Obama election signals change in stem cell fight

A commentary by friend and colleague Art Caplan in his MSNBC column:

'Change' was the horse that Barack Obama's presidential campaign rode to victory. Indeed the 2008 election will be remembered not only for Obama becoming the first African-American president, but also for its impact on core bioethical topics that have long dominated American domestic politics.

Divisive issues such as abortion bans failed to gain traction on state ballot initiatives, while newer bioethical concerns that are likely to dominate American politics for years to come, including physician-assisted suicide, emerged.

The past eight years of the Bush White House have seen stem cell research and the status of embryos at the center of the moral values debate. Obama's election has brought the fight over embryonic stem cell research in the U.S. to an end.

Loosening stem cell research
The state of Michigan passed Proposal 2, loosening restrictions on embryonic stem cell research. This means that in Michigan - whose universities such as Michigan State in East Lansing are major biomedical research powerhouses - scientists will be able to use the excess embryos created at in-vitro fertility clinics as a source of stem cells for research, as long as they have the written consent of the parents who sought treatment.

There are now 10 states that have laws permitting embryonic stem cell research. These 10 are likely to be the recipients of an executive order that the new president will undoubtedly sign shortly after taking office, freeing up federal funds for embryonic stem cell research while laying out new regulatory guidelines.

One of the main arguments against embryonic stem cell research is that all embryos are persons from the moment of conception. The voters of Colorado were given the chance to put that view into law with the proposed Amendment 48. The so-called "Personhood Amendment" sought to define fertilized eggs as human beings, extending them constitutional rights. Coloradoans defeated this amendment by a margin of three to one.

Many, including myself, would argue that the ongoing debate over the morality of stem cell research is really just a stalking horse for the abortion debate. But efforts to further restrict abortion did not fare well at the ballot box, either. California voters rejected a proposition that would have required doctors to notify parents before performing an abortion on a minor. The initiative also would have required a two-day waiting period before minors could get abortions.

In South Dakota a measure that would have banned abortions - except in cases of rape, incest and serious health threat to the mother - also lost. An even tougher version, without the rape and incest exceptions, was defeated two years ago. The 2008 initiative went down to a resounding defeat of 55 percent to 45 percent.

Taken all together this series of votes represents an important moment in public bioethics in America. Like it or not - and I am well aware that many are not ready to let go of these issues - the nation may be starting to move past the endless battles over stem cells, embryos and abortion. Stem cell research in all forms is proceeding. Embryos are not going to be given legal status as persons. Further restrictions on abortion are unlikely.

There will still be plenty to fight over! The most important topic to emerge from this election is how Americans die and treat painful medical conditions.

Michigan became the 13th state to enact an amendment legalizing marijuana use for medical purposes. Proposal 1 passed by a margin of 63 percent to 37 percent. It allows patients with "debilitating medical conditions" to register with the state and, with the permission of a physician, legally buy, grow and use small amounts of marijuana to relieve pain, nausea and appetite loss, among other symptoms. Massachusetts decriminalized possession of one ounce or less of marijuana, shifting the penalty to a $100 fine.

Help for terminally ill
Americans are clearly telling Washington that they want dying people to have access to whatever helps make that process less burdensome. It will be interesting to see how the new administration grapples with that message. If no one listens, then a much more controversial option may emerge - physician-assisted suicide.

Perhaps the most startling measure to pass at the state level was in Washington's Initiative 1000, offering terminally ill people the option of physician-assisted suicide. Washington voters decided that adults who are deemed competent and have been given less than six months to live by a physician can legally request and self-administer lethal prescription medicine. The measure passed by a margin of 59 percent to 41 percent.

This surely will not be the last state-level effort to legalize physician-assisted suicide if other policies aimed at minimizing the suffering of the dying are not enacted. While I have my doubts about the wisdom of offering help in ending one's life before offering them health insurance, I suspect it will become a political hot potato in a number of states in the next few years.
An aging population, the increasing cost of medical care and a lack of high-quality palliative and nursing-home care almost guarantee it.

The pundits will spend the next few months analyzing the election, pontificating on what led to the Obama victory and the Democrats taking greater control of Congress. They won't find the answers if they do not pay attention to the clear messages Americans sent concerning critical bioethical questions.

Original article here.

Biopolitics at the Bedside

In my opinion, it's not the doctors nor the scientists who have the most interesting insights into bioethics. It's the dreaded lawyers. And if you find one with a Masters of Theology, you can be sure they have important and compelling ideas on life and death. I recently came across an essay published in the Journal of Legal Medicine by Joshua E. Perry, Assistant Professor (School of Medicine and Law School) at Vanderbilt University. In it, Dr. Perry asks, and answers, the question "why has the anti-abortion movement obsessed with the beginning of life and seized on the issue of end-of-life feeding tubes?" He ultimately concludes that "biopolitics in the early twenty-first century United States context is about strategies and agendas for controlling and regulating the bodies of individuals even at the bedside as they lie dying. Politicized interventions that seek to control and regulate the personal and private space of one's final exit, in an effort to promote the 'culture of life' cliche, must be identified and resisted as abuses of biopolitical power that threatens individual decision making at the end of life." Right on!

Texas Futile Care Law

There is a case going on in Texas right now dealing with the Texas Futile Care Law. The bill, signed in 1999 by then Governor George W. Bush, allows hospitals to end life-sustaining treatment to patients whose medical treatment is declared "medically futile." Read the entire law here: Texas Statutes Health & Safety Code, Chapter 166. Advance Directives (specifically Section 166.046)

From the Washington Post:

Since Dec. 28, baby Emilio Gonzales has spent his days in a pediatric intensive care unit, mostly asleep from the powerful drugs he is administered, and breathing with the help of a respirator. Children's Hospital here declared his case hopeless last month and gave his mother 10 days, as legally required, to find another facility to take the baby. That deadline, extended once already, was due to expire Wednesday, at which time the hospital was to shut off Emilio's respirator. Without the machine, Emilio would die within minutes or hours, hospital officials have said.

Gonzales and her lawyers are seeking a transfer for the child, diagnosed with a terminal neurometabolic disorder called Leigh's disease, to a hospital that will perform a tracheotomy and insert a feeding tube so that he can live out his life in the facility or at home with his mother. But Children's Hospital doctors have declared that continuing treatment is potentially painful and is prolonging the child's suffering.

Read the rest of the article here.

On Wednesday a Judge issued a temporary restraining order preventing the hospital from ending the life-sustaining treatment. A hearing is set for April 19th.