Texas ‘Wrongful Birth’ Legislation

On March 21st, the Texas Senate passed SB 25, which eliminates “wrongful birth” as a cause of action for malpractice suits.  The text of the bill states, “A cause of action may not arise, and damages may not be awarded, on behalf of any person, based on the claim that but for the act or omission of another, a person would not have been permitted to have been born alive but would have been aborted. […]  This section may not be construed to eliminate any duty of a physician or other health care practitioner under any other applicable law.”

The bill’s supporters contend that the legislation “reverses a decades-old injustice and bad public policy that devalues babies, both unborn and born, who have a disability,” and removes pressure that physicians may feel to recommend abortions in order to preempt lawsuits.

However, opponents of the bill argue that it gives physicians the clearance to lie to patients about fetal health to prevent them from having an abortion. One activist argues that the legislation provides physicians the “opportunity to impose the religious beliefs on pregnant women by withholding information about the condition of their fetus and depriving them of making an informed decision about continuing with their pregnancy.”  The text of the bill, however, clearly precludes such a scenario.

In overturning wrongful birth precedent, this bill recognizes and defends the dignity of individuals with disabilities from the morally backwards concept of “wrongful birth.”

Euthanasia & Organ Donation in Canada

National Post reports that since Canada decriminalized euthanasia in June 2016, 26 of the 338 patients who have died by lethal injection in Ontario chose to donate tissue or organs.  Lethal injection, which causes cardiac death in two or three minutes, allows organs to be removed much more quickly than after natural death, which results in better organs for transplants.  Organ retrieval after euthanasia is thus an attractive prospect for some physicians.

Once one accepts the premise of euthanasia, it is easy to justify harvesting organs from consenting patients.  As Dr. James Downar argues, “If we accept people can make decisions to end life, and we accept the idea of cardiac death being sufficient for organ donation, this should be acceptable.”

However, even some proponents of euthanasia are uncomfortable with the idea, voicing concern that the opportunity to help others might pressure some to end their lives.  Others point out that it would be very difficult for a patient to change his or her mind after the process of the donation has been started and recipients for the organs have been found.

As this article demonstrates, accepting the morality of euthanasia makes it increasingly difficult to explain why other medical practices should be off-limits.  Questions of autonomy, consent, and coercion become harder to navigate once the basic moral principle that physicians should not kill is overturned. Indeed, it is not a long logical step from retrieving organs after lethal injection to harvesting before cardiac death.

Perspectives on Responding to Addiction

Christopher Caldwell has an essay in the April issue of First Things titled “American Carnage: The New Landscape of Opioid Addiction.” In this piece, Caldwell traces the history of opiate and opioid use and abuse in the United States and describes the shocking scope of the addiction crisis in America today. He then criticizes the societal shift in thinking about addiction from a moral to a therapeutic model, demonstrated in a new vocabulary of addiction that favors terms such as “negative drug test” over a “clean urine sample” and “unsuccessful suicide” over “attempted suicide.”  While Caldwell does not discount the medical aspect of addiction, he argues that ignoring moral and spiritual dimensions “belittles” those with addictions.

Matthew Loftus responds to Caldwell’s essay on the Mere Orthodoxy blog with his post, “Addiction: The Devil You Can Measure and the Devil You Can’t.” Loftus affirms much of Caldwell’s argument, but cautions for moderation in discussing the medical versus moral aspects of addiction, fighting reductionism in either direction. He concludes, “More Christian primary care doctors should start prescribing buprenorphine and more secular addictions counselors need to recognize that they are not battling flesh and blood alone. To respond to an epidemic of this magnitude, we are going to need every weapon we’ve got.”

Discussions of this nature are crucial as we deal with the worst drug crisis in our country’s history. Doctors, counselors, pastors, and family members will have to grapple with the social, medical, moral, and spiritual aspects of addiction in order to provide the best help possible to treat and prevent opioid addiction in our communities.

Googling PAS

While researching physician assisted suicide legislation this past week, I noticed something odd when I Googled the topic.

After I typed “physician assisted” into Google, the search engine’s autocomplete function suggested searches related to “physician assisted death.”

I then started to type out “physician assisted suicide,” but as soon as I typed the “s,” all suggestions disappeared.

Out of curiosity, I visited Google Trends to see how searches in the United States over the past year compare between the two terms.  As expected, “physician assisted suicide” has consistently been a more popular search term than “physician assisted death.”

Next, I pulled up Bing and Yahoo! to see what these search engines would fill in when I typed “physician assisted.”  Each site pulled up multiple “physician assisted suicide” suggestions prior to any terms related to “physician assisted death.”

 

Google is transparent about the fact that they censor autocomplete suggestions for offensive content; however, they have also been accused of ideologically driven censorship.  While the above screenshots are not evidence in themselves of an agenda, it is worth noting even subtle ways that corporations can influence public opinion on bioethical issues.  Vocabulary and branding are especially powerful tools in swaying sentiments, as those trying to steer people to the term “physician assisted death” are well aware.

New Opioid Legislation in New Jersey

On February 6th, New Jersey passed a law which “[r]equires prescribers to discuss addiction risk associated with certain drugs prior to issuing prescription to minor patient.”[1] New Jersey’s drug overdose rate is twice the national rate, and Governor Chris Christie has officially categorized opioid abuse as a public health crisis, issuing an executive order on January 17th with measures to combat the increasing rates of addiction in the state.[2]

Senate Bill 2156 requires physicians to educate minor patients and their parents or guardians about dependency risks of Schedule II controlled substances and any opioid prescription drugs, in addition to available alternatives, as appropriate. A written acknowledgement of the discussion must be obtained for the patient’s medical record.  There is an exception in the bill for patients receiving hospice care.[3]

A related bill was introduced in the New Jersey Senate on January 30th which would, among other things, require insurance providers to cover treatment for substance use disorders, prevent physicians from prescribing more than a five-day supply of Schedule II or opioid drugs in an initial prescription, and increase continuing education requirements for nurses, optometrists, dentists, physicians, and pharmacists.[4]  The bill was passed by the Senate on February 6th.[5]

New Jersey should be applauded for its efforts toward increasing responsibility and accountability in the prescribing of dangerous medications.  The results of this legislation, as it is implemented, will provide opportunity for discerning beneficial aspects of policy that could be incorporated in other states.

[1] https://legiscan.com/NJ/text/S2156/2016

[2] http://www.nj.com/essex/index.ssf/2017/01/gov_christie_declares_opioid_drug_abuse_public_hea.html

[3] http://www.njleg.state.nj.us/2016/Bills/S2500/2156_I1.HTM

[4] https://legiscan.com/NJ/text/S3/id/1488065/New_Jersey-2016-S3-Amended.html

[5] https://legiscan.com/NJ/bill/S3/2016

Funding Medical Innovation

In a recent National Affairs essay titled “Removing Barriers to Medical Innovation,” Thomas Stossel, Professor of Medicine at Harvard Medical School, cautions against “pharmaphobia,” a term he has coined for the widespread vilification of the private pharmaceutical industry. Stossel, a visiting scholar at the American Enterprise Institute, has written lengthily on the subject, most notably in his book titled Pharmaphobia: How the Conflict of Interest Myth Undermines American Medical Innovation (2015). In this particular essay, Stossel describes how the demonization of private industry inhibits medical innovation by hindering collaboration between the industry and the academy.   Moreover, he argues that the brightest future of medical innovation will be found in academic research that is done in partnership with private industry, rather than in publicly funded academic research.

Stossel refutes the common perception that publicly-funded academic researchers, part of what he terms the “government-academic biomedical complex,” are the parties primarily responsible for medical innovations, which the profiteering pharmaceutical industry then develops for market.  Instead, he argues that private industry, and not academia, is where most medical innovation already happens.  In fact, according to multiple investigations, “85% of the drugs approved by the FDA since 1988 arose solely from research and development performed within the industry.”  In addition, most publicly-funded research has little to do with treatment of disease. Stossel cites a study of over 25,000 “research articles published by academic investigators in prestigious basic biomedical science journals,” in which only 20 out of the 25,000 articles resulted in clinical trials.

One of the reasons Stossel cites for this is an “obsession with novelty,” as researchers compete for funding and strive to impress their peers, stuck in a cycle where the “measure of value of a researcher’s work is not medical innovation, but publication in prestigious journals that, in turn, serve as the currency for obtaining research grant funding.”  Thus, “making sure that findings are reliable…is far less interesting to academics than breaking new ground.”

Instead, Stossel proposes that a “private-academic partnership would allocate resources and talent far more effectively” than the current prevailing model of publicly funded academic research.  Private industry is naturally more driven toward innovation than researchers competing for public grant funding.  Moreover, medical innovation requires capabilities that are for the most part unique to the pharmaceutical industry, such as “drug formulation, manufacturing, quality control, procurement, market research, regulatory affairs, finance, toxicology, and many others.”  Stossel posits that such a partnership between private industry and academic research could best be realized through a “grassroots strategy” in which private companies invite academic researchers to collaborate on projects.