Codes of Professional Behavior for Medical School and Beyond

A study (NEJM Dec. 23, 2005 issue “Disciplinary Action by Medical Boards and Prior Behavior in Medical School” Maxine A. Papadakis, M.D and others) had shown that bad behavior in the later years of practice appear to be related to bad behavior which had been observed while the doctor was still in medical school.

Codes of professional behavior have been written by medical schools for their students to follow during their years in school. What should codes of professional behavior contain which we present to our medical students as they start out in their medical education? My opinion is that these codes not only should look at defining acceptable and ethical behavior of these students as they work in their educational environment in the classroom and on the hospital wards but also to emphasize to them they represent a “look ahead” to how they are expected to behave years from now when they have the full responsibility for patient care.

Here are my “look ahead” criteria definitions of honesty, integrity, responsibility, reliability, accountability and respect for patients which should be incorporated into medical schools codes of behavior, hopefully making the students understand why as students these elements of professionalism are necessary to observe now, identifying and correcting bad behavior to prevent loss of patients and even medical license in the future.


Honesty and Integrity:
Honesty and Integrity means Trust and Trust is the fiduciary responsibility that we must give to our patients and for which they expect from us.

Responsibility:
Responsibility includes the care of the patient that trumps the physician's self-interest.

Reliability:
Reliability means that the patient can depend on the doctor's medical skills and behavior to meet the challenges of patient care.

Accountability:
Accountability means that the physician is in the service of the patient and outcomes including medical errors and unattained goals or promises must be told and explained by the physician to the patient and whatever personal responsibility the physician holds should be accounted for.

Respect for Patients:
Respect for Patients means respect for their welfare as well as their autonomy. In addition, there must be respect for the patient's privacy (including issues of patient modesty along with any written or spoken personal details of the patient's life). There must be respect for the patient's religious beliefs, culture, their own personal view of the quality of their life and respect that the patient may be part of a family or other community.

Let me know if you have any suggestions about other points we should be teaching our students with regard to professionalism in medicine. ..Maurice.

"Going by the Numbers":When is Enough,Enough?

I received a very poignant e-mail today from a daughter about her father. Though in a number of threads, I have tried to cover the issue presented,I felt that this description brings home the concern some families have about their ill loved one and was appropriate for initiation of a new thread.


Dear Doctor,
I stumbled upon your Web site via an effort to make some moral sense of what is happening to my dad. Six months ago, at 81 years old, he was bowling three times a week, taking my 8-year-old son to school every morning because he enjoyed it and maintaining weekly bowling and lunch dates with my son and daughter, respectively. Tonight, he lies in CCU at the local hospital. It's day 19 since my mother, eldest daughter and myself made the decision to call 911. A few months previously, we tried to talk to him into seeing a doctor because of various symptoms that resembled prostate cancer and kidney disease. But, having consulted a doctor many years previous for various digestive disorders and having extremely painful, invasive and, to him, humiliating procedures, he opted out. He was adamant. He did not want to see a doctor.

... he remains hospitalized, skin and bones, enduring dialysis and tubes connected to every conceivable bodily oriface. Ironically, while he constantly expresses his fervent desire to go home, he has never questioned any of us about his presence in the hospital. His doctor initially told me that, by the numbers, he should have been dead. But as I see him beg for food and water that he can't have because of an as yet undiagnosed GI blockage...as I move his painfully cramping legs that once took him down the bowling lanes with such grace and precision...and as I see him grow progressively more angry and delusional, and not at all like himself, I can't help but wonder the futility of medical science. The doctor tells me that, of the plethora of problems my dad suffers from, none are "terminal." Yet, I know, without question, that if our beloved pet, as those in the past, was in such misery...we would feel obliged to do the right thing. Why is it that medical practitioners persist in "going by the numbers"... when is enough, enough?
Judy


Judy, I can't explain, in your dad's case, the physicians' need to continue supportive treatment. I do know that if an adult has the capacity to make medical decisions or if not, that members of the family who know the patient's desires well can request as surrogates that the physicians stop unwanted, energetic life-supportive therapy and provide only effective comfort care.

"When is enough,enough?". Finally, the answer should be set by an informed patient or an informed surrogate. Believe it or not, simply awaiting miracles represents only wishful thinking and should not trump the desire and need for the patient's peace and comfort. ..Maurice.

Fertility Treatment of a Lesbian: Can A Physician Refuse?

Here is the scenario:

In the United States of America it is accepted that all physicians have a right to choose their own patients except in the case of a medical emergency.

In the United States of America , no physician receiving government funding may discriminate against potential patients on the basis of race ,color, religion or national origin and in the state of X, the anti-discrimination laws include, as do some other states, gender and sexual orientation.

Miss K.. has gone to fertility doctor F, who is a Medicare provider, with her same sex partner Miss J. requesting that Doctor F. provides fertility treatment so that Miss K. can become pregnant by artificial insemination. Both Miss K. and Miss J. explain their desire to have a child.

Doctor F. has strong personal religious views against abortion (which he would never perform) and also about inducing a pregnancy in a homosexual. He rejects her request and subsequently Miss K. sues Dr. F. in X state court charging that under state X law, Dr. F.’s refusal to treat represented illegal discrimination on the basis of sexual orientation.

That’s the story. Now what is your ethical and legal interpretation of this scenario? . What if Dr. F. is also a general internist and has been treating Miss K as his patient. for various medical conditions over the past several years prior to her making the request?

(I want to acknowledge this thread was born out of an article “May Doctors Refuse Infertility Treatments to Gay Patients?” by Jacob M. Appel in the July-August 2006 issue of the Hastings Center Report.) ..Maurice.

Playing Doctor vs Being a Doctor

When we all started playing doctor around the time we were in Kindergarten, it was all about curiosity. We learned how our bodies were the same as some and different than others. There was no responsibility for our actions or for our “patient”. The requirements for a licensed physician are much different. Curiosity and self-interest without responsibility is not acceptable. Unfortunately there are some physicians who are in practice, as reported by angry patients on this blog, where curiosity and self-interest trump professional behavior and patient responsibility. In essence, these physicians are only playing doctor.

Students are selected to enter medical school by admissions committees. I have never participated on admissions committees (my only experience was being interviewed by one many years ago). However, there are general criteria which are used including amongst others, college grades both science and non-science courses, medical school admission test scoring, references, social activities including humanitarian and medically oriented participation, how the student communicates their understanding of medicine and their interest in the profession and the general behavior of the student during the interview. But despite all the screening, wrong students are selected and finally end up only playing doctor not being one. Perhaps, the committees are looking at the wrong factors or asking the wrong questions.

I would like to challenge my visitors (most likely experienced patients) to provide us with their own criteria that they think would be very important ones for medical school admission committees to consider when they are evaluating a medical student for admission. Any suggestions? ..Maurice.

“Physician, Heal Thyself”: But Is That Possible?

My visitor, Jaine, in response to the last thread asking for contributions of topics, presented a topic that I have touched upon in various threads but I think is worthy of devoting one specifically to this issue here and now. Jaine wrote:


A topic of interest to me is whether doctors are capable of monitoring their own profession, in an ethical manner, in a punitive system? Only extremely ethical people are capable of remaining objective and honest in a system that punishes members for being honest about mistakes. It is ridiculous, in my opinion, for doctors to promote themselves as being capable of self-governing in an ethical manner in a punitive system, when doctors are subject to human nature, as well as suffering from such things as personality disorders, to the same degree as the rest of the population. The approach encourages setting the standard of care very low to protect even the least skilled doctors instead of demanding doctors develop and maintain a high skill level.

“Critics of the current system say it discourages medical staff from honestly admitting errors, for fear of lawsuits.” Link.

“In Sweden, when a patient suffers avoidable injury, whether through gross negligence, such as a botched surgery, or through a more understandable but avoidable mistake, such as a misdiagnosis or medication error, the patient—usually with help from the doctor's office—fills out a form requesting compensation.” Link.

If anyone has a subscription to the New England Journal of Medicine I’d appreciate being able to read the article offered at entitled “Medical Errors and Medical Narcissism”

The case of Dr. Michael Swango, who is suspected of murdering between 35-60 patients, provides an example that begs questions be asked around what the priority and mindset of the medical system is. Is it to protect doctors or protect patients?

“After Swango's arrest, Stewart told the New York Times, "(His) case shows that the medical establishment will blindly trust the word of a fellow doctor over the word of other witnesses and that the medical profession cannot adequately police itself." Link.



So the issue Jaine brings up is essentially what I summarized in the title of this posting: “Physician Heal Theyself”: But Is That Possible? “Physician Heal Thyself” is a biblical proverb meaning that people should take care of their own defects and not just correct the faults of others.: But do any of my visitors think that physicians have the strength of professionalism and ethics to do that on their own? ..Maurice.

Visitor Generated Bioethical Issues: Find One, Research One and Post It Here

As someone really interested in the discipline called bioethics, I keep looking around me and looking for ethical issues, which have been popular but not fully resolved, or ethical issues about which many in society are not really aware. Then there are the ethical dilemmas which over the years has been settled by consensus but as social and political and technologic properties within society have progressively changed, these issues are reopened like a almost healed wound that is again abraded. So I keep thinking, what would be interesting next to put on my blog. There are many possibilities but then these are my possibilities. I can state with certainty that I cannot think of all the issues that are perplexing others. This is a democratic blog (notice the small d), therefore I thought now, maybe I should change the format of this blog a bit at times and have my visitors generate a new, yet undiscussed, bioethical issue; a matter of visitor creativity.

Skim through my archives or use the “Search This Blog” service provided by Google located at the top left hand corner of the page to see if the topic was covered previously. If you have a new topic or a new twist of a previously posted topic, post your comments here after you have done a bit of preliminary research on the topic. I might just start up a new thread with your commentary as the lead text of the thread. ..Maurice.

Not Telling Bad News: An Ethical Dilemma

In my now inactive "Bioethics Discussion Pages", I presented a scenario which provides a true dilemma with regard to the telling of bad news to a patient. The conflict is between the ethics of a patient's culture and the law and ethics and standards of practice in the "American culture". The most recent responses by visitors to the "Pages" are at the top of the posting. What would be your response? ..Maurice.

Not Telling Bad News

The patient, Mrs. F., is a 66 year old female mother of 4 sons and 5 daughters, who was born in Italy and lived there until 2 years ago when she moved to a northern city in the USA to be closer to 7 of her children who are now residents in America and live not far from each other. The patient is now living with her eldest daughter. The patient’s husband died some 10 years ago. The patient speaks and understands some English but is not at all fluent.

In the past several months, the patient has developed abdominal pain, nausea and a 15-pound weight loss from her usual 150 pounds. She was taken to a physician, Dr. G., the private physician of her daughter. Dr. G. examined Mrs. F, ordered tests and finally requested a gastro-intestinal specialist consultation. With the understanding by Mrs. F. that some tests needed to be done to find out the cause of her pain, she accepted the tests. By these tests including a biopsy, Mrs. F was found to have an ulcer in the stomach that was a cancer. According to the gastroenterologist the cancer could be surgically removed but the patient needed a surgical consult to determine how much of the stomach needed to be removed.

Before Dr. G spoke to the patient, the elder daughter talked to him and requested the diagnosis. He told her about the suspected stomach cancer. She then insisted that he not tell her mother that she had a cancer. She said that in her Italian culture these serious matters belonged to the knowledge and decision of the family and that the patients were not told since they might be harmed by the information through emotional fright and worries and as a consequence might not try to get better. She said she and the rest of the family would be the ones to be informed about the prognosis and treatment and the family would decide and give informed consent for the treatments. She was very emphatic about this directive she gave the physician. Two other family members present at the time confirmed what their sister said. The physician told them that Mrs. F was no longer in Italy and that in this country it was ethically and even legally wrong not to tell the patient what she had and not to get her own informed consent for the surgery and subsequent treatments. After much discussion with the family, Dr. G. suggested he go and ask the patient how much she wanted to know about her illness and what needs to be done. The daughter and family refused for the doctor to speak to the patient about this matter since they feared their mother might infer a bad diagnosis.

What should Dr. G. or any other doctor responsible for this patient do?



---- THE DISCUSSIONS ----


Date: Fri, Jul 16, 2004 1:40 PM From: monicawiest@shaw.ca To: DoktorMo@aol.com

It is true that the context of practice is North America, not Italy. Consequently, the law and ethics that guide clinical practice here must be seriously considered. As such, we cannot forget the principles of patient autonomy, beneficence, disclosure, and consent: the patient has a right to information to make informed choices. The patient also has the right to forego information and I think that the doctor's responsibility is to delicately find out how much the patient wishes to know. Autonomy also means respecting and working with a patient's beliefs and culture as much as possible. Relating to beneficence, would telling the patient cause her more harm? Most commentators don't think so, but if they don't have the same point of reference as the patient, how do they know? It strikes me that the challenge is not what the doctor should do, but HOW she or he finds out what the patient wants. Hopefully this doctor was taught some communication skills. The children may be right and so be it, or they may be wrong and then patient can be informed.


Date: Sun, Aug 4, 2002 12:27 AM From: cody_carlson@msn.com To: DoktorMo@aol.com

At first glance there may seem to be a dilemna here for Dr. G. After a moments thought, however, any such dilemna proves illusory. Mrs. F is the patient, not her family. Dr. G is the physician, not Mrs. F's family. Mrs. F has rights to the information regarding her health. The physician has the right to inform his patient as well. I'm not sure that any mentally stable person would want to be ignorant about their illness. Though one may not want bad news, it's certainly better than no news.

Let us not forget the gravity of the term, "rights" in this context. How often do we confuse rights with sole privilages? Remember that our duties and responsibilities in addition to our privilages give us our rights. Our right to act is not always just something we have the choice of doing, but also duties we must perform and responsibilities we must be held accountable for.

Having to disregard family/cultural tradition may not be easy, but Dr. G's responsibility as a physician is clear.


Date: Tue, Jul 23, 2002 9:59 AM From: mstern777@yahoo.com To: DoktorMo@aol.com

The doctor has an ethical dilemma. Is his responsibility to the patient or to the family of the patient? I would answer that in this case it is to the patient, (sometimes families have bad intentions or are ignorant or both). His obligation is to inform the patient. His skill as doctor to do so in a kindly supportive and understanding way is now put to the test. This meeting may be had with the family present, if the patient wants that.

Ultimately we are all prisoner's of our culture. If it was an ethical requirement to treat people form a different culture in the same manner that they would be treated were they still in that culture well... you can imagine the doctor putting on the voodo feathers and killing a chicken because that the way it was done in the patients old country.

This particular patient is not described as mentally incapacitated in any way only having a language fluency problem. This can be over come with a translator or by bringing in a doctor fluent in Italian. Bad news is bad news and no amount of cover up will make it go away. I believe some studies have show that the not-knowing the sense that things are going badly but nobody is telling me what is going on is more stressful, ultimately, than knowing the bad news and moving on to dealing with it or making peace with the outcome.

Michael Stern


Date: Tue, Jul 2, 2002 8:48 PM From: r_l_eaves@icehouse.net To: DoktorMo@aol.com

Of course the doctor should tell the patient of the situation that she is in...he should have told her before he told her daughter...then there would be no dilemma to begin with!!!!


Date: Tue, Jul 2, 2002 1:44 PM From: JeriNrich@aol.com To: DoktorMo@aol.com

Under the umbrella of veracity and autonomy (self-determination)the patient must be told. There are precious few times that I could think of where the patient should be lied to. Throw in the concepts of least harm/ most good as well as cultural relativism serve to strengthen my resolve. Richard Cherrin

Loss of Normal Human Anatomy , Human Enhancement: Two Poems

Visiting Ojai California today (recognized as an art colony and because of its hidden lush mountain valley geography, a "Shangri-La"), I visited the Ojai Center for the Arts and picked up a copy of *Rivertalk 2003". The booklet contains a number of poems by local folks who enjoy to write poetry. The booklet is published each year and is supported by the Ojai Center for the Arts and Edward C. Raymund. Opening "Rivertalk" I found two poems which say something special about the context of two recent threads on this blog: loss of normal human anatomy and human enhancement. I am reproducing them below for the consideration of my visitors. I would like to read how you interpret these two poems and what the poet's words mean to you in those contexts. This thread is going to be about these poems. (Please go to the appropriate threads elsewhere to write any comments about the subjects in general. Comments on this thread are only to be related to the poems themselves and their meaning to you.)

By the way, there is a developing interest in art and literature courses in medical schools thoughout the U.S. Students practicing interpretation of works of art and literature is felt to build skills useful in discernment of critical features of disease which can lead to more accurate diagnostic conclusions. ..Maurice.

And now to the poems:

A GREAT SORROW

Wild Woman is missing
her belly button today


maybe she lost it last night
when she had that dream
wondering how she was to dress
what costume she was supposed to wear
for the parade< >both the parade
and the missing belly button a puzzle

or maybe it fell off in the afternoon
when another part of her body
was disconnected
and her belly bore no visible mark
of its beginning

how could she find it?
could she put it back where it belonged
make it feel at home again?

not having a belly button
made her feel like a drum
without its beat< >the silence
inside her so empty
not even an echo whispered


---Bettina T. Barrett



AGE SEVENTY-FIVE

comes with a
third arm.
This is for comfort
and convenience,
a little extra
something tucked away,
so that when it rains
one can use it as a sort of
windshield wiper,
to sparkle and alert
possible lacklusterness -
quite definitely not
au fait -

I am thinking about
having mine
in the middle of my forehead
sort of a third eye
with an extension,
and a compass at the end
this way I will always
know where I am going
where the sea is and
what direction
that very large elephant
on the horizon is taking.
I can also direct traffic
in an emergency.

My third arm
will be great
for shaking hands, waving
while walking dogs on leads,
will bestow on me
status, focus, insight.
It will also be
a great conversation piece.
People will always be asking me
where I got my hat.

---Audrey Hargraves

Commercialization of Eggs and Sperm for Reproduction: Is It Ethical?

Here is a thread and comments from my now inactive "Bioethics Discussion Pages" originally posted in 2000. The most recent posting by a visitor today is at the top of the page and the oldest is at the bottom. I would be interested reading from my visitors to this bioethics blog the pros and cons of selling eggs and sperm. ..Maurice.



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A highschool student wrote me about an issue which is worthy of discussion in these days when methods to overcome infertility problems are becoming more popular and sophisticated. In addition, some families are looking for ways to produce smarter and more attractive children. As there has been ethical discussion about selling organs for transplant, there has been interest to consider the ethics of selling gametes.

An interesting point brought up by the student was what happens if the purchasers of the gamete finds that the final product does not meet expectations. Who is to be held responsible and what will be the attitude of the parents about the child?


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Date: Tue, Mar 7, 2000 9:59 PM From: ricababes@hotmail.com To: DoktorMo@aol.com

Dear Dr. Mo,

I am a high school student who was recently assigned to complete a project on a bioethics topic. What first caught my attention was the commercialization of eggs and/or sperm for reproduction, so I researched the topic and would like to share the insight that I gained.

I was really bothered by the fact that selling and "donating" eggs and sperm is actually becoming a business. People are paying up to $150,000 to buy eggs or sperm from supermodels. One sperm bank offers sperm donations from only scientists with an I.Q. of over 135. Healthy, young, Ivy-league donors are being offered up to $50,000 for their "donations." Need some quick cash? I'll bet if your good-looking and score above a 28 on your ACT test, you could get at least $1,000 for your sperm!

What is evolving from this new trend is a market in which people are competing to get the best genes and those on the other end are trying to make the most money. So, what's wrong with that? We are talking about kids here- remember?!

If we allow this to continue, I fear children will become commodities. Many times I have spent large sums of money on something-let's say a new stereo- only to be disappointed. "I spent 200 bucks on that!" Is this how parents are going to react when their child, born of genes from a rocket scientist, comes home with a below average report card or is not as smart as they hoped he/she would be? Children are a miracle of nature and I believe that parents should love their children for who they are, unconditionally. Each person is precious and we should put an end to trying to place a monetary value on genes, children, and life. As the Mastercard slogan goes, "A newborn child who you can love and call your own: PRICELESS."

Here is the question:

Is it ethical to commercialize and sell eggs and sperm for reproduction?



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Date: Thu, Aug 10, 2006 7:12 PM From:livinsobo@earthlink.net To: DoktorMo@aol.com

In response to your question is it ethical to sell your eggs or sperm? That is what America is about, freedoms. We in America can wear what we want, say what we want, and pretty much do what we want as long as we don't hurt anyone in the process. What better place to be, in some countries women do not have rights, people wake up to gunshots and bombs. We live in a wonderful country and are protected by a military that upholds our freedom of choices.

While I think it is crazy to spend $150,000 on supermodel genes in hope that your child turns out beautiful, I personally don't think it is unethical. Think about this, who is the idiot paying for the supermodel eggs, and there is no guarantee your child will be beautiful. As far as the rocket scientist sperm and the child being a brainiac, I am a firm believer that smarts have alot to do with the way one is raised, that old question nature vs. nurture pops into my mind. Many people are quick to pass the buck on why there child is bad or slow but when a child is wonderful they accept the responsibility, well parents need to take a good hard look at themselves and assume responsibility for the good and the bad.

I too, have contemplated selling my eggs, and here is the reason why, I do not plan to have any children at this time and nor do I feel that I would be able to offer a child the kind of home that he or she would need, however there are people out in this world that deserve to have children and can't. Also think about this, donating and receiving eggs can be an evasive process, the parent that goes through taking hormones, drugs, and possibility that it may not take the first go around, deserve it and would probably love that child more than anything.

So next time you are sitting in biology class in front of that state of the art microscope or that great computer that you have at your disposal, think about how that technology has helped you, and while that is on a different level than the topic at hand, that same technology that has helped you in school has helped people have babies, cure certain diseases, and hopefully cure something like AIDS or CANCER. Its all about progress. We can not live in the dark ages.

Sincerely
Future EGG DONOR
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Date: Thu, Jun 26, 2003 9:16 PM From: mistycrims@alltel.net To: DoktorMo@aol.com
I do not feel like this is a good idea because human life should not be used forpersonal gain. But are eggs and sperm seperately human life? I find it interesting that society generally sees prostitution as unethical but may argue "my eggs, my body, my right to sale". I believe this business could lead to more controversial issues. Like, can a woman sale her unborn child? Misty Crims


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Date: Fri, May 16, 2003 4:55 PM From: philosopher@paradox3000.com To: DoktorMo@aol.com
The ethical and moral nature of selling ones reproductive capability are completely arbitrary and specific to both the context and the culture at the time of the trade.

Any pretty woman can go out and seduce an intelligent man to "collect" his sperm, and I would bet a rich man could convince even a beautiful woman to mate and reproduce with him (it's not uncommon). How is this different than selling your cells? It isn't. Is the offspring of such a union less valuable than a union of "true love", of course not.

What is important at this time is that we are so ignorant as to the biological nature of properties like intelligence, beauty, or personality that to try to manipulate them is all but futile.

Why then shouldn't we give people better control over their reproductive power? Why not try and make people smarter, stronger, better? Religious fascists might object based upon their arbitrary beliefs, but we know that when they are faced with the fact that their offspring may be retarded while others will have genius level I.Q.s, their minds will change.

There are objective scientific reasons to regulate some of these new technologies. For instance you wouldn't want a man selling his sperm to millions of women. This would reduce genetic diversity and thus long term survivability. You wouldn't want people to misrepresent themselves and thus their genetic abilities, so smart buyers will use independent third parties to test the value of the genetic donors. Overpopulation is a world wide problem, perhaps we should start testing and licensing parents, too?


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Date: Tue, Mar 18, 2003 8:41 AM From: CurtsT@leb.k12.in.us To: DoktorMo@aol.com
Yes. I believe that it is ethical to sell your sperm or eggs for a profit. They are part of your body and you own them. Also you could be giving them to people who could not use their own eggs or sperm to have a child and want to provide a loving home. Maybe some of the motives behind this are wrong but that dosen't make this immoral or unethical. I do believe that for now it is not acceptable to society but as history has shown society is not that difficult to persude with time.


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Date: Thu, Feb 28, 2002 8:00 AM From: dpmartin@owc.net To: DoktorMo@aol.com
We should do two things. First, we should take care of the children we have. Second, we should minimize the genetic defects in the children we give birth to in the future. If commercialization of eggs and sperm is accomplished in a manner consistent with meeting these goals, then it is acceptable. The recent article in JAMA about the woman who chose to avoid having a child with early onset Alzheimer's disease is, in my opinion, a proper use of genetics in reproduction.


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Date: Sat, Feb 9, 2002 11:47 PM From: lettaylor@pisp.net To: DoktorMo@aol.com
As a Christian I feel that this is wrong. The Designer did not have this in mind when He made humans in His image. While humanity is learning much about life, we will fail the test if we do not learn that it is precious and NOT FOR SALE! I know that the original design was made by One far greater than ourselves and we cannot replicate that design without severe ramifications. Consider the atom!


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Date: Thu, Jan 17, 2002 7:14 AM From: bearmccloud@attbi.com To: DoktorMo@aol.com
NO!!!

It is not ethical to sell sperm. It is natures way of keeping mankind from being overpopulated to make some people infertile. If we were all fertile and all capable of creating children anytime we wanted to then the entire world would be like china is today. Overcrouded and under reasourced.


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Date: Sun, Jul 1, 2001 1:44 PM From: aim_2000@swbell.net To: DoktorMo@aol.com
This was interesting to me. I don't believe that everyone who is purchasing the sperm and eggs are doing so just to have smarter or more beautiful children. Some are doing so because it may be there only alternative. It is difficult to draw the line between allowing those people the ability to purchase gametes, and not the others who are doing it for personal gain. And by the way, just because someone is genetically inclined to be more intelligent does not mean that he or she will be. it takes lots of love and attention on the part of the parents to foster and encourage children in the love of learning.


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Date: Mon, Jan 29, 2001 3:25 AM From: cailab@tin.it To: DoktorMo@aol.com
Hello, we're two students of a high school and we'd like to say our opinion about eggs/sperma donation or sale.We think that selling eggs or sperm is immoral,because it's not a natural way to have children. We mean, there are so many orphans who need to be taken care of that it's useless "build" children in a scientific way. Nowadays man is trying to take control of the world, but we think this is a sort of "upsidedown" of natural order.


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Date: Tue, Jan 9, 2001 3:27 AM From: cailab@tin.it To: DoktorMo@aol.com
We are two students,we are interested about this discussion and we have decided to give our opinion. We desagree with the commercialisation of eggs and sperm.We believe that parents should appreciate their children for who they are without thinking only of their good qualities.They have also toappreciate their defauts because they are "BLOOD ON BLOOD" as a song of Jon Bon Jovi says.


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Date: Tue, Mar 28, 2000 7:38 PM From: sstellje@mesastate.edu To: DoktorMo@aol.com
Dear Dr. Mo: I am a nursing student and I was browsing your site for an assignment for one of my classes. When I read the topic "Is it ethical to commercialize and sell eggs and sperm for reproduction?" I was intrigued. The reason I was intrigued is because I also work in childcare, and every day I see parents and children and the way that they interact. There are so many unwanted, "oops" children in this world that it is heart breaking. I recently had an experience with a young mother who was planning on giving her third child up for adoption. Her two other children both had some sort of disabilities and were adopted out, and she did not want to "deal with" another one. However, when she had her child it ended up being a perfect little girl with no disabilities, so she decided to keep her. When I first read the comment of the high school student who wrote to you I did not think at first that someone would want a "refund" on a child. But, then I remembered this young mother who had no trouble adopting out her other two children because of disabilities and keeping the perfect child. Why wouldn't it be possible? In our world today it is sad to say that I do believe people would try to get a "refund" or even sue somebody because their child did not come out the way they were supposed to. What about the children who are created from the super models, if they are not pretty enough or glamorous when they grow up will the parents be upset? What if the child from the sperm of the scientist ends up having mental disabilities or an IQ below average, will those parents be upset and demand compensation? At first you would think no. However you would then think, did these parents really purchase the sperm and eggs to have a child or a trophy? I would hope it was to have a child, but more often than we would like it is to have a trophy. There are so many unwanted children that need to be adopted to families, that it seems really selfish for these people to spend thousands of dollars on eggs or sperm instead of on adopting and raising a child who really needs a home. I personally have a slim chance of having children, does that mean I should go out and seek the perfect egg so I can have a child? No, for me it means that I should look at the children in this world, this country that need homes and provide that for them. I should spend those thousands of dollars that would have been spent on those eggs and put it towards a child who needs a home, education, clothes, and most of all love.

Human Enhancement in Down Syndrome: Is it Ethical?

The issue of the ethics of human enhancement has so many different examples with multiple considerations that it is fascinating to dwell on that issue. On this blog we have already considered the role of physicians in the general issue of non-therapeutic cosmetic surgery and also the perhaps as yet esoteric use of nanotechnology in human enhancement. As you may have noticed on previous threads here on infant male circumcision, there is much consternation and concern about removal of normal foreskin of the infant’s penis for what purpose. If there is no medical benefit then should this procedure be acceptable? (Please don’t specifically write your opinion regarding circumcision on THIS thread but go to the circumcision thread.)

Another interesting human enhancement procedure to discuss is that of prescribing human growth hormone to children with normal growth hormone levels but of short stature or anticipated short stature because of short stature parents. I hope to go into this issue later.

The human enhancement issue that I would like to initiate in today’s post is the one discussed in the current August 2006 issue of Virtual Mentor “Adding burden to burden: cosmetic surgery for children with
Down syndrome” by Ann K. Suziedelis, PhD. The article starts out with the following:


Expectant parents dream of giving birth to a beautiful, robust and “perfect” baby. In reality this does not always happen. When things go wrong there is sometimes nothing parents can do to ameliorate the condition of their afflicted child. For others, the imperfections are so slight that they barely affect the child’s leading a normal life. It is a specific group caught in the middle of this spectrum—high-functioning children with Down syndrome (DS)—who evoke the ethical question discussed here. That is, is it ethical for parents to subject children with DS to purely cosmetic surgery that offers no medical benefit for them before the children are old enough to give any informed and freely considered assent?


Please go to Virtual Mentor and read the entire article and then return and write your opinions of whether it is ethical to subject a child, without the child’s assent, if not informed consent, to a surgery which may have no medical benefit but which some parents might feel would be in the child’s best interest and I think, perhaps, also in the parents own best interest. I will look forward toward reading your views. ..Maurice.