Tag: harm

Bioethics Blogs

A Feminist Neuroethics of Mental Health

By Ann E. Fink

Ann Fink is currently the Wittig Fellow in Feminist Biology at the University of Wisconsin–Madison, with an appointment in Gender and Women’s Studies and concurrent affiliations with Psychology and the Center for Healthy Minds. Her research in cellular and behavioral neuroscience has appeared in the Journal of Neuroscience, Journal of Neurophysiology, PNAS and other journals. Ann’s interdisciplinary work addresses the ethics of neuroscience in relation to gender, mental health and social justice.

Emotionality and gender are tied together in the popular imagination in ways that permeate mental health research. At first glance, gender, emotion, and mental health seem like a simple equation: when populations are divided in two, women show roughly double the incidence of depression, anxiety, and stress-related disorders^1-3. Innate biological explanations are easy to produce in the form of genes or hormones. It could be tempting to conclude that being born with XX chromosomes is simply the first step into a life of troubled mood. Yet, buried in the most simplistic formulations of mental illness as chemical imbalance or mis-wiring is the knowledge that human well-being is a shifting, psychosocial phenomenon. Learning and memory research offers a treasure trove of knowledge about how the physical and social environment changes the brain. Feminist scholarship adds to this understanding through critical inquiry into gender as a mode of interaction with the world. This essay explores how a feminist neuroethics framework enriches biological research into mental health.

Problems with “Biology-from-birth” stories

What if understanding gender and health isn’t a tale of two gonads (or genitalia, or chromosomes)?

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.

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.

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

* * *

Bioethics Blogs

What the Present Debate About Autonomous Weapons is Getting Wrong

Author: Michael Robillard

Many people are deeply worried about the prospect of autonomous weapons systems (AWS). Many of these worries are merely contingent, having to do with issues like unchecked proliferation or potential state abuse. Several philosophers, however, have advanced a stronger claim, arguing that there is, in principle, something morally wrong with the use of AWS independent of these more pragmatic concerns. Some have argued, explicitly or tacitly, that the use of AWS is inherently morally problematic in virtue of a so-called ‘responsibility gap’ that their use necessarily entails.

We can summarise this thesis as follows:

In order to wage war ethically, we must be able to justly hold someone morally responsible for the harms caused in war.
Neither the programmers of an AWS nor its military implementers could justly be held morally responsible for the battlefield harms caused by AWS.
We could not, as a matter of conceptual possibility, hold an AWS itself morally responsible for its actions, including its actions that cause harms in war.
Hence, a morally problematic ‘gap’ in moral responsibility is created, thereby making it impermissible to wage war through the use of AWS.

This thesis is mistaken. This is so for the simple reason that, at the end of the day, the AWS is an agent in the morally relevant sense or it isn’t.

If it isn’t, then premise 2 is either false and moral responsibility falls on the persons within the causal chain to the extent that they knew or should have known the harm they were contributing to and the degree to which they could have done otherwise, or premise 2 is true but vacuous because the harm was a result of a genuine accident.

Bioethics News

Drugs that Go Through FDA’s Expedited Review Might Be Better Drugs

August 14, 2017

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A new paper in the latest issue of Health Affairs is worth a look. “Drugs Cleared Through The FDA’s Expedited Review Offer Greater Gains Than Drugs Approved By Conventional Process“:

We investigated whether drugs approved by the Food and Drug Administration (FDA) through expedited review have offered larger health gains, compared to drugs approved through conventional review processes. We identified published estimates of additional health gains (measured in quality-adjusted life-years, or QALYs) associated with drugs approved in the period 1999–2012 through expedited (seventy-six drugs) versus conventional (fifty-nine) review processes.

The FDA has a strict process for drug approval, requiring a number of phases of testing to establish safety and efficacy. It can, however, expedite this process when it thinks a drug may address an unmet clinical need. Of course, you want such a process to be fair and work. You want it to be focused on “better” and “more important” drugs. The 21st Century Cures Act moved even further. Some worry that loosening standards will lead to increased exposure to harm, especially if there isn’t proof that these drugs provide more benefits.

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The Incidental Economist

Tags: access, alternative, bioethics, clinical trial, drugs, efficacy, evidence, expedited review, FDA, safety, subject, treatment

Bioethics News

CRISPR, Pigs, Organs, Ethics: Some Key Considerations

Michael S. Dauber, M.A., GBI Visiting Scholar

Luhan Yang and members of her research team at eGenesis have taken a crucial step in growing organs in animals that may be used to provide organs for therapeutic transplants in humans, according to a study published in Science Magazine on Thursday, August 10^th. Researchers involved in the study used CRISPR, a genetic editing technique, to “knock out” 25 genes that cause porcine endogenous retroviruses (sometimes referred to as “PERV genes”) that make ordinary pig organs unsuitable for transplants because PERVs can infect human transplant recipients. The result was the birth of 37 baby pigs without PERV genes.

The move comes at a time when CRISPR experiments are becoming increasingly popular. Last week, a team led by Shoukhrat Mitalipov published the results of the first successful attempt to modify human embryos using CRISPR by American scientists in Nature. The researchers successfully deleted a gene responsible for several fatal heart conditions.

While the results are a significant step in developing techniques for growing organs suitable for human transplantation, scientists must still travel a long road before any human patients will receive such organs. Researchers will need to determine whether or not organs from pigs developed using CRISPR can be safely and effectively transplanted into other animals first. Another hurdle is the cost and complexity of the technique: Yang’s experiments with her team involved embryos produced through cloning, an expensive technique that is not always completely effective: indeed, in Yang’s study, only a few of the cloned embryos were viable.

Bioethics News

Protecting My Son Meant Wishing for His Death

August 11, 2017

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I tell him that Miles has been a joyful son to have, my firstborn child. That from the beginning he has been quick, bright, an adventurer, a risk-taker. That one of the things that has defined him has been his brain. He got a first-class degree from Oxford. At 24 he was selected as one of five young people to represent Britain during the European Parliament’s Youth Convention. He started his own tech company at 26. He is writing a book in his spare time. He rides a motorbike, he sky dives, he dives with sharks. He practices qigong. He makes electronic music, he writes poetry. He is irascible, funny, kind, down to earth. He loves life, attacks it head on, dangerously, seeking adrenaline, sometimes foolhardy, learning from his flaws while exploring, always, his spiritual resources.

I am boasting about my son. But it is important the doctor should know about Miles’s brain, the brain that he and his team are now responsible for.

It is universally understood that a primal maternal instinct is to protect one’s young. To will the death of your child would appear to be a reversal of that instinct. But, as I found out, it can be the extension of it.

Image via Flickr Some rights reserved by A3Format

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NYTimes Well

Tags: bioethics, care, child, death, decision making, dying, harm, injury, parent

Bioethics News

Widowed Early, A Cancer Doctor Writes About The Harm Of Medical Debt

August 10, 2017

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…

How she got from there to here is a story about how health care and money are intertwined in ways that doctors and patients don’t like to talk about.

But Chino is determined to do so.

“I think of him every day,” Chino says of her late husband, Andrew Ladd. “It drives me to do the type of research that I do — that’s looking at the financial toxicity of cancer care.”

Chino is co-author of a research letter, published Thursday in JAMA Oncology, that shows that some cancer patients, even with insurance, spend about a third of their household income on out-of-pocket health care costs outside of insurance premiums.

It’s an issue Chino knows well.

Image via Flickr Some rights reserved by See-ming Lee 李思明 SML

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NPR Shots

Tags: access, billing, bioethics, costs, debt, experience, hospital, insurance, outcomes, quality of life

Bioethics Blogs

Right to Try: Why Logic and Facts Won’t Win This One

by Craig Klugman, Ph.D.

Last week the U.S. Senate passed bill S. 204, the Trickett Wendler Right to Try Act of 2017. Trickett Wendler was a woman with ALS. The ALS association and her family lobbied Congress to support this bill to give all patients living with a terminal illness the “right” to purchase experimental drugs from pharmaceutical companies. Essentially, this bypasses the FDA’s compassionate use program. Instead of filing an application for FDA compassionate use (which the FDA approves 99% of the time), the patient asks the drug manufacturer directly. As I have written in this space before, such laws threaten public health efforts through the FDA to ensure safe and efficacious pharmaceuticals.

Currently, 37 states have such right-to-try laws and more have considered them. The push for these laws begins with the Barry Goldwater Institute, a libertarian think-tank, funded in part by the Koch brothers. Last month I had the surreal experience of debating two right-to-try supporters (one from a business school and one from the Goldwater Institute) about these laws which they base in a “right to self-medicate.” There were two of us against self-medication and two in favor of it. You can read the commentaries and responses of the debaters here.

In this essay, I do not plan to restate my arguments against right-to-try. You can read my thoughts on this policy here and here. Instead, this post will examine the tools of argumentation that my opponents employed in the debate. It is important to show their debate techniques so that we all have a better understanding of how to analyze claims to support right-to-try and to realize why better facts and better arguments are falling on deaf ears.

Bioethics Blogs

In the Journals – July 2017 by Danya Glabau