First 3-Parent Baby Born in Mexico, Setting Off Regulatory and Ethical Concerns

According to an article published by CNN, dated September 28, 2016, on April 6, a baby was born with DNA from three people by using a new technique called “spindle nuclear transfer.” A team of doctors from New York went to Mexico to conduct the procedure since the Food and Drug Administration has not approved spindle nuclear transfer in the United States. Some are saying that this baby is the first to be born through this procedure, but critics state that the procedure produced children in the “1990s/early 2000s before the FDA” began to regulate it.

From Cnn.com, “Controversial 3-parent baby technique produces a boy”

Excerpt from article:

While in the past, the procedure was used to help women conceive and give birth to healthy babies in cases of infertility, the new version was created to tackle a specific problem: mitochondrial mutations.

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Editing Embryos: Scientist Begins Research Involving Modifying Genes of Human Embryos

In an article dated September 22, 2016, it was revealed that a Swedish scientist has become the first known researcher to begin attempts to modify genes in healthy human embryos—a practice which has been, and for many still is, considered “taboo.” Critics are concerned that people will begin to use such technology to create “designer” babies, or that such research could unintentionally create a new genetic disease; however, the scientist involved says he plans to use the embryos for no more than 14 days, in which time he may be able to discover new ways to treat infertility, prevent miscarriages, and use stem cells to treat various diseases.

From NPR.org, “Breaking Taboo, Swedish Scientist Seeks to Edit DNA of Healthy Human Embryos”

Excerpt from article:

“Lanner is planning to methodically knock out a series of genes that he has identified through previous work as being crucial to normal embryonic development. He hopes that will help him learn more about what the genes do and which ones cause infertility.”

Read Full Article.

 

Are Legal Limits for Marijuana Level Impairment Reliable?

The number of fatal car crashes involving marijuana use doubled in the state of Washington after the use of recreational marijuana was legalized.  One of the difficulties the state has encountered in preventing such crashes is determining per se limits for the amount of marijuana drivers can have in their systems.  Unlike alcohol impairment, which is defined by a blood alcohol content (BAC) level of .08 or higher, marijuana impairment is difficult to quantify. There is no reliable data showing that drivers become impaired at a specific level of marijuana content. Frequent users of marijuana, for example, may maintain higher levels of the drug for a longer period of time then occasional users. Thus, depending on the individual, drivers with relatively high levels of marijuana in their system might not be impaired, while others with low levels may be unsafe behind the wheel.  While there is no clear indication that a certain level of THC definitively increases the risk of car crashes, some states have implemented per se limits ranging from 1 ng/mL of THC to 5 ng/mL.

The AAA Foundation for Traffic Safety, however, is urging states to implement more comprehensive enforcement measures to improve road safety.  It suggests that, rather than relying on arbitrary legal limits, states should use a two-component system that requires (1) a positive test for recent marijuana use and, more importantly, (2) behavioral and physiological evidence of driving impairment. Marshall Doney, AAA’s President and CEO explained: “States need consistent, strong and fair enforcement measures to ensure that the increased use of marijuana does not impact road safety.”  But to maximize road safety, all motorists are advised to avoid driving while impaired regardless of whether the use of marijuana is legal in their state.

Source: https://www.sciencedaily.com/releases/2016/05/160510103131.htm

Legalization of Marijuana Reduces Teenage Use

According to the results of a biannual poll conducted by Colorado’s Department of Public Health and Environment, teenage marijuana use has not increased since the state legalized the use of recreational marijuana for adults over the age of 21. The poll surveyed about 17,000 high school students in Colorado, of which 21.2 percent responded that they used marijuana in the preceding thirty days. This is a slight decrease from the 2011 results of 22 percent. The 2015 survey also indicated that the nationwide average for teen marijuana use is slightly higher than Colorado’s at a rate of 21.7 percent. Yet, contrary to the results of Colorado’s survey, a survey by the U.S. Department of Health and Human Services placed Colorado at the top of the list of states which the highest rate of marijuana use in teenagers between the ages 12 to 17.

Advocates for legalization of marijuana believe that the results in Colorado’s survey prove that the “fears of widespread pot use by minors” in states with legalized cannabis are unwarranted. Yet, others are skeptical about the results. SMART Colorado, an organization that lobbies for stricter marijuana regulations, believes it is “‘deeply concerning” that according to the survey, only 48 percent of students in Colorado view regular marijuana use as a risky behavior.

Source: http://www.scientificamerican.com/article/colorado-s-teen-marijuana-usage-dips-after-legalization/

“Physician-Assisted Suicide is now legal in Canada”

With the passing of new legislation, Canada has become one of the few nations to legalize physician-assisted suicide.  The new law imposes strict requirements, however, by limiting the option to the incurably ill and requiring medical approval, a 15-day waiting period and two independent witnesses. Moreover, to obtain a request for physician-assisted suicide, a patient must: (1) be eligible for government-funded health care; (2) be a mentally competent adult over the age of 18; (3) have a serious and incurable disease, illness or disability; and (4) be in an “advanced state of irreversible decline” with enduring and intolerable suffering.

The legislation is more restrictive than some of the lawmakers had wanted.  Some argued that it should be broadened to include degenerative disease, whereby patients who are suffering from incurable degenerative diseases but are not necessarily close to death would also qualify for physician-assisted suicide. Yet, others believed that such a broad criteria would push the law too far. As Justice Minister Jody Wilson explained, the requirements in the final legislation “strike the right balance between personal autonomy for those seeking access to medically assisted dying and protecting the vulnerable.”

 Source: http://www.npr.org/sections/thetwo-way/2016/06/18/482599089/canada-legalizes-physician-assisted-dying

Texas Abortion Law Struck Down by Supreme Court

On June 27, 2016, the Supreme Court invalidated a Texas law that limited women’s access to abortion. The law required physicians performing pre-viability abortions to have hospital admitting privileges. It also required women’s health centers that offered abortion services to abide by certain surgical center requirements, causing many centers to close.

Proponents of the law claimed that it was an effort to maintain safety standards for women. However in a 5-3 vote, the Supreme Court concluded that the legislation imposed an undue burden on women attempting to obtain an abortion. Justice Breyer explained in his opinion that with the majority of clinics that offered abortions forced to close, the law would require women to travel long distances to the only “crammed-to-capacity” compliant facility. He further stated that nothing in the legislation provided any benefit to women’s health. Justice Ginsburg echoed this conclusion in her concurring opinion by explaining that complications from pre-viability abortions are rare and not life-threatening.

Justice Samuel Alito, Jr. wrote the dissenting opinion, which did not directly speak to the constitutionality of the law. Instead, he focused on the doctrine of res judicata, which prevents recurring litigation on a matter that has already been resolved. Justice Thomas affirmed this argument in a concurring dissent, claiming that the majority has repeatedly “distorted” the law and given preference to pro-choice arguments.

This is the first case the Supreme Court has decided regarding abortion rights in nine years, and while it was by no means a unanimous decision, it affirmed that the undue burden test established in Planned Parenthood v. Casey in 1992 continues to control the constitutionality of abortion laws.

Source: http://www.nytimes.com/2016/06/28/us/supreme-court-texas-abortion.html?_r=0; Marcia Coyle & Tony Mauro, High Court Strikes Down Curbs on Texas Abortion Clinics, N.Y. L.J., June 28, 2016, at 1–2.

 

Should Children Make Their Own Medical Decisions?

Julianna Snow, a 5 year old girl who suffered from an incurable neuromuscular disease, died on June 14, 2016 after a long, hard fight that sparked a great deal of debate among bioethicists. Julianna was diagnosed at 2 years old with Charcot-Marie-Tooth disease, and by 4 years old she could not use her arms or legs and had to use a feeding tube. However, the effects of her illness were only physical and not mental. After being in and out of the hospital, Julianna’s parents were informed they would need to make extremely difficult medical decisions the next time Julianna got an infection that would make it hard for her to breathe.  Even though Julianna was only 4 years old, her parents decided to include her in such medical decisions. To honor her wishes to “go to heaven” and not go back to the hospital, her parents decided to care for Julianna in the comfort of her own home.

This decision was highly criticized by some who believed Julianna’s parents “painted a coercive picture” to influence their daughter’s decision to “go to heaven.” Bioethicist Arthur Caplan, for example, argues that a 5 year old child is incapable of making this kind of decision especially in light of the case of Cassandra C., a 17 year old girl who refused chemotherapy but was mandated to receive treatment when a court concluded she lacked capacity to make such decision. Yet, the doctors who were most involved in Julianna’s care supported her parents’ decision. Even Bioethicist Arthur Caplan admitted after meeting Julianna that “she taught [him] and others that even a child can become very knowledgeable about a challenging illness and can convey thoughtful and remarkable feelings about her illness and her ideas.”

Julianna received hospice care for the last 18 months of her life and in that time she celebrated her fifth birthday as a princess. She died in her mother’s arms at home in her princess room.

 

Sources: http://www.cnn.com/2016/06/14/health/julianna-snow-heaven-over-hospital-death/

http://www.bioethics.net/2015/10/can-a-5-year-old-refuse-treatment-the-case-of-julianna-snow/

Study Concludes that Variability in Transplant Centers’ Decisions to Accept Organ Donations is as Much to Blame for Inequality in Transplant Care as Geographic Borders

A patient’s eligibility to receive an organ transplant is determined by, among other things, the patient’s location and consequently, geographic borders have been routinely blamed as the predominate cause of inequality among transplant care. However, the Perelman School of Medicine at the University of Pennsylvania recently found that transplant center variability in deciding whether to accept an organ may also play a role in such inequality and waitlist mortality.

As explained by the study, a Model for End-Stage Liver Disease (MELD) score is used to prioritize patients on the liver transplant list. Despite this uniform system, there remain disparities among the 11 Organ Procurement and Transplantation Network (OPTN) regions across the United States. When an organ becomes available, the United Network for Organ Sharing (UNOS) ranks all patients eligible to receive the organ based on blood-type match, the recipient’s geographic location, MELD score and the recipient’s willingness to accept organs with certain unfavorable characteristics. The organ is then offered at a transplant center at which the highest-ranked patient is waitlisted. The center may in turn decline the organ based on donor age, donor-recipient size mismatch, or a decision that a patient with lower priority has a greater risk of death and is therefore a better recipient for that particular organ. Perelman’s study found significant variability in the organ acceptance rate among transplant centers, with some accepting organs for their first-ranked patients as low as 16% of the time to as high as 58% of the time, even after adjusting for donor, recipient, and transplant center characteristics.

A center’s decision to accept an organ is a matter of life and death. In order to reduce the variability in such decision-making among transplant centers, and maximize access to lifesaving transplant care, the study suggests that organ acceptance rates of all transplant centers should be made public so that patients and referring providers can make informed decisions when selecting a center for their care.

 Source: https://www.sciencedaily.com/releases/2016/01/160127154825.htm

New Study Suggests that Medical Errors are the Third Leading Cause of Death in the U.S.

A new study published by BMJ (formerly the British Medical Journal) in May 2016 suggests that medical errors may cause more deaths than lower respiratory diseases.  This would make medical errors the third leading cause of death (following heart disease and cancer) in the United States.  The study indicates that at least 251,454 deaths each year are due to medical error.  This number is much higher than that reported by previous studies. One reason for such discrepancy may be the lack of accurate data regarding deaths caused by medical error.  Causes of death listed on death certificates are based on insurance billing codes, which “are designed to maximize billing rather than capture medical errors.” As a result, death certificates fail to address human errors or other system failures.

The doctors who completed the study hope that their analysis will “lead to real reform in a health care system [that] is letting patients down.” They suggest that better reporting mechanisms must be put in place to address medical errors that lead to death. Some proponents believe that a space should be added on death certificates to indicate whether death was related to a medical error. However, to avoid legal implications when a doctor indicates such a cause of death, legislation would need to attach some protection or privilege to this information (for example, by prohibiting the information to be used in a lawsuit). Such legal protections would encourage accurate reporting by doctors and, in turn, would help establish a course of action for minimizing the most common medical errors that lead to patient death.

Source: http://www.cnn.com/2016/05/03/health/medical-error-a-leading-cause-of-death/

Young, Mentally Ill Patients Placed in Nursing Homes Meant for Elderly

The trend of “population mixing” in nursing homes is on the rise as more young people with brain injuries and mental illnesses are being placed in facilities intended to serve an elderly population. Unfortunately, for young patients in need of long-term skilled nursing care who rely on Medicaid and other government funding for health care, placement in a nursing home is often the only available option. This is because there are few remaining facilities specifically designed for patients with mental illnesses or brain injuries.

 

Although “population mixing” in nursing homes has been occurring for some time, the recent increase is linked to a spike in resident-to-resident altercations (“RRAs”). RRAs are most common in nursing homes with shared rooms and pose a significant risk to elderly patients who are involved in an altercation with younger, more physically able patients. In order to decrease the incidence of RRAs between young, able-bodied patients and physically vulnerable elderly patients, experts opine that it is necessary to increase government funding for mental health facilities so as to provide better treatment options for young patients.  Nursing home could then be dedicated to care for the elderly populations they were designed to serve.

 

Source: http://www.bloomberglaw.com/exp/eyJpZCI6ImEwajR3N3E3YzE/anM9MCZzdWJzY3JpcHRpb250eXBlPWJuYWhsciZpc3N1ZT0yMDE2MDUyNiZjYW1wYWlnbj1ibmFlbWFpbGxpbmsmc2l0ZW5hbWU9Ym5hIiwiY3R4dCI6IkJCTkEiLCJ1dWlkIjoicHo5dVZVTENaOW12QXhKRDJkOHVlZz09a25WNVYxKzNzOG4vZUpvMGplYW4wQT09IiwidGltZSI6IjE0NjQxMTY1NjU1MzMiLCJzaWciOiIxYlE0cXhNQUZYZUczS1ZvVjlXNmFrVURoZU09IiwidiI6IjEifQ==?emc=bnahlr:blaw:1003