Remember a little while ago there was a rash of proposals in the US that’d force women to see a sonogram of the foetus, or to listen to detailed descriptions of it, before having an abortion?

Yeah: them.  Well, via Ophelia, here’s an account of what really happens.

Halfway through my pregnancy, I learned that my baby was ill. Profoundly so. [...] “I’m worried about your baby’s head shape,” she said.  “I want you to see a specialist—now.”

[... B]efore I’d even known I was pregnant, a molecular flaw had determined that our son’s brain, spine and legs wouldn’t develop correctly.  If he were to make it to term—something our doctor couldn’t guarantee—he’d need a lifetime of medical care.  From the moment he was born, my doctor told us, our son would suffer greatly.

So, softly, haltingly, my husband asked about termination.  The doctor shot me a glance that said: Are you okay to hear this now?  I nodded, clenched my fists and focused on the cowboy boots beneath her scrubs.

She started with an apology[...]

That’s not a good start, is it?  An expression of sympathy, maybe.  But an apology?  It’s as if she knows that things are about to get worse.  And they are. more…

There’s a flurry of papers on conscientious objection in the latest JME: Giles Birchley argues, taking his cue from Arendt, that conscientious objection has a place in medicine here; Sophie Strickland’s paper on medical students’ attitude to conscientious objection (which I mentioned in July) is here; and Morten Magelssen wonders when conscientious objection should be accepted here.

All this is coincident with the recent passing of the “Protection of Life” Bill by the American House of Representatives.  This also has a significant clause about conscientious objection: I’ll come to that  in a little while.

Magelssen claims that conscience is important for integrity, and there is a social interest in protecting integrity.  His position is that objections should be accepted if

1. Providing health care would seriously damage the health professional’s moral integrity by (a) constituting a serious violation (b) of a deeply held conviction.

2. The objection has a plausible moral or religious rationale

3. The treatment is not considered an essential part of the health professional’s work

4. The burdens to the patient are acceptably small ((a) The patient’s condition is not life-threatening; (b) Refusal does not lead to the patient not getting the treatment, or to unacceptable delay or expenses (c) Measures have been taken to reduce the burdens to the patient)

5. The burdens to colleagues and healthcare institutions are acceptably small

As elaboration, he claims that ”[a]n objection does not have a plausible rationale if it is based on erroneous factual premises”.  more…

When John Sentamu stood up in the House of Lords a couple of weeks ago and spoke about the need for the NHS to concern itself with “spiritual” needs – and illustrated his claim with an anecdote about something resembling an exorcism – the response from a lot of the blogosphere was, at its friendliest, one of pointing and laughing.  It’s very easy to see why.  Not only is it slightly embarrassing that in the UK you can be made a Member of Parliament for being good at believing in the right kind of god in the right kind of way, but the NHS – and healthcare generally – is successful when and because its clinical procedures are based on science and reason, not spooky ghosty stuff.  (In fact, I struggle to see what Sentamu actually meant.  He was empatic that the spiritual is not the same as the psychological, but this just prompts a question: what, then, is it – if anything?  If you remove the psychological from the spiritual, does anything remain?  And if it does, how do we know?)

Anyway: I was prepared to go along with the pointing and laughing.  But then, on Saturday, I saw a DVD of The Exorcist for a couple of quid and impulse bought it; and, that evening, I turned off the lights and watched it.*  You’ll have to bear with me on this, but it made me wonder if there might be something interesting about the idea of “spiritual” care on the NHS.  Not that I believe for a moment that there’s such a thing as demonic possession, or such a thing as a soul or spirit.  Of course there isn’t.  But it doesn’t follow from that that such terms have no place in respect of some forms of care. more…

A student writes:

I am a 5th Year Medical Student involved in a charity organisation that collects medical goods that are recycled/past expiry dates but still in good condition for re-use/excess from stocks, and aims to provide more impoverished clinics and hospitals abroad with these goods through students’ electives.

I have been trying to find ethical guidelines on this on the Net but have failed to find anything useful. 

Would you be able to help me on this matter?

We have already excluded any drugs/saline/liquid form of anything as I know that they will most definitely not be permitted.  However, the kind of equipments we collect include items such as sterile surgical tools such as scalpel blades, forceps, syringes, gloves, bandages, blood sugar monitors, catheter bags, etc.

I would very much appreciate your help!

I’m throwing this out to readers, because you may be able to suggest things.

For my part, I have a slightly sneaky feeling that whatever problems there might be with this are regulatory rather than stricto sensu ethical; I don’t think that there’re any standout ethical problems, but there’s a few things that’ve crossed my mind as possibilities that I suppose might be raised.

In no particular order, I suppose that some people might have worries like these: more…

Charles Foster’s post over at Practical Ethics about the news of the womb-transplant surgery that’s slated to take place in the near future is on the money in many respects.  Foster points out that

[p]redictably the newspapers loved it. And, equally predictably, clever people from the world’s great universities queued up to be eloquently wise about the ethics of the proposal.

But if ethics are [sic] concerned with what we should do, there was really nothing worthwhile to be said about Eva Ottosson’s altruism (bar the usual uninteresting caveats about dangerousness and resource allocation), except: ‘Fantastic’.

Of course it is possible to think of things to say. Anyone who has dabbled in philosophy or law could churn out a few thousand words of commentary. When I heard the facts I reflexively began to draft a mental essay plan. But (if one excludes insane religious objections) the bottom line is inescapable.

I shared the impulse to come up with an outline for a paper (and what I’d say if Newsnight felt the urge to talk to a gobby incompetent like me), before coming to the same sort of conclusion: there really isn’t all that much interesting to say about this transplant.  This in itself is remarkable: the media are normally quite good at rooting out someone to object to whatever-it-is-that’s-just-been-announced, but seem to have drawn a blank this time.  Nair et al published a more serious paper on the subject a few years ago, but that strikes me as saying just about all that there is to say (and, to be frank, a bit more; I wonder whether the rationale for writing the paper was along the lines that someone ought to, and someone probably would, so it might as well be them).  There might be something a bit more interesting to be said if the recipient of the transplant happened to be male – but, even there, the interest would (I suspect) be more anthropological and legal than ethical.

Still: while I agree with Foster’s implied conclusion that there is no sane reason to think that uterine transplants ought not to happen, I’m not quite as enthusiastic about them as he.  There’s a couple of reasons for this. more…

Today’s dose of righteous anger comes, via Ophelia Benson and Marie Myung-Ok Lee writing in The Atlantic, from the fifth annual Congress on Aesthetic Vaginal Surgery, held just outside Tuscon at the end of last year.

The affable organizer of the Tucson event, Dr. Red Alinsod, was an early entrant into cosmetic-gyn, and is recognized for inventing the procedure in which the labia minora are completely amputated to create a “smooth” genital look known in the field as “the Barbie.” Though he began his career by winning a prestigious fellowship in gynecology-oncology at Yale in 1990, Alinsod now spends his days making genitalia “look pretty” for the wealthy patients who flock to his Southern California practice from all over the world. He is also an evangelist for the field, spreading its lucrative gospel to fellow doctors tired of toiling in the time-intensive and high-liability fields of traditional obstetrics and gynecology.

Cosmetic gynaecology, it appears, has been pretty much rejected by mainstream medicine – which means that it’s all-but-unregulated.  It’s a deeply weird business, though.  Actually: scrub that.  It’s really rather sinister. more…

The more I think about it the more I think that one issue bioethicists should play much closer attention to is the language used to describe things.

This isn’t a new thought, Kongzi (known as Confucius in the West) said:

Tsze-lu said, “The ruler of Wei has been waiting for you, in order with you to administer the government. What will you consider the first thing to be done?”
The Master replied, “What is necessary is to rectify names.” “So! indeed!” said Tsze-lu. “You are wide of the mark! Why must there be such rectification?”
The Master said, “How uncultivated you are, Yu! A superior man, in regard to what he does not know, shows a cautious reserve.
“If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot be carried on to success.
“When affairs cannot be carried on to success, proprieties and music do not flourish. When proprieties and music do not flourish, punishments will not be properly awarded. When punishments are not properly awarded, the people do not know how to move hand or foot.
“Therefore a superior man considers it necessary that the names he uses may be spoken appropriately, and also that what he speaks may be carried out appropriately. What the superior man requires is just that in his words there may be nothing incorrect.”

From The Analects of Confucius, Book 13, Verse 3 (James R. Ware, translated in 1980.)

I’ll give an example to make my point clear.

One thing I remember vividly from my antenatal classes is a comment made by the teacher in response to one of the mothers in the class asking what would happen if she went overdue – she was told not to worry the doctors wouldn’t let her go more than two weeks overdue. Likewise my sister is now pregnant and slightly overdue, and I’ve heard her and others express the same sentiment, that she wouldn’t be let to go too overdue.

It is an interesting and revealing way of phrasing the situation – it seems to indicate that it is up to the doctors when the mother gives birth, and if she takes too long about it then she needs special permission from the doctor, otherwise they will make her give birth.

What a horrendously disempowering way of phrasing things, which implicitly passes control over the mothers body from her to the healthcare professionals involved. So much for the triumph of autonomy over paternalism…

It is better to say that if a mother goes more than two weeks overdue doctors will advise her to be induced – since it is her choice whether to be induced or not, and while it might be medically advisable to be induced no one can force her.

Are there other examples of where we need to tidy up our language in bioethics?

Lord knows why, but I keep going back to Secondhand Smoke, the pro-life, global-warmin’-denyin’, public-healthcare-hatin’, intelligent-design-lovin’,  Daily-Mail-quotin’ blog written by Discovery Institute affiliated lawyer Wesley Smith.  I try to stay away, but like a child peeping between his fingers while hiding his eyes, I’m just fascinated by it.

A recent post concerns a Kiwi woman whose doctors removed her life-support machine in the belief that it was futile.  This was contrary to the wishes of her parents, who are acupuncturists who “had drawn on specialist acupuncture and traditional Chinese medicine practitioners for support during the critical period when life support was withdrawn”.  She survived.

In Smith’s telling of the story, the doctors “forced” the patient off the machine – which, to be honest, can’t have been all that hard given that she was unconscious.  He goes on:

This is a warning.  Doctors don’t know everything.  Hospitals are not always right.

Well, yeah.  But that doesn’t mean that they oughtn’t to have made the decision that they made.  Isn’t it obvious that medics don’t have perfect foresight?  Isn’t it obvious that there’s always going to be the odd (very odd) recoveries from miserable situations?  That doesn’t mean that it’s illegitimate to make decisions about futility, or that it’s illegitimate to act on them.  It doesn’t mean that it’s wrong to make decisions based on medical judgement.  Couldn’t we equally well say that recovery was evidence that the life-support machine wasn’t necessary anyway, and ought to have been withdrawn a lot sooner (and perhaps not used at all)?  After all, if you’re going to play on medical fallibility, you can’t pick and choose between mistakes.

Is Smith saying that it’s always impermissible to remove treatment based on judgement short of godlike omniscience?  Strange.