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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?

The patient vanishes

by Dominic Wilkinson

If a patient’s family refuse to allow withdrawal of breathing machines should doctors provide long-term support in an intensive care unit for a patient who is clinically brain dead? Should doctors provide heart-lung bypass (ECMO) for a child with anencephaly? Should doctors perform a tracheostomy and provide a long-term breathing machine for a patient in a documented persistent vegetative state?Read More »The patient vanishes

Nothing is like mother’s ice cream

The Icecreamists, an ice cream parlour in Covent Garden began selling a human breast-milk based ice cream last month, only to have it confiscated recently by Westminster Council in order to check that it was “fit for human consumption”. New York chef Daniel Angerer was reported as served human cheese (he didn’t, but see his blog for the recipe). He was advised by the New York Health Department to stop, since although there were no departmental codes forbidding it they claimed “cheese made from breast milk is not for public consumption, whether sold or given away”. What is it exactly that is disturbing with a human milk ice cream or cheese? And are there any good reasons to hinder selling it?

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61-year-old woman gives birth to her own grandchild, and so what?

The “news” is that a 61 year old from Illinois served as a surrogate mother for her daughter’s son, carrying in her womb the embryo created using her daughter’s and her son-in-law’s egg and sperm.

Anyone shocked?

I guess no, and this is instead a (nice) surprise to me.

When I started my first class in Bioethics, in 2001, surrogate motherhood was still a very controversial topic, at least in Italy. People were passionately debating about the moral legitimacy of such  kind of “unnatural” practice. Also, people were really worried about the fact that women who had already passed menopause could procreate.

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Herbal Placebos

The seven-year period within which member states must implement the EU directive on herbal medicine ends next month. In the UK, the government last week announced that herbalists will now be regulated by the Health Professionals Council (HPC). The HPC is the body that currently supervises a number of health professions including paramedics and physiotherapists. The effect of the decision has been to trigger concerns, particularly from medical professionals, that the move will confer legitimacy on treatments with no proven benefit. But if the government is going to permit herbal medicine, then there are in fact grounds to make it as plausibly medical as possible.

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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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‘Spend a day with Charlie Teo’

Over the last few days the Australian media has been covering Sydney based Charlie Teo’s auction of ring side seats in his operating theatre. The auction is reported as raising about $1500 for a children’s cancer charity and while this might raise some eyebrows Teo has been clear about his commitment to ensuring that patient care is not compromised in any way.

He is a highly regarded neurosurgeon who has pioneered minimally invasive techniques and has a reputation for taking on very difficult cases. He’s also a prominent and respected public figure: he was a State finalist for Australian of the year in 2010, is the founder of the Cure for Life Foundation and was awarded Member of the Order of Australia. (The Australian Jan 26th 2011) Despite his high profile and assurances, he has attracted criticism from his peers.
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How to feed people dioxin and get away with it

Earlier this month German authorities closed around 4,700 farms following the discovery that pigs and poultry had been given feed contaminated with dioxins, which are thought to be among the most carcinogenic environmental pollutants. Yesterday Russia banned the import of untested pork products produced in Germany after 1 November 2010. This follows earlier import bans on some German food products in Slovakia, China, Belarus and South Korea.

Evidently the North German firm Harles und Jentzsch added a contaminated oil, possibly intended for industrial paper production, to an ingredient for animal feed that was then sold to 25 different feed manufacturers. Tests showed that the oil contained dioxin at 77 times the permitted level. Around 150,000 tons of feed incorporating this oil was reportedly fed to poultry and pigs across Germany, and affected eggs were sold in Germany, The Netherlands and the UK.

Internal tests at the Harles und Jentzsch plant revealed elevated dioxin levels in feed ingredients as early as March last year, suggesting the possibility that the human food supply may have been contaminated for months. And of course, this is nothing new. There were similar dioxin scandals in Ireland and Italy in 2008, Belgium in 1999 and 2006, and Germany in 2003.

How can such practices go unnoticed so often and for so long?

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Hypothetically donated organs

Every day three people die in the UK while waiting in the transplant queue. In the face of the urgency to increase the organs available, some propose introducing economic incentives. A more moderate solution consists in choosing a public policy with an appropriate default option, that is, a condition that is imposed on individuals when they fail to make a decision. A default option influences policy-outcomes in two ways: a) it can have a direct impact on people’s choices because they might interpret it as the option recommended by society; b) the effort involved in making a decision as opposed to accepting one –e.g. filling a form, having to think about one’s death, etc.- nudges people towards the default option.

Regarding organ transplantation, legal systems are divided between opt-out systems in which everybody is an organ donor unless she has registered not to be, and the so called opt-in systems that consider that nobody is an organ donor unless they have registered to be one. Countries with an opt-out system like Austria, Belgium or Spain tend to have higher organ donation rates. This fact is often used as a strong argument in favour of taking consent as the default option. Unlike the countries mentioned, UK has an opt-in policy. However, the Welsh are trying to pass a piece of legislation that would allow them to establish an opt-out system. Their initiative reopens the debate about the pros and cons of the two systems. Those who oppose introducing an opt-out system in the UK make the following claims:

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