Tag: death

Bioethics Blogs

Premortem Cryopreservation Does Not Cause Death

In 1990, Thomas K. Donaldson sued the California Attorney General for the right to an elective premortem cryopreservation. Most cryopreservation is postmorterm. But Donaldson wanted to act before a malignant tumor destroyed his brain.

Unfortunately for Donaldson, the Santa Barbara trial court and an appellate court rejected Donaldson’s claims. The courts construed his request as one for assisted suicide. That was a crime in California and the courts found (like state appellate courts everywhere in the USA) that there was no constitutional violation in applying that law to Donaldson’s situation.


But why was the case framed as a right to assisted suicide?  The whole point of cryogenic preservation is that sometime in the future, when a cure for Donaldson’s disease is found, then his body may be “reanimated.” If true, then he would not be brought back from the dead.  Legally, he would have never been dead.  


Since the Uniform Determination of Death Act requires irreversibility, it seems that premortem  cryopreservation does not cause death. Yes. Donaldson’s cardiopulmonary functions and brain functions may cease. But that cessation would not be irreversible. Of course, cryopreservation may not work. But it seems that factual predicate was not carefully examined.  


The case was dramatized in a 1990 episode of LA LAW.


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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

Medicaid Fueling Opioid Epidemic? New Theory Is Challenged

September 1, 2017

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WASHINGTON — An intriguing new theory is gaining traction among conservative foes of the Obama-era health law: Its Medicaid expansion to low-income adults may be fueling the opioid epidemic.

If true, that would represent a shocking outcome for the Affordable Care Act. But there’s no evidence to suggest that’s happening, say university researchers who study the drug problem and are puzzled by such claims. Some even say Medicaid may be helping mitigate the consequences of the epidemic.

Circulating in conservative media, the Medicaid theory is bolstered by a private analysis produced by the Health and Human Services Department for Sen. Ron Johnson, R-Wis. The analysis says the overdose death rate rose nearly twice as much in states that expanded Medicaid compared with states that didn’t.

Independent experts say the analysis misses some crucial facts and skips standard steps that researchers use to rule out coincidences.

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The New York Times

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

CAR-T cells: A drive to the future of cancer treatment

Conrad Fernandez describes the ethical challenges related to the use of CAR T-cell therapy for cancer patients.

__________________________________________

I am a pediatric oncologist and over the years have looked after hundreds of children with cancer – ranging in age from newborns into their early 20s. About a third of these children have suffered from leukemia. During my career of more than 25 years, I have seen my share of sadness and joy. Roughly one in five of these children have died – most often because of resistance intrinsic to their cancer but sometimes as a consequence of the toxicity of cancer therapy. These toxicities may occur acutely during the treatment (such as severe infections) or more insidiously appear years or decades later. A novel treatment approach that would overcome this resistance while avoiding chemotherapy toxicity would be most welcome.

A few years ago, I sat in a plenary session of the American Society of Hematology annual meeting (the preeminent hematology meeting in the world) where early phase CAR T-cell therapy was discussed. CAR (chimeric antigen receptor) T-cells are genetically reprogrammed immune cells that normally have the job of fighting infection or other foreign intruders into our bodies. CAR T-cells are manufactured to target a subtype of leukemia that is called B-cell leukemia – a type especially common in childhood. I thought to myself to take special note of what I was hearing, as this marked the potential for a paradigm shift in how we approached treatment of leukemia and perhaps other cancers. It is for these relapsed and refractory B-cell leukemia patients that the FDA’s Oncologic Drugs Advisory Committee (ODAC) has just recommended approval of CAR T-cell therapy – the first recommendation for approval of its kind.

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

CAR-T cells: A drive to the future of cancer treatment

Conrad Fernandez describes the ethical challenges related to the use of CAR T-cell therapy for cancer patients.

__________________________________________

I am a pediatric oncologist and over the years have looked after hundreds of children with cancer – ranging in age from newborns into their early 20s. About a third of these children have suffered from leukemia. During my career of more than 25 years, I have seen my share of sadness and joy. Roughly one in five of these children have died – most often because of resistance intrinsic to their cancer but sometimes as a consequence of the toxicity of cancer therapy. These toxicities may occur acutely during the treatment (such as severe infections) or more insidiously appear years or decades later. A novel treatment approach that would overcome this resistance while avoiding chemotherapy toxicity would be most welcome.

A few years ago, I sat in a plenary session of the American Society of Hematology annual meeting (the preeminent hematology meeting in the world) where early phase CAR T-cell therapy was discussed. CAR (chimeric antigen receptor) T-cells are genetically reprogrammed immune cells that normally have the job of fighting infection or other foreign intruders into our bodies. CAR T-cells are manufactured to target a subtype of leukemia that is called B-cell leukemia – a type especially common in childhood. I thought to myself to take special note of what I was hearing, as this marked the potential for a paradigm shift in how we approached treatment of leukemia and perhaps other cancers. It is for these relapsed and refractory B-cell leukemia patients that the FDA’s Oncologic Drugs Advisory Committee (ODAC) has just recommended approval of CAR T-cell therapy – the first recommendation for approval of its kind.

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

Moderate Consumption of Fats, Carbohydrates Best for Health, International Study Shows

A diet that includes a moderate intake of fat and fruits and vegetables, and avoidance of high carbohydrates, is associated with lower risk of death, research with more than 135,000 people across five continents has shown.

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

Jewish Guide to Practical Medical Decision Making

Check out
this new 368-page
book
 from Rabbi Jason Weiner: Jewish Guide to Practical
Medical Decision Making.


Due to rapid advances in the medical field, existing books on Jewish medical
ethics are quickly becoming outdated. 
Jewish
Guide to Practical Medical Decision Making
 seeks to remedy that by
presenting the most contemporary medical information and rabbinic rulings in an
accessible, user-friendly manner. 


Rabbi Weiner addresses a broad range of medical circumstances such as surrogacy
and egg donation, assisted suicide, and end-of-life decision making. Based on
his extensive training and practical familiarity inside a major hospital, Rabbi
Weiner provides clear and concise guidance to facilitate complex
decision-making for the most common medical dilemmas that arise in contemporary
society.


1. Facilitating Shared Decision-Making 

A. Understanding Terminology: Key Concepts to Facilitate
Collaborative Decision-Making

B. Truth-Telling: When Painful Medical Information Should
and Should Not Be Revealed 

C. Mental Illness: Determining Capacity and Proper Treatment
in Accordance with Jewish Law  


2. How Much Treatment? 

A. Risk and Self-Endangerment: Determining the
Appropriateness of Attempting Various Levels of Dangerous Medical Procedures

B. Making Decisions on Behalf of an Incapacitated Patient

C. Pediatrics: Jewish Law and Determining a Child’s Consent
and Treatment 

D. Palliative Care and Hospice in Jewish Law and Thought


3. Prayer  

A. Is Prayer Ever Futile? On the Efficacy of Prayer for
the Terminally Ill 

B. Viduy: Confessional Prayers Prior to Death


4.  At the End of Life

A. Advance Directives and POLST Forms  

B. End-of-Life Decision-Making: DNR, Comfort Measures,
Nutrition/Hydration, and Defining “Terminal” in accordance with Jewish Law

C. Withholding vs. Withdrawing: Deactivating a
Ventilator and Cessation of Dialysis and Cardiac Defibrillators at the End of
Life

D. Case Study: Deactivating a Total Artificial Heart

E. Supporting Patients who Request Physician-Assisted
Suicide: Towards a Nuanced Approach 

Appendix: Triage: Determining Which Patients to
Prioritize in an Emergency According to Jewish Law


5.

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

Elder Abuse: ERs Learn How To Protect A Vulnerable Population

August 28, 2017

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Abuse often leads to depression and medical problems in older patients — even death within a year of an abusive incident.

Yet, those subjected to emotional, physical or financial abuse too often remain silent. Identifying victims and intervening poses challenges for doctors and nurses.

Because visits to the emergency room may be the only time an older adult leaves the house, staff in the ER can be a first line of defense, said Tony Rosen, founder and lead investigator of the Vulnerable Elder Protection Team (VEPT), a program launched in April at the New York-Presbyterian Hospital/Weill Cornell Medical Center ER.

The most common kinds of elder abuse are emotional and financial, Rosen said, and usually when one form of abuse exists, so do others. According to a New York study, as few as 1 in 24 cases of abuse against residents age 60 and older were reported to authorities.

The VEPT program — initially funded by a small grant from The John A. Hartford Foundation (a Kaiser Health News funder) and now fully funded by the Fan Fox and Leslie R. Samuels Foundation — includes Presbyterian Hospital emergency physicians Tony Rosen, Mary Mulcare and Michael Stern. These three doctors and two social workers take turns being on call to respond to signs of elder abuse. Also available when needed are psychiatrists, legal and ethical advisers, radiologists, geriatricians and security and patient-services personnel.

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KHN

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

Florida Man Is First To Die Under New Lethal Injection Protocol

August 25, 2017

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A spokesperson for Janssen, the division of Johnson & Johnson that makes etomidate, told The Washington Post the company objects to the drug’s use in an execution.

Asay’s lawyers filed an objection to the use of etomidate, but the Florida Supreme Court denied the stay request, writing “Asay failed to establish sure or very likely risks of sufficiently imminent danger or a proposed alternative that is readily available.”

Jen Moreno, a lethal injection expert at the University of California, Berkeley Law School’s death penalty clinic, told the Miami Herald it was unclear if the drug would work. “There are outstanding questions about whether it’s going to do what it needs to do during an execution,” she told the paper. “The state hasn’t provided any information about why it has selected this drug.”

… Read More

Image via Flickr United States Government WorkUnited States Government Work

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NPR The Two-Way

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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

Germany Takes an Ethics Stance on Driverless Cars

August 24, 2017

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The idea of autonomous cars has always raised a big question: in the event of a serious crash that involves life-and-death decisions, what should the vehicle do? Clearly, it’s possible to program cars to do as humans desire, but there isn’t necessarily a clear course of action to take in every situation.

That, however, hasn’t stopped German regulators from taking a stance on the issue. Reuters reports that autonomous-car software must be “programmed to avoid injury or death of people at all cost.”

… Read More

Image: By Grendelkhan – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=47467048

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MIT Technology Review

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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

Canadian Law that Excepts Religious Hospitals from Offering Assisted Deaths Disputed by Dying with Dignity

The Canadian not-for-profit Dying with Dignity is considering challenging provincial Ontario legislation that permits religiously affiliated hospitals to refrain from offering medically assisted death. Under current Ontario law, hospitals, hospices and long-term care centers that wish not to facilitate assisted death may refrain from doing so, and are instead obligated to transfer the patient to an alternative willing healthcare facility. In this respect, the legislation parallels hospitals’ option to electively refrain from performing abortions on ethical grounds outlined by the Catholic Health Alliance of Canada. Under a potentially emergent legal challenge, however, these publicly funded healthcare facilities could lose their permission to deny direct facilitation of a patient’s death.

As part of its rationale for challenging the law, Dying with Dignity cites the prospective trauma that a patient can further undergo if a transfer is necessary. The not-for-profit’s chief executive Shanaaz Gokool also stated that “what Ontario did is they gave an opt-out to basic and essential health care to hospitals that don’t want to provide for the dying.” Though it is challenging a healthcare facility’s legal right to refrain from assisting death, it maintains that individual healthcare providers ought to maintain that individual right.

To date, over 630 Ontarians have legally ended their lives with medical assistance. Time will tell whether in this potential legal conflict between religious and medical institutions, the law may yet facilitate higher numbers.

The post Canadian Law that Excepts Religious Hospitals from Offering Assisted Deaths Disputed by Dying with Dignity appeared first on Global Bioethics Initiative (GBI).

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.