Children of lesser gods

I have been contemplating the value of human life, wondering if life is innately of value, or is some life more valuable than others. Is the life of the alcoholic as important or as valuable as that of the school teacher of pharmacist? Are nurses more valuable than rapist? who places value to human life, and are there different levels of humanity? Should people be ascribed value based on occupation or social contribution, education or wealth, the argument seams always to be framed in camps that are in conceptual opposition. You are either a bleeding heart liberal or a hard nose conservative but reality often times is much less polorized.

The question is how can we not label people; This I venture to say is impossible. The problem with labeling is that it has the potential to affect the quality of care that is delivered based on the value that we placed on the patient. As a human being the concept of all being equal is designed to provide the platform upon which care is provided and although this may sound great, in reality we know that there is no such thing as people being equal. Equality is a socio political construct, designed to maintain the social compact, in which people co exist feeling good about themself despite all their shortcomings. The equality philosophy is a lie. We are never equal from birth to death, we are born with different capacities to learn and grow, with different needs and desires, different strength and weakness.

As health care providers, we need to be mindful of these labels and try to find some unifying quality among patients in order that we provide compassionate care to all. This may require that we embrace a work philosophy which can sustain us through difficult and trying days, for some they may need to call upon their faith, for others, it may come from a strong desire to live up to a professional code, for in a profession in which we are at constant risk for becoming apathetic and desentisized to the suffering of those we treat. It is important that we keep a constant check of our humanity, or we may find ourselves treating some patients as though they were children of lesser gods.

Putting Judith Jarvis Thomson's argument to the test

Blog entry # 2: Elsie barthelemy

Putting Judith Jarvis Thomson’s argument to the test
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Judith Jarvis Thomson’s analogy regarding a pregnant woman’s right to unhook herself from a fetus later amended by Jane Thomas , I feel places the woman as the sole decision maker .I feel that all parties involved should equally take part in the decision making when such a drastic outcome such as “ ABORTION” is entertained.

A woman cannot conceive alone. So far, science has yet made this leap. Conception thus far is accomplished by two parties whether each one play either an active or passive role toward such an accomplishment. Even in the instance where the natural process of conceiving by sexual intercourse is bypassed to be replaced by unison of a donor egg and sperm in a Petri dish. One thing cannot be changed that is the creation of the origin of such a conception that is the starting ingredients: sperm and egg. Therefore both parties supplying the ingredients should have equal right to its product unless one decides to give up this right.

So far the argument made by both Judith J Thomson and Jane Thomas only supports the woman as the sole decision maker. The male donor/ parent must be taken into account as well. I do understand that a woman carries the unequal burden of pregnancy for 9 months in comparison to the male counterpart. This should not be the sole aspect taken into account when arguing such a controversial subject.

One can further argue that a man donating his sperm is doing so in the hope of accomplishing procreation even when the act is done in an immoral and illegal matter. Therefore shouldn ’t he be given his fair share of the right to choose to give up his right of fatherhood?

Now as far as the right of the embryo/ fetus, I still have some reservation . If one agrees with Joseph Fletcher’s 15 propositions of personhood , it would then be clear and simple to decide that indeed the product of conception at its earliest stage is untitled to any rights whatsoever . However, there is still a grey area in this issue of when to consider a person a person. The advent of ART’s definitely render this subject more and more complex…

So what is the final word then? I guess for a while , this will remain “THE” controversial subject for debate. I don’t believe we have yet seen the end of the ambivalence and confusion which exist when one is considering what the final true ethical, moral and legal decision regarding “ ABORTION” should really be. I myself am no exception to the rule………….

Criminal & Civil Liability for Failure to Follow Advanced Directives

Health care workers need to faced with both criminal and civil prosecutions for refusal to follow Advance Directives for Healthcare.

There has been alot of time and energy expended in our country on the issue of healthcare directives. The government as well as private institutions have provided many classes, seminars, and even attorneys to help individuals understand and prepare these directives. Many people, especially the elderly, agonize over the decisions as to whom they want to appoint thier attorney-in-fact and to express what their desires are. In accordance with most state laws, every patient mujst be questioned as the presence of Advanced Directives for Healthcare and must provide further information and assitance to the patient in procuring these directives if the patient requests. Why is then that we are constantly hearing about healthcare providers , primarily physicians, who are refusing to follow these documents.

I believe that physicians need to be arrested for battery and that the families of these patients need to file a civil lawsuit for the tort of committing a battery and that damages need to be paid. For example, a physician who intubates a patient in the Emergency Room after learning of an Advanced Directive requesting "No Intubation" and speaking with the Attorney - in - Fact who states No Intubation. The occurs many times when there are multiple family members who have different wishes. Even though every family member is important, we must lose focus of our patient. The reason the patient identified his or hers desires and appointed an Attorney - in - Fact is that the individual has made the decison for himself.

The definition of a battery is the wilful or intentional touching of a person against that person's will or by an object set in motion by that person. Intubation of the patient in mhy example is clearly the intentional touching of the patient against their will.

In order to intubate a patient, a practitioner must first obtain legal consent. The consent can either be expressed or implied. Neither of these types of consent would be present in this example. There woule be lack of express consent as the Attorney-in-Fact clearly did not give consent to the intubation and furthermore, this expression was consistent with those expressed in the Advanced Directive. Implied consent also would not apply here. While many procedures are performed via the doctrine of implied consent in the Emergency Room, the doctrine would be negated by the refusal of the Attorney-in-Fact to consent. If the patient came in the Emergency Room in respiratory distress and without an Advanced Directive, consent would be implied by the virtue of succumbing to the EMS system. However, the Advance Directive and POA clearly interfere from Implied Consent being necessary.

Criminal prosecution for Battery does not require that any harm occur so an argument by the offending practioner that no damage occured by extending the patient's life would not prevent a criminal finding of Battery with a sentence. The plaintiff in the civil action would be required to show damages and they may be difficult to prove in monetary terms but some degree of pain suffering would be present in these type actions.

Those who choose to work in areas where these issues are present must comply with law even if they do not agree. If they choose to disregard the law. they must be prosecuted. This will eventually affect their licensure as one of the questions we all must answer when renewing our licenses is whether or not you have been convicted of a crime other than speeding offenses.

We see everyday as healthcare providers how the HIV epidemic becomes more prominent. SInce the begining in the 1980's thousands of people have lost their lives to this epidemic. The numbers keep rising specially in Africa where screening and treatment are a matter of luxury. With this in hand we beging to question wether HIV screening should be part of a normal physical examination. The reality is that many americans do not know they have the HIV virus do to lack of screening.
The U.S Ceters for Disease COntrol and Prevention announced the recommendation to make HIV testing a standard testing for all americans as they aim to prevent further spread of the disease and prompt needed care for the estimated 250,000 americans who have AIDS but do not know. It has been found that nearly half of the new HIV infections are discovered when doctors try to diagnose another illness and turn out to have the virus. I believe that earlier screening will allow people access to life expanding therapy, and also through prevention education, learn how to avoid the transmittion of the HIV infection.
Although this is only the beginning is a very important step in the prevention and treatment of the disease, Is a very good sign that we understand that testing should not be only for high risk groups but for every sexually active individual. Although the implementation will be challanging, requiring alot of money for testing counseling, and testing.
Identififying more HIV patients however, will place an added burden on public health programs that pay for such care, some of which are facing potential cuts under a proposal before Congress. However, more diagnosis may help win more funding, people's awareness and responsability for this expanding killer.
There is also the matter of cost. Some healthcare economists say that universal screening for HIV is a t least as cost effective as test that detect diabetes, breast cancer, and other chroninc conditions because if the virus is caught early, medicines can give patienta long, productive life. However, there are others under the impression that it will add more to the already burden health system.
I will assume that many of our fellow physicians will question wether is necessary to expand testing behond high risk individuals. However, it is the beginning for the prevention and extintion of the disease. Also, a more routine testing would avoid the problem of patients not acknowledging their risky behaviors.

HPV Vaccine- A Giant Step towards Preventing Cervical Cancer

In the United States there are currently 20 million people infected with the HPV virus and an additional 6.2 million are newly infected each year. Of every 100,000 women, 8.7 will develop invasive cervical cancer and 4000 women will die each year from this disease. In the past, prevention of cervical cancer was limited to screening Pap cytology. However, a HPV vaccine has recently been approved by the FDA and has been found to be 100% effective against the most common high-risk HPV virus strains.

In my practice as a women’s health Nurse Practitioner, I have seen the burdensome treatment and anguish of pre-cancerous conditions and the tragedy of cervical cancer caused by the HPV virus. It is my opinion that all young females should be offered and encouraged to receive this vaccine. Unfortunately at the present time no state is requiring this vaccine and few health insurance policies cover this expense. This is ridiculous.

A bipartisan group of female legislators representing the State of Michigan has introduced a bill requiring all girls entering the sixth grade to be vaccinated against the HPV virus. This is the first state to consider mandatory vaccination for this virus and should receive our enthusiastic support. It is also our obligation to help educate the public of this opportunity, inform our patients of their options and to encourage their vaccination. This vaccine should lead to a substantial reduction of cervical cancer and, hopefully, to the ultimate elimination of this disease.


www.cdc.gov/std/hpv
www.cancer.org
www.fda.gov/bbs/topics/NEWS/2006/NEW01385.html

The BioEthics Cafe -- Essays from the Edge of Paradise

The BioEthics Cafe -- Essays from the Edge of Paradise


The threat or pressure placed on physicians at the time of making a life and death decision is even more influenced by the threat of litigation. In a time of extreme stress, physicians are required to make decisions that are in the best interest of the patient and that also agree with the patient's wishes. In terms of "End of life" decisions, often every minute counts. And while the physician may have a state recognized "do not resuscitate" (DNR) order that documents the patient's wishes, there can be many members of the patient's family who surface at the 11th hour with conflicting views about what the patient wants in that situation.
For example, there was a patient in my hospital who came into the emergency room unconscious and in septic shock. She was a 76 year-old, widowed nursing home patient with four children. Her oldest daughter was her medical power of attorney. She had also signed an Advanced Directive six months prior, that stated her life not be sustained by any artificial means. She had specifically documented no intubations or CPR.
It was determined by the attending physician that this woman was in respiratory distress and needed to be intubated to prolong her life. The power of attorney, along with two other siblings reiterated the patient's wishes of no intubation. However, the physician received a phone call from the fourth sibling, her son from Washington D.C., who stated "Everything be done". The wishes of the patient and the rest of the family were not enough to convince the son to change his mind. He threatened the physician with a lawsuit.
The emergency room physician intubated the patient contrary to her wishes. While in the AICU, the intensivist would not extubate the patient because of the son's wishes despite her advanced directive. She subsequently expired 4 days later of cardiac arrest but not before a prolonged megacode to keep her alive.
Because both these physicians felt legal pressure, they did not honor the patient's Advanced Directive. They were swayed from allowing the patient to naturally pass, as per her wishes, to avoid litigation.
Unfortunately, this is becoming a trend where the DNR paperwork that comes in with a patient is not worth the paper on which it is written. While it used to be a guide that the physcian could use in directing treatment, now the patient's wishes seem to be secondary to potential legal threat. Personally, I am yet to see a physician stand up to this threat and withhold treatment in accordance with the patient's wishes. In the future it will require the hospitals and the legislature to strongly support physicians so they can provide or withhold medical care as originally intended by the patient.

Right to Die: “Mercy Killing”

Back in the old days, dying was relatively simple. Patients with untreatable illnesses opted to stay at home and live the rest of their days under hospice care. These patients wanted to live their remaining life comfortably surrounded by friends and family, then die in their own beds. These days, however, dying has become a complicated issue with the help of machines. Some people are coming up different ways of defining a “good death.” Is good death similar to the one in old days? Or is good death equivalent to be heaving out the last of breaths using respirators, dialysis machines, and force-feeding using G-tubes?

Today, most patients die in hospitals surrounded by strangers in uniforms. These strangers try their best to keep the patient alive by providing them with the best of medical machines and equipment, beds, medical staff, etc. Now, some people may find this type of death as acceptable, some however, tend to give up quickly and want to die comfortable at home. People who want to die at home may find their wishes unacceptable by family and physicians, who are entangled in a web of moral, legal and medical considerations. The main question into consideration is – should people, who want to die, request their physicians to hasten their deaths? And is it morally acceptable for physicians for physicians to do so?

This raises more questions than answers: Why decides to kill the patient? Is it the doctor? Or is it the patient (who is not always in full mental capacity)? Or is it the family members? Wouldn’t killing the patient violate the Hippocratic Oath? From a religious point of view, is it moral for one person to take the life of another person – even if the other person wants to die?

My personal point of view is that the doctor and the patient’s family (if any) decide on terminating the patient. I have first-handedly witnessed the pains of a family friend during his last stages of life. This person had a motorcycle accident and was in a vegetative state, unable to move except roll his eyes and weakly move his fingers. I noticed when a nurse was cleaning his G-tube, the patient was vigorously rolling his eyes and clenching on the bed sheet – a sign of extreme pain. The patient himself, communicating only using his eyes, wanted to die. Furthermore, the patient’s wife and doctors supported in terminating the patient, however, the patient’s sister disagreed. In the end, after dragging his life for 12 more months, the patient developed various infections in the lungs and kidneys, together with many ulcers all over the body, and died an extremely painful death. I don’t think it was worth to waste all the time and resources on a patient whose life became excruciatingly painful. So, personally, I fully support mercy killing.

Quote of the Day

To my mind, democracy is more compassionate, more harmonious, more friendly than any other system. It respects others' rights and considers others equally as human brothers and sisters. Although you might disagree with them, you have to respect their wishes.

-His Holiness the Dalai Lama From "The Pocket Dalai Lama," edited by Mary Craig, 2002. Reprinted by arrangement with Shambhala Publications, Boston, www.shambhala.com.

The Last Word

The Last Word on the Last Breath, New York Times dated October 10 presented us with the case of a 35-year old patient “ in a persistent vegetative state for 15 years…” who despite of obvious clinical deterioration was given interventions as the family requested.

Here the patient is not able to decide what he would like done. His family members have notified the medical staff of what actions are to be taken pertaining to their loved one ‘s treatment, which brings up the issue of surrogate decision. They wanted “all revival efforts” with hope. This clearly conflicts with the issue of futility in treatment and the young physician involved knew it well.

The medical staff is aware of no prevalent benefit from any further intervention for the patient based on sound physical findings. The state has no interest in prolonging the dying process based on the irreversible condition of the patient’s multiple organ failure.

The goal of treatment is to improve the patient’s condition leading to mental and physical stability. Unfortunately here it does not apply given the kidney failure, the pneumonia, the generalized infection, and the general weakening status of the body, not to mention the apparent mental deterioration without any likely recovery.

All the following could qualify as futility treatments for this patient:

1.The artificial feeding is no longer beneficial since he was losing weight;

2.Cardiac arrest is taking place;

3.The CPR will fail to resuscitate the patient;

4. The patient is not expected to regain consciousness or recover.

The family’s request for lifesaving efforts, which included CPR, does not balance with the physician’s duty to prevent unnecessary treatment on the patient. They are legally representing the patient, but at times in surrogacy issues emotions will tend to take over decisions regarding patients’ interest. The members of the family will be assured that they have authorized the medical staff to try all that was in their power to do in terms of treatments and interventions and hopefully this will prevent internal family conflicts that would make the mourning process even more difficult.

If I were this physician, I would be morally compelled to spare performing any intervention, since there is no expected recovery based on the strong clinical evidence.(Based on the AMA guidelines , another physician has to be consulted on site) . The aim of CPR, according to the American Heart Association “ …is to preserve life, restore health…” but in this particular situation there is not any “expected physiologic “improvement as evidenced by the patient’s septicemia and failing vital organs. Hospital Ethics Committees do have decision–making charts available for physicians confronted with difficult situations such as this case, and they are very helpful and simple to use. The U.S. Congress in 1985, under the “ Baby Doe Rule,” protected physicians in discontinuing any interventions aimed at prolonging a person’s life if no improvement can be foreseen. Physicians are obliged to act in their patients’ best interests at all times, let alone when aware that death is imminent and any added intervention is just prolonging death. It was time to simply let the patient be. Every individual deserves dignity and the healthcare team ought to, as always, be their patients’ best advocate in avoiding unnecessary treatment and ease suffering when all comfort treatments have been exhausted.

posted by sophie at 5:41 PM

Removal of Terri Schiavo's feeding tube violated the rights of the disabled

Theresa Marie "Terri" Schiavo (December 3, 1963 – March 31, 2005) was a woman from St. Petersburg, Florida. Her death decision was a federal matter and her husband selfishness. She was 26 when she collapsed in her home in 1990 and experienced respiratory and cardiac arrest. She remained in a coma for ten weeks. Within three years, she was diagnosed as being in a persistent vegetative state (PVS).

From my prospective view, if a person becomes incapacitated and has no written statement that expresses his/her wishes regarding health care, should the law presumes that the person wants to live, even if the person is receiving food and water though a tube. Given lack of living will, Terri Schiavo’s husband claimed that she would not want to be kept on a machine with no hope to recovery while her parents claimed that she was a devout Roman Catholic who would not wish to violate the Church’s teachings on Euthanasia. Who was in her best interest her husband who has already a girlfriend with two children out of wedlock or her parents that brought her on the earth.?

The decision of a number of Florida courts was that during two funerals earlier in her life, she discussed with her husband, brother-in-law, and sister-in-law the possibility of being profoundly disabled in the future. She indicated that she would prefer to be allowed to die naturally. It is hard to believe. She never signed a formal medical directive or a living will, which was the least thing on her mind at that age . These battles could have been avoided if Terri had had one. Perhaps the greatest effect that she has had on the American psyche is to remind citizens to consider drawing up a living will while they is still mentally alert. Otherwise, husband, brother and sister-in-law, mother and father-in-law, son and daughter-in-law or a guardian (the court) will be making decision for you.

Although, according to the Christian doctrine, death is not the ultimate evil, but eternal damnation is; to allow Terri to die would be to allow her to join with God in eternal life. Yes, but NOT when it interfered without hydration and nourishment. Pope John Paul II discussed nourishment of patients in Terri Schiavo's condition during 2004-MAR: "...the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory, insofar as and until it is seen to have attained its proper finality, which in the present case consists in providing nourishment to the patient and alleviation of his suffering....we are called to provide basic means of sustenance such as food and water unless they are doing more harm than good to the patient, or are useless because the patient’s death is imminent."

Partial-birth Abortion

With the Supreme Court term beginning this past Monday, Oct. 2, it will quickly face cases on the federal law banning a procedure known as partial-birth abortion that are drawing attention from the religious community.

Court observers are eyeing two abortion cases, in which the 9^th and 8^th U.S. circuit Courts of Appeals each said the 2003 federal law banning partial-birth abortion was unconstitutional, to see if recent changes in the Supreme Court’s makeup will affect the outcome of abortion-related decisions.

In Gonzales v. Carhart, the 8^th Circuit sided with Dr. Leroy Carhart, a Nebraska abortion doctor who successfully sued to overturn that state’s partial-birth abortion ban. In 2000 the Supreme Court ruled 5-4 that the state law was unconstitutional because it lacked a provision allowing an exception in cases where the pregnant woman’s health is at risk.

Congress sought to reverse the effect of that ruling by passing a federal law banning the procedure nationwide. The bill did not include a health exception, because, the bill’s proponents argued, sufficient evidence had been heard that this particular procedure is never medically necessary.

The banned procedure involved partially delivering a live fetus and then puncturing the brain stem to kill the baby before completing the delivery. Supporters of keeping the procedure legal argue that it is usually used late in pregnancy when other abortion methods are more dangerous to the woman.

In Gonzales v. Planned Parenthood, the 9^th Circuit ruled on behalf of a San Francisco-based Planned Parenthood affiliate and its national organization that the federal law is unconstitutional because it lacks a health exception, imposes a burden on a woman’s right to choose to have an abortion and is constitutionally vague.

The legal question before the Supreme Court when it hears both cases November 8^th is whether the law is invalid because it lacks a health exception or otherwise is unconstitutional.

I believe the abortion issue is always very difficult to discuss. The main problem seems to stem from the question - When does a human being become a human being? When does life begin? Is abortion murder?

In conclusion, the basic protection which society must provide its citizens is the protection of the right to be. Our Declaration of Independence express as self-evident the truths "that all men are created equal, that they are endowed by their creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness," and that governments are instituted to secure these rights. Whether one believes in a creator or not, the responsibility of government in the matter of human life is clear. When abortion was legalized in our country, government, in effect, said that the unalienable right to life does not apply to certain beings that are, nonetheless, definitely human beings. This brings us back to the question when does life become life? For all practical purposes it made every unborn child legally vulnerable. In regards to the subject of partial – birth abortion, I believe there is no doubt that human life is being endangered. The child being aborted is a child – no questions asked.

" Don't let the bugs bite” : can genetic engineering defeat diseases spread by insects?

Reemergence of old diseases that were thought to be under control (in certain countries), was an unpleasant shock to the health care community. This illustrated an important principle that disease patterns change because of :

I. Organisms change,

II. Human activity change to create new opportunities for organisms to cause disease.

In the mid-20^th century, insecticides and other measures eliminated malaria from US and Europe. Many public health workers were optimistic over reducing the global burden of many vector-borne diseases, such as : Malaria, Chagas, Yellow fever, and Dengue fever, by spraying chemicals. With the comeback of these diseases, occurring more widely and more frequently than they have in recent decades, Frank H. Collins of the University of Notre Dame in Indiana, said in retrospect that it was naive of us to think that we could eradicate the mosquito by chemical attack. Many insect populations, especially in the tropics proved too hardy, as evident by the come back of diseases in regions that were considered free of such. Failure to control these vector-borne disease with chemicals, lead scientist to research alternate ways to target the problem.

Molecular Biologist Anthony James of University of California in Irvine has proposed; augmenting conventional measures with genetic engineering and other innovative approaches, to pare down vector population and leave others incapable of spreading disease. While controversial, the Sterile Insect Technique (SIT) has worked against disease vectors and agricultural pests.

1. Tsetse flies, the vectors of sleeping sickness, were eradicated from Zanzibar, an island of Tanzania.

2. California citrus groves were cleared of the invasive Mediterranean fruit flies.

3. Eradication of livestock parasites and flies.

SIT damages the male insects to such an extend that they can not reproduce but still compete with the wild males for mates. Entomologists are setting up research fields to study different ways to genetically modify, either the microbe or the vector insect that carry them.

Entomologist Celia Cordon-Rosales of the Universidad del Valle de Guatemala is targeting disease spreading insects, to genetically alter them or to manipulate organisms living in them. This approach remains controversial, and because the government will be tough on giving permission to release modified insects or micro-organisms in the environment, it is not too early to carry-out this project, because it involves a lot of basic research, and special precaution to ensure that potential problems with releasing the research sample, is properly secured. Cordon-Rosales' major research is with Chagas Disease. This is an insect-borne disease, that is contracted via infection with the single celled protozoa: Trypanosoma cruzi. Several insects are the vector of this disease. The bug is called “kissing” or” assassin “bug. Kissing because it has a tendency to bite people near the mouth. Chagas is prevalent in Latin America to as far North as the United States. 90 million people live in the areas where Chagas disease is endemic, 12-18 million (13-20%) people are infected of which 10-30% develop heart failure or other chronic life threatening symptoms. The mortality is approximately 50,000 people per year.

The basic research set-up is what she refers to as a ghost town, isolated from human life by fine mesh nets through which bugs can not escape. The imitation village would contain huts from straw and clay. It will be occupied by pigs in pens, and free living insects and bacteria. The mock hamlet will be encircled by a ditch, which will collect any runoff water that might permit micro-organisms to leave the site. Rosales hopes that with the results of her research project and that of her collaborators in the United States, that she will also be able to address the problem of the reemergence of Malaria, Sleeping sickness, Dengue fever and Yellow fever as well.

Posted By Ingrid Daly October 19, 2006

UHSA student Elijah Akper -- Stem Cell Debate Goes to Voters

Stem cell debate has put on a whole new face as voters are being asked to weigh job creation and potential life-saving cures against moral concerns over the destruction of human embryos in an impassioned battle over a Missouri ballot measure supporting the science. According to political analysts, the outcome of the initiative in Missouri could influence future federal and state efforts to either block or support the science. Embryonic stem cell research has gotten caught up in a tight U.S. Senate race between State Auditor Claire McCaskill (D) and incumbent Sen. Jim Talent (R), a race so tight that McCaskill has made support for embryonic stem cell research a keystone of her campaign.

Whereas Missouri is the only state with the question on the Nov. 7 ballot, the controversy over embryonic stem cell research is playing prominently in the Wisconsin governor's race and cropping up in state races scattered across the country. What is more, a few Republican gubernatorial candidates are breaking ranks with the Bush administration by running on their support for the controversial research topic. In a close state race, Wisconsin Gov. Jum Doyle (D) is using his support of embryonic stem cell research to differentiate himself from conservative challenger U.S. Rep. Mark Green (R), who opposes using human embryos for the research. Political analysts agree that Doyle's persistent, albeit unsuccessful, calls for the state Legislature to commit funds to the science give him an edge in the governor's race.

In the state of Michigan, Democratic Gov. Jennifer Granholm is waging a tough re-election bid against anti-abortion Republican Dick DeVos, who has blasted her efforts to overturn laws in the state that restrict the science. " While President Bush is building up walls in Washington to block this life-saving research, we have the opportunity to tear them down in Michigan," says Granholm in a written appeal to Michiganders to sigh a petition asking state lawmakers to repeal anti-stem cell research laws. She has argued that removing restrictions on the science would reduce health care costs and allow the state's emerging life-sciences industry to flourish.

As things are turning out, the Midwest is not the only political stage where science is colliding with religion over stem cell research. On both coasts, Republican governors up for re-election in November are touting their record of supporting the science for its medical potential and economic opportunities in a clear break with Bush admininistration policies that limit the research.
In Massachusetts, home to stem-cell leader Harvard University, both candidates for the open governor's seat have come out in support of the science. In the South, Georgia and Kentucky stem cell advocates already are taking steps to get the issue on the ballot in 2008. A statewide poll of Georgia voters found 63 percent approval for "research on stem cells taken from donated embryos from fertility clinics that would otherwise be discarded."

In July, right before President Bush vetoed a bill that would have lifted his 2001 restrictions on federal funding for embryonic stem cell research, Democratic governors from Delaware, Illinois, Iowa, Michigan, New Mexico, Oregon and Wisconsin urged Congress to push for stem cell funding. Some of those same governors continue to publicize their support for the research in their re-election bids..

Interestingly, sixty-eight percent of Americans approve of embryonic stem cell research, according to a recent NBC News/Wall Street Journal poll. Supporters include high-profile Republicans, such as Nancy Reagan, with loved ones who have suffered from debilitating diseases for which the research offers hopes of a cure.
Six states have ensured the legality of the science and committed state money to fill the gap left by the federal government's funding restrictions. So far, California has committed $3 billion for the research; Connecticut has committed $20 million; Illinois, $15 million; New Jersey, $5.5 million; Maryland, $15 million; and Massachusetts, 15 million.

While researching this topic, I had an opportunity to examine things from different view points. One such viewpoint that stand out for me is that of David Moyes of the Scottish Council on Bioethics. Moyes tries to sell us the following argument: we can't determine for certain what the moral status of an embryo is. That we as a society ought not to disregard the section of the population that ascribes infinite value to embryos and comes out against any destructive embryo stem-cell extraction and research.
The Cathilic Church, Mr Moyes and the Scottish Council on Human Bioethics are welcome to differ. Considering that he represents the Scottish Council on Human Bioethics, his choice of words is rather charged. It is misleadinig in the extreme to call embryos persons, as most embryos, even those naturally conceived, never result in babies due to the high natural rate of embryo failure. Infact stem cells are extracted around 14 days after conception. Crucially for the question of moral status: the embryos in question have no central nervous system, no brain, no capacity to suffer, they consists of a few hundred cells.
And there might still be people who think such cell accumulations ought to be called persons and they ought to be treated like you and me, but the fact of the matter is, there are not many such people as the result of the polls are now indicating. Most of us realised that these cell accumulations lack any of the dispositions that we normally accept to be necessary conditions for ascribing personhood to something.
Furthermore, as is typical of those who seek to "protect" embryos, he offers no suggestion as to what ought to be done with embryos if they were "saved" from research. It is almost certain that nothing would ever happen to them and they would remain frozen or be discarded. This would benefit the embryos in no way whatsoever, and would deny real people powerful medical treatments that Mr Moyes admits might be provided by stem cell research.

Those who seek to protect embryos would do well to give some thought to what would actually happen if they got what they wanted. I stand corrected, but in my humble opinion, we will do well to promote the stem cell research.

http://www.courierpostonline.com/pbcs.dll/article?AID=/20061004/NEWS01/610040

http://www.theherald.co.uk/features/71345.html

http://www.slate.com/id/2150545/fr/nt/

http://www.stateline.org/live/details/story?contentId=146780

A PROFESSION WITH SHARP DOUBLE EDGED SWORD

KWABENA ABRAH
Bioethics Blog Entry
UHSA 2006

A PROFESSION WITH SHARP DOUBLE EDGED SWORD

Introduction and Comparison
An OB-GYN (Obstetric and Gynecology), a branch in medicine that used to be, to my knowledge, a lucrative specialty field for many physicians in the western world, is probably losing its attraction because of increased in liability insurance and malpractice lawsuits.
Nonetheless, on the other side of the world, especially in some of the countries in sub Saharan Africa, it is rather the opposite. Both old physicians and those fresh from medical school are craving for this special branch of medicine, because this is where the money lies.

Supposedly Job description and discussion of some African Gynecologists
In some part of Africa, not only does a childless wife or woman is always get blamed for being the cause of her infertility, but also she does not command respect and dignity in the society in which she lives. She is as well treated among her kinsmen, and husband’s family as a “worthless being”. For an idea that men as well could become impotent and sterile, is of little knowledge to some of the African societies, especially those in sub Saharan.
In order to avoid emotional harassments, humiliations and embarrassment from the above three categories of people (society, kinsmen, and husband’s relatives), the women with infertility problems in this part of the world, try on tooth and nail to have their own biological children. Finally, they have to seek medical help from gynecologists who also cross-trained in infertility. The women or the couples have no choice, but to pay huge sums of money as exorbitant charges for the treatment of infertility.
One would have thought that the job description of a gynecologist is to perform a noble task such as the one stipulated above and the likes. They are also expected to treat incomplete, threatening and spontaneous abortions. Not to ignore other disorders like prolapsed cervix and uterus, removal of fibroid tissues from uterus, fallopian tubes and ovaries (total hysterectomy). Included are palp smear, and other diagnostics, which identify illnesses or disorders that are related to or associated with female genital and reproductive organs. Another important job that is supposed to be performed by or expected from a gynecologist is assisting child delivery (labor) and caesarean sections.
Besides the supposedly job description for some African gynecologists, there is another distinctive booming business of which I have termed and abbreviated “The Black-Market Commodity” (BMC), and “Real Gold Mines” (RGM) that raises an ethical question, which puzzles the public. As a matter of fact, it is on this side of the coin where many riches are acquired within a short period of time through illegal means. The said health professionals contribute to the termination or destruction of healthy pregnancy that poses no life threat to the host. There are some doctors who offer services in hospitals that are operated by their governments, and use the instruments and equipment belonging to the public to perform this unlawful act (aiding in criminal abortion).
People do wonder if the law allows these gynecologists to destroy healthy fetuses on one hand by means of causing criminal abortion, and the other hand to help infertile women become biological mothers.
In fact, the answer to the question is a big “No”: because they are not licensed to perform any none life-threatening abortions since almost all the countries in this region have laws against criminal abortions, irrespective of who is performing it.
However, as the laws are not strictly enforced; and also the easiest way for a gynecologist or a physician to become rich overnight, many of African gynecologists and even other physicians are engaged in this unacceptable and dubious transactions. To make it worse, some women in this part of the world show no remorse to submit themselves to this practice, and so criminal abortion is rampant over there.
I can set an example of a small town where I used to work as health care personnel. Even though there is no absolute or written records, yet based upon my own observations, investigations and hypothesis, a town with a population of about 30,000; one in every five women had either once or twice, or more terminated healthy pregnancy (criminal abortion) with the help of a gynecologist or a physician.
In some parts of Africa, by mere mentioning of the word abortion, sounds like pronouncing the word murder. Abortion takes to mean an offensive term, which sends a signal of indignation to the people around: thinking that it is an operation or a kind of intervention to end a pregnancy by removing a healthy embryo or fetus from a womb. At times, the procedure is badly done and leads to the death of both mother and embryo, which is quite unfortunate. As a result, in some areas, it is a taboo to hear the name “abortion.” It is quite uncomfortable and difficulties for someone to bring the word abortion in casual conversation. Hence, when another name was coined for abortion, it became widely accepted in this small town and her surroundings. The name “APPARA”, which was coined by the writer of this article, became popular and the people in the nearby towns and villages embraced it with whole heartedly. I believe the new name is still in use in those areas, and probably it has spread to the other nearby regions. I won’t be surprise to hear that the new name has spread to the entire nation and has completely replaced the old one, criminal abortion.

Defense and view points from Gynecologists and other Doctors
On the other hand, the gynecologists and physicians arguable protect their positions of engaging in this offensive business; saying that Africans have many forms of crude and unsterilized method of getting rid of unwanted pregnancy, which most often, caused a lot of health complications even resulted in death of most of the teenage girls and young ladies. They added that sometimes adult women are not exempted from being victims.
For that reason and many, they deemed it more appropriate, and healthier to offer the women more sanitary means of treatments. Moreover, these health care providers stressed that by tending to the women’s needs, they are in a way preventing premature death among the reproductive aged women, and also adding to their freedom of choice; therefore, women will have more autonomy over their bodies.
What is more, the physician emphasized that their services to their patients are not for their selfish reasons, but they are proper medical care providing to their patients to alleviate both their physical and mental suffering as well as social and economical hardships.

Summary
There is no doubt about the work of African gynecologists and/or general practitioners as a life-saving job. However, I do not side or agree with those gynecologists and physicians, who do not only practice to destroy healthy fetus for monetary gain, but also justify their deed by convincing the public that they are saving the lives of desperate young ladies who are facing difficult life-choices. I feel the self justification and self-defense by the gynecologists to cover-up their deeds is not the proper way to show compassion pertaining to women reproductive issue. To me, there is no reason to claim to save the life of young women at the expense of innocent fetuses, and my only position is that it is only done for financial reasons. For; almost every person that I know especially the Africans, believes that a human is formed the moment conception had taken place.

Conclusion
I want to conclude with the following stand point.
The work of gynecologists as well as physicians will be that of divine blessings if only they are to save lives and to restore health, but not to aid in destroying the seed of mankind.

The authenticity of this article
The writer of this article had served in various hospitals in sub-Saharan Africa and therefore, the contents of this article are based on his experiences of twenty-two years of working as a healthcare provider.

Reference:
For any question, contact the writer.
Thanks.

UHSA student post on Euthanasia -- Christine Livek

The world medical community considers both euthanasia and assisted suicide to be in conflict with basic ethical principles of medical practice. The World Medical Association, with members representing medical associations (including the American Medical Association) from eighty-two countries, has adopted strong resolutions condemning both practices and urging all national medical associations and physicians to refrain from participating in them even if national law allows or decriminalizes the practices.

Euthanasia is the act of deliberately ending the life of a patient, even at the patient’s own request or at the request of close relatives, is unethical. This does not prevent the physician from respecting the desire of a patient to allow the natural process of death to follow its course in the terminal phase of sickness.

Physician-assisted suicide, like euthanasia is unethical and must be condemned by the medical profession. However the right to decline medical treatment is a basic right of the patient and the physician should respect such a wish of a patient.

There are basically four arguments against euthanasia and or physician assisted suicide.

They include 1) Euthanasia would not only be for people who are terminally ill 2) Euthanasia can become a means of health care cost containment 3) Euthanasia will become non-voluntary and 4) Euthanasia is a rejection of the importance and value of human life.

1) There are many definitions for the word “terminal”. Some laws define “terminal” condition as one from with death will occur in a “relatively short time.” Others state that “terminal” means that death is expected within six months or less.

Even where a specific life expectancy is referred to, medical experts acknowledge that it it virtually impossible to predict the life expectance of a particular patient. For this reason, euthanasia activists have dropped references to terminal illness, replacing them with such phrases as “hopelessly ill,” desperately ill,” “incurably ill,” hopeless condition,” and “meaningless life.”

2) Euthanasia and physician –assisted suicide could become a means of health care cost containment. “….physician-assisted suicide, if it became widespread, could become a profit-enhancing tool for big HMOs.” “…drugs used in assisted suicide cost only about $40, but that it could take $40,000 to treat a patient properly so that they don’t want the “choice” of assisted suicide…” …Wesley J. Smith, senior fellow at the Discovery Institute.

Perhaps one of the most important developments in recent years is the increasing emphasis paced on health care providers to contain costs. In such a climate, euthanasia certainly could become a means of cost containment.

This could be quite a slippery slope. The pressure to contain costs by the insurance companies and big business could try to force the medical profession to participate in euthanasia and physician-assisted suicide. Hasn’t health care gone too far already with unethical decisions regarding “cost containment”? I think so.

3) Euthanasia and physician-assisted suicide would only be voluntary, they say. Emotional and psychological pressures could become overpowering for depressed or dependent people. If the choice of euthanasia is considered as good as a decision to receive care, many people will feel guilty for not choosing death. Financial considerations, added to the concern about “being a burden” could be used as powerful forces that would lead a person to “choose” euthanasia or assisted suicide. Who will make the evaluation that a person is in their right mind to make such a decision. What if they are just depressed? And, if they are in severe pain, why not change their pain medication? These are all questions physicians need to be asking themselves.

4) Euthanasia and physician-assisted suicide is a rejection of the importance and value of human life. People who support euthanasia often say that it is already considered permissible to take human life under some circumstances such as self defense – but they miss the point that when one kills for self defense they are saving innocent life – either their own or someone else’s. With euthanasia no one’s life is being saved – life is only taken.

I once had a patient that was diagnosed with lung cancer. She was given about six months to live by her physician is she had no treatment and about one year to two years with treatment. She opted for treatment. Soon after the chemo began she became very ill from the side effects of the chemo. She said she just wanted to go ahead and die. She said she was suffering more than she ever thought was possible and she felt like she was a huge burden to her family. She begged to have someone help her end her life. That was four years ago. Today she is an active person in our community and loving life because she says “I live life every day to the fullest”! If her physician had helped her end her life, the patient and her family would have missed out on these last four years and whose to say how many more years she will be alive! There are miracles and they happen everyday.

History has taught us the dangers of euthanasia and that is why there are only two countries in the world today where it is legal. That is why almost all societies – even non-religious ones – for thousands of years have made euthanasia a crime. It is interesting that euthanasia advocates today think they know better than the billions of people throughout history who have outlawed euthanasia – what makes the 50 year old euthanasia supporters in 2006 so wise that they think they can discard the accumulated wisdom of almost all societies of all time and open the door to the killing of innocent people? Have things changed? If they have, they are changes that should logically reduce the call for euthanasia – pain control medicines and procedure are far better than they have ever been any time in history.

Emergency Contraception for those under 18

University of Health Sciences Antigua (UHSA) student blogger Kirti Shah comments on a previous post from the WBP blog re emergency contraception:

Recently the Government of Chile announced that they are going to provide emergency contraception to any one over 14 at no cost. What a revolutionary idea from a Catholic country. We in the U.S. now have made it available over the counter to anyone over 18 but they still have to pay. This was blocked on political grounds ( religious grounds) a number of times by questioning its safety ( rejecting all the evidence) and the usual abortion arguments.

The current law permits the pharmacist to sell it to anyone over 18. Any person over 18 can then give it to a person under 18 but a pharmacist cannot. This makes the pharmacist a policeman and potentially liable in case of some kind of a mistake. This can potentially introduce a third party in the distribution chain. We need to change this law to accommodate any minor and this would at the very least allow a health professional to advise the patient on the proper use of this medication.. The “ morning after” pill has a 89% efficacy if taken within 72 hours of unprotected sex and is more effective if taken in the first 24 hours. Reducing the waiting time should be of utmost importance.

We should clarify what emergency contraception is. It is a backup method of preventing pregnancy or reducing chances of pregnancy after unprotected sex. Examples of unprotected sex would be a broken condom, if one forgot to take birth control pill for 2 or more days ( which happens a lot) , or if one was sexually assaulted. Plan B is not RU-486 ( the abortion pill) because plan B is used to prevent pregnancy. It will not work if you are already pregnant and it will not affect an existing pregnancy. Plan B is also safe and it is a larger dose of normal birth control pill. Plan B will decrease the chances of pregnancy by 89% if taken within the first 72 hours of unprotected sex. It works better if taken within the first 24 hours after unprotected sex. When birth control pills first came out their doses were very high almost similar to plan B.

Arguments have been and will be used against plan B with misleading and false arguments and a conscious effort has to be made to educate the public. Condoms were once sold behind the counter and today they are available all over and serve a useful purpose. We cannot deny services to people who need it using false arguments and we need to loosen up the law that will free up the pharmacist or any other health care professional to be able to provide these services in good faith.

http://womensbioethics.blogspot.com/2006/09/chile-birth-control-free-for-women.html