BioEdge 255 -- Wednesday, 27 June 2007

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BioEdge 255: Why deny the depressed their right to suicide?

THIS WEEK


bullet 
Why deny the depressed their right to suicide?
      They need to be released from mental suffering
bullet 
Suicide increasing worldwide
      1 million each year
bullet 
"Manimals" could be next step in medical research
      Saletan predicts new developments
bullet 
Scientists need hybrids, says Lutheran theologian
      Nature opens new stem cell site
bullet 
Hybrids have a right to live, say Catholic bishops
      ... just like other embryos
bullet 
Vegetative state often misdiagnosed
      Doctors are not getting better at it, either
bullet 
Hwang trying to restore his reputation
      But editors are sceptical
bullet 
Indian doctors call for medical ethics syllabus
      Recent cases ring alarm bells
bullet 
IN BRIEF: uninhabited; public support; disasters

WHY DENY THE DEPRESSED THEIR RIGHT TO SUICIDE?

One of America's leading bioethics journals features a strong argument for assisted suicide for the mentally ill in its latest issue. Jacob M. Appel, a short story writer and lawyer who writes on bioethics, contends in the Hastings Center Report that "the principles favouring legal assisted suicide lead logically to the extension of these rights to some mentally ill patients". In Switzerland this is already the case. In November last year the high tribunal in Lausanne set down guidelines for people with "incurable, permanent, severe psychological disorders" who want to terminate their own lives.

Mr Appel argues that that victims of depression or psychosis can make a rational choice about whether to end their lives, though given "the finality of a life-terminating decision", the bar for assessing competence should be set higher. "If the values championed by assisted suicide advocates are maximimisation of autonomy and minimisation of suffering -- even when they conflict with the extension of life -- then it follows that chronically depressed, competent individuals would be ideal candidates for the procedure," he asserts.

However, this could place psychiatrists in a particularly difficult situation, he warns. At the moment, contemporary psychiatry is committed to suicide prevention. Hence a psychiatrist would have to choose between acceding to a patient's legitimate request and the unreasonable standards of his colleagues. To get around this, Appel suggests the use of "full-time thanatologists [a specialist in death] specially trained for the act". ~ Hastings Center Report, May-June   

SUICIDE INCREASING WORLDWIDE

internet suicide According to a feature on suicide in the Economist, the global suicide rate has risen by 60% over the past 45 years, with about one million people killing themselves each year. However, it is exceedingly difficult to generalise about suicide, as the pattern varies markedly from country to country. In India, much publicity has been given to suicides by farmers -- 17,000 died by their own hand in 2003 alone. But in India's suicide capital, Bengalooru (Bangalore), most are skilled workers. In China, more women kill themselves than men, unlike most other countries.

In recent years the internet has made it easier for potential suicides to plan their demise. The first recorded case of using it to make a suicide pact took place in 2000 in Japan. Since then hundreds have done so, from Norway to Spain.

The Economist commends measures to make it harder for people to kill themselves, from barriers in front of trains in Korea, to policing the web in Australia, to limiting the use of paracetamol, which can be lethal in large quantities, in the UK. These can "save the lives of many who are confused, temporarily depressed or in need of sympathetic attention". ~ Economist, Jun 21   

"MANIMALS" COULD BE NEXT STEP IN MEDICAL RESEARCH

Chimeric mice "Manimals" are around the corner, according to the bioethics writer for the Washington Post and Slate, William Saletan. In an update on scientists' progress towards creating animals with varying degrees of human characteristics, he points out that "the more you humanise animals, the better they serve their purpose as lab models of humanity. That's what scary about species mixing. It's not some crazy Frankenstein project. It's the future of medicine."

Saletan points out that at Stanford, where human brain stem cells have already been inserted into foetal mice, even more ambitious projects are afoot. Ethicists there have tentatively endorsed the notion of humanised mouse brains. Even endowing mice with "some aspects of human consciousness or some human cognitive abilities" might prove useful. The UK's Academy of Medical Sciences and the US National Academy of Sciences have refused to permanently restrict the humanisation of animals. ~ Washington Post, Jun 24   

SCIENTISTS NEED HYBRIDS, SAYS LUTHERAN THEOLOGIAN

Nature has launched a new website dedicated to news and views about stem cells. "Our goal is enlighten and promote communication in stem cell research by providing content as diverse as the stakeholders in this field -- all the scientists, policy makers, ethicists, clinicians, and patients who are driving stem cell research forward," says Nature Reports Stem Cells.

Apart from serving as a way of keeping non-specialists and lay readers up to date, the site also seems committed to promoting embryonic stem cell research. One of its first comment pieces come from a Lutheran theologian who offers a theological justification for chimeras. Ted Peters, of Pacific Lutheran Theological Seminary and the Graduate Theological Union in Berkeley, finds that reasons offered by Catholics and Evangelicals are insufficient to proscribe the creation of chimeric human embryonic stem cells.

The "yuck factor", he feels, also fails in the face of the great possible good from this research. He even finds that arguments against the creation of hybrid creatures are "weak", although for the moment, this would be unwise. "When more is known, such a policy could be revised." ~ Nature Reports Stem Cells   

HYBRIDS HAVE A RIGHT TO LIVE, SAY CATHOLIC BISHOPS

Coming from a different angle, the Catholic bishops of England and Wales have told a parliamentary committee that human-animal hybrid embryos conceived in the laboratory should be regarded as human and their mothers should be allowed to give birth to them. The government is currently studying legislation which will allow the creation of chimeric embryos so long as they are destroyed within 14 days. However, the bishops do not see why "interspecies" embryos should be treated any differently than others.

In their submission to the committee, they said: "At the very least, embryos with a preponderance of human genes should be assumed to be embryonic human beings, and should be treated accordingly. In particular, it should not be a crime to transfer them, or other human embryos, to the body of the woman providing the ovum, in cases where a human ovum has been used to create them. Such a woman is the genetic mother, or partial mother, of the embryo; should she have a change of heart and wish to carry her child to term, she should not be prevented from doing so."

However, the bishops still oppose the creation of chimeras -- and most of the other provisions in the proposed legislation -- as a violation of human rights. ~ London Telegraph, Jun 27   

VEGETATIVE STATE OFTEN MISDIAGNOSED

Doctors should use extreme caution in pulling the plug on patients in a vegetative state, according to reports presented at the European Neurological Society.

Around 40% of patients in a Belgian study were wrongly diagnosed as being in a vegetative state when they were minimally conscious. And 10% of minimally conscious patients were actually communicating functionally. Furthermore, they found a strong tendency to underestimate levels of consciousness in brain injury patients. The level of misdiagnosis has not decreased in the last 15 years, says Dr Steven Laureys, from the University of Liège, in Belgium.

About one-fourth of patients who arrive at hospital in an acute vegetative state have a good chance of recovering a significant proportion of their faculties. And up to a half will regain some level of consciousness. Younger patients usually have a better prognosis.

People suffering traumatic brain injuries have a much better chance of some recovery. Some 70% of those with traumatic injuries were restored to some level of consciousness. People with non-traumatic injuries, such as oxygen deprivation, fared much worse. Only 36% in the study achieved comparable recovery.

"Our data show that acute vegetative state is certainly not rare among patients admitted to intensive care", says Dr Laureys. "What is important to note is that it may be transient and that the prognosis for patients with impaired consciousness depends to a great extent on the nature of the brain damage."

The study thus concluded that many doctors' diagnostic skills remain poor and the level of misdiagnosis has not decreased in the last 15 years. "The study showed how very hard it is to disentangle the minimally conscious state from the vegetative state", says Dr Laureys. ~ News-Medical.Net, Jun 20   

HWANG TRYING TO RESTORE HIS REPUTATION

Working days, nights and weekends, with criminal charges hanging over his head, disgraced stem cell scientist Hwang Woo-suk is trying to climb the steep hill to rehabilitation. Assisted by a team of 30 in a private lab south of Seoul, he is working on cloning animal embryos. A colleague told AP that he dreams of working with cloned human embryos again. "There are many good research results that we want to boast about," she says.

However, editors of leading journals are cautious. "Any submission form Dr Hwang would take into consideration the irreparable harm that his previous misconduct has inflicted on the scientific enterprise," says Monica Bradford, executive editor of Science, one of the journals duped by the Korean. And Curt Civin, editor of Stem Cells, who was also a victim of his fraud, says that he would worry about recidivism.

Somewhat surprisingly, Harvard researcher George Daley told an international meeting of stem cell scientists in Australia recently that Hwang's research was genuinely original. He had been the first to create stem cell lines from a parthenote, an activated, unfertilised egg. ~ AP, Jun 21; Nature Reports Stem Cells blog, Jun 18   

INDIAN DOCTORS CALL FOR MEDICAL ETHICS SYLLABUS

A recent scandal has brought to light the fact that most Indian doctors are not taught medical ethics. A doctor in Tamil Nadu allowed his 15-year-old son to perform a Caesarean section, outraging his colleagues. With cases like this emerging, private and government medical schools believe that a structured medical ethics curriculum may be needed. However, a proposal from the Medical Council of India to do this has been gathering dust health ministry for three years. It advises that entering students should spend their first three months learning medical ethics, computers and communicative English. ~ Times of India, Jun 22   

IN BRIEF: uninhabited; public support; disasters

Uninhabited: What would happen if mankind were to vanish from Planet Earth? An answer is given in a new book by US journalist Alan Weisman, The World Without Us. He says that the concrete jungle of New York City would eventually revert to a real forest. An entertaining video summary is available here.

Public support: About 60% of people with embryos frozen in US fertility clinics would be willing to donate them for human stem cell research, according to a survey in the journal Science by researchers at Duke University and Johns Hopkins University. About 28% would be willing to donate embryos to improve cloning techniques. ~ Reuters, Jun 20

Prepare for the worst: The American Medical Association has launched a new journal for a new discipline: disaster medicine, to be called Disaster Medicine and Public Health Preparedness. The inaugural issue features Hurricane Katrina, the Oklahoma City bombing, and "lifeboat ethics". ~ WSJ health blog, Jun 21   

  

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Australasian Bioethics Information
ISSN 1446-2117
Website:www.australasianbioethics.org
BioEdge editor: Michael Cook
New Zealand Contributing Editor: Carolyn Moynihan


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