Tag: anencephaly

Bioethics News

Organ donation for transplantation in children with cardiac arrest and dying person dignity

Premortem interventions before donation in circulatory arrest in children could have objective ethical problems 

(See our special reports about criterion of death and organs transplantation HERE)

Up until a few years ago, performing medical interventions in end-of-life situations had been proposed as actions centered on the best interests of the dying patient.

The growing demand for organs for transplantation has created a need to increase the number of organ donors (see HERE).

Since the number of brain-dead donors is currently insufficient to meet the needs of patients on the transplant waiting list, medical procedures have been developed in the last decade aimed at ensuring that the organs from donors in cardiac arrest are also suitable for successful solid organ transplantation (see HERE our article about the relation between excellent figures of organ donation and organ donors with cardiac arrest in Spain).

Nevertheless, in order to achieve sufficient organ viability in donors with cardiac arrest, a series of medical procedures need to be performed that have the main aim of reducing the warm ischaemia time to which these organs are subjected, in order to increase the chances of post-transplant success.

An article has recently been published in the Journal of Medical Ethics (1“Premortem interventions in dying children to optimise organ donation: an ethical analysis”, whose authors Joe Brierley and David Shaw analyze the ethical and legal aspects of premortem interventions performed in dying children, aimed at optimizing organ donation for transplantation following cardiac arrest.

Premortem interventions in pediatric patients for organ donation from an ethical perspective

This article examines the legislative aspects (specific to the United Kingdom), and also gives a description and analysis of the elements that, from an ethical perspective, might support – or contradict – the performance of premortem interventions in pediatric patients for organ donation.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Brain Death – 3rd Edition by Wijdicks

This third edition introduces new research in the intensive care unit, newly unearthed historical data on important US-UK differences, a thorough discussion of US guidelines and how it is used in hospital practices, and compares guidelines used elsewhere in the world. In this incisive work, the many complexities of diagnosis and management of brain death are examined but it also illuminates cultural beliefs and bioethical problems, highlights the nature of conferences with family members, and captures several organ procurement issues. The book also includes 30 commonly asked practice problems to resolve diagnostic uncertainties and conflicts along with 12 video clips to assist in neurological evaluation.  

Chapter 1: History of Brain Death

A New Comatose State Appears

Defining Neurologic Criteria for Death in Us

Chapter 2: Neurology of Brain Death

The Pathology of Brain Death

Clinical Examination in Adults

The Clinical Determination of Brain Death in Children

Documentation

Teaching Brain Death Determination

Errors and Alleged Recoveries

Legal Definitions and Obligations

Chapter 3: International Criteria of Brain Death

Guidelines in the United Kingdom

Guidelines World Wide

Consensus for a Uniform World Wide Standard

Chapter 4: Beliefs About Brain Death

Religious Beliefs

Cultural Views

Religious Conflict Resolution

Chapter 5: Critics and Brain Death

The Uncertainty of Death

Emerging Controversies

Critique

Chapter 6: Procurement After Brain Death 

Transitioning to Organ Donation

Organ Procurement Organizations

Organ Donation Requests

Preparation for Determining Organ Suitability

Donation Protocols

Medical Management of the Organ Donor

Chapter 7: Clinical Problems in Brain Death and Organ Donation

1. The Qualifications of the Examiner

2. Clinical Mimics

3.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

BioethicsTV (January 2-6, 2017): Violating promises, coma v. PVS, transplant evaluation, and whether to abort

by Craig Klugman, Ph.D.

Pure Genius (Season1; Episode 10- 1/5). In this episode, Dr. Channarayapatra is working with a patient in lung failure. Due to exposure to toxins dumped in the ground beneath her neighborhood, the patient’s lung tissue is disintegrating. Bunker Hill hospital is attempting to build the world’s first implantable, artificial lung but has not had success. With her lung function decreasing, the patient may soon face one of two options: death or ECMO—a process where a machine oxygenates her blood outside of the body. The viewer is told that ECMO can only be used for a maximum of two weeks. The patient tells Channarayapatra in no uncertain terms that she does not want to be on ECMO. Channarayapatra promises that she will not put the patient on ECMO. However, when the crisis appears and the patient’s lungs fall apart, Dr. Channarayapatra goes back on her promise and begins ECMO.

There are three concerns with this scenario. First, a doctor should never make a promise to a patient that she or he cannot keep. Second, a doctor should keep promises made to patients. Third, if a competent and capacitated patient has clearly rejected an invasive medical treatment, then the patient’s right to refuse consent and to reject that intervention must be honored, even if it results in the patient’s death. Otherwise, the physician commits a battery by touching a patient without permission and also violates the patient’s autonomy.

Of course, this being a show where the ends always justify the means, an artificial lung is created and implanted in the patient (without any animal or preliminary human testing of course).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

A Few Thoughts On Abortion and Valuing Human Life


Who could be against life? Ancient natural law theory in the
Catholic tradition tells us that human beings desire to live, and that life is
good, therefore humans have an obligation to live and not kill other human
beings. This ancient wisdom has been instilled into western ways of moral
thinking. So, who could not be prolife in terms of how we place value on all
individual human life?


 


Who could be against human freedom? Individual human beings
should be free to live peacefully in accordance with their own values and life
goals. This is a basic tenet of democracy that has shaped moral and political
thinking in the West for the past four centuries. So, who could not be against
the exercise of free choice, especially about something so basic as having
control over our bodies?


 


The two value perspectives contained in the prior two
paragraphs, all things equal, are eminently reasonable and most ethically unproblematic.
These two value positions represent two fundamental principles of ethics—the
intrinsic value of all individual human lives and the right of free individuals
to govern their own lives and bodies—that guide us in living an ethical life
and making ethical decisions. It is when these fundamental principles come into
direct conflict that a serious, a near irresolvable, ethical conflict arises.
There is no greater direct conflict of these two ethical principles than right
of women to have an abortion. It is commonly assumed that one is either on one
side of this moral abyss or the other and the twain shall never meet.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

UK health service may harvest organs from babies with lethal defects

The UK’s National Health Service is to encourage pregnant women whose children have a fatal birth defect to bring them to term so that their organs can be harvested. This shocking story was reported by the Mail on Sunday, so it must be taken with a grain of salt. However, the newspaper quotes a number of doctors who support the idea  and cites plans being studied by the NHS.

The proposal was apparently mooted at the annual conference of the British Transplantation Society in Glasgow. 

Transplant surgeon Niaz Ahmad, of St James’s University Hospital in Leeds, said: “We are looking at rolling it out as a viable source of organ transplantation nationally. A number of staff in the NHS are not aware that these organs can be used. They need to be aware. These can be transplanted, they work, and they work long-term.”

Apparently anencephalic babies are ideal for this purpose. These are children who are born without a brain, or with very little brain tissue. In today’s UK hospitals 230 are aborted annually and only 12 brought to term. However, more and more women are deciding not to abort the child, according to Dr Joe Brierley, a specialist at Great Ormond Street Hospital for Children in London. Women who have made this decision could be counselled that their child’s organs could benefit other patients. Near the time of birth the child would be pronounced brain-dead and its organs removed.

However, the newspaper reports that NHS Blood and Transplant said: “Under no circumstances would our staff or anybody else within the NHS pressure women to continue with a pregnancy solely for the possibility of organ donation.” 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Spread of Zika Virus Reignites Abortion Debate in Brazil

By Farzana Paleker
An increase in the number of babies being born with microcephaly in Zika-affected areas of Brazil has sparked a heated debate over the country’s strict abortion laws. Abortions in Brazil are illegal except in instances of rape and in cases where fetuses are diagnosed with anencephaly, a condition resulting in an underdeveloped brain and an incomplete skull. The World Health Organization has declared the Zika virus infection an international public …

The post Spread of Zika Virus Reignites Abortion Debate in Brazil appeared first on Global Bioethics Initiative.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Activists use Zika epidemic to press for abortion in Brazil

A woman in Brazil holds her daughter, who was born with microcephaly / New York Times   

The abortion debate has been reignited in Brazil amid fears about severe birth defects linked to the Zika virus. Zika is thought to cause defects such as microcephaly in the babies of pregnant women, though the link is yet to be scientifically proven.

A group of Brazilian academics and activists has created a petition to ask the country’s supreme court to allow abortions for women who have contracted the virus.

The group, based around the Anis Institute of Bioethics Human Rights and Gender at Brazilia University, successfully campaigned in 2012 for the adding of a third exception to Brazil’s ban on abortion. Now in addition to medical emergencies and cases of rape, women can legally seek an abortion if their child is suffering from the brain condition known as anencephaly.

The group is confident that they can secure yet another exception for Zika sufferers. Deborah Diniz, a legal academic at Brazilia University signatory of the petition, blamed the government for the outbreak of the Zika virus, and said that the poor should not be penalised for policy blunders: “The state’s neglect generates a state responsibility” Diniz told the BBC.  

The virus is spreading rapidly across the Americas, and on Thursday the WHO forecast that as many as 4 million people in the region may become infected before the epidemic is controlled.  

This article is published by Xavier Symons and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Responding to Zika: Ethical Challenges of Zoonotic Diseases

The World Health Organization will hold an emergency committee meeting on the pandemic reemergence of Zika virus and the explosive increase in reported cases of congenital microcephaly in Brazil possibly linked to Zika on February 1. The virus is a mosquito-borne infection in the same family as West Nile and dengue. Until 2015, Zika had rarely appeared in the Western hemisphere. The WHO will decide whether the pandemic should be considered a public health emergency of international concern. Hastings Center Fellow Lawrence Gostin and Daniel Lucey suggested that “the very process of convening the committee [will] catalyze international attention, funding, and research.”

Much of the fear and uncertainty around Zika stems from a suspected association between pregnant women infected with Zika and risk of their babies being born with microcephaly, a birth defect characterized by an abnormally small head and brain damage. But much remains unknown about transmission and diagnosis. Christian Pettker, chief of obstetrics at the Yale School of Medicine, wrote in The New York Times, “Fear of these unknowns explains the severity of some of the responses from the medical community,” like telling women in areas with active Zika transmission to avoid pregnancy.

In a December 2015 article in the South African Medical Journal, Solomon Benatar, a bioethicist at the University of Cape Town and a Hastings Center Fellow, reviewed the ethical challenges presented by the 2014-2015 Ebola outbreaks in West Africa and offered lessons for future public health emergencies. Benatar’s account of the   “interpersonal, public health and global” levels of ethical challenges offers a helpful framework for understanding what is at stake in the Zika pandemic and concerning other zoonotic (animal to human) diseases.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

False inevitabilities and irrational exuberance

Scans of media coverage carried out by CGS and others after the National Academies of Medicine and Sciences co-sponsored International Summit on Human Gene Editing in early December revealed that, for editors at least, it was a confusing event.  Some stories ran under headlines signaling that gene editing research had been given a green light [Science]; others said scientists were seeking a moratorium [The New York Times].

Since then, several disquieting themes have emerged online in mainstream media and science blogs. These include the phenomenal medical gains to be had from gene editing for somatic therapeutic interventions, with the attendant piquing of interest among venture capitalists in search of the next big profit-taking opportunity in biomedicine. 

There is also ongoing discussion of the desirability of “fixing” the human genome through reproductive genetic interventions.  Disturbingly, some commentators are touting the “inevitability” of human germline.  And a few powerful voices in science and bioethics seem to be at pains to prove that CRISPR-Cas9 modifications that aim to “improve” resulting offspring—eugenics by any other name—would be categorically different from any previous efforts of that sort because they would be driven by public demand rather than state mandate.

Take, for example, the December 22 Quartz piece whose headline trumpets that 2015 was “the year it became OK to genetically engineer babies.”  The article itself, by Akshat Rathi, makes less forceful claims about the “okayness” of designer babies, but does argue

[W]hen historians of science look back decades from now, they may well mark 2015 as the year genetically engineering humans became acceptable.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Pro-Lifers’ Arguments Might be their Greatest Gift to Pro-Choicers

Abortion is always going to be a controversial topic.  For what it’s worth, I that there’s nothing wrong with it.  That’s me speaking from my habitual non-consequentialist position.  From a more utilitarian perspective, I’m willing to concede that a world in which abortions happen is worse than a world in which they don’t because noone gets pregnant without wanting it, and everyone is perfectly happy to continue with her pregnancy; but it’s a whole lot less bad that a world in which women are compelled to continue with pregnancies they don’t want.  In other world, there’s no need or desire for abortion in super-happy-fluffy world, and super-happy-fluffy world is better than the real world – but we live in the real world, and having abortions available makes the real world better than it could be.

I’d like to think that I’m doughty enough to have my mind changed on this, though.  Should someone have a really good argument for the wrongness of abortion, or the overwhelming badness, I’d like to think that I could be persuaded – that I’d let the argument go wherever it takes me.  I think that that’s just intellectual honesty.  It’s just that I have yet to come across an argument that I find persuasive, and I don’t even know what such an argument would look like.

What I can say is that, while I find even the best pro-life arguments unpersuasive, some are worse than others, though.  There’s a guy who keeps posting to the Bioethics Facebook group with links to lamentably bad arguments.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.