A report from America: Baby M

Rachels reviews the social and legal facts of the celebrated "Baby M" case, in which surrogate Mary Beth Whitehead attempted to keep the daughter she had borne under contract to William Stern. The first phase of the legal battle between the parents ended in March 1988, when New Jersey Superior Court Judge Harvey R. Sorkow upheld the validity of the surrogacy contract, terminated Whitehead's parental rights, and awarded custody of the child to Stern. Rachels comments on public reaction to "Baby M," on Sorkow's decision, and on the impact the case may have on legislative attempts to regulate surrogacy. He also uses the example of "Baby M," as well as that of California heart transplant patient "Baby Jesse," to discuss how the media sensationalize controversial issues.     

Breast milk donation after neonatal death in Australia: a report

Lactation and breast milk can hold great value and meaning for grieving mothers who have experienced a recent death of an infant. Donation to a human milk bank (HMB) as an alternative to discarding breast milk is one means of respecting the value of breast milk. There is little research, national policy discussion, or organizational representation in Australia on the subject of breast milk donation after infant death. On 29 November 2013 the Mercy Hospital for Women in Melbourne, Australia hosted Australia’s first National Stakeholder Meeting (NSM) on the topic of milk donation after neonatal death. The NSM drew together representatives from Australian HMBs, neonatal intensive care units (NICUs) currently using donor human milk, and Australia’s chief NICU parent support organization. The NSM was video-recorded and transcribed, and analyzed thematically by researchers. This article reports the seven dominant themes discussed by stakeholders during the NSM: the spectrum of women’s lactation and donation experiences after infant death; the roles of the HMB and NICU in meeting the needs of the bereaved donor; how bereaved mothers’ lactation autonomy may interface with a HMB’s donation guidelines; how milk donation may be discussed with bereaved mothers; the variation between four categories of milk donation after neonatal death; the impact of limited resources and few HMBs on providing donation programs for bereaved mothers in Australia. This article provides evidence from researchers and practitioners that can assist HMB staff in refining their bank’s policy on milk donation after infant death, and provides national policy makers with key considerations to support lactation, human milk banking, and bereavement services nation-wide.     

A report from Australia: when a human life has not yet begun--according to the law

Victoria, Australia's Infertility (Medical Procedures) Act 1984, the first legislation to regulate reproductive technologies, permits research on surplus embryos fertilized in vitro but prohibits the creation of embryos for research purposes. The failure to define when an embryo has come into existence or when fertilization has occurred has prevented the continuation of potentially valuable research directed at overcoming infertility. The Standing Review and Advisory Committee on Infertility must now consider the debate over when fertilization occurs, an event that is no longer regarded as a discrete or instantaneous act but as a process revealing no clear point at which a human individual begins to exist. Because the law requires a clear line of demarcation, any legislation in this area will face the problem of defining this point. Interpretation of a 1987 amendment to the 1984 Act may allow the fertilization of ova for purposes other than implantation.     

Shaping the T-cell repertoire: a matter of life and death

Thymocyte selection aims to shape a T-cell repertoire that, on the one hand, is able to recognize and respond to foreign peptides and, on the other hand, tolerizes the presence of self-peptides in the periphery. Deletion of T cells or their precursors that fail to fulfill these criteria is mainly mediated by the Bcl-2-regulated apoptosis pathway. Absence of T-cell receptor (TCR)-mediated signals or hyperactivation of the TCR by high-affinity self-peptide-major histocompatibility complexes can both trigger apoptotic cell death in developing thymocytes. Notably, TCR-signaling strength also defines survival and outgrowth of the fittest antigen-specific T-cell clones in the periphery. TCR threshold activity leading to such drastically opposing signaling outcomes (life or death) is modulated in part by cytokines and other factors, such as glucocorticoids, that fine-tune the Bcl-2 rheostat, thereby impacting on cell survival. This review aims to highlight the role of Bcl-2-regulated cell death for clonal T-cell selection.     

evolution: the dialogue between life and death

Organisms have the ability to harness energy from the environment to create order and to reproduce. From early error-prone systems natural selection acted to produce present day organisms with high accuracy in the synthesis of macromolecules. The environment imposes strict limits on reproduction, so evolution is always accompanied by the discarding of a large proportion of the less fit cells, or organisms. Sexual reproduction depends on an immortal germline and a soma which may be immortal or mortal. Higher animals living in hazardous environments have evolved aging and death of the soma for the benefit of the ongoing germline.     

Unusual death due to a bleeding from a varicose vein: a case report

ABSTRACT: BACKGROUND: Varicose veins are a common entity presenting a worldwide distribution. Although they are usually benign, sometimes are proved to be a threatening condition. Massive hemorrhage is an unusual complication of this common venous pathology that demands immediate medical intervention. CASE PRESENTATION: We present a case of a 66-year-old woman found dead in her house surrounded by a large quantity of blood. Autopsy revealed a 7 mm ulcer on the internal surface of the left lower leg communicating with a varicose vein, signs of exsanguinations and liver cirrhosis. Toxicological analysis was negative. CONCLUSION: Massive hemorrhage from a ruptured varicosity is a severe medical emergency. Awareness of the risk of massive hemorrhage may provoke preventive treatment to be undertaken so as terminal loss of consciousness and a subsequent unattended death to be averted.     

Mitochondria: unravelling the secrets of life and death

Abstract

The endosymbiont theory states that 1.5 billion years ago a primitive anaerobic cell ingested a neighbouring bacterium. A successful alliance was to develop that would dramatically change the nature of life on this planet. The ingested prey was no ordinary bacterium. It was able to respire, utilising the oxygen that was becoming more abundant in the earth's atmosphere to oxidise its food. The host cell was able to utilise the large amounts of energy produced during respiration to develop more complex regulatory mechanisms, eventually becoming the eukaryotic cell from which all multicellular plants and animals evolved. The aerobic bacterium and its descendants were destined to become mitochondria, the combustion engines of the eukaryotic cell. But these organelles are not just the life force of the cell; they are also its executioners. Mitochondria appear to sense a variety of cellular signals and stresses, and orchestrate the release of factors that trigger the host's suicide pathways. In June and July, two papers have appeared in the journal Nature that investigate these life and death pathways of mitochondria.^1,2 They provide an opportunity to outline and compare the status of these two fundamental aspects of mitochondrial research.     

Modulating stress responses by the UPRosome: a matter of life and death

The accumulation of unfolded proteins in the endoplasmic reticulum (ER) triggers the unfolded protein response (UPR) through the activation of specialized sensors including inositol-requiring enzyme-1α (IRE1α). IRE1α signals by assembling a dynamic protein platform referred to as the UPRosome, where different modulator and adaptor proteins assemble to regulate the kinetics and amplitude of UPR effector responses. Conversely, chronic ER stress can cause apoptosis. Recent evidence indicates that several apoptosis-related proteins interact with IRE1α, regulating its prosurvival activities and performing a dual function in the regulation of cell death and adaptation to stress. Based on the increasing relevance of ER stress to the occurrence of diverse pathological conditions, strategies to target and modulate the assembly and composition of the UPRosome could have therapeutic benefits for disease intervention.     

p53: a heavily dictated dictator of life and death

In 2003, a p53-expressing adenovirus was approved as a cancer therapy drug in China. Consequently, there has been a surge in the need to understand the regulation of wild type p53 function in vivo. The majority of the progress made during the past two years has focused on the cellular factors and post-translational modifications that regulate the expression levels and activities of p53 in response to stress signals.     

The 'complexities' of life and death: death receptor signalling platforms

Cell death is critical to the normal functioning of multi-cellular organisms, playing a central role in development, immunity, inflammation, and cancer progression. Two cell death mechanisms, apoptosis and necroptosis, are dependent on the formation of distinct multi-protein complexes including the DISC, Apoptosome, Piddosome and Necrosome following the induction of cell death by specific stimuli. The role of several of these key multi-protein signalling platforms, namely the DISC, TNFR1 complex I/II, the Necrosome and Ripoptosome, in mediating these pathways will be discussed, as well as the open questions and potential therapeutic benefits of understanding their underlying mechanisms.     

Brain death and brain life: rethinking the connection

The connection between brain life and brain death is neither as simple nor as defensible as it might at first appear. The problem rests with the two dominant competing definitions of death:...the loss of that which is necessary for the organism to continue to function as a whole;....the loss of that which is essentially significant to the nature of the organism... If death is understood as the loss of that which is necessary for the continued functioning of the organism as whole, then the apparent symmetry breaks down. If...death could be understood as the loss of that which is essentially significant to the nature of the organism....consciousness, then the symmetry would hold. However, that definition of death is indefensible. Therefore...statements about the status of anencephalic infants and early human embryos based upon a connection between brain death and brain life are unfounded.