Is posthumous semen retrieval ethically permissible?

It is possible to retrieve viable sperm from a dying man or from a recently dead body. This sperm can be frozen for later use by his wife or partner to produce his genetic offspring. But the technical feasibility alone does not morally justify such an endeavour. Posthumous semen retrieval raises questions about consent, the respectful treatment of the dead body, and the welfare of the child to be. We present two cases, discuss these three issues, and conclude that such requests should generally not be honoured unless there is convincing evidence that the dead man would want his widow to carry and bear his child. Even with consent, the welfare of the potential child must be considered.

Distribution and retention of 137Cs in sediments at the Hanford Site, Washington.

137Cesium and other contaminants have leaked from single-shell storage tanks (SSTs) into coarse-textured, relatively unweathered unconsolidated sediments. Contaminated sediments were retrieved from beneath a leaky SST to investigate the distribution of adsorbed 137Cs+ across different sediment size fractions. All fractions contained mica (biotite, muscovite, vermiculatized biotite), quartz, and plagioclase along with smectite and kaolinite in the clay-size fraction. A phosphor-plate autoradiograph method was used to identify particular sediment particles responsible for retaining 137Cs+. The Cs-bearing particles were found to be individual mica flakes or agglomerated smectite, mica, quartz, and plagioclase. Of these, only the micaceous component was capable of sorbing Cs+ strongly. Sorbed 137Cs+ could not be significantly removed from sediments by leaching with dithionite citrate buffer or KOH, but a fraction of the sorbed 137Cs+ (5-22%) was desorbable with solutions containing an excess of Rb+. The small amount of 137Cs+ that might be mobilized by migrating fluids in the future would likely sorb to nearby micaceous clasts in downgradient sediments.

Pain management rather than assisted suicide: the ethical high ground.

Physician-assisted suicide and euthanasia (PAS/E) have been outside the bounds of acceptable behavior for physicians for hundreds of years and remain illegal in all jurisdictions except Oregon and The Netherlands. The morally, legally, and professionally acceptable alternative is excellent end-of-life care. In this article, the arguments in favor of PAS/E are discussed briefly and rebutted. The arguments against this practice are outlined and supported. Because pain (and fear of pain) at the end of life is one of the driving forces behind the recurrent debate about legalization of PAS/E, the medical profession as a whole, and pain specialists in particular, have an obligation to use all available means to relieve pain.

Prone position endoscopic transthoracic release with simultaneous posterior instrumentation for spinal deformity: a description of the technique.

STUDY DESIGN: A prospective series of 15 consecutive adult patients with spinal deformity who underwent endoscopic transthoracic release with simultaneous posterior instrumentation while positioned prone. OBJECTIVES: To describe the technique and clinical results of endoscopic transthoracic release performed with the patient prone (as opposed to lateral) on the concave side for scoliosis or on either side for kyphosis, with simultaneous posterior exposure, instrumentation, and correction of the deformity. SUMMARY OF BACKGROUND DATA: Use of endoscopic surgical techniques is rapidly advancing across all subspecialties. These techniques can be used to expose and operate on the spine in a less invasive fashion, thus avoiding damage to other tissues and facilitating earlier mobilization and rehabilitation. Current endoscopic techniques with the patient in the lateral decubitus position mimic open thoracotomy. A new technique is described with the patient positioned prone, which allows simultaneous posterior exposure. METHODS: Preoperative Cobb angle or thoracic kyphosis angle, maximal correction bending films, and postoperative Cobb angle or kyphosis angle were measured and compared. All perioperative morbidity, intraoperative complications, and surgical variables were prospectively documented and analyzed. RESULTS: There were no intraoperative technical problems with the endoscopic equipment or instruments and no immediate, 6-month, or 2-year postoperative complications related to the endoscopic component of the procedure. In the scoliosis patients, the average correction was 60%. In the kyphosis patients, the average correction was 39%. CONCLUSIONS: Transthoracic endoscopic techniques, compared with thoracotomy, offer a less invasive method of accessing the anterior spinal column, with the benefits of an excellent view of the area of the spine being instrumented, minimal soft tissue disruption, and an improved cosmetic result. With the simultaneous technique, staged or subsequent procedures can be eliminated, and a circumferential structural release as well as control of the mobilized spine can be achieved. This simultaneous technique can be extended for use in correction of a variety of thoracic spinal pathologies.

Cervical spondylotic myelopathy. Approaches to surgical treatment.

Cervical spondylotic myelopathy is the leading cause of spinal cord dysfunction in older patients. This review article looks at the natural history of the condition and examines the role of different surgical treatments for it. Anterior and posterior surgical approaches have a role in the treatment of cervical spondylotic myelopathy dependent on the number of levels involved and the alignment of the spine. Anterior decompression and fusion is useful in patients who have disease at three or fewer levels or in patients with kyphotic alignment. In more extensive disease, a posterior decompression and fusion is usually best. Canal expansive laminoplasty is useful in the treatment of myelopathy without radiculopathy in a patient with lordotic alignment. With the exception of laminoplasty, nonfusion procedures have little role in the treatment of cervical spondylotic myelopathy.

Ethical challenges in infant heart transplantation: a clinical case presentation.

Although heart transplantation has become recognized as a viable option for the treatment of incorrectable heart disease in infants and children, its application becomes less clear in infants with potentially serious neurologic impairment. The following case study illustrates one transplant team's approach to decision making in the case of an infant born with a chromosomal deletion syndrome.

Beyond justice.

Bioethicists have generally looked after the contractual and fiduciary obligations of health care professionals to patients by their adherence to and insistence on the principles of ethical action--autonomy, nonmaleficence, beneficence, and justice. But these principles, while necessary, only serve the best interests of people already recognized as patients. If we truly want to help vulnerable populations--those who fall outside the margin--then we need to go beyond justice to embrace the theological principles of mercy and grace; that is, we need to rely more completely on the way medicine was before secularization and commercialism. Competency and compassion intertwine in western medicine.