Friday, May 30, 2008

No semen for you!

I’ve been following the news out of the Supreme Court of (The Peoples Republic of) California, regarding the Oceanside woman suing a fertility clinic for their refusal to provide artificial insemination on the basis of religious beliefs. The article, courtesy of the San Diego Union Tribune, is here.

The case has been won by the woman locally, overturned by appeal in favor of the docs, and has hit the CA Supreme court. The ruling is pending, but sources believe it will be found in the favor of the woman.

Interesting. I was discussing a similar case regarding a photography business in New Mexico that was found to be discriminatory in its business practices. Marshall Art's blog was discussing this article in the American Thinker.

My comments then as to that case now appear quite relevant and I have rephrased them as such in the next several paragraphs:

Per the Federal Civil Rights Act, legally, unless there is a legitimate business reason for such discrimination, then they're out of luck.

Many states have additional legislation more stringent than the FCRA.

This is up for interpretation:

In California, a funeral home was sued by a family trying to keep out "punk rockers" from a service. The funeral home allowed their admission, thinking that under the Unruh Civil Rights Act of California, they could be sued if they didn't.

It is really discrimination--by the fact of refusing service--and in the definition as noted in the law. I am viewing the term "discrimination" as a legal term, not an ethical/moral one; which is logical, as we are discussing the interpretation of a specific law. One is better off asking if the law is moral or right, to address that component. On that, it is difficult, as I think there are specific rights of individuals to conduct business within a specific code of conduct.

The problem exists, in such code, as to where one draws limits. As a pragmatist, I do believe that society has the right to clarify, by law, the specific definitions as to how businesses have to act in providing service.

The question is thus in degree: Should a private business be allowed to discriminate (by refusing business) against a specific group of people purely on the basis of their sexual orientation? The law currently says no for each and every business.

Had the owners of this practice argued that this decision falls outside of a noted code of conduct, and made efforts to refer this couple to a willing provider of services, they probably could have made a viable argument of this being a business decision -as it could have caused them to lose other customers, etc. (It also probably wouldn't have become a court case). The bottom line is: Refusal of service needs to be defined in terms of a business or medical decision, lest it be open for such claims.


A few additional points and questions:

1. Why was there no suit against the insurance company for not facilitating any other willing provider? There are many instances where physicians may have standards which do not allow comfortable treatment by the physician. An example--treatment of multiple family members by one Psychiatrist is often contrary to professional standards. Shouldn't insurance companies be required to work with clients in these cases?

2. Does the fact that this is a voluntary medical procedure make any difference? Few would argue regarding emergency care, but should a physician have the right to refuse to treat under conscientious objection? Michigan is debating that issue currently. See here.

3. Does this standard apply for other religious groups? There is significant debate in the UK regarding docs of Islamic faith refusing to treat drug or alcohol issues, sexually transmitted diseases, or opposite genders. I am waiting for the day that a Jehovah’s Witness becomes an MD and refuses to treat anyone.

4. These are not the brightest docs to scribble on a pad. There are so many ways around this religious refusal of treatment that I cannot help but wonder if this is not merely a couple attempting to push a political agenda. C’mon! If I’m reading correctly, you agreed to treatment of mediations for this patient, but drew the line at artificial insemination. Huh?! That’s like giving band-aids but refusing stitches.

Thursday, May 29, 2008

Doc's Public Service Announcement #1

People with candidate bumper stickers should drive in a safe and courteous manner.

Tuesday, May 27, 2008

Medical Truths #1

I'm going to try to put out some opinions on how I see the medical field as it is and as it should be. These are truths in the sense of my own personal belief, not necessarily scientific axioms. I will try to keep the initial posts less tome-like, and hope to encourage dialog. With that said, # 1:

Medicine is a science.
The Practice of Medicine is an art.

I notice an increase in the cynicism of the public towards the health care field. I believe there are many political, social, and economic reasons for this. One reason, though, I believe is in the failure of our field to practice this simple truth. We are often blurring the lines of science, by not holding data up to an exacting standard. We are also poor artists. I think that many doctors have a presentation that suggests they are just throwing the drugs out there to see what sticks. Doctors do not often have (or take) the time to explain the science (how the stuff works), and even less time to explain the art (how did we come to this conclusion and plan).

Tuesday, May 13, 2008

Designer Babies?

From the AP. Link here.

By MALCOLM RITTER, AP Science Writer Mon May 12, 6:25 PM ET

NEW YORK - News that scientists have for the first time genetically altered a human embryo is drawing fire from some watchdog groups that say it's a step toward creating "designer babies."

But an author of the study says the work was focused on stem cells. He notes that the researchers used an abnormal embryo that could never have developed into a baby anyway.

"None of us wants to make designer babies," said Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at NewYork-Presbyterian/Weill Cornell Medical Center.

The idea of designer babies is that someday, scientists may insert particular genes into embryos to produce babies with desired traits like intelligence or athletic ability. Some people find that notion repugnant, saying it turns children into designed objects, and would create an unequal society where some people are genetically enriched while others would be considered inferior.

The study appears to be the first report of genetically modifying a human embryo. It was presented last fall at a meeting of the American Society for Reproductive Medicine, but didn't draw widespread public attention then. The result was reported over the weekend by The Sunday Times of London, which said British authorities highlighted the work in a recent report.

Rosenwaks and colleagues did the work with an embryo that had extra chromosomes, making it nonviable. Following a standard procedure used in animals, they inserted a gene that acts as a marker that can be easily followed over time. The embryo cells took up the gene, he said.

The goal was to see if a gene introduced into an abnormal embryo could be traced in stem cells that are harvested from the embryo, he said. Such work could help shed light on why abnormal embryos fail to develop, he said.

No stem cells were recovered from the human embryo, said Rosenwaks, noting that abnormal embryos frequently don't develop well enough to produce them.

Marcy Darnovsky, associate executive director of the Center for Genetics and Society, said the Cornell scientists were developing techniques that others might use to make genetically modified people, "and they're doing it without any kind of public debate."

A London-based group called Human Genetics Alert similarly criticized the work.

But Kathy Hudson, director of the Genetics and Public Policy Center in Washington, D.C., said she's not troubled by the work. She said the idea of successfully modifying babies by inserting genes remains a technically daunting challenge.

"We're not even close to having that technology in hand to be able to do it right," she said, and it would be ethically unacceptable to try it when it's unsafe.

A few questions:

1. Does it matter that they used an "abnormal embryo?"

2. While it would certainly be unethical for this group of scientists to use this technology for human modification, aren't others able to do so?

3. If so, should the progress be halted based on the possible malfeasance/malevolence of others?

4. Although the idea of successfully modifying babies is a technically daunting challenge at this time, doesn't that seem to be a planned goal?

5. Is that bad?

6. Couldn't we have a better name than "Designer Babies." Sounds like an LA girls pop band.