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Michael Cook

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Autonomy and aiding self-harm

​It’s very rarely good medicine to encourage a symptom of disease, especially one that leads to harm. I don’t help raise a patient’s temperature when they have a fever. I treat the infection and to keep the temperature from going up to dangerous levels.
In every case of cutting and self harm that I saw in my practice, the several girls and one boy had already been the victim of sexual abuse and were also abusing alcohol or drugs. The cutting was a symptom of depression, post-traumatic stress and the victimization that started the cascade.

And yet, the Journal of Medical Ethics has published an article arguing that since cutters are going to cut, doctors should aide them by providing sterile knives or razors. 

The Journal  is actually a forum for public arguments on controversial topics in bioethics, rather than a policy manual or review of facts and best practices. However, far too often the subjects are treated with respect and support those same controversial ideas. 

The online bioethics newsletter, Mercatornet, disputes this normalization of pathology and outlines the history of support and opposition to the concept of “safe” self harm.

Indeed, the argument for limiting harm is often given as the reason for elective abortion, physician assisted death and other forms of euthanasia.

Please, apply the suicide or cutting to illegal drug use. Does the rationale follow through? If a person is only happy after heroin, should we assist him by allowing and providing a cleaner, more pure product – as well as the needles so many State laws have made possible?

Cook sarcastically sums up with an imaginary Tweet:

“Bioethics is broken. Doctors respecting patients who make really BAD decisions. All because of AUTONOMY. DUMB!!! Back to human dignity!!!” 

I have long described Bioethics as “the formal study of who we can kill.” Now, we can add, “and aid in harming.”

Confusions About Totipotency: Stem Cells Are Not Embryos (Updated)

Dr. Maureen Condic explains why reprogrammed stem cells are not embryos – an “organism” is organized.

Totipotent zygotes are distinct from pluripotent or even plenipotent stem cells because they undergo development. The ability to both produce all cell types and to organize them into a coherent body plan is the defining feature of a totipotent human organism.

via Confusions About Totipotency: Stem Cells Are Not Embryos | Public Discourse.

Update: The original article by Dr. Condic is available by pdf at http://online.liebertpub.com/doi/pdf/10.1089/scd.2013.0364

Hat Tip to the bioethics newsletter, BioEdge, and Michael Cook http://www.bioedge.org/index.php/bioethics/bioethics_article/10888

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