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July 31, 2007

Handprints on a Wall

This is true compassion: The George Mark Children’s House of San Leandro, California (SF Bay Area), is the first freestanding hospice and respite center for children in the country (as hard as that is to believe). This new approach to pediatric end-of-life care has expanded the approaches to cherishing and caring for dying children. From the story in the Tri Valley Herald:

Painted handprints cover the wall of a room as a reminder of the many children who have come here to die. Most of the rooms at George Mark Children’s House, the country’s first freestanding pediatric hospice dedicated to helping children and their families cope with untimely death, have murals. But this mural is special because the kids have done it themselves–imprints left to keep their memories forever alive, even though they had reached the end of their own lives. “It’s a way for us to remember the child,” said Teri Rose, a spokeswoman for George Mark…

One of the reasons George Mark has gained so much recognition while still in its early stages is because of its unique approach to hospice care. Until now, most terminally ill children have had only two options when it comes to respite care, family therapy or grief support: staying at a hospital or at home.

But George Mark, which models its philosophy after similar facilities in England and Canada, takes end-of-life care to another level by offering a nurturing environment where the children can receive high-quality care while their families are able take a break from the nonstop responsibility of home care. Families are asked to pay what they can, but the rest is covered by private donors. “What we provide for families is that continuum of care that meets them in the middle of the hospital and the home,” Hull said.

More of this, please.

Killed For Organs?

One of the greatest fears among the general public about transplant medicine is that the sickest patients will not be viewed as people so much as organ farms, and indeed, that patients may be euthanized in order to gain access to their organs. Now, a San Francisco transplant surgeon is charged with doing just that. From the story:

A San Francisco transplant surgeon was charged Monday with prescribing overdoses of medication to speed up the death of a man at a San Luis Obispo hospital and harvest his organs.

Dr. Hootan Roozrokh, 33, prescribed excessive amounts of morphine and Ativan and injected the topical antiseptic Betadine into Ruben Navarro’s stomach in February 2006, prosecutors in San Luis Obispo County said. Navarro, 26, who was severely disabled mentally and physically, had suffered respiratory and cardiac arrest and had been taken off life support, authorities said.

The intended donation would have been an example of a “non-heart beating cadaver donor protocol,” under which life support is removed and if a patient goes into cardiac arrest, several minutes after death the organs are procured. However, if the patient doesn’t die within thirty minutes or an hour of life support removal, then the patient is to be reconnected to treatment and removed permanently from eligibility for organ donation. From what I can tell, this may be why the overdose was administered–to get him dead within the time limit–since the patient in this case died eight hours after removal of life support.

One of the supposedly iron-clad protocols to ensure ethical treatment of the living patient is that the transplant team is to have no involvement with the patient’s care prior to death. If Dr. Roozrrokh violated this fundamental and easy-to-understand rule–even if he didn’t intend to hasten the patient’s death–his license to practice medicine should be on the line.

Dr. Roozrokh denies all wrongdoing, but if this charge is true, he not only contributed to the death of a patient, but also will have caused tremendous harm to the people’s trust in transplant medicine.

Embryo ethics: Couples with leftover fertilized eggs face moral, political dilemma

Like thousands of other couples who go through in vitro fertilization each year, the Vancelettes have decided not to decide. They’ve reluctantly found themselves at the center of an explosive political and moral debate about the status of embryos — one that pits President Bush and two of the nation’s largest religious groups against a majority of Americans who favor using human embryos to develop cures for diseases. (Merced Sun-Star)

Death and dying: When is it time to let go?

End-of-life issues top the list of ethical dilemmas hospitals face as medical progress enables doctors to extend an endangered life to the hard-to-determine point where they may actually only be dragging out death. (CNN)

The spare-part baby boom, as MPs review test-tube laws

The creation of “spare part babies” could become more widespread following a report from MPs. (Daily Mail)

Why some sufferers choose suicide

For some Canadians with MS, the good death has meant leaving the country to seek an assisted suicide. (Globe and Mail)

Adult Stem Cell Research Puts Patients First, Proponents Say

Doctors and patients who have been involved in medical treatments derived from “adult” stem cells say they back federal legislation to promote such research — because “this stuff works.” (CNS.com)

Op-Ed: Senate Health Reform: Paying More to Help Fewer

Among other proposals, the Senate is eying two plans to provide health coverage to those currently lacking insurance. Plan 1 would extend coverage to around 4 million Americans for billions of dollars. Plan 2 would extend coverage to 24 million for no more than we’re spending now. Guess which approach Senate leaders are pushing? (Heritage Foundation)

A new issue of Pediatric Transplantation

As pre-released online. Full content is available by subscription only.

Original Articles

“Heart transplantation: Literature review” by Elfriede Pahl

A new issue of Developing World

As pre-released online. Full content is available by subscription only.

Original Articles

“Global Health Ethics for Students” by Andrew D. Pinto and Ross E.G. Upshur

July 30, 2007

Preview of Coming Attractions: The Push to Permit Reproductive Cloning


The big secret that the media rarely address is that many bioethicists and bioscientists actually support reproductive cloning. Yes, yes, I know: Most scientific organizations, such as the NAS, and big-name bioethicists currently oppose permitting a cloned embryo to be implanted and gestated to birth. But this opposition isn’t generally based on principled moral objections to cloning as a form of reproduction (replication). To the contrary: Many believe there is a fundamental right to reproduce by any means desired or necessary. Thus, objections among this camp are based on safety concerns. Currently, animal cloning is very inefficient, also leading to many miscarriages, birth defects, and the deaths of birth mothers.

Still, even now there are calls in some quarters to damn the safety concerns and go full speed ahead with permitting reproductive cloning. One such advocacy piece, “Let’s Legalize Cloning,” appeared in the July 18 New Scientist (no link available). Written by University of Glasgow bioethicist Hugh McLachlan, we are told that even safety should cause us little concern. He writes:

We know from animal cloning studies that the risks to the mother and the baby are likely to be very high, although they may diminish as the technique is perfected. Yet in other areas of reproduction (or life in general) safety alone is not seen as sufficient grounds to make something illegal. The risks should be explained to the prospective mother, and she should then have the right to decide for herself, as with any other medical procedure, whether to accept them.

The potential baby, of course, cannot give consent. There may be an increased risk of miscarriage or being born with a deformity, but for people born as a result of cloning, it is their only chance of life. Cloning is therefore not a risk but an opportunity. If you could only have been born as a clone, with the risks that entails, would you have wanted your life to have been prevented? I would say loudly: no.

The idea that cloning presents an “opportunity” for the nonexistent to become existent seems close to some religious doctrines about married couples having a duty to bring babies into the world. That point aside, non-existent beings have no right to come into existence, and if they don’t, they will never know it, because there will never be a “they” to know that they don’t exist.
Whew.

Moreover, notice the sheer indifference to the pain and suffering that would be caused, miscarriages, abortions, and human experimentation that would be involved in such an endeavor. To make cloning “safe” would require repeated creation of cloned embryos to study why gene expression is defective. It would require implantation and abortion to learn why some cloned fetuses develop with defects or in such a way as to endanger the birth mother. And it would require the surviving babies to be studied throughout their lives to determine whether they exhibit later resulting health or developmental difficulties. In other words, it would be to treat some people as experiments.

But when one’s philosophy denies the intrinsic value of human life–and the primary impetus in “ethics” becomes anything goes to fulfill wants and desires–advocacy such as McLachlan’s is entirely logical. This is why I don’t view him as a fringe rider, but merely a candid harbinger of things to come.

A new issue of Clinical Transplantation

As pre-released online. Full content is available by subscription only.

Case Reports

“Reuse of liver graft from a brain dead recipient” by Otmane Nafidi, Richard Letourneau, Bernard E. Willems and Real W. Lapointe

Original Articles

“Intracellular ATP concentrations of CD4 cells in kidney transplant patients with and without infection” by Pablo Sánchez-Velasco, Emilio Rodrigo, Rosalía Valero, Juan Carlos Ruiz, Gema Fernández-Fresnedo, Marcos López-Hoyos, Celestino Piñera, Rosa Palomar, Francisco Leyva-Cobián and Manuel Arias

A new issue of Journal of the American Geriatrics

As pre-released online. Full content is available by subscription only.

“Measuring the Quality of Dying in Long-Term Care” by Jean C. Munn, PhD, Sheryl Zimmerman, PhD, Laura C. Hanson, MD, MPH, Christianna S. Williams, PhD, Philip D. Sloane, MD, MPH, Elizabeth C. Clipp, PhD, RN, James A. Tulsky, MD, and Karen E. Steinhauser, PhD

Sending Back the Doctor’s Bill

Easy, liberals say. If Washington would just force cuts in prescription drug prices and insurance company profits, plenty of money would be left over to cover the uninsured. (New York Times)

Miracle on ice: Freezing time to save lives

Everyone in the operating room has just taken a deep breath. Gary K. Steinberg, M.D., Ph.D., the diminutive 54-year-old head of neurosurgery here at Stanford University medical center, looks up at his anesthesiologist. (MSNBC)

Nanogenerator Could Draw Energy from Human Blood

Scientists are working on a new type of nanogenerator that could draw the necessary energy from flowing blood in the human body, by using the beating heart and pulsating blood vessels. Once completed, this new cellular engine could find various applications, even beyond medicine. (Softpedia)

Freezing our future

Frozen ova may be the ‘bright new dawn in reproductive medicine’, writes Amanda Hooton. But we mustn’t count our chickens too soon. (Stuff.co.nz)

Living in the realm of spooks and spoofs

CityWatcher.com, a surveillance equipment provider in the US, attracted attention a year ago, when two of its employees had glass-encapsulated microchips with miniature antennas embedded in their arms. (IOL)

Op-Ed: Phoney organ maketh a man

Human are tool-using animals and have been for some time. Current estimates have our ancestors making simple stone tools about 2.5 million years ago. Back then, our forebears would have looked rather different to modern humans. Standing about 130 centimetres, they had a smaller skull (and a smaller brain) and were covered in fur. One key similarity is that they stood on two feet. In evolutionary terms, this is very important as it left the hands free to make and use tools. (The Age)

South Africa: Avoiding Slippery Slope of Drug-Rationing Debate

INTERNATIONAL medical and public health journals contain a growing body of writing on the practical and ethical implications of the rationing of antiretroviral (ARV) treatment around the world. The brief title of one important article neatly encapsulates the dilemma facing health profes- sionals: “Which patients first?” (allAfrica.com)

Future of Stem Cell Tests May Hang on Defining Embryo Harm

With the active encouragement of the Bush administration, U.S. scientists in the past year have developed several methods for creating embryonic stem cells without having to destroy human embryos. (Washington Post)

 

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