For the record: The Big BIOETHICAL Questions

July 27, 2009
The BBC's ethical debate programme is broadcast regularly (10 AM, BBC1, Sundays)

The BBC's ethical debate programme is broadcast regularly (10 AM, BBC1, Sundays)

As users of our Upcoming TV worth recording feature will know, the BBC’s Sunday morning studio debate show The Big Questions frequently includes bioethical topics amongst the three issues discussed each episode. It has not proven possible to add posts on each of the programmes, and unfortunately they are only maintained online for a week after transmission. However, with the current series now more than halfway through a 43 episode run, it felt like an appropriate time to document in one list the programmes that have featured the most overtly bioethical discussions, and to provide the TRILT code for each episode so that members of the BUFVC can order copies via the catch-up service.

Episodes including bioethical debate (Season 2)
Episode
Date
(all 2009)
Question
2
4th January Is it right to experiment on animals?
(issue #2 of 3, TRILT code: 00CD5D48)
 
4
18th January Are designer babies unethical?
(#1, TRILT code: 00D14F18)
 
6
1st February Should the terminal ill be helped to die?
(#3, TRILT code: 00D8DE1F)
 
10
1st March Should parents teach children that sex can
be wrong? (#1, TRILT code: 00E19004)
 
11
8th March Are father’s being sidelined?
(#1, TRILT code: 00E36E40)
 
14
29th March Should abortion services be advertised?
(#3, TRILT code: 00E95971)
 
16
3rd May Should assisting a suicide be made legal?
(#3, TRILT code: 00F498FF)
 
17
10th May Should we all be on the DNA database?
(#1, TRILT code: 00F5D006)
 
17
10th May Is surrogacy wrong?
(#2, TRILT code: 00F5D006)
 
21
14th June Should the NHS discriminate against the
very old? (#2, TRILT code: 01013759)
 
25
12th July Should disability be eradicated?
(#2, TRILT code: 01077439)
 
27
26th July Should great apes have rights?
(#2, TRILT code: 010A02C5)
 
32
30th August Are zoos unethical?
(#3, TRILT code: 0111E95B)
 

The series is continuing and additional issues will be added to this list as and when they are discussed.

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How old is too old to give birth?

July 27, 2009
Accounts of post-menopausal women having children have become a news staple over the past decade. From a UK perspective, a number of cases have been particularly prominent, these include: 60 year old Liz Buttle, who allegedly declared her age as 49 when receiving fertility treatment prior to the birth of her son in 1997; Lynne Bezant who was known to be 56 before receiving treatment that resulted in her giving birth to twins in May 2001; 62 year old Patricia Rashbrook who gave birth to a son in July 2006, having travelled to the former Soviet Union to achieve her conception with the aid of maverick Italian specialist Severino Antinori; and Elizabeth Adeney who, by giving birth just shy of 67, became Britain’s oldest mum.

Amanda Blue’s excellent Cutting Edge documentary The World’s Oldest Mums (Channel 4, 23rd July 2009) examined the cases of four women who were all at or near the age of 70 when the film was made.

Jenny Brown: 72 year old Jenny is “bursting to be a mother” and is seeking a clinic willing to help her to do so. The film shows her applying to, and being turned down by, the Bridge Centre in London and later trying to contact fertility specialists in Eastern Europe to fulfil her dream.

72 year old Jenny is seeking a clinic in the former Soviet Union willing to help her to have a child

72 year old Jenny is seeking a clinic in the former Soviet Union willing to help her to have a child

Rajo Devi: Currently, the oldest mother in the world is 70 year old Indian Rajo Devi. Partly due to the social stigma associated with childlessness, India is becoming a major centre for the fertility treatment of older women; more than half of the 200 patients at one IVF clinic featured in the documentary are aged over 50.

Rajo Devi became a mother at 70 and (at the time of writing) is the oldest mother in the world

Rajo Devi became a mother at 70 and (at the time of writing) is the oldest mother in the world

Mary Shearing: Interviews with 16 year old twins Amy and Kelly, reinforce the fact that fertility treatment to allow postmenopausal women per se is not a new phenomenon. The fact that their mother Mary Shearing has only recently turned 70, however, emphasises that the boundaries of possibility (and acceptability?) are certainly shifting.

Mary Shearing gave birth to twin daughters in November 1992 at the age of 53

Mary Shearing gave birth to twin daughters in November 1992 at the age of 53

Maria del Carmen Bousada de Lara: The saddest story in the documentary, concerns Maria del Carmen – saddest both in terms of the circumstances under which she came to find herself seeking fertility treatment, and the fact that she died a few weeks after the filming of her interview (see here for news report).

Maria

Maria died from ovarian cancer when her twin boys were 2 years old

With three brothers but no sister, Maria faithfully fulfilled the expected role and devoted much of her adult life to caring for her widowed mother. It was to Maria’s great misfortune that her mother lived to be over 100. It was only after this time that Maria felt able to seek fertility treatment, covertly flying to the USA and lying about her age to do so.

Is it right to give elderly women help to get pregnant?
What insights do these case offer regarding the ethics of helping post-menopausal women to have children? These four examples illustrate some of the arguments presented both in favour and in opposition to allowing fertility treatment for older women.

Arguments in favour
Advocates of fertility treatment for older women may argue in terms of individual autonomy, or may speak of rights, either rights to have a family per se, or more specifically under Article 8 of the Human Rights Act/European Convention of Human Rights, for the right to privacy. It is also possible to frame arguments in terms of the suffering of childlessness. In the case of Rajo Devi, it is clear that the stigma is greater; in her culture it is considered bad luck to encounter a barren woman on the street before lunchtime and in consequence her recent pregnancy has brought additional relief from ostracism (against this, it might be argued, we ought to challenge prejudice, not pander to it).

Advocates of treatment for older mothers may also highlight the unfair way in which women (in western culture, in particular) are villified for having families in their advanced years, whilst men who father children at equivalent ages are not judged in the same way, and may even by celebrated for their virility. Eric Clapton, for example had three daughters in his late 50s, and Rod Stewart‘s seventh child was born when he was 60.

Arguments against treatment
For many people there is an inherent ‘yuk’ factor regarding older mothers. How can this moral repugnance be substantiated? It has been argued that embarking on a family at extreme ages demonstrates gross selfishness. This, however, can be a misleading oversimplification. Whilst it may be the case that a woman has put career development before family (there is some evidence of this in the case of Jenny Brown, for example), there may be other reasons for the delay. As demonstrated in the case of Maria del Carmen, it was actually a lack of selfishness that resulted in her leaving it so late to start a family, since she had devoted her life to caring for her mother. Regardless of the motivation, Robert Winston is amongst several commentators warning women not to assume that IVF will routinely provide them with a family at a later stage (see Career women given ‘false optimism’ by fertility clinics).

Those opposed to fertility treatment for older women may argue that there are health risks for the mother, and risks that her children will likely lose their mum at a tender age. Taking each of these in turn; it is certainly true that becoming a mother late in one’s life can take a terrible toll on the body. Mary Shearing comes across as a remarkably active 70 year old – we see her in the film water-skiing and working out in the gym. She was, however, ‘only’ 53 when she had her twins. Rajo complains of ongoing stomach pains after the birth and, although it is not expressly suggested in the documentary, there may well be a connection between the fertility treatment received by Maria and her subsequent ovarian cancer.

Regarding the premature death of their mother, it is – of course – true that over the course of history mothers have generally died much earlier in the life of their children than is the norm today; indeed, many would have died during childbirth itself. Nevertheless, there does seem to be a qualitative difference between the possibility of a parent dying during your childhood and the likelihood that this will be the case. Maria’s case is a sad reminder of this reality.

Additionally, it may be stressed that donated oocytes are a relatively rare commodity within healthcare provision and since it is a biological truism that fertility treatment is less successful for older women than for younger, available eggs should be prioritised towards younger candidates.

If not age, what other criteria should be used to determine who gets the egg? Should priority be given to women who have not had children before? Several of the cited examples already had adult children, including Mary Shearing and Lynne Bezant. Should onset of the menopause be a cut-off point? If so, what about women who have early menopause (ie before 45) or even premature menopause (in women under 40) ?

Ability to pay is a likely factor, particularly since NICE (the UK National Institute for Clinical Excellence) has state that only women under 40 can receive fertility treatment paid for on the NHS, and some primary care trusts (e.g. Oxfordshire) have set a lower age threshhold for publicly funded treatment. Receipt of treatment on the basis of ability to pay is, of course, identified as a source of injustice against the poor.

Even private clinics may impose some age-related criteria. It is interesting to observe that both Liz Buttle and Maria del Carmen lied about their age to receive treatment, and other evidence suggests that they are not alone in this (see Thousands lie to IVF clinics in desperation to have baby). We must remember too that differences between one jurisdiction and another can lead to patients receiving treatment elsewhere, e.g. Maria going to America and Jenny’s attempt to follow Patricia Rashbrook and others in going to the former Soviet Union (see Older British women head abroad for IVF).

Cutting Edge: The World’s Oldest Mums was first broadcast on Channel 4 at 9 pm on Thursday 23rd July 2009. At the time of writing it is available via 4OD their catch-up service. BUFVC members can obtain a copy via their institutional representative in the usual way (TRILT ID: 0109BBFE).

(CJRW)


The 6th Day – an insight into human cloning?

July 24, 2009

[This is a first BioethicBytes post from guest reviewer, Robert Cane – welcome Rob]

6thday

(Warning: contains plot spoilers!) 2000 film The 6th Day takes its name from the Book of Genesis  ‘God created man in His own image, and behold, it was very good… And the evening and the morning were the sixth day.’ (Genesis 1:27,31), which is quoted during the opening credits.  In the near future as depicted in the film, animal cloning is ubiquitous, but, following a disastrous failed experiment, human cloning (beyond the cloning of organs) is strictly forbidden.

Adam Gibson (played by Arnold Schwarzenegger) is a commercial pilot who, along with his business partner Hank Morgan, is hired to provide transport for tycoon Michael Drucker. Drucker is the money behind Replacement Technologies, the company which, with access to the genetic code of almost every biological being, provides everything from new super foods to the cloning of recently deceased family pets.

At the last minute, Adam switches places and lets Hank do the flying for their first assignment for Drucker. Instead, Adam goes to the mall where he briefly considers having his family’s dead dog cloned before buying his daughter a life-size doll. Upon returning home for his surprise birthday party, Adam discovers that his family and friends have already begun the celebrations with an exact replica of him (a clone) in attendance.

From this point on, Adam must run for his life as the people behind the illegal creation of his clone attempt to kill him in order to erase any evidence of their crime. As the film progresses, Adam discovers that Drucker is running an illicit human cloning operation alongside scientist Dr. Weir and must destroy it to save his own life. Amidst a slurry of repetitive but passable action sequences in which Drucker’s henchmen are killed and cloned again and again, there are sporadic, but important, references to the many ethical questions surrounding cloning.

Although most of the film fails to rise above the level of an average Schwarzenegger action adventure and its action scenes are certainly nothing out of the ordinary, the 6th Day does make frequent attempts to engage with interesting ethical issues, and, even if a solid, but ultimately uninspiring action film does not appeal to you, many sections of it may be useful for facilitating discussions regarding cloning. Read the rest of this entry »


Private Practice: Acting ethically at the Wellness Center?

July 1, 2009

(Warning – contains plot spoilers!) Private Practice is a spin-off from Seattle hospital drama Grey’s Anatomy in which Dr Addison Montgomery (Kate Walsh) moves from Seattle Grace to join the staff of the Ocean Wellness Center in Los Angeles.

I have to admit that I tired of Grey’s Anatomy during Season 1 and although I was aware it has spawned another series I had no desire to watch. All this changed, however, following an excellent talk on the programme, given by Dublin Doctor Audrey Dillon at the 4th Postgraduate Bioethics Conference (Belfast, June 2009).

The writers of Private Practice, headed by Shonda Rhimes, have made a conscious decision to incorporate ethical issues into the storylines (see ‘Private Practice’ explores bioethics questions). This means, therefore, that the series may well throw up some interesting case studies as discussion starters.

At the time of writing, Living TV (UK) has just started transmission of Season 2 (see here for Episode guide). A Family Thing, the first programme of the series, was aired on 25th June 2009 (TRILT code 00FC042B). True to promise, it contained two subplots featuring ethical dilemmas.

Saviour siblings – a donor by design?

In the first (starting 7 minutes in), Molly and Eric Madison present at the clinic demanding that the staff deliver their baby daughter that day, despite the fact that she is only 27 weeks gestation. The girl, it transpires, has been conceived following Pre-implantation Genetic Diagnosis, to be a ‘saviour sibling’ for her older brother, Jason.  The boy has leukaemia and has had his own bone marrow wiped out in preparation for a transplant from a donor who has now fallen unwell with pneumonia. He is therefore immunocompromised and urgently needs umbilical stem cells courtesy of the new child.

Read the rest of this entry »