Category: Ethical Commentary

How Bill C-7 will sacrifice the medical profession’s standard of care

Amendments to assisted dying laws are a stunning reversal of the central role of the medical and legal concept of the standard of care

Trudo Lemmens, Mary Shariff, Leonie Herx

As Parliament discusses Bill C-7’s expansion of the Medical Assistance in Dying (MAiD) Act, one issue has been conspicuously absent from public debate, even though it has major implications for medicine and for patients: the impact of the bill on the role of the medical profession in determining the standard of care, as it applies to MAiD.

The government introduced Bill C-7 in response to the decision of Quebec Superior Court Justice Christine Beaudouin (in the Truchon case), who ruled unconstitutional the current law’s limiting of MAiD to those whose natural death is “reasonably foreseeable.”. . . [Full Text]

After all, what is really wrong with apotemnophilia?

BioEdge

Reproduced under Creative Commons Licence

Michael Cook*

Apotemnophilia is one of those words which may be useful in Scrabble© but seldom come up in day-to-day discourse, let alone medical practice. However, it is an increasingly contested issue in bioethics, though better known as BIID, Bodily Integrity Identity Disorder, or the amputation of healthy limbs.

BIID is a rare psychiatric condition in which people know that their leg (for instance) is normal and healthy, but still feel that it is not part of their identity; they want it cut off, even though they realise that they will become disabled. Oddly enough, however, they often do not seem to mind wearing a prosthesis to recover some of the limb’s functionality.

In a provocative article in The New Bioethics, Richard Gibson, of the University of Manchester Law School, in the UK, asks whether ultimately there would be anything wrong with BIID if a prosthesis provided equal or better functionality. . . [Full text]

Examining the thorny moral problem of foetal reduction

BioEdge

Michael Cook

It is a truth universally acknowledged that defending an opinion on abortion will make at least half of one’s readers unhappy. But Joona Räsänen, a Finnish bioethicist at the University of Oslo, defends an opinion on abortion in the Journal of Medical Ethics which is bound to make all of them unhappy.

He tackles the controversial question of foetal reduction: killing one or more foetuses in a multiple pregnancy. This may happen when one of them is diseased or has a birth defect or when the mother feels incapable of caring for more than one child. It often happens after IVF when a woman ends up with triplets or quadruplets – or even octuplets. Some doctors have refused to “reduce” the pregnancies because they regard it as immoral. . . [Full Text]

Navigating Vaccine Ethics

CMDA’s The Point

Reproduced with permission

Jonathon Imbody

CMDA Senior Vice President for Bioethics and Public Policy Dr. Jeff Barrows and I recently wrote a piece for The Public Discourse, “Is Receiving the Pfizer-BioNTech COVID-19 Vaccine Ethical?” that suggested principles to consider as we navigate ethical issues related to COVID-19 vaccines. I’ve included brief highlights below; more from the original article and also new observations will be published in an upcoming edition of CMDA Today (previously known as Today’s Christian Doctor).  

CMDA has approved an ethics statement that can help guide individuals’ analyses of immunizations and the potential for moral complicity with evil:

  1. “Using technology developed from tissue of an intentionally aborted fetus, but without continuing the cell line from that fetus, may be morally acceptable.
  2. “Continued use of a cell line developed from an intentionally aborted fetus poses moral questions and must be decided as a matter of conscience, weighing the clear moral obligation to protect the health of our families and society against the risk of complicity with evil.
  3. “Using a vaccine that requires the continued destruction of human life is morally unacceptable.”

Deciding which COVID-19 vaccine poses the least ethical concerns hinges in part on the implication of abortion in (a) the initial design of the vaccine, (b) the confirmatory testing of the vaccine and (c) the ongoing production of the vaccine. Vaccines that continue to use the abortion-derived cell line in ongoing production pose the most obvious ethical barrier to use by pro-life individuals. This category includes vaccines by AstraZeneca–University of Oxford and by Janssen–Johnson & Johnson. In fact, these vaccines employ abortion-related cell lines in all three stages—design, confirmation and production.

While still ethically concerning, the fact that this remote and limited interaction with abortion does not involve the continuing use of an aborted fetal cell line makes it less ethically problematic compared to its competitors that use these cell lines for ongoing vaccine production.

Unlike the aforementioned COVID-19 vaccine candidates that rely on abortion-derived cells for their ongoing production, the Pfizer-BioNTech vaccine used the HEK-293 cell line from a 1972 abortion only to confirm that messenger RNA was properly coding for the spike protein of the SARS-CoV-2 virus. While still ethically disconcerting, the fact that this remote and limited interaction with abortion does not involve the continuing use of an aborted fetal cell line makes it less ethically problematic compared to its competitors than use these cell lines for ongoing vaccine production.

A consideration of the harm to others that can come without vaccination goes to the heart of Christian ethics in a way that virtually every believer understands: Vaccinating yourself and those who depend on you is an important component of following the command to love thy neighbor.

We recognize that each individual must weigh ethical considerations before making a vaccine decision. When we examine the Pfizer-BioNTech vaccine in light of ethical principles of (a) loving our neighbor by protecting them through our own vaccination, (b) the distance in time from an abortion connection and (c) the fact that the vaccine does not continue to use cell lines derived from an abortion, we find these factors considerable in mitigating the ethical concerns and opening the door to receiving the vaccine in good conscience.

Is Reducing Down Syndrome Births a Form of Eugenics?

We are still choosing who lives and who dies based on genes.

Psychology Today

Richard Gunderman

A recently released study finds that Europe has reduced the number of babies born with Down syndrome by 54%. In 2016, the same researchers found that the U.S. rate of Down syndrome births had declined by 33%. Some friends and colleagues have asked me whether such reductions, which entail prenatal diagnosis and elective pregnancy termination, mean that we are still practicing some form of eugenics.

Down syndrome is a genetic disorder usually associated with an extra copy of chromosome 21 – hence its other name, trisomy 21. Children with Down syndrome generally exhibit growth delays, reduced intelligence, and a shortened life span of around 60 years. The risk of having a baby with Down syndrome increases with parental age. When prenatal testing reveals the diagnosis, some parents, including apparently many in Europe and the US, elect to terminate the pregnancy. . . [Full text]