Bioethic Predictions for 2015

For several years, I have been the resident prophet at the CBC, and if I don’t say so myself, I have been quite prescient. But life in the prognosticating business is always a “what have you predicted for me lately,” so let’s take a look how I did for 2014.
What I Got Right
Affordable Care Act: I predicted the ACA—aka Obamacare—would continue to “be the cause of more health care system turmoil and political tug of wars.” Impressive, no? Of course, a nursery school student could have gotten that one right, so let’s move on.
Assisted Suicide/Euthanasia: I definitely saw the angel of death’s handwriting on the wall. Here is what I said would—and has—come to pass:
• Belgium will legalize euthanasia for children. Mostly right. The country legalized assisted suicide for children, no age limit.
• Quebec will legalize euthanasia. Done. The new Quebec law permits euthanasia, and requires dissenting doctors to refer if they have moral qualms about killing patients.
• No U.S. state will legalize assisted suicide. Not for lack of trying.
Biotechnology: I predicted a “relatively uncontroversial year” in this field. I said “advances in ethically uncontentious stem cell research and induced pluripotent stem cells” would “continue at an exciting pace.” All true. I also said that human cloning would not further advance due to a shortage of eggs. So far, the field remains relatively quiescent in human efforts for that reason (among others). I also said correctly, “Embryonic stem cell research will continue to lose its grip on the public’s consciousness as the above advances proceed.” And indeed, I can’t recall one significant or heated public debate about embryonic stem cell research in 2014.
Reproductive Technology: Here I go, correct again. I predicted:
• “The notion that people have a fundamental right to reproduce by any means they desire or believe necessary will continue to expand.” We are about to see attempt to create three-parent embryos and IVF used to create non-traditional families is now widely supported by the public.
• No state—other than California—would pass a bill to permit egg buying in biotech.
• The use of “gestational surrogates” will continue to increase as more gay couples marry and decide they want children, and more older women decide they want children past usual childbearing age.
Miscellaneous: This is probably my best, most specific, and probably unexpected correctly made prognostication: I warned: “The Jahi McMath ‘brain dead’ controversy will continue.” And so it has. Jahi was moved from California to New Jersey. Contrary to the expectations of physicians, her brain did not liquefy, nor did her body shut down. Two noted neurologists have now said that Jahi no longer meets the criteria for brain death. More on her case in my 2015 predictions (below).
What I Got Wrong—And That’s OK With Me
I believed that legislation would pass in California to permit egg buying for biotechnology, and moreover, contrary to a previous version of the bill, that Governor Jerry Brown would veto. No such bill was introduced.
My crystal ball also failed to tell me the truth when I predicted that a British Columbia judge would “rule that a woman with Alzheimer’s must be denied spoon feeding.” In fact, the judge denied the request, and the case is on appeal. However, I still consider this to be the most important pending litigation in bioethics.
I expected legislation to be introduced in at least one state to permit paying for organs. The shortage of organs and increased advocacy for that course still has me thinking that it is coming, but it didn’t happen in 2014.
Ready or Not, Here it Comes
Two of my predictions may yet come true. But it’s not my fault. Sometimes, courts are slow. So, let’s fold them into what will happen in the next 11 months of 2015.
First, I believed last year—and still do—that the Canadian Supreme Court will declare a constitutional right to assisted suicide. The case was argued last year but no decision has yet been issues.
Second, I told you last year to expect a New Mexico trial judge’s ruling legalizing “aid in dying”—aka, assisted suicide—to be reversed. I still believe the court will exercise such wisdom.
But you ask, “Wesley, what’s new for 2015? How do you see it?”
Glad you asked: The Ghost of Bioethics Future is calling my name. Whoa, I feel as light as air! I am traveling through time and the mist is clearing. Here is what the GoBF revealed:
A British Columbia Court of Appeal will rule that people can require in an advance medical directive that nursing home caregivers to withhold spoon-feeding if they become seriously demented or otherwise cognitively compromised. This would permit people to force others help them commit suicide by self-starvation—known in euthanasia parlance as “Voluntary Stopping Eating & Drinking” (VSED)— when they are not competent to make medical decisions. I consider this the most dangerous lawsuit in bioethics as the real impact would be to legally force nurses and doctors to starve incompetent patients to death—even if they eat and drink willingly.
The first human experiments in the creation of three-parent embryos will begin. These embryos would be created by genetically combining two women’s eggs and fertilizing them with sperm. The supposed point is to prevent a mother from passing on mitochondrial disease. But as often happens in these matters, if successful, I believe the technique would be employed to create novel family arrangements.
Laws and regulations will increasingly require health insurance to cover sex change surgery and other interventions. San Francisco already covers such interventions for transsexuals. Look for regulators and courts to continue expanding the mandate, eventually (not next year) culminating in required coverage under the Affordable Care Act, under Medicare, in prisons, in the military, and by the Department of Veteran’s Affairs.
Well, that last prediction partially assumes that the ACA—also known as Obamacare—will remain the law of the land. The U.S. Supreme Court will rule in a landmark case, that the wording of law does not permit subsidies for insurance purchased on federal exchanges. That will make Obamacare fiscally untenable, leading to a massive national debate and brouhaha in Congress over repeal and reform of the federal law. Substantial compromise on the issue will prove impossible in 2015, leaving the law badly damaged but still in effect. Indeed, the debate about how to “fix” Obamacare over this and other matters will remain become a central issue in 2016’s state and federal election politics.
There will be a massive drive to legalize assisted suicide throughout the country—aided and abetted by in-the-tank media harnessing the raw emotionalism generated by the Brittany Maynard case—to bludgeon legislatures into passing “death with dignity” laws. That effort will reach the verge of success, but in the end, will be stymied. No new laws allowing assisted suicide will go into effect in the USA, although it might require a governor’s veto to prevent a fourth state from formally legalizing suicide as a “medical treatment.” Efforts in the UK and Scotland to legalize assisted suicide will also fall short. These defeats will not resolve the controversy, but the results will have been so close that the euthanasia movement will move forward even more energetically in 2016. That will be the year when the truly consequential battles in this area will mostly take place (particularly in California). But that’s a prediction for next year.
Oh, oh: The fog is back and I feel weightless. The Ghost has returned me to my own time. Until we meet again on these pages, please keep supporting the work of the CBC, which uniquely brings the truth about “making, taking, and faking life” to audiences all around the world.
________________________________________