Tooting my own horn -- one of 50 top blogs!

Allow me a moment of self-indulgence.

This blog has been rated in the Top 50 Medical Ethics Blogs in the world by the web site Uspharmd.com -- 23rd overall and Number One internationally. Or, at least, first on the international list.

Congratulations to me.

Uspharmd.com targets pharmacists, pharmacology students and consumers, rating schools, giving industry news and offering consumer information -- and has its own blog.

Here's what they say about this blog:

International Medical Ethics Blogs.

As the world grows more connected, medicine cannot be isolated to ethics in just one country. The following bioethics blogs offer an international perspective.

Medical Ethics blog. This blog at the Toronto Star, written by a long-time ethics journalist, gives a Canadian perspective on North American medical ethics.

The top blog in the world is blog.bioethics.net. "Written by the editors of American Bioethics Journal, this blog includes information the editors receive and share with readers," according to Uspharmd.com.

That's a tough act to beat, and it's certainly on honour to be on the same list.

Vatican issues bioethics instructions

The Vatican this morning issued its long-awaited Dignitas Personae detailing the Catholic Church's stand on several bioethics issues, from in vitro fertilization to cloning to freezing embryos.

There are few surprises, given past Catholic teachings on the sanctity of life, but the document gives full papal authority to those teachings.

Here's what's not allowed:

• in vitro fertilization.
• research in and use of embryonic stem cells.
• post-fertilization birth control methods such as morning after pills, the so-called abortion pill RU-486 (mifepristone) and the inter-uterine device (IUD).
• surrogate motherhood.
• human cloning, both reproductive and therapeutic.
• hybrid cloning using animal oocytes (immature female germ cells) to reprogram the nuclei of human somatic cells.
• freezing embryos or oocytes for use in artificial fertilization.
• re-implantation diagnosis of embryos to avoid genetic defects or select for gender or other qualities.
• reduction of implanted embryos to prevent multiple births.
• intracytoplasmic sperm injection (ICSI) to overcome male fertility problems.
• germ line cell therapy to modify genes transmitted to offspring.
• genetic enhancement for purposes other than medical treatment. 
• use of human biological material of illicit origin, such as experimentation on human embryos.

The following procedures are considered morally acceptable:

• promotion of natural fertility including hormone treatment and surgery for endometriosis or obstructed fallopian tubes.
• use of stem cells obtained from adult organisms, umbilical cord blood or fetuses dead by natural causes.
• research into the prevention of sterility.
• somatic gene cell therapy for strictly therapeutic purposes in an individual patient.

Assisted suicide in HD TV

At 9 pm tonight in London, 4 pm in Toronto, a British TV show will broadcast the assisted suicide of an American man with an incurable motor neurone disease.

  Craig Ewert, 59, died two years ago at a Swiss clinic. His death, the result of ingesting a lethal dose of barbiturates, is part of the documentary Right To Die? by Oscar-winning Canadian director John Zaritsky, who last year released the documentary The Suicide Tourist.

His death, for which Ewert paid $3,000 (US), has sparked a debate in Britain about assisted suicide, where the practice is illegal. Dr. Peter Saunders, director of the campaign group Care Not Killing, said the show was a "cynical attempt to boost television ratings."

"There is a growing appetite from the British public for increasingly bizarre, reality shows. It's a slippery slope. The danger is that we start to believe in a story that there is such a thing as a life not worth living."

Ewart's wife of 37 years, Mary, was at his side for the suicide and defended his decision.

"For Craig, my husband, allowing the cameras to film his last moments in Zurich was about facing the end honestly. This wasn't a film about him personally. He was keen to have it shown because when death is hidden and private, people don't face their fears about it. They don't acknowledge that it is going to happen, they don't reflect on it, they don't want to face it. That's the taboo."

Ewart defends his decision himself in a clip from Sky Real Lives posted to the Sky TV web site.

His final momentsshow Ewert being given a last-minute chance to back out, and his wife supporting him.

“Mr Ewert, if you drink this you are going to die,” the Dignitas staffer who prepared the mixture says.

Undaunted Mr Ewert drinks the mixture through a straw.

“Give me some apple juice. Please can I have some music?” he then asks.

As the moment of death approaches Mrs Ewert asks Mr Ewert: “Can I give you a kiss?”

“Of course,” Mr Ewert says. Ms Ewert says:

“I love you,” to which her husband replies, “I love you, sweetheart, so much.”

“Have a safe journey, I will see you some time,” Ms Ewert says.

Moments before his eyes close for the final time Mr Ewert says: “Thank you.”

His wife then says: “Safe journey. Have a good sleep.”

 

Bush White House boosting religion's role in medicine

With a little over a month left in his US presidency, George Bush is pushing through measures to boost the right of doctors to refuse to provide medical treatments that violate their own religious beliefs.

Called the "right of conscience" rule, it would allow medical facilities, doctors, nurses, pharmacists and other healthcare workers to refuse to participate in any procedure they find morally objectionable, including abortion and possibly even artificial insemination and birth control.

Even staff members whose job it is to clean the instruments would have the right to refuse.

The new rules would expand on current laws allowing doctors and nurses to refuse to perform an abortion by allowing them to refuse to even provide information on where to get one.

The move sets the stage for a showdown over abortion early in the Barack Obama administration, set to begin with his inauguration on Jan. 20. During the campaign, Obama sought to find middle ground on the issue.

Cecile Richards, president of Planned Parenthood, slammed the Bush While House move.

"It's unconscionable that the Bush administration, while promising a smooth transition, would take a final opportunity to politicize women's health."

The right of doctors to refuse treatment has also been controversial on this side of the border, with the Ontario Medical Association challenging the Ontario College of Physicians and Surgeons over the issue.

Genetic screening for children, for sports or disorders

For $149 (US), a company in Boulder, Colo., will tell you whether you child is best suited for soccer or the high jump.

Atlas Sports Genetics says it can help parents figure out if they have a gifted athlete on their hands -- one that might be able to one day go pro or get an athletic scholarship to a US university. It offers several "products" for sale from its website, each using genetic tests to screen for a child's athletic abilities, with enticing sales pitches.

"Finding any great Olympic champion normally takes years to determine. What if we knew a part of the answer when we were born?"

While parents might like the idea, scientists like Theodore Friedmann of the University of California-San Diego Medical Center’s interdepartmental gene therapy program warned it could be a modern version of snake oi.

“This may or may not be quite that venal, but I would like to see a lot more research done before it is offered to the general public. ... I don’t deny that these genes have a role in athletic success, but it’s not that black and white.”

Atlas president Kevin Reilly, a former weight-lifting coach, said his company's products are one tool of parents can use to figure out where their children's' strengths lie.

"We need to identify these kids from 1 and up, so we can give the parents some guidelines on where to go from there.”

Meanwhile, researchers in Texas say they have a way to genetically screen fetuses to more accurately predict an array of disorders. Arthur Beaudet, who led the study and heads Baylor University's Department of Molecular and Human Genetics, says some parents want an early diagnosis so they can decide whether to end a pregnancy. Others simply want to better prepare for a child's special needs.

Vatican to rule on human cloning, stem cell research

The Vatican will update Catholic Church teachings on bioethics in two weeks with the planned release of a new document looking at human cloning and stem cell research in Rome.

The document, prepared by the Congregation for the Doctrine of the Faith, will be released during a bioethics conference at the Vatican on Dec. 12.

It is expected to examine issues not explicitly considered by two previous church documents: "Donum Vitae" ("The Gift of Life") in 1987 and Pope John Paul II's encyclical "Evangelium Vitae" ("The Gospel of Life") in 1995.

Pope Benedict XVI, prefect of the Congregation for the Doctrine before becoming pontiff, told the grouplast January that new ethical problems needing their attention included the freezing of human embryos, the selective reduction of embryos, pre-implant diagnosis, research on embryonic stem cells and attempts at human cloning.

"The two fundamental criteria for moral discernment in this field are unconditional respect for the human being as a person from the moment of conception to natural death, (and) respect for the originality of the transmission of human life through the acts proper to spouses."

Stem cell researchers pin hopes on Obama

Stem cell researchers in the United States, hobbled for years by President George Bush's ban on federal funding for embryonic stem cell research, are looking forward to Barack Obama taking office in January.

And outside the U.S., researchers are using his election to push their own governments for more funding.

Mary Hendrix, a stem-cell scientist at Northwestern University in Chicago, said Obama needs to give a clear signal to the scientific community early in his administration that he will jump start research in the U.S.

"The biopharmaceutical industry has been skittish about making investment in this kind of research. An executive order would give the signal that it's acceptable."

Obama promised during the campaign to issue such an order.

James Thomson, a stem-cell scientist at the University of Wisconsin who created the first human embryonic-stem-cell line in 1998, however, said money will also have to accompany any such order -- but expects that sort of action to take time.

"To make stem-cell science take off, it needs something equivalent to Nixon's war on cancer. ... But because of today's economic realities, it's not going to happen for at least a couple of years." 

Opponents of embryonic research vow to continue fighting such work, saying it involves the destruction of life.

Obama has already named several pro-stem cell bioethicists to his transition team.

Meanwhile, researchers in Britain are warning their government that Obama's election could hurt them. With U.S. scientists held back by Bush's ban, scientists in other countries have been able to surpass the work of their American colleagues.

Chris Mason, professor of regenerative medicine at University College London, said an infusion of cash is needed to solidify the advances made by British scientists. 

“The UK, through its firm commitment of public money to stem cell research, remains at the cutting edge of the science. Now is the time to translate this valuable knowledge into real benefits for patients. This will require additional funding for translation [into the clinic] and manufacture, plus strong commitment to these advanced therapies."

The current credit crunch has made it difficult for researchers to raise private capital, making government funding all the more important, Mason, a member of the UK Stem Cell Network steering committee, said.

Medical ethics in the Obama White House

A few hintsare beginning to emerge about how a Barack Obama administration will approach some of the touchy bioethical issues of our times, particularly stem cell research, thanks to recent appointments to his transition team.

University of Wisconsin bioethicist Alta Charoand University of Pennsylvania bioethicist Jonathan Moreno have both been asked to advise the incoming US president as he prepares to take office in January.

Both are prominent proponents of stem cell research, and have called for an end to George Bush's ban on federal funding for embryonic stem cell research. While stem cell researchers have applauded the appointments, opponents see it as a warning of fights to come.

Richard Doerflinger, director of the Secretariat for Pro-Life Activities for Catholic bishops in the US, says the church will resist any change in policy.

"The question is, does the Bush policy get replaced with the law of the jungle? We are very concerned about it as a moral issue."

Supporters, however, including Robert Klein of the California Institute of Regenerative Medicine, are counting the daysuntil Obama takes office.

"Today there's trial ready for humans sitting at the FDA that the Bush administration blocked. 45 days from now, when there's a change in administration. I expect that trial to move forward."

Assisted suicide an "escape" few take: report

A report out of Oregon, which approved physician assisted suicide for terminally ill patients 11 years ago, says few patients actually use the option -- but like that it's there.

"Over the past 11 years in Oregon, 341 people have used the law, and the lethal medication provided by their doctors, to die."

That works out to about 1 in 1,000 deaths, according to the Oregon Health Division. The rate of talking about assisted suicide, however, is much higher. About 1 in 50 dying patients discuss assisted suicide with their doctors, according to the state, and one in six with their families.

"All this suggests that people just want to know that the escape is there if they need it, but very few decide that they do. It is powerful evidence that palliative care has come a long, long way since the Oregon measure took effect 11 years ago."

The report says palliative care -- health care for the terminally ill -- has done such a good job of making people's final days comfortable, that few patients want to end their lives early.

The Oregon Health Department is required maintain statistics on the law's uptake. The numbers provide an interesting glimpse into who uses such a law, and how. Over the past 11 years, 82 per cent of patients requesting assisted suicide had some form of cancer, and 93 per cent died at home. Top reasons for wanted assisted suicide were a loss of autonomy, a loss of dignity and an inability to still do things they always enjoyed.

Earlier this month, voters in neighbouring Washington state voted to approve a similar assisted suicide law for their state.

Medical ethics in an Obama White House

Medical ethicists in the United States are beginning to take stock of what a Barack Obama administration will mean to the medical community -- particularly as it relates to ethical questions.

Without doubt, the White House of George W. Bush has been very conservative when it comes to medical ethics.

But with the election of a more liberal Democrat, as well as the results of several state resolutions that were also on the ballot Nov. 4, American ethicists expect to see a loosening of attitudes.

Writing for MSNBC.com, Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, writes that "the 2008 election will be remembered not only for Obama becoming the first African-American president, but also for its impact on core bioethical topics that have long dominated American domestic politics."

"Divisive issues such as abortion bans failed to gain traction on state ballot initiatives, while newer bioethical concerns that are likely to dominate American politics for years to come, including physician-assisted suicide, emerged. The past eight years of the Bush White House have seen stem cell research and the status of embryos at the centre of the moral values debate. Obama’s election has brought the fight over embryonic stem cell research in the U.S. to an end."

On November 4, Michigan became the tenth state to approve embryonic stem cell research. The Bush White House has refused to fund such work, hampering research in the U.S. Calling the stem cell debate a "stalking horse" of the abortion debate (since objections to the use of embryonic stem cells are based on the same right to life arguments), Caplan points to Nov. 4 vote results in Colorado.

"The voters of Colorado were given the chance to put that view into law with the proposed Amendment 48. The so-called “Personhood Amendment” sought to define fertilized eggs as human beings, extending them constitutional rights. Coloradoans defeated this amendment by a margin of three to one."

Caplan later adds:

"Like it or not -- and I am well aware that many are not ready to let go of these issues -- the nation may be starting to move past the endless battles over stem cells, embryos and abortion."

Also, in Washington state, voters approved a resolution to allow physician-assisted suicide.

Bernard Lo, a professor of medicine and medical ethics director at the University of California San Francisco, for instance, has some advice for the new president, saying he should replace Bush's President's Council on Bioethics when its mandate expires next year.

A National Bioethics Advisory Council can help the American public and the new administration understand the ethical issues and choices that new biomedical advances present and think through the appropriate policy responses. Now is the time to consider this new national Council because the charter for the current President's Council on Bioethics expires next year and the incoming president will have the opportunity to form a new advisory body. The new Council can identify policy options, explain their pros and cons, and make recommendations to policymakers.

That would be a very different body from the current President's Council, which advises only the president and has been used by the White House to find ways to implement pre-determined policy -- such as a recent instruction from Bush to find a way around a California court decision that a doctor cannot refuse in vitro fertilization to a lesbian couple because of his personal religious beliefs.

The President's Council meets this week.