Tag: anesthesia

Bioethics Blogs

Politics of Pain: Investigating the Ethics of Palliative Care as a Global Human Right

by Alix Masters

Within the last decade, strides have been made in the field of global health policy to extend the reaches of palliative care universally.  In 2014, the World Health Organization formally declared palliative care a global human right.[1] This development in global health policy is a positive one when we consider the medical politics of pain relief across racial difference.  Both in the United States and abroad, there is a long medical history of discriminatory practices against certain groups of people with regard to pain management—including withholding necessary pain medication altogether.  Therefore, in many ways the declaration of palliative care as a human right is a necessary step in ensuring all peoples, regardless of identity, have their pain taken seriously by the medical establishment and have their comfort made a medical priority.  When we consider how different cultures negotiate beliefs around death and pain relief, however, the issue of palliative care as a universal human right becomes more complex.  For example, countries with strong histories of Buddhist thought and culture have traditionally opposed the ideology of palliative care.[26]  In Buddhism, suffering is considered an inextricable part of life and masking this suffering through medical intervention is looked down upon.[2]  For example, Vietnam, a country with a culture strongly imbued with Eastern Buddhist values, has a long history of rejecting palliative care and pain medications in general.[26]  Due to this, the World Health Organization’ declaration that palliative care is a universal human right could also be understood as a Western organization blatantly ignoring Buddhist cultural traditions. 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Neuroethics Blog Series on Black Mirror: White Bear

By Kristie Garza
Image courtesy of  Wikimedia Commons.

Humans in the 21st century have an intimate relationship with technology. Much of our lives are spent being informed and entertained by screens. Technological advancements in science and medicine have helped and healed in ways we previously couldn’t dream of. But what unanticipated consequences of the rapid expansion into new technological territory? This question is continually being explored in the British sci-fi TV series Black Mirror, which provides a glimpse into the not-so-distant future and warns us to be mindful of how we treat our technology and how it can affect us in return. This piece is part of a series of posts that discuss ethical issues surrounding neuro-technologies featured in the show and will compare how similar technologies are impacting us in the real world. 



*SPOILER ALERT* – The following contains plot spoilers for the Netflix television series Black Mirror. 

Plot Summary


“White Bear” begins with Victoria, the episode’s main character, awakening in an unfamiliar room in front of a TV displaying an unfamiliar symbol. She has no memory of who she is or how she wound up in the room.
Afraid, Victoria begins to explore her outside surroundings, where she finds “onlookers,” individuals in a trance-like state, filming her with their phones. A masked man then appears and begins chasing Victoria. While fleeing, she meets Jem, a fellow individual not under the trance. Jem explains to Victoria that the onlookers were put in their trance due to the strange symbol on the screens and that the masked man is a “hunter,” part of an evil people not affected by the strange symbol.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

My Sister’s Keeper: An Assessment of Living Organ Donation among Minors

by Alex Fleming

The 2009 film My Sister’s Keeper, based on Jodi Picoult’s 2004 New York Times bestselling novel which bears the same name, is among other things, a controversial story about a young girl (Anna Fitzgerald) who sues her own parents in order to obtain legal rights to the use of her body. For as long as she can remember, Anna has unwillingly been providing blood and bone marrow to her older and critically ill sister, Kate. As the story unfolds, tension within the family arises as the 13 year-old Anna Fitzgerald becomes fully aware of her reason for existence, so to speak, which is to prevent the death of her older sister by providing a regular supply of blood and bone marrow, which she has done regularly for several years. Later on, as Kate’s condition worsens and her renal function begins to fail, the parents naturally turn to Anna to provide what could be a life-saving kidney transplant for her older sister. The climax of the story begins as Anna confidently and heroically refuses. The story raises a slew of bioethical issues which are beyond the scope of this essay; however, the story sheds light on a topic worthy of discussion: living organ donation among minors.

As the supply of organs suitable for transplantation decreases and the demand for them increases, the question of living organ donation among those yet of age has become a question of greater concern, primarily among those who point to the various ethical implications which such a procedure creates.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals – June 2017, part two by Aaron Seaman

The first part of the In the Journals post for June 2017 can be found here. And now, for part two…

 

Medical Humanities

SPECIAL ISSUE: Communicating Mental Health

Introduction: historical contexts to communicating mental health

Rebecca Wynter and Leonard Smith

Contemporary discussions around language, stigma and care in mental health, the messages these elements transmit, and the means through which they have been conveyed, have a long and deep lineage. Recognition and exploration of this lineage can inform how we communicate about mental health going forward, as reflected by the 9 papers which make up this special issue. Our introduction provides some framework for the history of communicating mental health over the past 300 years. We will show that there have been diverse ways and means of describing, disseminating and discussing mental health, in relation both to therapeutic practices and between practitioners, patients and the public. Communicating about mental health, we argue, has been informed by the desire for positive change, as much as by developments in reporting, legislation and technology. However, while the modes of communication have developed, the issues involved remain essentially the same. Most practitioners have sought to understand and to innovate, though not always with positive results. Some lost sight of patients as people; patients have felt and have been ignored or silenced by doctors and carers. Money has always talked, for without adequate investment services and care have suffered, contributing to the stigma surrounding mental illness. While it is certainly ‘time to talk’ to improve experiences, it is also time to change the language that underpins cultural attitudes towards mental illness, time to listen to people with mental health issues and, crucially, time to hear.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Memories Shouldn’t Last a Megabyte

By: Shari Esquenazi

Imagine a world where you can take a picture of anything you desire with just your eyes. You can keep these images stored forever on a wireless device, immediately and infinitely retrievable.  Sounds great, right?

Recent scientific advancements have made contact lenses that are embedded with small cameras a reality. Such forthcoming technologies tend to bring an abundance of ethical considerations with them. 

Google’s “Glass” was the first step toward eyewear that can record photos and video. The tech giant applied for a patent for a contact lens camera in 2014.  Last year, Sony filed a similar patent for a contact lens-embedded camera. While these contacts have a variety of practical uses which both benefit individuals and the overall society, they are not without their faults.

This technology would be undeniably valuable in innumerable situations. A witness to a crime could take a photo that defends the word of a victim, trimming down court cases and protecting innocent citizens in society. A surgeon who finds herself in a problematic operation could live stream the images to another specialist for advice on how to quickly and safely remedy the situation and save a life. 

While the technology has unparalleled benefits, there are ethical concerns that need to be deeply weighed before a person opts for such a capacity in day-to-day life. A brief bioethical analysis illustrates these concerns. 

The existential and ethical theory of transhumanism is the belief that the human race can evolve beyond its current physical and mental limitations, particularly by means of science and technology.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

How World War I Revolutionized Medicine

February 24, 2017

(The Atlantic) – Medicine, in World War I, made major advances in several directions. The war is better known as the first mass killing of the 20th century—with an estimated 10 million military deaths alone—but for the injured, doctors learned enough to vastly improve a soldier’s chances of survival. They went from amputation as the only solution, to being able to transport soldiers to hospital, to disinfect their wounds and to operate on them to repair the damage wrought by artillery. Ambulances, antiseptic, and anesthesia, three elements of medicine taken entirely for granted today, emerged from the depths of suffering in the First World War.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Utah’s Anesthesia Abortion Law Unenforced

February 22, 2017

(U.S. News & World Report) – Last year, Utah enacted a first-in-the-nation law requiring that fetuses receive anesthesia or painkillers before elective abortions starting at 20 weeks gestation. Nine months later, the only licensed clinic providing those abortions in the state says no changes have been made in how doctors perform the procedures. The handful of doctors who do the abortions at the clinic run by the Planned Parenthood Association of Utah are trying to comply with the law passed last May but it contained no specific guidance on how to do so, said Karrie Galloway, the group’s CEO.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Consent and Sexual Advance Directives

Consent and Sexual Advance Directives

Fritz Allhoff, Center for Law and the Biosciences

Consent, including the ability to withdraw it, is a major issue in biomedical research, as well as in health care.  A recent Canadian case and the following discussion raises another issue around consent that may have implications for law and the biosciences.

In R. v. J.A. (2011), the Canadian Supreme Court considered a case involving a sexual advance directive.  The pertinent details are summarized in a law review artice by Prof. Alexander Boni-Saenz (Chicago-Kent), and were featured in a provocative discussion over on Volokh.  Here’s an excerpt:

In May of 2007, a woman and her long-time male partner engaged in consensual kinky sex. Specifically, the woman consented to erotic asphyxiation, or the practice of choking during a sexual encounter as a way to restrict oxygen flow and enhance sexual arousal. She also consented to sexual penetration while unconscious.

The man then choked the woman, something which they had done before, and she passed out for approximately three minutes. During that time, the man tied the woman’s arms behind her back and inserted a dildo into her anus. When she regained consciousness, he removed the dildo, and they had consensual penile-vaginal intercourse as well. After they had both finished, she said her safe word—“Tweet  Bird”—and he cut her free of her bonds. Despite the woman’s consent, the state still prosecuted the man for sexual assault, claiming that she could not consent in advance as a matter of law. (Boni-Saenz at 2-3; internal citations omitted.)

The trial court convicted the man, holding that the woman “cannot legally consent to an activity that takes place while she is unconscious.” 

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Confronting Race Issues in Medicine


As I am writing this, our nation is
mourning both the death of several police officers in Dallas, and the end of
two more young black men’s lives at the hands of police in Minnesota and
Louisiana.
  The issues of racial
prejudice, racial distrust, and racial profiling and stereotyping affect every
aspect of American life and culture, and so medicine is certainly not an
exception.
  Despite what I would wish, I
know that I have racial prejudices, and perhaps at times my patients can sense
them. But if medicine in non-unique in its racism, it bears a special
responsibility to heal itself so it can best heal others.


            I
remember a few years ago when I was still working in Oregon, I received the
evening sign-out from my partner as I took over the management of Labor and
Delivery for the night shift.
  In room 8,
she reported, there was an African-American woman with her partner.
  Labor was progressing slowly, and she would
need a check soon.
  My partner commented
that they seemed to have a lot of questions, and seemed a bit suspicious of her
decisions.
  I went in a few minutes later,
wary of what kind of reception I might receive.
 
True to my fears with the patient was a young black man wearing a hoodie
with the hood shading his face in an already dark room.
  I braced myself for a potentially contentious
discussion, and asked them how things were going from their perspective.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Cross-Cultural Perspectives on Brain Death

Several weeks ago, Harvard Bioethics produced a recorded seminar on “Cross-Cultural Perspectives on Brain Death.” 


The panelists were Qing Yang, MD, PhD (Department of Anesthesia, Massachusetts General Hospital) and Robert D. Truog, MD (Director, Center for Bioethics and Professor of Medical Ethics, Anaesthesiology & Pediatrics at Harvard Medical School; Senior Associate in Critical Care Medicine at Children’s Hospital Boston).


Even in the US, some controversy persists over the conceptual defensibility of brain death. Around the world, the philosophical defensibility of brain death is even more debatable. Watch as Dr. Qing Yang presents data regarding the adoption of brain death in China. She discusses cultural differences between Chinese and US medical professionals and patients that inform policy and law when it comes to brain death. Dr. Bob Truog, a prominent brain death critic, replies.


The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.