For more information: Global Health Outreach

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When she first applied for her position at Mount Sinai, her supervisor asked if she would be willing to participate in abortions. Ms. Cenzon-DeCarlo, a devout Catholic, said no, that such involvment would violate her deeply-held beliefs. Her conscientious refusal was put in writing, and is supposedly protected by federal conscience standards.

All that changed on May 24, 2009, 30 minutes after Ms. Cenzon-DeCarlo came to work. She saw, to her utter dismay, that she was scheduled to assist in the abortion of a 22-week pregnancy. She immediately informed her supervisor that this was unacceptable. The supervisor claimed that the patient had preeclamsia (a hypertensive condition that can lead to serious complications if not treated), and that the procedure was an emergency. Nonetheless, the hospital had a six-hour window of opportunity to replace Ms. Cenzon-DeCarlo, which they failed to do. The supervisor simply told the nurse that the patient would die if she refused to help. With great reluctance, and feeling that her job was threatened, the nurse assisted in the abortion.

After the procedure, Ms. Cenzon-DeCarlo noted that the operation was not classified as an emergency, and in fact, early treatment (with intravenous magnesium sulfate) had not been administered. She filed a grievance the following day with her union. Several days later, she was told by two supervisors that she would have to sign a statement agreeing to do abortions, which she refused to do. She was punished by being denied overtime shifts.

Catherina Cenzon-DeCarlo is still working at Mount Sinai, but she is suing the hospital. In her own words, the Phillipino nurse said, “I emigrated to this country in the belief that here religious freedom is sacred. Doctors and nurses shouldn’t be forced to abandon their beliefs and participate in abortion in order to keep their jobs.” She wants the hospital to restore her status and respect her religious beliefs.

The is an especially egregious example of the strong movement in this country to make health care professionals abandon their conscience rights. Abortion is not a part of normal reproductive health care. At the very least, doctors and nurses should not be forced to participate.

NY Post article

Source: After Harm, by Nancy Berlinger (Johns Hopkins University Press, 2005)

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Although GCP protocols claim common themes with the Declaration, key ethical requirements contained in the Declaration are absent from the GCP. These requirements include: post-trial access to treatment for the patient; the condition that research, especially research done in developing countries, should benefit and be responsive to the health needs of the populations of that country; that the study design be publicly disclosed; and that investigators reveal their sponsors, funding, and potential conflicts of interest to research ethics committees and study participants.

Key tenets of ethical human research include the right of the patient to informed consent, and protection of those who are vulnerable. Both of these important qualifications may be lost in GCP-guided international research. It would be impossible for a patient to truly exercise informed consent if the researchers are less than honest about the study design, sponsors, and potential conflicts of interest in the study. In addition, historic evidence demonstrates that people with fewer educational opportunities and lower socioeconomic status are often more vulnerable to pressure to join medical research. Many populations in third world countries could be vulnerable to undue pressure to participate in research studies.

Sadly, many developing countries lack the financial and healthcare resources to offer their own citizens the benefits of new treatments, even when their citizens participate in research for the treatment. A long-held concept of research ethics contends that research should be conducted only on populations that would receive benefit from the research. Populations that will receive no benefit, even due to socioeconomic reasons, do not seem to be ethically sound sources for research participants.

Good ethics has a global outlook. What we consider impermissible in U.S. research should not be accepted in international research. The Bible teaches us to love our neighbor as we love ourselves. We must stand up for our neighbors around the globe, and call for more accountability from the FDA in international medical research.

The Lancet Article

Critics point out that the test may produce misleading results, uncovering genetic markers that merely indicate an increased risk of disease. There is no knowledge of how severely a child would be affected by a particular syndrome, even if a DNA irregularity were detected. In the near future these tests could be used not only to detect disease, but to screen for a variety of genetic characteristics completely unrelated to heath, such as height, weight, and physical attractiveness.

What is at stake for human valuing with this new technology? Historically, “treatment” for known genetic disorders has included abortion of the fetus. The prevalent utilitarian thinking of our culture maintains that life is worthy and valuable insomuch as it contributes in a tangible way to human flourishing. This test gives us yet one more tool to assess the physical or mental fitness of an individual before birth. If that life is found to be deficient in some characteristic, why shouldn’t it be terminated before it becomes a burden to itself and to society? Arthur Beaudet, chair of the Baylor College Department of Molecular and Human Development, commented, ”Some of these disorders are quite burdensome… People say, ‘I wish you’d given me the opportunity to know ahead of time. It’s really destroyed our lives.’”

This is alarming to those of us who value life at all stages and abilities. Do we view another human life as a diseased and useless burden, or do we perceive that life as a God-given gift, valuable because it too bears the image of the Creator?

Article in the Washington Post

Lady Warnock has been called “Britain’s leading moral philosopher,” and is especially well known for directing the Warnock Committee that set government policy concerning reproductive technologies and embryo research in the early 1980s. Now 84 years old, she is well known as a secular humanist and utilitarian thinker, who does not believe that human beings in the womb are valuable or protectable.

Lady Warnock has now turned her sights on the elderly, especially those suffering from dementia. In a recent interview for the Church of Scotland’s magazine Life and Work, she claims, “If you’re demented, you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service.”

Here on this side of the pond, these comments are especially chilling to those whose loved ones have Alzheimer’s, the most common form of dementia, affecting as many as 5 million Americans. Her comments are the ultimate expression of the rampant utilitarian thinking so common in our society. This view of human value derives entirely from functional productivity, viz., those who have mental defects are less valuable simply because they cannot contribute to human flourishing in a tangible way.

But of course Lady Warnock misunderstands where the real duty lies in patients with Alzheimer’s. The duty lies, not with them, but with their caretakers. And it lies with each one of us, who must remain committed to the intrinsic value of life, where worth is not a functional thing to be earned, but a given to be respected and honored.

Article in the Telegraph

Today, however, kidney transplants are routine, as are transplants of other major organs such as the liver and heart. Survival has greatly improved, and the complication rate has dropped dramatically with the advent of powerful new anti-rejection drugs (with few side effects).

The problem? Not enough donor organs. For whatever reason, many members of the public are reluctant to sign up as donors. In Australia, there are only 10 donors per million people – compare that rate to 15/million in Germany, 27/million in the U.S., and 35/million in Spain.

This has led one Australian doctor to suggest a fee for donating. Kidney specialist Kevin Garvey has suggested that $50,000 might provide enough incentive to increase to donation rate. Federal Health Minister Nicola Roxon disagrees, saying:

Putting a price on somebody’s organs, and making it a economic proposition for people that might be financially vulnerable, we don’t think is the right way to go. We don’t want to open up that sort of exploitation.

In a recent post on this subject, I expressed concern over the dangers of commodifying our body organs. Are these concerns justified? After all, since there is such a critical shortage of donors, couldn’t paying for organs help meet our needs?

An amazing news story by BBC reporter Paula MacKinnon shows that concerns about exploitation are quite justified. Ms. MacKinnon is willing to donate one of her kidneys to a stranger in need, and she’ll do this as an act of selfless giving. Her justification is amazingly simple. She states, “I am donating one of my kidneys to a stranger. I don’t need two.”

Here’s where things get bizarre: While researching her story about kidney donation, Ms. MacKinnon secretly filmed people who tried to sell their kidneys. One woman wanted £250,000; another man wanted the price of a Mercedes, about £60,000 (note that at current exchange rates, the equivalent costs in U.S. dollars are $495,000 and $118,800, respectively). As part of her research, the reporter went to India, where she discovered a terrible legacy of butchered paid donors with long-term health problems (see our recent podcast which touches on this issue, as well).

Amazingly, Ms. MacKinnon is undeterred, trusting in the integrity of her own health care system to help her to carry out her altruistic plan safely. I’m impressed.

Financial incentives to make more organs available? It’s still a bad idea, with too many hidden dangers.

block quote source

BBC Report

Sources:

• MedAssist Web Site (includes Kevin Stewart video)
• Arthur Caplan Commentary

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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)

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.

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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]

At this stage of my medical education, I have begun to look at some practical ethics case studies. There are a few beacons, or waypoints, that I use to help guide me in making decisions. Consider the following.

1. Faith – As a Christian, my faith plays a vital role in moral living. This worldview based on Biblical principles and mandates serves as an anchor or foundation upon which to make ethical determinations. At the heart of Scripture is the concept of loving God and loving others. Thus, the Bible establishes immutable, transcendent, and absolute principles that serve as the ultimate authority in my moral and ethical dealings.

2. Reason – Reason is at the heart of all philosophical thought. However, reason alone (i.e. not tempered by a foundation based on principles – see point 1) is a slippery slope leading to consequences that we may not perceive or be willing to accept. But in my moral deliberations, I should not only be able to provide supporting arguments from faith, but should also be able to communicate arguments from reason that can be accepted more universally.

3. Precedent – A good argument can often be made from analogy, and history can help to clarify ethical dilemmas. Finding correlations with other related situations may shed light on the current problem.

4. Instinct – At least in the negative sense, this is sometimes called the “yuk factor,” – another way of describing our gut reaction. Though decisions cannot be made solely on feeling, our gut reaction can give insight as we look other well-founded arguments.

Constrained by conditions of his parole, he can speak publicly about laws to allow doctors to assist in suicide, but he cannot counsel individuals. “You see, I’m still in prison,” he said. “I’m on a tether. I’m on a virtual tether. If you don’t behave, you go back to prison.”

It is interesting to note that the former pathologist has received some sympathy for his views. As a tribute to the public ambiguity about assisted suicide, the original Michigan jury that convicted him could not agree on a capital murder charge.

Think of it — this was not a case of suicide, for it was Kevorkian who actually injected the lethal medicine that took the life of this particular patient, with the video cameras rolling. And what could be more premeditated than such an act, planned many days in advance, with calls to the press and TV stations?

Yet the jury could not agree on capital murder (murder in the first degree), which could have resulted in a life sentence. Instead, in defiance of logic, they convicted him of second-degree murder, as though this was a spontaneous act of passion.

So Dr. Death is free on parole, with his time shortened for “good” behavior.

New York Times Article

Except that sometimes the doctors are wrong.

In a teaching hospital in Florence, Italy, a woman had an abortion 22 weeks into her pregnancy. She chose this course after two separate ultrasound exams failed to detect the stomach, which the physicians interpreted as evidence for esophageal atresia. After the abortion, the baby was born alive, and doctors realized that he was perfectly normal. Weighting just 500 grams, the baby is now fighting for life in a pediatric intensive care unit. Due to a brain hemorrhage from the attempted abortion, the child is not expected to survive.

Dr. Joe DeCook, a pro-life colleague of mine, put it this way:

Doctors should be really careful when they assume God-like wisdom, and intrude into the realm of suggesting preemptive death as a treatment.

Granted, the hospital claims that their doctors advised the woman to seek further diagnostic tests, and she chose additional input from a private clinic. Yet the physicians should have told her two things:

• An ultrasound test can sometimes be misleading (as it was in this case)
• Even if present, a malformed esophgus can be surgically repaired, with a high likelihood of a normal life afterward.

Given the circumstances, the Vatican newspaper said that the child’s life had been “thrown away.”

Daily Telegraph article

Sources and Links:

• Stem Cells in Amniotic Fluid
• Ashley’s Treatment
• NPR Report on Ashley’s Treatment
• Katrina Baby

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Ukraine has become the self-styled stem cell capital of the world. There is a trade in stem cells from aborted foetuses, amid unproven claims they can help fight many diseases.

But now there are claims that stem cells are also being harvested from live babies.

A British forensic pathologist is “very concerned to see bodies in pieces,” as might be the case if stem cells were removed from the bone marrow of these infants.

There is real value to using bone marrow as a source of stem cells; such treatments have been used with volunteer adult donors for many years. Yet the rich clients who pay to obtain them from dead babies cannot seriously expect that some sort of “ethics” will guide the Ukrainian doctors who are complicit with murder.

If this horrible story turns out to be true (and the early evidence is very worrisome), it will be just one more indication of the hype and hysteria over “stem cell research” that promises much more than it can deliver.

BBC News Story

Perhaps you have kidney failure, and don’t wish to endure the long wait for a new organ in the United States. Just head for the Philippines, where you can buy a transplant operation for $100,000, of which the donor may receive as little as $1000.

Long waiting lists for transplants have given rise to a market that exploits and victimizes the poor. According to one 71-year-old Canadian, “When you’re desperate, morality goes out the window” (as reported by CBC News). But such desperate measures have a sinister side that even the transplant tourists do not suspect, or perhaps choose to ignore.

It is well known that transplanted organs in China often come from executed prisoners. The shocking news is that many of the donors are in prison simply because they are members of Falun Gong, whose only crime was practicing the meditation and exercise that this religious group recommends.

Consider the report in the Saint Louis Post-Dispatch on August 22nd. Reporter Deborah Shelton relates the story of Huangui Li, a 62 year-old Chinese woman arrested in 2001 for distributing banned literature. Ms. Li was taken to a hospital where physicians examined her fitness to be an organ donor. She believes that her high blood pressure (making her organs unsuitable for transplant) may have saved her life. Ms. Li now lives in the U.S.

The report documents a large number of abuses: between 2002 and 2003, as many as 2000 Falun Gong had their corneas removed at detention centers in a number of Chinese provinces. In a six-year period, 41,500 organs were removed from prisoners, many of them Falun Gong.

Even if the organs don’t come from prisoners, the gap between rich and poor means that transplant tourism will always be inherently exploitative. Such practices are illegal in many countries of the world, and immoral by any standard. Immanuel Kant has said that human beings should always be ends, and never means. In China and elsewhere, this standard has been turned on its head.

WHO Bulletin on Organ Trafficking