A February 12, 2014 www.cnn.com story entitled "Brain-Dead Canadian Woman Dies after Son's Birth" detailed a tragic scenario in which a pregnant woman named Robyn Benson suffered a cerebral hemorrhage and was declared brain-dead.  Fortunately such horrors are rare.  The "silver lining" in this tale, however, was the fact that the fetus remained viable and was able to be delivered safely, via C-section, after the father requested that his brain-dead pregnant wife remain on a ventilator until a safe birth could be accomplished.

The LIBERTARIAN BIOETHICS BLOGger has no complaints about the handing of this tragedy by anyone involved in the case.  Justice was served.  The husband of the brain-dead woman was clearly the "owner" of his brain-dead pregnant wife's body.  Thus, he wielded ultimate decision-making authority regarding the disposition of the body.  After learning that the fetus remained viable, he chose to request that her brain-dead body remain on a ventilator until a safe C-section delivery could be attempted.  The relevant physicians and hospital administration agreed to proceed with the husband's request due to the probable positive outcome of the C-section.  After the C-section was performed (the birth of the apparently health baby), the mother was disconnected from the ventilator and died peacefully.

The only quibble I have with this story is that the reporter, Paula Newton, failed to mention the age of the fetus at the time of the fatal cerebral hemorrhage.  I am curious if the fetus was more or less than 24 weeks status-post fertilization at the instant of brain-death.  Why?  I believe that a rights-bearing human emerges at approximately week 24 status-post fertilization based on functional brain activity (evidenced by bilaterally synchronous EEG activity).  If the fetus was 24 weeks of age or older and viable at the time of the tragedy, then it would have been a crime - murder to be specific - to disconnect the brain-dead body from the ventilator, for this action would have caused the death of the rights-bearing fetus.  If the fetus was 24 weeks of age or older and non-viable at the time of the tragedy, then it would have been medical malpractice to not disconnect the brain-dead body from the ventilator.  If the fetus was less than 24 weeks of age and viable at the time of the tragedy, then it would not have been a crime to disconnect the brain-dead body from the ventilator, for this action would have caused the death of a non-rights-bearing fetus.  If the fetus was less than 24 weeks of age and non-viable at the time of the tragedy, then it would have been medical malpractice to not disconnect the brain-dead body from the ventilator.  So, without additional information, I cannot further categorize this story.

A February 13, 2014 The New York Times article entitled "Ethics Questions Arise as Genetic testing of Embryos Increases" caught my eye.  It reviews the bioethics issues that are accumulating due to the rapidly evolving field of preimplantation genetic diagnosis (P.G.D.).  The LIBERTARIAN BIOETHICS BLOGger supports P.G.D.

What is P.G.D.?  P.G.D. is the genetic testing of embryos for specific disease-causing gene mutations.  Such testing is commonly the first test in a multistep pregnancy process, in which embryos with horrific disease-causing gene mutations are discarded while embryos without horrific disease-causing gene mutations are implanted into an eager female.  The relevant NYT article details the case of a young woman with Gerstmann-Straussler-Scheinker disease (GSS), which is a fatal neurologic disorder.  She originally planned to forgo childbirth to prevent the GSS gene from affecting any others in her family, but P.G.D. allowed she and her husband to have three children without the GSS gene.

Three bioethicists were interviewed for this article.  ECU bioethicist Janet Malek supports P.G.D., Yeshiva University bioethicist David Wasserman opposes P.G.D., and Columbia bioethicist Dr. Robert Klitzman waffles.  The reasons that neo-Luddite Wasserman gives to oppose P.G.D. are incoherent, so I won't waste your time.  

One P.G.D. negative mentioned by the author is the cost, "typically about $20,000".   

P.G.D. is the future of medicine.

On February 13 2014 the lower house of the Belgian Parliament passed a law that extended the "right" to euthanasia to minors.  On March 2 2014, King Filip-Phillippe of Belgium signed the bill into law.  I cannot find any record of a child exercising this "right" in the subsequent nine months.

What is euthanasia?  I define euthanasia as a deliberate intervention undertaken with the express intention of terminating a life, typically performed by a physician at the request of a particular patient to relieve intractable suffering.  The LIBERTARIAN BIOETHICS BLOGger supports the concept of euthanasia, but does not view euthanasia as a "right".  Why do I not view euthanasia as a right?  Genuine rights have corresponding obligations that must be provided by others; however, physicians cannot be coerced into participating in euthanasia, so euthanasia, by definition, is not a "right".

What about the concept of euthanasia for children?  I also support this idea if strict guidelines are followed by the relevant physician and the patient and the patient's guardians.  Per usual, these euthanasia guidelines should not be constructed , approved, or mandated by a State.

The Journal of Oncology Practice published a particularly interesting bioethics article entitled "Clinical Ethics Consultation in Oncology" in the September 2013 edition.  The LIBERTARIAN BIOETHIC BLOGger's career as a radiation oncologist is the reason he found this paper so intriguing.  The authors, Andrew Shuman et al, retrospectively reviewed the clinical ethics consultations at two National Cancer Institute-designated comprehensive cancer centers.

The conduct of this research was greatly facilitated by the existence of prospectively maintained clinical ethics consultation databases.  This is an outstanding idea.  In addition, the quality of the case reviews in this study was impressive.  "Multiple study authors independently reviewed raw data (medical records including the documentation of the ethics consultation) and classified consultations accordingly; in cases of disagreement, authors discussed and reached a consensus."  I assure readers that such raw data evaluations are tedious and time-consuming.

Two hundred eight (208) bioethics consults were noted.  The most common issues leading to request of the ethics consult were code status and advance directives (approximately 25%).  The most common persons to request the bioethics consults were the relevant attending physicians (approximately 61%).  Interpersonal conflict occurred in approximately 51% of patient cases, primary between staff and family.  Communication lapses were identified in approximately 45% of cases.  The ethics consultant(s) recommended additional evaluations in approximately 58% of cases, principally by social work departments.  Patient do-not-resuscitate (DNR) orders increased from approximately 26% of cases prior to the bioethics consult to approximately 60% of cases after the bioethics consult.  

The authors rightly made no novel conclusions from their study due its retrospective nature.

I view this study as a fascinating "snapshot" of a typical bioethics consult for oncology patients in the latter half of the first decade of the 21st century.