Tiny human brain organoids implanted into rodents, triggering ethical concerns

Stat

Sharon Begley

Minuscule blobs of human brain tissue have come a long way in the four years since scientists in Vienna discovered1how to create them from stem cells.

The most advanced of these human brain organoids — no bigger than a lentil and, until now, existing only in test tubes — pulse with the kind of electrical activity that animates actual brains. They give birth to new neurons2, much like full-blown brains. And they develop the six layers3 of the human cortex, the region responsible for thought, speech, judgment, and other advanced cognitive functions.

These micro quasi-brains are revolutionizing research on human brain development and diseases from Alzheimer’s to Zika4, but the headlong rush to grow the most realistic, most highly developed brain organoids has thrown researchers into uncharted ethical waters. Like virtually all experts in the field, neuroscientist Hongjun Song of the University of Pennsylvania doesn’t “believe an organoid in a dish can think,” he said, “but it’s an issue we need to discuss.” . . [Full text]

 

Is there any difference between euthanasia and palliated starvation?

BioEdge

Xavier Symons

While euthanasia and assisted suicide are currently illegal in most countries, the practice of voluntarily stopping eating and drinking (VSED) is seen by some as an ethically and legally permissible alternative. VSED refers to seriously-ill patients refusing to eat and drink for a sustained period of time with the intention of bringing about their own death.

Yet a new paper published in BMC Medicine argues that VSED is ethically indistinguishable from assisted suicide, and should be subject to the same legal regulations as more salient cases of assistance in dying.

The paper, lead-authored by Ralf J. Jox of the Institute for Ethics, History and Theory of Medicine at the University of Munich, argues that “supporting patients who embark on VSED amounts to assistance in suicide, at least in some instances, depending on the kind of support and its relation to the patient’s intention”.

While VSED does not involve an invasive or aggressive act like many other means of suicide, the authors write that “VSED should [nevertheless] be considered as a form of suicide, as there is both an intention to bring about death and an omission that directly causes this effect”. Doctors who assist patients in VSED — by encouraging them, or promising pain-relief if VSED is undertaken — are potentially instrumental in the deaths of the patients, as the suicide would not occur without them, and they share the patient’s intention of inducing death.

The authors of the paper conclude that the same legal prescriptions or regulations that apply to physician assisted suicide should also apply to VSED.

“[We] maintain… that future ethical discussions on assisted suicide require consideration of medically supported VSED, and vice versa…Thus, the widely held position by palliative care societies, professional bodies of physicians, legal scholars, and ethicists to disapprove of assisted suicide but approve of and even promote medically supported VSED appears inconsistent”.


This article is published by Xavier Symons and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees.

 

Accessed 2017-08-11

 

Proposed legislation to protect health professionals who object to assisted dying called ‘one-sided’

Dying with Dignity Canada says Bill 34 doesn’t protect patients’ rights to access assisted dying

CBC news

Holly Caruk

A bill that would protect Manitoba health professionals’ rights to refuse assisted dying services and protect them from reprisals is being called redundant and one-sided.

Bill 34, which was introduced in May and hasn’t yet reached a second reading in the House, would ensure health professionals cannot be compelled to go against their own religious or ethical beliefs when it comes to providing medical assistance in dying (MAID) services.

It would also ban any professional regulatory body from requiring members to participate in medically assisted deaths, which were made legal by the Supreme Court in 2015. . . [Full text]

 

What could help me to die? Doctors clash over euthanasia

Associated Press

Maria Cheng

GHENT, Belgium (AP) — After struggling with mental illness for years, Cornelia Geerts was so desperate to die that she asked her psychiatrist to kill her.

Her sister worried that her judgment was compromised. The 59-year-old was taking more than 20 pills every day, including antidepressants, an opioid, a tranquilizer, and two medicines often used to treat bipolar disorder and schizophrenia.

About a year later, on October 7, 2014, her doctor administered a lethal dose of drugs. It was all legal procedure in Belgium, which has among the world’s most permissive euthanasia laws.

“I know it was Cornelia’s wish, but I said to the psychiatrist that it was a shame that someone in treatment for years could just be brought to the other side with a simple injection,” said her sister, Adriana Geerts. . . .[Full text]

 

Contraceptive Coverage and the Balance Between Conscience and Access

Ronit Y. Stahl,PhD; Holly Fernandez Lynch, JD, MBE

When the Obama administration included contraception in the essential benefits package to be covered by employer-sponsored health insurance plans under the Affordable Care Act, it sought to preserve access for women while addressing the concerns of employers with religious objections. Although the accommodations and exemptions were not enough for some employers, balance was the ultimate goal. This also was reflected in Zubik v Burwell, the Supreme Court’s most recent decision on the matter; on May 16, 2016, the justices remanded the litigants to the lower court so they could be afforded the opportunity to reach a compromise between religious exercise and seamless contraceptive coverage. No further compromise was forthcoming.

Now the Trump administration has rejected balance as a worthwhile goal.1 Its new contraceptive coverage rules, released on October 6, 2017, prioritize conscientious objection over access.2,3 The rules take effect immediately, and new legal challenges, this time on behalf of patients rather than objecting employers, have already begun.4 The new rules preserve the default requirement that employers must include free access to contraceptives as part of their insurance plans. However, the rules now exempt employers with religious or moral objections to contraceptives, without requiring any alternative approaches to ensure that beneficiaries can obtain contraceptives at no cost.2,3
[Full Text]


Stahl RY, Lynch HF. Contraceptive Coverage and the Balance Between Conscience and Access. JAMA. Published online October 19, 2017. doi:10.1001/jama.2017.17086

The Hidden Professions of Conscientious Objection

Bob Parke*

Federal legislation permitting the killing of people who meet the criteria for Medical assistance in dying (MAiD) has challenged most healthcare professionals to carefully consider where they morally stand on causing someone’s death. While many healthcare providers may feel it is against their values to participate in euthanasia, we have all been asked or will be asked at some point about euthanasia by a patient or their family. . . .  In general, frontline conscientious objectors have been respected and accommodated. But, what about those behind the scenes? . . .[Full text]

Dignitarian medical ethics

Linda Barclay

Abstract

Philosophers and bioethicists are typically sceptical about invocations of dignity in ethical debates. Many believe that dignity is essentially devoid of meaning: either a mere rhetorical gesture used in the absence of good argument or a faddish term for existing values like autonomy and respect. On the other hand, the patient experience of dignity is a substantial area of research in healthcare fields like nursing and palliative care. In this paper, it is argued that philosophers have much to learn from the concrete patient experiences described in healthcare literature. Dignity is conferred on people when they are treated as having equal status, something the sick and frail are often denied in healthcare settings. The importance of equal status as a unique value has been forcefully argued and widely recognised in political philosophy in the last 15 years. This paper brings medical ethics up to date with philosophical discussion about the value of equal status by developing an equal status conception of dignity.


Barclay L. Dignitarian medical ethics. Journal of Medical Ethics Published Online First: 13 October 2017. doi: 10.1136/medethics-2017-104467

Health professionals’ pledge rejects any form of participation in or condoning torture

Sean Murphy*

Physicians for Human Rights is sponsoring a Health Professionals’ Pledge Against Torture that includes statements that signatories will never “participate or condone” torture and support colleagues who “resist orders to torture or inflict harm.”  It also commits signatories to insist that their professional associations support those facing pressure “to participate or condone torture and ill-treatment.”

What is noteworthy is that the pledge is not limited to simply refusing to torture someone, but is a pledge against participation (which would include forms of facilitation like referral) and against condoning the practice.

Replace “torture” with commonly morally contested procedures and it becomes obvious that the ethical position taken by Physicians for Human Rights vis-à-vis torture is identical to the position of many health care professionals who object to practices like euthanasia or abortion for reasons of conscience.

Conscientious objection: Can a hospital refuse to provide treatment?

Baylor College of Medicine

Claire Horner

Canada recently legalized medical assistance in dying (MAiD), which allows patients to receive a lethal drug that they can self-administer, or be administered a lethal drug by an authorized clinician with consent of the patient. As provinces and territories work to create and clarify legal guidelines for providing MAiD, many Catholic hospitals have refused to offer it, citing opposition to physician-assisted suicide and euthanasia in Catholic moral teaching.

This controversy surrounding institutional conscience-based refusals raises an important question: Should a health care institution have the right to refuse to provide a particular treatment for conscience-based reasons? . . . [Full text]

Is Costa Rica at the Epicenter of a Global Black Market in Human Organs?

If the events are in fact true, there were many people turning a blind eye and/or being paid off to not say anything about what was happening in these medical centers for years.

The Costa Rica Star

Wendy Anders

With criminal proceedings underway on a human organ trafficking case involving the trial of four Costa Rican doctors and their alleged accomplices, many interesting details are coming to light.

Intersecting forces of greed, corruption and international black markets are being identified and dissected as evidence is presented in this first of a kind trial in Costa Rica. More details will be forthcoming as prosecutors weigh testimony by numerous individuals over the next two months. . .[Full text]