It’s another day in the life of the busy Obama administration.  In this case, it means another day of despair for America’s social and religious conservatives.

President Barack Obama lifted restrictions on federal funding of human embryonic stem cell research on Monday, angering abortion opponents but cheering those who believe further scientific investigations could lead to breakthrough treatments for many diseases. You can see our report here.

Since taking office on Jan. 20, Obama has also lifted a ban on funding for overseas groups or clinics that provide or counsel on abortion services, rescinded a Bush administration rule to protect health workers who refuse to provide services and information on moral grounds, and publicly backed the constitutional separation between church and state which he said America’s founding fathers “wisely drew.”

This is a sharp departure from his predecessor, George W. Bush, whose eight years in office represented a challenge to the country’s liberals. Now it’s conservative Christians, who comprise a key base for the opposition Republican Party, who find themselves in a dilemma.

Religious and social conservatives oppose embryonic stem cell research because it involves destruction of human embryos.

Kansas Senator Sam Brownback, a leading member of the Republican Party’s conservative Christian wing,  summed up this view in a statement: “If an embryo is a life, and I believe strongly that it is life, then no government has the right to sanction their destruction for research purposes.”

Obama also signed a presidential memorandum directing the head of the White House Office of Science and Technology Policy to develop a strategy for “restoring scientific integrity to government decision-making.”

Some scientists accused Bush of sacrificing scientific research and subverting scientific findings to appease his conservative political and religious base, not only on stem cells but on climate change policy, energy and reproductive and end of life issues 

If you tune into conservative Christian radio stations or read press releases and blogs from groups such as the Family Research Council, it’s clear that the “Religious Right” sees more gloom and liberal doom on the horizon.

As Obama moves to unravel the Bush legacy on social and scientific policies, they are likely to have more sleepless nights over the next four years.

(Photo: A human embryonic stem cell line derived at Stanford University is seen in this handout photo REUTERS/Julie Baker/Stanford University School of Medicine/California Institute for Regenerative Medicine/Handout, March 9, 2009)

UPDATE: Eluana Englaro died on Monday Feb. 9.

What’s been called “Italy’s Terry Schiavo case” is starting to resemble its U.S. precedent in more ways than one. Prime Minister Silvio Berlusconi ordered doctors on Friday not to disconnect the feeding tubes that the country’s top appeals court had ruled could be removed. Doctors had began withdrawing them on Friday before the order came from Rome.

Eluana Englaro, 38, has been in a vegetative state since a car crash in 1992. Her  case has looked much like that of Schiavo, the American who spent 15 years in a vegetative state and was allowed to die in 2005 after a long court battle.

(Photo:Eluana Englaro in an undated family photo)

“Until we have a law about end-of-life issues, nutrition and hydration, because they are a form of vital life sustenance, cannot be suspended under any circumstances by those who are care-givers of people who are not self-sufficient,” Berlusconi said after making the case resemble the Schiavo drama even more by intervening to stop Englaro’s tubes from being removed. In the Schiavo case, President George Bush also stepped in at a late stage to try to block a court decision to disconnect her.

The cabinet acted in defiance of Italy’s President Giorgio Napolitano, who was opposed to dealing with the issue through a decree and has the power to block it. But Berlusconi said that if that happened he would call an emergency session of parliament, where he has a comfortable majority, to enact a law.

Catholic politicians, mostly in the centre right, have said that not feeding Englaro amounts to euthanasia, which is illegal in Italy, and had urged the government to intervene.

As in the Schiavo case, the Milan court that ruled on Englaro back in November said it was convinced that her condition was irreversible and that she would prefer to die rather than be kept alive artificially. Do you think those criteria are enough to allow doctors to remove the nutrition and hydration tubes?

(Photo: Prime Minister Silvio Berlusconi, 20 Dec 2008/Remo Casilli)

The Vatican daily L’Osservatore Romano published an article over the weekend claiming that the contraceptive pill pollutes the environment massively, contributes to male infertility and causes abortions. Those claims, if true, hit lots of hot buttons about science, ethics, faith and government policy. They should make headlines around the world. But apart from the Italian press, for which this is a home game, they haven’t. Why not?

(Photo: Japanese contraceptive pills, 26 Aug 1999/Kimimasa Mayama)

It’s probably because the article also sets off lots of red lights for anyone trying to assess the validity of its claims. Its author Pedro José Maria Simón Castellví, head of the International Federation of Catholic Medical Associations, makes several scientific-sounding claims but basically asks the reader to accept them on faith. Castellví says his article is based on a 100-page report by a Swiss doctor, Rudolf Ehmann, but doesn’t quote directly from it or say where it can be found.  This can’t be for lack of space, because he fills several lines with florid praise for the report with comments such as: “The original German text is beautifully written … it is written with all the scientific requirements, without any inferiority complex toward any discussion of obstetrics and gynaecology…”

The article’s headline — “Humanae Vitae - A Scientific Prophesy” — also hints its purpose is probably more religious than scientific. Humanae Vitae is the 1968 encyclical that reaffirmed the Church ban on artificial birth control. Its 40th anniversary last July prompted a series of Catholic statements, articles and conferences defending what was probably the most controversial encyclical of the 20th century. The major bioethics paper put out by the Vatican last month made several references to Humanae Vitae to bolster its argument.

Castellví’s article is still only available in the original Italian.  Silvia Aloisi in our Rome bureau provided FaithWorld with this quick summary of the article and comment in the Italian press:

The contraceptive pill is abortive, pollutes the environment and contributes to male infertility, according to an article published in the Vatican newspaper L’Osservatore Romano.  The head of the International Federation of Catholic Medical Associations (FIAMC), Pedro José Maria Simón Castellví, wrote in the article that the pill had “devastating effects on the environment by releasing tonnes of hormones into nature.”

“We have sufficient evidence to state that a non-negligible cause of male infertility in the West is the environmental pollution provoked by by-products of the pill,” he said.  This was a “clear anti-environmental effect demanding further explanation by manufacturers.”

Castellví gave no further details but said the findings were documented in a 100-page report recently published by his federation. He also said that the contraceptive pill, even when it had low hormone levels, was in many cases abortive because it prevented the embryo’s implantation into the woman’s womb.

The deputy chairman of the Italian Society of Contraception dismissed the article as “science fiction. “Gianbenedetto Melis told Italy’s Ansa news agency: “The pill cannot provoke an abortion because it blocks ovulation, and if there is no egg to be fertilised there can be no pregnancy.” Flavia Fronconi, a pharmacologist, said “the world is full of substances with oestrogen effects … Even a plastic bottle left in the sun releases oestrogen ‘polluting’ the liquid that we drink.”

Monsignor Elio Sgreccia, former president of the Vatican’s Pontifical Academy for Life, was cautious about the link made in the article between the pill and male infertility. “It’s true that the spreading of hormones in the environment increases the chances of multiple births and in turn provokes male infertility,” Sgreccia told the daily Corriere della Sera. “But there are several causes for this. And more than anything else, it stems from the fact that they are used in agriculture fertilisers, so they end up in vegetables and meat,” he said.

After some research on the Internet, I found Ehmann’s full report on the FIAMC website in the original German and a Spanish translation. There was only a four-page summary in English. In his report, Ehmann makes the claims mentioned in L’Osservatore Romano, sometimes with footnotes quoting scientific publications and sometimes not. It’s hard for a non-scientist to assess his scientific claims, but Castellví’s article gives the impression that it aims more to support doctrines than prove facts.  One sceptical blogger who got the same impression asks whether “the people responsible for the conclusion reported by Castellví are the same who were involved in the ‘research’ supporting Intelligent Design.”

Does this article reflect actual Vatican thinking or is it just a trial balloon? That’s hard to say. The fact that these charges are published in the Vatican newspaper doesn’t mean they’re official, but it does hint that someone there takes them seriously. If they want to convince others, they’ll have to provide more proof.

The Vatican issued a major document on bioethics today, “Instruction Dignitas Personae on Certain Bioethical Questions,” that outlines Roman Catholic teaching on the latest procedures concerning human reproduction. This is the third major Vatican document on bioethics in recent years after Donum Vitae (Gift of Life) in 1987 — issued by the Congregation for the Doctrine of the Faith (CDF), like today’s document — and Pope John Paul’s encyclical Evangelium Vitae (Gospel of Life) in 1995.

(Photo:Pope kisses baby at Vatican, 8 Oct 2008/Max Rossi)

Our news story on the document is here, accompanied by a list of procedures it declared morally unacceptable and acceptable and selected quotes from the text. The full text in English is here. The Vatican also has comments from the news conference presenting the document (here all in Italian).

Much of this is a restatement and updating of known Vatican positions. The wording is in places quite strong and sound-bite-like, which may mean those passages could be intended for use in national political debates about bioethics. There is too much to comment on individually here, so go to the links for details.

John Thavis of Catholic News Service has a useful “Vatican bioethics document at a glance” and John Allen has a detailed analysis at “Vatican issues new document on biotechnology.”

One interesting angle is the argument in the conclusion that modern societies have already banned other practices that violate human dignity such as “racism, slavery, unjust discrimination and marginalization of women, children, and ill and disabled people.:” It encourages Catholics to show “courageous opposition to all those practices which result in grave and unjust discrimination against unborn human beings, who have the dignity of a person, created like others in the image of God.”

(Photo:A microscopic view of undifferentiated human embryonic stem cells)

The document also speaks of spare frozen embryos as “orphans” but says it would be against human dignity to use them for research or give them up for “prenatal adoption” as some anti-abortion voices have suggested. “The thousands of abandoned embryos represent a situation of injustice which in fact cannot be resolved,” it says.  

Incidentally, Slate columnist William Saletan also writes today about “The frozen ones: the morally deserted world of spare embryos.” He says there are about 500,000 such frozen embryos in the United States alone and many parents have just left them in that limbo. An abortion rights advocate, he makes no mention of the Vatican document and uses no religious argument. But he also bemoans the fact that the increased freedom and choice brought by these new reproductive measures have not been matched by increased ethical concern about the results:

That freedom doesn’t eliminate moral obligation; it intensifies it. Each of us has to decide how to respect life in all its complexity. To me, embryos aren’t people, but they’re the beginnings of people. They aren’t to be created, killed, or frozen lightly … Don’t make or freeze embryos without thinking through what you’ll do with them. And if, after talking it over, you can’t stomach the options ahead, maybe you should reconsider whether you’re ready for this. That’s a lot to ask, I know. But nobody said choosing would be easy.”

What do you think about the Vatican document? And what should be done about spare frozen embryos?

Italy’s “Terry Schiavo case” has ended with the country’s top appeals court allowing a father to disconnect the feeding tube that has kept his comatose daughter alive for 16 years. Eluana Englaro, now 37, has been in a vegetative state at a hospital in northern Italy since a 1992 car crash. The Englaro case has been compared to that of American Terri Schiavo, who spent 15 years in a vegetative state before a long and very public dispute ended in 2005 with a court decision allowing her husband to have her feeding tube disconnected.

As in the Schiavo case, the Milan court that ruled on the case said it was convinced Englaro would prefer to die rather than be kept alive artificially. State prosecutors appealed that decision to the Cassation Court, the highest appeals court in Italy, and it was the Cassation Court’s decision on Nov. 13 that definitively settled the case.

(Photo:Eluana Englaro in an undated family photo)

This was the first time such a ruling has been made and upheld in Italy, where the influential Roman Catholic Church is implacably opposed to ending feeding and hydrating of patients in a vegetative state. Vatican Cardinal Javier Lozano Barragan called the decision a “monstrous and inhuman murder” .

When the Schiavo and Englaro cases began, the lines in this ethical dilemma were fairly clearly drawn. On one side were those who said a persistent vegetative state (PVS) was enough to declare a patient effectively dead and disconnect feeding tubes. On the other were those, like the cardinal above, who said that patient was still alive. In 2006, brain scans revealed that a woman in PVS after suffering devastating brain damage in a car crash could imagine playing tennis or walking around her home when doctors asked her to do this.

Do those brain scans prove that PVS patients are still effectively alive? Should courts take that into account?

P.S. According to David Waters at the Washington Post’s On Faith blog, a similar case is going on now in Washington where a hospital wants to stop treatment for a PVS boy but his Orthodox Jewish parents reject their standard of brain death as proof of death and want to wait until his heart stops.

Here’s a video from July when the Milan court ruled tht Englaro’s feeding tubes could be removed:

The Vatican has caused a stir by appearing to want to redefine death and then denying any such thing. If where there’s smoke, there’s fire, we haven’t heard the end of this yet.

It all started with a front-page article in the Vatican daily L’Osservatore Romano challenging the widely-accepted concept that brain death — the irreversible end of all brain activity — is the right standard for determining that someone has died. The article argued that doctors developed that standard 40 years ago to enable them to harvest organs for transplantation. The article by Lucetta Scaraffia, an Italian history professor and bioethicist, argued:

“The scientific justification of (the brain death standard) rests on a peculiar definition of the nervous system that is now being questioned by new research, which casts doubt on the fact that brain death leads to the disintegration of the body … The idea that the human person ceases to exist when the brain no longer functions, while the body is kept alive thanks to artificial respiration, implies an identification of the person with brain activity alone. This contradicts the concept of the person according to Catholic doctrine and thus contradicts the directives of the Church in the case of patients in a persistent coma.”

The Vatican accepts organ transplantation and the brain death standard, which is widely used in Catholic hospitals. Declaring the brain death criterion un-Catholic would mean those hospitals would have to revert to the cardiac death standard alone. But that leaves a much smaller window for removing viable organs and would make one kind of transplantation — heart transplants — all but impossible. As it is, there is already such a shortage of organs for transplantation that scandalous black markets for them exist and some experts want to see organs sold like commodities on an open market.

The Vatican has not changed its view on brain death despite holding two scientific conferences (in 2005 and 2006) to discuss it, but there are dissenters among Catholic bioethicists like Scaraffia who want to keep the debate going. She used the 40th anniversary of the pioneering Harvard Report that advocated the brain death standard to call for a reassessment.

Rev. Federico Lombardi, the Vatican’s chief spokesman, got plenty of calls asking whether this was a change in the Church’s position. “This is not a Vatican document,” he responded. “It is an article by a historian that takes some considerations into account but it is not part of Church teaching.”

End-of-life issues are some of the most difficult challengesin ethics and some bioethicists say people should choose their definition of death in advance to ensure they don’t leave the moral quandary to others.

The influential New England Journal of Medicine reopened this long-standing debate last month with an article questioning whether some patients declared brain dead were in fact really dead. Patients with massive brain damage can be declared brain dead even though their vital bodily functions continue to work, wrote Robert Truog of Harvard Medical School and Franklin Miller of the National Institutes of Health. “The arguments about why these patients should be considered dead have never been fully convincing,” they wrote.

Another criterion, the end of a heart’s beating, seems questionable when doctors can declare cardiac death and the transplant and restart the heart in another patient, they said. These cases suggested, they argued, that “the medical profession has been gerrymandering the definition of death to carefully conform with conditions that are most favourable to transplantation”.

Another article reported that doctors in Denver had taken hearts from three brain-damaged infants within 75 to 180 seconds after their cardiac deaths and then successfully implanted and restarted them in other babies.

In the same series, bioethicist Robert Veatch of Georgetown University’s Kennedy Institute of Ethics wrote that declaring cardiac death and then transplanting the same heart amounted to “ending a life by organ removal”.

Do you think the ethical issues that Scaraffia brings up justify a challenge to the brain death criterion? Or should the priority be on making sure doctors have as many organs for transplant as possible?

UPDATE:  Sandro Magister has just put out a very thorough analysis of this issue on his blog www.chiesa. For the English-language version, click here.

One of the largest medieval buildings in Paris reopens this week as a forum for discussion about faith in the modern world after more than two centuries being used mostly as a fire station and police training centre. The Collège des Bernardins was founded in 1247 by the English Cistercian monk Stephen of Lexington as a residential college for the order’s monks. After the French Revolution, it was taken over by the city.

The Roman Catholic archdiocese of Paris bought the building and spent five years renovating it to house its theology school and host debates, conferences, art exhibitions and evenings of film and music. Its first major event will be a speech on faith and culture by Pope Benedict, who will address an audience of 700 personalities from the world of French culture on the first day of his Sept. 12-15 visit to France.

The college, whose name comes from its original designation as St. Bernard’s College, stands on the Left Bank just off the Boulevard Saint Germain. The five-year restoration highlighted the building’s simple Gothic architecture while adding modern comforts such as heating, air conditioning and WiFi (see video). The college aims “to serve mankind in all its dimensions — its emotions, its intelligence, its liberty, its relations and its faith”.

The city’s archbishop, Cardinal Andre Vingt-Trois, told journalists during a pre-opening media tour that the Catholic Church needed to promote discussion with modern society. “Our Christian faith, our Christian tradition and wisdom are today immersed in a pluri-religious and pluri-cultural society. Despite the generous and multiple forms of religion on offer, many of our contemporaries do not belong to a specific religion, or have no religion or belief at all.” The discussions will bring together Catholics and non-Catholics, believers and non-believers, to discuss issues including culture, economics, international development and Christian-Jewish relations. Another issue will be the effects of scientific progress on society and questions of bioethics, he said. “How will human identity — what it means to be a man or a woman — be respected and promoted? Will it be reduced to the roll of a tool for the well-being of a few?

“All these questions face us. We don’t all have the same answer. We don’t always have an answer. But we are all confronted with these questions and we cannot avoid them, unless we consider human history to be a fate that mankind cannot change. That is not our conviction.”

The college is the largest civil building in Paris dating from the Middle Ages. Only Notre Dame Cathedral and a few other major medieval churches are larger, said Hervé Baptiste, the Culture Ministry’s chief architect for historical monuments. Thanks to its monument status, the Culture Ministry, Paris City Hall and the Ile-de-France region around Paris contributed 14.5 million euros of the college’s 50-million-euro renovation bill. The rest was financed by contributions from companies and individuals as well as bank loans guaranteed by rents the archdiocese receives from its real estate holdings in the French capital.

Culture Minister Christine Albanel, Paris Mayor Bertrand Delanoe and Ile-de-France Region President Jean-Paul Huchon will join Cardinal Vingt-Trois in inaugurating the college on Thursday.

“The Good Death,” a play about euthanasia, has brought the issue of “mercy killing” to Dutch theatres at a time when such deaths are falling. They dropped to 2,325, or 1.7 percent of all deaths in 2005, from 2.6 percent in 2001. Playing to packed houses throughout the Netherlands, which legalised euthanasia in 2002, the play shows the law has not removed the moral dilemma for many involved.

In fact, part of the reason for the drop in euthanasia deaths could be that agonised doctors are opting to give patients heavy sedation until they die, rather than putting an end to their lives. Even some patients who have asked for euthanasia are given continuous deep sedation instead. This feature by our Netherlands chief correspondent Emma Thomasson looks at the issues involved.

This raises the question of whether deep sedation, while being presented as palliative care that is ethically acceptable for many faiths, is not in fact “euthanasia lite.” Or at least whether it is being used as such. The British Medical Journal has suggested this in a report that prompted an editorial and a lively reader discussion. “Although the exact cause of this trend is unclear, there are indications that continuous deep sedation may in some cases be being used as a substitute for euthanasia,” a report in Science Daily said.

The fall in Dutch euthanasia deaths is sometimes cited by “death in dignity” campaigners in other European countries as a sign that legalisation is not a slippery slope towards the easy disposal of ailing patients. This suggests it might lead in another direction that could undermine the palliative care option often presented as the alternative to legalised euthanasia.

Where do you think the line should be drawn in end-of-life care?

Before it slips from the news, take a look at a scandal in India that illustrates one of the biggest bioethical challenges we face in a globalised world. Last weekend, Nepal handed over to Indian authorities an Indian man arrested on suspicion of running a huge illegal kidney transplant racket. It seems this ring duped poor Indians into selling kidneys that could be transplanted into rich Indians and foreigners at many times the fee that the unwitting donors received. At least five foreigners — two U.S. and three Greek citizens — were found in a luxury guesthouse run by the racket in a city of high-tech companies just outside New Delhi.

Demand for cheap kidneys has skyrocketed in recent years in rich countries, mostly because people there are becoming more obese and suffering from kidney failure. This has led to “transplant tourism” where patients from rich countries travel to the developing world to receive new kidneys. It has led to serious proposals to set up a global kidney market to meet the demand.

This black market in kidneys for transplants is widely denounced as illegal and immoral because it exploits poor people. But would creating a worldwide organ trade make the practice any more moral? Is the danger of exploitation of the poor so strong that lawmakers should ensure that money doesn’t end up deciding everything?

This is one of those bioethical challenges that are multiplying as science and technology create situations that were unthinkable not so long ago. Ethics councils, churches and philosophers develop guidelines to keep up, but reality has a way of pulling ahead of them. Globalisation means agents in one country can arrange for patients in a second country to have the transplant performed in a third. We will probably see more rather than fewer cases like this one in Nepal and India.

We’ve written on this issue from several datelines over the past year. Here are a few that give an idea of the problem:

Keen demand fuels global trade in body parts

The who, what, where and why of organ trafficking

Calls for kidney market as transplant demand soars

China, Pakistan bowing to pressure on organ trade

Beijing approves organ transplant hospitals

Human organ trafficking threatens donations schemes

Pakistani gang arrested for stealing kidneys

Here’s the video of the arrest of the Indian suspect in Nepal:

Science and religion are sometimes portrayed as adversaries, especially by the “new atheists“, but the real picture has always been more complex. The latest breakthrough in stem cell research shows how quickly opposing sides can become allies. On Nov. 20, two research teams announced they had transformed ordinary skin cells into stem cells without destroying human embryos in the process. That meant that scientists could solve an ethical dilemma they had effectively created when they began using human embryos to produce stem cells.

Religious groups critical of embryonic stem cell research immediately hailed the breakthrough as an advance that opened the door to ethnical use of these potential wonder cells. They have now begun to use it as a welcome argument to bolster their positions in disputes on the issue. This must be happening in quite a few places, but here are two examples that show how science is helping religion in this case.

In Germany, the Roman Catholic Church has severely criticised the governing Christian Democratic Union (CDU) party for agreeing to loosen tight restrictions on embryonic stem cell research there. The law bars German scientists from working on stem cell lines developed after January 1, 2002. Researchers say this is hampering their work and want the cut-off date to be moved up to 2007.

When the CDU agreed to this last week, two outspoken Catholic cardinals, Joachim Meisner of Cologne and Karl Lehmann of Mainz, condemned this as a betrayal of the Christian principles the party’s name claimed to represent. Meisner was especially critical of Research Minister Annette Schavan, a Catholic. He said the CDU decision was baffling, coming as it did “when science is opening up perspectives that present no ethical problems.”

Lehmann issued a statement as head of the German Bishops’ Conference: “The notable new successes in adult stem cell research and the reprogramming of cells are an additional argument against expanding embryonic stem cell research … so we call for a significant restructuring of European and German research funding from embryonic to adult stem cell research.”

In Belgium, the Catholic University of Leuven (KUL) thinks the breakthrough will help it keep its official Catholic status endangered by its stem cell research. The Vatican has been quietly investigating the university’s fertility centre, which does embryonic stem cell research that is firmly opposed by Catholic teaching. The university, with the support of Brussels Cardinal Godfried Danneels, has been arguing it needed to continue that work until research into adult stem cells — which it also does — finds an ethical way to produce them. No steps have been taken, but no compromise seemed possible. If the Vatican stripped KUL of its Catholic status, it could lose many Catholic students who study theology there.

“This reduces the bones of contention with Rome,” said KUL Vice-rector Mark Waer. “If these insights are confirmed, at some point it shouldn’t be necessary anymore to experiment with embryos.”

Cardinal Danneels agreed: “This is joyous news that can bring a turnaround on an important ethical question, the manipulation of the embryo. I’m very happy about this.” He also told the weekly Tertio that he always thought “the embryo problem might solve itself. Hasn’t Leuven been working all this time researching how equally good results could be reached with adult stem cells?”

There have been articles reporting that Asian laboratories had an advantage over those in countries with Christian traditions because Eastern religions had fewer qualms about using human embryos. The New York Times had a feature on Japanese scientist Shinya Yamanaka, one of the researchers pioneering the new technique. He gave no religious or philosophical reason for wanting to avoid destroying human embryos and simply said his scientific career changed when he saw a human embryo through a microscope: “When I saw the embryo, I suddenly realised there was such a small difference between it and my daughters … I thought, we can’t keep destroying embryos for our research. There must be another way.”