How not to promote organ donation

Julian Savulescu, the British ethicist who opined that religious doctors should shut up and perform, is back.

This time he's advocating the donation of organs from people who are not dead or dying, but who have "suffered such severe injury that they would be permanently unconscious, like Terry Schiavo, who would be allowed to die anyway by removal of their medical treatment."

Hat tip to BioEdge.com

American Society of Bioethics and Humanities Convention

I'm on my way to Cleveland, Ohio for "Future Tense," the Annual meeting of the American Society for Bioethics and Humanities.

Tonight, there's a pre-conference symposium focusing on the novel, House of God. The book written by Dr. Stephen Bergman was a rite of passage when I was pre-med. It's now 35 years old, and (although I didn't read it until the mid-'80's) I'm a bit older, myself. I'm about half-way through the re-reading, now.

The rest of the week, I'll be attending - and possible blogging on - "Welcome and Plenary Session How to Stay Human in Medicine: The House of God, Mount Misery, and the Spirit of the Place," "Building Better Humans," " Advancing the Debate on Futility to a New
Level: Ethical, Legal, and Clinical Implications," "Future Directions for Public Health Emergency Planning: Broader Moral Perspectives," and last, but not least, "Limiting Rights for the Public Good: Balancing Public Safety and Civil Liberty in Response toTerrorism, Epidemics, and National Security," with "Organizer," Paul Root Wolpe, PhD and Jonathan Moreno, PhD. The former has served as the ethicist for both NASA and Planned Parenthood, and the last is on staff at the Progressive bioethics arm of the "Center for American Progress."

For some reason, there always seem to be several very interesting sessions going on at the same time. For instance, Saturday morning, I have to choose between "Professionalism in Bioethics and Medicine" or "Role of Government in Public Health."

Wish me luck. The weather here in South Texas is in the 80's in the daytime, while in Cleveland, the highs will be in the 40's and the 50's. Before I knew Cleveland would have the heat wave, I bought gloves and dug out the scarves. Since I don't own a real coat - I'm claustrophobic more than I'm "cold-natured" and who needs a heavy coat in San Antonio, anyway? - I'll be the extra-bulky one in layers of red and black.

Discussion on Abortion in Australia

A med student's blog, "Degranulated" posts his thoughts about the presence of anti-abortion protesters outside and inside his medical school. It seems that the Australian medical community is in the midst of a debate like ours on conscience rights, with new laws that impose a duty to refer and /or perform abortions on physicians.

Public policy and medical ethics should be taught in medical schools. With every bit of the objectivity, pluralism, and inclusiveness that the most radical pro-abort demands from the rest of us.

(after the same old "men don't have the right to object to abortion")

Secondly, the opponents argue that the bill does not adequately deal with doctors whom object to abortion on moral grounds. In medical school, we are taught that the patient has a right to be made aware of all their options, and if a doctor is unwilling to refer a patient for a ToP, they should refer the patient to a doctor who is willing to explain all possible options. In this way, the patient's autonomy can be fully exercised. The opponents of this Bill appear to not currently do this. So, do they believe paternalism or patient autonomy, or even womens' rights? Hmph. Isn't it good to see how times have changed.

If times have changed, Dame Warnocke's call for the rest of us to kill ourselves and others in the face of dementia is the sign of those times.

Here's what I wrote in my comment:

I'm maternalistic, matronizing occasionally. And you sound/read as though you haven't had many conversations about the subject of abortion.

You should inform yourself, as the same rules apply to euthanasia, "assisted death," the death penalty, and our upcoming debates on genetic manipulation of future generations.

I'm sure that you understand the difference between the embryo or fetus and a body part or end stage cell line. There's no doubt that what we are discussing is a human being.

The nature of this individual human being is underscored by in vitro fertilization. Just as a neonate may be cared for by other people, that embryo in the lab can be nurtured by others and even adopted for implantation into a woman other than his or her biological oocyte- mother. What we do to that embryo affects the later toddler and adult, and even his or her own children.

Once the individual human being is acknowledged, we have to discuss whether or not to afford him or her the protection from intentional killing by others - what some call "personhood." This is the dangerous point of our conversation. How do we justify intentional, interventional and elective killing of that embryo or fetus in such a way that does not put other human beings that we acknowledge are "persons" at risk?

Autonomy should not be your first consideration in this deliberation. Instead non-maleficence, then beneficence and justice should be weighed with autonomy. Your own note about the decision to act or not act according to rules and laws by you future colleagues points out that these other values come into play when you are discussing the interaction of the mother, the unborn child, and the doctor and nurse, and the law.

George on "Obama and Infanticide"

"Obama chose to defend the widest possible scope for legal abortion by building a fence around it, even if that meant permitting a child who survives an abortion to be left to die without even being afforded basic comfort care."

Two of the greatest ethics minds today explain the controversy surrounding Senator Barack Obama's blatant misrepresentation of his pro-abortion and pro-infanticide legislative and public policy. Professor Robert B. George is joined by Yuval Levin at the Witherspoon Institute as he follows up on his earlier discussion about the por-abortion views of Democratic Presidential candidate, Barack Obama.

During the last Presidential Candidate debate, Obama stated,

''There was a bill that was put forward before the Illinois Senate that said you have to provide lifesaving treatment and that would have helped to undermine Roe v. Wade. The fact is that there was already a law on the books in Illinois that required providing lifesaving treatment, which is why not only myself but pro-choice Republicans and Democrats voted against it.''

George and Levin respond:

A few years ago, after it became clear that some infants who were born alive in the course of an attempted induced abortion at Christ Hospital in Chicago and elsewhere were being left to die without even comfort care, Republicans and Democrats around the country united in an effort to make the practice illegal and declare that any child outside the womb, even if she was an abortion survivor whose prospects for long-term survival might be in doubt, was entitled to basic medical care. Even the most ardent advocates of the pro-choice position agreed that a child born alive, even after an attempted abortion, deserves humane treatment.

The tragic stories of infants being left to die moved legislators to act at both the state and federal levels. In Washington, D.C., consensus can be a rare commodity, and never more so than on the issue of abortion. But the Born-Alive Infant Protection Act of 2002 was just such a rarity. The bill passed both houses of Congress without a single dissenting vote-it was 98-0 in the Senate-and numerous states then proceeded to enact similar measures. In Illinois, however, a series of efforts to pass ''Born-Alive'' legislation from 2001 to 2003 met with stiff resistance from legislators concerned the measure would constrain the right to abortion in the state. Prominent among these opponents, and the only one to actually speak in opposition to the bill when it was debated in 2002, was state Senator Barack Obama.

Obama's case against the bill did not revolve around existing state law, as he seemed to suggest last night. The law Obama referred to in the debate was the Illinois abortion statute enacted in 1975. But at the time of the debate about the Born Alive Act, the Illinois Attorney General had publicly stated that he could not prosecute incidents such as those reported by nurses at Christ Hospital in Chicago and elsewhere (including a baby left to die in a soiled linen closet) because the 1975 law was inadequate.

"The motivation is abortion"

“The motivation is abortion,” says R. Alta Charo, a professor of law and bioethics at the University of Wisconsin at Madison. “If the Supreme Court allows states to declare embryos as personhood, you would be in a position to say immediately that all abortions have to stop.”

LifeEthics covered this story a few days ago, but this quote deserves a second look - and repeating for the record.

The comment by (Robin) Alta Charo in the LA Times explains the opposition of "Resolve," the National Infertility Association, to Colorado's proposed State Constitutional Amendment 48. That Amendment reads,

“The term ‘person’ or ‘persons’ shall include any human from the time of fertilization.”

Here's an article on a rally in Colorado opposing the Amendment, led by Resolve.

The "foes" of the amendment are claiming that it would criminalize "several forms of contraception" and in vitro fertilization. However, I believe that IVF could be carried out in a manner that respects each individual begun that way, if each is treated as a human being deserving of life.

Surfing is brain exercise (buy your parents a computer)

Surfing the Internet stimulates middle-aged and elderly brains more than reading a book. In fact, the more you surf, the more stimulation of blood flow to the brain.

At left, a functional Magnetic Resonance Image (fMRI) of the brain while reading a book and at right, the brain while surfing the web. The red areas indicate increased blood flow.


From the press release at UCLA :

For the study, the UCLA team worked with 24 neurologically normal research volunteers between the ages of 55 and 76. Half of the study participants had experience searching the Internet, while the other half had no experience. Age, educational level and gender were similar between the two groups.

Study participants performed Web searches and book-reading tasks while undergoing functional magnetic resonance imaging (fMRI) scans, which recorded the subtle brain-circuitry changes experienced during these activities. This type of scan tracks the intensity of cell responses in the brain by measuring the level of cerebral blood flow during cognitive tasks.

All study participants showed significant brain activity during the book-reading task, demonstrating use of the regions controlling language, reading, memory and visual abilities, which are located in the temporal, parietal, occipital and other areas of the brain.

Internet searches revealed a major difference between the two groups. While all participants demonstrated the same brain activity that was seen during the book-reading task, the Web-savvy group also registered activity in the frontal, temporal and cingulate areas of the brain, which control decision-making and complex reasoning.

"Our most striking finding was that Internet searching appears to engage a greater extent of neural circuitry that is not activated during reading — but only in those with prior Internet experience," said Small, who is also the director of UCLA's Memory and Aging Research Center.

In fact, researchers found that during Web searching, volunteers with prior experience registered a twofold increase in brain activation when compared with those with little Internet experience.

The research is to be published in the American Journal of Geriatric Psychiatry. Additional coverage at the BBC and the UK's Daily Mail. Thanks to blog.bioethics.net for first alerting me to this study.

(Edited at 6 AM for citations and to add image.)

Robert P. George on "Obama's Abortion Extremism"

Professor Robert B. George has published a review of Democratic Presidential Candidate Barack Obama's abortion views and advocacy.

The information on the Freedom of Choice Act goes beyond politics to the heart of all pro-life advocacy and would more than likely offend even abortion "moderates."

But this barely scratches the surface of Obama's extremism. He has promised that ''the first thing I'd do as President is sign the Freedom of Choice Act'' (known as FOCA). This proposed legislation would create a federally guaranteed ''fundamental right'' to abortion through all nine months of pregnancy, including, as Cardinal Justin Rigali of Philadelphia has noted in a statement condemning the proposed Act, ''a right to abort a fully developed child in the final weeks for undefined 'health' reasons.'' In essence, FOCA would abolish virtually every existing state and federal limitation on abortion, including parental consent and notification laws for minors, state and federal funding restrictions on abortion, and conscience protections for pro-life citizens working in the health-care industry-protections against being forced to participate in the practice of abortion or else lose their jobs. The pro-abortion National Organization for Women has proclaimed with approval that FOCA would ''sweep away hundreds of anti-abortion laws [and] policies.''

In vitro fertilization and the beginning of life

The Los Angeles Times (a one time free registration may be required) finally notices that couples who initiate in vitro fertilization are "finding themselves ensnared in a debate about when life begins."

The proposed Colorado amendment states, "The term 'person' or 'persons' shall include any human from the time of fertilization." If it is passed, the courts would have to interpret the meaning of those words, says Kristi Burton, sponsor of the initiative and founder of Colorado for Equal Rights, which focuses on the rights of unborn children. The goal of the amendment, says Burton, a college student, "is to respect and protect all life."

Fertility advocates are skeptical that "personhood laws" wouldn't limit their choices for reproductive healthcare. In August, Resolve released a statement opposing the Colorado amendment.

"The motivation is abortion," says R. Alta Charo, a professor of law and bioethics at the University of Wisconsin at Madison. "If the Supreme Court allows states to declare embryos as personhood, you would be in a position to say immediately that all abortions have to stop."

The reproductive rights of infertile women may not be the target, says Dr. William Schlaff, director of reproductive endocrinology at the University of Colorado Health Sciences Center, "but the implications are massive depending on how this law would be used if adopted."

For instance, what happens to embryos determined to be afflicted with serious genetic diseases? "What do you do with that embryo then?" Schlaff asks.

Says Burton of the initiative's possible ramifications: "All those things would have to be dealt with later on. . . . We don't see it as preventing infertility treatment."

As for the Rathans, over the course of several weeks, the couple ruled out discarding the embryos. They discussed donating them to research but heard that option was a logistical nightmare. They pondered giving the embryos to another infertile couple.

"Before I became pregnant, I thought the decision would be easier for me," Gina Rathan says. "But when it actually happened, I realized these are three potential lives."

Finally, the couple paid for three more years of cryopreservation.

Healthcare lottery

When you buy a lottery ticket, do you choose the cash option with its immediate payout of half the winnings or do you choose the payment of the full amount, doled out over 20 years?

I've found this question to be a good way to help other people understand the difference between conservativism and those who think that someone else can take care of them or the "totalitarian mamas" who believe that they can take better care of us than we could ourselves and for our own good. (Of course, some Conservatives tell me don't gamble, so they never buy lottery tickets.)

It's amazing how many people tell me that they always buy the "cash option." Some say they worry that their families wouldn't get anything if they die before the 20 years is up. Some tell me that they believe they can manage and invest the money to earn more than they would if they wait out the smaller payments. A few tell me that they would rather not have all the money at one time, preferring the guaranteed income over the years or fearing blowing the money.

The latter group never understands why I suggest that their health insurance should be something that they own and control, rather than something doled out by government and their employers.

A "right" is something that we each have without conditions and which we can call on society and government to enforce or punish if someone infringes that right. The right to life is actually the right not to be killed. We expect our fellow citizens to protect us through providing armies and law enforcement, a militia and by allowing self-defense. If another person infringes our right not to be killed, we expect society to punish him.

Last night, Democratic Presidential Candidate Barack Obama stated that health care is a right. I strongly disagree.

"Health" and "health care" are difficult terms to define. Instead of people and their actions, health is threatened by disease, age and injury. If I'm not well, how will society protect my health - and who or what will be held responsible as I inevitably age? If I have a "right" to health care, then I want everything possible to maximize my health. Rights can't be rationed.

What we're really talking about is health care funding. Funding certainly can be rationed. Take a look at Medicare, Medicaid, and the Veteran's Administration.

These systems work fairly well most of the time. However, they rely on limiting the costs of health care. The limitations fail when demand for cutting edge, expensive treatments or emotional arguments override them. That's why Medicare won't pay for a tetanus shot after a dirty wound, but will pay for annual physicals, screening mammograms and prostate specific antigen tests, although there's no evidence that these prolong life.

Or why Oregon Health sends notes telling patients that they won't pay for cancer treatments, but they will pay for assisted suicide.

For more on this subject, here's another opinion.

Half the abortion rate

That's a quote from NARAL ("National Abortion Rights Action League" ), in a report on the effects of the Hyde Amendment (a pdf document). The Hyde Amendment restricts federal funding of abortions, including those for women who are eligible for prenatal care funding by Medicaid. NARAL urges us to examine the record of John McCain and Sarah Palin on abortion and "reproductive health." (The numbers are actually 18%-35% of women, according to this report on line at the Alan Guttmacher Institute (AGI), the research and education arm of Planned Parenthood.)

Cutting the abortion rate in half is a good thing, and a benefit of the Hyde Amendment.

It will be interesting to watch the response to a National Review article, "Unholy Messaging," by Douglas Johnson, who does just that for Democratic Presidential Candidate Barack Obama, while pointing out the bias of the New York Times editors.

The focus of the article is three specific points denied in the editorial:

. . . (free one time registration)on September 21, titled “Right to Smear.” The editorial expressed the hope that the federal courts and the Federal Election Commission would prevent a group called The Real Truth About Obama, Inc., from disseminating an ad that, the Times said, “trashes the candidate’s nuanced position [on abortion]. It even employs an Obama-like voice pledging to make taxpayers pay for abortions, help minors conceal abortions from their parents, and legalize late-term abortions."

Mr. Johnson documents the truth, one by one, of what the NYT calls "these lies."