No bioethics in country X

When I studied Evolutinary Biology, I had a good look at genetics and mutations. Currently we consume GMOs or genetically modified organisms. Most people are unaware that they even consume such items. Currently there is no regulation for GMO food lables. After seeing what nature can do that puts entire species out of existance, I am concerned that there is no federal regulation requiring labels. I thought about this while reading Orax and Crake and the problems encountered with transgenetic materials. I think comapeys have an ethical obligation to lable GMO foods.

How many Judges does it take to......

A 73 year old woman in in Wisconsin suffered from advanced Alzheimer's disease, bedriddenin the fetal position. Cannot move, cannot eat, and has no bowel or bladder control. She does not follow even simple commands. If there was a case for PAS, this is it! Her legal guardian, her sister, wanted to remove life sustaining measures. The patient named Edna at age 43 made statements such as she would rather die of cancer than lose her mind. Unfortunatly this vibrant accomplished journalist is now just that, losing or lost her mind. Betty her guardian petitioned to remove nutrition from the feeding tube and hydration. Wisconsin lacks some of the right to die wisdom of other states. The nursing home asked for all of her reletives to consent in writing. All but one did. The one niece gave verbal conscent but did not want to memorialize her conscent in writing. The nursing home then asked for a court order. The circuit court was not convinced that Edna was in a persistant vegitative state and denied the withdrawal based on the 14th amendment. Now, Her family agrees, her doctors agree, and the nursing home agrees this is in Edna's best interest. The Wisconsin Supreme Court upheld the Circuit court based on "substituted judgment" only applies to someone with a living will and the court rules that keeping her on the feeding tube is in her "best interest" The Wisconsin Supreme Court also cite that since she is not in a persistent vegitative state, they "feared falling down a confusing slipper slope toward legalized euthanasia." This comes after many other State Supreme Courts have ruled to the contrary. What does it mean when the legal system chooses biological life over intrests? Has Liberty really gone out of fasion or has the Law gone home for the day.

Source Shaprio, R.S. Theoretical Medicine and Bioethics 1999

Child Euthanasia

In class readings, Wolf describes age catagories for child euthanasia with the conclusion that it is not appropriate at any age. In an article I read (When Torment Is Baby's Destiny, Euthanasia Is Defended NY Times, march 10, 2005) the author states "We are convinced that life-ending measures can be acceptable in these cases under very strict conditions." The article describes three groups in which infants can be placed. Those with no chance of survival, those who who may not survive and require intensive care, and those with a "hopeless prognosis" and "what parents and medical experts deem to be unbearable suffering," even if they don't require intensive care. Again as I have blogged before, there is a cultural difference. Many with debilitating conditions lead productive happy lives. We saw this clearly with Harriet McBryde Johnson and many others that make up Not Dead Yet. I agree medicine is advancing every day (some good some not) and more can be done than in the past. However, if we treat with great resources those who will die or live in great suffering, we have not respected them as human, in fact we have turned them into research projects. They become experiments giving parents a false sense of hope.

Is Death Cost Effective?

I have been doing a significant amount of reading on Physician assisted suicide and euthanasia. The Netherlands seems to be one of the most progressive in this area. The Dutch system for PAS and issues like it are being debated in relation to how the US should proceed. The US has never had a socialized medical system. In Holland medical care is free to the citizens which totals around 16 million people compared to 303 million in the US. Having social medicine means that a set amount of money is put aside for treatment and being able to operate on that budget. In the US we have "managed health care". HMO's pay incentives to hospitals for keeping costs down. There are also physician incentives as well. Could PAS save money? Critical care medicine runs in the thousands per day and end of life events cost even more. While i don't agree with slippery slope theories, I can see how US health care from a corporate side may influence policy for those who are terminally ill to end their "suffering" sooner than later. Long term care beds cost about 63,000 per year and there are about 1.8 million beds in use. Thats about 11 billion dollars per year for long term BASIC care, not a hospital admission. Since health care is run as a business and not as a right of the people I think the US would need tighter restrictions than our Dutch friends.

Source for number: http://www.efmoody.com/longterm/nursingstatistics.html

The Island

At the advice of a friend, I watched the movie the Island.  Basically a program created by partial govenment research dollars and supported through rich and famous customers, create clones of their clients in order to cheat death.  These clones have no idea they are clones and are capped intellectualy at about age 16.  The clones think they were saved from a bioterror apocolyps and are now being cared for.  The hopes and dreams of going to "The Island" where they can life the rest of their lives in the last germ free place in the world.  Of course everyone selected to go to the island is really on a first class, expense paid trip to the harvest...of their organs.  When two clones figure it all out, they decide they want to live as other people do.  This has been my objection to cloning all along.  If we clone our own organs for replacement, I'm OK with that.  To clone another me....scary as that might be......and to murder for harvest is clearly wrong.  Who cares if a clone has "ensoulment" or not.  Life is life, and a life that is self aware and can be part of the moral community is to be protected.  Check it out!  it has Ewan McGregor and Scarlett Johansson (NICE!!!!!)

Sperm donor to pay child support?

I was watching the news when a report of a man who donated sperm twice to the same woman and she has birthed 2 children has won a case for child support. Since the donor was not anonymous and did have visitation, he was found to be partly financially responsible. In terms of the "Slippery Slope" does this open the door to DNA matches and identity search or anonymous donors for support?

Children on Statin Drugs

The July 8th Science Times had an article on children as young as eight being put on cholesterol lowering drugs called statins in hope that it would prevent heart attacks in the future.  The recommendations come from a panel at the American Academy of Pediatrics. Children with LDL cholesterol of 190 mg/dl or with a significant family history would be candidates for such a drug.  Doctors are divided on the issue and I tend to agree with the doctors who are against this practice.  

Side effects are muscle pain and cognitive problems.  There is no data that suggests it will prevent a heart attack or prolong life.  it would be a terrible shame to have children taking a medication that most could have done without if only they ate less McDonald's and exercised more.

Parents are often influenced by doctors advice.  If a child fits the criteria, drug companies advertise these drugs as life prolonging if not life saving, and a doctor advises so, parents will be likely to consent to the treatment.  Until a child reaches their age of majority (18 in most states) they cannot make their own medical decisions.  Since there is no long term studies that prove it will work, not what would happen to a person of statins for more than 50 years of their life, it would seen wreckless to force such a treatment on a child.  Children do have informed consent, parents make healthcare decisions.  Should we allow children who are not able to consent, be put on potentially dangerous medication that has no real multi year study to suggest it might actually work?

NY Times Cancer Drug

Yesterday I read an article titled "Costly Cancer Drug Offers Hope, but Also a Dilemma".  This is about a cancer drug called Avastin. It is FDA approved for advanced lung and colon cancer but is being prescribed for many different types of cancers without evidence of it actually working to prolong life or kill the cancer. The article quotes that the drug price from the maker (Genentech) ranges from, $4,000 to $9,000 a month, based on the patient’s weight and the type of cancer.
What was even more astounding to me was that it is not an unusual practice that doctors and hospitals can buy the drug and then sell it to patients or their insurance company at a mark up! I wonder where the financial incentive ends and the patient care begins? My former roommate and best friend, Billy has had colon cancer for 4 years now. I have not asked him, YET, if he is on this drug. Billy is willing to try anything that will make him well. If his oncologist were to suggest it, Billy’s insurance would pay for it (he is well insured). It is approved for colon cancer so is there REAL benefit to this or perhaps a strong placebo effect he can pay 50,000 a year for, or should I say WE ALL pay for through insurance premiums. If it would make him or others well, I would surely pay my share for it but I am appalled that it can be purchased and resold with a mark up. I am not saying by ANY stretch that money spent to save lives is money wasted but lets look at the numbers. In one case about its effectiveness against lung cancer the study’s Avastin patients lived no longer than those who got the chemotherapy plus placebo. The drug slowed the median time until progression of tumors but the difference was less than a month. This hardly seems like good money spent. If a tumor does not get larger, but the patient still dies, is that really a benefit? There is a case noted where a patient with brain cancer had a remarkable improvement and the physician has prescribed it to many other of her patients. This is an “off label” use or a use not defined by the FDA. Since this drug is always given in combination with chemotherapy, I guess it would be hard to decide whether or not it truly makes a difference. People will rightfully do anything to rid themselves of such a horrible disease and therefore would not go into a trial where this drug is used alone to reveal true if any benefits. Could it be the case that cancer is too profitable to cure? Sigh.......