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Bioethikos: Bringing Life to Bioethics

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Bioethics Challenges for the New Year

January 9th, 2017 by Dr. Dennis Sullivan

A colleague of mine has referred to this modern era as the “Biotech Century.” More than ever before, biological research and medical science have improved our lives, but have created new ethical dilemmas as well. Here are some of the major trends to watch for in the coming year.

Issues at the Beginning of Life

  1. Abortion. Forty-four years after the Roe v. Wade Supreme Court decision, Americans are more conflicted about the issue of abortion than ever before. 18 states have banned the procedure at 20 weeks of gestation. Such “pain-capable” abortion bans are based on the idea that the 20 week-old fetus has enough neurological development to feel pain, making abortion a form of torture. With a Republican administration in Washington, watch for renewed attempts to appoint conservatives to the bench and to overturn Roe.
  2. Reproductive technologies. Choices, choices: so many ways to have a baby. In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). have pushed the envelope, making a genetically-related baby more and more possible for childless couples. The downside? Thousands of human embryos frozen for future use, discarded, or experimented on. A fundamental question remains: Are our children the God-ordained offspring of a loving marital union, or are they merely the products of an assembly line?

Issues at the End of Life

  1. When does death occur? New protocols are making it easier to withdraw care from acutely-injured patients, in order to provide more organs for transplants. Slippery-slope concerns should cause all of us to worry about the details.
  2. Assisted suicide. The American Medical Association is re-thinking its traditional opposition to medically-assisted death. As a part of this trend, five states have passed laws allowing doctors to help terminally-ill patients to end their lives at a time of their choosing. So who owns the life that we live, we ourselves or the Creator Who made us?

From the Laboratory

  1. Animal-human chimeras. Here’s an interesting idea: genetically modify a species of pig, making it incapable of growing a pancreas. Incubate the pig embryo with human pancreas cells, so that the resulting piglet has a human-derived pancreas, which can be used as a donor organ for transplant. Such a procedure might be a cure for diabetes, and may be ready for human trials soon. How about the ethics of all this? The devil is in the details.
  2. Gene editing. The completion of the Human Genome Project in 2003 produced the genetic blueprint of the human species, leading to a plethora of new research ideas. One revolutionary new insight takes advantage of a bacterial defense mechanism to recognize foreign DNA. A new procedure modifies this into a molecular “machine” that can actually edit any genome, including those of human beings. So-called CRISPR technology may make some very nifty things possible: think of engineered mosquitoes incapable of transmitting the Zika virus. But this new technique opens up some very disturbing ideas about modifying human nature itself.

Stay tuned – We’ll be talking about these and other trends in 2017.

In the meantime, have a blessed and productive New Year!

Links Related to Topics Discussed:
Pain-Capable Abortion Bans
Reproductive Technologies

Brain Death

Assisted Suicide

Animal-Human Chimeras
More about Gene Editing

The New Push for Assisted Suicide

December 6th, 2016 by Dr. Dennis Sullivan

Mortar 

There is a growing movement within the American Medical Association (AMA) to legalize “aid in dying,” otherwise known as physician-assisted suicide. The current ethics statement of the AMA, with roots going back thousands of years, states the following:

It is the policy of the AMA that:
1.Physician assisted suicide is fundamentally inconsistent with the physician’s professional role.
2.It is critical that the medical profession redouble its efforts to ensure that dying patients are provided optimal treatment for their pain and other discomfort.
3.Physicians must resist the natural tendency to withdraw physically and emotionally from their terminally ill patients.
4.Requests for physician assisted suicide should be a signal to the physician that the patient’s needs are unmet . . .

 

Now this commonsense, compassionate standard is giving way to something more radical. At its meeting last June, the AMA’s Council for Ethical and Judicial Affairs approved the study of “aid in dying,” prior to its next annual meeting in 2017. The stated goal is to consider going “neutral” on assisted suicide. This would be an historical departure for the AMA.

There are many reasons this is a bad idea. It impairs the trust relationship between a doctor and her patients. It would detract from modern efforts to improve  palliative care and hospice. And given our utilitarian society that so devalues the sanctity of life, a “right to die” could easily morph into a “duty to die.”

All of this is bad medicine, and we should oppose it.

Current AMA Ethics Statement

The Ethics of Race (40)

September 21st, 2016 by Dr. Dennis Sullivan

david-myles

My guest is Pastor David Myles, Teaching Elder at Emmanuel Baptist Church in Xenia, Ohio. Pastor Myles. Our subject is the vexing problem of racism in the U.S., a problem that Christians often find difficult to discuss.
_________________________________________

To listen, just click on the player below (click on the Audio MP3 button if the player doesn’t appear).

Still Pushing the Limits with Abortion

August 23rd, 2016 by Dr. Dennis Sullivan

Month 7

(by guest blogger Dr. Mark Pinkerton)

It has been over a year since the shocking release of undercover videos showing Planned Parenthood executives haggling over the price of fetal body parts. Despite those disclosures, the abortion industry continues some very questionable practices. According to a recent news report, a congressional committee sent a letter to the New Mexico attorney general. The letter detailed how the University of New Mexico provided whole aborted fetuses from an abortion clinic as dissection specimens for a high school summer camp. The news article went on to state, “the students dissected the babies and had no feelings for the babies.”

As a physician, I understand the importance of anatomical dissection. If this were a camp for teens aspiring to be physicians, dissecting would be very educational. Is a human fetus the best choice for this purpose? Prior to medical school, I dissected a piglet and a cat. Once I got to med school, we employed adult human specimens, but only with that person’s prior consent to donate. Our dissection lab started with a moment of silence to respect the life and personhood this body once contained. But the casual use of late-term fetuses for a high school camp seems callous.

Is this what happens after years of society teaching us that our life is a merely the product of natural evolution? Is this how life is treated if viewed without a soul? It is time for our society to return to treating one another, including the recently deceased, with respect. No matter your religion or politics, human dignity demands it.

Life News Article
Daily Wire Article

 

 

 

 

Pharmacist Conscience Rights Denied

July 6th, 2016 by Dr. Dennis Sullivan

Mortar

Disappointing news from the United States Supreme Court: Pharmacists in the state of Washington have no conscience protections in regard to contraceptive drugs, even those that may induce abortion. In the case of Stormans v. Wiesman, the owners of Ralph’s Thriftway Pharmacy declined to stock certain contraceptives, such as Plan B, that may cause an early abortion. Dispensing such a drug conflicts with the sincere pro-life views of Kevin Stormans and his family.

In the past, when abortifacient drugs were requested, the Stormans would simply and graciously refer the client to one of “more than 30 other pharmacies within five miles of Ralph’s.” This type of arrangement is a time-honored move that has been legal and ethical in all 50 states – until now. Recently enacted State Board of Pharmacy rules now require dispensing all contraceptive agents, regardless of their mechanism of action, and regardless of any ethical views held by pharmacists. The Stormans family sued to retain their right of conscience.

An unfavorable Ninth Circuit Court ruling led to an appeal to the U.S. Supreme Court, which on June 28th denied certiorari, that is, they refused to hear the case. In his written dissent, Justice Samuel Alito described the clearly anti-religious bias of the high court:

This case is an ominous sign. At issue are Washington State regulations that are likely to make a pharmacist unemployable if he or she objects on religious grounds to dispensing certain prescription medications. There are strong reasons to doubt whether the regulations were adopted for — or that they actually serve — any legitimate purpose. And there is much evidence that the impetus for the adoption of the regulations was hostility to pharmacists whose religious beliefs regarding abortion and contraception are out of step with prevailing opinion in the State.

 

The impact of this ruling will be widespread, and directly affects healthcare professionals throughout the Ninth Circuit Court’s jurisdiction, which includes nine western states. A similar law is currently pending in California (part of the Ninth Circuit).

Make no mistake: conscience rights are under attack. Healthcare professionals of faith may be driven from their vocation by these draconian regulations. Christians must take a stand, and we must pray.

National Review

Alliance Defending Freedom

 

 

Animal – Human Chimeras May Solve Transplant Organ Shortage

June 9th, 2016 by Dr. Dennis Sullivan

pig

In a move guaranteed to raise ethical questions around the world, scientists in California are using gene-editing techniques to remove parts of a pig’s DNA, then replace it with human DNA that codes for the human pancreas. It is their hope that this will provide a source to grow human organs, toi deal with the desperate shortage of transplantable organs currently available:

Researchers at the University of California, Davis combined human stem cells and pig DNA and allowed the embryos to mature for 28 days, before terminating the experiment and analyzing the tissue. They believe the animals, if they had been carried to term, would have developed a human internal organ, but would have looked and behaved like any other pig. The goal is that in the future, similar animals could potentially act as a ready source of organs for life-saving transplants.

 

Of course, the key ethics question is: how much human DNA can be added to a pig before the pig becomes “too human?” Getting the balance right will be the goal of future research, which nonetheless promises an exciting new advance in transplantation medicine.

News Article from the Guardian

Profiteering from the Poor

May 24th, 2016 by Dr. Dennis Sullivan

euthan

Many of you will recall the highly publicized case last fall, of Martin Shkreli, CEO of Turing Pharmaceuticals, smirking and invoking his Fifth Amendment rights before a televised House Oversight Committee hearing. He had led his company to acquire a generic drug that had been available inexpensively for decades. The company immediately jacked up the price. As reported in Fortune Magazine:

Daraprim, a treatment for malaria and toxoplasmosis, is now 5,455% more expensive than it was only two months ago. The drug’s price jumped from $13.50 to $750 a pill, bringing the annual cost of treatment into the hundreds of thousands for some patients—and possibly out of reach for many.

 

Such unapologetic and unethical behavior by a major drug company has become common. Prices have skyrocketed on older drugs whose patents have expired, some of them on the World Health Organization’s essential medicine lists. Another good example is the antiparasitic drug albendazole, whose daily cost has jumped from about $5.92 in 2010 to $201.27 last year. One of my colleagues, who makes regular mission trips to Honduras, worries that the price increases will make the drug unavailable to the poor population he serves.

In fact, these price-gouging practices disproportionately hurt the poor.  A recent report in the New England Journal of Medicine (NEJM) put it this way:

What makes this business model particularly disturbing is that vulnerable patients — such as immigrants, refugees, and people of low socioeconomic status — are often disproportionately affected, since many of the medications are for tropical or opportunistic infections. These patients often have limited or no access to insurance, or have access only through public programs, so already stark health disparities are compounded.

 

Now I know you’ve heard the explanation for high prices usually offered by drug manufacturers: research and development (R&D) costs are high and risky. Yet here is the reality (from NEJM again):

Though some companies that have purchased and increased the price of niche medicines cite R&D as an explanation for high prices, it’s hard to find credible evidence of their involvement in substantial drug-development projects. Turing and Amedra state on their websites that they’re engaged in research, yet neither company lists substantial R&D activities or publications.

 

Let’s be clear: none of this is illegal, though it is highly unethical. The JAMA article concludes with this comment: “Timely market solutions that promote competition are needed when high prices result from monopolies.” In other words, drug companies will not do the right thing unless it aligns with their corporate self-interest. They will need a nudge from those who care about the poor.

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Fortune Magazine Article

WHO Essential Medicine Lists

NEJM Article (pdf)

Much Ado About MOLST

May 17th, 2016 by Dr. Dennis Sullivan

molst_form

Most healthcare professionals agree that patients rarely document their wishes about end-of-life care before a crisis occurs. This often makes decision-making difficult for both clinicians and families. I have long advocated that everyone should have an advance directive in place. This may take two forms. The first is a living will, which specifies the kind of medical treatments you want if you have a life-threatening illness and cannot make decisions for yourself. Better yet is a durable power of attorney for health care (DPAHC), which legally designates a surrogate decision-maker, typically a spouse or child, who can make decisions for you, knowing your values and acting in your best interests.

For the very sick, especially those unlikely to live more than a year, a newer document has arisen in over 20 states, called MOLST (Medical Orders for Life-Sustaining Treatment) or POLST (Physician Orders for Life-Sustaining Treatment). Unlike a ‘do-not-resuscitate’ (DNR) order, MOLST documents address more than just CPR. They may also involve the use of a ventilator, a feeding tube, dialysis, antibiotics, or simple I.V. fluids. The purpose is to carry out the specifics of the patient’s advance directives in the form of a persistent medical order. In theory, this should be a better guarantee that a patient’s final wishes are carried out.

Advantages of MOLST:

  • Can help protect dying patients from unwanted, intrusive, or disproportionate treatments (e.g., ventilators or CPR).
  • May relieve the burden of decision-making for family members and other surrogates.
  • Transferable as part of the medical record to various institutions.

Some Concerns about MOLST:

  • It is a medical document, not a legal one. It is therefore more difficult to modify or revoke it.
  • Advance directives (living wills and DPAHC) are enacted only when a patient loses decision-making capacity; a MOLST document is effective immediately. regardless of a patient’s capacity.
  • On the form, the default is to limit treatments, which may imply a utilitarian agenda that devalues life for the elderly and infirm.
  • Many pro-life groups oppose MOLST legislation, fearing that it paves the way for legalizing assisted suicide, and ultimately, euthanasia.

I have some reservations about MOLST, though the goal is to protect patients’ rights. Specifically, Ohio Right to Life is neutral on the proposed Ohio law, while other Ohio RTL groups oppose it.

ORTL Statement

Greater Cinci RTL (click on ‘Life Issues’)

Now Proven: Zika Virus Causes Microcephaly

April 15th, 2016 by Dr. Dennis Sullivan

SAMap

When I first heard about a newer mosquito-borne infection in South America, similar to Dengue fever, but with the possibility of causing birth defects, I was not too worried. I thought the news reports were overblown, and that the actual danger here in the U.S. was minimal. I was wrong. Now even the normally conservative Center for Disease Control and Prevention claims that Zika is “scarier than we initially thought.”

The Zika virus is transmitted by the Aedes aegypti mosquito, endemic in Brazil and other parts of South American, but also common in the southern United States. It should be noted that sexual interaction can also spread the virus.So far, the disease has only appeared in those patients who have visited affected areas:

With global infection rates of the Zika virus increasing rapidly, physicians should be prepared to handle possible cases of the virus and answer patients’ questions. No locally acquired vector-borne Zika virus cases have been reported in the continental United States, but cases have been confirmed in returning travelers.

 

A recent CDC report has confirmed that Zika can definitely cause microcephaly. This leads to abnormally small brains in babies born of women infected with Zika during the first trimester of pregnancy. It is not yet known what percentage of infected women’s babies actually have this problem, or what other abnormalities may appear. It is entirely possible that other problems may arise with Zika infection, or that it may even lead to miscarriages.

This is all the more worrisome because symptoms of Zika infection are often mild, and many infected subjects are asymptomatic. The CDC and World Health Organization have both issued recommendations that women in affected areas should use birth control or avoid sexual intimacy at this time.

In predominantly-Catholic South American countries, such as Peru, Brazil, Colombia, and Venezuela, abortion is illegal. But fear of Zika-infected women having babies with birth defects has led many to demand termination of their pregnancies. The Zika crisis may be used as a wedge to loosen abortion restrictions in the near future.

AMA Resource Website on Zika Virus

USA Today report on CDC advisory

Religious Liberty: Making Our Case

March 15th, 2016 by Dr. Dennis Sullivan

rings

The current climate of secular society has declared, aided and abetted by the U.S. Supreme Court, that traditional views of marriage are unacceptable. For those who protest, the cry of “religious liberty” has become a synonym for bigotry.

Individuals and groups that wish to uphold the view that marriage is between one man and one woman have turned to the First Amendment for help: “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.” Yuval Levin, in the February issue of First Things. points out that efforts to defend religious liberty could go two ways: based on the establishment clause, or based on the free exercise clause, and that efforts in the courts have depended on the latter.

Free exercise arguments work like this: religious believers should be free to act out their convictions, even when public opinion is against them. In other words, the state should carve out exemptions for such individuals. But the argument does not work very well when the individuals in question are part of larger groups, which the judiciary is loathe to exempt. And yet it is membership in such groups that should give strength to the dissenters, because the groups have a positive message to convey.

“Free exercise” arguments assert a right to not be constrained by secular public opinion. But perhaps it’s time that we made an “establishment” argument, to be free from the civil religion called progressive liberalism. And the argument should be positive rather than negative, a right to advocate for a certain view of human flourishing, rather than just to be free from constraint. Yuval Levin puts it this way:

This means we need to see that we are defending more than religious liberty: We are defending the very idea that our government exists to protect the space in which various institutions of civil society do the work that enables Americans to thrive, and we are defending the proposition that this work involves moral formation and not just liberation from constraint. That is an entire conception of the meaning of a free society that goes well beyond toleration and freedom of religion. It is ultimately about the proper shape and structure of American life.

 

There is a reason that we hold the views we do: we believe, with good cause, that heterosexual marriage as a civil institution should be preserved, and that this is the best course for our republic. Even if we are called bigots, we have a message designed to make this world a better place.

First Things article