Blogging with Brewster

I thought this week we would take a break from the serious side of bioethics, and just check out Brewster Rockit's take on blogging. We'll get back to more intense matters next week, when I resume my usual blorg, er . . . blog.

For more Brewster: http://www.comicspage.com/brewster/brewster.html

Desperate Donors

Anyone who doubts that there are terrible human rights abuses in the world should consider the latest news on “transplant tourism.” This is the practice where rich Americans go overseas to a less developed country to purchase an organ for transplant.

Perhaps you have kidney failure, and don’t wish to endure the long wait for a new organ in the United States. Just head for the Philippines, where you can buy a transplant operation for $100,000, of which the donor may receive as little as $1000.

Long waiting lists for transplants have given rise to a market that exploits and victimizes the poor. According to one 71-year-old Canadian, “When you're desperate, morality goes out the window” (as reported by CBC News). But such desperate measures have a sinister side that even the transplant tourists do not suspect, or perhaps choose to ignore.

It is well known that transplanted organs in China often come from executed prisoners. The shocking news is that many of the donors are in prison simply because they are members of Falun Gong, whose only crime was practicing the meditation and exercise that this religious group recommends.

Consider the report in the Saint Louis Post-Dispatch on August 22nd. Reporter Deborah Shelton relates the story of Huangui Li, a 62 year-old Chinese woman arrested in 2001 for distributing banned literature. Ms. Li was taken to a hospital where physicians examined her fitness to be an organ donor. She believes that her high blood pressure (making her organs unsuitable for transplant) may have saved her life. Ms. Li now lives in the U.S.

The report documents a large number of abuses: between 2002 and 2003, as many as 2000 Falun Gong had their corneas removed at detention centers in a number of Chinese provinces. In a six-year period, 41,500 organs were removed from prisoners, many of them Falun Gong.

Even if the organs don't come from prisoners, the gap between rich and poor means that transplant tourism will always be inherently exploitative. Such practices are illegal in many countries of the world, and immoral by any standard. Immanuel Kant has said that human beings should always be ends, and never means. In China and elsewhere, this standard has been turned on its head.

Saint Louis Post-Dispatch Article
WHO Bulletin on Organ Trafficking

The Bioethics of Bodies

Several of my pre-med biology students have asked me about Gunther von Hagens' exhibit "Body Worlds," now touring the country. Since we offer cadaver dissection as part of our undergraduate courses in human biology, I guess my initial reaction was "Hmm, sounds educational; I guess that's alright." Mind you, I had not seen the exhibit. Now, having viewed images from the Body Worlds Web site, I've changed my mind, and I'm downright uneasy about this new brand of voyeurism.

Body Worlds is a an exhibit of plastinated human cadavers that have been completely dissected and posed in "artistic" positions. The Web site touts the result as "edutainment," but may seriously violate human dignity in the process.

Take, for example, the remarks of bioethicist Ruth Levy Guyer, whose invited commentary appeared on National Public Radio's All Things Considered on August 12th. After visiting the exhibit, she asks the question, "Do we really need to entertain ourselves with dead bodies?" Guyer describes one such "artistic" pose: an athlete with arms outstretched, holding a ball in one hand and his internal organs in another. Guyer is amazed that people can so casually pass by the figure of "a recumbent partially-dissected young woman, with her partially-dissected fetus in-situ." Such unnatural poses seem to show a real disrespect for the dead, and for the living human beings they once were.

It gets worse. As reported on the NPR Web site, reporter Neda Ulaby documents that the cadavers may not all come from ethical sources. Some are obtained from China. Dr. von Hagens claims that he only uses sources he trusts, yet "no outsider has verified that they might not be, in a worst-case scenario, dissidents killed in a Chinese prison." At the very least, it appears that the science centers who exhibit these displays may not have subjected the matter to much ethical review.

You may be interested to know how we handle cadaver dissection in a university setting. Here is an exerpt from the syllabus of one of our human biology courses:

Several classes will take advantage of a unique resource: a human cadaver. This specimen will help us to more effectively learn human anatomy. The impulse that led this gentleman to donate his earthly remains for our study is a noble and generous one, one that we should all appreciate . . . The cadaver should be treated at all times with great respect. It should never be given a name, but should be referred to as "the specimen" or "the cadaver." The cadaver should never be posed or placed in an undignified position.

The contrast between our respect and appreciation for the human form and the exploitation of exhibits like Body Worlds should be abundantly clear. Utilitarian attitudes are more and more taking the place of the sanctity of life. An important signpost of this change in focus is seen in the way we treat our dead.

The Business of Babies

Debra Spar, an economics professor at Harvard, has written a nice piece that shows just how pervasive the desire to have children can be, and how easily economic manipulation can take advantage of it. She writes:

To those who suffer from it, however, infertility is a wretched curse — a disease that isn’t really a disease, with an outcome that seems to defy nature . . . many infertile couples become consumed with the desire to conceive, and are willing to do whatever it takes to create a child of their own.

The science of assisted reproductive technology (ART) has taken advantage of this desperation-driven market. In some cases, it has resulted in blessings for those who can afford such techniques as in-vitro fertilization or intra-cytoplasmic sperm injection, but at what cost for society as a whole?

Many are concerned about the commodification of reproduction, with the possibility that we will see children more as product than progeny. What are the limits? Do all couples have a right to reproduce, to have a child "of their own?" What about the unintended consequences of the unfettered drive to have a technological baby?

Many couples who engage in ART haven't really thought through the long-term implications of their decision. That is one reason there are over 400,000 frozen embryos in cryogenic storage in the U.S. alone. The couples who "own" these embryos have created a legal and moral dilemma. Are they persons or property? Should they be destroyed, given over for stem-cell research, or donated to childless couples who wish to adopt them? Most couples have deferred their decision to some later date, even if they have no intention of implanting the embryos themselves.

Sympathetically, Professor Spar recognizes that regulating the fertility industry and its excesses will be difficult: "These decisions will not be easy, since they will inevitably involve drawing thin lines across a slippery slope and subjecting private tragedies to public scrutiny."

Professor Spar's article can be found at: http://www.stnews.org/Books-2929.htm