Thursday, February 16, 2017

Doctor assisted suicide in Colorado: repugnance outlives legalization

You can figure out much of this story from the headline (but there's more): Colorado’s aid-in-dying law in disarray as big Catholic health systems opt out

...
"A third big health system in the state, HealthONE, has decided it won’t dispense life-terminating medications or allow patients to take them on the premises of its eight hospitals. But HealthONE, which is not faith-based, won’t impose similar restrictions on its doctors. A spokeswoman declined to provide details.

"The state’s law, which became effective last month, requires that such patients be 18 or older, have six months or less to live, be mentally competent, and ask for aid in dying twice over 15 days, in addition to a separate written request.

“Everyone is in a mad scramble figuring out what they’re doing to do and how they’re going to do it,” said Jennifer Moore Ballentine, president of The Iris Project, a Colorado consulting firm that is running a series of seminars on the new law over the next few weeks.

Colorado’s aid-in-dying law contains “conscience” provisions allowing physicians, nurses, and pharmacists to “opt out” of participating. Health systems can also bar the practice on their premises. Other states where aid in dying has become legal — Oregon, Washington, California, Vermont, and Montana — have similar provisions, and Catholic health care systems in those states have taken advantage of it.

But the Colorado law specifically states that health systems can’t prohibit doctors who work for them from discussing end-of-life options with patients or writing prescriptions to be taken off-site. This provision was crafted to prevent health systems from erecting barriers to access; only Vermont has a similar rule, but it doesn’t have a heavy concentration of Catholic hospitals.

Advocates for Colorado’s law say the two big Catholic health systems may be testing that provision."
************

And in Vermont: Vermont governor discloses his father used state’s end-of-life law

Wednesday, February 15, 2017

The politics of assisted suicide / death with dignity

My discussions of assisted suicide / death with dignity as a repugnant transaction included a recent post noting that in the most recent elections, Colorado joined the states (including California) that allow physicians to prescribe lethal drugs to mentally fit, terminally ill adults who want to end their lives.

It's therefore interesting to note that Supreme Court nominee Judge Neil M. Gorsuch has a 2006 book The Future of Assisted Suicide and Euthanasia suggesting that this is never justified. The publisher's website says:
 “The Future of Assisted Suicide and Euthanasia provides the most thorough overview of the ethical and legal issues raised by assisted suicide and euthanasia--as well as the most comprehensive argument against their legalization--ever published.”

In other (related) news, 
House committee moves to block D.C.’s assisted-suicide law

"In a rare step, a House committee voted 22 to 14 Monday night to block a law that would make assisted suicide legal in the District, opening a new front in the conflict between congressional Republicans and the overwhelmingly Democratic capital city.

It was one of only a handful of times in the four-decade history of D.C. home rule that members of Congress have tried to use their constitutional power to overturn a city law, and the first attempt since the GOP took control of both Congress and the White House in January.

The vote was largely along party lines, as 21 Republicans and one Democrat, Rep. Jim Cooper of Tennessee, voted yes while 13 Democrats and one Republican, Darrell Issa of California, voted no."

Tuesday, February 14, 2017

An interview about travel bans, and universities, and science...


NOBELPREISTRÄGER ALVIN ROTH ZUM EINREISEVERBOT
„Grenzschließung wäre eine große Schande“

PREMIUMStanford-Professor und Nobelpreisträger Alvin Roth sorgt sich um den Forschungsstandort USA. Im Interview spricht er über die Folgen von Donald Trumps Einreiseverboten und die Universitäten als Spiegelbild Amerikas.


Im Jahr 2012 gewann Alvin Roth den Nobelpreis für Wirtschaftswissenschaften. Der 65-Jährige, der an der Universität Stanford in Kalifornien lehrt, macht sich Sorgen um den Forschungsstandort Amerika.
It's in German, and it's gated, but the interviewer asked me what I thought the effects of travel bans and immigration bans would be on the U.S. I replied that universities are in some ways a microcosm of the US, in that both have thrived by being open to participation from people around the world.  Universities, American science, and America will all suffer if we cut ourselves off from the rest of the world.

Valentine's day

What do Valentine's day and National organ donor day have in common?  Well...hearts.  And love. And the same day...

February 14: National Donor Day
Focused on five points of life: organs, tissues, marrow, platelets, and blood. Many nonprofit health organizations sponsor blood and marrow drives and organ/tissue sign-ups across the nation. National Donor Day was started in 1998 by the Saturn Corporation and its United Auto Workers partner with the support of the U.S. Department of Health and Human Services and many nonprofit health organizations.

February 14 is National Donor Day

Each year, February 14th is significant for more than just Valentine's Day.  Today is designated as National Donor Day focusing on the "five points of life"  organ, tissue, marrow, platelets, and blood donation.  Donation drives are held throughout February nationwide.  Be a hero!  Be a donor!  And THANK YOU!








*************

Valentine's day celebration is also repugnant in some places:
Pakistan bans Valentine's Day for being unIslamic
Ban on the traditional Christian celebration of love follows a similar move by Saudi Arabia
"Pakistan has become the latest country to ban Valentine's Day.
It has prohibited all public celebrations and any media coverage because the celebration is not part of Muslim traditions."

And (I'm sorry to say) this: Mob Kills Eloped Lovers After Storming Afghan Police Station

Monday, February 13, 2017

First kidney exchange in Vietnam

The first kidney exchange in Vietnam was performed last month. It was a two-way exchange in Ho Chi Minh City: VietNamNet has the story.

VN doctors perform first paired-kidney exchange transplant
Doctors at Cho Ray Hospital in HCM City have successfully performed the country’s first living paired-kidney exchange transplant.

"The surgery was successful and the four patients are in stable condition, according to Dr Thai Minh Sam, head of the hospital’s urology department.
Nguyen Thi Hue, 58, volunteered to donate one of her kidneys to her daughter Vu Thi Hue, 32, from Kien Giang province who had end-stage renal disease and has been on dialysis since June 2014.
But she and her daughter did not match well, Sam said at a press meeting held yesterday.
Another pair in the same situation, Le Thi Anh Hong, 31, from Dak Nong province with end-stage renal disease, has been on dialysis since April 2015.
Hong’s stepfather, Truong Ngoc Xuan, 51, could not donate one of his own kidneys to his daughter as they were incompatible.
Paired donation matches an incompatible donor and recipient to another pair in the same situation.
Doctors at Cho Ray Hospital carefully consulted opinions from leading experts in kidney transplant and explained the procedure to two donor/recipient pairs who agreed to undergo paired kidney exchange.
Hue’s mother gave one of her own kidneys to Hong. In exchange, Hong’s stepfather, Xuan, donated one of his own kidneys to Hue.
Doctors removed the kidneys from the donors in the morning and transplanted them in the recipients on January 11."

Sunday, February 12, 2017

Living kidney donation in Israel: a competition between two towns

Ran Shorrer points me to this story...

תחרות בין ההתנחלויות: מי יתרום יותר איברים לזרים גמורים

עשרות מתיישבים החליטו לתרום את אחת הכליות שלהם לאדם זר, ללא תמורה. המעשה האצילי הפך אפילו לסוג של תחרות בין היישובים. "ביצהר מובילים עם 10 תורמים, ואנחנו רק שלושה", מסביר תורם מאיתמר. היוזמה מדהימה, אך התרומות לא מיועדות באמת לכל אחד: מרביתן ליהודים בלבד


Google translate:

Competition between the settlements who contribute more organs to complete strangers?

Dozens of settlers decided to donate one of their kidneys to a stranger, for no consideration. Even the noblest deed became a kind of competition between communities. "Yitzhar lead with 10 donors, and we are only three," says Itamar contributor. 

Saturday, February 11, 2017

Friday, February 10, 2017

Vatican conference on organ trafficking and transplant tourism

A recent meeting at the Pontifical Academy of Sciences of the Vatican:
Summit on Organ Trafficking and Transplant Tourism resulted in a statement and a number of news stories.  Here are several that caught my eye, with divergent views on the situation in China and how it is changing:

From the NY Times: Debate Flares Over China’s Inclusion at Vatican Organ Trafficking Meeting
"China has admitted that it extracted organs from death row prisoners for decades, in what critics have called a serious violation of the rights of inmates who cannot give genuine consent. Since Jan. 1, 2015, Chinese officials have said they no longer use prisoners’ organs, though doubts persist.

“We urge the summit to consider the plight of incarcerated prisoners in China who are treated as expendable human organ banks,” wrote the 11 signatories, who included Wendy Rogers of Macquarie University in Australia; Arthur Caplan of the New York University Langone Medical Center; David Matas and David Kilgour, both Canadian human rights lawyers; and Enver Tohti, a former surgeon from the western Chinese region of Xinjiang."
*********


From Statnews.com
China moves to stop taking organs from prisoners, WHO says
"The World Health Organization says China has taken steps to end its once-widespread practice of harvesting organs from executed prisoners but that it’s impossible to know what is happening across the entire country.

At a Vatican conference on organ trafficking this week, a former top Chinese official said the country had stopped its unethical program, but critics remain unconvinced.

In an interview Thursday, WHO’s Jose Ramon Nunez Pena said he personally visited about 20 hospitals in China last year and believes the country has reformed. But he acknowledged that it was still possible “there may still be hidden things going on.” China has more than 1 million medical centers, although only 169 are authorized to do transplants.

Nunez Pena said he had seen data including organ transplant registries and was convinced the country was now shifting away from illegally harvesting organs.

“What is clear to me is that they’re changing,” he said. “But in a country as huge as China, we can’t know everything.”
...
"Campbell Fraser, an organ trafficking researcher at Griffith University in Australia, agreed the trends over the past few years have shown a drop in the number of foreigners going to China for transplants and an increase of organ seekers heading to the Middle East.

At a press conference at the Chinese Embassy in Italy following the two-day Vatican organ conference, Fraser said migrants — including Syrians, Somalis and Eritreans — sometimes resort to selling off a kidney to pay traffickers to get them or their families to Europe.

Egypt is where the biggest problem is at the moment,” he said, adding that it has the best medical facilities in the region and can perform the live donor surgeries.

He estimated as many as 10 such illicit transplants could be happening per week, though he had no statistics and said he based his research largely on anecdotal information from recipients, law enforcement, doctors and even some organ “brokers.”

Fraser said he has access to transplant patient “chat boards” because he himself had a kidney transplant in his native Australia in 2003.

Nunez Pena said it was likely that organ trafficking would find its way to conflict-plagued regions.

“We’re hearing about a lot of problems in Egypt, Pakistan and the Philippines,” he said, predicting that authorities were poised to break up an organ smuggling ring in Egypt in the next few weeks. “Wherever you have vulnerable people, you will see these kinds of problems.”

*****************


From Science:

Study retraction reignites concern over China’s possible use of prisoner organs

A journal has decided to retract a 2016 study because of concerns that its data on the safety of liver transplantation involved organs sourced from executed prisoners in China. The action, taken despite a denial by the study’s authors that such organs were used, comes after clinical ethicist Wendy Rogers of Macquarie University in Sydney, Australia, and colleagues authored a letter to the editor of Liver International on 30 January, calling for the paper’s retraction in the “absence of credible evidence of ethical sourcing of organs.”
For years, Chinese officials have come under fire for allegedly allowing the use of organs from executed prisoners for transplants, including for foreigners coming to the country for so-called medical tourism. In January 2015, it explicitly banned the practice and set up a volunteer donation system, but doubts persist that much has changed.
The disputed study—published online in October 2016—analyzed 563 consecutive liver transplantations performed before the ban (from April 2010 to October 2014) at a medical center in China. Suspicious, Rogers organized the protest letter to the journal. “Publication of data from prisoners is ethically inappropriate given that it [is] not possible to ensure that the prisoners freely agreed either to donate their organs, or to be included [in] a research program,” she tells ScienceInsider.

Thursday, February 9, 2017

Ethicists on compensation for blood stem cells (aka bone marrow aka hematopoietic cells) donors

The site http://donationethics.com/ hosts a letter signed by many ethicists opposing an amendment to the National Organ Transplant Act to reverse the court decision outlawing payment to blood stem cell donors. (Got that? the letter is pro compensation.)

The site is full of interesting related links.

Here's the site's front page:
This site houses an open letter to Shelley Grant of the Department of Health and Human Services regarding a proposed amendment to the National Organ Transplant Act that would effectively outlaw offering compensation for hematopoietic cells donation. The signatories are professional ethicists who believe that the proposed amendment is unethical and should be rejected.
The details of the proposed amendment can be found here.
The case that prompted the amendment, Flynn v. Holder, is explained here.





Peter M. Jaworski conceived of the letter and is its primary author.
David Faraci was a major contributor to the letter and maintains the website.
**************

Here's a link to Hemeos, a startup service for matching stem cell donors to patients, which plans to compensate donors.

Wednesday, February 8, 2017

Celebrating Adam Bingaman at Methodist Hospital in San Antonio

Working in kidney exchange has given me the opportunity to meet some remarkable surgeons, and one of them, Adam Bingaman, is being celebrated in in the San Antonio media:
Methodist Hospital Leads Nation in Live-Donor Kidney Transplants

Methodist Specialty and Transplant Hospital's Dr. Adam Bingaman

"Dr. Adam Bingaman, head of the live-donor kidney transplant program, joined the Texas Transplant Institute at Methodist Specialty and Transplant Hospital in 2007 and became the Director of Abdominal Organ Transplantation in 2012.
...
"For those awaiting a kidney transplant but lacking a live-donor match, the only chance for a kidney donation may be from a kidney-paired donor (KPD) exchange. This offers a transplant option for patients with a living donor who is both willing and medically fit but isn’t a compatible match with the recipient.
The donor’s information is entered into a nationwide database with those of other incompatible donors and recipients who are willing to exchange kidneys. It is here that the process of finding suitable exchanges occurs. Kidney-paired donation provides a means for all transplant centers to increase patient access to live-donor transplantation.
Methodist Specialty and Transplant Hospital’s Program
Launched in 2008, the paired-donor program at Texas Transplant Institute at the Methodist Specialty and Transplant Hospital has performed more kidney-paired donation exchanges than any other center. The program focuses not just on the kidney recipient, but on the donor as well. All transplants are performed in one integrated facility, with targeted care provided for the donor from initial screening to post-surgery follow-up for two years.
The program’s approach to building community partnerships enables patient access and follow-up care in less populated areas across Texas. The program’s team has forged relationships with nephrologists throughout the state and through dedicated clinics in Corpus Christi, Laredo, McAllen, Lubbock, Waco, Temple, and Austin. The transplant physicians and team members visit these locations regularly to check on patients who have either donated or received a kidney.
“We build relationships of trust,” Bingaman said. “Community partnering in underserved areas is very important to patient outcomes. Our goal is to integrate our services with those of a patient’s nephrologist, so that we provide a true umbrella of care.”
...
"The Texas Transplant Institute at Methodist offers an educational seminar three to four times a year. The series (and videos here) teach people how to “End Your Wait” with an education program explaining living kidney donation and how to go about finding a donor on their own.
“We give them tools that help their awareness about the need for a kidney transplant,” Bingaman said. “We started this program because more than 50% of kidney donations do not come from family members. They are from coworkers, church members, or someone in the extended social network.”
“We’ve already hit a crisis point,” Bingaman said. “If you have kidney disease and diabetes and maybe heart disease, after six years on dialysis, you probably won’t be healthy enough for a transplant. So your best bet is to find a living donor as early as possible.”

Tuesday, February 7, 2017

U.S. academic conferences and the travel ban. What would be the effect of a boycott? Can conferences usefully be moved?

Part of the international reaction to the recent U.S. travel ban on people from seven countries has been a call to boycott U.S. academic conferences.
Here, e.g. is one such call: In Solidarity with People Affected by the ‘Muslim Ban’: Call for an Academic Boycott of International Conferences held in the US
"Among those affected by the Order are academics and students who are unable to participate in conferences and the free communication of ideas. We the undersigned take action in solidarity with those affected by Trump’s Executive Order by pledging not to attend international conferences in the US while the ban persists. We question the intellectual integrity of these spaces and the dialogues they are designed to encourage while Muslim colleagues are explicitly excluded from them."

I have had an opportunity to think about this regarding the ASSA conference run in January by the American Economic Association, and it seems to me that such a boycott won't help the majority of academics (students and professors) from the banned countries who come to our conference, or to many American academic conferences.

In our (the AEA's) particular situation, my sense is that we have had few if any Yemeni and Sudanese economists participating in the AEA meetings, and the people potentially affected by the current U.S. entry bans are mostly Iranian.*  And the majority of Iranians who have participated seem to be working or studying in the U.S.

So…if a travel ban is in place next January, and we moved the conference to some civilized city like Toronto, we would be depriving most of the potential Iranian participants of the ability to attend, since they couldn’t leave and then reliably re-enter the U.S..

My current sense is that the AEA will decide to take care of the Iranians as best we can (which for the minority who aren’t in the U.S. may involve some electronic communication efforts), rather than cater to any economists whose scruples would require us to abandon the Iranians living and working in the U.S.  by moving the conference elsewhere.

To be clear, I think moving the AEA meetings outside of the U.S. would harm the majority of Iranians who participated in past years.

Of course I’m hopeful that we’ll have come to our senses long before then.


*see this article in the Chronicle for a wider view of who studies in the U.S.:
Why the Travel Ban Probably Hits Iranian Professors and Students the Hardest

see also the data compiled by the Institute of International Education:
 International Students: All Places of Origin 2014/15 - 2015/16, and for previous years:  2016 | 2015 | 2014 | 2013 | 2012 | 2011 | 2010 | 2009 | 2008 | 2007 | 2006 | 2005 | 2004 | 2003 | 2002
Selected Years 1950-2000
and see
Universities Spoke Up in Case That Led to Ruling Halting Trump’s Travel Ban

Monday, February 6, 2017

Pictures from the Wilson CME MSRI prize ceremony

We gathered in Chicago to celebrate Bob Wilson. Here's a story, with some nice quotes from Andy Skrzypacz:
ROBERT WILSON APPLIED GAME THEORY TO ECONOMICS AND WON

And here are some of the pictures I took:

Bob Wilson

Drew Fudenberg, Hari Govindan, Roger Myerson

Hugo Sonnenschein

Leo Melamed

Roger Myerson and the beer-quiche game

There was also a panel of some proud Wilson students, consisting of me, Paul Milgrom, and Bengt Holmstrom. Mary Wilson took this picture afterwards:


Sunday, February 5, 2017

IVF: Experience suggests there's room for some regulation

The Guardian has the story: IVF mix-up: wrong sperm may have fertilised eggs of 26 women
Dozens of women may have had eggs fertilised by sperm cells from someone other than the intended father, say Dutch authorities

"A Dutch medical institution has launched an investigation after discovering that up to 26 women’s eggs may have been fertilised by the wrong sperm at its IVF laboratory.

"A “procedural error” between mid-April 2015 and mid-November 2016 during the in-vitro fertilisation was to blame, the University Medical Centre in Utrecht said.

"“During fertilisation, sperm cells from one treatment couple may have ended up with the egg cells of 26 other couples,” said a statement.

“Therefore there’s a chance that the egg cells have been fertilised by sperm other than that of the intended father.”

Although the chance of that happening was small the possibility “could not be excluded”, said the centre.

Half the women who underwent fertility treatment had become pregnant or given birth.

“For some of the 26 couples frozen embryos are still available but the chance remains that they [too] have been fertilised by the sperm from a man other than the intended father,” the UMC said.

"The couples had been informed, the centre said.

“The UMC’s board regrets that the couples involved had to receive this news and will do everything within its powers to give clarity on the issue as soon as possible.”

...

"Mix-ups do occur, including one in 2012 when a Singapore mother sued a clinic for alleged negligence after it mixed up her husband’s sperm with that of a stranger.

"The ethnic Chinese woman first suspected that something was amiss when her baby, who was born in 2010, had markedly different skin tone and hair colour from her Caucasian husband, news reports at the time said."
***********

Here's are two recent updates on the Singapore story (and subsequent legal proceedings) from the Straits Times: the first has some details of how the error happened, the second speaks about the legal issues associated with possible damages that might be assessed, and if so for what...
IVF mix-up at Thomson Medical: A look back at the case of 'Baby P'

IVF mix-up at Thomson Medical: Court continues to hear appeal of woman who conceived baby with stranger's sperm

Friday, February 3, 2017

Market for ideas vs travel bans: academic societies and universities react

A large group of scientific societies have signed this Multisociety letter deploring the recent Executive Order regarding travel to the U.S.  (The American Economic Association is represented through its membership in COSSA, the Consortium of Social Sciences Associations.)
http://www.cossa.org/wp-content/uploads/2017/01/Multisociety-Letter-on-Immigration-1-31-2017.pdf
"The Executive Order will discourage many of the best and brightest international students, scholars, engineers and scientists from studying and working, attending academic and scientific conferences, or seeking to build new businesses in the United States. Implementation of this policy will compromise the United States’ ability to attract international scientific talent and maintain scientific and economic leadership.
Today, we urge the Administration to rescind the Executive Order and we stand ready to assist you in crafting an immigration and visa policy that advances U.S. prosperity and ensures strong borders while staying true to foundational American principles as a nation of immigrants. "

Below are a variety of other reactions (in no particular order), many of which balance charters which require some scientific societies to be nonpartisan, with the concern that the recent Executive Order negatively affects their core mission.

http://president.mit.edu/speeches-writing/best-serve-nation-and-world

Thursday, February 2, 2017

Turing's law: UK posthumously pardons thousands of gay men

On Christmas Eve in 2013 Alan Turing received a posthumous pardon from the crime of being homosexual in Britain in the 1950's.  Tuesday, thousands of other men received similar posthumous pardons.

The Guardian has the story:
UK issues posthumous pardons for thousands of gay men
Justice minister hails ‘momentous day’ as so-called Turing’s law receives royal assent, but critics say move does not go far enough

"Tuesday 31 January 2017
Thousands of men convicted of offences that once criminalised homosexuality but are no longer on the statute book have been posthumously pardoned under a new law.

"A clause in the policing and crime bill, which received royal assent on Tuesday, extends to those who are dead the existing process of purging past criminal records.

"The general pardon is modelled on the 2013 royal pardon granted by the Queen to Alan Turing, the mathematician who broke the German Enigma codes during the second world war. He killed himself in 1954, at the age of 41, after his conviction for gross indecency.

"Welcoming the legislation, the justice minister Sam Gyimah said: “This is a truly momentous day. We can never undo the hurt caused, but we have apologised and taken action to right these wrongs. I am immensely proud that ‘Turing’s law’ has become a reality under this government.”

"There is already a procedure in place for the living to apply to the Home Office to have their past convictions, relating to same-sex relationships, expunged from their criminal records.

"Under what is known as the disregard process, anyone previously found guilty of past sexual offences that are no longer criminal matters can ask to have them removed.

"A disregard can be granted only if the past offence was a consensual relationship and both men were over 16. The conduct must also not constitute what remains an offence of sexual activity in a public lavatory.
...
"Rewriting history will not be easy. The complexity of the evidence, for example, that led to Oscar Wilde’s conviction in 1895 for gross indecency – including evidence of procuring male prostitutes – would make it difficult to assess.

"The gay rights organisation Stonewall has suggested the playwright and author, who was sentenced to two years hard labour in Reading jail, should be entitled to a pardon.

"The Ministry of Justice said there would be no historical limit in relation to past offences. It declined, however, to say whether Wilde would be among those deemed posthumously pardoned."

Wednesday, February 1, 2017

Global Entry: blanket discrimination replaces "extreme vetting"

A number of Iranian scientists received messages yesterday from U.S. Customs and Border Protection. These are long-term American residents who had chosen to go through the personal interview process needed to get into the Global Entry Program, which allows trusted travelers to enter the U.S. in an expedited way.  (I use Global Entry, and it allows me to go to a kiosk which examines my passport and fingerprints, without the necessity of standing in a long line to speak to a border agent.)

Nevertheless, these individuals have been informed that they no longer meet the eligibility requirements. (Here's a screen shot...)



Note that the people who received this message had already passed "a comprehensive background investigation."  Presumably that is what is meant by "extreme vetting."  But now, it seems, a blanket nationality ban is being invoked.

That is, as someone might say, "Sad."