Tag: consent

Bioethics Blogs

Texas Outlaws DNR Orders Written without Consent

The Texas Legislature has passed and the Governor has signed S.B.11.  This effectively bans non-consensual DNR orders. 

Look for my analysis of this legislation and its relationship to TADA at ICEL2, next month in Halifax.

Source: bioethics.net, a blog maintained by the editorial staff of The American Journal of Bioethics.

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

Does Female Genital Mutilation Have Health Benefits? The Problem with Medicalizing Morality

By Brian D. Earp (@briandavidearp)

Please note: this piece was originally published in Quillette Magazine.

 

Four members of the Dawoodi Bohra sect of Islam living in Detroit, Michigan have recently been indicted on charges of female genital mutilation (FGM). This is the first time the US government has prosecuted an “FGM” case since a federal law was passed in 1996. The world is watching to see how the case turns out.

A lot is at stake here. Multiculturalism, religious freedom, the limits of tolerance; the scope of children’s—and minority group—rights; the credibility of scientific research; even the very concept of “harm.”

To see how these pieces fit together, I need to describe the alleged crime.

* * *

The term “FGM” is likely to bring to mind the most severe forms of female genital cutting, such as clitoridectomy or infibulation (partial sewing up of the vaginal opening). But the World Health Organization (WHO) actually recognizes four main categories of FGM, covering dozens of different procedures.

One of the more “minor” forms is called a “ritual nick.” This practice, which I have argued elsewhere should not be performed on children, involves pricking the foreskin or “hood” of the clitoris to release a drop of blood.

Healthy tissue is not typically removed by this procedure, which is often done by trained clinicians in the communities where it is common. Long-term adverse health consequences are believed to be rare.

Here is why this matters. Initial, albeit conflicting reports suggest that the Dawoodi Bohra engage in this, or a similar, more limited form of female genital cutting – not the more extreme forms that are often highlighted in the Western media.

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

Does Female Genital Mutilation Have Health Benefits? The Problem with Medicalizing Morality

Does Female Genital Mutilation Have Health Benefits? The Problem with Medicalizing Morality

By Brian D. Earp (@briandavidearp)

Please note: this piece was originally published in Quillette Magazine.

 

Four members of the Dawoodi Bohra sect of Islam living in Detroit, Michigan have recently been indicted on charges of female genital mutilation (FGM). This is the first time the US government has prosecuted an “FGM” case since a federal law was passed in 1996. The world is watching to see how the case turns out.

A lot is at stake here. Multiculturalism, religious freedom, the limits of tolerance; the scope of children’s—and minority group—rights; the credibility of scientific research; even the very concept of “harm.”

To see how these pieces fit together, I need to describe the alleged crime.

* * *

The term “FGM” is likely to bring to mind the most severe forms of female genital cutting, such as clitoridectomy or infibulation (partial sewing up of the vaginal opening). But the World Health Organization (WHO) actually recognizes four main categories of FGM, covering dozens of different procedures.

One of the more “minor” forms is called a “ritual nick.” This practice, which I have argued elsewhere should not be performed on children, involves pricking the foreskin or “hood” of the clitoris to release a drop of blood.

Healthy tissue is not typically removed by this procedure, which is often done by trained clinicians in the communities where it is common. Long-term adverse health consequences are believed to be rare.

Here is why this matters. Initial, albeit conflicting reports suggest that the Dawoodi Bohra engage in this, or a similar, more limited form of female genital cutting – not the more extreme forms that are often highlighted in the Western media.

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

Review of countries where Euthanasia has been legalised. Increaing of involuntary euthanasia, without consent by patients

Euthanasia a Slippery slope that could end in involuntary euthanasia

Euthanasia was legalised in Belgium in 2002, where is defined as “the intentional termination of a patient’s life by a physician at the patient’s request”, so that only voluntary euthanasia may be legally carried out in Belgium (J Med Ethics 41; 625-629, 2015). However, this legal requirement of voluntarism is not always fulfilled.

Thus, a study conducted in Flanders in 1996 found that 3.3% of cases of euthanasia had occurred without the prior request of the patient. In other words, they were involuntary euthanasias. Another study (also in Flanders) found that there had been 1796 cases of involuntary euthanasias (3.2%). A more recent study from 2007 found that the percentage of involuntary euthanasia was 1.8%, while another in 2013 found 1.7%.

However — and we believe this is important — the percentage of involuntary euthanasia in patients who were 80-years-old or over rose to 52.7%, while in those with diseases other than cancer, this figure reached 67.5%. The decision was not discussed with the patient in 77.9% of cases (J Med Ethics 41; 625-629, 2015).

Canada experience

A Recent statement of Professor Somerville, who spent 40 years living and working in Canada,  has recently returned home to Australia to take up the position of Professor of Bioethics in the School of Medicine at The University of Notre Dame Australia, Sydney where she says claims by Australian pro-euthanasia advocates, including media personality Andrew Denton, that euthanasia and assisted suicide is working safely overseas don’t stand up to basic scrutiny.

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

British Columbia Court of Appeal Tosses Unwanted Treatment Claim

I have recently highlighted (here and here and here) the growing success of legal claims when clinicians administer unwanted life-sustaining treatment.  One recent case from British Columbia goes the other way.


Brenlee Kemp sued Vancouver General Hospital for battery on her mother. The trial court rejected the hospital’s claim to dismiss the claim. The court ruled the battery claim should go to trial, because there was conflicting evidence regarding whether consent was given.


The Court of Appeal reversed. The court explained that the existence of express consent is irrelevant, because the clinicians had implied consent. First, Brenlee made desperate pleased to “help” her mother. Second, she was present during the resuscitation and made on objections to the resuscitation efforts taking place in close proximity to her.

Source: bioethics.net, a blog maintained by the editorial staff of The American Journal of Bioethics.

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

British Columbia Court of Appeal Tosses Unwanted Treatment Claim

I have recently highlighted (here and here and here) the growing success of legal claims when clinicians administer unwanted life-sustaining treatment.  One recent case from British Columbia goes the other way.


Brenlee Kemp sued Vancouver General Hospital for battery on her mother. The trial court rejected the hospital’s claim to dismiss the claim. The court ruled the battery claim should go to trial, because there was conflicting evidence regarding whether consent was given.


The Court of Appeal reversed. The court explained that the existence of express consent is irrelevant, because the clinicians had implied consent. First, Brenlee made desperate pleased to “help” her mother. Second, she was present during the resuscitation and made on objections to the resuscitation efforts taking place in close proximity to her.

Source: bioethics.net, a blog maintained by the editorial staff of The American Journal of Bioethics.

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

Meyerhoff Professor Grapples with Bioethical Issues

crossposted from Rising to the Challenge: The Campaign for Johns Hopkins

 


 

 

How should resources be allocated between HIV treatment for those already infected and finding ways to prevent HIV to avert more illness and death in the long run?

 

This is the sort of thorny question Jeremy Sugarman, MD, MPH, MA – deputy director for medicine of the Johns Hopkins Berman Institute of Bioethics and the Harvey “Bud” M. Meyerhoff Professor of Bioethics and Medicine – tackles in his research.

 

And he credits the Meyerhoff Professorship for not only bringing him to Hopkins, but giving him the freedom to take chances in his research and help those who are most vulnerable.

 

“The professorship made it possible to explore things that were a little bit more risky in bioethics. Classically, we need to raise money to do particular projects, and those particular projects are very circumscribed. We can’t always take on a venture, something new, something unusual,” Sugarman explains.

 

“The professorship gave me the opportunity to work with colleagues in the School of Medicine, in the Bloomberg School of Public Health, and across the university, on questions of bioethics that otherwise may not be addressed,” he says. Some of these earlier projects involved international HIV prevention trials in border regions of China and Thailand and preventing HIV transmission from mother to child in Uganda.

 

“Previously, I wouldn’t have time to just leave, go on a trip, work with those people, and grapple with some of the ethical issues that people around the globe were facing.

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: The Entire History of You

By Somnath Das
Somnath Das recently graduated from Emory University where he majored in Neuroscience and Chemistry. He will be attending medical school at Thomas Jefferson University starting in the Fall of 2017. The son of two Indian immigrants, he developed an interest in healthcare after observing how his extended family sought help from India’s healthcare system to seek relief from chronic illnesses. Somnath’s interest in medicine currently focuses on understanding the social construction of health and healthcare delivery. Studying Neuroethics has allowed him to combine his love for neuroscience, his interest in medicine, and his wish to help others into a multidisciplinary, rewarding practice of scholarship which to this day enriches how he views both developing neurotechnologies and the world around him. 
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 may be lurking behind our 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 will 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.

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

Should Medical Offices Be Run Like Law Firms?

By Shailin Thomas Earlier this summer, the Supreme Court of Pennsylvania ruled that a physician cannot delegate obtaining informed consent from a patient to a member of her staff.  In Shinal v. Toms, a neurosurgeon perforated a patient’s cranial artery while … Continue reading

Source: Bill of Health, examining the intersection of law and health care, biotech & bioethics.

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

Texas Advance Directives Act – Broad Alliance Files Amicus Brief Defending TADA Constitutionality

Kelly v Methodist Hospital challenges the constitutionality of the Texas Advance Directives Act. The case is getting ready for trial in Harris County District Court.


At the end of July, a broad alliance submitted a 28-page amicus brief on behalf of the defendant. The amici include:

  • TEXAS ALLIANCE FOR LIFE
  • TEXAS CATHOLIC CONFERENCE OF BISHOPS
  • TEXAS BAPTIST CHRISTIAN LIFE COMMISSION
  • TEXANS FOR LIFE COALITION
  • COALITION OF TEXANS WITH DISABILITIES
  • TEXAS ALLIANCE FOR PATIENT ACCESS
  • TEXAS MEDICAL ASSOCIATION
  • TEXAS OSTEOPATHIC MEDICAL ASSOCIATION
  • TEXAS HOSPITAL ASSOCIATION
  • LEADINGAGE TEXAS

I will make just two observations about the brief.


1.  The amici argue that there is no state action, because clinician and hospital use of TADA is completely voluntary. They may but need not use TADA. On the other hand, the amici concede that similar process based approaches in other states “had little practical effect” because of the threat of liability. Consequently, they concede that TADA’s provision of safe harbor immunity really did change clinician and hospital behavior. Texas clinicians and hospitals would not withdraw life-sustaining treatment without consent BUT FOR the immunity conferred by TADA.


2.  Since the 1970s, numerous appellate courts (e.g. Quinlan) have held that all sorts of medical treatment issues can and should be handled by hospital committees. But these judicial opinions are very clear that conflicts and disputes should still go to court. Since TADA authorizes hospital review committees to adjudicate life and death disputes, these committees are exercising a judicial function. That is state action sufficient to make constitutional requirements apply to private hospitals like Methodist Houston.

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.