Tag: organizations

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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.

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Living with Moral Disagreement: Activism, Advocacy, and Interaction

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This May, the Center for Ethics Education at Fordham University oversaw it seventh successful installment of installment of Theories and Applications in Contemporary Ethics. The theme of this year’s intensive ethics workshop was Living with Moral Disagreement: Activism, Advocacy, and Interaction. In this course, students from Fordham University and around the world engaged with faculty members from six disciplines on how to live in a world with a vast and deep moral disagreement

The Center brought together Michael Baur, PhD on Law, Melissa Labonte, PhD on Political Science, Charlie Camosy, PhD on Theology, Orit Avashai, PhD on Sociology, Gwenyth Jackaway, PhD on Communication and, the Center’s new Director of Academic Programs, Bryan Pilkington, PhD on Philosophy. From each of these distinct perspectives, the faculty engaged with students on topics about which we deeply disagree, including rights to healthcare, religious and legal exemptions around the concept of death and female genital mutilation or cutting. The conversation was lively, practical and steeped in the deep theoretical commitments.

The Center was pleased to have Lerato Molefe as a participant in this workshop, thanks to the Fordham/Santander Universities International Scholarship in Ethics Education. Lerato Molefe visited Fordham from Johannesburg, South Africa where she is the founding and managing director of Naaya Consulting, a legal and strategy consulting firm for large and high growth organizations spanning a range of industries across the African continent. She has degrees from Harvard Law School, Fletcher School of Law and Diplomacy at Tufts University and Smith College.


How to Apply for the International Santander Universities International Student Scholarships

For information on how to apply to the 2018 Workshop or Fordham University’s Master’s in Ethics and Society program, please visit our Santander Universities scholarship page.

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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Living with Moral Disagreement: Activism, Advocacy, and Interaction

Image via

This May, the Center for Ethics Education at Fordham University oversaw it seventh successful installment of installment of Theories and Applications in Contemporary Ethics. The theme of this year’s intensive ethics workshop was Living with Moral Disagreement: Activism, Advocacy, and Interaction. In this course, students from Fordham University and around the world engaged with faculty members from six disciplines on how to live in a world with a vast and deep moral disagreement

The Center brought together Michael Baur, PhD on Law, Melissa Labonte, PhD on Political Science, Charlie Camosy, PhD on Theology, Orit Avashai, PhD on Sociology, Gwenyth Jackaway, PhD on Communication and, the Center’s new Director of Academic Programs, Bryan Pilkington, PhD on Philosophy. From each of these distinct perspectives, the faculty engaged with students on topics about which we deeply disagree, including rights to healthcare, religious and legal exemptions around the concept of death and female genital mutilation or cutting. The conversation was lively, practical and steeped in the deep theoretical commitments.

The Center was pleased to have Lerato Molefe as a participant in this workshop, thanks to the Fordham/Santander Universities International Scholarship in Ethics Education. Lerato Molefe visited Fordham from Johannesburg, South Africa where she is the founding and managing director of Naaya Consulting, a legal and strategy consulting firm for large and high growth organizations spanning a range of industries across the African continent. She has degrees from Harvard Law School, Fletcher School of Law and Diplomacy at Tufts University and Smith College.


How to Apply for the International Santander Universities International Student Scholarships

For information on how to apply to the 2018 Workshop or Fordham University’s Master’s in Ethics and Society program, please visit our Santander Universities scholarship page.

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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FDA Advisory Committees and Industry-Funded Patient Advocacy

Cross-posted on Objective Intent and Notice & Comment.

Industry funding of patient advocacy organizations recently has received attention from media and researchers.  For example, one 2017 study in the New England Journal of Medicine found that over 80% of patient advocacy organizations with annual revenues of at least $7.5 million reported receiving industry funding; another study in JAMA Internal Medicine found that approximately 65% of patient advocacy organizations with a median annual revenue of about $300,000 reported receiving industry funding; and a post on the Hastings Center’s website (and an earlier JAMA Internal Medicine editorial) reported that one pharmaceutical company funded an advocacy organization that, in turn, recruited other patient advocacy groups to speak in favor of the company’s drug when the FDA was considering approving it.  This last story highlights one area where the rubber meets the road with respect to FDA and patient advocates’ conflicts of interest: advisory committee meetings.

Advisory committees play an important role at FDA, including for new drug approvals.  Often when FDA is considering whether to approve a new drug, it will ask an advisory committee—a group of outside experts—to provide the agency with advice on various scientific questions about the drug.  At a typical drug-related advisory committee meeting, the drug company and FDA will each take a turn presenting the scientific evidence about the unapproved drug, then there will be an open public hearing at which any interested member of the public may speak, followed by the advisory committee’s discussion of, and vote on, the questions that FDA has posed to it. 

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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The United States Government has presented an amend to abolishe Planned Parenthood government subsidies

The current Government of the United States has presented an amend to the “Affordable Care Act“, with the result that they will not longer awarding Planned Parenthood 500 million Euros annually, around two fifths of their total budget. Planned Parenthood has 57 local affiliates that operate around 650 health centres in the United States. In 2015, the organisation received $553 million from federal funds, $309 million from private insurers, $353 million in donations and $80 million from other sources. According to their own figures, 2.5 million people use their facilities every year, and they believe that 1 in 5 American women has visited a centre at least once in her life (JAMA 177; 307-308, 2017).

Official reasons to defund Pllaned Parethood, “We don’t want to commit taxpayer funding for abortion, and Planned Parenthood is the largest abortion provider,” House Speaker Paul Ryan said during a CNN town hall .

Planned parenthood government subsidies to promote abortion also in other countries.

A step has been made in last februay when President Trump signed an executive order barring federal funds from organizations that promote abortion around the world, including the International Planned Parenthood Federation.

Photo The MQ

La entrada The United States Government has presented an amend to abolishe Planned Parenthood government subsidies 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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Book review: Traces of the Future: An Archaeology of Medical Science in Africa by Damien Droney

Traces of the Future: An Archaeology of Medical Science in Africa

Paul Wenzel Geissler, Guillaume Lachenal, John Manton, and Noémi Tousignant, editors

Intellect Ltd./University of Chicago Press, 2016, 256 pages, 500 color plates

 

The first reaction to an encounter with Traces of the Future: An Archaeology of Medical Science in Africa is likely to be a set of questions. Firstly, “what is it?” This 7×9” hardcover book, brimming with pleasingly displayed full-color photographic contributions by 18 authors, resembles a museum exhibit as much as it does a conventional academic volume. The contributing authors themselves describe it as a “sutured assemblage” (12) and a “fragmentary and idiosyncratic” (27) result of collaborative research presented in “a book-like package” (12).

Traces of the Future is the remarkable product of a long-term collaborative research project by a group of anthropologists, historians, and photographers. It examines the legacies of twentieth century biosciences in Africa in five historical sites of transnational medical science. Each of these sites manifested dreams of medical modernity and social progress characteristic of the twentieth century, dreams which are unevenly remembered in these sites today. The book is driven by the diverse research objects that it assembles. Beyond some rewarding orienting essays, the bulk of the book appears as a profusion of material. Each chapter includes an array of images, including fieldwork snapshots, archival documents, blueprints, manuscripts of musical scores, and unearthed beakers. These images are interspersed with timelines, interview transcripts, fieldnote excerpts, quotes from academic literature, and essays.

It also features haunting professional art photographs of Amani Hill Research Station by Evgenia Arbugaeva and Mariele Neudecker.

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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Legal Briefing: Unwanted Cesareans and Obstetric Violence

In my latest legal briefing for the Journal of Clinical Ethics, I discuss “Legal Briefing: Unwanted Cesareans and Obstetric Violence.”


A capacitated pregnant woman has a nearly unqualified right to refuse a cesarean section. Her right to say “no” takes precedence over clinicians’ preferences and even over clinicians’ concerns about fetal health. Leading medical societies, human rights organizations, and appellate courts have all endorsed this principle. Nevertheless, clinicians continue to limit reproductive liberty by forcing and coercing women to have unwanted cesareans. This “Legal Briefing” reviews recent court cases involving this type of obstetric violence. I have organized these court cases into the following six categories:
1.   Epidemic of Unwanted Cesareans
2.   Court-Ordered Cesareans
3.   Physician-Coerced Cesareans
4.   Physician-Ordered Cesareans
5.   Cesareans for Incapacitated Patients
6.   Cesareans for Patients in a Vegetative State or Who Are Brain Dead


Legal Briefing: Unwanted Cesareans and Obstetric Violence
Thaddeus Mason Pope, The Journal of Clinical Ethics 28, no. 2 (Summer 2017): 163-73.

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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California’s Aid-In-Dying Law Turns 1, But Not All Doctors Have Adopted It

The organization reports that nearly 500 hospitals and health systems and more than 100 hospice organizations allow aid-in-dying to be offered to their patients and 80 percent of insurers statewide cover expenses related to it. The California law created a process for dying patients to ask their doctors for a lethal prescription that they can then take privately, at home

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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MCDES Fall Conference: Medical Aid in Dying (MAiD)—Lessons Learned in Oregon and Colorado

Join me, physician David Grube, and thanatologist Kim Mooney, at the MCDES Fall Conference: Medical Aid in Dying (MAiD)—Lessons Learned in Oregon and Colorado Mission (September 29, 2017).


Objective – promote thoughtful deliberation about challenges faced by healthcare professionals and healthcare systems as they create patient-centered policies to respond to medical aid in dying legislation and requests. They are neither promoting nor condemning aid in dying, but rather, focusing on how to achieve the best possible care for seriously ill patients and their families if medical aid in dying is legalized.


Pragmatic and Ethical Concerns

  • How will practicing clinicians be educated to respond to requests for physician aid-in-dying, and to connect patients to resources, such as hospice and mental health, in the course of discussing these requests? 
  • How will required legal safeguards, such as establishing prognosis and second opinions, be implemented? 
  • How will the “final attestation” process be implemented? 
  • How will decision-making capacity be assessed? 
  • How will pharmacy policies be implemented, including the management of aid-in-dying medications in health care facilities? 
  • How will health care organizations that elect not to participate respond?
  • How will health care organizations assess and manage conscientious objections by clinicians or other staff?
  • How will health care systems share best practices as issues arise? 
  • How will health care organizations plan for the needs and concerns of diverse populations?

Outcomes

  • Lift up “points to consider” for health care workers and organizations in drafting local policies. 
  • Ongoing collaborations between ethics, palliative care and other allied health care professionals; for example, many believe that improved palliative care services was one outcome of the physician aid-in-dying legislation in Oregon.

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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ERISA: A Bipartisan Problem For The ACA And The AHCA

On Monday, the Supreme Court decided another case that enhances ERISA’s deregulatory impact, Advocate Health Care Network v. Stapleton (holding that pension plans maintained by church-affiliated organizations, including hospitals, are exempt from ERISA’s pension protections as “church plans.”). Justice Sotomayor joined the … 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.