Dr. Dianne N. Irving has written a paper "When Do Human Beings Begin? 'Scientific' Myths and Scientific Facts" which she considers a lay version of her doctoral thesis "Philosophical and Scientific Analysis of the Nature of the Early Human Embryo" and dozens of papers she has published in both scientific and philosophical/medical ethics journals.  Excerpts from her paper:

Introduction

"The question as to when a human being begins is strictly a scientific question, and should be answered by human embryologists - not by philosophers, bioethicists, theologians, politicians, x-ray technicians, movie stars or obstetricians and gynecologists. The question as to when a human person begins is a philosophical question..."

Embryology

Dr. Irving then proceeds with basic human embryological facts, explaining the processes of game-togenesis and fertilization, directing readers to embryology textbooks for further details.

"Scientific Myths", scientific facts "

...Given these basic facts of human embryology, it is easier to recognize the many scientifically inaccurate claims that have been advanced in the discussions about abortion, human embryo research, cloning, stem cell research, the formation of chimeras, and the use of abortifacients - and why these dis-cussions obfuscate the objective scientific facts." Dr. Irving goes on with a "sampling" of 14 "scientific myths", addressing misconceptions such as: "the product of fertilization, up to 14 days, is ... a 'pre-embryo'- and therefore it can be used in experimental research..." "pregnancy begins with the implantation of the blastocyst (ie. about 5- 7 days)" "human sperms and human ova are human life too" "the embryonic period begin at implantation" "a human person begins with 'brain birth'..." "a 'person' is defined in terms of the active exercising of 'rational attributes'..."

Conclusions

"Ideas do have concrete consequences - not only in one's personal life, but also in the formulation of public policies. And once a definition is accepted in one public policy, the logical extensions of it can then be applied, invalidly, in many other policies, even if they are not dealing with the same exact issue - as happens frequently in bioethics. Thus, the definitions of 'human being' and of 'person' which have been concretized in the abortion debates have been transferred to several other areas, e.g., human embryo research, cloning, stem cell research, the formation of chimeras, the use of abortifacients - even the issues of brain death, brain birth, organ transplantation, the removal of food and hydration, and research with the mentally ill or the disabled. But both private choices and public policies should incorporate sound and accurate science whenever possible..." To order a copy of Dr. Irving's paper, see reply card or contact Canadian Physicians for Life.

Dianne Irving, M.A., Ph.D. teaches Medical Ethics and the History of Philosophy at The Dominican House of Studies, Washington, DC. She has presented two amicus curiae briefs on "fetal personhood" for U.S. Supreme Court cases. Dr. Irving testified in February 1998 before the U.S. House of Representatives as an invited member on the Scientific Panel considering the issue of the cloning of human beings. Dr. Irving has recently co-authored a book with human embryologist Dr. C. Ward Kischer, "The Human Development Hoax: Time To Tell The Truth!" which is distributed by the American Life League

Reprinted from the Canadian Bioethics Society's home page - www.bioethics.ca

Public and professional interest in bioethics has increased dramatically during recent years, for many reasons. Prominent among these are:

• The rapid growth of medical technology
• Increased patient expectations due to increased educational levels and increased affluence
• Recognition of patient autonomy in health care decision making
• Higher incidence of iatrogenic complications from therapy
• Alternative health care practices
• The interaction of democratic and 'market' ideologies
• The limits on available health care resources
• The development of interprofessional health teams
• The multicultural nature of Canadian society.

Health care workers now encounter an unprecedented number of difficult and challenging problems, and many patients now demand a role in health care decision-making: there is an ethical element in each health care decision.

11th Annual Canadian Bioethics Society Conference Edmonton, Alberta - October 28 - 30, 1999 "Expanding the Boundaries of Ethics" For information, call (780)492-667

 

Notes from the World Medical Association's annual General Assembly held October 14 to 18, 1998

1st Presenter: Dr. Rob Dillmann, Secretary General of the Royal Dutch Medical Association

Euthanasia in the Netherlands

Dr. Dillman stated that the practice of euthanasia and assisted suicide is a great challenge for the medical profession. The medical killing of patients has been legitimized by the courts in Holland forcing physicians to adapt to the changes as defined by the legal system.

Dr. Dillman stressed the importance of transparency and stated that the "practice of euthanasia is a moral hazard if it takes place in the dark." A number of charts were projected which gave a glimpse into the actual practice of euthanasia and assisted suicide in Holland. (Ed. These reports were from the study by van der Maas and Van der Wal - see box on page 4)

The Slippery Slope

As part of the expos‚ on Holland, Dr. Dillman reflected on whether the slippery slope argument applied to the practice of medical killing in Holland. He seems to believe that it does not, but a look at the figures seems to point to another conclusion. He does not seem to be concerned with the 25% increase in actual cases of euthanasia and assisted suicide which occurred from 1990 to 1995. He is quick to point out the decrease of 10% of cases of actively ending the patient's life without request but ignores the reality that these cases now include disabled newborns and at least one psychiatric patient who suffered only from depression. When challenged during the question period, Dr. Dillman did refer to this psychiatric case as an exception and admitted that these cases do represent a challenge to Dutch physicians.

Deadly Weapon

A representative of the African Medical Association pointed out that the slippery slope is difficult to contain. He expressed concern that in some cultures it could be used as a deadly weapon by despots and dictators who would find no shortage of doctors willing to participate. He is concerned that we could be unleashing a monster in certain cultures.

2nd Presenter: Dr. Nuala Patricia Kenny, Director of the Office of Bioethics Education and Research, Dalhousie University

Do No Harm

The second speaker to address the challenge of assisted suicide and euthanasia to medicine was Dr. Kenny who began her presentation by reminding physicians of the Hippocratic tradition to do no harm to their patients. The audience was reminded that debate before and during the Hippocratic tradition had always rejected any attempt to legitimize the killing of patients. Dr. Kenny stated that causing death is against the goals of medicine. Dr. Kenny believes that legalizing assisted suicide and euthanasia would erode the trust between physicians and patients and that it would not be possible to contain killing by physicians. It was pointed out that historically, even if something is legalized in extreme cases, it is only a matter of time before we find other reasons to justify the action.

A duty to kill

Dr. Kenny explained that we now have a different world view under which we operate. The sanctity of life ethic is no longer relevant for many in our pluralistic society. God, who used to have dominion over life, has been replaced by science and technology. We now live with the expectation that science and technology can fix everything. Now that technology is so much a part of our lives and that personal autonomy is seen as the most important principle guiding our life, there is a real danger of physicians being forced to accept death as a treatment option. Dr. Kenny pointed out that a patient's right to die becomes the physician's duty to kill. Of special concern is our inability to define "unbearable suffering." People suffer for all kinds of reasons not related to health care. Physical pain is rarely cited as the reason for requesting assisted suicide or euthanasia. It is usually some broader definition of suffering which is advanced, making it difficult to define guidelines for regulating assisted suicide and euthanasia based on "suffering."

Tough questions

Dr. Kenny cautioned doctors to not be influenced by the consumerism which characterizes our society and now threatens even health care. The practice of medicine is based on the principle of beneficence, promoting only treatment options which are in the best interest of patients. As the acceptance of personal autonomy becomes rampant are the goals of medicine to be redefined? As patients demand everything that science and technology has to offer, must physicians be obliged to respond even when they know the treatment option may not be of benefit to the patient? Health care could become a consumer product where the patient drives in, requests his treatment, receives it and then drives out. Physicians must now decide if they are to give in to this tendency or if they will maintain the central moral tradition of medicine which is concerned with the best interest of patients. This is the challenge which the medical profession must address.

by Carroll Rees , Action Life Ottawa

 

by: Dr. Henk Jochemsen

In May 1997 the KNMG (Royal Dutch Medical Society) published its final report on life terminating actions with incompetent patients. Starting in 1988, a special committee of the KNMG published several discussion papers on life terminating actions with several categories of incompetent patients, namely severely ill or handicapped newborn babies, patients in PVS and severely demented patients, and also on assisted suicide for psychiatric patients.

Several people and organisations reacted to these discussion papers. The committee has studied all the submissions and has used them and responded to them in their final report, called "Medical care around the end of life of incompetent patients".

The position of the KNMG in this final report is not principally different from the discussion papers in that the organisation continues to condone intentional termination of life of the three categories of incompetent patients and assisted suicide to psychiatric patients. At the same time the formulation of this acceptance and its justification is more careful and restricted than in the discussion papers. If the formulations of this report would be followed in practice the number of cases of intentional life termination would at least be quite limited.

The report considers every form of artificial administration of food and fluid as a medical treatment that can or even should be stopped when no improvement of the patient's condition can be expected. Such withdrawal is not considered as an intentional termination of life, though death will be its inevitable conse quence. According to the report the withdrawal of artificial feeding can be justified even when the artificial administration itself is not unduly burdensome. This applies to handicapped babies, demented elderly people and PVS patients. In my opinion the important ethical distinction between withdrawal of tube feeding that has become disproportional in itself and stopping this form of care as a kind of intentional life- shortening is blurred.

In case of PVS patients according to the KNMG it is justified to withdraw artificial feeding after a certain number of months after they became comatose, and let them die. Though an individual diagnosis must be made, the report mentions periods of 3 - 6 months for non-traumatic patients and about 12 months for trauma patients as a rule of thumb (p.100). The KNMG even asserts that the physician has a moral duty to with-draw treatment (including tube feeding) when the coma must be considered permanent. When the family insists on continuing care (including tube feeding if necessary) then the physician should try to make them change their mind. The physician cannot refuse to stop tube feeding on grounds of conscientious objections. At this particular point the position of the KNMG has become more directive in comparison to the discussion paper on PVS patients.

This report is not likely to help - to say the least - in reducing the number of cases of life terminating actions with incompetent patients. Particularly in view of the fact that the courts in cases of life terminating actions rely heavily on the opinion of the medical profession. On the whole I am certainly not happy with this report. I have serious objections to permitting intentional life terminating actions by physicians especially in cases of incompetent patients. Such actions are beyond the ethical limits and the mandate of medicine.

Dr. Jochemsen is director of the Lindeboom Institute, Centre for Medical Ethics in Ede, The Netherlands and holds a Chair for Medical Ethics, established by the Institute at one of the medical faculties in the country.

EUTHANASIA AND ASSISTED SUICIDE: The Current Debate Edited by Ian Gentles

This book gives a good overview and brings out the complexity of the euthanasia debate. Written by Canadian contributors including Ian Hunter, Ian Gentles, Dr. John Scott and Robert Nadeau, the latest developments are not included in this 1995 publication, but it is still an excellent resource.

Following is an excerpt from the chapter by Dr. John Scott, head of the University of Ottawa Institute of Palliative Care.

FEAR AND FALSE PROMISES

The Challenge of Pain in the Terminally Ill by: Dr. John Scott (pg. 103, 104)

. . . Beneath all pain lies fear - fear within the patient, the family, professionals and community. The fear of pain itself and of death are central, yet one also can recognize the fears of

• abandonment
• losing control of decision-making
• overtreatment or artificial prolongation of suffering
• incontinence
• going crazy
• dying in distress from bleeding, suffocation, etc.
• becoming a burden to family

Relief can only be achieved by attacking what is a viper nest of terror. Advocates for euthanasia in Canada are, with rare exceptions, healthy persons who are afraid of death and pain and losing control. Euthanasia is promoted as the solution to fear, promising to end our fears of suffering and losing autonomy by offering, instead, control over the method and timing of death. This is a false promise. Euthanasia and assisted suicide have arisen as a direct consequence of unresolved fear and denial; sanctioning it would lead to a spiral of mounting fear, both in dying patients and in the worried well of the community. Euthanasia legislation, far from diminishing suffering, would enhance the pain of dying by

• increasing mistrust between patient and professional care givers
• increasing fear of the drugs of symptom control
• diverting attention and resources away from palliative care

The pain of advanced disease presents us with a tremendous challenge. Canada has the skills and resources to meet this challenge as long as we maintain our focus and our courage. We must not be diverted by the mirage of euthanasia, by this seductive quick-fix approach to suffering and death. Euthanasia, in fact, would open a floodgate of fear and pain. It would rob us of scarce resources and block the development of the effective community responses to pain that we so urgently need.

Formed in 1997, Last acts is a U.S. national coalition of health, ethics, and consumer groups emphasizing compassionate end-of-life care. The 315-member Last acts coalition is led by honorary chair Rosalynn Carter, the former First Lady. Partners in the coalition include the American Medical Association, the American Nurses Association, the American Cancer Society, the Alzheimer's Association, and hundreds of other health, bioethics, religious, and consumer organizations.

On March 17, 1999, Last acts released the findings of a national survey conducted March 5-7 showing how critical Americans are of the way care is delivered to dying people in the United States. By more than a 2-to-1 margin, Americans say that the national priority should be improving care and pain relief for people who are dying, rather than making physician-assisted suicide legal (65% to 23%).

Roughly half of those surveyed by the public opinion poll believe that the health care system does an "only fair" or "poor" job of helping dying patients stay as comfortable and pain-free as possible (46%), helping them maintain their dignity (54%), and including patients and their families in decisions about care (48%). Very few Americans believe the system does an "excellent" job in any of these areas.

Last acts also introduced a blueprint for end-of-life care, calling for more public attention for patient care and less for physician-assisted suicide. The coalition is promoting a five-part vision for ensuring that people's physical, emotional, and spiritual needs are met by family, health care providers, the clergy, and others who can provide comfort.

"We believe the Kevorkian debate raises important questions, but leads to the wrong answers," said Last acts Ira Byock, M.D., author of Dying Well, and former president of the American Academy of Hospice and Palliative Medicine. "The debate addresses people's many fears about terminal illness, especially their fears that the health care system will not respond to their pain and suffering. But Americans should expect and be able to get end-of-life care that respects their own wishes and needs. As long as there is life, we can treat people with medically excellent care, but also tender loving care," said Byock.

The Last acts blueprint for better end-of-life care has been published as a leaflet and will be distributed nationwide to individuals, families, health care professionals, and health care institutions as a way of expanding Americans' knowledge of quality care at life's end. For further information, visit Last acts' excellent web site at www.lastacts.org

The 1963 Code of Ethics of the Canadian Medical Association (CMA) had this to say about abortion: "The induction or procuring of abortion involves the destruction of life. It is a violation both of the moral law and of the Criminal Code of Canada, except when there is justification for its performance. The only justification is that the continuance of pregnancy would imperil the life of the mother." Note that the text mentions specifically the life, not the health, of the mother.

One cannot help but be struck by the fact that not a word about abortion or, more generally, about the respect that is due human life appears in the most recent version of the CMA Code of Ethics (December 1984).

Does the CMA think that the omission of any reference to abortion somehow makes it less immoral? Or does the CMA hope that its most recent stand in favour of what amounts to abortion on demand (Can Med Assoc J 1985: 133: 318A) will, through some strange alchemy, make abortion appear less immoral than it was rightly considered to be just over 20 years ago?

If the answer to these questions is Yes, I submit that the CMA is very mistaken, and the reason for this view is that no decision by any court or by any legislative or professional body can change anything intrinsic to certain acts or situations.

Blacks in the United States were no less human just because Judge Roger Taney of the US Supreme Court decreed in 1957 that they were not human; he actually described them as chattel. And who would pretend that Canadian women were not "persons" just because the judges of our Supreme Court decreed in 1957 that they were not? Should the world have accepted the view that Jews are not persons in the legal sense simply because of a decision by the Teichsgericht (German Supreme Court) in 1936 to that effect? Should child abuse be tolerated? What if a majority of our society decided that it is an acceptable way of treating children?

The fact that the US Supreme Court in 1973 and our Parliament in 1969 decided that abortion should be freely available to women does not change the basic nature of abortion. The facts that abortion is now sanctioned by the laws of our country, that it is carried out by health care professionals instead of back-alley butchers and that it is done in hospitals (institutions supposedly devoted to the restoration of health and the preservation of life) rather than in insanitary surroundings do not change one iota what abortion has always been and will always be the destruction of a living, defenceless, innocent human being and, as such, a procedure that is basically immoral and totally unacceptable.

It is probably not superfluous to recall a few passages of the International Code of Ethics and of the Declaration of Geneva, both of which the CMA professes to endorse "as a general guide". The first document states that "a doctor must always bear in mind the importance of preserving human life, from the time of conception until death". The second document states: "I will maintain the utmost respect for human life, from the time of conception; even under threat, I will not use my medical knowledge contrary to the laws of humanity."

Considering how far it has strayed from what it professes to adhere to, I feel that the CMA would be well advised to explain what it means by "a general guide"? Moreover, all physicians, members of the CMA or not, should never forget that these two documents were adopted in 1948 as an almost direct consequence of the Nuremberg trials, which had just revealed to a shocked world the extend of the atrocities, including medical ones, committed by the Hitlerian regime and that any departure from the moral code of behaviour enshrined in these documents will always carry undeniable and significant risks.

W. Andre‚ Lafrance, MD

This letter appeared in the Can Med Assoc J 1985: 133 p. 1108. It is reprinted with permission as we mark 30 years of legal abortions in Canada. Dr. W. Andre Lafrance practices dermatology in Ottawa and is a pro- life activist.

Wesley J. Smith National Post - March 12, 1999

She's not merely dead, she's truly most sincerely dead  - The Wizard of Oz

A fundamental ethical rule of organ transplantation requires that donors be dead before their organs are removed. But these days people are asking, is "dead" really dead? Indeed, when is dead, dead enough?

For more than 20 years, a finding of "brain death" the cessation of all function within the entire brain has been the primary method used to declare a human being dead when organ donation is contemplated. (The other method of declaring death is a finding of irreversible cessation of heart and lung functions.) Brain death suffers from an aesthetics problem; brain dead people don't look dead. They still breathe with the aid of medical machines and their hearts still beat, keeping their organs viable for transplantation. But doctors assure us no real life exists because, without any brain function, a circum stance that can be determined with objective medical tests, life does not really exist. Moreover, without the application of medical technology, the hearts within these bodies would immediately cease beating and body tissues, deprived of oxygen, would begin to decay and become unusable.

Now, the concept of brain death, which has served humanity so well, is being questioned, threatening the availability of the primary source of organs used in transplantation: people with catastrophic brain injury whose brains cease to function while they are in hospital on life support. Ironically the questioning of brain death comes from two conflicting perspectives. The view that has received the most media attention, is that the definition of brain death is too liberal, permitting organ procurement from people who are not actually dead. Another less well known line of argument claims that the concept of brain death is too conservative, unduly limiting the supply of organs while potential recipients die as they wait for transplantable organs to become available. Both challenges represent significant threats to public confidence in organ transplantation.

A very alive Ruth Oliver, who recovered from a brain haemorrhage after being declared clinically dead, made headlines when she appeared before a parliamentary committee last week warning that brain death should not be permitted as a criterion for organ procurement because people like her could be victimized. Ms. Oliver's testimony struck a chord. People are increasingly nervous about recent trends in medical ethics. They sense that many doctors and bioethicists increasingly eschew the Hippocratic tradition of "do no harm," in favour of a utilitarian approach to health care that views the most medically vulnerable among us as expendable.

In the area of organ transplantation, this fear translates into worries that brain death will be declared prematurely in order to obtain organs for the benefit of people seen by medical ethicists as more worthy of life. Happily, there is little evidence that brain death criteria are actually being abused in the clinical setting. Assuming proper protocols are adhered to strictly, in my view, brain death is a valid ethical concept.

The greater long-term threat to public confidence in transplantation comes from bioethicists who, in their desire to increase supply, argue that people in permanent coma should be acceptable sources of organs. These advocates claim that human life, in and of itself, is not morally meaningful. What matters is human rationality. Thus, they urge that patients who have been diagnosed as permanently unconscious be considered "dead," so that their organs can be procured for transplantation.

Some of the world's most notable bioethicists favour redefining death in this way. One is Robert M. Veatch, the influential director of the Kennedy Institute of Ethics at Georgetown University, who has written that when the "organic and mental functions" of a human being are "irretrievably disjoined, then human life no longer exists." Similarly, a 1997 article in the British medical journal, The Lancet, argued that permanent unconsciousness for 12 months should be deemed "dead," after which it should be acceptable to end the body's functioning through "lethal injection, and then remove the organs needed for transplantation, subject to the usual criteria for consent."

But the diagnosis of permanent unconsciousness is notoriously unreliable and is often confused with other neurological conditions. Indeed, unlike those who are brain dead, people who are "permanently" unconscious sometimes for years occasionally wake up. Expanding the definition of death to include permanent coma would not only destroy the dead donor rule and threaten the public's support for organ procurement, it would seriously undermine the public's confidence in the medical system's treatment of cognitively disabled people.

Increasing the supply of organs for transplantation is laudable. That is best done by educating the public about the opportunity to give "the gift of life," maintaining strict adherence to the clinical rules for determining brain death, and by rejecting unwise utilitarian proposals that would cause far more harm than good.

Reprinted with permission Wesley J. Smith is the author of Forced Exit: The Slippery Slope from Assisted Death to Legalized Murder. His next book is an examination of bioethics

.

Too busy poking our noses into other cultures, we blithely ignore the dysfunctionality of our own callously convenience-centred one.       Naomi Lakrtiz Calgary Herald - 99/02/25

Some years ago, an acquaintance named Debbie launched into a discourse about a married friend who was pregnant with her third child and considering aborting it because she and her husband wanted only two children.

"I told her just to go and get it over with because she'll feel so much better. Then she won't have to think about it any more. I had an abortion at 16 and I've never given it a thought," Debbie said.

She then switched topics, as if she'd been discussing nothing more earth-shattering than the weather and prattled on about a duckling she'd found near her home. She'd made a little bed for it in a cardboard box, kept it in her kitchen, fed it, got it warm and then taken it to the river where she'd restored it lovingly to the rest of the duck flock.

"That poor little baby duck might have died. I couldn't let that happen," Debbie said.

How could she be so proud of saving a duckling, when she had so cavalierly counselled her friend to do away with an unborn baby and dismissed it as no big deal? Is not the life of the latter worth at least as much as that of the former?

It's not that the lives of animals should be treated with callous disregard. Far from it. Rather, it's that the lives of unborn babies shouldn't, either.

The Montreal SPCA recently mounted a noble, if misguided, $4,000 mission of mercy to save six dogs from being shot as strays in a remote Inuit village. Calling the villagers' attitude of cold practicality toward animal control a 'cultural problem,' officials airlifted the dogs out of the village and put them up in Montreal's shelter with an eye towards adopting out these free-roaming pack members from the Arctic as suburban pets.

The fate the villagers had ordained for these dogs was upsetting to urban sensitivities. Many people are equally upset, and rightly so, at the large number of dogs and cats put to sleep in animal shelters every year. But they are far less troubled by the 100,000 unborn humans also destroyed each year in Canada. We do not describe abortion as a 'cultural problem,' but it certainly is one. Too busy poking our noses into other cultures, we blithely ignore the dysfunctionality of our own callously conve nience-centred one.

Lately, California activists have begun pushing for legislation that would force the furriers on Beverly Hills' posh Rodeo Drive to affix labels to the coats they sell, telling the buyer in graphic detail how the animal which became that coat was killed.

Describe in graphic detail how unborn humans are killed and you will be dismissed as a fanatic, the details pooh-poohed as a fallacy and the issue shrugged off as merely one of choice.

Nothing must interfere with choice for, elevated to the status of a virtue, it is believed to provide the ultimate meaning to life, leading as it does to a more liberated and fulfilling existence for the chooser. The limitations which are the inevitable byproduct of a profound moral code are unfashionable and stifling. They are also incompatible with woman's obsessive striving for total freedom and so they are cast aside as unnecessary roadblocks on the path to nirvana.

Those who question whether total freedom and its incumbent disregard for one's own children is indeed a laudable personal goal are castigated and shouted down for being anti-woman. I

t is safer to campaign for baby animals because such a campaign carries no risk of personal compromise to the lobbyists and threatens none of their hard-won, if terribly empty, freedoms.

For what is the freedom to dispose of one's child if not the most terrible and the emptiest of all?

And so baby birds continue to be tenderly rescued, sad-eyed seals have their vigorous defenders and puppies and kittens are spirited out of shelters to be saved from death after emotional public appeals.

This, while the equivalent of one-eighth the population of Calgary is put to death in Canada annually with nary a murmur of protest from anyone. Hordes of protesters hand out buttons and loudly exhort us to save the whales, but when it comes to saving the children, the silence is ear-splitting.     Reprinted with Permission