Euthanasia in Quebec?

Quebec legislators are reportedly within days of passing a law that would permit euthanasia for competent adult patients with incurable disease which causes constant and unbearable physical or mental suffering. The euthanasia-related portion of Bill 52 (an English-language copy of which can be download here) seem modeled on euthanasia laws in Europe, in that it requires a diagnosis of incurability rather than of terminality, and explicitly ties access to euthanasia to suffering. A person is eligible to receive a physician's aid in dying only if he or she "suffer[s] from an advanced state of irreversible decline in capability; and suffer[s] from constant and unbearable physical or psychological pain which cannot be relieved in a manner the person deems tolerable." The term "aid in dying" is not actually defined in the bill, presumably in order to leave methodology in the hands of physicians.

Euthanasia is illegal according to Canadian national law, and it's not clear that the Quebec provincial law's alternative reference to "aid in dying" will skirt that national prohibition. Parti Quebecois officials are reportedly thinking of simply asking Crown officials not to prosecute euthanasia within Quebec after the law passes.

The bill covers a great deal of ground in addition to the euthanasia innovation. It creates a provincial commission to gather information on end-of-life care, establishes a regime for the creation and registration of advance directives, and addresses the provision of hospice and palliative care.

The bill has attracted a fair bit of high-profile opposition from groups of physicians, from the Catholic Church, and from some bioethicists. Here's a piece on the slippery-slope argument ("Soon we'll be killing children and the demented, just like in Belgium") being advanced by prominent conservative Canadian bioethicist Margaret Somerville.

Bad Argument Linking Belgian Euthanasia With US Death Penalty

Eugene Kontorovich (Northwestern Law) has penned an egregious argument over at the Volokh Conspiracy. Go read it, if you're entertained by egregious arguments. In sum, it goes like this:

In Roper v. Simmons (2005) the Supreme Court found unconstitutional the execution of persons who had committed their crimes while under 18. In doing so, they "caved in to pressure" from Europeans who opposed the death penalty. Indeed, the court "cited the European position as support for its conclusion." Part of the court's reasoning was that juveniles were "too immature to understand the consequences of their decisions, or the meaning of life and death." But now Belgium is permitting juveniles to decide to have themselves euthanized. This proves that Roper misread the European's belief system. It wasn't one of "paternalistic concern for youth."

"Rather [Kontorovich continues], a system that permits the euthanasia of innocent 12 year-olds but not the punishment of guilty 17-year-olds is one that exalts autonomy without culpability....So it comes out that the juveniles cannot really make accountable decisions when it comes to killing people, unless it is themselves. Or to put it differently, Belgium will not hold children responsible when they hurt others, but gives them free license to hurt themselves."

All of which goes to show you that the US Supreme Court shouldn't pay attention to what other countries do, because they're different from us. And because the Supreme Court misunderstood what other countries stand for, Roper should be overruled.

I feel a bit unclean picking up this rotting fish of an argument, so I'll summarize its major faults quickly:

1)   Roper mentioned, but was not based on, the broad consensus of other countries that juveniles shouldn't be executed. "The opinion of the world community," wrote the court, "while not controlling our outcome, does provide respected and significant confirmation for our own conclusions."
2)  The Roper majority did not get the idea that juveniles were immature from Europe, but from developments in the Supreme Court's own death penalty jurisprudence and that of many states, which were in turn based on ample expert psychological testimony about juvenile judgment. Read the opinion and see. 
3)  A system that lacks capital punishment for juveniles is not, on that account, a system that does not permit "the punishment of guilty 17-year-olds." It is not actually constitutive of the idea of "holding someone responsible when they hurt others" that you must kill them.
3) The Belgian law doesn't "permit the euthanasia of innocent 12-year-olds" unless they are terminally ill and in untreatable pain, and unless they are deemed competent to make the decision by a physician. And their parents have to agree! So Belgium does not give children "free license to hurt themselves."

Sorry, Eugene. The fact that Belgians now approve euthanasia for terminally-ill, competent, suffering children who request it (and who get their parents' permission) doesn't actually give Americans a reason to execute juvenile offenders. I'm baffled that anyone thought that it did.

Belgium Passes Law Permitting Voluntary Euthanasia for Children

Belgium has become the first country to permit euthanasia for children. Amendments to the country's 2002 euthanasia statute will now permit competent terminally-ill children in a "medically hopeless condition of constant and unbearable physical suffering" to request euthanasia. For the request to be honored, a medical professional must deem the child mature enough to understand the meaning of the request. The child's parents or guardians must also approve. A Google-translation of the text of the amendment is here.

In January, the Parliamentary Assembly of the Council of Europe voted to condemn the Belgian Senate's approval of the measure. The measure also attracted the opposition of a substantial number of Belgian pediatricians, 170 of whom signed a petition urging delay of passage of the law. But the Chamber of Representatives has now approved the measure (86 to 44 with 12 abstaining), and King Philippe is expected to sign it.

Ventilating the Dead: Canada Update

Robyn Benson, who has been brain-dead--which is to say, dead--for the last six weeks, was disconnected from ventilation after giving birth, via c-section, to a premature but reportedly healthy son. Her husband was understandably overwhelmed at the prospect of burying his wife just as his new son arrives. It's as hard a thing as I can imagine.

The article I linked is headlined, "Brain Dead B.C. Woman Dies After Giving Birth to Son," but in fact she died weeks before giving birth to her son. It ends by saying that she was "kept alive for six weeks so the couple's child would have a better chance of survival...." But in fact her dead body was kept ventilated and connected to various medications for that reason. This kind of confused use of language is rampant in the coverage.

My previous post on the case is here.  

Ventilating the Dead, More Updates

The following message was posted on the Facebook website, Keep Jahi McMath on Life Support, less than an hour ago (boldface added):

Thank you for all your prayers, thoughts and good wishes for Jahi, her family and others helping them. Jahi is Gods own child, she is being properly taken care of and loved by many. She is stable and she is much better in the new facility. Keep the love and prayers going. When there's any eventful information on her continuous healing, you will be updated. Please continue to be respectful of Jahi, her family and each other, have a blessed weekend and let us keep praying for Jahi. Matthew 18:20, "For where two or more are gathered together in My name, there I am in the midst of them". Thank you and God Bless.

McMath was declared brain dead by the state of California on December 11, and her parents have been keeping her body on ventilation and artificial nutrition/hydration at an undisclosed location ever since. It is very unlikely that she is "much better," or that she is undergoing "continuous healing." The power of the loving eye to see evidence for hope is strong indeed.

Meanwhile, Salon is reporting that the family of Marlise Munoz, the brain-dead Texas pregnant woman who was kept on ventilation against her family's and her own previously-expressed wishes, may be faced with $300,000 of medical bills. Alternatively, the taxpayers of Tarrant County may end up footing the bill for their county hospital's actions. The hospital spent the money because of its view (rejected last week by a Texas judge) that a Texas law prohibiting the removal of "life-support" from any pregnant "patient" applied to the dead pregnant woman.

My previous coverage of the McMath case is here and here. Previous posts on Munoz are here (initial news), here (update), here (family's intention to sue), here (court proceedings), and here (removal from ventilation). A contrast of the Munoz case to a similar case in Canada is here.

Use of Animals in UK Research

The UK's coalition government made reduction of the number of animals used in research a plank in its platform early on. Today, a report released jointly by the Home Office, the Department for Business Innovation & Skills, and the Department of Health purports to lay out a plan for that reduction. Indeed, the document is called, "Working to Reduce the Use of Animals in Scientific Research." The report has been greeted warmly by scientists and decried as as whitewash by animal-rights activists. This is in part because the report clarifies the government's platform position in this way:

[In] 2010, the Government made a commitment to work to reduce the use of animals in scientific research. This commitment is not focused on baseline numbers which are influenced by a range of extraneous factors. Instead, it encompasses replacement, reduction and refinement (the 3Rs) more broadly, putting them at the heart of a science-led approach.

In other words, the report contains no promises and no target numbers for animal-use reduction, but instead relies upon the 3Rs, as developed by the National Centre for the Replacement, Refinement and Reduction of Animals Used in Research (NC3Rs). The government has promised to increase NC3Rs' funding. The report contemplates a more active role for inspectors in recommending "3Rs" steps to the facilities they inspect. It also introduces a new initiative to limit use of animals by other countries via education and outreach; it mentions as an example a plan to use education to reduce the use by China of animals in cosmetic testing. Such use has been banned in the UK for 15 years; one strange result of this ban is that UK cosmetic products (such as those sold by the Body Shop) cannot be imported into China, precisely because they have not been tested on animals. The government hopes that by persuading China to alter its animal-testing standards, it can benefit animals--and also open an enormous cosmetics market to British manufacturers.

The report shows a dramatic increase in the number of procedures done on animals in recent years.

(For a Yale Bioethics/Hastings Center joint project on the use of animals in medical research, look here.)

Drug Trials in India: The Pendulum Swings?

In India, 2013 began with allegations that an American NGO (Programme for Appropriate Technology, or PATH) had conducted illegal trials of cervical cancer vaccines on tribal girls. A subsequent Supreme Court filing named major firms including GlaxoSmithKline and MSD pharmaceuticals in the scandal. In September, that court gave the government a month to come up with regulations to curb industry practices which one judge said were "heaven for clinical trials" but were "proving hell for India." Meanwhile, the court banned all new trials. Pharmaceutical firms immediately threatened to leave India. The central government's response was the Drugs and Cosmetic (Amendment) Bill 2013, which included (on and after page 11 in the linked document) much sharper governmental regulation of drug trials, including sponsor liability for all harms caused to subjects by trials, including not only necessary medical care but also damage awards. The new rules required videotaping of subjects' consent, and required that agreements between subjects and companies be filed with India's Drugs Controller-General.  

Now, with industry having dropped the number of trials going on in India by more than half, many are wondering whether the government is regretting its fairly hard-line stance of last year. Speaking after the inauguration of a new Baxter global research center in Syngene, Union Health Minister Ghulam Nabi Azad said,

“The industry has complained that the regulations are too stringent, but there have also been complaints by parliamentarians, NGOs and others that they are too lax, which the Supreme Court had taken note of....We are happy with the current balance between the different interests, but industry also needs to be happy....

Pointing out the decline in the number of trials, he added: "While we are interested in the matter of patient safety, we also want to make sure that innovation is not hampered.”

Many in the press seem to be taking this as a sign that the law will be relaxed. Stay tuned!

Ventilating The Dead: Canadian Case, McMath Update

Dylan Benson of British Columbia, Canada, is keeping the pregnant body of his brain-dead wife Robyn ventilated in order that their son might develop inside her and be born. Robyn was 22 weeks pregnant when she was struck dead by a brain hemorhage. Benson is using donated funds to pay for Robyn's ventilation; when his son is delivered by C-section, he will then bury his wife.

This case is strikingly parallel, of course, to last month's Marlise Munoz case in Texas, but there are also some striking differences. In the Benson case, the husband and the hospital agree on the aim of saving the developing fetus, and the husband believes his late wife would have wanted the child saved. In the Munoz case, both husband and parents wanted ventilation removed, and husband believed that his wife, an EMT, would not have wanted to be kept hooked up to machinery. Benson was 22 weeks pregnant when she died; Munoz only 14. Munoz's fetus went without oxygen for the same period of time that Munoz herself did; the lack of oxygen that killed her brain left her developing fetus devastated. But Benson was still breathing, though unresponsive, when her husband found her and rushed her to the hospital; it is possible that her fetus was unaffected by her brain hemorrhage.

Meanwhile, last week, a video was posted on the Keep Jahi McMath On Life Support Facebook page, purporting to show the feet of Jahi McMath, the brain-dead 13-year-old whose parents are keeping her on ventilation and artificial nutrition and hydration, responding to cold stimulus. The video has since been pulled, but remains widely available on the web. A female voice on the video says, "I don't understand how a brain-dead person could do this." But spinally-mediated movement by brain-dead persons has been documented for a long time.

Infertility Funding in the UK

The UK's National Infertility Awareness Campaign has published the results of its recent audit of infertility-treatment provision in the UK. The UK's own National Institute for Health and Care Excellence (NICE) recommends providing 3 full cycles to IVF to women under 40 who have not conceived after two years of unprotected intercourse or 12 cycles of artificial insemination. But the Awareness Campaign's audit shows that, for funding reasons, 73% of Clinical Consulting Groups in the UK do not offer treatment up to the NICE guideline standard. Of the 198 Clinical Consulting Groups that do offer some funding for IVF, 49% offered only one cycle and another 24% only two. Only 24% of the CCGs that fund IVF actually offer all three recommended cycles.

Nuffield on "Public Ethics"

I always enjoy and benefit from reading the reports of the Nuffield Council on Bioethics. Its latest on Emerging Biotechnologies is no exception. I hope to have more to say about the substance of this report in future posts, but for now I want to single out one of its features for questioning. The report makes a great point of the importance of thinking about emerging biotechnologies from what it calls a "public ethics" perspective. The public, the Council urges, has various important interests at stake in the regulation of emerging biotechnologies: the impact they'll have "on a public scale;" the public resources invested in them; the "significance attached to living things;" and their potential to change our lives, and to benefit some at the expense of others. We need to hold these public interests in mind when doing our ethical analyses. We can't leave private or scientific interests in charge. The Council articulates three "values" of public ethics (equity, solidarity and sustainability) and five "procedural virtues" of public ethics (Openness and inclusion,Accountability, Public reasoning, Candour, Enablement, and Caution).

When I first saw this, I thought immediately of Rawls's "Idea of Public Reason." But it turns out there's nothing so subtle or interesting here. Where Rawls was thinking about the kinds of reasons that could properly be mobilized in a public debate (general principles of equity, for example, rather than private religious convictions), the Council's talk of "public ethics" seems to be asserting the claims of public and collective interests against those of private interests. Their insistence on public ethics is not an insistence on a way to conduct ethical debate in public, but rather an insistence that ethical debate should be dominated by public rather than private interests. Normally, regulation is bargained for by those with focused interests in that regulation's structure. Those who would benefit or be burdened by a proposed regulation organize themselves politically in order to shape it. Folks tend not to mobilize and organize to shape regulations that will benefit them or burden them only in a diffuse, small way. (That's why the US Clean Air Act poses a classic mystery for Poli Sci. Its burdens--costs of compliance--were concentrated on a highly-motivated few, while its benefits--slightly cleaner air--were diffuse and uncertain. Yet it passed.) The Council here seems to be arguing, "Don't let the focused interests of industry run away with nanotech or synthetic biology; regulatory framing should instead be dominated by consideration of the admittedly diffuse and disorganized interests of the general public--because, diffuse as they may be, they weigh more in the end than the focused and organized interests of the small numbers of people concerned with developing new biotech."

On this reading, the Nuffield Council's promotion of "public ethics" is a quiet sort of attack on the normative Interest Group Theory of Politics.

The Liverpool Care Pathway Kerfuffle

The British press has been hurling around various accusations about the use and misuse of the Liverpool Care Pathway for the Dying Patient ("LCP") for a couple of years now. The LCP is a UK care pathway covering palliative care and nursing options for patients at the end of life. It includes prompts for management of a wide range of end-of-life symptoms; crucially for the debate, it provides for cessation of artificial nutrition and hydration for some patients. The latest round of adverse coverage is largely based on findings of an audit undertaken by the LCP's developer; the audit found that in 44% percent of cases in which a decision was made to place a patient on the LCP, there was no record of a discussion with the patient about that decision; and that one-third of patients' families were never given an informational leaflet describing the LCP. Additionally, there are accusations that hospitals are putting people on the LCP who shouldn't be, perhaps in order to secure financial rewards that flow to facilities that reach targets for LCP use. These allegations, combined with earlier alarmist claims that the LCP was being used to "euthanize" scores of thousands of patients who weren't dying, resulted last month in the government's announcing the launch of an independent investigation into the use of the LCP.

Since that announcement, though, an additional accusation has been leveled in the Daily Mail (which has been pressing the LCP issue all along). Citing this anonymous article from BMJ about withdrawing feeding from newborns, the Daily Mail claimed that babies were being put on the LCP. The trouble is, the BMJ article was written by a physician not based in the UK, and not using the LCP. Of course, that didn't prevent the Daily Mail piece from being picked up here in the states by, for example, Wesley Smith, whose sensitive treatment of the subject, entitled "Dehydrating Disabled Babies in UK Hospitals" ran in the National Review Online. "This is what happens when a country allows bureaucrats to control healthcare," he intoned--and then drew the "parallel" to Obamacare. Similar discussion could be found on numerous right-wing websites. Will any of those sites revise their comments now that their foundation in the Daily Mail piece has been exposed as fact-free? I'm not holding my breath.

At this point, I hope the independent investigation is thorough and that it makes serious recommendations for addressing all of these concerns. A tough review with real suggestions for training and reform might well save the LCP, and the LCP is well worth saving. The protocol has won plaudits in palliative care journals, was well reviewed in the Royal College of Physicians original National Care of the Dying audit, has garnered the support of palliative care nurses, and undoubtedly eases the deaths of many tens of thousands annually. But there seems also to be little doubt that it has sometimes been carelessly implemented, or implemented with insufficient discussion and explanation.

One suggestion--indeed, a plea--for anyone who wants to comment on the issue, though: Read the actual pathway. That will have the salutary effect of enabling you to distinguish problems that result from following it from those that result from not following it.

Canada and the Crime of HIV Exposure

The Supreme Court of Canada has just issued two rulings, one on an appeal from Quebec and the other on an appeal from Manitoba, which together clarify and restructure the circumstances under which criminal sanctions can be applied to an HIV+ person who has sex without disclosing that HIV status to his or her sexual partner.

Since 1998, Canadian law has held that those who fail to disclose their HIV status can be charged with sexual assault or aggravated sexual assault if their sexual relations pose "a significant risk of bodily harm" to their partners. Lower court holdings over the years have held that there was no significant risk of bodily harm where the accused used a condom, or where the accused had a low viral load due to medication. The new Supreme Court holdings agree that there is no significant risk, and no legal duty to disclose HIV status, where the accused's viral load is low due to medication, and a condom is used. But the Supreme Court upheld the convictions of defendants who did not use condoms, even if their viral loads were low.

The decisions have drawn immediate criticism from opposite sides. Advocates for persons with HIV/AIDS accuse the court of reinforcing irrational and unscientific fears of HIV transmission, of stigmatizing those who are infected, and of creating a world in which even responsible condom use offers no surefire protection from prosecution for those who do not disclose their HIV status. The threat of criminal prosecution for an act of consensual sex, they argue, doesn't protect people from HIV transmission. Conservative critics of the opinions lament the Court's having given legal permission for people not to disclose their HIV+ status to their sexual partners in some circumstances.

The Court also said that the "significant risk" necessary to underwrite criminal prosecution would vary with the sex-act in question, and could also change with medical progress.

Three Genetic Parents?

The UK's Human Fertilization and Embryology Authority is conducting a public consultation on the question of whether they ought to permit the creation of children with three genetic parents. The question is about a new assisted reproductive technology that could prevent children from suffering from diseases carried in mitochondrial DNA. In essence, the fertility clinic would fertilize an egg, and then remove the genetic material from that egg and pop it into a de-nucleated egg from a donor. The result would be an embryo with Mom and Dad's nuclear DNA, but with mitochondrial DNA from Donor--free from any mitochondrial diseases of which Mom is a carrier.

I'm not actually bothered by this. While having three genetic parents is something new, surrogacy has given us many children with three biological parents (egg Mom, sperm Dad, and surrogate Mom--who, make no mistake, makes some serious contributions to the basic makeup and future health of the child, via hormonal and epigenetic influences, diet, gestational environment, and so on). And after all, what will we call the child of this high-tech intervention, with her three different pro-genitors?

"Baby."

Council of Europe on Euthanasia

The Parliamentary Assembly of the Council of Europe ("PACE") has issued a non-binding declaration (mainly aimed at getting member states to beef up their laws governing living wills and advance directives) in which it opines that "[e]uthanasia, in the sense of the intentional killing by act or omission of a dependent human being for his or her alleged benefit, must always be prohibited."

A number of different publications are mistakenly alleging that PACE has called for a permanent ban on assisted suicide. The resolution explicitly says that it "is not intended to deal with the issues of euthanasia or assisted suicide," and while it goes on to condemn euthanasia, it says nothing additional about assisted suicide.

The PACE declaration may indeed have some political effect on movements within Europe toward legalization of euthanasia. But it's a mistake to report it as a condemnation of assisted suicide, or to anticipate that it will have strong effect on pending cases involving assisted suicide. The European Court of Human Rights, for example, has repeatedly recognized the distinction between assisted suicide and euthanasia, and has held that Article 8 of the Convention for the Protection of Human Rights and Fundamental Freedoms protects the individual's choice to avoid a painful and undignified death.

Commission Report on Assisted Dying in UK

Here is the final report of the UK's Commission on Assisted Dying. The private commission was funded by author-turned-end-of-life activist Terry Pratchett, who suffers from Alzheimer's disease and founded the UK's Dignity in Dying organization. It was led by Lord Falconer, a vocal proponent of liberalization of laws prohibiting assisted suicide. No one expected the Commission to come out with anything other than a pro-assisted-suicide view, Falconer's protestations of independence and neutrality notwithstanding. The Church of England has condemned the report, as have many (sometimes predictable) others.

But it is perhaps interesting to notice what the Commission actually ends up recommending: a relatively modest assisted suicide program rather similar to those in place in the US states of Oregon and Washington. The proposed program would help only competent adults with terminal diagnoses verified by two physicians. ("Terminal" means under a year to live, as opposed to the 6-month requirement in place in Oregon and Washington.) The patient's decision would have to be voluntary, not subject to undue influence, and not the result of a treatable mental condition such as depression. All requesting patients would be told about available social services and about other end-of-life treatment options such as palliative care. And the program would be open only to patients who are physically capable of taking the lethal medication themselves.

The report doesn't advocate euthanasia, though Falconer is often condemned by the other side as "pro-euthanasia." The program it recommends won't help Mr. Pratchett, whose Alzheimer's will likely render him incompetent before he has the report's recommended 12-month terminal diagnosis. Nor, as the Guardian points out, would the recommended program help Debbie Purdy, whose litigation forced prosecutorial authorities in England and Wales to issue guidelines backing away from criminal prosecution of those who assist their loved ones to die. Purdy has MS--a chronic, rather than a terminal, illness, and one that will likely make it impossible for her to take her own lethal medication within a year of her forecast death.

US Restricts Antibiotics in Animals

From the "it's about time" department: the New York Times reports that the FDA is restricting the use of cephalosporins in livestock feed, in order to slow down the development of antibiotic-resistant bacteria. (Recent studies have shown that such resistant bacteria are indeed passed from feed animals to human beings.) Cephalosporins are a class of antibiotic widely used to treat strep, pneumonia, UTIs, skin infections and childhood bacterial infections. Europe banned the use of several antibiotics important in human medicine in 1998; banned the use of all antibiotics for growth-enhancement of livestock in 2006; and has recently moved to ban all prophylactic use of antibiotics in feed animals.

Canadian AIDS Researchers Oppose HIV-Exposure Prosecutions

The current CMAJ includes this letter from three researchers at the British Columbia Centre for Excellence in HIV/AIDS, arguing for an end to Canada's criminal prosecution of people who allegedly expose sexual partners to HIV. The letter points out that the actual risks of transmission to sexual partners are quite low for well-controlled HIV; that prosecutions have never been shown to reduce rates of infection: and that they may in fact discourage or interfere with HIV testing and treatment. In this interview, one of the co-authors also notes that while Canadian rates of prosecution for HIV exposure have been on the rise, there is no similar policy of prosecuting those who expose partners to other potentially serious viruses like HPV.

GMC Will Draft Guidance on Assisted Suicide

According to this report in The Guardian, the UK's General Medical Council is planning to issue new guidance for investigation of physicians who've allegedly assisted a patient in suicide. The problem is in part with uncertainty over what sorts of actions by doctors really count as assisting in suicide. Is a sympathetic conversation enough to count as "assisting"? How about a factual assertion about the availability of assisted suicide in Switzerland? Some physicians' words or actions may not lead to criminal charges, but may nonetheless lead to complaints about their fitness to practice; a handful of investigations of this sort have already been conducted.

GMC plans to publish the guidelines for public comment next month.

"Postcode Lottery" for Healthcare

The 2011 NHS Atlas of Variation is out! And sure enough, it shows dramatic variation in healthcare utilization and in GP practice patterns around the UK. North Lancashire doctors, for example, prescribe 25 times as many pills for dementia as those in Kent. Only 3 of every 100,000 people in Devon and Cornwall are admitted to NHS care homes, while in Northumberland that number is 190. Peterborough has an angioplasty rate treble that of County Durham. Coverage here and here.

The US has regional practice variation which is just as dramatic; it's been documented for decades by the Dartmouth Atlas of Healthcare, whose creator, Jack Wennberg, is the father of regional-variation research.

NHS has a webpage collecting different countries' medical-variation atlases here.

Morning-After Pill: Contrasting News

President Obama defended HHS Secretary Sebelius's decision yesterday to override the FDA's recommendation that morning-after contraceptive pills like Plan B be made available over-the-counter to women and girls of any age. Critics were accusing Obama of having directed the override in order to avoid controversy during the upcoming election. Obama today said that he wasn't in on the decision, but that he approved of it, "as the father of two daughters." As a result of the override, the drug will remain behind pharmacy counters, available without a prescription only to women over 17 years of age. Proponents of the FDA's plan saw its main advantage in putting the drug out on the pharmacy floor, where sexually active women could easily locate it, rather than in making it available to young girls; one expert observed that "not many 11-year-old girls" go into drugstores to buy anything, let alone single pills that cost $50.

Meanwhile in the UK the British Pregnancy Advisory Service is offering to make morning-after pills available free to women over 17 via post, after a preliminary telephone interview with a nurse ensures that they understand the pill's use. The charitable organization, which is the UK's largest abortion provider, is urging women to stock up in advance of the holidays, when unwanted pregnancies occur with higher-than-average frequency. The pills are sold online and in pharmacies to girls and women over 16, and are widely available, free of charge, in doctors' offices and NHS clinics.