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The Paradox of Altruistic Gamete Donation and Surrogacy

The various forms of artificial human reproduction are, all of them, problematic; not least because they present all sorts of complex moral and legal issues. And this blog touches on such issues but, before going into the complexity, let us first have a little simplicity.

Let us, therefore, consider what appears to many to be the least problematic forms of artificial human reproduction: altruistic gamete donation and altruistic surrogacy. They are called ‘altruistic’ because they are the freely given gifts of women who seek no profit; women who simply want to do good, and who are under no pressure to do so.

Such an altruistic woman is Anne, a healthy young woman who donates eggs so that an infertile couple can have children. Let's suppose that no monetary exchange is involved, not even in the form of compensation for expenses, which is still a subtle form of exchange. Anne, remember, expects nothing in return from the couple. This is altruism, not commerce. Some people would find her action morally acceptable, even laudable; and they would see no good reason why it should not be considered perfectly legal.

Another such altruistic woman is Marie. Like Anne, Marie is a healthy young woman and absolutely altruistic. Anne acts as a surrogate mother for a couple because the woman who wants to become a mother cannot carry a pregnancy. Again, let's suppose that no monetary exchange is involved, not even in the form of compensation for expenses. Marie allows the use of her womb for mere altruism and expects nothing in return from the couple. Some people would find her action, too, to be morally acceptable; even laudable. This, too, they believe, should be perfectly legal.

Certainly, appropriate forms of regulation would be necessary in the cases of both, Anne and Marie, to anticipate and avoid possible conflicts that just might arise between the parties involved. But, in general, there are not many people who would find the actions of either Anne or Marie to be, in any way, dreadfully, seriously, problematic.

Now, let us imagine another healthy, young, and exceptionally altruistic woman, whom we shall call, for obvious reasons, Annemarie. Annemarie, in this imaginary case, both donates her eggs to, and, acts as a surrogate mother for, a particular infertile couple, the woman of which cannot carry a pregnancy. Annemarie does the same, and is the same, as Anne and Marie. The same: but, different.

Yes, here is the paradox: while some people would approve of the actions of Anne, and of Marie, the actions of Annemarie seem to them to be very different. Because very few people would consider the practice of conceiving and gestating a child with the deliberate intention to give the child away to a commissioning couple, even for purely altruistic reasons, to be either morally or legally acceptable. So, with Anne and Marie: not problematic. Yet, with Annemarie: so problematic.

What is so wrong in the case of Annemarie that is not seemingly wrong in the cases of Anne or Marie? If two actions are individually good, why are they not good when combined together?

The paradox obviously does not arise for those who do not consider gamete donation – that is the donation of either eggs or sperm - or surrogacy, (or both,) to be in any way acceptable. For others, the paradox is there.

Ova are donated with a view to generating children; and if a surrogate mother is needed to complete the process why shouldn’t she be the very same woman who donates the eggs?

Similarly, if an altruistic surrogate mother is doing something good, isn’t she doing something even better if she is also the altruistic donor? Would it be different if Annemarie donates her ova to one couple and acts as a surrogate for a different couple?

We can easily imagine all sorts of permutations and combinations of roles, genders, relationships, number of people involved, etc., between the process of gamete donation and surrogacy. We can easily imagine just how complex and problematic the whole business can become.

In the reality of the world out there, cases are usually much more complicated that those presented here in such a simplified way. But, even as we discuss clear cut simplified cases, sooner or later some contradiction appears; and it points to something seriously wrong with splitting up the normal, and naturally composite, action of becoming the mother and the father of a child.

Those who would defend altruistic gamete donation and surrogacy should, if they are being logical, also defend the practice of generating children with the purpose of donating them to couples. For that is the logic of it all. Somehow, we feel that there is more to this than cold logic; this does not feel right and proper.

And those who have no problems with some form of compensation (be it a fee, or expenses, or whatever) for gamete donation and surrogacy, should have no problem with turning the bringing of a child into this world into a commercial business.

We demand to know: Since when has treating children as commodities to be given is progress?

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Euthanasia is promoted under the disguise of neutrality

Last week, a spokeperson for Fianna Fáil told the Medical Independent that they would not oppose the referral of assisted suicide to a Citizens’ Assembly for further discussion. Delegating the debate to an unelected body means that neither Fianna Fáil, nor any other major party, is not actively opposing the introduction of legislation that could legalise euthanasia and assisted suicide. (1)

In 2017 the Oireachtas Joint Committee on Justice and Equality considered possible recommendations on legislating in favour of euthanasia andassisted suicide. They heard from a number of experts, and the strongest opposition to the introduction of new liberalising laws came from the representatives of the medical profession and of disability advocacy groups. (2)

Des O’Neill, professor of medical gerontology at Trinity College Dublin, said “We have to send out a message to people of disability of whatever age that our impulse is to care, to cure sometimes, to relieve often and comfort always.” (3)

Dr Regina McQuillan of the Irish Association of Palliative Care said: “Suicide is rightly considered a blight on society and there are many efforts made to reduce it. That there are some people for whom suicide is considered appropriate may suggest that there are people whose lives are not deserving of the same level of protection.” (4)

At the end of the hearings, the Committee did not achieve a clear consensus. Accordingly, they did not recommend legislative change. Instead, they urged the Houses of the Oireachtas “to consider referring the issue to the Citizens’ Assembly for deliberation”. (5)

But why should a non-representative body, with no specific expertise, discuss and recommend vicariously, when there was no majority in the Oireachtas Committee in support of the change?

Political parties cannot stay neutral and delegate to others such a critical debate. Even small changes must be opposed or they will have catastrophic effects.

We can learn from the experience of other countries that the legislation on these issues is usually introduced on some limited ground (for terminally ill patients, for instance) but, with time, it becomes more and more liberal. Once the general principle that doctors should not participate in procuring death is eroded, it is difficult to change the trend and go back.

Psychiatrist Mark Komrad has said, “Several governments, in the last two decades, have invited and permitted physicians to transgress the prohibition against killing their patients. … Originally, the class who can be voluntarily killed or helped to suicide was limited to those at the very end of life. However, principles of justice have made it very difficult to limit such procedures to that category of people. The more experience a country has with such practices, the more the horizon of eligibility has expanded far beyond extreme end-stage cases. … The so-called “choice“ that is offered to the suffering to end their lives is a pseudo-choice, filtered through a physician’s own values, and commonly forced, by having very limited choices in other domains — economics, social support, healthcare, etc. It is unjust, and therefore impossible, in a democratic society, to limit these procedures to some — like the terminally ill — but refuse it to others — like those with chronic physical and psychiatric disabilities. Yet, it signals that chronic disability and its sufferings might constitute a “life not worth living.” (6)

The pressure on doctors to support and participate in euthanasia and assisted suicide is growing everywhere.

In October 2018, at the General Assembly of the World Medical Association (WMA), representatives from Canada and the Netherlands attempted to change the WMA code of ethics, which has always condemned the participation of physicians in procuring death through direct euthanasia or providing drugs for suicide. (7)

During the debate, all sort of euthanasic practices were rejected and eventually the proposal has been withdrawn, reiterating the WMA’s long-standing opposition to procuring death.

This debate, though, continues on national level.

The Royal College of Physicians (RCP), in the UK, has recently dropped its opposition to assisted dying in a surreptitious manner that has attracted strong criticism. They are now neutral on the issue and will not officially engage in public discussions but how they have arrived at this position appears to be despicable. (8)

In 2014, 57.6% of the RCP membership opposed a change in the law that would legalise assisted suicide. In January this year, after announcing the third poll on this topic among its members since 2006, it was decreed that a 60% majority was needed to stop changing the RCP position to non-opposition. This means that even if 59,9% were against the change, it would have occurred nonetheless. Such a majority was even more difficult to achieve as three options were given (yes, no or neutral), while the previous vote was binary (yes or no).

A group of members of the RCP have challenged them in court, arguing that “the use of a ‘super-majority’ vote on such issues is without precedent in professional organisations in the UK. They have said that it appears to be a tactical move to give a strong boost to the campaign to change the law on assisted suicide. The largest euthanasia lobby group in the UK has previously identified the opposition of medical bodies as a key obstacle to changing to law. Two well-known patrons of this organisation, and active campaigners for legalising euthanasia, are on the RCP Council – the internal body driving the RCP poll.” (9)

In spite of the robust protestation, the poll was carried out in February and found that 43.4 pc were opposed adopting a pro-assisted suicide policy, 31.6 pc were in favour and 25 pc were neutral. This means that even though the majority of the voters were against, the Royal College of Physicians will now be neutral on the matter.

In this case, as with the Joint Committee referral to the Citizens’ Assembly, we see that even when there is no clear majority in support for a significant change, certain issues are considered so important by a minority that they have to be promoted, under the disguise of neutrality, until they are accepted.










New video: Do restrictive abortion laws reduce the abortion rates?

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More restrictive laws contribute to reduce the incidence of abortion.

A new study found that 70% of unintended pregnancies end in abortion in countries where it is broadly legal, while in countries where abortion is restricted, this happens only in 50% of the cases.

A new multi-authored study ( ) published by The Lancet medical journal investigated the occurrence of abortion in unintended pregnancies world-wide. By unintended they mean pregnancies that occurred sooner than desired or were not wanted.

The researchers developed a new statistical model that jointly estimates unintended pregnancies and abortion.

It should be highlighted that four of the eight authors of the article are from the Guttmacher Institute, historically associated to the US abortion provider Planned Parenthood. Funding was provided by pro-choice organisations such as the Bill and Melinda Gates Foundation.

Nonetheless, the study proves what pro-life groups has always claimed: more restrictive laws contribute to reduce the incidence of abortion.

The study divides all the countries in the world in two categories: where abortion is restricted and where it is “broadly legal”. By restricted they mean that it is prohibited, permitted to save the life of the woman or to preserve physical and mental health. By broadly legal is intended where abortion is available on request or on broad socioeconomic grounds.

Interestingly, Ireland is listed among those countries where abortion is available on request while the United Kingdom is among those where it is permitted on socioeconomic grounds.
( )

Two results are particularly significant: in the period 2015-19, in countries where abortion is broadly legal, the abortion rate per 1,000 women aged 15-49 was 40. The rate was 36 where abortion is restricted.

In the same period, 70% of unintended pregnancies ended in abortion in countries where it is broadly legal, while in countries where it is restricted, this happens only in 50% of the cases.

Those two results prove that where more restrictive laws are in place, both the abortion rate and the number of unintended pregnancies ending in abortion are lower, compared to countries with more liberal abortion regimes.

There is no simple cause and effect between legislation and those two rates, as they are determined by a complex number of factors (socioeconomic conditions, quality of the health system, culture, etc.), but the association is clear.

The study also divided countries into three groups, according to their income as calculated by the World Bank, and found that the annual unintended pregnancy rate is 34 per 1,000 women aged 15-39 in high-income countries, 66 in middle-income countries, and 93 in low-income countries. It is not a surprise that unintended pregnancies are inversely proportional to the country income. Nonetheless, both the abortion rate and the proportion of unintended pregnancies ending in abortion is higher in middle-income countries, than in low or high-income countries. In other words, even if in poor countries there are more unintended pregnancies, those pregnancies don’t end in abortion as much as in middle-income countries.

The limit of this world-wide studies is that they group dozens of countries that might have one element in common (abortion legislation, in this case) but too many other factors that cannot be taken into consideration.

In the study the authors make some claims that are contradicted by their own results. For instance, they say: “We found no evidence that abortion rates were lower where abortion was restricted”.

In saying this, they refer not to the figures that I have quoted above. Instead, they have to exclude India and China, so that abortion rate in countries where abortion is legal decreases from 40 per 1,000 women to 26 per 1,000 women.

But why should those countries be excluded? Because they “skew” the results and the authors of the study are not happy with that.

In a quite unreasonable explanation they say: “We found that China and India, which comprised 62% of women who were at reproductive age in countries where abortion was broadly legal, skewed the averages in countries was broadly legal. Averaging among all other countries where abortion is broadly legal, abortion rates were higher among countries where abortion was restricted.”

( )

That is quite astonishing. Of course, if you exclude 62% of the population, the results will be different but that is not a good reason to do it. Manipulating a sample to achieve a preferred result is not science.

Yes, even this new study from pro-choice researchers confirms that abortion rates are lower where abortion is more restricted, unless you want to ignore the two most populated countries in the world.

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The purposes of medicine

Medicine has three main purposes: to prevent and cure diseases, and to take care of patients. It is not simply a science but also a practice inspired by ethical values. So, what is the difference with the other sciences? Take for instance mineralogy. It is the description of the chemical and physical properties of minerals. Medicine, instead, aims not simply at describing what a human body is but it is also based on the assumption that there is a natural order, which we call health, and the purpose of the medical practice is to keep or to restore this order. There is an intrinsic good (health) that we discover through science and we preserve and reestablish through practice.
For instance, anatomy and physiology tell us what is the proper function of the eyes, i.e. to see. This is not simply a description but it also contains a prescriptive element because the ideal eye is also the normative model that the doctor uses when she acts to keep the patient’s eyes healthy or to prevent their diseases.
This understanding of medicine doesn’t require a particular religious faith but it is nonetheless intrinsically ethical. It is inspired by a certain conception of the good (health) that we find in human nature through the correct use of reason. The principle of “do not harm”, which has guided health care since ancient times, has the form of an ethical imperative.
Not everything that happens (or might happen) in a hospital or a clinic is medicine, unless it aims at preventing and curing diseases, and also at the same time at taking care of patients. Not all interventions that alter our bodies surgically or chemically are medicine, even if a scientist (medical expert) might be involved. Getting your facial features surgically changed to look more like your music idol is not medicine. Killing the unborn because she was unplanned or is disabled is not medicine. Augmenting your muscles through drugs to win a weightlifting contest is not medicine. Removing a perfectly healthy organ to adjust your body to your perceived gender is not medicine. Facilitating suicide is not medicine.
In all these examples a certain level of scientific knowledge is necessary but they lack what makes medicine more than a science: the ethical value of health. They might involve someone who has a proper knowledge of the human body but his purpose, in these examples, is not to restore or preserve the good of the functioning body. They are instances of scientific techniques without good and true medical ethics.
There is a growing pressure by certain ideologies to transform medicine, which is necessarily led by an objective good that we call health, into the satisfying of the subjective requests and choices of the patient. If bodily autonomy (my body, my choice), rather than health, is the ultimate value then there is no reason why doctor should not amputate a healthy arm or leg, when requested, or administer a dangerous substance, for recreation or self-harm or death. Without the guiding principle of health, practitioners become simply the executors of someone else’s desires. Obviously, people can do what they want with their bodies but this is not medicine.
There is no good medicine without ethics. Hospitals don’t need to be under church or religious influence but they cannot exist without an ethos, without values. When their core value is not health – an intrinsic good indicated by human nature- they don’t serve medicine anymore but trends, ideologies, business.

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The future of the world population

The world population will peak and then decline by the end of this century, according to a new study. Countries with low fertility rates will suffer economically.
A new major study published by The Lancet, one of the most prestigious scientific journals, presents a new model to forecast the changes in the world population.
The study projected the global population to peak in the year 2064 at 9.73 billion people and then decline to 8.79 billion by the end of the century. In 2017, the world population was estimated at 7.64 billion but, the study claims, this figure could go as low as 6.28 billion by the end of the century, if certain measures will be implemented.
The paper forecast population changes from 2018 to 2100 for 195 countries and territories and found that all regions, except sub-Saharan Africa, will have substantial population declines in the next eighty years.
These estimates invalidate some of the predictions based on other models, particularly the model from the United Nation which is the most commonly quoted. The Population Division of the Department of Economic and Social Affairs of the UN Secretariat (UNPD), in their last forecast claimed that in the year 2100 the global population will be 10.88 billion and the sub-Saharan Africa will be 3.78 billion.
Demographic forecasts are based on a complex series of variables but there are two key factors at stake: the fertility rates in sub-Saharan Africa and what happens to countries with fertility levels below replacement rate. 2.1 children per woman is considered the miminum rate for generational replacement. When the total fertility rate (TFR) goes be below 2.1 some countries experience declines followed by upturns, while others stagnate at very low levels.
The study developed 5 different scenarios. The “reference scenario” is the one more likely to happen, in their view, and it is the one I will refer to. Other four possible alternatives are also presented and they reflect two faster and two slower trajectories for key drivers such as education of women and access to birth control.
For instance, the Irish population was 4.86 million in 2017. It will peak 5.77 in the year 2057 and decrease to 5.44 by the end of the century, according to the reference scenario. Nonetheless, it might go well below the current figures in the fastest pace scenario. (In some countries the decline will be dramatic. Italy will go from 60 to 30 million, Spain from 46 to 23).
The global total fertility rate (TFR) will drop below the replacement level (2.1 children per woman) in 2034, reaching 1.66 in 2100. By then, 183 out of 195 countries will have a TFR below replacement level.
Sub-Saharan Africa, which is the region with the highest TFR in the world, will stay above replacement level until 2063 and then drop.
The only regions forecast to have higher population in 2100 than currently are sub-Saharan Africa, north Africa and the Middle East.
This means that after a peak, the global population will likely continue to decline, even in the next century.
All five scenarios forecast substantial changes in the age structure of the population. People will live longer and the proportion of adults will also increase.
The number of children under 5 will decline from 681 million in 2017 to 401 million in 2100 (-41%) while individuals over 80 will increase form 141 million to 866 million.
In 1950, 25 births occurred for every person turning 80. In 2017 the number was 7 and in 2100 there will be only one birth for every 80-year-old person.
There will be significant differences between countries, according to their fertility rates.
In Ireland, the over 65 will account for about 30% of the population by the end of this century. The Italian figure is projected to be 37%. In Nigeria, instead, where the general population is expected to grow from 206 to 790 million, the over 65 will be 18.6% of the total. In other words, Nigeria like many countries of that region, will be a nation of mostly young people, in contrast to the “old” European countries.
In society experiencing such demographic contractions, the whole health and welfare system has to be reconsidered.
“Although good for the environment, population decline and associated shifts in age structure in many nations might have other profound and often negative consequences”, the article says. “In 23 countries, including Japan, Thailand, Spain, and Ukraine, populations are expected to decline by 50% or more. … These population shifts have economic and fiscal consequences that will be extremely challenging. With all other things being equal, the decline in the numbers of working- aged adults alone will reduce GDP rates”.
In the eighty years, India will have the largest working-age (over 15) population of the world, followed by Nigeria and China. Inevitably, some of those will emigrate to countries where there is more demand for labor forces.
On the other hand, countries going through a demographic decline will also lose economic and geopolitical power. This is why population forecasts are essential to plan and manage public policies, but they are also crucial for business and NGOs.
In order to estimate the need for services, for investments, for the allocation of resources, it is vital to know the characteristics of population in short-term and mid-term scenarios.
The Lancet study suggests four options to stop the “demographic winter”: increasing the fertility rate creating a supporting environment for mothers, restricting access to birth control and abortion, increasing labor force participation, promoting immigration.
A debate about which ones of these options are preferable is urgently needed.

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This is really interesting. They colorized a photo by overlaying some lines in a grid and ONLY adding color to the lines but oversaturating the color. The rest of the image is black and white.

The result is that at a distance or in the thumbnail it just looks like an ordinary color photo. It is only when you look up close you notice what is going on.

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#GospelToday (Mt 13:24-30)
He proposed another parable to them. "The kingdom of heaven may be likened to a man who sowed good seed in his field. While everyone was asleep his enemy came and sowed weeds all through the wheat, and then went off. When the crop grew and bore fruit, the weeds appeared as well.

The slaves of the householder came to him and said, 'Master, did you not sow good seed in your field? Where have the weeds come from?'

He answered, 'An enemy has done this.' His slaves said to him, 'Do you want us to go and pull them up?'

He replied, 'No, if you pull up the weeds you might uproot the wheat along with them. Let them grow together until harvest; then at harvest time I will say to the harvesters, "First collect the weeds and tie them in bundles for burning; but gather the wheat into my barn."'"

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