The New Lobotomy

This Friday’s version of The New York Times had a front-page article that described the well being of two men. The first man was older and found “himself completely unable to wash himself or brush his teeth”, while the second was a teenage who had “become so terrified of germs that he would regularly shower for seven hours”. These OCD patients both decided to undergo an experimental surgery that would, idealistically, allow them to overcome their disorder. This surgery requires that “four raisin-sized holes” would be “burned deep in their brains”. 24 months after the surgery, the first man insists that there was no change in his behavior as he “still doesn’t leave the house”. The second subject, however since the surgery, has been able to return to a “normal” life and is even able to attend college. This modern day lobotomy immediately evokes a comparison to One Flew Over the Cuckoo’s Nest. He argument over this procedure lies within the risk. Some medical ethicists still believe the results are hugely unpredictable. The Times explains, “It was not so long ago…that doctors considered the frontal lobotomy a major advance- only to learn the operation left thousands of patients with irreversible brain damage”. So far this experimental surgery is exercise for only extreme untreatable cases of OCD (5- 15 percent of OCD patients qualify). I believe that we need to make the distinction between progress toward a solution and deeming this surgery a solution. Careful research should continue, while only using this treatment on very drastic cases. It is our nature to desire to help everyone in need immediately, but we are not fully aware of the repercussions. We must recognize this step in the right direct, but not deem it the end of our journey to help these people.


Thanks to: Surgery for Mental Ills Offers Hope and Risk by Benedict Carey The New York Times

PGD Testing - Selecting healthy embryos

Recently, specialists have been able to use pre-implantation genetic diagnosis to implant healthy embryos into the womb and discard the embryos which are damaged. Experts believe that this genetic screening of embryos could eventually eliminate diseases such as breast cancer and cystic fibrosis. However, this prospect worries many ethicists. Bernadette Tobin, an ethicist at Australian Catholic University, was quoted in the article saying that selecting some embryos while rejecting others is a morally unacceptable way of avoiding having a child with a serious disease. Furthermore, discarding embryos with certain diseases creates a slippery slope. Sydney IVF medical director Dr. Mark Bowman says that they "are testing for serious genetic diseases." But, who's to say where a disease stops being "serious" and becomes "mild." By allowing this kind of embryo selection parents will start discarding possible children in search of that perfect embryo with no setbacks whatsoever. Eventually, this process could lead to an experience in which parents line up their embryos and select the best one from the bunch, much like one shops in the mall or the supermarket. Though this is probably not reasonable at the moment because we do not know the functions of all of the genes, it is certainly possible that one day it could be a reality.

I do understand that the main goal of this testing is to prevent children being born with incredibly painful and challenging lifelong diseases. However, another objection to this type of selection is that people will almost always choose to throw out the embryos with genetic "malfunctions" and we will start to see a decline or even lose much of the disabled population. This genocide of sorts against the disabled is also unethical. They should have just as much of a right to survive as perfectly healthy children do. There is no reason that a child with a severe disability cannot live a worthwhile life.

Instead of rejecting embryos because of an undesirable genetic trait, we should strive to create cures for diseases so that when a person with a serious illness chooses, they will be able to reduce the suffering or improve their condition. They should be allowed to live and subsequently, they should be given the choice to live with their disease or to use the cure. It is not our jobs to play God and choose which embryos gets to develop and which get put in the trash.

Relevant site: http://www.theage.com.au/lifestyle/lifematters/designing-principles-at-birth-of-a-new-era-20091121-is43.html

A New Form of Psychiatry

A new cure for obsessive compulsive disorder, depression, Tourette’s syndrome, and maybe even obesity may have been found, but not in the form of any drug. Instead, patients with severe cases of obsessive compulsive disorder have turned to brain surgery. A new technique of psychosurgery, called cingulotomy, surgeons can thread wires into a circuit connecting the regions of the brain processing emotions to the frontal cortex. This circuit appears to be overactive in patients with OCD, and the surgery can help relax the patients. Other surgeries can stimulate the brain by providing more or less electric current to certain areas of the brain, while others burn out sections of certain brain circuits associated with a particular disease.
So far, only patients who meet strict criteria have been permitted to undergo this surgery (such as a boy who spent seven hours a day in the shower or a man who refused to wash himself). In some cases it has been successful while some surgeries have not created much of a change. Patients have to undergo strict screening and many are turned down if their symptoms are not disabling enough. Now the surgery is used as a last resort for patients who have tried everything else, with the understanding that it may or may not be successful.
This surgery can provide relief to severely affected people, but we still do not know enough about the brain to promise a positive outcome. We are essentially tampering with these patients’ brains and rewiring parts of their minds. At the moment it is in its experimental stages, but once scientists have learned enough to promise success, how will we determine who is disabled enough to undergo treatment? So far, obsessive compulsive disorder has been the most common cause of surgery, but anxiety, depression, and obesity have also been mentioned as “diseases” that may be cured. However, there is no marker that specifically defines someone as anxious. Eventually, will healthy people look to have their brains stimulated to help them relax more, concentrate better, or otherwise enhance their minds? It makes sense to help people whose day-to-day lives are severely affected by their mental disorders, but we need to make sure that these surgeries to do not cross over the line separating treatment and enhancement, no matter how tempting may be.

Article Relevant to my Post:
"Brain Power--New Techniques in Brain Surgery Mix Hope with Risk" by Benedict Carey
http://www.nytimes.com/2009/11/27/health/research/27brain.html?_r=1&ref=health&pagewanted=all

To Decide or Not to Decide

When I was researching a topic for the third essay, I came across the ethical dilemma of whether teenagers should be able to make decisions in the context of life-altering situations such as surgery or the refusal of certain medical treatments. A teenager under 18 is not legally in charge of his or her own medical care, but the question is should they be able to make their own decisions? There is a very arbitrary line drawn at the age of 18 when an individual is suddenly capable of legally making all the decisions in his or her life. Ironically, the day before your 18th birthday you need parental consent and are considered incapable of these same decision making processes? A better judge of capability is the level of maturity of such an individual, because it is quite clear from everyday experience that some individuals are mature beyond their years, and just as many are the opposite; they are extremely immature.

One example comes to us from Britain, where a 13-year-old girl decided to refuse a life saving heart transplant. Understandably, this worried a few of her doctors and outside observers. They said she was making a rash decision and that she did not have enough life experience to know what was truly good for her. However, she had thoroughly thought about the surgery and decided that one more surgery would only prolong her life a little longer before she needed another one too. Also, she wanted to spend time with her family instead of in a hospital and believed she would be saving the life of another patient who needed a heart transplant. Her rational, logical argument and contemplation convinced the lawyers and the local child service agent as well as a good number of those who learned of her story. This rational and convincing logic is a sign of maturity, and teenagers who can make decisions in this fashion seem to be capable of choosing what is best for them. However, these teenagers still lack the degree of knowledge their parents and doctors have, so the question remains, who makes the decision in these cases?

Souces Relevant to my post:
“Teenagers and the right to be wrong” by Dominic Wilkinson
November 14, 2008 on the website Practical Ethics: Ethical Perspectives in the News

“Hannah's Choice: Saying No to a New Heart” by Nancy Gibbs.
Thursday, Nov. 13, 2008 in Time.com

The Perfect Egg Donor

Recently, as I was browsing Facebook, I stumbled upon an advertisement requesting egg donors. With curiosity heightened by our studies of human experimentation, I followed the link to EliteEggDonors.com. The site was offering $75000 to donors with the specific characteristics that Preferred Donors must have. Among these characteristics were: at least 5’8, athletic—“college or professional level”, very attractive--“Modeling experience a plus,” genetically healthy, and “proven intelligence.” While I could understand how future parents seeking a donor would want to reduce the number of problems their child may have and thus request the best possible donors, I was struck by the requirements of being “very attractive,” having “proven intelligence,” and being “athletic.” While I thought that egg banks coul offer help and support to couples that cannot successfully produce a child, and understood that the banks often go through a rigorous way of appropriately matching eggs and parents, I was initially skeptical of an egg bank requesting such “perfect” eggs. However, I realized that unlike designing children, egg donation is a way of resolving the problem of infertility, rather than seeking enhancement.

If an increasing number of humans began to use the eggs of, in their opinion, the most ideal or perfect person, diversity would probably begin to decline, and people may begin to follow trends in character, rather than accepting differences. While the comparison may be a stretch, the type of eggs in demand may follow a pattern similar to that of clothing—one “style” is in demand, but only a few months or years later, and a whole new “style” becomes popular. Looking at it from an economical perspective, the value of model-like looks, for example, or athletic ability would go down because almost everyone would embody those qualities. Long-term, people would become similar, which could have an array of social and perhaps even psychological consequences, such as devaluation of those without those qualities, inability to accept imperfection, and the like.

While these issues would become a concern if people turned to egg donation and in vitro fertilization as a primary means to choose their child’s characteristics, social chaos could ensue. However, egg banks really only appeal to those who physically cannot conceive or produce children, because in general, people want to have children of their own, with a genetic makeup derived from their own. Egg banks also tend to only offer their service as a solution for couples with existing procreative limitations, so it egg donation and usage can be placed in the realm of therapy, while it is not necessarily therapy by definition. Therefore, since egg banks serve those with reproductive disabilities, egg donation is ethical. Also, in order to reduce emotional complications for the family and the child, choosing children with favorable traits is in the favor of the entire family. In order to reduce unfavorable genetic tendencies that could cause more emotional duress, egg banks request those with the most preferable traits, so as to ensure, as best as possible, family contentment.

EliteEggDonors.com

www.northshorelijivf.com/donor-egg-program-long-island/donor-egg-faq-recipient.html

How Is This Cosmetic?

As I sat in my car on the ride home from the doctors office I was faced with a decision to make: do I get surgery so I can pursue my athletic career or do I not get surgery and be content with my decision that I will never be able to run without pain again; moreover, I may have to quit the sport I love? Tears streamed down my face. Having surgery meant having 5-inch scars on both sides of both of my legs for the rest of my life as reminders of what I did so I could be able to play college lacrosse. Not getting surgery meant quitting the sport that ultimately made my decision of what college I ended up going to and was the sport that was responsible of some of the greatest times of my life so far.

My dad turns and looks at me and says “Ultimately your surgery is a cosmetic surgery.” Obviously I was confused. It wasn’t like I was getting a nose job or breast implants. The doctor would remove tissue from my legs in order for my muscles to expand more and so I could run without pain or numbness. How is that considered cosmetic? But then I thought the situation over and realized that this surgery wasn’t necessary. My life wasn’t in jeopardy if I didn’t receive the surgery. However, in my mind, receiving surgery seemed like the only option. I love lacrosse, and if the only way I could continue to play was to receive surgery, I was going to get the surgery. But to outsiders, including my parents, surgery was just a huge step to take just so I could play a sport, moreover, and optional sport.

Although I may consider my sport part of my life and huge part of shaping me into who I have become today, my sport does not define me. I would be receiving surgery so I could play something for 4 years and then my career would be over since there is no women’s professional lacrosse. I was stuck. Of course I wanted to play lacrosse, but surgery was such a drastic step to take. Was I mature and willing enough to accept that step, for better or for worse, and accept that I may regret it in the future?

I ended up going through with the “cosmetic surgery.” Currently I have 40 plus stitches in my legs. My legs are swollen and I’ve been so doped up on medication I can’t even watch tv. But in my mind, it was all worth it. Some people look at my parents and me and think we are crazy. They question my parent’s moral. How could they let their 18-year-old daughter go through surgery so she could play a sport especially if the surgery wasn’t even necessary? It’s because they love me and love me enough to let me strive at the thing I love. Sure, I may regret this surgery in the future, I may be angry with my parents that they allowed me to have it, or I may be mad at myself that I let myself get lost so lost in a sport that I was willing to put my life as risk to be able to play at a higher level. But for now, knowing that I will have the ability to play at a level I know I can play at pain free is all the motivation I need to get me through this. I couldn’t be happier with my decision and I am looking forward to making great progress with my new legs. Whether this surgery was an enhancement is a whole other story that only time will be able to tell.

Paralyzed But Conscious For 23 Years

Three years ago, a Belgian man who had been assumed to be in a coma since 1983 was found to be completely paralyzed, but completely conscious. Entirely unable to communicate, Rom Houben, 46, was believed to be in a persistent vegetative state until examination using (unspecified) "a state-of-the-art scanning system" as part of a larger study of coma patients revealed that his brain was functioning normally. Since then, he has been able, through intense physical therapy, been able to regain a modicum of control, and can now speak via typing with one finger on a computer keyboard.

This admittedly staggering news story brings with it a degree of sensationalism. To American minds, it is most strongly reminiscent of the national imbroglio that was the Terri Schiavo case, which culminated in 2005 with her removal from life support. Indeed, the neurologist who discovered Houben's brain activity, Steven Laureys, acted as an adviser for that case.

Had Houben, like Schiavo, been removed from life support, his doctors would have unknowingly murdered him. This is especially chilling when one considers Laureys's assertion that misdiagnosis occurs in coma cases "on a disturbingly regular basis."

Yet Houben's family had taken him to the United States for reexamination five times; not until twenty three years into his "coma" was his consciousness able to be diagnosed. Were he removed from life support several years before this discovery came about, it would be tragic, yes, but not retroactively unethical. The curse of medical technology is that each advance brings with it the burden of hindsight; had we been able to transplant a particular organ a year before, Patient X may not have died on the table. What we now know casts a new light on cases of the past, but does not and cannot revise them. We cannot fault those who pulled the plugs for not knowing what they could not have known.

Relevant sites:
"Trapped In His Body For 23 Years" - The Guardian UK