Holiday Ethics

While this article takes a light-hearted approach to "Santa the public health menace," some of the jokes ring true. The ethical issue that the journalist-turn-comedian gets at is whether parents should be limiting their children's exposure to unhealthy role models? Perhaps if there were some other jolly, old fat man who thought he was magical the parents wouldn't be as pleased. So, does that mean that in the sake of tradition, it is ethically defensible to encourage children's admiration of unhealthy behaviors?

(Submitted by Tara Vaughn)

Organ Donation and Kidney Transplants

In class, specifically during one group's presentations, we talked about organ donation. The following article describes a program which helped supply new kidneys to 13 patients through a mix-and-match effort. Our discussions focused on whether or not one should be able to decide who gets their organs. In this article, friends or family members who were not matches to needed recipients would give their kidneys to others in order to get one in return for their friend or family member in need. Although they do not get to pick where their organs go, is this really an altruistic action considering these people know they will be receiving a kidney for a loved one in return? In addition, do these kidney matching programs conflict with traditional UNOS lists?


(Submitted by Caren Steinway)

Doctor-Patient Relations

The doctor-patient relationship has been a changing one ever since its inception. Traditionally focused on the ideas of beneficence and paternalism, the doctor-patient relationship has now changed into one that focuses on autonomy. The following article addresses the issue of doctors being called by their first names during routine clinical visits. Does this alter the doctor's ability to do no harm? To benefit others? Does this matter at all?


(Submitted by Caren Steinway)

PGD and IVF

As we improve technology more and more, we are faced with ethical dilemmas that were unimaginable to past generations. In the following article, a technique called PGD is highlighted. This technique was developed to allow doctors to screen embryos for genetic disorders when using IVF. In addition to screening for these genetic disorders, it is also possible to detect the babies sex. Is it ethical for parents to choose the sex of the embryos being implanted? What further ethical dilemmas can you see stem from this? In addition, the article shows the opinions of people from different countries. Do the differing view points impact the ethical issues at play? How does cultural relativism play a role? More info is available here.

(Submitted by Caren Steinway)

H1N1 Vaccine Revisited

In light of the H1N1 outbreak that began last spring, there was extreme determination to create and distribute large quantities of vaccine to protect against the virus. One of the most targeted populations for this vaccine have been children. The following article highlights a current recall of H1N1 vaccine that was targeted for young children. Although the vaccine poses no health risks to the children, the vaccine is not potent enough. Taking the utilitarian approach (the greatest good for the greatest number of people), is there a moral problem here? Is it safe to say that the companies producing the vaccine did so too quickly thus compromising the positive affect they could have? More info is available here.

The Ethics of the Octomom

We talked about this awhile ago, but I thought this article brought up some interesting issues that never came up in class, namely the insurance aspect of the case. Medical insurance covers IVF, so people like the Octomom have the opportunity to have children; however, those without insurance must pay out of pocket, which can run in the tens of thousands of dollars. With the right to give birth being a negative right, how can doctors and insurance companies limit a woman's ability? Why is the right to have children only a wealthy right? Should abuses, like the octomom, constitute grounds for unethical behavior by both the mother and the doctor? What can be done to stop such abuses, and allow for more equitable justice of the right to give birth?

(Submitted by Jane Tingley)

Assisted Suicide

In this article, a man was found trying to assist his terminally ill wife in her own death. Principally, is this ethical or unethical? Consider the rights that family members have in other medical circumstances. Compare this case to the Terri Schiavo case. What similarities are there? Why is this case ethically different?

(Submitted by Jane Tingley)

Zen and the Art of Hospital Care

Another NY Times article, which further explores the issues involving medical and faith

In this article, it acknowledges the further blending of medical and faith, and the duality that bother clergy and doctors have started to exhibit. We have already considered this issue of duality, but not that some doctors are so open about it, does anything change? Consider a doctor who is also in training to become a deacon. Is this ethical? Unethical? What factors are at play here? Consider the duties to his patient, the type of care he might provide with this dual role, the end of like decisions he would assist in making.

(Submitted by Jane Tingley)

Poor Children Less Likely to Get Antipsychotics

Another NY Times article, which uncovers a recently discovered health disparity.

In reading this article we must think about whether or not doctors treating poorer patients can, in an ethically defensible manner, change the course of treatment? Do the duties of doctors change to patients of different financial means? If a patient has unlimited funds for treatment, what duties does the doctor have to that patient, and his others? Are doctors motivated by principles of justice and equability when treating the poor?

(Submitted by Jane Tingley)

How much do we disclose?

Here is an article from the NY Times weekly Ethicist column. The question pertains to the right to disclose a medical condition to avoid harm to others.

For this case, I do believe that the patient should disclose their radioactive condition; however, its begs the question, what other risky behavior or conditions we should disclose to those around us. Consider smoking, the secondhand risks are a lot greater than this patients radioactive condition; however, rarely in any circumstances do smokers have the responsibility to disclose their condition. Is this ethical?

I think it is unethical, because smokers are putting others at risk just as much, if not more, than this radioactive patient, and for smokers, this risk is present every day until they stop smoking. Therefore, smokers are disregarding the autonomy of those around them, and are committing maleficent acts by smoking around others, since you can still get lung cancer even if you are not the one smoking. Thoughts?

surrogacy: ethical?

By STEPHANIE SAUL
Published: December 12, 2009
Unable to have a baby of her own, Amy Kehoe became her own general contractor to manufacture one. For Ms. Kehoe and her husband, Scott, the idea seemed like their best hope after years of infertility.
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Working mostly over the Internet, Ms. Kehoe handpicked the egg donor, a pre-med student at the University of Michigan. From the Web site of California Cryobank, she chose the anonymous sperm donor, an athletic man with a 4.0 high school grade-point average.
On another Web site, surromomsonline.com, Ms. Kehoe found a gestational carrier who would deliver her baby.
Finally, she hired the fertility clinic, IVF Michigan, which put together her creation last December.
“We paid for the egg, the sperm, the in vitro fertilization,” Ms. Kehoe said as she showed off baby pictures at her home near Grand Rapids, Mich. “They wouldn’t be here if it weren’t for us.”
On July 28, the Kehoes announced the arrival of twins, Ethan and Bridget, at University Hospital in Ann Arbor. Overjoyed, they took the babies home on Aug. 3 and prepared for a welcoming by their large extended family.
A month later, a police officer supervised as the Kehoes relinquished the swaddled infants in the driveway.
Bridget and Ethan are now in the custody of the surrogate who gave birth to them, Laschell Baker of Ypsilanti, Mich. Ms. Baker had obtained a court order to retrieve them after learning that Ms. Kehoe was being treated for mental illness.
“I couldn’t see living the rest of my life worrying and wondering what had happened, or what if she hadn’t taken her medicine, or what if she relapsed,” said Ms. Baker, who has four children of her own.
Now, she and her husband, Paul, plan to raise the twins.
The creation of Ethan and Bridget tested the boundaries of the field known as third-party reproduction, in which more than two people collaborate to have a baby. Five parties were involved: the egg donor, the sperm donor, Ms. Baker and the Kehoes. And two separate middlemen bro-kered the egg and sperm.
About 750 babies are born each year in this country through gestational surrogacy, and twice that many surrogacies are attempted. Most are less complicated than the arrangement that resulted in the birth of Ethan and Bridget.
But as the dispute over the Michigan twins reveals, surrogacy arrangements that go badly can have profound implications, particularly for the children. Surrogacy is largely without regulation, with no authority deciding who may obtain babies through surrogacy or who may serve as a surrogate, according to interviews and court records.
Instead, surrogacy is controlled mainly by fertility doctors, who determine which arrangements are carried out and also earn money by performing the procedures. And while some agencies that coordinate surrogacies and some clinics that carry them out strictly adhere to guidelines, others do not, the interviews and records show.
The lax atmosphere means that it is now essentially possible to order up a baby, creating an emerging commercial market for surrogate babies that raises vexing ethical questions.
In some cases, parents must go through adoption proceedings to gain legal custody of the children. But even in those situations, the normal adoption review process is upended. In surrogacy, prospective parents with no genetic link often create their own baby first, then ask for legal approval, potentially leaving judges with little alternative. Some states allow prebirth orders that place the parents’ names on the birth certificates without any screening.
When disputes arise after the babies are born, the outcome can vary from state to state. In California, considered a friendly state for surrogacy, courts have upheld the validity of surrogacy contracts, meaning that the people who hire surrogates are very likely to keep the babies if a dispute arises.
But a statute in Michigan, where Ethan and Bridget were born, holds that surrogacy is contrary to public policy and that surrogacy agreements are unenforceable, giving the woman who gives birth a strong case if she decides to keep the babies.
A handful of other states have similar laws, according to an analysis by the Center for American Progress, a liberal research group.
About 10 states have laws that allow for surrogacy but impose restrictions; several of those states require at least one parent to have a genetic relationship to the baby. But the majority of states are silent on surrogacy, according to the analysis. Legal uncertainty in some states means that babies are sometimes left in limbo, their parentage left up to courts.
•
“When they go bad, it’s so sad,” said Mitzi Heineman, the Michigan broker who supplied Ms. Kehoe’s donor eggs. “You feel sorry for the baby. Who are the baby’s parents?”
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Four-year-old twin girls in Union City, N.J., have lived under such uncertainty. Their short lives have included two tours in the foster care system.
New Jersey child welfare officials alleged earlier this year that the girls were neglected by Stephen Melinger, 62, who arranged their birth almost five years ago. In July, a New Jersey judge exonerated Mr. Melinger of those accusations. But the Supreme Court in Indiana, where the girls were born, recently ruled that his adoption of the twins was improperly executed and must be redone.
Fewer problems arise when the prospective parents have a genetic link to the offspring, lawyers who have handled such cases say. Gestational surrogacy frequently involves couples who can produce their own eggs and sperm, but in which the female partner cannot carry a baby.
Doctors say that when surrogacy arrangements go smoothly, they are very rewarding.
“It’s been unbelievably satisfying seeing these families grow that otherwise wouldn’t have,” said Dr. James Goldfarb, director of fertility services at the Cleveland Clinic and president of the Society for Assisted Reproductive Technology. Dr. Goldfarb was involved in one of the world’s first gestational surrogacies in 1986. Today, the Cleveland Clinic takes part in 8 to 10 such arrangements a year, he said.
But even less complex arrangements can lead to legal challenges. In another case in New Jersey, a woman agreed to be a surrogate for her brother and his male partner, who donated sperm. But the three are now playing tug of war over 3-year-old twin girls. The woman is seeking custody and a declaration that she is the mother, even though she did not supply the eggs. Lawyers in both New Jersey cases asked that the children’s names be withheld for reasons of privacy.
The New Jersey physician who performed the procedure, Dr. Susan Treiser, did not require psychological screening and waived what is commonly a prerequisite for being a surrogate — that she must have given birth to her own child.
Ms. Baker, the surrogate in Michigan, says the fertility clinic where she was impregnated failed to perform psychological screening of the Kehoes, which is recommended by professional societies. Such screening, she believes, might have prevented her from going through with the pregnancy.
Partly in hopes of standardizing the disparate laws governing surrogacy, the American Bar Association has developed a model act for state legislatures. Judges across the country have said they need guidance to sort out complex legal issues posed by reproductive technology. One section of the proposal says that when prospective parents have no genetic link to the babies, surrogacies would require preapproval by a court in a process that would include a home study.
Lawyers who handle surrogacy arrangements say those cases represent only 5 percent of surrogacy cases, but they are the riskiest.
George J. Annas, a bioethicist who is chairman of the health law program at Boston University, said, “This is the main problem with commercialization, seeing children as a consumer product.”
“This is especially true when there is no genetic connection with the child,” he said. “It really does treat children like commodities. Like pets.”
Brokers and Fees
It was a pet — a pet bird — that transformed the birth of the Melinger twins from a private transaction into a public controversy.
Employees at Methodist Hospital in Indianapolis became alarmed when the man who had commissioned their creation, Stephen Melinger, took his pet bird to the neonatal intensive care unit where they were hospitalized. It was among several things that raised concerns about Mr. Melinger’s ability to care for the two girls, according to court documents.
When Mr. Melinger, a single man who taught elementary school in Union City, decided he wanted a child, he enlisted the help of an agency called Surrogate Mothers in Monrovia, Ind.
The American College of Obstetricians and Gynecologists has adopted a set of guidelines for surrogacy arrangements. Among its recommendations are that surrogacy be handled by nonprofit agencies. Currently it is largely for-profit and can be very lucrative.
Between brokers, legal and medical expenses and surrogate fees, a successful surrogacy can cost prospective parents $80,000 to $120,000. About an estimated 100 agencies advertise themselves as surrogacy brokers.
“People can get into this business easily,” said Charles P. Kindregan Jr., a professor at Suffolk University Law School who was co-chairman of the American Bar Association committee that drafted the model legislation.
Surrogate Mothers, one of the older agencies, advertises on its Web site that it can arrange surrogacies for under $50,000.
On April 8, 2005, the twins intended for Mr. Melinger were born in Indianapolis to a surrogate mother from South Carolina. The girls were 9 weeks premature and weighed only 3 pounds each.
Steve Litz, a lawyer who runs Surrogate Mothers, filed a petition on behalf of Mr. Melinger seeking to adopt the twins, identified in court papers as the “infants H.” According to court documents, the petition identified Mr. Melinger as an Indiana resident, born in Indiana and employed as a teacher.
The woman who carried the children was giving up her rights to them. She had listed Mr. Melinger as “father” on the birth certificate.
The private adoption was on track to be granted, almost as a perfunctory matter. But hospital employees became concerned by Mr. Melinger’s eccentric behavior. On one day, he arrived at the intensive care unit carrying his pet bird, which posed a risk of infection. Mr. Melinger testified that his bird was not near the babies because he had stayed in the office area. Yet on a separate visit, hospital workers said he had gone into the intensive care unit with bird feces on his clothing.
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The hospital staff was also worried about what they considered Mr. Melinger’s unrealistic plan for taking the babies home. He hoped to make the 12-hour drive from Indianapolis to Union City in his car, alone, with the two premature infants strapped in car seats.
Hospital workers asked Indiana’s child welfare agency to investigate.
After learning of the investigation and the possibilities that there would be difficulties in getting Mr. Melinger’s adoption approved, Mr. Litz filed another motion on his client’s behalf, calling the children “hard to place” because their mother was African-American, he said, making the girls biracial.
It is easier for out-of-state residents, like Mr. Melinger, to adopt “hard to place” children. But it was not true that the girls were biracial. The surrogate mother was African-American, but the babies she had carried grew from eggs from a white donor. The twins were white.
It was merely one of the assertions in papers filed on Mr. Melinger’s behalf by Mr. Litz that turned out to be false, according to the Indiana Supreme Court.
“An earlier representation that Mr. Melinger was a sperm donor likewise turned out not to be true,” the court said, so the children were not his biological offspring.
In addition, Mr. Melinger was not born in Indiana, but New York. The Indiana residence he claimed was a hotel room.
A lower court had criticized the submissions for “lack of candor.”
In an e-mail message, Mr. Litz denied that he had misled the courts. “I have never knowingly made a misrepresentation to a judge in my life,” he said. Mr. Melinger declined to be interviewed.
As the case moved forward amid a swirl of Indiana news reports, the girls were placed in foster care. Mr. Melinger continued his fight to adopt the girls, finally prevailing in 2006. Mr. Melinger returned to New Jersey with the girls, but the Indiana Department of Child Services appealed the adoption to the Indiana Supreme Court.
The appeal was still pending in January when the girls had another encounter with the child welfare system, according to records disclosed by Mr. Melinger’s lawyer, Anthony Carbone of Jersey City.
It began as a simple family outing to a park in January.
A woman who saw Mr. Melinger with his children complained to the police that the girls were dirty and inappropriately dressed for cold weather, the records show.
One was wearing a pink coat, a skirt, ankle socks and black shoes. The other was wearing pajamas, a yellow coat and sneakers with no socks. Mr. Melinger later said that it had been a particularly warm winter day and that he had taken extra clothes for the girls.
The complaint prompted a review by the New Jersey Department of Youth and Family Services, which sent a worker the next day to Mr. Melinger’s apartment in Union City.
When a caseworker arrived “she noticed a strong smell of urine in the apartment,” according to a court document. Mr. Melinger later said that the girls were not completely toilet trained and had accidents, and that he tried to clean up after them as best he could.
The home was “particularly dirty,” the caseworker said, with inadequate clean clothes for the twins. Department workers also said the children’s pediatrician, Dr. Pearl Cenon, had concerns about their care and had considered contacting the agency. The girls were removed from Mr. Melinger’s custody.
But in a hearing last summer, a parade of witnesses came to Mr. Melinger’s defense. They included Dr. Cenon, who denied being concerned about the girls and testified that Mr. Melinger was an excellent father.
In July, Judge Bernadette N. DeCastro of New Jersey Superior Court ruled that the Department of Youth and Family Services had failed to prove its claim against Mr. Melinger. The girls had already been returned to his custody in April.
Meanwhile, the Indiana Supreme Court had also ruled.
Uncertain Laws on Surrogates Leave Custody at Issue

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Published: December 12, 2009
(Page 4 of 5)
In a decision issued in April and reaffirmed in October, the court said the adoption of the 4-year-old twins must be repeated. Among missing elements in the original adoption, the Supreme Court said, was a letter from New Jersey authorities stating that the placement was in the twins’ best interest.
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The Indiana court said that as the case continued, the girls would be allowed to remain with Mr. Melinger. Frances Watson, a professor at the Indiana University School of Law in Indianapolis who briefly served as the appointed legal representative of the children, said the case provided a stark example of what the state’s adoption laws attempted to prevent.
“You should not be able to come from out of state on some contract and order up some babies and then go about your business,” Ms. Watson said.
Barriers to Adoption
On July 11, 2004, Donald W. Robinson, a Manhattan accountant, boarded the Norwegian Dawn cruise ship with his partner, Sean Hollingsworth.
The departure from New York was the maiden voyage of the “Rosie” cruises, named after the entertainer Rosie O’Donnell, which cater to gay men and lesbians and their families.
The cruise was also the genesis of a major surrogacy dispute.
As the 1,600 passengers sailed from New York to Florida and the Bahamas, one of the speakers was Dr. Treiser, the fertility specialist.
The weeklong cruise was an excellent way to promote her clinic, IVF New Jersey, to an important surrogacy niche market: gay partners who might want to become parents.
The shift from traditional surrogacy, in which women carry their own biological children after artificial insemination, to gestational surrogacy, as well as the wide availability of donor eggs, has opened the possibility of parenthood to a variety of people who cannot have children of their own.
In Manhattan, the Lesbian, Gay Bisexual & Transgender Community Centersponsors monthly seminars on having families through surrogacy. The well-attended sessions often feature speakers with children born through surrogacy arrangements.
In many of those cases, one of the male partners donates sperm that is used, along with a donor egg, to impregnate a surrogate.
Many of the people who have children through surrogates would have had difficulty adopting because of sexual orientation, marital status or age. Some foreign countries place upper age limits on adoptive parents. And birth mothers giving up their children in the United States often hand-pick the adoptive parents of their children.
“The default position for young birth moms tends to be a mother and a father in a stable relationship and a white picket fence around the yard,” said David C. Cole, a Dallas lawyer with Little Flower Adoptions, which also handles surrogacy arrangements.
After Dr. Treiser’s speech, Mr. Robinson and Mr. Hollingsworth approached her to discuss their plans for having a child through surrogacy.
As Dr. Treiser remembered during a deposition, they wanted to use Mr. Hollingsworth’s sperm and an egg from Mr. Robinson’s sister, Angelia Gail Robinson, a resident of Texas. That way, both Mr. Robinson and Mr. Hollingsworth would have genetic ties to the child.
But testing later revealed that Ms. Robinson, already in her 40s, could not produce viable eggs. Instead, the couple decided to use another egg donor. Ms. Robinson agreed to serve as the gestational carrier and intended to play a role in the life of the baby.
“She was going to be the doting aunt and live close by,” Dr. Treiser testified in a deposition.
Ms. Robinson sold her home in Texas and went to work in her brother’s Manhattan accounting office.
As the agreement proceeded, there were several things that should have waved cautionary flags. Foremost among them was that Ms. Robinson did not have her own children.
A previous birth provides proof that a surrogate can deliver a baby without medical complications, fertility doctors said. And it gives assurance that the surrogate understands the biological and emotional implications of pregnancy and childbirth.
“If a surrogate has not had a baby before, we won’t use her,” said Dr. Goldfarb of the Cleveland Clinic.
In an interview, Dr. Treiser said she made an exception because Ms. Robinson was carrying a child for her sibling and expressed no interest in children of her own.
In a deposition, Dr. Treiser said that she offered Ms. Robinson psychological screening, but that it was declined.
As her pregnancy progressed, Ms. Robinson now says, fissures developed in her relationship with her brother. At the same time, she says in court papers, she began to bond with the twins she was carrying.
It turned out to be an extremely difficult pregnancy that ended on Oct. 4, 2006, when Ms. Robinson was rushed to the hospital suffering from pre-eclampsia, a pregnancy-induced condition that includes extremely high blood pressure. Uncertain Laws on Surrogates Leave Custody at Issue

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Published: December 12, 2009
(Page 5 of 5)
In March 2007, after Mr. Robinson and Mr. Hollingsworth had custody of the children for five months, she filed papers for custody of the children in family court in Jersey City, where the men live. The two were married in California in September 2008, and Mr. Robinson has taken his spouse’s name.
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Ms. Robinson has also asked to be declared the legal mother of the children. Her lawyer, Harold J. Cassidy of Shrewsbury, N.J., has cited the Baby M decision two decades ago, in which the New Jersey Supreme Court upheld the maternal rights of Mary Beth Whitehead, who delivered her own biological child for another couple after artificial insemination with the man’s sperm. Mr. Cassidy also represented Ms. Whitehead.
The court ruled that even though Ms. Whitehead had agreed to a payment of $10,000 for the service, “There are, in a civilized society, some things that money cannot buy.”
Unlike Ms. Whitehead, Ms. Robinson has no genetic relationship to the girls. But as the case continues, the family court has temporarily awarded Ms. Robinson three days a week of parenting time, according to records. The girls are shuttled back and forth between Ms. Robinson’s frame house in Keansburg, N.J., and the home of their father.
Their fate may be determined by a trial as early as April.
Charges of Betrayal
Ethan and Bridget, the babies born in Michigan, are propped in their car seats in a booth at Stoney Creek Koney Island, a diner in a strip mall in Ypsilanti. They are out for breakfast with the woman who gave birth to them, Laschell Baker, and her husband, Paul.
The Bakers have picked out new names for them. They are calling the boy Peyton and the girl Dani. As soon as they can spare $320, they will file papers for legal name changes. It is a way to leave the past behind.
Someday, though, the twins will know all about what happened. “I’ll tell them the truth,” Ms. Baker said.
For Ms. Baker, 35, they are babies No. 8 and 9. In addition to her four children, she has delivered three other surrogate babies, including another set of twins. Her previous surrogacy arrangements went smoothly, and the children are with the family who requested them.
Ms. Baker said she had been vilified by the national community of professional surrogates, who chat regularly online. The Internet community is mad at her, siding mostly with the Kehoes. They even collected money for legal funds for the Kehoes, who say they were betrayed by Ms. Baker.
“They don’t want anything to do with me,” Ms. Baker said. “I’m the bad apple that ruins the name of surrogacy.”
But, she says, this is not a story about a surrogate who changed her mind.
“My husband and I would not do something like this unless we thought it was given to us to do,” Ms Baker said. “My belief is that God placed this on my heart for a reason.”
In the fall of 2007, Ms. Baker advertised in surromomsonline.com saying she would carry a baby for a Christian couple.
Amy Kehoe saw it and was delighted to find that Ms. Baker lived only two hours away.
Ms. Baker said she chose the Kehoes for the same reason. “I picked them because I wanted a couple that was local so they could enjoy the whole pregnancy with me,” she said.
They traded e-mail messages and phone calls and met for dinner before agreeing to go forward with the surrogacy.
Under Michigan’s law, commercial surrogacy is punishable by five years in prison and a $50,000 fine. Ms. Baker said she did not carry the children for money and was reimbursed only for actual expenses like doctor’s appointments. Neither she nor the Kehoes have disclosed exactly how much that was.
Ms. Baker said she was the one who recommended Dr. Jonathan Ayers of IVF Michigan for fertility services. Dr. Ayers was involved in her two previous surrogate pregnancies.
She has generally praised Dr. Ayers, but says the failed arrangement might have been avoided if IVF Michigan had required psychological screening.
A nurse at IVF Michigan said Dr. Ayers would not comment on his clinic’s policies because of patient privacy laws.
On Tuesday, July 28, the babies were born by Caesarean section. The following Monday, in court in Ann Arbor, Ms. Baker said she first learned of Ms. Kehoe’s psychiatric history.
During a hearing to transfer guardianship to the Kehoes, Scott Kehoe said his wife had paranoid schizophrenia. Ms. Kehoe’s psychiatrist listed the diagnosis as a “psychotic disorder not otherwise specified.” Ms. Kehoe takes an antipsychotic to control her symptoms.
Before her diagnosis in 2001, Ms. Kehoe told the judge, she had self-medicated, and that was the reason for her arrest on charges of cocaine use and driving under the influence.
Adoption experts said that mental illness was not a bar to adoption if the illness was under control and the patient went to doctor’s appointments and took medications. And Ms. Kehoe’s psychiatrist wrote a letter saying she would be a good mother because her disease had been fully controlled for eight years and she currently had no symptoms.
Ms. Baker, however, said she was stunned at the disclosure of Ms. Kehoe’s mental illness, which she believes she should have known in advance. And she became concerned that Ms. Kehoe might relapse and be unable to take care of the twins.
“I’m not going to be the one that’s going to feel guilty if something happens,” Ms. Baker said.
Ms. Kehoe said Ms. Baker’s decision made no sense in light of her doctor’s statement and other letters of strong support. “Does she really think she knows better than a psychiatrist who has known me for nine years?” Ms. Kehoe said.
Instead, she says, Ms. Baker “legally stole our babies from us.”
Because Michigan law states that surrogacy contracts are void and unenforceable, it was an easy matter for Ms. Baker to go to court and have the Kehoes’ guardianship rescinded.
Last month, Amy and Scott Kehoe made a decision.
“We are stopping the fight to get our babies back,” Ms. Kehoe wrote in an e-mail message. “The reason is because of the slow court system, and because of the terrible Michigan laws. JUSTICE DOES NOT PREVAIL in this case due to Michigan laws.”
Ms. Kehoe still has hope, though. It is stored in a tank of liquid nitrogen at IVF Michigan. The tank contains 20 frozen embryos made from the eggs and sperm she bought.

Addiction, Drugs, and Morality

Addiction on 2 Fronts: Work and Home


By SARAH KERSHAW
Published: December 7, 2009
WASHINGTON — His son had been dead from an overdose only three months when A. Thomas McLellan, among the nation’s leading researchers on addiction, got a call from the office of Vice President Joseph R. Biden Jr. Would he accept the nomination to be the government’s No. 2 drug-control official? e

Brendan Smialowski for The New York Times
A PERSONAL MATTER A. Thomas McLellan says he is working against not just drug abuse, but also the belief by many that it is a moral, not medical, issue.

Dr. McLellan, 61, makes no secret of his cynicism about government — “I hate Washington,” as he put it in an interview — and he had no intention of leaving his job as a professor of psychology at the University of Pennsylvania School of Medicine and scientific director of the Treatment Research Institute in Philadelphia.
But the loss of his younger son, who overdosed on anti-anxiety medication and Scotch last year at age 30 while his older son was in residential treatment for alcoholism and cocaine addiction, changed his perspective.
“That’s why I took this job,” said Dr. McLellan, who was sworn in as the deputy director of the Office of National Drug Control Policy in August. “I thought it was some kind of sign, you know. I would never have done it. I loved all the people I’ve worked with, I loved my life. But I thought maybe there’s a way where what I know plus what I feel could make a difference.”
Married to a recovering cocaine addict, Dr. McLellan has been engulfed by addiction in life and work. His own family has been a personal battleground for one of the country’s most complex and entrenched problems, while as an expert he has been a leading voice for the idea that addiction is a chronic illness and not a moral issue.
This view squares with that of his boss, R. Gil Kerlikowske, a former Seattle police chief who declared on taking office as drug czar in May that President Obama’s administration would no longer use the term “war on drugs” — and that the term implied the government was waging a battle against its citizens.
Instead, the two men say the government needs to change its drug-control strategy, redirecting some of the resources into prevention and treatment and away from law enforcement and antitrafficking efforts, which consumed 75 percent to 90 percent of the budget during the Bush administration.
Dr. McLellan said that of the 25 million substance abusers he estimated were in this country, only about 2 million were receiving treatment. He and Mr. Kerlikowske want to triple that number, partly by spending more money and partly through other tactics, like integrating addiction treatment into the primary health care system.
Many veterans of the long and frustrating fight against addiction say it is about time. “This is an extraordinary moment of opportunity,” said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse and one of the colleagues and friends who helped persuade Dr. McLellan to take the job.
Still, even Dr. McLellan’s most ardent supporters say the challenges are formidable. The federal drug-control office can do only so much, and the Obama administration decided the drug czar would no longer be a cabinet-level position. State and local governments, law enforcement agencies, the health care system and schools are all big players. And taxpayers tend to have little sympathy for addicts or for treatment programs with track records that are mixed at best.
“I can tell a state legislator that if you would only provide treatment for these guys, we’d have the greatest reduction in crime,” said Joseph A. Califano Jr., chairman of the National Center on Addiction and Substance Abuse at Columbia University. “But those constituents want computers in the schools, better roads, better sewage systems.”
Mr. Califano, who was been involved with government efforts to combat the drug problem since the days of President Lyndon B. Johnson, said that he had great admiration for the new leaders of the drug-control office but that “you need a presidential commitment here.”
“I think if Obama gave these two guys the spark, they would know how to turn into a fire,” he said.
The office is preparing its drug policy strategy, to be released in February along with Mr. Obama’s budget. “We are going to get the money to do this,” Dr. McLellan insisted. “I can’t tell you the amount or where it’s coming from, but we’re going to get it.”
The drug czar himself, who has made passing reference to his adult stepson’s struggles with drugs but does not discuss it openly, was more cautious, as he tends to be.
“I think for some folks, radical change will be their only measure of success,” Mr. Kerlikowske said in an interview. “I don’t think we’ll see that. I think we’ll make a lot of progress, we’ll slow the freighter down and start turning it in the direction of the more balanced view.”
The two make an interesting pair — the former police chief who has plenty of experience parsing words with reporters, and the plainspoken, quirky and mustachioed psychologist who says “ain’t” and “yeah,” and whose candor can make Washington insiders nervous.
Dr. McLellan, who has written or collaborated on more than 400 papers on addiction, is well known among his colleagues and friends for both his passion for the subject and his bluntness.
In a recent interview in his office here — still sparsely decorated except for a photocopied picture of his family, including his surviving son and two young grandsons (or “grand felons,” as he called them) — Dr. McLellan put his feet up on the coffee table and declared, “I hate this job.”

“This is a job that needs scientific background,” he went on. “But if you come to it with the kind of desires to turn everything into a scientific experiment, you will have your poor little heart broken.”
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Despite Mr. Kerlikowske’s insistence that putting more resources into prevention and treatment does not mean the government is going soft on crime, such policies are bound to be controversial. Conservatives point out, for example, that drug treatment and detoxification programs have relapse and dropout rates as high as 80 percent or 90 percent.
“I’m not sure the federal government has an obligation to try to rehabilitate addicts,” said Heather Mac Donald, a senior fellow at the Manhattan Institute, a conservative policy research group. “Government has an obligation to provide safe streets to people, and policing has an extremely effective track record in places in like New York City and Los Angeles.”
Dr. McLellan grew up in Mechanicsburg, Pa., and while his family was “riddled” with addiction, he says he wound up in the field almost by accident. He said that while he drank, he was “constitutionally unfit to be an alcoholic,” and therefore did not have what he and many others consider to be a genetic disease.
He earned his doctorate in experimental psychology, with a focus on animal learning, from the Bryn Mawr in 1976.
“You’ve undoubtedly — I think almost every American has read my Ph.D. thesis by now,” he said. “ ‘Negative Autoshaping in the Rat, Cockroach, Pigeon and Crayfish.’ And armed with this kind of knowledge and obvious preparation for the business world, I was shocked to find that there weren’t many jobs available.”
So he went to the veterans’ hospital in Coatesville, Pa., to see what was available. He was offered a job as a technician to evaluate the effectiveness of one of the nation’s first drug and alcohol rehabilitation programs, and that led him and a team of researchers to develop the Addiction Severity Index, now established as a standard assessment tool for drug and alcohol abuse.
In recent years, Dr. McLellan has focused on the lack of addiction screening in primary health care settings like doctors’ offices and emergency rooms. For example, he said, just as with hypertension or diabetes, there is a concrete way to measure whether someone has an alcohol problem.
The measuring stick is known as “3-14” — so if someone is having 3 or more drinks a day, or 14 per week, that should raise a red flag, and physicians should be much better equipped to intervene and offer treatment options if there is a problem. Ideally, Dr. McLellan said, that treatment would be available in the medical system itself, not segregated in rehabilitation and detox programs, with their high failure rates.
He said another goal was to get a better handle on measuring the use of drugs and alcohol by those under 21, the time of highest risk for the onset of addiction. His younger son was in eighth grade when he began to struggle with addiction, and by then Dr. McLellan was a prominent researcher in the field.
“If it has to happen, better it happens to me, I’m an expert, right?” Dr. McLellan said. “I didn’t know what to do and none of my buddies knew what to do, and let me tell you they were experts. So I said, ‘What the hell are we doing?’ ”
That prompted him to start the Treatment Research Institute to evaluate addiction treatment. But both of his sons continued to struggle with addiction.
Dr. Volkow, of the national drug-abuse institute, said the death of the younger son “epitomized how unprotected people who are addicted to drugs are, even with that father.” Of Dr. McLellan, she added, “He’s an absolute true warrior in the best sense of the word.”
The older son is doing well now, and the two enjoy working together to restore houses and sell them. “Maybe when I get out of here, I’ll do more of that,” Dr. McLellan said.
Then he quickly added, “There’s a lot of need for drug-free housing.”

U.S. OK's research on 13 stem cells

Please read this article from the Boston Globe discussing recent changes to the U.S.'s stem cell research policy and respond with your thoughts.

In the following article highlights studies done that indicate the radiation from mammograms (used to detect breast cancer) can lead to a high risk of breast cancer.

After reading the article and thinking about all sides presented, do you think it would be ethically to use mammography to screen for breast cancer in younger, higher risk, patients, even if it meant their chances of getting breast cancer in the future? Why or why not?


[Submitted by Caren Steinway]

Psychiatry and Ethcis

The following article talks about a covert investigation of Psychiatric Hospitals in the Netherlands. Undercover observers posed as patients in order to get admitted into hospitals in order to attest to the real conditions of the facilities. Would anything like this study every get funded in the US today? Is it ethically moral to pose as a psychiatric patient? Was the information they were looking for only obtainable by this method?

[Submitted by Caren Steinway]

altruism

We May Be Born With an Urge to Help


By NICHOLAS WADE
Published: November 30, 2009
What is the essence of human nature? Flawed, say many theologians. Vicious and addicted to warfare, wrote Hobbes. Selfish and in need of considerable improvement, think many parents.
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But biologists are beginning to form a generally sunnier view of humankind. Their conclusions are derived in part from testing very young children, and partly from comparing human children with those of chimpanzees, hoping that the differences will point to what is distinctively human.
The somewhat surprising answer at which some biologists have arrived is that babies are innately sociable and helpful to others. Of course every animal must to some extent be selfish to survive. But the biologists also see in humans a natural willingness to help.
When infants 18 months old see an unrelated adult whose hands are full and who needs assistance opening a door or picking up a dropped clothespin, they will immediately help, Michael Tomasello writes in “Why We Cooperate,” a book published in October. Dr. Tomasello, a developmental psychologist, is co-director of the Max Planck Institute for Evolutionary Anthropology in Leipzig, Germany.
The helping behavior seems to be innate because it appears so early and before many parents start teaching children the rules of polite behavior.
“It’s probably safe to assume that they haven’t been explicitly and directly taught to do this,” said Elizabeth Spelke, a developmental psychologist at Harvard. “On the other hand, they’ve had lots of opportunities to experience acts of helping by others. I think the jury is out on the innateness question.”
But Dr. Tomasello finds the helping is not enhanced by rewards, suggesting that it is not influenced by training. It seems to occur across cultures that have different timetables for teaching social rules. And helping behavior can even be seen in infant chimpanzees under the right experimental conditions. For all these reasons, Dr. Tomasello concludes that helping is a natural inclination, not something imposed by parents or culture.
Infants will help with information, as well as in practical ways. From the age of 12 months they will point at objects that an adult pretends to have lost. Chimpanzees, by contrast, never point at things for each other, and when they point for people, it seems to be as a command to go fetch something rather than to share information.
For parents who may think their children somehow skipped the cooperative phase, Dr. Tomasello offers the reassuring advice that children are often more cooperative outside the home, which is why parents may be surprised to hear from a teacher or coach how nice their child is. “In families, the competitive element is in ascendancy,” he said.
As children grow older, they become more selective in their helpfulness. Starting around age 3, they will share more generously with a child who was previously nice to them. Another behavior that emerges at the same age is a sense of social norms. “Most social norms are about being nice to other people,” Dr. Tomasello said in an interview, “so children learn social norms because they want to be part of the group.”
Children not only feel they should obey these rules themselves, but also that they should make others in the group do the same. Even 3-year-olds are willing to enforce social norms. If they are shown how to play a game, and a puppet then joins in with its own idea of the rules, the children will object, some of them vociferously.
Where do they get this idea of group rules, the sense of “we who do it this way”? Dr. Tomasello believes children develop what he calls “shared intentionality,” a notion of what others expect to happen and hence a sense of a group “we.” It is from this shared intentionality that children derive their sense of norms and of expecting others to obey them.
Shared intentionality, in Dr. Tomasello’s view, is close to the essence of what distinguishes people from chimpanzees. A group of human children will use all kinds of words and gestures to form goals and coordinate activities, but young chimps seem to have little interest in what may be their companions’ minds.
If children are naturally helpful and sociable, what system of child-rearing best takes advantage of this surprising propensity? Dr. Tomasello says that the approach known as inductive parenting works best because it reinforces the child’s natural propensity to cooperate with others. Inductive parenting is simply communicating with children about the effect of their actions on others and emphasizing the logic of social cooperation.
“Children are altruistic by nature,” he writes, and though they are also naturally selfish, all parents need do is try to tip the balance toward social behavior.
The shared intentionality lies at the basis of human society, Dr. Tomasello argues. From it flow ideas of norms, of punishing those who violate the norms and of shame and guilt for punishing oneself. Shared intentionality evolved very early in the human lineage, he believes, and its probable purpose was for cooperation in gathering food. Anthropologists report that when men cooperate in hunting, they can take down large game, which single hunters generally cannot do. Chimpanzees gather to hunt colobus monkeys, but Dr. Tomasello argues this is far less of a cooperative endeavor because the participants act on an ad hoc basis and do not really share their catch.
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An interesting bodily reflection of humans’ shared intentionality is the sclera, or whites, of the eyes. All 200 or so species of primates have dark eyes and a barely visible sclera. All, that is, except humans, whose sclera is three times as large, a feature that makes it much easier to follow the direction of someone else’s gaze. Chimps will follow a person’s gaze, but by looking at his head, even if his eyes are closed. Babies follow a person’s eyes, even if the experimenter keeps his head still.
Advertising what one is looking at could be a risk. Dr. Tomasello argues that the behavior evolved “in cooperative social groups in which monitoring one another’s focus was to everyone’s benefit in completing joint tasks.”
This could have happened at some point early in human evolution, when in order to survive, people were forced to cooperate in hunting game or gathering fruit. The path to obligatory cooperation — one that other primates did not take — led to social rules and their enforcement, to human altruism and to language.
“Humans putting their heads together in shared cooperative activities are thus the originators of human culture,” Dr. Tomasello writes.
A similar conclusion has been reached independently by Hillard S. Kaplan, an anthropologist at the University of New Mexico. Modern humans have lived for most of their existence as hunter gatherers, so much of human nature has presumably been shaped for survival in such conditions. From study of existing hunter gatherer peoples, Dr. Kaplan has found evidence of cooperation woven into many levels of human activity.
The division of labor between men and women — men gather 68 percent of the calories in foraging societies — requires cooperation between the sexes. Young people in these societies consume more than they produce until age 20, which in turn requires cooperation between the generations. This long period of dependency was needed to develop the special skills required for the hunter gatherer way of life.
The structure of early human societies, including their “high levels of cooperation between kin and nonkin,” was thus an adaptation to the “specialized foraging niche” of food resources that were too difficult for other primates to capture, Dr. Kaplan and colleagues wrote recently in The Philosophical Transactions of the Royal Society. We evolved to be nice to each other, in other words, because there was no alternative.
Much the same conclusion is reached by Frans de Waal in another book published in October, “The Age of Empathy.” Dr. de Waal, a primatologist, has long studied the cooperative side of primate behavior and believes that aggression, which he has also studied, is often overrated as a human motivation.
“We’re preprogrammed to reach out,” Dr. de Waal writes. “Empathy is an automated response over which we have limited control.” The only people emotionally immune to another’s situation, he notes, are psychopaths.
Indeed, it is in our biological nature, not our political institutions, that we should put our trust, in his view. Our empathy is innate and cannot be changed or long suppressed. “In fact,” Dr. de Waal writes, “I’d argue that biology constitutes our greatest hope. One can only shudder at the thought that the humaneness of our societies would depend on the whims of politics, culture or religion.”
The basic sociability of human nature does not mean, of course, that people are nice to each other all the time. Social structure requires that things be done to maintain it, some of which involve negative attitudes toward others. The instinct for enforcing norms is powerful, as is the instinct for fairness. Experiments have shown that people will reject unfair distributions of money even it means they receive nothing.
“Humans clearly evolved the ability to detect inequities, control immediate desires, foresee the virtues of norm following and gain the personal, emotional rewards that come from seeing another punished,” write three Harvard biologists, Marc Hauser, Katherine McAuliffe and Peter R. Blake, in reviewing their experiments with tamarin monkeys and young children.
If people do bad things to others in their group, they can behave even worse to those outside it. Indeed the human capacity for cooperation “seems to have evolved mainly for interactions within the local group,” Dr. Tomasello writes.
Sociality, the binding together of members of a group, is the first requirement of defense, since without it people will not put the group’s interests ahead of their own or be willing to sacrifice their lives in battle. Lawrence H. Keeley, an anthropologist who has traced aggression among early peoples, writes in his book “War Before Civilization” that, “Warfare is ultimately not a denial of the human capacity for cooperation, but merely the most destructive expression of it.”
The roots of human cooperation may lie in human aggression. We are selfish by nature, yet also follow rules requiring us to be nice to others.
“That’s why we have moral dilemmas,” Dr. Tomasello said, “because we are both selfish and altruistic at the same time.”

enhancement/disability

spotted by Leslie...


The modern sports ethos that we've constructed is based upon increasing advantages. Because certainly, in so many sports, we have pushed past natural human function to facilitate a more exciting game—better times, better performance. But where does an advantage become unfair? The crux of that question lays under the umbrella of ethics, which should indeed govern our rule structure within the competitive arena, but there's something in this story which specifically points toward a deep-seated fear, one we don't want to talk about in polite conversation, one which parallels historical instances of racial integration of sport and gender integration of sport. If we allow a person, one who we view as our inferior (in whatever way), to play with us, and then that person beats us, what does that say about us?

In the 1930s, Jesse Owens and Joe Louis blew the lid off common thinking of how "capable" an athlete of African descent was compared to an athlete of European descent, although the beginning of league integration took a decade more to achieve, and in some sports another three decades. It was as recent as 2003 when some members of the PGA balked at Annika Sorenstam's quest to compare her talent to the best men in the world, admitting their fear of how it might feel to have a woman beat them, an embarrassing display of archaic thinking.

In 2001, golfer Casey Martin, who played with a degenerative circulatory leg condition that made it nearly impossible to walk an 18-hole course, successfully won a Supreme Court decision allowing him to use a cart as an acceptable assistive medical device. The PGA Tour fought Martin for years, saying all pro golfers must walk because uniform rules are essential for the integrity of the sport. "Accommodating Martin with a golf cart will not fundamentally change the game," Justice John Paul Stevens wrote for a 7-2 majority.

What keeps percolating for me is this perceived discrepancy between advantage and "unfair" advantage. It's absurd to look at a star line-up of athletes and think that they all have an equal shot. We don't cry foul play when an athlete from the United States, with the best access to training facilities, coaching staffs, and nutritional science is up against someone from say…Uzkbekistan. It's tough luck that 5' 11" Tyson Gay has to line up against a 6'5" Usain Bolt.

It makes me twitch when we talk about "a level playing field." No two athletes are the same genetically and environmentally, and the mental and emotional factors they've endured in their life are relevant in their performance, too. The only reason athletes today are better than those of decades ago is because of science and technology: We know exactly what and when to feed our bodies for maximum energy, we have lighter shoes and better bikes and new rubberized track surfaces and (legal) supplements and altitude training. We are upping the ante each Olympic year with "smarter" design of an athlete's tools, both inside and outside the body.

A whopping 74 world records were broken last year between March and November with the Speedo Fastskin LZR Racer suit. 74! Do you wonder if Mark Spitz is annoyed that his times are compared to those of athletes using something he didn't have the opportunity to use or wear?

My interest was piqued in the latest version of the Fastskin LZR suit, an R&D collaboration with NASA. From the initial press releases to subsequent monthly articles, whatever I could find describing it was overwhelmingly celebratory: Writers cooed about the sharkskin-inspired biometric fiber panels for less drag in the water, and its corset-like torso construction, enabling a swimmer to compress their physique and keep better, more supported form during fatigue, making them markedly more efficient in the water.

Very, very few writers brought up any kind of ethical concern of such a tool like this suit until after the Beijing Olympics, choosing to focus on the race between swimwear companies to develop their own supersuit. Even then, the majority of articles on swimming were marveling at how Michael Phelps says he "literally felt like a rocket coming off the wall" using the device. Jason Rance, the lead designer on this Speedo suit, commented, "It's part of the evolution of the sport, and it's really exciting for swimmers. They say they feel like Superman."

After the ensuing arms-race to out-do the performance of the Speedo, the Americans and Australians led a protest to FINA, the governing body of swimming. In July of this year, FINA banned the full-length suit, having the suit stop at the knee instead, and mandated that all must be constructed of a "textile," which is in itself an incredibly ambiguous, vague rule. The ban will take effect in January 2010, and—most intriguing—FINA will allow all records set with the suits to stand.

Let's think about Tiger Woods having not one, but two LASIK surgeries to achieve 20/15 vision, when what we consider the best of natural vision to be is a mere 20/20. Before his first LASIK surgery, Woods had lost 16 straight tournaments. Immediately following the surgery, he won 7 of his next 10. Advantage through technology, or not?

On a company website he endorses, there's a quote from Tiger after his first LASIK surgery, and I found what he said remarkable on a few levels. He said:

For years I played golf with an invisible handicap, invisible to everyone but me. It was my contact lenses. My eyes would sting burn and water all the while I was trying to concentrate on championship golf. I had the Lasik procedure with a TLC laser eye center surgeon and the results were fabulous. I'm 20/20 with no contacts. My vision is so crisp I feel I can read all the subtleties of the green and look down the fairway hundreds of yards and focus perfectly on the fly. I'm very happy with the results, and grateful for my TLC center experience.

The first remarkable aspect of this is that for him, the "handicap" was the ineptitude of the contact lenses, and not the fact that he was visually impaired. (He suffered from -11 nearsightedness, considered the worst 1%, legally blind without corrective glasses or contacts.) The second is his own literal description of being able to now clearly see—without the impediment of burning, stinging eyes—hundreds of yards down the fairway thanks to his technological altering. He himself declares the advantage.

"Invisible to everyone but me." So is that why nobody's up in arms, the fact that you can't see his augmentation? Is that why nobody's challenging this medical method which assists him in achieving dominance in golf? Of course, in the same way that my running legs don't power themselves, Tiger's new eyes don't power and execute a beautiful swing. His athletic talent is further revealed and enabled than what it would have been under the limits of nature, thanks to technology.

Advantage is just something that is part of sports. No athletes are created equal. They simply aren't, due to a multitude of factors including geography, access to training, facilities, health care, injury prevention, and sure, technology.

I really don't know how we compare world records of today to those of 50 years ago. A modern climber's ascent to Everest has innumerable inherent differences than an ascent of a climber who didn't have access to lighter tanks, comfortable breathable fibers against the skin, medical support at base camp, etc. The competitive benchmarks in that sport have changed from simply being, "Can you climb the mountain?" to "Can you climb it with oxygen, or without?" A wooden tennis racket isn't the same thing as the graphite ones used now. We wholeheartedly accept titanium golf clubs, LASIK surgery, the invention of new pitches, better injury prevention and repair, titanium knee and hip replacements, Tommy John surgery (surprisingly even in Youth Leagues), and a notable shift in the size of the average NFL player.

Where do we draw this ethical line on performance enhancement? I'm not sure I can answer that right now. What I will say is that I don't think it's useful to have this discussion around the existing Cheetah Leg, confusing the current non-enhanced technology with future prosthetics that will indeed provide augmentation. As with all evolution in sport, let's decide the parameters of competition when the technology actually exists, when we have metrics that inform us as to what extent augmentation is a certainty. Conjecture has no place in this discussion.

Maybe our acceptance of Tiger's LASIK super vision is really answered in the question, "Can everyone have access to it?" In other words, perhaps because the average citizen out there on the street can get laser surgery, it's okay for Tiger to get it, too, whereas the nature of a bionic prosthetic is still viewed as exclusive, and having to wear one isn't exactly a position the average citizen covets.

What's going to happen in the future, especially with the rise of more capable prostheses? The human leg is actually a series of internal motors and springs, so the fact that external motors aren't allowed in track is kind of interesting. (Case in point: Dean Kamen placed 14 motors in his new design of the artificial arm to simulate human function.)

In the not-so-distant future, designers will be able to build a prosthetic leg with a chip in it that they can program to accurately simulate human performance thresholds. (Since we know that no two "able-bodied" athletes have the same bodies, and therefore what they can achieve with their bodies are different, will they average out individual "able-bodied" thresholds to get those metrics? Will they cap how fast they imagine the fastest man on earth to be at 9.58? That time was unimaginable even 18 months ago, when Bolt then set the new WR at 9.72.)

The chip used in a prosthetic that will dictate "acceptable human" metric-based output is what will be allowed in the Olympic standard; meanwhile, the Paralympics will be no holds barred. In an ironic, amazing cultural flip, you will see runners in the Paralympics going faster than those in the Olympics. Now won't that be an interesting comment on "dis"ability?

Aimee Mullins is an athlete, speaker, actress and model we met at TEDMED. She's also the guest editor for our theme week This Cyborg Life. Read her bio here.

This week, Gizmodo is exploring the enhanced human future in a segment we call This Cyborg Life. It's about what happens when we treat our body less as a sacred object and more as what it is: Nature's ultimate machine.





Is it right that disabled athletes are an "inspiration" when they are trailing behind, but the second a disabled athlete beats or competes on the same level as able bodied athletes they're called cheaters? As the author discusses, how is an amputee running with a prosthesis any different from Tiger Woods golfing after having LASIK surgery to correct his vision? Is it ethically appropriate to distinguish between athletes who have disadvantages such as poor eyesight or amputated limbs, and athletes who are "able bodied"? Where do we draw the line?

End of Life: Man emerges from coma 23 years later

from NIkhil:

Trapped 'coma' man: How was he misdiagnosed?
By Mark Tutton, CNN
November 24, 2009 -- Updated 1651 GMT (0051 HKT)
Click to play
23 year coma patient communicates
STORY HIGHLIGHTS

* Man diagnosed as being in vegetative state for 23 years was fully conscious
* Study found that 41 percent of patients in minimally-conscious state were wrongly diagnosed
* Lack of careful assessment can contribute to misdiagnosis

London, England (CNN) -- A Belgian car crash victim who was misdiagnosed as being in a vegetative state for 23 years was conscious the whole time, it has emerged.

For years he listened to the conversations going on around him but he was unable to communicate with his doctors or family.

Rom Houben was 23 at the time of the near-fatal car crash in 1983 that left him paralyzed. Doctors presumed he was in a vegetative state following the accident and they believed he could feel and hear nothing.

Neurologist Dr.Steven Laureys of the University of Liege, in Belgium carried out a brain scan using state-of-the art scanning system and discovered that Houben's brain was fully functional.

In an interview with the UK's ITV news Monday, Rom communicated by typing on a special keyboard attached to his wheelchair, and aided by his carer.

He said: "At some moments it was terribly lonely but I knew my family was believing in me."

"I simply want to enjoy life," he added. "I notice a big difference now I'm back in contact with the world."
Video: Assessing comas
He was conscious for a long time, but it's difficult to know for how long.
--Caroline Schnakers, Coma Science Group
RELATED TOPICS

* Brain Injuries
* Health Care Issues
* Health and Fitness

The case has highlighted the difficulties doctors face when trying to diagnose the level of consciousness of a patient in a coma-like state.

Watch Laureys explain how comas are assessed

A study carried out last year on 103 patients by Laureys and his colleagues at Liege's Coma Science Group found that 41 percent of patients in a Minimally Conscious State (MCS) were misdiagnosed as being in the much more serious Vegetative State (VS).

Dr. Daniel Hanley, professor of neurology at Johns Hopkins Medicine, in Maryland, told CNN that VS is a coma-like state in which patients have a sleep and wake cycle, and can show reflex chewing, swallowing and blinking, but don't respond to language or stimulation.

Patients in MCS occasionally show they are aware of their environment, for example moving to face a doctor when asked, but only infrequently.

Laureys said of his research, "Differentiating the vegetative from the minimally conscious state is often one of the most challenging tasks facing clinicians involved in the care of patients with disorders of consciousness.

"Misdiagnosis can lead to grave consequences, especially in end-of-life decision-making."

Watch one iReporter's reaction to the situation

Caroline Schnakers, who carried out the research with Laureys, told CNN that one probable reason for the high rate of misdiagnosis is that doctors often base their diagnosis on observations of a patient's behavior, rather than assessing patients using standardized tests.

"Assessment is usually behavioral," Schnakers told CNN. "For example, if you come into a room and a patient's eyes follow you, or if they smile when you make a joke, they are conscious -- but it doesn't mean they will still be able to do that one hour later."

Schnakers said that using standardized tests could reduce incidents of misdiagnosis.

The Glasgow Coma Scale is a standardized test that classifies a patient's motor, verbal and eye response on a graded scale. It was widely used until about 2000 to classify a patient's level of consciousness, but Schnakers says it may contribute to misdiagnosis.

She told CNN, "In our study we used the JFK Coma Recovery Scale-Revised (CRS-R), which is standardized for detecting signs of consciousness in someone recovering from a coma. It's very sensitive and avoided a lot more misdiagnosis than the Glasgow Coma Scale."

The CRS-R was developed at the JFK Johnson Rehabilitation Institute and grades patients' verbalization, communication, motor function, visual function and response to sound.

Diagnosis can be further complicated by another condition, called Locked-In Syndrome. Much less common than VS or MCS, patients in a locked-in state are totally aware of their environment but have minimal reflexive movements, typically only being able to blink their eyes. Hanley told CNN that Houben may have been in a locked-in state.

But Houben's diagnosis may have been made more difficult by the fact that he was partly paralyzed, meaning he was unable to show a motor response.

"He was conscious for a long time, but it's difficult to know for how long," said Schnakers. "Maybe he had a period of VS, but you wouldn't know how long it lasted, even if you ask a patient how long they were in VS or MCS."

Hanley explained that diagnosis is also more difficult if a patient is being treated with sedative drugs, which can cause severe neurological impairment that can mimic VS. But even given those considerations, Hanley says neurologists should easily be able to tell the difference between a patient in VS and MCS.

Dr. Nicholas Schiff, of the Weill Cornell Medical Center, in New York, told CNN that the risk of misdiagnosis is increased because a patient's condition can change over a long period and the transition from VS to MS often takes place outside the time window of careful assessment.

"The 'standard' is probably transfer to nursing home from acute care at an early stage, where an accurate diagnosis of VS gets replaced at the nursing home with an inaccurate prognosis of permanent VS, explicitly or implicitly," Schiff said.

"Because there are no standards for reassessment or any access to rehabilitation centers for many of these patients this is the status quo."

CNN's Caleb Hellerman contributed to this story.

stem cell human research

Human trials of ES cell research could begin soon

23 November 2009

By Alison Cranage

Appeared in BioNews 535

Stem cell therapy came one step closer to being tested for the first time in people this week, as a US company applied to the Food and Drug Administration (FDA) for a licence to start a clinical trial. The embryonic stem (ES) cell therapy is being developed to treat Stargardt, a currently incurable disease that causes blindness in young people.

Advanced Cell Technology, a Massachusetts-based firm, has tested the treatment on rats and mice which model the human Stargardt disease, and found it prevented further vision loss without adverse side effects.

Stargardt's macular degeneration destroys a part of the retina, leading to loss of vision. The treatment involves a single injection of a type of retinal cell that supports the photoreceptors needed for vision. The researchers have generated the retinal cells from ES cells derived from day-old human embryos left over from IVF (in vitro fertilisation) treatment and donated for research purposes. ES cells have the potential to develop into any type of cell in the body and, as such, scientists envisage they could be used to mend any broken part of the body, from kidney and liver to brain. They hold promise as a treatment for a range of diseases from Parkinson's to heart disease. However, using ES cells in medical research is controversial as many view the embryo as sacrosanct and inviolable, and oppose the use of human embryos in research.

'After years of research and political debate, we're finally on the verge of showing the potential clinical value of embryonic stem cells,' said Dr Robert Lanza, the chief scientific officer at Advanced Cell Technology. He added: 'We've seen absolutely no adverse effects whatsoever in any of the preclinical experiments and our cells are more than 99.9 per cent pure.'

'Our research clearly shows that stem cell-derived retinal cells can rescue visual function in animals that otherwise would have gone blind. We are hopeful that the cells will be similarly efficacious in patients,' Dr Lanza continued.

The trials would involve 12 Stargardt patients, and could begin early next year if the FDA grants approval. The clinical trial could be the first in the world as US company Geron, the only company so far to have received a licence from the FDA, has delayed the start of its clinical trial until the end of next year due to safety problems.

A similar proposal to treat age-related macular degeneration with ES cells is being developed by scientists in the UK led by Professor Pete Coffey of University College London, but this clinical trial is unlikely to start until early 2011.



RELATED ARTICLES FROM THE BIONEWS ARCHIVE
Spinal stem cell treatment gets go ahead from the FDA
08 November 2009 - by Jay Stone
American company Geron Corporation (GC) has been given permission to resume its clinical trials testing the embryonic stem cell treatment GRNPOC1....[Read More]
FDA approves trial of neural stem cells to treat Lou Gehrig’s disease
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The US Food and Drug Administration (FDA) has granted approval to NeuralStem Inc., a Maryland-based biotherapeutics company, to conduct the first human trial using neural stem cells for treatment of amyotrophic lateral sclerosis (ALS). ALS is a type of motor neuron disease often referred to as 'Lou Gehrig's' and 'Maladie de Charcot'. The late-onset condition, of unknown cause, affects approximately two in 100,000 people, including the UK physicist Stephen Hawking and US rock gui...[Read More]
Geron issues statement on halted stem cell trial
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Information has come to light regarding the US Food and Drug Adminstration (FDA)'s freeze on the clinical trails of GRNOPC1, a groundbreaking therapy for spinal cord injury derived from human embryonic stem (ES) cells being undertaken by biotech company Geron...[Read More]
US company's stem cell trial put on hold
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The US Food and Drug Administration (FDA) has delayed the start of a clinical trial that plans to use human embryonic stem cell(ES) cells to treat spinal cord injury. The trial is being run by Californian based company Geron. The FDA originally gave the go-ahead for the trial in January, but now has halted the start in order to review new data submitted by Geron....[Read More]
SOURCES & REFERENCES
Company seeks FDA permission to conduct clinical trial using human embryonic stem cells
LA Times | 19 November 2009
Embryonic stem cells to cure eye disease
Nature blogs | 19 November 2009
First human trials for stem cell blindness therapy
The Daily Telegraph | 20 November 2009
Huge potential balanced against ethical fears
The Independent | 20 November 2009
People facing blindness may pioneer stem-cell therapy
The Times | 20 November 2009
Stem cells: the first human trial
The Independent | 20 November 2009
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fyi

What About Ethics?
November 18, 2009

A group of doctors, medical ethicists, and others sent NIH director Francis Collins a letter yesterday urging the NIH "to fund studies on medical ethics, conflicts of interest in medicine and research, and prescribing behavior." The 96 authors add that moving research funded by NIH "into clinical practice is strongly affected by the complex web of relationships that exists among industry, academicians, medical educators and clinicians." The letter was organized by PharmedOut, an independent project run by Georgetown University's Adriane Fugh-Berman and she told ScienceInsider that many ethics research projects aren't funded by NIH. "I think that NIH has thought that it doesn't comes under their domain, and the trouble is that it doesn't come under anybody's domain," she says.

The Hastings Center's Thomas Murray, who did not sign the letter, says that Collins may consider the request. "The letter is actually quite gentle and modest in what it requests," he says to the Chronicle of Higher Education.

BIO NEWS- Many new articles

http://www.bionews.org.uk/
TOP NEWS STORIES




Trial to re-grow breasts after cancer surgery planned for next year
16 November 2009 - by Charlotte Maden
Scientists in Australia have developed a way for women diagnosed with breast cancer to regrow their breasts after a mastectomy. The group at the Bernard O'Brien Institute of Microsurgery in Melbourne plan to start clinical trials with the technique next year. It is believed that this will be only the second time in the world that tissue engineering has been carried out in a human....[Read More]

Stem cell treatment in irradiated rats offers hope for radiotherapy patients
16 November 2009 - by Marianne Neary
Following radiation to the head, rats transplanted with stem cells had greater improvements in learning and memory, showed a research team at the University of California....[Read More]

Public consulted on research involving animals with human genes
16 November 2009 - by Ben Jones
The UK's Academy of Medical Sciences has launches a broad study into the scientific, social, ethical and legal implications of research on animals containing human genetic material. Such animals, mostly mice, are found in labs across the UK and mostly consist of animals into whose DNA (deoxyribonucleic acid) single sequences of human genetic code have been inserted. However, with developing stem cell and other technologies, there is a perceived ethical crisis point ahead which t...[Read More]

genetic testing the deceased

Families Could Benefit From Gene Tests in Sudden Cardiac Death Victims Identifying mutation in deceased cuts costs for evaluating risk in relatives, study shows
Posted November 15, 2009

SUNDAY, Nov. 15 (HealthDay News) -- Genetic testing of people who've suffered sudden unexplained death is an effective and cost-efficient way of identifying genetic mutations that may put surviving relatives at increased risk for potentially deadly heart rhythm disturbances, a new study suggests.


Genetic defects that can cause sudden cardiac death occur in 25 percent to 30 percent of victims of sudden unexplained death. The current recommended approach is for first-degree relatives of sudden unexplained death victims to undergo comprehensive cardiac testing.

In this study, U.S. researchers compared the results and costs of postmortem genetic/molecular autopsy testing in 146 sudden unexplained death cases and found that 40 of the victims (26.7 percent) had either a catecholaminergic polymorphic ventricular tachycardia mutation (18 people) or a long QT syndrome mutation (22 people). Both are known to cause sudden death.

The researchers then estimated the costs of testing the 584 relatives of the sudden unexplained death victims. The total cost of postmortem genetic testing, genetic confirmation testing of the 160 relatives of victims who tested positive for mutations, and cardiac tests for both relatives of mutation-positive and mutation-negative sudden unexplained death victims was $6.78 million.

In comparison, comprehensive cardiac testing for all 584 relatives of the sudden unexplained death victims, followed by directed genetic testing, would have been more than $7.7 million.

"With less than 150 sudden unexplained death cases, use of a cardiac channel molecular autopsy would be estimated to save almost $1 million indicating a much less expensive way of evaluating those left behind," study co-author David Tester, a senior research technologist at Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minn., said in a news release.

"If you identify a mutation in a sudden unexplained death victim, you can do a simple genetic test in first-degree relatives to assess their risk and perform a disorder-directed clinical evaluation rather than a full clinical evaluation. If a relative is negative for the causative mutation, they may not need to undergo further clinical evaluation at all, and that saves money," Tester explained.

The study was to be presented Sunday at the American Heart Association's annual meeting in Orlando, Fla.

sample ethical issue

An Ethical Question: Does a Nazi Deserve a Place Among Philosophers?
Published: November 8, 2009

By PATRICIA COHEN

For decades the German philosopher Martin Heidegger has been the subject of passionate debate. His critique of Western thought and technology has penetrated deeply into architecture, psychology and literary theory and inspired some of the most influential intellectual movements of the 20th century. Yet he was also a fervent Nazi.

Now a soon-to-be published book in English has revived the long-running debate about whether the man can be separated from his philosophy. Drawing on new evidence, the author, Emmanuel Faye, argues fascist and racist ideas are so woven into the fabric of Heidegger’s theories that they no longer deserve to be called philosophy. As a result Mr. Faye declares, Heidegger’s works and the many fields built on them need to be re-examined lest they spread sinister ideas as dangerous to modern thought as “the Nazi movement was to the physical existence of the exterminated peoples.”

First published in France in 2005, the book, “Heidegger: The Introduction of Nazism Into Philosophy,” calls on philosophy professors to treat Heidegger’s writings like hate speech. Libraries, too, should stop classifying Heidegger’s collected works (which have been sanitized and abridged by his family) as philosophy and instead include them under the history of Nazism. These measures would function as a warning label, like a skull-and-crossbones on a bottle of poison, to prevent the careless spread of his most odious ideas, which Mr. Faye lists as the exaltation of the state over the individual, the impossibility of morality, anti-humanism and racial purity.

The book is the most radical attack yet on Heidegger (1889-1976) and would upend the philosophical field’s treatment of his work in the United States, and even more so in France, where Heidegger has frequently been required reading for an advanced degree. Mr. Faye, an associate professor at the University of Paris, Nanterre, not only wants to drum Heidegger from the ranks of philosophers, he wants to challenge his colleagues to rethink the very purpose of philosophy and its relationship to ethics.

At the same time scholars in disciplines as far flung as poetry and psychoanalysis would be obliged to reconsider their use of Heidegger’s ideas. Although Mr. Faye talks about the close connection between Heidegger and current right-wing extremist politics, left-wing intellectuals have more frequently been inspired by his ideas. Existentialism and postmodernism as well as attendant attacks on colonialism, atomic weapons, ecological ruin and universal notions of morality are all based on his critique of the Western cultural tradition and reason.

Richard Wolin, the author of several books on Heidegger and a close reader of the Faye book, said he is not convinced Heidegger’s thought is as thoroughly tainted by Nazism as Mr. Faye argues. Nonetheless he recognizes how far Heidegger’s ideas have spilled into the larger culture.

“I’m not by any means dismissing any of these fields because of Heidegger’s influence,” he wrote in an e-mail message referring to postmodernism’s influence across the academy. “I’m merely saying that we should know more about the ideological residues and connotations of a thinker like Heidegger before we accept his discourse ready-made or naïvely.”

Although the English text published by Yale University Press won’t be out in the United States for a few weeks, it is already making waves, as signaled by an essay in The Chronicle Review, the opinion and ideas journal of The Chronicle of Higher Education. In an essay titled “Heil Heidegger!” Carlin Romano, a critic for The Review, called Heidegger a “Black Forest babbler” and fraud who was “overrated in his prime” and “bizarrely venerated by acolytes even now.”

Few people have read the book, but the article has generated more than 150 online comments from vehement advocates and detractors, more than any other piece The Review has printed this year, said Liz McMillen, the editor. Others joined the fray.

Ron Rosenbaum, the author of “Explaining Hitler,” even extended the argument to the German Jewish philosopher Hannah Arendt, a former student and lover of Heidegger’s. Citing a recent essay by the historian Bernard Wasserstein, Mr. Rosenbaum wrote in Slate.com that Arendt’s thinking about the Holocaust and her famous formulation, “the banality of evil,” were contaminated by Heidegger and other anti-Semitic writings.

Commentators heatedly rejected the notion that significant ideas could not be distilled from vile ones. Writing for The New Republic’s Web site, tnr.com, Damon Linker declared it was “absurd” to “implicate Heidegger’s entire philosophical corpus.

He and others echoed the views of the influential American philosopher Richard Rorty, who once wrote in The New York Times, “You cannot read most of the important philosophers of recent times without taking Heidegger’s thought into account.” Mr. Rorty added, however, that “the smell of smoke from the crematories” will “linger on their pages.”

In Mr. Faye’s eyes Heidegger’s philosophy cannot be separated from his politics in the way, say, T.S. Eliot’s poetic skills or D. W. Griffith’s cinematic technique might be appraised independently of his own beliefs. While he doesn’t dispute Heidegger’s place in the intellectual pantheon, Mr. Faye reviews his unpublished lectures and concludes his philosophy was based on the same ideas as National Socialism.

Without understanding the soil in which Heidegger’s philosophy is rooted, Mr. Faye argues, people may not realize that his ideas can grow in troubling directions. Heidegger’s dictum to be authentic and free oneself from conventional restraints, for example, can lead to a rejection of morality. The denunciation of reason and soulless modernism can devolve into crude anti-intellectualism and the glorification of “blood and soil.”

Passions about Heidegger have simmered for years. He joined the Nazi party in 1933 when he became rector of Freiburg University and oversaw the dismissal of all Jewish professors. After the war Heidegger was banned by a de-Nazification tribunal from teaching. In the 1950s Arendt re-established ties with him and labored to revive his reputation.

Heidegger was a critic of modern technological society and of the Western philosophical tradition that gave rise to it. He argued that we must overcome this tradition and rethink the very nature of human existence or being.

His prose is so dense that some scholars have said it could be interpreted to mean anything, while others have dismissed it altogether as gibberish. He is nonetheless widely considered to be one of the century’s greatest and most influential thinkers.

Theologians have used his critique of reason to explain the leap of faith; architects have been inspired by his rejection of conventional rules to introduce a buffet of new styles, materials and shapes to building design. His criticism of mechanistic technology has attracted environmentalists and planners.

A verbal brawl over Heidegger’s theories should not be surprising, though. After all, the classic American position on how liberal societies should treat dangerous ideas is with more discussion.

That is precisely what Mr. Faye says he wants. In his view teaching Heidegger’s ideas without disclosing his deep Nazi sympathies is like showing a child a brilliant fireworks display without warning that an ignited rocket can also blow up in someone’s face.

several bioethics stories

British mother asks court to turn off her infant's machine
Nov 07, 2009

"Amicably separated" parents in Britain are at loggerheads over whether to let their disabled 13-month-old son die. RB, as the boy is called to protect the family's privacy, has congenital myasthenia syndrome, a rare neuromuscular condition that prevents him from breathing on his own and severely restricts his power to move his limbs. The British health service has applied to the High Court in London to allow life-saving care to be withdrawn.

His doctor, who cannot be named, has described the child as at the "most severe end" of physical disability. He lacks the ability to cough or swallow and must be moved every two hours to prevent pressure sores. The mother believes that her child will be better off dead. But the father contends that he should have a tracheotomy so that he can be cared for at home. Unlike many children with severe developmental disorders, RB may have normal intelligence. The father contends that he can see, hear, feel, and recognise his parents and deserves to live.

Although most of the media presented a very dark picture of RB's future, the Daily Mail published an open letter from the mother of a 10-year-old with a similar condition who went on to have a tracheotomy. He goes to school in a wheelchair and is a popular and well-loved child. "Today I look at my gorgeous, funny, cheeky little boy and I am endlessly grateful we gave him a chance to live," writes Niki Shisler. She says that doctors are normally cautious and pessimistic and speculates that they may be too concerned about the cost of care. -- BMJ, Nov 4



Aborted foetus cells used to make beauty cream
Nov 07, 2009

A San Francisco cosmetics company, Neocutis, has admitted that it used cells from an aborted male foetus as an ingredient in a beauty cream. The Swiss product is manufactured from patented processed skin proteins (PSP), and is used for conditions such as psoriasis and eczema, and, unsurprisingly, ageing. It is controversial because the proteins were obtained from a postage stamp-sized rectangle of skin taken from a terminated 14-week old male foetus in Switzerland.

Anti-abortion groups were particularly scandalised by the company's brazenness in defending the use of aborted tissue in beauty creams. Neocutis contends that harvesting the skin cells was responsible and ethical. "The small skin donation" taken to develop this cosmetic treatment "originated from a single terminated pregnancy that could not survive to term and that was deemed medically necessary by the attending physicians." The company compared this use of foetal tissue to the 1954 Nobel Prize, which was awarded to "researchers who utilized fetal kidney cells to develop the polio vaccine."

The PSP is used in Neocutis bio-restorative skin cream, Journée bio-restorative day cream, Lumière bio-restorative eye cream and Bio-gel bio-restorative hydrogel. The Neocutis website says that "Through years of research, physicians [have] discovered fetal skin has a unique ability to heal wounds without scarring."

The moral status of foetal material is widely disputed. For some, as an entry in the American Journal of Bioethics Blog suggests, "foetal proteins in a face cream aren't any different from animal or plant protein because for them the moral status of the aborted foetus doesn't have the moral status to give one concern if consent to both abortion and research took place."

On the other hand, the Vatican discussed the use of "biological material of illicit origin" in its recent statement on bioethics, Dignitas Personae. This insisted that "The corpses of human embryos and fetuses, whether they have been deliberately aborted or not, must be respected just as the remains of other human beings." ~ Washington Times, Nov 3,


My genes made me do it, says Italian murderer
Nov 07, 2009

An Italian of Algerian descent who stabbed a man to death in 2007 has had his sentence reduced because he has a gene which predisposes him to violence. Abdelmalek Bayout originally received a relatively mild sentence of 9 years and 2 months because he had a psychiatric illness. But his lawyer succeeded in knocking another year off by pointing out that he had gene variants linked to aggression, notably the gene encoding the neurotransmitter-metabolizing enzyme monoamine oxidase A (MAOA). A molecular neuroscientist and a cognitive neuroscientist testified that this would make him more prone to violence when provoked.

This is not the first time that MAOA has been invoked as a defence in criminal law. In the last 5 years, it has come up more than 200 times in US trials, according to Nita Farahany, of Vanderbilt University. She specialises in the ethical and legal perspectives on neuroscience and is sceptical of the "my genes made me do it" defence. "The point is that behavioural genetics is not there yet, we cannot explain individual behaviour, only large population statistics," she told Nature News.

Genetic determinism is far from being a dogma amongst geneticists. "90% of all murders are committed by people with a Y chromosome -- males. Should we always give males a shorter sentence?" says Steve Jones, of University College London. "I have low MAOA activity but I don't go around attacking people." -- Nature News, Oct 30



Genetic tests used to prove nationality in UK
Nov 07, 2009

British immigration officials want to use genetic tests to determine the nationality of asylum seekers, a move which scientists have criticised as "fundamentally flawed science". "Genes are not aware of national borders," said Sir Alec Jeffreys, a geneticist at the University of Leicester. "Nationality is a legal concept, and it's got nothing to do with genetics at all."

And bioethicist John Harris, of Manchester University, commented: "Genetic testing may be able to tell you where somebody's ancestors started out, but it doesn't tell you where they're from. It won't give them anything worth knowing, and it's very likely that what it will give them is misleading."

The United Kingdom Border Agency launched a pilot project in September because it feels that many African asylum seekers are claiming that they have come from a dangerous and war-torn country like Somalia or Sudan rather than a relatively peaceful place like Kenya. The refugees are asked to give a voluntary cheek swab or hair or nail sample which the Agency says yields valuable, if not conclusive, evidence about their country of origin. So far the tests are only being used on people who claim to come from Somalia, Ethiopia, Eritrea, Kenya, Uganda and Sudan.

According to AP, the agency originally planned to use the tests as definitive proof of nationality, but retreated after scientists protested. Now the agency declares that they will only be used in combination with other ways of determining a refugee's nationality, such as language analysis and interviews. ~ AP, Nov 6



British IVF clinic makes worst mistake possible, says industry watchdog
Nov 07, 2009

A serious error in a British fertility clinic's screening processes has led to concerns about the safety of IVF procedures. The London Women's Clinic (LWC) was found this week to have produced a large quantity of embryos using unscreened sperm. The sperm had a serious chromosomal abnormality which could be passed on to any of the unborn children, the Independent newspaper found. The mistake led to a miscarriage for at least one of the couples to whom these embryos were donated. Twenty-two other embryos resulting from the sperm were destroyed.

The incident could spark more investigation into the practices of British IVF clinics and the industry's current regulatory system. The Human Fertilisation and Embryology Authority (HFEA), the UK's fertility industry watchdog, has stated that it will name and shame similar errors in future. The LWC's mistake has been described as the worst possible for a fertility clinic.

Current HFEA figures reveal that there have been 182 "incidents" in British fertility clinics in 2008, eight of them "serious". But lawyers are sceptical of these figures and say that the actual numbers could be far higher. A number of affected couples are initiating legal proceedings.

The LWC was pulled up earlier this year in an HFEA inspection, after the required number of "witnessing stages" crucial to correct screening procedures, was not carried out. However, the clinic was found still producing embryos using unscreened sperm in June, according to some prospective parents.

The couple later demanded compensation from the LWC. "It made us so aware that IVF is a business and it all comes down to money," the couple told the Independent. They were eventually remunerated; the LWC sent them abroad for fertility treatment; and they are now expecting a child. ~Independent (UK), Nov 1



Oklahoma abortion reporting law "misrepresented"
Nov 07, 2009

A new law affecting patient privacy has become the centre of political controversy in Oklahoma. As reported last week in BioEdge, abortion advocates complained that women could easily be identified using the information gained from a new questionnaire. But the state chairman of Oklahomans For Life, Tony Lauinger, says that this misrepresents the new abortion-reporting law.

He says that new law actually repeals the existing law's requirement for identifiable residential information. The legislation reads: "Nothing in the Individual Abortion Form shall contain the name, address, or information specifically identifying any patient." However, the form is highly comprehensive. Doctors are required to tick about 37 boxes, many of which are comprised of several (in one instance around 40) sub-questions about the patient's reasons for abortion, number and nature of past abortions, method of payment, as well as the mother's race, age, marital status and other details. The new legislation also requires information about abortion complications.

Lauinger points out that the abortion industry, particularly the Guttmacher Institute (formerly the research arm of the Planned Parenthood Federation of America) already collects and publishes demographic information through annual surveys.

Medical privacy is a major concern in the age of the internet. As the amount of publicly available information grows, medical information can be increasingly matched to demographic data. Latanya Sweeney, of Harvard's Center for Research on Computation and Society, says that "policies on data sharing are not very good, and the result is that data tend to flow around and get linked to other data." ~ BioEdge, Oct 30 , National Right to Life Committee Oct 21, Harvard Magazine Sept-Oct 2009



New suicide drug available next year, says Nitschke
Nov 07, 2009

A "peaceful pill" for people who want to commit suicide will be made available by mail order in 2010. The pill is a stable solid form of the barbiturate Nembutal. Developed by the euthanasia group Exit International, it is designed to withstand transport and can be stored for up to 50 years. Customers will only have to mix it with water. An activation kit with the chemicals for reconstitution and a test kit to check the strength of the resulting product are nearly finished so that the pill can be distributed.

Dr Philip Nitschke, a leading right-to-die advocate and director of Exit International, said "Exit believes that all seniors of sound mind should have the option of a peaceful death at the time of their choosing should this be their wish - this Exit Pill will go some way to ensuring this." Nitschke is set to hold instructional suicide talks in San Francisco this Sunday. ~ Assisted-Suicide Blog Oct 30, CBC News Nov 4


Next year, says Geron, embryonic stem cell trials will begin. We hope
Nov 07, 2009

One of the most convincing advocates of human embryonic stem cell research, quadriplegic actor Christopher Reeves, died without seeing any substantial progress towards a cure for spinal cord injury. However, he was buoyed up by the hope that hESC research at Geron Corporation might help him walk again. Geron has announced many times that it would soon start human hESC trials -- but so far no trials have begun. The latest announcement came last week when it announced that the trials would begin next year. Its share price rose 4.2% at the news.

Dr David Prentice, of the Family Research Council, a critic of embryo research, has been logging Geron's announcements since 2002 and found that trials were going to begin "next year" every year since 2004. He argues that "the obsession with embryonic stem cells has obscured the real hope for patients-adult stem cells. Peer-reviewed evidence of adult stem cell success for spinal cord injury patients has already been published by groups in Portugal, in Australia, in Ecuador,and in Brazil". The trials with embryonic cells have usually been delayed over safety concerns, as they could cause tumours. --Forbes, Oct 30