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Bioethics

Should we be able to know how long we have to live?

A new test, soon to become available to the general public in the UK, can tell people how fast they are aging, thereby allowing them to estimate their life expectancy. The test, which should be available for €500 (£435), is based on an analysis of the telomeres, small protective caps at the extremities of a person’s chromosomes. Short telomeres are associated with a shorter lifespan and indicate a more advanced biological age (by contrast with the person’s chronological age). The test has been described as opening an “ethical Pandora’s box”. Concerns have been raised regarding people’s possible reaction to information about how long they still have to live. Some are also worried that the test might be used by organizations selling dubious “anti-aging” remedies to attract potential customers, and that insurance companies might demand to have access to such information before providing cover, requiring people with shorter telomeres to pay higher premiums. Should the prospect of the public availability of such a test concern us, and should we try and restrict it?

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Why Wills and Kate must breed

By Charles Foster

As some may have noticed, today there is a wedding.  It has been immensely costly, and while I do not for a moment resent that expenditure, the cost has an important ethical corollary.

The money has been spent primarily to ensure dynastic continuity. By accepting our money for their Bollinger and bobbies, William and Kate are impliedly accepting our commission to use their best endeavours to breed. They have taken the People’s Shilling, and have become, first and foremost, breeding animals. Their gametes are held in trust for the nation, and they should guard them.  Kate must marinate her eggs in the finest organic nutrients that Fortnums has to offer: William must never wear tight underpants, and always wear a box when he plays cricket.Read More »Why Wills and Kate must breed

For sale: one womb

In a world where you shouldn’t have to wait for anything, why wait nine months for your child to be born?

This is the marketing pitch of Silver Sling, a Manhattan-based surrogacy clinic. Silver Sling offers ‘chemically accelerated births’ that can shorten the duration of surrogate births to three months. Wealthy clients who wish to have a child but do not wish to undergo pregnancy themselves – much less have to wait nine months to have a child – may pay for these accelerated pregnancies as a means of convenience and time efficiency. Silver Sling enables them to have a child in three months by transferring the couple’s embryo to the uterus of another woman who agrees to act as a surrogate for a fee. These surrogates are, for the most part, women from the lower end of the economic spectrum.

Lydia is one of these women. She is a Russian immigrant in her late 20s and is considering becoming a surrogate for the third time. In doing so, she will make enough money to bring her brother to the USA from Russia, something she promised her dying mother she would do. This is despite the fact that undergoing a third accelerated pregnancy will make her sterile, ending her own dreams of having a child with her boyfriend, Stephan.Read More »For sale: one womb

Knowing is half the battle: preconception screening

In a recently released report the UK Human Genetics Commission said there are “no specific social, ethical or legal principles” against preconception screening. If a couple may benefit from it, testing should be available so they can make informed choices. Information about this kind of testing should also be made widely available in the health system (and in school). The responses in the news have been along predictable lines, with critics warning that this is a modern version of eugenics or that it would lead to some people being stigmatized.

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Autonomy: amorphous or just impossible?

By Charles Foster

I have just finished writing a book about dignity in bioethics. Much of it was a defence against the allegation that dignity is hopelessly amorphous; feel-good philosophical window-dressing; the name we give to whatever principle gives us the answer to a bioethical conundrum that we think is right.

This allegation usually comes from the thoroughgoing autonomists – people who think that autonomy is the only principle we need. There aren’t many of them in academic ethics, but there are lots of them in the ranks of the professional guideline drafters, (look, for instance, at the GMC’s guidelines on consenting patients) and so they have an unhealthy influence on the zeitgeist.

The allegation is ironic. The idea of autonomy is hardly less amorphous. To give it any sort of backbone you have to adopt an icy, unattractive, Millian, absolutist version of autonomy. I suspect that the widespread adoption of this account is a consequence not of a reasoned conviction that this version is correct, but of a need, rooted in cognitive dissonance, to maintain faith with the fundamentalist notions that there is a single principle in bioethics, and that that principle must keep us safe from the well-documented evils of paternalism. Autonomy-worship is primarily a reaction against paternalism. Reaction is not a good way to philosophise.Read More »Autonomy: amorphous or just impossible?

Suicide for sale in Oregon: a “valuable service”?

Oregon is currently the scene of a controversy about the sale of so-called “suicide kits” or “helium hoods” (see here and here). These kits are sold by mail by a two-person company called The Gladd Group; one of its owners is reported to be a 91-year-old San Diego County woman who has been selling the kits for four years. The device is now receiving increased media attention following the suicide, with the help of the helium hood kit, of 29-year old Nick Klonoski, who had health-related issues that had brought him into depression, but was not terminally ill. His tragic death has now sparked a movement to outlaw the sale of those kits in Oregon. However, the woman selling the kits protests that she is providing a valuable service, and is quoted as saying that “[i]t is not my intention to hurt anybody, but to offer people comfort when they die”. Is the sale of those suicide kits a legitimate form of business, or should it be banned?

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Catholic bishops condemn France’s first ‘bebe medicament’

Last month, doctors in France announced the arrival of the country’s first so-called ‘saviour sibling’. Born to parents of Turkish origin, Umut Talha (Turkish for ‘our hope’) was conceived through in vitro fertilisation (IVF) using preimplantation genetic diagnosis (PGD). This technique, in conjunction with Human Leukocyte Antigen (HLA) typing, commonly known as ‘tissue-typing’, has enabled families to have a child – a ‘saviour sibling’ – that is capable of donating life-saving tissue (usually umbilical cord material) to an existing sick sibling. Umut’s parents approached the hospital in Clamart a year ago requesting tissue-typing PGD. Their two existing children had beta thalassaemia, an inherited blood disorder that requires monthly blood transfusions.

An embryo was screened and genetically selected from an original group of twelve embryos to ensure that it was both free of the disorder and a tissue match for one of the existing siblings. The resulting saviour sibling, Umut, did not have thalassaemia, and cells from his discarded umbilical cord will be used to cure his older sister, now aged two, and her monthly blood transfusions will be discontinued. Umut’s parents plan to return to Clamart to undergo the same procedure to cure their other child, Umut’s four-year-old brother.  

Saviour sibling selection is nothing new. Read More »Catholic bishops condemn France’s first ‘bebe medicament’

All between the ears? Homeopathy and experimental treatments for chronic fatigue syndrome

On Monday,  Belgian endocrinologist Francis Coucke appeared before the ‘Orde van Geneesheren’, a national body responsible for enforcing standards within the medical profession. Dr Coucke risks a two year suspension from the profession because his treatment (gamma globulines and home TPN) of patients with the chronic fatigue syndrome (CFS) has been deemed non-scientific: it has not been proven to work in large studies. Last year, he and a neuropsychiatrist colleague were required to pay a 635,000 euro fine for prescribing medicines not licensed for CFS to CFS patients. The fine was imposed even though special authorization for the prescriptions had been granted by the medical advisor to the national healthcare service.
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You want to publish? Let’s hear all your dirty secrets

By Charles Foster

Most scientific journals require contributors to declare any conflict of interest.

But what about ethicists? We are much more ambitious and presumptuous in our aims than most scientists. We purport to tell our readers not which drug will reduce their blood cholesterol, or which type of plate is best for their radial fracture, but how best to live: how to make right decisions about things that matter far more than cholesterol; how to be the right sort of people. If we write good papers, amounting to more than newspaper opinion pieces, the papers support their conclusions with supposedly objective reasoning. We try to look scientific. And yet, try as we might, we can’t escape from our own histories and tendencies. If an ethicist has been sexually abused as a boy by a paedophilic priest, or forced to watch US evangelical TV, he’ll never be able to think that religion is anything but evil or ridiculous, and his articles will argue, with apparent but wholly fake objectivity, towards that conclusion. If the Jesuits got him before the age of 7, and etched the catechism into his subconscious rather than buggering him, the man they made out of the boy will be theirs for ever, in the Journal of Medical Ethics just as devoutly as in the confessional. And yet there’ll be not a whisper of a warning next to their papers. Those influences are likely to be far more determinative of the views expressed than any financial conflict of interest in a drug trial ever was. Everything about an ethicist’s life raises a potential conflict of interest.Read More »You want to publish? Let’s hear all your dirty secrets