Tag: kidney dialysis

Bioethics Blogs

Speculation, Certainty and the Diagnostic Illusory: The Tricorder and the Deathless Man by Thierry Jutel

In the paragraphs which follow, we will be discussing the ways in which two pieces of speculative fiction, the science fiction film Star Trek IV: The Voyage Home, and the novel The Tiger’s Wife use diagnostic and prognostic certainty as part of their creative narratives. In both cases, the confidence vested in the diagnosis and its outcome is contrasted to the “diagnostic illusory” of contemporary medicine.

Even while diagnosis is medicine’s primary classification tool, it is far less circumscribed than diagnostic taxonomies suggest, as well as the power afforded those who diagnose. Even very material conditions have porous boundaries (Jutel 2013) which muddy the waters in a system that is based on tidy categories. Sarah Nettleton and her colleagues have developed the term “diagnostic illusory” to describe how medicine invests in generalisation as a way of understanding disease. In the diagnostic illusory, for the cases that resists classification, or perturb a diagnostic category, one turns to ever-more sophisticated forms of technology, with the belief that it’s just a matter of time before the explanation will become clear, and the diagnosis justified. Nettleton and her colleagues raise the idea of “illusory” to highlight the “ambiguities and nuanced complexities associated with the biomedical imperative to name and classify” (Nettleton, Kitzinger, and Kitzinger 2014).

In this short essay, we will explore how two speculative texts represent diagnosis, highlighting through their respectively futuristic and supernatural approaches the yearnings of contemporary medicine, and the society it serves, for diagnostic certainty.

 

Star Trek IV: The Voyage Home and the Tricorder

In the science fiction epic Star Trek IV: The Voyage Home (Nimoy 1986), the Starship Enterprise and its crew have come back to planet earth in 1986 to save the humpback whale from extinction and by extension, to save planet earth from destruction in the future.

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

Bioengineered Blood Vessels Appears Safe for Dialysis Patients

May 13, 2016

(Medical Xpress) – Man-made blood vessels developed by researchers at Duke University, Yale University and the tissue engineering company Humacyte appear to be both safe and more durable than commonly used synthetic versions in patients undergoing kidney dialysis, the researchers report. The findings, published May 12 in The Lancet, resulted from a phase 2 study among 60 patients with kidney failure who required dialysis, which often requires a synthetic graft when the patient’s own blood vessel degrades from frequent needle sticks. Such grafts, however, are prone to infection, clotting, and other complications. And alternative bioengineered grafts derived from the patient, a donor, or animal tissue have been shown to perform no better than synthetics.

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

Kidney Dialysis Might Not Extend Survival of Elderly

March 21, 2016

(U.S. News & World Report) – Dialysis does not significantly improve survival for elderly kidney failure patients, a new study indicates. The findings suggest that conservative care may be a reasonable option for some kidney failure patients over 80. The researchers don’t say that dialysis treatment should not be given to anybody older than 80 or with severe co-occurring conditions. “But we show that the treatment is on average of little advantage regarding survival,” said study co-leader Dr. Wouter Verberne of St. Antonius Hospital in Nieuwegein, the Netherlands.

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

Resistance to Colistin: A Doomsday Scenario?

Julie Perry calls for action to prevent antibiotics resistance.

__________________________________________

A report published in The Lancet Infectious Diseases on November 18, 2015 documented the emergence of a new form of antibiotic resistance in China. This report has garnered a lot of international attention because scientists found resistance to colistin, an antibiotic of ‘last resort’ without which many bacterial infections would be completely untreatable. Bacteria carrying this new resistance gene were found in raw meat, food animals, and some hospital patients.

As these bacteria spread, so too does resistance to colistin. What is most worrying to scientists is the fact that the resistance gene found in the bacteria was found on a mobile genetic element called a plasmid. This means that the resistance gene can easily spread amongst bacterial species and could eventually end up in bacteria that cause severe disease.

Antibiotics are drugs that kill bacteria. They do so by targeting structures or genetic pathways that are only found in bacteria (not in humans or animals), and are therefore generally very safe and effective drugs. Antibiotics are vital to the treatment of infectious diseases. They are also crucial to the prevention of infection following Cesarean sections, organ transplantation, cancer chemotherapy, kidney dialysis, and a myriad of other areas of modern medicine we now consider routine. The downside of the ubiquitous use of antibiotics, however, is the development of antibiotic resistance.

Hospital-Associated Methicillin-resistant Staphylococcus aureus (MRSA) Bacteria. Interaction of MRSA (green bacteria) with a human white cell. Credit: NIAID

Antibiotic resistance is generally a misunderstood concept.

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

Taiwan End-of-Life Policies Inflict Unwanted Pain & Torture

Doctor Chen Hsiu-tan of National Yangming University Hospital said after a legislative hearing Thursday that Taiwan needs to take stock of the pain its end of life policies are inflicting on the living and those being kept artificially alive.

Patients should have the right to choose to die with dignity instead of having to accept futile medical treatment, said Chen, a longtime hospice care advocate.

Citing a survey, Chen said that one-third of terminally ill patients in Taiwan were “tortured” by such futile treatment as resuscitation, respirators, kidney dialysis and extra-corporeal membrane oxygenation (ECMO) before their last breath, causing pain to the living as well as the dead.

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

Not-so-lethal – the ethics and costs of extraordinary fetal intervention

By Dominic Wilkinson (@Neonatal Ethics)

Late last month, a paper in the US journal Obstetrics and Gynecology reported the extraordinary case of Abigail Beutler. Abigail is now 14 months old. She was born without kidneys, a condition sometimes called ‘Potter’s syndrome’. Potter’s syndrome is normally universally fatal in the newborn period, because without kidneys the fetus does not produce urine and has little or no fluid around them. Without any fluid around the fetus, their lungs do not develop.

Abigail is the first baby to ever survive with this condition. Doctors infused artificial fluid into the uterus around her (amnioinfusion) on five occasions during the pregnancy. This seemed to allow her lungs to grow. Although she was born 3 months prematurely, she had only minor breathing problems at birth. She has received kidney dialysis since soon after birth, was discharged home after 19 weeks and is now reportedly being considered for a kidney transplant. There are a number of issues raised by Abigail’s case.

First, this case represents the ultimate challenge to the concept of a ‘lethal congenital malformation’. Some birth defects are so severe that doctors refer to them as ‘lethal’. The implication is that the baby will inevitably die despite treatment. However, long-term survival had been described in almost all of the conditions that are commonly referred to as ‘lethal’, for example Trisomy 13, trisomy 18, anencephaly, suggesting that this terminology was misleading. The only exception to this used to be Potter’s syndrome, where survival had never been reported.

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.