Saturday, January 31, 2009

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."

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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.

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Friday, January 30, 2009

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.

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Thursday, January 29, 2009

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!

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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.

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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.

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Wednesday, January 28, 2009

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.

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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.

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Tuesday, January 27, 2009

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.

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Sunday, January 25, 2009

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.

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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.

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Saturday, January 24, 2009

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.

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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.

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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.

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Friday, January 23, 2009

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.

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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.

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Thursday, January 22, 2009

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%.

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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.

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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.

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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.

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Wednesday, January 21, 2009

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.

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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.

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Tuesday, January 20, 2009

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.

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Monday, January 19, 2009

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.

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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.

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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.

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SHS Funnies

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

Sunday, January 18, 2009

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.

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Saturday, January 17, 2009

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.

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"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?

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Friday, January 16, 2009

The Death Bureaucracy Begins in Washington State




















It is sickening to read the proposed bureaucratic forms that patients and their death doctors will fill out and send to the state when planning assisted suicides. Twenty years ago, people would have called me a total paranoid if I predicted this is what we would become. I wouldn't have believed it myself. Nonetheless, this is where we are as a culture. From the Proposed Rule Making document filed by the now ironically misnamed Department of Health:

REQUEST FOR MEDICATION
TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER
I, ______________________________________________________________________, am an adult of sound mind.
First Middle Last
I am suffering from _____________________________________, which my attending physician has determined is an incurable, irreversible terminal disease and which has been medically confirmed by a consulting physician.
I have been fully informed of my diagnosis, prognosis, the nature of medication to be prescribed and potential associated risks, the expected result, and feasible alternatives, including comfort care, hospice care, and pain control.
I request that my attending physician prescribe medication that I may self-administer to end my life in a humane and dignified manner and dispense or to contact a pharmacist to dispense the prescription.

Initial One
I have informed my family of my decision and taken their opinions into consideration.
I have decided not to inform my family of my decision.
I have no family to inform of my decision.

I understand that I have the right to rescind this request at any time.
I understand the full import of this request and I expect to die when I take the medication to be prescribed. I further understand that although most deaths occur within three hours, my death may take longer and my physician has counseled me about this possibility.
I make this request voluntarily and without reservation; and I accept full moral responsibility for my actions.

Signature: County of Residence: Date:

Even the name of the form is propaganda. The death culture, or a death cult?

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Thursday, January 15, 2009

My Predictions for 2009 in Bioethics

Each year the Center for Bioethics and Culture asks me to prognosticate about the coming year. This year, that duty is painful. I believe we are entering dark days. But it is my job to call them as I see them without honey coating. (This is an abridged version. For more details read the original article.) I predict:

Biotechnology:
-- The Bush Embryonic Stem Cell Funding Policy is Toast...
-- The Amount of Federal Funding of Human ESCR Will Remain Roughly the Same...
-- New Federal Law Will Explicitly Legalize Therapeutic Cloning...
-- The Federal Government Will Not Fund Human Cloning in 2000;

Assisted Suicide:
-- Washington Assisted Suicide Will Quickly Seem Routine...Any abuses or problems that come to light in WA, will, as in Oregon, be ignored by state authorities and go mostly unreported by the media.
-- The Montana Supreme Court will Create a Constitutional Right to Assisted Suicide...
-- At Least One State Legislature Will Vote to Legalize Assisted Suicide: Look for Hawaii, California, and/or Vermont to legalize assisted suicide through the legislative process.

Miscellaneous:
-- Abortion: The Freedom of Choice Act (FOCA)--which would erase all state laws limiting abortion--will be fought tooth and tong by the pro life movement. It will not pass in 2009...
-- Conscience Clauses:...The Bush Administration passed a regulation at the end of his term protecting such dissenting health care workers from being discriminated against in employment for hearkening to the call of conscience. Look for this rule to be overturned by the Obama Administration, or overturned by legislation...
-- Human Exceptionalism: Timing is uncertain, but look for the European Court of Human Rights to declare that chimpanzees are legal persons in Europe, perhaps this year, but almost certainly by the end of 2010...
-- Futile Care: Texas will not rescind its law legalizing medical futility in 2009...
-- Biological Colonialism: Alas, despite legal attempts to restrict the exploitation of the world's destitute for their body parts, biological colonialism (such as buying organs), will increase in 2009.
I have been asked privately why I would be so publicly pessimistic, even if realistic, in this prediction. The worry is that people might get discouraged. Perhaps, but I hope it will wake people up! I am so tired of hearing, "It can't happen here," that the time has come for all to understand that not only can it happen here, it is happening now. It is now or never to defend the ramparts!

If you'd also like to listen to my predictions, check out the current edition of my podcast, What It Means to Be Human and you can download it into your MP 3.

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Wednesday, January 14, 2009

Don't Worry: Refusing to Fund Human/Animal Hybrid Cloning Not About Morals

With The Independent on a tear because moral concerns might have been behind the failure of scientists to garner public funding to conduct human cloning with animal eggs, we get this badly needed assurance. From the story:

Reports in the British media that grant applications to create hybrid human--animal embryos for research were turned down on moral grounds, have been rejected by the funding bodies and scientists involved.

The story broke in the Independent newspaper on Monday, which claimed Stephen Minger, a leading stem cell scientist at King's College London, said that the grant applications may have been blocked by scientists on the funding committees who are morally opposed to the creation of cloned hybrid embryos. But when Nature spoke to Minger he said the Independent misinterpreted his comments, adding he did not have any evidence that moral objections led to his proposal being rejected. "I was not saying that religious or moral opposition to the proposal led to its rejection," he said.
Whew, that's a relief. We sure wouldn't want morality to play any role in government funding of scientific research.

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Genetic Cleansing and the Corruption of Science Through Political Redefinition

Slate's Will Saletan--a favorite of mine even though we often disagree because he is a very good writer and unfailingly honest in his reportage--is onto the story of the baby girl born in the UK who was selected in--as her siblings were destroyed--because she did not have a gene that can cause adult onset breast cancer. From his column "Eugenics Euphemisms:"

It's happy news. But let's take a closer look at the announcement, starting with the test "before conception." This baby was tested as an embryo in a dish. She was one of 11 such embryos made by injecting drugs in the mother to stimulate production of excess eggs, which were then fertilized with the father's sperm. Six of the embryos had the gene for breast cancer. Three more had "other abnormalities." All nine were "discarded." The other two were implanted, and one became this baby. In sum, at least six human embryos were made and then thrown away because they failed a test.
Saletan then illustrates how science is being corrupted (my word) via redefining terms to make us feel okay with the way we now instrumentalize nascent human life because, well, we want what we want:
We now call such tests "preconception." This is the next step in our gradual devaluation of embryos. First, we said IVF embryos weren't pregnancies. That's technically correct: Pregnancy begins when the embryo implants in the womb. Then we called early embryos "pre-embryos" so we could dismantle them to get stem cells. That was technically incorrect, but we did it because it made us feel better. Now we're adjusting the word conception. Henceforth, testing of IVF embryos to decide which will live or die is preconception. Don't fret about the six eggs we fertilized, rejected, and flushed in selecting this baby. They were never really conceived. In fact, they weren't embryos. According to Serhal, each was just "an affected cluster of cells."
And the slavering media--Saletan being a rare exception--go right along because all of this is part of the coup de culture. (This particular episode mixes utilitarianism and hedonism, by which I mean believing we have the right to fulfill every desire, including both having children and the children we want.)

Saletan also catches the enormity of it all:
"The lasting legacy is the eradication of the transmission of this form of cancer that has blighted these families for generations." Lasting. Legacy. Eradication. Families. Generations. We're no longer talking about protecting an individual. We're talking about cleansing families forever. "We are eliminating the gene from our line," says the happy mother. Serhal agrees: "We are eradicating it from the whole family tree." From the standpoint of efficiency, this is wonderful. But efficiency and collective cleansing are the core principles of eugenics.
And what if science discovers other genes that lead eventually to disease--opt them out too? And what of the unintended consequences? Genes we seek to eradicate might play other beneficial roles. Besides, if anyone thinks this human manipulation will be restricted to preventing disease, I have a beautiful orange bridge that spans the Golden Gate that I'd be happy to sell you. Think of all the tolls you will be able to collect.

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SHS Funnies

Pig and I have much in common:


Yes, it's true:

Tuesday, January 13, 2009

Whining Scientists Always Get Their Way in Brave New Britain

I posted yesterday about how "the scientists" in the UK are whining because their human/cow embryo cloning scheme has not been funded by the government. I said that once their whining hit the papers, things would change quickly, because in the UK--what the scientists want, the scientists get. That process of, ironically, imposing politics onto science funding is now well under way. From the story:

The two research councils that have turned down requests to fund stem-cell studies using human-animal "hybrid" embryos are to be questioned by MPs on both sides of the House of Commons to explain why they have refused to issue the grants.

As revealed by The Independent yesterday, the Medical Research Council (MRC) and the Biotechnology and Biological Sciences Research Council (BBSRC) have declined to fund two separate teams of scientists who have been given licences by the Human Fertilisation and Embryology Authority to carry out the work. Evan Harris, the Liberal Democrat spokesman on science, said that he had written to the research councils to make sure that the funding decisions were made on scientific grounds alone, rather than being influenced by the personal moral position of anyone sitting on the expert funding panels.
Good grief! Mengele's infamous twin experiments could be justified on "the science grounds alone." They were moral atrocities. That means ethics, which means very little in this utilitarian age that will countenance anything but policy based on moral judgments about the intrinsic importance of human life.

Meanwhile, the BBC points out that just human/animal hybrid cloning is legal, doesn't mean it will be funded. (We'll see about that!) Moreover, it seems that the great IPSC breakthrough may be inhibiting coughing up the pounds to pay for nascent Isle of Dr. Moreau experiments, which could make the funding dearth a "science" rather than a moral decision after all. From the story:
Science has also continued to move on since last year's heated debate. Induced pluripotent stem cells (IPS) are adult stem cells which are made to act like embryonic ones with the ability to become any cell in the human body.

They too have the potential to be used to treat a range of degenerative conditions and also circumvent the need to use human eggs or destroy embryos - although scientists involved admit therapies could still be many years away.

"There has been a lot of movement on this front and this probably has caused the scientific community to reflect a bit - technologies move on very rapidly," says Chris Mason, professor of Regenerative Medicine Bioprocessing at University College London and a member of the UK National Stem Cell Network. "But none of this is mutually exclusive and there is still definitely a role for hybrid research. I simply do not believe that moral reservations are at play - the right proposal will always find the money."
Meanwhile the NHS is in full meltdown as "the scientists" huff and puff about wanting to clone. Prioritize Gentlemen and women. Prioritize.

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Defending Human Exceptionism: The Medical Safeguards Project

Some people talk--and some people act. In the latter category are the good people in Massachusetts who operate The Medical Safeguards Project. Understanding that people with developmental disabilities are at particular risk in our increasingly utilitarian health care system, the Medical Safeguards Project literally puts people into hospitals to protect the vulnerable. From the MSP Website:

The Medical Safeguards Project has two major components: health care enhancement, and safeguarding and advocacy...

The health enhancement component is oriented to complementing and assisting, as necessary, primary health care providers in delivering optimal care for clients of the Department of Mental Retardation living in Southeastern Massachusetts. Assisting primary care physicians and other health care providers means...preparing accurate, complete, and up-to-date medical information for a consultation...

The safeguarding and advocacy component focuses on assuring that clients of the Department of Mental Retardation living in Southeastern Massachusetts have family, friends and advocates in their lives, as well as an active and competent guardian who will defend their right to treatment. Our objective is for people to receive the same level of excellent care and support as the most socially valued persons in their community.
I have been privileged to speak to and interact with these valiant and dedicated people. I have heard the harrowing tales of the fights they have waged to ensure that their clients receive proper and humane care. The term, "They walk the walk," definitely applies.

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The Problem of "Biological Colonialism"

To The Source asked me to write an essay for its newsletter on what I call biological colonialism. I was pleased to comply. From the article:

Commentators who reflect on this moral crisis [the weakening of the sanctity/equality of life ethic] usually focus on "culture of death" issues such as assisted suicide, abortion, and Terri Schiavo-type cases. But there is another profound threat posed by this ongoing rejection of human exceptionalism; the commoditization and exploitation of the body parts and functions of the poor, effectively treating human beings as mere natural resources to be exploited and/or harvested.
I discuss, at some length, problems such as the rich buying the organs of the poor, womb renting, embryo purchasing, the potential for exploiting destitute women for their eggs for use in human cloning research, and unethical human experimentation. I conclude:
One definition of evil is treating human beings as objects rather than subjects. That is precisely the implication of biological colonialism. While the poor may always be with us, that does not justify our exploiting our destitute sisters and brothers or putting them at risk to improve our own health or fulfill our familial desires. Rather, the proper and humane response to deep poverty is loving and selfless outreach, assistance, and devotion.
A more succinct way to describe my final point is that we should all follow the Golden Rule. And as I wrote the last sentence, it struck me that I haven't heard that term mentioned in a long time. Alas.

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Monday, January 12, 2009

Ethics Warning to CIRM Poobah

The ethical and management disaster that is the California Institute of Regenerative Medicine continues to disappoint. Now, a member of the board has received a warning letter from the California Fair Political Practices Commission. From the story:

The California Fair Political Practices Commission warned Dr. John Reed in an official letter that his effort to appeal the denial of a Burnham Institute grant application raised "ethical concerns."

But the commission found Reed did not violate conflict-of-interest laws because the decision denying the grant could not be appealed. The letter was made public Monday by Consumer Watchdog, a public interest group that brought the conflict-of-interest accusation against Reed in late 2007.
So, the man tried to do the wrong thing, but because it was structurally impossible to accomplish the misdeed, he got off with a letter slap-on -the-wrist.

Fine. The law is the law. But bad appearances are bad appearances. Why is Dr. Reed still on the board?

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Apology but No Accountability in Starvation Death of Martin Ryan

The hospital that allowed Marin Ryan to starve to death has issued a statement telling Martin's parents and the country that all concerned are very, very sorry that they allowed him to starve to death over 26 days and "die in agony."From the story:

Chief executive Kate Grimes said the trust had apologised personally to Mr Ryan's parents, and that the staff involved 'very much regret' his death.

She said the communications breakdown was 'inexcusable and our staff have learned very serious lessons'. She added: 'Personally, I would also like to say we feel for Mr Ryan's parents over the loss of their much-loved son. We know we cannot make things better for them but we have made major changes to ensure another similar tragedy does not occur.
That's all well and good, and I have no doubt the apology is sincere. But it is inadequate to the profound wrong that occurred in this case. Where is the accountability? Where are the resignations? Why haven't--apparently--any of the derelict caregivers been fired or disciplined by the hospital and their professional organizations? Indeed, why nearly four years after Martin's death is the matter still at the inquiry stage?

I have no doubt that if Martin did not have Down syndrome, heads would have figuratively rolled. Indeed, it isn't vindictiveness but simple justice that demands that this case not be allowed to rest with a simple apology, no matter how sincere or abject.

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Denying Funding for Human/Hybrid Cloning in Brave New Britain

"The scientists" in the UK are throwing a tantrum because their funding for the creation of human/cow hybrid embryos has apparently slowed. From the story:

Britain's effort to lead the world in stem cell research with the creation of human-animal "hybrid" clones has ground to a halt through lack of funding less than a year after the controversial technique was legalised.

Funding bodies are refusing to finance the research and existing projects have been run down to the point at which they may end completely within weeks. One of the researchers involved in the work said last night that the grant applications may have been blocked by scientists on the funding committees who are morally opposed to the creation of cloned hybrid embryos derived from mixing human cells with the eggs of cows, pigs or rabbits.
In other words, they don't really know why. It could be there is a lack of money. The UK is in a deep recession--not that "the scientists" think it should affect them. Or, it could be that the research proposals weren't considered of sufficient scientific merit to justify spending the public's money. But I hope they are right and the refusal to fund has been about ethics and morality. To claim that such matters have no place in science policy decisions--particularly when spending the public money--is not only dangerous, it is folly.

Then came the usual fear mongering:
The decision threatens Britain's leading position in the world in terms of creating of stem cells from animal-human hybrid embryos, research which in the US is banned from receiving federal government funding.
Well, I suppose that is technically true. But that's a pretty narrow parameter. It doesn't mean that UK biotechnology itself is falling behind.

I am sure this shot across the bow from the scientists in a left wing paper (The Independent) will prime the pump and get the money flowing. To date, "the scientists" in the UK have gotten just about whatever they want. I doubt this bump in the road will be any different.

But we can always hope.

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Crisis in Health Care Funding: Better to Slow Down Research Than Open the Door to a Culture of Death


Articles that worry about the rising costs of health care and hand wring about what we are to do about it are a dime a dozen. Still, Washington Post Science and Medical Reporter David Brown has written a lengthy article that presents a good summary of the problem. From the story:

This difficult truth, which has emerged over the past half-century, is leading the United States and the rest of the industrialized world into a new era of humankind. We are on a collision course between our wish to live longer, healthier lives and our capacity to pay for that wish. Whether we can somehow avoid the collision is perhaps the most important domestic issue of this century. From now on, health care costs will be up there with globalization, terrorism and climate change as a force shaping our world.
So tell me something I don't know--although I think the problem with climate change is more hysteria than reality. Still, the billion dollar question, obviously, is what do we do about the problem of rising health care costs?

One part of the solution might be to reign in the billions of public dollars we pour into medical and scientific research at the federal level and use it to fund current needs. Don't get me wrong: Most research money is well spent. But we are heading into a time in which we will have to triage government. If and when we hit that point--and given the growth in public debt, we may well already be there--it strikes me that we may have to choose between pushing the medically vulnerable out of the lifeboat or dramatically slowing the pace of medical research and scientific advancement.

If that point is reached, we should choose the latter option. I am all for research, but not at the expense of people. Better to do less research than impose a utilitarian medical ethic that denies care to--our countenances the killing of--the elderly, dying, or people with disabilities. Moreover, once the financial crisis ended, we could up the funding for science. But once we went down Utilitarian Road, it would be nigh on impossible to ever get back to a truly moral health care system.

Hopefully, we will find an ethical way to have decent health care system and bounteously fund scientific research too: Never underestimate scientific ingenuity. But if we ever do have to choose, I know which way I will want society to go.

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UC Davis Animal Researchers Threatened with Death

Bomb threats should be called what they are: Death threats. Animal researchers at UC Davis are being threatened. From the story:

Police at UC Davis are on high alert while they are investigating a threat made on a controversial Web site targeting two of the university's researchers.

According to UC Davis spokesman Andy Fell, the "Revolutionary Cells Animal Liberation Brigade" posted on a Web site that they had sent mail bombs to the UC Davis researchers late Saturday. The researchers work at the California National Primate Research Center, which conducts tests on primates to try and benefit human and animal health. The center does studies on HIV/AIDS and other infectious diseases, asthma, autism and Alzheimer's disease.
This should be condemned unequivocally by everyone, regardless of their beliefs about the use of animals in research. But the silence from most leaders of the animal rights movement continues to be deafening.

Remember, letter bombs were the murder weapon of choice of the UNABOMBER. Such threats may or may not be empty, but they are terrorism.

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SHS Funnies

The Culture of Death reaches into elementary school:
Rat: I feel your pain but quitting is not the answer:

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Sunday, January 11, 2009

Media Bias: What They Don't Tell You is Often the Story

The media continue to report narratives (theirs) instead of stories. Here's a headline you didn't see, but should have: "Sea Ice Returns to 1979 Levels: Growth Is Fastest Rate of Change Ever." From the notice at Daily Tech:

Thanks to a rapid rebound in recent months, global sea ice levels now equal those seen 29 years ago, when the year 1979 also drew to a close.

Ice levels had been tracking lower throughout much of 2008, but rapidly recovered in the last quarter. In fact, the rate of increase from September onward is the fastest rate of change on record, either upwards or downwards. The data is being reported by the University of Illinois's Arctic Climate Research Center, and is derived from satellite observations of the Northern and Southern hemisphere polar regions.
Surely, this story was worth with reporting prominently as it is relevant to the debate over the existence and/or causes of global warming. But the media's narrative--as opposed the the reality--holds that there is no debate; it's getting hotter and something must be done!. This story counters the narrative. Hence, we heard the sound of crickets from the major outlets.

Meanwhile Pravda is predicting a catastrophic ice age. Can't we stop it with the terror headlines already? Weather changes and nobody can really do anything about it.

Back to the point: C'mon journalists--stop being advocates and do your jobs! If you will just follow LAPD Sergeant Joe Friday's advice when questioning witnesses (boy, am I aging myself), and give us "the facts, Ma'am. Just the facts," media can rebound. We need our newspapers!

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Media Reportage Reads Like Press Release for Geron Corp.--Again

The media is at it again, pushing the stem cell line desired by a Big Biotech company. This story in the Chicago Tribune seems sparked by Geron's publicity department rather than having been garnered through independent reporting. It's about why the field has moved slowly and how Geron is uniquely poised to make big breakthroughs. Anybody want to buy stock?

First, we find that embryonic stem cell research has supposedly been starved for funds. From the story:

The biggest hurdle may have been the lack of government funding for stem cell studies. Because there is no federal money for this kind of research, other than through the National Institutes of Health, there has been little movement in the embryonic stem cell arena outside of Geron's privately funded effort. That means regulators lack the data needed as comparison to Geron's studies, further slowing the clinical-trial approval process.
But the NIH is the major funding arm for most federally funded research, so saying that only the NIH dished out government funds for ESCR is to state very little. Moreover, the NIH gave about $160 million during the Bush years for human ESCR. Add in Proposition 71's California Institute of Regenerative Medicine has put out hundreds of millions as have other states. Indeed, when adding in philanthropic giving, the Rockefeller Institute noted in 2007 that nearly $2 billion has been poured into this research in the USA alone. Starved for funds? Hardly! The implication in the story that only Geron had money for embryonic stem cell research is thus baloney.

Geron is once again claiming it is on the verge of human clinical trials, including a description of the same rat videos that have made "news" for years:
In a video presentation to analysts and investors in New York in November, Geron showed rats with spinal cord injuries that could barely move. Within weeks after they were injected with the stem cell-derived drug known as GRNOPC1, the rodents were seen scurrying around their cages, back legs moving and tails no longer dragging.

Should the clinical trial be approved, a half-dozen spinal cord patients would be administered the drug seven to 14 days after they suffer traumatic injuries and during typical treatments, which include surgery, Okarma said. "It would be a single injection to restore function," he said. "This goes way beyond the reach of pills and scalpels. [This year] human embryonic stem cells will finally reach the point of being tested in FDA-sponsored clinical trials in the U.S. "Hopefully, this will reach thousands of spinal-cord-injury patients."
Geron has been claiming to be on the verge of human trials for at least five years. Perhaps this year it will be true. I just wish the media would stop publishing stories that look more like shilling than journalism.

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Saturday, January 10, 2009

Stop Google Searches to Save the Planet!

The coup de culture is driving some of us out of our minds. This post has to do with the radical environmentalism/earth religion part of the triad of the New Western Order that includes as its other manifestation, utilitarianism and hedonism. A physicist has warned that we are destroying the planet by engaging in Google Web searches. From the story:

Performing two Google searches from a desktop computer can generate about the same amount of carbon dioxide as boiling a kettle for a cup of tea, according to new research. While millions of people tap into Google without considering the environment, a typical search generates about 7g of CO2 Boiling a kettle generates about 15g. "Google operates huge data centres around the world that consume a great deal of power," said Alex Wissner-Gross, a Harvard University physicist whose research on the environmental impact of computing is due out soon. "A Google search has a definite environmental impact."
This may be worse than the dairy herds! Now you know why I call this blog Secondhand Smoke!

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Eugenically Child Born in Brave New Britain

Several SHSers have sent me the story of the birth of the baby girl, who was selected "in" as an embryo, as her "defective" siblings were destroyed, and permitted to be implanted and born because she did not carry a gene that gives rise to breast cancer. Yuval Levin has already discussed this matter over at NRO's blog The Corner, and he points out both the ethical implications of this event and an example of post modernism in journalism in which the BBC redefined "conception" to mean implantation in the womb instead of fertilization. From Levin's post:

Better to eradicate the carriers, it seems, than to risk a potentially curable if very serious adult-onset illness. So should cancer patients wish they had never been born? Should the rest of us wish they hadn't been? The BBC itself then [states]:

Pre-implantation genetic diagnosis (PGD) involves taking a cell from an embryo at the eight-cell stage of development, when it is around three-days old, and testing it. This is before conception--defined as when the embryo is implanted in the womb.

By whom, exactly, is "conception" defined as "when the embryo is implanted in the womb"? I suppose if you can't deny that life begins at conception you just insist that conception means whatever you want it to mean. So why not call it "pre-conception genetic diagnosis"?

Curing the disease by killing the patient is hardly a step forward for medicine, and eliminating the unfit before they’re born so they won't pass on their genes to future generations is just eugenics, pure and simple. That little girl is very lucky to be alive.

I believe that these procedures, while well-meaning, are the early steps that will ultimately lead to a utilitarian dystopia of the kind warned against by Aldous Huxley. As I wrote in Consumer's Guide to a Brave New World:

Huxley's novel [Brave New World] never described the events that led to the end of history. Had he written a prequel, what might he have imagined induced the ancestors of the characters in his novel to unleash a biotechnology that became so powerful that it resulted in a "Brave New Man...so dehumanized that he doesn't even realize what has been lost" [in the words of Leon Kass]. Perhaps it would have been a fervent desire to exercise hyper-control over our health and mortality, a trend building to gale force in our own time.
I was referencing embryonic stem cells. But I think pre-implantation genetic diagnosis qualifies too. In our understandable desire to alleviate potential future suffering, we presume to decide who is worthy of being born and who should not be allowed to live. Once that principle is accepted, it will go from stopping embryos and fetuses with a propensity to cancer, Down syndrome, dwarfism, and other disabling conditions or illnesses from being born (or killing them as newborns if a mistake is made and they are born), to wiping out people with conditions that may be socially disdained, such as a propensity to obesity or homosexuality (if a genetic cause is ever identified).

I submit we have not the wisdom for such hyper-control. I submit that all of us must be welcomed equally in life, or at some point we will all reach the point where most of us will be in pronounced danger of being hustled out of it.

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"Death by Indifference:" Medically Neglectiing People with Developmental Disabilities to Death in the UK

Regular SHSers will recall the horrific case of Martin Ryan, an adult with Down syndrome who, after a stroke left him unable to talk, was allowed to starve to death over 26 days in a UK hospital. I have done some Googling, and found some more on the story. Martin's and other deaths came to light because of a campaign by MENCAP, an NGO, to bring to light abuses in the medical context against people with developmental disabilities.

There is apparently something of a pattern in this and other appalling deaths of people with developmental disabilities. From the Telegraph coverage:

The six cases were raised by Mencap in a report entitled Death By Indifference. A spokesman for the charity said last night: "These people were completely and unacceptably failed by the treatment they received. " It was a catalogue of disasters and poor treatment of very vulnerable people who deserved so much more.
Still, the coverage, based on what I can see from the USA, seems very muted, particularly given the horrendous nature of Martin's death and the other problems reported. When I Goggled it, there were only nine stories listed. Perhaps it is because these deaths didn't just happen--Martin died in 2005. But think of that! It has been nearly 4 years and nothing has been done about his plight. That is why I suspect there is more at work here.

Let's play a mind game about the same death, but a different patient. Imagine, if you will, that Martin was gay, or a Muslim, or a person of color, and that his starvation seemed part of a pattern of indifference and neglect that had been inflicted on other similarly situated patients: Wouldn't the media have been in a full-fledged feeding frenzy from the moment the news came out demanding that heads roll and cases be prosecuted criminally? Why have we not seen that same kind of intensity with regard to these deaths? Yes, there is going to be a government report, but I am talking about the intensity of the thing.

I suspect it is that people like Martin aren't valued equally by many in society and among journalists. And indeed, given the indifference to the high eugenic abortion rate, the respect in the media for people like Peter Singer who asserts it is okay for parents to kill babies born with Down (can you imagine the reaction if he said the same thing about murdering a baby based on race?), there is a (perhaps unconscious) mindset afoot that people like Martin should never be born.

Here's another horror story from the MENCAP report:
Emma was admitted to hospital for tests – she was upset and in pain. The hospital found her behaviour difficult to manage and sent her home without any help to control her pain. When Emma and her mum went back to the hospital for the results they were told Emma had cancer.

There was a 50:50 chance that she would survive if she was treated, but the doctors decided not to treat her. They said she couldn't consent to treatment. Again Emma was sent home with no way to help with her pain.

A week later Emma wasn't eating or drinking, so her mum took her back to the hospital and tried to make the doctors treat her daughter. Still having to watch her daughter suffer from the cancer, Emma's mum went to the High court to force the doctors to treat her daughter, but by the time the order came through, the cancer had progressed too far. Emma was admitted to a palliative care hospice where she died a month later.
Awful. Just awful. There's another way to spell indifference: B.I.G.O.T.R.Y.

Not being in the UK, perhaps I am missing the outrage that is being expressed there. But based on what I can tell from this side of the Pond, I am not seeing it. I would be interested to hear from UK SHSers about their perceptions of the matter.

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Friday, January 09, 2009

"Nature" Has No Rights Against the Powerful

I wrote previously about how President Correa of Ecuador, who gave rights to nature in his new constitution, was pushing a new mining law. The indigenous people objected, and relied on the constitutioanl rights of nature to protect their region from exploitation. Well, now riots have broken out and been forcibly dealt with. From the blog Upside Down World:

A number of leaders have been arrested and other protesters were beaten and shot at by police. Campesino and indigenous protesters, who depend on clean water to farm and for drinking water, are demanding that the government shelve President Rafael Correa's proposed Mining Law, saying that it would be a social and environmental disaster. The rural blockades follow months of regular protests in Quito and other parts of the country.

Protesters also argue that the law contradicts important provisions of the new constitution protecting water, the environment and indigenous peoples' rights. The document drew international attention for awarding legal rights to nature. The new constitution, approved by popular referendum in September, is the centerpiece of Correa's first term.
Idealistic Leftists--ya gotta love them. This is the lesson: Nature rights, if literally applied, would put a complete end to human flourishing. That may be what the loony environmentalists want, but that isn't the way of the world. Nature will have rights when the powerful and the elites say it will have rights because it meets their ends, whether political, financial, or ideological. There will be times when it will be used as a powerful club to prevent human activity. But that will be because it serves a purpose for those on high. It was never meant to be a ready tool to protect the poor and indigenous people.

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PETA Urges Children to Fight Against the "Hunting" of "Sea Kittens"

Remember, PETA is always after your children to get them to buy into animal rights ideology. The latest is the renaming of fish "sea kittens," in an online interactive aimed at children. From the "Save the Sea Kittens!" Web Page:

Ask the U.S. Fish and Wildlife Service to Stop Promoting the Hunting of Sea Kittens

Given the drastic situation for this country's sea kittens—who are often the victims of many major threats to their welfare and ways of life--it's high time that the U.S. Fish and Wildlife Service (FWS) stop allowing our little sea kitten friends to be tortured and killed. Who'd want to hurt a sea kitten anyway?!

Sea kittens are just as intelligent (not to mention adorable) as dogs and cats, and they feel pain just as all animals do. Please take just a few moments to send an e-mail to H. Dale Hall, the director of the FWS, asking him to stop promoting the hunting of sea kittens (otherwise known as "fishing"). The promotion of sea kitten hunting is a glaring contradiction of FWS' mission to "conserve, protect and enhance fish, wildlife and plants and their habitats."
These people are shameless. PETA well knows that the "littlest lobbyists" (as Secondhand Smokette once called children who were being exploited by their teachers to publicly support a teacher's union political position) will never succeed in outlawing fishing, er sea kitten hunting. Not to mention that real kittens, cats, bears, and other animals love to eat sea kittens, and that sea kittens eat each other without mercy. But actually outlawing fishing isn't the point. Getting kids under PETA's influence is what the group is after. Pretty cynical to take advantage of innocent children in my view.

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New Book Pushes Futile Care Theory

I haven't read the book, but I thought the review in the Journal of the American Medical Association by Michael Bevins, MD, Ph.D., brought up some important points for pondering. In Defiance of Death: Exposing the Real Costs of End-of-Life Care illustrates the growing utilitarian emphasis in medicine and apparently pushes futile care theory as a way of supposedly saving big bucks. From the book review (no link):

Who decides when care is inappropriate is an even more difficult question. The crux of this book's argument is its proposal of a system of "appropriate-care committees" made up of experienced physicians who would review each questionable case on an individual basis. These local, state, and national committees would be organized into a hierarchical structure, with local committees answerable to state committees and so on. Committee members would be paid a stipend,thereby avoiding financial conflicts of interest, and they would have the authority to withhold payment for care deemed inappropriate.
Right. I'd sure trust that system (he said sarcastically)! The idea appears to be to empower faceless bureaucrats to second guess care decisions by deciding after the fact whether hospitals should be paid for services rendered. That would put the economic benefit of doubt into refusing wanted care, not to mention making it a federal policy to impose futile care on unwilling families.

The ironic thing is that futile care theory will not save all that much money. When I was researching Culture of Death, end of life care took up about 10% of the nation's entire health care budget. Most people don't want expensive interventions until the bitter end. Thus, even if medical futility were imposed on all dying patients, the savings would be minimal, a point noted in the review:
Fisher admits it remains an open question whether hospice care actually saves money. While he valiantly tries to defend the claim that shifting from more aggressive, "inappropriate" care to more compassionate, palliative care would save oodles of money, this is a hard assertion to prove. Furthermore, saving money is not the most important reason for making some treatment decisions. In some cases, not doing certain things (eg, intubation, cardiopulmonary resuscitation, chemotherapy, surgery,feeding tubes) in favor of doing other things (eg, aggressive symptom control, spiritual support, bereavement support) is the right choice simply because it is the right thing to do, regardless of the cost.
I totally agree. But the method by which that shift should be accomplished is not the bludgeon of coercion, but education, compassionate counseling, and honest discussion. In the end, if people want their lives maintained, that should be permitted because keeping people alive when that is what they want is the quintessential purpose of medicine.

Moreover, going in the opposite direction poses a great risk to the sanctity and equality of human life, adherence to which is essential to a moral medical system. I once asked a futilitarian (as I call them), what would be withheld from patients next once the principle of withholding wanted treatment was established. He told me "marginally beneficial care." When I asked for an example, he said, "An 80-year-old woman who wants a mammogram."And so we see the terrible potential for medical discrimination masking as benign cost control.

We have to be very careful that in our reasonable desire to control costs and do right by suffering patients, that we don't institute a brutal regimen of medical discrimination in which our consciences are assuaged by self deception and euphemisms.

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Swiss Assisted Suicide Group Investigated for Profiteering

The Swiss Government is investigating the assisted suicide facilitating/tourist host group Dignitas for making money off of helping people make themselves dead. From the story:

Dignitas, which is meant to be a non-profit organisation, is being forced to open its accounts to prosecutors in Switzerland and disclose how much money it is receiving from its controversial business of assisting suicide.
The founder of the group is reported to have become a millionaire by helping at least 870 terminally ill people--an estimated 100 of whom were British--die. It is said to have taken as much as £61,000 from one woman, 10 times its usual fee.

Swiss law allows Dignitas to provide patients with a dose of barbiturate and a room in which their deaths are filmed, to prove they administered the lethal injection. But it remains illegal to help someone die for personal gain.
The money shouldn't be the issue. The killing should. Besides, if assisted suicide is just a medical treatment--which is belied by a lay group providing the "therapy"--shouldn't profit be part of the medical enterprise? Oh, right: This is Switzerland, where plants have individual dignity based on their similar molecular makeup with people, the mentally ill have a right to assisted suicide, and there is a growth industry in suicide tourism.

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Thursday, January 08, 2009

NHS Breakdown: "Communication Breakdown" Results in Down Syndrome Patient Starving to Death

I feel like ripping my hair out! How can something like this happen in a civilized country? Martin Ryan, who could not swallow after a stroke, was allowed to lie in a bed and starve to death over a period of 26 days! And surprise, surprise--he had Down syndrome. From the story:

Mr Ryan, who had Down's syndrome, died in hospital in Kingston-upon-Thames. An internal inquiry by the hospital found that doctors had thought nurses were feeding him through a tube in his nose. By the time they found out this was not happening, he was too weak for an operation to insert a tube into his stomach.

He died in agony five days later. Mr Ryan's distraught family, from Richmond, South-west London, are convinced he could have been saved by the correct treatment.

One relative said of him: 'Martin will always be the light of my life. He had a quirky sense of humour and oodles of charm. He was often smiling--he loved to go out, liked the movement of the coach and listening to the music.
I am sorry, it can't rest with a mere "our bad," kind of analysis! At best, this was criminal neglect, if it was neglect: I don't believe it is a coincidence that Martin had Down syndrome. I mean, how can anyone starve to death over nearly a month in a hospital and it go unnoticed? Questions must be answered. What was done when the "mistake" was discovered to try and help him? And why was he allowed to "die in agony?"

This travesty should be investigated at the highest levels of government until the full truth is known!

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Man's Wife Cheats: He Wants His Kidney Back

This may ibe the biggest case of ingratitude about which I ever heard: Dr. Richard Batista gave his wife Dawnell one of his kidneys--and then, he says, she cheated on him. Now, as part of the divorce he wants compensation for his lost kidney. From the story:

"There's no deeper pain you can ever express than to be betrayed by the person you devoted your life to," he told reporters. "I saved her life but the pain is unbearable."

The vascular surgeon's lawyer Dominic Barbara said his client wanted $1.5 million in compensation for the kidney as part of a bitter matrimonial break-up which has dragged on for three years. "As part of the litigation we are asking for the value of the kidney that he gave his wife," said Mr Barbara. "In theory we are asking for the return of the kidney. Of course, he wouldn't really ask for that, but the value of it. This has never been done before in the State of New York."
I completely understand the poor man's pain, but sorry: A gift is a gift. Legally, once an offered gift is accepted it belongs to the receiver. Besides, compensating him would be to let him, in effect, sell his kidney, which is a big no can do. The judge should commiserate but firmly reject the claim.

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Father Richard John Neuhaus Has Died

Fr. Richard John Neuhaus, who started First Things magazine, has died from the complications of cancer. Like many Martin Luther King liberals, the Left left him, and he became identified as a conservative. From the story:

During the ferment of the 1960s, Neuhaus was identified with progressive causes. Alongside the Jesuit peace activist Fr. Daniel Berrigan and Rabbi Abraham Joshua Heschel, Neuhaus co-founded "Clergy Concerned about Vietnam." Even after his later turn to the right, Neuhaus continued to admire figures such as Berrigan, saying that although he found their activism misplaced, they shared a profound conviction that public life ought to be shaped by Gospel values.

Neuhaus would later recall that the trigger for his break with the left was the 1973 Roe v. Wade decision of the U.S. Supreme Court, legalizing abortion in America. He became an outspoken voice for pro-life causes, helping craft the policy of the Bush administration, for example, on embryonic stem cell research.

I knew Fr. Neuhaus, but it would be an exaggeration to say we were friends. Friendly acquaintances would be more accurate. But he was beloved by those who knew him well. My good friend Jody Bottum, editor of First Things, put it this way in the immediate wake of Fr. Neuhaus's death:
My tears are not for him--for he knew, all his life, that his Redeemer lives, and he has now been gathered by the Lord in whom he trusted.

I weep, rather for all the rest of us. As a priest, as a writer, as a public leader in so many struggles, and as a friend, no one can take his place. The fabric of life has been torn by his death, and it will not be repaired, for those of us who knew him, until that time when everything is mended and all our tears are wiped away.
I admired Neuhaus for his incisive writing style and the way he deconstructed nonsense arguments. He also saw the dark days in which we are entering and as his final illness struck, was preparing to pull more than his weight to strive against the flowing tide. Alas, those of us left behind will now have to pick up that burden, which, given Neuhaus's prodigious intellect, will be a heavy weight indeed. He will be sorely missed.

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Judicial Tyranny in Montana




















When a very controversial ruling comes down from our rulers in black robes, it is customary that pending an appeal to the highest court, the decision be stayed--that is suspended--until the final decision from a higher court is in. But Montana's assisted suicide maven, Judge Dorothy McCarter, refused, dismissing a request for a stay of her ruling declaring a constitutional right to assisted suicide. This means because she believes in assisted suicide--unless and until a higher court intervenes--it is now legal for doctors to assist suicides of the terminally ill in Montana and there are no "protective guidelines." (Come to think of it, that's more honest, isn't it?) From the story:

A judge here on Wednesday dismissed a request to freeze her own decision upholding Montana's right to physician-assisted suicide until the state's Supreme Court rules on the matter.

The decision means that "as of today" Montanans have the right to physician-assisted suicide, said Stephen Hopcraft, a spokesman for Compassion & Choices, a national end-of-life choice group that worked with a now-deceased Billings man who sought to end his life with physician help while battling terminal leukemia.

Helena District Judge Dorothy McCarter ruled in December that the Montana Constitution guarantees both a right to privacy and to human dignity, which includes the right of terminally ill citizens to choose to end their lives with a doctor's help.
I have no idea what will happen now--the former attorney general who opposed the case is now on Montana Supreme Court and has (properly) recused himself.

This I do know: Judges are becoming too arrogant for our good as a nation. Culture-rending changes in law and morality should not be decided undemocratically by promoting a judge's own ideology through wrenching and twisting constitutional terms to mean things that were not intended when they were enacted. This is especially important because of all the branches of government, the judicial has the fewest checks and balances, thus requiring some humility on the part of judges for the system to work.

Let's hope the Supreme Court issues a stay so that this matter can be heard with the gravity and care it deserves.

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Wednesday, January 07, 2009

Coup de Culture Alert: Media Mislead About Effectiveness of Abstinence Pledges

Once again the media are caught with their, if you will excuse the pun, pants down. A study was released a week or so ago that claimed there is no difference in the initial onset of sex between teenagers who took abstinence pledges and other teenagers. Sounds bad for promoting sexual restraint, doesn't it? Not so fast. It turns out that the study actually compared religious conservative teens who took the pledge and religious conservative teens who didn't, where there is indeed little difference. But between teenagers who took the pledge and the average teen--which is sure what I thought the story was about--there is a big difference. From the expose` in the Wall Street Journal, byline William McGurn:

The chain reaction was something out of central casting. A medical journal starts it off by announcing a study comparing teens who take a pledge of virginity until marriage with those who don't. Lo and behold, when they crunch the numbers, they find not much difference between pledgers and nonpledgers: most do not make it to the marriage bed as virgins.

Like a pack of randy 15-year-old boys, the press dives right in. "Virginity Pledges Don't Stop Teen Sex," screams CBS News. "Virginity pledges don't mean much," adds CNN. "Study questions virginity pledges," says the Chicago Tribune. "Premarital Abstinence Pledges Ineffective, Study Finds," heralds the Washington Post. "Virginity Pledges Fail to Trump Teen Lust in Look at Older Data," reports Bloomberg. And on it goes.

In other words, teens will be teens, and moms or dads who believe that concepts such as restraint or morality have any application today are living in a dream world. Typical was the lead for the CBS News story: "Teenagers who take virginity pledges are no less sexually active than other teens, according to a new study."

Here's the rub: It just isn't true.
In fact, Dr. Bernadine Healy, of US News and World Report crunched the numbers and discovered that the average age of initial sexual intercourse for most teens is 17, but the conservative teens--including abstinence pledgers--wait until age 21! That's a huge difference that translates into fewer unwanted pregnancies, fewer abortions, a lower rate of STDs, and less suffering from the acute emotional difficulties that intense early sexual relationships can cause.

Why push the false story? Part of it is that the study's authors seem to have been engaged in the ubiquitous practice of using the scientific study as advocacy. But that doesn't excuse the media--who should be used to such deception by now, and who certainly check stories the import with which they disagree! But when a story fits the media's own narrative, they often merely print off the press release. On a more fundamental level, I think it is part of the coup de culture. Media reflect the views--and indeed, many consider themselves members of--the liberal elite (as are social scientists), and liberal elites loathe moralizing, which I think they see as the real basis of advocacy for teenage abstinence.

Politicized science, a biased media--all part of the coup de culture that seeks to remake our society--and in my view, not for the better.

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How My 2008 Predictions in Bioethics Turned Out

Each year, the Center for Bioethics and Culture asks me to make predictions for the upcoming year about what can be expected in the field of bioethics. I didn't do too badly last year--although when my head told me I-1000 would pass legalizing assisted suicide in WA, and my heart told me (hoped) it wouldn't, I went with my heart. In any event, here is my article for the CBC summing up how I did, beyond the assisted suicide issue. From the newsletter:

I was right that assisted suicide would not be passed legislatively...
I was right that Futile Care Theory would not advance...
I was mostly right about the year in embryonic stem cell and human cloning research:...Here is what I was right about:

-- Research into human iPSCs will advance toward overcoming the need to use viruses in the cell reprogramming...
-- No laws will be passed to permit egg buying for biotechnological research...
-- The Bush ESCR funding restrictions will not be overturned -- There will be no changes in the law about human cloning...

Here is where I was wrong: I predicted that "the first human cloned embryonic stem cell line would be created,"...They tried but the task is apparently very difficult...

I also missed the extent to which human exceptionalism would be undermined : Last year saw the enactment or near-enactment of some of the most radical proposals in history, which I never imagined would come to pass.
1. Spain's Parliament cleared away all procedural impediments to passing the Great Ape Project into law that will create a “community of equals” among human beings, chimpanzees, orangutans, gorillas, and bonobos in that country.
2. Switzerland established the intrinsic dignity of individual plants... 3. Ecuador granted “rights” to “nature” that are coequal with those of human beings.
The import of this trend cannot be overstated. We are being led by radical environmentalists and anti human exceptionalists toward an international public policy that will sacrifice human welfare and prosperity “for the animals," or "to save the planet."

And that's the way it was. Next week, my predictions for 2009. Hint: It isn't pretty.

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Tuesday, January 06, 2009

I Learn About The "Georgia Guidestones"

I gave a speech on Sunday hitting on the threats to human exceptionalism. I brought up my concern about deep ecology's call to reduce humankind to under 1 billion, as well as Spain passing the Great Ape Project, Switzerland's "plant dignity," and Ecuador's granting rights to Nature.

During the Q and A, an audience member asked me what I thought of the Georgia Guide Stones. I had never heard of them, but promised to look it up. Here is what I found. From Wikipedia, I learned that that huge granite monoliths were erected by unknown persons in 1979, written in different languages. The Stones' message pushes one world government, and may involve occultism, issues with which we don't concern ourselves here. Some of it is feel good pabulum. But some of the directives do appear to chillingly call for eugenics and the imposition of a deep ecology that would require mass human extermination--issues with which we are very much involved here at SHS. Here is the Stone's message:

MAINTAIN HUMANITY UNDER 500,000,000 IN PERPETUAL BALANCE WITH NATURE

GUIDE REPRODUCTION WISELY--IMPROVING FITNESS AND DIVERSITY

UNITE HUMANITY WITH A LIVING NEW LANGUAGE

RULE PASSION--FAITH--TRADITION AND ALL THINGS WITH TEMPERED REASON

PROTECT PEOPLE AND NATIONS WITH FAIR LAWS AND JUST COURTS

LET ALL NATIONS RULE INTERNALLY RESOLVING EXTERNAL DISPUTES IN A WORLD COURT

AVOID PETTY LAWS AND USELESS OFFICIALS

BALANCE PERSONAL RIGHTS WITH SOCIAL DUTIES.

PRIZE TRUTH--BEAUTY--LOVE —SEEKING HARMONY WITH THE INFINITE

BE NOT A CANCER ON THE EARTH--LEAVE ROOM FOR NATURE--LEAVE ROOM FOR NATURE
Hmmm. This could be the inspiration for the remake of The Day the Earth Stood Still.

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Haleigh Poutre Abuser Jailed




















Haleigh Poutre, the little girl almost dehydrated to death by the State of Massachusetts because she had a severe brain injury, has lived to see her step-father/abuser, Jason Strickland, jailed for twelve-fifteen years. From the story:

A judge sentenced the stepfather of Haleigh Poutre yesterday to 12 to 15 years in state prison for participating in a horrific pattern of child abuse, saying he had deprived Poutre of the "most precious gift" of a normal childhood...

The sentencing of Jason Strickland was handed down three years after the case drew national attention when the state prematurely sought to remove Poutre's life support after she fell into a coma from a near-fatal head injury in September 2005. A few months later, just when the state won court approval to end her life, saying her condition was "hopeless," the 11-year-old girl became alert, breathing on her own and responding to commands.

And therein lies a terrible irony: Had MA finished Haleigh off--which is what the state would, in effect, have been doing by removing her feeding tube--Strickland might have been punished for murder while the state's action, taken to cause her death, would have been merely described as a sad but necessary example of medical ethics. Such are the times in which we live.

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NHS Meltdown: Deaths Caused by Hospital Mistakes in UK Up 60%

I ran this cartoon yesterday in an edition of SHS Funnies. But it is apt here, and not in a humorous vein. Tragically, it isn't healthy to go to the hospital under the NHS. In the last two years--think about how short a time that is--hospital-caused deaths are up a whopping 60%. From the story:

NHS records show that 3,645 people died as a result of "patient safety incidents"--including botched operations and the outbreak of infections - between April 2007 and March 2008. The figure was 1,370 higher than two years earlier. Patient groups have warned that the true toll is likely to be higher because some hospitals do not record all incidents.
We have the problem here too, of course. But such a soaring rate in such a very short period of time, reflects deep problems within the NHS.

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Don't Buy Stock in Denture-Making Companies: Adult Stem Cells Grow New Teeth

Wisdom teeth are a rich source of stem cells, and apparently they can be used to grow teeth on demand. From the story:

As long as there are hockey players, there will be niche markets for false teeth. But the real news about the future of dentures is that there isn't much of one.

Toothlessness has declined 60 percent in the United States since 1960. Baby boomers will be the first generation in human history typically to go to their graves with most of their teeth.

And now comes tooth regeneration: growing teeth in adults, on demand, to replace missing ones. Soon. It turns out wisdom teeth are prolific sources of adult stem cells needed to grow new teeth for you. From scratch. In your adult life, as you need them. In the near future. According to the National Institutes of Health.
If this pans out, denture-making companies may go the way of the buggy whip industry.

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Embryonic Stem Cell Cancer Issue Remains Unresolved

Scientists have been working on this for nearly a decade now on making ES cells capable of being used directly in therapies. They have been stymied by three primary problems; the potential for tissue rejection (which we will not get into in this post), the cells' propensity to form tumors called teratomas, and the problem of some ES cells appearing to be pre cancerous, making them very risky to inject into a living patient. With regard to the latter issue, it turns out that the healthiest appearing ES cells may be the most dangerous. From a blog entry over at Nature:

Are ruddy cheeks a sign of health or a symptom of sickness? New work from Mickie Bhatia and colleagues at McMaster University suggests that, when it comes to embryonic stem cells, the very qualities researchers use to pick out a robust cell line may in fact be bestowed by precancerous transformations. "Current measurements are not capable of distinguishing the difference between great stem cells and cancer stem cells in vitro," says Bhatia.
The problem, apparently, is that abnormalities are submicroscopic and can't be determined before they transform into specific body tissues (differentiation). This could mean that the potential cancer threat--which is in addition to the teratoma tumor issue--may be very hard to solve:
"This paper shows that human ES lines with submicroscopic genetic abnormalities can display altered growth and differentiation properties suggestive of premalignant change," says Martin Pera who studies embryonic stem cells at the University of Southern California in Los Angeles. "In other words, a normal karyotype is not necessarily a guarantee of a normal genetic makeup within a cell line."...One of the "major challenges to the field" is developing techniques that can detect rare, abnormal cells, particularly if the transformations are not due to changes in gene sequence.

Also important, he says, is figuring out just how and when such cells might be dangerous. "Ultimately it may be difficult or impossible to rule out with certainty that a given culture is totally free of abnormal cells."
If that is true, these cells may never be able to meet the potential scientists held out for therapies (which is to be distinguished from bench science use).

Note, this has nothing to do with the Bush policy or using older stem cell lines. It may be a consequence taking these cells out of their sphere of natural development in the living embryo.

What of the alternatives to ESCR? So far, IPSCs also have a teratoma problem--which is one of the signs of pluripotency--and a potential cancer problem caused by using viruses to affect the changes, although the virus issue appears well on its way to being solved. Umbilical cord blood stem cells can be tissue typed more readily than bone marrow and so far as I have seen, have no tumor issues. Adult stem cells do not exhibit tissue rejection (since they are the patient's own cells), tumor formation, or cancer, and are in many early human trials for a variety of ailments, as we have often discussed here.

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Monday, January 05, 2009

SHS Funnies

Just another day at the NHS.


Is Everything a Cause for "the Experts" to Worry?

So, a study shows that girls play less energetically than boys. Big whup and, as they say, vive la difference. But some find even this innocuous information a cause for hand wringing. From the story:

Girls tend to play less energetically than boys, because they are more interested in chatting, a new study shows. Researchers found the girls spent six per cent less time in vigorous physical activity than the boys Even at the age of 10, girls are more likely to stand around gossiping than playing games or sports like their male classmates, the research found.
And here's the kicker:
Researchers warn that the trends last a lifetime and could lead to obesity.
Please. But, don't worry "experts:" the men catch up by drinking more beer. And I am sure you are all worried about that, too.

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International Endocrine Society: Block Puberty in Kids with Gender Questions














Things continue to go from the strange, to the surreal. The International Endocrine Society is advocating that drugs be given to children with gender identity questions to block puberty, which is already done in some places. From the story:

Transsexual children as young as 12 should be given drugs to postpone puberty and make it easier for them to change sex at the age of 16 if they still want to. That's the suggestion of controversial draft guidelines, the first of their kind, issued last week by the international Endocrine Society.

The guidelines state that transsexual children and young teens who have begun early puberty should be given puberty-blockers to avoid inevitable changes to their bodies, which they perceive as out of line with their true gender. In the worst cases, these changes can drive children to self-harm or even suicide. The idea is to buy thinking time for young people so they can decide if they want to begin a sex change using hormones when they are older...However, surgery should be avoided until the age of 18, the guidelines state.

Let me get this straight. We are going to interfere with a child's biology due to a his or her severe emotional confusion--the seriousness of which I am not denigrating--and basically use medicine to transform a healthy body into one that doctors would treat as an illness if it occurred naturally? Doesn't that about sum it up?

This is getting into very deep and turbulent waters:
But doctors opposed to early treatment say that young people may not fully understand the full consequences of their actions. For example, blocking puberty in boys who later go on to have hormone treatment and surgery that turns them into a woman means that they will never produce mature sperm...Russell Viner of the Institute of Child Health in London cites the case of a transsexual man who had both surgery and hormones to become a man, but still wanted to become pregnant. "That may not have been possible if they'd had early intervention," he says. "When is it reasonable to let a young person remove major life choices?"
Remember the "man" who gave birth that Oprah cooed over?

More to the point, what have we come to when doctors urge that natural and normal physical development be blocked? (Remember "Ashley's Treatment?") Do we know what the impact of such heavy hormonal interference will be on the health of these young people both long and short term? Do we know what psychological impact it will have? If not, doesn't this border on unethical human experimentation? This is how we are twisting ourselves into pretzels from a mindset that cares almost entirely about subjective internal states.

In this regard, an editorial in the New Scientist about this story made some good points:

...some 80 per cent of boys who experience transsexual feelings no longer feel this way when they grow up. There is some evidence that those who persist after the first flush of puberty are less likely to change their minds, but this has been based on a handful of cases. So too has our understanding of the side effects of delaying puberty--or in the case of those who go through with gender reassignment, preventing natural puberty from occurring at all.

The issue becomes thornier still when you consider that the age of puberty is falling. Does, say, a 9-year-old have the emotional maturity to make a decision of this magnitude? Unlikely. Intervention to delay puberty could even be complicated by a broader issue: the possibility that the sexualisation of children at ever-younger ages is raising the numbers with temporary transsexual feelings.
If we are going to let doctors intentionally create unhealthy biological abnormalities in patients, where will it stop? When Body Identity Integrity Disorder sufferers point to things such as this and sexual reassignment surgeries, do they not have a point when they say, "If a child's normal biological development can be arrested in preparation for removing his or genitals, why can't I, as an adult, have my right arm amputated?".

Step-by-step and inch-by-inch we get closer to harming people in the name of helping them.

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Sunday, January 04, 2009

Fear Mongering For Assisted Suicide in Scotland

Assisted suicide is not really about a "safety valve" against intractable suffering--that is just an assertion intended to soften the political ground, a cynical tactic intended to panic the public into supporting killing as an acceptable answer to human suffering. Scotland is the latest target of the international euthanasia movement, and true to form, the fear mongering is well under way. From the story:

A DETERMINED group of pensioners have taken their right-to-die fight to the Scottish Parliament. Militant Retired have lodged a petition at Holyrood calling for a referendum on assisted death. The group's founder George Anderson said: "If I got to a stage where I was very ill, I would want the right to die to end my suffering. It's all about having a dignified death, rather than seeing people forced to exile themselves in Europe for treatment."
By "treatment," he means assisted suicide. Reminds me of the euphemistic term "healing treatment" used by German eugenicists for the infanticide/euthanasia holocaust that took place there between 1939-1945.

But I digress. Here's the fear mongering:
And it was his experiences of caring for terminally ill patients that led to his decision to fight for choice over assisted death. "I cared for the terminally ill, both young and old, and was left feeling there must be a better way of facing our last days. People die dreadful deaths in hospital, hooked up to machines. At times, it's about changing nappies and keeping their heart beating. And for what?"
What a cruel thing to say. People do not have to be "hooked up." It's as if hospice doesn't exist. And what a message that incontinence makes one's life somehow less worth protecting. Awful. Just awful.

Do you think the reporter would at least bother to call hospice or someone with a different perspective that might present at least a counter balancing view and help people know that dying doesn't make one undignified? Apparently that's too much work. Or, perhaps it is really that there is only one side the media care to hear from any more, and it is the one--as in this story--that pushes the culture of death.

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Saturday, January 03, 2009

What is Your Prediction for 2009?

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Friday, January 02, 2009

An Ironic Illustration of how "Nature Rights" Could Bring Human Thriving to a Screeching Halt

Well, this is rich: The President of Ecuador is one of the first to be on the receiving end of the ridiculous granting of "rights" to nature that he put in Ecuador's new constitution. It seems Correa wants to open up some of the country to mining, which would increase the prosperity of the population. No can do!, say opponents. That would violate the rights of nature. From the story:

[Ecuador President] Correa insists that responsible mining is necessary for Ecuador's development....But Dr. Byron Real López, an expert in environmental law, wrote in a recent report that the Mandate "is concerned with solving important issues...such as the corruption surrounding the indiscriminate granting of concessions. But the proposed law ignores the ecological and social conflicts that mining activity causes...and thus would tend to aggravate them." López argues that the proposed law would violate a number of provisions in the new constitution, such as those protecting the rights of nature and indigenous communities.

I have no idea whether the mining plan is good or bad. But, it should be judged by determining what is best for the people of Ecuador, which includes analyzing the hoped for benefits of the harvest, while also keeping in mind our duty to conserve and protect the environment, both because there is intrinsic value in that, and for the benefit of posterity.

What did Correa expect from this hair brained scheme? Granting rights to nature puts flora, fauna, and perhaps even minerals, on an equal footing with people, giving the no growthers just what they need to stymie prosperity and human flourishing, because, thanks to the new constitution, natural resources are now people too.

We can now see how nature rights, if the concept spreads, would bring most productive human activities to a screeching halt as the earth firsters would have constitutions on their side. What a stupid idea, but one fully in keeping with the cultural currents pushing us toward human unexceptionalism.

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Dawkins Yearning for Human/Chimp Hybrid Again

I am not sure why some materialists are so fervently anti human exceptionalism. I suspect they believe that by humbling us into believing our lives are no more important than that of animals, it would undermine Judeo/Christiam moral philosophy in general and theism in particular. Some too, I think, wish to have us sacrifice ourselves to "save the planet," in pursuit of the neo- nature worship that seems to be growing.

This desire leads some materialists to yearn for scientists to find (or create) a human/chimpanzee hybrid that could interbreed with both species, and thereby "break the species" barrier. James Hughes yearned for such a hybrid to be manufactured through genetic engineering in Citizen Cyborg, because he wrote, it would prove humans are not special and undermine what he calls "human racism." Similarly, the crusading atheist and biologist, Richard Dawkins has repeatedly expressed the same desire, for example in supporting the Great Ape Project in an essay in the book of the same name in 1993. (The illustration on the left at the top of this post is a depiction of what such an animal might look from Dawkins' essay.)

Dawkins is at it again at The Edge, answering the question, "What will change everything," he answered, "Breaking the Species Barrier." He writes:

Our ethics and our politics assume, largely without question or serious discussion, that the division between human and 'animal' is absolute. 'Pro-life', to take just one example, is a potent political badge, associated with a gamut of ethical issues such as opposition to abortion and euthanasia. What it really means is pro-human-life. Abortion clinic bombers are not known for their veganism, nor do Roman Catholics show any particular reluctance to have their suffering pets 'put to sleep'. In the minds of many confused people, a single-celled human zygote, which has no nerves and cannot suffer, is infinitely sacred, simply because it is 'human'. No other cells enjoy this exalted status.

But such 'essentialism' is deeply un-evolutionary. If there were a heaven in which all the animals who ever lived could frolic, we would find an interbreeding continuum between every species and every other. For example I could interbreed with a female who could interbreed with a male who could . . . fill in a few gaps, probably not very many in this case . . . who could interbreed with a chimpanzee. We could construct longer, but still unbroken chains of interbreeding individuals to connect a human with a warthog, a kangaroo, a catfish. This is not a matter of speculative conjecture; it necessarily follows from the fact of evolution.
To which I respond, so what? How would that change the moral value of humans vis a vis that of catfish and kangaroos? Besides, the contrary is true: Supporting human exceptionalism could fit within the neo evolutionary paradigm since caring exclusively for one's own species is almost universal within the natural world, and certainly caring for one's own species the most is. Why should we be held to a different standard? The only reason would be because we are exceptional, which also explains why our lives have greater value than animals that our genetic ancestors might once have been able to interbreed with--although even Dawkins would admit that hasn't been true since the emergence of modern man 100-000-1 million years ago.

Dawkins also claims that that the question of why we should be considered separate and apart from the rest of the fauna goes unasked. What world is he living in? Anti-human exceptionalism views are all the rage among the intelligentsia of a certain philosophical persuasion, which is part of what is leading us toward a culture of death. And then there is the popular culture that is moving swiftly in the same direction-think the horrible remake of The Day the Earth Stood Still.

If the species barrier is ever broken, Dawkins says he will experience "a frisson of enjoyment," a fancy way of saying he would experience the same thrill talk show host Chris Matthews reported ran up his leg while listening to President Elect Obama speak. I have to admit that if the Dawkins of the world are successful in destroying society's belief in human exceptionalism, it would send a thrill up my leg too. But unlike his frisson, mine would be of cold fear based on my sure knowledge that doing so would result in the undermining of universal human equality and on the concomitant universal rights that flow, as the UN Charter states, simply from being human.

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Thursday, January 01, 2009

More Thoughts on Conscience Clauses as Way to Protect Dissenting Health Care Professionals

I have written before--and no doubt will again--that the death culture brooks no dissent. I haven't gotten my mind totally around why this is yet, but I have developed some theories. I think issues such as assisted suicide are part of a (partially unconscious) but clearly unfolding coup de culture. Part of it too, perhaps, is that culture of death adherents are hypersensitive to the charge of supporting moral wrongdoing, and hence want all of us to be complicit in the system--a big reason in my view why the science community had a conniption over the Bush embryonic stem cell policy. Add in that many believe individuals will not be truly free to control their own lives unless virtually all impediments to abortion--and perhaps one day, assisted suicide, and other policies--are removed, and we can begin to see why refusenik medical professionals might be targeted for excommunication from their careers.

Some see conscience clauses as an answer to protect dissenting health professionals in a society that no longer agrees on fundamental issues of morality. I agree, although I don't think the privilege should be absolute. The issue is just coming to the fore of my thinking and I have begun to reflect on it here at SHS. A few days ago, I posted some thoughts on the matter over at the First Things blog. From my FT blog entry:

How ironic that physicians and others who simply wish to adhere to the precepts of the Hippocratic Oath are declared persona non grata in medicine.

Be that as it may, those who believe in protecting medical conscience rights need to begin preparing the intellectual ground to protect dissenting professionals' careers without also opening the door to conscience being used as a club to deny wanted life-sustaining treatments such as feeding tubes by physicians who consider it wrong to maintain patients with a "low quality of life"--a proposal already gaining stream in bioethics known as "medical futility."

To keep from so throwing out the baby with the bathwater, I suggest that we consider at least two crucial distinctions in determining what would be a protected refusal to provide a requested medical intervention; first, between elective and non-elective procedures, and second between treatments and patients. Thus, doctors should be permitted to refuse elective procedures--that is, interventions not immediately necessary to save the patient's life or prevent serious physical harm--if their conscience so dictates, whether it be rhinoplasty, abortion, or assisted suicide. To prevent care refusals from being a mere cover for discriminatory attitudes, the requested procedure should generally be what violates the conscience, not bias against the patient. In this way, for example, an oncologist should not be able to refuse to treat a lung-cancer patient because the patient smoked or was a member of a racial minority.

No doubt there will be nuances within nuances here, so there will be much to consider. But with the rights of conscience likely to be an explosive bioethical controversy in the coming decade, the time to begin planning for the struggle is now.
Other cultural conflicts beyond issues we generally deal with here at SHS have already become part of the conscience issue; such as the recent California Supreme Court ruling permitting a lesbian couple to sue a doctor who refused to artificially inseminate one of the partners due to a religious objection--even though the refusing doctor found another physician willing to perform the treatment for the patient, who was subsequently impregnated.

So there will be much with which to grapple. Not fun, but necessary. At stake--literally--will be whether people of certain religious and moral beliefs will be able to enter and/or remain in the health care field, and whether religiously based hospitals and other institutions will be able to keep their doors open.

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