Lots of Americans buy the argument that we should ration health care according to lifestyle. So do many employers who are trying to charge their obese employees more for health insurance.  But if we are going to penalizing the health care sinners amongst us, shouldn’t we target all of those who raise our collective health care bill through poor lifestyle choices? This means you, cat owners.

The costs of a cat-loving America ought to be looked at in the same vein as recent calls to tax fat people. According to a Forbes magazine poll, one in three Americans believe that obese people should pay more in taxes than those who maintain a healthy weight. The same sentiments prevail among doctors in the UK. 

Overweight people cost the system a ton. People seem to think it's fair to ask them to pay more if they choose to munch chips while reclining on the Lazyboy watching Paula Deen on TV. Let's apply the same logic to all lifestyle choices. Cats are costing each one of us a lot of money to treat the allergies, asthma, skin problems and hospitalizations that they cause.

According to the Humane Society of the United States, there are over 86 million owned cats in the USA.  Nearly a third of you own these furry disease vectors. More than half of you cat owners have the gall to own more than one! 

At a recent meeting on immune diseases in Chicago, doctors and scientists who are studying allergies made it clear that cats are a menace. I learned that 17 percent of Americans, or 60 million of us, have allergies to cats.  So that means the odds are high that either you are allergic or someone you have over to your house could be.

Once a cat is in a home it is nearly impossible to get the cat allergens out of the bedding, carpets and furniture. The cost to all of us of treating cat-induced asthma, rhinitis, skin reactions and allergies is big. While there are no specific numbers for paying for the shots and drugs to treat the health problems due to cats, the overall medical cost for treating all allergies in the USA exceeds $7 billion.  And that does not include time lost from work or days out of school due to allergies.

One drug that is now frequently prescribed for kids and adults with chronic asthma due to exposure to cats, omalizumab, costs anywhere from $6,000 to $24,000 a year depending on dose. One in 2,000 of those with cat allergies require a trip to the hospital in any given year due to an acute adverse reaction to shots or drugs!

If we apply the "fat tax" logic, the obvious ethical question is why the heck are we cat-free citizens paying for the health problems associated with tolerating cat ownership? If you choose to own a cat or refuse to get rid of one even after being told to do so by your doctor, then why should I pay for this gross irresponsibility? 

So bring on the fat tax -- but tax all those who choose to make themselves, their kids and visitors sick by lifestyle choices, whether it's eating too much junk food or housing felines. And hey, employers, don’t hire cat owners, or at least make them go to classes where they can learn about the true cost that kittens impose on us all.  

While we are at it, let's impose a fine on those who fail to wear a hat while at the beach, risking melanomas, and a skiing tax for those nutty enough to speed downhill knowing that the orthopedic clinic awaits at the bottom.

Of course, none of this applies to dogs or dog owners such as me. Those who own them should receive a tax break. Pet ownership has a lot of benefits for your health, particularly if the pet is a dog. But cats are a very different matter. Those who insist that personal responsibility ought to drive what everyone pays for health insurance had better let cat owners know what is best for them.

More from Art Caplan:

• For organ donation, Facebook beats the DMV
• Time to think of health costs to IVF babies
• Youth hockey injuries border on child abuse

An article just published in the highly respected journal Fertility and Sterility ought to give anyone thinking about using “test tube” baby technology pause. A review of 124,000 children born through two very common infertility treatments -- in vitro fertilization, creating embryos in a dish and transferring them to a womb and ICSI, in which a single sperm is injected directly into an egg -- showed large increase in the risk of having a child with a birth defect. The risk was 37 percent higher than that seen in children made the old fashioned way. That is a huge number.

There is some danger that this message will not get heard by those thinking about using infertility treatments or considering putting off having a baby until later in life figuring they can use IVF if they need to. 

Celebrities continue to appear on television gab shows proclaiming that they used infertility treatment to have a child and that it was a breeze. Stories about Nadya Suleman and other super-multiple pregnancies rarely mention the grim facts about disability and premature death that accompany these morally dubious pregnancies. Too many clinics providing reproductive services for cash fail to emphasize the risks faced by kids made technologically.

I am not anti-technology when it comes to making babies. The position of the Catholic Church and some social conservatives in opposing the creation of life with a technological assist when infertility prevents a married couple from reproduction strikes me as cruel and anti-life.  And those who worry about turning baby-making into manufacturing when it is done in a clinic seem to me to have a very optimistic view about the circumstances that accompany the creation of a huge number of kids when sex is used.

That said, the large risk factor now on the table needs to be a key part of how everyone thinks about making babies in medical settings. The authors of the study say they do not know why the risk is so large. And it has taken far too long for this question to get asked. We need to be sure that long-term monitoring of children born by means of infertility treatment is routine and that more research is done into the causes of health problems for kids who cannot make choices about facing risk. 

Infertility treatments have brought a great deal of joy to many.  But, the price is high -- so high that we need to be sure it is a key element in thinking about using these treatments.

What do you think? Tell us on Facebook.

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A 32-year-old pregnant woman from Massachusetts, known only as Mary Moe, is at the center of a heated battle over abortion and sterilization, in a case so complex you could use it to teach an entire course on bioethics.

Moe suffers from severe schizophrenia and bipolar mood disorder. She has been pregnant before: The first time she had an abortion, and the second pregnancy resulted in a boy now being raised by Moe’s parents. Between her abortion and the birth of her son, she suffered what court papers refer to as a “psychotic break," and had to be hospitalized. She now takes medication, but her diseases are so severe that she is still not in touch with reality.

Forced abortion for mentally ill woman? No way, court says

At a court hearing last December the state Department of Mental Health asked that her parents be made her guardians. The parents wanted their daughter, then two months pregnant, to have an abortion. During that hearing doctors testified that the drugs Moe is taking threatened the health of her fetus. They also said stopping them would place her at serious risk of going "deeper into madness."  

The judge found the argument for an abortion persuasive. She ordered that Moe's parents be appointed as co-guardians, and said they could do whatever was necessary including having their daughter "coaxed, bribed, or even enticed ... by ruse" into a hospital where the abortion could be performed. The judge added that Moe should be sterilized after the abortion so that the same situation did not come up again.

The decision was immediately appealed. Now, a Massachusetts appellate court has overturned the lower court, and sterilization is off the table. The appellate court said that if Moe were competent she would not want an abortion, since she has said she does not want one. So no abortion is in store either.

Did the appellate court make the right decision? I think so -- but for the wrong reasons.

The state of North Carolina just paid out big sums of money to people who had been sterilized without their consent in the 1960s and 1970s. Sterilization has been abused again and again in this and other countries. There is no reversing it. Whatever needs to be done to help Moe, it is not sterilizing her.

If she is not to be sterilized, can severely mentally ill persons like Moe be told never to have sex? The court didn't broach the subject, but it is a key ethical question.

It is probably impossible to prevent Moe from having sex.  But given her mental state she is hardly capable of consent.  I think she needs to be on permanent birth control until and unless she somehow recovers from her mental illnesses. Then, and only then, should she be free to have a child.

What about the abortion? She cannot consent to it. The Massachusetts courts are trying to guess what she would want if she were competent using some of her statements to guide them. That is a hopeless quest. Moe is too sick to tell us anything. And, despite the judges’ efforts, it is pointless to pretend to know her wishes about this pregnancy.

Her poor parents do not want to worry about their daughter, raise one of her children and find themselves with another. But their stake in all this disqualifies them to decide what ought to happen.

What we are left with when autonomy is gone and family are conflicted is trying to do what is best for Moe and her fetus. I do not think an abortion clearly meets that principle.

If Moe’s medicines put the fetus at risk, then try to lower the dose. If Moe herself becomes even more impaired, stop. If Moe cannot possibly raise the baby and her parents cannot either, then adoption is the best road to follow.

Allowing Mary Moe to become pregnant again is not in her best interest. Ending the life of her fetus when she cannot tell us what to do is not in the best interest of the fetus. There is a lot to think about in the case of Moe, but forced sterilization and non-consensual abortion should not be part of that thinking.

What do you think about the case of Mary Moe? Tell us on Facebook.

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Three-year-old Amelia Rivera has a rare, very serious genetic disease known as Wolf-Hirschhorn Syndrome that can cause mental impairment, epileptic-like seizures and kidney failure. In the future, it's very likely she’ll need a transplant.

But, according to her parents, Amelia's mental disabilities are the reason she's being denied  the kidney transplant. Her parents told the Associated Press Wednesday that the decision is being determined by a doctor with The Children's Hospital of Philadelphia.

AP

The parents of 3-year-old Amelia Rivera, claim she is being denied a kidney transplant because of her mental disabilities.

"It's one doctor who's never seen us who is making this call," the father, Joe Rivera, told the Associated Press.

In a recent blog post written by her mother, Chrissy Rivera says they were told by her doctor and social worker that Amelia would not be a candidate for a transplant because of her mental disability, not even if a family member donates a kidney.

In the blog post, Rivera recounts this exchange with the doctor when she heard the news:

“So you mean to tell me that as a doctor, you are not recommending the transplant, and when her kidneys fail in six months to a year, you want me to let her die because she is mentally retarded? There is no other medical reason for her not to have this transplant other than she is MENTALLY RETARDED!”

“Yes, [said the doctor]. This is hard for me, you know.”

The blog post sparked an online firestorm -- including more than 15,000 signatures on a petition demanding that the decision be reconsidered by the Children’s Hospital of Philadelphia, an affiliate of the University of Pennsylvania where I work. 

In response to the uproar, the child's parents are planning to meet with hospital officials next week, according to AP.

The issue of disability and access to a life-saving transplant merits serious reflection.

Whether the kidney comes from a cadaver donor or a living one, transplant teams always think about a set of medical facts in deciding whether to transplant anyone. Is the person able to go on kidney dialysis? Is she healthy enough to survive surgery? Does the patient have a donor who closely matches her blood and tissue type increasing the chance that the transplant will work? There is nothing special about the presence or absence of mental disability with respect to these questions. But morally, things get a little stickier.

Those being considered for a transplant must be able to comply with what is required after a transplant — taking a lot of medicines and watching out for early signs of rejection of the transplanted kidney. This means that those with severe mental impairment need willing, round-the-clock helpers so that the transplant has a reasonable chance of succeeding.

Transplant teams also think about the chance for long-term survival, especially when a scarce cadaver kidney is involved. Some severe mental disabilities are linked to genetic problems that create other daunting physical challenges -- bad hearts, severe diabetes, malformed organs, etc., which can drastically shorten lifespan.

Because of that, some transplant programs don't consider operating on those who are facing significantly shortened lives on the grounds that the need for transplants among kids is huge and the scarce supply of cadaver kidneys should be used to save the most lives and the most years of life.

It’s even more complicated when the patient is a very disabled person who resides in a care facility. A child who is immunosuppressed, whose bodily defenses are knocked out to permit the transplant to work, will be put at huge risk of getting a deadly infection if she lives in an institution.

Each transplant case involving a disabled person has to be looked at individually.  All that said, children with intellectual disabilities do not appear on transplant waiting lists with the frequency that should be expected.  And in 1990 Congress passed the Americans with Disabilities Act  which prohibits discriminating against patients solely on the basis of a disability.

There are reasons why anyone with an intellectual or physical disability might not be considered a good candidate for a transplant.  But those reasons, to be ethical, have to be linked to the chance of making the transplant succeed. Otherwise they are not reasons, they are only biases.

What do you think? Discuss this column on Facebook. 

Those who are grossly overweight often feel guilty about many things. Now, add one more to the list: Their weight even gets in the way of helping others after their death by donating their bodies, according to an msnbc.com article.

If warnings about health issues don’t motivate people to lose weight, perhaps that reason will for those who want others to learn from their bodies after their deaths.

Fat bodies are not ideal for teaching anatomy in medical school. Given all the health issues associated with being blubbery you might imagine that students could learn a lot from an overweight corpse.  But first, they need to learn what a body not affected by the ravages of too much weight looks like. You simply can’t start with the abnormal and work your way back.

The fact that so many of us are obese does not, contrary to the laments of some fat advocacy groups, make obesity normal. When it comes to learning about the body and its parts, a student needs to be able to see what a healthy body is even if there are a lot of folks who do not have one.

Another, more practical problem, is that anatomy class equipment is not built for plus-sizes. Even if those who run body donation programs want to take bigger bodies, they simply cannot manage them. The process of embalming involves 5 to 6 gallons of fluid which adds as much as one hundred pounds to an already heavy body.  It is hard for the staff to transport, lift and manipulate this kind of dead weight. 

As we know, Americans are packing on the pounds.  The obesity epidemic will be a huge factor in driving up the bill for the next generation.

In recent years, there has been a proliferation of furniture, clothes, towels, seat belt extenders and funeral caskets aimed at large people.  But, that revolution hasn’t and, given the cost, won’t reach the world of body donation and anatomy class.

If you want yet another reason to lose weight, know that if you want your last act to be the gift of helping medical students to learn after your death, you need to slim down.

Story: Donating your body to science? No one wants a chubby corpse

featurepics.com

People intending to leave their bodies to science might find they bump up against weight limits, especially given America's growing girth.

It’s a rare day when Richard Drake turns down a dead body, but last week, he had no choice.

At 6-foot-1 and 350 pounds, the deceased in question was simply too big for the Cleveland Clinic Body Donation Program, which provides specimens for anatomy classes at the Lerner College of Medicine and elsewhere.

“Someone that’s shorter and carrying a lot of weight, that is a problem,” said Drake, director of anatomy and a professor of surgery. “The storage is one issue, but when you are obese, there’s a lot of tissue everywhere. The students don’t get as good a learning opportunity.”

Reluctantly, Drake informed the dead man’s family he’d have to turn down the donation request because their loved one exceeded the size limits for medical research.

“They understood that, because, actually, they had tried a few other places,” Drake said. “They were sort of checking around.”

In a country where more than a third of adults are obese, the impact of extra weight extends, it seems, even beyond death.

Officials at some whole body donation programs in the United States tell msnbc.com they’ve turned away corpses that are too fat for scientific study. Others say the bigger issue is that potential donors simply don’t sign up once they learn of weight limits that can be as low as 170 pounds, but generally top out at 300 pounds.

“Family members, or the person themselves, sometimes they’re a little taken aback,” said Stephen D. Anderson, coordinator of the Willed Body Program at the University of Louisville School of Medicine in Kentucky.  “They didn’t assume there were any restrictions.”

That surprise could be a problem, considering that a 2004 Johns Hopkins School of Medicine study found that about half of adults surveyed would consider donating their bodies to science.

But officials at the university-affiliated programs that supply perhaps 10,000 to 15,000 dead bodies each year to the nation’s nearly 140 medical schools say that weight and height limits are an unavoidable part of the process.

“The embalming process adds considerable weight. Generally, a 250-pound person might weigh 350 to 400 pounds when embalmed,” said Richard Dey, professor and chairman of the Department of Neurobiology and Anatomy at West Virginia University in Morgantown. His program receives about 275 bodies a year and turns away at least a few.

To be frank, bodies taller than about 6-foot-4 or heavier than about 300 pounds simply don’t fit on the trays that are sometimes stacked six high in the coolers where the deceased are kept, experts say.

It can be difficult for technicians to handle huge corpses, which have to be lifted and transferred frequently, often by slim technicians or students, said John Lee Powers, curator of anatomical materials at the Brody School of Medicine at East Carolina University in Greenville, N.C.  That program limits donors to between 170 pounds and 180 pounds, though an exceptionally tall donor might be allowed at 190.

“It’s the maximum our equipment will handle,” Powers said.

There’s also the educational aspect to consider. Donated bodies are used primarily for first-year anatomy students, who need to learn how the human body is supposed to look, said Ronn Wade, director of the Anatomical Services Division of the University of Maryland Medical School in Baltimore.  

Bioethicist: A final reason to lose weight

“In a perfect world, they’d like to have a perfect body with perfect anatomy -- or near perfect,” said Wade, whose program is among the largest in the nation, with a peak donation of some 1,800 bodies a year.

Studying obesity and other pathologies can come later, once students are familiar with the basics, he added.

Obese bodies are more difficult, time-consuming and unpleasant to study, said Wade, who also heads his state’s anatomy board.
“Basically it’s having to get at the structures you want to see,” he said. “Between the skin and the rest, there’s layers and layers of fat cells.”

Only about a quarter of the bodies Wade receives meet the ideal criteria, he said. Perhaps 5 percent of them are morbidly obese.

Wade generally doesn’t reject them outright. But they won’t be used by medical students in first-year classes. They might wind up as clinical specimens used for practice by paramedics or other medical professionals. Some obese bodies can't be used at all, so they're simply cremated and the remains are returned to the families -- without ever serving any research purpose.

So far, medical schools are still able to get enough lean bodies for students to use, experts said. Some programs use corpses from for-profit tissue brokers, which are loosely regulated and supply an unknown number of bodies each year.

Still, considering America’s growing girth, some experts are worried about the future.

Anderson, the director of the University of Louisville program, says he can’t use about 10 percent of the 175 to 200 bodies donated each year because of size problems.

He said he’s thought about upping the program’s weight limit from 200 pounds to 250 pounds to ensure a steady supply.

“If we keep it at 200, we may see that we’re turning down potential donors because of that,” he said.

Having to turn down any willing donor is a shame, said Drake, the Cleveland Clinic expert who is also an officer with the American Association of Anatomists. He doubted the family of the 6-foot-1, 350-pound man would find a program to accept his remains. Instead, they likely had to make other arrangements for the man’s disposition.

“It is an emotional thing,” he said. “People really do want to do this.”

That was the case for the mother of Tara Parker-Pope, a New York Times health reporter who recently wrote about the struggle to lose weight and keep it off, both in her own family and in the population at large.

“My mother died of esophageal cancer six years ago,” Parker-Pope wrote. “It was her great regret that in the days before she died, the closest medical school turned down her offer to donate her body because she was obese.”

Those who leave their remains to science tend to be sensitive folks interested in enhancing the public good, said Wade, the Maryland expert who has promoted whole body donation for more than 35 years.  

At the end of a life perhaps spent struggling with weight, learning they’re too heavy to fulfill those altruistic wishes can be devastating.

“It’s kind of another stigma,” said Wade. “They kind of feel victimized.”

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