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The Point - March 2012

In this edition:

Article #1
Excerpt from "Sex-changing treatment for kids: It's on the rise,", by Lindsay Tanner. February 20, 2012--A small but growing number of teens and even younger children who think they were born the wrong sex are getting support from parents and from doctors who give them sex-changing treatments, according to reports in the medical journal Pediatrics.

It's an issue that raises ethical questions, and some experts urge caution in treating children with puberty-blocking drugs and hormones. Switching gender roles and occasionally pretending to be the opposite sex is common in young children. But these kids are different. They feel certain they were born with the wrong bodies. Some are labeled with "gender identity disorder," a psychiatric diagnosis. But Dr. Norman Spack, author of one of three reports published and director of one of the nation's first gender identity medical clinics, at Children's Hospital Boston is among doctors who think that's a misnomer. Emerging research suggests they may have brain differences more similar to the opposite sex.

"Offering sex-changing treatment to kids younger than 18 raises ethical concerns, and their parents' motives need to be closely examined," said Dr. Margaret Moon, a member of the American Academy of Pediatrics' bioethics committee. It's harmful "to have an irreversible treatment too early," Moon said. Doctors who provide the treatment say withholding it would be more harmful.

Commentary #1

H. Patrick Stern, M.D. Professor of Pediatrics Chief, Section of Developmental/Behavioral ETSU Pediatrics: "Whether they are boys or girls, all children have some qualities of masculine and feminine behavior, with some displaying more evident behaviors of the opposite sex. Animal research demonstrates that animals castrated at birth and given physiological amounts of the hormone of the opposite sex will develop behaviors and physical characteristics of the opposite sex.

"Children may express that they believe that they are the opposite sex. Should children who state this belief be given the option to change their biological sex so that they are 'happy', or should the gender identity confusion be treated so that they will accept their biological gender? Sex change operations have anesthetic risk and the reconstruction of genitalia does not create normal functions. Hormones used to promote sexual behaviors and physical changes can cause serious, life-threatening side effects. Behavior modification techniques, especially when introduced during the preschool years, can promote acceptance of the biological gender identity of the child. Hormone supplementation determined by the biological sex of the child can promote normal sexual behavior and physical characteristics.

"Our culture promotes immediate, self-centered gratification regardless of the risk to the individual, other people and society. Children should not be given authority to make decisions because they want something; adults should make decisions based on the best interest of the child. Interventions targeted to help children accept their God-given sexual identities can cure what has been identified as a disorder and can teach children that applying biblical principles to manage stress can promote spiritual growth. Physicians sometimes think that they are wiser than God. God does not make mistakes."

Article #2
Excerpt from "New National Sex-Education Standards Stir Controversy," LifeNews, by Steven Ertelt. February 28, 2012--Two “ethicists” who are college professors in Australia are furthering the pro-infanticide arguments of American professor Peter Singer by calling for so-called “after-birth abortions.” Alberto Giubilini with Monash University in Melbourne and Francesca Minerva at the Centre for Applied Philosophy and Public Ethics at the University of Melbourne write that in “circumstances occur[ing] after birth such that they would have justified abortion, what we call after-birth abortion should be permissible.” The two are quick to note that they prefer the term “after-birth abortion" as opposed to ”infanticide.” Why? Because it “[emphasizes] that the moral status of the individual killed is comparable with that of a fetus (on which ‘abortions’ in the traditional sense are performed) rather than to that of a child.” The authors also do not agree with the term euthanasia for this practice as the best interest of the person who would be killed is not necessarily the primary reason his or her life is being terminated. In other words, it may be in the parents’ best interest to terminate the life, not the newborns.

The circumstances, the authors’ state, where after-birth abortion should be considered acceptable include instances where the newborn would be putting the well-being of the family at risk, even if it had the potential for an “acceptable” life. The authors cite Downs Syndrome as an example, stating that while the quality of life of individuals with Downs is often reported as happy, “such children might be an unbearable burden on the family and on society as a whole, when the state economically provides for their care.” This means a newborn whose family (or society) that could be socially, economically or psychologically burdened or damaged by the newborn should have the ability to seek out an after-birth abortion. They state that after-birth abortions are not preferable over early-term abortions of fetuses but should circumstances change with the family or the fetus in the womb, then they advocate that this option should be made available. Giubilini and Minerva say that merely being a human being is not enough to warrant a respect for a person’s right to life.

The second we allow ourselves to become the arbiters of who is human and who isn’t, this is the calamitous yet inevitable end. Once you say all human life is not sacred, the rest is just drawing random lines in the sand. It’s almost a pro-life argument in that it highlights the absurdity of the pro-abortion argument. These two “ethicists” seem to draw the distinction I’ve seen elsewhere of “self-awareness.” But isn’t that a sliding scale? Isn’t that a bit of a judgment call? Doesn’t this also put the crosshairs on the mentally disabled or those who have suffered brain injuries? They throw around this term “potential person” like it’s a real thing. As if it’s science. But there’s no such thing as potential persons. It’s anti-science. There’s defenseless people. Maybe that’s what they mean. In fact, isn’t that really the point? There’s defenseless people and indefensible ethicists.

And Wesley J. Smith, the prominent American bioethics attorney, says bioethics now contains no ethics whatsoever. Or to put it another way, too often bioethics isn’t. On the other hand, to be fair, the ancient Romans exposed inconvenient infants on hills. These authors may want to take us back to those crass values, but I assume they would urge a quicker death.

Commentary #2
CMDA Senior Vice President Gene Rudd, MD: "Res ipsa loquitur: quotes from the article by Giubilini and Minerva:

  • “After-birth abortion (killing a newborn) should be permissible in all cases where abortion is, including cases where the newborn is not disabled."
  • “We propose to call this practice ‘after-birth abortion’, rather than ‘infanticide’ to emphasis that the moral status of the individual killed is comparable with that of the fetus.”
  • “It should be permissible to practice an after-birth abortion on a healthy newborn too, given that she has not formed any aim yet.”
  • “Both a fetus and a newborn certainly are human beings and potential persons, but neither is a ‘person’ in the sense of ‘subject of a moral right to life.’”
  • “Merely being a human being is not in itself a reason for ascribing someone a right to life.”
  • “A consequence of this position is that the interests of actual people over-ride the interests of merely potential people to become actual ones.”“since non-persons have no moral rights to life, there are no reasons for banning after-birth abortions.”
  • “We do not put forward any claim about the moment at which after-birth abortion would no longer be permissible.”“In cases where after-birth abortion were requested for non-medical reason, we do not suggest any threshold.”

"Aghast? You should be. I was, even though this is not the first modern advocacy for infanticide. And even though many of us have predicted this to be the next decent on the slope upon which we slide.

"I hope you do not forget your visceral response to this. This idea will gain momentum. Moral boundaries are typically breeched subtly by having what was once shocking become debatable, then tolerant. We must allow a God-guided righteous indignation to motivate us to stand boldly against such an affront to life and our Creator.

"I have long resisted the strategy of likening Western civilization’s moral decline to that of Nazi Germany in the 1930s. I thought that comparison unkind, unhelpful and perhaps unfair. No longer! In his 1949 Nuremberg War Crime Trials report published in the New England Journal of Medicine, Dr. Leo Alexander, chief U.S. medical representative, commented, 'it became evident to all who investigated that they (the crimes) had started from small beginnings. The beginnings at first were merely a subtle shift of emphasis in the attitudes of physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as a life not worthy to be lived.'

"After first being shocked by this article, I now have a sense of foreboding, knowing this 'attitude' was accepted for publication in a prominent medical journal."



Article #3Excerpt from "Montreal doctors accused of taking bribes," CBC News. February 21, 2012--Two Montreal cardiologists are facing disciplinary action over allegations they received hefty kickbacks to push patients to the top of the waiting list, the Quebec College of Physicians says. The college's investigation uncovered at least two doctors who were allegedly taking envelopes of cash in exchange for providing faster service, Dr. Charles Bernard told CBC News.



The investigation was triggered 14 months ago, when a Montreal woman told the news media she had paid a $2,000 cash "incentive" to have her mother bumped to the top of a waiting list. After the investigation, the college said two cardiologists from Montreal would face a disciplinary hearing later this year in connection with such incidents. Bernard would not discuss the details of the cases, as nothing yet has been proved.

Dr. Gaetan Barrette, the head of Quebec's federation of specialist doctors, said he hoped the college would send a clear message that the alleged behavior is unacceptable. "It's disgusting for the medical profession," he told CBC News. "There are no other reasons I can think of other than greed for those doctors to go in that direction." Barrette said the two cardiologists could be suspended, but it is unlikely they will be prohibited from practicing permanently. A sanction that harsh is typically reserved for extreme cases, such as sexual assault of a patient, he said. Jean-Pierre Ménard, a lawyer who specializes in health law and patients’ rights, said there is little incentive for those who know about these practices to bring them to light. "When the patient is offering cash to the doctor, and the doctor is accepting the cash ... both of them have an interest not to tell the story," he told CBC News.

Commentary #3
CMDA CEO David Stevens, MD, MA (Ethics): "Bribery is possible when those entrusted with power use it for personal gain.

"Medical bribery is now common around the world. Mahajan V. relates that patients in India have to pay bribes to get the bodies of their dead relatives released from the hospital mortuary. Transparency International reports that surveys showed 95 percent of Pakistanis think the health system is corrupt and 96 percent of people had paid a healthcare provider (they don’t merit the term 'professional') a bribe. I know first-hand stories of patients routinely bribing doctors in Russia to get even basic services. The Chronicle of Higher Education in July documents the corruption in medical services that is literally killing Russia. Students bribe their way into medical school and then bribe their professors for their grades.

"The China Daily wrote last month of the 'commercial bribery in the country's hospitals and medical institutions' and the demands made on the government to curb it. The 'five biggest public hospitals in Hanoi banned their staff from taking ‘envelope’ (tip or black money) from patients in September 2011.' These tips are a common practice to avoid getting a 'chilly response' from healthcare providers.

"I don’t know if the doctors accused in Canada are guilty or whether corruption is widespread in the Canadian health system. I do know the conditions that lead healthcare professionals to break their covenant with patients. Corruption thrives when personnel are underpaid and overworked, and when resources considered very valuable are limited or rationed. We are rapidly moving down that path in the U.S. Like a cancer, corruption starts small but rapidly grows until it becomes endemic in these conditions.

"The best defense against corruption is the character and integrity of the individual physician or dentist. Simply teaching ethics does not produce trustworthy doctors; character development begins long before medical and dental school. That's why it is so important to screen for character as well as intellect when interviewing prospective students. Upright students must then learn, through worthy mentors and courses emphasizing ethics, what it means to be a true and trustworthy professional.

"If not, we may all have to pay bribes in the not so distant future to get the healthcare we need."

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