Tag: law

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A Start-Up Suggests a Fix to the Health Care Morass

August 16, 2017

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In Congress, a doomed plan to repeal the Affordable Care Act, President Obama’s health care law, has turned into a precarious effort to rescue it. Meanwhile, President Trump is still threatening to mortally wound the law — which he insists, falsely, is collapsing anyway — while his administration is undermining its being carried out.

So it is surprising that across the continent from Washington, investors and technology entrepreneurs in Silicon Valley see the American health care system as the next great market for reform.

Some of their interest is because of advances in technology like smartphones, wearable health devices (like smart watches), artificial intelligence, and genetic testing and sequencing. There is a regulatory angle: The Affordable Care Act added tens of millions of people to the health care market, and the law created several incentives for start-ups to change how health care is provided. The most prominent of these is Oscar, a start-up co-founded by Joshua Kushner (the younger brother of Mr. Trump’s son-in-law, Jared Kushner), which has found ways to mine health care data to create a better health insurance service.

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NYTimes

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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.

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Review of countries where Euthanasia has been legalised. Increaing of involuntary euthanasia, without consent by patients

Euthanasia a Slippery slope that could end in involuntary euthanasia

Euthanasia was legalised in Belgium in 2002, where is defined as “the intentional termination of a patient’s life by a physician at the patient’s request”, so that only voluntary euthanasia may be legally carried out in Belgium (J Med Ethics 41; 625-629, 2015). However, this legal requirement of voluntarism is not always fulfilled.

Thus, a study conducted in Flanders in 1996 found that 3.3% of cases of euthanasia had occurred without the prior request of the patient. In other words, they were involuntary euthanasias. Another study (also in Flanders) found that there had been 1796 cases of involuntary euthanasias (3.2%). A more recent study from 2007 found that the percentage of involuntary euthanasia was 1.8%, while another in 2013 found 1.7%.

However — and we believe this is important — the percentage of involuntary euthanasia in patients who were 80-years-old or over rose to 52.7%, while in those with diseases other than cancer, this figure reached 67.5%. The decision was not discussed with the patient in 77.9% of cases (J Med Ethics 41; 625-629, 2015).

Canada experience

A Recent statement of Professor Somerville, who spent 40 years living and working in Canada,  has recently returned home to Australia to take up the position of Professor of Bioethics in the School of Medicine at The University of Notre Dame Australia, Sydney where she says claims by Australian pro-euthanasia advocates, including media personality Andrew Denton, that euthanasia and assisted suicide is working safely overseas don’t stand up to basic scrutiny.

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.

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Americans Eager For Leaders To Cooperate To Make Health Law Work

August 11, 2017

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Move on.

That’s what most people say Congress and the Trump administration should do after the Senate failed to approve legislation in July to  revamp the Affordable Care Act, according to a survey this month.

Nearly 8 in 10 Americans say President Donald Trump should be trying to make the health law work, according to poll conducted by the Kaiser Family Foundation. This includes large majorities of Democrats (95 percent) as well as half of Republicans (52 percent) and President Trump’s supporters (51 percent). (Kaiser Health News is an editorially independent program of the foundation.)

Almost 6 in 10 people think the Republicans should work with Democrats to improve the health law.

Only 17 percent of the public — and 40 percent of Republicans — think the Trump administration should take steps to make the health law fail, the survey said.

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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.

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Vaccination Rate Jumps in CA After Tougher Inoculation Law

The vaccination rate for California’s kindergartners soared this fall from the previous year, fueled by a state law that made it significantly tougher for parents to exempt schoolchildren from shots

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.

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Criminal Law and Neuroscience: Hope or Hype?

August 1, 2017

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Most commonly, many thought that traditional notions of criminal responsibility would be undermined for various reasons, such as demonstrating that people really cannot control themselves as well as we believe, or as indicating that more action was automatic, thoughtless and non-rational than we think. Most radically, the neuroexuberants argued that neuroscience shows that no one is really responsible because we are not agents; rather, we are victims of neuronal circumstances that mechanistically produce our epiphenomenal thoughts and our bodily movements. Similar claims were made when the genome was cracked. The age of cognitive, affective, and social neuroscience (behavioral neuroscience)—the neurosciences most relevant to law—is almost two decades old. What have we learned that is legally relevant and how has it transformed criminal law doctrine and practice?

Despite the astonishing advances in neuroscience, most of what we know is not legally relevant, has not transformed doctrine in the slightest and has had scant influence on practice except in death penalty proceedings. The reasons are conceptual, scientific, and practical. The first and most basic conceptual problem is that we have no idea how the brain enables the mind and action, although we know that it does. If your brain is dead, you have no mental states and do not act. The brain/mind/action connection is one of the hardest problems in science and neuroscience is not about to crack it anytime soon, if ever.

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Neuroethics Blog

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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.

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Harvard Grad Students: Applications Due Friday, August 4! Petrie-Flom Center Student Fellowship, 2017 – 2018

The Center and Student Fellowship The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics is an interdisciplinary research program at Harvard Law School dedicated to the scholarly research of important issues at the intersection of law and health policy, … Continue reading

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.

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Surrogacy in American male same-sex couples

Of the 594,000 same-sex couple households in the United States, 115,000 have children

In 2014, approximately 37,800 male same-sex couples in the United States had children, most through gestational surrogacy.   Little is known about the reasons these couples have for choosing this technique to have a child. A study has now been published (see HERE) that has evaluated the reasons why same-sex couples choose surrogacy.

Most do so because of the genetic links established. Just over half of fathers (55.74%) were satisfied with surrogacy. All this is apart from the objective ethical difficulties that surrogacy entails.

Men with children

There is one group whose incomes are far above the rest: same-sex “married” men with children. Their income is rough $275,000, more than double the pretax income for heterosexual couples and same-sex married female couples with children. This is a select group of people for whom the cost of children is particularly high. Using a surrogate can cost $250,000, and adoptions can cost upward of $30,000.

Of all the ART available to intending parents, surrogacy is arguably the most controversial (Jadva, 2016). Only 19 states in the USA currently allow commercial gestational surrogacy to married same-sex couples and in 15 states it is practiced because no statute or published case law prohibits it (Creative Family Connection, 2016).

La entrada Surrogacy in American male same-sex couples aparece primero en Bioethics Observatory.

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.

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In a Nutshell II: Ontario Court Decision & MAiD

Jocelyn Downie describes the recent Ontario Superior Court of Justice decision in A.B. v. The Attorney General of Canada and the Attorney General for Ontario, which provides an interpretation of “reasonably foreseeable natural death” within the Canadian federal legislation on medical assistance in dying (MAiD).

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On June 17, 2016, new Canadian federal legislation on medical assistance in dying (MAiD) came into effect. The legislation was the government’s response to the Supreme Court of Canada’s decision in Carter v. Canada striking down the Canadian Criminal Code prohibitions on medical assistance in dying. The legislation established eligibility criteria for access to medical assistance in dying (e.g., competent adult) as well as procedural safeguards (e.g., a ten day waiting period between the initial request for medical assistance in dying and the provision).

On June 19, 2017, almost a year to the day after the legislation came into effect, a judge in Ontario issued the first decision to provide an interpretation of one of the most confusing and controversial elements of that legislation.

The Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) establishes that individuals are only allowed access to medical assistance in dying if, among other things, “their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.” (s.241.2(2)(d)) But what does it mean to say that a natural death is “reasonably foreseeable”?  Does this mean, as various government statements and documents have suggested, that the person is on “an identifiable path” to natural death or that the person’s natural death is “not too remote” or is “in the not too distant 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.

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Human genetic editing (engineering) is here

A “hat tip” again to Wesley Smith, who at the National Review Online blog, provided a link to this week’s report in the MIT Technology Review that the first editing of genes in human embryos in the US is underway—and apparently not yet formally published—at an academic center in Portland, Oregon.  Similar efforts have been undertaken in China, but US scientists have been a little more tentative about taking this step in humans.

In 2015, US scientists were clearly against trying to initiate a pregnancy with an IVF embryo whose genes had been altered in the laboratory.  They were, apparently, divided on whether experiments on early human embryos, sperm, or eggs in the laboratory were “responsible.”

This blog discussed the matter back then.

Earlier this year, the National Academies of Science, Engineering, and Medicine were more open to proceeding with changing human genes in a way that would be permanent—inherited from generation to generation—as long as the process was done as carefully as they thought it could be. 

The work still appears to be held very close to the vest.  Funded by private money—the law prohibits public expenditures for this kind of work on humans—the MIT report says the Oregon scientists changed some genes (the MIT reporters did not find out which ones) in “many dozens” of IVF embryos that were created and destroyed specifically for research.

The ultimate goal sounds laudable:  repairing genes that cause inherited disease.  The posts linked to above reviewed some of these arguments, or provided further links to those discussions.

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.

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Wendy Epstein on ‘The Week in Health Law’ Podcast

By Nicolas Terry and Frank Pasquale Subscribe to TWIHL here! Our guest this week is Wendy Netter Epstein, who is an Associate Professor of Law at DePaul University, and Faculty Director of DePaul’s Jaharis Health Law Institute. Her teaching and research interests focus on health … Continue reading

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.