When Does Life Begin and End? -- the Debate Continues

Frederick Grinnell of Oxford University press in his blog post, Redefining Death — Again responds to the recent Nature editorial, “Delimiting death.” Grinnell’s post contributes to the ongoing public policy debate regarding the relationship between biological and spiritual life.

In addition to this post, there are several other articles that are of significance: Dr. James Bernat, neurologist at Dartmouth, wrote an article entitled Chronic Consciousness Disorders, Annu. Rev. Med. 2009. 60:381–92. The article notes that new functional neuroimaging techniques using PET and fMRI provide a new and complementary way to assess consciousness; that fMRI technologies are showing that 'persistent vegetative state' is not always clear cut -- that there is more of a continuum and that some 'PVS' patients are in fact closer to 'minimally conscious.' The author cites recent provocative studies suggesting that fMRI in unresponsive patients may detect evidence of conscious awareness when a careful neurological examination cannot.

Second, while doing research for my chapter on regenerative Nanomedicine, I came across this very interesting article, available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672310/ , entitled Shorting Neurons with Nanotubes by Gabriel Silva, a professor of bioengineering at UC San Diego. The abstract explains that new insights are emerging about the interactions between brain cells and carbon nanotubes, which could eventually lead to the development of nanoengineered neural devices, i.e., possible neural prostheses.

Finally, there are excerpts on CNN of Dr. Sanjay Gupta’s Cheating Death, available at http://www.cnn.com/2009/HEALTH/10/12/cheating.death.excerpt/index.html, which explores novel applications of therapeutic hypothermia to prevent injury to the brain, along with other stories of life-saving medical discoveries.

These articles and recent findings all have profound implications for end-of-life decisionmaking. While recently, an editorial in Nature magazine called for expansion of the definition of death in order to increase organ donation (http://www.nature.com/nature/journal/v461/n7264/full/461570a.html ), it seems that between the new diagnostics, the potential for neuro-prosthetics, and what we are finding out about 'cheating death’, that we should not necessarily be expanding the definition of death, but realizing that we that are expanding the boundaries of life. In doing so, we need to consider the implications for an aging population, as well as the societal and environmental impacts.

Progress in Bioethics - MIT Press

Bioethics has become increasingly politicized over the past decade. Conservative voices dominated the debate at first, but the recent resurgence of progressivism and the application of its core values (social justice, critical optimism, practical problem solving) to bioethical issues have helped correct this ideological imbalance. Progress in Bioethics is the first book to debate the meaning of progressive bioethics and to offer perspectives on the topic both from bioethicists who consider themselves progressive and from bioethicists who do not. Its aim is to begin a dialogue and to provide a foothold for readers interested in understanding the field.

The chapter authors, leading scholars in the field, discuss the meaning of progressive bioethics, the rise of conservative bioethics, the progressive stance toward biotechnology, the interplay of progressive bioethics and religion, and progressive approaches to such specific policy issues as bioethics commissions, stem-cell research, and health care reform.

The arrival of a new administration in 2009—one that is open to progressive ideas and rejects ideological interventions in science—makes this book and its new approach to bioethics relevant and timely.

Contributors: Sam Berger, Daniel Callahan, Arthur L. Caplan, R. Alta Charo, Marcy Darnovsky, John H. Evans, Kathryn Hinsch, James Hughes, Richard Lempert, William F. May, Eric M. Meslin, Jonathan D. Moreno, Michael Rugnetta, Paul Root Wolpe, Laurie Zoloth

From: http://mitpress.mit.edu/catalog/item/default.asp?ttype=2&tid=12074

Kudos to Susan M. Wolf for her election to the IOM

You may have noticed that we have been on hiatus, while we revamp and reorganize our blog, but I wanted to take this opportunity to give credit where credit is due: One of my heroes, Susan M. Wolf, has been elected to the prestigious Institute of Medicine. She is the McKnight Presidential Professor of Law, Medicine & Public Policy and the Faegre & Benson Professor of Law at U of MN, the founding Director of the Joint Degree Program in Law, Health & the Life Sciences and the founding Chair of the Consortium on Law and Values in Health, Environment & the Life Sciences. She is also a professor of medicine in the University's Medical School and a faculty member in the University's Center for Bioethics. She is also the author of Feminism and Bioethics: Beyond Reproduction, which was one of the first books that I read when I went back to school to get my degree in Biomedical Ethics. She has served as an inspiration to many in the field and she richly deserves this recognition and honor.

A Heartfelt Congratulations and Kudos, Susan!

The French health care system

Many countries envy the French health care system. The difficult reformation that is involved itself to the United States reminds me the fight of the French workers to obtain an equitable system. Nevertheless, the reformation of the United States is wished by the President Barack Obama and this decision seems to divide the American people, even beyond the borders.

Interesting it seem to we to retrieve the big points that do the force of the French system but equally not to conceal the problems.

The French health care system works on the basis of the solidarity between the active persons. Every month, the employees see a part of their salary versed to the State to finance the retirements and the social security besides the state ordinary taxes.

The social security is the strong point of the French health care system. The affiliated employees inform the social security of their health problems (benign diseases, engrave, disability, work accident). The social security is a cashdesk that will transfer the money of the contributions of salary to its affiliated employees according to the disease that they meet.

The cares opening right to repayment:
Medical consultations with a nonspecialized doctor or specialist
hospitalization
consultations and dental cares
purchases of medicines
As a whole of these medical practices, the cares will be refunded for a party. If the employee wishes to be more refunded, it is necessary for him to be affiliated with a mutual insurance company health.

Besides the cares, the social security towards a daily compensation to the employees on vacation diseases, in stop of work and to the women on vacation maternity.

The affiliation to a mutual insurance company health is not obligatory. On the other hand, to be affiliated with the social security is obligatory. Certain jobs have their special insurance cashdesk but it works as the social security.

The social security offers a cover health to the body of the employees and retired. Working thanks to the salaries of the active persons, the social security is today in deficit. More the unemployment in France is important, more the social security and the French health care system can be put in difficulty and to rediscover itself in a precarious position.

The social security is an equitable system that the employees want absolutely preserved.

The French health care system resting on the social loads, it did not take in load the persons in precarious position, without job and sometimes without residence. With the emergence of the precariousness, it was set up the universal healthcare coverage. It takes account of the inexistence or weakness of income and allows the free access to the medical cares.

It is certain that even if the French healthcare system is equitable, it knows malfunctions. But it stretches to respect the constitutional texts requiring the care access to all.

The system of American health seems to cost very dear. Can a common cash, like french social security, be a solution?




In French:
De nombreux pays envient le système de santé français. La réforme difficile qui s’engage aux Etats-Unis me rappelle la lutte des ouvriers français pour obtenir un système équitable. Toutefois, la réforme des Etats-Unis est souhaitée par le Président Barack Obama et cette décision semble diviser le peuple américain, même au delà des frontières.

Il nous semble intéressant de rapporter les grands points qui font la force du système français mais également ne pas occulter les problèmes.

Le système de santé français fonctionne sur la base de la solidarité entre les personnes actives. Chaque mois, les salariés voient une partie de leur salaire versée à l’Etat pour financer les retraites et la sécurité sociale outre les taxes étatiques usuelles.

La sécurité sociale est le point fort du système de santé français. Les salariés affiliés informent la sécurité sociale de l’ensemble de leurs problèmes de santé (maladies bénignes, graves, invalidité, accident du travail). La sécurité sociale est une caisse qui va reverser l’argent des cotisations de salaire à l’ensemble de ses salariés affiliés en fonction de la maladie qu’ils rencontrent.
Les soins ouvrant droit à remboursement:
consultations médicales chez un médecin généraliste ou spécialiste
hospitalisation
consultations et soins dentaires
achat de médicaments
Dans l’ensemble de ces pratiques médicales, les soins sont remboursés pour une partie. Si le salarié souhaite être remboursé en totalité, il lui faut être affilié à une mutuelle santé qui versera la somme restante à hauteur des plafonds imposés.

Outre les soins, la sécurité sociale verse une indemnité journalière aux salariés en congés maladies, en arrêt de travail et aux femmes en congé maternité.

L’affiliation à une mutuelle santé n’est pas obligatoire. En revanche, être affilié à la sécurité sociale est obligatoire. Certains emplois ont leur caisse spéciale mais elle fonctionne comme la sécurité sociale.

La sécurité sociale offre une couverture santé à l’ensemble des salariés et retraités.
Fonctionnant grâce aux salaires des personnes actives, la sécurité sociale est aujourd’hui en déficit. Plus le chômage en France est important, plus la sécurité sociale et le système de santé français peut être mis en difficulté et se retrouver dans une situation précaire.

La sécurité sociale est un système équitable que les salariés veulent absolument conservés.

Le système de santé français reposant sur les charges sociales, il ne prenait pas en charge les personnes en situation précaire, sans emploi et parfois même sans domicile. Avec l’émergence de la précarité, il a été mis en place la couverture maladie universelle. Elle tient compte de l’inexistence ou de la faiblesse des revenus et permet aux bénéficiaires d’accéder à l’ensemble des soins gratuitement.


Il est certain que même si le système de santé français est équitable, il connaît des dysfonctionnements.
Mais il tend à respecter les textes constitutionnels exigeant l’accès des soins à tous.

Le système de santé américain semble coûter très cher. Une caisse commune comme la caisse de sécurité sociale lui permettrait-elle de faire des économies?

Bookclub Selection: Normal At Any Cost

The Women's Bioethics Project's July 2009 non-fiction bookclub selection is:

Normal at Any Cost: Tall Girls, Short Boys, and the Medical Industry's Quest to Manipulate Height by Susan Cohen and Christine Cosgrove. 

From the Library Journal:

Two science journalists examine the fascinating history of medical science's flawed attempts to manipulate height and the ethics involved. In the first section, set primarily in the 1950s and 1960s, they discuss middle-class families who were urged to try to reduce their daughters' height before it was too late for them to be "successful adults." The tall girls were given estrogens to send them prematurely into puberty and force their growth plates to close.  In the second half, the authors focus on the use of human-growth hormone to increase the height of naturally short children. Before synthetic-growth hormone was developed, there was a painstaking procedure for extracting it from cadaver pituitary glands. This defective process led to the spread of neurological diseases as horrible as Creutzfeldt-Jakob disease (the human version of mad cow). Interestingly, neither the growth hormone nor the estrogen resulted in systematically proven results. This startling look at medical ethics and history has implications for the future of "human improvement" therapies; recommended for large academic and public libraries.

Normal at Any Cost would also make a great text for introductory high school or college bioethics courses because it manages to tackle in an accessible and compelling manner a wide range of bioethical issues from the medicalization of social problems, the pharmaceutical industry’s influence on physician education, limits of informed consent, definition of therapeutic v. enhancement interventions, to the appropriate allocation of medical resources (social justice considerations).

Read it this summer.

Empire State will pay for human eggs for research use

According to The Scientist, the Empire State Stem Cell Board determined last week that it's ethical to pay women to obtain eggs for use in stem-cell research.

The ESSCB points to the practice of paying women who donate eggs for reproductive purposes, which is not prohibited under New York law, and argues that donation for research purposes is not meaningfully different from that practice. You can read the ethics board's statement here.

An interesting difference in this case, however, compared with the reproductive instance, is that ESSCB will be using taxpayer funds to buy eggs. (Yeah, yeah, they're careful to say they're not buying eggs ... they're paying donors. Anybody buy that distinction?)

Some articles on our radar screen this past week...

Autonomy and Authenticity of Enhanced Personality Traits
Abstract: There is concern that the use of neuroenhancements to alter character traits undermines consumer's authenticity. But the meaning, scope and value of authenticity remain vague. However, the majority of contemporary autonomy accounts ground individual autonomy on a notion of authenticity. So if neuroenhancements diminish an agent's authenticity, they may undermine his autonomy. This paper clarifies the relation between autonomy, authenticity and possible threats by neuroenhancements.

Tech-assisted reproduction growing worldwide:
Worldwide report shows increase in assisted reproduction: 250,000 babies (approximately) born in 1 year.
Assisted reproductive technology (ART) is responsible for an estimated 219,000 to 246,000 babies born each year worldwide according to an international study. The study also finds that the number of ART procedures is growing steadily: in just two years (from 2000 to 2002) ART activity increased by more than 25%. As this technology becomes more accessible to more people, will this encourage the ART industry to go further in their efforts and should more regulation be considered?

Boy or Girl? As early as 10 weeks gestation, a new at-home test has an 80% accurate predication rate. But will this result in more female fetuses being terminated?

Should Politics and Values Be Removed from Science?

Associate executive director of the Center for Genetics and Society and WBP supporter, Marcy Darnovsky argues in a new article in the Democracy Journal that for too long progressives have built a bioethics around opposition to the religious right, and have thus failed to explicate a positive vision. In an article complementary to the WBP’s report (downloadable here), Darnovsky outlines a framework for just such a vision, one that balances individual autonomy with the real social concerns raised by biotechnological advances, such as how will human biotechnologies reshape our sense of ourselves, our relationships, the shape and feel of the world we occupy together? Who will profit, who will lose, and who will survive?:

“For many progressives and liberals, President Barack Obama’s March 9 announcement on stem-cell research affirmed the now-conventional wisdom that virtue lies in protecting science from the interference of politics. Fulfilling a campaign promise, the president repealed his predecessor’s stem-cell funding restrictions and pledged to ensure that ‘scientific data is never distorted or concealed to serve a political agenda–and that we make scientific decisions based on facts, not ideology.’

Scientists and stem-cell research advocates celebrated. The president of the Christopher & Dana Reeve Foundation said he was thrilled that the new Obama policy will ‘remove politics from science.’ A vice president of the Juvenile Diabetes Research Foundation lauded the commitment to ‘keep politics out of science.’ John Kessler, director of the Northwestern University Stem Cell Institute, recalled Bush’s funding limit and labeled it a ‘really, really unwelcome intrusion of politics into science.’

The policy is certainly a victory for progressives. But the assumptions embedded in its reception deserve close examination. Embedded assumption number one is that Bush’s restriction on federal funding of embryonic stem cell research was part of a broad ‘anti-science’ agenda. Assumption number two is that this policy constituted an illegitimate incursion of politics into science. The third assumption–and the one of greatest import as progressive politics tries to keep pace with scientific developments–is that we want to insulate science from moral values and political commitments.”

For access to the complete article, click here (free registration required).