The image of organ donation in Singapore has been tarnished after a hospital used security guards to restrain weeping relatives while it whisked away a brain-dead donor to an operating theatre. Doctors at Singapore General Hospital maintained that they could not delay switching off the life support system because of the risk of further damage to the organs. The relatives, who did not object in principle to organ donation, wanted to wait just one more day in the hope of a miraculous recovery. For its non-Muslim citizens, Singapore has an "opt-out" system of organ donation.

The incident did not dent the commitment of the Singaporean government to its "opt-out" policy on organ donation. (Muslims are exempt.) Health minister Khaw Boon Wan complained that Mr Sim's liver ended up being unusable because the hospital had already given the relatives a day's reprieve. The kidneys and corneas were successfully transplanted. "We try our best to be compassionate, but the bottom line is we need to be firm with this opting-out policy and respect the wishes of the dead," said Mr Khaw. "People have a choice to opt out and if they don't, we assume that they must have no objections."

This embarrassing imbroglio came at a moment when Singaporeans were already immersed in a debate over organ donation sparked by a letter in the Straits Times. The author was no ordinary correspondent, but Lee Wei Ling, the director of the National Neuroscience Institute. She is also the sister of the prime minister and the daughter of Singapore's revered first prime minister, Lee Kwan Yew.

Dr Lee strongly supports a market for organs, although organ trafficking is currently forbidden. Her approach is thoroughly utilitarian. "What makes an organ more sacred than a medical device or medicine that can save a life?" she wrote. "The supplier of the organ or the pharmaceutical company producing the new drug must be appropriately remunerated or there would be no incentive to part with the organ or undertake the R&D required to produce a safe and effective drug." Emotional arguments about the sacredness of organs were mere political correctness, she said. ~ Reuters, Feb 28   

CALIFORNIA ORGAN DONATION INCIDENT UNDER INVESTIGATION

STEM CELL BANKS PROLIFERATE IN US

As American baby boomers move into their 60s, many are taking out "bioinsurance policies" in the form of frozen stem cell samples. It is being called the next big thing in consumer health marketing. Already more than 20 companies store umbilical cord blood. One stores stem cells from circulating blood and another opened recently which extracts stem cells from the soft pulp in children's baby teeth. A company called Cytori Therapeutics is planning to open a bank for fat stem cells harvested from liposuction procedures.

However exciting the potential of these procedures may be, they are still unproven and clients are risking their investment. "Heads are spinning right now," says Dr Marc Hendrick, the president of Cytori. "I'm bullish on [stem-cell banking] long term. But as a practical matter, either doctors or patients will need better proof of therapeutic use before a big market will develop." According to the Los Angeles Times, "even those who are enthusiastic about the potential of adult stem cells say they're dismayed by the pace at which the marketplace is running ahead of the science." ~ Los Angeles Times, Mar 5   

"FALSE IDOLS OF INTELLECTUAL CAPACITY" DENOUNCED

An interesting response to Singer's observations came from two academics whose 37-year-old daughter is as handicapped as Ashley. Eva Feder Kittay, who teaches philosophy at the State University of New York, Stony Brook, and Jeffrey Kittay, the founder of the renowned journal Lingua Franca, indignantly object that "We don't give IQ tests to determine if a person is entitled to the things that go with human dignity, such as human rights." They describe how their daughter Sesha's development and memories are manifested in her musical tastes.

The Kittays maintain that the lives of severely retarded people like Ashley and Sesha raise questions about "false idols of intellectual capacity". "Life is precious; all individuals have intrinsic worth, the source of their dignity; and joy, like the human body, comes in many varieties." ~ Bioethics Forum (the Hastings Center), Feb 28   

MEDICAL ETHICS AND MISSION CREEP

The federal Office for Human Research Protection says that new guidelines will be published soon to clarify the role of the 5,564 IRBs in the US. They appear to be sorely needed. IRBs are only required to monitor research if federal funding is involved, but many universities use them for all research. There is little oversight and no appeal process. Researchers in the humanities and social sciences complain that legitimate concerns in medicine and science over safety and ethical behaviour are largely irrelevant to their work. ~ New York Times, Feb 28   

CONTROVERSY OVER BRAIN-DEAD PATIENT

The unsettling experiment has now been criticised by other scientists. Two letters in Science observe that the words "tennis" and "house" might have elicited automatic responses in the brain. However, the original researchers still insist that their patient was "consciously aware". Had the response been automatic, they argue, there would only have been a flicker in the word processing region of the brain. But what they observed was a sustained response in regions of the brain which are involved in "purposefully imagining coordinated movements" and "real or imagined spatial navigation". The simplest explanation of their data, they conclude, is that the patient was truly consciously aware. ~ Science, Mar 2   

SCIENCE IS NOT ETHICS, SAYS SCIENTIST

Similarly, in an line of reasoning which is rarely aired in Nature, Dr Campbell says that the decision of whether to value scientific and medical advances more than the destruction of an embryo is not a scientific question, but an ethical one. "Thus, instead of being an example of science versus anti-science, this is a case of competing ethical claims." ~ Nature, Mar 1   

DOCTORS ARE ACCOMPLICES IN INDIA'S SKEWED SEX RATIO

A series of harrowing articles in the

For centuries, Indian society has welcomed sons and treated daughters with contempt. Dowries, which can impoverish a girl's parents, have now been banned, but this is also ignored. If a dowry is not high enough, wives are sometimes abused and killed. "Raising a daughter is like watering your neighbour's garden," runs a Punjabi proverb. With the legalisation of abortion and the spread of ultrasound technology, it has now become possible to abort girls even before the neighbours know of the pregnancy. The problem is most acute in the wealthiest districts of India, the states of Haryana and Punjab. The sex ratio has fallen to 820 girl births for every 1,000 boy births in Haryana.

A shortage of women is leading to perverse practices. Women-starved districts are importing them from Nepal and Bangladesh. Sold at slave markets in Bihar, India's poorest state, they are then trucked to Punjab and Haryana. The price is between US$220 and $330. There have been reports of wife sharing amongst brothers.

Sikh obstetrician Puneet Bedi, an activist against female foeticide, blames Malthusian population controllers for kick-starting the problem. American foundations financed family planning programs to bring down the birth rates, but they had not counted on the entrenched preference for sons. The only way to sell contraception to Indians was to guarantee sons. "Foeticide was invented, touted and sold by the medical profession, and it operates with the complete consent of all factors of our society," says Dr Bedi. "Abortion has been sold as a patriotic duty. So, killing babies was an extension of that." And it was the girls who were killed. Twenty years ago, a study of 8,000 abortions showed that 7,999 happened after tests that the foetus was female.

The government seems unwilling to enforce its own laws. Journalists and activists have often highlighted the issue, but nothing happens. The Sahara Samay TV network recently sent an undercover reporter to 140 clinics in four states and found that 100 either agreed to do a sex determination test and abortion or to refer to someone who would. The government filed charges against 21 doctors in Rajasthan, but did not prosecute them. The Rajasthan Medical Council suspended the licences of seven -- but allowed them to continue practicing.

Perhaps the most troubling allegation is American complicity in the abortions. Many of the ultrasound machines are manufactured by General Electric in conjunction with the Indian multinational Wipro. Although 25,770 machines have been registered, as required by Indian law, it is estimated that the actual number is 100,000. Activists have harsh words for the medical profession. "Doctors are a bunch of criminals," says Donna Fernandes, of the women's rights group Vimochana, "but no one wants to see them as such. They are a powerful class, economically and politically." ~ Washington Times, Feb 26, Feb 27, Feb 28, Mar 1   

PEEKING INTO THE FUTURE

It presents four scenarios for "our biopolitical future" based on the ascendancy of technology, greed, religion and common sense by the year 2021. It makes fascinating and thought-provoking reading -- and it is short!

In the first scenario, libertarian transhumanism triumphs. Designer babies are commonplace, the environmentalist movement fades away, and society resigns itself to the development of a genetic caste system. In the second, the West is revolted by dehumanising technology. Religious fundamentalism takes hold and imposes an anti- science agenda. The third scenario is the most pessimistic: a "techno-eugenic arms race". Governments embrace eugenics; racism re- emerges as a powerful force; and artificial viruses become weapons of mass terror. Ethics are tossed out the window. Finally, there is a good news: the victory of common sense, bipartisanship, international consensus, restraint and liberal democracy. Cloning and designer babies are banned, but not abortion or embryonic stem cell research.

This is a very clever, thoughtful attempt to promote discussion. Read it!   

 

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