Tag: costs and benefits

Bioethics Blogs

Climate Policy in the Age of Trump

by Mathias Frisch

ABSTRACT. The Trump administration is in the process of undoing what were the two central planks of President Obama’s climate policy: First, Trump has called for a review of how the social cost of carbon is calculated in used in analyses of regulatory rule making and, second, Trump has announced that the United States is withdrawing from the Paris Agreement. In this paper I examine some of the conservative critics’ objections to the first plank: calculations of the social cost of carbon in climate cost benefit analyses. I argue that while some of these criticisms are justified, the criticisms end up strengthening arguments for the importance of the second plank: the urgent need for an ambitious climate policy, in accord with the Paris Agreement, as precaution against exposing others to the risk of catastrophic harms.

1. INTRODUCTION

As the record-breaking heat of 2016 continues into 2017, making it likely that 2017 will be the second hottest year on record just behind the El Niño year 2016, and as Arctic heat waves pushing the sea ice extent to record lows are mirrored by large scale sheets of meltwater and even rain in Antarctica—the Trump administration is taking dramatic steps to undo the Obama administration’s climate legacy.

In its final years, the Obama administration pursued two principal strategies toward climate policy. First, by signing the Paris Accord it committed the U.S. to contribute to global efforts to hold “the increase in the global average temperature to well below 2°C above pre-industrial levels and to pursue efforts to limit the temperature increase to 1.5°C

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

E-H-ARRGH: The Frustrating Costs and Benefits of the Electronic Health Record

April 28, 2017

by Jami Starr, MD, Clarkson University Bioethics Policy Certificate 2017

E-H-ARRGH: The Frustrating Costs and Benefits of the Electronic Health Record

 The concept of electronic medical recordkeeping was first introduced in the late 1960’s but it did not really become established until this century. Electronic Health Records (EHRs) are expected to provide a number of benefits, including: ability to track data over time, monitoring use of interventions (i.e. vaccinations), and identifying patients in need of preventive screening. Data are forthcoming as to how effectively EHRs meet these goals. What is clear, however, is that it is third party payers profit from EHRs as a result of improvements in claims processing.

The use of EHRs carries implicit hazards with respect to confidentiality. It seems no cyber security system today is impenetrable.  We have witnessed multiple breaches in the past few years involving government agencies, major retail chains, and financial institutions. If a hospital database were hacked, not only would pertinent demographics be exposed (social security numbers, insurance policies, etc.) but also personal information about diagnoses, socioeconomic circumstances, and the like.  While this is a risk with paper medical records as well, the rapid and potentially widespread dissemination of information though a computer data system is far more menacing in scope.  In most clinical settings where EHRs are employed, paper charts have been eliminated and patients do not have an option as to how personal data are maintained.  Vulnerability has been increased de facto by reliance upon this new medium.

Aside from the issues related to cyber security, there are start-up costs related to productivity, burnout and physician-patient relationships.

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

Give them sterile razors: controversial self-harm strategy

Some people who self-harm should be provided with sterile razors, says a mental health expert in the Journal of Medical Ethics. Patrick Sullivan, of the University of Manchester, argues that this approach may be more respectful of patients’ autonomy.

He suggests that a harm-minimisation strategy for self-harming individuals could include provision of sterile cutting implements, education on how to self-injure more safely to avoid blood poisoning and infection, as well as therapy and alternative coping strategies.

Sullivan argues that high rates of self-injury among people admitted to mental health units suggest that the standard method of dealing with this behaviour–forcibly stopping them–doesn’t work.

People who self-injure do so because the negative feelings they experience threaten to overwhelm them: injury reduces tension and increases control, providing a coping mechanism. Infringements of this are likely to be seen as confrontational and distressing rather than therapeutic, he contends. These patients usually understand the nature and consequences of their actions, so denying them this freedom thwarts their autonomy.

“Where the risks of serious injury are low, limitations on basic freedoms are more difficult to justify,” he suggests. Restrictions could even make the problem worse; many of those who injure themselves have a history of abuse or trauma, and stopping them from doing it could intensify their feelings of powerlessness.

“This increases the risk that individuals will self-injure covertly, in more dangerous ways, or attempt suicide,” he contends, citing anecdotal evidence indicating the increasing use of other forms of self-injury, such as hanging, among those in mental health units who prefer to cut their skin.

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

Harm: Could It Sometimes Be a Good Thing?

Guest Post: Patrick Sullivan

Response: Hanna Pickard and Steve Pearce, Balancing costs and benefits: a clinical perspective does not support a harm minimization approach for self-injury outside of community settings

BBC news recently reported on the approval of plans for facilities to support self-injection rooms to allow drug users to inject safely under supervision in Glasgow. Needless to say the initiative is  controversial and as yet is  only approved in principle. The plan would involve addicts consuming their own drugs and in some cases being provided with medical-grade heroin. The move aims to address the problems caused by an estimated 500 or so users who inject on Glasgow’s streets. This initiative again brings into the public eye the issue of harm minimisation.

The concept of harm minimisation has been widely applied in a number of areas such as drug misuse where needle exchange programmes are the obvious example. The basic idea is that where we are unable to stop people engaging in dangerous activities we may sometimes have to settle for the fact that the best outcome possible is that the harm associated with the activity can be reduced. Many day-to-day activities are associated with harm reduction; seat belts on cars, motorcycle helmets, safety measures to reduce risks in extreme sports, advice on safe drinking levels. People will drive, ride motorbikes, engage in dangerous sporting activity and drink alcohol. If they do these things then it is important that they are done safely. Basically this is what harm minimisation is about.

A controversial application of these ideas has been in the area of self-injury.

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

Balancing Costs and Benefits: A Clinical Perspective Does not Support a Harm Minimization Approach for Self-injury Outside of Community Settings

Guest Post: Hanna Pickard and Steve Pearce

Responding to: Harm may sometimes be a good thing? Patrick Sullivan

Sullivan’s emphasis on the importance of supporting autonomy and independence among vulnerable people who self-injure is fundamental to good clinical practice. This is why some forms of harm minimization, such as encouraging reflection, responsibility, safe cutting and where appropriate self-aftercare, are uncontroversial and already widely practiced within community settings. The situation is different, however, with respect to both secure and non-secure inpatient settings. It is also different when we consider the other forms of harm minimization that Sullivan advocates, namely, the provision of self-harming instruments on wards alongside education about anatomy.

In secure (forensic) inpatient settings, it is neither practical nor ethical to provide implements that can be used as weapons to any patient, for any reason. This would be to severely compromise staff and patient safety.

In non-secure inpatient settings, patients are likely to be detained under the Mental Health Act. This raises the question of the grounds of detention. Typically, patients who self-injure are detained because they are judged to be currently at risk of life-endangering or life-changing injury. As Sullivan notes, it is not clinically or ethically appropriate to provide patients with the means to self-injure when they are in this state of mind. This means that the relevant inpatient population for which a harm minimization approach could even be considered is relatively small: those who have a standing pattern of self-injury and who are detained on non-secure units for reasons other than acute self-injury.

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

The Costs of Chimpanzee Research

Andrew Fenton shares a cautionary tale about the Liberian chimpanzees who were abandoned after being used for vaccine research.

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You might have read about the end of publicly-funded invasive research on chimpanzees in the United States and thought that the fight to protect these laboratory great apes was over. The story of what has happened to a little over 60 chimpanzees living on six islands in a river estuary in southern Liberia serves as a reminder that it isn’t over yet.

These chimpanzees are not there by choice nor can the islands they live on support their nutritional needs. They are a legacy of Vilab II, a facility in southern Liberia that was run by the non-profit New York Blood Center, where chimpanzees were used in vaccine research. The original chimpanzees were procured from the illegal ‘pet’ trade or taken by force from free-living communities before being bred for research. Vilab II stopped experimenting on chimpanzees in 2005. The surviving chimpanzees were moved to the six islands. After supporting their care for about ten years, the New York Blood Center abandoned the chimpanzees.

The official reasons for ceasing support include: as a non-profit organization, their funds are “best used” to fund research that might benefit humanity (not care for a population of ex-biomedical chimpanzees); they did their bit for these chimpanzees and it’s unreasonable to think that they’re on the hook for their care in perpetuity; they’ve tried to find alternate means of support but talks with interested parties, including the Liberian government, have failed; and they actually don’t own these chimpanzees—they’re property of the Liberian nation—and the property owners are properly responsible for their care.

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 Ethics of Using Brain Stimulation to Enhance Learning in Children

By Peter Leistikow

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris in Summer 2016.

Peter Leistikow is an undergraduate student at Emory University studying Neuroscience and Sociology. When he is not doing research in pharmacology, Peter works as a volunteer Advanced EMT in the student-run Emory Emergency Medical Service. 
Ever since the advent of electricity, people have tried to harness this power for therapeutic purposes. Nineteenth century posters touted the benefits of “self-applicable curatives for nervous, functional, chronic, and organic diseases” in the form of electric belts and harnesses (Browne 2014). Although these items are historical curiosities today, scientists are still trying to harness the potential benefits of electricity, especially in the treatment of psychiatric and learning disorders.
Transcranial direct current stimulation (TDCS) is a non-invasive experimental procedure that utilizes direct currents applied to two electrodes on the head with the goal of stimulating specific brain areas (John Hopkins Medicine 2016). Although there is evidence that this technology, and it’s closely related variant transcranial random-noise stimulation (TRNS), can increase attention and aid in treating cognitive impairments and depression, TDCS has caught the interest of companies and hobbyists assembling these devices for cognitive enhancement (Hogenboom 2014). This has worried some researchers, who have called for regulations regarding the sale and use of this technology which they fear can have detrimental effects if used incorrectly (Wexler 2015).

Meanwhile, researchers have continued to investigate TDCS, and the media has taken notice.

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

New Frontiers in Animal Research Neuroethics at the Center for Neuroscience and Society

By Tyler M. John

Tyler John is a postbaccalaureate fellow at the National Institutes of Health Department of Bioethics interested in resource allocation, animal ethics, and moral theory. This fall, he will begin a PhD in Philosophy at Rutgers University. 


The opinions expressed are the authors’ own. They do not reflect any position or policy of any U.S. governmental entity, including the National Institutes of Health or the Department of Health and Human Services. 
On June 9-10, I joined a gathering of philosophers, psychologists, veterinarians, and biomedical researchers for the Animal Research Neuroethics Workshop at the Penn Center for Neuroscience and Society. The workshop, organized by neuroethicists Adam Shriver, James Serpell, and Martha Farah, focused on the ethical issues raised by new advances in neuroscience research with non-human animals. Here, researchers from many disciplines came together to share notes from the field and discuss new neuroethics problems. 
Over two days, we discussed problems like, What is the moral status of so-called “brains in dishes”? Is it morally permissible for scientists to cognitively enhance mice, rats, and chimps, giving them advanced cognitive capacities? Is it even conceptually possible to have a mouse model of human depression given the substantial psychological differences between humans and mice? What, more broadly, should we say about the scientific validity and moral permissibility of current neurological research on non-human animals? 

Despite our vast disciplinary diversity and some disagreement about issues in moral theory, participants were very quickly able to bridge disciplinary divides and create broad areas of consensus.

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

Mark A. Largent, Vaccine: The Debate in Modern America, Johns Hopkins University Press, 2012; Mark Navin, Values and Vaccine Refusal: Hard Questions in Ethics, Epistemology, and Health Care, Routledge, 2016

Over the last twenty years or so, vaccines have developed as one of the standard examples of major public scientific controversies, alongside climate change and genetically modified foods. This public contention has attracted scholarly attention, and the current review examines two recent attempts at such scholarly intervention. While both books have their limitations, I recommend both to anyone interested in a sophisticated introduction to the vaccine controversy. Specifically, the first substantive chapter of each book would be an excellent set of readings for one-session discussion of the controversy in a bioethics class or science communication workshop.

Mark Largent’s Vaccine: The Debate in Modern America was published in 2012 by Johns Hopkins University Press (Largent 2012). Largent is a historian of science at Michigan State University, and most of the book takes the form of historical narratives of some key figures or moments in the development of the vaccine controversy. Mark Navin is a political philosopher at Oakland University in Auburn, Michigan, and so his Values and Vaccine Refusal—published in 2016 by Routledge—focuses on a more abstract analysis of arguments (Navin 2016). Both books are broadly accessible. While Largent’s book was published a few years ago, the two books work well together; thus the current, joint review.

Before getting into the details, let me introduce some terminology and provide a brief overview of the state of the vaccine controversy and vaccine compliance. Following Navin, vaccine denial is a denial of mainstream medical beliefs about the safety and efficacy of vaccines, while vaccine refusal is the behavior of refusing routine childhood vaccinations.

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.