British doctors have been told that they risk jail or lawsuits for damages if they fail to allow patients who have made living wills to die. A senior cabinet minister, Lord Falconer, has set out guidelines to the Labour Government's Mental Capacity Act, which become effective next year. Living wills, which can be made years in advance, often stipulate that if a patient becomes incapacitated, doctors should withdraw food and water. The new act gives their wishes legal force. Conscientious objectors are required to pass the patient to another doctor who will carry out the living will.
Critics of the act say that it raises the possibility that a doctor who refuses to kill a patient could go to jail, or that relatives could sue him for not killing a patient, or even that a patient who recovers could sue because he did not die.
Dr Peter Saunders, head of the Christian Medical Fellowship, says that "we are concerned that patients will make unwise and hasty advance refusals of food and fluids without being properly informed about the diagnosis. It is too easy for patients to be driven by fears of meddlesome treatment and 'being kept alive', into making advance refusals that later might be used against them... Commonly patients change their minds about what care they would like, as their condition changes."
He complains that the law does not support conscientious objection: A doctor who believes it would be clinically wrong to withdraw food and fluids must pass their patient over to another doctor who will do so. That makes them complicit in the death."
Critics have also seized upon the ease with which a living will can be made. A patient need not even sign his name to a document if he is too ill. And doctors who allow patients to die, even if the will was not valid, will not be prosecuted. ~ Evening Standard, Nov 17
WHAT'S WRONG WITH SEX SELECTION, ASKS IVF PIONEER
The UK's most prominent IVF researcher, Lord Robert Winston, has taken a strong stand as a supporter of social sex selection. Writing in the London Daily Mail, he writes that every parent has a right to choose their baby's sex. Although this practice is currently banned in the UK, he feels that the justification for this is flimsy.
He even argues that in countries like India and China, where the sex ratio has become grossly distorted because of abortions of girls, IVF sex selection would be beneficial. "Pre-conception sex selection might reduce the incidence of selective abortion and female infanticide. Of course, sex selection is hardly the ideal way of dealing with such an iniquitous practice but, in the short term, it would be a far better option until there was a radical change in a culture which seemingly prefers boys to girls," he argues. In the UK, he says, sex selection is unlikely to lead to an imbalance in the sex ratio.
On the other hand, Lord Winston is troubled by the possibility of genetic manipulation for increased strength and intelligence and so forth. "Such meddling would be a serious threat to our humanity, devaluing those 'ordinary humans' who haven't been genetically enhanced. If a genetic mistake was made -- almost an inevitability -- this would lead to permanent and irreversible genetic problems in all future generations," he writes. He calls for a public debate on these issues -- rather than submitting to the "knee-jerk" reactions of the UK's fertility regulator. ~ Daily Mail, Nov 21
SILICON IMPLANTS RETURN IN US
After a 14-year moratorium, US cosmetic surgeons may now use silicon breast implants. In 1992, the Food and Drug Administration imposed a moratorium on their use because many women had complained that silicone from leaky or faulty implants made them ill. However, several subsequent studies claim that they are safe, although there is always a chance of rupture or infection. "I think this is a huge victory for women," says Dr David Song, of the University of Chicago, "not just for those seeking cosmetic surgery but also for many reconstructive patients after breast surgery". It is also a victory for the cosmetic surgery industry. Breast augmentation is the second-most popular procedure in the US, after liposuction, with nearly 365,000 patients in 2005.
The FDA's decision has savage critics. Dr Sidney Wolfe, of the Public Citizen's Health Research Group, told the New York Times that the breast implant was "the most defective medical device ever approved by the FDA. The approval makes a mockery of the legal standard that requires 'reasonable assurance of safety'." Feminist opponents say that women are supposed to have regular MRIs to check for problems. But these are expensive and many women will not get them. ~ ABC, Nov 17; Biopolitical Times, Nov 22
SINGER SUPPORTS ANIMAL EXPERIMENTS
Peter Singer has blindsided his many critics by backing some medical experimentation on animals. In a BBC documentary on the controversial issue, he says: "It is clear at least some animal research does have benefits. I would certainly not say that no animal research could be justified and the case you have given sounds like one that is justified." Singer, an Australian bioethicist now working at Princeton, is the author of the well-known book Animal Liberation.
His unexpected flexibility may offset remarks he made back in May to an Australian gay magazine. He asserted then that chimps were too social and sensitive to be used in AIDS research. He suggested that patients in a persistent vegetative state could be used instead. "Maybe we could keep them alive for another month or two to do some research that could save millions of lives potentially, and then allow them to die," he told an interviewer. ~ Observer, Nov 26; SX News, May 25
The Party for Animals has won two seats in the Dutch Parliament after last week's election. It is the first time that a party whose focus is animal rights has won a seat in a national parliament. "Finally we can start realising our party's highest priority, namely ending all animal suffering," says its leader, Marianne Thieme. ~ Reuters, Nov 23
An Australian zoo will feature humans in its great apes exhibit in January. Adelaide Zoo will have an enclosure with four teams of six people each staying a week. The homo sapiens will be allowed to wear some clothes. Zoo officials say that the project will help visitors rethink their place in the animal world and raise awareness of the need for conservation. US bioethics observer Wesley J. Smith scoffs at the project. "We will be ecologically responsible only in so far as we accept our exceptional status," he writes in his blog. "If all we are is another animal, we have no greater duty 'to the planet' than do elephants, mice, lions, or sharks." ~ Sunday Mail (Adelaide), Nov 26; Secondhand Smoke, Nov 27
DRUG COMPANIES HIDE ADVERSE RESULTS,
SAYS HARVARD PROFESSOR
In a stinging article in the New England Journal of Medicine, a Harvard Medical School professor has accused big drug companies of hiding evidence of adverse results of their products. The latest example, says Dr Jerry Avorn, is Bayer's behaviour over a drug used in cardiac surgery, aprotinin. On September 21, the Food and Drug Administration decided that despite a negative study in the NEJM, there was no need for an additional warning to consumers. But only a few days later, on September 30, it warned that the drug could cause renal failure, congestive heart failure, stroke or death. What had happened in the meantime was that the FDA had learned that Bayer had commissioned its own report. This confirmed the NEJM study's conclusions and showed that patients who received aprotinin had substantially higher mortality rates and renal failure. But it withheld the study from the FDA -- which Bayer later described as "a mistake".
Dr Avorn feels that drug companies often fail to reveal adverse results, even though the health care system relies upon them to provide most of the safety data. "It is naïve to expect companies to voluntarily fund studies that could sink lucrative products [and] the FDA lacks the clout to require them," he writes. His solution is to propose publicly supported studies of drug risks whose data will be open to all researchers. ~ NEJM, Nov 23, New York Times, Sept 30
CHILDREN OF YOUNG MOTHERS LIVE LONGER
If you want to live to be 100, make sure that your mother is under 25. That's what scientists at the University of Chicago say after analysing historical data on 198 centenarians born in the United States between 1890 and 1893. They found that first-born children were 1.7 times more likely to live to 100. The reason, they surmise, is the age of the mother (but not of the father). Why? Perhaps a younger woman's eggs are more youthful; perhaps a younger woman has not been exposed to as many diseases and infections and therefore provides a healthier environment in the womb. The study was presented to the Gerontological Society of America's annual meeting. ~ Newsday, Nov 20
MIDDLE AGE IS UPWARDLY MOBILE
Cosmetic surgery has been given a big boost by consumers who think that their 60s are the new middle age, according to an A.C. Nielsen survey of 42 countries. In the US, 60% believe this, and on a global scale, 60% believe that the 40s are the new 30s. With more and more people turning back the clock on their mental age, cosmetic surgery is becoming more popular. The survey found that about 20%, world- wide, would consider cosmetic surgery to maintain their looks. The Russians were the most willing (48%), and people in Hong Kong the least willing (6%).
Cosmetic surgery has become more acceptable and financially it's become affordable, says Frank Martell, of A.C. Nielsen. "Our mothers might have gone to Tupperware parties but this generation is more likely to be invited to Botox parties." With Botox now considered mainstream, Martell predicts that the next beauty trend will be liposuction. "Lunchtime 'lipo' is likely to become the next cosmetic 'special' on the menu," he said. ~ Reuters, Nov 27
ARE IVF CLINICS CREATING TRANSGENIC HUMANS?
An Italian researcher has discovered that IVF clinics could unwittingly be creating transgenic humans. Dr Corrado Spadafora, of Italy's National Institute of Health, recently told the British Andrology Society that frog DNA had turned up in mouse sperm after his laboratory had somehow been contaminated. The reason seems to be that naked sperm -- those which have been stripped of their seminal fluid -- are remarkably good at absorbing strands of DNA and RNA from their environment.
This phenomenon has been observed in a number of species, including humans. Often the foreign genes have been incorporated into embryos when the sperm fertilised an egg. Occasionally the modification has been passed on to the next generation. "This work suggests, in theory at least, that IVF laboratories could unwittingly create transgenic sperm," reports The Economist. ~ The Economist, Nov 23
IN BRIEF: Hwang; animal thinktank; kidneys; Lanza
Hwang: Disgraced South Korean stem cell researcher Hwang Woo-suk wants to resume his work on therapeutic cloning. According to his lawyer, creating patient-specific stem cells is the only way that he can atone for "all the stir he has caused". Within six months he and his team could create the cells, he believes. ~ Korea Times, Nov 23
Thinktank: The world's first thinktank devoted to animal ethics has been set up at Oxford. The centre's director is an Anglican priest and theologian, Professor Andrew Linzey, who is an opponent of militant activism. One of the first items on the centre's agenda will be the relationship between animal abuse and violence to human beings. The centre, called the Ferrater Mora Oxford Centre for Animal Ethics, has already launched a Journal of Animal Ethics and a course for students. ~ Guardian, Nov 27
Kidneys: The influential magazine The Economist supports a market in kidneys from live donors. It points out that a flourishing and largely unregulated market has sprung up in Iran and a waiting list has been eliminated. It argues that similar markets are legal in the United States -- body parts of deceased people and surrogate motherhood, for instance -- and that having a kidney removed is as safe as many kinds of elective surgery, such as liposuction. ~ The Economist, Nov 16
Clarification: Robert Lanza and his embryonic stem cell company Advanced Cell Technology are back in the news. In August he created a stir when he published a paper in the journal Nature which was denounced as deceptive by opponents of embryo research. He declared at the time that a cell could be removed from an embryo and morphed into embryonic stem cells without killing the original embryo. There was an outcry, however, when scrutiny of his data showed that none of his embryos had actually survived. Now Nature has released a revised version of the controversial paper which is easier to understand and clarifies misleading wording in the text. "There was nothing either scientifically or technically wrong with the paper," says Dr Rita Dhand, Nature's chief biology editor. ~ New York Times, Nov 22
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