This is worse than awful: A 54 day old baby was sexually abused and beaten to death by her father. Yet during her brief life 30 different health care workers cared for her, and somehow didn’t notice a thing. Plus, her mother is schizophrenic, which should have triggered a referral to social services–but didn’t. From the story:

A report has revealed that Jessica, whose mother was schizophrenic, spent nearly half her life in hospital. She was seen by 30 health workers and had also been seen at home on 10 separate occasions. Yet no one noticed what was happening, so the emergency child protection procedures that could have led to her being removed from her family were not triggered…

He had abused and sexually assaulted Jessica, who was born five weeks prematurely with a heart defect, from “the moment she left hospital”…At one stage he forced three fingers down his daughter’s throat and on other occasions held her arms and legs and twisted her as if he were wringing a cloth…

He said Jessica was last seen at the hospital a few days before she died, when she was admitted because she was twitching. Dr O’Malley said the doctor who saw her suspected she was being abused but did not include an “extensive account” of those suspicions in his notes because he felt his examinations of her ruled it out.

I read the UK papers every day and they are filled continually with stories of medical malfeasance and misfeasance, of filthy hospitals, personnel shortages, failed efforts at improvement, not to mention rationing and futile care impositions. The NHS is in chaos. Surely the time has come for the UK to try a different route.

Good news in the Golubchuk case. The court has enjoined the hospital from cutting off Mr G’s treatment. But there will be a trial. But that is how it should be: Let these doctors and bioethicists justify themselves in open court in front of the press and the world and be subjected to cross examination. Let the Golubchuck family present their own evidence. An open proceeding with transparency and the right of appeal sure beats unilateral termination of treatment and decision making behind closed doors.

I have warned that “personhood theory” will lead to terrible oppression of so-called human non persons. It allows cloning for the purpose of treating created human organism as a corn crop. It permits us to dehydrate people to death based on their once having made vague statements about not wanting to live with profound cognitive disability, and it is the ideological basis for denying wanted medical treatment that sustains life. In short, it is the prescription for medical oppression in which people deemed to be without sufficient cognitive capacities become almost the equivalent of the dead and the value of their lives is stripped from them like the medals from a Foreign Legion soldier being kicked out of the corps. At that point, their only remaining task is to die and get out of the way–or perhaps become fodder for experimentation or organ procurement. But don’t say that these futilitarians aren’t compassionate: They will provide comfort care as they make sure you die from their medical neglect. (Big of them.)

Lest you think I overstate, lest you think I caricature those with whom I disagree on this issue, check out this opinion article in the Winnipeg Free Press from a bioethicist named Arthur Schafer in support of forcing Samuel Golobchuk off of life support. From his column:

Inevitably, doctors are the gatekeepers for patient access to medical resources. You can’t obtain restricted medicines unless a doctor is willing to write a prescription; you can’t gain admission to hospital unless a doctor decides that you will benefit thereby. There is a scarcity of intensive care beds; so, to admit or keep patients in the ICU who cannot benefit is to rob others who could benefit. Put simply, one person’s provision is another person’s deprivation. It’s unethical to waste scarce life-saving resources.

If a patient will never again know who or where he is, as appears to be the case for Golobchuk, then to artificially prolong his breathing seems at best a waste of precious ICU resources and at worst a cruel ordeal for the patient. Doctors and nurses are not simply technicians providing marketplace services to customers. They are health-care professionals who are bound by the ethical obligation “first of all, do no harm.” When a patient has irreversibly lost self-awareness, then using medical high technology in a vain attempt to resist death is often experienced by doctors and nurses as both unprofessional and deeply demoralizing. Physician integrity includes the right, even the duty, to say “no” when treatments offer no genuine benefit to the patient.

Forget for the moment the many times doctors have been wrong about people never regaining consciousness. Schafer is the one de-professionalizing medicine. A plumber can refuse to unclog a pipe, but a doctor has no right to abandon his or her patient. Moreover, Schafer wants doctors to impose their value judgments–as instructed in continuing education clases by bioethicists like Schafer–that the burden of treatment isn’t worth the benefit of continuing to live. But that isn’t a medical judgment, it is a value judgment that we have always been told resides with the patient and family. Moreover, the treatment isn’t being stopped because it doesn’t or might not work but because it does or will–and hence it is not really a “vain attempt to resist death,” but a potentially successful one. And thus it is really the patient who has been declared futile.

Schafer says that staying alive when that is what the patient wants offers no genuine benefit to the patient. He only has the right to make that claim for himself, not for Mr. Golobchuck, you, me, or anyone else. You are watching the redefining of the ultimate purpose of medicine before your very eyes. It isn’t keeping patients alive who want to live, it is treating those who can be cured and reserving the right to refuse service to those who probably won’t improve.

This is what socialized medicine–and its’ private equivalent the HMO–creates. Medical futility is health care rationing that pits one cadre of patients against others, leading to division and discord. It is the end of trust in medicine because if you are too sick or profoundly disabled, medicine wants little to do with you.

Finally, if Futile Care Theory prevails, what in the world makes anyone think that the forced removal of people from wanted treatment will stop at the ICU? People who only need feeding tubes will soon be dehydrated (if they are not lethally injected first), and care will be rationed based on other criteria. For example, as reported in my books, I once asked a futilitiarian what would come after futile care, since cutting off the dying would not save a lot of money. He immediately said restricting “marginally beneficial care.” I asked for an example. He responded, “An 80-year-old woman who wants a mammagram.”

Be afraid. Be very afraid.

A new implantable device can extract stem cells for therapeutic transplant or program cancer cells to die. (Technology Review)

The state’s largest for-profit health insurer is asking California physicians to look for conditions it can use to cancel their new patients’ medical coverage. (Los Angeles Times)

Are embryos morally equal to people? I say no. Robert George, a member of President Bush’s bioethics council, and his colleague Christopher Tollefsen say yes. In their new book, Embryo: A Defense of Human Life, George and Tollefsen conclude not only that embryo-destructive stem-cell research should be defunded but that any research involving embryos should be banned if it even slightly risks an embryo’s health. They propose to halt the common practice of producing extra embryos during in vitro fertilization and to require that every IVF embryo be transferred to a womb. (Slate Magazine)

Kyoto University Prof. Shinya Yamanaka, who has attracted the world’s attention with his research on induced pluripotent stem (iPS) cells, discussed the significance and implications of his work in a recent interview with The Yomiuri Shimbun. (The Daily Yomiuri)

Only about a third of U.S. medical schools have policies aimed at curbing conflicts of interest arising from their financial ties with companies like drug and medical device makers, researchers said on Tuesday. (Yahoo! News)

Geron CEO plans embryonic stem cell tests in humans this spring if the biotech meets the FDA’s ‘high bar.’ (CNNMoney)