Switching your bait and tackle

The world's first penis translant took place recently and a report on the operation will be published next month in European Urology. But the press has already given out some of the non-technical details. A 44-year old Chinese man had an accident this year that left him with a 1 cm long stump where his Johnson should be, and rendered him unable to urinate or have sexual intercourse. The parents of a brain-dead 22 year old man agreed to donate their son's organ to the older man, and the Chinese microsurgeons went to work. Medically, the operation seemed fairly successful, but after two weeks the man decided to have his new penis removed, because it was causing psychological problems for both the man and his wife. Better no penis than someone else's, seemed to be their rationale.

It is an interesting ethical issue. On the one hand, a penis seems to be not as personal as those controversial tranplant items, i.e. faces or hands. As the cliche goes, if you have seen one, you have seen them all. On the other hand, the penis is both flesh and symbol, deeply prized, fetished and the source of multiple anxieties, as David Friedman has illustrated in his A Mind of its Own: The Cultural History of the Penis. Whatever the penis' magic power may be, you don't just sew somebody else's on and expect things to be fine.

Or don't you? As we have seen with other developments involving reproduction, what is first an object of revulsion may become an object of desire. With all the consumer demand for penis enlargement and drugs to combat erectile dysfunction, who knows, maybe some healthy men, in search of enhancement, will want a penis translant if the technique is made safe and has good results. One can count on someone saying that having a longer penis, via transplant technology, is a human right. And no doubt, an underground market in male members would emerge, similar to markets now in kidneys and lungs. The movie possibilities are endless.

Global bioethics: the very idea

I admit I easily took the bait. It was hard not to, what with an enticing title like "Global bioethics -- myth or reality". The article by Soren Holms and Bryn William-Jones in BioMed Medical Ethics seemed to suggest, among other things, that the name of this blog might need a rethink. Maybe, after all, there is no such thing, and in fact the word 'global' has been linked to the word 'bioethics' for purely public relations purposes. If nothing else, global sounds jet-settingly cool. And it links with the current trend among schools of public health to set up a wing of Global Health, and hopefully pull in some money from Bill Gates or Bill Clinton.

The article, however, understands 'global bioethics' in an unfamiliar way. It identifies global bioethics as the idea of there being a shared way of thinking about (similar) bioethical issues around the world, and uses rather unusual way of ascertaining whether this is the case, namely by studying linking patterns of bioethics institutions, citation patterns of bioethics articles and the buying patterns of bioethics books.

The result of the study indicate that bioethicists around the world do not link to each others sites very much, they do not cite papers very much from bioethics journals from other countries, and do not buy the same sort of books. So the idea of there being a 'global bioethics' in this sense seems to a myth. But then again, the idea of there would be a global bioethics if bioethicists around the world were just a bit more incestuous (citing one another, linking one another, shopping like one another) seems pretty unwholesome itself. If that kind of universal conformity is what global bioethics comes to, the notion deserves to be put to sleep. Immediately. It is painfully uncool.

Holms and William-Jones mention another conception of global bioethics in passing, i.e. the call to globalize bioethics by focusing more attention on, for example, issues of resource-poor countries, public health, or global justice and equity. Given the somewhat parochial concerns of bioethicists in the world's most powerful countries, this seems to be form a global bioethics worth wanting. So the name of this blog remains the same, until further notice.

Holding patients hostage for their hospital bills

Human rights Watch has just issued a report of how some hospitals in Burundi try to ensure some of their revenue: by physically detaining patients who have not yet paid their hospital bills. Many of those detained are women who unexpectedly needed caesarean sections, and hence found themselves birthing beyond their financial means. Being poor, sick and seeking clinical care in Burundi apparently takes you on a slippery slope to the hospital pokey. Only the help of friends and relatives, selling anything from goats to land plots, can buy you your freedom back.

Human Rights Watch may be wrong to focus on Burundi, because I have heard of the same practice in the Congo, and chances are that patient detention is widespread among African hospitals themselves struggling to make ends meet. Hopefully, the practice will not spread to the United States -- overly fond of locking people up already -- and be recast as a novel form of 'cost-recovery.'