Transhumanism Seminar in Second Life

Transumanar, a site devoted to transhumanism, has announced a virtual, online seminar on Transhumanism and Religion in Second Life.

I'm not sure that I'm ready for a Second Life, and I always get bored when I try to come up with an avatar. But, I may have to check this out, if possible. (In my First Life, I'll be at the Texas Medical Association annual meeting the rest of the week.)

Economists Discuss Bioethics (healthcare, neuro-economics)

There's no answers, just more intelligent and informed questions, but here's an interesting discussion on "Money Driven Medicine" at the blog, Marginal Revolution.

One of the blog owners, Tyler Cowen, has a piece in the business section of today's New York Times, "Enter the Neuro-economists: Why do investors do what they do?:

Vaginal approach to gallbladder removal

Or removal of the appendix through the mouth?


I finished my residency training in 1993, and was privileged to witness some of the first "laparoscopic" gallbladder removals on one of my rotations with some private surgeons. After 5 years or so of observing and assisting with the old technique that required a 7 to 10 inch incision at the right upper abdomen and months of recovery, I was used to patients lying very still and needing encouragement to breathe after the surgery. I nearly fell apart myself when, just an hour after we removed her gallbladder, one of my patients sat up in bed. I've never moved faster than I did that time, trying to catch her before she tore her wound or fell out of bed when the pain hit!

My first reaction to this story was one of alarm about possible harm due to trying a new, risky maneuver, just because it's surgically possible.

I wasn't sure how much of my distaste was a woman's reaction to invasion through the vagina. After I read the description of the appendectomy through the mouth, I decided that it's a true caution about the risk of such a route.


The biggest problem with recovery from surgery is the trauma to the tissues surrounding the surgical site, especially the muscles that are cut and sewn.

I finished my residency training in 1993, and was privileged to witness some of the first "laparoscopic" gallbladder removals on one of my rotations with some private surgeons. After 5 years or so of observing and assisting with the old technique that required a 7 to 10 inch incision at the right upper abdomen and months of recovery, I was used to patients lying very still and needing encouragement to breathe after the surgery. I nearly fell apart myself when, just an hour after we removed her gallbladder, one of my patients sat up in bed. I've never moved faster than I did that time, trying to catch her before she tore her wound!

The new technique allowed for us to remove the gallbladder - and later, the appendix (and other stuff) - by making 3 or 4 cuts, all less than an inch and using instruments and a camera that allowed remote or video-guided surgery. Without all that cut skin and all those layers of muscle, patients got better, faster.

It's almost routine to perform hysterectomies through the vagina these days. But let's face it, in this case, everything's right there. The surgeon just has to watch for the blood vessels, the bladder and the rectum, and virtually no muscles have to be cut, at all.

Either of these operations would require muscles and "surface" tissues to be cut, and each require that the surgeons' instruments pass other organs. There's also the problem of making the surgical field sterile and maintaining infection control.

With removal of the gallbladder, there is also the risk to the liver, and especially, the common bile duct from the liver to the intestines. For that matter, an oral approach to the appendix would require reaching past the lungs, the diaphragm, the liver and the intestines, unless the instruments can be passed through the esophagus and stomach. (How would you intubate this patient, protect her lungs, or handle the leaks of acid from the stomach into the abdominal cavity?

The surgeons quoted in the New York Times article are proponents of "no scar" surgery.

I'm a little concerned about the way they "read":

Dr. Bessler said his patient agreed to the procedure (two others had declined) because he told her he thought it would have advantages for her, and she accepted his judgment. She was the first in a study that is to include 100 women who need gallbladder surgery, appendectomies or biopsies taken from inside the abdomen. All the procedures will be done through the vagina.

Dr. Dennis Fowler, another surgeon who participated in the operation, said the team began experimenting on women because “incisions in the vagina have been used for a variety of procedures for decades, and proved safe with no long-term consequences.”
. . .
The operation took about three hours, twice as long as the usual laparoscopic surgery, but it was the team’s first operation on a human, and the time should decrease with practice, Dr. Bessler said. Also because it was the first time, to be on the safe side, the doctors did make three small openings in the abdomen for surgical tools. But their ultimate goal is to perform the operation entirely through the vagina.

Artificial Intelligence vs. believers

The subject of believers and those who actively oppose them is only tangential to this blog. However, anyone exposed to cutting edge technonology, futurism, and, especially, transhumanism and enhancement will eventually run across at least one fundamental atheist.

George Dvorsky, transhumanist and anti-theist, has published his review of a movie called "The Jesus Camp." In fact, he titled the post, "The Jesus Camp and the art of Brainwashing Children."

As interesting as it is that Mr. Dvorsky discusses the mimetic convergence of Islam and Christianity rather than noting the divergence(since both teach that we can trace our history back to Abraham and his God), I was stirred to post from the gallery of the Senate of the Texas Legislature by this remark of one of the visitors to the site:

The best news, however, is that AI, when it is invented, will be immune to religion; I suspect it this will remain true even if the AI is designed by a deeply religious person. (anyone agree/disagree?) And what's the likelihood of a religious person being the maker of the first AI? Are there many christian AI programmers?

And the world didn't end (Supreme Court Partial Birth Ruling)

I'm minding my own business, visiting a few hundred blogs in an effort to complete the database on Bioethics Internet resources for my Bioethics capstone project, and one of the headlines said that the Supreme Court had up held the Federal ban on Partial Birth Abortions.

There was no earthquake, no sonic boom, and I might have slept through the whole thing!

It appears that Justice Kennedy wrote the opinion for the majority.

Watch the National Review "Bench" blog for the analysis. (And FreeRepublic for the people's reaction.)

As I said, the world didn't end, and this ruling evidently specifically did not rule on Roe v. Wade, the legitimacy of the Court's ruling on abortion, or even overturn Carhart, the previous Supreme Court case on partial birth abortion.

Justice Ginsburg, at least, wrote a dissent predicting the end of the world for women.

I expect the conversation to get ugly.

The procedure that intentionally delivers part of a child in the second or third trimester in order to decrease the needed dilation of the mother's cervix by reducing the size of the skull is a particularly barbaric example of abortion. I believe that only the extreme pro-abortion advocates (those who see any restrictions as placing the entire elective abortion "right" at risk) are truly supportive of this procedure.

Those who are so pro-abortion as to see this ban as "the end of the world," shouldn't worry: there will still hysterotomies, saline abortions and multiple ways of killing the child in utero.

(There may be a shortage of fetal tissues for research, however.)

More Complaints About Texas Legislator

A blogger over at the Daily Kos is complaining about the Texas State Affairs meeting on HB 225. The complaint is that people with disabilities had to wait until the early morning to testify.

There's more comments at the South Texas Chisme: Sneaky Republicans ban stem cell research funding" (See the problem with the headline? Nothing has been banned, other than funding for a certain type of stem cell research that carries restrictions from the NIH, as well as being unethical.)

More at "Brains and Eggs," and Texas Freedom Network (self-defined as "A Mainstream Voice to Counter the Religious Right") has an article and a petition.

Perhaps I should tell them some of the realities about testifying in front of the Texas State House Affairs Committee.

1. First, Chairman Swinford believes that everyone should have their say. He never puts time constraints on witnesses, unlike some of the other Chairs, who have lights and buzzers and 3 minute limits. We all mutter, but we're all grateful when it's our turn.

2.The Chairman always lets kids go first. The other bill had children as witnesses, none of us there to testify on HB 225 had brought children.

3. Those early morning meetings are always interrupted by the House meeting and resume when the house adjourns for the day.

4. We should just be thankful that only two bills came before the Committee the other night -- they might all still be there.

"Sneaky" Texas Legislator

Perhaps this article, written by an Associated Press writer, should be receive the Yellow Brick Award. (Should I put "copyrighted" here? No, there's others, although most - like the award for finishing the obstacle course at Quantico - are awards for achieving the impossible, not for misdirection.)

Someone is practicing distraction and projection by calling a vote in the Texas House State Affairs Committee a "Sneak attack."

Friday's vote came after a committee meeting that began Thursday and lasted through the night. Critics said the vote came hours after testimony concluded and while the committee was focused on an unrelated bill.

"Those of us who rely on the hope stem cell research holds, and anyone who cares about an open public dialogue, should be outraged at the manner in which the vote was taken on Friday afternoon — without discussion and while two members opposed to the bill were absent," said Judy Haley, president of Texans for the Advancement of Medical Research.

Kathy Miller, president of the Texas Freedom Network, called the vote's timing a "sneak attack."

"It's a shameful case of putting politics ahead of science as well as patients and their families," she said.

The bill, HB 225 by Ken Paxton (R - District 70, McKinney)reads as follows:

By: Paxton, Olivo, Christian, Chisum, Parker, H.B. No. 225 et al.

A BILL TO BE ENTITLED AN ACT
relating to prohibiting the use of state money for certain
biomedical research.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle H, Title 2, Health and Safety Code, is amended by adding Chapter 169 to read as follows:

CHAPTER 169. BIOMEDICAL RESEARCH
Sec. 169.001. PROHIBITION ON USE OF STATE MONEY FOR CERTAIN BIOMEDICAL RESEARCH. A person may not use state money for biomedical research if federal law prohibits the use of federal money for that research on January 1, 2007.
SECTION 2. This Act takes effect September 1, 2007.

For those of us who object to embryonic stem cell research, the bill serves the purpose of preventing our tax dollars from being used to destroy embryos whether from existing in vitro embryos or from purposeful creation of new embryos for the purpose of research, including cloning or parthenogenesis.

And for the fiscally responsible, the bill ensures that any research we pay for will be eligible for additional Federal research funds, and/or we won't spend money on redundant labs and equipment.

The House was in session until nearly midnight last Thursday, and began hearing testimony on HB 225 about 1 AM. They were in session, hearing about stem cells and cloning, until 5:30. (I had to work on Friday, so I went home at 1, and didn't get to testify.) The Committee met again on Friday: for a few minutes at 8 AM and again after the House adjourned for the day. The Chair, Representative David Swinford (R- 87th District, Amarillo), was a little punch drunk from being up all night - the maximum amount of sleep he could have gotten if he'd stayed at the Capitol would have been about 2 hours.

Representative Swinford made an effort to make sure that the members were present, and all were at certain points. However, the Committee members came and went both Thursday night and Friday. In fact, Representative Farrar (D-148, Houston) didn't attend Thursday's meeting at all, and Chairman Swinford reminded her on Friday that she probably wanted to "vote against this bill."

It's possible to watch both Committee meetings on line.

Yellow Brick Award

The Yellow Brick Award will note those in the Biotech and Bioethics research and policy communities who attempt to lead us down a winding, deceptive path, using explosions, smoke and mirrors, pulleys and levers, novel definitions, distraction, projection and destruction. There are usually at least a few wicked witches, projectiles (not necessarily houses), lots of hot air and maybe a few gene-mod flying monkeys and a forest of threatening trees.

When we look behind the curtain, we find that with stem cell research and abortion, we're just like Dorothy and the gang: we already have what we thought we needed. We just didn't know how to use it or notice when we did.

The Best Misdirection on Stem Cell Research

This guy deserves some sort of note/notoriety:

From the "News" section of the online Worcestershire (Massachusetts) Telegram & Gazette:

Apr 12, 2007

Stem-cell reversal

Scrap Romney restrictions on legitimate research


Gov. Deval L. Patrick’s effort to reverse restrictions on stem-cell research imposed by his predecessor is most welcome.

The restrictions, adopted by the state Public Health Council, are in direct opposition to 2005 legislation, enacted over former Gov. Mitt Romney’s veto, that permits human embryonic stem-cell research in the state. The former governor was opposed to the provision in the law that allowed for “somatic cell nuclear transfer.” The technique gives researchers a new way to study the development of a particular disease because the stem cells are created from the DNA of patients who suffer from that disease. Just this week, researchers reported that 13 young diabetics in Brazil being treated with their own stem cells are living insulin-free, some for as long as three years.

Make no mistake: Exacting and consistent guidelines must apply to research using stem cells. Human cloning already is banned in Massachusetts, a prohibition enforced by strong criminal and civil penalties. The law passed in 2005 also limits to two weeks of development the time during which embryonic stem cells could be harvested for research or treatment of patients. (Emphasis mine)

First this is an editorial, not news.

Second, Human cloning is not banned in Massachusetts. There is an attempt to redefine cloning as implanting a cloned human embryo, and a mandate to kill those clones by the time they are 14 days old.

However, the greatest fraud is the last sentence of the first paragraph: plopping a report of adult stem cell success into a story about embryonic stem cells, as though the latter were a ". . . a new way to study the development of a particular disease because the stem cells are created from the DNA of patients who suffer from that disease."

Enough: ultrasounds, abortion, women and blood

While calling us "anti-choice," some "pro-choice" men and women are beginning to look at the true nature of what is being chosen. They're noticing that we who oppose abortion are more likely to accept the woman with an unwanted pregnancy and championing the laws that make adoption and parenting a true choice. They're noticing that we have valid reasons, too.

The Family Research Council blog has a beautiful post quoting the words of one of the many "pro-choice" women that are being convicted about the humanity of the unborn child.

In the May, 2007 Atlantic, Caitlin Flanagan recounts a heart wrenching review of two books, The Choices We Made, and The Girls Who Went Away, of abortion, maternity homes and the girls and women who are and have been impacted by it.

Along the way, she tells us,

But my sympathy for the beliefs of people who oppose abortion is enormous, and it grows almost by the day. An ultrasound image taken surprisingly early in pregnancy can stop me in my tracks. In it is much more than I want to know about the tiny creature whose destruction we have legalized: a beating heart, a human face, functioning kidneys, two waving hands that seem not too far away from being able to grasp and shake a rattle. One of the newest types of prenatal imaging, the three-dimensional sonogram—which is so fully realized that happily pregnant women spend a hundred dollars to have their babies’ first “photograph” taken—is frankly terrifying when examined in the context of the abortion debate. The demands pro-life advocates make of pregnant women are modest: All they want is a little bit of time. All they are asking, in a societal climate in which out-of-wedlock pregnancy is without stigma, is that pregnant women give the tiny bodies growing inside of them a few months, until the little creatures are large enough to be on their way, to loving homes.

These sonogram images lay claim to the most powerful emotion I have ever known: maternal instinct. Mothers are charged with protecting the vulnerable and the weak among us, and most of all, taking care of babies—the tiniest and neediest—first. My very nature as a woman, then, pulls me in two directions.

Abortion hurts us all. As Ms. Flanagan says, abortion has left a trail of blood. It doesn't matter whether the abortion is legal or illegal, the blood flows from the cuts made by the culture that makes so many women throughout history and all around the world believe that they have no choice other than to choose this child or their lives, this child or their future, or (Lord help us) this child or his father.

It's past time to look at abortion and say, "Enough."

Judge rules to restrain hospital on Emilio Gonzales

I'm very glad that the judge in Austin has ruled that Children's Hospital can't remove him at this time from the ventilator and that he has named a guardian ad litum, to look at the evidence from the baby's best interests.

The Austin News 8 TV news also tells us that Emilio's mother and her lawyers have another doctor who will step in to evaluate his condition and whether he is a candidate for a tracheotomy.

Hopefully, some new voices will bring the two sides together for Emilio. I'm convinced that the doctors and nurses caring for Emilio have been doing their best, saving Emilio's life daily. And I'm sure that his mother is getting through the whole ordeal the best way she knows how.

For more information, you can read the Ethics Committee Report at the North Country Gazette, published in a same March 18th post by June Maxam.

Juvenile Diabetes Adult Stem Cell Cure?

The Journal of the American Medical Association has published a study - free online here - that describes successful treatment of 13 patients with their own stem cells. Some of the patients have been able to go without insulin or any other medications to control their diabetes.

15 patients with new onset "Juvenile Onset," "Insulin Dependent," or Type I diabetes received shots to stimulate production of their own bone marrow stem cells. Those cells were collected by "leukapheresis," a process where the blood is filtered to remove specific cells.

The bone marrow was killed and the patients received anti-thymocite antibodies to wipe out more of the white blood cells (from the thymus that might not be in the bone marrow.

Then, the patients received their own bone marrow stem cells.

During a 7- to 36-month follow-up (mean 18.8), 14 patients became insulin free
(1 for 35 months, 4 for at least 21 months, 7 for at least 6 months; and 2 with late response were insulin-free for 1 and 5 months, respectively).

Just as Dr. John Willerson of the University of Texas Health Science Center at Houston did a few years ago to explore the use of adult stem cells in the treatment of heart disease, Dr. Richard Burt of Northwestern University in Chicago went down to Brazil in order to perform the research. It was easier to receive permission from the local ethics board to use stem cell transplants - actually, an autologous bone marrow transplant.

The news reporters and some bloggers are criticizing the research for a lack of controls as well as the use of teen subjects.

Tell me - if your son or daughter were diagnosed tomorrow with insulin dependent diabetes, would you look into a plane trip to Brazil?

Embryos and cloning on Senate agenda this week

Opponents argue that the research is unethical, because deriving the stem cells destroys the blastocyst, an unimplanted human embryo at the sixth to eighth day of development.

Michael Sandel, Ph.D. )philosopher)in the April 4, 2007 Boston Globe

WASHINGTON (Reuters) - Stem cells will be at the top of the agenda for the U.S. Senate when it returns on Tuesday with supporters of the research hoping they can change the president's mind on the issue and opponents hoping to have a say about their stand.

. . ."We got a super-majority under the Republican-controlled 109th Congress," said Sean Tipton of the American Society of Reproductive Medicine, which lobbies in support of embryonic stem-cell research.

Tipton said the current Democratic-controlled Senate will be even friendlier. "When the Senate passes this bill, the president is going to be under incredible pressure to acknowledge that the science has changed and to acknowledge that the American people support this research," he said in a telephone interview.

Washington Post April 8, 2004

"The bill is a Trojan Horse. It contains language directing the Secretary of HHS "to conduct and support basic and applied research having pluripotent potential" so long as "That the isolation, derivation, production, or testing of such cells will not involve-(1) the creation of a human embryo or embryos for research purposes"

SCNT involves just such technique. The clear implication is that under this language SCNT is "unethical." Passage of this bill would make the day for NIH funding of SCNT difficult or impossible."

Bernie Seigel, lawyer (the one who sued the Raelians for custody of their children) on Stem Cell Information blog


We will hear much about how "science has changed" since people really really want cloning and stem cell research this week.

We'll hear that it's all morals and wrong-headed religion.

We'll hear that we're killing people by opposing SCNT and embryonic stem cell research.

We probably won't hear a lot about the heart repair news, the man who's Parkinson's is improving after a trip to Asia, or all the people who receive bone marrow and umbilical cord blood cells this week.

We probably won't hear much about Dr. Atala's cells from the placenta. Or the embryonic-like stem cells from umbilical cord.



Call your Senators every day this week!

How not to question research

What bothers me most about this controversy is that the whole thing began when the authors announced that they were about to release their raw data. Where is the discussion about the evidence in question, rather than historical questions without the numbers.

(I'll admit that the numbers boggle me - I'm not sure how one source could differ from one another by one third to one million deaths, without other groups noticing.

However, I can't help wonder how even 5 teams could interview 38 families during the violence that those teams were reporting.)


Last October, the journal Lancet published a report (available by subscription only and I don't have access) by Les Roberts and Gilbert Burnham claiming that Iraqi citizens suffered hundreds of thousands of "excess" deaths due to the war. Last month (Feb 28th online and in the March 1 issue), Nature published a news article (available by subscription only, excerpts below) critiquing the study:

On paper, the study seems simple enough. Eight interviewers questioned more than 1,800 households throughout Iraq. After comparing the mortality rate before and after the invasion, and extrapolating to the total population, they concluded that the conflict had caused 390,000–940,000 excess deaths (G. Burnham, R. Lafta, S. Doocy and L. Roberts Lancet 368, 1421–1428; 2006). This estimate was much higher than those based on media reports or Iraqi government data, which put the death toll at tens of thousands, and the authors, based at Johns Hopkins University in Baltimore, Maryland, and Al Mustansiriya University in Baghdad, have found their methods under intense scrutiny.

Much of the debate has centred on exactly how the survey was run, and finding out exactly what happened in Iraq has not been straightforward. The Johns Hopkins team, which dealt with enquiries from other scientists and the media, was not able to go to the country to supervise the interviews. And accounts of the method given by the US researchers and the Iraqi team do not always match up.

The authors of the original study have answered and Nature has published it:

In our opinion, your News story about our Lancet paper "Death toll in Iraq: survey team takes on new critics" (Nature 446, 6–7; 2007) has confused the matter rather than clarified it. You outline three criticisms of our work: that there was not enough time to have conducted the survey; that the sampling method suffered from a 'main-street bias'; and that the study team fabricated the data (the last being attributed to anonymous "researchers"). These criticisms have been previously addressed, and have little merit.

On the first point, the 1,849 interviews in 49 days described in our study suggest that 38 interviews had to be conducted each day by our eight interviewers. Although introducing themselves and explaining the confidentiality agreement might have taken interviewers several minutes, the five-question interview would take only a couple of minutes for most households that reported no deaths. The idea that eight interviewers could not conduct a total of 38 interviews in a day is not credible.

Second, we dismiss the suggestion that our sampling over-represented main streets, where car bombs are more likely. As stated in our paper (G. Burnham, R. Lafta, S. Doocy and L. Roberts Lancet 368, 1421–1428; 2006), when excluding the statistically outlying cluster of Falluja from the first report, we estimated 98,000 (95% c.i.: 8,000–194,000) excess deaths versus 112,000 (95% c.i.: 69,000–155,000) over the same period with the second survey. The first survey was done selecting random starting points with a Global Positioning System unit. The second used the random street-selection process, which is being criticized as biased. It rarely occurs in the field that two sampling methods are used allowing for comparison, and here the results are nearly identical. Moreover, there is no plausible mechanism for a significant main-street bias to operate, because only 15% of all deaths are from car bombs and other ordnance, and because most violent deaths are believed to occur away from the home.

Third, as for the accusation that researchers fabricated the data, we are ready, willing and eager to have an established international authority take a sample of the cluster forms and go to the field with our interviewers to verify the findings. Until that time, the Coalition and Iraqi governments' statements that during the first three years of occupation, Iraq's violent-death rate was lower than those of Russia, Estonia, Latvia, South Africa and Kazakhstan remain an implausible contrast with our findings.

When Nature called one of our study members in Iraq and asked if local officials joined them during the survey, that individual later clarified to Nature by e-mail that 'local officials' did not mean local clinicians and colleagues. This was inaccurately reported in the Nature summary along with a statement by our co-author that interviewers often worked alone. These points were wrongly cited as contradictions between the study team members in your News story.

All reports will eventually have "criticisms that dogged the study", if previously addressed criticisms with so little merit are given a voice in the press.

Mama's last lesson

Easter Sunday, April 8, 2007 would have been my mother’s 70th birthday. Helen Margaret Jernigan Burnett, “Mama,” died from complications of thymic carcinoma last August.

Mama is probably the source of my addiction to arguing and politics. Some people might think it comes from being the oldest daughter of a Baptist preacher, but I believe it comes from being the daughter of a certain Baptist preacher's wife.

Mama was a teetotaler, prolife, conservative who believed in equal opportunity for anyone who would do the work, but also worked to help others. She and Daddy stopped to “early vote” on the way to see the chest surgeon – just in case her surgery was scheduled before the election a few weeks away. She was semi-famous in her hometown as the food demonstration lady at the local Wal-Mart, the one who handed out samples and root beer floats. She won awards at work for leading fund raising and selling at the store, and ran the early morning Senior Citizens Bingo. Most of all, she was the best “Grandmama” in the world.

As Daddy pushed her wheelchair into the hospital for what turned out to be her last admission, she suddenly looked up at the people around her and said, “I have the best insurance in the world: Jesus Christ!”

It turned out that she was suffering a series of strokes that would steal her ability to do even basic self-care and make her delirious most of the time. Daddy, my sister or I took turns to be with her most of the time; feeding her, helping with her baths and trying to help her control her pain. I wasn’t always patient and I’m afraid that I preached a few of the lessons I learned from her, back at her. But I was better at doing what I could for her than I would have ever thought.

In spite of what I knew of her condition and prognosis, Mama’s death was totally unexpected. Evidently, she had her final stroke while in the MRI, as I sat at the head of the machine, singing to her and trying to keep her (both of us) calm.

I’ve often heard people say that they wouldn’t want to be a burden to their children. Needing someone else to feed us and wipe our chin when we can’t hold the spoon, much less assist us in performing much more intimate acts of hygiene, seems to be the worst thing we can imagine.

I’ve never had a good answer for patients or family members when they express this fear to me. Now, I know that the worst thing that I can imagine is living the rest of my life without having fed Mama, washed her, and rubbed her back on that last day.

The faith that she and Daddy surrounded me with as a child makes me sure that Mama is in heaven. But it’s the memories of caring for her those last few days that let me live here on earth knowing that I loved her as best I could when I could. Mama's last lesson was that we owe it to our loved ones to allow them to care for us, for their sakes.

End of life on the internet

LifeNews and Channel 8 TV in Austin, as well as several bloggers are reporting on the denial of the temporary restraining order for Emilio Gonzales in Austin, Texas.

Unfortunately, there are quite a few errors in the story.

I'm disturbed that the false information is spread and that there seems to be no problem in accusing the doctors of wanting to cause Emilio to die. In fact, the disease is causing Emilio to die, and his mother has said as much. The nurses and doctors have fought to prevent Emilio from having a "natural" death.

The doctors have worked with Emilio's mother, and have kept him alive in spite of repeat episodes where the baby's lungs developed a leak - or a "pneumothorax" - caused by the very high ventilator pressures required to keep Emilio's oxygen levels up.

Somehow, the North Country Gazette obtained the Ethics Committee Report and they have posted it on the Internet. I have copied part of the report at this post.

A pneumothorax allows air to escape into the chest around the lung, the pressure outside the lung grows each time the ventilator pushes air into the lungs. The lungs will collapse unless a chest tube is placed, the air is sucked out of the chest, and the lung reinflates. The ventilator pressures, high concentrations of oxygen and the collapsing of the lungs each cause further damage to the lungs.

The same high pressures explain why the doctors did not put in a tracheotomy earlier. The "trach" would have leaked if placed while the lungs needed such a high pressure.

There's no question of the diagnosis and the vitamin IV was not one of the "life sustaining treatments" and probably was not needed at all.

There's no doubt that the child has Leigh's syndrome. The syndrome is diagnosed by a group of symptoms, findings on the exam and sometimes by labs. In Emilio's case, there are also MRI's that show areas of the brain are dead and there are EEG's that show he has seizures one third to one half of the time. There are some tests for finding whether and how many or how severely the cells are affected with a genetic defect that makes the mitochondria - the energy factories of the cells - damaged. In the worst form, the type that causes "necrosis," or cell death, of the brain cells, children die very early. An alternate name is "necrotizing encephalomyopathy," meaning that the nerve and muscle cells are affected.

What is not known is the exact nature of the genetic defect that is causing the child's cells to die. There are at least several dozen and from my reading, I'll bet there are a hundred or so genetic defects that can be inherited or may be a new mutation. Some are "X-linked," meaning they are passed through the mother. Some - especially the X-linked forms - disturb the metabolism of the pyruvate dehydrogenase enzyme within the mitochondria.

In the past, some children with the form of the syndrome that changed the metabolism of pyruvate dehydrogenase got better after given high doses of IV thiamine. Now we know that that only works for certain types of defects that cause the syndrome. Other people get better with Co-Q 10 or some other diet change. (The article that the lawyers used to "prove" that the doctors were denying needed therapy was from 1974. There is much more known about the Sydrome than was known then - for one thing, more is known about DNA and certain mutations. However, these types are usually much more slow in developing and it's much more likely that the docs have been able to order tests for this specific defect - the DNA is evaluated.

While the hospital ethics committee did vote behind closed doors, they heard the testimony of in a hearing that included the lawyers, Emilio's mother and at least one employee of Texas Right to Life. No one is disputing the facts of the report.

Doctors understandably can debate and discuss medicine in a closed conversation, without lawyers and non-medical family members present. How else could they freely discuss the case, without fear of more lawsuits and/or while using the exact medical terminology that doesn't always mean the same thing to lay people that it does to doctors?

The difference is between those who want to keep Emilio alive no matter what pain he is caused by his treatments, no matter how many times his body must be invaded by tubes and needles while his brain tissue - and probably his muscles and intestinal lining as well - dies as the ventilator forces air into his stiffened lungs.

How many needles will Emilio have before his mother changes her mind and lets him go in peace? How many times will he be snatched back from the edge of death by the doctors before he is allowed to live - even a short time - without the pain and irritation of chest tubes, ventilators that push air into him, etc.?

There's no mention of removing the food and water because Emilio's brain does not cause him to breathe without the ventilator. If the ventilator is removed before the damaged areas of the brain heal -- a very unlikely scenario in children without Leigh's disease -- Emilio will die within minutes. The disease will kill him, not the doctors. Removing the ventilator will allow - not cause - him to die.

One of the lawyers has been posting about Emilio at Wesley Smith's blog since mid February.

And yet, neither of the lawyers mind saying things like,

People who could profit from an innocent person’s death should not get to decide when it occurs. Whatever the hospital’s motives are for pushing to end Emilio’s treatment, a child's life outweighs all other concerns--whether it’s to cut costs, or for convenience, or something else,” said Carden. “And furthermore, the twisted state law that allows hospitals to exterminate disabled children over their parents’ wishes needs to be changed.”

There is no profit for the doctors - the child has Medicaid and Medicare, according to what the lawyers and Texas Right to Life staffers have told me.

It is wrong to falsely accuse. It will not help Emilio. I sincerely doubt that it will help Emilio's mother get ready to let him go. And many people are being made angry and sad about the doctor's, hospital employees, nurses and even the Bishop of the Diocese of Austin's "murder" of Emilio. (The post at ProLife Blogs that had that last has been "snipped" to remove it, but the note of protest about accusing the bishop is still there. The quotes from Melanie Childers are still online at the North Country Gazette.)

About those ultrasounds before abortion

Over the last few days, Kelly at Blog.Bioethics.net has been blogging about House Bill 3355, passed in the South Carolina, which will require the abortion doctor to review the ultrasound with the woman or girl at least one hour before the abortion. The woman has to sign a statement that she's received the informed consent and a review of the US.

Kelly and several of the other visitors at the site are concerned that the woman who has made the choice to have an abortion is being unduly influenced, browbeaten and/or the target of images capable of emotional blackmail. (Words from the bloggers are in italics.)

Oh, and "a guy can go around and have sex until the cows come home,he's never going to have to deal with the emotional decisions attached to an unwanted pregnancy."

But, somehow, it's no big deal, anyway.

The conversation is the same one we've been having for 30 plus years, but you might want to take a look.