BioEdge 248 -- Wednesday, 16 May 2007

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BioEdge 249: The latest rubbery figures on Dutch euthanasia

THIS WEEK


bullet 
The latest rubbery figures on Dutch euthanasia
      Euthanasia falls; terminal sedation rises
bullet 
Artificial wombs to free women from "barbaric pregnancies"
      Ethicist calls for ectogenesis
bullet 
"Ashley treatment" illegal, says report
      Ethicist protests
bullet 
Morality is all in the brain, say researchers
      Are we hard-wired to do the right thing?
bullet 
D-Day for embryonic stem cells
      Clinical trials to begin soon
bullet 
Egg market grows in US
      Average price US$4,200

THE LATEST RUBBERY FIGURES ON DUTCH EUTHANASIA

About every five years, statistics on Dutch euthanasia are released. Figures for 2005, four years after the practice was legalised in the Netherlands, show that the number of euthanasia cases fell "sharply": from 3,500 in 2001 to 2,325 in 2005. The number of assisted suicides also fell, from 300 to 100. Overall, the percentage of all death by euthanasia dropped from 2.6% to 1.7%. Good news about a successful law?

Deputy Health Minister Jet Bussemaker thought so, but for a different reason. "The most important finding of the research... is that 80% of euthanasia cases are now being reported," she said. It was a pleasing improvement from 2001, when only 54% of euthanasia cases were reported. The Dutch doctors' lobby group also welcomed the improvement in transparency. "Doctors have shown that they are open to scrutiny."

However, the figures, which are set out in a detailed report in the New England Journal of Medicine by a group of Dutch doctors, including some of the country's leading advocates of euthanasia, can be spun in quite a different way. These show that a small decrease in voluntary euthanasia has been more than offset by a hefty increase in what is called "terminal sedation". Patients are given drugs which sedate them "continuously and deeply" until death, in 8.2% of all deaths.

In 7.1% of all deaths, hydration and nutrition were withheld in 2005, compared to 5.6% in 2001. In other words, 7.1% of all people who died in the Netherlands in 2005 died in much the same way as Terri Schiavo, of starvation and thirst, in conjunction with the course of their own disease. To put it even more starkly, voluntary euthanasia (7.1%), non-voluntary euthanasia (0.4%) and terminal sedation accompanied by withdrawal of nutrition and sedation, accounted for nearly 1 in 10 Dutch deaths.

What is the explanation for the shift in the pattern of deaths? The report in the NEJM mentioned three causes, all of them interesting. First, because of the rapid ageing of Dutch society, there are more people over 80, which -- surprisingly -- is the age group least likely to request euthanasia. Second, doctors increasingly favour palliative care, at least a Dutch version of it, and are using more terminal sedation. Interestingly, the over-80s don't like this either.

Third, the goalposts for "non-voluntary euthanasia" have shifted. Where some doctors used to do this with opiates, it now appears that opiates don't really do a good job. They may be doing the same thing, but not calling it "non-voluntary euthanasia".

Definitions are the bugbears of euthanasia studies. According to an editorial in the NEJM by Dr Timothy Quill, a professor of medicine at the University of Rochester School of Medicine, in New York State, "There is no evidence of a 'slippery slope' in Oregon or the Netherlands." Perhaps not, but slippery statistics abound. ~ AP, May 10; NEJM, May 10   

ARTIFICIAL WOMBS TO FREE WOMEN
    FROM "BARBARIC PREGNANCIES"

A scene from scifi film The Island It's not here yet, but a British bioethicist has already constructed a moral argument for ectogenesis, or bringing babies to term in artificial wombs. Writing in the Cambridge Quarterly of Healthcare Ethics, Anna Smajor, of Imperial College, London, contends that it is unfair for women to be "the sole risk takers in reproductive enterprises". Although in vitro babies is a scenario straight out of Aldous Huxley's Brave New World, Dr Smajor points out that the window of time required for pregnancy is shrinking all the time. Embryos can be grown in Petri dishes for at least two weeks, and babies are viable at 21 weeks. So ectogenesis looks as though it could be viable.

How about her arguments for a process which she acknowledges has a big "yuk factor"? Are they also viable? Her first point is that "pregnancy is barbaric". It is unjust that half of the population undergo its dangers to renew the population. An injustice calls for a remedy. Second, pregnancy "often takes a serious toll on [women's] autonomy". Ectogenesis would provide this.

Furthermore, nine months in a test tube would be unlikely to affect children. If one were to say that gestation is needed for a mother to bond with a child, all step- and adoptive parents would be insulted. "Physical gestation of a child is thus neither necessary nor sufficient for the development of a loving parental bond," she says.

What importance should society give to ectogenesis as a social need? Dr Smajor is realistic: at the moment its chances of becoming a top priority for government welfare funding is small. But the day may come: "just as it was thought absurd that women should vote or ride horses astride, so it may come to seem absurd that they were chained to the degrading and dangerous processes of pregnancy and childbirth simply because of our inability to get our heads round the possibility of an alternative." ~ Cambridge Quarterly of Healthcare Ethics, July   

"ASHLEY TREATMENT" ILLEGAL, SAYS REPORT

Ashley X The Seattle hospital where a profoundly disabled girl received the controversial "Ashley Treatment" broke the law, says group which conducted an official investigation into the procedure.

The Washington Protection and Advocacy System (WPAS), which represents people with disabilities, found that Seattle Children's Hospital and Regional Medical Center violated the constitutional and common law rights of six-year-old Ashley by performing a hysterectomy without a court order.

The hospital has acknowledged its error, but blames the slip on flawed legal advice obtained by the parents. The case became known after the doctors involved published an article in a medical journal describing the procedure.

Ashley, or the "pillow angel", as her parents call her, has static encephalopathy, a severe brain impairment. She cannot walk, talk or swallow food. Her mental age is measured in months rather than years. To make it easier for her parents to care for her, the doctors at the hospital surgically removed her breast buds, her uterus and her appendix.

On a bioethics listserv, the bioethicist who consulted on the case, Dr Douglas S. Diekema, expressed his exasperation with the opinion of the WPAS. Its report, he says, only shows that the treatment may have been illegal, not unethical. In his opinion the notion that a court order should be sought for all medical procedures on developmentally disable children is absurd. By the same reasoning, he says, many similar operations on these children would require court intervention. "That's starting to look like a lot of court orders and sends a message of incredible disrespect to the parents of these kids," he writes. ~ CNN.com, May 8; Bioethics Discussion Blog, May 11   

MORALITY IS ALL IN THE BRAIN, SAY RESEARCHERS

Neuroscientists believe that they have discovered a biological basis for morality. If certain brain cells are knocked out with an aneurism or a tumour, the ability to think straight about some issues of right and wrong is permanently skewed. "It tells us there is some neurobiological basis for morality," said Harvard philosophy student Liane Young, who helped to conceive the experiment.

The neuroscientists studied people who had injured an area that links emotion to cognition which is located in the ventromedial prefrontal cortex several inches behind the brow. When they were asked to consider hypothetical moral dilemmas which involved taking one life to save others, they felt no compunction whatsoever.

The experiment highlighted the importance of unconscious empathy and emotion in guiding decisions, the scientists contend. "When that influence is missing," said University of Southern California neuroscientist Antonio Damasio, "pure reason is set free."

This suggests to Harvard neuroscientist Marc Hauser that the brain is hard-wired for morality. He says that most moral intuitions are unconscious, involuntary and universal, based on surveys of thousands of people in hundreds of countries. He feels that this may proves a shared innate capacity for morality.

While this might sound comforting to some moralists, it could become a revolutionary concept if it were linked to ethical theories which argue that humans are destined to transcend their biology. What if we could transcend our biological revulsion at assassination or suicide bombing? It could be very useful to certain groups. ~ Wall Street Journal, May 11   

D-DAY FOR EMBRYONIC STEM CELLS

D-Day is approaching for embryonic stem cells, says the CEO of Geron, Tom Okarma. The world's first clinical trial will begin early next year on patients with spinal cord injury in six trauma centres across the US.

Because of the intense scrutiny that these trials are sure to receive from the US Food and Drug Administration, from the media, and from hostile critics of the ethically contentious technology, extensive preparatory work has taken place. Animal tests have already showed that nerve cells grown from human embryonic stem cells can repair spinal cord injuries in rats. "Paralysed rats can walk again," says the Financial Times, although this has been disputed by critics.

Mr Okarma claims that rapid progress has been made since human embryonic stem cells were first isolated in 1998. Even more ground could have been covered except for the intransigence of the Bush Administration. However, he and his supporters are wary of raising public expectations too high. Hans Kierstead, head of the embryonic stem cell team at University of California Irvine, says: "I find it unfair that people demand so much from such a young field. Just look at the strides we have already made."

And Bob Klein, the chairman of the California Institute for Regenerative Medicine, which has been authorised to a spend at least $3 billion over 10 years on stem cell research, told the BIO biotechnology conference in Boston recently that good spin doctors would be needed to put across the right message in the event of setbacks.

The ideological right is not asleep," said Mr Klein. "They will be prepared to spin [any problems] to promote their opposition to embryonic stem cell research, and we'll need a sophisticated fast- response messaging team to put across our message." ~ Financial Times, May 9   

EGG MARKET GROWS IN US

The average payment in the US for egg donation was US$4,217, according to a recent article in the journal Fertility and Sterility. However, at least one centre told the authors that it paid $15,000 for eggs and stories abound of college students being paid tens of thousands of dollars. The American Society of Reproductive Medicine has set guidelines which stipulate that payments of $5,000 or more "require justification" and that payments over $10,000 are not appropriate.

No one is comfortable with payments for eggs, an invasive and uncomfortable process at best, and painful and dangerous at worst. Little research has been done on the long-term effects of fertility drugs.

Bioethicists also worry whether the allure of dollars to cover college fees or credit card bills might cloud young women's judgement. "We hear about egg donors being paid enormous amounts of money, $50,000 or $60,000," Josephine Johnston, of The Hastings Center told the New York Times. "How much is that person actually giving informed consent about the medical procedure and really listening and thinking as it's being described and its risks are explained?"

The problem is that without compensation, women are unlikely to donate eggs, either for fertility treatment or for research. "I just completed an outreach initiative to 21 institutions across the state that we've funded," Dr Geoffrey Lomax, of the Institute of Medicine, said. "No one has had an egg donated specifically for research." ~ New York Times, May 15   

 

  

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Australasian Bioethics Information
ISSN 1446-2117
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BioEdge editor: Michael Cook
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