Category: Ethics

Euthanasia dispute in Belgium: When do doctors cross a line?

CBC News

Associated Press

A disputed case of euthanasia in Belgium, involving the death of a dementia patient who never formally asked to die, has again raised concerns about weak oversight in a country with some of the world’s most liberal euthanasia laws.

The case is described in a letter provided to The Associated Press, written by a doctor who resigned from Belgium’s euthanasia commission in protest over the group’s actions on this and other cases.

Some experts say the case as documented in the letter amounts to murder; the patient lacked the mental capacity to ask for euthanasia and the request for the bedridden patient to be killed came from family members. The co-chairs of the commission say the doctor mistakenly reported the death as euthanasia. . . [Full Text]

The War on the Hippocratic Oath

First Things

Wesley J. Smith

The screaming was so loud, you would have thought that the Trump administration had overturned Roe v. Wade. It hadn’t, of course. But it had directed needed attention at the existing legal protection that allows doctors and nurses to refuse to participate in abortions without fear of firing or other job sanctions. This protection is sometimes called “medical conscience rights.”

The occasion for the uproar? The Department of Health and Human Services announced its intention to create a new office of Conscience and Religious Freedom Division in the HHS Office for Civil Rights (OCR) to enforce medical conscience. It is worth noting that this proposed action will not change the law. But it will revitalize enforcement efforts after years of the Obama administration’s hostility toward religious liberty generally and medical conscience rights specifically. Indeed, the newly created enforcement office will put medical employers on notice that the current administration considers medical conscience rights to be fundamental. As the HHS press release put it:

The creation of the new division will provide HHS with the focus it needs to more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom, the first freedom protected in the Bill of Rights.

In a country with a long and venerable history of honoring conscientious objection and protecting the free exercise of religion, one would think this step would be met by applause. But for some, it was akin to a declaration of social war. The Massachusetts Medical Society sniffed in opposition:

As physicians, we have an obligation to ensure patients are treated with dignity while accessing and receiving the best possible care to meet their clinical needs. We will not and cannot, in good conscience, compromise our responsibility to heal the sick based upon a patient’s racial identification, national or ethnic origin, sexual orientation, gender identity, religious affiliation, disability, immigration status, or economic status.

The New York Times was equally condemning. In an editorial titled, “The White House Puts the Bible Before the Hippocratic Oath,” the editorialists warned hyperbolically:

The decisions may make it more difficult for teenagers wanting to get tested for sexually transmitted diseases, for gay men looking to prevent HIV and even for women seeking breast exams or pap smears.

Please. No one who supports a robust protection of medical conscience advocates compromising the physician’s responsibility to “heal the sick.” No one wants to prevent women from obtaining cancer screenings. Nor do supporters of medical conscience seek to authorize doctors and nurses to discriminate against individuals.

Rather, medical conscience prevents doctors and nurses from being forced to act in opposition either to their religious beliefs – e.g., commit a grievous sin – or to their moral consciences by being forced to participate in morally objectionable procedures, such as taking innocent human life in abortion, assisted suicide, or lethal injection euthanasia. It could also protect medical professionals from being required to administer hormones to inhibit puberty in adolescents experiencing gender dysphoria – a controversial recent innovation that the American College of Pediatricians has called “mass experimentation.” That opinion is becoming heterodox in the field, but surely no doctor should be forced in an elective procedure to act in a way that he believes actively harms the patient. The same goes for physicians who object to participating in sex-change surgeries based on the belief that sex is biologically determined or that it is wrong to remove healthy organs. Conscious protections should also apply to a doctor or nurse who objects to participating in infant circumcision based on a moral objection. And surely no doctor should be forced to participate in an execution, not even the administrative act of declaring the condemned prisoner dead after the execution.

People of good will can hold radically divergent moral beliefs, including about legal medical services and procedures. The stakes in this controversy are very high. As I have written here before, there is a concerted effort underway to drive pro-life and Hippocratic Oath-believing doctors, nurses, and other professionals out of medicine – a lamentable potentiality. We need increased comity and tolerance for those medical professionals who object to reigning moral paradigms and hold to sanctity-of-life ethics. The new HHS office represents a positive step toward achieving that end.

Post Script: The best and most efficient way to protect medical conscience would be for the states and the federal government to allow medical conscience rights to be enforced via private causes of action in civil court, which is not currently allowed generally. I will discuss that idea in a future column.

 

Why would my terminally ill father be denied a medically assisted death?

The Globe and Mail

Paul Taylor

The question: My father was in the advanced stages of prostate cancer and wanted a medically assisted death. He was told he needed the approval of two health-care providers. One said yes, but the other said no because he “was not in any distress.” But that decision was so wrong. My father was a very stoic man, and was not one to complain. Did the doctor want him to break down in tears and beg to be put to death? My father died two weeks later in a hospice – instead of his home, the place where he wanted to die.

The answer: It has been over a year and a half since Parliament passed a law that makes medical assistance in dying – called MAID for short – legal across Canada. The story you tell reflects one of the many challenges in creating a standardized system to handle these requests and to ensure that patients and their families are properly informed.

One key failing in your father’s case is that he was not apparently told he could have asked for another assessment after the second MAID assessor turned him down. If another assessor had agreed that he was eligible, he could have proceeded with an assisted death.

It’s impossible to say whether his assessors were unaware he had this option or simply failed to mention it.

Whatever the case, “we need to do a better job educating health-care providers about what they must be disclosing to patients,” says Jocelyn Downie, a professor in the faculties of law and medicine at Dalhousie University in Halifax.

In the meantime, it’s certainly worthwhile reviewing how the process is supposed to work. . . [Full Text]

First compensation claim for compulsory sterilisation in Japan

BioEdge

Michael Cook

A Japanese woman in her 60s is planning to sue the government over her forced sterilization under a 1948 law. This will be the first time that state compensation has been sought for sterilisation. The mentally disabled woman in Miyagi Prefecture was a teenager when she was forced to undergo the procedure.

Records of 2,700 people who were sterilized under the Eugenic Protection Law — which was in force until 1996 — have been found in local government archives, a development which could help victims seek state compensation.

Like some Western countries, Japan has a dark eugenic past.

A 1948 Eugenic Protection Law (EPL) was intended to prevent the births of “inferior descendants” and to foster the health of mothers and pregnant women. It provided for both voluntary and involuntary sterilisation. Doctors could apply for permission for sterilisation to a regional board if a patient suffered from a range of conditions which were believe to be hereditary, including schizophrenia, manic-depressive psychosis, epilepsy, abnormal sexual desire, “remarkable criminal inclination,” Huntington’s disease, muscular dystrophy, albinism, achromatopsia, deafness, haemophilia, and so on.

The Ministry of Health issued guidelines in 1953 clarifying what doctors could do: “It is permissible to restrain the patient’s body, to administer an anesthetic, or to deceive the patient, etc.”

According to government statistics, between 1949 to 1994, 16,520 involuntary sterilizations were performed, 11,356 on women, and 5,164 on men. Most were performed on inmates of psychiatric hospitals and institutions for intellectually disabled people.

Compulsory sterilisation lapsed in 1996 with the passage of the Mother’s Body Protection Law. However, the Japanese government has refused to apologize to the victims of the law or offer them compensation.

First compensation claim for compulsory sterilisation in JapanThis article is published by Michael Cook and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees. Some articles on this site are published under different terms.

Tiny human brain organoids implanted into rodents, triggering ethical concerns

Stat

Sharon Begley

Minuscule blobs of human brain tissue have come a long way in the four years since scientists in Vienna discovered1how to create them from stem cells.

The most advanced of these human brain organoids — no bigger than a lentil and, until now, existing only in test tubes — pulse with the kind of electrical activity that animates actual brains. They give birth to new neurons2, much like full-blown brains. And they develop the six layers3 of the human cortex, the region responsible for thought, speech, judgment, and other advanced cognitive functions.

These micro quasi-brains are revolutionizing research on human brain development and diseases from Alzheimer’s to Zika4, but the headlong rush to grow the most realistic, most highly developed brain organoids has thrown researchers into uncharted ethical waters. Like virtually all experts in the field, neuroscientist Hongjun Song of the University of Pennsylvania doesn’t “believe an organoid in a dish can think,” he said, “but it’s an issue we need to discuss.” . . [Full text]