Ethical Issues

Medical Ethics

China – Tests the theory of male pregnancy

Recently, a team of scientists in China at the Naval Medical University in Shanghai tried to create a model to test the hypothesis that you could get a male rat to deliver babies. They took a male and a female rat and literally joined their blood circulation to get female hormones into the male bloodstream. Then they transplanted the uterus of the female rat into the male rat. Embryos were transferred from the female that they had created in vitro and the male gave birth to 10 rat cubs, and they seemed normal. It’s obvious that this model will not be used in humans since you would have all kinds of immunologic and other problems. Medscape, Study.

UK – WHO declares human genome editing as safe

The World Health Organization (WHO) is offering a pathway to establish human genome editing as a safe, effective and ethical tool for public health. WHO Director-General explained that “Human genome editing has the potential to advance our ability to treat and cure disease, but the full impact will only be realized if we deploy it for the benefit of all people, instead of fuelling more health inequity between and within countries,”. Doctors For Life’s (DFL) official stance on genome editing is that we see no issue in genome editing as a therapeutic intervention however, when it comes to using this tool for enhancing humans ability to exceed normal human capabilities, DFL disagrees at this point. More

UK – Devices that help people control electronics with their mind becomes reality

Researchers from Imperial College London have reviewed commercial brain-computer interface (BCI) devices in the journal APL Bioengineering. The most promising is electroencephalography (EEG), a method for monitoring the brain noninvasively through its electrical activity. However, these devices raise social, ethical, and legal concerns. These devices allow a person to control electronics, which is useful for medical patients who need help controlling wheelchairs, but it may also change the way the brain functions. “For some of these patients, these devices become such an integrated part of themselves that they refuse to have them removed at the end of the clinical trial,” said one of the authors. “It has become increasingly evident that neurotechnologies have the potential to profoundly shape our own human experience and sense of self.” Other concerns are what if companies own the neural data? Since it is considered to be the most intimate and private information that could be associated with any given user it is worrisome said another author. More

Medical Ethics

USA – New movement calls for a change in determining brain death

The Uniform Determination of Death Act (UDDA) is a model state law agreed upon in 1981 by a number of expert bodies, which gives criteria for deciding whether a severely brain-damaged person is dead or not. Most states have adopted it, but only two-thirds of them have used the complete language of the act. Now, a movement calling for revision of UDDA is a try for uniformity, and called the Revised Uniform Determination of Death Act (RUDDA). 107 experts in medicine, bioethics, philosophy, and law, spanning a wide variety of perspectives, agree that UDDA needs an update but not as RUDDA because: “ (1) the Guidelines have a non-negligible risk of false-positive error, (2) hypothalamic function is more relevant to the organism as a whole than any brainstem reflex, and (3) the apnea test carries a risk of precipitating BD [brain death] in a non-BD patient, provides no benefit to the patient, does not reliably accomplish its intended purpose, and is not even absolutely necessary for diagnosing BD according to the internal logic of the Guidelines; it should at the very least require informed consent, as do many procedures that are much more beneficial and less risky. The issue of brain death is as much metaphysics as medicine. It requires a deep understanding of both to define the necessary criteria. More

Medical Ethics

USA – New York drops stem cell research

In 2007 New York State created a fund for research on stem cells, including human embryonic stem cells. However, it has been quietly dropped in the State’s current budget. According to Science, “Researchers expect the termination to be especially harmful to the study of human embryonic stem cells.” However, the program has experienced serious problems in recent years and has only distributed $400 million so far. In 2016, its board stopped meeting and reporting expenditures on its website. A government official told Science that stem cell science should “advance within academic and private research communities rather than the Department of Health, which is focused on its core mission of delivering direct services and achieving positive health outcomes for all New Yorkers.” More

China – Joined USA in making human-monkey chimeras

Researchers in China and the United States have injected human stem cells into primate embryos and grown chimeric embryos for up to 20 days. Despite ethical concerns, the scientists says that the procedure has potential for providing insights into developmental biology and evolution, into disease and transplants, and into drug development. In the current study, six days after the monkey embryos had been created, each was injected with 25 human cells. Human-monkey chimeras do raise worries, said the National Academies of Sciences, Engineering, and Medicine: “In the specific case of neural transplantation and chimera research, the slippery slope concern is that if small increments in mental capacities develop in transplants or chimeras, there will be no logical point at which the research should be stopped, or it may not be possible later to institute policies to block research that could result in nonhuman animals with unacceptable human capabilities.” More

Medical Ethics

USA – New state plan to decide life-saving treatment of overwhelmed hospitals

The NC Institute of Medicine, the NC Healthcare Association, and the NC Medical Society developed a hospital triage released a plan to help guide medical providers navigate ethical questions of who would get life-saving treatment when hospitals are overwhelmed by critically ill patients, and running out of equipment or space in a pandemic. The plan ranks patients based on how well their vital organs are functioning, as well as determinations of whether they would live long enough to leave the hospital if they got intensive medical care. The goal is to do the greatest good for the greatest number. This is different from the traditional focus of medical ethics, which is centered on promoting the well-being of individual patients.

In a webinar with reporters, one doctor said this was a dramatic shift in the thinking of physicians and the public’s expectations of medical staff during times of shortages. This is difficult for medical providers who take a professional oath to save individual lives whenever possible and this shift is uncomfortable for everyone involved. Some concerns that medical staff had about making decisions using patient health scores were about whether internal biases would creep in and whether all doctors’ medical assessments were reliable. More

USA – Physician coalition calls for ethical vaccines devoid of reliance on abortion derived fetal cell lines

The American College of Pediatricians, the American Association of Pro-life Ob-Gyns, the Christian Medical and Dental Associations et al, released a joint statement calling for the development of ethical vaccines devoid of any reliance upon abortion derived fetal cell lines. “Recent reports of the effectiveness of the Pfizer/BioNTech and Moderna COVID-19 vaccines, which are both mRNA vaccines, are encouraging. Although it is true that the animal-phase testing for these vaccines used abortion-derived fetal cells, commendably, it does not appear that production methods utilized such cells.” The statement concluded that if COVID-19 vaccines are approved as safe and effective, then use of the least ethically problematic vaccine available in the prevention of disease and death can be justified. More

South Africa – SA suspends vaccine AstraZeneca immunization campaign

South Africa’s (SA) first immunisation campaign has been halted since the coronavirus vaccine, AstraZeneca, has been found to show less protection than elsewhere. The South African trial of the vaccine, conducted in about 2000 people, found such a low efficacy against mild and moderate disease, under 25%, that it fails to meet minimal international standards for emergency use. COVID-19 vaccines made by Johnson & Johnson (J&J) and Novavax also offer weaker protection against the SA variant that causes the vast majority of all infections in South Africa. Shabir Madhi of the University of the Witwatersrand, the trial’s principal investigator, was still optimistic because the J&J and AstraZeneca still convincingly protected against severe disease and death. More

USA – Ultrasound treatment used to recover coma patients with severe brain injuries

In 2016, a team led by UCLA’s Martin Monti reported that a 25-year-old man recovering from a coma had made remarkable progress following treatment to jump-start his brain using ultrasound. In the journal Brain Stimulation, Monti and colleagues now report that two more patients with severe brain injuries have made impressive progress thanks to the same technique. Monti, a UCLA professor of psychology and neurosurgery considers this new result much more significant because these chronic patients were much less likely to recover spontaneously than the acute patient they treated in 2016. The scientists used a technique called low-intensity focused ultrasound, which uses sonic stimulation to excite the neurons in the thalamus. The hope is to translate the technology into an inexpensive, portable device so the treatment could even be delivered at patients’ homes. More

Medical Ethics

USA – Vaccine manufacturer Merck shifts focus

Vaccine manufacturer Merck has abandoned development of two coronavirus vaccines, after extensive research concluded that the shots offered less protection than just contracting the virus itself and developing antibodies. The company announced that the shots were ‘well tolerated’ by test patients, but generated an ‘inferior’ immune system response in comparison with natural infection. Merck will instead focus on research into therapeutic drugs labelled as MK-7110 and MK-4482 which aim to protect patients from the damage of an overactive immune response to the virus. Interim results from a phase 3 study showed a greater than 50% reduction in risk of death or respiratory failure hospitalized patients with moderate to severe COVID-19 using the MK-7110 drug. Merck is to receive around $356 million from the US government to fast-track production. More

USA – COVID-19 guidelines for Moderna and Pfizer vaccine administering

The World Health Organization (WHO) has issued new guidance on the Moderna Covid-19 vaccine. Pregnant women should not get vaccinated with Moderna unless they are at high risk of exposure like being a health worker. WHO director of immunisation Kate O’Brien said that clinical trials of the Moderna vaccine were still needed on pregnant women. The report also emphasised the need for facilities that treat allergic reactions to be readily available at vaccine administering sites with regards to Pfizer/BioNTech vaccine. Latest guidance from Public Health England states, “The early Covid-19 vaccines do not contain organisms that can multiply in the body, so they cannot infect an unborn baby in the womb.” More

South Africa – Prisoners to get vaccinated first

Outrage is brewing over the government’s decision to vaccinate awaiting trial and sentenced prisoners before ordinary citizens, when vaccines for the coronavirus become available. The reason for this is believed to be due to confinement and overcrowding and therefore prisons are considered to be the prime sites for the virus. Phase one will mean that frontline workers such as healthcare workers will be vaccinated first, Phase two will vaccinate teachers, police, municipal workers and other front-line personnel. People with comorbidities and people over 60 years of age, institutions including old age homes, shelters and prisons will be prioritised. Phase three will then vaccinate the remaining adult population. Experts, including the World Health Organization said the reason why prisoners should be prioritised was that when they (prisoners) contract Covid-19, they can easily and immediately transmit the disease to their fellow prisoners and prison staff as well as healthcare workers who treat them. More

Medical Ethics

Australia – Surgeons to have patients’ psychiatric evaluation before cosmetic or otherwise surgeries

A paper published in the Medical Journal of Australia warns surgeons to be cautious about taking on a patient whose had numerous past procedures performed by a list of different practitioners, which they refer to as “inadequate”. Patients need to have their psychiatric history and state of mind assessed before cosmetic procedures are performed because certain psychiatric disorders – such as body dysmorphic disorder (BDD), depression or a psychotic diagnosis – can present with a heightened concern about the way in which the patient looks. The surgeon should clearly outline what is realistic, and what the risks and complications might be. A psychiatric evaluation would prevent instances of unrealistic expectation and unnecessary litigation. More

South Africa – Telemedicine was an expensive lesson for one woman who sought cosmetic surgery

The Health Professions Council of SA had previously banned all telemedicine consults, except for telephonic prescriptions, – but due to pressure and being in line with global trends of virtual consults – the council relaxed restrictions for the pandemic only. One woman with scoliosis who wanted cosmetic surgery from a Medical Spa in Sandton, had to pay R120 000 to secure her appointment without a physical consultation and without adequate consultation. After doing some research, Rania discovered that she was at heightened risk for things to go wrong and wanted a refund but was told there are no refunds and then ignored. It turns out that the same clinic was sued for trademark infringement. This should caution practitioners and patients/buyers to make full disclosures and first have a physical consultation before paying for procedures. More

Medical Ethics

California – A bill to Sterilize Children Awaits Governor’s signature

While California has been in lockdown the state legislature has been passing legislation that creates a fund to pay for children to be sterilized in the name of transgender ideology. A law creating this fund is not only unnecessary and irresponsible use of taxpayer dollars, promoting an agenda at their expense, but it makes it legal and possible for young people to receive treatments that could adversely affect their health for life—treatments many doctors oppose. Dr James Grisolia, a San Diego neurologist and California state director of the American Academy of Medical Ethics expressed his concern for the youth because the legislation states that funds will go to transgender organisations who will partner with medical clinics they choose, and mean that transgender organisations will be in the driver’s seat on the treatment of children. Read more

UK – International Commission on the Clinical Use of Human Germline Genome Editing      

The National Academy of Medicine, of Engineering and of Sciences, The Royal Society and Heritable human genome editing -says “making changes to the genetic material of eggs, sperm, or any cells that lead to their development, including the cells of early embryos, and establishing a pregnancy – raises not only scientific and medical considerations but also a host of ethical, moral, and societal issues. Human embryos whose genomes have been edited should not be used to create a pregnancy until it is established that precise genomic changes can be made reliably and without introducing undesired changes – criteria that have not yet been met. Read more