Nearly 100 million Americans are at risk of being denied "legal medical interventions" by religious doctors, according to a feature article in the New England Journal of Medicine. In the light of numerous news stories about health care workers who have refused to dispense contraceptives and editorials in leading clinical journals, doctors from the University of Chicago polled about 2,000 of their colleagues to assess the scale of the problem.
They found that it was big -- and implied that it was quite scary. About 14% of patients, more than 40 million Americans, may be cared for by doctors who do not feel obliged to disclose information about treatments which they object to. And 29%, or nearly 100 million, may be cared for by doctors who will not refer to other doctors for morally controversial practices such as "terminal sedation" (sometimes described as euthanasia), abortion and providing teenagers with contraceptives without parental consent. Since 52% of doctors objected to abortion for failed contraception and 42% to contraception without parental consent, the authors feel that patients should be worried.
The study also found that male doctors with religious convictions are the least likely to endorse full disclosure of their prejudices and referral to more compliant colleagues. "Thus, those physicians who are most likely to be asked to act against their consciences are the ones who are most likely to say that physicians should not have to do so," say the authors.
The study shows that "a lot of physicians out there... are not, in fact, doing the right thing," commented David Magnus, a Stanford bioethicist. He said that since emergency contraception is considered standard care in ER, doctors who are opposed should avoid working there. Many doctors may have solved the dilemma by acting against their conscience. The lead author of the study, Farr Curlin, says that although doctors tend to be slightly more religious than the public, they are much less likely to carry their beliefs into their workplace, with 58% saying that they do, compared with 78% of the public.
The issue of conscientious objection for health care workers also troubles the Vatican. The Pontifical Academy for Life will host a conference on the topic later this week in Rome, with speakers from the US, Australia, England and France, amongst others. ~ NEJM, Feb 8
MENTALLY ILL DESERVE THE RIGHT TO SUICIDE, SAYS SWISS COURT
Switzerland's highest court has ruled that mentally ill people should be allowed to ask doctors to kill them. "It must be recognised that an incurable, permanent, serious mental disorder can cause similar suffering as a physical (disorder), making life appear unbearable to the patient in the long term," the ruling said. "If the death wish is based on an autonomous decision which takes all circumstances into account, then a mentally ill person can be prescribed sodium-pentobarbitol and thereby assisted in suicide." The court insisted that doctors would have to sift out patients who are suffering from a curable psychiatric disorder. The case at issue was brought by a 53-year-old man suffering from a serious bipolar affective disorder.
The American bioethicist Arthur Caplan was highly critical. "The ruling opens the door to anyone who says they have unbearable psychological or emotional suffering to request help in dying people with terrible burns, those who are terribly disfigured, those who are emotionally bereft at the loss of a child or partner or loved and even those suffering from career setbacks and failures," he said. ~ AP, Feb 2
LINGUISTIC MUDDLE OVER OREGON LAW
Shakespeare called it "self-slaughter". Oregon bureaucrats call it "participation in the Death with Dignity Act". It's tough finding a word to describe suicide which appeals to voters. In a 2005 Gallup poll, 75% of Americans agreed with "ending the lives" of patients with incurable diseases voluntarily. But when asked if they supported "assisting the patient to commit suicide", only 58% agreed.
So in Oregon, where it is legal, and California, where it is being pushed, creative writers in Circumlocution Offices have come up with "compassionate choices", "assurance of peaceful dying", "aid in dying", "choice in dying", "end-of-life choices" and even "choice and control at the end of life". As The Economist, normally a supporter of assisted suicide, points out, the official euphemisms used by the Oregon government to stave off lawsuits and keep voters happy would have " George Orwell rotating longtidudinally in his subterranean post-life enclosure". ~ The Economist, Feb 15; LA Times, Feb 12
EGG PAYMENT TO GET GREEN LIGHT IN UK
The UK's fertility authority is expected later this week to give a green light for researchers to pay women £250 for their eggs. Donors will have to show that they are acting altruistically. Campaigners for the change in current regulations claim that unless they remunerate women, it will be almost impossible to obtain eggs. In 2003, only 20 eggs were donated for research.
The change to a commercial system is sure to outrage many people, including some supporters of stem cell research. The editor of the American Journal of Bioethics, Glenn McGee, observed sardonically in his blog that Britain will become the "wild, wild west of egg donation". He recalled that a Korean bioethicist had been "100% certain of the ethical propriety of the Hwang group's procurement group" -- when in fact women had been coerced into donating.
Women's rights supporters are particularly unhappy. "The sum of £250 would still be enough of an inducement for women from eastern Europe... to come to Britain to sell their eggs," said Professor Donna Dickenson, a British expert on egg donation.
However, Dr Peter Braude, of King's College London, said that women were intelligent enough to think for themselves and assess the risks of the procedure. "With any sort of procedure, nurses and doctors are paid for their involvement, so why shouldn't the women concerned be compensated themselves? To expect to get people to do everything altruistically is hard. There could be a payment for the inconvenience involved - the trips to hospital, the scans, the drugs received. Women need to invest quite a lot of time if they choose to donate their eggs." ~ Observer, Feb 18; bioethics.blog.net, Feb 18; Scotsman, Feb 19
WARNING OF SIDE-EFFECTS OF FERTILITY DRUGS
At the same time, an article in the journal Thrombosis and Thrombolysis has warned of a possible increase in side effects of fertility drugs, including paralysis, limb amputation and death. Among all women undergoing fertility treatment -- or donating eggs for research -- about 10% will suffer milder forms of ovarian hyperstimulation syndrome (OHSS), while 1% will be at risk of life- threatening blood disorders. The authors of the study believe that the problem will become more common as the number of procedures rises. Doctors prescribing the drugs needed a better understanding of the potential risks, they said. ~ Sunday Telegraph, Feb 19
ANTHROPOLOGISTS FACE DILEMMA OVER TASMANIAN BONES
The descendants of the Aboriginal people of Australia's island state of Tasmania are used to dealing with museums. Their ancestors' bones are treated as a unique anthropological resource, as they belonged to a race isolated for 12,000 years from contact with other human groups. But by the middle of the 19th century, they had all perished, victims of disease and violence. The last Aboriginal woman insisted that her body be cremated, but instead her skeleton ended up in a museum. The grave of the last Aboriginal man was robbed on the evening of his burial and his head and hands were stolen. The perpetrator was almost certainly the Tasmanian surgeon-general, who later became the state premier.
Now the UK's Natural History Museum is finally returning a small collection of bones to a Tasmanian Aboriginal group, which plans to cremate them. A number of anthropologists told Nature that this was the wrong decision. Weak-willed, said Robert Foley, of Cambridge University. "Who knows what kind of questions we could ask," said Daniel Lieberman, of Harvard University. "Bizarre," sniffed another researcher, who preferred to be anonymous.
However, a letter to Nature this month from an Australian doctor defends the move to repatriate the remains. "If only the Tasmanian Aborigines had been regarded with ethical consideration, they would not have been systematically exterminated. Science was not responsible for their deaths, of course, but we can derive lessons from this sad history. Perhaps sometimes we have to learn to put ethics and humanity above our scientific curiosity," comments Jason Coombes. ~ Nature, Nov 23, Feb 1
GERMAN BIOETHICIST DEFENDS SEX SELECTION FOR WESTERNERS
Although medical sex selection for genetic diseases has a halo of respectability amongst practitioners of reproductive medicine, social sex selection is far more controversial. In many countries, including Germany, Italy, Switzerland, Austria, Belgium and the UK, it is banned. Widespread awareness of the growing distortion of the sex ratio in India and China after years of sex selective abortions has put the idea in a very bad odour. (Amazingly, sex selective abortion is also banned in these two countries, too.)
However, libertarian bioethicists are arguing more and more loudly that preventing couples from choosing boys or girls is a violation of a "presumption in favour of liberty". While aborting girls may be a problem in Asian countries, Western couples often prefer girls. There seems to be little danger of skewing the sex ratio. Why forbid it, then, they ask.
The latest to take up the cudgels is Edgar Dahl, a German with strong links to Australian bioethicists. Writing in the journal Reproductive BioMedicine Online, he offers 10 reasons why a ban is immoral. Amongst them are the following:
Sex selection is "playing God" -- but this is an explicitly religious claim, and religious people must not "use the coercive powers of the law to impose their theology upon others.
Sex selection is not medicine, but a lifestyle choice -- but no one is suggesting that cosmetic surgery should be banned because it offers personal benefits. Dahl also uses the widespread acceptance of cosmetic surgery to counter another objection: that sex selection is a misallocation of scarce medical resources.
Sex selection in the West will send the wrong message to Asian countries -- but such messages will be ignored, says Dahl. "As long as there are religious and economical incentives for preferring boys over girls, our moral pleas will fall on deaf ears on the subcontinent."
Sex selection will lead to designer babies -- but what is wrong with this, anyway? "I am sorry," writes Dahl. "but I cannot see that this would herald the end of civilisation as we know it." ~ Reproductive BioMedicine Online, February
IN BRIEF: vasectomies, fibs, stem cells
Vasectomies: Vasectomies may increase the risk of a debilitating brain disease, primary progressive aphasia, according to an article in the journal Cognitive and Behavioral Neurology. A survey of men with the disease found that 40% had vasectomies, compared with 16% in a control group. A similar result was found for men with frontotemporal dementia, the second-leading cause of dementia after Alzheimer's. Doctors suspect that sperm leaking into the bloodstream could trigger an allergic reaction in brain cells. The authors cautioned that their results were small and preliminary. ~ Chicago Sun Times, Feb 13
Department of fibs: The world's oldest mother, 67-year-old Carmen Bousada, of Spain, has admitted that she lied to a California fertility clinic in order to become pregnant. She told them that she was only 55. She had twins in December and now she is hoping to find a younger husband to help her raise her two boys. ~ Boston Globe, Jan 28
Virgin stem cells: Entrepreneur Sir Richard Branson has announced that he will add stem cell banking to his Virgin empire. Parents will be able to freeze blood from the umbilical cord in case their child's stem cells are needed for medical treatment. The service is becoming increasingly popular in the US, although doctors have warned that there is insufficient evidence to show that it will work. ~ Independent (UK), Feb 19
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