Tag: legal rights

Bioethics Blogs

What We Do When We Resuscitate Extremely Preterm Infants

by Jeremy R. Garrett, Brian S. Carter & John D. Lantos

This editorial is made available on bioethics.net. The editorial along with the target article and open peer commentary is available via tandfonline.com

Neonatal intensive care is one of the most successful medical innovations of the last half century. Every year, in the United States alone, nearly 500,000 babies are born prematurely. Before neonatal intensive care, most of those babies died, and those who survived often suffered significant life-limiting impairments. Today, most preemies survive without impairments.

In spite of this success, neonatal intensive care unit (NICU) care has always been viewed as ethically problematic. The objections to this care have taken different forms at different times.

Economists questioned whether neonatal intensive care was cost-effective. Careful studies showed that it was more cost-effective than any other form of intensive care, and even more cost-effective than many modalities of preventive care (including, for example, Pap smears).

Some parents claimed that doctors were not honestly informing them of the potential long-term sequelae of NICU care, and that, if honestly informed, many parents would choose palliative care. Careful studies showed that these parents were unusual. Most parents want more intensive care than even doctors and nurses think is appropriate, and they want it even when informed that survivors might be left with significant disabilities.

Bioethicists and doctors argued that neonatologists were playing God, that premature babies were not full-fledged persons, and that saving disabled babies was like an ill-conceived military mission. Each of these attempts to undermine the commitment made by parents, doctors, and society to saving preemies has been met with hard questions and strong rebuttals.

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

My Sister’s Keeper: An Assessment of Living Organ Donation among Minors

by Alex Fleming

The 2009 film My Sister’s Keeper, based on Jodi Picoult’s 2004 New York Times bestselling novel which bears the same name, is among other things, a controversial story about a young girl (Anna Fitzgerald) who sues her own parents in order to obtain legal rights to the use of her body. For as long as she can remember, Anna has unwillingly been providing blood and bone marrow to her older and critically ill sister, Kate. As the story unfolds, tension within the family arises as the 13 year-old Anna Fitzgerald becomes fully aware of her reason for existence, so to speak, which is to prevent the death of her older sister by providing a regular supply of blood and bone marrow, which she has done regularly for several years. Later on, as Kate’s condition worsens and her renal function begins to fail, the parents naturally turn to Anna to provide what could be a life-saving kidney transplant for her older sister. The climax of the story begins as Anna confidently and heroically refuses. The story raises a slew of bioethical issues which are beyond the scope of this essay; however, the story sheds light on a topic worthy of discussion: living organ donation among minors.

As the supply of organs suitable for transplantation decreases and the demand for them increases, the question of living organ donation among those yet of age has become a question of greater concern, primarily among those who point to the various ethical implications which such a procedure creates.

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

The Very Early Embryo & Its Moral Signifiance

by Andrew J. Prunty

As technology and biological research continue to develop in the twenty-first century, it is necessary to address and further define the ethical considerations of embryonic research and the appropriate rights that may limit the extent of human research on zygotes, blastocysts, and fetal scientific advancement. Because the area of harvesting embryonic stem cells remains significantly undefined, both legally and morally, there are vastly different opinions between researchers and bioethicists, mainly because of ethical limitations, on the rights that should be granted to cells with the potential to develop into human beings and the consequences of neglecting significant scientific research or advancement.

Current laws in the United States differ at the federal and state level, but there is no consistency in recognizing human embryos as humans, or affording them the same legal rights granted to a child; in fact, legal precedent actually detracts certain rights from developing embryos, favoring a human’s ability to destroy a potential human being (i.e. Roe v. Wade[i]) or the categorization of embryos as property (i.e. Davis v. Davis[ii], A.Z. v. B.Z.[iii], Marriage of Dahl[iv], or Reber v. Reiss[v]). These case law samples suggest the courts’ inability to reach a conclusion as to what is the status of an embryo.

The debate is not only circumscribed to matters of research, but to fundamental controversial and intertwined issues of bioethics such as: when life begins, embryonic stem cells, fetal rights, abortion, et cetera. All these topics are contentious and when one topic arises, they begin to comingle.

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

Water, Health, & Social Justice

Shawn H.E. Harmon and Janice E. Graham advocate for a public interest approach to the governance of water.

__________________________________________

Earlier this month, a boil water advisory was issued for Schreiber Ontario. Such advisories are not uncommon in Canada, despite it being one of the world’s wealthiest and most developed countries. In 2015, there were over 1,838 boil water advisories, including 139 in First Nations and Inuit communities, where an estimated 20,000 Indigenous Canadians have no access to running water or sewage. Boil water advisories were placed in 29 Nova Scotia communities on 21 December 2016. On that same day, the Canadian Radio-television and Telecommunications Commission (CRTC) declared access to broadband internet a basic service. If access to the internet is critical to our economy, prosperity, and society, and to every citizen, as suggested in the CRTC decision, then water can be nothing less than an inalienable right, tied up as it is with life, health, and human flourishing.

Relevant fundamental human rights are enumerated in Articles 1-3 and 26-29 of the Universal Declaration of Human Rights (1948), and in many other legal instruments. As well, the right to “sufficient, safe, acceptable, physically accessible and affordable water” has been recognized by the United Nations Committee on Economic, Social and Cultural Rights. The European Declaration for a New Water Culture, published in 2005, encouraged a holistic approach to water that recognizes its ethical, environmental, social, economic, political, and emotional value, as well as its natural inclusion in the Heritage of the Biosphere. A subsequent 2006 United Nations Report characterized water as an essential component of security and development.

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

A New Zealand River Now Has The Legal Rights Of A Human

The legislation marks a monumental victory for the local Māori people, who view the river as “an indivisible and living whole,” Gerrard Albert, lead negotiator for the Whanganui tribe, tells The Telegraph.

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

The complications and practicalities of cryopreservation

Someday we might get the technique right    

The publicity surrounding the cryopreservation of the body of a 14-year-old British JS after her death from cancer has prompted more commentary.

Heather Conway, of Queen’s University Belfast, ruminated on the legal complications arising from reanimation after decades or even centuries on ice.

From a legal perspective, the problems are obvious – starting with the fact that the person has already been declared legally dead. How would, how could, the law reinstate them? Could that person reclaim assets that they owned in life, but had passed to family members on death? Could inheritance laws be undone? And if the person’s spouse is still alive but has now remarried, would that marriage still be valid when the former partner returns from the dead? Even before this happens, what is the status of the corpse during its time in the deep freeze: does it have any legal rights? How long should a frozen corpse be stored, and would the individual’s family have the right to thaw or destroy the corpse without reanimating it?

And Alexandra Stolzing, a lecturer in regenerative medicine, at Loughborough University, in the UK, points out that it is still impossible to cryopreserve brains successfully. Besides she points out,

But there’s another huge hurdle for cryonics: to not only repair the damage incurred due to the freezing process but also to reverse the damage that led to death – and in such a manner that the individual resumes conscious existence.

From a purely technical point of view, this added complication might be worth avoiding.

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

Is someone reanimated from cryogenic freezing legally dead or alive? And other problems

The idea that your dying or recently deceased body could be frozen in the hope that some future technology could revive you is no longer science fiction. It is now something people will pay handsomely for – as the recent court ruling that allowed a 14-year-old British girl with terminal cancer to have her remains cryogenically frozen and stored indefinitely in a US clinic has shown. While the possibility that even future medical technology could revive anyone from death is moot, in the here and now the practice of cryopreservation raises all sorts of novel legal issues.

Freezing a corpse keeps its physical structure intact – and there have been stories of grieving relatives preserving a loved one’s remains in this way. Long-term cold storage of the dead in purpose-built refrigeration facilities is permissible, although DIY preservation in a freezer at home is not such a good idea and inevitably prone to electrical or technical failure, as was the case for a frozen French doctor and his wife who unexpectedly thawed.

Cryonics takes this to a whole new level, seeing freezing as an interim solution. A speculative technology, it uses extremely cold temperatures of –196°C to preserve human remains until a medical cure is found for whatever caused death in the first place. At this point, so the theory goes, the corpse can be thawed and reanimated. Sometimes the whole body is frozen, or sometimes just the person’s head – with the intention of reconstructing the individual from their brain. H

However, the science itself is at least suspect.

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

CFAS Guidelines on Third Party Reproduction

Vanessa Gruben argues that the Canadian Fertility and Andrology Society’s Guidelines on Third Party Reproduction offers important information for patients and the public about third party reproduction.

__________________________________________

The Canadian Fertility and Andrology Society (CFAS) recently published Clinical Practice Guidelines on Third Party Reproduction (Practice Guidelines). Third party reproduction refers to the use of sperm, eggs or embryos from a third party donor(s) or the use of a surrogate to build a family. Third party reproduction allows either individuals or couples to attain a pregnancy where they are unable to do so using their own gametes or uterus. This includes people who are suffering from medical infertility as well as LGBT families and single parents by choice.

The Practice Guidelines address many aspects of third party reproduction including, medical and infectious disease screening of donors, providers and surrogates,  the retention medical records, psychological counselling, and independent legal counsel. While not legally binding per se, these Practice Guidelines seek to fill in glaring legal gaps and offer greater certainty in clinical practice.

Take, for example, the retention of third party donor medical records. The current law in Ontario requires that medical records be kept for ten years from the date of the last entry in the record and the College of Physicians and Surgeons of Ontario recommends that physicians retain medical records for 15 years. Yet neither the law nor the College recommendations take into account the possibility that a donor conceived person may require access to his or her donor’s medical record well past either of these time lines because of the important information it contains about the donor conceived person’s family medical history.

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

Who decides what to do when a foetal abnormality is diagnosed; surrogate mother or contacting parents?

The “professional model” defends the right of the surrogate mather to decide whether or not she wishes 
to have an abortion

As we know, surrogacy consists in initiating a pregnancy in a woman other than the biological mother, with the intention that, when the child is born, he or she is to be handed over to the contracting parents. This usually takes place in couples with infertility issues, single people or even homosexual couples.

There are two well-differentiated types of surrogacy: altruistic and commercial. In the latter, the surrogate is paid to accept the pregnancy, while in the former, acceptance is for any other reason, generally altruistic.

Surrogacy is known to present a multitude of medical, social and ethical problems (read HERE), not least of which is knowing what to do when abnormalities of any type are detected in the unborn child that presuppose that it may suffer objective medical problems after birth, many of them serious. Should the pregnancy be continued? Should an abortion be performed? And in this case, to whom does the responsibility fall? The woman carrying the child? Or the biological parents? In the event that the pregnancy must be continued, who should be responsible for the child born disabled?

These are all serious objective issues that very much need reflection, and, if possible, the establishment of objective action guidelines.

An interesting article has recently been published on this topic in Bioethics (29; 529-535, 2015).

The article discusses the difficult moral dilemma that arises for the biological parents and the surrogate if a foetal abnormality is diagnosed: What should be done with the child?

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

Nurses Cannot be Good Catholics

Guest Post by John Olusegun Adenitire

It seems that if you are a nurse you cannot be a good Catholic.  Or, better: if you want to work as a nurse then you might have to give up some of your religious beliefs.  A relatively recent decision of the UK Supreme Court, the highest court in the country, seems to suggest so.  In a legal decision that made it into the general press (see here), the Supreme Court decided that two Catholic midwives could not refuse to undertake administrative and supervisory tasks connected to the provision of abortions.

To be sure, no one asked the nurses to directly assist in the provision of abortions.  The Abortion Act 1967 says that “No person shall be under any duty … to participate in any treatment authorised by this Act to which he has a conscientious objection.”  The Nurses argued that this provision of the Act should be understood widely.  Not only should they be allowed to refuse to directly assist in abortion services: they should also be entitled to refuse to undertake managerial and supervisory tasks if those were linked to abortion services.  The nurses’ employer was not impressed; neither was the Supreme Court which ruled that the possibility to conscientiously object only related to a ‘hands-on’ capacity in the provision of abortion services.

In a recent paper in the JME (available here) I have argued, albeit only indirectly, that this decision is only half-correct.  Nurses and other medical professionals have a human right to object to the provision of a wide range of services which they deem incompatible with their conscience.

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.