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March 31, 2008

The Nuffield Council on Bioethics Public Lecture 2008

“The ranking of values as a basis for ethical decision making”
By Professor Göran Hermerén, Chair of the European Group on Ethics and Professor of Medical Ethics, University of Lund

Wednesday 7th May 2008 at 6.30pm to be followed by a drinks reception (registration and refreshments available from 6.00pm)
The Royal Society, 6-9 Carlton House Terrace, London SW1Y 5AG [Free, all welcome]

The Nuffield Council on Bioethics bases the conclusions of its reports on ethical principles in combination with the best scientific evidence available. In this lecture, the internationally renowned philosopher Professor Göran Hermerén will argue that these ethical principles have to be based on values of various kinds, and that the challenge is not only to clarify the meaning and application of these values but also to rank them in order of importance. He will use the current debate on interspecies embryo research to illustrate his approach and will consider the notion of European values in an age of globalisation.

To book your place, please contact: Carol Perkins, (+44 20 7681 9619), cperkins@nuffieldbioethics.org

Another Suicide Machine Makes News

The media is abuzz about the creation of a “suicide machine” by a Swiss doctor that let’s people kill themselves at the push of a button. Amazing times in which we live, no? But this is hardly new. Even though he sought a license to engage in human vivisection, Jack Kevorkian broke through to international celebrity with his suicide machine. Why, the media so loved Kevorkian in his prime that Time invited him to its 75th anniversary party where Tom Cruise rushed up to shake his hand!

Phillip Nitschke, Australia’s “Dr Death,” also invented a suicide machine where the despairing pushed a button on a computer. He has also invented the “peaceful pill,” a concoction of common household ingredients that can be used to end life. (The media has quivered over this, but they don’t ask how it was tested. Did Nitschke kill animals, for example? Inquiring minds want to know.)

Then there is the Nu Tech crowd led by Derek Humphry with their suicide machines such as the “debreather” and his instruction in the use of helium and a plastic bag to plunge into the great beyond.

And who can forget the Church of Euthanasia? And the ongoing Internet suicide pacts?

So, this suicide obsession is hardly news. But it should cause us all to ponder why there is so much interest and fascination with self destruction. I think the Canadian journalist Andrew Coyne put it best years ago when he wrote in the Globe and Mail in 1994:

A society that believes in nothing can offer no argument even against death. A culture that has lost its faith in life cannot comprehend why it should be endured.

Or to put it another way, paraphrasing the Buffalo Springfield classic: Nihilism strikes deep/Into your heart it will creep…

Language Enginieering: Joel Connelly Gets It on Initiative 1000:

The Seattle PI columnist Joel Connelly is a refreshing exception to much of the media that continue to see assisted suicide as a modernistic “choice” issue rather than one founded in abandonment and inequality. He has a column today (for which I was interviewed) properly critical of the word engineering in which the “Death with Dignity” crowd engages to persuade people that hemlock is really honey. From his column:

If you are campaigning for the “right” of people to kill themselves, the first challenge is finding a nonlethal definition: Soft, reassuring terms must be substituted for the off-putting phrase “assisted suicide.”…

Apparently Gardner and political consultants advising him never met Derek Humphrey, plain-spoken co-founder of the Hemlock Society.”As the author of four books on the right to choose to die, including ‘Final Exit,’ I find the vacillation by (Oregon’s) Department of Human Services on how to describe the act of a physician helping a terminally ill person to die by handing them a lethal overdose–which they can choose to drink (or not)–an affront to the English language,” Humphrey wrote to The Register Guard newspaper in Eugene, Ore. ” ‘Physician’ means a licensed M.D.; ‘assisted’ means helping; and ‘suicide’ means deliberately ending life. “The department’s cop-out choice of the words ‘death with dignity’ is wildly ambiguous and means anything you want. Let’s stick to the English language and in this matter call a spade a spade.”

That would be the approach for those respectful of democracy. But assisted suicide activists want to win, and are not about to let a little language deconstruction get in the way of their goal.

Then, there is the money:

Among local political consultants, I-1000 is becoming a cause to die for. The Yes-on-1000 Committee has shelled out more than $333,000, in increments of $10,000 to $50,000, to 12 consulting firms and consultants.

Prominent Democratic consultants are on the receiving end. J. Blair Butterworth, chief political adviser to former Gov. Gary Locke, has received $15,000. And Northwest Passage Consulting, headed by Sen. Maria Cantwell’s former campaign aide Christian Sinderman, has received $21,789. The list is growing. “Signature Gatherers Needed Immediately. Great $$$!” read an ad on Craigslist.com last week. A company, National Ballot Access, seeks paid signature gatherers for assisted suicide, promising 75 cents for each voter that signs the petition.

Gardner’s letter referenced by Connelly, which I discussed here at SHS, whines about all the money the opponents will spend to prevent “compassion.” But the reverse is actually true. Assisted suicide is primarily an elitist agenda. The primary advocates are almost all among the well tailored. Millions are being poured into the effort internationally, and hundreds of thousands from around the country into the Washington campaign–and that’s before Gardner opens his own wallet.

I have predicted that this measure will fail in the end. Perhaps that is my heart overruling my head. But there is so much bad about assisted suicide that it can be defeated, as it has repeatedly been in legislatures and voter initiatives since Oregan’s law passed in 1994.

The key, though, is getting the message out. We’ll see how it goes.

The Doping Dilemma

Naturally, most of us do not want to believe that any of these stellar athletes are guilty of doping. But the convergence of evidence leads me to conclude that in cycling, as well as in baseball, football, and track and field, most of the top competitors of the past two decades have been using performance-enhancing drugs. The time has come to ask not if but why. The reasons are threefold: first, better drugs, drug cocktails and drug-training regimens; second, an arms race consistently won by drug takers over drug testers; and third, a shift in many professional sports that has tipped the balance of incentives in favor of cheating and away from playing by the rules. (Scientific American)

The Curious Lives of Surrogates

Thousands of largely invisible American women have given birth to other people’s babies. Many are married to men in the military. (Newsweek)

Sweeps of Human DNA Yield Discoveries

Scientists are scanning human DNA with a precision and scope once unthinkable and rapidly finding genes linked to cancer, arthritis, diabetes and other diseases. (AP)

Mental Health Insurance Parity – The Murky Politics of Mind-Body

The debate lives on these days in less abstract form in the United States: How much of a difference should it make to health care — and health insurance — if a condition is physical or mental? (New York Times)

Stem Cells From Hair Follicles May Help ‘Grow’ New Blood Vessels

For a rich source of stem cells to be engineered into new blood vessels or skin tissue, clinicians may one day look no further than the hair on their patients’ heads, according to new research published earlier this month by University at Buffalo engineers. (ScienceDaily)

D.C. Plan Could Aid Uninsured

A D.C. Council member will propose a sweeping plan next week to mandate health-care coverage for all District residents by offering a city-subsidized program for the uninsured that would be funded through new taxes on health companies and cigarettes. (Washington Post)

Sir Leszek Borysiewicz says Church is wrong on hybrid embryo Bill

In an exclusive interview with The Times, Sir Leszek, chief executive of the Medical Research Council, said that in spite of Church teachings on the issue he saw nothing in the experiments or the plans by the Government to regulate them that was incompatible with his faith. (Times Online)

Mobile phone inventor dreams of human-embedded wireless

When Martin Cooper invented the mobile phone 35 years ago, he envisioned a world with people so wedded to wireless connections that they would walk around with devices embedded in their bodies. (ABC News)

March 30, 2008

“Hypsokilia:” Are Our New Doctors Poorly Trained?

A very interesting and disturbing article, written by medical school professor Dr. Herbert L. Fred, has been published in the Texas Heart Institute Journal. Dr. Fred warns warns that our medical students have a “laboratory oriented” rather than a “patient oriented” mindset due to poor training. From his article:

I call this malady hyposkillia–deficiency of clinical skills. By definition, those afflicted are ill-equipped to render good patient care. Yet, residency training programs across the country are graduating a growing number of these “hyposkilliacs”–physicians who cannot take an adequate medical history, cannot perform a reliable physical examination, cannot critically assess the information they gather, cannot create a sound management plan, have little reasoning power, and communicate poorly. Moreover, they rarely spend enough time to know their patients “through and through.” And because they are quick to treat everybody, they learn nothing about the natural history of disease.

These individuals, however, do become proficient at a number of things. They learn to order all kinds of tests and procedures–but don’t always know when to order or how to interpret them. They also learn to play the numbers game–treating a number or some other type of test result rather than the patient to whom the number or test result pertains. And by using so many sophisticated tests and procedures, they inevitably and unwittingly acquire a laboratory-oriented rather than a patient-oriented mindset. Contributing to this mindset, incidentally, are the health maintenance organizations that force physicians to care for a maximum number of patients, in a minimal number of minutes, for the lowest number of dollars.

That ain’t all:

The bottom line is this: While modern medical technology has greatly enhanced our ability to diagnose and treat disease, it has also promoted laziness–especially mental laziness–among many physicians. Habitual reliance on sophisticated medical gadgetry for diagnosis prevents physicians from using the most sophisticated, intricate machine they’ll ever and always have–the brain.

Tough stuff, but I think it is important for all of us to read the whole thing. Dr. Fred says, in essence, that the art of medicine is being tossed overboard. He goes into some of the societal causes of the problem about which he is warning and suggests some remedies.

I thank him for his courage in bringing this cause for concern to the attention of his colleagues and through the wonders of computer-downloading and linking, to all of us.

HT:Gerry Sotomayor

March 29, 2008

NHS Meltdown: Voucher System Experiment



The NHS is continuing to implode, and apparently some have seen that perhaps a private/public system is the answer. From the story:

Tens of thousands of NHS patients will be given money to pay for their own health care in a controversial “voucher” scheme under new government plans. Patients with a range of illnesses will have direct control of “individual health budgets”, allowing them to decide how to spend money at present allocated for them by the NHS.

It will be the most radical part of a wider policy, to be launched this week, to give patients more choice over their health care. From Tuesday, most of those referred for hospital treatment will be given a choice of more than 500 hospitals, including 160 private units, across the country. Under the “voucher” scheme, patients will not be given money directly, but will decide themselves how to spend sums normally administered by the NHS.

Well something had to be done. This is the first breath of hope I have seen for the NHS in some time.

Adult Stem Cells from Uterus Treat Parkinson’s in Mice

Well, the old days of “the scientists” such as some of the people over at Amendment 2 in Missouri telling reporters and legislators that adult stem cells are merely “unipotent,” that is, that they can only create their own kind of tissue, are beyond defending any more. Uterine stem cells have been injected into mice–and they grew new brain cells helping to ease the symptoms of Parkinson’s disease. From the story:

The injection of uterine stem cells trigger growth of new brain cells in mice with Parkinson’s disease, Yale School of Medicine researchers report in an abstract presented at the 2008 Society for Gynecologic Investigation (SGI) Annual Scientific Meeting held March 26-29 in San Diego, California. “Previously, we were able to coax these multipotent stem cells to differentiate into cartilage cells,” said lead author Hugh S. Taylor, M.D., professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine and section chief of Reproductive Endocrinology and Infertility at Yale School of Medicine. “Now we have found that we can turn uterine stem cells into neurons that can boost dopamine levels and partially correct the problem of Parkinson’s disease.” …

The stem cells in this study were derived from human endometrial stromal cells that were cultured under conditions that induce the creation of neurons. These cells then developed axon-like projections and cell bodies with a pyramid shape typical of neurons. “The dopamine levels in the mice increased once we transferred the stem cells into their brains,” Taylor said. “The implications of our findings are that women have a ready supply of stem cells that are easily obtained, are differentiable into other cell types, and have great potential use for other purposes.”

A few years ago, I watched,my mouth agape at the baldness of the mendacity, as a scientist in Missouri testified to a legislative committee that adult stem cells were merely unipotent. It wasn’t true then, and it is beyond any repeating now.

March 28, 2008

Dutch Doctors Turning to Terminal Sedation Over Euthanasia

Demonstrating the subversive nature of the euthanasia/assisted suicide movement on proper medical care, Dutch doctors are switching from lethally injecting patients to sedating them into a permanent coma so they die by dehydration over a period of days or weeks. This is the angle being taken in new proposals in CA and Vermont, demonstrating that what we are really dealing with here is a form of euthanasia. From the story:

Terminally-ill patients in the Netherlands increasingly receive drugs to render them unconscious until death, according to a study that suggests people are substituting deep sedation for legal euthanasia. The researchers found that 1,800 people–7.1 percent of all deaths in the Netherlands in 2005– were drugged into so-called continuous deep sedation shortly before dying. This compares with 5.6 percent of cases in 2001.

At the same time, the use of euthanasia fell from 2.6 percent of all deaths to 1.7 percent, representing a decrease of 1,200 cases, the researchers reported in the British Medical Journal on Friday. “The increased use of continuous deep sedation for patients nearing death in the Netherlands and the limited use of palliative consultation suggests that this practice is increasingly considered as part of a regular medical practice,” Judith Rietjens of Erasmus University Medical Center in Rotterdam and colleagues wrote.

I suspect that Dutch doctors are switching euthanasia methods because in formal euthanasia, they have to be present at the bedside at death, meaning they watch as the killing actions they take terminate life. With terminal sedation, they don’t have to be present.

This intentional co-opting of a proper palliative measure, rarely needed, at the very end of life–known as palliative sedation–in which the disease causes death, not dehydration, is scandalous. But why should we be surprised? The killing agenda corrupts all it touches.

In California Assisted Suicide Advocates Again Undermine Medicine

For shame! Assemblywoman Patti Berg and Assemblyman Lloyd Levine are at it again in the California Legislature. Soon to be term limited out of office, desperate to pass a bill–any bill– that will open the door to assisted suicide/euthanasia, thwarted in their desire by a powerful and diverse strange political bedfellow coalition including disability rights activists, medical professionals, activists for the poor, pro lifers, and the Catholic Church, they have found a new way to undermine the delivery of proper medical care.

In place of assisted suicide, they now want to legalize doctors placing their patients into drug-induced comas and dehydrating them to death. Just as bad, they co-opt the good and proper medical practice of “palliative sedation,” which they redefine as a method of killing.

The bill is AB 2747. First, Berg and Levine define terminal illness as having one year or less to live–an extremely problematic matter since at that distance from death it can be very difficult to determine expected lifespan.

Then, comes the disgraceful redefinition of palliative sedation, which is properly used in rare cases at the very end of life for irremediable suffering such as agitation, at a time in which the patient generally dies of the disease, not denial of sustenance.

442 (d) “Palliative sedation” means the use of sedative medications to relieve extreme suffering by making the patient unaware and unconscious, while artificial food and hydration are withheld, during the progression of the disease leading to the death of the patient.

Then, this is tied with a diagnosis of terminal illness, which you will recall is now a 1 year window:

442.5 (5) The patient’s right to comprehensive pain and symptom management at the end of life, including, but not limited to, adequate pain medication, treatment of nausea, palliative chemotherapy, relief of shortness of breath and fatigue, VSED [voluntary self starvation and dehydration], and palliative sedation.

So, what this bill would do is allow people with a one year life expectancy to request to be put into a coma by their doctors for the purpose of being dehydrated to death. Proving the intent of the bill, AB 2747 requires that if a doctor doesn’t wish to comply with request, he or she must assist in transfer to a doctor who will:

442.7. If a physician does not wish to comply with his or her patient’s choice of end-of-life options, the health care provider shall do both of the following: (a) Refer or transfer a patient to an alternative health care provider. (b) Provide the patient with information on procedures to transfer to an alternative health care provider.

The medical profession should be up in arms. These petty politicians are corrupting medicine by establishing a false political definition for a proper palliative technique that, if passed, would result in terrible public confusion and distrust in palliative medicine overall. I repeat: For shame!

FDA Probing Possible Link Between Asthma Drug and Suicide Risk

The U.S. Food and Drug Administration said Thursday it was investigating the possibility of an increased risk of mood changes and suicidal behavior among those who take the highly popular asthma drug Singulair. (HealthDay)

Report: Crazy Xs

Human embryonic stem cells (hESCs) are genetically unstable over time in culture, which raises concerns about their clinical safety. Epigenetic changes, heritable controls over gene expression that do not alter DNA sequence, in hESCs may contribute significantly to this instability. Two studies published recently in the Proceedings of the National Academy of Sciences used complementary methods to examine X-chromosome inactivation in hESCs, reporting that this particular epigenetic change shows an incredible amount of variability between hESC lines regardless of the source of derivation. (Nature)

Clinton Details Premium Cap in Health Plan

She said, for instance, that it “might be appropriate” to require insurers to spend a heavy proportion of every premium dollar on health care as opposed to overhead and profit. Several governors, including Arnold Schwarzenegger of California and Edward G. Rendell of Pennsylvania, have proposed requiring that insurers spend 85 percent of premiums on health care. (New York Times)

For big surgery, Delhi is dealing

Medical tourism soars as Americans seek major savings on health care in hospitals abroad. (Chicago Tribune)

Do Unions Still Shape the Healthcare Debate?

A survey released this week came to the unsurprising conclusion that people are having a hard time paying for healthcare. The totally nonrandom sample of more than 26,000 people who took the online survey skewed heavily toward the insured (77 percent), unionized (57 percent), college educated (80 percent), and white (86 percent). If anybody should be able to afford healthcare, it would be these folks, right? So it was interesting to see that a third of them said they’d skipped getting necessary medical care because it was too expensive, and half of those with health insurance said it doesn’t cover what they need at a price they can afford. (US News)

 

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