Practical Ethics

The point of death

The Guardian yesterday reported the death of the man who had been so tragically shot in Antigua, with his wife, three weeks after their wedding. It began like this:

"Ben Mullany, the newlywed who was shot on honeymoon in Antigua in an attack that killed his wife, Catherine, died in hospital in Wales yesterday after his life support machine was switched off.  The 31-year-old trainee physiotherapist, who had suffered a fractured skull and had a bullet lodged in the back of his head, was flown back to Britain while in a coma on Saturday. Tests carried out when his condition stabilised after the 24-hour journey established he was brain dead." 

This is a familiar way of describing such happenings, even among clinical professionals.   Brain death is pronounced, so the life support machine is switched off, and the patient dies.   The clear implication is that brain death is not death.  The machine is still keeping the patient alive, and it is switching off the machine that causes real death. 

HFEA and Regulating Reproduction:Triumph for Rationality and Victory for Secular Ethics

MPs voted on Tuesday on two of the most controversial issues surrounding reproduction- the provision of IVF treatment, and the availability of legal abortion. Under the new laws, IVF clinics will no longer have a legal requirement to consider the need for a father, but will instead be asked to ensure provision of 'supportive parenting', removing any barrier to single women and lesbian couples conceiving through the treatment. In a separate amendment, MPs were asked to consider the legal time limit on abortion, which currently stands at 24 weeks. Given the option to reduce this limit to 22, 20 or even just 12 weeks, MPs voted by a comfortable majority to stick with the status quo. 

The UK is now at the forefront of rational reform to legislation governing reproduction and research. The Human Fertilisation and Embryology Bill has now approved the creation of human admixed embryos, with important implications for scientific advance.

Blog on Admixed Embryos
Savulescu, J., The Case for Creating Human -Non Human Cell Lines, Bioethics Forum
Human Enhancement papers, media and other resources for free download

It has also reformed the regulation of reproduction in a thoroughly sensible manner.

The Choice to Have Artificial Blood: Less than the Best?

Controversy has erupted around whether experiments to test artificial blood should stop. Experimental blood substitutes raised the risk of heart attack and death, yet U.S. regulators allowed human testing to continue despite warning signs, says a scathing new report.

Blood substitutes, or artificial blood, could be stored for years without refrigeration, and be used in battlefield situations. It would carry no risk risk of infection with hepatitis or HIV. It would be an acceptable alternative to Jehovah’s Witnesses who refuse life saving blood transfusions.
In a new report, researchers pooled data from 16 separate studies of five different blood substitutes, involving over 3,700 patients. Researchers found a 30 percent higher risk of death overall for patients who received transfusions using the blood substitutes. The risk of heart attack was nearly tripled in the groups receiving blood substitutes.

“Experts speculate that hemoglobin in the blood substitutes scavenges nitric oxide from the blood, causing blood vessels to constrict and sticky platelets to build up. That increases the risk of heart attacks.”

Do we own our bodies? Should we?

There was a sad story last week about a young woman who died unexpectedly at the age of 19.   She was on the organ donor register, and her own mother was on the waiting list for a kidney donation, but the mother was refused one of the kidneys.  Even the transplant coordinator was ‘crying her eyes out’, but there was apparently no escape.  Rules were rules.  Cadaveric donations must go impartially and anonymously to the most compatible people at the top of the waiting list, and the authorities decreed that these organs must go to three strangers – whose identity the mother will never even know.