Showing posts with label medical ethics. Show all posts
Showing posts with label medical ethics. Show all posts

Thursday, May 19, 2016

Vulnerability and Human Dependency


Are vulnerabilities desirable, even necessary, to our moral identity as humans?




There has been growing interest among ethicists in the theme of vulnerability. Some have gone as far as to suggest that vulnerability could serve as a new principle in bioethics. In a recent edition of the journal Theoretical Medicine and Bioethics, a number of leading bioethicists explored the topic of ‘human vulnerability in medical contexts’. This recent journal edition – a first among any of the leading bioethics journals –provides significant insight into the notion of vulnerability and its relevance to contemporary clinical practice. Xavier Symons, the deputy editor of Bioedge, recently spoke with guest editor Stephen Matthews about the key themes discussed.

Stephen Matthews is a senior research fellow at the Plunkett Centre for Ethics and a member of the Centre for Moral Philosophy and Applied Ethics at Australian Catholic University. Steve co-edited the special edition with Bernadette Tobin, Director of the Plunkett Centre for Ethics.

******


Xavier Symons: You contend that vulnerability need not always be seen as “an obstacle or pathology to be removed”. Do you think this idea is relevant to the treatment vs. enhancement distinction in medicine?

Steve Matthews: Yes, it’s absolutely relevant. An implicit assumption of those whose moral position is quite permissive of the technologies of human enhancement is a kind of perfectionism, or at least a maximising kind of attitude that can tend to swamp moral contemplation regarding vulnerable traits, the possession of which is not undesirable.

This is the idea expressed in John Quilter’s very thoughtful piece, and I take it that something like this is being expressed for the medical context in the article by Wendy Rogers and Mary Walker.

Actually there is a background fundamental question to all of this and it’s about whether certain vulnerable traits we have as subjects are desirable to our moral identities as human beings. If we think there are such traits, this would inform the treatment vs enhancement question from the outset. It may be that we possess such traits and we should be concerned not to enhance ourselves to eliminate them. It may be, also, that we should not be jumping in to treatment occasioned by the slightest deviation from the path of a happy life.

Read it all here: Vulnerability in medical contexts: An interview with Steve Matthews


Friday, March 7, 2014

Muslim Women Oppose Honor Killing


Conscientious objection to “patriarchal norms”

by Michael Cook | 1 Mar 2014



Informed consent and conscientious objection are easy to fulminate about, but tricky to discuss with consistency. Take, for instance, the delicate topic of requests for hymen restorations and virginity certificates. Worldwide, an estimated 5,000 women were victims of honour killings in 2000. If a young woman from a culture which sanctions honour killing approaches a doctor, what should he or she do?

Refusal is not a popular or even, in some jurisdictions, a legal option for doctors who are asked to refer for an abortion or to prescribe contraception. But a request which reinforces “patriarchal norms” is different.

Swedish ethicists surveyed about 1000 general practitioners and 1000 gynaecologists. They report in the Journal of Medical Ethics that a small majority would agree to the woman’s request. However, a large minority, supported by the Swedish community, insist that they would never do so. In other words, conscientious objection to patriarchal norms is socially acceptable, even if it involves refusing a woman’s fully informed request for a medical procedure:

“the political message in Sweden is that hymen operations should be considered a non-option and that the appropriate response to such requests should be information about the medical aspects of sexuality and human rights and, if necessary, referral to police or social authorities for protection. The main argument for this practice is that Swedish society should take a stand against practices expressing control of female sexuality. The official Swedish viewpoint hence expresses a zero tolerance policy against patriarchal norms and values.”

Opposition to these practices in Sweden is so vehement that doctors try to dissuade women. If this fails, it is not illegal to perform them, but they do so reluctantly and secretly.

The authors favour the pragmatic policy followed by doctors in the Netherlands. There doctors inform women of the issues involved, but do the procedure if they insist. This allows them to give women better health care.

Source: BioEdge


Sunday, December 29, 2013

Turkey proposes to block medical treatment of injured protestors


A new law before the Turkish General Assembly may prevent severely injured protesters from being treated by medical personnel. The draft bill, accepted by a parliamentary commission last week, sets out that where "formal health services" (for example state ambulances) are present, no alternative medical care may be provided for injured people.

Hence, if a state ambulance is present at a protest, doctors and medical personnel may not assist injured participants.

Human rights monitors fear that the law will be used to prevent political dissidents from receiving emergency care. Dr Vincent Lacopino, senior medical advisor at Physicians for Human Rights (PHR), said that "This bill would not only force doctors to abandon their ethical duty to provide care for those in need, but could also have dire consequences for anyone in urgent need of medical assistance."

A coalition of medical associations jointly authored a letter to the Turkish Minister of Health, Dr. Mehmet Müezzinoğlu, calling for the controversial provisions to be omitted from the law: "We call upon you, and the Turkish parliament to...exclude any provisions that would undermine independent, ethical, non-discriminatory care to those in need".

Source: Bioedge

Saturday, November 23, 2013

Availability of Voluntary Sterilization


The choice not to have children places women in a difficult situation. They are often judged as selfish, and their motives are questioned. They must rely on long-term contraception which poses health risks. Should conception occur, they usually opt for termination of the pregnancy. Ironically, the option of voluntary sterilization is not as available. Here is a BioEdge review of a recent report:

Voluntary sterilization has been legal since 1974 in the United States for women over 21. Why, then, is it so difficult for them to find a doctor who will do the procedure, asks Cristina Richie in the latest issue of the Hastings Center Report.

About one in five white women in the US will never bear a child, writes Richie, a theology graduate student at Boston College. This is the highest proportion in modern history. Of these, half, or 10% will be voluntarily childless. Life for them would be much easier without the stress and inconvenience of contraception. Yet many doctors refuse to sterilize them. Their position is that women may regret their decision in later years. "Yet regret is the competent woman's burden, not the doctor's. Very few providers of other permanent elective treatments like plastic surgery refuse treatment over fear of regret. Why should sterilization be different?" Richie asks.

Why do women want to remain childless? Richie says that there may be several reasons. They may have well-founded fears that pregnancy will damage their health. They may be carriers of a genetic disease. They may have vaguer personal reasons: the financial burden of children or revulsion at traditional maternal roles. One group, the GINKS (green inclinations, no kids), fear creating more agents of pollution and carbon emissions. Some dislike "unnecessary hard work".

Why do doctors refuse? Normally because women are deemed too young or have no children. Many doctors are not trained in sterilisation techniques. Memories of forced eugenic sterilisations early in the 20th century have coloured some doctors' attitudes.

Oddly enough, Richie does not counter the common objection that medicine is about restoring diseased organs to health, not about destroying healthy organs.

Richie argues that it is no business of the doctor what reasons a mentally-competent woman over the age of 21 might have. "American medicine should act as the law permits and good patient care requires, providing sterilization to women who are legally able to obtain it, regardless of parity."


Sunday, November 17, 2013

Palliative Care Undermined by Euthanasia


Palliative care is undermined by euthanasia and assisted suicide, according to many palliative care organisations. In Australia, where end-of-life issues are hotly debated, the peak palliative care body has joined the chorus of opposition.

The Australia and New Zealand Society for Palliative Medicine (ANZSPM) has released a new position statement on the practices, arguing that they are not a solution to patient suffering, and that legalising the procedures would take attention away from the real issue - a lack of access to palliative care.

In the document the ANZSPM emphasises, "There is a clear distinction between good care for the dying and active interventions instituted in order to deliberately end the life of a patient." Instead of providing VE or PAS, doctors should try to alleviate symptoms: "When requests for euthanasia or assisted suicide arise, particular attention should be given to gaining good symptom control, especially of those symptoms that research has highlighted may commonly be associated with a serious and sustained 'desire for death' (e.g. depressive disorders and poorly controlled pain)."

Out of a the ten point policy statement, three points stressed "the significant deficits in the provision of palliative care in Australia and New Zealand". ANZSPM called for new government "health reform programs", as well as increased carer support for respite care, so as "decrease the sense of burden for many patients at the end of life."

Source: BioEdge

Sunday, November 10, 2013

Should the War on Terror Trump Medical Ethics?


An independent report has highlighted ongoing violations of medical ethics at Guantánamo Bay and called on the Department of Defense (DoD) and the medical community to conform to ethical principles. The Task Force on Preserving Medical Professionalism in National Security Detention Centers claims that medical staff have been forced to act unethically.

"As a doctor who has been to Guantánamo and examined detainees, I am appalled that medical care there is controlled by command and security prerogatives," said Vincent Iacopino, of Physicians for Human Rights, a member of the task force. "It is time for the administration to end the inhuman and degrading practice of force-feeding and restore the ability of medical staff to act independently and according to their clinical and ethical obligations."

The 269-page report, Ethics Abandoned: Medical Professionalism and Detainee Abuse in the 'War on Terror', follows two years of review of public records by 19 medical, military, ethics, public health, and legal experts.

It discusses how medical personnel established and participated in torture. It also outlines how the DoD committed a number of ethical breaches, including improperly using health professionals during interrogations; implementing rules that permitted medical and psychological information obtained by health professionals to be used during interrogations; requiring medical staff to forgo independent medical judgment and force-feed competent detainees; and failing to adopt international standards for medical reporting of abuse against detainees.

The report also says that the CIA's Office of Medical Services played a critical role in torture, including waterboarding. It had advised the Department of Justice that "enhanced interrogation" methods, such as extended sleep deprivation and waterboarding, were medically acceptable. CIA medical personnel were present during waterboarding, the Task Force claims.

"Putting on a uniform does not and should not abrogate the fundamental principles of medical professionalism," said David Rothman, of the Institute for Medicine as a Profession, a sponsor of the report. "'Do no harm' and 'put patient interest first' must apply to all physicians regardless of where they practice."

Adding to the criticism, more than 35 prominent doctors and public health professionals - including a former US surgeon general, six Nobel laureates, and 18 deans of public health and medical schools - have asked President Obama to end force-feeding at Guantánamo Bay. "Force-feeding undermines appropriate medical care and ethical responsibilities because physicians act as agents of command - a fundamental violation of professionalism," they say in an open letter.

Source: BioEdge


Friday, July 19, 2013

California sterilization of women prisoners


The California Department of Corrections and Rehabilitation has been accused of forcing female prisoners to have tubal ligations. In an article that has sparked public outcry, the Centre for Investigative Reporting (CIR) claimed that 150 inmates had been pressured into being sterilized. This included a woman who was told during labour; she barely escaped after protesting.

The CIR says that "doctors under contract with the California Department of Corrections and Rehabilitation sterilized nearly 150 female inmates from 2006 to 2010 without required state approvals." The report also states "At least 148 women received tubal ligations in violation of prison rules during those five years."

Many of the sterilizations were performed by Dr James Heinrich, the former Valley State Prison obstetrician. In an interview with the CIR, Heinrich felt the need to justify the spending of tax payers money on the procedure - he said that "this isn't a huge amount of money compared to what you save in welfare paying for these unwanted children - as they procreated more."

The shocking report has raised the spectre of eugenics in a state which sterilized about 20,000 people between 1910 and 1964. "I was like, 'Oh my God, that's not right,' " a former inmate who worked in the infirmary, Crystal Nguyen, told CIR. "Do they think they're animals, and they don't want them to breed anymore?"

In fact, in 2003, Governor Gray Davis issued a formal apology for eugenic sterilisations. "Our hearts are heavy for the pain caused by eugenics. It was a sad and regrettable chapter in the state's history, and it is one that must never be repeated again," he said.

State politicians have reacted strongly to the report and a number of groups are calling for a government enquiry. Senator Ted Lieu has sent a letter to California's medical board demanding answers. The California Legislative Women's Caucus has sent a letter to the head of California Correctional Health Care Services.


Source: BioLogos


Sunday, May 26, 2013

Montana Man Survives Wrong Diagnosis


A Montana man brain cancer diagnosis shows how difficult it is to determine whether or not a person has a "terminal illness". Mark Templin was awarded US$59,000 for expenses and emotional stress after his doctor wrongly told him in 2009 that he had only six months to live. "It is difficult to put a price tag on the anguish of a man wrongly convinced of his impending death," said the judge. "Mr. Templin lived for 148 days ... under the mistaken impression that he was dying of metastatic brain cancer."

One of Templin's daughters asked the doctor how her father would die and "he explained one of the tumors would grow 'like cauliflower' and Templin would die from a brain bleed."

After that disturbing diagnosis, Mr Templin sold his truck and quit his job. He put his affairs in order and displayed a large sign in his home saying "Do Not Resuscitate". His family held a "last birthday" dinner for him and he paid for a funeral service. His son-in-law made a wooden box for his ashes. He entered a hospice for dying patients.

He even considered shooting himself to spare himself and his family the pain of a terminal illness.

However, Mr Templin began to get better, not worse. He booked himself out of the hospice and had more tests. These revealed that he had had a stroke and that he did not have a brain tumor.

Good thing he didn't live in a state like Oregon or Vermont that pushes euthanasia!


Monday, May 13, 2013

What does US accomplish by Guantanamo force feeding?


Of the 166 detainees at Guantanamo Bay, about 100 are on a hunger strike. About 20 are being force-fed, according to the New York Times. About 40 medical staff have arrived to ensure that the detainees are fed.

The men want their cases heard before a court. Many of them have been at Guantanamo for 12 years without being charged.

What are the medical ethics of force-feeding? It seems to violate the norms of informed consent and refusing burdensome treatment. The American Medical Association sent a letter to Secretary of Defense Chuck Hagel on April 25. It quoted the 1975 Tokyo Declaration of the World Medical Association which takes an umambiguous stand on the issue: "Where a prisoner refuses nourishment and is considered by the physician as capable of forming an unimpaired and rational judgment concerning the consequences of such a voluntary refusal of nourishment, he or she shall not be fed artificially".

It is not clear how many doctors, if any, are involved in the force-feeding.

However, President Obama has ignored the niceties of medical ethics for the hunger strikers. He simply told the media, "I don't want these individuals to die." Politically it is impossible to release the detainees; legally it is hard to try them. So they remain in limbo, frustrated and angry.

The military has not released much information about the force-feeding regimen. But in The Daily Beast, infectious diseases expert Kent Sepkowitz, of Memorial Sloan-Kettering Cancer Center, makes it sound excruciating:

"Without question, it is the most painful procedure doctors routinely inflict on conscious patients. The nose--as anyone knows who ever has received a stinger from an errant baseball--has countless pain fibers. Some patients may scream and gasp as the tube is introduced; the tear ducts well up and overflow; the urge to sneeze or cough or vomit is often uncontrollable... The procedure is, in a word, barbaric. And that's when we are trying to be nice."

However, he also is unsure what is to be done.

"In this debate individual doctors are stuck at a crossroads of unusual complexity. Sworn to alleviate pain and prevent death where possible, we also are sworn to respect the wishes of the individual. For us, there is no simple way out. Though sharing some similarities, the situation is distinct from respecting the wishes of a patient dying from an untreatable illness--starvation has a remedy."

From here.


Friday, April 5, 2013

Planned Parenthood Endorses Infanticide



Florida legislators considering a bill to require abortionists to provide medical care to an infant who survives an abortion were shocked during a committee hearing this week when a Planned Parenthood official endorsed a right to post-birth abortion.

Alisa LaPolt Snow, the lobbyist representing the Florida Alliance of Planned Parenthood Affiliates, testified that her organization believes the decision to kill an infant who survives a failed abortion should be left up to the woman seeking an abortion and her abortion doctor.

"So, um, it is just really hard for me to even ask you this question because I’m almost in disbelief," said Rep. Jim Boyd. "If a baby is born on a table as a result of a botched abortion, what would Planned Parenthood want to have happen to that child that is struggling for life?”

Read it all here.

Saturday, March 9, 2013

Big Money Backs Sterilization Camps




A government hospital in West Bengal's Malda district is facing an inquiry for conducting mass sterilization of women and relocating the women to a nearby open field.

Biswa Ranjan Satpathi, West Bengal's director of health services, was reported to have said, "This is inhuman and we have ordered a probe into the incident." 

Staff at a mass sterilization camp in West Bengal dumped 106 women in a field to recover after their painful surgeries.

The Bill and Melinda Gates Foundation and the British government organized a family planning summit in London. Rich nations and NGOs pledged US$2.6 billion for population control/contraception in the developing world.

At the summit "sterilization camps" were not mentioned, but India's representatives spoke of a "paradigm shift" in their family planning. Likely, some of the $2.6 billion went into the pockets of the doctors who sterilized Indian women at the Manikchak Rural Hospital.

After the operation, women still under the effects of anesthesia, were dumped in an open field. According to the local media, "such frenzied sterilization camps are routine".

India no longer has centralized family planning quotas, but in practice state and district officials set targets, leading to disgraces like this.


Related reading: Australia Forced Sterilization Investigated; Israel's Abuse of Ethiopian Women; Judge Harms' Abortion-Sterilization Order Overruled


Tuesday, February 26, 2013

Poor Care of Elderly in UK Govt. Hospitals


Doctors, nurses, politicians, bureaucrats, patients and the public, in short, everyone in the UK, have been stunned by the results of two inquiries into dreadful conditions at a hospital in the Midlands.

A report in 2010 into Stafford Hospital found that hundreds of patients had died unnecessarily and that conditions were sometimes unspeakably bad. Some patients were left in excrement-soaked sheets and some had to drink from dirty flower vases because nurses failed to bring them water.

A second report by a leading barrister, Robert Francis, into the causes of this disaster makes depressing reading. He found that there had been a total collapse of the system at the Mid Staffordshire NHS [National Health Service] Foundation Trust, which is responsible for running the hospital. In the report, which was released earlier this month, Mr Francis writes:

"This is a story of appalling and unnecessary suffering of hundreds of people. They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety. Patients were let down by the Mid Staffordshire NHS Foundation Trust. There was a lack of care, compassion, humanity and leadership. The most basic standards of care were not observed, and fundamental rights to dignity were not respected."

Mr Francis's brief was to identity the reasons for the breakdown in care. He made 290 recommendations to change the toxic culture at the hospital and to make sure that patient care comes first, ahead of financial targets.

Some of the more important recommendations are that failure to comply with standards should be a criminal offence if death or serious injury results; misleading patients, the public or regulators should be a criminal offence; nursing staff should be trained to give compassionate care; and a NHS leadership college should be established to ensure high standards.

The reaction of the UK government was entirely predictable. Prime Minister David Cameron denounced the enormity of the failure, apologised to patients and their families and promised root and branch reform. However, the scepticism of Mr Francis about whether this will actually happen is frightening.

"The experience of many previous inquiries is that, following the initial courtesy of a welcome and an indication that its recommendations will be accepted or viewed favourably, progress in implementation becomes slow or non-existent...

"Stafford was not an event of such rarity or improbability that it would be safe to assume that it has not been and will not be repeated or that the risk of a recurrence was so low that major preventative measures would be disproportionate. The consequences for patients are such that it would be quite wrong to use a belief that it was unique or very rare to justify inaction."

The reports can be downloaded at the Inquiry's website.

Thursday, February 14, 2013

Colorado: the Question of Personhood


Jeremy and Lori Stodghill at their wedding in 2001
On the morning of the day she died, 31-year-old Lori Stodghill balanced her breakfast plate on her very pregnant belly and watched it bob up and down as the twin boys inside her kicked and kicked. The saucer-sized dish was "bouncing back and forth," her husband, Jeremy Stodghill, remembers — a sure sign that at 28 weeks, the babies were alive and well.


The politics of "personhood" has been a big issue in Colorado in recent years. In 2008 and again in 2010 pro-life groups fought for an amendment to the state constitution which would have defined a person as "every human being from the beginning of the biological development of that human being." The controversial initiative attracted nationwide publicity but failed both times. Last year supporters tried again but failed to get enough signatures for the November ballot.

That's one reason why Coloradans on both sides of the debate were surprised that lawyers for a Catholic hospital were arguing that a fetus has no rights in a malpractice case.

The circumstances were tragic. In 2006, 31-year-old Lori Stodghill, who was seven months pregnant with twin sons, died of a pulmonary embolism at St Thomas More Hospital & Medical Center in Canon City. The hospital is owned by a group which operates hospitals in 17 states, Catholic Health Initiatives.

Jeremy Stodghill sued CHI, the hospital and two doctors, alleging that the doctors failed to perform an emergency Caesarean to save the twins, who also died. CHI's lawyers countered that under Colorado's Wrongful Death Act, fetuses do not have legal status.

William Kuntz, St. Vincent's trial attorney, defended the hospital's stance at the time.

"We've never contended that a fetus is not a person," Kuntz told the Orlando Sentinel in 1996. "We've always said that an unborn person does not have the right to bring a lawsuit in Florida."

This is clearly at odds with Catholic bioethics. The Ethical and Religious Directives for Catholic Health Care Servicesaffirms the sanctity of life 'from the moment of conception until death'".

When Colorado's Catholic bishops found out about the case, they protested vigorously, even though they were not managers of CHI. Now CHI and the hospital have accepted that they erred. "Although the argument was legally correct, recourse to an unjust law was morally wrong," CHI said in a statement.

After losing the initial case and an appeal, Mr Stodghill is trying to appeal to the State Supreme Court. If he succeeds, CHI's lawyers will not cite the Wrongful Death Act. Instead their argument will dispute allegations of negligence.

Thursday, December 27, 2012

California's Ban on "Conversion Therapies"


California's legislature has voted to ban therapies which seek to the change sexual orientation of minors. The law, which will become effective January 1, has Christian groups worried that parents of teenagers with unwanted homosexual attractions will be deprived of an important means of providing for the psychological health of their children. Legislators claim that the law is necessary to protect children from abusive interventions which may cause lasting harm.

Conversion therapies are psychological treatments which purport to be able to alter a person's sexual orientation. Proponents of these therapies believe that homosexuality is a mutable condition which has psychological roots, usually arising as a result of wounds in early childhood. Reparative therapy, one of the popular variants, seeks to alter the homosexual condition by helping the client to repair broken relationships with their father and with same-sex peers.

It is hard to judge the effectiveness of these treatments.

The first difficulty lies in what people mean by “sexual orientation”. Many Christians who hold the traditional position on homosexuality see someone who abandons homosexual activity and achieves a stable heterosexual marriage as “straight”, even if that person continues to experience some degree of same-sex attraction. Most people within the LGBTQ community would see such a person as bisexual, or as a gay person who only has cross-orientation sex. The first view makes sexual orientation a question of behaviour; the second a question of feelings.

In popular discourse, sexual orientation is generally understood as a pattern of physical attraction. This is problematic because it conflates involuntary physical arousal with a capacity for on-going emotional intimacy, fidelity and sustainable desire. Most people will recognize that there is not necessarily a direct relationship between immediate attraction and success in long-term relationships. A man who prefers blondes may happily marry a brunette, and a woman who is attracted to aggressive, dominating types may find it impossible to sustain an emotionally fulfilling relationship with such men.

Unfortunately, prominent reparative and conversion therapists are often unclear about what they are promising to change. Sometimes they merely claim that their treatments will help homosexually attracted individuals deal with their unwanted attractions; but in other contexts they seem to be offering complete remission from all homosexual thoughts and impulses. This can be very confusing for potential clients, and for the parents of children with same-sex attractions.

Organizations offering these therapies also tend to give confusing reports concerning rates of success. When someone like Dr Joseph Nicolosi, a therapist with NARTH, claims that a third of his clients are successfully treated by reparative therapy, the casual listener will naturally form the impression that a very significant percentage of clients are able to go on to have successful heterosexual relationships. This is highly misleading. Most people who are successfully treated by conversion therapies achieve chastity, not heterosexuality.

There are no controlled, longitudinal, peer-reviewed studies examining the likelihood of long-term heterosexual functioning amongst former clients of conversion therapies. However, the best available study, published by Jones and Yarhouse in 2007, followed a group of homosexuals seeking orientation change through the supports offered by Exodus International. The study findings were modest: 15 percent of respondents reported “orientation change”, with a larger group reporting that the program helped them to be chaste. It is not known what percentage of these respondents have gone on to enjoy successful heterosexual marriages.

That said, it is not impossible for a homosexual to have a happy marriage with an opposite-sex spouse. My own experience speaks to that: I am same-sex attracted, but have chosen heterosexual marriage for a combination of religious and personal reasons. I would not say, however, that I have achieved orientation change. I am not attracted to men, I am in love with a man. This is typical of the real experience of “ex-gays”: usually what changes is not the underlying pattern of attraction but rather the sort of relationship that a person chooses to pursue.

It's important to make this distinction. A lot of anger within the gay community stems from those who have suffered because of false expectations, including people who entered into heterosexual marriages in the mistaken belief that they were “cured.” My own marriage has been successful and continues to be deeply fulfilling because both my husband and myself have been willing to engage honestly and authentically with the issues surrounding my sexual identity. This has allowed me to exercise moral freedom with respect to my sexuality without having to alter my personality or practice self-deception.

There are some homosexual people who have found therapy helpful in overcoming obstacles that prevent them from having successful opposite sex relationships. These obstacles are usually much the same as the difficulties which exclusively heterosexual people experience: difficulty trusting, poor relationship role-modelling within the family of origin, unresolved traumas, deep-seated insecurities, emotional barriers and so forth. These are psychological difficulties which any secular therapist would happily treat. In so far as conversion therapies address issues of this sort they may be helpful – though they may not ultimately lead to the elimination of homosexual desires or to heterosexual marriage.

Clients must, however, have the right to receive accurate information about treatment in order to form realistic expectations and goals. I have tried diligently to uncover ex-gay success stories, and have so far not found anyone who has experienced a complete elimination of same-sex desires over the long haul. Chambers and other Exodus leaders have recently distanced themselves from conversion therapies because they have found the same thing within their ministry.

While it is generally not possible to eliminate homosexual desire, there are people who have found therapy helpful in learning to integrate their same-sex attractions with their religious convictions. Others have found that by resolving issues in their past, they are able to have increased self-awareness and greater moral autonomy when it comes to their sexuality. Therapeutic models which concentrate on helping people achieve chastity and self-possession are less controversial and seem to be more effective than models which focus on changing people's underlying pattern of attraction.

Some therapists acknowledge this. They are very conscientious, deal honestly with their clients, will not work with patients who are unable to fully consent, and use only responsible means. These therapists do not harm their patients. Other therapists, however, use morally questionable means, make false claims about the efficacy of treatment, and blame the client when treatment fails. Former clients of such therapies report that treatment increased feelings of shame, guilt, self-loathing and depression without in any way allaying homosexual desire.

Adults who have chosen to undergo therapy are in a position to change therapists or to abandon treatment if they find that the therapy does more harm than good. Minors who are forced into therapy by adult authority figures do not have this option. Even if young people are theoretically seeking treatment under their own power, many feel intense pressure to overcome homosexual desires in order to please their parents, and some fear punishment or recrimination if they fail. Unscrupulous therapists often market their services primarily to parents and guardians, preying on the hopes and fears of those who have the ability to place adolescents in treatment.

Moreover, conscientious therapists openly state that conversion therapy does not have any real chance of working unless it is freely chosen by the client. Teenage dependants are not in a position to make a free choice of this kind.

The more legitimate forms of conversion therapy rely on the theory that homosexuality arises as a result of other psychological causes. If these theories are accurate, then the benefits of treatment should be accrued by patients who are treated for the underlying condition, even if homosexuality is not directly addressed. If parents are concerned that their child's homosexuality might be evidence of problems within the dynamics of the family, they should seek family counselling to remedy those dynamics. If they fear that their child may be suffering the long-term effects of early childhood bullying or rejection by same-sex peers, they should seek help to heal those wounds.

Treatment which focuses on the overall psychological health of the child or of the family is not prohibited by law in any jurisdiction; neither is it likely ever to be. Additionally, such treatment avoids the risk of placing a child in a therapeutic situation where they may suffer harm as a result of unscrupulous or dishonest practices.



Melinda Selmys is the author of Sexual Authenticity: An Intimate Reflection on Homosexuality and Catholicism. She is a homeschool mother with six children, writes for the National Catholic Register, and has published articles in numerous other venues. Her blog, sexualauthenticity.blogspot.com, explores issues surrounding faith and sexuality.





Wednesday, December 26, 2012

Neolithic Medical Care


An article in the New York Times this week highlighted the life of a young man in northern Vietnam between 3,700 to 4,500 years ago. "M9" as archeologists have named him, was paralyzed from the waist down and would have had very limited upper body mobility. Yet he apparently lived into his early 30s.

How was survival possible in a subsistence Neolithic community? The answer, writes Lorna Tilley, of Australian National University, in the International Journal of Paleopathology was round-the-clock, high quality personal care. This would have included regular bathing, toileting, massaging, and turning to avoid pressure sores.

Ms Tilley and her co-author make some interesting observations about the ethics of care. In modern society, people with extreme disability often succumb to depression, sometimes resulting in suicide either directly, or indirectly by refusing care. In a Neolithic community depression would have been lethal.

Survival, therefore, meant that the young man lived in "a secure, emotionally-supportive, inclusive environment in which care was provided ungrudgingly, enabling M9 to grow to adulthood, to develop a role for himself within the group, to retain a sense of self-respect, and to interact with others in his community at whatever level was possible. In view of the prolonged and particularly demanding nature of the care provided, it seems justifiable to speculate that the carers' motivations included compassion, respect and affection."

As for M9 himself, the "bioarcheologists" suggest that he must have had a remarkable personality. "M9's prolonged survival with disability suggests an extraordinarily strong will to live; a robust psychological adaptation; a self-esteem capable of overcoming the complete loss of independence; and a personality capable of inspiring others to maintain high quality and costly care over time."

This is not the only example of a prehistoric ethic of care. A Neanderthal who lived in Iraq 45,000 years ago survived cranial trauma, amputation of his right arm, other injuries and osteomyelitis thanks to the care of his community. A skeleton dating back 10,000 years ago in Calabria exhibited signs of severe dwarfism. Since the young man would not have been able to keep up with other tribesmen in searching for food, his companions must have accommodated his handicaps.




Saturday, September 1, 2012

Nazi Criminal Medical Experiments


The German physicians who ran SS and Wehrmacht medical institutions, along with medical personnel at lower levels, participated actively in carrying out Nazi extermination plans. SS physicians assigned to the concentration camps, including Auschwitz, played a special role. They conducted criminal medical experiments on prisoners and committed other acts that violated medical ethics. Having furthered the extermination program in the concentration camps, they have gone down in history as medical criminals.

The SS physicians who carried out pseudo-medical experiments in Auschwitz included:

Professor Dr. Carl Clauberg
    He experimented with sterilization in the camp. Part of Block No. 10 in the Main Camp was put at his disposal. Several hundred Jewish women from various countries lived in two large rooms on the second floor of the building. Clauberg developed a method of non-surgical mass sterilization that consisted of introducing into the female reproductive organs a specially prepared chemical irritant that produced sever inflammation. Within several weeks, the fallopian tubes grew shut and were blocked. Clauberg's experiments killed some of his subjects, and others were put to death so that autopsies could be performed.

    In June 1943, Clauberg wrote to Himmler:
    "The non-surgical method of sterilizing women that I have invented is now almost perfected . . . As for the questions that you have directed to me, sir, I can today answer them in the way that I had anticipated: if the research that I am carrying out continues to yield the sort of results that it has produced so far (and there is no reason to suppose that this shall not be the case), then I shall be able to report in the foreseeable future that one experienced physician, with an appropriately equipped office and the aid of ten auxiliary personnel, will be able to carry out in the course of a single day the sterilization of hundreds, or even 1,000 women."
Dr. Horst Schumann
    Like Clauberg, Schumann was searching for a convenient means of mass sterilization that would enable the Third Reich to carry out the biological destruction of conquered nations by "scientific methods"--through depriving people of their reproductive capacity. "X-ray sterilization" equipment was set up for Schumann in one of the barracks at Birkenau. Every so often, several dozen Jewish men and women prisoners were brought in. The sterilization experiments consisted of exposing the women's ovaries and the men's testes to X-rays. Schumann applied various intensities at various intervals in his search for the optimal dose of radiation. The exposure to radiation produced severe burns on the belly, groin, and buttocks areas of the subjects, and festering sores that were resistant to healing. Many subjects died from complications. The results of the X-ray sterilization experiments were unsatisfactory. In an article that he sent to Himmler in April 1944, titled "The Effect of X-Ray Radiation on the human Reproductive Glands," Schumann expressed a preference for surgical castration, as being quicker and more certain.
Dr. Mengele
    Josef Mengele held a Ph.D. and a medical doctorate. In close collaboration with the Kaiser Wilhelm Institute for Anthropology, Genetics, and Eugenics, he studied the phenomena of twins, as well as the physiology and pathology of dwarfism. He was also interested in people with different-colored irises and in the etiology and treatment of noma ("water cancer" of the cheek). This latter disease, widespread in the Gypsy Camp, had been previously almost unknown in Europe. Mengeles first experimental subjects were Gypsy children. He had a laboratory in the so-called "Gypsy Family Camp." On Mengele's orders, children suffering from noma were put to death in order for pathology investigations to be carried out. Organs and even complete heads of children were preserved and sent in jars to institutions including the Medical Academy in Graz, Austria.

    Mengele also began selecting dwarves and persons with physical peculiarities (including inborn disabilities and the developmental defects that appear in dwarfism) from the Jewish transports brought to Birkenau for extermination, from the Jewish "Theresienstadt Family Camp" in Birkenau, and from the so-called Mexico (Sector BIII).

    In the first phase of his experiments, Mengele subjected pairs twins and people with physical handicaps to special medical examinations that could be carried out on the living organism. Usually painful and exhausting, these examinations lasted for hours and were a difficult experience for starved, terrified children (for such were the majority of the twins). The subjects were photographed, plaster casts were made of their teeth and jaws, and their fingerprints and toeprints were taken. As soon as the examinations of a given pair of twins or dwarf were finished, Mengele ordered them killed by phenol injection so that he could go on to the next phase of his experiments, the comparative analysis of internal organs at autopsy. "Scientifically" interesting anatomical specimens were preserved and shipped to the Institute in Berlin-Dahlem for more detailed examination.
Dr Johann Paul Kremer
    The killing of prisoners was also accompanied by research into the changes that occur in the human organism as a result of starvation--in particular, liver atrophy ("braune Atrophie"). This research was carried out at Auschwitz Concentration Camp by SS-Obersturmführer Johann Paul Kremer, M.D., Ph.D., professor at the University of Münster, where he lectured on anatomy and human genetics. At the Block No. 28 clinic in the main camp, he carried out assessments of prisoners attempting to gain admission to the hospital. Many of them were at the point of exhaustion, in the "Musselman" state, in the final stages of starvation to death. Kremer ordered most of them killed by phenol injection. Kremer selected prisoners who struck him as particularly good experimental material, and questioned them just before their deaths, as they lay on the autopsy table awaiting injection, about such personal details as their weight before arrest and any medicines they had used recently. In some cases, he ordered these prisoners photographed. Before their bodies were cold, they were subjected to autopsies and slides were made for Kremer of the liver, spleen, and pancreas.
SS physicians Friedrich Entress, Helmuth Vetter, and Eduard Wirths
    In 1941-1944, SS camp physicians Friedrich Entress, Helmuth Vetter, and Eduard Wirths carried out clinical trials of the tolerance and efficacy of new medications and drugs, with such code names as B-1012, B-1O34, B-1O36, 3582, P-111, rutenolu, and peristonu, on Auschwitz Concentration Camp prisoners. They did so on commission from IG Farbenindustrie, and particularly from the Bayer firm, which was part of that cartel. These preparations were given to prisoners suffering from contagious diseases, who had in many cases been deliberately infected.
Prof. Dr. August Hirt
    In 1942, SS-Hauptsturmführer Prof. Dr. August Hirt, chairman of the anatomy department at the Reich University in Strassburgu, set about assembling a collection of Jewish skeletons under the auspices of the Ahnenerbe Foundation. To this end, he received permission from Himmler to select the required number of prisoners at Auschwitz Concentration Camp. The selection of 115 persons (79 Jewish men, 30 Jewish women, 2 Poles, and 4 "Asians"--probably Soviet POWs) and the preliminary preparation, consisting of biometrical measurements and the collection of personal data, were carried out by Hirt's collaborator, SS-Hauptsturmführer Dr. Bruno Beger, who arrived in Auschwitz in the first half of 1943. Berger finished his work by June 15, 1943. After going through quarantine, some of the prisoners whom Berger selected were sent in July and early August to Natzweiler-Struthof Concentration Camp, where they were killed in the gas chamber. The victims' corpses were sent to Hirt as material for his skeleton collection, which was intended for use in anthropological studies that would demonstrate the superiority of the Nordic race.


From here.

Saturday, August 4, 2012

Massachusetts Doctors Debate Assisted Suicide


On election day in November, Massachusetts will also vote on a referendum on assisted suicide - or, as its supporters call it, "assisted dying." On July 31 Boston Globe featured parallel statements by a leading advocate of the measure and a leading foe.

Marcia Angell is a former editor of the New England Journal of Medicine and a senior lecturer in social medicine at Harvard Medical School. She argues that because the proposed bill, which is "virtually identical" to Oregon's Death with Dignity law, has already been found roadworthy there, Massachusetts voters should have no hesitation in supporting it.

Although the Massachusetts Medical Society (MMS) staunchly opposes assisted suicide, Dr Angell believes conventional arguments, like "physicians are only healers", "physicians should never participate in taking life", and "patients who request assisted dying may be suffering from treatable depression", are wrong. She acknowledges that palliative care can relieve pain in most cases, but, she says, existential suffering can be even worse for patients:

"They know that their condition will grow worse day after day until their deaths, that their course is inexorably downhill, and they find it meaningless to soldier on. Why should anyone -- the state, the medical profession, or anyone else -- presume to tell someone else how much suffering they must endure while dying? Doctors should stand with their patients, not against them."

Barbara A.Rockett, a physician at Newton-Wellesley Hospital and a former president of the Massachusetts Medical Society, argues that "To substitute physician-assisted suicide for care represents an abandonment of the patient by the physician."

Rockett reminds readers that, by and large, doctors do not support assisted suicide. In Massachusetts, more than 75% of member of the MMS oppose it. And this is true at a national level as well. At a meeting in 2003, the AMA went on record to say, "Physician-assisted suicide is fundamentally incompatible with the physician's role as healer, would be difficult or impossible to control, and would impose serious societal risks." She concludes:

"Physician-assisted suicide has been falsely advertised as death with dignity. Believe me, there is nothing dignified about suicide. I ask the voters of this Commonwealth, as they enter the voting booth, to vote for dignity for life and not for death. Please vote no on physician-assisted suicide."

What is at stake? If Massachusetts voters approve the referendum, other New England states could follow suit. The Massachusetts Medical Society is the oldest of its kind in the United States and the publisher of the New England Journal of Medicine, the nation's leading medical journal.



Thursday, August 2, 2012

Serbia World's Hub for Sex-change Surgery


Serbia has become an international hub for sex-change surgery with four clinics catering to an international market, according to the New York Times.

Last year 100 people had the operation, which costs only about US$10,000. The same surgery would cost at least $50,000 in the USA. Additionally, Serbian surgeons perform most surgeries in a single six-hour operation.

To qualify, candidates need two letters from psychiatrists attesting that they are suffering from gender identity disorder, a year of counselling and a year of hormone therapy.

This procedure is flourishing in Serbia, though the Serbs have little tolerance for homosex. It appears that the Serbs distinguish between legitimate gender confusion, which is relatively rare, involving less than 2% of the world's population, and homosexuality as a life choice.


Related reading:  Transgendered Woman Decries Action of Episcopal General Convention


Thursday, May 24, 2012

Senate Committee Investigating "Epidemic of Deaths" from Narcotic Painkillers




The US Senate's Finance Committee has asked seven organisations, including the well-known Center for Practical Bioethics, in Kansas City, for information about financial ties to the pharmaceutical industry. This inquiry is part of the committee's investigation of links between manufacturers, doctors and organisations which have advocated increased use of narcotic painkillers.


The Committee claims that the US is suffering from "an epidemic of accidental deaths and addiction resulting from the increased sale and use of powerful narcotic painkillers" and that opioid-based prescription painkillers kill more people than heroin and cocaine combined. It is concerned about "extensive ties between companies that manufacture and market opioids and non-profit organisations".


The Centre for Practical Bioethics also received a letter demanding information about financial ties because Purdue Pharma, the manufacturer of OxyContin and other pain drugs, is a substantial donor. Myra Christopher, its founder and former president, is an outspoken advocate of pain relief, especially in palliative care. She has always insisted that funds came with no strings attached. The Center says that it will cooperate fully in the investigation.


Because the American Journal of Bioethics is linked to the Center through Glen McGee, the founding editor of AJOB and a former ethicist at the Center, some bioethicists have alleged that AJOB will be drawn into the investigation. AJOB has vigorously denied this. "No financial relationship exists or ever existed between AJOB and Purdue Pharmaceuticals or any pharmaceutical company. AJOB received no financial support from the Center for Practical Bioethics," it says on its blog.


Sunday, March 11, 2012

Moldova: Chemical Castration for Sex Offenders



Chemical castration will be mandatory in Moldova for those convicted of violently abusing children under 15.

Under a new law, foreigners and Moldovans convicted of violent paedophile offences will be chemically castrated. Rapists will also face castration on a case-by-case basis. Many Moldovans believe their country has become a haven for sex tourism, AP reports, with 5 foreigners of the 9 men convicted of child sex offences over the past 2 years.

Chemical castration involves a man taking hormones which suppress the production of testosterone for 3 months, reducing his sex drive. Some MPs in Moldova’s parliament questioned the effectiveness of the measure, pointing out that it is reversible, and pressing legislators to explore other methods.

Moldovan legislator Valeriu Munteanu, of the Liberal Party, said the measure was necessary after the outrage sparked by a number of cases involving US and West European nationals. “The Republic of Moldova has been transformed in recent years into ‘a tourist destination’ for Western pedophiles and there have been cases where rapists have repeatedly offended even after they served prison time,” said Munteanu.

Amnesty International Moldova criticised the decision, saying it erodes fundamental rights to physical and mental integrity. Executive Director Cristina Pereteatcu described chemical castration as “incompatible with human rights, which are the foundation of any civilized democratic society”. The new law will become active on July 1. Legislation for mandatory chemical castration exists in Poland and Russia, and both Germany and the Czech Republic have used voluntary surgical castration to treat sex offenders. ~ AP, Mar 7; BBC, Mar 6