Tag: contracts

Bioethics Blogs

End-of-Life Healthcare Sessions at ASBH 2017

The 2017 ASBH
conference
 in October 2017 includes over 400 workshops, panels, and
papers in bioethics and the health humanities.  Here are ones that pertain
to end-of-life issues.


THURSDAY, OCTOBER 19


THU 1:30 pm:  End-of-Life Care and Decision-Making in the ICU – Limited
English Proficiency as a Predictor of Disparities (Amelia Barwise)


Importance: Navigating choices in predominantly English-speaking care settings
can present practical and ethical challenges for patients with limited English
proficiency (LEP). Decision-making in the ICU is especially difficult and may
be associated with disparities in health care utilization and outcomes in critical
care. 


Objective: To determine if code status, advance directives, decisions to limit
life support, and end-of-life decision-making were different for ICU patients
with LEP compared to English-proficient patients. 


Methods: Retrospective cohort study of adult ICU patients from
5/31/2011-6/1/2014. 779 (2.8%) of our cohort of 27,523 had LEP. 


Results: When adjusted for severity of illness, age, sex, education, and
insurance status, patients with LEP were less likely to change their code
status from full code to do not resuscitate (DNR) during ICU admission (OR,
0.62; 95% CI, 0.46-0.82; p


Conclusion: Patients with LEP had significant differences and disparities in
end-of-life decision-making. Interventions to facilitate informed
decision-making for those with LEP is a crucial component of care for this
group.


THU 1:30 pm:  “But She’ll Die if You Don’t!”: Understanding and
Communicating Risks at the End of Life (Janet Malek)


Clinicians sometimes decline to offer interventions even if their refusal will
result in an earlier death for their patients. For example, a nephrologist may
decide against initiating hemodialysis despite a patient’s rising creatinine
levels if death is expected within weeks even with dialysis.

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

Some Comments about Being a Philosopher of Color and the Reasons I Didn’t Write a (Real) Paper for this (Seemingly) Ideal Venue for my Work

by Sean A. Valles

ABSTRACT. This special issue conspicuously lacks work by Philosophers of Color (with the exception of this commentary). I have been given this opportunity to discuss the impediments that kept me from submitting my relevant work, offered as a small step toward recognizing the impediments faced by other Philosophers of Color. I highlight factors including direct and indirect consequences of a disproportionately White community of US philosophers, and some underrecognized risk-reward calculations that Philosophers of Color face when choosing an article project. I urge further discussion of the topic, starting with an exhortation to choose the right phenomenon and accordingly frame the right question: Why are White philosophers deliberating the “ethical and social issues arising out of the 2016 US presidential election” in a prestigious journal, while Philosophers of Color are deliberating the same issues in tense classrooms, closed offices, and on-/off-campus forums?

This is not a real article. But in this special issue on the 2016 US election and Trump it is, to my knowledge, the only contribution written by a Philosopher of Color. It is a commentary about the fact that it is the only contribution written by a Philosopher of Color.

After Editor-in-Chief Rebecca Kukla expressed consternation that the issue was full of excellent papers, but written by a roster of White philosophers, I offered to say something about why I didn’t submit any of my relevant philosophical work (on nativism, racism, health policy, Latinx health, etc.), and why it didn’t surprise me that almost none of the other well-qualified Philosophers of Color did either.

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

Research Ethics Roundup: Nature Argues Against Research Censorship, New Comparative Genetics Study, WHO Considers Deploying Experimental Ebola Vaccine, Majority of Completed Stem Cell Clinical Trials Never Published

This week’s Research Ethics Roundup highlights a Nature editorial that encourages researchers to push back against both public and private forms of censorship in research contracts, the National Institute of Health (NIH)’s Comparative Genomics Branch issues new study with implications for both human and dog disease research, the World Health Organization (WHO) speaks with Doctors Without Borders about using an experimental vaccine to target a new Ebola outbreak, and bioethicists’ concern about stem cell researchers’ failure to publish study results including discoveries on side effects.

The post Research Ethics Roundup: Nature Argues Against Research Censorship, New Comparative Genetics Study, WHO Considers Deploying Experimental Ebola Vaccine, Majority of Completed Stem Cell Clinical Trials Never Published appeared first on Ampersand.

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

Surrogacy Now Legal in DC

As of April 7th, surrogacy is now legal in the District of Columbia.  B21-0016, the Collaborative Reproduction Amendment Act of 2015, allows surrogacy agreements to be made and enforced.  Previously, surrogacy contracts of any kind (commercial or not) were illegal, and contracting parties could be imprisoned and fined.[1]  The new law permits both gestational and traditional surrogacy.[2]

DC joins 46 states in permitting surrogacy contracts.  Only Michigan, New Jersey, New York, and Washington prohibit surrogacy arrangements.[3]  Although surrogacy is legal to varying degrees across the country, it is a harmful and exploitative method of assisted reproduction.[4]  Perhaps most often overlooked is the fact that surrogacy arrangements violate the human rights of the child.  As George Annas argues, “Surrogacy [arrangements] never [consider] the child’s welfare, only the welfare of the contracting parents.”[5]

[1] http://www.nbc-2.com/story/35095100/legislation-ends-decades-old-ban-on-surrogacy-contracts-in-dc

[2] http://www.creativefamilyconnections.com/us-surrogacy-law-map/dc

[3] http://www.thepublicdiscourse.com/2017/04/19109/ e

[4] http://www.cbc-network.org/pdfs/What-is-Wrong-with-Surrogacy-Center-for-Bioethics-and-Culture.pdf

[5] George J. Annas, “Fairy Tales Surrogate Mothers Tell” in Surrogate Motherhood: Politics and Privacy, ed. Larry Gostin (Bloomington and Indianapolis: Indiana University, 1990), 52.

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

A New Common Rule for Human Subject Research

On January 19, 2017 – one day
before the expiration of President Obama’s second term – the Office of Human
Research Protection (OHRP) in the Department for Health and Human Services issued
a revised regulation dealing with the “Common Rule.” The final regulation is officially
titled “Federal Policy for the Protection of Human Subjects (known as the
“Common Rule”). 

The
new regulation is the product of years of study and deliberation offered as an
update of the Common Rule introduced more than 25 years ago. It’s considered a
“common rule” because it applies to the clear majority of all federal agencies
which fund human subjects research grants and contracts. Of course, the principal
objective of the Common Rule is to have a uniform inter-agency approach to
human subject protections through local institutional review boards (IRBs).

As
one might expect with many federal regulations, rules quickly become outdated
because they simply cannot keep up with technological advances. With the last
issuance of the Common Rule in 2005, regulators probably gave little thought to
the future problems that might occur with universal computerization of research
data and health records, tissue banking, genomic medicine initiatives,
personalization of therapies, and global privacy concerns.

The
new Common Rule helps a great deal in that it: (1) clarifies the categorization
of “exempted” or “excluded” research projects using risks to patients as
measures; (2) improves the elements of informed consent required and mandates
posting of the forms online in certain cases; (3) gives researchers broader
authority in using identifiable and future deidentified biologic specimens with
and without specific consent; (4) allows the use of a single IRB to oversee
multi-institutional projects within the United States; and (5) specifically
excludes routine and emergency public health surveillance work from human
subjects research.

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

Aetna-Humana and the challenges of regulating while outsourcing

The health insurance industry has been in flux over the past few years, from the phasing in of major provisions of the Affordable Care Act (ACA) to a frenzy of consolidation. Of the country’s “big 5” health insurers (see table), UnitedHealth approached Aetna and Aetna approached Cigna about potential acquisitions. In July 2015, Aetna agreed to buy Humana for $37 billion and Anthem agreed to pay $54 billion for Cigna. Both deals were blocked by the Department of Justice (DOJ) and then litigated.

“Big 5” health insurersMarket Value
UnitedHealth Group$155.7 billion
Aetna$41.3 billion
Anthem$41.1 billion
Cigna$38.2 billion
Humana$30.1 billion

Judge John Bates of the United States District Court for the District of Columbia recently enjoined the merger between Aetna and Humana. Judge Bates sided with the DOJ, concluding that the merger would likely substantially lessen competition in violation of antitrust law. He was not convinced that efficiencies resulting from the merger and then passed on to consumers—cost savings that come from a stronger negotiating position with respect to other healthcare players, for instance—would counteract the anticompetitive effects that would operate to consumers’ detriment.

While the opinion focused on the impact of the putative merger on consumers, it also raises concerns about the power dynamic between health insurance companies and the government. The case considered whether competition would be diminished in two product lines, one being individual plans offered on state public exchanges created by the ACA. The DOJ identified 17 counties across three states where market concentration in public exchanges would reach unlawful levels post-merger.

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

Can Science Survive in a Communications Blackout: Restricting Speech Violates Scientific Ethics

by Craig Klugman, Ph.D.

That good ethics begins with good facts is an oft-heard mantra and was my first lesson when I began conducting clinical ethics consults 20 years ago. In the clinic, good facts come from many sources such as talking to health care providers, patients and families and from looking at test results. Empirical facts come from good science whether that is social science, bench science, health science, or theoretical science to name a few. The sharing of scientific facts, studies, and results is at the heart of the scientific enterprise. Sharing your work allows for peer-review, for confirmation of the work, for challenges to other’s work, and for furthering the progress of other scientists. What if Watson and Crick had been forbidden from publishing on the double helix? Would we have the genetics revolution of today? What if the government scientists who created DARPA net had never been allowed to share their work? Would the internet exist?

According to several news reports, the new administration issued a gag order to research scientists in several executive branch agencies. The Environmental Protection Agency, Department of Health & Human Services, US Department of Agriculture’s Research Service, as well as the departments of the Interior and Transportation have been ordered to cease external communications and to funnel such desires to communicate through “leadership.”

This gag rule is more than simply limiting social media posts. It apparently means no communication with the media, Congress, blogs and press releases. This may extend to webinars, presenting at scientific conferences, and even scholarly publication since some agencies have been asked to submit lists of such external speaking engagements.

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

Material as opposed to what? Three recent ethnographies of welfare, biological labor, and human dignity by Leo Coleman

Catherine Fennell. Last Project Standing: Civics and Sympathy in Post-Welfare Chicago. Minneapolis: University of Minnesota Press, 2015.

Kalinda Vora. Life Support: Biocapital and the New History of Outsourced Labor. Minneapolis: University of Minnesota Press, 2015.

Gaymon Bennett. Technicians of Human Dignity: Bodies, Souls, and the Making of Human Dignity. New York: Fordham University Press, 2016

A new materialist studying housing projects, a feminist-Marxist postcolonialist, and a Foucauldian bioethicist—what do they have in common? This sounds like the start of a very bad academic joke. But a great deal of cultural anthropological research has in fact been motivated and disciplined—made readable as part of a common project—over the past fifteen or twenty years by such oddly overlapping interests in materiality or materialisms of diverse stripes, on the one hand, and reasoning about biology and the biological constitution of the human, on the other. Drawing on usefully heterogeneous philosophical and social-scientific currents, the discipline has turned to examine the physical effectiveness of things, networks, or infrastructures in shaping populations, and the medical and technical regulation of the biological life of these populations. World-spanning (and world-making) institutions and infrastructures have been opened to ethnographic investigation under the rubrics of technopolitics and biopower. This was no mere scholarly “turn” but was impelled by real forces that included an intense medical and institutional recrafting of humanity itself as a global biological reality (Rees 2014), and the disparate impact of novel machines, techniques, and infrastructures that worked to disaggregate governance, individualize the political subject and materially support new authority for corporate and private actors (e.g.,

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 News

The battle continues over the A-List embryos

In happier times   

What began as soap opera is turning into a master class in metaphysics. “Modern Families” TV star Sofia Vergara, 44, and her former partner, entrepreneur and Hollywood producer Nick Loeb, 41, have been at war over two frozen embryos in a California IVF clinic. Vergara, now married to “True Blood” star Joe Manganiello, refuses to allow the embryos to be brought to term with a surrogate mother; Loeb insists that they have a right to life.

Both of them have deep pockets and wily lawyers. With 600,000 supernumerary embryos in deep freeze in the US, the outcome could set legal precedents in a number of areas. However, the dispute is not theoretical, but passionate and sometimes vindictive.  

The latest moves are as follows.

Slut-shaming

In mid-November Vergara’s lawyers demanded that Loeb disclose the names of two former girl friends who had abortions. They want to show that his belief that life begins at conception is insincere. “Oddly, Loeb wants us to believe that he supports a woman’s right to privacy, and to make a choice concerning reproduction. However, he seems to believe that his celebrity ex-fiancé, Sofia Vergara, does not have those same rights,” said her lawyer.

Loeb, who now has strong pro-life views, was adamant in his refusal. “Could you imagine if you had moved on with your life, gotten married and had children and kept this a secret from your family, then all of a sudden 15 years later (you were) made to reveal your abortion to the world.

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.