Genetic Engineered food and animal products

genetic engineered food and animal products.
During the past decade, biotechnology companies commercialized the first generation of genetically engineered crops—primarily corn, soybeans, and cotton altered to control insects and weeds. U.S. commodity crop producers responded by planting millions of acres of these engineered crops. Because corn and soy are widely used in food processing, small amounts of engineered ingredients show up in a majority of processed food products. But most foods—the vast majority of vegetables, grains, fruits, and nuts—remain unaltered. Of the eight other engineered food plants allowed in U.S. grocery stores, it appears that only engineered canola and papaya are currently available.
Among food animals, only engineered fish are under active consideration by U.S. regulators. Other engineered plants, animals, and microbes are farther down the research pipeline but few are poised for introduction in the near future.


Recently, a second wave of biotech products began emerging—crops, mainly corn, engineered to produce pharmaceuticals and industrial and research chemicals. Several such products are already on the market and companies are seeking approval from the Food and Drug Administration of corn-based drugs and vaccines.

Scientists are concerned that engineered organisms might harm people’s health or the environment. For example, engineered crops might contaminate the food supply with drugs, kill beneficial insects, or jeopardize valuable natural resources like Bt toxins. Engineered fish may substantially alter native ecosystems, perhaps even driving wild populations to extinction.

To protect human health and the environment from engineered products, we need strong federal oversight and active citizen participation.

What Implications Does Behavioral Genetics Research Have For Society?

Researchers in the field of behavioral genetics have asserted claims for a genetic basis of numerous physical behaviors, including homosexuality, aggression, impulsivity, and nurturing. A growing scientific and popular focus on genes and behavior has contributed to a resurgence of behavioral genetic determinism—the belief that genetics is the major factor in determining behavior.
Are behaviors inbred, written indelibly in our genes as immutable biological imperatives, or is the environment more important in shaping our thoughts and actions? Such questions cycle through society repeatedly, forming the public nexus of the "nature vs. nurture controversy," a strange locution to biologists, who recognize that behaviors exist only in the context of environmental influence. Nonetheless, the debate flares anew every few years, reigniting in response to genetic analyses of traits such as intelligence, criminality, or homosexuality, characteristics freighted with social, political, and legal meaning.
What social consequences would genetic diagnoses of such traits as intelligence, criminality, or homosexuality have on society? What effect would the discovery of a behavioral trait associated with increased criminal activity have on our legal system? If we find a "gay gene," will it mean greater or lesser tolerance? Will it lead to proposals that those affected by the "disorder" should undergo treatment to be "cured" and that measures should be taken to prevent the birth of other individuals so afflicted?
There are several scientific obstacles to correlating genotype (an individual's genetic endowment) and behavior. One problem is in defining a specific endpoint that characterizes a condition, be it schizophrenia or intelligence. Another problem is in identifying and excluding other possible causes of the condition, thereby permitting a determination of the significance of a supposed correlation. Much current research on genes and behavior also engenders very strong feelings because of the potential social and political consequences of accepting these supposed truths. Thus, more than any other aspect of genetics, discoveries in behavioral genetics should not be viewed as irrefutable until there has been substantial scientific corroboration.
How do genes influence behavior?
No single gene determines a particular behavior. Behaviors are complex traits involving multiple genes that are affected by a variety of other factors. This fact often gets overlooked in media reports hyping scientific breakthroughs on gene function, and, unfortunately, this can be very misleading to the public.
For example, a study published in 1999 claimed that overexpression of a particular gene in mice led to enhanced learning capacity. The popular press referred to this gene as "the learning gene" or the "smart gene." What the press didn't mention was that the learning enhancements observed in this study were short-term, lasting only a few hours to a few days in some cases.

New System Might Increase Organ Donations

Could Changing the Way People Volunteer Increase Organ Donations?


According to a Gallup poll, 83 percent of Americans understand the benefits of organ donation and approve of the practice but only 28 percent have granted written consent to release their organs if they die. Since 1995, more than 45,000 people have died waiting for an organ donor.
Avoiding the Question
Some say the problem lies in a reluctance to make what can be a very uncomfortable decision. They say a new opt-out system, which would assume people are donors unless they specify otherwise, could dramatically increase the number of donors and save lives. A similar example lies in the do-not-call telemarketing system, where it is assumed telemarketers may call people at home unless they add their names to a do-not-call list.
But because releasing your organs to medicine after death can be such a profound decision, critics say adopting a similar opt-out system for organ donation would also introduce all kinds of ethical land mines.
Numbers from some European countries show that forcing people to confront the decision can make a big difference.
In several countries, including Austria, Belgium, France, Hungary, Poland, Portugal and Sweden, authorities assume everyone is willing to be a donor — with the approval of family after death — unless they say otherwise in written form. In those countries, 85 percent to 99 percent of people are on paper as willing donors and actual donations are higher by about 56 percent.

Troops returning home with hearing loss???

Majority soldiers and Mariens caught in roadside bombings and firefights in Iraq and Af. are coming home in epidemic numbers with permanent hearing loss and ringing in their ears. hearing damage still number 1 disability in the war. the numbers are staggering. One major explanation given is the insurgency's use of fearsome weapon the Pentagon didn't fully anticipate, powerful roadside bombs. Their blasts cause violent changes in air pressure that can rupture the eardrum and break bones inside the ear. Also, much of the fighing consists of ambushes, bombings are firefights, which come suddenly and unexpectedly, giving soldeirs no time to use their military issued hearing protection.
In addition, some servicemen on patrol resfuse to wear earplugs for fear of dulling their senses and missing sounds that can made the difference between life and death.
The Navy and Maries have begun buying and distributing state of the art earplugs, know as Quiet pro" that contain digital processors that block out damaging sound waves from gunshots and explosions and still allow users to hear everyday noises. The cost about $600 a pair.
My common is.... if there isn't a War, then we don't have to cost that money to treat this medical problem.... War doesn't create money, maybe later on for "oil", but for now, it cost more money for medical treatment...

The living will

There is no age limit for anyone to become severely ill. Anyone can be faced with a life threatening illness or an accident at any age and can become in a state that cannot speak for themselves. In such situations our life will be in the hands of others. We might be put to death when we wished to be resuscitated or we might be kept alive with life-supporting machines when we wished to be dead. A living will can save anyone from such a dilemma. With a living will we can make the final decisions for ourselves in a life ending situation without depending on others mercy.

Living will is a part of advance directives which tells the doctors what kind of care anyone wish to have in an end of life situation. The abscense of a living will can create unwanted turmoils in the families. The best examble is Terry Schiavo's case in Florida. 41 year old Terry Schiavo, after creating an intense legal conflict and a vast press coverage died in 2005 two weeks after the removal of her feeding tube which had kept her alive since 1990. There was no clear evidence for what her real wish was. The husband says that she mentioned sometimes during their married days that she never wanted to live with the help of life supporting machines. He might be true or might be lying for his own interests. He had some conflicts of personal interests in a large malpractice settlement money and also he was living with a girlfriend whom he cannot marry as long as Terry Schiavo was alive. Since she did not put anything in writing in the form of a living will only she knew what her real last wishes were. I cannot even imagine myself something like this happening to me. I do not think anyone would want to have the court to decide for their fate. With a living will anyone can make their own final decisions by themselves and also can spare their families from tearing apart trying to decide what is the best fate for them.

pro-choice and pro-life, who wins?

As the debate on abortion between the pro-choice and pro- life takes a political direction, the focus drifts from the subjects of abortion and the impact the process of abortion impresses upon the lives of the women that undergo the process to that of justifying and condemning. In a study done in Zealand and published in the Journal of Child Psychology and Psychiatry in 2006, it was established that abortion has effect on women's mental health. The researchers concluded that "Abortion in young women may be associated with increased risks of mental health problems" Even though women's rights and decision for an abortion are protected by autonomy and right to privacy, echoes of condemnation from the society may lead to a life of guilt and self-condemnation.
In the 'Aftermath of Abortion trauma', by Joanne Angelo, a research in Finland found the rate of suicide in women the year after an abortion to be nearly six times greater than the suicide rate after live birth and significantly higher than the suicide rate in the general population of women of childbearing age.
The united States in an effort to address the dynamic of the issue of abortion has put emphasis on providing women with information prior to an abortion. In some pregnancy center clinics an ultrasound is used so that the women can visualize the fetus before the abortion is done. In a clinic in North Carolina, six teenagers out of eight changed their minds when they saw the movement of the fetus. This is not without controversy as the the pro-choice view it as a way to inflict fear and guilt by the pro-life supporters. As the division between the pro-choice and pro-life continues, there are no winners, but there could be losers; the women that live with the guilt or condemnation of abortion in the rest of their lives, or those that end it all by committing suicide.

Life vs. patient vs. HMO

At the end of 2007, there is a big case in LA county. 17 years old is diagnosed hepatocarcinoma and need liver transplant, usually liver transplant isn't happened with this age. it is a rare case. All the MD agreed to do prior authorization with Cigna insurance. Cigna failed to comply with MD's request, not only one MD, all hemo& oncologist MD in addition to internal medicine, family practice, pulmonary critical care MD.After 4 months Cigna continued to deny all MD's request for all the treatment. Cancer levels start to reach to stage 3.??? Family's member start to require more attention from law maker (house representative, county supervisors, and state senator), include CMA- california medical Association.Patient passed away 1 day after Cigna's approved for her medical treatment.So, the question arrived is why insurance company is too late for approving for her medical treatment. Patient is paying insurance due very on time. The case is reaching to bioethics committees law firm in Los Angeles county.
An insurance company that initially refused to pay for a liver transplant for a 17-year-old Northridge girl who died in a hospital should face criminal charges and pay civil damages,Cigna HealthCare "literally, maliciously killed" Nataline Sarkisyan, attorney Mark Geragos told reporters in downtown Los Angeles.
Sarkisyan's 21-year-old brother, Bedros, told reporters that UCLA had a liver available for transplant, but they could not perform the procedure because of Cigna's refusal to cover it. The girl's father, Krikor Sarkisyan, held a photograph of his daughter, and with his eyes wet with tears, cried out. "They took my daughter away from me!" "The Cigna people, they cannot make people's decision if they (are) going to life or die," he said through a heavy accent. "Doctors ... they all signed the papers. ... Cigna denied it two times." Cigna insurance initially declined to pay for the transplant for Nataline Sarkisyan because her plan did not cover "experimental, investigational and unproven services," her doctors said. The denial promAbout 15 minutes into the rally, Cigna announced it would approve the transplant.pted nationwide protests, including a rally outside Cigna's Glendale offices.
CIGNA released the following statement: "Our deepest sympathies are with Nataline's family. Their loss is immeasurable, and our thoughts and prayers are with them. We deeply hope that the outpouring of concern, care and love that are being expressed for Nataline's family help them at this time."

The Moral and Ethical Physician

The moral and ethical foundation of our society has dual personalities: that which the average human being carries and that which is carried by a professional, in this specific case, by a physician.

There is a great amount of conflict as professionals to not make decisions based on our own personal morals and ethics. Instead we have to make a decision as a provider, educator, and a healer. It is our job to provide our patient with the best of our capabilities.

Always keep in mind that when a client approaches you as their physician, they have a level of dependency towards you to help with their illnesses, problems, and/or fears. If we are consistent with our professional moral principles and accepted code of conduct, then act on what you believe to be correct, but always making sure that your patient has the appropriate resources to meet their care.

As the Modern Hippocratic Oath States:

“I will not be ashamed to say “I know not, nor will I fail to call in my colleagues when the skills of another are needed. I will remember that I remain a member of society with special obligation to all my fellow human beings, those sound of mind and body as well as the infirm.”

Yenima Martin
UHSA Medical School 2008

The Impaired Medical Professional

The Impaired Medical Professional

Alcohol and drugs abuse, often categorized together as “substance abuse” and addiction, is a common problem in our society as a whole. It is prevalent among the general population and therefore it stands to reason that it would also be prevalent among various occupations within a population. Thus, all people and occupations are represented, including the health care worker.

We often think of our health care professionals, including doctors and nurses as being exemplary and above such “vices”. Although the exact figures are unknown, the medical profession suffers along with the general population in this area. In fact, the prevalence of chemical dependence for medical professionals may even exceed the public. The reasons for this may have to do with the stress of the job and the long hours worked, coupled with the relative easy access to “pharmaceutical grade” drugs, whose use do not carry the stigma of “street drugs”.

The ethical question arises when we are forced to consider what to do with such impaired medical professionals. Are such folks to be treated as common criminals that do not get a pass just because they are members of a “noble” profession? Or are they to be treated as a still valuable and “salvageable” resource, who with proper treatment can return to the medical field not only functional, but with a “unique perspective” that may serve their patients and co-workers. In order to properly answer those kinds of questions, one has to decide what chemical dependence is about. Are such chemically dependent people bad deserving censure and punishment, or are they sick needing treatment? Or is the situation even that black and white? The problem, is of course, complicated by the fact that mistakes made by a medical professional who is impaired, can cost the life of a patient and therefore, by necessity a lower tolerance is usually applied.

Fortunately, much precedent has been set in today’s work setting. There have been many impaired professionals who have been confronted with their addiction and forced (usually) or somehow coerced into treatment. Many, if not most, of these individuals have received the proper treatment and returned to the field of medicine to function productively. This return to work is almost always contingent upon joining a professional recovery organization that monitors the practitioner. Typically, meetings of the 12 step variety and random drug screens are mandatory for an extended period (usually five years), once return to work is allowed. The combination of follow up care and random drug screening has proved to cut down on the relapse rate. Therefore, with proper recognition and treatment, the impaired medical professional, who may have been scorned and summarily dismissed in earlier days, can be given a second chance. Thus, public safety is preserved and a very valuable resource in the form of a medical professional is salvaged.

Culling Embryos

So, this wonderful guy asks me out on a date. We meet at an Italian restaurant with great atmosphere in NYC and right after our appetizers reach the table he asks “Are you sickle cell trait?” Great conversation for a first date, huh? I answer no, but he continues to tell me that he really likes me and he is sickle cell trait so he needs to be sure that I’m not. Scary, I’m trying to enjoy the live music and he is planning our possible future as parents! But I assured him that I did not have the trait and sure enough we were married a year later.

For about two years the New York Times has been running a series of articles on how the genetic information we have unraveled from DNA thus far has been impacting varying levels of society. They are all very interesting – including the most recent one on how genetic testing is raising insurance cost fears in the United States (link at bottom of blog). Another trend has been the use of in vitro fertilization (IVF) techniques, not to aid infertile couples, but to allow couples to literally choose which embryo they want to keep and discard the others. There are couples who choose their baby based on very superficial characteristics, like sex, height, likeliness to be thin or eye color. I won’t discuss any those choices because I truly cannot understand how anyone can create and discard life based on eye color and feel that it is totally ok. More importantly, there are couples who feel compelled to use IVF in hopes of ensuring their offspring are free of genetic disorders that may make them sick one day. My question: when did being sick translate to mean that you don’t deserve to live or don’t deserve a chance at life?

It certainly seems to me that the further medical technological advances are made is the more disregard we have for the sanctity of life. Now that children with Down’s syndrome are able to grow into adult hood and have productive lives it chosen to abort them and try again for a “normal” baby. Very recently it was found that a severely autistic teen, labeled as mentally retarded, had somehow managed to teach herself how to type and has revealed just how intelligent she really is. Her autism just made it extremely difficult to communicate, but now via typing she has written a few papers on what it’s like having severe autism. Our notion is that people with an illness have a poor quality of life, but without even realizing it our society is saying illness takes away your right to live. One of the potential mothers’ from the article said afterwards she felt like she allowed the other embryos to drown in the ocean and chose the one who happened to be a better swimmer…

Sometimes avoiding passing on certain genetic diseases to your children is as simple as asking a few questions before getting into a relationship. Other times, it’s not that easy. A close friend of mine had sickle cell disease. Neither of his parents knew they were carriers until his first crisis when he was a toddler. He died at 19 just when he was beginning his first year of college. He didn’t have a “normal life” and everyone said that he died so young, but his life wasn’t any less meaningful then my own or anyone elses. I remember him being so vibrant and smart. Even if he was just discharged from the hospital he’d be back in church at the next service. After his funeral his mom told me that even if she knew he had this disease when she was pregnant she would have still chosen to have him regardless of how strenuous it had been on the family. This said it is often the parents who don’t want to have to deal with having a sick child why they make certain decisions. In the article I mentioned one of the fathers said he’s happy knowing that his “daughter won’t ever be sick,” that he won’t ever have to stay up all night by her hospital bed wondering if she’s going to live.

Of course there is an argument to be made for diseases that are lethal. However my opinion is that it is selfish and irresponsible to KNOW that you have an Autosomal dominant LETHAL disease like Huntington’s and still have children. It may seem harsh, but I personally would simply adopt. There are millions of children around this planet and in the United States who need a safe and supportive home. If you fall into this unfortunate situation and you want children, why not offer them yours?

Culling Embryos posted by Octavia
UHSA Medical Student

http://topics.nytimes.com/top/news/national/series/dnaage/index.html

please go through some of the articles at the above link they are very well written and present important, current and relevant issues on DNA technology, thanks.

No Food for Thought

No Food for Thought


Don’t throw away that New Year’s resolution to lose weight just yet. If law makers in Mississippi have their way, you might need to really stick to that diet if you visit their state. Legislation was recently introduced that would band restaurants from serving obese people. Bill No. 282 contains the key to the future of the obese in Mississippi. Restaurants would keep a scale there to measure your BMI and if >30, could refuse to serve an obese customer. I suppose legislators equate this to refusing alcohol to someone who has had too many drinks.

Obesity is a disease that affects approximately 60 million people in the United States. With the increase in pre-packaged foods, the increased number of fast food restaurants, and lack of activity; the number of obese people in America has had a steady rise since the 1960’s. No wonder we have an obesity epidemic in the United States. Food is everywhere-on television, vending machines and on busy roadways with potential traveling customers. Food is involved in just about every fiber of our daily lives. If you couple this with a life of sitting behind desks and cars, you have a recipe for obesity.

Well, whose fault is it? This is difficult to answer given that people are free and can make the choice to eat healthier foods. We live in culture where the environment has dictated a lack of activity. With the advancement of technology, it has made us more sedentary. We have remote televisions, elevators, and fast foods. There are even cars set up to hold our food. In addition, it is cheaper to buy a burger for a dollar versus buying a six dollar salad at the salad bar. It costs more to eat healthier.

Obesity, however, does not come without a cost. Obese people run the risk of chronic deadly conditions such as cancer, type 2 diabetes, hypertension and heart disease. So, why do we still over eat knowing that obesity can cause these conditions? And this is the question that lawmakers have probably asked themselves and the reason for the proposed bill.

Mississippi has found themselves at the top of the list of the fattest people in the country. This has happened for the third year. There has been an increase in death rates from cardiovascular diseases and cancer for which obesity was a factor. Mississippi also holds the record of being the first state to record an obesity rate at over 30%.

As a result, law makers have decided to take matters into their own hands. If this legislation is passed, it would be enacted this summer. For the restaurants that do not adhere to this law, they would be sited and probable fined. The department would monitor compliance and have the power to revoke violators' permits. "I was trying to shed a little light on the number one health problem in Mississippi," co-sponsor Republican Rep. John Read of Gautier, a former pharmaceutical company sales representative, told the Associated Press, acknowledging that at five feet, 11 inches (1.8 meters) and 230 pounds (104 kilograms), he might get the restaurant boot under his own bill.
This is certainly discrimination and stereotyping against obese people to say the least. If an obese person walks into a restaurant, will that person be stopped at the door? How do we know this person does not want to order a salad? Now we are policing people on the lowest level. Will that customer need to carry around a doctor’s note confirming they are indeed on a diet? Where will it end? Will it extend to grocery stores as well? There are many other causes for obesity. Will this individual need to carry proof that their obesity is due to steroid medications? We would just be looking at people and judging them according to their weight. So, I guess this would lead to the hiring of only skinny waiters and waitresses; which would be another form of discrimination against the obese.
There are many other ways to help obese people over come this disease besides policing their restaurant visiting habits.

Although some law makers in Mississippi state that the bill will never reach the committee and onto the floor of the legislature for a vote; just the thought that someone proposed this is very disturbing. I don’t’ believe this will be the last if this debate. As a country, we are constantly battling racial and social discrimination, but we have not come to real terms with our discrimination of over weight people. Look at how some airline companies want to charge double fair for an obese person if they require two seats. Obese people have been the target of discrimination for many years because their problem is perceived to be controllable. With a law like this, overweight people would continue to suffer across the board. The introduction of this bill this has sparked a dialogue about the obesity epidemic. However, it has given someone else the ammunition to continue the attack on the obese people of America.

Healthcare Proxy and Advance Directives

Healthcare Proxy means “appointing someone to make healthcare decisions for you in the event that you are unable to so yourself”. This has to be in writing. Appointing a healthcare proxy is a big problem for many of us and our patients. This could be due to any of several reasons. The primary one being that “nothing will happen to me”, another is that we do not like to discuss death. It can also be that we have many loved ones (especially children) that we don’t want to offend any by just appointing only one, and in some cases, we just assume that our spouse or parent is automatically our healthcare proxy. In the rare cases where one appoints a proxy, there is no documentation giving the appointed proxy legitimacy because it is not written on paper. Unfortunately, not taking the time to make this important decision and taking the necessary action brings unimaginable suffering to the patient, rips the family apart and places the healthcare practitioners in very awkward position. Many of us hope to live to ripe old age and die peacefully in our sleep, or have a massive heart attack and die instantly, while others don’t even want to think about death at all. The inevitable truth is that we all will die one way or another someday.
Advance directive on the other hand is making one’s wishes known about end-of-life care. In the rare cases that people appoint a proxy, they fail to make their wishes known and this leaves the proxy with a lot of burden as to what decisions to make. This also has ripped families apart. Make your wishes known. Do you want life support or not? Under what conditions?
I work in the medical intensive care unit in a hospital where people die in life support or under circumstances that require decisions of end-of-life issues. It is sad to witness the fights, struggle for power and even accusations that go on among family members at the bedside of a dying patient because there is no appointed proxy or advance directives. There have been cases where the spouse or one child doesn’t want to let go, but another wants to end the patient’s suffering. People accuse one another of not caring about the dying one or of wanting to torture the patient. In some cases, it becomes a power contest. Sometimes others just want to be vindictive for whatever reason. But the issue remains, that a decision has to be made as to the course of care. The question becomes, “who is making this decision for you?” Is it in your best interest?
One particular case involved a man who was separated (not divorced) from his wife for seven years. He lived with his fiancée of seven years in one state and his estranged wife lives in another. Shortly after his separation, he was diagnosed with cancer, his fiancée was with him during his treatments, remissions and relapses. In his final days, he became unconscious and was put on life support. He did not appoint his fiancée as proxy and because she was not his wife, she could not make decisions for him. The hospital has to wait for the wife who hasn’t seen this man in the seven years of his illness to make decisions for him. She wanted everything done. She never showed up at the hospital. This man had to be resuscitated each time his heart stopped (which was several) while the fiancée cried that “he never wanted any of this, please let him go”. Of course the wife’s wishes have to be carried out.
It is important that patients make these decisions when they are in good health and of sound mind. In most states, it doesn't have to involve a lawyer but it has to be signed and notorized. Find out what is acceptable in your state. Physicians are in a better position to educate their patients on this important decision. I understand how difficult it will be for a patient to go for his annual physical and his doctor is talking to him about making end-of-life decisions. However, it is a decision that has to be made and patients cannot make it unless they are aware of it. As individuals too, we have to make these decisions because physicians die too. Let us educate ourselves, our family members and most importantly our patients on the need for appointing a healthcare proxy and having advance directives in writing. It saves everyone the pain and agony of uncomfortable decisions.

ETHICAL ISSUES SURROUNDING ABORTION

Abortion is the most difficult and controversial moral topic in today’s society. Many people view abortion as a murder of unborn children. On the other hand, some people view it as freedom for women. We need to listen to both sides, even if that is difficult to do. Both sides have negative and positive moral insights, even if ultimately these insights are outweighed by the insights of the other side. There are two principal morals we need to consider; first, the moral status of the fetus. Is the fetus a person? At what age in its development does it becomes a person? Conception? First trimester? Birth? Secondly, the right of the pregnant woman, does the pregnant woman have the right to decide if she is going to carry the baby to term or not? As we consider these difficult issues, it is imperative to distinguish two other questions. Is abortion morally wrong or should abortion be illegal? These are distinct issues because not everything that is immoral is necessarily illegal. For instance, it is immoral to be unfaithful on your marriage but it is not illegal. Another argument that is usually advanced against abortion is the fact that the fetus is an innocent person. It is morally wrong to end the life of an innocent person; therefore, it is morally wrong to end the life of a fetus. Much of the debate in regard to abortion has been centered on whether the fetus is a person or not. If the fetus is a person then it has the right that belongs to persons, including the right to life. In my view, women have the right of privacy, ownership of their body, treatment, and right to self-determination. Therefore, I am not against it or for it because everyone has they own freedom and belief.

HPV VACCINE FOR CHILDREN

HPV VACCINE FOR YOUNG CHILDREN

Human papillomavirus (HPV). Vaccine is a vaccine that is focuses on certain sexually transmitted type of human papillomavirus. HPV is known to cause cervical cancer and genital worst. We have now discovered 100 types of HPV about 37 of them are caused by sexual contact. According to the centers for disease control, HPV infection is now common world wild among adults. It is estimated that at the age 50, more than 80% American women would have contacted at least one strain of HPV.

Two years ago, the Texas governor wanted to legislate a mandatory HPV vaccine for young girls in Texas, ages 10 years and above. It was a highly controversial issue in Texas. If the legislation has passed, all 6 grade girls will be vaccinated with HPV vaccine by the state. I am against the vaccination of ten years old girls with HPV vaccine, here are few of my reasons, I am against the government or the state making health care decision for our children. I think is the place of the parent to make that decision for their children. I am not against the consented adult women, for they will have no one to blame if any thing goes wrong inn the near future. What if in few years we found out we were wrong? I don’t know if we have enough statistics to prove the efficacy of this vaccine in human, or any possible side effects that may be detrimental to the young girls. I think if we are worried about the contacting the sexually transmitted disease like HPV we should have massive educational programs for children and their parents. Education can be duplicated, and no side effect it will help more children than the vaccine. If we can stop our children from having early sex that we help prevent the cervical cancer. At the age of 9, 10 the child tissue is not matured any sexual intercourse may traumatize the young tissues; the virus can easily penetrate and cause the cancer.

HPV vaccine should be given to the adult women who are responsible their own decision; the children’s health care decision should be made by the parent who is responsible for their well being. Government or state should not be making our children’s health care decisions. I do not think young people are the Wright population to focus on when the issue is controversial. We need to study the a little more on adults, may while we educate our young girls to avoid early sex, a good education program is ever lasting and can be duplicated. I also think that letting our children take vaccine at that age, we are given them the go ahead to have sex, you now protected.

Jibao L. Musa

UHSA Antigua

"SILLICON WOMB " FOR BETTER EMBRYOS.

"SILICON WOMB " FOR BETTER EMBRYOS

LONDON: A team of UK researchers will soon be conducting trials of a "silicon womb" inserted into a woman's own womb which incubates embryos to provide a more naturalenvironment. The research team led by Simon Fishel, at UK fertility group CARE Fertility, in Nottingham, UK, hopes that this new device may produce better quality embryos and reduce the need to harvest so many eggs from infertile women. Usually, a standard In Vitro Fertilisation (IVF) involves the eggs harvested from a woman to be fertilised in the lab where they are allowed to develop in an incubator for 2 to 5 days. Then the doctors pick up the healthiest embryos to be transferred into the uterus. But, the new device, developed by Swiss company Anecova, allows embryos created in the lab to be incubated inside a perforated silicon container inserted into a woman's own womb. After a few days, the doctors recover the capsule and select some embryos for implantation in the womb. The new device is a step ahead from the standard IVF that requires changing the growth medium of the embryos incubated in the lab, every few hours to provide new nutrients and get rid of waste, while the new device provides a more natural environment. The silicon capsule used measures about 5 millimetres in length and less than a millimetre in width having perforated walls with 360 holes, each around 40 microns across. When the embryos have been transfered inside, the ends of this tube are sealed and the container is connected to a flexible wire that holds the device inside the uterus. It has a thread that trails through the cervix for its recovery later on. A small trial on the device has already been conducted in Belgium and according to Fishel, the results were encouraging but not conclusive. CARE’s trial will be conducted on 40 women, each of whom will be having between 8 and 12 eggs harvested, then half their embryos incubated in the lab, and the other half inside the new device. "We will be able to directly compare the results of the in vitro and in vivo techniques," said Fishel. He also added that women will be made pregnant using only the healthiest embryos no matter which technique produced them. After 2 days, half of the devices used will be removed and the embryos will be tested for genetic defects. The rest will remain in place for 4 days, then it will be possible to assess the more mature embryos visually. According to Fishel, the new device could do away with some of the guesswork out of incubating embryos. "We don't really know the full ambient conditions of the reproductive tract. It is also a dynamic environment that changes constantly, and we can't replicate that," he said. He thought that embryos grown in the device will be more resilient, which implies that fewer eggs may need to be harvested from women to achieve a successful pregnancy. The majority of IVF techniques need the woman to stimulate egg production by taking hormones, which can sometimes lead to dangerous side-effects. However, he confessed that the Anecova capsule will not be placed exactly at the place where an early embryo would naturally develop, inside one of the fallopian tubes. An embryo normally spends around 7 days travelling down the tube towards the womb. "It's a lot closer to a fallopian tube than a plastic tray, but this new device is not an artificial fallopian tube. The trials will tell us whether the environment in the womb will do instead," said Laurence Shaw from the Bridge Centre fertility clinic in London and a spokesman for the British Fertility Society.
After reading the article, I thought what an amazing thing to do , a step further from IVF ,is it not amazing that the embryo will be placed in the capsule ,incubated and tested for genetic defects.My main concern is what the effects of the reasearch will have on the women being used .This is a newly tested techinque , I guess we all will have to wait and see how this advancement works out in the future.
This technique will further make it possible to have a higher probability of pregnancy with the capsule implant ,because it can be monitored and embryo growth can be confirmed ,vs the IVF , which in some cases the embryo does not form well after implant and another IVF is required. This silicon capsule insert is more like in vitro vs in vivo, which I think will be more cost efficent and less stressful on the woman who can go to the Doctor knowing that she has a higher probability of having the embryo form and grow to term. Verses the IVF which has a lower probability and once failed can cause severe emotional stress on the mother.

Reference:
Article from The Times Of India.

Ethical Implications of a Patient's Right to Refuse Treatment

Following the delivery of her child, a patient is bleeding heavily and her obstetrician proposed and received approval for a dilation and curettage to take out the piece of the placenta which had been retained. However the bleeding continued, consent was then sought to give the patient a blood transfusion and it was denied based on religious belief. After an emergency court hearing in which the procedure was approved by a judge, the patient received the transfusion, recovered and was discharged.
This is the case of Stanford versus Vega in Connecticut 1996. Person’s rights to refuse care or life saving treatment have been the paramount of autonomy, and great burden and moral conflict to health care personal who have sworn the oath of beneficence and nonmaleficence.
Melissa Ann Rowland in Salt Lake City is still in jail for criminal homicide with charges stemming from depraved indifference to human life and child endangerment because she refused c-section to save lives of her twin babies contrary to doctor’s advice. Although Melissa eventually consents to c-section but then it was too late, one of the babies died.
The possibility that a patient and people empowered by the patients to speak on their behalf, can refuse life saving treatment for themselves or the patient, and be allowed to do so is becoming dangerous ground for those who have taken personal and professional oaths to save lives. Most human beings are capable of making informed decisions if the are given the ability and knowledge to do so. These decisions are not always acceptable to everyone. In the case of the patient it may be a religious reason, or reason based on fear of the outcome of treatment or on a lack of consensus on the part of physicians. Whatever the reason may be, the number of patients choosing not to undergo treatment is on the rise, and mirroring that increase is the dilemma faced by healthcare providers. The underlying basis of beneficence is that a person should do right unto others and prevent harm. This principle is most sacred in a healthcare facility. However, a patient’s autonomy however crazy sounding or harmful to them is to be respected. Patient’s autonomy shall be upheld at all times. Patient consent is the principle that anyone over the age of 18 has the right to accept or decline all physical interventions, from operations and injections, to help with getting dressed. Providing that a person is competent (that they understand what is going on and the consequences of their actions) and that they are acting voluntarily, the decisions of adults about physical intervention cannot be overridden or ignored. Nurses and doctors can suggest treatment, but should answer the patient's questions and provide a balanced, full picture of the options and their consequences. In both two cases, patient’s autonomy has been severed, patient right was denied for good reasons. While there are laws that states what circumstances a person’s wishes should be respected irrespective of the outcome (permanent injury to invite all in or even death). Health care providers must battle not only their personal desires to save (or attempt to save) a patient’s life, but they must also contend with the legal parameters that govern healthcare operations. In the health care industry there is an ever increasing predicament as to a patient’s right to refuse life saving care. While the patient’s right to refuse treatment is not a new occurrence, nor is the resulting legal action that is usually taken when a patients requests are ignored. Despite the principles of deontology, kentanism and beneficence that guide health care provider, heath care providers should thrive to protect and respect patient’s right to refuse treatment.

Genetic Testing: When does life start?

Based on what you know about pre- implantation diagnosis, do you think that, given a negative outcome, destroying the other blastomeres is taking the life of the baby?

The Blastomere Biopsy is a matter of performing the procedure IVF which has been done for many years and the process is very accurate. By performing the procedure, would allow a couple the opportunity to make a more informed decision as to whether or not they want to proceed with the implantation. In addition, the only other issue with the Blastomere Biospy would probably be a Bioethical one due to the method in which the Blastomeres are disposed of, and why, if not implanted into the uterus.

If given a negative outcome, I do not think by destroying the remaining blastomeres is taking the life of a baby for various reasons. First of all, I believe life starts after the baby is born. A blastomere does not contain any cognitive processes. In addition the blastomere may contain such gross chromosome abnormalities the fetus probably could not survive pass the first trimester if implanted; therefore, leading to a spontaneous abortion. The cells have yet to become a fetus nothing has been implanted into the uterus. I view it as simple cell division in a lab and nothing else.

MALE PREGNANCY-HOW FAR SHOULD WE GO?

Male pregnancy – how far should we go?
Before enrolling into this class I never knew that there was research being done on male pregnancy. This surprised me and gave me lots of questions to contemplate. My first response was, why? If God created women with everything needed to carry out a pregnancy why interfere with nature? Who’s money will be spent on this research just to see if it can be done? Then, is it ethical and morally correct?

The Beijing doctor –doctor Chen Huanran, one of China's most-prominent sex change surgeons -- says he has developed the technology to impregnate a man, and now he wants to use his technique to help his transsexual patients have children of their own.

Chen, who works at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, said he has already lined up four men for the procedure. An internet discussion of his "male mother" project has caused hundreds of men around the country to volunteer for swollen ankles, morning sickness, and the many other joys of pregnancy. Would the procedure be safe? Aren't men missing a really important component, the uterus?
While getting a man pregnant is not quite as easy as impregnating a woman, it is just wrong. First, the man would have to be injected with female hormones to prepare him for the pregnancy. Then the embryo would be implanted, through a laparoscopy in the man's abdomen, near the omentum, a fatty, blood-rich tissue that hangs in front of the intestines. The baby would be delivered, at term via Casearan section.
I feel that it is dangerous, not only for the man, but especially for the embryo that will be implanted. What are the long term effects on human health and environment? What are the personal, social and cultural consequences? Male pregnancy is too ridiculous. It is against human nature. If a man wants a child, he can adopt one. There are so many kids that need homes. We, as health care providers, should be working to improve the quality of life. If there were no other options for having children, it might be a viable solution, but with so many more safe and proven ways for a couple to have children I can find no reason to proceed with the time, talent, medical resources and let’s not forget to mention, millions of dollars on research to fix something that isn’t broken. We surely have not run out of cancers to cure, prosthesis to develop, genetic and aging illnesses that could be prevented or cured, etc. Let’s spend our dollar for high yield, maximum impact research and discourage (i.e. cut off funds) for research that is just someone’s ticket to fame, regardless of human life.
Feb 29,2008
Sabina,R

A LOOK AT XENOTRANSPLANTATION

A LOOK AT XENOTRANSPLANTATION
End-stage organ failure is one of the most highly publicized, controversial public health issues facing the industrialized world today. There is a worldwide shortage of organs for clinical transplantation and sadly, many patients who are listed to receive new organs die while waiting.
Xenotransplantation is the transplantation of organs, tissues or cells between different animal species including humans. There have been advances in understanding the mechanisms of organ transplant rejection. Such discoveries have allowed for reasonable consideration to the usage of organs from other species, such as pigs, specifically engineered to minimize the risk of serious rejection. Also, the use of pig tissue as an alternative to human tissues will eliminate human organ shortages. Other procedures, some of which are being investigated in early clinical trials, aim to use cells or tissues from other species to treat life-threatening illnesses such as cancer, AIDS, diabetes, liver failure and Parkinson's disease.
Xenotransplantation, however, raises many novel medical, legal and ethical issues. Medical concerns partly center on organ rejection, but also include the possible risk of infection. Organisms in host animals may be transferrable to humans and crossover of disease from species to species will therefore be a risk. The effects of xenotransplantation on the human gene pool and possible long-term genetic problems offer a note of caution. Equally, any permanent alteration to the genetic code of animals is a cause for concern.
Should we develop technologies which would allow us to use the organs of other animals in human beings? There are arguments both for and against, but most people really aren't very aware of them. This is unfortunate, because the time when it will be possible to perform such transplants is fast approaching. The first xenotransplants were failures, but things are changing, and usage will be radically increased before we know and we need to be equipped to handle the debate.
There are very good reasons for seriously considering the idea of using organs from other animals. The biggest of these is the fact that almost all of the major problems involved with human-to-human transplants would be eliminated. We wouldn't need to wait until a person is nearly dead before doing a transplant.The surgery could be done earlier when the patient is healthier and has a better chance of surviving. We also would not need to wait until another person has died to find an organ, meaning we don't need to debate when someone has "really" died and when to remove their organs. Also, the transplanted organs do not have to travel several hours from person to person which means that they will be fresher and healthier. The quality of the organs would also be better. In addition, organs will be more plentiful, eliminating concerns about availability and even eliminating some of the cost. Organs for infants would become available, saving even more human lives. These considerations have room for debate and promote continuing dialogue on the ethical, moral, and economic benefits.
Given all of these benefits, is it a realistic possibility to use the organs from other animals. There have been attempts to use primate organs, but those haven't worked as well. One would think that primate organs would be the best candidates, and for a number of different reasons that might be true. However, primates are difficult, time consuming, and costly to rise. Moreover, being primates, people are uncomfortable with killing them for organs. The same is not true of pigs. Pigs breed quickly, grow quickly, and are already consumed for food in large quantities. Moreover, their physiology is close to human physiology, thus they are among the best candidates for non-human organs in large quantities and good quality. The are some health issue related to xenotransplantation of pigs. Such concerns are the transmission of many viruses that humans do not have at this point but can acquire via transplants of the pig animal organs. Consequences may include infections such as influenza, bacterial infections and retroviruses carried naturally by pigs. Here another ethical and medical question rises, “Could it mutate into something which is not neutral, as with pigs, but which is instead harmful?” Yes, that is a possibility.
We just don't know what will happen. We can't. So what do we do? We could save hundreds of thousands of lives if we are able to use pig organs in xenotransplants. We could kill millions the same way, however. How do we weigh the risks? How do we balance the interests of those who would be saved against those who might die? These questions and more create the ethical dilemma in using xenotransplantation. Until we have a consensus with the general public and the scientific world, the use of xenotransplantation will be placed on hold.

Ethics and law
February, 2008

Challenges to Medical Autonomy

Along the line of decision making doctors have always argued that the only person who can evaluate the work of a doctor is a fellow doctor. However, medical autonomy has been increasingly challenged in recent years. The effectiveness of medical treatments has been challenged as the number of court cases increase and when the cost of imdemnity insurance becomes almost unaffordable the societal consequences are far reaching.
We are at the point now when the determination of terminal illness is not soley a medical decision, but rather a hybrid medical, ethical, social, political and legal determination. It is clear that hospital admistrators/managers and health insurance companies have exerted a certain amount of control over doctors. Managers can direct funding from one medical specialty to another; or from hospitals to community-based practitioners. Challenges have also come from the professionalization of other 'paramedical' occupations, especially nursing, which has developed into a more autonomous profession with its own professors of nursing in many universities.

The medical profession is also acutely aware of how the profession as a whole is represented in factual and fictional media. Doctors may still be heroes in fiction, but intense public attention has been given to the villains. Their power to promote stereotypes,as protraying people with mental illness as violent, helps us understand how the media sometimes represent health and illness. The media has breeched taboos to put important and vital issues on the public agenda,in the case of aids, bowel and testicular cancer. It has to be credited with provoking debate on the ethics of scientific and medical developlents and keeping a focus on stem cell research. Medical practioners can with ease suggest behavioural changes to their patients based on what is 'on the news'.

Within medicine, there have been attempts to change the heirarchical structure of the profession and to embrace complimentary therapies such as homepathy and accupunture. The new strides in transgenics, gene therapy and the gamot of genetic engineering will provide many opportunities for collaborative efforts.

HUMAN CLONING: DESTINY AND RESPONSIBILITY

In the sixteenth century, the Reformed theologian John Calvin wrote this about childbirth:
Although it is by the operation of natural causes that infants come into the world ... yet therein the wonderful providence of God brightly shines forth. This miracle, it is true, because of its ordinary occurrence, is made less account of by us. But if ingratitude did not put upon our eyes the veil of stupidity, we would be ravished with admiration at every childbirth in the world.'
Four centuries later, we find that infants do not always come into the world through "the operation of natural causes." The miracle of childbirth has already moved beyond "ordinary meaning" through such procedures as in vitro fertilization. Now that we face the possibility of human life springing not from a fertilized egg but from a clone, we are making great account (some would say too much account) of this possible new way for infants to come into the world. Many people wonder whether this is indeed a miracle for which we can thank God or an ominous new way to play God ourselves. At the very least, it represents the ongoing tension between faith and science.
On the one hand, the church has sometimes taken an overly antagonistic opposition to scientific advances, so that Galileo was charged with heresy for supporting the seemingly unbiblical Copernican notion that the earth revolves around the sun. Darwin's theory of evolution (which apparently even frightened him a bit) is still opposed by some Christians who want equal time given to "creationism." Such examples remind us that the church must not assume that faith requires protection by being shrouded in ignorance. We should be able to celebrate human accomplishments, including accomplishments in genetic research, as the result of divinely bestowed gifts of knowledge and technical skill.
On the other hand, the church rightly understands that sin can lead us to use scientific advances for extremely evil purposes. We can never support the pursuit of knowledge for its own sake apart from asking serious moral questions about the implications of that which we seek to know. To date, we have not been able to keep up with the moral and legal implications of adoption, much less of the dilemmas presented by artificial means of reproduction. We certainly are not yet morally, legally, or spiritually prepared to tend to the difficult issues that would arise if human cloning became a reality.

Proper Health Care Before Money

Proper Health Care Before Money?

As I am reflecting on the present health care system of our country, the United States of America, I came down to one and only conclusion. The conclusion is that we are living in a free market economy. If it is the case, the purpose of every private health insurance or health care institution is to make money. When I say making money, I mean making money at all cost. Maybe, there is nothing wrong with that if freedom or too much leeway is given to those private institutions. Simply with the thinking of making money no matter what, I feel a burning pain in my chest. Why is it an alarming issue? Is there any issue to it? Or, am I making it more than what it is? Well, consider this! It was reported, at the beginning of 2004, nearly 50 million Americans were without health insurance, and the number kept growing higher together with increased number of unemployment.

Millions more have had only partial, inadequate health care coverage. More than eighteen thousand people die in America every year as a direct result of not having access to health care. Beyond that, it was reported that those million people who could afford to pay health insurance were paying more than $100,000 for the hospital stays for their elderly parents in their final days before they died. Four years later, the condition cannot be less alarming than before.

As a reminder to the article 25 of the Universal Declaration of Human Rights that states: Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. The idea behind the article 25 is excellent on the paper, not in practice to those it tends to affect financially.

It must be understood, in every civilized country, the rule of law has to be the turning point for its people. Further, civil instructions and moral values are to be the guided accordingly. Those qualities, I may say, are to be taught and reinforced at home, school, and in public enterprises. With normal practice, we will recognize our duty to other people who breathe and have similar needs as we do. In my humble opinion, I believe, it is unethical and immoral to refuse to give medical care to a sick individual on the basis that individual does not have health insurance, or even deny health insurance to an individual because that individual has a pre-medical condition.

I, sincerely, think no one chooses to be an advocate of illnesses. It is an unfortunate course of life, everyone has to face. To conclude, as un-American I may sound, medical care to every individual needs to be top priority, not money. As the old saying, money is a good servant but is an evil master. We need to value and invest in people more than material objects we can leave in a second. And, as a powerful industrial nation, we must strive to understand that the world exists because of our existence. I do not mean to say it in a trivial way. What I am saying is that without any basic understanding of where we are and what we need to do to foster a sense a well-being in our people, all across the board, we are set to continue with the same egocentric attitude that will remain in existence for centuries to come.

Ronet Jean, MS. PT., MHC

Medical Student, UHSA

School of Medicine to the World, Antigua.

WHAT IS LIFE?

Ethics as a subject is not only very interesting but very important in this generation. The second law of thermodynamics states that the entropy of the universe is increasing. Restated, the universe has a tendency for disorderliness. Over the years, man being a component of the universe has demonstrated the truth in that law by various activities of man that has plunged the world from one catastrophe to another.
The most recent global event is the second world war which led to the death of 60 million people. Notable during that war was the scientific experiments during which people were treated as commodities. The chilling effects of that war moved world leaders, including medical doctors to hold series of meetings to prevent future occurrences .The outcome of such meetings are far reaching. It gave rise to:
1 The Geneva Convention on Human rights [http://www.un.org/Overview/rights.html]. This observed that contempt and disregard for human rights resulted in acts that are outrageous to human conscience therefore ruled that no one should be subjected to torture.
2 Three months earlier, the World Medical Association[ http://www.cirp.org/library/ethics/geneva/] adopted the Physicians' oath. The 6th verse says, '' I will maintain the utmost respect for human life from the time of conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity''


After the industrial revolution knowledge has increased and with it science. Science has contributed a lot in uplifting the life of individuals. However, man if left uncontrolled, like the universe, drifts to chaos. This underscores the importance of currently hot topics, in the media, scientific conferences, and labs, namely Abortion, stem cell research, cloning, genetic engineering etc Undoubtedly, if the end is of primary importance, all of them are very beneficial, however, if the means is put in question, one can say that it appears we have quickly forgotten the second world war, it appears as if we are drifting from the resolutions taken after the war and the physicians oath.
Both the Geneva convention and the World Medical Association uphold the dignity of human being. On the contrary one feels that the proponents of the above topics regard the human entity as a commodity. Also, whereas the physician oath recognizes life as starting at conception, abortionists, and perhaps embryonic stem cell researchers argue 'it is not yet human'. Where then is the place of the oath?

Another subject of concern is the subject ' life'. What is life? For more than 400 years scientists and philosophers have been asking that question. This question moved the physicist, Erwin Schroedinger in 1944 to write a book with that title. To date, nobody has an answer to it. Carl Zimmer[http://www.seedmagazine.com/news/2007/09/the_meaning_of_life.php?page=3] wrote that in a meeting hosted by the American Association for the advancement of science in 2001, entitled, “The Nature of Life.”a leading Philosopher with NASA said scientists should stop looking for the definition of life as they can't understand what life is and that either it is impossible to define life or it is trivial. To wrap up, this scientist is quoted as saying, “We don't want to know what the word life means to us. We want to know what life is," Carl Zimmer, also said that, Radu Popa stated in his book, “Between Probability and Necessity: Searching for the Definition and Origin of Life” that he came across about four hundred definitions of life in scientific literature while researching his book. Rabu Popa is quoted as saying, “"A science in which the most important object has no definition—that's absolutely unacceptable,"

From the forgone, one can summarize that scientists are confused about life and lack the capacity to determine life. If that be the case, one is surprised that they and abortionists are busy destroying the same life they know nothing about.

Concluding, I will like to draw lessons from history. Kenneth Stampp, said ''With the historian it is an article of faith that knowledge of the past is key to understanding the present. http://hnn.us/articles/1328.html “http://hnn.us/articles/1328.html ”Neglect of historical knowledge is to a nation what the loss of memory is to a man'' [ W. Stubbs, http://web.jjay.cuny.edu/~jobrien/miscellaneous/ob46.html] ''We learn from History that we never learn anything out of history''.[Hegel, http://hnn.us/articles/1328.html]. Since man has been at the center of most of the crisis the earth has faced since historical time it is best not to allow man decide on what will impact on the future. I am for the “ Modified Divine Command Theory” [http://www.iep.utm.edu/d/divine-c.htm]

Mary Chukwu

UHSA

WHAT'S THE DIFFERENCE?

Euthanasia and physician assisted suicide

What’s the difference?

In the past decade I have gained significant understanding about attitudes towards euthanasia and Physician assisted suicide in the United States, as well as the practices themselves.

One of the problems plaguing the field of euthanasia and PAS is vague and emotionally laden definitions. The term euthanasia without a qualifying phrase means voluntary active euthanasia; that is, the physician intentionally ends the patient's life at the patient's request and with the patient's full informed consent. This is the intervention that has been the subject of intense public debate and controversy. Only a few people argue for nonvoluntary active euthanasia, which is generally viewed as wrong. On the other hand, PAS refers to the physician's act of providing medication, a prescription, information, or other interventions to a patient with the understanding that the patient intends to use them to commit suicide.

The terms "passive" euthanasia and "indirect" euthanasia are occasionally heard; these are incorrect terms because they are not really types of euthanasia. Passive euthanasia is the practice of terminating life-sustaining treatments, such as respirators and artificial nutrition. I can still recall the case of the Florida woman Terry Schiavo . For centuries these practices have been deemed ethical and legal. Similarly, administering opiates or other interventions that pose the risk of death, so-called indirect euthanasia or palliative sedation, is deemed ethical. Since the discovery of ether anesthesia and hypodermic morphine in the 19th century, medical societies have endorsed their use for terminally ill patients even if the patients die from respiratory depression, as long as the intention was pain relief. Again, these are not cases of euthanasia, and the term should not be associated with them; it only confuses nonexperts like us. The question is, what is the difference? I simply cannot distinguish between the two.

For the sake of argument, I would favor permitting or legalizing euthanasia and /or PAS for the following reasons: First, it is argued that individual autonomy justifies euthanasia and/or PAS. If autonomy means that individuals have the right to pursue their own personal view of what kind of life is best, including when and how to die, then to respect autonomy requires permitting individuals to decide when it is better to end their lives by euthanasia or PAS than to continue living.

Secondly, beneficence means furthering the well-being of individuals. This also supports permitting euthanasia and/or PAS. In some cases, living creates more pain and suffering than death. In these cases, ending a painful life will actually relieve more suffering and thereby produce more good. In fact, just the reassurance of having the option of euthanasia or PAS, even if people do not use it, can provide "psychological insurance" and be beneficial.

Thirdly, in my opinion, euthanasia and PAS are not different from terminating life-sustaining treatments, which is recognized as ethically justified. In both cases, the patient consents to die, in both cases the physician intends to end the patient's life and takes some action to cause this to happen; the final result is the patient's death. If there is no difference in patient consent, physician intention, or the final result, there can be no difference in the ethical justification.

Finally, the supposed "slippery slope" that would result from permitting euthanasia and/or PAS is not necessarily likely. Some say permitting euthanasia or PAS will undermine the physician-patient relationship or lead to forced euthanasia is completely speculative and not borne out by the available data, and therefore should not govern public policy.

MOHAMED

Womb for Rent?

TAKE a sperm donor, add an egg donor, mix in appropriate lab conditions and rent a womb for nine months. That’s the recipe for a surrogate baby.

Surrogate motherhood has been a controversial practice ever since the widely-publicized "Baby M" case in 1986. That's when surrogate mother Mary Beth Whitehead fought an unsuccessful court battle for custody of the child she was paid to bear for another couple. Since then, a quiet and fundamental change has swept through the business known as "commercial surrogacy." Unlike Mary Beth Whitehead, most surrogate mothers today are not genetically related to the children they carry. That fact may increase both the number of babies born this way and the legal security of the arrangements.

Surrogacy by gestational carrier is simpler in some ways since the surrogate has no genetic link to the child. Surrogate parenthood involves expensive procedures but it is now entirely medically viable. The money that's being used when you are working toward a surrogacy arrangement isn't purchasing a child. Since no surrender of parental rights is necessary, payment for the services of a surrogate would not be in exchange for surrendering parental rights. That makes it an option for wealthy people with fertility problems and no desire, for whatever reasons, to adopt.

In the US there is no national policy regarding surrogacy. Each state has come up with their own legal approach to this relatively new method of procreation. The laws vary from making surrogacy contracts enforceable to criminalizing all forms of commercial surrogacy. In general many of the laws have been the result of cases which have gone to court which has left judges to essentially write the laws with each ruling. Those laws usually are designed to protect women from exploitation and tend not to hold genetic fathers in the same regard as birth mothers. The cases shaping laws today tend to address the issue of whether a contract can be binding can a woman sign a contract regarding custody of a child not yet conceived with informed consent, can payment be made to a woman for her reproductive services but not the final product of a surrogacy? These questions are legally and morally baffling at best and so while legislature tries to keep up with the ever changing reproductive needs of its citizens many states are left with laws which require parents to adopt their own genetic child and other such actions which at first glance seem to make little sense.

The concept of commercial surrogacy may make you uneasy. But in an ideal case, everybody concerned is happy. And, if surrogacy is a de facto industry, it needs safeguards to protect its workers, like any other industry. It needs standard, enforceable employment contracts. Otherwise, there is room for abuse and unhappiness. Above all, the best interests of the child should be the paramount issue in any surrogacy legislation and resulting surrogacy arrangement.

Ref: http://www.everythingsurrogacy.com/cgi-bin/main.cgi?Laws#general

LIFE IS NOT A BOX OF CHOCOLATES

As life progresses and with increased exposure to different environments, cultures, and value systems, it is only a natural process to ask yourself, “what do I really believe?” The answer to that question seemed so easy 12 years ago when I was living in a small southwestern Virginia town at the age of 18, fresh out of high school and on my way to change the world. There was right and wrong, black and white, donkeys and elephants. Those were the basics that would carry me through life, right??

During my undergraduate work, I was exposed to men and women from all over the country. With that came continuous heated discussions of interracial relationships, the latest political topics, homosexual rights, and all other controversial topics that typical excited, eager teenagers enjoy arguing. At that time I was openly opposed to all freedom rights of the mother. How could a woman choose to abort this wonderful creature that she developed?? Life at that point had not exposed me to hardships that many men and women face every day.

Moving to New England for three years came the cold but also a new perspective to the world of “the lefties.” Die hard Democrats. At that time I was training in various clinical offices that offered an array of diverse medical conditions. For the female population, in particular, I saw a mother battling bipolar disorder while having to feed and clothe 4 children under the age of 8 (which ultimately led to Child Protective Services removing the children from the home). I witnessed a 14 year old girl discuss her own pregnancy with her mother (whom was also pregnant at the time). I saw the physical, financial and emotional hardships one woman faced raising her only severely handicap son on her own. The list goes on. I decided at that time that I cannot save the world; however I can certainly provide some education.

When I settled in Maui, Hawaii, I started working in Family Practice/Urgent Care and attracted a younger population of patients, primarily women age 13-45. In discussing issues such as pregnancy, STD’s, child rearing and sex, it seemed the majority of younger women were not comfortable discussing their social history with their parents. Time and time again I heard, “Will my mom find out about this?” or “Do you promise you won’t tell. My parents would kill me.” The reassurance was of course given but also what was given was factual, evidence based medical information on life issues applicable to women of child bearing age.

Humans were developed in a systematic manner. Women were designed to begin child rearing as early as 9 years old. It is these biological changes that conflict with emotional and “societal” maturity. Unfortunately not all parents’ view their children as emotionally/socially inept, regardless of their biological maturity. Equally unfortunate is the discomfort seen when discussing heavy issues with women of child bearing age and their parents.

Subject bias benefits no one. Individualizing and remaining open to your patients’ social and personal concerns will establish a sense of trust and understanding between you and your patients (regardless of age). Through life’s path I have become aware of the complexity that young women, in particular, face in determining the best outcome for both themselves and their offspring. It is important as health care providers to deliver an unbiased truth of the medical facts that accompany these social issues. In this way we can allow our patients to make educated decisions about what is best for their personal wellbeing.

The Ethical Issues Surrounding Rural Health Care Delivery

Is it ethical for rural residents to be deprived of an adequate health care system?

One of the major challenges rural areas are facing is lack of physicians. Physicians are not attracted to practice in rural areas for several reasons. First, the demand for their service may not be to their satisfaction. Since the revenue of physicians is often dependent on the number of patients they see, their income will be directly affected by the lack of demand. For this reason, they much rather service areas where they are needed to maximize their value. Their goals are not to perform charity care or work in an area that will eliminate their opportunity to maximize their income. Their goal is also not to under utilize all of the skills and knowledge they acquired during the course of their training. Working in a rural area will not generate the opportunity to maximize their value and grow in their profession because the area is too scarce. It is even more challenging to have specialist and mental health providers because the demand is not evident. For this reason there is a massive shortage of specialist and mental health providers. A neurosurgeon will probably undergo at least 17 years of post secondary education. His annual salary is obviously dependent on the number of surgeries performed. In a rural area, it is vastly doubtful he will have many opportunities to utilize his skills.

A second major problem is generating funding to build a hospital. The federal government is not in the business of delivering health care. It is not economically logical to build a huge facility that will not demand a constant rotation of patients. In the past, it was difficult to attain 50% above occupancy rate in a 30-49 beds facility. There are not enough available funds to operate such a facility. A hospital cannot afford to employ doctors, nurses, technicians, nurse practitioners, physician assistant and administration staff on a daily basis if the beds are not occupied. Unlike the urban areas, there will not be enough volume of patients requiring services from doctors and nurses to compensate them. In order to operate a hospital financially, quality care and capital needs to be generated on a daily basis. It is crucial for a hospital to receive adequate amount of patients to be successful.

The United States have made some efforts to overcome some of these challenges. In 1948 they started the Hill Burton Act. This bill took federal money to build hospitals. Over 3,500 hospitals were built however many shut down due to lack of funding and problem noted above. Another method that was used is telemedicine. This was geared towards radiologist. Radiologist was able to diagnose patients using imaging studies. This method was effective because physicians were able to view these imaging away from their office. Although this method brought some resolution to the problem, it opened another drawback which was lack of physical contact with the patients. It is important that patients are physically examined and consulted by a clinician. This is just practice of good medicine. Two other ways the government made some efforts to alleviate some of these challenges were through paraprofessional and ambulatory care clinic. It was obvious patients needed to have physical contact with the physicians. These two methods were able to subsidize health care to rural area. Patients had a location to be treated and evaluated by a clinician.

The question states is it ethical for rural residents to be deprived of an adequate health care system? In my opinion, the elimination of the deficiencies is warranted. In order to eliminate the deficiencies, recruitment of more physicians who appreciate the challenge to work in rural areas is necessary. I understand the privilege that comes with being a doctor; however, the reward stills lies on providing quality care to patients in need. With the assistance from the government, special grants and scholarship can be offered to medical students, PA’s and NP’s with the commitment of servicing rural areas for a period of time upon completion of their studies. Loan repayment for licensed physicians who are willing to commit their services to a rural area is also an attractive incentive. Educational scholarships to current residents of the rural areas may generate committed providers because since they already live in these rural areas, they are more likely to stay there once they complete their education. As an alternative, I would recommend the establishment of mini care stations throughout the different communities of rural area. This has proved to be quite useful in many states because of its convenience and cost effectiveness. Care station offer basic primary care services at an affordable rate. They are usually employed by physicians and cost effective mid level clinicians and are available on a walk in and appointment basis for non emergent and semi-emergent cases. The facility is not as big and costly as a hospital but offers more than a private doctor’s office. Instead of having one big hospital, the idea of having a few mini care stations could bring better results. I would also campaign for more preventative medicine strategies. Until the shortage is resolved, the healthier the rural residents remain the less doctors, facilities and specialist will be needed. Physicians should not base their decision of where they will practice on the basis of the potential income they will generate; it should be based on the need and the difference their commitment will make in the lives of all human being. Urban or rural, rich or poor, black or white, female or male.

SPIRITUALITY AND END OF LIFE CARE

SPIRITUALITY AND END OF LIFE CARE

WE CAN HELP BY SIMPLY BEING PRESENT

Although we have not yet discussed the subject of death and end of life decision makings, I would like to take this great opportunity to address the role of the clinician and share my feelings about the ill and dying patients. A sudden death is very different from someone that is chronically ill and expecting to die. When you die suddenly you do not have time to think, feel or express any feelings about death. In the contrary, when a person knows that will die than he/she has the ability and choice to prepare spiritually, religiously and culturally.
We as health care professionals have the opportunity to assist our dying patient with their decisions by just “simply” being present and allow the patient to practice their cultural and spiritual beliefs, and if possible take place and act when appropriately along with them.
Religious, spiritual, and cultural beliefs and other practices play a significant role in the patient’s life that is seriously ill and dying. In addition to providing an ethical foundation for clinical decision making, spiritual and religious traditions provide a conceptual framework for understanding the human experience of death and dying, and the meaning of illness and suffering.
Most patients derive comfort from their religious/spiritual beliefs as they face the end of life, and some find reassurance through a belief in continued existence after physical death. However, religious concerns can also be a source of pain and spiritual distress, for example, if a patient feels punished or abandoned by God.
A common goal for the dying patient, family members, and the health care professional is for a meaningful dying experience, in which loss is framed in the context of a life legacy. Such an experience includes support for the patient's suffering, the avoidance of undesired artificial prolongation of life, involvement of family and/or close friends, resolution of remaining life conflicts, and attention to spiritual issues that surround the meaning of illness and death. Clinicians can and should help dying patients find meaning and hope through recognition of the spiritual dimension of their experience. Although they may lack the expertise to address spiritual concerns in depth, healthcare professionals should be able to discuss spirituality with their patients and identify those in spiritual distress so that appropriate referral may be made to spiritual care providers. These include chaplains, community-based clergy, spiritual directors, pastoral counselors, and culturally based healers.
An important component of spiritual care has to do with the relational aspect of the healthcare professional-patient partnership. All clinicians should strive to deliver relationship-focused care that is delivered in a compassionate, caring manner. Compassion means "to suffer with", and to render compassionate care requires a commitment on the part of the healthcare professional to be a partner with the patient in the midst of their suffering.
This means: Being fully present and attentive to the patient during the time that the healthcare professional has with that patient.
Creating an atmosphere of trust where patients and their family members can share their deepest concerns. Instead of focusing on agenda-driven conversations about treatments and outcomes, being more open to the patient and listening to his or her concerns, beliefs, hopes, fears, and dreams. The focus of care should be on the whole person, including the physical, emotional, social and spiritual aspects of the individual. Treatment plans should be formulated that incorporate what is important to the patient.
An important component of this exchange is listening fully to the patient's story: who they are, what they value, how they make decisions, who is important in their lives, what gives their lives meaning, and how they understand illness and dying. Giving voice to patients who cannot speak for themselves. This comes from either knowing the patient from previous clinical encounters, or learning enough about him or her from family, friends, and/or their spiritual or religious communities to be able to defend what is important to them, even if it conflicts with what may be the recommended evidence-based course of action.
Focusing on the inherent dignity of all people regardless of their physical condition. Providing the patient and his or her family with opportunities for closure, forgiveness, and the best quality of life that can be achieved.
Some patients may request that the healthcare professional pray with him or her. The extent to which this is possible depends on the clinical setting and circumstance and the individual beliefs of the patient and healthcare professional. Clinicians or other healthcare professionals should never feel obliged to pray with patients; some clinicians and healthcare professionals may feel comfortable with the requests, while others may not. A clinician or healthcare professional should never coerce a patient into praying or into accepting the prayers of the clinician. That could potentially violate the trust a patient places in the clinician and be outside the boundaries of legitimate medical practice.
Spiritual and religious beliefs, values, and practices play a significant role in the lives of patients who are seriously ill and dying.
Some important considerations for physicians and other healthcare professionals regarding spirituality include the following:
For patients facing the end of life, spiritual care is interdisciplinary collaborative care, and requires the participation of all members of the healthcare team. Clinicians should clarify the patient's concerns, beliefs, fears, and spiritual needs, and be sensitive to comments that may indicate spiritual distress. Active listening and supportive dialogue may help patients work through existential issues and find peace. Patients who are in spiritual distress should be referred to certified and trained spiritual care professionals such as chaplains, spiritual directors, pastoral counselors and clergy.
All clinicians should strive to deliver relationship-focused care that is delivered in a compassionate, caring manner. This includes being fully present and attentive to the needs of the patient and all aspects of the patient's suffering—the physical, emotional, social and spiritual, and creating an atmosphere of trust where patients can share their deepest concerns. Clinicians should be knowledgeable about and sensitive to the individual death practices and customs that characterize the major world faiths. Attending funeral services for patients who have died may mean a great deal to the family, but may also bring closure to the healthcare professional.

In closing, I would like to thank Linda MacDonald Glenn, my professor, teacher and inspirer who made all this possible for us to voice our feelings, thoughts and expertise to the world. In addition, thanks to all fellow classmates for being there at all times of the good, the bad and the ugly.

Furthermore, thanks to University of Health Sciences (UHSA) that brought us all together. Indeed, UHSA is education to the world and providing doctors beyond borders.

John Aidonis, BC-FNP

Medical Student, UHSA

February 25, 2008.

KEEP IT SIMPLE, PROCHOICE IS PROLIFE

PRO-CHOICE, A PRO-LIFE DECISION

KEEP IT SIMPLE

Well, this Bioethics and Law course has certainly been one of my favorites. What a wonderful opportunity to learn other health care professionals opinion on some very controversial issues and why they feel that way. Being from the South, and probably the only Republican Southern Baptist on the island has certainly put me in the middle of most of the controversy. My classmates know I am passionate about what I believe and blessed with the “gift of gab” so this course has been a wonderful outlet for me!

It would seem that no matter what the topic of the day was, our class would inevitably migrate back to “when does life begin” and how do you feel about unwanted pregnancies.

Having discussed this in great detail over the last few months and having read many profound and well written and documented details on the facts of embryology and fetal

Development, I feel I have broadened my horizons extensively. Many will wish that I had been “converted”, but know what a tough sell that would be. As passionate as I am about life, children, varying levels of different abilities of humans, and my moral believes, I am equally passionate that everyone else has that same right to their opinion and beliefs as I do. I don’t seek to change theirs and ask they not seek to change mine. Agree to disagree. Having said all of this, finally brings me to a brief point I would like to make and share with fellow students before, during and after me.

Let’s just keep it simple. We have tried so hard for so many years to convince each other that we have the correct interpretation of ethical issues, that maybe it’s time to just get back to the basics of life. A doctor came into my mother’s hospital room and put a stethoscope to her chest and waited. No heartbeat. Time of death 5:55pm. We place a stethoscope on a mothers abdomen at 3 weeks and sometimes earlier and, we can certainly use a ultrasound and visualize what is yet too faint to hear before a woman realizes she will not have another menstrual cycle and there it is, life has begun. Yes, admittedly, there are some circumstances that influence each situation, but that answer is pretty cut and dry. If we kill a caterpillar before it is a butterfly, that does not change the fact that left to develop and mature, it is and will be a complete product. Humans have to develop, that doesn’t make them nonhuman or dead. Let’s stop while it is still that simple and just go with that in almost all circumstances that would answer the first question, When does life begin, Is it killing a baby to have an abortion, and when can you abort without ending a forming life? If someone is contemplating abortion, that moment has probably already arrived and (see above instructions), pick up a stethoscope and let them decide.

Next is the right to choice. Again, let’s keep it as simple as possible. Having cleared up the above issue should make this even more simple. Unless you have no aversion to taking a life, it’s again pretty simple. Birth control if you plan ahead. Adoption or taking responsibility for your lack of planning if plan A is not in place or failed. There you go, Freedom of choice, pick one. You have the right, nay, even dare I use the word, RESPONSIBILITY?? Yes, you say there are circumstances that make it hard to imagine bringing a child into this world. Teenage pregnancy is bad, but I personally know a apple of Grandma’s eye that we can’t imagine life without now. Yes, it was hard. Yes, lives were changed forever. Yes, a life that is irreplaceable was given to us to enjoy. You deal with what you have to. I know handicaps and disabilities are hard for people to look at and imagine having to deal with 24/7. I have personally seen the look of pity in peoples eyes as they watch my beautiful, yet legally blind 7 year old struggle to play T-ball, and ride the merry-go-round, and watch Hannah Montana. But you know what? She doesn’t know she is the one with a problem. To her, everyone sees just like she does. That is all she knows. I can’t imagine life without her for sure and I will never know the countless number of people she has inspired to enjoy life. I will forever be thankful for a teenage girl that didn’t believe she could deal with a handicapped child and gave me the most precious gift I will ever receive, her child. Bless you forever.

Yes, life is hard at times, and we face decisions we can’t imagine how we will handle. You just do the right thing. Two wrongs doesn’t make a right, never was more appropriate. It will be ok. Talk to someone. Ask for help. Make an informed decision. Make a choice. Keep it simple. Life will get more complicated. Let’s let the easy stuff go and work on some really tough issues for a while.

Just a simple opinion from a country girl with a simple upbringing, but educated enough to share some information, some experience, and a shoulder if someone needed it.

Best of luck fellow physicians, Keep It Simple anytime you can!!!

Anita Turner, FNP

UHSA Med Student

Feb. 22, 2008