Tag: legal obligations

Bioethics Blogs

Let’s Talk About Wishes, Values, and Beliefs

Angel Petropanagos reflects on her experiences asking dialysis outpatients questions about healthcare wishes, values, and beliefs.

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I want to tell you about one of the most rewarding ethics projects I’ve been involved with. Over the past few months, I’ve been speaking with dialysis outpatients about what they want, what’s important to them, and what they believe. I’ve been asking them about who they want as their substitute decision-maker if they lose the capacity to consent to treatment, and whether they have or would like to have a living will (or a Power of Attorney for Personal Care). I’ve been asking them if they have any wishes related to receiving Cardio Pulmonary Resuscitation if their heart stops. I’ve also been asking them how they feel about their dialysis treatment. With these types of extremely challenging personal and moral questions I’m getting to know a lot about these patients.

Most of these conversations have happened at the bedside while outpatients have been receiving their dialysis treatment. Often, when I have asked patients these questions, they have smiled at me, paused to reflect, or just laughed. Some patients have told me that they had never thought about their healthcare wishes before. Others have told me that they were glad that someone was finally asking them about their wishes.

These conversations are part of an ethics quality improvement project called ChELO (Checklist to meet Ethical and Legal Obligations). Ethics quality improvement is a novel approach to clinical ethics that aims to improve quality of care. Improved quality of care means giving patients care that they want and can benefit from.

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

The battle continues over the A-List embryos

In happier times   

What began as soap opera is turning into a master class in metaphysics. “Modern Families” TV star Sofia Vergara, 44, and her former partner, entrepreneur and Hollywood producer Nick Loeb, 41, have been at war over two frozen embryos in a California IVF clinic. Vergara, now married to “True Blood” star Joe Manganiello, refuses to allow the embryos to be brought to term with a surrogate mother; Loeb insists that they have a right to life.

Both of them have deep pockets and wily lawyers. With 600,000 supernumerary embryos in deep freeze in the US, the outcome could set legal precedents in a number of areas. However, the dispute is not theoretical, but passionate and sometimes vindictive.  

The latest moves are as follows.

Slut-shaming

In mid-November Vergara’s lawyers demanded that Loeb disclose the names of two former girl friends who had abortions. They want to show that his belief that life begins at conception is insincere. “Oddly, Loeb wants us to believe that he supports a woman’s right to privacy, and to make a choice concerning reproduction. However, he seems to believe that his celebrity ex-fiancé, Sofia Vergara, does not have those same rights,” said her lawyer.

Loeb, who now has strong pro-life views, was adamant in his refusal. “Could you imagine if you had moved on with your life, gotten married and had children and kept this a secret from your family, then all of a sudden 15 years later (you were) made to reveal your abortion to the world.

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

Ethics, Law and Futility – November 18

Join me for “Ethics, Law and Futility” on Friday, November 18th, 2016, at the American Swedish Institute – Larson Hall in Minneapolis.  

There is a knowledge gap between what is presumed as one’s ethical and legal obligations to patients during cases of futility and what actually their responsibility is. This conference will assist in clarifying these issues and provide the audience with tools for managing futility cases.

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

Law of Brain Death in Los Angeles,California

With the media attention on the latest developments in the Israel Stinson case, it might be worth refreshing on the basics of the law of brain death in California.  

Here is a video of a 2015 Los Angeles conference where I explained the history and basics of the two controlling statutes.  

Below that, I include references to more recent articles and resources I prepared.  I will be speaking on the law of brain death this fall at (1) the University of Kansas Medical Center, (2) the University of Minnesota, and (3) Cedars Sinai.  

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Brain Death Articles by Thaddeus Pope

  • Physicians’ Opinions About Accommodating Religiously Based Requests for Continued Life-Sustaining Treatment, 51 JOURNAL OF PAIN AND SYMPTOM MANAGEMENT (forthcoming 2016).
  • Brain Death Rejected: Expanding Legal Duties to Accommodate Religious Objections, in LAW, RELIGION, AND AMERICAN HEALTH CARE (Cambridge University Press forthcoming 2016) (proceedings from 2015 Petrie-Flom Center Annual Conference at Harvard Law).
  • Legal Standards for Brain Death, 13 JOURNAL OF BIOETHICAL INQUIRY 173-178 (2016).
  • Brain Death: Legal Duties to Accommodate Religious Objections, 148(2) CHEST e69 (2015).
  • Brain Death: Legal Obligations and the Courts, 35(2) SEMINARS IN CLINICAL NEUROLOGY: THE CLINICAL PRACTICE OF BRAIN DEATH DETERMINATION 174-179 (2015) (with Christopher M. Burkle).
  • Legal Briefing: Brain Death and Total Brain Failure, 25(3) JOURNAL OF CLINICAL ETHICS 245-257 (2014).
  • Chapter 6, in THE RIGHT TO DIE: THE LAW OF END-OF-LIFE DECISIONMAKING (3rd ed. Wolters Kluwer Law & Business) (with Alan Meisel & Kathy L. Cerminara) (commencing with the 2016 supplement).

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

Parliamentary Committee Recommends Protection for Physicians Withdrawing Futile Treatment

The Parliament of Victoria Legal and Social Issues Committee recently released a 350-page report, “Inquiry into End of Life Choices.”  It is heavily focused on palliative care, advance care planning, and assisted dying.  

Recommendation 29 caught my attention.  It recommends: “The Victorian Government legislate to enact the protection doctors currently have under the common law regarding withholding or withdrawing futile treatment.”

The Report notes that physicians in Victoria are already are protected from obligations to administer futile treatment.  They have unilateral decision making power to determine treatment is futile.  But they are still uncertain about their legal obligations.  Therefore, there is benefit in clarifying these rights and duties in legislation.

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

China’s Terrible Transplant Secret

Guest Post by Wendy Rogers
Earlier this year, a Malaysian politician, Datuk Bung Moktar Radin, travelled to China to receive a kidney transplant.  The details are scanty. There is no mention of the source of the kidney that the Malaysian MP received.  Reports of foreigners travelling to China for transplants rarely make the media, yet they may be an important link in trying to untangle the secrets of China’s secretive transplant system.

Back in the early to mid-2000s, Chinese hospitals brazenly advertised on the internet for foreign customers, offering kidney, liver and heart transplants with astonishingly short waiting times of 2-4 weeks.  In contrast, patients in countries like Australia, the UK, and the US typically wait years, with many dying before an organ becomes available.  Despite initial denials, Chinese officials eventually admitted that virtually all their organs were sourced from executed prisoners.  Using executed prisoners as organ donors is uniformly considered unethical because of concerns that prisoners may be manipulated or coerced rather than being genuine volunteers.  Voluntary donation is at the heart of most transplant programs world-wide, although there are exceptions.

Violating this ethical principle by selling organs from executed prisoners to foreign (and Chinese) patients might seem enough to make China a pariah in the international transplant community.  But this is only one part of China’s terrible transplant secret. Reputable international investigators have gathered evidence that Chinese prisoners of conscience, mainly Falun Gong practitioners, Uyghurs, house Christians and Tibetans, are murdered for their organs.  Falun Gong practitioners, who make up the bulk of the millions of Chinese citizens in “re-education through labour (laojiao)” camps, are subject to medical tests to examine the health of their transplantable organs.

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

Why Zika Matters to Canada

Gaëlle Groux and Steven J. Hoffman discuss three ways that Canada can help stem the spread of the Zika Outbreak.

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The World Health Organization (WHO) recently announced that clusters of microcephaly that are possibly linked to the Zika virus constitute a “public health emergency of international concern.” This virus has captured the attention of the international community because thousands of babies are being born with underdeveloped brains to women who were infected with Zika during their pregnancy.

Should Canadians be worried? For now, WHO says no, because our country doesn’t harbour the mosquito types that spread the disease, aedes aegypti and albopictus. But Canadians shouldn’t be too complacent about the spread of the virus. Here’s why.

For starters, Canadians are not entirely off the hook within Canada. Mosquitoes carrying Zika could in the future spread here too. Aedes albopictus is an invasive species and increasingly warm climates could allow them to migrate farther north. Researchers are also investigating the possibility that a mosquito native to Canada, the Aedes culex which already transmits viruses of the same family as the Zika virus, could be a cause for concern.

And then there’s travel. The Canadian government has advised Canadians to “exercise a high degree of caution” in most South American travel destinations, and some travel doctors are advising pregnant women to avoid travel to affected countries altogether. Ontario’s Chief Medical Officer, when confirming the province’s first case of Zika recently, went so far as to advise all travelers heading to affected areas to first consult their healthcare providers.

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

Confidentiality and Disclosure Dilemmas in Psychotherapy with Adolescents

Dr. Adam Fried

Psychologists who provide mental health services to adolescents and their families must navigate complex ethical challenges with respect to confidentiality and disclosure decision-making.

How do mental health clinicians develop confidentiality policies that serve to protect minors from serious harm, fulfill professional and legal responsibilities, and preserve the therapeutic relationship with the adolescent and parents/ guardians?

Fordham University Center for Ethics Education Assistant Director Dr. Adam Fried is the editor of the ethics column of The Clinical Psychologist, a publication of the American Psychological Association (APA) and addressed that subject in his most recent column.

Fried’s third column addresses confidentiality and disclosure ethical dilemmas in psychotherapy with adolescents.

“Confidentiality policies and disclosure decisions always require careful ethical analysis by clinicians,” Fried writes in his column. “Disclosure dilemmas related to treatment with adolescents and their families may raise unique ethical concerns and seemingly competing moral principles.”

“Therapists may understandably experience tension when confronted by difficult disclosure decisions that require consideration of both professional/ legal obligations and the adolescent’s expectation to privacy (as well as the potential impact to the therapeutic relationship that may be associated with disclosure),” he continues. “Therapist promises of absolute confidentiality, while intended perhaps to help clients and/or facilitate positive therapeutic change, may in actuality endanger the safety and well being of clients, threaten the integrity of the professional work, and place the psychologist at increased professional liability risk.”

Dr. Adam Fried is the Assistant Director of the Fordham University Center for Ethics Education, and the Director of the M.A. in Ethics & Society and Interdisciplinary Bioethics Minor.

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 fish lives to fish law: learning to see Indigenous legal orders in Canada by Zoe Todd

“The necessity of respecting game is still widely acknowledged by Inuit. The awareness, that the continuity of society depends on the maintenance of correct relationships with animals and the land, is still very strong.” (Aupilaarjuk et al. 1999: 2)

In 2012, I spent eight months living and working in the Inuvialuit hamlet of Paulatuuq, which is situated on the coast of the Beaufort Sea in the Inuvialuit Settlement Region, in Canada’s Northwest Territories. I was interested in people’s relationships to fish, and how fishing relationships were being asserted within the community in the face of cumulative colonial and environmental impacts, including looming mining interests, affecting the region. My first two degrees are in Biology and Rural Sociology and when I started ethnographic work in Paulatuuq, I still saw the relationships between humans and their environments with colonial eyes: fish were food, fish were specimens, fish were inputs in surveys and dry policy documents.

Ice-fishing in Paulatuuq at Dennis Lake, June 2012

I knew better than to see fish this way. I grew up fishing with my parents and sisters on Baptiste Lake in north-central Alberta through the 1980s and 1990s. I swam with the fish in that green prairie kettle lake every summer throughout my entire childhood. I dreamt about fish and their fish-lives beneath the inscrutable, rippled lake-surface. I squealed with joy at the silver flash of minnows in the shallows on lazy July days and, for many dinners through my adolescence, we ate fish my step-dad caught in the Red Deer River, Pepper’s Lake, and on his own re-watered wetland in central Alberta.

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

APA Bars Psychologists from Participating in National Security Interrogations; ‘It is time to do the same for psychologists’ involvement in death penalty cases’

 

 

Earlier this month, the American Psychological Association (APA) voted almost unanimously to adopt a policy banning psychologists from participating in national security interrogations, including noncoercive investigations now conducted by the Obama administration.

“The vote followed an emotional debate in which several members said the ban was needed to restore the organization’s reputation after a scathing independent investigation ordered by the association’s board,” The New York Times has reported.

Psychologists are now barred from working at “Guantánamo, CIA black sites and other settings deemed illegal under the Geneva Conventions or the U.N. Convention Against Torture, unless they are working directly for the persons being detained or for an independent third party working to protect human rights,” according to a report by Democracy Now.

The final vote – which was 157-1, with six abstentions and one recusal – resulted in a standing ovation from APA members, as well as many in attendance, including anti-torture activists, some of whom wore T-shirts reading “First, Do No Harm,” a reference to the Hippocratic oath.

Fordham University Center for Ethics Education Director Dr. Celia B. Fisher, who has previously addressed human rights issues with psychologists’ involvement in death penalty assessments, weighs in on the APA’s new policy:

“The most recent APA ban on psychologists’ involvement in national security interrogations makes clear that psychologists’ ethical duties supersede their legal obligations when their activities contribute in any way to a violation of human rights,” Dr. Fisher explained.

In addition, Dr. Fisher, who chaired the 2002 revision of the APA’s Ethics Code and is author of Decoding the Ethics Code: A Practical Guide for Psychologists, now in its third edition, has called for the end of psychologists’ involvement in death penalty evaluations.

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.