Tag: nutrition

Bioethics Blogs

In the Journals – August 2017 by Livia Garofalo

Here is the article round-up for August, put together in collaboration with Ann Marie Thornburg.  There is a special issue section of Social Science and Medicine out this month on Austerity, Health, and Wellbeing (abstracts below). Also of note is a recent ‘Takes a Stand’ statement on the End of AIDS published in Global Public Health by Nora Kenworthy, Richard Parker, and Matthew Thomann. You can take advantage of the article being temporarily free access and on early view here. Enjoy!

 

Cultural Anthropology (Open Access)

Tangles of Care: Killing Goats to Save Tortoises on the Galápagos Islands

Paolo Bocci

If calls to care for other species multiply in a time of global and local environmental crisis, this article demonstrates that caring practices are not always as benevolent or irenic as imagined. To save endemic tortoises from the menace of extinction, Proyecto Isabela killed more than two hundred thousand goats on the Galápagos Islands in the largest mammal eradication campaign in the world. While anthropologists have looked at human engagements with unwanted species as habitual and even pleasurable, I discuss an exceptional intervention that was ethically inflected toward saving an endemic species, yet also controversial and distressing. Exploring eradication’s biological, ecological, and political implications and discussing opposing practices of care for goats among residents, I move past the recognition that humans live in a multispecies world and point to the contentious nature of living with nonhuman others. I go on to argue that realizing competing forms of care may help conservation measures—and, indeed, life in the Anthropocene—to move beyond the logic of success and failure toward an open-ended commitment to the more-than-human.

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

Jewish Guide to Practical Medical Decision Making

Check out
this new 368-page
book
 from Rabbi Jason Weiner: Jewish Guide to Practical
Medical Decision Making.


Due to rapid advances in the medical field, existing books on Jewish medical
ethics are quickly becoming outdated. 
Jewish
Guide to Practical Medical Decision Making
 seeks to remedy that by
presenting the most contemporary medical information and rabbinic rulings in an
accessible, user-friendly manner. 


Rabbi Weiner addresses a broad range of medical circumstances such as surrogacy
and egg donation, assisted suicide, and end-of-life decision making. Based on
his extensive training and practical familiarity inside a major hospital, Rabbi
Weiner provides clear and concise guidance to facilitate complex
decision-making for the most common medical dilemmas that arise in contemporary
society.


1. Facilitating Shared Decision-Making 

A. Understanding Terminology: Key Concepts to Facilitate
Collaborative Decision-Making

B. Truth-Telling: When Painful Medical Information Should
and Should Not Be Revealed 

C. Mental Illness: Determining Capacity and Proper Treatment
in Accordance with Jewish Law  


2. How Much Treatment? 

A. Risk and Self-Endangerment: Determining the
Appropriateness of Attempting Various Levels of Dangerous Medical Procedures

B. Making Decisions on Behalf of an Incapacitated Patient

C. Pediatrics: Jewish Law and Determining a Child’s Consent
and Treatment 

D. Palliative Care and Hospice in Jewish Law and Thought


3. Prayer  

A. Is Prayer Ever Futile? On the Efficacy of Prayer for
the Terminally Ill 

B. Viduy: Confessional Prayers Prior to Death


4.  At the End of Life

A. Advance Directives and POLST Forms  

B. End-of-Life Decision-Making: DNR, Comfort Measures,
Nutrition/Hydration, and Defining “Terminal” in accordance with Jewish Law

C. Withholding vs. Withdrawing: Deactivating a
Ventilator and Cessation of Dialysis and Cardiac Defibrillators at the End of
Life

D. Case

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

Call for Papers: Health and Food Ethics

August 14, 2017

October 2018

Health and Food Ethics

Hippocrates once said, “Let food be thy medicine and medicine be thy food.” Physicians in some U.S. cities have followed this advice by writing prescriptions for patients to obtain fresh produce through healthy food outreach programs. Clinical encounters, however, cannot fully reverse the negative health effects of low quality diets. Further, millions remain hungry as the quantity of the global food supply is at risk. Providing safe, nutritious, and environmentally- sustainable food to all is a great challenge, and if the global community cannot find solutions to feed the world, economic and social costs will be high. “Ending hunger, achieving food security, improving nutrition, and promoting sustainable agriculture” is one of the Sustainable Development Goals set forth by the United Nations. As such, a central question worth exploring in the October 2018 issue of the AMA Journal of Ethics is: What should be the roles of health professionals in promoting accountability by governments, non-governmental and civil society organizations, and the food and beverage industry in promoting strategies that can meet the nutrition and health needs of our global population? Other issues include: reducing and redistributing food loss and waste; incentivizing responsible food production and labeling practices; communicating about food practices and food access during clinical encounters; and strategies to promote food security as a goal of health professions.

Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 12 February 2018.

Link for more information


Image: By Original: lyzadangerDerivative work: Diliff – http://www.flickr.com/photos/lyza/49545547,

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

Charlie Gard Post-Mortem: Could He Have Been Saved?

Charlie Gard would have turned one year old tomorrow.

Two days before the British infant died of a mitochondrial disease on July 28, a short article in MIT Technology Review teased that Shoukhrat Mtalipov and his team at Oregon Health & Science University and colleagues had used CRISPR-Cas9 to replace a mutation in human embryos, a titillating heads-up that didn’t actually name the gene or disease.

Yesterday Nature published the details of what the researchers call gene correction, not editing, because it uses natural DNA repair. I covered the news conference, with a bit of perspective, for Genetic Literacy Project.

Might gene editing enable Charlie’s parents, who might themselves develop mild symptoms as they age, to have another child free of the family’s disease? Could anything have saved the baby?

A TRAGIC CASE

The court hearing testimony on the case between Great Ormond Street Hospital (GOSH) and the family, published April 11, chronicles the sad story. The hospital had requested discontinuing life support based on the lack of tested treatment.

Charlie was born August 4, 2016, at full term and of a good weight, but by a few weeks of age, his parents noticed that he could no longer lift his head nor support any part of his body. By the October 2 pediatrician visit, Charlie hadn’t gained any weight, despite frequent breastfeeding. After an MRI and EEG, Charlie had a nasogastric tube inserted to introduce high-caloric nutrition.

By October 11, the baby was lethargic, his breathing shallow. So his parents, Connie Yates and Chris Gard, took him to GOSH.

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

Charlie Gard Post-Mortem: Could He Have Been Saved?

Charlie Gard would have turned one year old tomorrow.

Two days before the British infant died of a mitochondrial disease on July 28, a short article in MIT Technology Review teased that Shoukhrat Mtalipov and his team at Oregon Health & Science University and colleagues had used CRISPR-Cas9 to replace a mutation in human embryos, a titillating heads-up that didn’t actually name the gene or disease.

Yesterday Nature published the details of what the researchers call gene correction, not editing, because it uses natural DNA repair. I covered the news conference, with a bit of perspective, for Genetic Literacy Project.

Might gene editing enable Charlie’s parents, who might themselves develop mild symptoms as they age, to have another child free of the family’s disease? Could anything have saved the baby?

A TRAGIC CASE

The court hearing testimony on the case between Great Ormond Street Hospital (GOSH) and the family, published April 11, chronicles the sad story. The hospital had requested discontinuing life support based on the lack of tested treatment.

Charlie was born August 4, 2016, at full term and of a good weight, but by a few weeks of age, his parents noticed that he could no longer lift his head nor support any part of his body. By the October 2 pediatrician visit, Charlie hadn’t gained any weight, despite frequent breastfeeding. After an MRI and EEG, Charlie had a nasogastric tube inserted to introduce high-caloric nutrition.

By October 11, the baby was lethargic, his breathing shallow. So his parents, Connie Yates and Chris Gard, took him to GOSH.

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 Role of Plant-Based, Meatless Meats In Sustainable Diets

July 27, 2017

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The two American companies are not the first to create innovative alternative proteins (known as APs, such as tofu), meat analogues, or imitation meat (e.g. veggie burgers, tofurkey). Other start-ups such as Memphis Meats and Mosa Meats are creating animal-based cell-cultured meats. But Beyond Meat and Impossible Foods are the first start-ups to market their non-meat products to meat eaters (or “lovers,”), not vegetarians or vegans. The companies excel at targeted marketing: meatless meats bring to mind foods with all the sensory and nutritional benefits of meat without any of its environmental or health harms – but meatless meats are simply rebranded, repackaged, and reimagined meat analogues. After all, their products contain plants, just like veggie burgers. The difference in terminology between meatless meats and meat analogues or imitation meat is primarily in intended audience – not in substance.

Beets are the secret to Beyond Burger’s bleeding patty, while the “magic” ingredient that simulates sizzling fat in the Impossible Burger is genetically-modified plant-based heme, an iron-compound found in most animal muscles. The long-term health and nutrition impacts of meatless meat are not yet fully known. However, both the Beyond and Impossible Burger burgers contain 20 grams of plant protein per serving, relatively equivalent to one beef patty. Compared to normal burgers, these patties have significantly more calories (40-50 kcal per serving more) and sodium (about six times as much). The difference between beef and vegetable fats is also striking – the Impossible Burger has 15 grams of saturated fat (triple that of a beef burger) – and may contribute to any taste differential noticed by a serious meat eater(link is external).

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

End-of-Life Healthcare Sessions at ASBH 2017

The 2017 ASBH
conference
 in October 2017 includes over 400 workshops, panels, and
papers in bioethics and the health humanities.  Here are ones that pertain
to end-of-life issues.


THURSDAY, OCTOBER 19


THU 1:30 pm:  End-of-Life Care and Decision-Making in the ICU – Limited
English Proficiency as a Predictor of Disparities (Amelia Barwise)


Importance: Navigating choices in predominantly English-speaking care settings
can present practical and ethical challenges for patients with limited English
proficiency (LEP). Decision-making in the ICU is especially difficult and may
be associated with disparities in health care utilization and outcomes in critical
care. 


Objective: To determine if code status, advance directives, decisions to limit
life support, and end-of-life decision-making were different for ICU patients
with LEP compared to English-proficient patients. 


Methods: Retrospective cohort study of adult ICU patients from
5/31/2011-6/1/2014. 779 (2.8%) of our cohort of 27,523 had LEP. 


Results: When adjusted for severity of illness, age, sex, education, and
insurance status, patients with LEP were less likely to change their code
status from full code to do not resuscitate (DNR) during ICU admission (OR,
0.62; 95% CI, 0.46-0.82; p


Conclusion: Patients with LEP had significant differences and disparities in
end-of-life decision-making. Interventions to facilitate informed
decision-making for those with LEP is a crucial component of care for this
group.


THU 1:30 pm:  “But She’ll Die if You Don’t!”: Understanding and
Communicating Risks at the End of Life (Janet Malek)


Clinicians sometimes decline to offer interventions even if their refusal will
result in an earlier death for their patients. For example, a nephrologist may
decide against initiating hemodialysis despite a patient’s rising creatinine
levels if death is expected within weeks even with dialysis.

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

CHARLIE GARD: 37 European deputies stand against the European Court of Human Rights decision

In an open letter, 37 Eurodeputies support Charlie Gard and his parents and demand the respect of the right to live (see original letter signed at Strasbourg and titled, Charlie Gard must be given right to life, human dignity)

After the decision of the British Courts and of the European Court of Human Rights, the support provided by parenteral respiratory, nutrition and hydration assistance to Charlie Gard, the 10-months-old baby suffering from mitochondrial encephalopathy, can be suspended. This will lead to the certain death of the child. 37 European deputies[1]  have signed an open letter to express their “concern about the scandalous outcome of Charlie’s case, which violates the most fundamental European values, in particular, the right to live, the right to human dignity and to personal integrity”. In this case, they denounce “the approval of the successive courts to interrupt his supportive care, including nutrition and hydration”, ending with the European Court of Human Rights (ECHR), last recourse for Charlie Gard’s parents.

The European signatory deputies condemn a shameful behaviour which violates “the values of our civilised society” when a country “does not act in the best interest of its people”. They have committed themselves to oppose such practices with a firm “no”. (Genethiques informs you)

Eurodeputies stand against European Court of Human Rights names,

[1] The signatory deputies: Miroslav Mikolášik MEP, Luigi Morgano MEP, Laurentiu Rebega MEP, Laima Andrikiene MEP, Elisabetta Gardini MEP, Ivan Štefanec MEP, Lara Comi MEP, Marijana Petir MEP, Lorenzo Fontana MEP, Nicola Caputo MEP, Tunne Kelam MEP, Marek Jurek MEP, Beatrix von Storch MEP, Franc Bogovič MEP, Patricija Šulin MEP, Pavel Svoboda MEP, György Hölvenyi MEP, Michal Boni MEP, Jan Olbrycht MEP, Zbigniew Kuzmiuk MEP, Jadwiga Wiśniewska MEP, Thomas Mann MEP, Annie Schreijer-Pierik MEP, Daniela Aiuto MEP, Alojz Peterle MEP, Branislav Škripek MEP, Enrico Gasbarra MEP, Anna Záborská MEP, Arne Gericke MEP, Steven Woolfe MEP, Mylene Troszczynski MEP, Lars Adaktusson MEP, Remo Sernagiotto MEP, József Nagy MEP, Pál Csáky MEP Marek Plura MEP, Robert Jaroslaw Iwaszkiewicz MEP.

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

CHARLIE GARD: 37 European deputies stand against the European Court of Human Rights decision

In an open letter, 37 Eurodeputies support Charlie Gard and his parents and demand the respect of the right to live (see original letter signed at Strasbourg and titled, Charlie Gard must be given right to life, human dignity)

After the decision of the British Courts and of the European Court of Human Rights, the support provided by parenteral respiratory, nutrition and hydration assistance to Charlie Gard, the 10-months-old baby suffering from mitochondrial encephalopathy, can be suspended. This will lead to the certain death of the child. 37 European deputies[1]  have signed an open letter to express their “concern about the scandalous outcome of Charlie’s case, which violates the most fundamental European values, in particular, the right to live, the right to human dignity and to personal integrity”. In this case, they denounce “the approval of the successive courts to interrupt his supportive care, including nutrition and hydration”, ending with the European Court of Human Rights (ECHR), last recourse for Charlie Gard’s parents.

The European signatory deputies condemn a shameful behaviour which violates “the values of our civilised society” when a country “does not act in the best interest of its people”. They have committed themselves to oppose such practices with a firm “no”. (Genethiques informs you)

Eurodeputies stand against European Court of Human Rights names,

[1] The signatory deputies: Miroslav Mikolášik MEP, Luigi Morgano MEP, Laurentiu Rebega MEP, Laima Andrikiene MEP, Elisabetta Gardini MEP, Ivan Štefanec MEP, Lara Comi MEP, Marijana Petir MEP, Lorenzo Fontana MEP, Nicola Caputo MEP, Tunne Kelam MEP, Marek Jurek MEP, Beatrix von Storch MEP, Franc Bogovič MEP, Patricija Šulin MEP, Pavel Svoboda MEP, György Hölvenyi MEP, Michal Boni MEP, Jan Olbrycht MEP, Zbigniew Kuzmiuk MEP, Jadwiga Wiśniewska MEP, Thomas Mann MEP, Annie Schreijer-Pierik MEP, Daniela Aiuto MEP, Alojz Peterle MEP, Branislav Škripek MEP, Enrico Gasbarra MEP, Anna Záborská MEP, Arne Gericke MEP, Steven Woolfe MEP, Mylene Troszczynski MEP, Lars Adaktusson MEP, Remo Sernagiotto MEP, József Nagy MEP, Pál Csáky MEP Marek Plura MEP, Robert Jaroslaw Iwaszkiewicz MEP.

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

Burke, Briggs and Wills: Why we should not fear the judgment in Charlie Gard

In a blog post today, Julian Savulescu argues that in a parallel adult version of the highly controversial Charlie Gard case, a UK court might thwart an unconscious patient’s previously expressed desire for self-funded experimental medical treatment. He finds the Gard decision deeply disturbing and suggests that we all have reason to fear the Charlie Gard judgment.

I respectfully beg to differ.

Julian’s thought experiment of the billionaire ‘Donald Wills’ is not analogous to the real Charlie Gard case, his analysis of the UK legal approach to best interests cases for adults is potentially mistaken, his fear is misplaced.

Wills and Gard

Thought experiments are an important tool in philosophy and medical ethics. They enable us to analyse our intuitive responses to ethical questions. Comparing parallel cases – for example as James Rachels did in his now famous 1975 paper ‘Active and Passive Euthanasia’ – can helpfully identify factors that are relevant to ethical analysis, as well as factors that aren’t relevant. However, like scientific experiments, thought experiments need to be carefully designed. Otherwise they can mislead.

Julian imagines a wealthy adult patient, Donald Wills, who has a rare mitochondrial illness very similar to Charlie Gard. While Wills’ wife has identified a potential treatment and requested that he be transferred overseas for an experimental treatment, the imaginary court, in a decision parallel to the Gard case, finds that this treatment would not be in Donald’s best interests. The judge denies the request and Donald’s treatment is withdrawn.

However, in a divergence from the Gard case, Julian tells us that Wills

“wishes to live as long as possible.

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.