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The Point Washington Update - April 24, 2014

In this edition of The Point:

Article #1

Excerpted from "Cloning advance using stem cells from human adult reopens ethical questions,"Washington Post, April 17, 2014 - Scientists have grown stem cells from adults using cloning techniques for the first time — bringing them closer to developing patient-specific lines of cells that can be used to treat a whole host of ailments, from heart disease to blindness. The research, described in Thursday’s online edition of the journal Cell Stem Cell, is a controversial advance likely to reopen the debate over the ethics of human cloning.

The scientists’ technique was similar to the one used in the first clone of a mammal, Dolly the sheep, which was created in 1996. They “reprogrammed” an egg cell by removing its DNA and replaced it with that of an adult donor. Scientists then zapped the cell with electricity, which made it divide and multiply. The resulting cells were identical in DNA to the donor.

Paul Knoepfler, an associate professor at the University of California at Davis who studies stem cells, called the new research “exciting, important and technically convincing.”

“In theory you could use those stem cells to produce almost any kind of cell and give it back to a person as a therapy,” he said.

While the research published Thursday involves cells that are technically an early stage embryo, the intention is not to try to grow them into a fully formed human. However, the techniques in theory could be a first step toward creating a baby with the same genetic makeup as a donor.

Shoukhrat Mitalipov, director of the Center for Embryonic Cell and Gene Therapy at Oregon Health & Science University, developed the method that Chung’s group built upon. He emphasized that the work involves eggs that have not been fertilized.

“There will always be opposition to embryonic research, but the potential benefits are huge,” Mitalipov said.

Seventeen years ago, news about Dolly’s birth led to impassioned calls for a ban on human cloning for the purpose of producing a baby who is a genetic copy of someone else. Several countries took measures to limit or outlaw such work. But in the United States, the issue became entangled in the politics of abortion, and Congress became deadlocked. Some lawmakers called for a ban on reproductive human cloning, but others refused to support such legislation unless it included a ban on human cloning whether it was for the purposes of reproduction or for the development of new therapies. At least 15 states have laws addressing human cloning.

Commentary #1

CMDA Member and Senior Fellow for Life Sciences at Family Research Council David Prentice, PhD: – “The language continues to be deceptive. Growing ‘stem cells from adults using cloning techniques’ sounds innocent, as if they had taken one heart cell and multiplied it in a dish. Making a ‘reprogrammed’ egg cell, getting it to divide, producing cells ‘identical in DNA to the donor.’ And the requisite ‘exciting’ and ‘new therapies.’

“But the reality is that a new human being was produced by the cloning technique (somatic cell nuclear transfer.) This news story notes that it is ‘technically an early stage embryo,’ but goes on to minimize the humanity of this young being, created asexually in the lab, and instead point toward the theoretical possibilities if the embryo is instead used as raw materials, destroyed for embryonic stem cells that have in reality produced not a single therapy.

“But there is no technicality--this is really an embryo, the youngest stage of human life, just as Dolly the sheep started as a cloned sheep embryo. And while any therapies are conjectural, the reality is the increased likelihood of cloned human children from this scientific advance. In other stories, the cloners themselves admit that the clones they created could develop and be born if implanted in surrogate wombs. It all starts with creation of the new, cloned embryo, an embryo that could then be used for cell stock or transferred to a womb.

“Further, left unsaid is an additional scientific abuse inherent in cloning technology—exploitation of women. Cloning relies on eggs to make the new, living clones, no matter their intended final use. Lots and lots of eggs. The current experiment used seven young women as egg donors (a procedure known to risk their health), collecting a total of 126 eggs for experiments, but resulting in only two cell lines. Egg donors were ‘financially reimbursed,’ an economic incentive that can prey especially on poor young women. An industry that induces women to exchange their eggs and risk their health is exploitive and should not be countenanced.

“It’s time there was an outcry to prohibit manufacture and trafficking of any cloned humans.”

Article #2

Editor's note: Under JAMA's Conflict of Interest Disclosures, each of the authors of this excerpted article "report consulting for Compassion and Choices," an assisted suicide advocacy organization formerly known as the Hemlock Society.

Excerpted from "The Changing Legal Climate for Physician Aid in Dying," JAMA, April 14, 2014 - Voters in Oregon and Washington have legalized aid in dying by public referendum, legislators in Vermont have done so by statutory enactment, and courts in Montana and New Mexico have done so by judicial rulings. Support for aid in dying is increasing, and it would not be surprising to see voters, legislators, or courts in other states approve the practice.

At one time, it was not clear whether patients could hasten death by refusing life-sustaining medical treatment. Recognition of the right to refuse life-sustaining care reflected a societal consensus that people should be able to decline treatment when they are suffering greatly from irreversible and severe illness. Although a right to refuse treatment did not go too far in allowing death-causing actions, many people felt it did not go far enough. For instance, some patients are seriously ill and suffering greatly from widely metastatic cancer or other advanced diseases, but are not dependent on life-sustaining treatment. For those patients, aid in dying can be an important option.

However, there are real risks if patients are allowed to receive a prescription for a lethal dose of medication. Not all patients who would ask for a prescription would be suffering from an irreversible and severe illness. Some might have become tired of life, depressed, or feel that that their life has insufficient meaning. Accordingly, a right to aid in dying could be recognized only with assurances that access would be limited to patients who are truly seriously ill. In addition, as with the withdrawal of treatment, the government could not impose limits by making quality-of-life judgments.

The terminal illness requirement provides the right kind of limit for aid in dying. It does not empower the government to make quality-of-life judgments, and it restricts the practice to patients who are suffering from irreversible and severe disease.

This is not just a matter of theory. Oregon has had more than 15 years of experience with aid in dying limited to the terminally ill, and the state’s experience has been reassuring. Vulnerable patients are not succumbing to aid in dying. It is not surprising that once Oregon’s experience with aid in dying was reassuring, other states were willing to consider authorizing aid in dying.

By restricting aid in dying to competent and terminally ill adults, the law can ease the dying process for patients, and their families, and avoid the potential for the mistreatment of patients.

Commentary #2

CMA VP for Government Relations Jonathan Imbody – “These assisted suicide advocates cleverly employ several techniques to break down barriers to their radical position, which is that we should obviate over two millennia of Hippocratic medicine and empower doctors to help their patients kill themselves.

  • Employing euphemisms: The authors insist that the euphemistic term ‘aid in dying’ replace the clear and accurate term ‘assisted suicide.’ The group they support changed its name from the Hemlock Society to Compassion and Choices.
  • Linking a radical idea to an accepted idea: We're supposed to think that just as our society once hesitated to allow patients to refuse life support but now accepts that notion, we likewise should see the light and embrace assisted suicide. As if there is no difference between letting someone die naturally and killing them with secobarbital.
  • Stressing meaningless safeguards: The authors try to position themselves as the concerned, conservative protectors of patients and ethics, emphasizing that ‘a right to aid in dying could be recognized only with assurances that access would be limited to patients who are truly seriously ill.’ But since ‘the government could not impose limits by making quality-of-life judgments,’ who determines what ‘seriously ill’ means? You guessed it--physicians like the authors, whose bias toward assisted suicide will doubtless expand the definition beyond meaning.
  • Citing misleading statistics: ‘Figures don't lie, but liars figure.’ Crafty assisted suicide advocates wrote into Oregon's assisted suicide measure the following secrecy clause: ‘...the information collected shall not be a public record and may not be made available for inspection by the public.’ That clause prohibits anyone-- relatives, media, watchdog groups, medical associations--from investigating the details of any of the reported assisted suicide cases. State bureaucrats, who, of course, maintain a vested interest in covering up any problems or abuses that might reflect negatively on the state, annually trot out their own bland, general statistics without detail or the possibility of review. Year after year, assisted suicide advocates point to these meaningless, whitewashed, non-verifiable numbers as proof that the system is working wonderfully.

“For secular audiences, some effective arguments against assisted suicide include:

  • highlighting the lack of safeguards in most assisted suicide measures, including inadequate diagnosis and treatment of depression, the absence of requirements to notify family members and the dangers of storing lethal medications at home;
  • explaining how assisted suicide perverts the safe nature of the patient-physician relationship, removing the vital assurance that the physician will always ‘do no harm;’ and
  • emphasizing that healthcare payers including insurers, the government and even heirs have a tempting financial incentive that leans heavily toward your premature death.”

Article #3

Excerpted from "Campaign speech case is regulatory overkill," commentary by George F. Will, Washington Post, April 18, 2014 - Former U.S. representative Steve Driehaus, a Cincinnati Democrat who considers himself antiabortion, says he lost his 2010 reelection bid because the antiabortion Susan B. Anthony List violated Ohio’s law with ads saying that when he voted for the Affordable Care Act (ACA), he voted for taxpayer funding of abortion. When he learned that the SBA List planned to erect billboards proclaiming “Shame on Steve Driehaus! Driehaus voted FOR taxpayer-funded abortion,” he filed a complaint with the Ohio Elections Commission, the truth arbiter and speech regulator. So the billboard company refused the SBA List’s business.

Driehaus says the ACA does not specifically appropriate money for abortions. The SBA List counters that the ACA can subsidize abortion-inclusive insurance coverage.

Driehaus says insurance companies must collect a “separate payment” from enrollees and segregate this money from federal funds. The SBA List says money is fungible, so this accounting sleight of hand changes nothing.

Driehaus says an executive order issued after passage of the ACA, which was promised to get him and a few other pro-life Democrats to vote for the act, prohibits ACA funds from being used for abortions. The SBA List says the executive order proved that the ACA itself allowed taxpayer-funded abortions.

Ohio’s law, which obviously is designed to encourage self-censorship, certainly chilled the SBA List’s political speech. The SBA List’s brief to the Supreme Court notes that “a law requiring citizens to pay $1 before they could publicly comment on electoral issues or candidates for office would be immediately justiciable (and promptly invalidated).” Yet Ohio’s law makes it easy for literally millions of Ohioans to subject participants in the political process to much more expensive costs — not to mention the threat of incarceration.

This case, which comes from Cincinnati, where the regional IRS office was especially active in suppressing the political speech of conservative groups, involves the intersection of two ominous developments. One is the inevitable, and inevitably abrasive, government intrusions into sensitive moral issues that come with government’s comprehensive and minute regulation of health care with taxes, mandates and other coercions. The Supreme Court will soon rule on one such controversy, the ACA requirement that employer-provided health-care plans must cover the cost of abortifacients. The other development is government’s growing attempts to regulate political speech, as illustrated by the Obama administration’s unapologetic politicization of the IRS to target conservative groups.

These developments are not coincidental. Government’s increasing reach and pretensions necessarily become increasingly indiscriminate.

Commentary #3

CMA VP for Govt. Relations Jonathan Imbody: – “Government actions hostile to religious freedom have triggered a raft of cases that now are reaching the Supreme Court. They're worth tracking because (a) they involve our faith-based and pro-life colleagues and (b) the principles impact virtually every believer, and especially those who own or work for businesses--including medical and dental practices. These cases include, but are not limited to:

  1. the recently heard religious freedom cases of faith-motivated for-profit employers forced to violate their conscience convictions by participating in providing HHS-mandated contraceptives that the FDA notes can end the life of a human embryo;
  2. the free speech case analyzed above, of a pro-life organization censored for political speech that sought to educate voters on abortion-related provisions in the Affordable Care Act (Obamacare);
  3. the upcoming religious freedom cases (of a total of nearly 100 cases in all) of non-profit organizations also opposed to participating in the HHS contraceptives mandate.

“With the number of Americans who hold no religious affiliation increasing (read my analysis of that trend here), the faith community is losing natural supporters of religious freedom. That means we have to step up our efforts to protect ourselves in law and also to educate our countrymen.

“Some basic points to emphasize about religious freedom:

  1. Faith-based groups help the poor and needy. (Polling shows that even the non-religious still appreciate the charitable services of the faith community.)
  2. Religious liberty protects against discrimination and promotes tolerance and diversity. (Why should religious views be censored in the public arena? Religious tolerance is a hallmark of our democratic republic designed to aid the coexistence of disparate groups and viewpoints.)
  3. A threat to one group’s First Amendment freedoms is a threat to all. As Protestant Pastor Martin Niemoller lamented after serving in a concentration camp during the Nazi holocaust, ‘First they came for the Jews. I was silent. I was not a Jew. Then they came for the Communists. I was silent. I was not a Communist. Then they came for the trade unionists. I was silent. I was not a trade unionist. Then they came for me. There was no one left to speak for me.’”
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