To Donate or Destroy: Embryo Donation Practices in Australia Shed Light on Ethical Dilemmas

Embryo donation raises a series of challenges. In Australia, the market for embryo donation is comprised of high demand and low supply. In addition, embryos cryopreserved for future reproduction are only kept frozen for a maximum of ten years; then the family must decide whether to destroy or donate the embryos. However, there is no legislation in Australia to direct this decision or to protect the interests of families who choose to donate.

While the thought of destroying an embryo feels unethical to many individuals, the decision to donate may not seem acceptable either. Australian law prohibits anonymous donations and presumes that, at the age of 18, a person is entitled to know the identity of those who donated gametes from which he or she was conceived. Yet, Australia has no legislation that requires people who conceive using donated embryos to inform their children of the embryos’ origins or to inform the donors about the children their embryos helped conceive.

Although the law does not clearly protect the interests of donors, some Australians have found positive experiences when deciding to donate rather than destroy their embryos. Koby and David Argall, for example, explain that the possibility of an embryo staying “frozen in time” was not an option for them and believe that the decision to donate is one of the most important and positive decisions an individual can make.

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New York Approves Use of Medical Marijuana for PTSD Treatment

New York has become the latest state to legalize medical marijuana for treatment of post-traumatic stress disorder (“PTSD”). New York will join 28 states and the District of Columbia which have already approved such use of medical marijuana. The news was widely celebrated by many veterans groups who have found their current treatments too severe or ineffective.

Veterans groups also hope this trend in state law will motivate change in federal law, which currently prohibits physicians engaged by the U.S. Department of Veteran Affairs from prescribing medical marijuana to veterans for PTSD. Some commentators contend that evidence on the efficacy of medical marijuana has been inconclusive and therefore, the legalization of such treatment is premature, but clinical trials assessing the effectiveness of medical marijuana in treating PTSD are ongoing.

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Controversial U.K. Policy Withholding Surgery from Smokers and Obese Patients

The United Kingdom’s county of Hertfordshire has expanded a controversial health care policy that withholds surgery from patients who are obese or who smoke. The policy was originally implemented in 2011 and, at the time, only applied to hip and knee operations. In 2012, it was expanded to include other non-urgent routine surgeries. Under the policy, patients were banned from having surgery for a specific period of time as an effort to urge them to improve their health by losing weight or quitting smoking in order to become eligible for surgery. However, the most recent expansion of the policy is labeled as an “indefinite” ban on all routine surgeries until the patient’s health is improved.

Proponents assert that the expanded policy will help patients improve their health while also alleviating the county’s health care budget and reducing length of hospital stays. Opponents, however, argue that the policy is unethical.  One professor of psychology, Robert West, has expressed that “[r]ationing treatment on the basis of unhealthy behaviors betrays an extraordinary naivety about what drives those behaviors.” Although reducing obesity and smoking prior to any surgery is beneficial to a patient’s recovery, it remains unclear whether withholding surgery altogether is actually successful in improving overall health.

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Ethical Dilemmas Presented by the Legal Euthanization of the Mentally Ill

Cornelia Geerts, a fifty-nine year old woman who struggled with mental illness in Belgium, asked her psychiatrist to help her end her own life. In 2014, about one year after her initial request, a physician administered a lethal dose of drugs that killed her. Euthanasia is currently legal in only five countries: Canada, Colombia, Luxembourg, the Netherlands, and Belgium, where Ms. Geerts’ death occurred. Euthanasia is not legal anywhere in the U.S., but six states and Washington D.C. have legalized physician assisted suicide, which allows physicians to prescribe lethal drugs to terminally ill patients for patients to administer themselves. Belgium and Luxembourg permit euthanasia of people suffering from terminal illnesses as well as people suffering from mental illnesses, who may not be at the end of life.

The number of patients euthanized because of psychological suffering makes up a small percentage of euthanization cases in Belgium—of the approximate 2,000 euthanasia deaths that occur per year, only about 40 involve those who were suffering from mental illness. Though these cases are few, they highlight the bioethical dilemmas that physicians and lawmakers face in dealing with mental health issues and an individual’s right to make his or her own healthcare decisions. Advocates argue that individuals suffering from mental illness should be afforded the same rights as those who suffer from a physical illness. Yet, others believe that it is nearly impossible to know when a mentally ill individual decides to end his or her own life with sound mental capacity and not as a result of their underlying mental health disorder. Opponents believe that society has a responsibility to help those suffering from mental illness and to find help through means other than euthanasia.

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Hospital Puts Transplant for Two-Year Old Patient on Hold after Donor, the Patient’s Father, is Arrested

Two-year-old A.J. Dickerson, who was born without kidneys, was awaiting a transplant from his father, Anthony Dickerson.  However, after Anthony was arrested just days prior to the scheduled procedure, Emory University Hospital put the procedure on hold.  Even though Anthony was subsequently released from jail and is available to undergo surgery, the Hospital is requiring that Anthony comply with his parole obligations for at least 3 months before they continue with the transplant.

Such decisions to halt a transplant can entail added risk to the patient. Without the procedure, A.J.—who has already suffered a stroke because of his condition—may not survive the 3 month period required by the Hospital, or the long wait to find an alternative donor from the donor list.  A.J.’s family contends that the transplant should not be contingent on the actions of the father, but should focus on preserving the life of the child.

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Tags: Transplant, Donor, News

Sweden Dismisses Investigation of Stem Cell Scientist

Swedish authorities have dismissed claims against Dr. Paolo Macchiarini, an Italian stem cell scientist, who had been under investigation for voluntary manslaughter in connection with the death of three of his patients following windpipe transplants that were made partly from the patients’ own stem cells. The procedure is considered experimental by many researchers and experts. Yet, many scientists and physicians believe it could revolutionize medicine, particularly in regards to organ renewal and growth of new organs in laboratory settings.

The Swedish authorities argued that the use of “artificial” windpipes is negligent and medically unjust. However, there is very little consensus from medical experts regarding treatment and standard protocols that should be implemented with stem cell research. In addition, the Swedish authorities could not establish a direct connection between Dr. Macchiarini’s actions and the deaths of his patients. Without sufficient causation or standard of care protocols, the claims against Dr. Macchiarini were dismissed.

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Catholic Health Services Provider Faces Lawsuit for Denying Transgender Surgery

Seventeen year old Paxton Enstad, a transgender male, sought chest-reconstruction surgery as part of his gender dysphoria treatment.  When his parents, Cheryl and Mark Enstad, sought to obtain pre-authorization for the surgery, PeaceHealth St. Joseph Medical Center, a Catholic organization, denied the services without offering a rationale as to why it was denied.

The Enstads filed suit in U.S. District Court, claiming that PeaceHealth’s refusal to cover the services violates the Affordable Care Act (“ACA”) and the State of Washington’s anti-discrimination laws.  Specifically, they claim that the refusal to authorize the surgery enforces gender stereotypes and amounts to gender discrimination.

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Read Complaint Here.

 

 

 

Healthcare Advocates Push for Improvements in Advance Care Planning

Advanced directives, such as a health care proxies, promote quality health care by allowing individuals to leave specific instructions on how others should make medical decisions on their behalf in the event they lose capacity to do so themselves. Yet, nearly two-thirds of Americans do not have an advanced directive in place, and even those that do are at risk that their advanced directives will not be easily located when needed, as most are not recorded electronically.

Currently, the Centers for Medicare and Medicaid Services (“CMS”) reimburses health care providers for discussing advance care planning with their patients, but advocates are pushing for additional measures that would encourage a greater dialogue about end-of-life care, promote the execution of advanced directives, and ensure that advanced directives are readily accessible to providers and health care proxies. Most recently, a bipartisan bill was introduced in legislature that would require CMS to pay Medicare beneficiaries a nominal amount in exchange for writing and electronically recording advanced directives. Advocates hope that the payment would encourage more individuals to execute advance directives. In addition, CMS would maintain all such documentation online and would ensure that it can be accessed by providers and health care proxies as necessary.

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The National Institute of Health’s Path to “Precision Medicine” and the Barriers Associated with the “All of Us” Study

In connection with a data-gathering experiment known as “All of Us,” the National Institute of Health (NIH) is seeking a pool of over 1 million participants. NIH hopes that at least half of the participants will be made up of individuals who have historically been underrepresented in research studies, including certain minority communities. NIH believes this study can pave the way for “precision medicine,” a more personalized type of medicine with treatments based on a person’s genes. However, due to historical mistrust of researchers by minority communities, NIH knows that it has a challenge ahead to encourage underrepresented individuals to participate in the study.

From Stat News, “To advance medicine’s future, the NIH tries to win the trust of communities mistreated in the past”

Excerpt from article:

“People are afraid of being experimented on . . . Researchers know it won’t be easy to find hundreds of thousands of people who have little reason to let the government sequence their DNA but who might be willing to take a chance for a healthier future for their children.”

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Tags: National Institute of Health, NIH, All of Us, Tuskegee, Henrietta Lacks, mistrust, minorities, minority communities, revolution in healthcare, health research, biomedical research, healthy futures, precision medicine

The Risks of Antidepressants: Suicide and a Lawsuit for Inadequate Labeling on Pharmaceutical Drugs

Stewart Dolin began to take an antidepressant called Paxil five days before he committed suicide. His wife, Wendy Dolin, who had noticed a change in his behavior when he started taking the drug, remembers her husband being abnormally agitated in the days prior to his death. Ms. Dolin alleged that a side effect of Paxil, called akathisia, played a role in his decision to commit suicide. Akathisia brings on a state of acute physical and psychological agitation. Ms. Dolin sued the manufacturer of Paxil, GlaxoSmithKline, claiming that the company had not sufficiently warned of the dangerous side effects.

Evidence that surfaced during the trial brought to light results of early clinical trials conducted on Paxil in 2006. According to the studies, “the frequency of suicidal behavior was higher in patients treated with paroxetine compared with placebo” among adults of all ages with major depressive disorder. Though the label on Paxil had once reflected the risk to adults of all ages, the newer label only stated that the increased risk was seen among people under 25 years old. Both labels failed to capture, however, was the true magnitude of the heightened risk. The frequency of suicidal behavior in patients being treated with Paxil was found to be 6.7 times higher than the frequency for those being treated with the placebo. There have also been studies that have found a correlation between akathisia and suicidal behavior.

Ms. Dolin was successful in her lawsuit against GlaxoSmithKline, and a jury awarded her $3 million dollars in damages. This verdict is particularly unusual, as many lawsuits involving suicides are either dismissed or settled outside of court; it serves as a stark reminder to pharmaceutical companies that labels on antidepressants must adequately reflect the risks associated with them.

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Ms. Dolin started an organization called The Medication-Induced Suicide Prevention and Education Foundation (Missd) in memory of her husband and to raise awareness of akathisia. You can learn more about Missd at:  http://missd.co/