Siamese Twins: Kill One or Let Both Die?

Post inspired by this article: http://www.cbhd.org/resources/healthcare/hollinger_2000-09-14.htm

 

In 2000, conjoined twins were born in England and their medical status generated much concern.  This set was conjoined at the lower abdomen so that one of the girls, (lets call her Mary) was totally dependent on the other (Jodie) for cardiac and pulmonary support because the twins’ lungs and heart resided in Jodie’s part of the body.  The dilemma came when doctors informed the parents that if they kept the twins conjoined, they would both die in 6 months, but if they separated them, Debbie would die instantly but Jodie could live for much longer.  Difficult questions quickly arise: should the parents save Jodie by killing (should it be called that?) Mary?  Should both lives be treated as intertwined, with potential lifespan as an arbitrary and inapplicable concern, so that both girls should live as long as possible without inciting the (unnatural or pre-term death of one of the girls?  Who has the authority to decide this? 

 

The author of the article that incited this post, Dennis P. Hollinger, presented five reasons as to why the parents should elect to do the surgery and should attempt to save Jodie’s life at the expense of a few more months of Mary’s life.  I want to address his second point that because Mary would not be alive if she weren’t conjoined to her sister, it is justified to allow her to die by un-separating them because their connection is unnatural while separation, and thus its consequences, are natural.  I think that Hollinger’s argument missed the crucial point that Mary has mental activity and thus she is an autonomous and legitimate person.  Just because her organs are not hers (just like someone on life support or with organ transplants) does not mean that the benefits from those organs are illegitimate. 

 

 This case not only presents a very difficult and quite possibly a lose-lose situation but also a situation that, I feel, is mostly complicated because it has to juggle the divergent interests of the multiple parties.  Until we determine clearly who is in charge of these situations and what capacity of control they hold, the continued complexities will compound and thus we must continue to try to sort out the debate of what is ethical and who, especially in difficult situations, has the authority to decide what’s ethical.  

Guinea Pigging among Surrogate Mothers?

I never understood why any woman would volunteer to be a surrogate mother. Why would anyone carry another’s child? Or risk experiencing the mental or physical consequences of giving birth then having to give up the child that was inside one’s body for nine months? However, the same questions could be asked to any person giving up their body for human experimentation. Although these volunteers see financial incentives as their primary goal of becoming involved in surrogacy or human experimentation, there are other moral values that can come into play as well. For instance, Jennifer Cantor, a 34-year old woman with her own 8-year old daughter, claims that she gets pleasure from carrying a child, whether it is hers or not. She claims that there is no emotional attachment to the baby she gives birth to; she merely wants to help others who are unable to have children. In fact, there are an increasing number of American women – more since the attack on Iraq in 2003 and husbands left their young wives to go overseas – who volunteer to be surrogate mothers. In the past five years, the small percentage of all surrogate mothers reported to be 1,000 – a 30% increase from 2000. What is the cause of such popularization of surrogacy?

The reasons for this dramatic increase during war time may be due to a number of causes. Perhaps the absence of the husband leaves women needing to find means of economic support. In fact, a surrogate mother can earn up to $20,000 to $25,000! However, as mentioned before, financial gains are often not the incentives for the surrogate mothers; noble values of benevolence and sympathy drive women like Jennifer Cantor to help other women find ways to have their own babies – those who derived from their own genes. Then, a question arises similar to the one raised concerning “guinea pigging” effect. Could the potential for “guinea pigging” and hence subtle coercion be eliminated by eliminating the financial incentives to surrogate mothers?

Source: http://www.newsweek.com/id/129594

Malpractice suits

Malpractices suits are of grave concern in many fields of medicine. Obstetrics and gynecology is the biggest hitter, costing each OB/GYN $175,000 in malpractice insurance and are liable for malpractice up to 18 years after the delivered their final child. Many times, people take advantage of these malpractice laws in order to earn money on the physician’s behalf. Many choose to force their patients to sign waivers that remove their rights to file such a suit and if they fail to do so, then the doctor refuses his or her services to the patient.
The question lies in the ethical acceptability of such action. On one had, the doctor is trying to safeguard himself from unethical patients who just want to reek the most financial benefit. But what about those patients that he actually does harm, don’t they have a right to wreak the monetary compensation for his mistakes. But then, there is always the risk that the doctors will attempt to monopolize this malpractice risk and in order for any patient to get medical care they will have to sign off their rights without choice. After all, a doctor is just meant to help people and shouldn’t worry about the external risks or benefits, right?
Now, what an individual must decide is where the happy medium lies with this. Perhaps the papers should have disclaimers saying what is acceptable as a ground for a lawsuit and what isn’t. What do you think is a possible solution?

Terri Schiavo, Revisited

The upcoming campus visit (tomorrow, April 8th, Frist 302, 7:30 pm if anyone is interested) of Terri Schiavo’s brother, Bobby Schindler, has gotten me thinking again about the issue of euthanasia, or mercy killing, and whose decision it should be. I’m sure you all remember the epic battle between Terri Schiavo’s husband, Michael, and her parents over her life. Eventually, Michael won the right to remove Terri’s feeding tube and she died in March 2005, after spending over ten years in a “persistent vegetative state.”

Many of the articles I have come across online characterize Terri’s death as “horrific” and indicate that she was “cruelly starved to death and dehydrated.” There is no doubt that Terri died from lack of food and water, as she was able to survive without any help beyond a feeding tube. The controversy lies in whether or not her death was “cruel.” Because Terri did not leave a living will, her loved ones bickered over whether or not she would have wanted to die based on vague recollections of things she had said. For me, personally, I remember how much it sucked to be stuck on the couch for a week after I had my appendix out, effectively not being able to feed myself because I couldn’t get up, and I can be sure that I would not want to live in a persistent vegetative state, so brain damaged that I was not aware of my own existence.

I believe that severely brain damaged people are not alive anymore in the sense that they are of course living because their organs are functioning, but they no longer possess that which makes them truly human. I do not particularly believe in souls per se, but I feel that every person attains personhood through having a mind that can think and learn and create new ideas in and of itself. If someone’s mind is dead, they are no longer alive.

From there, the decision between life and death could have been left in the hands of either her biological family or her husband. Because Michael Schiavo had already moved on to a new life and had children with another woman, I do not think he should have been the one to make the decision regarding Terri’s future. Terri’s family was willing to pay all medical expenses to keep Terri alive, so she would not have been a burden to Michael in any way. I definitely believe that Terri was already dead in the most crucial sense of the word and I think that removing her feeding tube was the right decision for Michael to make. However, I also think that it may have been better for her family to make that final decision because they still had a strong emotional attachment to Terri and were willing to take care of her as necessary. Who are we to dictate what someone else’s family should do in that instance?

Overall, I think that this was an incredibly difficult decision and Terri’s case was incredibly unfortunate and of course everyone would have been better off if Terri had either died on the day she fell ill, or had never fallen into her vegetative state in the first place. I think that Terri’s parents should have been able to make the decision regarding her future as they had a more vested interest in her well being as Michael had already separated himself from Terri significantly. However, as the right to make a decision was given to Michael, I believe that he did make an appropriate decision.



http://jewishworldreview.com/cols/hentoff040308.php3
http://www.princeton.edu/~soapbox/vol2no4/24murray.html
http://www.princeton.edu/~paw/archive_new/PAW05-06/09-0308/notebook.html

Silly Americans, ADHD is for Kids…Not

According to the American Academy of Child and Adolescent Psychiatry, approximately 15% of grade school children can be diagnosed with ADHD, which has lead to a sevenfold increase in the production of Ritalin between 1991 and 1998. Because there are no biological tests for ADHD, diagnosis largely depends on reports from parents and teachers. Unfortunately, accounts from parents and teachers may not be entirely accurate; how can they differentiate between an active, energetic child and one who suffers from ADHD?

Compared to other countries, the incidence of ADHD in the United States is especially high. In Japan, for example, ADHD has not achieved the label of a disorder like it has in the United States. The Japanese view the “symptoms” of ADHD as temporary childhood characteristics that all individuals eventually grow out of. Americans, on the other hand, do not share the same perception. In fact, most Americans view ADHD as permanent disabilities, meaning that children diagnosed with ADHD will carry the burden of ADHD for the rest of their lives.

I believe that the common misconception in America regarding ADHD revolves around our inability to accurately diagnose the “disorder” and our hastiness in turning to medications to correct problems. America has fallen into the trap of believing that ADHD is a common “disorder” thereby leading to its over diagnosis. Part of the problem with the high incidence rate of ADHD is that society fosters the diagnosis of the “disorder” by relying heavily on medications (Ritalin) to “cure” undesired traits associated with young children. ADHD may essentially serve as a scapegoat for parents to better control their children. This scapegoat will only continue to grow unless Americans remove the stigma that undesired childhood characteristics spell ADHD.

References:

Donovan, Denis M. “An Alternative Approach to ADHD.” The Harvard Mental Health Letter May 2000: 5-7.

It's a bird..it's a plane..it's a human-cow baby?

In Britain, they have recently created human-cow embryos using cow egg cells. They claim that their aim is not to make human-cow hybrids but to use such embryos for stem cells. This is part of the bigger goal of creating organs as part of the booming field of regenerative medicine. We don't, however, know what these human-cow embryos really could amount to. Based upon biological predictions, successful animal-human embryos of this sort could not be made but it has not been entirely investigated.

Scientists who advocate the fertilization of cow egg cells with human DNA do so for two reasons: one being that we must save human egg cells. Such cells are "precious" and have been destroyed too often in the process of research. Another reason is that they believe that the negative stigma surrounding the debate of stem cells lies mostly in the fact that human stem cells are being used. Arthur Caplan is quoted in the article (big surprise) as saying that he "sees no risk in making 'monsters' [aka human-cow embryos] this way."

Numerous complications can be seen with this method. Is it really true that all of the negative connotations associated with embryos used for stem cells would just disappear? Afterall, the embryo is still part human. It is unlikely in the highly controversial subject of stem cells that negative attitudes would dissipate. The ethical controversies of stem cell research are complex and therefore cannot be solved using a simple solution, such as removing the human egg cell component. In addition, it is likely that more ethical issues will be created in using animal and human embryos. Animal rights activists may have something to say about animal DNA being used for the production of stem cells. Others may simply fear the combination because it is "unnatural."

The question remains: should this type of experimentation be allowed even though we do not know the outcomes? Will it help solve the need for stem cells by eliminating some of the controversial aspects (such as destroying a potential human fetus)? Or instead, will more ethical issues arise?

http://news.yahoo.com/s/nm/20080402/sc_nm/cloning_cows_dc;_ylt=Ag0w0E0eYSI3G2F6JJBOy2eJhMgF

Sex Selection in the US

This post was inspired by the article: "Some Asian Families in the US Choosing Sons" found on http://ap.google.com/article/ALeqM5jIOvYV1zOH5fKHW5lqNFlR3RhZ8AD8VOLE502

This article reveals that some Asian families are using sex selection techniques to increase their chances of having a son, especially if their first child is a girl.

The main problem highlighted in this article is that the sex selection techniques are simply a fetal ultrasound to discover the sex of the baby, and then abortion if it is a girl. I don't want to get into the ethics of abortion here, so I want to discuss the implications of sex selection in general.

There are ways of increasing the probability of having a child of particular gender, but suppose you could pick for certain. However, you could only pick if you already had a child of the opposite sex. Therefore, you could only pick a boy if you already had a girl and vice versa.

I wouldn't have a problem with this at all. There are practical reasons why a parents would want to have a balance, and there are also practical reasons why parents would want to have a boy (to carry on the family name, manual labor, etc.) There are also practical reasons why a family would want to have a girl if their first child was a boy. I don't agree with Sandel and May in their argument that such a selection would remove the humility of parenthood and their general argument about "openness to the unbidden". You are not choosing the child's traits, simply what gender they are. And it is not like the parents have full control. They would not be able to choose to have a family of four boys.