Phew, I thought, when I heard that Measure 26, the proposal to redefine “personhood” to cover the unborn, had been thrown out by the electorate of Mississippi.  To catch up: the prosaically-named piece of legislation would have

amend[ed] the Mississippi Constitution to define the word “person” or “persons”, as those terms are used in Article III of the state constitution, to include every human being from the moment of fertilization, cloning, or the functional equivalent thereof.

(In the end, 58% of the electorate voted against it; it is, for now, dead.)

In the light of this, it’s a bit of a disappointment to learn that there’s still a live-and-kicking (if you’ll excuse the expression) attempt to achieve the same thing, only this time on a national level: H.R. 212 IH aims to protect all human life from the moment of conception.

A curious feature of such attempts is the weight they put on defining the moment at which life starts; thus HR 212 specifically states that

the life of each human being begins with fertilization, cloning, or its functional equivalent, irrespective of sex, health, function or disability, defect, stage of biological development, or condition of dependency, at which time every human being shall have all the legal and constitutional attributes and privileges of personhood

- a point that is singularly unimportant.  What counts is not when a (discrete) human life begins, but when that life becomes morally important enough to warrant legal protection.  But, still: let’s imagine a world in which one of these proposals, or one significantly like them, makes it on to the statute books.  Leaving aside, too, the difference between the meanings of the word “personhood” in the mouth of the lawyer, the philosopher, and the person on the street, would they make all that much of  a difference? more…

Comment on “Bedside detection of awareness in the vegetative state: a cohort study” by Damian Cruse, Srivas Chennu, Camille Chatelle, Tristan A Bekinschtein, Davinia Fernández-Espejo, John D Pickard, Steven Laureys, Adrian M Owen

Published in The Lancet, online Nov 10.

Cruse and colleagues founds evidence of some kind of consciousness in 3 out of 16 patients diagnosed as being permanently unconscious. They used an EEG machine, capable of being deployed at the bedside. Is this good news?

This important scientific study raises more ethical questions than it answers.  People who are deeply unconscious don’t suffer.  But are these patients suffering?  How bad is their life?  Do they want to continue in that state?  If they could express a desire, should it be respected?

The important ethical question is not: are they conscious?  It is: in what way are they conscious?  Ethically, we need answers to that.  Life prolonging treatment has been and legally can be withdrawn from patients who are permanently unconsciousness.  We need guidelines for when life-prolonging treatment should be withdrawn in these minimally conscious states.  Paradoxically, it could be worse for some than being permanently unconscious.  And in countries like the Netherlands, we need guidelines on whether and when active euthanasia should be performed.  For some of these patients, consciousness could be the experience of a living hell. more…

Dipping in and out of the Nuffield Council on Bioethics’ recent report on organ donation (available in various forms from this page), I’ve been struck by a couple of things.

One is that the Council is painfully keen to maintain its distance from the idea that organs – especially those from live donors – could be sold.  The report makes clear that not every form of payment for donation implies this kind of commodification, and is correct to do so.  But, all the same, it’s pretty clear in its insistence that sale would be a Bad Thing.  And, of course, this just invites fairly conventional arguments about whether, and why, sale of organs really would be so bad after all.  One of the worries nodded towards here is the commodification objection – but it seems plain to me that it’s one thing for you to treat me or my body as a mere commodity, but quite another for me to treat my own body as such.  And there’s also a difference – at least on the face of it – between being treated as a commodity and being treated merely as a commodity.

(On this note, I cringed at the way that Kant is mangled on p 120 of the full report.  But that’s possibly just me and my soft spot for the Prussian weirdo.)

So far, so conventional.  What really caught my attention – partly because it caught the attention of headline-writers in the news media – was the proposal that payment might be offered to defray the funeral costs of people whose organs could be used. more…

“Martin”‘s story has been generating a reasonable amount of media and blog attention over the lat few days.  (Udo Schuklenk considers some of the Telegraph‘s coverage, for example, and finds it severely wanting.)  Paralysed after a stroke, “Martin” wants help to end his life; but his wife doesn’t want to be the one to help him.  The next best person would be one of his medical attendants.  According to the DPP’s guidance on assisted suicide, though (which I examined here), prosecution is more likely  if

[t]he suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer (whether for payment or not), or as a person in authority, such as a prison officer, and the victim was in his or her care.

“Martin” claims that this is unfair discrimination, and has launched a legal bid to ensure that medics wouldn’t face prosecution for assisting his suicide.  You’d have to have a heart of stone not to sympathise with his plight.  Cast in a certain light, I think he’s got a moral case (though perhaps on slightly more slender grounds than might appear at first: as far as I can tell, he’s got noone lined up who would be willing to help; and absent a willing assistant, the bid looks empty, since it’s one thing for Smith to be entitled to assist Jones’ suicide, but another entirely for Jones to be entitled to Smith’s help).  Whether he’s got a legal one… I’m really not so sure.  And so I think I know how this is going to go.

The judges will hear his case.  They’ll look at the law.  They might acknowledge that they can see “Martin”‘s legal point.  They’ll express heartfelt sympathy.  Then they’ll tell him that there’s nevertheless nothing they can do without a change in the law.  And they’ll tell him to go home.

There’ll be a bit of a media flurry; but the law on assisted suicide won’t change, and the ethical arguments won’t change, and the minds of the people making the arguments won’t change, and “Martin” will still be in his bed.  And in a couple of years, someone whose case is similar but different enough will emerge asking the same sort of thing, and we’ll go through it all again.

Lather, rinse, repeat.

How much would I love to have been on the ethics committee that was faced with this?

Researchers at the University of Pennsylvania were interested in a method of treatment for leukaemia that made use of modified versions of white blood cells.  Cells were taken from leukaemia patients and genetically modified in two ways: first, they were adapted to target the cancer cells; second, they were adapted to reproduce like crazy.  This second modification is important, because attempts to make use of the first have hitherto fizzled out as the modified cells died off.  Or, in slightly more scientific language, the New England Journal of Medicine explains that

[f]irst-generation chimeric antigen receptors had limited clinical activity, primarily because in vivo activation of the chimeric antigen receptor T cells induced only transient cell division and suboptimal cytokine production, which failed to produce prolonged T-cell expansion and sustained antitumor effects. These deficiencies were overcome by the addition of a costimulatory signaling domain in second-generation chimeric antigen receptors, which enhanced the proliferation, survival, and development of memory cells — features that appeared to be the hallmarks of successful therapy with EBV-specific T cells and tumor-infiltrating lymphocytes.

And this approach, based on preliminary results, seems to be very promising, having exceeded expectations.  The paper reporting the experiment is available here.

But how do you get the modification into the cells to begin with?  The team

used HIV-derived lentiviral vectors for cancer therapy, an approach that may have some advantages over the use of retroviral vectors.

And that, of course, is where things get interesting. more…

Andrew Dilnot’s report into social care is published today; the full document is here, (2.3 Mb) and Dilnot’s covering letter to the Chancellor and Health Secretary is available here.

I’ve not had a chance to read the report in any particular detail yet, but one of the most widely talked-about features (since significantly  before the report was published: this article in the Telegraph was over a week ago) has been the proposal that individuals’ liability to pay for their own long-term care should be capped at £35k.  The first of the main recommendations is that

[t]o protect people from extreme care costs we recommend capping the lifetime contribution to adult social care costs that any individual needs to make at between £25,000 and £50,000.  We think that £35,000 is an appropriate and fair figure and have used this example throughout our report. Where an individual’s care costs exceed the cap, they would be eligible for full support from the state. This change should bring greater peace of mind and reduce anxiety, for both individuals and carers.

The second recommendation recognises that

[n]ot everyone will be able to afford to make their personal contribution, and those currently just outside the eligibility for means-tested help are not adequately protected. To address this, means-tested support should continue for those of lower means, and the asset threshold for those in residential care beyond which no means-tested help is given should increase from £23,250 to £100,000.

But there’s something that confuses me. more…

Much as I try to avoid the Daily Mail, it seems never to be too far out of my view; and it’s not uncommon that people bring it to my attention for one reason or another.  On this note, I’m dubiously grateful to Muireann Quigley and Sorcha Uí Chonnachtaigh for pointing me in the direction of this gem: “Dozens of IVF babies aborted ‘after women change their minds about becoming a mother‘” (see it via istyosty* here).

The general gist of the story is that some women who get pregnant by IVF later terminate their pregnancy.  If you think about it for a moment, this oughtn’t to be a surprise.  For one thing, though IVF providers will take care to ensure that an embryo is viable and healthy before implantation, 100% accuracy in the process obviously can’t be guaranteed: some foetuses will turn out to be non-viable, or to have some condition that is judged to justify abortion.  Some mothers, too, will turn out to have latent conditions that make continued pregnancy inadvisable – or they might develop one.

But that’s not the impression you get from the headline, or from the first few sentences of the article:

Dozens of women are aborting babies conceived by IVF because they have changed their minds about motherhood, figures suggest.

Many are in their teens, twenties and early thirties, implying that numerous abortions were carried out for social reasons, rather than on health grounds.

Relationship breakdowns, fears about motherhood and simple changes of heart are all likely to have played a part in the terminations.

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…

If you’ve not yet seen “Choosing to Die”, Terry Pratchett’s film about Dignitas from Monday night, I recommend that you go and watch it now.  (I don’t know if it’s available outside the UK: I’m sure it’ll appear on YouTube soon, though; or, if you’re outside th UK, get a Brit to download it and put it on a USB for you.  It’s worth it.)  It’s an astonishing piece of film-making: simultaneously gripping, heartbreaking and deeply uncomfortable.  And it raised all kinds of hard questions.  Was Peter Smedley, the man whose death was filmed, making a genuine choice?  He looked as though he was in the process of signing a contract to have his hall decorated, so calm and rational was he.  Wouldn’t you expect a bit less detachment?  A bit less bloody Englishness?  But then, how much emotion do you want?  One of my problems with the unbearable suffering criterion in Joffe’s Assisted Dying for the Terminally Ill Bill a few years ago was that the more someone’s suffering, the more it’s legitimate to worry about the clarity of their thought.  Smedley seemed very clear.

And what about Andrew Colgan?   more…

There’s been a lot in the news over the last couple of days about the Military Covenant, and how there’s a plant to give it a legal footing as part of the Armed Forces Bill.  Some of the reportage over the weekend suggested that there would be explicit prioritisation for members and ex-members of the forces in respect of healthcare.  In the document that was published yesterday (link to 1.4M .pdf file), that commitment seems to be moderated – which is a good thing (for reasons that are basically the same as I outlined in an earlier post).

But healthcare does get special mention in the document; and, though it’s too long a mention to do proper justice here, it is worth quickly noting the highlights – or, rather, lowlights.  It’s the sort of thing that seems designed to please the tabloid press, but which will, in practice, please noone – not people like me, who think that special pleading for the military is moral hokum, nor people who think that special provision ought to be made but won’t find it here. more…