Insurers, you go first

You did know that due to the Social Security Act and the Patriot Act your medical records can be viewed and copied by anyone who claims to be an agent of the Secretary of Health and Human Services, didn't you? Or that those same agents write their own subpoenas? (The best reference is this ACLU webpage, although most of the regulations were there in a weaker form before the Patriot Act.)

Health insurers - the American Health Insurance Plan group and Blue Cross/Blue Shield - said that they would begin covering everyone regardless of pre-existing conditions if the government will mandate the purchase of their products and subsidize Medicaid and SCHIP. And so grows the government ownership of health care.

From what I've seen of mandatory auto insurance, prices don't go down when the government forces everyone to buy a certain product. I don't believe in government mandates as a rule and haven't been favorably impressed with the way government interference in health care, with the creation of HMO's, ERISSA, and the invasion that has resulted in our current draconian Medicare rules and regulations.

Not to mention $2 Billion dollar stock option bonuses and $125 Million dollar salaries, such as those given to William McGuire by United Health Care in the past and the $13 million to $15 million salary of his successor in 2006 and 2007. (For a look at the compensation of the big companies, click on the names of companies at this page.)

I do believe that insurers abuse their ability to refuse or limit coverage and increase fees due to prior conditions. The industry should be able to evaluate the effect of removal of pre-existing conditions by looking at the history of the insured in States like Texas, which do not allow such limitations for most people covered by employers' health insurance. Let us see those numbers and facts and demonstrate your trustworthiness before we even consider using government laws to increase your customer base.

From the press release of the American Health Insurance Plan group:

Health plans today proposed guaranteed coverage for people with pre-existing medical conditions in conjunction with an enforceable individual coverage mandate.

Under the new proposal, health plans participating in the individual health insurance market would be required to offer coverage to all applicants as part of a universal participation plan in which all individuals were required to maintain health insurance.

Health plans also said that premium support for moderate-income individuals and broad spreading of risk was necessary to promote affordability and maintain premium stability in the individual health insurance market.

To ensure that all Americans can access coverage, health plans also reiterated their long-standing support for making eligible for Medicaid every uninsured American living in poverty and strengthening the Children’s Health Insurance Program.

In the interest of showing good will, let the sellers go first.

I'd rather see a law allowing various levels of coverage, including support for Health Savings Accounts (rather than the ridiculous limits on numbers that we currently have) and encouraging more major medical and high deductible plans.

"A return to power"

That's the sub-heading from Science Magazine's "Obama takes the reigns." The story was yesterday's little "ScienceNOW" report on the (newly created) Office of the President Elect's selection of Mario Molina, who will be co-lead for the review of the White House Office of Science and Technology Policy. Molina has received the Nobel Prize for his discovery of the nature of the "hole" in the atmospheric ozone layer. He worked in the Clinton OSTP.

That's the sub-heading from Science Magazine's "Obama takes the reigns." The story was yesterday's little "ScienceNOW" report on the (newly created) Office of the President Elect's selection of Mario Molina, who will be co-lead for the "review" of the White House Office of Science and Technology Policy (OSTP) Molina received the Nobel Prize for Chemistry for his discovery of the effects of chlorofluorocarbon gases of the "hole" in the atmospheric ozone layer. He worked in the Clinton OSTP. You can watch him talk about global warming, here.

The (newly created) Office of the President Elect also announced that Robin Alta Charo would join the group "reviewing" the Department of Human Health and Services, especially the issues of bioethics, health care and science policy. Charo is a lawyer, one of the founding members of the Center for American Progress and their Bioethics Initiative (a pdf transcript) and Science Progress, formerly on the "medical advisory" boards of the Alan Guttmacher Institute and Planned Parenthood and on Clinton's National Bioethics Advisory Committee that made the recommendations on human cloning (continue with cloning for research, but have a 5 year moratorium on cloning for reproduction). She's notable for coining the term the "endarkenment" as description for President Bush's Bioethics Council (more, here) and for her comments that there shouldn't be any problem with abortion for sex selection and that cloning might prove that there isn't a God and we humans are just a step in evolution.

Many Adult Stem Cell Treatments in the News

This week, we've heard about a the new "bandages" for torn knee cartilages and hope for a collagen fibers made using nanotechnology.

Animal treatments for joint disease and injury are common in horses and the treatments for dogs are now being advertised by private veterinarians in Oklahoma.

The research is ongoing in humans, too.

From the BBC, an article on the first organ regenerated from the patient's own stem cells and transplanted

Scientists in Spain have carried out the world's first tissue-engineered whole organ transplant - a windpipe - made with a patient's own stem cells.

The groundbreaking technology also means for the first time tissue transplants can be carried out without the need for anti-rejection drugs.

Five months on the patient is in perfect health, The Lancet reports.

Osiris, a company that has been developing treatments developed from adult stem cells, announced earlier this month that it is making a profit and that the rights to sell 2 treatments:

Prochymal is being evaluated in Phase III clinical trials for three indications, including acute and steroid refractory Graft versus Host Disease and also Crohn's disease, and is the only stem cell therapeutic currently designated by FDA as both an Orphan Drug and Fast Track product. Osiris also has partnered with Genzyme Corporation to develop Prochymal as a medical countermeasure to nuclear terrorism and other radiological emergencies. Furthermore, Prochymal is being developed for the repair of heart tissue following a heart attack, the protection of pancreatic islet cells in patients with type 1 diabetes, and the repair of lung tissue in patients with chronic obstructive pulmonary disease. The Company's pipeline of internally developed biologic drug candidates under evaluation also includes Chondrogen for arthritis in the knee.

(There's more on Osiris from the Washington Post, here.)


Way back in 2006, we heard about bladders grown for patients from adult stem cells and transplanted. The transplants were actually done in 1999 but the news came out about the time that Dr. Ayala was in the news for his work with Umbilical Cord stem cells.

The (manufactured) Stem Cell Debate at Dartmouth

I don't believe I've ever seen a report on a presentation that allowed half the space for "debate," after the fact.

The Stem Cell Debate at Dartmouth

Sunday, November 16, 2008

Father Tadeusz Pacholczyk, Ph.D. was recently invited to give a lecture entitled “Stem Cells and Cloning: Understanding the Scientific Issues and the Moral Objections” at Aquinas House, in observance of the Feast of St. Luke, the patron saint of medical professionals. Pacholczyk, or Father Tad as he encourages his audience members to call him, is the Director of Education for the National Catholic Bioethics Center. He arrived at this position after receiving degrees in philosophy, biochemistry, molecular cell biology, and chemistry, a Ph.D. in Neuroscience from Yale University, and years of research in molecular biology, bioethics, and dogmatic theology. In a free public lecture lasting more than two hours, Pacholczyk outlined both the scientific and ethical considerations of human embryonic stem cell research and to a lesser extent cloning, giving justifications for the Catholic Church’s positions on these technologies.

After giving an in depth layman’s version of the science involved in stem cell research and a history of both scientific milestones and relevant policy decisions, Pacholczyk corrected what he believed were some of the most pervasive myths about stem cell research. He believes that individuals and organizations within the media and others who engage in expensive advertising campaigns have deliberately misled the American people in an effort to reframe the debate over the use of human embryos for research.

**************
The Dartmouth Review understands that this is an issue on which reasonable moral people can disagree, and so Michael S. Gazzaniga ‘61, Ph.D., Director of the Sage Center for the Study of Mind at the University of California, Santa Barbara was asked to explain some of the ethical justifications. He indicated that, “The handling of human tissue has always commanded the respect of the biomedical community and always will.” However, Gazzaniga does not consider an embryo to be in possession of the same moral status as an adult human, while acknowledging that the issue has “deep meaning to millions of people.”

The Review has raised several ethics questions regarding the virtual debate they created by interviewing Dr. Gazzaniga after Dr. Pacholczyk's talk.

Will they seek out opposing views in the future or is it only Catholic priests who require such answers? Will they now give Dr. Pacholczyk an opportunity to respond?

In addition, Dr. Gazzaniga finds the determination as to when a human being becomes a human being fairly simplistic:

Asked the basic question underlying this debate and that about abortion, when a human embryo becomes a human being, Gazzaniga called it a “social decision, not unlike the kind a society makes about when to call someone legally blind.”

Does Dr. Gazzaniga's emphasis on contrasting "adult" human beings with embryonic human beings indicate that he finds differing moral values in the lives of infants, children, and "adults," does he extend these differences to the state of function of the brain, and can he justify these variations at least as well as we can our culture's definition of "legally blind?"

More on the Obama Transition Team

Many of the coordinators of the Agency Review Teams and the Working group members have already been reviewed by Daily KOS-er "joehoevah," here. This is not my usual referral, and he doesn't look for the connection to Podesta, but I couldn't demonstrate the left-leaning nature of this team nearly as well. (Let me know if the page disappears, I've archived the information.)

I use the political terms because of the need for balance in the appointments to medical, scientific and bioethics jobs and advisory committees. When all of the OTT have worked for "progressives" and such pro-abortion men as Daschle, Gebhardt, Waxman, and/or are credited with claiming that Senator McCain cannot send an e-mail (Pfeiffer), their politics are more than relevant.


There are several famous (on Google) Lisa Browns, including a State Senator from Washington and an actress. This one is a former Clinton Staffer who's spent the last few years at the American Constitution Society for Law and Policy, teaching lawyers and law students to oppose "an activist conservative legal movement [which] has gained influence - eroding these enduring values and presenting the law as a series of sterile abstractions. This new orthodoxy, which threatens to dominate our courts and our laws, does a grave injustice to the American vision."


Here's Lisa Brown on a youtube video, introducing a briefing by the American Constitution Society on the 2nd Amendment.

And from the 2nd page of my "progressive" Google search:

"The American Constitution Society for Law and Policy is one of the nation's leading progressive legal organizations. Founded in 2001, ACS is composed of law students, lawyers, scholars, judges, policymakers, activists and other concerned individuals who are working to ensure that the fundamental principles of human dignity, individual rights and liberties, genuine equality and access to justice are in their rightful, central place in American law.

"This conference provides an extraordinary opportunity to engage and energize members of the moderate and progressive legal community as we begin a concerted effort to reclaim the Constitution and ensure that our laws and public policy reflect our nation's founding values," said ACS Executive Director Lisa Brown."

Science in Obama's Administration

After lots of 'Net speculation on science and medicine advisory councils and committees in addition to mine of this morning, we find out that the Obama leader for the transition team on the President's Council on Bioethics Review Team will be Jonathan Moreno the associate at the bioethics arms of the Center for American Progress, founded by co-chair of the Obama "office of the President-Elect" transitionist John Podesta.

And Moreno and Podesta are not the only "Progressives" on the transition team. Note the names Tom Perez (that's a Word document), Anthony Brown, Pam Gilbert ( a .pdf from the Center for American Progress online book, "Change for America"), Nicole Lurie, (former Clinton HUD appointee, lesbian rights attorney and San Francisco Supervisor) Roberta Achtenberg, Bruce Katz, Jim Roosevelt.

And that's just one sub-committee and only the top lines of the result of their Google searches.

Among the chatterers are the authors of Science Progress, an online newsletter and blog (with a biannual print edition) for the Center for American Progress. Jonathan Moreno is the Editor - - which is not mentioned at all in the Moreno biography linked above - - and all the usual suspects are on the advisory board. If you like the "match game" we used to play as kids, compare the names on Science Progress' advisory board with the Clinton National Bioethics Advisory Commission.

Those virtual pages contain advice from Moreno, Weiss, and Bernard Lo on what sort of scientists ought to be appointed by President-elect Obama and his minions and to which offices.

While Moreno advocates for the return of the science adviser to Presidential Cabinet meetings, Lo wants a National Bioethics Advisory Commission (the name that the Clinton appointed group used in the '90's) that not only will advise the President and the Administration by answering their specific questions, he wants the new NBAC to act:

"the Council should be addressing the nation. The Council should reach out to the American people, for example, by inviting testimony from community organizations and patient and public advocacy groups, soliciting public comments on draft proposals, and responding to criticisms by explaining the reasons why suggestions were not accepted. Further, a new council could approach communication with the public as a two-way street. Rick Borchelt and Kathy Hudson have argued here on Science Progress, “the end game of public engagement should be empowerment: creating a real and meaningful mechanism for public input to be heard far enough upstream in science and technology policymaking and program development to influence decisions.”"

Professor Lo is the co-author of one of the popular textbooks on Bioethics, Resolving Ethical Dilemmas. (Although not pro-life or based on a Christian worldview, the principles in use for clinical ethics are covered fairly well. In fact, it was the text assigned in my clinical ethics class at Trinity International University, as part of the Bioethics Masters Degree program.)

I don't believe that Professor Lo actually wishes to have a trickle up scientific policy from the citizens to direct science and ethics or public policy about either. Science cannot give empirical evidence, conduct controlled experiments or make an argument for one or the other approach to determining public policy. However, I believe that Lo, along with so many of the progressives, prefer to have scientists and academics decide science policy for the public and government, and to have carte blanche, without regard to the pro-life, religious or cultural beliefs of others. And that, in my opinion, is just as influential as money and careers in the opposition to the Bush science policy and bioethics appointees.

Science Magazine contains at least one more comment on the upcoming Obama administration appointees (Subscription only, I'm afraid.)

Gregory A. Good's review of Zuoyue Wang's book, In Sputnik's Shadow, completely ignores the inclusion of many men and women who belie his description of the President Bush as only appointing "advisers who told [President Bush] what he wanted to hear." He should at least be aware of examples such as the service of Michael Gazzaniga on the President's Council on Bioethics, Paul Wolpe as NASA's ethicist, even Jonathan Moreno as an adviser for the Department of Health and Human Services during the Bush Administration.

Of course, most of the discussion is about representation and money for research. However, if you enjoyed the match game above, take a look at the actual "incumbents" who are paid governmental appointees under President Bush, available in an online book available for free, here. There's more information here on jobs and volunteer science and technology advisory committees. Compare those names and backgrounds to the authors of a similar report from 2005, here. Now, take a look at the names on the advisory boards of Science Progress, Nature, Science Magazine, and (again, of course) the American Journal of Bioethics and at the people featured on the "Science Debate 2008" webpage videos.


Where does the balance fall between the right and the left, between the pro-life and the pro-choice?

(As one of the thousands of appointees by the Bush Administration, I am deeply offended that Good would imply that anyone who served did not do so with "the best interests of the country at heart." Is this projection on his part? Good will soon leave the History Department of West Virginia University for the American Institute of Physics - a society of societies that must have too much money to come begging to the government if they have a budget for a Center for the History of Physics, but you can e-mail him at greg.good@mail.wvu.edu through the end of the year.)

Science: "A call to serve"

Some of you may know that I served on the National Advisory Committee on Violence Against Women from 2002 through the end of 2005. Attorneys General Ashcroft and Gonzales and Secretaries of Health Thompson and Leavitt were co-chairmen during their terms. They and the Office on Violence Against Women were more interested in protecting the citizens of the US than in furthering strict Party discipline and appointed many members who were advocates for victims of abuse, but not necessarily "pro-life". Or even Republican.

This was the policy of the Bush Administration. I'll admit to a few rants about this policy, especially when the media and academia were claiming just the opposite. (If they're going to hate us anyway . . .)

However, for all of the criticism against it, the President's Council on Bioethics was not partisan or one sided. 7 of the original members favored expansion of funding for embryonic stem cell research and not all were pro-life. In contrast, Clinton's National Bioethics Advisory Commission did not have any members that I (or others)can identify as prolife.

We must demand that *our* new President and his Administration maintain balanced citizen representation. And we must, as this opinion piece notes, answer the call to service.

Every pro-life man and woman should volunteer for a position in their State or on one of the National advisory committees. We should demand representation of our views through the coming years. Here is the current page for application to Executive Branch nominations. However, the best thing would be to start with a letter to your Congressional Representative's office or one of your Senators and others to any sort of association or organization that you work with, outlining your interests.

If we don't, who will?

From this week's Science Magazine:

Once Barack Obama becomes the 44th president of the United States in January 2009, he will, sooner or later, appoint individuals to science and technology policy positions within the executive branch of government. It seems as though every science- and engineering-related think tank either has published, or shortly will, a report calling on the new administration to appoint these people quickly and give them the authority and tools to do their job.

But it is not just an administration choice; qualified scientists and engineers need to be willing to take those jobs. The quality of the decisions and actions of an administration directly depends on the quality of those appointees and others who serve. Our premise is that every engineer and every scientist ought to include service to their country in their career plan.

Too often we have heard "I am too busy," or "my research is my service to the country," or various disparaging remarks about government bureaucrats and not wanting to be associated with them. There are several reasons why technically literate people should serve. First, they are needed. The world is more technologically sophisticated than it has ever been, and today most public policy issues have technical dimensions. Without sound technical input, some bad public policy will result. Without unrelenting oversight by individuals with technical expertise to ensure sound implementation, foolish actions will be taken.

The U.S. population broadly supports the nation's research and, frankly, in return the research community owes it to society to ensure that the best possible policy decisions are made. And there is a self-interest factor. This community believes that increased support for research would benefit the nation in the long term, but that case needs to be made from within the government as well as from the outside. The same argument is valid for other nations as well. Lastly, government service can be intellectually interesting. Executive agencies have resources to deal with problems. The challenge is to address them creatively and effectively.

Scientists and engineers think about problems differently. For example, lawyers, who disproportionately populate government positions, are trained to marshal an argument to support a predetermined conclusion (e.g., the client is innocent). In contrast, scientists and engineers are taught to analyze and design so that the outcome is not predetermined but is derived from the constraints of the problem. They collect relevant information, and only solutions that fit the data are acceptable. Scientists and engineers also think in terms of the total problem—for today and for tomorrow. An engineer will design a bridge to be taken down cost-effectively at the end of its life. This culture of thought and analytic tools and decision-making methods needs to have a stronger influence in decisions made about issues that at their root involve science or technology.

So how might one try out such service? One approach is to volunteer to advise some element of the government. Once a person is seen to contribute, they are increasingly called on to advise at higher levels. This can lead to appointment to more senior advisory bodies. Alternatively, an individual can apply to be a program officer in a federal or state government agency. Universities routinely grant leaves of absence for such service. Although one does not begin as the head of an agency, these program officer positions wield considerable resources and can materially address important challenges.

We believe that the scientists and engineers of all countries need to step up. Every one has a contribution to make. Shouting from the sidelines does not work. And if the technical community does not engage, we will get what we deserve.

10.1126/science.1167218

Clarification on Brain Death

The news reports about the Pope's recent cautionary remarks on the determination of death include quotes from a Vatican newspaper describing false assumptions about the use of brain death as the definition of death.

The whole brain criteria for brain death is not based on the cessation of function of the brain. Instead, it is based on our knowledge that when the upper and lower brain have died, degeneration of the body will always follow, at least with current medical technology. The cascade of lower brain death always leads to failure of cardiac and respiratory function without medical intervention. We are able to maintain the heart beat and artificially inflate the lungs for longer and longer periods each year, thanks in part to better and better medications to support blood pressure and kidney function. However, with the serial verification of lower brain death, there has never been renewed function of the brain stem. Brain cells die in 6-7 minutes after being denied blood flow. The rest of the body's cells will die when the brain does not drive the respiratory reflex or send the nerve signal to the heart to beat.

(In the case that we do hear of a man who came back to life after being declared brain dead, it does not appear that the first test was repeated.

The Pope's remarks were given at a conference on organ donation, held at the Vatican by the Pontifical Academy for Life, the International Federation of Catholic Medical Associations, and the Italian National Transplant Center.

Tenth of California votes still not counted

California mail in votes and provisional votes are still being counted. As of Tuesday, November 11, The counted votes number just over 11 Million.

2.1 million votes are still uncounted, 1.1 million of which are mail-in votes.

The votes cannot make a difference in the Presidential race, since Obama is already more than 2.1 million votes ahead of McCain. However, both Proposition 4 (on requiring parental notification of a minor's abortion) and Proposition 8 (State Constitutional amendment defining marriage as one man and one woman) differ by only about 500,000 votes and the outcome could be changed by the mail-in ballots, alone.

The Secretary of State's information on unprocessed ballots is available, here. The daily breakdown of unprocessed votes in a .pdf report is here and this page also shows which counties' reports are final and which are partial.

Current counts, with links to interactive maps are here.

Another end of life dispute (Motl Brody)

Doctors at a hospital in the District of Columbia have determined that a 12 year old boy, Motl Brody, has no upper or lower brain activity. He was declared dead by legal criteria November 4. Here's the Washington Post article on the case.

By legal and medical criteria, the boy died last week.

The dilemma is that he was placed on a ventilator and receiving drugs to stimulate his heart beat before the determination that he met the criteria for legal death in the District. His parents are Hasidic, Orthodox Jews and have legally objected to turning off the ventilator or stopping the medications, saying that their religion does not recognize anything other than cessation of breathing as "death." The case is now in court.

Perhaps the parents would consider discontinuing the addition of new doses of medications when the current ones run out? In this way, there is no intentional act of stopping the heart, and there would be no intervention if the heart continued to beat.

One way to look at the case is that it's never ethical to force doctors to act against their medical judgment as to what is in the patient's best interest. However, this patient is now dead. What do we owe the parents of a dead child?

The child's doctors have said, '"Ethically, there is no appropriate treatment except removal of the ventilator and of the drugs."'

However, it is considered ethical to continue cardiopulmonary support in order to preserve organs for harvest and transport. So, the organ support itself is not unethical. Is support for the body ethical in order to meet the religious requirements of the deceased patient's family?

Finally, who is responsible for carrying out acts that the doctor believes is not in the medical best interest of the patient? And for how long?

Charo: No "Presidential sleight of hand" on stem cells

"The Wicker-Dickey Amendment cannot be changed by Presidential sleight of hand or wave of pen."

R. Alta Charo, World Stem Cell Summit, Madison Wisconsin, September, 2008 See video, at time marker 11:18/01:01:29.

John Podesta, the founder of the Center for American Progress and the leader of the transitional team for the newly invented "Office of the President Elect,"
told Chris Matthews of Fox News Sunday (transcript here) that Barack Obama intends to do what he can to change the US policy on "stem cells" by the use of the Presidential Executive Order (EO).

In light of current law (the Dickey Amendment) and regulations that seem to require legislation such as that vetoed by President Bush last year, some may join me in wondering how much the new President will actually be able to accomplish by the use of EO's.

In fact, according to one of the original members of the CAP's Progressive Bioethics initiative, R. Alta Charo, a lawyer with quite a bit of experience in this sort of law, it won't be as easy as Mr. Podesta said. Ms. Charo made the statement above as a keynote speaker for the program at that World Stem Cell Summit that I mentioned in September.

Videos of much of the program can be found here.

While searching for information on the current laws on embryonic stem cells, I found this blog, "World Stem Cell Summit 2008," . Blogger Kate Willet summarized the proceedings in an unofficial capacity. From the parts I've watched, her impressions on the program and speakers as it happened are fairly accurate.

The real-time video of R. Alta Charo's talk is here, and the paraphrased report is here.

California rejects parental notification for minors' abortions

California voters have voted against a State Constitutional amendment to require doctors to notify parents when minor girls obtain an abortion.

From the San Francisco Gate:

Proposition 4 would alter the state constitution to prohibit a minor from obtaining an abortion until 48 hours after her doctor notified her parent, legal guardian or, in certain cases, a substitute adult. An exception would be made for medical emergencies and also the minor would be permitted to seek an order in court waiving notification.

It appears that the vote was 52% against and 47% to 48% in favor.

More on the vote from KTLA TV news:

Proposition 4, known officially as the Waiting Period and Parental Notification before Termination of Minor's Pregnancy Amendment and unofficially as Sarah's Law.

The proposition would add a section to Article 1 of the California Constitution to require doctors to inform the parent of guardian of a minor 48 hours before providing an abortion.

This proposition is similar to California's Proposition 73 92005) and California Proposition 86 (2006) both of which were rejected by the majority of voters; however it introduces significant changes to allowed exceptions.

The way it is now:

A pregnant minor (an unmarried girl under 18 years old) can get an abortion in California without telling her parents.

Washington State passes assisted suicide law

Washington has joined Oregon in legalizing "physician assisted death." From the Wall Street Journal blog post on the initiative:

A state measure known as Initiative 1000 passed by a margin of 59% to 41%, making it legal for doctors to prescribe a lethal dose of medication for patients with less than six months to live.

As we reported last week, the law is packed with provisions intended to limit the practice. Patients must make two separate requests, orally and in writing, more than two weeks apart; must be of sound mind and not suffering from depression; and must have their request approved by two separate doctors. Doctors are not allowed to administer the lethal dose.

Backers of the bill, including national right-to-die organizations and a former Democratic governor who has Parkinson’s, raised $4.9 million to support it. Opponents, including several Catholic organizations, raised $1.6 million to fund their fight, the Seattle Times reports.

In Oregon, the only other state with a similar law, some 341 patients have committed physician-assisted suicide in the 11 years the law has been in effect, the New York Times reported last week.

Upside down ethics

That last post definitely points out the mess of current bioethics: Autonomy as the first principle, before the more traditional "Heal when possible, but first do no harm."

Is the purpose of medicine to give the patient what he or she wants, or is it to save lives and restore or maintain health?

As I've noted (see my profile statement at the right of this post), "bioethics" is not strictly medical ethics. In fact, it does entail science, research, public policy and politics and public funding as well as, and sometimes more than, the ethics of medicine. The problems of limited funds - or the act of providing and/or limiting funds - from government resources along with political and philosophical divisions in our United States debates drives those debates more than the traditional weighing of physical health and risks to life and health.

Questions I'm asking these days:

Why include "ethics" in "bioethics," at all? Why not just skip to public policy and public health?

What sort of person practices anything - or even lives - without "integrity," if the conscience is over-ruled by outside forces?

On Conscience: Philosophical, not Scientific or Medical Debate

Some of you may have already seen this transcript from the September '08 President's Bioethics Council meeting. Three physicians gave testimony on September 12th, including Dr. Farr Curlin, Dr. Howard Brody, and (from the American College of Obstetrics and Gynecology, although she says she's not there as an ACOG representative) Dr. Anne Drapkin Lyerly.

Council member Robert P. George has this to say about the debate (speaking specifically on conscience and the American College of Obstetrics and Gynecology's Ethics Statement on conscience and physicians, "The Limits of Conscientious Refusal in Reproductive Medicine," )

The first thing to notice about the ACOG Committee report is that it is an exercise in moral philosophy. It proposes a definition of conscience, something that cannot be supplied by science or medicine. It then proposes to instruct its readers on, "...the limits of conscientious refusals describing how claims of conscience should be weighed in the context of other values critical to the ethical provision of health care."

Again, knowledge of these limits and values, as well as knowledge of what should count as the ethical provision of health care, are not and cannot possibly be the product of scientific inquiry for medicine as such. The proposed instruction offered here by those responsible for the ACOG Committee report represents a philosophical and ethical opinion — their philosophical and ethical opinion.

The report goes on to, "outline options for public policy," and propose, "recommendations that maximize accommodation of the individual's religious and moral beliefs while avoiding imposition of these beliefs on others or interfering with the safe, timely, and financially feasible access to reproductive health care that all women deserve."

Yet again notice that every concept in play here — the punitive balancing, the judgment as to what constitutes an imposition of personal beliefs on others, the view of what constitutes health care or reproductive health care, the judgment about what is deserved is philosophical, not scientific or, strictly speaking, medical.

To the extent that they are medical judgments even loosely speaking they reflect a concept of medicine informed and structured, shaped by philosophical and ethical judgments. Those responsible for the report purport to be speaking as physicians and medical professionals.

The special authority the report is supposed to have derives from their standing and expertise as physicians and medical professionals, yet at every point that matters, the judgments offered reflect their philosophical, ethical, and political judgments, not any expertise they have by virtue of their training and experience in science and medicine.

At every key point in the report their judgments are contestable and contested. Indeed they are contested by the very people on who consciences they seek to impose, the people whom they would, if their report were adopted and made binding, force into line with their philosophical and ethical judgments or drive out of their fields of medical practice. And they are contested, of course, by many others. And in each of these contests a resolution one way or the other cannot be determined by scientific methods, rather the debate is philosophical, ethical, or political.

Lay aside for the moment the question of whose philosophical judgments are right and whose are wrong. My point so far has only been that the report is laced and dependent upon at every turn philosophical judgments. I've not offered a critique of those judgments, although anyone who cares to can find plenty of criticisms in my work of those judgments. But lay that aside for now.

The key thing to see is that the issues in dispute are philosophical and can only be resolved by philosophical reflection and debate. They cannot be resolved by science or methods of scientific inquiry. The committee report reflects and promotes a particular moral view and vision and understandings of health and medicine shaped in every contested dimension and in every dimension relevant to the report's subject matter, namely the limits of conscientious refusal, by that moral view and vision.

The report, in other words, in its driving assumptions, reasoning, and conclusions is not morally neutral. Its analysis and recommendations for action do not proceed from a basis of moral neutrality. It represents a partisan position among the family of possible positions debated or adopted by people of reason and goodwill in the medical profession and beyond. Indeed, for me, the partisanship of the report is its most striking feature.

Its greatest irony is the report's concern for physicians' allegedly imposing their beliefs on patients by, for example, declining to perform or refer for abortions — or at least declining to perform abortions or provide other services in emergency situations and certainly to refer for these procedures. The assumption here, of course, is the philosophical one that deliberate feticide is morally acceptable and even a woman's right.

But lay that aside for now. Of course, the physician or the pharmacist who declines to dispense coerces no one, though I think that Prof. Brody and I would have a debate about that.

Interesting that both Dr. Lyerly and Dr. Brody refuse to discuss the ACOG statement.

A compelling look at the problem of contrasting world views is posed by Dr. Gilbert Meilander:

. . . the fascinating question you raised under your slide on professional integrity about a professional elevating the — in this case the patient's needs above his own interests, and then you said does one's own interest include one's personal integrity. But then you confused — and I think that's — it's like, you know, "Should I be prepared to go to hell in order to help somebody," a question which theologians have actually discussed.

But you gave the, to me, puzzling example of physicians who should be willing to risk their own lives in an epidemic, for instance, to do it, and then you said, you know, if you'd risk your life, why wouldn't you risk your integrity.

But I thought the reason for a physician being willing to risk his life in an epidemic was precisely that he didn't think staying alive was the most important thing, that there was something else that was morally more compelling and obligatory even than preserving his existence. And that would have something to do with the personal integrity that you seem willing to think may be — one should be willing to set aside in embracing what one thinks is evil.

How can anyone live well without integrity? Or, from the Christian philosopher, Paul, "What shall it profit a man if he gains the whole world, but loses his soul?"

(Edited to add italics on that long quote.)

How not to promote organ donation

Julian Savulescu, the British ethicist who opined that religious doctors should shut up and perform, is back.

This time he's advocating the donation of organs from people who are not dead or dying, but who have "suffered such severe injury that they would be permanently unconscious, like Terry Schiavo, who would be allowed to die anyway by removal of their medical treatment."

Hat tip to BioEdge.com

American Society of Bioethics and Humanities Convention

I'm on my way to Cleveland, Ohio for "Future Tense," the Annual meeting of the American Society for Bioethics and Humanities.

Tonight, there's a pre-conference symposium focusing on the novel, House of God. The book written by Dr. Stephen Bergman was a rite of passage when I was pre-med. It's now 35 years old, and (although I didn't read it until the mid-'80's) I'm a bit older, myself. I'm about half-way through the re-reading, now.

The rest of the week, I'll be attending - and possible blogging on - "Welcome and Plenary Session How to Stay Human in Medicine: The House of God, Mount Misery, and the Spirit of the Place," "Building Better Humans," " Advancing the Debate on Futility to a New
Level: Ethical, Legal, and Clinical Implications," "Future Directions for Public Health Emergency Planning: Broader Moral Perspectives," and last, but not least, "Limiting Rights for the Public Good: Balancing Public Safety and Civil Liberty in Response toTerrorism, Epidemics, and National Security," with "Organizer," Paul Root Wolpe, PhD and Jonathan Moreno, PhD. The former has served as the ethicist for both NASA and Planned Parenthood, and the last is on staff at the Progressive bioethics arm of the "Center for American Progress."

For some reason, there always seem to be several very interesting sessions going on at the same time. For instance, Saturday morning, I have to choose between "Professionalism in Bioethics and Medicine" or "Role of Government in Public Health."

Wish me luck. The weather here in South Texas is in the 80's in the daytime, while in Cleveland, the highs will be in the 40's and the 50's. Before I knew Cleveland would have the heat wave, I bought gloves and dug out the scarves. Since I don't own a real coat - I'm claustrophobic more than I'm "cold-natured" and who needs a heavy coat in San Antonio, anyway? - I'll be the extra-bulky one in layers of red and black.

Discussion on Abortion in Australia

A med student's blog, "Degranulated" posts his thoughts about the presence of anti-abortion protesters outside and inside his medical school. It seems that the Australian medical community is in the midst of a debate like ours on conscience rights, with new laws that impose a duty to refer and /or perform abortions on physicians.

Public policy and medical ethics should be taught in medical schools. With every bit of the objectivity, pluralism, and inclusiveness that the most radical pro-abort demands from the rest of us.

(after the same old "men don't have the right to object to abortion")

Secondly, the opponents argue that the bill does not adequately deal with doctors whom object to abortion on moral grounds. In medical school, we are taught that the patient has a right to be made aware of all their options, and if a doctor is unwilling to refer a patient for a ToP, they should refer the patient to a doctor who is willing to explain all possible options. In this way, the patient's autonomy can be fully exercised. The opponents of this Bill appear to not currently do this. So, do they believe paternalism or patient autonomy, or even womens' rights? Hmph. Isn't it good to see how times have changed.

If times have changed, Dame Warnocke's call for the rest of us to kill ourselves and others in the face of dementia is the sign of those times.

Here's what I wrote in my comment:

I'm maternalistic, matronizing occasionally. And you sound/read as though you haven't had many conversations about the subject of abortion.

You should inform yourself, as the same rules apply to euthanasia, "assisted death," the death penalty, and our upcoming debates on genetic manipulation of future generations.

I'm sure that you understand the difference between the embryo or fetus and a body part or end stage cell line. There's no doubt that what we are discussing is a human being.

The nature of this individual human being is underscored by in vitro fertilization. Just as a neonate may be cared for by other people, that embryo in the lab can be nurtured by others and even adopted for implantation into a woman other than his or her biological oocyte- mother. What we do to that embryo affects the later toddler and adult, and even his or her own children.

Once the individual human being is acknowledged, we have to discuss whether or not to afford him or her the protection from intentional killing by others - what some call "personhood." This is the dangerous point of our conversation. How do we justify intentional, interventional and elective killing of that embryo or fetus in such a way that does not put other human beings that we acknowledge are "persons" at risk?

Autonomy should not be your first consideration in this deliberation. Instead non-maleficence, then beneficence and justice should be weighed with autonomy. Your own note about the decision to act or not act according to rules and laws by you future colleagues points out that these other values come into play when you are discussing the interaction of the mother, the unborn child, and the doctor and nurse, and the law.

George on "Obama and Infanticide"

"Obama chose to defend the widest possible scope for legal abortion by building a fence around it, even if that meant permitting a child who survives an abortion to be left to die without even being afforded basic comfort care."

Two of the greatest ethics minds today explain the controversy surrounding Senator Barack Obama's blatant misrepresentation of his pro-abortion and pro-infanticide legislative and public policy. Professor Robert B. George is joined by Yuval Levin at the Witherspoon Institute as he follows up on his earlier discussion about the por-abortion views of Democratic Presidential candidate, Barack Obama.

During the last Presidential Candidate debate, Obama stated,

''There was a bill that was put forward before the Illinois Senate that said you have to provide lifesaving treatment and that would have helped to undermine Roe v. Wade. The fact is that there was already a law on the books in Illinois that required providing lifesaving treatment, which is why not only myself but pro-choice Republicans and Democrats voted against it.''

George and Levin respond:

A few years ago, after it became clear that some infants who were born alive in the course of an attempted induced abortion at Christ Hospital in Chicago and elsewhere were being left to die without even comfort care, Republicans and Democrats around the country united in an effort to make the practice illegal and declare that any child outside the womb, even if she was an abortion survivor whose prospects for long-term survival might be in doubt, was entitled to basic medical care. Even the most ardent advocates of the pro-choice position agreed that a child born alive, even after an attempted abortion, deserves humane treatment.

The tragic stories of infants being left to die moved legislators to act at both the state and federal levels. In Washington, D.C., consensus can be a rare commodity, and never more so than on the issue of abortion. But the Born-Alive Infant Protection Act of 2002 was just such a rarity. The bill passed both houses of Congress without a single dissenting vote-it was 98-0 in the Senate-and numerous states then proceeded to enact similar measures. In Illinois, however, a series of efforts to pass ''Born-Alive'' legislation from 2001 to 2003 met with stiff resistance from legislators concerned the measure would constrain the right to abortion in the state. Prominent among these opponents, and the only one to actually speak in opposition to the bill when it was debated in 2002, was state Senator Barack Obama.

Obama's case against the bill did not revolve around existing state law, as he seemed to suggest last night. The law Obama referred to in the debate was the Illinois abortion statute enacted in 1975. But at the time of the debate about the Born Alive Act, the Illinois Attorney General had publicly stated that he could not prosecute incidents such as those reported by nurses at Christ Hospital in Chicago and elsewhere (including a baby left to die in a soiled linen closet) because the 1975 law was inadequate.

"The motivation is abortion"

“The motivation is abortion,” says R. Alta Charo, a professor of law and bioethics at the University of Wisconsin at Madison. “If the Supreme Court allows states to declare embryos as personhood, you would be in a position to say immediately that all abortions have to stop.”

LifeEthics covered this story a few days ago, but this quote deserves a second look - and repeating for the record.

The comment by (Robin) Alta Charo in the LA Times explains the opposition of "Resolve," the National Infertility Association, to Colorado's proposed State Constitutional Amendment 48. That Amendment reads,

“The term ‘person’ or ‘persons’ shall include any human from the time of fertilization.”

Here's an article on a rally in Colorado opposing the Amendment, led by Resolve.

The "foes" of the amendment are claiming that it would criminalize "several forms of contraception" and in vitro fertilization. However, I believe that IVF could be carried out in a manner that respects each individual begun that way, if each is treated as a human being deserving of life.

Surfing is brain exercise (buy your parents a computer)

Surfing the Internet stimulates middle-aged and elderly brains more than reading a book. In fact, the more you surf, the more stimulation of blood flow to the brain.

At left, a functional Magnetic Resonance Image (fMRI) of the brain while reading a book and at right, the brain while surfing the web. The red areas indicate increased blood flow.


From the press release at UCLA :

For the study, the UCLA team worked with 24 neurologically normal research volunteers between the ages of 55 and 76. Half of the study participants had experience searching the Internet, while the other half had no experience. Age, educational level and gender were similar between the two groups.

Study participants performed Web searches and book-reading tasks while undergoing functional magnetic resonance imaging (fMRI) scans, which recorded the subtle brain-circuitry changes experienced during these activities. This type of scan tracks the intensity of cell responses in the brain by measuring the level of cerebral blood flow during cognitive tasks.

All study participants showed significant brain activity during the book-reading task, demonstrating use of the regions controlling language, reading, memory and visual abilities, which are located in the temporal, parietal, occipital and other areas of the brain.

Internet searches revealed a major difference between the two groups. While all participants demonstrated the same brain activity that was seen during the book-reading task, the Web-savvy group also registered activity in the frontal, temporal and cingulate areas of the brain, which control decision-making and complex reasoning.

"Our most striking finding was that Internet searching appears to engage a greater extent of neural circuitry that is not activated during reading — but only in those with prior Internet experience," said Small, who is also the director of UCLA's Memory and Aging Research Center.

In fact, researchers found that during Web searching, volunteers with prior experience registered a twofold increase in brain activation when compared with those with little Internet experience.

The research is to be published in the American Journal of Geriatric Psychiatry. Additional coverage at the BBC and the UK's Daily Mail. Thanks to blog.bioethics.net for first alerting me to this study.

(Edited at 6 AM for citations and to add image.)

Robert P. George on "Obama's Abortion Extremism"

Professor Robert B. George has published a review of Democratic Presidential Candidate Barack Obama's abortion views and advocacy.

The information on the Freedom of Choice Act goes beyond politics to the heart of all pro-life advocacy and would more than likely offend even abortion "moderates."

But this barely scratches the surface of Obama's extremism. He has promised that ''the first thing I'd do as President is sign the Freedom of Choice Act'' (known as FOCA). This proposed legislation would create a federally guaranteed ''fundamental right'' to abortion through all nine months of pregnancy, including, as Cardinal Justin Rigali of Philadelphia has noted in a statement condemning the proposed Act, ''a right to abort a fully developed child in the final weeks for undefined 'health' reasons.'' In essence, FOCA would abolish virtually every existing state and federal limitation on abortion, including parental consent and notification laws for minors, state and federal funding restrictions on abortion, and conscience protections for pro-life citizens working in the health-care industry-protections against being forced to participate in the practice of abortion or else lose their jobs. The pro-abortion National Organization for Women has proclaimed with approval that FOCA would ''sweep away hundreds of anti-abortion laws [and] policies.''