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Biomedical Science

Compulsory chemical castration for sex offenders

A month ago, the Polish Prime Minister, Donald Tusk, called for the introduction of forced chemical castration for sex offenders. The call followed a particularly nasty case of incest and paedophilia in the country: a 45 year old man was found to have sexually abused his 21-year-old daughter over a period of six years, and to have fathered two children by her. A poll showed that 84% of the Polish population supported the Prime Minister’s proposal, however many commentators condemned it as an affront to human rights. In response, the Prime Minister, Donald Tusk, claimed that the sex offenders he has in mind cannot be described as human beings, and therefore have no human rights (see here). Nevertheless, high level opposition has forced the government to replace the proposal with a plan for voluntary chemical castration, which is already allowed in Great Britain, Denmark, Sweden, Germany, Switzerland, and some US states. 

It is interesting to compare the claims that have been made for and against Mr Tusk’s proposal with those that we might expect to surround alternative proposals for reducing rates of re-offending among sex offenders. Suppose the Prime Minister had instead suggested the introduction of a compulsory education programme for sex offenders in which they would be forced to confront the devastating effects that their actions can have on their victims. It is difficult to imagine such a proposal being greeted with the claim that it breaches human rights. And it is also hard to imagine the proponents of such a programme resorting to the claim that sex offenders aren’t human. Instead, the debate would probably focus on weighing the costs and benefits of the proposed programme.

Can these differing responses be justified? Is there any good reason to think that compulsory chemical castration is a matter of human rights, while compulsory re-education is not?

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The objections to assisted suicide are misguided

In a recent article in The Observer, philosopher Mary Warnock makes an eloquent plea for assisted suicide in relation to the case of Daniel James, a 23-year old rugby player from Worcester who requested to be helped to die after an accident at a training session last year left him paralyzed from the chest down, and whose parents helped to fulfill his request by travelling with him to an assisted suicide clinic in Switzerland. Warnock has many sound points to make on this issue, and I will not repeat all of them here. Rather, I will consider some of the arguments that those opposed to assisted suicide have presented in response to that particular case.

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If evolution grinds to a halt, we move on

According to professor Steve Jones human evolution is grinding to a halt. The reason is, at least in the developed world, we have so good living standards and hence low mortality that we are not suffering any selection. He also argues that the mutation rate has been reduced because changes in reproduction and the larger gene pool. He concludes: "So, if you are worried about what utopia is going to be like, don’t;
at least in the developed world, and at least for the time being, you
are living in it now." As I see it, he has a very modest view of utopia. More seriously, do we have some kind of obligation to evolve?

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Radical organ retrieval procedures

I wrote recently
about the controversial news that surgeons in Denver had taken organs,
including the hearts, from newborn infants who had died in intensive
care.
In recent years the retrieval of organs from patients whose hearts have
stopped (so-called donation after cardiac death, DCD) has become more
popular. In part this is because of the problem that there is a
shortage of organ donors who are brain dead. It is also because of the
recognition that when patients die after removal of life support, their
organs may still be viable for transplantation.

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When the heart stops: harvesting organs from the newly (nearly) dead

In the New England Journal of Medicine yesterday, doctors from Denver reported on three controversial cases of heart transplantation from newborn infants. These cases are striking for several reasons. They were examples of so-called ‘donation after cardiac death’ (DCD), an increasingly frequent source of organs for transplantation, but done very rarely in newborns. They are controversial because the transplanted organs were hearts that were ‘restarted’ in recipients after they had stopped in the donor. Transplant surgeons waited only a relatively short period after the donor’s heart had stopped (75 seconds) before starting the organ retrieval process. These transplants raise serious questions about the diagnosis and definition of death.

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The point of death

The Guardian yesterday reported the death of the man who had been so tragically shot in Antigua, with his wife, three weeks after their wedding. It began like this:

"Ben Mullany, the newlywed who was shot on honeymoon in Antigua in an attack that killed his wife, Catherine, died in hospital in Wales yesterday after his life support machine was switched off.  The 31-year-old trainee physiotherapist, who had suffered a fractured skull and had a bullet lodged in the back of his head, was flown back to Britain while in a coma on Saturday. Tests carried out when his condition stabilised after the 24-hour journey established he was brain dead." 

This is a familiar way of describing such happenings, even among clinical professionals.   Brain death is pronounced, so the life support machine is switched off, and the patient dies.   The clear implication is that brain death is not death.  The machine is still keeping the patient alive, and it is switching off the machine that causes real death. 

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Reproductive science: is there something we’re missing?

Thirty
years after the first test-tube baby, Nature
asks various experts for their views on what the next thirty years of
reproductive medicine will bring.
Some of the more startling predictions are:

  • No more infertility, with both children and 100-year-olds able to have children
  • Embryos created from stem cells, increasing the ease of embryo research and genetic engineering of children
  • … with the resulting greater availability of embryos making it easier to create cloned humans
  • Artificial wombs, enabling babies to develop outside the mother’s body
  • … which, some worry, could become compulsory as an alternative to abortion, or to avoid premature birth or fetal alcohol syndrome
  • ‘Genetic cassettes’ implanted in embryos to counteract the effects of inherited diseases
  • Increase in litigation following evidence that IVF babies may later suffer adverse effects from the environment in which they were grown as embryos

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Testing alternative therapies

The journal Science is today reporting on a controversial plan by the US National Institute of Mental Health (NIMH) to test an alternative treatment for autism on children. The treatment, known as chelation therapy, involves the use of drugs that remove heavy metals from the blood. It’s based on a the theory – unsupported by conventional science – that mercury in vaccines triggers autism.

Chelation therapy is widely used, but its benefits and effects are not well understood. The NIMH have therefore argued that there is a "public health imperative" to test the drug. But opponents claim that any such study would be unethical, since the quality of the trial is likely to be poor, and any results – especially negative ones – would be unlikely to alter the behaviour of parents who support the therapy.

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Is there a duty to execute prisoners humanely?

An article published this week in PLoS Medicine discusses the ethics of research on US lethal objection protocols. The authors conclude:

While lethal injection and the death penalty present a host of ethical questions, the specific, pressing issue now faced by 36 US states, the federal government, and the 3,350 prisoners on death row is the movement to amend lethal injection protocols to comport with Eighth Amendment requirements and to minimize the potential for pain and suffering, in itself a commendable goal. As jurists demand lethal injection protocol changes, however, corrections officials, governors, and their medical collaborators are left in a legal and ethical quandary. In order to comply with the law and carry out their duties, they are employing the tools and methods of biomedical inquiry without its ethical safeguards. Given the current guidelines for human experimentation, it is difficult to conceive of circumstances in which lethal injection research activities could be carried out in a fashion consistent with these ethical norms, and yet those engaged in such research would seem to be required to do so.

This passage raises many questions. Is is the movement to amend lethal injection protocols really the pressing issue? Can a movement to execute prisoners more humanely really be commendable? But let’s focus on the authors main claim: namely that the states in question face a legal and ethical quandary since, (i) they are under "duties", as well as legal requirements, to execute more humanely, but (ii) they cannot do so without breaching the ethical and legal requirements.

The authors devote most of their attention to the second claim, (ii), but arguably (i) is more problematic.

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Brain Boosting and Cheating in Exams: Four Responses

A report by the Academy of Medical Sciences looking at different aspects of drug use and mental health has identified a growing trend for off-label use of drugs intended for the treatment of diseases including narcolepsy, ADHD and Alzheimer’s. The use of such drugs by a healthy individual can improve memory, alertness and concentration. While the report does not condemn the practice, it raises a number of potential concerns over safety, and fairness. Professor Les Iversen, report co-author, highlighted concerns that the use of enhancement in exams would unfairly advantage wealthier students, and suggested that the use of such drugs could be considered cheating. The report recommends that legislation is prepared to tackle the misuse of such drugs, including the potential for urine testing in schools and universities.

Below are responses from Julian Savulescu, Nick Bostrom, Anders Sandberg and Mark Sheehan on the effects of cognitive enhancing drugs, and the issue of cheating

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