An ethical adviser to the British Medical Association has firmly backed non-voluntary euthanasia for patients who are too ill to ask for death. Professor Len Doyal, an emeritus professor of medical ethics and a member of the BMA's ethics committee, writes in the new Royal Society of Medicine journal Clinical Ethics that dignity in dying sometimes means that doctors should kill their patients.
Debate over euthanasia and assisted suicide has vexed the UK for months. Supporters normally deny that legalisation would shove the country down the slippery slope towards euthanasia of the non- voluntary kind. However, Professor Doyal not only backs non- voluntary euthanasia, but argues that it is "morally wrong" to be silent about it out of political expedience. There has been no disavowal or reaction from the BMA, which last year withdrew its long-standing opposition to legalisation in favour of neutrality.
The crux of Professor Doyal's argument is that withdrawal of life-sustaining treatment like food and water from unconscious patients is morally equivalent to active killing. Hence, to spare patients needless suffering, direct killing is preferable, presumably by a lethal injection. He contends that "regulated, intentional active killing can have a proper place in good medical practice".
Of course, even incompetent patients would not suffer if they had adequate palliative care. But Professor Doyal points out that there is already a shortage of palliative care specialists for competent patients. "What would be the moral point," he asks, "in expending such valuable resources on severely incompetent patients whose best interests will be served by a quick and painless death?"
The co-author of a 2000 book with Professor Doyal, Professor Jeffrey Tobias, of University College London, wrote an indignant letter to the Guardian. "It is exceptionally unusual for life to continue in an extended and distressing way once a medical decision has been made to discontinue support -- a decision always taken with the patient's or family's consent. I would go further and argue that this is precisely the reason why clinicians become so irritated with so-called ethicists like Professor Doyal who, by and large, have no medical qualification and no direct experience of the burdens, challenges and privileges of clinical responsibility, but none the less adopt the moral high ground." ~ Clinical Ethics, June; Guardian, June 9
SEX SELECTION SPREADS TO CANADA WITH MIGRANTS
The practice of selectively aborting girls is spreading from India and China to Canada as immigrant communities take root there. Normally the ratio of boy to girl births is 105 to 100. But according to an exposé in the magazine Western Standard, in several suburbs around Vancouver and Toronto, the ratio has risen to as high as 116 to 100 in recent years. "Since the communities... have seen hundreds of thousands of live births in the last decade, the number of missing daughters may be somewhere in the thousands," writes Andrea Mrozek.
Statisticians warn that the numbers are too limited to reach firm conclusions about the practice. Other factors may be contributing to the increasing skewed ratios. However, because abortion is such a politically sensitive issue, it is difficult to get access to the government statistics to establish exactly how widespread the practice is.
The magazine also claims that some hospitals do sex selective abortions. A leaked internal document from Women's Hospital in Vancouver, for instance, claims that "not allowing sex selection causes increased harm to women who must endure repeated pregnancies in efforts to have a son" and advises health care workers to accommodate their requests.
Public opinion in Canada opposes aborting children simply because of their gender. Sex-selecting IVF embryos was banned in 2004. But catching doctors who abort girls on request is all but impossible and apparently it is not illegal. ~ Western Standard, republished in National Post, June 6
HARVARD TO BEGIN EMBRYO CLONING
Harvard University has decided to become the first non-commercial institution in the US to attempt human embryo cloning. Researchers will focus on diabetes, neurodegenerative diseases and blood disorders. All funding will come from private donations because of restrictions on human embryonic stem cell research imposed by US President George W. Bush.
Although the decision was made after two years of discussion amongst eight institutional review boards at five institutions, Harvard President Lawrence H. Summers anticipated criticism of Harvard's ethics. "While we understand and respect the sincerely held beliefs of those who oppose this research, we are equally sincere in our belief that the life-and-death medical needs of countless suffering children and adults justifies moving forward," he said. The New York Times praised the decision as "bold moves made after intense soul- searching".
Not everyone was so congratulatory. A stem cell biologist delivered a broadside in the Boston Globe. Associate Professor James L. Sherley, of the Massachusetts Institute of Technology, declared that pigs will grow wings and fly before this approach leads to successful medical therapies".
Although this gives Harvard a head start on California where a state stem cell institute has become bogged in a legal morass, there could be a snag. The researchers do not know how they are going to source the human eggs needed for cloning, although they have already begun advertising for volunteers. These women will have to be highly principled, as Massachusetts law forbids payment for eggs to be used in stem cell research. The most a volunteer can get in Boston for a risky procedure from which she gets no benefit is a cab fare. ~ Harvard press release; New York Times, June 9; Boston Globe, June 8
INSTITUTION REVIEW BOARDS DROWNING IN PAPERWORK
American institutional review boards are drowning in paperwork and the resulting frustration could "alienate some researchers enough to turn them into scofflaws", says an editorial in Science. IRBs were established after the 1979 Belmont report to protect human subjects in potentially risky research. But after a quarter of a century, IRBs are being "overwhelmed by a focus on procedures and documentation at the expense of thoughtful consideration of the difficult ethical questions surrounding the welfare of human subjects," writes a team from the University of Illinois Urbana- Champaign.
This "obsession" with paperwork could undermine the protection of human subjects, comment the authors of the editorial, if IRBs get a reputation as "ethics police". "It will be a sad day if scholars come to see human protection in research as the source of frustrating delays and expensive paperwork." ~ Science, June 9
CONTROVERSIAL DOCTOR COULD BE DEREGISTERED
The British doctor who sparked an international health scare by claiming the standard measles, mumps, rubella vaccine was linked to autism may be charged with serious professional misconduct. Dr Andrew Wakefield, a gastroenterologist at Royal Free Hospital in London, published this sensational claim in 1998 in The Lancet with 12 other doctors. His conclusions were based on a study of only 12 children. Against fierce opposition from the medical establishment, he promoted his theory and became a media favourite.
The result was a bitter controversy, a split with his colleagues, and a steep drop in UK vaccinations. In some parts of London it fell to 61%. Perhaps as a consequence, a 13-year-old unvaccinated boy died near Manchester of measles -- the first in 14 years in the UK. A minor epidemic of mumps in the US is being blamed on a Briton who visited the state of Iowa.
In 2004 Dr Wakefield's case was further clouded when it emerged that he had been given £55,000 to further his work by lawyers representing the parents of autistic children. They were preparing a lawsuit for damages. The editor of The Lancet said that he never would have accepted the paper had he been aware of this apparent conflict of interest.
Now the UK's General Medical Council is drafting charges that Dr Wakefield published "inadequately founded" research, failed to get ethical committee approval, obtained funding "improperly" and subjected children to "unnecessary and invasive investigations". If he is found guilty, he could be struck off. ~ London Telegraph, June 13; Nature Medicine, June
ORGANS GO TO RICH QUEUE-JUMPERS
Some American patients get priority on organ donor lists by signing up on several lists, creating a system in which the wealthy have a better chance of getting a transplant. Critics complain that the practice, known as "multiple listing", is unfair to the poor, and expensive for Medicare, which normally pays most of the costs. People donate organs with the idea that everyone will have a fair shot at getting them," says bioethicist Arthur Caplan. "I think it diminishes people's willingness, especially the poor, to become donors."
For the purpose of organ transplants, the United States is divided into 11 regions. Organs normally stay within a region and go to patients depending on how sick they are and how long they have been waiting. But patients can better their luck by signing up on two or more lists. The poor can hardly afford this, as it involves extra air fares. Duplicating expensive blood tests and medical checkups also costs the government dearly. About 6,000 of the 90,000 Americans waiting for an organ are listed in two or more regions, according to the United Network for Organ Sharing. UNOS has tried to ban the practice several times, but lost after opposition from patient advocacy groups and large transplant centres. ~ Kansas City Star, June 5
AUSTRALIAN ECHO OF SCHIAVO CASE
A family dispute over the fate of a brain-damaged Adelaide man echoes the bitter controversy over Terri Schiavo. Mark Leigep, 31, a single father, was badly injured in a car smash on March 26 and is now in a so-called persistent vegetative state. His mother asked for his feeding tube to be removed, but he survived for three days before senior staff reversed the order. It turns out, however, that his mother, Joanne Dunn, had abandoned Mark and his brother Brian at an early age to their paternal grandparents and since then has had little to do with him. Brian, on the other hand, hopes that his brother will recover and says that she has no right to turn off his life support. He plans to apply to become his brother's legal guardian. ~ Australian, June 12
CZECH WOMAN DIES IN CAGED BED
The parents of a mentally ill Czech woman are suing a hospital after she died in a controversial caged bed. An estimated 700 patients are being kept in caged beds in the Czech Republic and about 100 in neighbouring Slovakia. Until January the parents of Vera Musilova had cared for their daughter at home. When her condition deteriorated, they admitted her to the Bohnice psychiatric hospital in Prague. They were shocked to find her in a caged bed, naked, dirty, dehydrated, and with her head shaved.
The director of Bohnice, Mr Ivan David, defended the caged bed policy, arguing that they were needed to pacify extremely aggressive patients when medication did not work. However, Jan Fiala, of a Hungary-based disability rights group which is preparing a lawsuit against the hospital, says that several patients have died in the beds and other have been injured. He says that the practice is grotesque, degrading and torturous" and will only make their condition worse. ~ The Lancet, June 10
MEDIA HYPE AND MEDICAL RESEARCH
Media accounts of medical research are often based on unpublished results at professional conferences and omit important information, say Dartmouth researchers. Writing in the Medical Journal of Australia, they say that journalists often omit basic study facts, such as their size or design. Many times they overlook the limitations of studies. For example, only 6% of news stories about animal studies reported that the results might not apply to humans. And only 2 out of 175 articles about unpublished reports mentioned that they were unpublished.
However, not all the fault is the media's, say the authors. Researchers benefit from the attention because it is a mark of academic success, their academic affiliates benefit because good publicity attracts patients and donors, and research funders -- public and private -- benefit when they can show a good return on their investments. The meeting organisers benefit too; extensive media coverage attracts more advertisers, and higher profile scientists for the following year, guaranteeing more dramatic report and ultimately more press." ~ Dartmouth Medical School press release, June 11
IN BRIEF: stem cells; baby of brain-dead woman
Stem cells from testicles: Deep inside testicles lies a rich source of stem cells -- perhaps 0.3% of their tissue. Now British scientists plan to investigate whether these could substitute for embryonic stem cells and develop into different tissue types, including brain and heart cells. The research will be led by fertility specialist Lord Robert Winston. ~ Guardian, June 6
Baby born to brain-dead woman: A baby girl has been born in a Milan hospital 11 weeks after her 38-year-old mother suffered a cerebral aneurysm and was pronounced brain dead. The baby, named Cristina after her mother, was 8 weeks premature but has a good chance of survival. A few hours after the birth, the woman's respirator was turned off. Her kidneys and cornea were donated for transplant. ~ AP, June 12
