- Euthanasia Round-Up
- Second patient dies by euthanasia under New Act
- US supreme court ruling on euthanasia
- Dutch cabinet relaxes euthanasia legislation
Mrs Janet Mills, a 52 year old suffering from the rare skin cancer mycosis fungoides, has become the second Australian to die under the Rights of the Terminally Ill Act'.
Mrs Mills died in Darwin on 2 January after receiving a lethal injection from the death machine' developed by a GP, Dr Philip Nitschke. The first patient, Bob Dent, died in September 1996.(BMJ 1997;314:92)
A survey carried out in the Northern Territory of Australia found that 47% of the public strongly approved of the Act which legalises euthanasia. This compares with only 14% of doctors and 34% of nurses. (Lancet 1997;349:577)
The United States Supreme Court is expected to rule this summer on two federal decisions attempting to make state prohibition of physician-assisted suicide unconstitutional.
The Second and Ninth Circuit Courts of Appeal had each used parts of the 14th amendment to justify the practice. The 14th amendment says, in part, that states shall not deprive any person of life, liberty, or property without due process of law'. The federal courts contend that people should have a liberty interest in choosing the time and manner of their deaths'.(BMJ 1997;314:165)
The Supreme Court ruling Roe vs Wade' effectively legalised abortion on demand throughout the US in 1973. It is possible that another liberal judgement in this case could open the floodgates for euthanasia.
The Dutch Cabinet has further relaxed euthanasia legislation. Euthanasia remains a criminal offence in the Netherlands although, since 1983, courts have acquitted doctors acting within strict guidelines. These include explicit, informed and voluntary requests on the grounds of unbearable suffering'.
Regional committees of doctors, lawyers and ethicists, rather than the courts, will now decide whether the guidelines have been followed. (BMJ 1997;314:325) A separate national committee to be established in 1998 will rule on cases involving coma patients and handicapped children.
According to the Remmelink Report (Lancet 1991;338:669-74) nearly 2% of all deaths in the Netherlands result from euthanasia, and of the estimated 3,300 cases per year over 1,000 are involuntary.
Mrs Diane Blood has finally won her fight to conceive her dead husband's child by artificial insemination. In February 1997, the Appeal Court ruled that she should be allowed to take the sperm abroad for treatment. The Human Fertilisation and Embryology Authority (HEFA) have now agreed.
In 1995, doctors took semen from Stephen Blood at his wife's request as he lay comatose after contracting bacterial meningitis. However, the HFEA had originally informed her that it would be unlawful to use the sperm in Britain as the Human Fertilisation and Embryology Act (1990) requires paternal written consent. Mrs Blood had maintained that her husband had wanted children and that this should over-rule the need for written consent. The Authority had earlier rejected her plea to take her husband's sperm to Belgium or the United States where she could have been lawfully inseminated.
According to a survey by two bioethicists, more than a dozen American clinics have so far admitted to harvesting sperm from dead men at their partners' requests and storing it for later use. (BMJ 1996; 313;1424) According to the Bible sexual intercourse should be in the context of marriage (Gn 2:24) which itself ends with the death of either partner. (Rom 7:2)
Several infants destined to develop the severe combined immunodeficiency syndrome (SCIDS) have had their disease prevented by in utero transabdominal bone marrow transplantation. The success of the technique may herald a new era in the treatment of some types of genetic disorders.
In two recent cases the infants were born and remain healthy with a reconstituted immune system. SCIDS is a hereditary immunodeficiency disorder leading to recurrent opportunistic infections and death, usually within the first two years of life. Conventional postnatal bone marrow transplantation for the condition is hampered by graft rejection, graft versus host disease and the need for immunosuppression.
This successful application of fetal bone marrow transplants has sparked hope for the prevention of other genetic diseases such as thalassaemia and sickle cell anaemia, Gaucher's, Hurler's and Tay-Sachs disease. (BMJ 1997; 314:170)
The US Food and Drug Administration has decreed that folic acid must be introduced into all bread and pasta products by January 1998. Folic acid has been shown to reduce the incidence of neural tube defects (one of the commonest indications for abortion) and it is hoped that this will reduce the number of abortions for congenital abnormality. The cause of the remaining neural tube defects has yet to be ascertained, although cocaine, amphetamines, marijuana and alcohol have all been ruled out. (Am J Epidemiol 1996;144:1155-60; BMJ 1997;314:8) The latest research attributes the protective effects of folic acid and hard water to changes in lead metabolism. (BMJ 1997; 314:688)
Four blind patients have had their vision partially restored with experimental fetal retinal cell transplants. They all had late-stage retinitis pigmentosa, an incurable hereditary disease.
Dr Manuel del Cerro of New York presented the results of eighteen patients at the Society of Neuroscience's annual meeting in November 1996. About one million photoreceptor cells from aborted fetuses aged 14-16 weeks were implanted into the fovea of one eye in each patient. In the future Dr del Cerro hopes to try transplants at an earlier stage of the disease. His work was well received at the meeting.
The ethics of fetal tissues in transplantation has been recently reviewed in Nucleus. (Nucleus July 1996; 16-20)
The Human Genome Project is world-wide initiative to locate and characterise the DNA sequence of nearly all our 90,000 genes. Scientists believe that they may complete this task by about the year 2004. The knowledge that the project promises to create, has potential use in the screening, prevention and treatment of genetic disorders.
Many of the ethical implications have not been thought through by the scientific and medical communities and in practice it is far easier to search out and destroy genetically impaired individuals than it is to correct existing genetic abnormalities. While somatic gene therapy has proved effective in SCIDS (see above) germ cell gene therapy (which alters the entire genetic constitution of an individual rather than just one line of cells) has not been successfully performed and is currently illegal.
The British Government is to set up a regulatory authority to monitor all research into xenotransplantation (the transplantation of animal tissues into humans). This follows an advisory committee report Animal tissues into humans' which concluded that transplantation from pigs (but not primates) was ethically acceptable. The regulatory authority will be similar in nature to the Human Fertilisation and Embryology Authority'. Attitudes to regulation of xenotransplantation vary between the US and the UK. There are fears that if UK law is too strict then research companies will simply carry out work in countries where the regulations are more lax.
The interest in xenotransplantation stems from the large shortfall in the supply of donated organs compared to the demand. Pigs seem the ethical' choice due to their distance' from man. More research is required before transplantation becomes reality as there are still problems with rejection of animal tissue. Transgenic pigs are being developed to reduce these problems.
Although the advisory committee has recommended that clinical trials should not yet be carried out, they could start in as little as twelve months. New problems could be generated due to diseases, especially those caused by yet unidentified viruses, crossing over from animal to man. (BMJ 1997;314:242,247)
The Old Testament makes some interesting comments on DNA transfer (Lev 19:19) and speciation (Gn 1:25).
Scientists from the Roslin Institute in Edinburgh have cloned a lamb by implanting the nucleus from a sheep mammary gland into an oocyte.
Dolly' is believed to be the first mammal to be cloned from adult tissue. David Shapiro, executive secretary of the Nuffield Council on Bioethics has dismissed suggestions that human clones are imminent, claiming that the HFEA Act 1990 provides a legal framework to prevent human applications of the technology.
However human cloning of even deceased human beings is now theoretically possible, and the US president, Bill Clinton, has called for an inquiry into the ethical issues involved.(BMJ 1997;314:623)
The student BMJ, started in 1992, had been hailed by the British Medical Journal as the first international journal for medical students. However, in a recent letter published in the BMJ, our valiant ex-editor, Ruth Selwood, pointed out that Nucleus had recently celebrated its 25th birthday, and had a worldwide readership of 3300, with over 600 copies sent to over 30 countries abroad. (BMJ 1996;313:766; 1996;313:1557)