All posts by Sasha Barghachie

New Tools for Childhood Immunization


The concept of childhood immunizations may seem exhausted to us now, given the number of discussions we’ve held on the subject. However, I find that Isaacs, Kilham and Marshall, in their paper Should Routine Childhood Immunizations be Compulsory?, do an excellent job of wholly representing convincing arguments for both sides as well as bringing up a few aspects of the debate that we have yet to discuss.

One subject that we have touched on briefly in class, the risk of injury from the vaccination versus the risk of injury if not vaccinated, is again mentioned here, but this time more in depth. Isaacs et al. provide actual numbers. For example, the routine measles vaccination “causes acute encephalitis with an incidence of one in a million doses” where as the risk of acute encephalitis if the person was to naturally be infected with measles, or the “wild-type infection”, is one in a thousand (399). This is a huge difference. I think it’s very important for this kind of comparative information to be presented to parents and the general public as part of an educational effort. If these are the crude facts, why do parents (assuming that they have this information) still say no to vaccinations? Isaacs et al. offers psychological reasoning that there is a tendency for parents to be more afraid of causing harm to their children because of something they actively did than because of something they didn’t do. “This is referred to as the fear of commission rather than of omission” (400). I think this is a very salient concept that is important for doctors to be aware of when discussing immunization with parents. In a moving quote from Benjamin Franklin, after the death of his son to smallpox after having not vaccinated him, Franklin proposes that regret is the same either way, and so the safer route (immunization) should be chosen (400).

Another topic we have discussed in regards to immunizations is the concept of free-riders and herd immunity. Once again, Isaacs et al. provides very vital information on the subject. Free-riders are those who opt out of immunizations under the impression that enough of the population will have gotten the vaccination that they will be protected from infection without needing to vaccinate themselves or their child. The issue that we haven’t discussed yet, however, is that there are known, calculated disease-specific percentages of the percentage of the population that needs to have been immunized for herd immunity to work. Going back to the example of measles, it is known that 95% of the population has to have received the measles immunization to ensure that no outbreaks will occur (401). For Hib disease, the percentage is slightly lower at 85%, but this only guarantees that rates will begin to rapidly decline (401). These percentages are an excellent tool for doctors to be equipped with when interacting with a “free-rider” parent. The doctor can then confidently tell them whether or not there is currently a sufficient amount of people immunized for their plan to work. Certainly though, there will be doctors who won’t care that these percentages have been reached and will still push for the parent to immunize, as I think the doctor should. But then the ethical question arises of whether the doctor is in the right to do so if the vaccination may not actually be necessary. Ethics would most likely find that at that point, the parent is ok not to vaccinate.

One last issue that I think Isaacs et al. did well to bring up is the idea of inducements instead of punishments to encourage child immunization. There has historically been, and currently been talk of, jail time as a punishment for refusing to immunize your child because you are not acting in the best interest of the child. However, putting the parent in jail certainly would not be in the best interest of the child, so realistically that is not an option. However, they offer the suggestion of child care benefit payments or maternity benefit payments to encourage parents to immunize their children. They also mention those families who rely on welfare. I think it is not only a great idea, but arguable as well. Why not require all children who receive Medicaid to be immunized? Isaacs et al. offer this idea, saying “if society provides child and family payments, it is reasonable for society to expect and even demand that children be immunized to help protect the whole community” (404).


Isaacs, Kilham, and Marshall. “Should Routine Childhood Immunizations be Compulsory? Holland, Stephen. Arguing About Bioethics. 398-406.

The Fight for Organ Donation


The Uniform Anatomical Gift Act (UAGA) authorizes the indication, either in a will or on a driver’s license, of a desire to donate one’s organs or body post mortem to act as a legal document. It is crazy to think that any form of legal documentation not be honored and upheld in American society, but apparently it is not uncommon for doctors or even the Organ Procurement Organization (OPO) to allow the family to act against the expressed wishes of the deceased. According to the UAGA, if a person has indicated their preference to be an organ donor, legally, the family has no say in the matter. So, why is such a decision, one made autonomously and ethically accepted as to be respected, so easily overruled at times? D. W. Donovan, a chaplain and vice president for mission and spiritual care at Providence Regional Medical Center in Everett, WA, claims that it is common practice to grant families the ability override previous declarations made by the deceased and offers three reasons for this in his article Defending the Donor’s Decision.

Although a doctor or OPO official have no legal reason to honor or even consider a family’s request to override the wishes of the deceased in regards to donating their organs, Donovan points out that it can often leave medical personnel caught in the middle of an emotionally charged event” and put them in an awkward position when confronted by an “angry family member who is strenuously opposed to donation” (1). A study conducted in 2001 indicated that only 8% of OPO’s were likely to procure the deceased’s organs if the next of kin objected (1). Respecting a family’s overriding wishes, spares the doctor and the family member’s emotional distress presented by the situation.

Refusing to appease a grieving family member’s desire to keep their deceased love one “whole” or in-tact can have negative repercussions on the health facilities and is another reason that Donovan offers as to why we give in to family member’s requests. Although supporting a person’s decision to be an organ donor is an act of respect for the patient’s autonomy, it can be perceived alternately by the public as an “invasion of privacy and bodily integrity” and can result in poor public perception of that medical facility which is something that doctor’s would obviously want to avoid.

The third reason Donovan offers is that many regard a person’s choice to be an organ donor to not be an authentic autonomous decision. Miller’s article (that we read the other day) listed 4 qualifications for a decision to be regarded as autonomous: free action, authenticity, effective deliberation, and moral reflection. The choice to become an organ donor or not is made by checking a box at the DMV that literally just asks you if you want to be an organ donor. There is no explanation of what that entails, how the process works, how the organs will be procured, etc. Surely Miller would say that this is not a truly autonomous decision. Without any information about risks, benefits or alternatives to consider, how can one actively participate in effective deliberation even if it is a choice free of coercion and true to one’s generous disposition?

Are these common arguments enough to grant a family paternalistic authority over the body of a deceased loved one? I think it’s important to realize that emotions over the loss of a loved one often cause family members to act/think irrationally which certainly should at least prompt discussion of its own to determine whether decisions made in such emotional states can even really be consented to as autonomous.



The hype about Dolly

Dolly Time

I decided that I wanted to do a bit of research on Dolly, the sheep that captured the world’s attention and sparked much debate about cloning for the public. All I knew of Dolly was that she existed and was a clone. She was heralded as a huge scientific breakthrough, which unarguably, she certainly was. But much to my surprise, it’s not for the reason I thought (and many others I’m sure). I believed that Dolly was famous because she was the first animal to be cloned and honestly, to this day, still believed her to be the only successfully cloned animal. Neither of these is true. Dolly is not even the first sheep to be cloned. Nor was she the first sheep to be cloned by Ian Wilmut of The Roslin Institute who is famous for her creation.

Dolly was actually the ninth of ten sheep cloned at The Roslin Institute by Ian Wilmut (2). So why is it that she is the only one that I have ever heard about and the only one that the media so desperately followed the story of? Because even though Dolly was not the first, she was the most significant (scientifically speaking).

All 10 of these sheep were cloned using the most common process of doing so: Nuclear Transfer. This is when the nucleus of an existing cell is removed and replaced with that of a new donor cell. I was curious about what was done with the “old” nucleus (wondering if it could pose as an ethical issue of its own), but couldn’t find any information about it. The 9 other sheep cloned at The Roslin Institute were cloned using embryonic cells. As stated in David Elliot’s paper (Chapter 12), Dolly was considered a break through because of the fact that she was cloned using the adult cells taken from an adult ewe’s udder. It was the first time something had been cloned using cells other than embryonic cells. Why had that never been done before?

Dolly Process

The body contains many different types of cells, such as blood cells, liver cells, skin cells, etc. These specific types of cells are referred to as differentiated cells and although all of them contain the same genetic information, they “can only access the genes needed for its particular function” (3). Differentiated cells were thought to be non-reprogrammable and therefore it was not believed possible to clone an entire being using only differentiated cells. Ian Wilmut proved that this was false and that it was in fact very possible to use differentiated (adult) cells for cloning. What he did was to take these adult cells and grew them under “starvation conditions” (3). This entails depriving the cells of various forms of “nutrients” such as carbon for instance. This causes the cells to de-differentiate and enter what is called the g0 state, essentially turning them back into unspecific, embryonic cells. This is why Dolly was special. Her creation represented the possibility to turn a differentiated cell back into any kind of cell.

There is some controversy about the successfulness of Dolly. The process by which she was created was without a doubt a novel success. But how did Dolly fare in regards to health and life? Wanting Dolly to live as normal a life as possible, she was allowed to breed and over the course of her life gave birth to 6 lambs. In 2001, Dolly developed arthritis which was odd for a sheep of only 5 years. The cause of this was never determined and after medication, her stiffness disappeared (1). In 2000, 2 of the other cloned sheep died of sheep pulmonary adenomatosis (SPA) which causes tumours to grow on the sheep’s lungs (1). Later, one of Dolly’s own babies contracted the disease and it was confirmed that Dolly herself was infected. When she was seen coughing in February of 2003, she was given anaesthetics and a CT scan was performed. The scan confirmed the presence of tumours on her lungs. Not wanting Dolly to suffer from this painful disease, the decision was made not to allow her to regain consciousness, and an over dose of anaesthesia was administered and Dolly was put to sleep on February 14, 2003. Sheep generally live to be around 12 years old and the development of SPA is not commonly seen in young sheep. Dolly developed it around the age of 5. This, along with her development of arthritis, has caused concern that using differentiated, adult cells causes premature aging in the clones. This has yet to be proven. (1)

Kass, in Chapter 11, calls for a universal ban on human cloning while still allowing “all cloning research on animals to go forward” insisting on the “inviolable distinction between animal and human cloning” (146-147). Researchers at the Universities of Cambridge and Edinburgh have successfully developed genetically modified chickens   that are incapable of transmitting the avian bird flu. They have been provided with an RNA molecule that stops the reproduction of the virus, and although they can still be infected with the bird flu, the fact that they are incapable of passing it on to other chickens has the potential of stopping the transmission of the virus. (1) It is easy to see the appeal of genetic modification in this sense. But again, a distinction must be made both between animals and humans and between cloning and genetic modification.

Just as an interesting side note, many animals have actually been successfully cloned. They include cows, cats, a deer, goats, sheep, frogs, horses, mice, pigs, monkeys, wolves and dogs. One of the dogs (according to Wikipedia) glows when exposed to UV lighting. (4)