The ethics of birth and death

A couple of interesting stories in the Toronto Star this morning, looking at two medical ethics issues. I was out of town, so didn't write either.

The first looked at when a woman is too old to have a baby, sparked by the death of Maria del Carmen Bousada, who gave birth to twins in December 2006 at age 66.

When it comes to motherhood, how old is too old?

Fertility experts and ethicists re-examined that question yesterday after hearing that a 69-year-old Spanish mother died Saturday, leaving behind 2-year-old twins conceived with a younger woman's eggs and donated sperm.

Maria del Carmen Bousada is believed to have been the world's oldest new mother. She gave birth in December 2006, shortly before her 67th birthday, after telling a clinic in Los Angeles she was 55, the facility's maximum age for single women receiving in-vitro fertilization.

The story goes on to outline the medical reasons for most in-vitro clinics to refuse the treatment to older patients -- the children have more health problrms -- and concluded with Margaret Somerville of McGill questioning whether medical science should be used to do things that are impossible in nature, rather than just stepping in when nature fails.

The other story looked at the other end of the spectrum. Pegged to the assisted suicide death of British conductor Edward Downes and his wife, Joan, at a Swiss clinic it asked whether more countries, including Canada, should allow assisted suicide.

"Whenever it's in the news, we know this comes up again and again," said Olga Krassioukova-Enns, executive director of the Winnipeg-based Canadian Centre for Disability Issues. "This issue, this question, affects people with disabilities and seniors and anyone part of a family."

In May, Bloc Québécois MP Francine Lalonde of Montreal reintroduced a private members' bill to amend the Criminal Code to allow assisted suicide. A similar one she introduced in 2005 failed.

A number of high-profile cases in Quebec recently drove her to try to get the bill passed again.

"We need to have this in order to allow people to make their own choice under certain conditions when the time is right for them to die," said Lalonde yesterday.

Last year, a Quebec man was acquitted after he was charged with helping his disabled uncle commit suicide. A Vancouver man was charged in May with giving his friend a loaded shotgun and a demonstration on how to use the weapon to commit suicide.

Alex Schadenberg, founder of Euthanasia Prevention Coalition, said Canadians want better end-of-life care. The mindset that older people and those with disabilities don't want to live as long as possible is a misconception, he said.

Making academic fraud a crime, have your say

A story in the online version of The Scientist is sparking calls from readers that academic fraud be criminalized, with the journal now polling readers.

The original story documentedsome $23 million (US) in grants handed out to researchers at the University of Alabama at Birmingham who lied about their methodology and falsified data in at least 16 journal articles. The story is based on records from the US Department of Health's Office of Research Integrity.

The scientists, Judith Thomas and Juan Contreras, formerly at the University of Alabama at Birmingham (UAB), falsely reported that they performed double kidney removals on several rhesus macaques in experiments designed to test the effectiveness of two immune suppressing drugs -- Immunotoxin FN18-CRM9 and 15-deoxyspergualin (15-DSG) -- in preventing rejection of the a single transplanted kidney.

The experimental protocol was to remove one intrinsic kidney, replacing it with a transplant and starting the monkeys on immunosuppresants, and then remove the other intrinsic kidney a month later, according to Richard Marchase, UAB's vice president of research. "What occurred in a good number of these animals was that [Contreras and Thomas] never performed the second surgery," Marchase told The Scientist. In a statement emailed to The Scientist Marchase called the misconduct "a very serious offense."

Thomas's and Contreras's research was funded with more than $23 million in grants from the National Institutes of Health. UAB officials learned that Contreras and Thomas had left one native kidney intact in at least 32 animals -- which allowed those animals to live and inflated the apparent effectiveness of the drugs -- on January 27, 2006, when Thomas reported that she found an experimental monkey with one of its native kidneys intact and blamed Contreras for the mistake.

The scale of the fraud and the implications of the falsified results -- patients could have ended up getting dangerously wrong treatment -- led to readers of the original story going onto the Scientist web site to call for criminal fraud charges to be laid, prompting the journal to poll readers for their thoughts.

Feel free to join in.

 

Pope gives Obama a bioethics lesson

US President Barack Obama met the Pope today at the end of an economic summit of the world's top industrialized nations, and he was given some instruction from the top on the Catholic Church's position on bioethical issues.

In addition to giving Obama a copy of his latest encyclical, which the pope had been presenting to visiting heads of state since its release July 7, the pope also presented a copy of the Vatican document on biomedical ethics, "Dignitas Personae" ("The Dignity of a Person").

When presenting the gifts after their 35-minute closed-door meeting, the pope gave Obama a signed, white leather-bound copy of the encyclical, "Caritas in Veritate" ("Charity in Truth"), then indicated the light-green soft-cover instruction on bioethics issued last December by the Vatican Congregation for the Doctrine of the Faith.

"Oh, what we discussed earlier," said Obama, referring to their closed-door discussions. "I will have some reading to do on the plane."

Obama was given the instruction to help him better understand the church's position on bioethics, Msgr. Georg Ganswein, papal secretary, told journalists in the pool covering the visit.

The Caritas in Veritate released Tuesday called for more ethics in economics and rules to reign in free market excesses.

The Dignitas Personae, released in December, was a sweeping update of the Vatican's bioethics code barring Catholics from using IVF, participating in medical research involving cloning or embryonic stem cells, banning surrogate mothers, the morning-after pill and the testing of embryos for defects. Hormone therapy, adult stem cell and sterility research are okay.

Obama's stance on abortion and embryonic stem cell research has not been popular with many devote Catholics, though more liberal Catholics rallied behind him in last fall's election.

US President Barack Obama met the Pope today at the end of an economic summit of the world's top industrialized nations, and he was given some instruction from the top on the Catholic Church's position on bioethical issues.

In addition to giving Obama a copy of his latest encyclical, which the pope had been presenting to visiting heads of state since its release July 7, the pope also presented a copy of the Vatican document on biomedical ethics, "Dignitas Personae" ("The Dignity of a Person").

When presenting the gifts after their 35-minute closed-door meeting, the pope gave Obama a signed, white leather-bound copy of the encyclical, "Caritas in Veritate" ("Charity in Truth"), then indicated the light-green soft-cover instruction on bioethics issued last December by the Vatican Congregation for the Doctrine of the Faith.

"Oh, what we discussed earlier," said Obama, referring to their closed-door discussions. "I will have some reading to do on the plane."

Obama was given the instruction to help him better understand the church's position on bioethics, Msgr. Georg Ganswein, papal secretary, told journalists in the pool covering the visit.

The Caritas in Veritate released Tuesday called for more ethics in economics and rules to reign in free market excesses.

The Dignitas Personae, released in December, was a sweeping update of the Vatican's bioethics code barring Catholics from using IVF, participating in medical research involving cloning or embryonic stem cells, banning surrogate mothers, the morning-after pill and the testing of embryos for defects. Hormone therapy, adult stem cell and sterility research are okay.

Obama's stance on abortion and embryonic stem cell research has not been popular with many devote Catholics, though more liberal Catholics rallied behind him in last fall's election.

Pope gives Obama a bioethics lesson

US President Barack Obama met the Pope today at the end of an economic summit of the world's top industrialized nations, and he was given some instruction from the top on the Catholic Church's position on bioethical issues.

In addition to giving Obama a copy of his latest encyclical, which the pope had been presenting to visiting heads of state since its release July 7, the pope also presented a copy of the Vatican document on biomedical ethics, "Dignitas Personae" ("The Dignity of a Person").

When presenting the gifts after their 35-minute closed-door meeting, the pope gave Obama a signed, white leather-bound copy of the encyclical, "Caritas in Veritate" ("Charity in Truth"), then indicated the light-green soft-cover instruction on bioethics issued last December by the Vatican Congregation for the Doctrine of the Faith.

"Oh, what we discussed earlier," said Obama, referring to their closed-door discussions. "I will have some reading to do on the plane."

Obama was given the instruction to help him better understand the church's position on bioethics, Msgr. Georg Ganswein, papal secretary, told journalists in the pool covering the visit.

The Caritas in Veritate released Tuesday called for more ethics in economics and rules to reign in free market excesses.

The Dignitas Personae, released in December, was a sweeping update of the Vatican's bioethics code barring Catholics from using IVF, participating in medical research involving cloning or embryonic stem cells, banning surrogate mothers, the morning-after pill and the testing of embryos for defects. Hormone therapy, adult stem cell and sterility research are okay.

Obama's stance on abortion and embryonic stem cell research has not been popular with many devote Catholics, though more liberal Catholics rallied behind him in last fall's election.

US President Barack Obama met the Pope today at the end of an economic summit of the world's top industrialized nations, and he was given some instruction from the top on the Catholic Church's position on bioethical issues.

In addition to giving Obama a copy of his latest encyclical, which the pope had been presenting to visiting heads of state since its release July 7, the pope also presented a copy of the Vatican document on biomedical ethics, "Dignitas Personae" ("The Dignity of a Person").

When presenting the gifts after their 35-minute closed-door meeting, the pope gave Obama a signed, white leather-bound copy of the encyclical, "Caritas in Veritate" ("Charity in Truth"), then indicated the light-green soft-cover instruction on bioethics issued last December by the Vatican Congregation for the Doctrine of the Faith.

"Oh, what we discussed earlier," said Obama, referring to their closed-door discussions. "I will have some reading to do on the plane."

Obama was given the instruction to help him better understand the church's position on bioethics, Msgr. Georg Ganswein, papal secretary, told journalists in the pool covering the visit.

The Caritas in Veritate released Tuesday called for more ethics in economics and rules to reign in free market excesses.

The Dignitas Personae, released in December, was a sweeping update of the Vatican's bioethics code barring Catholics from using IVF, participating in medical research involving cloning or embryonic stem cells, banning surrogate mothers, the morning-after pill and the testing of embryos for defects. Hormone therapy, adult stem cell and sterility research are okay.

Obama's stance on abortion and embryonic stem cell research has not been popular with many devote Catholics, though more liberal Catholics rallied behind him in last fall's election.

Pope gives Obama a bioethics lesson

US President Barack Obama met the Pope today at the end of an economic summit of the world's top industrialized nations, and he was given some instruction from the top on the Catholic Church's position on bioethical issues.

In addition to giving Obama a copy of his latest encyclical, which the pope had been presenting to visiting heads of state since its release July 7, the pope also presented a copy of the Vatican document on biomedical ethics, "Dignitas Personae" ("The Dignity of a Person").

When presenting the gifts after their 35-minute closed-door meeting, the pope gave Obama a signed, white leather-bound copy of the encyclical, "Caritas in Veritate" ("Charity in Truth"), then indicated the light-green soft-cover instruction on bioethics issued last December by the Vatican Congregation for the Doctrine of the Faith.

"Oh, what we discussed earlier," said Obama, referring to their closed-door discussions. "I will have some reading to do on the plane."

Obama was given the instruction to help him better understand the church's position on bioethics, Msgr. Georg Ganswein, papal secretary, told journalists in the pool covering the visit.

The Caritas in Veritate released Tuesday called for more ethics in economics and rules to reign in free market excesses.

The Dignitas Personae, released in December, was a sweeping update of the Vatican's bioethics code barring Catholics from using IVF, participating in medical research involving cloning or embryonic stem cells, banning surrogate mothers, the morning-after pill and the testing of embryos for defects. Hormone therapy, adult stem cell and sterility research are okay.

Obama's stance on abortion and embryonic stem cell research has not been popular with many devote Catholics, though more liberal Catholics rallied behind him in last fall's election.

US President Barack Obama met the Pope today at the end of an economic summit of the world's top industrialized nations, and he was given some instruction from the top on the Catholic Church's position on bioethical issues.

In addition to giving Obama a copy of his latest encyclical, which the pope had been presenting to visiting heads of state since its release July 7, the pope also presented a copy of the Vatican document on biomedical ethics, "Dignitas Personae" ("The Dignity of a Person").

When presenting the gifts after their 35-minute closed-door meeting, the pope gave Obama a signed, white leather-bound copy of the encyclical, "Caritas in Veritate" ("Charity in Truth"), then indicated the light-green soft-cover instruction on bioethics issued last December by the Vatican Congregation for the Doctrine of the Faith.

"Oh, what we discussed earlier," said Obama, referring to their closed-door discussions. "I will have some reading to do on the plane."

Obama was given the instruction to help him better understand the church's position on bioethics, Msgr. Georg Ganswein, papal secretary, told journalists in the pool covering the visit.

The Caritas in Veritate released Tuesday called for more ethics in economics and rules to reign in free market excesses.

The Dignitas Personae, released in December, was a sweeping update of the Vatican's bioethics code barring Catholics from using IVF, participating in medical research involving cloning or embryonic stem cells, banning surrogate mothers, the morning-after pill and the testing of embryos for defects. Hormone therapy, adult stem cell and sterility research are okay.

Obama's stance on abortion and embryonic stem cell research has not been popular with many devote Catholics, though more liberal Catholics rallied behind him in last fall's election.

Congrats to me and my blog

I just found out that this Medical Ethics Blog has been put on a list of the Top 25 Healthcare Policy Blogs in the world.

The list is compiled by Medicine 3.0, a blog on a site dedicated to helping nursing students.

Here's what it says:

Are you concerned about health care policies and reform? You can learn more about the direction that health care policies are taking through the blogs listed below. We discovered writers who were doctors, attorneys, journalists and politicians who all lend their perspectives to the volatile and ethical issues surrounding health care reform.

The blogs are listed below in alphabetical order. This method assures our readers that we do not favor one blog over another. All blogs listed, however, are up-to-date and all information is provided by professionals in their fields. ...

Medical Ethics Blog: Stuart Laidlaw has covered faith and ethics for over a decade, and he applies these attributes to a blog that covers health and health policies.

I'm blushing.

Bad news for men -- artificial sperm

A team of British researchers claimed this morning to have developed a method to create sperm from embryonic stem cells.

Researchers at Newcastle University and the NorthEast England Stem Cell Institute say they used a new technique to derive what they described as sperm cells from embryonic stem cells. Stem cells have the potential to become any cell in the body.

Newcastle research leader Karim Nayernia said in a statement Wednesday that the technique would allow researchers to study how sperm develops and possibly help develop treatments for infertile men.

The research was published Wednesday in the journal Stem Cells and Development.

The Independent newspaper immediately wondered if this meant "a world without men." Ethicist John Harris, professor of bioethics at The University of Manchester and editor-in-chief of the Journal of Medical Ethics, said no man would need to be considered infertile again.

Now, if this research is confirmed, all they will need is a very large supply of male stem cells. Might we see the George Clooney stem cell line (assuming he were to consent to it)? I can see no objection. It is no more wrong to choose the genes of your child than your reproductive partner. Indeed, we have always sought to do both, choosing our partners on the basis of our -- sometimes erroneous -- belief about the sort of children likely to result. I see nothing wrong with people exercising that choice using the technology as it becomes available.

If it is not wrong to wish for a bouncing brown-eyed baby girl, why would it become wrong once we had the technology to play Fairy Godmother to ourselves and grant our own wish?

Not all ethicists see it so simply.

"This area has potential powerful clinical applications mixed with people's concerns over embryo research," says Insoo Hyun, a bioethicist at Case Western Reserve University who specializes in stem-cell-related ethical issues. "All the ingredients are there for a really, really lively ethical debate."

Others simply doubt the research.

"I am unconvinced from the data presented in this paper that the cells produced by Professor Nayernia's group from embryonic stem cells can be accurately called 'spermatazoa," said Allan Pacey, a senior lecturer in andrology at the University of Sheffield.

Pacey said in a statement that the sperm created by Nayernia did not have the specific shape, movement and function of real sperm.

Azim Surani, a professor of physiology and reproduction at the University of Cambridge said the sperm produced by the Newcastle team were "a long way from being authentic sperm cells."

Too much Tamiflu

The case of a Danish woman developing a drug-resistant strain of swine flu after being given low doses of the Tamiflu vaccine is raising questions about how and when to hand out the vaccine.

On 29 June, Denmark's National Board of Health announced the first known case of H1N1 swine flu resistant to the most popular antiviral drug. The woman was in contact with an infected person and was put on low-dose Tamiflu as a precaution, but she developed flu anyway.

She has now recovered after taking the antiviral Relenza, and the drug-resistant strain appears not to have spread. The State Serum Institute in Copenhagen assumes resistance emerged during treatment with Tamiflu, as low doses can favour the emergence of resistant strains.

It appears to be an isolated case, so on one is ringing alarm bells at the moment, but the case is is causing some questioning of the standard policy to treat those close to swine flu patients as a preventive measure. Doing so, after all, could lead to the development of a more dangerous strain of the flu than the current one -- which could be disastrous. 

British Medical Journal blogger Iain Brassington, a bioethics lecturer at the Centre for Social Ethics and Policy at the Law school at Manchester, points out that this puts governments and medical officials in a bind. Do they risk making things worse down the road by treating people now, or not?

There seems to be an interesting dilemma generated: while governments presumably ought to take steps to ensure the availability of prophylaxis, this also generates a risk that they’re creating a much bigger problem further down the line. I don’t think that this is an argument against prophylaxis per se - of course governments should deal with the threat as it stands at the moment (and anything else would be a counsel of despair), and the threat of resistant H1N1may never be realised - but the point would stand that, in doing what they ought to do now, they may be making things worse in the long run. And that means that meeting the present danger isn’t nearly as morally straightforward as it would seem at first.

I'll be keeping an eye out for more drug-resistant strains.