilders considers this ruling an all-out assault on freedom of speech." The appalling decision to try Wilders, the Freedom Party's head and the Dutch Parliament's only internationally famous member, for "incitement to hatred and discrimination" against Islam is indeed an assault on free speech.

I am not defending Wilder's views, which I understand are quite xenophobic. But here is the point: The Dutch prosecute offensive speech, but not the killing by doctors of babies born with disabilities! Wilders is "evil" for what he says, according to one official quoted in the story, but eugenic murder is respectable, and the killing guidelines (Groningen Protocols) are openly published and applauded. Topsy-turvy is a polite way to put it.

Geron ESCR Drug Approved for Human Trial

Well after years of saying it was coming, finally Geron got permission to attempt a human trial of its ESC-derived drug for acute spinal cord injury. (This is not a direct infusion of stem cells, but of a type of adult neural stem cell created by differentiating the ES cells.) This is not an efficacy trial, but a safety trial, and will only target patients with new injuries since it did not work in rats with older paralysis. From the story:

Although the FDA says it does not make decisions based on politics, the company made the decision public just days after Obama was sworn into office. Stem cells are the body's master cells, giving rise to all the tissues, organs and blood. Embryonic stem cells are considered the most powerful kinds of stem cells, as they have the potential to give rise to any type of tissue.

But they are difficult to make, requiring the use of an embryo or cloning technology. Geron and some other companies have been pursuing the goal without the use of federal funds.

The story doesn't mention it, of course, but adult stem cell therapies have been in human trials for several years for paralysis caused by spinal cord injury--and the first peer reviewed study showing a restoration of feeling never received the coverage in the media that Geron has received repeatedly for years about this prospective trial--apparently because our news censors believed they were the wrong kind of stem cells.

And this part of the story make my Nader genes itch and illustrates vividly what has gone so wrong in this field--it is utterly market/stock obsessed:

Shares of Geron rose nearly 30 percent to $6.75 in premarket electronic trading on Nasdaq.

One can't and shouldn't wish this trial bad luck--people's health is involved. But one can hope that if this drug proves safe in humans--still a big if--and if it works--perhaps a bigger if--its benefits are soon swamped by methods of treating spinal cord injury that are ethical and don't require the destroying of nascent humans to help those who are not in the developing stage.

Health Care Concerns Not Highest Concerns in Poll

We have a lot of problems, but I was mildly surprised that health care only scored in at 60 percentile as a matter of high concern to the American people in a Pew Poll, with Medicare at 59%--a sharp decline from previous samples. And this was a surprise: Health insurance was at 52%. From the story:

Of the 20 issues people were asked to rate in both January 2008 and January 2009, five have slipped significantly in importance as attention to the economy has surged. Protecting the environment fell the most precipitously-- just 41% rate this as a top priority today, down from 56% a year ago. The percentage rating illegal immigration as a top priority has fallen from 51% to 41% over the past year, and reducing crime has fallen by a similar amount (from 54% to 46%). And while reducing health care costs remains a top priority to 59% of Americans, this is down 10-points from 69% one year ago.

The economy and jobs were top, natch, with concerns in the 80s. Terrorism came in at 76%--glad to see people still care, while moral decline a mere 45%: It would have been higher for me. And despite all the hysteria, the common sense of the American people shined through: Global warming came in at only 30%.

Eluana Englaro Case: Media Bias and Non Cooperation With the Culture of Death.

Readers of SHS have heard of the tragic case in Italy of Eluana Englaro, diagnosed for 17 years to be in a persistent vegetative state. Her father won the right in Italian court to remove her feeding tube, but has been unable, so far, to find a medical facility willing to dehydrate Eluana to death. That my have changed. Note the language in the following report, headlined "Clinic May Help Eluana End Her Life":

A clinic in Udine on Thursday said it may be ready to help a woman trapped in a vegetative state for 17 years end her life in accordance with a landmark right-to-die ruling. Beppino Englaro, who has fought for more than a decade for a dignified end to his daughter's life, has yet to find a clinic prepared to carry out November's court ruling. The Quiete Clinic, which receives partial public funding, said it would make a final decision by the end of next week on whether it can accommodate 38-year-old Eluana Englaro. ''I think it's right for Udine to offer a just and civil solution to this matter,'' Udine Mayor Furio Honsell told ANSA. Eluana's lawyer, Franca Alessio, said the family had been in touch with the clinic, but added that they were also investigating other possibilities.

Media just can't use accurate language on these issues, it seems. Eluana isn't trying to end her own life. If she is PVS, she is unaware of what is happening. Moreover, before the media call dehydration a "dignified death," they should talk to Terri Schiavo's brother Bobby Schindler--who, as his sister's death was imminent, told the world that Terri's tissues had become so dry blood was pooling in her eyes.

If the culture of death cannot be defeated legally, it must be resisted with total non cooperation. We see that happening in Washington State, for example, with medical facilities there beginning to declare "assisted suicide free zones."

That issue was also well discussed in the Italian situation--with promoters of the culture of death threatening a truly draconian action (which I put in italics):

[Italian Health Minister Maurizio] Sacconi on Thursday warned national health service clinics that they have a duty to keep patients fed and hydrated, adding that it was the State's responsibility to guarantee basic levels of assistance as laid out in the Italian Constitution. This will remain the case until parliament passes a general law on end-of-life issues, he added. Sacconi stressed that while the court ruling permitted the removal of Eluana's tube, it did not ''place any specific obligation on national health service clinics'' to do so. However, the Cassation Court's deputy prosecutor general, Marcello Matera, has argued in the past that it would be ''theoretically possible'' to ask the police to see that the court sentence is carried out in the event that a clinic does not come forward.

We will have that same fight here over conscience clauses, and it is going to be gargantuan. Remember this: Once it is in the driver's seat, the culture of death brooks no dissent. And those of us who oppose the COD have to be just as determined--within the confines of law and/or principles of peaceable resistance--to refuse any and all cooperation.

A New "Haleigh Poutre" in Texas?

SHS's good friend, attorney Jerri Ward, is gearing up to fight a case in Texas that is eerily reminiscent of the Haleigh Poutre case. An attorney ad litem for a terribly abused baby named David Coronado Jr., wanted to stop all treatment because the baby is expected to remain profoundly cognitively disabled. From the story:

The fate of a brain-damaged 6-month-old Dallas boy is uncertain after his court-appointed attorney on Tuesday withdrew a motion to let doctors take the baby off life support...The baby's attorney ad litem, Holly Schreier, told a juvenile district court judge that doctors at Children's Medical Center Dallas had assessed a change in the baby's condition. She did not say what the change was, and she did not return a call for comment.

A doctor reported in December that he expected David to suffer severe disabilities if he survived. It is unclear if doctors now expect the baby to remain in a vegetative or minimally conscious state. Meanwhile, word of the possible hearing on withdrawing the child's life support had spread over the weekend among right-to-life and disabilities-rights groups, at least one of which readied attorneys to intervene Tuesday morning. "Brains are very resilient, and in a 6-month-old baby, to conclude that he's neurologically devastated and is going to stay permanently that way I think is irresponsible," said Jerri Lynn Ward, an attorney representing Not Dead Yet, a disabilities-rights group.

A few points: First, the child was only injured last month. What's the rush? Second: It is wrong for a guardian to want her ward dead "in his best interests" because he is expected to be seriously disabled if he survives. The message of that decision is stark: his death is better than living with serious disabilities--which I don't think a guardian should be allowed by law to assume.

We saw this same rush to remove treatment and "death is better than profoundly disabled" kind of thinking in Haleigh's case. But for the time it took to get the Supreme Court's approval for the dehydration, Haleigh would be dead today instead of in rehabilitation and going to school. Good grief! Do we never learn?

Hopefully, this will be the end of the matter and the baby will receive proper care. If not, I will comment about it here.

A Tale of Two Cadaver Cell Trials

In the UK, an adult stem cell trial using cadaver cells will begin seeking to cure blindness. From the story:[

[A] two-year trial involving 20 patients with corneal blindness will begin this month at the Princess Alexandra Eye Pavilion in Edinburgh and the Gartnavel General Hospital in Glasgow. The treatment being used involves using the stem cells of dead adult donors, rather than the more controversial research involving embryonic stem cells, and if successful could help millions of people around the world who suffer from corneal blindness, around 80 percent of whom are elderly.

As part of the process, adult stem cells are cultivated and then transplanted onto the cornea's surface. "This study is the first of its kind anywhere in the world and it is exciting to be involved in such groundbreaking work," said Professor Bal Dhillon, who is heading the trial.

More controversially, scientists expect to use fetal tissue in an attempt to treat stroke injuries:

Doctors are hoping to launch the world's first trial for a treatment that aims to improve the quality of life for thousands of stroke victims on patients in Glasgow in June, although the procedure must still be approved by an ethics committee.

The treatment, which uses cells taken from an aborted foetus that are to be injected into the brains of stroke victims to see if they can effectively regenerate damaged areas, was developed by Britain-based company ReNeuron. "That single cell was expanded by means of technology so we can have something to treat many, many thousands of patients," said ReNeuron founder John Sindon, who is working with consultant doctor Keith Muir on the planned trial at Southern General Hospital in Glasgow. "You could make the argument that it would have otherwise gone to waste. The reality is that we're trying to turn that into something with a lasting effect."

Interesting that Dr. Muir seems so defensive.

Many SHSers may disagree with me, but I do think there is an ethical distinction to be made between an embryonic stem cell experiment in which a nascent human life is destroyed for the purpose of research, and the fetal experiment which will use tissue taken from a fetal cadaver who wasn't killed in order to obtain the cells.

Think of this analogy using the eye stem cell experiment mentioned above: ESCR would be akin to a murderer executed for his eye stem cells, while the fetal tissue experiment would be analogous to adult stem cells taken from a prisoner executed without thought of how his body parts might be used after death. If one opposes capital punishment (and lets not argue that issue here), both executions would be wrong, and no subsequent instrumental use of tissues would justify the death. But using the body parts of the second prisoner after his death wouldn't in and of itself be unethical. Or am I wrong in this comparison?

On a different note, using fetal tissue to treat neural insults has been tried in the early 1990s in an attempt to ameliorate the effects of Parkinson's--with devastating results: Many of the patients experiences such severe side effects that the trials were halted. So, I hope the ethics committee--such as they are these days--treads very carefully.

A Reader Reacts to the Abandonment to Agonizing Suicide of Kerrie Wooltorton

SHSers may recall the awful death of Kerrie Wooltorton in the UK, who drank anti freeze as a suicide method and was let die because she had a note pinned to her clothes saying she didn't want to be saved (even though she called the ambulance).

A reader who has asked to remain anonymous sent me a poignant letter off stage, and has kindly permitted me to reproduce it here. I think the comments are important:

I was wondering if you have heard any update on the Kerrie Wooltorton story and whether the inquest has made a decision regarding a duty of care owed to people like Kerrie.

Her story touched me because I am a law student who has had 6 suicide attempts in the last 16 months. 5 of those attempts resulted in ICU admission, ventilated and intubated in an induced coma (at various hospitals). The other in the cardiac ward for 10 days. In one particular hospital, I was discharged from ICU without any follow up care. I was told numerous occasions that my actions were my responsibility because I had a personality disorder.

If I had a legitimate mental illness such as depression which would have resulted in me having impaired judgment and affected my capacity to think rationally they would have had a duty of care towards me, I was told by a psychiatrist. I told the same psychiatrist that I was still suicidal and whether it was my responsibility or not, I was still in deep despair and wanted out of the world. He had to then schedule (section) me as "a mentally disordered" person who was at serious harm to herself. I asked him why he was scheduling me since he thought it was my full responsibility, if not only to save his legal arse. He could not answer.

When I was severely ill, I agreed with the doctors because I had a right to "self-determination". I feel quite sick because I could have easily ended up like Kerrie. Like her, I felt hopeless about the future or that anything would improve. I would be interested to know whether the inquest determines it lawful to let people with personality disorders die by their own hand when this could have been prevented.

By any name, allowing Kerrie to die was abandonment. I am so happy that our correspondent has been able to fight through the darkness and back to the light of day--despite the seeming indifference of her psychiatrist.

Bristol Hospital (Connecticut) Punished for Apparent Futile Care Imposition

I think the punishment is woefully weak, but it is a rare case of a health facility (Bristol Hospital, Bristol, CT) being publicly sanctioned for withdrawing or refusing wanted life sustaining treatment. From the story:

In one case, a woman who suffered a heart attack and congestive heart failure completed an advance directive when she entered the intensive care unit, indicating that she wanted CPR and ventilation, but no tracheotomy.

When the woman's condition deteriorated, a doctor and the woman's health care agent changed her status to "comfort measures only." Bristol Hospital's policy required informed consent from the patient in such a situation, but regulators found that medical records did not indicate that the woman was consulted, even though she was still alert. The doctor told regulators that she spoke with the patient's health care agent, but could not recall whether she consulted the patient. The woman was taken off the ventilator, and she died that night.

This raises another issue, too: Advance directives' naming of surrogate decision makers should only apply if the patient is unable to personally make such decisions. Weakness, illness, and disability are no excuses for taking the patient out of the loop.

The punishment was only $4000 for this and other types of violations! But at least it was a public punishment, and SHS feels duty bound to help in that process in the belief that open chastisement has greater power to deter than puny money fines.

Obama Administration Already Pushing Utilitarian Medical Poison

Uh, oh: Here it comes. Incoming Secretary of Health and Human Services Secretary Tom Daschle wants to create a US Agency to control costs based on the UK's Orwellian-named National Institute for Health and Clinical Excellence (NICE), which substantially controls the ethics and medical availability of care under the NHS. From a column in the Wall Street Journal:

Here in the U.S., President-elect Barack Obama and House Democrats embrace the creation of a similar "comparative effectiveness" entity [as NICE] that will do research on drugs and medical devices. They claim that they don't want this to morph into a British-style agency that restricts access to medical products based on narrow cost criteria, but provisions tucked into the fiscal stimulus bill betray their real intentions.

The centerpiece of their plan is $1.1 billion of the $825 billion stimulus package for studies to compare different drugs and devices to "save money and lives." Report language accompanying the House stimulus bill says that "more expensive" medical products "will no longer be prescribed." The House bill also suggests that the new research should be used to create "guidelines" to direct doctors' treatment of difficult, high-cost medical problems.

The bill gives incoming Health Secretary Tom Daschle wide discretion to set priorities, and he's long advocated a U.S. approach modeled on the British agency, the National Institute for Health and Clinical Excellence (NICE). Mr. Daschle argues that the only way to reduce spending is by allocating medical products based on "cost effectiveness." He's also called for a "federal health board" modeled on the Federal Reserve to rate medical products and create central controls on access.

This sounds like even if we maintain a technically private health care system, it will have to operate under federal care rules. Bring on the futile care theory!

When I was in the UK in the wake of Terri Schiavo, advocating for Leslie Burke's right to have a feeding tube when the time came that he could no longer swallow--Burke has a degenerative neurological disease akin to a slow motion Lou Gehrig's and he sued to make sure he wouldn't be dehydrated--I saw the legal briefs NICE filed against Burke's position. It wanted total control by the doctors over whether he lived or died when he became totally disabled based on quality of life/resource standards. Horrible, just horrible.

In 2005, I wrote about the case for the Weekly Standard in "The English Patient," which included a quick description from official testimony about how the NICE works. From my piece:

"[Under NICE standards, an] assessment is made of the cost of the treatment per additional year of life which it brings, and per quality adjusted life year (QALY) . . . which takes into consideration the quality of life of the patient during any additional time for which their life will be prolonged. The clinical and cost effectiveness of the treatment under review is then used as the basis for a recommendation as to whether or not . . . the treatment should be provided in the NHS..." In other words, medical care is effectively rationed by the National Health Service under guidelines set by bioethicists based on their beliefs about the low quality of life of patients whom they have never met. While the views of patients and families are to be taken into account when deciding whether to provide treatment, they are not determinative.

I don't think the American people will yet accept such a program here--if they know about it. But it seems that this financial fiasco through which we are careening is being used as a pretext to carve out obscure legal nooks and crannies with the potential to hide much perfidy.

Fantastic Voyage-Type Mini Robot in the Bloodstream--For Real

As regular SHSers know, I love non controversial biotechnology. Here's another good example. If it works, it will be a case of life imitating, well not art exactly, but schlock.

Scientists have invented a mini robot that might be injected into a stroke patient's blood stream with which to perform delicate surgeries--sort of a Fantastic Voyage without miniaturizing Raquel Welch to the size of a red blood corpuscle. From the story:

A tiny robot which could be injected into patients' bloodstreams to carry out potentially life-saving operations has been designed by scientists. They hope that the minuscule "submarines", which measure less than the width of two human hairs, could help surgeons treat stroke patients and those with dangerous heart conditions.

Of course, before something like this can be tested in living human beings, it must be first tried in large animals--after non animal work is completed:

The team has tested the device in human blood and artificial arteries and later this year it will begin experiments in pigs, whose arteries and brains are similar to humans, before proceeding to full-scale human trials. A spokesman for the Institute of Physics, which published the report, said that using the miniature robots could "save lives by reaching parts of the body, like a stroke-damaged cranial artery, that (other instruments) have previously been unable to reach."

People who oppose animal research on moral grounds deserve our respect. But the cost of their perspective would be to not move forward with potentially life-saving research such as this, since it would be unethical to try it in humans before determining whether it appears safe and efficacious in living organisms. So, that leaves us with the inevitable hard choice: No research on pigs (in this case) or no chance for humans to benefit from this new technology.

Assisted Suicide Laws Will Never be Liberal Enough

One of the things I have come to understand about the euthanasia movement is that the law will never be loose enough to satiate the appetite of the ideologically committed for death on demand. As one example, when the Dutch formally legalized euthanasia, the very next day the Minister of Health opined that suicide pills should be made available to the elderly who are tired of living but don't qualify to be killed. Similarly, suicide tourism would continue to Switzerland even if the UK legalized assisted suicide for the terminally ill.

Then, there will always be people like Derek Humphry who has spent most of his adult life selling how-to-commit suicide kits and books. Now, he is promoting suicide "helium hoods." From his blog:

Last Rights Publications' in Canada went out of business some time ago, just after the 3rd edition of Final Exit was published. So ignore the information at the bottom of page 140 of my book about where to buy the helium hood kit. Instead, today a person may purchase the helium hood kit (not the tanks) for $60 USD either from: [addresses omitted]

Supplying this equipment is not an ERGO [his suicide kit organization] project, but we have heard that both are reliable, with a fairly good turn-around time. Overseas price is the same = $60. Check, money order or cash. No internet or telephone orders. Both groups operate discreetly, low-key--quietly serving those in need

The callousness is beyond belief.

The Bioethics Drive to Kill for Organs Grows

The agitation to increase the pool of potential organ donors by allowing people who are unquestionably not dead, but who have profound cognitive disabilities, to be killed for their organs continues. An article in the American Medical News, primarily concerned with organ procurement after "heart death," is the latest example. From the story:

Other critics said the concept of transplanting a heart after cardiac death isn't logical. "If someone is pronounced dead on the basis of irreversible loss of heart function, after all, it would not be possible for heart function to be restored in another body," wrote Robert M. Veatch, PhD, a Georgetown University medical ethics professor, in an Aug. 14, 2008, NEJM essay. "One cannot say a heart is irreversibly stopped if, in fact, it will be
restarted."

This is to sow intentional confusion. The heart can beat outside the body because it has its own nerve clusters, and no one would say that the body from which it came was not dead. The issue is whether the heart could spontaneously restart beating, not whether the heart itself is so degraded it can no longer function.

Here's the advocacy part:

Veatch said the dead-donor rule should be changed to allow patients or their families to opt for a standard that takes a loss of functioning consciousness (short of brain death) as another kind of death. Physicians could then procure hearts "in the absence of irreversible heart stoppage."

Robert D. Truog, MD, said the Denver cases illustrate the underlying problem in how death is defined to facilitate organ donation and transplantation. He said it is time to reconsider the dead-donor rule. "The existing paradigm, built around the dead-donor rule, has increasingly pushed us into more and more implausible definitions of death, until eventually we end up with such a tortured definition that nobody's going to believe it," said Dr. Truog, professor of medical ethics and anesthesia at Harvard Medical School in Massachusetts.

This is known in the trade as "redefining death," and if it ever comes to pass--people like Terri Schiavo could be called dead instead of unconscious and harvested to death. Moreover, we are not being "pushed" into this. Some want to choose it. It is our job to make sure it doesn't happen.

Obama Not to Rescind Bush ESCR Funding Policy?

I am not sure what to make of this. According to a Politico writer, President Obama many not rescind President Bush's embryonic stem cell funding executive order. He is going to leave it to the Congress. From the story:

Obama pledged during the campaign to lift the restrictions, and political observers had expected him to move swiftly to reverse President Bush's 2001 executive order--most likely with his own executive order.

But the president-elect suggested Friday that he would wait for Congress to weigh in on the issue. "Well, if we can do something legislative then I usually prefer a legislative process because those are the people's representatives," Obama said in a CNN interview. "And I think that on embryonic stem cell research, the fact that you have a bipartisan support around that issue, the fact that you have Republicans like Orrin Hatch who are fierce opponents of abortion and yet recognize that there is a moral and ethical mechanism to ensure that people with Parkinson's disease and Alzheimer's can actually find potentially some hope out there, you know, I think that sends a powerful message.

Hmmm. That would be a dramatic reversal of an earlier promise. Moreover, it will take time to accomplish. On the other hand, it would mean that his fingerprints would not be on the deed. Good politics, I think, because he would get credit for signing the bill but not blame for opening the door.

Also, it can lead to a far more radical research license than could be done by the President alone. But legislation is never totally predictable. That uncertainty can also open up opportunities for opponents to educate the President (whose comment about Alzheimer's shows that he needs it) and the public--such as the incredible breakthroughs happening with adult stem cells and the potential of "alternative methods" to heal the breach that this issue has caused to the body politic.

SHS Funnies

After seeing The Day the Earth Stood Still ten times, Rat throws the earth baby out with the human bathwater:

Coup de Culture: Media--One-Sided Panic Mongers

The coup de culture, as I have defined it, is the process by which the reigning cultural value system of human exceptionalism--which is itself founded in the moral philosophy of Judeo-Christianity/humanism-- is being subverted and replaced by a new paradigm steeped in utilitarianism/hedonism/radical environmentalism. The consequence has been an all out attack on the unique importance of human life, pounded constantly into the consciousness of the general population by outlets of popular culture and a biased media.

The coup relies on hyper alarmist rhetoric so that its value presumptions and assertions won't be challenged. Here's a case in point on the radical environmental front. The global warming ideologue James Hansen is once again warning that we are all doomed if we don't immediately destroy (what is left of our) economies so as to stop carbon emissions. We only have four years! From the story:

Soaring carbon emissions are already causing ice-cap melting and threaten to trigger global flooding, widespread species loss and major disruptions of weather patterns in the near future. "We cannot afford to put off change any longer," said Hansen. "We have to get on a new path within this new administration. We have only four years left for Obama to set an example to the rest of the world. America must take the lead."

Hansen said current carbon levels in the atmosphere were already too high to prevent runaway greenhouse warming. Yet the levels are still rising despite all the efforts of politicians and scientists.

Only the US now had the political muscle to lead the world and halt the rise, Hansen said. Having refused to recognise that global warming posed any risk at all over the past eight years, the US now had to take a lead as the world's greatest carbon emitter and the planet's largest economy. Cap-and-trade schemes, in which emission permits are bought and sold, have failed, he said, and must now be replaced by a carbon tax that will imposed on all producers of fossil fuels. At the same time, there must be a moratorium on new power plants that burn coal--the world's worst carbon emitter.

That could lead to brownouts and blackouts. It might well also turn a recession into a depression and cause inflation, to boot. Is such a draconian policy really necessary? What do those who might disagree have to say, and on what do they base their contrary opinions? We don't know. The reporter never bothered to find out.

This kind of media bias is an important issue to which I am going return often because once it is seen clearly, it loses its power to persuade. In subject after subject, whether the culture of death issues, radical environmentalism, or other areas that promote the new cultural order, the media act as conduits for one side. When they report in this way, they cease to be journalists, and play the roll of shill or propagandist.

It seems to me that in a story like the one at hand that seeks to panic us into precipitous action, readers should have been told that China, not the USA, is now the world's largest carbon emitting country. And how could the fact that this is turning out to be one of the coldest winters in a long time be ignored? Or that the computer models upon which so much of this panic is based have not proved reliable? Or that some of the biggest names in climatology don't subscribe to the climate change panic? Or, the fact that sea ice grew at a record rate in the last quarter of 2008? Or, for that matter, that the earth is actually a tad cooler today than when President Bush took office? Such contrary evidence might keep us from acting! The new earth religion demands that we sacrifice our prosperity and flourishing to save the planet, no time for questions or dissent! Otherwise, it will be as the alien says about us in the deep ecology propaganda movie, The Day the Earth Stood Still!

And the funny part is that all of this apocalyptic scare-mongering comes from the side claiming the exclusive mantle of rationalism.

Maryland House Bill 30: De-professionalizing the Care of People With Terminal Illnesses

In addition to pushing assisted suicide, groups like Compassion and Choices yearn for respectability and desire to be seen as legitimate care givers for patients, at least in an informational context. That was part of the point last year when California passed AB 2747, requiring doctors to inform patients with one year or less to live of their terminal care options, such as refusing to eat or hospice. (As originally written, it would have permitted patients to demand to be sedated and dehydrated to death--a back door method of assisted suicide.) If the doctor doesn't wish to so counsel, he or she is required to refer terminally ill patients to another doctor or to organizations that counsel the terminally ill in such matters. Not coincidentally, the bill was co-sponsored by Patty Berg, the good pal of Compassion and Choices (formerly Hemlock Society), that "counsels" the terminally ill, including about assisted suicide. So, while the original euthanasia purpose of the bill failed, assisted suicide groups took a big step forward by becoming approved conduits of information.

Two Maryland Delegates (Bobo and Manno) are now pushing this same line, with House Bill 30. If it passes, groups like C and C will be able to set up shop as an organization "specializing" in providing information for end-of-life care and receive referrals from doctors for patient counseling. No link yet [Update: Here is link], but here is the relevant language filed last year in preparation for the current legislative session:

E- Terminal Condition Care Counseling may include:...3) Information from organizations specializing in terminal condition care that provide information on fact sheets and Internet Websites to convey the information.

It is worth noting that there are no minimal credentials required for the counselors in the legislation, nor any minimal training for qualified "counselors." Isn't that odd? I mean, if this counseling is so important it must be legally required--then isn't its value diminished by setting such a low bar for qualifying to receive physician referrals? (Another clause of the legislation states that the organization need only be on that "specializes in terminal condition case management and consultation.") Indeed, doesn't this open the door to what are, in essence, advocacy groups pushing their agendas in the guise of "counseling?" As such, doesn't this bill actually de-professionalize the field?

Of course patients and their doctors need to work through these important issues together. But proposals such as this are not only unnecessary and very loosely worded, they certainly seem to have agendas that go far beyond ensuring that patients receive appropriate information about proper end-of-life care.

"Choice" is a One Way Street

As I have often said, the culture of death brooks no dissent. The Bush "conscience clause" regulations protecting health care workers from being discriminated against in their employment for refusing to participate in medical procedures with which they disagree on religious or moral grounds, has been attacked in court by six states. From the story:

In filing the lawsuit, Attorney General Richard Blumenthal is seeking an injunction to stop the Provider Conscience Rule from taking effect. The lawsuit also asks the court to invalidate the regulation.

Blumenthal said the rule would allow health care providers or pharmacists to deny a patient medical care without explanation or offering the patient a referral or information on alternatives, upsetting the balance between health providers' religious freedom and patients' rights.

It would also override a 2007 Connecticut law that guarantees that all hospitals in the state provide emergency contraception, commonly known as Plan B, to rape victims. That law has been endorsed by Catholic leaders, who initially opposed it, and has not produced complaints, Blumenthal said.

This is just the opening of a drive that will seek to make all health care workers potentially complicit in abortion, assisted suicide, and other such activities in the medical context, that seeks to drive doctors, nurses, and others who believe in the literal interpretation of the Hippocratic Oath out of medicine altogether.

And all too typically, the the story doesn't even bother to present the perspectives of advocates for the other side--surely somebody could have been found to defend the regulations. But it was able to get this surreal quote from the ACLU representative:

Andrew Schneider, executive director of the ACLU of Connecticut, drew a distinction between religious rights and the Provider Conscience Rule. "We have long protected religious liberty rights, but not when it curtails basic rights to reproductive freedom," he said.

Fascinating. Religious freedom is explicitly guaranteed in the U.S. Constitution, but reproductive liberty is a "penumbra" that the courts have found to be implied therein. Which should have the first protection under the law and the support of a group claiming to stand up dispassionately for individual civil liberties?