Biomedical Ethics: Voluntary Active Euthanasia

Voluntary and Active Euthanasia

In Voluntary Active Euthanasia (http://philpapers.org/rec/BROVAE), Dan Brock discusses the controversy surrounding the issue of physician assisted suicide and how is it possible to support it while opposing voluntary active euthanasia and whether there is a moral difference between both of them.  Furthermore, Brock means to enlighten the argument about physician assisted suicide establishing what he believes are the best arguments for both conflicting sides and underlining the moral issues involved in the conflict. For instance, whether euthanasia is unjustified killing and, if so, whether physicians can be convinced to accept the practices despite their opposing moral views.  Brock also argues, in a third section, the cost-benefit ration of adopting voluntary active euthanasia and concludes his argument by favoring a change in policy to adopt physician assisted suicide, obviously with some limitations, to help competent terminally ill patients to end their agony and alleviate their pain.

Brock’s main argument supporting voluntary active euthanasia and physician assisted suicide relies on personal self-determination and autonomy. He believes that competent patients ought to have the freedom to weigh the benefits and burdens of their own life, establish its’ value and decide whether their life is truly worth living. Brock argues that both, physician assisted suicide and voluntary active euthanasia, are very similar to each other although physician assisted suicide is endorsed in recent bioethics and not euthanasia. Typically in physician assisted suicide a patient terminates his or her own life with a lethal dose of a medication provided by the physician. On the other hand, in euthanasia the physician directly applies the lethal dose on the patients, many of which are unable to perform that tasks themselves. The only difference lies on who applies the lethal dose but the final decision is always the patients.’  Thus, the same morals exist in both cases and Brock advocates that both cases rely on the consent of the patient. The choice rests fully in the hands of the patients. Why, then, does the public or legal policy permit one such practice while condemning the other? Why should anyone else deny a patient the right to die with dignity?

On the contrary, the opposition of physician assisted suicide and active euthanasia claim that whether patients’ self-determination and autonomy supports such practices it is nevertheless still ethically immoral and impermissible to allow such practices. In addition, a second argument claims that even when physician assisted suicide or euthanasia is not really morally or ethically wrong, the public and legal policy should never to permit it. Conservative people believe that allowing euthanasia or physician assisted suicide would influence a bleak murderous trend and lead society to morally and ethically decay into a “society of death.” However, if we consider a case of a patient with a terminal case of thyroid gland cancer and all the agony that such patients go through in the terminal state of their lives, wouldn’t it be immoral to force such patients to practically go through hell on earth? Since when is human torture ethical?

 Brock advocates change in current policy to allow voluntary active euthanasia for competent patients. I personally believe that each individual is in charge of their own life and should, therefore, be allowed to decide how to die. “Life, liberty, and the pursuit of happiness” are fundamental rights in American society. Therefore, each individual ought to follow his own autonomy and decide what is in his or her own best interest. Who is more capable to evaluate whether your life is worth living other than yourself?

Finally, Brock concludes his argument by supporting voluntary active euthanasia. Physicians have to be involved in the process, one way or another, but ought to seek only for the best interest of the patient. Ideally, the physicians involvement is necessary and preferable to counter possible social disapproval and because someone has to be accountable and responsible for exercising such authority. Even though the issue seems highly controversial at this time, I believe there will be a time when we, mankind, truly understands one another, including our pain, and sympathize with the practice to alleviate agonizing patients and provide them with a dignifying death. Ancient Greeks always believed that “to die with glory [and dignity], is to live forever” and nowadays people highly regard how they will be remembered upon their deaths. In extreme cases, people have gone as far as launching their bodies to the universe. Why should any of us force others to die without dignity and wander endlessly in agony for days, weeks, sometimes even months or years? Voluntary active euthanasia lends itself to a practical application. Perhaps in the near future, there will be drastic changes to adopt such practice and allow fellow persons do die with dignity and respect, of course as long as the practice of euthanasia is closely monitored and never abused.

Poverty and Parasites in the U.S Border Regions: Poverty Bridges Parasitic Disease into the Rio Grande Valley (RGV)

Introduction: Poverty Borne Parasitic Diseases

The United States of America ranks among the most prosperous countries in the world and the mortality rate of parasitic diseases has immensely reduced over the twentieth century. Nonetheless, a high prevalence of parasitic induced diseases, referred to as the neglected infections of poverty, remain in divergent areas of the United States where poverty is common. Poverty in the United States is focally distributed into a few defined geographic areas of which the border regions of the United States and Mexico are most relevant to Americans living in the Rio Grande Valley (RGV). The Rio Grande Valley, approximately, allocates an estimated population of 1, 100, 000 people, the majority of which are Hispanic, and many of these border communities possess substandard and insubstantial housing conditions which enhance the exposure, infection and transmission of parasitic diseases including but not limited to Cysticercosis, Chagas Disease, Dengue and Leishmaniasis among others which prominently affects the Hispanic population in the area. Roughly, 20.6% of the Hispanic population live in poverty and, hence, are detrimentally exposed to acquiring parasitic diseases. Therefore, serious precautions must and ought to be enforced to prevent the contamination of parasites and their successful reproduction such as treating contaminated patients, administering active surveillance, acquiring vector control, adopting hygienic approaches to improve housing conditions and further research and development of preventive vaccines to improve the treatment of Cysticercosis, Chagas Disease, Dengue fever and Leishmaniasis (Hotez).

Cysticercosis

Cysticercosis is among one of the most prevalent parasitic diseases in the United States and Mexico bordering regions with an estimate of in between 41,400 and 169, 000 cases. Cysticercosis is acquired by ingesting the eggs of Taenia solium, the pork tape worm, which are defecated near the households and families exposed areas. Children are often common host for this parasite because of their lack of hygiene and their young tendency to place their hands in their mouths which facilitates the transmission of Taenia solium eggs into humans. Poor living conditions and a lack of hygiene drastically increase the transmission rate of Taenia solium. Cysticercosis, similarly to other fecal–oral-transmitted diseases, can be spread either directly from person to person or through contaminated food. Persons infected with the adult Taenia solium tapeworms are typically asymptomatic and may not be aware of their infection or of the potential risk to themselves and the transmission to others. If hygiene is poor, transmission of eggs may occur more readily, particularly within households where repeated opportunities for exposure exist among family members. In addition, Cysticercosis can also be acquired by ingesting raw or undercooked pork. Thereafter, Taenia solium is responsible for serious illness and even death in certain cases among which neurocysticercosis, when the larvae invades the central nervous system, yields the most serious pathology. Currently, this condition is the leading cause of seizures, epilepsy, and other neurological disorders among the United States-Mexico borders and presumably accounts for nearly 10% of seizures presenting to the emergency rooms in border cities. Hence, it should be seriously considered to establish cysticercosis as a nationally notified disease and implement public health response to cases of cysticercosis. Such a response should include establishing surveillance, screening, for the disease and required reporting of cases. Upon the discovery of a cysticercosis case, follow-up and testing of household members and other close contacts should be conducted to identify tapeworm carriers, treat them and remove their infection as sources of continuing future transmission (Eberhard).

Vector Transmitted Diseases: Chagas Disease, Dengue Fever and Leishmaniasis

            Furthermore, a vast divergent number of vector borne parasitic diseases such as Chagas disease, Dengue fever and Leishmaniasis are enhanced by poor living conditions like housing without plumbing, air conditioning, or window screens. A vector refers to any agent that acts as a carrier or transporter for an infection. Unfortunately, more than 30, 000 households in the border as well as a vast number of mobile homes have been estimated to qualify as potential refuges for vector and host interaction and the consequent parasitic reproduction, according to studies conducted by A.K, Glasmeier.

            Chagas’ disease, for example, is an infection caused by the presence of Trypanosoma cruzi transmitted to humans by the feces of Reduviidae, also known as “kissing bugs,” when they feed on the blood of humans. Kissing bugs serve as vector, transporting Trypanosoma cruzi from one host to the next as it feeds on blood. On the other hand, transmission of the infection also occurs via vertical transmission from the mothers’ placenta to her offspring, via blood transfusion, organ transplants, and ingestion of triatomine-contaminated food or drink in the most part. Chagas’ disease is characterized by having two stages, an acute stage and a chronic stage. During the acute phase of infection, the multiple waves of trypomastigotes invade host cells and damage them, thus, resulting in fevers, neurological disorders as well as heart failure

            On the contrary, the chronic phase of infection is characterized by a slower onset of symptoms although it might affect intestinal muscles and heart muscles, eventually leading to heart failure and death. Substandard housing in the bordering regions of the United States like the Rio Grande Valley (RGV) bridges vectors and, in this case, Trypanosoma cruzi to invade an altogether prosperous country like the USA. The implementation of vector control and eradication of vector via insecticide can eventually lead to the eradication of the infection. However, Trypanosoma cruzi is able to utilize other mammals as reservoir host, a host that serves as a source of infection and potential re-infection of humans and as a means of sustaining a parasite when it is not infecting human’s in whom the parasite causes a lower pathology, making the control of Chagas’ disease infinitely more difficult (Southern et al).

In addition, a higher quality in housing positively correlates with a lower rate of infection of the Dengue fever, vectored by mosquitoes. Dengue fever in the United States is not as prevalent as it is in Mexico, for instance, because of the superior dwellings which the Americans inhabit. Nonetheless, a cross- sectional survey in of Brownsville, Texas and Matamoros Tamaulipas, Mexico detected that a 2% of the Brownsville population is recently infected with Dengue compared to a 7.3% of Matamoros’ residents and further provided with evidence to support that, time ago, even a 40% of Brownsville residents suffered of Dengue. Common factors among the infected Brownsville population include a low weekly family income, as well as the lack of air conditioning and inadequate draining system in the streets all of which together contribute to a poor housing environment (Hotez).

            Finally, Leishmaniasis is an infectious disease that is extremely recognized as a concomitant of poverty with high rates of morbidity and mortality in addition to a vast geographical distribution. Poor environmental sanitation, detrimental housing conditions and proximity of domestic animals are imperative factors underlying the cause of the infection. Leishmaniasis can be transmitted by direct contact with domestic animals like cats, zoonosis, and vertically transmitted from mother to offspring which is why pregnant women are told to avoid changing the cat glitter. Leishmaniasis comprises two major diseases, the Cutaneous Leishmaniasis form (CL), which can heal spontaneously but leaves despicable disfiguring scars and the more dangerous visceral Leishmaniasis (VL), which can be fatal if untreated (Alvar, Yactayo and Caryn).

Conclusion: Annihilating Poverty Induced Parasitic Diseases

            Despite of the improvement of living conditions and the consequent decrease of neglected infections of poverty in the United States there still remain areas in the country like the border regions which possess a high prevalence of infection where policy needs to be implemented to limit the transmission, reproduction and to seek the possible eradication of neglected infections of poverty diseases. According to Peter J. Hotez, estimates of a preliminary disease burden of the neglected infections of poverty identifies tens of thousands, or in some cases, perhaps even hundreds of thousands of poor Americans that host these chronic infections, which readily represent some of the greatest health disparities in the United States. Consequently, specific policy recommendations such as active surveillance (including newborn screening) to ensure accurate population-based estimates of the disease burden; as well as epidemiological studies to determine the extent of the transmission of Chagas’ disease and other infections; mass or targeted treatments towards infected individuals or populations; vector control; maintenance of a hygienic living environment; education of the affected population to enhance their opportunities to avoid or limit their level of infection and, lastly, research and development for new control tools including improved diagnostics and accelerated development of a vaccine to prevent or annihilate poverty induced parasitic diseases are a few of the many options available to improve the life of residents of unprivileged areas, in this case residents of the border regions of Mexico and USA.

The Controversy of Evolution

Evolution is a fundamental component of the biological sciences as well as one of the most controversial scientific theories. On the one hand, evolution simply refers to the change of a population over time. Therefore, the theory of evolution advocates that humans share a common ancestry with other organisms and differ from such organisms due mainly to natural selection and descent with modification, that is the natural process that cause change in traits of an organism and passing down these altered traits to their offspring, both processes which will be discussed in more detail in a future blog.

However, the idea of a drastic change over long periods of time contradicts the religious beliefs that God created men and women as they are today. The theory of evolution is highly accepted in most industrial countries, yet, it remains a controversial issue in certain countries, including the United States, with the main opposition coming from religious groups that advocate “creationism.” Creationism, on the other hand, refers to the belief that the world as we know it, particularly the complexity that is evident, can only be explained by supernatural forces. In simple terms, creationism indicates the belief that God created the world.

The conflict between advocates of evolution and advocates of creationism resulted in the Scopes Trial, a landmark case in 1925, in which a biology teacher, John Scopes, was charged with violating Tennessee’s Butler Act which prohibited “to teach any theory that denies the Story of the Divine Creation of man as taught in the Bible, and to teach instead that man has descended from a lower order of animals.” The Scopes “monkey” Trial was a fierce contest between the prosecutors represented by William Jennings Bryan, a three time presidential Democratic candidate, and Clarance Darrow, the defense attorney, who represented Scopes. Thus, the Scopes Trial drew intense national attention as the theological battle between advocates of science and fundamentalist.

Scopes was found guilty under Tennessee law but the verdict was overturned on a technicality. In 1968, nonetheless, the Supreme Court of the United States ruled in Epperson v Arkansas that “such bans contravene the Establishment Clause because their primary purpose is religious” and, therefore, allowed schools to teach evolution as we learn it today.