Fight to the death: Why Canada’s physician-assisted dying debate has only just begun - The Globe and Mail

[...] How to balance often competing values has bedevilled the country ever since the Carter decision, amidst a conservative medical culture that espouses, but is reluctant to deliver, patient-centred care at end of life; a federal government that enacted a restrictive Medical Assistance in Dying (MAID) law; and provincial exemptions that allow publicly funded faith-based institutions and long-term care homes (outside Quebec) to refuse to provide MAID on their premises.

While constitutional challenges slowly grind their way through the hierarchical provincial court systems, so many doctors have erred on the side of caution that some desperate patients have voluntarily refused to eat and drink, in order to hasten their deaths. Others have died in secret by self-inflicted and often violent means. Still others who can afford it have booked flights to Switzerland, the only country that allows foreigners to receive an assisted death. A good number of patients who have been approved for MAID have died before it could be provided. Many who are acutely ill have forgone pain drugs and other medications to remain lucid enough to affirm consent before the procedure. And patients suffering from intractable mental illness and other non-terminal diseases, who would have qualified under the Supreme Court decision in Carter, have not even been able to have their requests assessed under the current law.

https://www.theglobeandmail.com/opinion/sandra-martin-physician-assisted-death-debate/article37742446/

Prisoners of Pain by Peter Singer - Project Syndicate

Whereas the quantity of available opioids in the United States is more than three times what patients in need of palliative care require, in India, the supply is just 4% of the required quantity, and just 0.2% in Nigeria. The reason is a misplaced fear that clinical use of opioids will fuel addiction and crime in the community.

https://www.project-syndicate.org/commentary/opioid-undersupply-developing-countries-by-peter-singer-2018-01

How evolutionary biology makes everyone an existentialist | Aeon Essays

Questions about what matters, and why, and what exists in the world, are quintessentially philosophical. The answers to many of these questions are informed by how we conceive of ourselves. How has what is often described as the ‘Copernican revolution’ effected by Charles Darwin changed our self-conception? One particularly surprising feature of evolutionary biology is that it lends significant support to existentialism

https://aeon.co/essays/how-evolutionary-biology-makes-everyone-an-existentialist

How Philippa Foot set her mind against prevailing moral philosophy | Aeon Essays

In moral philosophy it is useful, I believe, to think about plants.’ The words were spoken to an audience of American philosophers in 1989. The speaker was trying to provoke a reaction, but this might have gone unnoticed. After all, Philippa Foot – nearly 70 by then – didn’t look like a heretic.

There is a clue in her reference to moral philosophy. For at least the past 200 years, people who have thought about these things have suspected – or hoped – that morality is the one thing that sets human beings apart from nature (or should one say, the rest of nature?). Nature is the realm of laws, stern and unbreakable, and morality that of freedom. Nature is how things are, morality how they ought to be. If there’s anything to these points of contrast, then what seems at first a mere platitude sounds more like an absurdity. We are not, in the relevant sense, part of nature – not even of that part of nature that consists in our fellow animals, and, still less, plants.

Have we anything to learn about morality from plants? This might well depend on that bigger question: are we, or aren’t we, part of nature? One of the many things that set Foot and her allies in philosophy apart from others of their generation was their refusal to make an either/or of it.

https://aeon.co/essays/how-philippa-foot-set-her-mind-against-prevailing-moral-philosophy

Faith-based health facilities shouldn’t prolong patient suffering

Christopher De Bono’s Policy Options article on medical assistance in dying (MAID) attempts to persuade us that there is no problem with health care providers refusing to allow MAID in faith-based institutions. I am a MAID provider in the Comox Valley in British Columbia. Until two months ago our local acute care hospital, the only hospital in our community, was Catholic. It prohibited MAID. Fortunately, that hospital, St. Joseph’s, has now been replaced by a new secular facility, the Comox Valley Hospital. Our hospice is still in Catholic hands.

I believe that no individual health care worker should be required to take part in MAID, be they a physician, a nurse, a pharmacist or any other practitioner, and De Bono would agree.

Where he and I part company is over faith-based institutions. An individual health care professional — the actual hands-on provider of health care — has a conscience, and for some this means they cannot take part in MAID. Bricks and mortar cannot have a conscience, however. Neither can the institutions housed within those bricks and mortar. Institutions and facilities can possess an ethos — not a conscience — but this must not be allowed to interfere with the rights of individual patients seeking legal treatments and with the staff willing to provide them. This is especially true when almost all the funding of the work of the institutions is provided by the general public, as is the case for most hospitals and hospices across Canada.

http://policyoptions.irpp.org/magazines/december-2017/faith-based-health-facilities-shouldnt-prolong-patient-suffering/

From Oregon to Belgium to Victoria – the different ways suffering patients are allowed to die

[...] Under the Victorian model, there is scope for a doctor to administer the drugs if the patient is physically incapable of doing so themselves. To access the scheme, the patient must meet strict criteria. They must have an illness likely to end their life within six months (12 months for neurodegenerative conditions such as motor neuron disease) and be experiencing suffering that can’t be managed in a way tolerable to the patient. They must be over the age of 18 and a resident of Victoria.

Victoria’s model is pretty conservative compared to other jurisdictions. Some broaden eligibility to minors, non-residents and people suffering non-terminal conditions and disabilities. Others include access to both voluntary euthanasia and physician-assisted dying.

Here is a roundup of the laws around the world that permit assisted dying or euthanasia and ways in which they differ.

http://theconversation.com/from-oregon-to-belgium-to-victoria-the-different-ways-suffering-patients-are-allowed-to-die-88324

For the First Time Ever Scientists Have Boosted Human Memory With a Brain Implant - ScienceAlert

With everyone from Elon Musk to MIT to the US Department of Defense researching brain implants, it seems only a matter of time before such devices are ready to help humans extend their natural capabilities.

Now, a professor from the University of Southern California (USC) has demonstrated the use of a brain implant to improve the human memory, and the device could have major implications for the treatment of one of the US's deadliest diseases.

http://www.sciencealert.com/for-the-first-time-ever-scientists-have-boosted-human-memory-with-a-brain-implant

 

End Canada’s criminal ban on contentious CRISPR gene-editing research, major science group urges | National Post

MONT-TREMBLANT, Que. — It’s one of the most exciting, and controversial, areas of health science today: new technology that can alter the genetic content of cells, potentially preventing inherited disease — or creating genetically enhanced humans.

But Canada is among the few countries in the world where working with the CRISPR gene-editing system on cells whose DNA can be passed down to future generations is a criminal offence, with penalties of up to 10 years in jail.

This week, one major science group announced it wants that changed, calling on the federal government to lift the prohibition and allow researchers to alter the genome of inheritable “germ” cells and embryos.

http://nationalpost.com/health/end-canadas-criminal-ban-on-contentious-crispr-gene-editing-research-major-science-group-urges

Donor organs created by dissolving and rebuilding pig livers | New Scientist

Will we ever be able to grow transplant organs like the heart, lungs and liver on demand? A method that uses pig organs as scaffolding for creating new organs suggests it may be possible.

In an effort to tackle lengthy waiting lists for organ transplants, researchers have been trying several approaches for creating replacement organs. One approach is to grow organs in the lab from stem cells. Another would be to take organs from pigs that have been genetically altered so their cells are more human-like, and less likely to be attacked by a person’s immune system.

Now an in-between method is taking off. The approach starts with an organ from an ordinary pig, but involves dissolving the cells away from it to leave a protein scaffold in the original shape of the organ. This is then reinfused with human cells.

Until now this technique – dubbed “decel/recel” – has been mainly investigated for small or thin structures such as layers of skin because it is hard to dissolve away the inside a large organ. But a new technique is now making that possible, leading a US biotech firm called Miromatrix to announce this month that it has successfully created livers this way.

https://www.newscientist.com/article/2151910-donor-organs-created-by-dissolving-and-rebuilding-pig-livers/

Ethical case for abolishing all forms of surrogacy | The Sunday Guardian

All surrogacy is cruel to human infants because even so-called “altruistic surrogacy” demands the removal of the neonate from her or his gestational mother when every aspect, every cell, every desire of that neonate, is geared toward being on the body of the gestational mother, to suckle and seek comfort and safety.

As an adoptee, I was removed at birth from my gestational mother, her breasts bound for three days in another room while I screamed for her, and my hospital records record my growing distress. Adoptees around the world testify to their battles with depression and rage, difficulties in trusting and attachment, and a profound sense of loss and grief caused by the loss of their mothers at birth. Scientific studies prove that maternal-neonate separation in the crucial months after birth disturbs the baby’s heart rate and sleep and other biological systems, predisposing the child to difficulties later in life which can include relationship and emotional difficulties, mental disorders and illnesses. In taking a child-centered view of surrogacy, we must take into account what we know of the trauma and confusion of separation from the natural family, especially from the birth mother, experienced by adoptees. 

http://www.sundayguardianlive.com/lifestyle/11390-ethical-case-abolishing-all-forms-surrogacy

Eugenics 2.0: We’re at the Dawn of Choosing Embryos by Health, Height, and More - MIT Technology Review

Nathan Treff was diagnosed with type 1 diabetes at 24. It’s a disease that runs in families, but it has complex causes. More than one gene is involved. And the environment plays a role too.

So you don’t know who will get it. Treff’s grandfather had it, and lost a leg. But Treff’s three young kids are fine, so far. He’s crossing his fingers they won’t develop it later.

Now Treff, an in vitro fertilization specialist, is working on a radical way to change the odds. Using a combination of computer models and DNA tests, the startup company he’s working with, Genomic Prediction, thinks it has a way of predicting which IVF embryos in a laboratory dish would be most likely to develop type 1 diabetes or other complex diseases. Armed with such statistical scorecards, doctors and parents could huddle and choose to avoid embryos with failing grades.

https://www.technologyreview.com/s/609204/eugenics-20-were-at-the-dawn-of-choosing-embryos-by-health-height-and-more/

Parental Authority Should Be Overridden for a Sick Child (Transcript)

Hi. I am Art Caplan, and I am at the division of medical ethics at the New York University (NYU) School of Medicine.

An increasing phenomenon in American society, and Canada too, is parents who, for religious reasons, don't want to take their child to the doctor. Now, we have had this issue for many, many, many decades. It goes back to Christian Science, which has always had a leery attitude about healthcare.

We have certainly seen some Jehovah's Witnesses who go to get healthcare, but they are not accepting of blood transfusion, and then there are a host of other people who either belong to an increasing number of more fundamentalist sects, or they may pursue natural healing, some types of more homeopathic approaches, not scientific, but they find themselves in groups or choose to follow those modes of responding to illness and disease.

https://www.medscape.com/viewarticle/887406

Big data meets Big Brother as China moves to rate its citizens | WIRED UK

n June 14, 2014, the State Council of China published an ominous-sounding document called "Planning Outline for the Construction of a Social Credit System". In the way of Chinese policy documents, it was a lengthy and rather dry affair, but it contained a radical idea. What if there was a national trust score that rated the kind of citizen you were?

Imagine a world where many of your daily activities were constantly monitored and evaluated: what you buy at the shops and online; where you are at any given time; who your friends are and how you interact with them; how many hours you spend watching content or playing video games; and what bills and taxes you pay (or not). It's not hard to picture, because most of that already happens, thanks to all those data-collecting behemoths like Google, Facebook and Instagram or health-tracking apps such as Fitbit. But now imagine a system where all these behaviours are rated as either positive or negative and distilled into a single number, according to rules set by the government. That would create your Citizen Score and it would tell everyone whether or not you were trustworthy. Plus, your rating would be publicly ranked against that of the entire population and used to determine your eligibility for a mortgage or a job, where your children can go to school - or even just your chances of getting a date.

http://www.wired.co.uk/article/chinese-government-social-credit-score-privacy-invasion

What could help me to die? Doctors clash over euthanasia

GHENT, Belgium (AP) — After struggling with mental illness for years, Cornelia Geerts was so desperate to die that she asked her psychiatrist to kill her.

Her sister worried that her judgment was compromised. The 59-year-old was taking more than 20 pills every day, including antidepressants, an opioid, a tranquilizer, and two medicines often used to treat bipolar disorder and schizophrenia.

About a year later, on October 7, 2014, her doctor administered a lethal dose of drugs. It was all legal procedure in Belgium, which has among the world’s most permissive euthanasia laws.

“I know it was Cornelia’s wish, but I said to the psychiatrist that it was a shame that someone in treatment for years could just be brought to the other side with a simple injection,” said her sister, Adriana Geerts.

https://www.apnews.com/4b6877fab2e849269c659a5854867a7b/%22What-could-help-me-to-die?%22-Doctors-clash-over-euthanasia

Canada should OK ‘three-parent babies’: Commentary argues for lifting of ban on controversial technique | National Post

Canada should lift its criminal prohibition against the creation of so-called “three-parent babies,” genetic ethicists and fertility experts say. 

The controversial technique, which involves swapping a certain type of DNA between two women’s eggs, is a “novel, promising intervention” that allows women to avoid passing on sometimes fatal inherited diseases to their children and shouldn’t be outlawed because of “misplaced apprehension” over tinkering with the human genome, according to a commentary published in the most recent issue of the Journal of Obstetrics and Gynaecology Canada.

http://nationalpost.com/news/canada-should-ok-three-parent-babies-commentary-argues-for-lifting-of-ban-on-controversial-technique

Rewarding families of deceased organ donors is an ethical minefield, especially in India

Last month, the Central government announced plans to set up a fund for families of people who have donated organs after brain stem death. The fund will support the education of children of deceased donors as well as medical expenses of other family members.

There is no doubt that many families would benefit from the kind of rewards being proposed. On the other hand, providing support that has financial value to the family of the deceased on the condition that donation is approved may be construed as payment for organs and open a Pandora’s Box. In organ donation, the lines between inducement, incentivisation and support to a donor or her family is very thin. India has an unfortunate history of rich people, including foreigners, inducing poor Indians to sell their organs. In spite of the punishments, such rackets are still being exposed.

https://scroll.in/pulse/852124/rewarding-families-of-deceased-organ-donors-is-an-ethical-minefield-especially-in-india

Is Anyone Home? A Way to Find Out If AI Has Become Self-Aware - Scientific American Blog Network

Every moment of your waking life and whenever you dream, you have the distinct inner feeling of being “you.” When you see the warm hues of a sunrise, smell the aroma of morning coffee or mull over a new idea, you are having conscious experience. But could an artificial intelligence (AI) ever have experience, like some of the androids depicted in Westworld or the synthetic beings in Blade Runner?

The question is not so far-fetched. Robots are currently being developed to work inside nuclear reactors, fight wars and care for the elderly. As AIs grow more sophisticated, they are projected to take over many human jobs within the next few decades. So we must ponder the question: Could AIs develop conscious experience?

https://blogs.scientificamerican.com/observations/is-anyone-home-a-way-to-find-out-if-ai-has-become-self-aware/

Science is inching closer to bringing species back from extinction — but the rise of necrofauna has risks | National Post

The gastric brooding frog is no regular frog. Like some horror story of ancient myth, it gives birth out of its mouth. After incubating fertilized eggs in its stomach, it literally vomits up its offspring at the moment of birth, having cleverly used its stomach as a temporary uterus.

Rather, it used to do this. The Australian amphibian was discovered in the 1970s, and by the mid 1980s, it had gone the way of 99 per cent of the four billion species that have roamed this planet. It went extinct, mostly because of a fungus introduced to its habitat by people.

Its end, however, marked a beginning of sorts: The death of the last gastric brooding frog almost exactly coincided with the first conference, in 1983, of the Extinct DNA Study Group, which produced a paper on recovering dinosaur DNA from blood-sucking insects preserved in amber, which made its way into the imagination of sci-fi writer Michael Crichton, and from there into popular culture as Jurassic Park.

http://nationalpost.com/news/canada/science-is-inching-closer-to-bringing-species-back-from-extinction-but-the-rise-of-necrofauna-has-risks

Consciousness is not a thing, but a process of inference | Aeon Essays

I have a confession. As a physicist and psychiatrist, I find it difficult to engage with conversations about consciousness. My biggest gripe is that the philosophers and cognitive scientists who tend to pose the questions often assume that the mind is a thing, whose existence can be identified by the attributes it has or the purposes it fulfils.

But in physics, it’s dangerous to assume that things ‘exist’ in any conventional sense. Instead, the deeper question is: what sorts of processes give rise to the notion (or illusion) that something exists? For example, Isaac Newton explained the physical world in terms of massive bodies that respond to forces. However, with the advent of quantum physics, the real question turned out to be the very nature and meaning of the measurements upon which the notions of mass and force depend – a question that’s still debated today.

As a consequence, I’m compelled to treat consciousness as a process to be understood, not as a thing to be defined. Simply put, my argument is that consciousness is nothing more and nothing less than a natural process such as evolution or the weather. My favourite trick to illustrate the notion of consciousness as a process is to replace the word ‘consciousness’ with ‘evolution’ – and see if the question still makes sense. For example, the question What is consciousness for? becomes What is evolution for? Scientifically speaking, of course, we know that evolution is not for anything. It doesn’t perform a function or have reasons for doing what it does – it’s an unfolding process that can be understood only on its own terms. Since we are all the product of evolution, the same would seem to hold for consciousness and the self.

https://aeon.co/essays/consciousness-is-not-a-thing-but-a-process-of-inference