Organ Transplantation: Legal and Ethical Challenges (EdX Course)

My university has recently joined EdX and is offering four courses starting February 2015. I have had the privilege of being selected as one of the instructors. I, along with Alicia Pérez Blanco (a skillful intensive care physician, wonderful colleague and sharp bioethicist), will be teaching a course on the ethical and legal challenges of organ transplantation. This has been possible partly because both of us, at different moments, could benefit from the extraordinary resources and the intellectual environment of the Petrie Flom and the Division of Medical Ethics at Harvard, where I stayed during my sabbatical year in 2011-2012.

The course will be delivered in Spanish (we will vocalize with utmost care and speak very, very slowly, it will sound almost like English…) but we will provide exercises and reading materials in both languages. We will cover a lot of the hot topics (DCD, death determination, organs’ conscription, nudges in organ donation, opting-out, markets of organs, death penalty and organ donation, transplantation tourism, among others) and (hopefully) will have a lot of fun (in spite of the nature of the topic). We are very excited and, I have to confess, a bit anxious about the final result. For more information please visit the EdX official announcement.

ART, lesbians and justice in the distribution of health care

In the wake of our seemingly everlasting economic crisis, the Spanish health authorities have decided to exclude single women to access ART treatments – mainly artificial insemination- in the public health care system. “The lack of a male partner is not a medical problem”, has said Ana Mato, our Secretary of Health. Coming from a devout Catholic and extremely conservative politician, her remark, and ultimately, her Department’s policy, have been widely interpreted as another vindication of the idea that only traditional, i. e. heterosexual, families are suitable for rearing children. The spokeswomen of various feminist and lesbian NGOs have entered the public arena to denounce her lesbophobia.

The fact of the matter is that women in Spain, whether married to another woman or single, will still be authorized to be artificially inseminated (in some European countries such as France, Austria or Sweden, for instance, single women are excluded from medically assisted reproduction). Even the fertile, married heterosexual woman might still get artificial insemination – maybe she just wants to do things differently, for a change- although they will all have to bear the costs. The public health care system has, therefore, reconfigured ART as a pure medical remedy for a medical condition: infertility. The days of IA as an “alternative means of reproduction” for “alternative life-styles” are over. But with this new policy the demand made by economically disadvantaged lesbian couples willing to procreate finds an answer along the following lines: “go find a male”. A crude response if there is one. Read More

Pool of Siloam in Tennessee? Brute luck in health care distribution

I had recently come across this piece in the NYT. The first thing that came to my mind is the biblical story about the pool of Siloam, a tale that, with all due respect to believers, illustrates the unfair distribution of health, but mostly the unfair distribution of health care (if we take as “health care” the healing powers of the pool). I have tried to adapt the story, as told in the Bible (John 5, 1-8) to the crude reality of the Tennessee of our days, in which, as reported by the NYT, many of its citizens lack access to basic health care services and have to trust in a sort of “phony miracle”. My paraphrasing experiment gave the following result:

“Now there is in Tennessee a program ran by the State Government, called TennCare, which has a hotline for applications. In these lay a multitude of invalids–blind, lame, and paralyzed [waiting for the opening of the line;] [for the Governor went down at certain seasons and opens the line: whoever gets in first after the opening of the line was helped for whatever disease he had.] One man was there who had been an invalid for thirty-eight years. When people from the Legal Aid Society in Nashville saw him lying there and knew that he had already been there a long time they told him, “Do you want to be helped?” The sick man answered him, “Sir, I have no one to put me into the pool when the line is open, and while I am trying to go through another connects before me.” The people from Legal Aid said to him, “Get up, take up your bed, and dial.” And at once the man was healed, and he took up his bed and walked…”

[The original King James version’ of the Gospel can be read here]

Slipping Euthanasia in Belgium

Happy New Year billofhealthfans!!

As you all know Belgium legalized euthanasia in 2002 following the path of The Netherlands. The legalization came in the midst of a huge controversy. The influence of the Catholic Church is significant in Belgium. You might recall that in 1990 King Balduino refused to sign an Act legalizing abortion, something unseen in the history of Belgium. The solution could not be more ingenious: the King resigned for a couple of days, the Act was signed by the Prime Minister, and then Parliament restored Balduino in his throne.

According to a recent survey in Flanders, euthanasia and assisted suicide in Belgium follows a classical pattern: cancer patient between 65 and 79 years of age. The cases in which the individual is not in the terminal stage of his illness and requests assistance in dying are rare. Nothing significantly deviant from what is going on in other jurisdictions in which aid in dying (in its various forms) is permitted. At least that was the trend until last December 14th… Read More

Should autopsies prevail over organ donation? A drama in three acts

Picture the scene (I). Its 4 am, November 1st. 4 young girls in their Halloween costumes are being rushed to the hospital after the tragic stampede that took place minutes ago at the “Madrid Arena”, a huge disco in which more than 10,000 people gathered to listen to a super DJ which goes by the name of “Aoki”. You can read here the whole story. Three of the girls were pronounced dead on arrival, and the fourth, although not dead yet, suffers from devastating brain injury due to the anoxia. She is placed on a ventilator and the subsequent tests confirm the horrible prognosis. Her family, members of the ultraorthodox catholic sect known as “Opus Dei” (remember “The Da Vinci Code”?), agrees to the withdrawal of Belen’s life sustaining treatment and to donate her organs. Pedro Almodovar would not have written the script in a better fashion. But wait… Read More

Should the Government enforce “moral doping”?

Forget Lance Armstrong for a second and think about “biomedical moral enhancement”, a proposal recently defended by Ingmar Persson and Julian Savulescu in Unfit for the Future. The Need for Moral Enhancement. In this book Persson and Savulescu claim that neither our current moral software – our morality of common sense as they call it- nor the institutions of liberal democracies are capable of coping with what they label as “ultimate harms”: the perils of terrorism and climate change which might efface human species from Earth.

The reason is that according to Persson and Savulescu we suffer from certain cognitive biases which prompt our moral blindness towards the suffering of those who are not near and dear. Also that we remain hooked to a causal conception of responsibility which gives us the perfect excuse for not blaming ourselves for our tiny – albeit jointly necessary- contributions to the causation of big disasters: from the emission of pollutants to the consumption of red meat. In a nutshell: Evolution did not equip us with the sense of justice and altruism that global poverty and the environmental destruction demand. The solution? Read More

Disability, fetuses and discrimination

By Pablo de Lora

Is “eugenic abortion” better described as discrimination against the disabled? That is one of the hottest issues currently debated in Spain (yes, we sometimes have some spare time to avoid discussing our financial crisis), now that the conservative party is attempting to amend our latest legislation on abortion (2010).

Down España, among many other advocacy groups for the disabled, is encouraging the Spanish Government to enforce the Convention on the Rights of Persons With Disabilities (2006) which states (article 10) that “every human being has the inherent right to life” and that States “shall take all necessary measures to ensure its effective enjoyment by persons with disabilities on an equal basis with others”. In support of their position, these groups refer to the recent Recommendations made by the Committee on the Rights of Persons with Disabilities as regards to the Report submitted by Spain (Sixth Session, 19-23 September 2011). It is worth quoting the Committee’s own phrasing: “[it is recommended] that the State Party [Spain] abolish the distinction made in Act 2/2010 in the period allowed under law within which a pregnancy can be terminated based solely on disability” (the full text can be found here).

Interestingly enough, in the United States, far from relying on the Convention to fuel their cause, some pro-life groups despise it as a pro-choice instrument and are urging their representatives not to ratify it (see here and here).

Very broadly, since 2010, a woman in Spain may abort in the first 14 weeks of pregnancy (with the requirement of receiving advice and waiting for three days to mature her decision). Beyond that term, and up to week 22, terminating a pregnancy is legally permitted either if the mother’s life or health is at serious risk or the fetus has been diagnosed with some “anomaly”. When the disease is life-threatening (think, for instance, anencephalic fetuses or the fatal condition known as “bilateral renal agenesis”) or extremely severe and incurable, the abortion might be performed even after the 22 weeks threshold. So, as opposed to a “normal fetus”, a “disabled fetus” – so to speak – is not given the same opportunity to be safe after 14 weeks of gestation. Is that a form of morally impermissible discrimination? I think not. Read More