Friday, 2 January 2004·Issue 106

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BioEdge 106: Melbourne hospital defies family, applies for withdrawal of dialysis

IN THIS WEEK'S BIOEDGE


bullet 
Melbourne hospital defies family, applies for withdrawal of dialysis: demented woman might die without treatment
bullet  Euthanasia could cut health costs, says former minister : Mo Mowlam points to soaring bill for longevity
bullet  Patient challenges doctors' right to stop treatment: fears euthanasia without his consent
bullet  Top government institute investigated for conflict of interest: scientists moonlight for medical companies
bullet  Tissue regeneration a step closer: Scripps discovers dedifferentiating molecule
bullet Should doctors assist in humiliating Saddam?: Anger over photos of medical examination
bullet  Indian IVF doctors use 400 women as guinea pigs for fertility drug: Cancer drug used off-label without consent
bullet  Controversial morning-after pill hits the shelves: AMA protests
bullet  Danish sperm donor centre opens New York office: one-third of world's sperm business in Scandinavia
bullet  Human embryonic stem cells may become cancerous with age: new study by stem cell pioneer
bullet  New Jersey passes wide-ranging embryo research bill: second in US to endorse stem cell experiments
bullet  IN BRIEF: PPL sells up; embryo experiments; apologies :

Melbourne hospital defies family, applies for withdrawal of dialysis

Doctor Monash Medical Centre has applied to withdraw life-saving kidney treatment from a 78-year-old demented Melbourne woman who speaks only Arabic against the wishes of her family. Mrs Fahima Sharoubim has lived in a Coptic Hostel in Melbourne for 2½ years after she became unable to care for herself. She requires kidney dialysis three times a week. When she fell ill in late November, she was taken to Monash. There, claims her son Sobhy Girgis, staff put enormous pressure on him to agree to stop treatment. He refused.

In view of the family's recalcitrance, the hospital then made a legal application for a guardian to make medical decisions about the "best interests" of Mrs Sharoubim. In the opinion of Monash kidney specialist Associate Professor Peter Kerr, this means withdrawal of treatment. Death would result within days or weeks. Dr Kerr told The Age that this opinion was based solely on the woman's overall condition and not on available resources, as his unit had enough facilities and there were no restrictions on funding. Mrs Sharoubim appears to be distressed by the treatment and has pulled out her needles during dialysis several times in recent weeks.

Her son, however, contends that money was a factor. One staff member had told him that the hospital bed cost a lot of money and doctors wanted his mother out. "One member of staff said, don't take this personally, it happens on a regular basis," he said. According to an unnamed medical specialist, many hospitals try to stop continuing dialysis treatment once a patient needs a nursing home.

Mr Girgis is angry about the hospital's attitude towards his mother. "She is conscious, she is able to move about, she is still enjoying what she is doing," he told The Age. "She is an old woman, but she's entitled to the end of her life to be treated humanely. It's about ethics and how you value a human being. This is not a chicken or a horse." ~ Age, Dec 21  

Euthanasia could cut health costs, says former minister

Dr Mo Mowlam A former UK minister has suggested that voluntary euthanasia should be legalised because of the prospect of a steep rise in the cost of health and social services with increasing longevity. Writing in the Independent, the popular and outspoken Dr Mo Mowlam, secretary of state in Northern Ireland from 1997 to 1999, argues that "the longer we live the more tax will have to be paid, because the things that old people need are more likely to be provided by the state than the private sector. The demand for health care is much greater for the old than for the young... I would even go so far as to say we should look at voluntary euthanasia. Making an increase in longevity of life a government priority is not necessarily in the nation's interest." ~ Independent, Dec 29 

Patient challenges doctors' right to withdraw treatment

A UK man with a degenerative brain condition has mounted a legal challenge to keep doctors from withdrawing his food and water when he is no longer mentally competent. Leslie Burke, 43, has cerebellar ataxia, and fears that when he can no longer make decisions on his own, doctors will decide that his quality of life is so poor that he should no longer be kept alive.

According to the government solicitor in charge of looking after the interests of mentally incompetent adults, "in the extreme cases of PVS (permanent vegetative state) you need to go to court. And yet if you're comatose and unaware for other reasons there is no legal authority to say doctors must go to court." Mr Burke's own solicitor, Paul Conrathe, says that "we are concerned that Mr Burke's right to life under the European Convention on Human Rights could be violated without the protection of due legal process." ~ Guardian, Dec 24 

Top govt institute investigated for conflict of interest

The US National Institutes of Health has announced a probe into financial conflicts of interest after the Los Angeles Times revealed that several of its leading scientists had collected more than US$2.5 million in fees and stock options by moonlighting as consultants for drug companies. In one instance, the director of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, Dr Stephen Katz, received about US$500,000 in fees from Schering AG and six other companies. During this time, his institute conducted a clinical trial involving one company's drugs and pledged US$1.7 million in small business research grants to another.

Twenty years ago the NIH was described as "an island of objective and pristine research, untainted by the influences of commercialisation". This is no longer true, says the Times. Even worse, the NIH allows its employees to keep much of their outside income hidden from public view. A former editor of the New England Journal of Medicine, Dr Arnold S. Relman, says that private consulting by government scientists poses "legitimate cause for concern".

With billions of dollars at stake in medical products, temptations abound for researchers to work for private industry, while private industry is eager to exploit the cachet of connections with NIH scientists. "If you are going to distribute money from grants and if you are going to be turned to for independent evidence about different drugs or research ideas, which is what NIH's role is, then they've got to be a lot more careful about generating conflicts of interest," commented an often-quoted US bioethicist, Arthur Caplan. ~ The Scientist, Dec 10; Los Angeles Times, Dec 7 

Tissue regeneration a step closer

California scientists have discovered a possible way of making adult cells revert to an immature state, offering a way to create stem cells without using human embryos. A team from the Scripps Research Institute has identified a small synthetic molecular called reversine that can induce a cell to "dedifferentiate", or to move backwards to form its own precursor cell.

"This [type of approach] has the potential to make stem cell research more practical," says one of the researchers, Dr Sheng Ding. "This will allow you to derive stem-like cells from your own mature cells, avoiding the technical and ethical issues associated with embryonic stem cells."

The dream of the researchers is to mimic the natural regenerative process in animals like amphibians which can replace lost limbs. However, they acknowledge that this is still years away. ~ Telegraph (UK), Dec 24; Scripps press release, Dec 25 

Should doctors assist in humiliating Saddam?

Newspaper headlines about Saddam's capture Angry correspondents to the British Medical Journal have complained that the doctors who examined toppled Iraqi dictator Saddam Hussein should not have cooperated with the US military in conducting a medical examination for TV cameras. Professor Ian Roberts, of the London School of Hygiene and Tropical Medicine, recalled that the Geneva Convention forbids humiliating and degrading treatment and states that POWs must be protected against insults and public curiosity. Another writer said that the doctors who examined him "should have insisted on privacy, dignity and confidentiality for their patient". BMJ.com, Jan 3 

Indian IVF doctors test fertility drug without consent

Four hundred unsuspecting women were used as guinea pigs to see whether an anti-cancer drug could also be used as a fertility drug, the Indian Express has reported. A company called Sun Pharmaceuticals persuaded several IVF doctors to use Letrozole to induce ovulation even though it has not been approved anywhere for this purpose. Indian drug expert Dr C.M. Gulhati even claimed that Letrozole -- a breast cancer drug for post-menopausal women -- is "embryotoxic, featotoxic and teratogenic even at minuscule doses". The IVF specialists responded that the doses were small and that results of an overseas study had been published in an American journal. They did not mention whether the women had given their informed consent. ~ Indian Express, Dec 22 

Controversial morning-after pill hits the shelves

morning after pill The morning-after pill became an over-the-counter product on January 1 despite protests from the Australian Medical Association and misgivings by pharmacists. AMA ethics committee chairwoman Dr Rosanna Capolingua said that the decision to sell Postinor-2 without a prescription was a mistake and called upon Health Minister Tony Abbott to reverse it. Pharmacists were not prepared to deal with the sensitive issues involved, she said. A consultation with a doctor was needed for appropriate counselling. According to the Age, pharmacists who are morally opposed to selling Postinor-2 can refuse to dispense the drug, but may leave themselves open to legal action. ~ Age, Dec 28, Jan 1 

Danish sperm donor centre opens New York office

The world's largest sperm bank, Cryos International, has opened an office on Broadway in New York and plans to launch a global franchise so that it can provide sperm from Indian, Asian and African men as well. Cryos currently claims to export its product to 40 countries. According to Reuters, Nordic countries are responsible for one- third of the world's sperm donor industry. However, Sweden, Norway and Finland already have, or soon will have, bans on anonymous donation. Only Denmark and Iceland will allow anonymity, which the vast majority of donors prefer. "Very few donors want 'their' children to be able to contact them, that's the reality," says Cryos founder Ole Schou. "In Sweden, donors diminished overnight when anonymity was taken away and forced most Swedish couples wanting insemination to go to Denmark." ~ Age, Dec 28 

Embryonic stem cells may become cancerous with age

human embryonic stem cells After growing in a laboratory for several months, human embryonic stem cells develop genetic abnormalities, British and US researchers have found. Peter Andrews of the University of Sheffield and stem cell pioneer James Thomson of the University of Wisconsin report in the latest issue of Nature Biotechnology that the cells which they studied developed extra bits of chromosomes 12 or 17. Similar changes are found in some types of cancer cells, they observe. The news adds to the list of technical difficulties associated with using human ESCs for treating patients. ~ Economist, Dec 30; Nature Biotechnology, Jan 

New Jersey passes wide-ranging embryo research bill

The American state of New Jersey has passed an embryo research bill described by its critics as "the worst bioethics bill in the world". It forbids reproductive cloning but allows cloning for research. Unlike other embryo research bills, however, the New Jersey legislation allows researchers to implant an embryo and support its development up until birth. "In other words, it's okay to clone as long as you kill," acidly comments Kathryn Jean Lopez in the National Review. As well, although the bill makes it illegal to profit from the sale of tissue from embryos or foetuses, it does authorise "reasonable payment" for them. In the eyes of its critics, this opens the door to "a commercial market in the sale of baby parts".

The New Jersey governor, Jim McGreevey, is expected to sign the bill into law. New Jersey will then become the second American state after California to have authorised research on "excess" embryos. The bill does not provide research funding. ~ National Review Online, Dec 12; kaisernetwork.org, Dec 16, 19 

IN BRIEF: PPL sells up; embryo experiments; apologies

  • The Scottish cloning technology which was used to create Dolly the sheep has been sold to an American company in the latest stage of a fire sale of the assets of PPL Therapeutics. Once worth £500 million, the biotech firm has been forced to liquidate after backers refused to bankroll one of its major products. Despite Dolly's fame, the cloning technology has never been used to create a single marketable product. ~ Sydney Morning Herald, Jan 3

  • Australian experiments on "surplus" human embryos could begin within a few weeks after the Federal Government processes the paperwork. It is believed that as many as 15 different groups may have applied for licenses. Melbourne IVF and Melbourne-based biotech Stem Cell Sciences have lodged a joint application to do research. Monash IVF has applied to use embryos for training and quality assurance work such as testing embryo growth in new media. ~ The Age, Jan 3

  • Formal government apologies for unethical medical experiments and for forced sterilisations are "soothing balms", but do not guarantee that exploitation will never happen again, says an American medical historian. Writing in the New York Times, Dr Howard Markel complains that formal apologies prompt reflection on the past but not the present. "Thankfully we have moved out of an era of heavy-handed, coercive sterilisation statues, but many of the era's ethical issues remain. Today there is a great risk of societal pressures more subtly influencing reproductive choices thanks to an ever-expanding repertoire of genetic reproductive technologies, therapies and prenatal genetic screening tests." ~ New York Times, Dec 23  

       

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    Australasian Bioethics Information
    ISSN 1446-2117
    Website:www.australasianbioethics.org
    Director: Dr Amin Abboud
    BioEdge editor: Michael Cook
    New Zealand Associate: Carolyn Moynihan


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