Assisted suicide considered in Pennsylvania

Pennsylvania may soon become the third state in the U.S. to allow assisted suicide.

The Death with Dignity Act is based on the Oregon law that allows physicians to prescribe lethal amounts of medication to the terminally ill at the patient's request.

"Most people do not choose to end their lives," said Dr. Arthur Caplan, the director of the department of medical ethics at the University of Pennsylvania. "Most just like having the fallback to choose to do it."

According to Oregon's annual report on the Death with Dignity Act, the average age of a person who has died under the law is 72. Among those who have died, 80 percent had cancer and 97 percent died in their homes.

Challengers of the bill argue the legislation undermines the healing and life-preserving functions of the medical system. Caplan, who did not say whether he supports the bill, said many opponents feel it'll be a "slippery slope" if the bill is passed and fear the law will be wrongly used against mentally ill or disabled persons.

Earlier this month, Washington became the second state to allow assisted suicide after voters in November approved the move. Washington's law is also based on Oregon's, which has had an assisted suicide law for more than a decade.

Under the (Pennsylvania) bill's guidelines, those who seek to end their lives would have to be diagnosed with a fatal disease that leaves them six months or less to live. Patients have to be conscious, at least 18 years of age and of sound mind to put in a request.

Doctors are also required to inform patients of alternatives to suicide, including hospice care and a variety of pain medications.

For the patient to be prescribed the lethal medications, they would have to file a verbal and written request and then be evaluated by doctors and psychologists who are unrelated to that patient's health care providers.

The suicide option would only be available for in-state residents to prevent terminally ill from collecting in the state of Pennsylvania.

A report last year found that while few people in Oregon actually chose assisted suicide, many more consider it and discussed the possibility with doctors and family members. Many also reported taking comfort from the knowledge that the option was there, even if it isn't used.

This is the second time Democratic Senator Daylin Leach has tried to get such a bill passed.

Singapore decides to pay for organ donations

After about five months of debate, Singapore has decided to allow organ donors to be paid for their troubles.

“This is a bill about fairness, being fair to donors who do suffer financial consequences as a result of their act of donation,” Health Minister Khaw Boon Wan told parliament Tuesday during the final debate on the issue.

“I know the controversial nature of paying donors,” Khaw Singapore said.

“But we also realize that it is unfair to allow genuine donors to bear all the financial consequences of their altruistic acts.”

The new law allows living organ donors to be reimbursed the costs for travel, accommodation, costs of domestic care and child care, loss of income and long-term medical care.

The controversial bill passed last week.

Legislator Christopher de Souza objected the new law, saying "the framework in the bill could be the subject of abuse."

Another dissenter, Halimah Yacob, said that many foreign workers in Singapore, who are hit hard by the recession, could become "a ready and vulnerable pool of organ donors to be exploited and abused."

"To a desperate foreign worker, even a reimbursement of S$10,000 would be attractive compared to going home empty-handed with a huge debt waiting for him," the report quoted her as saying.

The Singapore government proposed to change the law after ailing retail magnate Tang Wee Sung was jailed for a day and fined S$17,000 in June last year for trying to buy a kidney from an Indonesian donor.

Tang finally received a kidney from former organized crime boss Tan Chor Jin, who was hanged in a Singapore prison in December for the killing of a nightclub owner.

The case prompted the government to amend the law to allow living organ donators to get monetary compensation.

Khaw said hospital panels set up to assess the fitness of the donors and review payments made to them will ensure that there are no financial inducements involved in people giving up a kidney, just reimbursement of the costs involved.

Now on Twitter

I'm just back from almost three weeks off, and have just set up a Twitter account, which you can follow to get regular updates on the things I am blogging about.

I also plan to use Twitter as a way to get debates going on various medical ethics topics -- such as one I will be blogging about in a few minutes: organ sales. It seems that Singapore has gone ahead with plans to legalize payments to people who "donate" organs, such as a kidney.

What do you think?

GlaxoSmithKlein plan for developing countries backfires

A recent announcement by drug giant GlaxoSmithKlein to spend 20 per cent of its profits from developing country sales on building the health care infrastructure of those same countries, and to sell patented drugs there at a quarter of their market price, sounded quite generous.

At least on the surface.

The plan, however, has not held up to the scrutiny of some of those analyzing it, including The Global Bioethics Blog, which focuses on biotech research in developing countries.

These promises may make GSK look saintly, but the impression largely fades on reflection. 20% of GSK's profits in developing countries does not amount to much. ...

Gestures of philanthropy towards the world's poorer nations, on the part of aggressively profit- seeking pharmaceutical companies, is to be taken with a grain of salt at the best of times. In a down economy, when pharmaceutical companies are merging for their own survival, full-blown skepticism is in order.

The blog cites an editorial in the respected medical journal, The Lancet, and an analysis of the Glaxo plan by the Policy Innovations think tank -- which both point out that because the company makes so little money in poor developing countries (where few can afford its products), 20 per cent of its developing country profits is very little indeed.

... an editorial in the Lancet calculates it as less than 0.1% of GSK's total profits, and the folks at Policy Innovations see this as boiling down to about $50,000 per country, hardly a generous investment in local health infrastructure. Selling patented medicines at a quarter of the usual (bloated) price may not be of much help either to those who live on a few dollars per day. And while giving access to patents sounds nice, the road from possession of patent information to research to marketing is a long and winding road paved by a great deal of money. Who has that kind of money? The big pharmaceutical companies, like GSK. But they won't really invest to create drugs for conditions affecting developing countries because the profit margin would be meagre. We come full circle.

Not everyone, of course, questioning the company's move. New Scientist welcomed it, noting that it at least will spark a debate about how much Big Pharma should do to help people in developing countries.

Oxfam spokesman Rohit Malpani urged other companies to emulate GSK, but would like to see the company free up its anti-HIV medication patents as well. Richard Barker of the Association of the British Pharmaceutical Industry says GSK's stance will spark a debate about "how much further industry can and should go" in promoting global health.

 

Obama to move on stem cells today

US President Barack Obama is expected to make official today his long-held promise to reverse his predecessor's ban on embryonic stem cell research.

More than that, according to the Washington Post, he will use the executive order he signs today to shield research in the US from politics.

"The president believes that it's particularly important to sign this memorandum so that we can put science and technology back at the heart of pursuing a broad range of national goals," Melody C. Barnes, director of Obama's Domestic Policy Council, told reporters during a telephone briefing yesterday.

Although officials would not go into details, the memorandum will order the Office of Science and Technology Policy to "assure a number of effective standards and practices that will help our society feel that we have the highest-quality individuals carrying out scientific jobs and that information is shared with the public," said Harold Varmus, who co-chairs Obama's Council of Advisors on Science and Technology.

A decision by George Bush to ban federal funding for embryonic stem cell research was heavily criticized within the scientific community, and hurt the US's competitiveness in the field. The researchers have been waiting, sometimes impatiently, for Obama to make this move.

Not all, however, are happy. Catholic League president Bill Donohue told Catholic Online that Bush's ban was leading to alternatives to using embryonic stem cells.

 “When President Bush placed restrictions on embryonic stem cell research, there was no way for scientists to approximate the effectiveness inherent in embryonic stem cells. But that is no longer the case.

"Last fall, Harvard University stem cell researcher Konrad Hochedlinger announced that he was able to coax adult cells to regress into an embryonic state. Scientists everywhere were ecstatic. “It is precisely because there are ethical alternatives to killing embryos that President Obama’s decision is doubly flawed: (a) it is immoral to intentionally destroy nascent human life, and (b) it is even more irresponsible to do so when morally acceptable alternatives exist."

Scientists have long said that embryonic stem cells are best.

Stem cell breakthrough

There's news of a scientific breakthough tonight that could help avoid the ethical and religious objections to stem cell research.

Toronto scientists have scored a major coup in stem cell research, coming first in a world-wide race to find a safer way to make human skin cells act like embryonic stem cells. The discovery could well bring the promise of personalized organ repair within reach of patients.

Andras Nagy, and his team of scientists at Mount Sinai Hospital, are the first to re-program adult human cells into embryonic-like stem cells without using potentially dangerous viruses that could cause cancer.

... Embryonic stem cells are known as the body’s master cells and can turn into any type of tissue or blood cell. Scientists want to harness that power for regenerative medicine, but groups opposed to the research say human embryos should not be destroyed to advance scientific study. Both scientists and opponents see re-programmed cells as a way to get around that controversy.

The breakthrough is already being classified by some as the discovery of an "ethical stem cell" that will overcome the objections of pro-life groups to stem cells.

Josephine Quintavalle from the lobby group Comment on Reproductive Ethics, which opposes embryonic stem cell research, said: "What we've got here is something that will bring joy to the pro-life movement, a way of obtaining embryonic-type stem cells without having to destroy human embryos.

 "There are some scientists who like to hold on to what they've got, but I don't think people are going to waste time on embryonic stem cells any more. Half of Europe is opposed to embryonic stem cell research. Ideally you want something that everybody can use without any problems. This is definitely a very, very promising way forward and a very promising solution to the embryonic stem cell battle."