"Why did you sterilise me?": Tragedy in Namibia

In June of this year, a troubling report emerged from the south African country of Namibia. Three women, upon being diagnosed as HIV positive, were subsequently sterilized by their doctors without their knowledge and against their will. Further investigation has revealed that these are not the only cases of forced sterilization of HIV positive women in Namibia, with at least 15 having been reported in the past two years.

Looking at this issue for a moment in the frame of relative ethics, it is clear that forced sterilization of HIV positive women in the United States would be unquestionably unethical, both because it usurps the patient’s free will and because we have developed effective and much less invasive ways of preventing an HIV positive mother from transmitting the disease to her children. In a June 6, 2010 post on the blog “women’sbioethicsproject”, the author Ayesha writes, “I can only surmise that the goal for preventing future pregnancies of these women is to halt this method of potential transmission of the HIV virus…. Does [the high mortality rate of HIV in Namibia] make a doctor’s action to perform a sterilization on an HIV+ woman who may not have consented with capacity and competence, or not consented at all, any easier to understand?” Although Ayesha frames her discussion of the controversy only in terms of questions, reading between the lines suggests that she perhaps believes that the particular circumstances in Namibia make forced sterilization ethically acceptable.

But what in truth are the differences between the United States and Namibia with respect to this issue? For one, performing the procedure without informing and gaining the consent of the patient violates the patient’s integrity and most likely goes against the patient’s wishes no matter what country it takes place in, so on this point alone there is no way to consider what was done in Namibia to be ethical (not to mention the fact that if women find out that they will be forcefully sterilized, they will probably not go get tested for HIV, making the situation even worse).

Taking away the aspect of the sterilization being forced (let’s say the patients did give informed consent), it still strikes me that Namibian doctors who advocate for HIV+ women to sterilize themselves are acting unethically. As we discussed in class, effective protocols to lower the rate of HIV transmission from mother to child have been successfully developed and implemented in Africa. Combining these with a nation-wide program to encourage the use of condoms (which would certainly not be expensive to implement compared to the amount of money the US spends on pharmaceuticals), the transmission rate of HIV could be dramatically reduced in a feasible and effective manner without the invasive and psychologically devastating step of sterilizing HIV positive Namibian women (who most certainly have already endured enough pain in their lives). If it seems that I am exaggerating the impact that widespread condom use can have on decreasing the rate of HIV, consider the fact that from 1991 to 2003, new HIV infections in Thailand declined by 90% largely due to a campaign by schools, businesses, media, and the government to promote condoms (see Mechai Viravaidya’s TED talk for more: http://vodpod.com/watch/4556040-how-mr-condom-made-thailand-a-better-place-mechai-viravaidya-at-ted). If there were absolutely no other choice to stem the tide of HIV in Africa, sterilization of HIV positive women might possibly be an ethical solution, but as it stands today it is unjustifiable anywhere in the world.

Sources:

http://womensbioethics.blogspot.com/2010/06/forced-sterilisation-in-namibia.html

http://www.bbc.co.uk/news/10202429

http://vodpod.com/watch/4556040-how-mr-condom-made-thailand-a-better-place-mechai-viravaidya-at-ted

HPV: An Equal Opportunity STD

Cancer is something that freaks most people out. Who would want to get cancer? So a simple treatment that might prevent you from getting cancer is definitely a good thing. There are two vaccines currently on the market that claim to do just that. Gardasil, made by Merck, and Cervarix, made by GlaxoSmithKline, are vaccines that protect against four strains of HPV (human papilloma virus), including the two that are currently suspected to cause two thirds of all cervical cancers. However, there are some concerns about how these vaccines are being used.

The two vaccines are both meant to be used primarily by females, to prevent them from getting the two types of HPV that are most likely to lead to cervical cancer. The curious thing is that they are mainly marketing the vaccine to girls. Since HPV is spread through sexual activity, why are we only vaccinating one of the partners? If we vaccinate both men and women, we can prevent these strains from being spread to those who are not vaccinated, and prevent more cases of cancer or genital warts, which are also caused by this virus. Even though only women can get cervical cancer, which is the most dangerous complication of HPV, men still benefit from not having genital warts, or penile cancer which are linked to HPV.

With the obvious benefits of the vaccines, some states, including Texas and Virginia, have moved to require all girls to have the vaccine as a requirement for attending public schools. But the vaccines are expensive, with each of the three doses needed costing about $100. The state would cover the costs for those who are not insured, but it is still expensive enough to make cash strapped families think twice before seeking it for their daughters. These vaccines are also relatively new, and we don’t know how long the protection will last. If we vaccinate girls at 11, what happens if the immunity wears off in ten years, when they are in the age group with the highest incidence of HPV? There are other ways to prevent an infection, such as using condoms, reducing the number of partners, or practicing abstinence. Most HPV infections clear up on their own, and the risk of getting cancer is very low to begin with, even though HPV is the single most common STD. For right now, it is a better idea for these vaccines to remain voluntary, for both boys and girls, so that we have a chance to find out what the side effects really are, before we require this vaccine for an entire generation.

http://health.nytimes.com/ref/health/healthguide/esn-cervicalcancer-ess.html

http://www.cwhn.ca/PDF/CWHN_HPVjuly30.pdf

http://www.nytimes.com/2010/10/29/us/29vaccine.html?_r=1&hpw

Honey, I Drugged the Kids!

I’m sure that many of us have been on an airplane, bus, or train where a mother or father struggles to calm the loud and disturbing screams of a child. We’ve all presumably experienced this annoyance, but for the most part haven’t given it much thought after the situation ends. To avoid potentially embarrassing situations such as this, parents often times give their children drugs (ie. Benadryl, other ADHD medications) for sedation. According to parents, it makes their lives a lot easier as they no longer have to deal with an overly fussy child and can relax more. Yet several critics argue that drugging up children who are problematic can have some seriously detrimental health effects, and should be considered a form of child abuse.

Dr. Shan Yin from the University of Colorado believes that the illicit drug use on children is a growing problem that threatens the health of children throughout the United States. According to Yin, about “51 percent of 1,634 ‘malicious’ poisonings that occurred over [an] eight-year period studied involved drugs for sedation”. There are caregivers out there who give children sedatives with the intent of hurting them, but I do not believe this is the intention of the vast majority. He speculates that parents may have administered these drugs in an attempt to calm a crying or screaming child or simply escape the responsibilities of being a parent if only for a few hours. I do not doubt the fact that many parents do not have ill intentions for their child when giving them such sedatives, however I believe that administering drugs that typically require a prescription or may have unknown side effects on the healthy is an extremely reckless move on the caregivers’ part. Children rely on their parents to ensure that they are raised in a healthy and safe environment, and sedating children can lead to an immeasurable amount of risks that simply aren’t worth whatever reason they were given to begin with.

It is highly unlikely that parents are aware of how great of a dosage they should give their children, according to a Associate Professor Paul at the Penn State College of Medicine in Hershey, "Dosing is so difficult...Physicians will say give a quarter teaspoon. People will mess up. They will use a food teaspoon. They will use a tablespoon instead of a teaspoon. There is a lot of room for mistakes to occur." With so many opportunities for error, giving children sedatives even for non malicious intent is unethical on the most fundamental level. Parents and caregivers are responsible for the well-being of their children, and putting them in a position where there are so many potential heath risks makes them inexcusably irresponsible.

Sources:

http://seattletimes.nwsource.com/html/health/2013456049_babies19.html

http://www.elementsbehavioralhealth.com/drug-abuse-addiction/parents-sedating-their-children-with-drugs-called-child-abuse/

Prison Health and the Poor That Suffer

Prisoners pose more threats than we know to society. For a long time, issues of bioethical importance have been pervasive in prisoners - many relating to the inhumane use of prisoners in experimentation without informed consent - and now, yet another ethical dilemma has descended upon the realm of prison bioethics.

It has been proven that prisoners have a typically higher rate of diseases like AIDS, hepatitis, and tuberculosis, among others, and the concern has been raises about the introduction of these prisoners back into society with the knowledge that they are essentially walking carriers (Associated Press). There is an obvious risk that these carriers will cause outbreaks in the general population, and possible solutions have been voiced. As it stands, the criminal justice system oversees the health of prisoners. What has been suggested is that the public health systems of countries do the overseeing instead of the criminal justice system, and the World Health Organization counsels nations to provide the best possible health care to prisoners. Furthermore, researchers suggest that prisoners should be screened before they are let go, and subsequently treated. The ethical dilemma then lies in the unfairness of the situation: why should incarcerated prisoners receive the benefits of the "best possible healthcare", free of charge no less, when much of society will never see these benefits? Why should criminals get benefits when so many innocent people suffer with terrible healthcare?

To me, the answers to these questions are simple. I do in fact believe that criminals do lose some rights when they make the choice to violate the laws that keep society in order, and choose to deprive the rights of others. However, it is not their interests that I am concerned with in this situation. The population I am concerned with is poor society. Most criminals come from impoverished backgrounds, and therefore their reintroduction into society places them back where they came from. The outbreaks of disease will affect nations' poor societies, and these are the people that this healthcare would be protecting. Seena Fazel and Jacques Baillargeon, who wrote the medical review of prisoner's health, stated that "Prisoners act as reservoirs of infection and chronic disease, increasing the public health burden of poor communities" (Associated Press). Furthermore, being in prison has the potential to worsen prisoners' conditions, therefore making them more likely to be infectious. What would be unfair is not that prisoners receive better healthcare, but instead that poor communities, which are already burdened, would have to deal with the further burden of HIV/AIDS, hepatitis, and tuberculosis outbreaks.

The further motion to screen prisoners being released for illnesses and treating those illnesses before they are freed is, in my opinion, complete common sense. Even if people do not believe that prisoners should be treated while in prison, then they should at least concede that screening them before they reinsert themselves into society would serve nobody more than the poor. Although a small measure, it could potentially save lives - innocent ones, nonetheless.

If the health of prisoners does not concern us, then the health of the innocent poor should. This is not something to ignore because we have moral holdings that criminals should not be given benefits, it should be acted upon now.

Works:
http://www.washingtonpost.com/wp-dyn/content/article/2010/11/18/AR2010111805660.html

Transplant Tourism: When there is no other option

In May of 2008, 43-year old Ibrahim El-Sheikh left his house in Canberra, Australia to travel to Lahore, Pakistan for a kidney transplant. After being escorted by an unknown middle-man from the airport, Mr. El-Sheikh arrived at the Aadil Hospital and payed 27,000 dollars to receive his long awaited kidney transplant. Though he planned on having his operation done at home, Australian doctors predicted that he could possibly waiting eleven years for a transplant--and after three years of waiting, Mr. El-Sheikh made the decision to look elsewhere for a kidney: "'I don't have eight years to live,' he said. 'I'm getting sicker every month. My wife and children never leave home because of me. I am too sick to take them anywhere or do anything. It's no life for them. I'm letting them down as a husband and a father'" (qtd). He understood that he was risking his life by doing the surgery, but he saw no other alternative.

Though this happened more than two years ago, Mr. El-Sheikh's story is still much too common and the problems of transplant tourism continues to prevail. Between 2004 and 2006, more than 300 tourism transplants occurred among American patients, yet there has still not been a complete consensus regarding possible solutions to the problem. Recently, a 46-year old American accountant traveled to China for a liver transplant and returned with a condition much worse than what he had when he left. He needed to be hospitalized and received a replacement transplant in the United States.

This situation highlights one of the biggest problems of transplant tourism. Many organ transplants in 3rd world countries are from executed prisoners, are poorly matched to the donor, use unhealthy or unexperienced doctors, fail to use proper surgical techniques, and do not provide the donor with proper records or education about the procedure--all of which breed the possibility of re-infection and possibility of necessary re-transplantation.

But many doctors are incredibly skeptical when it comes to providing care for individuals who participated in transplant tourism. Is it really fair that they take away an organ from someone who waited to give it to someone who did the transplant elsewhere? This patient was treated, but many ethical concerns still remain.

It is imperative that better procedures and guidelines be put in place to prevent this problem to begin with. Though many organizations have issued statements about their position on transplant tourism, there are no international laws in place that truly regulate this practice. For example, the International Transplant Society and the American Association for the Study of Liver Diseases both have "positions against the exploitation of donors, the recovery of organs from executed prisoners, and condemned the sue of paid living donors", but there needs to be firm international guidelines and better local policies put in place to regulate transplant tourism--these statements are not enough.

With what is currently in place, doctors are forced to make difficult decisions regarding their patients that received organ transplants in unsafe environments. There needs to be an organization in place to regulate these practices and stricter guidelines need to be in place in 3rd world countries that participate in transplant tourism. But, the fact that so many people turn to this practice highlights another problem. 40% of the 300 donors participating in transplant tourism between 2004 and 2006 were from New York and California (the two most populated parts of the country). Before being forced to turn elsewhere for there transplants, they should be referred to other parts of the country for their procedure, because often less populated places have much shorter transplant lists. Furthermore, the United States needs to increase education about the dangers of transplant tourism and the benefits of organ donation. To solve the ethical dilemmas that result from transplant tourism, there needs to be better international regulation of these procedures and better alternatives available at home.

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Sources:

http://www.eturbonews.com/2373/transplant-tourist-sees-one-way-out

http://www.sciencedaily.com/releases/2010/01/100126133354.htm

http://dmmsclick.wiley.com/share.asp?m=s8gib7hywostp6rgw2mh&f=h

http://abcnews.go.com/Health/transplant-tourism-hidden-risks/story?id=9702948

Synthetic Ethics

This past May, geneticist Craig Venter and his team pioneered the synthetic biology movement by manufacturing the genome of a bacterium from scratch. They essentially drew up the chromosomal ‘software’ and injected the genetic material into a cell. In describing the feat, the primary investigator Venter sees his study as adding to “the planet’s inventory of life.” Even the profession of genetic engineering itself conjures an image of people as nuts-and-bolts contraptions…and with the redesigning of existing biological systems to perform specific tasks, that conception wouldn’t be too far from the truth.

Venter’s research paves the way for even more progress in the 21^st century: more efficient vaccination studies as scientists create microbes that harness energy, bacteria that produce biofuel, or vaccines that can be administered more easily. With all its benefits, it’s no wonder syn bio is likely to be a $4.5 billion industry by 2015. According to Venter, various ethical review boards, including the Sloan Foundation, had approved the science behind his studies before his team proceeded. He is proud that the bioethics discussion has served as a guide, and that his research is accordance with the moral principles of the populace. As Venter himself notes in an interview, “This is an important step both scientifically and philosophically.”

Over the past few months, however, bioethicists have rekindled the syn bio ethics discourse. Although Venter thought a few IRBs gave his brainchild legitimacy, the American public have something different to say. Almost half of the responses to a survey conducted by the Hart Research Associates in September believed the federal government should regulate syn bio. Arguments against syn bio include the weaponization of new scientific research (much like what happened with the atom bomb), bioterrorism, environmental damage, and the difficulty of containing these new organisms. What is most interesting, however, is the philosophical nature of the counterargument 25% of America believes: synthetic biology is morally apprehensible. In short, it’s just plain wrong for scientists like Venter to ‘play God.’

But to take that view is to place a cap on scientific innovation and progress. Unlike Ashley’s treatment, synthetic biology can spearhead a totally new way of addressing energy and medicine. As for Sandel’s “giftedness” arguments which have equal applicability in the syn bio debate, we are not decreasing any appreciation for the chanced lot of mankind per se. Like stem cell research, the real issue is the idea of Promethean interference with creation- even if it is only bacteria and viruses; and this argument never really had much credence to its claims, because the entire field of medicine ‘plays God’ in some sense. By considering the potential of synthetic biology and eschewing a by-the-book mentality, we can approach bioethics from a more pragmatic view.  

Unlike abortion and stem cell research, synthetic biology calls for ethicists to consider the morality of creating any type of life- not just human life (as President Murray of the Hastings Center mentions). In that way, we’re not addressing human giftedness or Kantian ethics at all, but a completely new dimension to bioethics. 

Is the creation of life for experimentation/progress permissible? If we take beneficence out of the picture, does synthetic biology violate any morals? To what extent can we play God for the betterment of society?

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http://www.sciencedaily.com/releases/2010/09/100909003704.htm

http://www.guardian.co.uk/science/2010/may/20/craig-venter-synthetic-life-form

http://whyy.org/cms/news/health-science/2010/09/13/maximizing-the-benefits-of-synthetic-biology/45357

http://www.youtube.com/watch?v=1y4jt7oDrZI

The Bottom Line on Stem Cell Research

Today, "Stem Cell Research" are household words. Everybody heard of this "promising", "futuristic" new science several years ago, and everyone thinks that they know what it is. If it is so promising, though, why hasn't it yielded the expected results?

In 1995, three years before the first isolation of human stem cells took place, Congress reluctantly passed a bill into law that contained the Dickey-Wicker Amendment, a provision which banned federal funding for any investigation which would endanger human embryos. This amendment, while clearly not in direct opposition to the stem cell research that would be found possible three years after its passage, has had the effect over the past decade of severely crippling our ventures into this new area of discovery. Under the Clinton and Bush Administrations, some feeble effort was taken to circumvent this amendment, but it remained until recently that Presidential policy directly interfered with Dickey-Wicker. In 2009, President Obama issued an executive order lifting the ban on federal funding for stem cell research, but just several months ago, a federal judge placed an injunction on this because of its opposition to Dickey-Wicker, and this injunction still stands.

Even though Dickey-Wicker only affects the federal funding of stem cell research, it is indicative of this country's blindness to the needs of our species. Today, humans suffer from a wide variety of deadly afflictions with no known cure, and stem cell research has shown glimmers of hope for those with these problems. Even those causing curable afflictions today are evolving into more developed strains against which we cannot protect, so why can't we stop our bickering and agree to push for research in this promising area? The total amount of sperm and egg cells that have been "wasted" in history by all of the natural somatic processes and by human ingenuity is nearly uncountable, so why can't we use those cells which would be otherwise "recycled" in order to further a better future for our species? The obvious "sanctity of life" counterargument becomes moot after a certain length of time, anyway: if every embryo that would be used for research were to grow into a human being, the Earth would quickly become overpopulated and the very policy preserving the sanctity of the embryos' lives would end up threatening the survival of our species. It is imperative that we eradicate contemporary policy regarding stem cell research and allow it to continue with the full power of society under its wings, investigating it like the responsible human beings that we strive to be.

http://www.huffingtonpost.com/don-c-reed/remove-dickeywicker-time-_b_780071.html

http://www.dailytitan.com/2010/11/08/we-should-support-stem-cell-research/