The Obama administration is preparing to roll back a rule that prevents discrimination against medical workers who refuse to take part in procedures, provide medication, or hand out information based on their moral or religious beliefs. As 80beats reported in December, the Bush administration pushed the rule through as one of its final policy initiatives. Seven states, including California, Illinois and Connecticut, and two family-planning groups have filed lawsuits challenging the Bush rule. They argue that it sacrifices the health of patients to the religious beliefs of medical providers [Los Angeles Times].
Pre-existing federal law protects doctors and nurses who decline to provide abortion services because of their ethical beliefs, and changing the so-called conscience rule would have no effect on that law. But an official from the Department of Health and Human Services says the Bush administration’s rule is too broad. “We’ve been concerned that the way the Bush rule is written it could make it harder for women to get the care they need. It is worded so vaguely that some have argued it could limit family planning counseling and even potentially blood transfusions and end-of-life care” [Washington Post], an unnamed department official said.
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The recent birth of octuplets in California has riveted the nation’s attention with the strange story of Nadya Suleman, who had six young children at home but went back to a fertility clinic for more. The 33-year-old Suleman says she used in vitro fertilization to have six embryos implanted, and that two of those embryos split into twins. But the incident has shone a bright light on the $1 billion fertility industry, and has many people wondering about the ethics of implanting so many embryos simultaneously. The California Medical Board says it is investigating the doctor who implanted Suleman…. The consequences could range from a reprimand to loss of medical license [CBS News].
The American Society for Reproductive Medicine adopted guidelines in 2008 encouraging the transfer of only one embryo for women under 35, and no more than two, except in extraordinary circumstances. The guidelines allow more for older women, up to a maximum of five. But unlike some other countries, the United States has no laws to enforce those guidelines [The New York Times]. Given the expense of each attempt at in vitro fertilization and the fact that not all implanted embryos develop successfully, many women prevail upon their doctors to implant multiple embryos–according to federal statistics, only 11 percent of in vitro procedures in the United States involve a solitary embryo.
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Health care workers who have a moral or religious objection to a medical procedure can’t be punished or discriminated against if they refuse to perform it, according to a sweeping new rule (pdf) announced by the Bush administration yesterday. The right-to-refuse rule includes abortion, but [the department of Health and Human Services] said it extends to other aspects of health care where moral concerns could arise, including birth control, emergency contraception, in vitro fertilization, stem cell research or assisted suicide. The rule will take effect the day before President George W. Bush leaves office [Baltimore Sun]. If a hospital, clinic, pharmacy, health plan, or any other medical establishment refuses to follow the new law it will forfeit all federal funding.
The rule has been eagerly anticipated by anti-abortion activists, but has raised furious objections from family planning groups and much of the medical establishment (groups such as the American Medical Association and the American Hospital Association opposed the regulation). Officials at hospitals and clinics predicted the regulation will cause widespread disruptions, forcing family planning centers and fertility clinics, for example, to hire employees even if they oppose abortions or in vitro fertilization procedures that can destroy embryos. “It is going to cause chaos among providers across the country,” said Cecile Richards of the Planned Parenthood Federation of America. The regulation could also make it difficult for states to enforce laws such as those requiring hospitals to offer rape victims the morning-after pill, experts said [Washington Post].
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With robotics companies already selling devices that allow us to outsource intimate tasks like caring for children and the elderly, a concerned researcher is advising society to grapple with the ethical implications of relying on robots for personal care now, before the consumer trend goes any further. In an essay in the journal Science [subscription required], robotics expert Noel Sharkey notes that an estimated 5.5 million professional and personal service robots (a category that doesn’t include industrial robots) were sold in 2008, and says sales are likely to reach 11.5 million by 2011.
Babysitting robots are already on the market: They make conversation, recognize faces and keep track of kids. They’re not a replacement for TV or games, but for personal care — and some researchers worry that kids will be harmed. “If you leave a small child in front of the TV, you have to keep popping in to make sure they’re OK. But these are so safe that people will eventually leave their children in the care of robots” [Wired News], says Sharkey. No one knows what the long-term effects might be of letting an isolated child depend on a robot for companionship and learning, he says.
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The first face transplant operation in the United States has been completed and initial results are positive, reports the medical team at the Cleveland Clinic. The patient, who had suffered severe facial disfigurement from trauma, had 80 percent of her face replaced with one taken from a cadaver, leaving only her own upper eyelids, forehead, lower lip, and chin. After the transplant, “I must tell you how happy she was when with both her hands she could go over her face and feel that she has a nose, feel that she has a jaw,” said the lead surgeon, Dr. Maria Siemionow [AP].
Although the woman’s identity and the nature of her trauma has not been revealed, doctors say her injuries were so severe that she lacked a nose and palate, and could not eat or breathe on her own without a special opening into her windpipe [AP]. The 22-hour-long surgery took place sometime in the last two weeks and is the most radical facial transplant ever attempted. Along with about 500 square centimeters of skin, the transplant also included bones, muscles, blood vessels, nerves, a nose, sinuses, the upper jaw, and even some teeth. The doctors hoped the operation would allow her to regain her sense of smell and ability to smile [AFP].
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The Vatican has issued new ethical guidelines in response to the biomedical advances of the last 20 years, and has come down hard on assisted reproduction technologies and genetic engineering. The document, Dignitas Personae (which translates as “human dignity”), reaffirm the church’s opposition to in vitro fertilization. It also tells Catholics that the church also doesn’t condone “adopting” leftover fertilized embryos from fertility clinics, and frowns upon the genetic testing of embryos before implantation, which could lead to the embryo being discarded. The Vatican says these techniques violate the principles that every human life — even an embryo — is sacred, and that babies should be conceived only through intercourse by a married couple [The New York Times].
These instructions stem from two fundamental theological principles: that life begins at conception and that the origin of human life is the “fruit of marriage.” … The document now makes clear that the morning-after pill, RU-486, and intrauterine devices (IUDs), which either intercept the embryo before implantation or eliminate it after implantation, “fall within the sin of abortion” [Scientific American]. The guidelines may come as a surprise to many Catholics who don’t realize that the church takes such a strict stance on medical technologies like in vitro fertilization that are often seen as routine and beneficial.
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If you could take a pill to boost your concentration and mental stamina, would you do it? Around the country, thousands of college students are already answering “yes” to that question and are using prescription medications like Ritalin as study aids, and researchers say the demand for such “smart pills” is likely to grow. Now, in a new essay, a group of neuroscientists and bioethicists is arguing that society shouldn’t frown on such practices; instead the authors assert that “we should welcome new methods of improving our brain function,” and that doing it with pills is no more morally objectionable than eating right or getting a good night’s sleep [Chronicle of Higher Education].
Stimulants like Ritalin and Adderall are prescribed for attention deficit hyperactivity disorder and are commonly used by people without a prescription to help them focus their attention, while a narcolepsy drug called Provigil is sometimes used by people trying to keep their brains alert and awake. The new essay cited a recent survey that found nearly 7 percent of students in U.S. universities have used prescription stimulants, and on some campuses, as many as a quarter of students have used the drugs for non-therapeutic purposes. “It’s a felony, but it’s being done,” [coauthor Martha] Farah said [Reuters].
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Even after people struggling with infertility have found a happy ending with in vitro fertilization, another complicated dilemma remains: what to do with extra fertilized embryos created during treatment. A new study found that more than 400,000 of these embryos are currently chilling in the freezers of fertility clinics around the country; while some of those are being stored for women who want more children, many others are being kept on ice because women have qualms about disposing of them. And while some women are willing to donate their embryos to research, that option frequently isn’t offered.
Ethical and personal considerations have led some people to a stalemate. For nearly 15 years, Kim and Walt Best have been paying about $200 a year to keep nine embryos stored in a freezer at a fertility clinic at Duke University — embryos that they no longer need, because they are finished having children but that Ms. Best cannot bear to destroy, donate for research or give away to another couple…. “There is no easy answer,” said Ms. Best, a nurse. “I can’t look at my twins and not wonder sometimes what the other nine would be like” [The New York Times].
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In a landmark court case, a European court has ruled that law enforcement agencies can’t keep DNA samples from people who have never been convicted of a crime. In the unanimous judgment, the European Court of Human Rights ruled that keeping the samples was in violation of people’s right to a private life, a protection under the Human Rights Convention [AP].
Its decision, which is binding on all 46 members of the Council of Europe, will have an immediate impact on around 850,000 innocent people whose genetic profiles are stored on the police DNA database in England and Wales [The Economist]. In those parts of the United Kingdom, the police collect a DNA sample from anyone arrested on a “recordable” offense, a category that includes everything from murder to “fraudulently evading bingo duty.” That sample is stored for the rest of the person’s life, even if they’re never convicted of the crime they were arrested for. If the U.K. doesn’t appeal the new ruling, the English and Welsh police will have to immediately destroy the genetic profiles of everyone without a criminal record.
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Clinics around the world are offering unproven stem cell treatments to desperate patients with diseases like Parkinson’s and multiple sclerosis, a new report says, and consumers should be on the lookout for snake oil salesmen. A new set of guidelines issued by the International Society for Stem Cell Research (ISSCR) gives consumers some hints on how to identify the scammers: Beware, it warns, of clinics claiming to treat multiple diseases with the same cells, boasting that there is no risk, and offering patient testimonials – rather than results from clinical research – as evidence that their treatment works. “Patients want to believe so much that a treatment is helping them that they can convince themselves that is has” [New Scientist], the guidelines caution.
In an accompanying study in the journal Cell Stem Cell, researchers examined the direct-to-consumer advertising that shady clinics use to attract customers. They looked at 19 Web sites that advertised stem cell treatments in several countries, including China, Mexico, and Russia, suggesting that stem cell clinics are becoming a lucrative part of the “medical tourism” industry. Researchers wrote: “The average cost of a course of therapy among the four websites that mentioned costs was $21,500, excluding travel and accommodation for patients and care givers. And examples of serious treatment side effects can be found” [Reuters] for the types of treatments being advertised.
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A controversial proposal to switch the U.K.’s current system of voluntary organ donation to a system of “presumed consent” was rejected by the UK Organ Donation Taskforce, which said the change would not increase organ donations and could damage patient-doctor as well as donor-recipient relations. Presumed consent would designate everyone as an organ donor unless the individual or the family of the deceased opted out; the current system is just the opposite, harvesting organs only from people who opt in to organ donation.
The task force advised against the switch supported by Prime Minister Gordon Brown, the British Medical Association (BMA), and several physician groups. Nevertheless, Brown continues to support a presumed consent system. “While they are not recommending the introduction of a presumed consent system, as I have done, I am not ruling out a further change in the law,” he said [The Guardian].
The U.K. has one of Europe’s lowest rates of organ donation. Of an estimated 8,000 people on waiting lists for organ transplants, only about 3,000 receive transplants every year, and 1,000 die while waiting for a transplant. Vivienne Nathanson, the BMA’s Head of Science and Ethics, said presumed consent was not a panacea, but was likely to result in a 10 to 15 per cent increase in donated organs, if sufficient surgeons, intensive care beds and transplant coordinators were put in place. She said it would also encourage families to discuss their views, and make their wishes clear before death: “We know that the majority of the population want to be organ donors, but only 25 per cent are on the register” [Times Online].
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About half of surveyed U.S. doctors say they regularly prescribe placebos without their patients knowledge, and most admit to no qualms about handing out vitamins, aspirin, and other benign pills that have little relevance to the symptoms their patients complain of, according to a new study. Several medical ethicists say they’re troubled by the results, including study coauthor Franklin Miller: “This is the doctor-patient relationship, and our expectations about being truthful about what’s going on and about getting informed consent should give us pause about deception” [The New York Times].
Study coauthor John Tilburt says these findings are a reflection of the modern mentality that for every symptom you may experience, there’s a pill to make it all better…. “Doctors feel pressured to prescribe something in order to show the patient that they are taking their symptoms seriously and trying to do something about it, so they try to find creative ways to make patients feel better, and will use any tool available, including psychological benefits” [ABC News].
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In a controversial new procedure, doctors removed the hearts from three severely brain damaged infants soon after the babies were removed from life support and transplanted the organs to three other infants, where the hearts were restarted. The news is raising complicated questions about when a patient can be declared dead, and whether doctors are pushing an already controversial organ-retrieval strategy beyond acceptable legal, moral and ethical bounds [The Washington Post].
The hearts of the three donor babies stopped beating soon after their ventilators were removed. In the first case, the Denver team waited three minutes after what appeared to be the last heartbeat. But because there has never been a case where the heart restarted itself after 60 seconds, they waited only 75 seconds for their next two cases [Reuters]. All three babies who received new hearts would have died without the transplants; six months after the operations, all three were doing fine. Doctors believe the swift organ removals from the donor babies increased the odds of survival for the recipient babies.
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Several medical research institutions are reconsidering the use of five stem cell lines that are approved for federal-funded research by the National Institutes of Health, citing recently discovered problems with the consent forms signed by the patients at fertility clinics who donated their extra embryos to medical research. Now, ethics oversight committees at universities across the United States are questioning which lines should be permissible for research [Nature News].
Stanford and San Francisco-based [California Institute for Regenerative Medicine] — the $3 billion state agency created when California voters approved the sale of bonds to fund embryonic stem cell research — along with Johns Hopkins University have stopped or may stop research on five of the 21 lines that President Bush in August 2001 deemed acceptable for federal funding [San Jose Business Journal]. Researchers had already chafed at the narrow range of genetic diversity available from the 21 lines; this new development is likely to further limit their research options.
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