The execution of a California man convicted of rape, torture and murder 25 years ago has been delayed because of ethical scruples by two doctors who will help him die.
A Federal judge recently ruled that the State must ensure that Michael Morales is unconscious when a lethal injection is given. So the prison organised two anaesthetists in addition to the doctor who would pronounce him dead. However, the two anaesthetists realised that if something were to go wrong, they would have to intervene in the execution, not just ensure that he was asleep when prison officials injected lethal drugs.
"Any such intervention would clearly be medically unethical," the two nameless doctors said in a written statement. "As a result, we have withdrawn from participation in this current process." Morales was due to be executed on Tuesday at 12.01am, but the doctors' refusal now means that the execution will be delayed for at least a month.
This snafu has rekindled debate about the participation of American doctors in executions. Of the 38 American states which allow executions, all but one use lethal injections. The American Medical Association, the American Society of Anesthesiologists and the California Medical Association have all condemned involvement in executions as unethical and unprofessional.
"The use of a physician's clinical skill and judgment for purposes other than promoting an individual's health and welfare undermines a basic ethical foundation of medicine -- first, do no harm," said Dr Priscilla Ray, who chairs an AMA ethics committee. However, no participating doctor has ever been formally reprimanded because their participation is legal.
Attempts to challenge this have not succeeded. In 1998 a California court dismissed a lawsuit over the legality of physicians attending executions. Last year Kentucky's state medical board dismissed a grievance filed against its governor, Ernie Fletcher, a qualified doctor, alleging that he had breached medical ethics by signing a death warrant. The board argued that Fletcher was acting as governor and not as a doctor. ~ AP, Feb 17; San Francisco Chronicle, Feb 21, 22
HWANG'S AMERICAN COLLEAGUE SLAPPED ON WRIST
The American co-author of disgraced Korean stem cell scientist Hwang Woo-suk has been found innocent of research misconduct, but guilty of "research misbehaviour" after an in-house investigation. The University of Pittsburgh said that there was no evidence that Gerald Schatten had falsified any data or was aware of Hwang's fabrications. However, it has censored him for "shirking" his responsibilities as co-author on what was initially regarded as groundbreaking research -- and has now become notorious as one of the worst scientific frauds ever.
Dr Schatten was senior author on a May article in the journal Science in which Hwang's Korean team claimed to have cloned human embryos and used them to create 11 stem cell lines. All of this turned out to be false. He also was co-author of Hwang's paper about the first cloned dog (which turned out to be true).
The scientific community was divided on Schatten's role in the scandal. "Dr Schatten was as much of a victim as the scientific community," says Evan Snyder, a leading stem cell scientist at the Burnham Institute in La Jolla, California. But bioethicist George Annas, of Boston University, called UP's report "pathetic". This was echoed by another bioethicist, David Magnus, of Stanford: "He may not have been the one who walked in and robbed the bank. But he was the getaway driver who did not ask why his friends wanted him to drive away when they ran out of the bank".
Even the term "research misbehaviour" raised some eyebrows. "Nobody I know knows what 'research misbehaviour' is," commented the editor of Science, Donald Kennedy. The university recommended no specific disciplinary action.
How did Schatten fail to notice Hwang's fabrications? In another creative (and tactful) turn of phrase, the UP investigators suggested his desire for "reputational enhancement". Schatten was listed as a co-author on the cloned dog paper, which made headlines around the world, even though his contribution was basically engaging a professional photographer for the publicity shots. Money may have helped, too. The American received honoraria totalling US$40,000, including $10,000 in cash at the end of the press conference last May announcing the stem cell lines. Dr Schatten has not commented on the affair since he broke with Hwang last November. ~ Science, Feb 17; Nature, Feb 16; Blog.Bioethics.net, Feb 12.
IN THE WAKE OF THE HWANG DEBACLE
A new South Korean science and technology minister wants to give Hwang Woo-suk and his team a second chance. Kim Woo-sik says that the scientist may have disgraced himself, but he had still achieved a great deal. "These techniques should not be discarded," he told the National Assembly. "I was moved by Hwang's comments that he wants to produce tangible results and that he is ready to serve even as a rank-and-file researcher towards that end." ~ Korea Times, Feb 10
Scientific journals are now starting to check images for signs of manipulation and possible fraud. In the Hwang scandal some photographs of cells were altered to make support the text. The problem is not new. The Journal of Cell Biology says that it rejects 1% of all the papers which get through the first selection round because of possibly fraudulent images. The problem is particularly acute in biology, in which images play a large role.
After the publication of a fraudulent paper, many journal editors complain that their job is to detect bad logic, not deliberate fraud. However, some journals routinely check for telltale signs of manipulation by enlarging and scrutinising photos. And Hany Farid, of Dartmouth College, is developing mathematical techniques which will highlight manipulation by software such as Photoshop. His work is partly funded by the FBI, which is interested in checking for tampered crime-scene photos. ~ Nature, Feb 2; Boston Globe, Jan 11
Hwang still has fans in Korea -- legions of them. Earlier this month, a 59-year-old truck driver immolated himself in Seoul, after calling for the scientist to be allowed to continue his research. ~ Reuters, Feb 4
Korea is not kind to whistleblowers. The Hwang Affair's Deep Throat, a doctor in his early 30s who alerted an investigative TV program, about the fraud, has been pushed out of his job and is unable to find work. The doctor, described only as "Mr K", is believed to be a member of Hwang's team who is married to another Hwang researcher. Hwang has accused him and others of concocting the fake clones. ~ LA Times, Feb 14
BELGIAN EUTHANASIA RISING
Belgian doctors reported nearly 400 cases of euthanasia in 2005, up from about 200 after it was legalised in 2002. However, Wim Distelmans, of Brussels Free University, claims that the true number of cases is about five times higher than the official figures. About 80% of Belgian euthanasia is done by Flemish doctors, because they have the support of a good network, the Life Ending Information Forum, which is based in neighbouring Holland.
And a Belgian doctor has defied the existing law by publishing an article in the medical magazine Huisarts (Family Doctor), stating that he had killed an 87-year-old demented patient. Dr Marc Cosyns, a general practitioner and lecturer in end-of-life care at the University of Ghent, said that he wants to spark a debate about providing euthanasia for demented patients and children. ~ BMJ.com, Feb 18; Expatica, Feb 7
DETAILS EMERGE OF KATRINA'S MERCY KILLINGS
Rumours of patients in a hospital being euthanased in the chaotic days after Hurricane Katrina struck New Orleans are probably true, according to secret court documents reviewed by National Public Radio. Although details are still sketchy, it appears that the killings took place on the seventh floor of Memorial Medical Centre, which was leased out to LifeCare Hospitals, a private company providing long-term patient care. Conditions there were appalling. The building was surrounded by water, all power had failed, looters were outside, the temperature was about 100°F, the plumbing had broken down, and the stench was overpowering.
Police were forcing people to leave the hospital, but it seemed impossible to evacuate about eight patients on the seventh floor. According to statements by four workers in the documents obtained by NPR, the evacuation plan for the seventh floor was "not to leave any living patients behind". It is unclear who gave the order, but a doctor, Anna Pou, and two nurses informed at least one witness that lethal doses would be administered.
No one has been charged in the investigation yet. Dr Pou has not commented, but her lawyer says that she had worked tirelessly to save and evacuate patients, "none of whom were abandoned". The New Orleans coroner says that it will be difficult to determine whether lethal doses of morphine had been given, as the bodies were not recovered until two weeks later. ~ NPR, Feb 16
BIOETHICIST SLAMS CONSCIENTIOUS OBJECTION
Amongst the paradoxes of contemporary bioethics are simultaneous appeals to individual conscience as the arbiter of murky moral issues and disdain for conscientious objection by doctors. Oxford bioethicist Julian Savulescu is squarely in the second camp. In a controversial recent article in the BMJ, he contends that "a doctor's conscience has little place in the delivery of modern medical care".
What should be provided to patients is defined by the law and consideration of the just distribution of finite medical resources... If people are not prepared to offer legally permitted, efficient, and beneficial care to a patients because it conflicts with their values, they should not be doctors."
Most of the decisions which Professor Savulescu has in mind revolve around reproductive issues, such as doctors refusing to do abortions, especially late-term abortions, refusing to give reproductive advice to gay couples, or refusing to prescribe emergency contraception. He gives four reasons to support his stand:
- By forcing patients to "shop around" for their doctors, conscientious objection creates inequity and inefficiency.
- It gives a special, unwarranted status to religious scruples. Doctors who believe that elderly sick should not be treated cannot appeal to their consciences to protect themselves from censure.
- Some skills are "a part of being a doctor". Refusing to exercise those skills "corrupt[s] the delivery of the just and legal delivery of health services".
- It privileges religious values above secular values and thereby constitutes unfair discrimination.
Professor Savulescu's blast against the "Pandora's box of idiosyncratic, bigoted, discriminatory medicine" which results from conscientious objection rendered many BMJ readers apoplectic. The response of Professor Shimon M. Glick, of Ben Gurion Hospital in Israel, was representative. He asked: "What is one to do in countries where torture is legal and physicians are asked to participate as loyal citizens? Again are we to leave our consciences behind?" He called upon Savulescu to retract his position "which has great potential for harm to young medical students and physicians, who may take him too seriously". ~ BMJ.com, Feb 4
MIT RESEARCHERS MULTIPLY ADULT STEM CELLS
One of the drawbacks of adult stem cells is that they have proved hard to "expand", or multiply, in the lab. Now MIT researchers have taken a step forward by using a cocktail of growth factors to increase the rate of multiplication by mouse bone marrow stem cells about 30-fold.
"One of the major issues for haematopoietic and bone marrow transplantation has been the inability to get sufficient numbers of cells because they just don't want to grow in the laboratory," Bruce Bunnell, of Tulane University, told HealthDayNews. "In general, we get maybe a two- to five-fold expansion, and for most patients and most transplants you need many more cells. The ability to generate many more cells would more than likely significantly enhance the efficiency at which engraftment occurs. The ability to go from five- fold to 30-fold is a tremendous advancement."
Experiments like this could lead to important advances in stem cell medicine. It would increase the efficiency of existing bone marrow transplants. And a larger number of cells could help gene therapy work consistently, leading to cures for some diseases. ~ HealthDayNews, Jan 23
IN BRIEF: sex selection; PGD; face transplant
India sex selection: Despite an increasingly skewed sex ratio resulting from the abortion of girl foetuses and despite harsh laws banning sex selection, almost no Indian doctors are being prosecuted. Health activists complain that only 300 doctors have been prosecuted since the law was passed 12 years ago, and only four have been convicted. "There is confidence, almost arrogance, among some doctors that they can get away with this," says Arvind Kumar, a senior government official in Hyderabad. ~ BMJ.com, Feb 19
PGD: Babies conceived through IVF and after pre-implantation genetic diagnosis should be monitored carefully in long-term follow-up studies, says a UK report from the Human Genetics Commission. At the moment, there is little data about the long-term effects of these reproductive technologies. ~ BMJ.com, Feb 19
Face transplant: The woman who received the world's first face transplant, Isabelle Dinoire, has given a press conference about her experience. She expects to resume a normal life eventually. Her voice, says AP, is heavily slurred, and she has difficulty in opening or closing her mouth or smiling. However, she can eat and drink -- and smoke. Ms Dinoire's doctors have applied to French authorities to perform five more transplants. ~ AP, Feb 6
