Tag: organizations

Bioethics Blogs

Whatever Happened to Long-Term Care Reform?

From the Trenches: A Prescription for Change

I have enjoyed looking at the pictures of protestors being arrested in our nation’s capital. I concur with many commentators who credit the civil disobedience of the protestors – many of whom are members of the disability rights activist group ADAPT – with the defeat of the Senate bill to abolish the Affordable Care Act. It’s also been fun because I know so many people in the photos.

The Affordable Care Act was a massive piece of legislation. The complexities and moving parts are best understood by people who have very closely followed or implemented the law. I generally think of the ACA as three things:

1. Reform of the private insurance market with the goal of providing greater access to insurance coverage;

2. Changes to Medicare, such as closing the prescription drug donut hole; and

3. Changes to Medicaid. 

Mike Oxford, Executive Director for Policy at the Topeka Independent Living Resource Center and a member of the national chapter of ADAPT, was one of many who protested against the Senate bill to repeal the Affordable Care Act.

Community Services Optional?

The Medicaid issue that has drawn the most attention is the matter of expanding access, appropriately called “Medicaid expansion.” But the law contains other Medicaid provisions as well. It provides incentives for states to continue to “re-balance” their systems of providing long-term care. “Re-balance” is often mentioned in quotation marks because states were never in balance. Nonetheless, through the ACA, states were provided additional federal matching funds if they would transfer more long-term care to community services and away from institutions, such as nursing homes.

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

Wisconsin Company to Implant Microchips in Consenting Employees

A company in Wisconsin is offering employees the option of being implanted with microchips that will allow them to simply swipe their hands to carry out tasks such as opening company doors, making break room purchases, and logging onto computers. Though such technology is already employed in Europe, its debut at Three Square Market (32M) marks the technology’s debut in the United States.

On August 1st, the company will be holding a “chip party” to implant the rice-sized $300 microchips into employees’ hands. Over 50 of the company’s 85 employees are voluntarily receiving the optional implants. The microchip insertion is a seconds-long procedure, and involves using a syringe to place the chip between the thumb and forefinger. It can similarly be removed within seconds.

The Washington Post noted that though the technology “has raised privacy concerns because of the potential to track a person’s whereabouts and purchases, officials at 32M said the data in the microchip is encrypted and does not use GPS.”

“Part of my general concern is that we don’t go too fast and that we understand the implications of these sorts of (technologies),” University of Wisconsin-Milwaukee Professor Michael Zimmer told the newspaper, which cited his concern about “the potential for ‘function creep,’ where the stated purpose of a technology ends up spilling over into other uses, including surveillance.”

32M COO Patrick McMullan noted that the company is currently limiting its microchip use to its workplace, but has received expressions of interest from a hospital chain and other organizations. “We need to be responsible with this. This is not something you can do fast,” he acknowledged.

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 Blogs

Refugees, Narratives, or How To Do Bad Things with Words

By Anna Gotlib

ABSTRACT. This paper addresses and critiques the anti-refugee rhetoric and policies, as well as their uncritical uptake, which developed around the candidacy of Donald Trump. My intent is to examine some of this election’s cruelest, most violent, and most racist rhetoric, reserved for Syrian (and other) refugees, and to consider some possible responses to such speech in the future. To that end, I problematize the representations and treatment of refugees within the United States from three distinct groups: European Jewish refugees of the Second World War; the Eastern Bloc refugees of the mid- and late twentieth century; and the current Syrian, largely Muslim refugees. I begin by defining the concepts of homelessness and moral luck. Second, I examine the three varying histories of refugee policies in the context of these two notions. Finally, I conclude with a combination of despair and hope: First, I offer a few observations about the role of language in the recent presidential election; second, I propose alternatives to the resulting linguistic and political violence by extending Hilde Lindemann’s notion of “holding” into sociopolitical contexts.

“How odd I can have all this inside me and to you it’s just words.”
― David Foster Wallace, The Pale King

I.  Introduction

The American election of 2016 was, in its vitriol, polarization, and outcome, unlike any in recent memory. This paper addresses and critiques the anti-refugee rhetoric and policies, as well as their uncritical uptake, which developed around the candidacy of Donald Trump. My intent is to examine and confront the fact that some of this election cycle’s cruelest, most violent, and most racist rhetoric was reserved for Syrian (and other) refugees, and to consider some possible responses to such speech in the 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.

Bioethics Blogs

Fake News and Partisan Epistemology

by Regina Rini

ABSTRACT. This paper does four things: (1) It provides an analysis of the concept ‘fake news.’ (2) It identifies distinctive epistemic features of social media testimony. (3) It argues that partisanship-in-testimony-reception is not always epistemically vicious; in fact some forms of partisanship are consistent with individual epistemic virtue. (4) It argues that a solution to the problem of fake news will require changes to institutions, such as social media platforms, not just to individual epistemic practices.

Did you know that Hillary Clinton sold weapons to ISIS? Or that Mike Pence called Michelle Obama “the most vulgar First Lady we’ve ever had”? No, you didn’t know these things. You couldn’t know them, because these claims are false.[1] But many American voters believed them.

One of the most distinctive features of the 2016 campaign was the rise of “fake news,” factually false claims circulated on social media, usually via channels of partisan camaraderie. Media analysts and social scientists are still debating what role fake news played in Trump’s victory.[2] But whether or not it drove the outcome, fake news certainly affected the choices of some individual voters.

Why were people willing to believe easily dis-confirmable, often ridiculous, stories? In this paper I will suggest the following answer: people believe fake news because they acquire it through social media sharing, which is a peculiar sort of testimony. Social media sharing has features that reduce audience willingness to think critically or check facts. This effect is amplified when the testifier and audience share a partisan orientation.

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

Trust, Communities, and the Standing to Hold Accountable

by Thomas Wilk 

ABSTRACT. During the 2016 US Presidential campaign and in the aftermath of the election of Donald Trump, many of us have tried to hold friends, family, and acquaintances accountable for their support of a candidate and campaign that we judged to be racist, xenophobic, sexist, transphobic, ableist, and authoritarian. Even when our friends and family avowed, for example, anti-racist norms, our attempts to hold them to those norms were often met with rejections of our standing to do so: What gives you the right to call me out for my vote? In this paper, I argue for the regrettable conclusion that these challenges to our standing to hold are, in at least some cases, justified on the grounds that the targets of our holdings have little evidence that we would allow ourselves to be reciprocally held accountable. As such, recognizing our standing to hold them accountable would be a threat to their agency. I conclude by arguing that we now ought to engage in a project of rebuilding the kinds of communities in which the mutual trust that is foundational to our moral practices can be rebuilt.

 

INTRODUCTION

Who are you to tell me what I should do? What gives you the right to order me around? How dare you call me a racist!? Many of us have heard these refrains over the course of the 2016 US Presidential campaign and since the election of Donald Trump. We try talk to Trump supporters—family, former classmates, hometown friends, and online acquaintances—about the racism, xenophobia, sexism, transphobia, ableism, and authoritarianism that some of us have judged to be endemic to his campaign and nascent administration.

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

Disability Rights Advocates Sue Uber for Wheelchair Inaccessible Cars

Nonprofit organization Disability Rights Advocates has filed a class-action lawsuit against Uber, claiming that the ride service discriminates against riders with disabilities in New York City. Filed in New York State Supreme Court in Manhattan on Tuesday, July 18th, the suit is founded on the accusation that Uber does not supply enough available wheelchair-accessible cars through its app.

According to the New York Times, the lawsuit alleges that though Uber provides wheelchair-accessible cars through its related service UberWAV, the specially equipped vehicles “account for a tiny fraction of the 58,000 for-hire cars dispatched by Uber in New York City’s five boroughs” and that “this already limited pool of cars can be used for other riders, and… may be unavailable when needed by those with disabilities.”

Filed on behalf of numerous advocacy organizations and individual New Yorkers, the lawsuit comes after two discrimination lawsuits against the Metropolitan Transportation Authority regarding the subway system’s dearth of elevators and lifts. The suit requests that the court order Uber to “develop and implement a remedial plan to ensure full and equal access to its services for riders who require accessible transportation.”

For its part, Uber has in the past offered monetary incentives to drivers of wheelchair-accessible cars. It has also suggested that New York City law implement an “accessibility fee” on certain types of rides across companies to raise funds for further monetary incentives. The case raises notable questions regarding civil and corporate duties to persons with disabilities.

The post Disability Rights Advocates Sue Uber for Wheelchair Inaccessible Cars appeared first on Global Bioethics Initiative (GBI).

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

Brain Death – 3rd Edition by Wijdicks

This third edition introduces new research in the intensive care unit, newly unearthed historical data on important US-UK differences, a thorough discussion of US guidelines and how it is used in hospital practices, and compares guidelines used elsewhere in the world. In this incisive work, the many complexities of diagnosis and management of brain death are examined but it also illuminates cultural beliefs and bioethical problems, highlights the nature of conferences with family members, and captures several organ procurement issues. The book also includes 30 commonly asked practice problems to resolve diagnostic uncertainties and conflicts along with 12 video clips to assist in neurological evaluation.  

Chapter 1: History of Brain Death

A New Comatose State Appears

Defining Neurologic Criteria for Death in Us

Chapter 2: Neurology of Brain Death

The Pathology of Brain Death

Clinical Examination in Adults

The Clinical Determination of Brain Death in Children

Documentation

Teaching Brain Death Determination

Errors and Alleged Recoveries

Legal Definitions and Obligations

Chapter 3: International Criteria of Brain Death

Guidelines in the United Kingdom

Guidelines World Wide

Consensus for a Uniform World Wide Standard

Chapter 4: Beliefs About Brain Death

Religious Beliefs

Cultural Views

Religious Conflict Resolution

Chapter 5: Critics and Brain Death

The Uncertainty of Death

Emerging Controversies

Critique

Chapter 6: Procurement After Brain Death 

Transitioning to Organ Donation

Organ Procurement Organizations

Organ Donation Requests

Preparation for Determining Organ Suitability

Donation Protocols

Medical Management of the Organ Donor

Chapter 7: Clinical Problems in Brain Death and Organ Donation

1. The Qualifications of the Examiner

2. Clinical Mimics

3.

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

Vaccines Promoted As Key To Stamping Out Drug-Resistant Microbes

July 19, 2017

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The battle against drug-resistant superbugs has neglected a key weapon, scientists say: using vaccines to quell the spread of resistance.

As drug-resistant infections sweep across the globe, public-health organizations have focused mainly on developing new antimicrobial treatments and cutting the overuse of existing ones, to prevent resistant strains emerging.

But not enough attention has been paid to vaccines as a defence strategy, say microbiologists and vaccine-developers from academic institutes and drug companies around the world. They attended a meeting at the Wavre, Belgium-based campus of drug firm GSK on 6–7 July, to discuss the issue with representatives from funding agencies and regulatory authorities.

… Read More

Image: By User:Graham Beards – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10936866

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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.

Bioethics Blogs

Diagnostic dilemmas: When potentially transient preexisting diagnoses confer chronic harm

By Elaine Walker
Elaine Walker is the Charles Howard Candler Professor of Psychology and Neuroscience at Emory University.   She leads a research laboratory that is funded by the National Institute of Mental Health (NIMH) to study risk factors for psychosis and other serious mental illnesses.  Her research is focused on the behavioral and neuromaturational changes that precede psychotic disorders.   She has published over 300 scientific articles and 6 books. 
The diagnostic process can be complicated by many factors. Most of these factors reflect limitations in our scientific understanding of the nature and course of disorders. But in the current US healthcare climate, legislative proposals concerning insurance coverage for preexisting conditions add another layer of complexity to the diagnostic process. It is a layer of complexity that is riddled with ethical dilemmas which are especially salient in the field of mental health care. The following discussion addresses the interplay between medical practice and health-care system policy in the diagnostic process. The diagnosis of psychiatric disorders is emphasized because they present unique challenges [1]. 

Of course, some of the complications associated with diagnosis are a function of ambiguous and/or changing diagnostic criteria. For example, the criteria for designating the level of symptom severity that crosses the boundary into clinical disorder change over time as a function of scientific advances. This has occurred for numerous illnesses, including metabolic, cardiovascular, and psychiatric disorders [2]. Further, especially in psychiatry, diagnostic categories undergo revision over time, even to the extent that some behavioral “syndromes” previously considered an illness have been eliminated from diagnostic taxonomies.

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.