Issues Magazine

Editorial

By By Sally Woollett

Editor, Issues

An overview of what's in this edition of Issues.

This edition of Issues is about beginnings and endings: how we feel about the start and finish of life and how we understand what happens in between.

Alan Dorin at Monash University is interested in how we have represented life through the ages to try to clarify our understanding of ourselves – from crude clay approximations to industrial robots. His field of study is artificial life – “the creation and study of technological organisms” – and he explains that whether or not you think something technological is alive is a matter of definition (p.6).

Also at Monash, Rebecca Lim at the Faculty of Medicine describes advances in obstetric and neonatal care as a “catch-22” (p.9). Many births previously considered unviable are now resulting in living babies – but they have health problems, sometimes including the chronic lung disease bronchopulmonary dysplasia. Using stem cells isolated from afterbirth is a therapy for which research has moved into the clinical trial phase. “A team of clinicians and scientists are working closely to translate research findings to a curative therapy for bronchopulmonary dysplasia in premature babies,” Lim says.

A paper published in BMJ Open has questioned the idea that higher rates of medical interventions during childbirth in private hospitals has better outcomes. “For those with low-risk healthy pregnancies, private obstetric care in a private hospital, with their higher rates of intervention, may be leading to avoidable health problems for their babies,” say Hannah Dahlen and Sally Tracy of the University of Sydney (p.16).

Similarly Karin Hammarberg of the Jean Hailes Research Unit at Monash University examines quoted figures relating to the chances of having a baby with IVF. “Some of the figures … seem overly optimistic … and this may be because it is not clear what the denominator is,” she writes (p.12).

Last year, a Bill known as Zoe’s Law was passed in the NSW lower house of parliament. If passed by the upper house, separate charges can be laid where grievous bodily harm occurs to foetuses of at least 20 weeks’ gestation. Some groups are concerned that recognition of the foetus in this way will have “flow-on” effects related to abortion. Helen Pringle of The University of NSW says (p.14): “Concern for the status of the foetus has been identified almost exclusively with pro-life positions on abortion, but there are other legitimate voices and stories that need to be heard in this discussion”.

The Senate is currently considering a document concerned with the opposite end of life: The Medical Services (Dying with Dignity) Bill 2014 (Cwth). BioEdge editor Michael Cook asks (p.26): “… will it ever be possible to have a humane [assisted dying] law that will not be abused?” He cites several potential problems, including radical supporters, the definition and control of pain, and enforcement. “But even for many in-principle supporters,” says Cook, “legalisation is simply too dangerous. Years of experience in Belgium and Oregon show that there is an enormous potential for abuse.”

Psychiatrist Christopher Ryan poses another question (p.30): “What safeguards should be put in place to protect people who might be wrongly killed?” Even those opposed to physician-assisted dying should be interested in this question, he says. He argues that people should not be offered physician-assisted dying without first seeing a psychiatrist. This step would reduce the risk of physician-assisted dying being offered to people with delirium and medical depression, which are both common in terminal illnesses and can prevent someone from making a genuine choice. “Making a terminally ill person see a third doctor – a psychiatrist – in order to access a desired peaceful death is an impost, but if we are serious about protecting people it is a burden worth imposing,” Ryan says.

Death comes to us all eventually, and many countries, including Australia, are struggling to cope with demand for burial space. A growing population entails many demands on land use, and acquiring space for cemeteries has become expensive. Renewable tenures for graves, already quite common overseas, “green” burials and cremation are all practices that factor into a solution. Jo Davenport of the Australasian Cemeteries and Crematoria Association says (p.32): “A strategic, coordinated approach to management of the interment industry in Australia is essential to address the critical shortage of burial space and to ensure that a full range of interment options are accessible and affordable to all cultural and religious communities across the country”.

When organs and tissues are donated, the death of one person can mean a chance at life for another. The Organ and Tissue Authority encourages individuals to talk with family members about end-of-life decisions. Donation rates are improving, but organ donation is still a rare event. National school resources have been developed and are available at junior secondary school levels. “Due to the rare opportunity for organ donation to occur, it is critical that every Australian family discuss and know each other’s donation decisions. This is because in Australia every family of a potential donor will be asked to confirm the donation decision of the deceased,” says the Authority (p.21).

One complicating factor that is still debated and discussed by medical professionals worldwide is deciding whether a person is indeed dead, and then explaining this to family members. “Brain death does not equal traditional death, and it is hard to accept,” says Syd Johnson at Michigan Technological University (p.24).

Synthetic biology – the design and engineering of new life – is at the heart of exciting international research of which Ian Paulsen and Isak Pretorius at Macquarie University are a part. “With a genome size of ∼12 Mb [the yeast] S. cerevisiae is marching on to become the world’s first eukaryote with a chemically synthesised genome,” they write (p.36).

We are experiencing a longevity revolution, explain Ina Voelcker, Louise Plouffe, Silvia Costa and Alexandre Kalache at the International Longevity Centre Brazil (p.18). As life expectancies increase worldwide, we need to rethink our life courses and the suitability of our health and social care systems. The Centre’s Rio Declaration “calls for a fresh perspective on gendered dimensions of care in policy and in society… Emphasis is given to achieving a care system, spanning health promotion to end of life care that is characterised by communication, continuity, coordination, comprehensiveness and community linkages.”

Could robots as personal caregivers be part of the longevity revolution? Daily interaction with robots is part of the near future, explains human–robot interaction researcher Julie Carpenter (p.39). Robots have the capacity to help around the house, in health care and in emergency services such as firefighting. In his opening piece, Alan Dorin refers to representations of life and the power of models. Closing on a similar note, Carpenter explains that “our past experiences help us create mental models, and these help us to decode new technologies like robots”. As a result, a sense of attachment becomes possible. “A person’s therapeutic use of a robot for companionship or caregiving could be extremely helpful to making their life better at some level,” Carpenter says.