Tag: colon cancer

Bioethics News

Canada Today: End-of-Life Stories

In summary, this is a brief article consisting of multiple short stories. They particularly provide perspectives of patients in Canada who have faced end-of-life situations. Based on Catherine Porter’s article, there are various contextual motives behind these patients’ decisions to discontinue treatment or choose euthanasia. However, there is a common, general theme for such clinical practices. For example, a patient named June Vaile had been suffering from near-total blindness due to macular degeneration.

Subsequently, her learning of having colon cancer was a relief to her. Knowing this was an opportunity to attain medically-assisted suicide, Vaile sought this to end the misery associated with her inability to enjoy her life pursuits resulting from her former condition. Likewise, a patient named Eva McLeod was also diagnosed with cancer. Prior to such revelation, however, her mother had passed away. Already distraught, and fearing continued emotional pain from the onset, she viewed euthanasia as a palatable means to the end of suffering.

These two patients demonstrate that death is not always a immoral type of action in itself. The overall life circumstances of a patient may be too severe to warrant the continuation of a functional, healthy life. Therefore, death may be justified. This affirms the humanity through beneficence and non-maleficence in compliance with societal moral standards and our obligations to patients. Thus, patient narratives are very important. Such provides a personal, humanistic viewpoint to the identity that patients present in the clinical setting. Consequently, in the case of end-of-life situations, healthcare professionals are empowered to become more compassionate and prepared to serve the greater welfare of the patients and practices moving forward.

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

Unsustainable

This picture shows changes in the cost of treating colon cancer, from 1993-2005. It shows unsustainable growth in these expenditures: By unsustainable, however, I do not mean unjustifiable. Patients with colon cancer have much better prognoses in 2005 than 1993, … Continue reading

The post Unsustainable appeared first on PeterUbel.com.

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

Extreme and Outrageous End-of-Life Communication – Beyond the Bounds of Common Decency

I have read hundreds of complaints in end-of-life medical treatment conflicts.  But I have never seen allegations like those in Wilson v. University of Alabama Health Services Foundation.  


I teach the tort of intentional infliction of emotional distress in my Torts class.  This is a textbook example.  The family is seeking $10 million in punitive damages.


90-year-old Elizabeth Monk Wilson was taken to UAB Hospital with a “full measures” advance directive.  The clinicians there disagreed with that plan and thought that only comfort measures were appropriate.  But the way in which they conveyed that to the patient is simply beyond belief.  Here are just a few examples from the complaint.


“You’re eaten up with colon cancer which is spreading and partially blocked your colon. You are going to die soon. You have lived your life. Accept your death.”


“Don’t you understand what I just said? Your mother is dying and we need to send her home. She is 89—let her die. She has lived her life and needs to let go and die. Our time and treatments will be wasted on her. She simply needs to die. She needs to accept it.  You need to accept it. We need to get her out of here and quit wasting everybody’s time.”


“I know what is best for you. When you code, the resuscitation attempt will break your ribs violently and cause you great pain and suffering. Why do you want to go through a violent procedure instead of dying? What is wrong with you? Your life is over.

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

Snapshots of Life: Tales from the (Intestinal) Crypt!

Caption: This “spooky” video ends with a scientific image of intestinal crypts (blue and green) plus organoids made from cultured crypt stem cells (pink). 

As Halloween approaches, some of you might be thinking about cueing up the old TV series “Tales from the Crypt” and diving into its Vault of Horror for a few hours. But today I’d like to share the story of a quite different and not nearly so scary kind of crypt: the crypts of Lieberkühn, more commonly called intestinal crypts.

This confocal micrograph depicts a row of such crypts (marked in blue and green) lining a mouse colon. In mice, as well as in humans, the intestines contain millions of crypts, each of which has about a half-dozen stem cells at its base that are capable of regenerating the various types of tissues that make up these tiny glands. What makes my tale of the crypt particularly interesting are the oval structures (pink), which are organoids that have been engineered from cultured crypt stem cells and then transplanted into a mouse model. If you look at the organoids closely, you’ll see Paneth cells (aqua blue), which are immune cells that support the stem cells and protect the intestines from bacterial invasion.

A winner in the 2016 “Image Awards” at the Koch Institute Public Galleries, Massachusetts Institute of Technology (MIT), Cambridge, this image was snapped by Jatin Roper, a physician-scientist in the lab of Omer Yilmaz, with the help of his MIT collaborator Tuomas Tammela. Roper and his colleagues have been making crypt organoids for a few years by placing the stem cells in a special 3D chamber, where they are bathed with the right protein growth factors at the right time to spur them to differentiate into the various types of cells found in a crypt.

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

Mouse Study Finds Microbe Might Protect against Food Poisoning

Caption: Scanning electron microscopy image of T. mu in the mouse colon.
Credit: Aleksey Chudnovskiy and Miriam Merad, Icahn School of Medicine at Mount Sinai

Recently, we humans have started to pay a lot more attention to the legions of bacteria that live on and in our bodies because of research that’s shown us the many important roles they play in everything from how we efficiently metabolize food to how well we fend off disease. And, as it turns out, bacteria may not be the only interior bugs with the power to influence our biology positively—a new study suggests that an entirely different kingdom of primarily single-celled microbes, called protists, may be in on the act.

In a study published in the journal Cell, an NIH-funded research team reports that it has identified a new protozoan, called Tritrichomonas musculis (T. mu), living inside the gut of laboratory mice. That sounds bad—but actually this little wriggler was potentially providing a positive benefit to the mice. Not only did T. mu appear to boost the animals’ immune systems, it spared them from the severe intestinal infection that typically occurs after eating food contaminated with toxic Salmonella bacteria. While it’s not yet clear if protists exist that can produce similar beneficial effects in humans, there is evidence that a close relative of T. mu frequently resides in the intestines of people around the world.

The discovery comes from Miriam Merad at the Icahn School of Medicine at Mount Sinai, New York, and colleagues, including graduate student Aleksey Chudnovskiy and postdoctoral fellow Arthur Mortha.

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 Post: If you can screen for brown eyes, you should be able to edit out genetic disease

Not everyone’s choice of scarf. Shutterstock

It has long been known that cognitive diversity is important to collective performance. Diverse groups are more productive, more innovative and better at solving complex problems than less diverse groups. And recent research suggests that cognitive diversity also drives scientific progress.

Such research has direct implications for how we regulate reproductive technologies. Late last year, the London Sperm Bank was criticised for its decision to ban sperm donors who suffer from minor neurological disorders, including dyslexia and Asperger’s syndrome.

Selection against these conditions may be problematic because it could reduce valuable forms of cognitive diversity. People with dyslexia and Asperger’s syndrome see problems from unique perspectives and use different methods to solve problems.

The fact that the London Sperm Bank could implement such a policy highlights the great inconsistency in how the selection for and against different inherited conditions is regulated.

Gamete screening (GS) – the screening of sperm and egg donors based on their features – is widely unregulated. Not only can it be used to select against mild disabilities such as dyslexia, but it can also be used to select for non-disease traits such as eye colour and height. Companies such as Elite Egg Donors, allow you to choose between various donors based on a wide variety of factors including education, weight, and ethnicity. While GS is still relatively imprecise, it is becoming more powerful.

Only candidate. Shutterstock

In 2013, personal genomics company 23andMe received a patent to a technology called “gamete donor selection based on genetic calculations”.

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

Patient Views about Consent, Confidentiality & Information-Sharing in Genetic Medicine.

Guest post by Sandi Dheensa, Angela Fenwick and Anneke Lucassen

Imagine you’re a clinician in genetic medicine.  For a while, you’ve been seeing Joe Bloggs, a patient with a mutation in a gene that’s caused a hereditary form of colon cancer.  As is your standard practice, you help Joe identify who in his family is also at risk and spend some time talking about how he’ll tell them.  The Bloggs’ are a large bunch: Joe has children, siblings, nieces, nephews, aunts, uncles, and cousins, all of whom might have the mutation.  Anyone who tests positive would be eligible for regular bowel screening, which – while not pleasant – makes it much more likely that any cancer will be caught at a  treatable stage.  Unfortunately, despite all this, you’ve reason to believe that Joe hasn’t told his relatives anything and now you’re unsure what to do.

What are your options?  You might say Joe’s confidentiality and autonomy are paramount: it’s up to him what he does, and, as his doctor, you’ve done your part by telling him the cancer is heritable.  Or you might argue that Joe’s family needs to know – but how  and when?  The GMC says you can share a patient’s personal information without consent if the benefit of doing so outweighs the risk: does the situation meet this criterion?  What if you share the information and Joe sues you for breaching his confidentiality?  But what if you don’t say anything and a relative develops a cancer that could’ve been prevented?  Won’t their trust in the health service be shaken if they knew you’d chosen not to share?

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

Clinton fumbles on end-of-life choices

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Clinton’s response is at 2.00 minutes 

After California, the biggest state in the US, legalized assisted suicide, and after a video by Brittany Maynard went viral on YouTube, you might think that candidates for the White House would have clear and crisp opinions on its ethics and feasibility.

But when Hillary Clinton was asked for her opinion in a New Hampshire town hall debate, she was stumped. “This is the first time I’ve been asked that question,” she told an 81-year-old man with colon cancer. Fumbling for words, she produced a few woolly platitudes. At least it is clear that she is opposed to involuntary euthanasia.

“We need to have a conversation in our country. There are states, as you know that are moving to open up the opportunity without criminal liability for people to make this decision, in consultation by their families, even, in some cases, with medical professionals.

But the issue is whether the medical professionals want to be involved or just be counselors. So it is a crucial issue that people deserve to understand from their own ethical, religious, faith-based perspective.

So here’s how I think about it.

I want — I want, as president, to try to catalyze that debate because I — I believe you’re right, this is going to become an issue more and more often. We are, on the good side, having many people live longer, but often, then, with very serious illnesses that they can be sustained on, but at some point, don’t want to continue with the challenges that poses.

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

When Medical Ethics Enters the Campaign

Ethical questions in medical care and science will be prevalent throughout the presidential election season. How deeply they are considered will vary greatly. In the past week, two in particular have come to the fore, and how well they were engaged is worth considering.

Asked in Saturday’s Republican debate whether he would consider quarantining Americans returning this summer from the Olympics in Brazil, New Jersey Gov. Chris Christie said, “You bet I would.”

Christie, you will recall, was a vocal supporter of quarantine during the Ebola outbreak, memorably locking up Kaci Hickox in a tent for three days when the nurse returned from caring for Ebola patients in Sierra Leone (though she tested negative for Ebola). So perhaps the certainty of Christie’s reply, now that Zika is the new viral fear, is not surprising.

Rival candidate Ben Carson, a neurosurgeon, countered that “just willy-nilly going out and quarantining people because they’ve been to Brazil, I don’t think that’s going to work.”

In reporting this story, the news service STAT (www.statnews.com) noted that while the World Health Organization has declared a global public health emergency because of Zika, WHO “has not called for quarantining anyone who may have been exposed to the disease. In Zika-affected countries such as Colombia, pregnant women infected with the virus sometimes share rooms in the maternity wards with women who do not have Zika, with only a mosquito net to separate them. There is no evidence the virus can be transmitted through casual contact, or through sneezes or coughs.”

Mortality and care of the dying also became a campaign topic during a town hall sponsored by CNN, when Jim Kirhan, an 81-year-old, terminally ill man, asked Hillary Clinton how she would “advance the respectful conversation that is needed” about physician-assisted dying.

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

“This is the first time I’ve been asked that question.” Hillary Clinton on PAD

As the Washington Post reported, a recent CNN Democratic Town Hall in New Hampshire featured Hillary Clinton’s response to a question about physician-assisted dying from Jim Kinhan, an 81 year old man who described himself as a Clinton supporter and as a person who is “walking with colon cancer with the word terminal very much in my vocabulary.” In response to Kinhan’s carefully worded question about what Clinton, as president, could do to “advance the respectful conversation that is needed around this personal choice,” Clinton acknowledged that she’d never been asked this question before, at least not in a public forum, although it seems clear that she recognized that the question was about physician-assisted dying.

It’s not surprising that this came up for the first time in New Hampshire, which borders Vermont, whose Oregon-type provision for physician-assisted dying has been in place since 2013, and Massachusetts, where similar legislation is pending after a ballot measure was narrowly defeated in 2012.  Kinhan has written about his support for pending legislation in New Hampshire that would commission a study of the issue.

Clinton’s response was far from a polished sound bite, but the transcript suggests that she views aid-in-dying as a question of public importance, one that people “deserve to understand” whether or not it is an option they would choose for themselves. She concluded her remarks in a way that those who follow this complex issue will recognize as thoughtful – interdisciplinary, cross-cultural, and attentive to evidence, experience, and diverse moral perspectives:

“So I don’t have any easy or glib answer for you. 

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.