Tag: pain

Bioethics Blogs

Snapshots of Life: Fighting Urinary Tract Infections

Source: Valerie O’Brien, Matthew Joens, Scott J. Hultgren, James A.J. Fitzpatrick, Washington University, St. Louis

For patients who’ve succeeded in knocking out a bad urinary tract infection (UTI) with antibiotic treatment, it’s frustrating to have that uncomfortable burning sensation flare back up. Researchers are hopeful that this striking work of science and art can help them better understand why severe UTIs leave people at greater risk of subsequent infection, as well as find ways to stop the vicious cycle.

Here you see the bladder (blue) of a laboratory mouse that was re-infected 24 hours earlier with the bacterium Escherichia coli (pink), a common cause of UTIs. White blood cells (yellow) reach out with what appear to be stringy extracellular traps to immobilize and kill the bacteria.

Valerie O’Brien, a graduate student in Scott Hultgren’s lab at Washington University, St. Louis, snapped this battle of microbes and white blood cells using a scanning electron microscope and then colorized it to draw out the striking details. It was one of the winners in the Federation of American Societies for Experimental Biology’s 2016 BioArt competition.

As reported last year in Nature Microbiology, O’Brien and her colleagues have evidence that severe UTIs leave a lasting imprint on bladder tissue [1]. That includes structural changes to the bladder wall and modifications in the gene activity of the cells that line its surface. The researchers suspect that a recurrent infection “hotwires” the bladder to rev up production of the enzyme Cox2 and enter an inflammatory state that makes living conditions even more hospitable for bacteria to grow and flourish.

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

Agreement and disagreement about experimental treatment. The Charlie Gard Appeal

by Dominic Wilkinson and Julian Savulescu

@Neonatalethics

@juliansavulescu

Tomorrow, the UK Court of Appeal will review the controversial case of a British infant, Charlie Gard. Charlie’s parents are appealing a recent High Court decision that gave doctors permission to withdraw his life support. They have raised money for Charlie to travel to the US for an experimental medical treatment.

 

Best Interests

The legal decision for Charlie will be based upon an assessment of his best interests. He has a rare genetic disorder affecting his muscles and his brain. He has been on life support since last October and has been progressively deteriorating. A neurologist in the USA has suggested that experimental nucleoside treatment might, in theory, offer some benefit, though it has never previously been tried in this situation.

The central ethical question is whether it would be best to provide the experimental treatment and continue intensive care for Charlie for several months more, or to withdraw treatment and allow him to die. How should we weigh up the risks and benefits of those two alternatives?

We have previously written about this difficult question. In a pair of editorials in the Lancet medical journal, we expressed different points of view. Dominic Wilkinson argued that the proposed course of treatment would do more harm than good. In his view, it is likely that Charlie would experience pain and discomfort from continued treatment; it is also unlikely, given what is known about it, that Charlie would benefit from nucleoside treatment. In contrast, Julian Savulescu argued that it is not clear that continued mechanical ventilation in intensive care is so terrible a life that it would not be worth living.

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 Ethics of In Vitro Gametogenesis

Françoise Baylis comments on the ethics of using gametes derived from human induced pluripotent stem cells for future human reproduction.

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A recent New York Times article, provocatively titled “Babies from Skin Cells? Prospect is Unsettling to Some Experts,” has once again drawn attention to controversial research by scientists at Kyushu University in Japan who succeeded in making fertile mouse pups using eggs created through in vitro gametogenesis (IVG). This is a reproductive technology that involves creating functional gametes (sperm and eggs) from induced pluripotent stem cells. Induced pluripotent stem cells are cells derived from adult body cells (such as skin cells) that have the ability to become other body cells including reproductive cells (sperm and eggs).

Supporters of this reproductive technology eagerly anticipate similar research in humans. Indeed, enthusiasts are quick to trumpet the potential benefits of in vitro gametogenesis. These benefits fall into three general categories.

First, we are told that research to derive human gametes from induced pluripotent stem cells is important for basic science. It will advance our understanding of gamete formation, human development, and genetic disease. In turn, this increased understanding will create new options for regenerative medicine.

Second, we are told that this research will allow clinicians to improve fertility services. For example, with in vitro fertilization (IVF), women typically have to undergo hormonal stimulation and egg retrieval. This can be onerous in terms of the time required for interviews, counseling, and medical procedures. It can also be harmful. Potential psychological harms include significant stress and its sequelae.

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

Silence = Death

May 18, 2017

by Sean Philpott-Jones, Chair, Bioethics Program of Clarkson University & Icahn School of Medicine at Mount Sinai

Silence = Death

As Donald Trump fights for his political life following new revelations about wholly inappropriate disclosure of classified materials and potential obstruction of justice, he has quietly issued new orders that will condemn thousands of women and children around the world to death.

Largely overlooked given the media frenzy about the appointment of a special prosecutor to investigate Russian interference in the US Presidential election was an announcement that the TrumpAdministration will vastly expand the scope of the “Global Gag Rule”, the international anti-abortion policy first enacted by Ronald Reagan in 1984.

Also known as the Mexico City Policy, the rule prohibits organizations that receive family planning money from the United States Agency for International Development (USAID) from providing or promoting abortion. This is true even if they do so with private money. In fact, if they take so much as a single dollar from the US, they can’t even mention the word ‘abortion’ regardless of whether or not these organizations actually provide such services.

Every time a Democrat is in the White House, the global gag rule is rescinded. Every time a Republican enters the Oval Office, it is reinstated. President Trump himself did so just three days after assuming office. Until now, family planning organizations around the world have largely learned to deal with this ebb-and-flow. That is all about to change.

On Monday, Trump announced a new policy called Protecting Life in Global Health Assistance. That policy expands the scope of the Global Gag Rule.

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

Undermining the USPSTF: The most important stakeholders are the patients

A strange “health care” drama plays out daily in our clinics and hospitals. A healthy person has a medical test done (even though he or she is healthy): a blood test, a chest x-ray or mammogram, maybe an ultrasound of some body part. The test comes back abnormal. The patient (for she has now gone from being a healthy person to being a patient) is struck with worry, and undergoes a further round of testing to determine whether the initial, “screening” test was accurate. This more invasive, risky definitive testing causes the patient pain, complications, infections, further procedures to fix the complications. But the testing shows that the original screening test was wrong, and the patient is relieved of their worry and overcome with a sense of gratitude: “Yes, the follow-up surgery was painful, but at least it’s not cancer.” However, notice what caused the worry in the first place: not some symptom that they were experiencing, but a test that was performed on a healthy person. What a marvelous bit of sorcery: we take a happy patient, create unnecessary worry, then win their undying gratitude by performing risk-laden procedures on them to remove their worry!

There is something very intuitive about the concept that detecting a disease (especially cancer) early leads to better outcomes, that screening tests are inherently good. Yet when one studies the actual outcomes of implementing mass screening programs in a population of people who have no signs or symptoms of a particular disease, one finds to one’s surprise that, not infrequently, more people are harmed by our screening test than are helped (See: PSA testing, carotid ultrasounds, annual stress tests, etc).

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, sexuality, and dementia in long-term care

Alisa Grigorovich and Pia Kontos suggest that long-term care residents with dementia can benefit from leisure and social activities that are supportive of sexual expression and the formation of intimate and romantic relationships.

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Recently, media stories on dementia have focused on the sexualities of persons living with dementia in residential long-term care settings, such as nursing homes. This media attention has been predominantly negative, consisting of descriptions of sexual violence, and apocalyptic warnings of the legal, ethical, and moral dangers of allowing persons with dementia to express their sexuality.

Often the primary criterion used to determine whether sexual encounters between residents with dementia are involuntary is the cognitive ability of the female resident. Frequently, she is characterized as globally incapable of agreeing to sexual activity because of cognitive impairment.

Consider, for example, the now infamous case of Henry Rayhons. He was accused (and ultimately acquitted) of sexually assaulting his wife who had dementia. As well, there is the lawsuit filed in a case involving two residents with dementia who had intercourse while living in Windmill Manor. While such stories highlight the importance of protecting vulnerable persons from sexual abuse, they ignore the need to also ensure that persons with dementia have opportunities to pursue intimate and romantic relationships.

Sexual expression is a universal human need that transcends age and disability. It has many positive health and wellness benefits, including the opportunity to experience pleasure, decreased pain sensitivity, and increased relaxation. However, older persons living in nursing homes often experience reduced sexual freedom.

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

All we like SHEEFs, Part 2

Carrying on with last week’s musings…

In thinking further, I think my attempt was confused by conflating the moral status of a SHEEF—a synthetic human entity with embryo-like features, something more than a clump of cells of human origin, but less than a human being—with reasons why I might want to hold that nobody should ever make certain sorts of SHEEFs.

Again, SHEEFs are human, not non-human.  But they may not command a “right to life” in every instance.

I would return to a statement I made last week, that any totipotent human entity, that is, any human entity capable of developing into a full human being under the right circumstances, should be accorded a full human right to life from the moment he or she comes into existence.  We other humans ought to give him or her a chance to live, care for him or her as one of us, grant him or her any research protections extended to human research subjects in general, and so on.  So-called human “embryos in a dish” would be in this group.

The same cannot be said for individual human cells, including human gametes formed from cells like induced pluripotent stem cells.  There may be arguments why those ought not to be produced, but that is for another time.

I would not say that a laboratory-created or sustained human heart, for example, ought to be protected from instrumental uses, including destruction for the research enterprise.  I think I would want to argue that we humans ought not make such a thing as part of a human-non-human animal hybrid, but again, that’s a different argument.   Such a hybrid would not make human moral claims on us to be preserved and cared for as humans.

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

Oxford Uehiro Prize in Practical Ethics: Is Sex With Robots Rape? Written by Romy Eskens

This essay was the winner in the Graduate Category of the Oxford Uehiro Prize in Practical Ethics 2017

Written by University of Oxford student, Romy Eskens

On The Permissibility of Consentless Sex With Robots

Recent movies and TV-series, such as Ex Machina and Westworld, have sparked popular interest in sex robots, which are embodied AI systems designed to provide sex for humans. Although for many it may seem absurd to think that humans will ever replace their human bedpartners with artificial machines, the first sexbots have already entered the commercial market. In 2010, TrueCompanion introduced Roxxxy, a sexbot with synthetic skin and an AI system that allows her to interact with her user through speech and affective communication. Another example of sexbots currently for sale are the RealDolls, which are silicone sexbots available in different models and upgradable with insertable faces and body parts. The question I address in this essay is: do humans require consent from sexbots for sexual activity to be permissible?

There are convincing ethical reasons to create sexbots. To begin with, sexbots can replace human sex workers, thereby reducing harmful practices such as sex slavery and sexual abuse.[i] Moreover, they can provide satisfying alternatives for individuals with sexual desires that could harm human beings if brought into practice, such as the desire to have sex with children or to engage in extremely violent or degrading sex. Furthermore, sexbots can provide a solution for individuals who experience difficulty in finding sexual partners, and can provide intimate companionship for those who feel lonely or isolated.

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

An IVF Keepsake?

As a father of two teenagers (and one who will join that esteemed company in a month), I am fluent in “sarcasm,” the native tongue of this group. Mine only use English sparingly, to do business. So, I often read headlines of stories in newspapers (remember those?) and online as sarcastic, and the articles they lead as spoofs. This one, in the “Parenting” section of an Australian web journal called “Kidspot,” immediately led me there. It speaks of a company that will take embryos from in vitro fertilization (IVF) that have not been implanted, and for which the biological parents have no plans of implanting, and turn them into keepsake jewelry. But this is no spoof.

The couple interviewed in the piece, having completed a 6-year journey through infertility and IVF, has a 4-year old son and twin toddlers. With seven remaining embryos, they had a decision to make. For them, “Donation wasn’t an option, the annual storage fee was an added financial strain, and disposing of them unimaginable.” Enter a company called “Baby Bee Hummingbirds,” who placed the embryos in a heart-shaped pendant.

My first impulse, not without some merit, was to find this all a rather ghastly business. Each of these embryos is a unique genetic human created in the image of God. I find myself critical of parents who don’t seem to have fully thought out the ramifications of fertilizing ten or more eggs. If these are genuinely human beings, then the creation (if that’s the right word) of “leftovers” is itself deeply problematic.

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

Oxford Uehiro Prize in Practical Ethics: Secondary Intentions in Euthanasia, written by Isabel Canfield

This essay received an Honourable Mention in the Undergraduate Category of the Oxford Uehiro Prize in Practical Ethics 2017

Written by University of Oxford student, Isabel Canfield

The debate about the moral permissibility of euthanasia is often presented as hinging upon the distinction between killing and letting die. This debate is often focused around a discussion of intention. This paper will attempt to answer the question, is there an additional level of intention, that has not been considered in the current debate on the moral permissibility of euthanasia, that should be considered?

It will be helpful to begin by outlining some of the terms that I will use throughout this paper. To this end, “euthanasia” is the act of killing someone else with the intention of avoiding the harm of living a continued life that is worse than death.[1 2] The distinction between active and passive euthanasia is complicated and at times not entirely clear. Typically, and for the purposes of this paper, active euthanasia is defined as an act that requires the agent who brings about death to do so purposefully. This purposeful action can be the completion of some task or tasks to accomplish this specific end. Meanwhile, passive euthanasia comes about when the agent who brings about death, if an agent can be said to bring about death at all in these cases, does so by purposefully not acting to continue to sustain the life of the person who dies.[3]

Any distinction in intention between active and passive euthanasia, supporters of active euthanasia argue, has been artificially created.

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.