Ethics of Sun and Sand

I will be slow posting and answering comments for the next week as I'm embarking on a personal study of the effects of "sand gravity" and sun in the Carribean. I'll have spotty access, at best.

Please stand by . . .

Austin, TX woman receives ethical stem cells

An Austin woman is the first patient in the town to receive her own bone marrow stem cells to speed spinal fusion or regrowth after surgery. Lottrell Davis is the beneficiary of a technology that allows rapid processing and concentration of the bone marrow so that the procedure can be done during one surgical procedure.

The procedure is ethical because no one had to die for it. No one except the patient who stands (forgive the pun) to benefit greatly from the procedure undergoes any sort of risky procedure.

The Austin, Texas television news station, KXAN, website has a video interview (Windows Media Player required)with the Doctor, Dr. Scott Spann, and the news video itself as well as this text report (reproduced here because these news reports disappear after a few days):

Stem Cell Procedure Faster Now
May 18, 2006, 07:35 PM

A Central Texas woman has become Austin's first recipient of a stem cell implant. The procedure was performed at the new hospital at Westlake Medical Center.

Thanks to two Austin companies, what used to take months can now be done in just a few hours.

Lottrell Davis takes her first steps since undergoing innovative surgery on May 9 to alleviate her chronic back pain. While she grimaces in pain, she readily admits the discomfort resulting from her rehab is nothing compared to the back pain she's endured for the last decade.

"On a scale of one to 10, it was about a 15. Sometimes I would just sit on my bed and just cry because I couldn't do anything else with the pain," Davis said.

Over the last 10 years, Davis has had everything from routine back surgery to epidural steroid injections to spinal cord stimulators, which are supposed to trick the body into thinking it's not really experiencing as much pain.

The trick was on Davis because nothing worked. Then orthopedic spine surgeon Dr. Scott Spann told Davis about a procedure that uses stem cells from the patients own bone marrow to aid in spinal fusion.

"The stem cells don't make her lose the pain. The idea is they will enhance her body's ability to achieve the fusion," Spann said.

Thanks to two Austin companies, this procedure, which used to take months, can now be done in one operative session.

Spinesmith developed the special needle and other equipment that extracts or harvests the stem cells. Surgical Outcomes designed the centrifuge system which produces sort of the cream of the crop of the patient's stem cells.

Spann says the technology allows the body to jump-start its own bone healing process.

"We're just enhancing the body's natural biology," Spann said.

After her surgery, Davis has just one question.

"Now I wonder, why did I wait so long? The way I feel now, as opposed to how I was feeling before, I don't understand why I did wait for so long," Davis said.

Before this new Austin-developed technology, patients would have to go in, be put under and have bone marrow scraped from their legs. That was then sent to a lab where the stem cells were extracted. Then another operation was needed to insert the stem cells.

Now it's all done in just a few hours.

When people hear the words stem cells they may think this is a controversial procedure, but that's not the case here.

The controversy that arose a few years, and eventually went before the president, was over embryonic stem cells.

The stem cells used in this procedure are harvested from the patient's own body.

UCalIrvine, fertility clinic team for new Embryonic stem cells

University of California at Irvine is teaming with an Orange County fertility clinic to create new unethical, destructive embryonic stem cell lines from human embryos.

This is the same site that brought us the scandalous embryo switching in the mid-1990's. Are we supposed to believe that the informed consent and accounting will be any better this time around? Or any better than what we saw in South Korea? Especially since we know that destructive researchers are competing with those same fertility clinics for oocytes?

They're going to use both healthy and diseased embryos that are "left over" after their parents achieve their purpose of having one of the embryos grow to a baby in their previously empty arms. Those embryos will be grown for 5 days or so, and destroyed in order to obtain stem cell lines that the researchers say they plan to give away, "free of charge."

From the "Today@UCI":

Home > News > Press Releases & Media Advisories > Press Release

UCI scientists to generate new embryonic stem cell lines

Lines to be made available free-of-charge for research

Irvine, Calif., May 16, 2006

A research team led by UC Irvine neurobiologist Hans Keirstead will generate up to five new human embryonic stem cell lines to be used for research into treatments for spinal cord injury and diseases such as diabetes and Parkinson’s disease. The lines will be the first developed at UCI.

Keirstead, co-director of UCI’s Stem Cell Research Center, and Gabriel Nistor, a scientist in his laboratory, will derive the new lines from surplus embryos donated by couples undergoing fertility treatment at West Coast Fertility Centers in Orange County. Embryo donations will be made with the informed consent of donor couples and under a procedure approved by UCI’s Embryonic Stem Cell Research Oversight Committee. Once the lines have been created and tested in labs at UCI, Keirstead plans to make them available to researchers worldwide free of charge.

“Generating new stem cell lines is an essential next step in the progression of stem cell research toward the development of new research tools and treatments for human disease,” said Keirstead, associate professor of anatomy and neurobiology. “We are committed to making these lines available to the scientific community so that other researchers may join us in our pursuit of better therapies for devastating diseases.”

Keirstead will work with Dr. David Diaz, West Coast Fertility Centers’ medical director, to use novel techniques for developing the new lines, as well as freezing and preserving the lines after they have been created. The techniques for freezing and preserving lines were developed at the clinic for the preservation of embryos.

Stem cells are the “master” cells that give rise to each of the specialized cells within the human body. During organ and tissue development, these cells transform into a particular specialized cell, such as a heart cell or a liver cell, when prompted by their environment or by their internal genetic programming. If researchers can control the processes directing stem cell transformation, they may one day be able to use these cells as a source of healthy replacement cells for tissues damaged by disease or injury. This work has been the subject of Keirstead’s recent research.

New embryonic stem cell lines are derived from three- to five-day-old embryos produced during fertilization treatments. The excess embryos are often frozen indefinitely or discarded as medical waste. Donors must give permission before these embryos can be used for research purposes.

Keirstead will make lines not only from healthy embryos, but also from embryos known to harbor genetic abnormalities. Stem cells derived from these lines can be used as cellular models of human disease that may help scientists better understand these genetic diseases.

And from Gary Robbins of The Orange County Register:

UC Irvine and an Orange County fertility clinic are teaming up to create at least five new lines of human embryonic stem cells, becoming one of the few groups in the country to try to produce fresh lines for the study of everything from spinal cord injuries to Parkinson's disease.

Using private money, the University of California, Irvine, will try to produce new lines from surplus embryos that people donate through West Coast Fertility Clinics, which has offices in Fullerton, Fountain Valley and Irvine.

If successful, the team will donate cells to scientists around the world who are studying the so-called master cells that have the potential to become any one of the more than 200 cells in the body. Researchers say it might be possible to program these cells to cure or treat disease and some injuries.

The team will be led by UCI neurobiologist Hans Keirstead, who will attempt to create the lines from healthy embryos and those with genetic abnormalities.

"We want to expand the genetic diversity of the cells we study," said Keirstead, co-director of the UCI Stem Cell Research Center. "Creating new lines is challenging. But our lab has six years of experience in stem cells and we believe we can do this."

Great discussion on embryo debate

Naaman the Ex-Leper has a great post today. It's too good to excerpt. You can read it here.

The Violence Against Women Act

I just finished two terms on the President's National Advisory Committee on Violence Against Women (NACVAW)(we were against VAW). So, a friend asked me what I thought about Eagle Forum founder,Phyllis Schlafly's, latest column on Townhall concerning the Violence Against Women Act.

(Not surprisingly)I had a few thoughts:

I know the law is focused more on women than on men - I wish it could be gender neutral. But I disagree that the law "criminalizes ordinary private behavior" or that the Act, rather than human failure in carrying out the law, infringes on civil rights. In fact, I was lucky enough to serve with two members of the NACVAW who helped with the successful legal challenge on the Constitutionality of the original law that allowed civil suits for rape even when a woman didn't file criminal charges.

There's still too much of a double standard in the real world and most (battered and assaulted) women and children (and men) still do need the extra protection. I agree that there should be enforcement of the penalties for lying. It's just that the abuse - rape, coercion, beatings, and murder - is so much worse. Men are much more likely to kill or maim than women. Women are more likely to be coerced into silence due to threats to themselves or their children. It's hard and (still) far more rare for a woman to sexually assault, much less rape a man.

The Act and funding do cover children, men (we've housed men and their families in our local shelter), American Indians on their reservations,the elderly, military personnel and families at risk, sexual assault, and human trafficking. One of the best measures was the changes in protections from (real) sexual assault on college campuses. The new Family Justice Centers (where law enforcement, health care, and legal and social services are all in one place) in San Antonio, San Diego and other big cities improves the process and probably cuts the abuse of the system and by the system.

It's true that physical violence or sexual assault doesn't always have to be proved. Stalking is one such crime covered by the Act. And part of the problem is that most abuse ends up to be "he said, she said." The old way was similar to the "every dog gets one bite."

And sometimes more than one bite.

As late as two years ago, I talked to a sheriff's deputy who thought some women "deserved it" when they were beat up by their husbands.

I've taken care of several professional men's wives who were abused by the local law enforcement system and by public opinion when they were obviously abused by their husbands. In one case, the police initially refused to arrest the husband because they couldn't see the bruises under her clothes and she needed my exam notes to help her press charges. When I asked an older colleague for advice on what to do about the police, he told me, "If you only knew her the way people in this town do, you'd know that she drove him to it." What I knew was that the bruises and wrist abrasions were real. I think people (like my friend, the older family physician) knew the husband was an alcoholic and abusive - and probably depressed - but ignored it because it was "private family business."

On the other hand, we had a woman in our town who intentionally tried to kill her husband by blowing up their house while she and her husband were in it. She was convicted, despite unproved accusations of abuse.

There is a whole school of thought on domestic violence called "gender symmetry." The claim is that women hit, too. Most people intuitively know that there's a difference between the force of a woman's fist and that of a man. In fact, at lower levels of aggression, women do abuse as often as men. But the force and damage, the difference in morbidity and mortality on the records are obvious. Men are more likely to cause permanent damage or kill. But, instead of calling for equal enforcement of the law, advocates of gender symmetry want to get rid of the Act.

Sexual assault crimes still carry the assumption or implication that the woman or girl wasn't modest enough or whatever. I know one divorce that began because the husband was angry that his wife pressed charges against her rapist rather than let it go so no one else would know. And I've heard and read statements that imply that a rape victim who doesn't want an abortion probably wasn't raped.


We do need to change the name to the "Domestic Violence" Act, enforce perjury and false statement laws, and retrain or replace our judges who cannot or will not follow the law.

I do agree with her that it's dumb for the Republicans to try to curry favor with the left with this law - they're going to hate us anyway, so we might as well do it right.

NOW and other (left) feminists will never agree with the way that Republicans administer the Act. They're appalled that some of the appointees are Republican! The left asks for huge increases in funding and then accuses the Administration of "cutting" funds because they only adjust a little for inflation. The abortionists demand that the morning after pill be mandated (forget "choice") as a part of the response to sexual assault and are all up in arms that that decision is left as a local one, between the doctor and the woman.

Mrs. Schlafly and I agree about most things, but we disagree on whether she is a feminist or not. I"ve written her to explain that she and I are feminists. In fact, she's one of the examples of what I believe a feminist should be. She's been pretty much out there in the workplace for 40 years or so, doing the right things. A woman who can guide a Nation to the right, help elect a President and write some of the best selling books ever written all while raising a family and remaining married rather than killing off her own children is what feminism should be about: we are women who are wives, mothers, grandmothers and act and speak to make the world a better place for our families. I believe that we right-thinking women need to take back the meaning of the word so that it's true advocacy of women as whole beings.

Violence and abuse in families, the work place and schools, sexual assault and rape, and infringement of liberty and "the pursuit of happiness" by stalking and trafficking are common ground for the left and right, the pro life and "pro-choice." While we on the right have the White House, the Senate, and the House, we should mold the discussion and solutions our way with the tools we have at hand, including the VAW act.

Texas Embryonic Stem Cell Research

The good news is that phone calls and emails from Texas voters created enough fuss and bother in Austin last week that lobbyists from the UT system joined our efforts to successfully convince the House and the Senate to remove the proposed $41 million bond issue for a biomedical technology center at the UT Houston. The Universities didn't want a debate on embryonic stem cell research. Were they were afraid that the taxpayers would learn about plans to use tax money on research that isn’t eligible for federal funds? See this note from last week’s Austin American Statesman.

The bad news is that the Universities continue investing and engaging in destructive research on human embryos, rather than focusing on the non-destructive umbilical cord and adult stem cells which show progress and – unlike embryonic stem cells - yield cures.

That Houston facility would have been a first: State taxes would have supported destructive research on embryonic human research subjects that don’t qualify for federal funds. For proof from last year's debate on these bills (HB 153 and SB 46 were formerly SB 6), use your Real Play to watch the debate on July 25, 2005 at the Texas Legislature Online video archive beginning one hour into the segment. You can also read about it from the August, 2005 article at ReasonOnline, or the at the Journal of American Bioethics and Humanities.

UT Houston didn’t need our $41 million anyway: the privately funded $200 million Brown Foundation Institute of Molecular Medicine
with its new $120 Million Sarofim Research Center building, just received a $100,000 grant to do research on frozen IVF embryos that don't qualify for federal or State funds.

With all those private donations, why come asking for State taxpayer money at all?

Instead, Texas should focus on ethical stem cell research like these examples:
1. UT Medical Branch at Galveston reports “Embryonic-like” umbilical cord stem cells and techniques to greatly expand stem cells for therapy, developed in cooperation with NASA and British researchers.
2. Houston just received approval from the Federal FDA for patient trials using stem cells from patients’ own bone marrow in heart disease and another study that will treat children with brain trauma.
3. Umbilical cord blood stem cell transplants to replace bone marrow are available at all the large medical centers in Texas and Texas has our new Cord Blood Bank.

Hwang Woo Suk "Egg" Count Updated

Here's the one and only report I've been able to find covering the revelation that more oocytes or "eggs" were used in the laboratory procedures under Korean veterinarian and dog cloner Hwang Woo Suk's supervision. The records in that lab were partially destroyed just aboutthe time that the scandal broke in December. In fact, the record-keeping was apparently so bad in the first place, that I doubt that anyone knows the truth or ever will.

From that Korean Times article:

Prosecutors said last Friday that Hwang received 2,236 ova extracted from 136 donors between November 2002 and December 2005 through four medical institutions collaborating with Hwang's research team.

The institutions that cooperated with Hwang include Hanyang University Medical Center, fertility clinic MizMedi Hospital, Jeil General Hospital and Hanna Women's Clinic.

In January, a fact-finding committee at Seoul National University (SNU) said Hwang's team amassed up to 2,061 eggs from 129 donors, far more than the 427 eggs Hwang's team had claimed to have used.

A month later, the National Bioethics Committee revealed Hwang gathered 2,221 eggs from 119 donors for his stem cell research from 2002 until last December, 160 more than reported by the SNU investigative panel.

The committee also concluded his research team ran into serious ethical problems with its ova procurement.

Last Friday, the prosecution indicted without detention Hwang on charges of fraud, embezzlement and breaches of the bioethics law, ending a five-month probe into the research fabrication scandal.

Prosecutors said he embezzled 2.8 billion won ($3 million) out of some 40 billion won in research funds for personal purposes and the illegal purchase of ova used in his experiments.
They also accused him of illegally paying some 38 million won to 25 women who provided ova for his research through Hanna Women's Clinic in the first eight months of 2005.

Meanwhile, Hanyang University Medical Center was found to have provided ova from its patients to Hwang's team without the consent of donors, violating the Korean bioethics law.

The center, which sent its researchers to collaborate on the experiments, provided a total of 121 human eggs to Hwang's team between April and November of last year.

Investigators discovered that 113 ova extracted from 72 patients between 2002 and 2003 were sent to Hwang's team without the consent of the donors.

Last month, two women who donated their eggs to Hwang's laboratory filed a lawsuit against the state and two medical centers, claiming they had not been informed about potential risks posed by the egg retrieval processes.

There were many stories reporting the indictment of the Korean veterinarian and dog cloner Hwang Woo Suk last week. No surprise that the data was falsified, that money was embezzeled and laundered to hide the embezzelment, or that some of the money was given to politicians and others. But, where are the rest of the stories about this waste and irresponsible behvior?

Peter Singer wrote my blog today

Peter Singer, from Salon.com:



Salon: How does the ethicist put a price on the impulse of a chicken to spread its wings?

Singer: We recognize the chicken as another conscious being. It's different from us, but it has a life, and if something is really important for that chicken, if it would work hard to try to get it, and if we can give it without sacrificing something that's really important to us, then we should.

You can't make this stuff up.

Dear Professor Singer,

Call on the chicken for protection of your own life and right not to suffer when you are attacked by your own animal rights fanatics. After all, you, yourself, compared the chickens to the Jews, while denying that you are equating them:

Singer: The question is whether saying that you are not a member of my kind, and that therefore I don't have to give consideration to your interests, is something that was said by the Nazis and the slave traders, and is also something that we are saying to other species. The question is, what is the relevant difference here? There is no doubt that there is a huge difference between human and nonhuman animals. But what we are overlooking is the fact that nonhuman animals are conscious beings, that they can suffer. And we ignore that suffering, just as the Nazis ignored the suffering of the Jews, or the slave traders ignored the suffering of the Africans. I'm not saying that it's the same sort of suffering. I am not saying that factory farming is the same as the Holocaust or the slave trade, but it's clear that there is an immense amount of suffering in it, and just as we think that the Nazis were wrong to ignore the suffering of their victims, so we are wrong to ignore the sufferings of our victims.

(Wasn't one of these Jews your own grandfather, Peter?)

Culling the Children

News from the United Kingdom tells us about a woman (and her partner) who desired a child although the prospective mother has a genetic disease, hereditary retinoblastoma. Embryos were created by in vitro fertilization (IVF), tested for the gene that causes hereditary retinoblastoma, and only those which were without the trait were implanted. I haven't read the numbers of embryos involved, but the chances are that half of the woman's oocytes contained the gene. (Of course, that's a statistic. The target gene might or might not have been in all or none of the oocytes that were fertilized.) In her The London Times Online reporter comments on the religion of the blind man who draws comparisons between PGD and amniocentesis and abortion which is already common in families with genetic diseases.

Hereditary Retinoblastoma is a horrible disease that causes malignant cancers in the eye and usually manifests by 5 years old in the children who carry the disease. They may loose one or both eyes to the cancer and treatment, and then develop tumors of the bone or soft tissues by the time they are 50 years old. People who have the gene defect associated with Retinoblastoma have an 80%-90% chance of developing the cancers. (If they make it to birth - embryo de-selection and abortion are 100% fatal.)

Since the UK's authority on the use and utility of embryos, the Human Fertilization and Embryology Authority (HFEA), first began authorizing pre-implantation genetic diagnosing (PGD) of embryos for disease it seems we have daily updates on Britain's discovery of new ways to create and kill the tiniest of our children. PGD is the technique of removing one cell from a very early embryo - at about the 4 to 10 cell or "morulla stage" - for genetic testing.

Unfortunately, there isn't any regulation of artificial reproduction and genetic testing in the United States. We don't know how many of the babies who are now in the arms of their mothers and fathers because of the intentional use of in vitro fertilization had several siblings who were discarded in the lab because of their genetic disabilities which were diagnosed by PGD. And which don't know how many and which diseases are under scrutiny. This article, from pregnancy-info.com
a site that specializes in information on infertility, speaks about PGD for sex selection in the case of sex-related genetic disease and even for "family balancing." More and more genetic tests are being developed. Among the possibilites: a test for the gene(s) that increase the chance of developing breast cancer, which is a multifactoral disease - meaning that environment and other genetic influences are at least as important as the gene being tested for.


30 years ago, the public, scientists and ethics community were still reeling from the abortion debate (more in the US than in the UK, where abortion has been legal since 1967). (Click here for a history of the abortion laws in the UK, written for "young people"!!!) When IVF was introduced as the treatment for millions of infertile couples, we were assured by the ethicists and OB/Gyns that our concerns about eugenics by picking those children who would survive and which would not because of disease or the possibilities of disease was pure science fiction. How could we be so heartless and cruel to deny these women their "right" to have children of their own. Then came the awareness that "spare embryos" were being frozen indefinitely, that we needed to somehow regulate surrogacy, and that we could now "cure" genetic diseases like Tay Sachs and being female before implantation.

Those of us who engage in debate with "pro-choicers" or cloning advocates or plain ol' utilitarians are familiar with the accusation that we are hypocrits because we don't picket IVF clinics. Either we don't care enough about embyros to overcome our compassion for the infertile or we're dishonest when we object that babies with Down's syndrome are aborted.

The few who are consistent are treated as worse than hypocrits: they are heartless ideologues who would "force" women to carry "defective" babies to term or remain childless. The same people who decry the money we "waste" at the end of life on futile care are appalled that we would waste our Medicaid funds by allowing these babies to be born in the first place.

With IVF, we were expected to ignore the eugenics that eliminated random children because they weren't wanted or because they were "spare" embryos. Now, with IVF, PGD and developing genetic manipulation in vitro, we'll be expected to show compassion for the mothers and fathers, show practical utilitarian ethics to protect the "scarce resources" of tax-funded health care and ignore the more specific practice of creating, testing and culling what the HFEA's own publication calls "Tomorrow's Children."

The focus is wrong, because the basic ethics are wrong. "Tomorrow's Children" discusses the policy of evaluating the welfare of the child before IVF, and concludes that,

"There should be a presumption to provide treatment to all those who request it, unless there is evidence that the child to be born would face a risk of serious medical, physical or psychological harm."

And so, in order to fit the history of evolving utilitarian ethics to reduce barriers to abortion and creating enough in vitro embryos to have "spares," the drive to seek better (post natal) testing and screening and cures for disease, or, at the very least, investigating ways to test gametes for the disease before fertilization - the beginning of the new, organized organism that is the embryonic human child of his parents - is blunted. IVF, PGD, and prenatal in vivo testing despite ethical qualms about the "option" of "therapeutic abortion" are tolerated and tolerance has become societal pressure on parents.

The UK press' fascination with the new HFEA policy should remind us in the States that we've had unregulated IVF, amniocentesis, and genetic diagnosis. We've used it for the selection of "designer babies" who can donate stem cells to a sibling or who can be "guaranteed" to be healthy.

That there's a reason that the incidence of Down's syndrome is going down.

That there's less research on cures than on detection and distruction.

That there's a higher standard for "every child should be wanted."

Texas stem cell center and taxes

The Texas House passed HB 153 without authorizing bond money for a biomedical research building at the University of Texas Health Science Center at Houston. The UT powers-that-be withdrew their funding request and the bill was amended on the floor.

The debate lasted only a few minutes. Several Democrats and Representative Wooley (author of the regular session's HB 1929, a clone and kill bill) stood to complain and assure us all that destructive embryonic research would be revisited next Spring, during the 80th Legislature.

The Houston Chronicle, the Austin American Statesman and the San Antonio Express News pretty much all gave the same report, quoting one of the proponents of destructive embryonic research as they praised "stem cell research."

And no one noticed that UT Houston already has a $200 million dollar stem cell research center: the Brown Foundation Institute of Molecular Medicine. The $120 million dollar Serafim Research Center building is supposed to be open this month. Two researchers were awarded a grant to begin research on embryos produced by IVF. They're looking for a "universal donor stem cell." I very much doubt the usefulness of this research - the best they should be able to get is a universal tumor cell.

While I'm glad that the news is out that "prolifers" are a powerful voting block, it's a shame that the reporters let the Representatives get away with using the generic term "stem cells." I'm one of the "pro-lifers" they were talking about an I'm all for stem cell research, just not destructive embryo research.

After all, we know that embryonic stem cells do turn into any cell in the body. They did in you and me. You just have to use the original container.

Texas Legislature to fund unethical embryonic research?

It appears that the Governor may expand his call to allow HB 153, funding for construction and repairs at universities and colleges. The bill would allow bonds on $3.7 Billion (edited that number from $3.2 Billion I don't know whether it grew or my memory shrank.) in new construction and repair.

Stem cells may come up in Lege
Lawmakers want to limit research.

By Laylan Copelin
AMERICAN-STATESMAN STAFF
Thursday, May 11, 2006

The Texas House is poised to debate restricting embryonic stem cell research in some public university buildings.

Rep. Geanie Morrison, R-Victoria, chairwoman of the House Higher Education Committee, has told both sides that she will accept an amendment on the stem-cell issue to legislation she has filed to allow colleges and universities to issue bonds to pay for construction projects.

Unfortunately, there's a million here and there that are ear-marked for facilities for unethical research that doesn't qualify for federal funding. Witness the battle last July 25th (requires Real Play for the video) on the same funds and the big fuss on the floor over banning cloning and embryonic stem cell research.


Here's more from that Austin American Statesman article:

House Bill 153 would authorize Texas universities to fund $3.7 billion in construction at public universities and medical schools.

The amendment would bar biomedical research at those newly constructed sites if federal funding is prohibited for the research. Under rules established by President Bush in 2001, federal money for embryonic stem cell research has been limited to previously established stem cell lines.

Gov. Rick Perry is expected to expand the agenda of the 30-day special session today to allow lawmakers to take up the so-called tuition revenue bonds authorized in Morrison's bill, Lt. Gov. David Dewhurst said late Wednesday. That could clear the way for the stem cell debate as soon as today.

Joe Pojman, executive director of Texas Alliance for Life, praised the stem cell amendment.

"It protects state taxpayers from paying for what many of us consider unethical activity," he said of embryonic stem-cell research. He said research with adult stem cells could continue.

Pojman said the amendment would just bring Texas in line with federal funding guidelines, an argument hotly disputed by the other side.

Judith Haley, president of Texans for Advancement of Medical Research, said the amendment would have far-reaching effects on biomedical research in Texas.

She said the amendment would bar any embryonic stem-cell research, even when financed by private dollars, in those public research facilities.

She said the amendment would put Texas out of step with the rest of the country even as Congress is considering easing funding guidelines on the research.

"It not only disallows research with private funds," Haley said, "it sets it in stone" through the life of the buildings.

Morrison said she was looking for language that would satisfy both sides, a high bar.

University of Texas officials did not comment on the proposal Wednesday. But when the same issue arose last summer, they said scientists at the UT Health Science Center in Houston were conducting research on human embryonic stem cells but only on federally approved ones. They were hoping to build a $41.1 million facility there to focus on adult and animal stem cell research.

Scientists affiliated with the school previously did a study in which they injected patients' hearts with adult stem cells to reverse damage and said a new facility would help them maintain a leadership position in the field.

Scientists say adult stem cells show promise in their ability to turn into certain types of tissue. Embryonic stem cells, they say, have even greater potential and might be able to morph into almost anything, including organs.

Opponents say that the uses of embryonic stem cells are unproven and that studying them is unethical because it could promote the destruction of embryos to retrieve stem cells.

If it is not resolved this session, the issue probably will arise again next year.

House Speaker Tom Craddick said he was leaving the issue in Morrison's hands.

lcopelin@statesman.com; 445-3617

Self-referent (On comments about TADA)

Second note (see bottom for first note): I'm so sorry to report that Andrea Clark has died. My heart goes out to everyone who loved her.)

I've been accused of idolatry, self-reference, and toeing the party line. And the accusations are being repeated on other pro-life blogs. My accuser attacked Dr. James Dobson before, both he and Ambassador Alan Keyes of RenewAmerica.us apologized for it. I don't have a link to the source of the essay. It's not on the RenewAmerica.us website, and it looks like Mr. Longman's not associated with them anymore. There is an email address given: columns@andrewlongman.com.

It would have been polite for Mr. Longman to discuss his criticism with me or to at least let me know that he was passing around such comments. Or for those quoting him to alert me or at least link to LifeEthics, so readers could judge for themselves.

Hopefully, those who read the blog will see that I, too, adamantly demand that medicine return to the First Principle of nonmaleficense, "First, do no harm." At least a link to the original article on LifeEthics might have shown an attempt to explain the art of medicine as a process of using what we know, what we can measure, and what others can and have reproduced and proven true and reliable in other situations. And that I didn't approve of removing the ventilator against the objections of the family.

Just to make it clear: the doctor assumed his actions were futile. If he assumed any patient to be futile, his priorities are wrong and they are as bad as this essay accuses.

Again, I was trying to explain the law and correct often-repeated myths about it. The law does not require that a patient be transferred from the original hospital after the ethics committee rules on the treatment decision of the doctor. And, of course, the fact that Mrs. Clark is still at St. Luke's shows this to be true.

As to the "self-referent" comments on reevaluating: hopefully, a lot of people, including the original attending doctor, have learned important lessons about life, death and hubris from Mrs. Clark and her survival at least a week longer than the doctor and hospital predicted. Would they have made the same choices knowing what they know now? What clues were missed and will the lessons we all learn change our actions the next time?


Unfortunately, it appears that Mrs. Clark's condition has worsened after the gallbladder procedure and that the assumption that the gall bladder was blocked was mistaken. She, her loved ones and doctors and other care-givers should still be in the prayers of those of us with faith.


Edit Note: that email address doesn't work.

Terri Schiavo's Judge Greer vs. the Constitution

"That a question is important does not mean that it is constitutional. The Founding Fathers did not establish the United States as a democratic republic so that elected officials would decide trivia, while all great questions would be decided by the judiciary." From comments by Judge Arthur J. Kleinfeld, in the dissenting opinion in the 9th Circuit Court "right to die" case, Compassion in Dying vs.Washington, 79 F.3d at 857, 858.

Contrast these words with the opinion of the probate court judge in Florida, who ruled that Terri Schiavo would have wanted to die and not only ordered that her feeding tube be removed and artificial nutrition stopped, but forbade, on penalty of arrest, any natural feedings. The Washington Post reports that Judge George Greer does not believe that legislators are as qualified to make law as the duly elected representatives of the people.

Andrea Clark will not be removed from ventilator

Wesley Smith has a wonderful update on Andrea Clark. Her care has been transferred to her new doctor and the team of consultants will continue her intensive treatments in the hospital.

We need to all be grateful that the answer to our prayers was, "Yes." Not only has Andrea's life-sustaining treatment been continued past the original dead-line (pun sort of intended), but her sister is reporting that her health condition was already improving, before the 10 days were up.

I hope that Mrs. Clark and her family can have a time of happiness and peace, now. And I hope that all the doctors, nurses and ethicists will re-evaluate adjust their protocols from the lessons learned in the last (very hard) few weeks.

Do you pull the switch?

We've had a real-life philosophy problem right in front of us this last two weeks, with the sad case of Andrea Clark. Now, here's your chance to see why it's so hard for some who call themselves "philosophers" and "ethicists." (Or maybe why so many of them seem to have gone insane.)

The BBC has an article on their online magazine titled, "What if...?". The author, Daniel Sokol, lays out some of the classic philosophy thought problems for us, and there is an on-line poll that will allow you to test yourself.

Of course, these are pretty fantastic cases, with either-or answers. As I commented on the page, we shouldn't make up our ethics and laws during emergencies and based on hard cases.

When we are theorizing, we can lay down right and wrong, and evaluate each intention and action. In real life, we may make ethical mistakes because of the perceived emergency or crisis, our own emotions and prejudices, and gut-reactions.

It's human nature to justify those mistakes by elaborate explanations and arguments. I call this the "I Want" school of ethics. But every body has different wants, and they often conflict with other's and our own needs.

(Begin "Rolling Stone" sound track.)
(For the younger crowd: "You cain't always get what ya want.....")

On the contrary, the reactions and emotions to hard cases and in emergencies simply reflect how well we've learned our ethics lessons. We may not act with the intention to cause the death of another person unless that person is a real threat to someone's life.

Babies are always miracles (Cystic Fibrosis and stem cells)

Exciting news out of Australia, concering umbilical cord stem cell therapy and Cystic Fibrosis research. Unfortunately, the very informative article has a silly title, "Will baby Aiden be a miracle?" Aiden is already a miracle, of course.

The story, from the Herald Sun in Melborne, Victoria, Australia, explains that both Aiden and his older sister have cystic fibrosis, a genetic disease of the endocrine (secretion-producing) glands that causes problems with excessively thick mucus in the lungs and pancreas.Aiden's miracle was noted by the Victoria news because he was the first baby that we know about who donated his cord blood for stem cell research on treatments for Cystic Fibrosis.

We often diagnose the babies because someone notices their excessively salty sweat. Children tend to grow slowly, due to clogged ducts that won't allow digestive enzymes to pass into the intestines. The thickened mucus in the lungs clogs the airways, encouraging frequent pneumonias that lead to hospitalizations and constant treatment to loosen the mucus in the lungs. Medical advances, including improved antibiotics, "asthma" medicines and treatments, and pancreatic enzymes in tablet form which have been developed and improved in the last 20-30 years has enabled the life expectancy of patients with CF to increase from the low teens to the 30's or even 40 plus years old. Now, there's another miracle.


The disease is recessive, meaning that both parents must be carriers for the child to have it. And one in 25 of us with European heritage are carriers.


Scientists have already been able to produce lung cells from the stem cells in umbilical cord blood. (Betcha didn't know that, from the skewed coverage in the mainstream media. Virtually every line of specialized cells have been developed from adult and umbilical cord stem cells.) Now, we hope that the research on Aiden's stem cells will lead us to treatment and, maybe, a cure, by learning how to grow replacement tissue from a child's own stem cells. Now, that's "patient-specific stem cells."

"Texas Futile Care Act" doesn't exist

As a matter of fact, the word "futile" is nowhere in the law, which is actually, Chapter 166 of the Health and Safety Code, the Texas Advance Directive Act (TADA).

I have just finished a Clinical Ethics class in my work on my Master's in Bioethics. From a critique by the instructor (a well-known, Christian physician who was one of the first hospital-based clinical ethicists) on one of my evaluations, comes this comment on "futile" care:

You stated in your Narrative that “the NICU team believes that it is time to consider removal of support, as it appears to be causing the child pain without hope for her recovery.” This sounds like “virtually futile and inhumane”. (Emphasis mine.)

The instructor was pointing out that I could have used wording from a famous medical case. However, I don't like the word "futile," because it is not as clear to everyone as my longer, more specific definition. (And, as you've seen, I like my words and love to explain.)

Not many people would disagree that it is futile to do chest compressions on a very old demented patient with brittle bones. To describe a patient like this is not to say that "old," "demented," or "brittle bones" makes anyone less valuable. It simply acknowledges that there is less chance of healing and recovering from a heart attack and the decreased blood flow to the brain as we age, that brittle ribs will break and puncture organs, and that demented patients will never be able to understand why we hurt them. We don't want the patient to die when we deem that CPR is inappropiate, we just don't believe the evidence indicates that the patient will survive our treatment. In fact, we may make things worse by increasing their pain in our "futile" attempts.


TADA does not mention "quality of life," only preferences, wishes, directives, medical and physical health, refusal, and appropriate or inappropriate care. The only mention of insurance in Chapter 166 is to make it clear that the insurance can not be involved in or affected by decisions concerning Advanced Directives.

In contrast to some sensional accusations, the ethics committee does not make "life-value judgements" or determine whether someone's life is "worth living" as many are calling it. Chapter 166 defines "irreversible condition," "terminal condition," "life-sustaining treatment," and many other terms. However, there is no mention of "quality of life" or the "value" of anyone's life. But, sometimes the treatment is not really treatment, only prolonged infliction of pain.

There is certainly no conspiracy or agreement, unspoken or not, among "hospitals," or the people who work in hospitals, around Texas. First, conspiracies this complicated don't often hold up for long, that's just human nature. Second, does this picture seem consistant with the nurses, doctors and social workers that you know? (Unfortunately, too many "ethicists" might have us make these sorts of agreements, but that's a different matter.)

Much more likely is that the medical judgments of one doctor and ethics committee are trusted to be valid by the other hospitals and that the other facilities would reach the same conclusion if they were to examine the patient and the record.

It is not necessary to transfer the patient from one hospital to another, as some are asserting. The law, in 166.045 and in 166.046, specifically states that whomever (the physician, the patient or whomever is making decisions for the patient) disagrees with the ethics committee, can petition a court for a delay if

" a physician or health care facility that will honor the patient's directive will be found if the time extension is granted."

I do wonder whether the fact that a patient survives ten days after the ethics committee indicates that he or she is stronger than first thought. I would sure want to reevaluate my earlier decision and celebrate if the care given by myself and my colleagues had been more successful than we predicted.

Prolife medical comment on Andrea Clark

The Houston Chronicle clears up one question about the cancelled transfer of Andrea Clark: the doctors in Illinois discovered that they could not meet the needs of Andrea. More than likely, this was as they viewed the records released to them by the hospital, after the family signed the release.

Wesley Smith’s “Secondhand Smoke” has a letter from Andrea Clark’s lawyer to St. Luke’s Episcopal Hospital. There are a few things I think I can explain.

Under # 2, the discussion about the “interim summary” and the doctor’s “making himself unavailable to the family”

The best interim summary – a synopsis of the medical record and treatment during this hospitalization - is going to be in that ethics consult. If you need more information, it will only be from the time that the report was written until now. More than likely, the ethics committee has reviewed the chart, summarized and discussed the events described by the nurses notes, physicians notes (including progress notes, consults and surgical and procedural notes), and labs and tests. Or, you could just look at the “Assessment” of the last consult on the chart and work your way forward from there.

I wrote before that it is not reasonable – much less “unconscionable” – that the doctor took his vacation, if he arranged coverage. This is a hard lesson that we have to learn in med school or residency. We can’t be at work, on call 24/7/365. We can do it for days or even weeks at a time, but we have to get some rest without phone calls and trips to the hospital at night, sometime. If we have families – and want to keep them – we had better learn this lesson well.

#3, the discussion about HIPPA is mistaken in assuming that the medical record can be changed. Lawyers have taught us better than that! The procedure is to have the patient (or surrogates) write their assessment and it is added to the record. Nothing would be removed from a medical record, especially not the ethics committee consult.

#5, the request that Dr. (3) be removed from the case, with the objection that he is an “ob-gyn.” The specialties of members of the ethics committee are irrelevant to their function on the committee. In fact, many committees, like this one, have lay members including clergy, who have specialized training to offer. Not all of them will have formal clinical ethics training. There are books and papers about the practice of clinical ethics, and many certification and degree courses available. None of the members needs to be able to actually treat the patient. They should have a general understanding of medical care and disease. The actual care and report on a patient’s status and treatments come from the attending doctors, nurses, the chart, and sometimes consultants (such as neurologists).

If the committee did not believe what the attending told them about the medical care and status of a patient, I imagine that they would report him to the hospital medical administration. They certainly wouldn’t agree to confirm his treatment.
I’m sure that Dr 3 will be more than happy to withdraw from the case.

#7, the assertion that anyone would attempt “to unduly or unreasonably persuade, intimidate or bully any potential treating physician into accepting Dr. 3's opinion that life-sustaining treatments should be withdrawn” is not realistic. The best description of trying to get doctors to cooperate is that it’s “like herding cats.” We’re a pretty independent, prideful bunch, who depend on and live by our skills and reputations. We are self-driven to be the best.

(I’ll tell you a secret that’s gotten me through the day without many – well, with fewer than there could be – cat fights: remember that most if not all of the docs were the kids who always made A’s and thought themselves smart and competent. If you challenge this self-view, you will end up with someone motivated to prove you wrong and to be smarter and more competent than ever.)

I don’t know how #8 can be satisfied. Any pressure from the insurer will be in the form of denial of payment, requests for documentation, preauthorization and daily status reports. I doubt that anyone would keep any notes on any of this.

As to the last 2 paragraphs, I would suggest that the lawyer should file her papers with the court for a delay as laid out in TADA, but I doubt that the doctors will stop the intensive life-sustaining care before the meeting that is scheduled. I don’t understand why the doctor just doesn’t take over the case. Perhaps their doctor can get emergency privileges. There’s no validity to the claim that the law requires transfer to another facility, except where no doctor in that facility will accept transfer of care.

Finally, the care has been deemed futile and not in the best interests of the patient. That is not to pass judgment on quality of life or whether life is worth living. It simply means that the treatment and the side effects that build up from it hurt the patient more than it helps.