by D Sullivan in Bioethics, stem cells
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by D Sullivan in Bioethics, medical ethics, conscience
In this age of radical patient autonomy and patient rights, the rights of doctors, nurses, and other health care professionals can sometimes be shortchanged. This may happen when individual choice trumps the right of a health care worker to refuse to perform a morally-controversial procedure.
The latest assault on conscience comes from the Ethics Committee of the American College of Obstetricians and Gynecologists. The committee has issued an opinion, summarized in an article entitled, “The Limits of Conscientious Refusal in Reproductive Medicine.” It reads, in part:
Physicians and other health care providers have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request. In resource-poor areas, access to safe and legal reproductive services should be maintained. Providers with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively have an impact on a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care.
Notice the implications of this statement (source):
1) The millennia-old Hippocratic tradition of medicine is “first of all, do no harm.” Pro-life physicians feel that participation in abortion violates this tradition.
2) At the very least, the right to refuse to go against one’s conscience has been protected in ethics and by law.
3) The ACOG ethics statement insists that physicians must refer requests for abortion to other practitioners, even though such referral makes them complicit with the abortion act.
4) This even goes so far as to dictate where a physician may practice.
5) Finally, the statement insists that physicians must perform the procedure if no one else is available, if refusing might have a negative impact on physical or mental health (note the wording: we’re not necessarily talking about an immediate threat to the life of the mother here).
Furthermore, there is a move to link adherence to this ethics statment to board certification for OB-GYN doctors. Physicians who refuse to provide or refer for abortion may lose their right to practice medicine.
The ACOG ethics statement has not yet become policy, and has generated widespread disagreement and controversy, especially in view of the fact that it conflicts with laws in 46 out of 50 states.
Stay tuned.
(Conscience laws by state)
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by D Sullivan in Bioethics, stem cells
In a recent post, entitled “Good News for Everyone,” we rejoiced over the news that two independent teams of researchers had converted ordinary human skin cells into embryonic stem cells. They started out with human fibroblasts, then inserted four genes that caused the cells to become pluripotent, that is, to have the ability to grow into all the major tissues of the adult human body. This has great promise for medical research, and may offer eventual cures for a variety of chronic diseases.
I guess the “devil” is in the details. At the time I wrote my first post, I did not yet have access to the Science article in which the Thomson team (Wisconsin) first reported their results. But I found this out indirectly from a blog post:
[T]hey tested this combination of genes in a commercially available, genetically modified cell culture, IMR90 fetal fibroblasts. (These cells were cultured from a little girl aborted at 16 weeks gestation). These cells are fetal cells, not adult cells, and they were chosen because they have been studied and the genome is well known.
According to
LifeSite News, both research teams “used several versions of the 293 aborted fetal cell lines to modify the DNA of the host adult skin cells, in order to accomplish the reprogramming.”
Ethically, this clouds the picture quite a bit. The fact that they used a culture of cells from an abortion that took place in the past nonetheless raises questions about moral complicity. This would be similar to the use of vaccines derived from aborted fetal research (several of such vaccines are still in use today). According to biotech industry analyst Dr. Theresa Deisher:
There are other ethical ways to produce the DNA needed for transformation, efficiently and morally. If these means were employed to produce the needed DNA, there would be no moral issues with the use of reprogrammed adult cells for research.
I can still hope that future developments will not cut ethical corners, and human personhood and dignity may yet be upheld in subsequent research. But I’m not holding my breath.
Original Scientific Papers:
Takahashi, et al (Yamanaka research group in Kyoto, Japan)
Yu, et al (Thomson research group in Wisconsin)
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by D Sullivan in Bioethics, medical ethics
In today’s podcast, we talk about one of the most egregious abuses of ethics in modern history: the horrible medical experiments carried out by Nazi physicians during WWII. Should we make use of the data that the Nazi doctors obtained, even though it was often gathered by taking the lives of Jewish prisoners in death camps? Or is it more respectful of the dignity of those who died in the Holocaust to let this information die with them?
My special guests in today’s podcast are some Cedarville University students in my ‘Principles of Bioethics’ class.They are: Katie Condit, Tara Self, Jessica Seman, Kate Temple, and John Wildman.
Sources:
- When Medicine Went Mad: Bioethics and the Holocaust, Arthur Caplan, Humana, 1992.
- The Nazi Doctors: Medical Killing and the Psychology of Genocide, Robert Lifton, Perseus, 2000.
Theme Music: Gli Uccelli (The Birds), Part I. Prelude (Allegro moderato), by Respighi, courtesy of Shockwave Sound.
Special Music: “Melancholy,” by Mark Heimonen
Music Bumpers: “Winter I plead,” by Acoustic Rosh and “Lost Acoustic” by Flashover.
To listen, just click on the player below (click on the “Audio MP3″ button if the player doesn’t appear).
Player:
The Nazi Medical Research Data: Use It or Lose It?:
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by D Sullivan in Bioethics, stem cells
Recently, with Christmas still over a month away, two independent teams of scientists gave the world an early holiday present. And this is a gift that may keep on giving for years to come.
I’m talking, of course, about the announcment on November 20th that researchers had converted ordinary human skin cells into embryonic stem cells. They did this by simply adding four genes that caused these cells to de-differentiate into a “pluripotent” form. If the works holds up, such cells could become the foundation for growing all kinds of starter cells, with the promise of cures for heart disease, Parkinson’s disease, and diabetes, to name just a few possibilities. According to the New York Times:
Researchers and ethicists not involved in the findings say the work, conducted by independent teams from Japan and Wisconsin, should reshape the stem cell field. At some time in the near future, they said, today’s debate over whether it is morally acceptable to create and destroy human embryos to obtain stem cells should be moot.
There is still a lot of work to be done, and actual clinical trials on humans may actually be years away. But the ethical concerns that have so bitterly divided our society on this issue may be alleviated.
Imagine – men and women of good faith, from all different religions and worldviews, working together to solve the health problems of humanity.
Stay tuned. This could be a wonderful Christmas present indeed.
NYTimes Article
Further Analysis
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by D Sullivan in Bioethics, personhood
The CedarEthics podcast for November, 2007 is a discussion of the soul, and how this impacts our understanding of human personhood. We look back at Plato’s dialogue Phaedo, and we examine the history of the concept. We also look at the soul in Scripture.
Finally, we consider a beautiful engraving by William Blake, to illustrate a Robert Blair poem, The Grave, and how it captures the idea of the soul.
Sources and Links:
Theme Music: Gli Uccelli (The Birds), Part I. Prelude (Allegro moderato), by Respighi, courtesy of Shockwave Sound.
Special Music: “Minnie,” by Psykosoul
Music Bumpers: “Untitled,” by Axiom to Zeal and “Tolkien: The Hobbit” by the Brobdingnagian Bards
To listen, just click on the player below (click on the “Audio MP3″ button if the player doesn’t appear).
Player:
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by D Sullivan in Bioethics, stem cells
In a surprising development for the Garden State, a recent poll shows that nearly half of New Jersey citizens want to leave. Economic factors such as high property taxes, high health-insurance premiums, and expensive housing are making emigration more and more appealing, especially to the middle-class.
The solution? Governor John Corzine wants to borrow half a billion dollars more and invest it in embryonic stem cell research. Presumably, he thinks this is worth the risk, since some predict there will be a huge jackpot if his gamble pays off.
Of course, he is flying in the face of facts. No studies currently show any benefit to human beings, and in mice embryonic stem cells cause tumors. Assemblyman John Rooney said, ”We’ve taken a failed [area of] research and are now giving them money with no strings attached.”
Don’t worry. Future governors can just raise taxes further to pay for this huge gamble.
National Review Article
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by D Sullivan in Bioethics, organ transplantation
In a move that is likely to stir debate, medical and public policy groups are suggesting some fundamental changes in the way we regard organ transplantation.
Consider the case at a New York medical center where a woman and her brother were both operated on at the same time. One of the woman’s kidneys was removed, but not for transplanting into her brother. Instead her organ went to a man she had never met.
At the same time, another woman had her kidney removed to give to the first woman’s brother (once again donor and recipient had never met). This idea was mutally beneficial, since donors and recipients were good tissue matches for each other. The operations were timed to occur at exactly the same moment, so no one could back out.
How much is a new kidney worth? With the advent of these so-called “paired exchanges” (the first was in 2001), some advocates are suggesting that kidneys should be considered commodities - that people could offer their own kidneys for sale.
A moment’s reflection will reveal some of the dangers of this idea. Think of the exploitation of the poor that might occur with schemes like this. After all, this has already happened in other countries, where rich foreigners “buy” organs - a sort of “transplant tourism” (see my blog post on this).
It is a disturbing thought that our body parts might be for sale. This seems like a bad solution to the problem of a shortage of donor organs. Such commodification of ourselves can only add to the devaluation of human beings throughout society.
[General News Article]
[Kidney Swap Article]
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by D Sullivan in Bioethics, abortion
If abortion can be done earlier, it can be done with fewer complications for women. So goes the familiar rationale for Mifeprex (mifepristone), the so-called abortion pill, developed in France by the designation ‘RU-486.’ Yet such early medical abortions are not easy. The pill must be followed up by a prostaglandin (misoprostol) which causes the uterus to contract. The combo of the two drugs causes an abortion in most cases, but may lead to persistent bleeding (over 30 days) in 8% of cases, and requires surgical intervention in 8%.
Of course, abortion is not even legal in some countries, and Mifeprex is expensive. What if pregnant women could just take misoprostol (the prostaglandin) alone? It is is cheap, readily available, and it can often cause an abortion all by itself.
A recent article in the medical journal The Lancet attempts to study this question (Vol. 369, No. 9577, June 9, 2007). Looking at data from five different countries, misoprostol was effective as the sole agent most of the time. All women were carefully followed by OB-GYN doctors, with follow-up surgical procedures performed where necessary. One Web-based article on the technique states: “In approximately 10% to 35% of cases, aspiration intervention is required.”
So is this a boon for the reproductive rights of poor women? How will this translate into developing countries where medical follow-up is almost nonexistent? Under the guise of ‘easy’ and ‘cheap’ abortions, the many complications from this short-cut technique may never be known. It seems that many women who will die of infection after incomplete induced abortion.
Oh, and by the way, a lot of unborn babies will die as well.
Misoprostol Abortion: Article
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