Tag: knowledge

Bioethics Blogs

Texas Considers Letting Doctors Lie to Patients

by Craig Klugman, Ph.D.

The Texas Senate just passed a new bill (SB 25) that would shield doctors from a lawsuit if a baby is born with a disability even if the doctor knew of the concern and chose not to tell the parents. Opponents of the bill say that it permits doctors to lie to their patients if the doctor believes that knowledge might lead the woman to choose an abortion. The Houston Chronicle reports the bill’s aim is to “chip away at abortion rights.”

The Texas law does not go as far as a 2015 Arizona law that mandated physicians lie to patients by telling them that an abortion can be reversed. The new Texas bill would “allow” doctors to lie to patients and shield them from lawsuit unless the patient could prove gross negligence. The burden is on the patient to prove that the doctor should not have lied.

One of the first rules of professionalism that I teach in undergraduate and medical school bioethics courses is that in general, you never lie to the patient. Telling the truth is a bedrock concept necessary to respect patient autonomy. In order to make decisions, patients need to have knowledge of their condition and their treatment options (risks, benefits, and alternatives).

There are a few circumstances in which lying to patients is ethically acceptable: If the physician has strong reasons to believe that information would push the patient to do harm to him/herself or others, or if the family has requested that a patient not be told information because of cultural practices and the patient has agreed that she/he does not want to know the news.

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

From My Students Most of All

By Zev Leifer

The Talmud (Taanis 7a) quotes Rabbi Chanina who declared that, “I have learned much from my teachers, more from my colleagues and most from students.”  There is a tendency amongst educators, in general and more so, I suspect, amongst medical educators (given their many years of training and vast experience) to take a top-down approach.  This approach assumes that we have a contractual relationship wherein “I have the knowledge and we are here so that I can share it with you”.

In contrast, the digital age has humbled many of “our” generation since the best advice when faced with a new piece of digital equipment or software, is to “ask a ten-year old” (even an anonymous ten-year old).  But our students?!  I submit that example is a challenge – to ego and to the “Central Dogma of Education” that information flow is unidirectional.

I would like to share some of my experiences teaching digital pathology, to perhaps update that notion…

For the past 35 years I have been teaching Pathology Lab at the New York College of Podiatric Medicine.  For most of that time, the classical techniques of diagnostic pathology – analyzing a glass slide of a tissue slice to determine if normal or pathological, or pathological to what extent – has been by looking at the slide in a microscope.  Now the world has changed.  For the professional pathologist and, by extension, for the aspiring pathology student, it is all digital.  The slide is digitized and, with appropriate software, made available on the computer which acts as microscope.

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

Pornography as a Public Health Issue

Jacqueline Gahagan advocates for a national sexual health promotion strategy.

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Pornography is concerned with the development and the circulation of sexually explicit books, magazines, videos, art, and music aimed at creating sexual excitement. Public health is concerned with keeping people healthy and preventing illness, injury and premature death. With the growing use of internet-based pornography and the relative ease by which it can be accessed, the effects of “online violent and degrading sexually explicit material on children, women and men” have become an important public health issue. This issue is best addressed through the development and introduction of a national sexual health promotion strategy – a strategy that includes current and comprehensive sexual health education in our primary, secondary, and post-secondary schools.

Health promotion, in concert with public health, involves encouraging safe behaviours and improving health through healthy public policy, community-based interventions, active public participation, advocacy, and action on key determinants of health. I am confident that several of these strategies can be used to address concerns about the ready access to internet-based pornography. For example, health promotion initiatives that take a harm reduction approach to healthy sexuality include an emphasis on screening and testing for sexually transmitted infections, the use of condoms, a shared understanding of consensual sex, as well as the use of other safer sex interventions.

A review of existing sexual health education in Canadian schools, however, reveals that many Canadian youth do not receive the level of sexual health education they need to help them make informed decisions about sexual risk-taking.

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

Mortal remains

One of the star exhibits in the Royal College of Surgeons’ Hunterian Museum of anatomy in London is the skeleton of Charles Byrne, an 18th Century Irishman who was about 8 feet tall. However, the museum is to close in May for renovations and there are calls to use the opportunity to remove or bury the remains. Does this make sense?

A celebrity in his day, Byrne died in 1783 of ill health and drink in London. He knew that John Hunter wanted to dissect him after his death, so he directed his friends to sink his body in a lead-lined casket in the English Channel. Alas, Hunter succeeded in stealing the body anyway and it eventually turned up in a display case.

Similar events darken the history of the Australian state of Tasmania. The last full-blood Aboriginal Tasmanian, William Lanne, died in 1869. Although the story is murky, it appears that before his funeral the Surgeon-General of the colony, William Crowther, stole his head for “scientific study” and someone else removed his hands and feet. There is no record of scientific studies. Crowther went on to become premier, and an impressive bronze statue of him was erected in the centre of the city.

The last full-blood Aboriginal woman in Tasmania, Truganini, was terrified that the same thing would happen to her and directed that her body be cremated. Her wishes were ignored and her skeleton ended up in a display in the Hobart Museum. It was finally cremated in 1976.

Nowadays body-snatching would not be tolerated (although the Hunterian Museum still refuses to remove Byrne’s body from display).

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

Rationing of antibiotics in the critically ill: not if, but how?

Guest Post: Simon Oczkowski
Paper: Antimicrobial stewardship programmes: bedside rationing by another name? 

The threat posed by antimicrobial resistant organisms (AROs) has long been recognized by the medical community as an emerging problem in public health. Though slow and insidious changes in the ability of bacteria, fungi, parasites, and viruses have real and profound effects on patients around the world, it is often dramatic examples of patients dying from infections resistant to all antibiotics which receive the most attention.

What is the solution to this problem? Given its complexity it is unlikely to be a single, simple intervention. The development of new antimicrobials could promises to have a major impact on reducing the mortality, morbidity, and cost of ARO infections, developing new antimicrobials takes time and significant financial resources. The development of AROs resistant to almost all known antimicrobials only a century from their initial widespread use suggests that this is a biological arms race that we can not win.

A systematic reduction in antimicrobial use can actually prevent the development of AROs. In simplistic terms: when bacteria, fungi, parasites, and viruses are exposed to antimicrobials, the individuals which are susceptible to the antimicrobial die, leaving behind those who have some resistance to the organism to live and multiply and to spread their resistant genes on to the next generation, or to other nearby organisms. In short— the use of antimicrobials, over time, will result in the development of AROs. So how can we fairly reduce the use of antimicrobials?

It is well recognized that much antimicrobial use is unnecessary, such as antibiotics for the common cold.  Reducing the use of antimicrobials in patients with minor, non-life-threatening illnesses is a large-scale challenge, but poses little threat to individual patients.

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

What are the Ethics of Avoidance?

Mark McQuain, in his February 21st blog post, discussed an interesting article which proposed that ethical decisions be made by robots. Although the author’s specific arguments invite numerous responses, underneath these arguments lies the question: why does modern man spend such effort to use technology to rid himself of yet another intrinsic function of his existence?

It seems to me that this wish to pass off ethical decision making is a prime example our drive to divest ourselves of difficult, painful, messy, and often guilt-inducing work in our moral and spiritual lives.

J. Budziszewski described this problem in his book What We Can’t Not Know when he wrote, “…two universals are in conflict: universal moral knowledge, and the universal desire to evade it.”

If we look closely, behind the artfully constructed arguments heavily refined in postmodern academia, is an unspoken motive of moral avoidance–the desire to distance oneself from the emotionally painful or otherwise costly consequences of man’s existence. Technology has already been used quite well to help us avoid other discomforts— why not to help us avoid emotional discomfort as well?

For example, how many instances of discussion of physician-assisted suicide are really driven by the physician’s, family’s, and government’s sense that their lives would be so much easier if this person would just die before things got messy? How neatly this prevents emotional strain on the part of everyone besides the patient. The all-too-well-developed arguments invoking “compassion” and “dignity” are in fact contrived as a veneer to cover this motive.

And here abortion is the close cousin of assisted suicide– far better to promote “choice” than to deal with the unpleasant social consequences of unwanted pregnancies.

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

What is Feminist Neuroethics About?

By Ben Wills

Ben Wills studied Cognitive Science at Vassar College, where his thesis examined cognitive neuroscience research on the self. He is currently a legal assistant at a Portland, Oregon law firm, where he continues to hone his interests at the intersections of brain, law, and society.
As the boundaries of what may be considered “neuroethics” extend with the development of new kinds of technologies and the evolving interests of scholars, its branches encounter substantial structures of adjacent scholarship. “Feminist neuroethics” is a multidimensional construct and a name that can be afforded both to approaches that fall within the bounds of mainstream neuroethics and metatheoretical challenges to the scope and lines of debate within neuroethics. While acknowledging that scholarship at the intersections of academic feminism/gender studies, feminist science studies, ethics, and neuroscience is much more substantial and diverse than I’m considering here, my modest aim in this post is to highlight how the label “feminist neuroethics” has been used to look at what scholars consider important for neuroethics. In so doing we can see what scholars in these fields see as worth highlighting when identifying their work as such.

The phrase “feminist neuroethics” is young, first used (to my knowledge) in peer-reviewed literature by philosopher Peggy DesAutels in her 2010 article on “Sex differences and neuroethics,” published in Philosophical Psychology (though see Chalfin, Murphy, & Karkazis, 2008 for a close antecedent). She writes that, having found herself considering the ethics of neuroscience, the neuroscience of ethics, and sex/gender differences, her “overlapping approach could neatly be summarized as feminist neuroethics” (p.

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 Value of Oversight in a Century of Promise & ‘Cures’

This post, by CEC member Paul McLean, originally appeared on WBUR’s CommonHealth blog.
The blood-thinner heparin is not a 21st-century cure. It was discovered 100 years ago by a scientist looking for something else entirely, and is one of the oldest drugs still in regular use.
After my daughter was diagnosed with a potentially fatal blood disorder, heparin played a key daily role in her treatment. We’d wash our hands meticulously, lay out gloves and antiseptic wipes, saline flushes for the access lines to her fragile immune system, and finally the sealed heparin syringe.
For many months, we went through boxes of heparin and never questioned its safety. Never had reason to.
But in 2008, after my daughter was officially declared cured and we’d used heparin for the last time, contamination in the supply from China killed 19 Americans and harmed many others. Writing that sentence still gives me the chills. My daughter survived thanks to medicine, but it also could have killed her.
So you can understand why, as the 21st Century Cures Act sailed to passage, I experienced both excitement and dread.
That heparin contamination was in part due to lax oversight of the drug supply chain. It reminds me why I do not want to see the work of the Food and Drug Administration compromised by overeager drug companies taking advantage of the hopes of desperate patients, and taking shortcuts on safety.
The “giant piñata” of a bill, as science blogger Derek Lowe aptly described the 21st Century Cures Act, is destined to explode in unexpected ways.

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

Lenore Manderson, Elizabeth Cartwright and Anita Hardon’s The Routledge Handbook of Medical Anthropology by Casey Golomski

The Routledge Handbook of Medical Anthropology

Edited by Lenore Manderson, Elizabeth Cartwright and Anita Hardon

Routledge, 2016, 393 pages.

 

This is not a run-of-the-mill medical anthropology reader. Thank Routledge, its editors, and contributors for it. As someone who regularly convenes intermediate-advanced courses in medical anthropology, I’m grateful for its readability, teachable qualities, and particular theoretical angles. I’m going to trace four areas where I think the new Routledge Handbook of Medical Anthropology is innovative among the current offerings of similar edited volumes on the market for our discipline.

 

Visual innovation :: contextualized photographic figures

Recently, there’s been hot and necessary discussion about the images used for anthropology book covers: Tunstall and Esperanza (2016) over at Savage Minds provide interesting practical guidelines for book cover image selection as a way to decolonize anthropology. Ethnographies of medicine, suffering, and war with nuanced photographic figures of belabored people arguably make these books more compelling and help them win awards (De Leòn with Wells 2015, Biehl with Eskerod 2007, 2013), and also raise ethical questions about the images we choose to give life to our writing. The Routledge Handbook contains 16 photographic figures, taken by both contributors and others selected from a global Internet-based call-for-submissions in 2015, each placed as a ‘prelude’ (xii) to its respective chapter. A thoughtful, roughly 150-175 word description by the photographer accompanies each figure, giving it fuller context beyond the usual one sentence caption.

I appreciate projects that aim to decolonize higher education, the academy and our respective discipline, and find Tunstall and Esperanza’s approach insightful.

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

In the Journals: February 2017 by Christine Sargent

American Ethnologist

Good ramps, bad ramps: Centralized design standards and disability access in urban Russian infrastructure

Cassandra Hartblay

Accessible design seeks to reconfigure the social by restructuring the material. As the idea moves globally, it becomes entwined in local logics of moral obligations between citizens and the state. Wheelchair users in the city of Petrozavodsk, in northwestern Russia, talk about inaccessible infrastructure as being embedded in moral relationships. In their stories, hierarchies of expertise diffuse responsibility for outcomes and devalue user knowledge. When accessible design elements are installed to meet minimum standards, they are “just for the check mark” and often do not “work.” Wheelchair ramps produce value for businesses or governments by representing an idea of access that circulates as a commodity. Failed accessible design draws attention to a moral field governing the responsibilities of actors to produce a “good” built environment, imbricated in teleologies of progress. [disability, design, infrastructure, access, ramps, postsocialism, Russia]

Self-governance, psychotherapy, and the subject of managed care: Internal Family Systems therapy and the multiple self in a US eating-disorders treatment center

Rebecca J. Lester

“The self” has seen a surprising resurgence in recent anthropological theorizing, revitalizing interest in whether and how it can be studied ethnographically. These issues are brought to the fore by a newly popular psychotherapy technique, Internal Family Systems therapy (IFS), as practiced in a US eating-disorders clinic. There, clinicians and clients negotiate tensions between this model’s understanding of a multiple, refracted self and managed-care companies’ insistence on personal responsibility. In considering the moral and pragmatic work of IFS in the clinic, a new critical anthropology of selfhood illuminates the vectors through which economic and political commitments become imbricated in the self.

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.