Tag: burns

Bioethics Blogs

“There’s a Person in There”

By Joe Burns The elderly female patient was a frequent visitor of the dermatology clinic.  Her physician had provided routine care for her, removing suspicious spots for decades.  Today she was presenting for an exacerbation of her psoriasis.  We entered the room and the patient was visibly distraught.  She was wearing a wrinkled t-shirt and […]

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

‘Malignant: How Cancer Becomes Us’ / a conversation with Lochlann Jain by Tara Mahfoud

In the Stanford Hospital car park, there is a sign that reads “WARNING: This garage contains gasoline and diesel engine exhaust which is known to the State of California to cause cancer and/or reproductive toxicity.” The paradox is deadly – one runs the risk of developing cancer on their way to cancer treatment. The sign blatantly highlights the starting point of Lochlann Jain’s analysis of cancer in her 2014 award-winning book Malignant: How Cancer Becomes Us, which is to understand “the ways that key aspects of the economy involve both causing and treating cancer” (p. 12). Jain showed the image of that sign, taken from her book, during her talk at the Department of Global Health and Social Medicine’s 2015 Public Lecture at King’s College London. Malignant is an ethnographic investigation into how cancer, despite the millions spent to cure and prevent it, remains deeply entrenched in so many aspects of American life and culture. Jain uses her own cancer experience to reflect on prognosis and treatment, time and lifespans, screening and preventative treatment, misdiagnosis and malpractice, IVF and hormones, the war-loaded history of cancer and its treatments, and cancer objects like prostheses, wigs, and make-up. Malignant forces the reader to acknowledge the paradoxical, ugly, and inevitable reality of cancer today.

I am a teaching assistant on the Introduction to Social Medicine course at the Department of Global Health and Social Medicine at King’s College London, which is taught by Carlo Caduff. The course is offered as part of an interdisciplinary BA/BSc programme in Global Health and Social Medicine that combines social science and biomedical science courses.

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

BioethicsTV: Mass Casualties & Triage

by Craig Klugman, Ph.D.

Chicago Med (Season 2; Episode 14). Over the last few years I have been working in the area of crisis standards of care. In fact, just today I presented the conclusion of 3 years of work on an ethics white paper to the state of Illinois crisis standards of care task force leadership. Serendipitously, tonight’s episode of Chicago Med dealt with a limited mass casualty situation: A multiple car pile-up on a freeway brings a large number of patients to the hospital. However, there is a major snowstorm and there is no chance of additional personnel or supplies coming to the hospital. How do they deal? First, they moved all able-bodied patients in the ED to the waiting room. Second, they canceled all non-emergency surgeries and reassigned staff to the ED. Both are good moves and follow what most crisis guidelines to prepare for the influx of crisis patient.

One of the patients brought to the ED suffered third degree burns over 90% of his body when his car caught on fire. Dr. Latham declares the patient to be “black tag.” In a mass casualty incidence, triage comes into play to determine which patients to treat and in what order. There are those who seem okay, those who need treatment but can wait, those who need treatment quickly and have a good chance of survival, and those who require massive resources in their intervention and have a low likelihood of survival. Patients are sorted into these categories and given tags with the color of their group.

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 – January 2017 by Anna Zogas

Welcome to a new year of Somatosphere’s In the Journals section! Here are some of the articles available in January 2017. Enjoy!

Medical Anthropology

Chronic Subjunctivity, or, How Physicians Use Diabetes and Insomnia to Manage Futures in the United States
Matthew Wolf-Meyer & Celina Callahan-Kapoor

Prognostication has become central to medical practice, offering clinicians and patients views of particular futures enabled by biomedical expertise and technologies. Drawing on research on diabetes care and sleep medicine in the United States, in this article we suggest that subjectivity is increasingly modeled on medical understandings of chronic illness. These chronic conceptions of the self and society instill in individuals an anxiety about future health outcomes that, in turn, motivate practices oriented at self-care to avoid negative health outcomes and particular medical futures. At its most extreme, these anxieties of self-care trouble conceptions of self and social belonging, particularly in the future tense, leading patients and clinicians to consider intergenerational and public health based on the threats that individual patients pose for others.

Decoding the Type 2 Diabetes Epidemic in Rural India (open access)
Matthew Little, Sally Humphries, Kirit Patel & Cate Dewey

Type 2 diabetes mellitus is an escalating public health problem in India, associated with genetic susceptibility, dietary shift, and rapid lifestyle changes. Historically a disease of the urban elite, quantitative studies have recently confirmed rising prevalence rates among marginalized populations in rural India. To analyze the role of cultural and sociopolitical factors in diabetes onset and management, we employed in-depth interviews and focus groups within a rural community of Tamil Nadu.

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

Reflections on Egg Donation in Canada

Claire Burns recommends legal and practical changes for promoting the ethical treatment of egg donors within Canada.

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Have you heard? The Government of Canada plans to introduce regulations to support the Assisted Human Reproduction Act of 2004! Amazing! I’m jumping for joy! After more than 12 years, the government may finally make good on its promise to protect the interests of women involved in assisted reproduction.

I’m Claire, and I am an egg donor.  I am also an egg donor advocate. Much of my advocacy work is done through the We are Egg Donors website. As part of that work, sometimes I get asked to be speak on the radio or to talk to journalists. ALWAYS I am asked, “how much do you think egg donors should get paid?” Often the question is asked as if it’s news that women are getting paid to sell parts of their bodies. Yeah. That’s a real modern day news story.  Let me tell you Canada, illegal payments and reimbursement to so-called ‘donors’ is only the TIP of the ethical iceberg. Swim deep here with me friends, swim deep.

According to the Government notice from Health Canada, the Assisted Human Reproduction Act “was written to be a comprehensive legislative framework to help protect and promote the health, safety, dignity and rights of individuals who use or are born of assisted human reproductive technologies in Canada.” The problem with this statement is that egg donors don’t technically USE assisted human reproductive technologies. Rather, reproductive technologies are USED on us.

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

Letter from Iraq: Ethical Dilemmas in an Iraqi Burn Centre

Guest Post by Mustafa AL-Shamsi

Health requires a multidisciplinary approach.  In the absence of proper support, facilities and literate people, there is little that a physician can do to cure his patient regardless his proficiency.  The following is not a story; it comes from what I experienced when I was an intern at the burn unit.  I faced a lot of ethical rather than medical challenges.  Some I could cope with; others were not so easy.

I was an intern in Basra city, according to the internship curriculum.  My internship in the burn unit changed my outlook and made me aware of how fragile the health care system is in Iraq.  Being a doctor in the Iraqi health care system is tough; there are many challenges to stand against, but you have little to do because of a limited resources, poor training and supervision.  The most disturbing thing is you have little to do for your patient!  (Others have noted similar problems.)

I learned a lot of good-sounding terms like mercy and empathy during medical school, but is any of them is applicable in the burn unit?  There was too much sorrow and pain to deal with.  Human lives were placed on the shelf without care from authorities.  On my first few days I was upset by every burn patient; however, this made me feel sick and frustrated, and I began to project my emotion on my family, friends and patients.  I realised that I would not able to manage patients properly if I continued dealing with this situation from this position, so I developed a new strategy: apathy.

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

Artificial skin . Recent study opens the doors to production of functionally active skin

A very interesting innovation of using iPS cells for the production of epithelial tissue

A recent study published in Science Advances (2016; 2: e1500887, 1 April 2016), led by Takashi Tsuji of the Riken Center for Developmental Biology in Kobe, Japan, describes the production of skin, functionally active epithelial tissue, an undoubtedly major step for the possible treatment of patients with skin lesions, especially burns. In addition to its scientific-clinical interest, the study also has an attractive bioethical appeal, since it was carried out using induced pluripotent stem (iPS) cells.

Up until now, scientists have been able to generate artificial skin, but by developing epithelial cell structures only, without the concurrence of other types of skin cells necessary for the tissue produced to be functionally active.

The aforementioned study was conducted in mice, using cells from their gums, from which iPS cells were derived and cultured in a laboratory medium to develop three-dimensional skin structures.

The skin created was then transplanted to mice that had been previously genetically engineered to reduce their immune defences (called “nude” mice), in which normal epithelial tissue developed. This tissue was then transplanted in unmodified mice. The transplanted tissue was not rejected and they developed normal, functionally active tissue which connected with the surrounding tissue.

Main contribution of the study from a medical and bioethical viewpoint of the production of artificial skin

Technically, the main contribution of the Japanese team is that they used a molecule, Wnt 10b, in the generation of the iPS cells, which facilitated the production of sebaceous cells and hair follicles in the epithelial tissue produced.

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

Undertake a Clinical Trial at Your Own Risk

June 13, 2016

(U.S. News & World Report) – Burns, 65, of Phoenix, had stumbled into a black hole of medical ethics. There are no rules in the U.S. requiring research organizations to compensate people injured in clinical trials, despite many demands to put such a program into place. No less than three presidential bioethics commissions have tackled the question, starting four decades ago when the Presidential Commission for the Protection of Human Subjects of Biomedical and Behavioral Research ruled that failing to provide compensation is unjust.

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

Three New Technologies for Self Deliverance

To the extent that I focus on end-of-life issues, I focus (in articles, conferences, medically-managed means of hastening death:
policy counsel) on

  1. Withholding/Withdrawing Treatment
  2. Voluntary Stopping Eating & Drinking (VSED)
  3. Medical Aid in Dying

Contrast the just-concluded World Federation of Right to Die Societiesconference in Amsterdam. One session reviewed three new technologies for self-deliverance: 

  1. Richard Cone, MD, with Final Exit Network, provided data on ten patients who used nitrogen for self-deliverance. Comparing it with sparse data on the helium method it appeared to be almost the same in terms of time from inhalation to coma and to death. Everyone died in less than 17 minutes. The tank was easier to use than helium (now mostly diluted) and can be ordered on line and delivered to one’s home.
  2. Ted Ballou (NuTech) and Tom Curran (Exit International) presented ona kit for measuring the purity of nembutal ordered from abroad.
  3. George Eighmey (Death with Dignity National Center) explained the new formulation which is replacing the now very expensive secobarbital (US $3000 to $3500): chloral hydrate, morphine and phenobarbital — which apparently burns the throat going down. More work on alternatives needs to be done and the audience of about 70 people were enthusiastic in making suggestions.

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

Talking Plasma and Markets with my Mother

Matthew Herder shares a conversation with his mother about why she is a regular plasma donor.

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My mother came for a brief visit to Halifax in early April. One evening during her visit, she heard a story on CBC about Canadian Plasma Resources and its for-profit operations in Saskatchewan. She recited the story’s narrative as she went up the stairs to bed. Plasma (the watery part of blood that contains red blood cells) was in short supply and we needed a company like Canadian Plasma Resources to collect more plasma.

I asked my mother if she could spare a few minutes to talk to me about her experience as a donor of whole blood and plasma.

Mum, how long have you been giving blood and why do you do it?

Since 2010. Thanks to your sister. She got me started. Just something, she thought, that was easy to do. I always thought that because I was O+, that they didn’t need my blood. But that was stupid; as the most common blood type, they sure could use it.

How many donations of whole blood and plasma have you made?

Seventy-five donations in total. Originally, I was a whole blood donor. But you can only do that every 56 days and so I’ve probably only given whole blood ten times or so. But if you do that consistently, they [Canadian Blood Services] start asking you to donate plasma or platelets. Until they know you’re a regular, they won’t ask you about donating plasma because this takes a full hour and donating platelets takes two hours.

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.