Doctors, Abortion and Conscience

The debate on medical ethics has definitely moved from "Our Bodies, Our Choice," to "My Choice, You Don’t Have a Choice." Autonomy, the "I want" ethics, trumps the right to life, the right to liberty and the physician's duty to do no harm. Where once laws were written to punish doctors who harmed patients, doctors are now threatened with lawsuits and the loss of our licenses for refusing medications or procedures demanded by patients and their surrogates.

The American College of Obstetricians and Gynecologists ethics statement, "The Limits of Conscientious Refusal in Reproductive Medicine" is a case in point. Abortion is so important to the ACOG Ethics Committee that they deny the right not to be killed and threaten the right not to be enslaved by calling abortion the “standard reproductive care that patients request” and demands that doctors who “deviate from standard practices” (object to abortion) “practice in proximity to individuals who do not share their views or ensure that referral processes are in place” (with a willing abortionist). The President of ACOG then wrote letters asking Congress for laws to force these limits on our consciences: doctors who object to abortion should either change their practice so that they don't take care of women and girls or move close to a willing abortionist.

The Christian Medical Association and 28 other pro-life, pro-family organizations have written a letter criticizing ACOG’s Statement as “a profound misunderstanding of the nature and exercise of conscience, an underlying bias against persons of faith and an apparent attempt to disenfranchise physicians who oppose ACOG's political activism on abortion.”

GrannyGrump posted several reasons conscientious doctors should consider elective intentional abortion bad for the mother. I agree with her that abortion is wrong because it is bad for women. I also believe that she begins from the same viewpoint that I do: Even if abortion weren't bad for women, it would still be wrong.

Elective intentional abortion is immoral because it takes the life of a human being. If the mother's life is in danger, she has the right to self preservation and it is moral to help her save her life. Even then, the child's life should also be protected if at all possible. The intent can never be to produce a dead child.

State officials have mandated that all medical students learn to perform abortions in New York and that all pharmacies stock and dispense contraceptives in Illinois and Washington. ER doctors are forced to dispense Emergency Contraception in Connecticut, California, Massachusetts, New Jersey, New Mexico, New York, Ohio and Washington. How long before autonomy supersedes the physician's right to conscience at the end of life since the American Medical Association has condoned the use of Oregon's "Physician Assisted Suicide" law (now renamed and redefined as "Aid in Dying")?

Laws against the conscience are a poor substitute for medical ethics and will result in the death of those same ethics. The end result of limiting the physician’s conscience is cook book health care written in court rooms by lawyers and judges. The practice of medicine will no longer be a profession, much less a calling, practiced by men and women of conscience. It will become a job done by people capable of following orders, doing what they believe is wrong.

Review: What we know about stem cells

The Journal, Stem Cells, has published a free open access article about those cells that become the different blood cells, including red blood cells, white blood cells and platelets, entitled "Concise Review: Hematopoietic Stem Cells and Tissue Stem Cells: Current Concepts and Unanswered Questions" by Donald Metcalf, MD, of Australia.

An interesting point from this article is the current controversy about the definition of "stem cells." Dr. Metcalf gives his definition and notes that some cells now called stem cells are actually better described as "self proliferative" progenitor cells, which have been committed to only fewer lines of cells.

Which will be important to understand the controversy that surrounds another type of stem cell, which is described in another, newer article published this week online in advance, entitled, "Concise Review: Mesenchymal Stem/Multi-Potent Stromal Cells (MSCs): The State of Transdifferentiation and Modes of Tissue Repair - Current Views" by Donald G. Phinney and Darwin J. Prockop of the Center for Gene Therapy, Tulane University Health Sciences Center, New Orleans, LA.

These adult stem cells are found in most organs and tissues in the body including umbilical cord blood, skeletal, muscle, fat, joint fluid, blood and the cells surrounding the blood vessels, the pulp in teeth, and amniotic fluid. (They have also been harvested from aborted infants.) In the body, they are known to become bone cells, fat cells, and cartilage. When they are grown in the lab, they form a wide variety of tissues depending on the conditions in which they are grown. They can be induced to form cells that function as nerve, lung tissue, retinal pigment cells, blood vessel cells, and repair kidneys and hearts.

However, you may read that these cells are not as "plastic" as embryonic stem cells, that it's hard to study them and cause them to form the exact cells that are desired. While it's true that they do not form "all the cells in the body," they can be induced to form a wide range of cells and tissues and it's no harder to control the development of these cells than it is to control embryonic stem cells. They may in fact be different types of progenitor cells, depending on the source, but there are an awful lot of sources. And they don't require the destruction of a human life.

Medical Ethics and the Holocaust Lecture Series

The Holocaust Museum of Houston and the University of Texas at Houston are sponsoring a lecture series, "Medical Ethics and the Holocaust."

I'm not sure of the procedure, but there is information at the website on watching the lectures, live, on the Internet.

Prolonged culture of embryos, stem cells and more Free Stuff

This week's (June 27) Nature.com "Advance Online Publication" contains two "Letters" describing the production of embryonic stem cells from "epiblast" cells, one in mice and rats, one focusing on mice.

Full content is restricted to subscription-only, but you can listen to a discussion about the studies on the free podcast from Nature, here, and the first paragraph of each is available for free, here and here. I believe you can also download the pdf of the Supplementary material for the articles here and here. You can find old podcasts and the English transcripts of previous podcasts, here.

One point that I find interesting is the statement on the Podcast that "what we thought were mouse eS Cells (embryonic stem cells), probably weren't." The second is that, beyond the obvious concerns about increased interest in growing human embryos to a later stage, this research was carried out in human embryos before moving on to mice and rats. From the first reference:

We initially determined that prolonged culture of human ES cells in chemically defined medium (CDM) containing activin A and FGF2 (CDM/AF) maintained their fundamental characteristics (See Supplementary Data). We then tested similar conditions for derivation of pluripotent cells from pre- and post-implantation rodent embryos.

The good news is that the scientists are convinced that these "EpiSC's" - or Epiblast stem cells - will be useful as models for the study of embryonic development and substitute for the human embryonic stem cells, without the limits on US Federal funding. (I'm always fascinated by the interest that British publications have in our US funding schemes and politics.)

If I'm correct in interpreting the importance of this information, scientists should find it easier to do experiments that they've been wanting to do by using rodent embryonic stem cells, now that they know how to find the actual cells, themselves. We will also hear more advocacy for the "culture" of human embryos longer than the previous 3 to 5 days, in order to harvest truly pluripotent eSC's, from what one article calls the "embryo proper" or the body of the would-have-been-born individual. One researcher tells us on the Podcast that these cells from embryos at the stage when the embryo would naturally implant are the "universal stem cells" that scientists have been searching for.

"Should Science Speak to Faith?"

That free Scientific American issue also contains a dialog between two scientists on faith, religion and the scientific community. Laurence M. Krauss and Richard Dawkins discuss their different views on engaging in "seducing" people of faith. ("Teaching is seduction." "No one appreciates a dishonest seducer.")

Gentlemen, the main point you should understand is that those of us of faith believe that science lets us understand what is - not what we should do or why.

Oh, well, at least you agree that there's a difference between right and wrong. We can begin our conversation, from this common ground.

Free Scientific American issue

2 days only, through June 30th, the new Scientific American magazine is available for download online, here.

This month's issue invites us to learn all about how humans are making global warming, about the possible effects on hurricanes, which could get stronger, how memories are laid down in the human brain, how cats evolved, and last, but not least, how to measure the impact of humans on global warming by imagining that there are no humans around at all. Of course, first, you've got to get rid of all those pesky humans.

Seriously, I expect to read these things in Analog: Science Fiction and Fact, but not in Scientific American. I could buy better graphic novels (read: comic books) if I wanted to see "what if" stories in pictures!

Free Access Nature Reviews Molecular Cell Biology

If you'd like to learn how little you know (except you, Rebecca of Mary Meets Dolly), Nature Reviews Molecular Cell Biology is offering free access this month, with free registration.

The free registration itself is valuable - because you'll be able to access some of the news@nature items and receive Tables of Contents of many of the Nature Group of journals each month.

The titles this month include "Stem cells: Fledglings escape from the niche," "Post-translational modification: A smooth handover," and a review of "Research Highlight: In the News: A distinct human signature". Some of which I think I understand.

Edited March 6, 2007 for the wrong name of the owner of "Mary Meets Dolly," which I tried to change from Rebecca to Rachel.

Drug company gifts - corruption of medical judgment and education?

[Edit note April 21, 2007 - spelling in the title and "labels"]
I don't know about the rest of you, but while it's possible that I can be bought, it's not for the price of a free pen or a lunch. I pay $100 extra for my subscription to Contraception because I won't sign off on the mission statement for the Association for Reproductive Health Professionals, for pity's sake.

I guess that since doctors are such an unreliable and untrustworthy lot(who can somehow trusted with sharp objects and every personal detail about your life and body), we shouldn't permit them to accept give-ways from salesmen.

Come on! Doctors need education in ethics and practice making ethical choices. But, this is not the way to teach them: assuming that their patient's life is worth less than an ink pen bearing advertising.

However, I do hate seeing the drug samples lumped into the "free gifts" prohibition. Even the well-to-do are helped when we can give them a a day's worth of antibiotics to get them going or a week's worth of BP meds to see how they handle the new med. The poor and the working poor who live from payday to payday or have to get by on a limited formulary and limited number of scripts a month depend on my samples, at least until we can get them on the indigent program for the drug.

The "bioethicists" at the blog.bioethics.net, run by the editors of the American Journal of Bioethics, claim to have proved that we are influenced by pens, back in 2003. (In a Journal that maintains closed access to articles even 3 years after publication, and which is difficult to subscribe to, because subscriptions appear to run according to the calendar year.) The social science Ph.D.'s often seem hostile toward physicians, and this is one of the subjects that brings it out in them.

From the Kaisernetwork.org:

Tuesday, September 12, 2006

Prescription Drugs

Stanford University Medical Center Expected To Announce Policy Banning Doctors From Receiving Drug Industry Gifts

Stanford University Medical Center on Tuesday is expected to announce a policy under which physicians will no longer be allowed to accept gifts from pharmaceutical sales representatives in an effort to limit the drug industry's influence on doctors' medical choices, the New York Times reports. The policy, set to take effect Oct. 1, would prohibit doctors from accepting even small gifts such as pens or mugs from sales representatives for pharmaceutical, medical device and other companies. The policy also will prohibit doctors from accepting free drug samples and from publishing articles in medical journals that are underwritten by drug companies. Doctors who purchase medical equipment will be responsible for reporting any financial relationship they have with medical device suppliers, and, in some cases, could be excluded from the purchasing process. The new policy will not affect consulting agreements between physicians and companies that develop drugs or devices, which already are covered by an existing conflict-of-interest policy. The Times reports that the "move is part of a reaction against corporate influence on medicine at a time of growing concern over the safety and rising cost of drug and medical devices." The pharmaceutical industry spends about 90% of its $21 billion marketing budget on physicians each year, according to an article published in the Journal of the American Medical Association in January that encouraged academic medical centers to adopt no-gift policies. The article stated even small gifts can engender a sense of obligation, while free drug samples are "a powerful inducement for physicians and patients to rely on medications that are expensive but not more effective."

Comments
Stanford School of Medicine Dean Philip Pizzo said, "We want to secure the public trust to value what happens in academic medicine," adding that the policy would cost the institution millions of dollars per year. "Many faculty members and departments have become dependent on sponsored meals from industry in order to run seminars," Pizzo said. David Mangus, director of the Stanford Center for Biomedical Ethics and a contributor to the new policy, said it would lead to "a pretty major change in our culture." Scott Lassman, senior assistant general counsel for the Pharmaceutical Research and Manufacturers of America, said the new policy is a "disservice to patients and physicians," adding, "The company sales representatives, in our point of view, have a lot of useful information on drug products and how to use them, and how not to use them" (Pollack, New York Times, 9/12).