Dueling moral choices

The South Florida Sun-Sentinal discusses the battle to determine whether tax dollars will be used in the State of Florida for embryonic stem cell and other research that results in the destruction of human embryos.

For some reason, the article mentions religion and morals when discussing the position of those who would protect human embryos from destruction. The morals of the pro-destruction side are not mentioned.

In fact, both positions are based on moral judgments - although from different ethical bases. One is the traditional medical ethic of nonmaleficense or "First, do no harm," and the other is consequentialist and utilitarian.


We're back after a brief vacation in the Smokey Mountains and a course in Media Training at the national headquarters of the Christian Medical and Dental Association.

Mandatory Abortion Referral, Again

The Christian Medical and Dental Association (CMDA) has a press release on the recommendation, what the CMDA rightly calls "hypocrisy," of the American College of Obstetrics and Gynecology.

For more on why it is wrong to change the law concerning requirements on physicians who object to killing our children before birth, see my last post.

Mandatory Abortion Referral Bill

The American College of Obstetricians and Gynecologists (ACOG) is sponsoring a bill that would require that all doctors refer patients to abortionists. ACOG is asking that Senators tuck this provision into the the FY06 Labor, Health, and Human Services, and Education Appropriations bill. According to an internet alert from the American Association of Pro-Life Obstetricians and Gynecologists, if the provision is not voted down by our Senators, every doctor would be required to help arrange abortions at the patient's request.

This would be the first time that doctors have ever been required to refer for an elective procedure. Physicians are not required to refer for plastic surgery, for instance.

Referral would include, at the least, giving patients the name of "providers." That would make it the doctor's legal and moral responsibility to be familiar with the skills of the other doctor. It would also make the doctor responsible for follow up and, possibly/probably, legally liable for bad outcomes. I have always preferred to have my office staff assist the patient in making an appointment in referrals.


No one would disagree with a referral for care in the case of a tubal pregnancy or some other life threatening event. Caring for a woman whose child has already died or who has a severe infection in her uterus - or even a need for life-saving cancer treatment could justify a referral. In the latter cases, I'd actually refer to a doctor that believed in the sanctity of life. Both for the mother's sake as well as her child's.

But an elective, intentional abortion doesn't even rise to the level of a tummy tuck in urgency or medical necessity. A tummy tuck or eyelid lift can at least make the patient's life better. And there is no third life (the unborn child) involved.


Some of us believe that putting a patient in contact with an abortionist is too close to aiding in the unethical procedure intended to kill a member of our species. How can anyone be required to act to aid the killing of our children?



Everyone should write their Senators and let them know that we object to any requirement to refer for an elective medical procedure. Is it right for physicians to be required to provide any service for their patients when we are certain that the service is not in the interest of our patients?

labels added 12/20/08

Mainstream Media Confused on Stem Cells Origin

The front page article on Pro-Life Blogs displays the confusion the MSM has about stem cells, their origins, and what they actually are.

The original article describes the method for obtaining the stem cells and describes them as "fetal." But in several of the MSM articles referenced, the cells are clearly called "adult." (see my post from yesterday)

More on CDC Sexual Behavior Survey

The report can be downloaded at the CDC website.. The data tables, rather than the "highlights" are far down on the 56 page document.

The numbers for teens are skewed by lumping 18 and 19 year olds in with teens 15 to 17 years old. However, the numbers for the younger ages are disturbing, with over 33% of 15 year old girls and 45% of males reporting sexual activity of any kind. (Tables 3, 4) There's a stronger correlation between vaginal sex and "any" sex in the girls than in the boys. (In old fashioned terms, the girls are more likely to have "gone all the way" if they've had any sexual experience at all.)

The numbers for monogamy within marriage are encouraging, with 91% of married men and 93% of married women reporting one partner in the last year. (Tables 1, 2) The numbers decrease for those cohabiting.

Stem cells repair spinal cord injury

The good news is in the title of the article, "Human neural stem cells differentiate and promote locomotor recovery in spinal cord-injured mice," available in full and for free from the Procedings of the National Academy of Sciences.

The bad news is that the stem cells used in these experiments were derived from fetal tissues.

Hopefully, the lessons learned will enable the recruitment of stem cells from the patient's own body in the future, so that no harvesting, in vitro manipulation and injection of stem cells at the area of injury will be necessary.

The fetal tissues are presumably from aborted fetuses. There is a (very narrow) distinction between the ethics of utilizing the information and treatments which depend on fetal tissues and those depending on embryonic stem cells. The unborn children in the first place were not created for the purpose of killing and weren't killed for the purpose of obtaining medical materiel. In the second, the nascent humans were either created specifically with the intention of destroying them for their body parts or they were abandoned by their parents who began them in an attempt to have a child. The embryos were purposefully destroyed for their utility as "spare parts."

NYT abortion story painful

Thanks to ProLife Blogs, The Dawn Patrol, and Hennessy's View, I learned of today's New York Times story about an abortion clinic in Little Rock, Arkansas.

It's heart wrenching to read these stories about women coming for their 3rd and 4th abortion, as late as 20 weeks. One woman, a Sergeant in the Army, was beat by the father of her child when she told him about their child. (That's how she learned she wasn't going to get married. He's now in jail, thankfully.) Several mention their Catholic or Baptist background. One girl's mother threw a stool at her, threw her out of the house, and then gave her $1700 to travel from another State, lie to get a judicial bypass and the abortion.

Almost all of these women and girls have had a previous abortion, sworn that they would not allow themselves to repeat the mistake, and feel that they have no choice, at all. The only men who are present are the men who kill the children, one of whom ironically complains that State regulations are "death by a thousand scratches."

One woman is said to be carrying twins. Another, the mother of a nine year old, is carrying a baby, 20 weeks or 5 months along, that would have a fair chance at life if born alive.

Another is identified by her full name. After viewing the ultrasound of her 12 week old child she is quoted as saying,
.

"I feel pretty messed up," she said after seeing the image. "It's different, just knowing. My husband told me not to look. This changes my feelings, but I'm sticking by it. Damn it, $650, I'm sticking by it."

Where are the fathers, the mothers, the sisters and friends who will stand by these women and their babies? We are here, at Pregnancy Crisis Centers, Food Banks, churches, and organizations such as Feminists For Life.

I hope that the NYT will give equal time and space to the rescuers, the supporters, the Good Samaritans who would help these women choose life for their children and hope for themselves.

Study claims half of teens have had oral sex

The Washington Post (requires free registration) reports with shock and horror (okay, mild amusement) that not only half of all teens have had oral sex, including a large number of those who have never had vaginal intercourse, but girls are as likely to be the receivers as the givers.

I'm not quite sure how much credence to give this information.

I'll admit that this may seem an odd idea to me becaues I'm too old -a child of the '70's. But I'm also someone who hears stories from kids and adults in the examining room. The patient population I've seen indicates that the double standard is alive and well.


On the other hand, the last two "genital herpes" cultures I sent off were reporte as "Herpes Simplex I," what we used to call "oral herpes," assuming that one type preferred one area.

Thankfully, the data used is over 2 years old. The pregnancy rates are going down, so hopefully these numbers are going down, too.

Another thing to notice is how heavily weighted those numbers are toward teens 17-19 years old. And people up to age 44 are included in some of the statistics. I have not had a chance to read the fine print of the actual report, and will report back.....

Kill humans, save animals

Ian Wilmut, one of Dolly's technological fathers, wants to save animals - and it wouldn't hurt if he could save some money, too.

Of course, that's all in the future. Probably less remote than cures for his ALS patients, but still pretty far off.

In the meantime, he wants our daughters' oocytes (eggs).

Defining birth or the right to life

Today's news about the Michigan law restricting abortion points out an aspect of the last 30 year's debate on abortion:

Under our Constitution, the State may define the moment of birth as this law does. But the State may not infringe on the principle that all humans who "are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness to enjoy those "certain unalienable rights, endowed by their Creator."

After reading the history of this law, it's almost enough to make us review the rest of the Declaration.

Soundbites

Statements which sum up my arguments against human embryo destruction for research:

I'm all for stem cell research, I just wouldn't kill anyone for it.

What part of embryo in embryonic stem cell research don't you understand?

These "spare" embryos are the brothers and sisters of babies in the arms of parents who wanted children so desperately that they were willing to spend thousands of dollars, risk their own health, and undergo invasive, cutting edge medical procedures.

Scientific American biased

The October, 2005 edition of Scientific American includes a biased, political editorial, "Fill This Prescription." (subscription only)

The summary:

SA Perspectives: Fill This Prescription; October 2005; by Staff Editor; 1 page(s)

No one's health should be hostage to a caregiver's opinion of his or her morality. In prisons, even hardened murderers are entitled to decent, prompt medical attention. A woman walking into a pharmacy with a prescription deserves no less.

Yet in at least a dozen states, pharmacists have refused to fill clients' orders for birth control on personal moral grounds. Often the prescriptions have been for emergency contraception--the "morning-after" pills marketed as Plan B and Preven that prevent a fertilized egg from implanting in the uterus if taken within 72 hours of unprotected sex. By medical definition, the pills block rather than terminate pregnancy. To the objecting pharmacists, however, it is abortion, and they want no part of it.

The editorial concerning pharmacists who act on their consciences contains factual errors and false assumptions. Every time a woman has a prescription filled by a pharmacist, her "health is at the mercy of their pharmacist’s conscience." As a physician and a patient, I don't want pharmacists to practice suppressing their consciences.

First, pharmacists are members of a profession which is charged with protecting the patient and aiding the physician in treatment. We all depend not only on the ability of pharmacists to count pills and read labels correctly but to judge to the best of their ability about interactions with the patient's other medicines and medical conditions. They often act on knowledge that the physician or the patient may not have about the risks (such as allergies, interactions and prescriptions form other physicians) to the patient from a given medication. It is also a legal, common and helpful practice for pharmacists to judge the legitimacy of a prescription and to refuse to fill it if it is forged or if the patient is abusing medications by obtaining multiple prescriptions from different doctors for addictive and otherwise harmful medications.

Second, the latest medical information indicates that the morning after pills block ovulation when they work. There is no evidence that the pills stop the implantation of an embryo. The editors should review the information published in May 2005 concerning the work of Croxatto, et. al.,
at http://www.popcouncil.org/pdfs/popbriefs/pbmay05.pdf or the original articles which are even older. It would be helpful if they used their platform to educate rather than to politicize medicine.

Third, in nature, the pregnancy of a human woman begins in the fallopian tube, at the time of fertilization. In those pregnancies begun by artificial reproductive methods, the pregnancy of the woman and the fertilization of the child may be artificially separated by time and location. Regardless, the human child's life begins at fertilization, as did the life of each of us.

Fourth, birth control (as the information above indicates) is not synonymous with abortifacient.

Fifth, the difference between dispensing abortifacients and dispensing antivirals is that one of these is intended to end the life of a human being and the other is intended to save life. (By the way, pregnancy is not a disease state.)

Hospital heroes

Most of the stories in the press are of the sacrifice and compassion of doctors, nurses, and other staff members in the areas affected by Hurricane Katrina. This is what I would expect and what I believe happened. The stories apparently describing euthanasia are hopefully in fact distortions of those describing comfort care and the relief of pain and distress without an actual intent to kill.

From the LA Times (free subscription required):

Lalla recalled how a dietary specialist ripped his shirt into rags, dipped them in water and stroked the head of one patient as he lay dying. Others gave patients food.

Death to suffering

The Daily Mail reports that some doctors in Louisiana hospitals may have intentionally caused the deaths of their patients.

Some of the comments appear to imply that the injections of morphine were intended to relieve pain and suffering when the ventilators and other machines no longer had electrical power. Other comments imply that the intention was to kill those who could no longer be treated.

The principles of right and wrong do not change during times of disaster and stress. But, we are reminded of the importance of those principles in times of disaster. Sometimes in the violation of them and other times because these are the times when we are so much more likely that to be faced with the truly hard questions.

But it is in these times that we find out how well or how poorly we are prepared by habit and knowledge to practice what is right.

Doctors should never relieve suffering by killing those who are suffering.

Life, Death, Pregnancy: 73% of Reporting Innacurate?

Most deaths associated with pregnancy - and even more associated with induced (intentional abortion) and spontaneous (miscarriage) abortions - are not reported as such.

In 2003, the United States implemented a a revised death certificate including information on whether or not women who died had been pregnant within the last year. Many have speculated whether or not this will affect the statistics on pregnancy-related death and the myth that abortion is safer than carrying a pregnancy to term.

In the November, 2004 issue of Paediatric and Perinatal Epidemiology, there is an article which points out that, historically, the reporting of all deaths associated with pregnancy has been innacurate.

(registration required for full text)

Here is the summary from the article:

To find maternal and pregnancy-related deaths, it is important that all pregnancy-associated deaths are identified. This article examines the effect of data linkages between national health care registers and complete death certificate data on pregnancy-associated deaths. All deaths among women of reproductive age (15-49 years) in Finland during the period 1987-2000 (n = 15 823) were identified from the Cause-of-Death Register and linked to the Medical Birth Register (n = 865 988 births), the Register on Induced Abortions (n = 156 789 induced abortions), and the Hospital Discharge Register (n = 118 490 spontaneous abortions) to determine whether women had been pregnant within 1 year before death. The death certificates of the 419 women thus identified were reviewed to find whether the pregnancy or its termination was coded or mentioned. In total, 405 deaths (96.7%) were identified in registers other than the Cause-of-Death Register. Without data linkages, 73% of all pregnancy-associated deaths would have been missed; the percentage after induced and spontaneous abortions was even higher. Data linkages to national health care registers provide better information on maternal deaths and pregnancy-associated deaths than death certificates alone. If possible, pregnancies not ending in a live birth should be included in the data linkages.

The problems with innacurate reporting of pregnancy-related deaths are consistent with data from Canada
and the U.S.

Stem Cells Found in Human Heart

Scientists in Tokyo announced Thursday that they had used stem cells collected from the hearts of 50 (human) patients to treat heart attacks in mice. Further trials in pigs and dogs are pending, with plans for tests in humans after the technique is proven safe.

The culture of these cells in the lab and their use in animal trials should lead to practical information about the stimulation and recruitment of each patient's own stem cells in situ. Again, the ideal would be to be able to induce the patient's heart to repair itself without surgery or transplants.

Kass replaced by Pellegrino

Dr. Edmund Pellegrino has replaced Dr. Leon Kass as head of the President's Bioethics Council. It should be interesting to watch the way Dr. Pellegrino and the PBC are treated and whether it's any different from the reception that Dr. Kass received these last four years. Wonder how long the honeymoon will last?

I wonder that anyone would serve this Administration, with the strong probability that he or she will be attacked simply because of that affiliation.


Dr. Pellegrino may prove to be every bit as conservative as Dr. Kass. From the CBHD website:

The ethical questions are related to the means by which these new treatments are developed and applied. Genetic manipulations, cybernetics, nanotechnology, and psychopharmacology are in themselves not intrinsically good nor bad morally. Procedures, however, derived from the destruction of human embryos, distortions and bypassing of normal reproductive processes, or cloning of human beings, etc., are not morally permissible no matter how useful they might be therapeutically.

Embryonic stem cells mutate

It's not surprising that tissues kept at an immature state for an indefinite time would have genetic mutations. I would think it would be even more expected that cells whose natures it is to change and develop would be susceptible to mutations.The Boston Globe and others reported on Sunday, September 4, that minute nuclear changes build up as the cultures of embryonic stem cells repeatedly divide in the lab.

However, instead of creating an understanding that the focus of research should be non-destructive, non-embryonic stem cells, the press reports seem to call for the creation of even more embryonic stem cells lines in order to find out what went wrong.

Since these stem cells carry the ethical problem that someone has to die in order for them to be harvested, and since they will have to be transplanted into any patient who is treated, I believe this entire line of research should be dropped.

One more for adult stem cells

You might not be able to tell it from the media coverage, though.

Professor David Williams of the UK is in the news today for a $32 Million (17 million Great Britain Pound) push to grow human tissues suitable for transplant from adult stem cells.

Unfortunately, most of the stories about the multidisciplinary research effort never mention that these are adult stem cells. Here's a quote that supports that very important fact:

Professor David Williams, director of the UK Centre For Tissue Engineering at the University of Liverpool, said: "Nobody has been really successful at tissue engineering on a consistent basis yet and what this programme is hoping to do is bring together these complementary expertises and build a system from which we can take cells and stem cells from patients and use them to regenerate new ones."

I'm still convinced that the study of adult stem cells will lead to treatments at the site of injury and the goal should not be transplant, but healing in situ. Such treatments would be more specific to each patient and each wound or disease, and it would be more likely to avoid the problems of genetic mutations in stem cells grown in the lab, as well as the ethical problem of the necessity to destroy human embryos to obtain embryonic stem cells.

New Embryology: Same old bias called "Bioethics"

There's a brand new book, Bioethics and the New Embryology: Springboards for Debate (WH Freeman and Sinauer Associates, 2005) available to "dispel the myths" that you and I may have about the nature of the human embryo and clear up our confusion about bioethics.

I haven't read the $15 book yet, since it was only introduced this morning, although I've ordered it. I'm more concerned about the information that was deemed important in the Press release concerning the book. (The press release and the reviews on Amazon.com are the only information that I can find on Google or Google News.)

Dr. Gilbert is the author of a book on developmental biology, which is used in colleges. His co-authors are doctoral candidates molecular biology (the new pathway to studying embryology as a tool) and political science (the tried and true pathway to a public policy as a tool).

The book is a series of questions and discussions concerning cutting edge biological and medical science. This is not a biology book, giving facts and descriptions. It is a bioethics book, which asks questions about right and wrong and what we should do. Like most of us, Dr. Gilbert approaches the subject with obvious bias - as shown by this excerpt from the press release:

Gilbert hopes his new book will help dispel some myths about embryology. “One common misconception is that embryonic stem cells come from embryos with eyes, hearts, ears, and limbs,” he says. “But the actual cells come from a much earlier embryo which has not formed any of these structures yet. Nor is it true that the DNA of the nucleus contains all the information needed to form a functional human infant.”

Many people also assume there is a consensus among scientists that human life begins at fertilization. “The truth is that scientists have as many opinions on this as laypeople,” Gilbert says. The book reviews several embryonic stages at which different groups of scientists have postulated human life begins.

I doubt that many of us have misconceptions about the appearance of the embryo at the time that embryonic stem cells are harvested or when the embryo implants in the uterus in nature. After all, we are repeatedly told that it's just a "hollow ball of cells." In fact, he or she is what each of us was at that age: a hollow ball that has differentiated enough that at least 2 distinct layers are present, one layer which is coveted as stem cells. I definitely want to see whether Dr. Gilbert can explain how the embryo's life has not begun by day 5 to 10, when the stem cells are harvested or the embryo is implanted, and the conclusions he draws from the lack of "consensus" about that life.

It is important to repeat that science, the study and reporting of what "is," cannot answer the questions of "should" or "ought." What we should do - what is right and wrong - are ethical questions which cannot be redefined to allow some humans to be used as tools and spare parts for the benefit of others without abandoning the oldest and best of all medical and scientific ethics: "Heal when possible, but, first, do no harm."

On Moral Grounds, Some Judges Are Opting Out of Abortion Cases

Here's the original article about the judges who are threatened because they are following their consciences. Free subscription is required for the New York Times. There's no subscription required for the Tennesseean.com, linked below.

Judges with consciences

Another step in the supposedly private act of aborting one's child is exposed as anything but private:

Judges in Tennessee are recusing themselves from hearing the "judicial bypass" cases - where minor girls may obtain abortion without notifying (much less obtaining permission from) their parents - because of moral objections to abortion. In Tennesse, the girls can be as young as 13. In Texas, 14 year olds qualify.

The abortion advocates are of course upset and would make judges as well as pharmacists, slaves:

Professor Susan P. Koniak, who teaches legal ethics at Boston University and signed the letter to the Tennessee Supreme Court, said judges were free to express their moral disagreement with a law but were not free to decline to enforce it.

"I expect them to bring their moral sense to a case," Koniak said in an interview, "but the law comes first."

McCarroll's sole lawful options, the law professors' letter said, are to enforce the law or resign from the bench.

Judicial bypass imposes secrecy on the court, which hampers collection of information as to how many girls are granted legal exception to the State's rules on telling parents about the abortion or seeking consent from the parents. The State must pay for the court procedings, the lawyer, and a "guardian ad litum," or substitute guardian for the girl. Often, the records of the proceding are not even available to the girl, herself, due to the confidentiality rules. There is concern that the process enables child abusers to escape the consequences of their actions.

Many organizations, including "Jane's Due Process," assist the girls in obtaining the bypass.

FDA Chief Resigns Over Plan B

FDA Assistant Commissioner for Women's Health, Susan Wood, says she can't remain at the Agency because of the refusal to change the status of the drug protocol, "Plan B" often called the "morning after pill." The Henry J. Kaiser Foundation's daily news reports the fuss.

I agree with the former Commissioner, she should not be the face of women's health for the agency if she is certain that all of our current regulation of health matters should be changed for this one area of "women's health."

Well, then.

Why not just go ahead and make all oral contraceptives over the counter? Why not sell vacuum "menstrual extraction" machines for monthly use in the home? Why have medical regulations at all?

"one can justify sacrifice of some embryos"

Here's one argument for limits on science from a Commentary in Stem Cells, "A Proposed Stem Cell Research Policy" by Louis M. Guenin of the Department of Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts, USA :

COMMENTARY
A Proposed Stem Cell Research Policy
Louis M. Guenin

Department of Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts, USA

Correspondence: Louis M. Guenin, Lecturer on Ethics, Department of Microbiology and Molecular Genetics, Harvard Medical School, 200 Longwood Avenue, Boston, Massachusetts 02115, USA. Telephone: 617-484-5591; Fax: 617-738-7664; e-mail: guenin@hms.harvard.edu

The aspirations of scientists and patients for human embryonic stem cell (hESC) research in the U.S. motivate attention to the nitty-gritty of law and regulation and its confluence with such moral consensus as lies within our reach. Federal law and regulation form a tangle. Analysis yields several conclusions not widely appreciated. A legislative enactment is the rate-limiting step of federally funded research, the restriction of research imposed by the previous administration’s policy as reprised in current proposals fails to achieve its objective of avoiding complicity in embryo sacrifice, the current administration’s policy is another failed noncomplicity scheme under which research cannot be expanded without demolishing its putative justification, and the Food and Drug Administration has already effectively interdicted procreative cloning. While it is not plausible to deny complicity in embryo sacrifice when performing or funding hESC research, one can justify sacrifice of some embryos by an argument whose premises are consistent with a wide range of moral and religious views. This paper proposes a rule of public policy providing for the use of donated embryos barred from the womb. This rule would optimize research while manifesting its moral justification. The rule is suitable for implementation by any government that funds hESC research. The rule’s justification provides a cogent argument for such incremental steps toward its implementation as become politically feasible from time to time.

The sacrifice of one human life for another, by organized, intentional and regulated means, much less with government funds, can never be justified when that life is not a threat to another.

How far we have come from the ancient (Greek) affirmation that "First, do no harm."

Limit Science ("Why?")

The Guardian contains an op-ed piece by Lord Robert Winston of the UK declaring that that Nation's regulation of in vitro fertilization should stop. He questions, But why should this one treatment area be singled out? and then complains:

The 1990 Act emphasises that clinicians must regard the welfare of any child that might be born after treatment. This is unique to IVF; it doesn't apply to other fertility practice. It is undesirable in principle because it risks injustice, and unworkable in practice because nobody can forecast the future.

In fact, IVF was/is the first technological, intentional and purposeful intervention that could in reality change who and what it is to be human. Past eugenic efforts failed because of the lack of specificity and sensitivity, while both of these qualities are increasing due to IVF and all its variations and outgrowths.

The ultimate subjects of the treatment did not exist when the treatment began. They, their children - and our children who will marry and bear children with them - had no chance to consent.

No one could have given informed consent.

We have real-life examples of the outcomes of manipulation with plant and animal life and the enviroment when diversity is artificially reduced by human manipulation.

The outcome of reducing the diversity of the manipulators would call at least for caution and regulation.

(Another viewpoint may be seen at Blog.Bioethics.net

Real Life Help for Katrina's Victims

We're working on saving lives and giving aid to the victims of Katrina, over at FreeRepublic.com.