Tag: military personnel

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.

Bioethics Blogs

They Can’t Say No: Ebola & Quarantined Soldiers

Sheena M. Eagan Chamberlin calls attention to the limited autonomy of military personnel regarding mandatory quarantine following the Ebola crisis.

__________________________________________

In March 2016, The World Health Organization terminated its public health emergency warning for Ebola. We can now reflect upon this epidemic with particular attention to the ways in which we could improve our response to future public health crises.

From 2014-2016 West Africa experienced the largest outbreak of Ebola in history. There were over 28,000 cases of Ebola, and 11,325 people left dead. Many governmental and non-governmental organizations responded to this public health emergency. As well, the international military community provided a significant amount of logistical support in West Africa.

Numerous ethical challenges were faced by those who responded to the Ebola epidemic. Among the most complex challenges were those related to quarantine policies. Due to the novel and deadly nature of the virus, many people (including patients, healthcare workers, and logistic support workers) were quarantined for periods of time throughout the epidemic. Policies concerning quarantine varied from place to place. In some cases, exposed individuals were under mandatory ‘self-quarantine,’ and in other cases, large groups of low-risk and unexposed people were quarantined.

In the United States, in a civilian context, the forced quarantine of returning health care workers met with criticism and condemnation. Many argued that public health interventions should not overtly infringe on personal freedom without adequate justification. In the case of Ebola, the mode of infection was known, as were the signs, symptoms and incubation period. Public health professionals determined that active-direct monitoring was sufficient.

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

Is memory enhancement right around the corner?

“Everyone has had the experience of struggling to remember long lists of items or complicated directions to get somewhere,” Dr. Justin Sanchez of DARPA said in a recent press release. “Today we are discovering how implantable neurotechnologies can facilitate the brain’s performance of these functions.” The US Department of Defense is interested in how the brain forms memories because hundreds of thousands of soldiers – or “warfighters” as they are now called – have suffered from traumatic brain injury (TBI) and some have severe memory problems. Beyond the military, TBI is a major public health concern that affects millions of Americans as patients and caregivers and is incredibly expensive. A breakthrough treatment is needed and for that, ambitious research is required.

But does this research agenda end at treating disease, or could these findings also be applied to memory enhancement goals?

Beyond helping us to grab all the items on the grocery list and find the car in the parking lot, our memories fundamentally help us to form our sense of identity and personal narrative. It is a common observation in profound dementias and Alzheimer’s disease, that family members feel like their loved one who has lost the ability to recall recent events or names or to form new memories is no longer the same person they once were. While this basic truth about the importance of memory is persuasive as an argument for the significance of this research, it also brings the risks involved sharply into focus: tinkering with an individual’s memories and their ability to form them can have the effect of profoundly altering their identity and sense of 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.

Bioethics News

Secrecy, Security, & Science

In 1994, before the Berman Institute of Bioethics at Johns Hopkins was established, Ruth Faden was asked to consult the US Department of Energy (DOE) on reports of government-sponsored radiation-related medical research on citizens without their knowledge. At the time, Faden was a professor at the Johns Hopkins School of Hygiene and Public Health, teaching medical ethics. Shocked by the accounts of widespread radiation experiments on unknowing, unconsenting citizens, Faden suggested that the DOE needed an independent investigation, and it should not be limited to that department alone.  Secretary of Energy Hazel O’Leary and President Bill Clinton agreed, and asked Faden to lead the investigation as chair of the White House Advisory Committee on Human Radiation Experiments (ACHRE).  Faden assembled her ideal interdisciplinary staff of historians, clinicians, philosophers, lawyers, and scientists who went on to work together the committee named by Pres. Clinton for 18 months before issuing its report on October 3, 1995.

 

On October 5, 2016, Johns Hopkins will host a day-long symposium to consider the committee’s work and its impact in the 20 years since the release of its report. Members of the ACHRE committee and staff will reflect on the seminal report, its impact since 1995 and into the future on topics including the regulation of human-subject research, considerations around remedies for past wrongs, and the use of historical information to make moral judgments about the past.

 

According to a New York Times story published in 1994 shortly after President Clinton established ACHRE, Faden said the most difficult task for the committee would be deciding what standard of ethics to measure the experiments against.

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 Clinic in Crisis” – Special Issue of Culture, Medicine, and Psychiatry by Anna Zogas

Adia Benton and Sa’ed Atshan have edited a special issue of Culture, Medicine, and Psychiatry called The Clinic in Crisis: Medicine and Politics in the Context of Social Upheaval. Here are the abstracts of the articles in this timely collection.

“Even War has Rules”: On Medical Neutrality and Legitimate Non-violence (open access)
Adia Benton, Sa’ed Atshan

[excerpt] This special issue is the result of a two-day symposium held at Brown University, which was co-sponsored by the Watson Institute, the Humanities Initiative and the Department of Anthropology at Brown University and the Science, Religion and Culture Program at Harvard Divinity School in May 2014. It broadly addresses the challenges that political conflicts pose to the practice of medical neutrality and impartiality by mostly local clinicians under conditions of state-sponsored and intrastate violence. The speakers at the symposium worked in places as diverse as the US, Sierra Leone, Mozambique, Pakistan, Egypt, Somalia, Israel/Palestine and Turkey. Although they represent a small sample of what was presented during the symposium, the papers in this issue contain ethnographic case studies that address the everyday negotiations of medical neutrality in times of crisis and kin concepts: global health diplomacy and humanitarian medicine. Together these papers highlight the conflicts, tensions and solidarities that politicize clinical spaces and clinical practice.

In this introduction, we will outline three themes that emerge in this set of papers, rather than providing a case-by-case summary of their contents. Together, the papers demonstrate that, as integral members of the communities in which they live and practice, doctors and other health workers are always positioned socially and politically.

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

Military Suicide Capsules and Medical Ethics

by Steven H. Miles, MD

In December 2013, a Hearing Panel for the Health Professions Council of South Africa found Wouter Basson MD culpable for unprofessional conduct because of his work to produce chemical weapons, to medically assist rendition by commandos (kidnappings), and to provide cyanide containing suicide capsules to Special Forces’ operatives leaving for clandestine meetings. I served as an expert witness for the prosecution in the Basson matter in the area of medical ethics and military medicine.

The French philosopher-sociologist Emile Durkheim (1858-1917) is partly responsible for the confusion about strategic military suicide. He defined suicide as “all cases of death resulting directly or indirectly from a positive or negative act of the victim himself, which he knows will produce this result.” He did not distinguish a soldier whose actions entail accepting the high probability (or even certainty) of death in order to accomplish some task from actions in which the soldier’s chooses to die during the course of a military operation. For example, a soldier who throws himself over a grenade to save compatriots is valorous valor but not primarily suicidal. Such a soldier would, if given the opportunity, equally bravely put himself at risk by throwing a blast suppression blanket over the bomb.

A second kind of military suicide is a soldier who serves as a smart bomb as with the Kamikaze pilots of World War II or the suicide bombers of today.

A third kind of soldier’s suicide is that which is the tragic end of combat-induced mental illnesses such as Post Traumatic Stress Disorder, depression, substance abuse disorders, or despair.

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

Deterrence or Disarmament?: The Ethics of Nuclear Warfare

Corroral Missile in front of the Center Exchange, 1957.                                          Photo via NYPL Digital Archives.

STUDENT VOICES

By: Kayla Giampaolo

On July 16, 1945 at 5:29 a.m., a 30,000 foot mass of smoke rose in New Mexico’s desert: the first atomic bomb had just been successfully tested. At the time, most people were unaware that the course of warfare and ultimately the world was about to change irrevocably. Since that eerie summer morning, nine nations have developed the intelligence to create and possess nuclear weapons (Granoff, 2000, p. 1414). The United States is one of these nuclear superpowers, making the ethical issues associated with these weapons critical and relevant.

Is using a nuclear weapon morally permissible under some circumstances? Is it ethical to implement nuclear deterrence (threatening to use atomic weapons) as a self-defense strategy?

Most research across disciplines unanimously agrees that it is immoral to detonate an atomic weapon due to both short and long-term catastrophic effects. Therefore, this piece shall not focus on the actual use of nuclear weapons, but instead analyze the latter question. Using various philosophical concepts, it will explore the fundamental question as to whether any implementation of nuclear deterrence that involves a risk to civilians is morally acceptable. The models, though differing in origin and rationale, provide a unique lens from which to view this ethical dilemma.

Before analyzing various frameworks, it is first important to understand the concept of nuclear deterrence and why it is a pressing ethical issue.

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

Some things never change

Hopes for a reform in China’s organ donation practices have faded, with revelations that the Chinese government is simply “reclassifying” organs obtained from executed prisoners.

Since the faux-announcement of an end to organ donation from prisoners in January, the state-controlled Chinese media has repeatedly suggested that the government is disguising inmates’ organs as “altruistic donations” from free citizens.

As early as January, the People’s Daily was reporting that prisoner’s would still be allowed to donate their organs “to atone for their crimes”. The head of China’s organ donation committee, D. Huang Jiefu, said he was confident these ‘voluntary’ donations would prevent any shortfall as a result of the new policy.

In March, Dr. Huang told The Beijing Times, “Once the organs from death-row prisoners who have voluntarily donated are included in our national distribution system, they are counted as voluntary citizen donations.”

According to Huige Li, a Chinese-born doctor at the University of Mainz, the government has merely performed an administrative trick. “They just reclassified prisoners as citizens”, he said.

“The practice there is unethical and should be changed to an ethical practice,” he said of China. “Administrative tricks don’t make it ethical.”

Dr. Torsten Trey executive director of Doctors Against Forced Organ Harvesting, fears that the practice of harvesting prisoners’ organs may never end.

‘‘Some sourcing pathways are altered,’’ Dr. Trey told the New York Times in an email. ‘‘Some previous channels are closed. Others are kept open.’’

Since ‘‘prisoners are under the control of the state, in contrast to free citizens who might enter an organ donation contract on the black market, we have to assume that — at least partially — policy makers, police, prison guards and military personnel are aware and backing the practice,’’ he said.

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

Killer Robots: Where Is the World Heading?

Before I start blogging the kickoff of this week’s United Nations meeting on killer robots, a little background is called for, both about the issue and my views on it.

I have worked on this issue in different capacities for many years now. (In fact, I proposed a ban on autonomous weapons as early as 1988, and again in 2002 and 2004.) In the present context, the first thing I want to say is about the Obama administration’s 2012 policy directive on Autonomy in Weapon Systems. It was not so much a decision made by the military as a decision made for the military after long internal resistance and at least a decade of debate within the U.S. Department of Defense. You may have heard that the directive imposed a moratorium on killer robots. It did not. Rather, as I explained in 2013 in the Bulletin of the Atomic Scientists, it “establishes a framework for managing legal, ethical, and technical concerns, and signals to developers and vendors that the Pentagon is serious about autonomous weapons.” As a Defense Department spokesman told me directly, the directive “is not a moratorium on anything.” It’s a full-speed-ahead policy.

What counts as “semi-autonomous”?
Top: Artist’s conception of Lockheed Martin’s
planned Long Range Anti-Ship Missile in flight.

Bottom: The Obama administration would
define the original T-800 Terminator as
merely “semi-autonomous.”

The story of how so many people misinterpreted or were misled by the directive is complicated, and I won’t get into details right now, but basically the policy was rather cleverly constructed by strong proponents of autonomous weapons to deflect concerns about actual emerging (and some existing) weaponry by suggesting that the real issue is futuristic machines that independently “select and engage” targets of their own choosing.

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

Research Ethics Roundup: The vague moratorium placed on risky virus research, the use of animals in military medical training, and more

U.S. Urged to Clarify Extent of Funding Moratorium on Risky Virus Research:

Researchers are pleading with the US government to clarify the details of a recent moratorium placed on funding projects that show potential risks due to the use of certain viruses. Concerns include confusion on the specific viruses and experiments covered by the new policy. A statement released by the National Science Advisory Board for Biosecurity (NSABB) echoes these concerns, urging the government to clarify and grant urgent exceptions to the moratorium.

Military to Curtail Use of Live Animals in Medical Training: A new policy set to go into effect on January 1 will halt the use of live animals in a variety of medical training programs. This policy brings the military into better alignment with both the civilian medical community and the Pentagon’s NATO allies. Alternatives suggested by the Pentagon include using lifelike human simulators that are already in use by military personnel.

The Impossibility of Informed Consent?: The discussion on issues surrounding “informed consent to medical treatment and research, and its relation to autonomy, trust and clinical practice” has evolved with innovations in technology and different means of conducting research. The Journal of Medical Ethics shares a variety of examples over the past 40 years that highlight these very issues and show how language and considerations have changed.

Pills Spilled

Why Are So Few Blockbuster Drugs Invented Today?: The number of researchers taking the initiative to pursue developing new blockbuster drugs has dropped significantly over the years. Factors contributing to the lack of development of new drugs, including the process by which new drugs are invented and approved, and an over-reliance on genomics, are explored by the New York Times Magazine.

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.