Tag: practice

Bioethics News

Artificial hearts. Update on clinical use and ethical assessment

After 2500 artificial hearts implanted only in Europe. Until now it has been only implanted in patients with very severe heart failure, almost terminal.

The use of artificial hearts (a device that replaces the functions of the heart) is increasing worldwide, and in fact, they have already been used in 26 patients in Spain and in 2500 in Europe.

While this practice gives rise to exciting medical possibilities, it also raises some ethical issues that we addressed in a previous article (see HERE). We will now update the latest findings on this practice.

Technically, artificial hearts consist of a continuous flow pump that can pump approximately 10 litres per minute from the left ventricle. The healthy heart can pump around four.

These hearts have a wire that exits the body at the belly button and connects to a small computer powered by 2 batteries, which last for between 8 and 10 hours; their half life is around 10 years.

Artificial hearts are placed inside the chest and connected to the heart in order for it to pump the blood to the aorta. The surgical procedure is not very long — around 2 hours — and has now been substantially simplified, as only two small incisions are required: one at the lower end of the heart and another near the aorta.

There is no doubt that the artificial heart is a major medical advance for patients who require transplant and who, for some reason, especially due to a lack of donor organs, are unable to have one.

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:In It To Win It: Is Prize-giving Bad for Philosophy? Written by Rebecca Buxton

This essay received an Honorable Mention in the Graduate Category of the Oxford Uehiro Prize in Practical Ethics 2017

Written by University of Oxford student, Rebecca Buxton

INTRODUCTORY REMARKS
We live in a culture of prize-giving. The Nobel Prize, the Medal of Honour, the Man Booker and, not least, the Oxford Uehiro Prize in Practical Ethics. But, in giving such prizes, and indeed prize money, we operate under the assumption that prizes are ‘good’. However, the fact that I am offered a prize for writing
a practical ethics paper is itself a practical ethical conundrum. This essay takes a preliminary amble into the ethical problem of prize-giving with regards to Philosophy specifically, offering reasons as to why we should question current practice. Primarily, I will define what we mean by the term ‘prize’ noting its
necessary and sufficient features. Secondly, I discuss the impact of prize-giving on research, considering how the ramifications of ascribing value through prizes affects the course of academia, especially when focusing on the lack of diverse voices within the subject. I then consider the deeper question of philosophical value: does the very act of constructing an ethical argument for a prize diminish the value of the work?

THE IDEA OF ‘THE PRIZE’
Though prize-giving is prolific in our current institutional culture, we lack any analytically clear literature on what constitutes a ‘prize’. There is, however, some work focusing on the philosophical concept of ‘the gift’, most notably Derrida’s argument that the ‘true’ gift is impossible as we can never eliminate the possibility of the counter-gift.[1] Unlike gifts, prizes depend upon a reciprocal process; you receive a prize in virtue of being or doing something.

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

How Different are Female, Male and Intersex Genital Cutting?

By Brian D. Earp  (@briandavidearp), with Rebecca Steinfeld, Goldsmiths, University of London 

Three members of the Dawoodi Bohra sect of Islam were recently indicted on charges of “female genital mutilation” (FGM) in the US state of Michigan. In Norway, meanwhile, one of the major political parties has backed a measure to ban childhood male circumcision.

Fearing that objections to female forms of genital cutting will be applied to male forms, some commentators have rushed to draw a “clear distinction” between them. Others, however, have highlighted the similarities.

In fact, childhood genital cutting is usually divided not just into two, but three separate categories: “FGM” for females; “circumcision” for males; and “genital normalisation” surgery for intersex children – those born with ambiguous genitals or mixed sex characteristics.

In Western countries, popular attitudes towards these procedures differ sharply depending on the child’s sex. In females, any medically unnecessary genital cutting, no matter how minor or sterilised, is seen as an intolerable violation of her bodily integrity and human rights. Most Westerners believe that such cutting must be legally prohibited.

In intersex children, while it is still common for doctors to surgically modify their genitals without a strict medical justification, there is growing opposition to non-essential “cosmetic” surgeries, designed to mould ambiguous genitalia into a “binary” male or female appearance.

Belgian model Hanne Gaby Odiele, for example, has spoken openly about the negative impact of the “irreversible, unconsented and unnecessary” intersex surgeries she was subjected to growing up.

In male children, by contrast, the dominant view is that boys are not significantly harmed by being circumcised, despite the loss of sensitive tissue.

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

Welcome 2017 HIV and Drug Abuse Prevention Research Ethics Training Institute Fellows!

The Fordham University HIV and Drug Abuse Prevention Research Ethics Training Institute (RETI) is pleased to announce that the following individuals have been selected as 2017 fellows:

Dr. Stephanie Cook, New York University
Estreet
Dr. Anthony Estreet, Morgan State University
Fielding Miller
Dr. Rebecca Fielding-Miller, University of California, San Diego
Guta
Dr. Adrian Guta, University of Windsor
Pagano-Therrien
Dr. Jesica Pagano-Therrien, University of Massachusetts 
Pasipanodya
Dr. Elizabeth Pasipanodya, University of California, San Diego
Philbin
Dr. Morgan Philbin, Columbia University
John_S
Dr. John Sauceda, University of California, San Francisco

The Fordham University  HIV and Drug Abuse Prevention Research Ethics Training Institute (RETI), now in its 7th year, is a training grant sponsored by the National Institute on Drug Abuse (NIDA) (R25 DA031608-07), Principal Investigator, Dr. Celia B. Fisher, Director, Center for Ethics Education). The RETI provides early-career investigators in the social, behavioral, medical and public health fields with an opportunity to gain research ethics training. In doing so, RETI addresses the urgent need for HIV and drug use investigators who can identify and address ethical issues, engage drug using and other at-risk communities in the construction and evaluation of population sensitive research protections, and generate empirical data to inform ethical practice and policies for HIV prevention science. Through their funded Mentored Research Projects (MRP), RETI fellows generate empirical data, publish their findings in a variety of high-impact academic journals, and are trained to apply for increasing grant opportunities.

The program’s aims are to: (1) increase trainees’ knowledge of and capacity to address key ethical issues in HIV and drug abuse prevention research; (2) increase trainees’ capacity to ethically engage participants and communities in the construction of participant protections that reflect the values and merit the trust of all stakeholders in HIV and drug abuse prevention research.; (3) increase trainees’ capacity to conduct research that will generate data to inform HIV and drug abuse prevention research practices and policies; and (4) create and sustain an information and communication network for trainees, faculty and others in the field for enhancing ethical knowledge, ethical dialogue and future professional collaborations in HIV and drug abuse prevention research ethics.

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

Welcome 2017 HIV and Drug Abuse Prevention Research Ethics Training Institute Fellows!

The Fordham University HIV and Drug Abuse Prevention Research Ethics Training Institute (RETI) is pleased to announce that the following individuals have been selected as 2017 fellows:

Dr. Stephanie Cook, New York University EstreetDr. Anthony Estreet, Morgan State University Fielding MillerDr. Rebecca Fielding-Miller, University of California, San Diego GutaDr. Adrian Guta, University of Windsor Pagano-TherrienDr. Jesica Pagano-Therrien, University of Massachusetts  PasipanodyaDr. Elizabeth Pasipanodya, University of California, San Diego PhilbinDr. Morgan Philbin, Columbia University John_SDr. John Sauceda, University of California, San Francisco

The Fordham University  HIV and Drug Abuse Prevention Research Ethics Training Institute (RETI), now in its 7th year, is a training grant sponsored by the National Institute on Drug Abuse (NIDA) (R25 DA031608-07), Principal Investigator, Dr. Celia B. Fisher, Director, Center for Ethics Education). The RETI provides early-career investigators in the social, behavioral, medical and public health fields with an opportunity to gain research ethics training. In doing so, RETI addresses the urgent need for HIV and drug use investigators who can identify and address ethical issues, engage drug using and other at-risk communities in the construction and evaluation of population sensitive research protections, and generate empirical data to inform ethical practice and policies for HIV prevention science. Through their funded Mentored Research Projects (MRP), RETI fellows generate empirical data, publish their findings in a variety of high-impact academic journals, and are trained to apply for increasing grant opportunities.

The program’s aims are to: (1) increase trainees’ knowledge of and capacity to address key ethical issues in HIV and drug abuse prevention research; (2) increase trainees’ capacity to ethically engage participants and communities in the construction of participant protections that reflect the values and merit the trust of all stakeholders in HIV and drug abuse prevention research.; (3) increase trainees’ capacity to conduct research that will generate data to inform HIV and drug abuse prevention research practices and policies; and (4) create and sustain an information and communication network for trainees, faculty and others in the field for enhancing ethical knowledge, ethical dialogue and future professional collaborations in HIV and drug abuse prevention research ethics.

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 is not a magical practice

Why does hearing about research sometimes scare us in a vertiginous way? I mean the feeling that researchers sometimes dig too deeply, that they see through what should not be seen through, that they manipulate the fundamental conditions of life.

It does not have to concern GMOs or embryonic stem cell research. During a period, I wrote about studies of human conversation. When I told people that I was working on conversation analysis, I could get the reaction: “Oh no, now I dare not talk to you, because you’ll probably see through everything I say and judge how well I’m actually talking.”

Why do we react in such a way? As if researchers saw through the surface of life, as through a thin veil, and gained power over life by mastering its hidden mechanisms.

My impression is that we, in these reactions, interpret research as a form of magic. Magic is a cross-border activity. The magician is in contact with “the other side”: with the powers that control life. By communicating with these hidden powers, the magician can achieve power over life. That is at least often the attitude in magical practices.

Is this how we view research when it scares us in a dizzying way? We think in terms of a boundary between life and its hidden conditions; a boundary that researchers transgress to gain power over life. Research then appears transgressive in a vertiginous way. We interpret it as a magical practice, as a digging into the most basic conditions of life.

The farmer who wants to control the water level in the field by digging ditches, however, is not a magician who communicates with hidden forces.

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

Inner Sense and Gender Dysphoria

Steve Phillips posted on “Caring for people with gender dysphoria” almost one year ago. In his post, he referenced a talk at a previous CBHD Summer Conference by Prof. Robert George, where Dr. George posited that the concept that the belief that one’s gender is based one’s innate or inner sense rather than one’s biological/physical sex is rooted in the Gnostic idea that human beings consist of a personal mind that lives in a non-personal body and that this stands in contrast to the longstanding Christian understanding of unity of non-material soul/spirit and material body making up the whole person. I did not attend that talk but offer a recent paper by Dr. George which covers the same ground as backdrop to this post.

The reason for the discussion of Gnosticism related to an earlier point in that same blog referencing the opinion of Dr. Paul McHugh, retired psychiatrist at Johns Hopkins University, who has over the past few years published comments arguing that gender dysphoria is a result of disordered thinking, that is, a mental disorder, requiring treatment, not surgery to complete a gender transition. Dr. McHugh has made much of the fact that Johns Hopkins, despite being an early leader in gender transition surgery, decided very early on that gender transition surgery was not sufficiently efficacious and discontinued the practice.

What a difference a year can make. Johns Hopkins has recently decided to resume what they are calling gender-affirming surgery and specifically point out that when “individuals associated with Johns Hopkins exercise the right of expression, they do not speak on behalf of the institution.”

Johns Hopkins is not alone.

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: Global Warming & Vegetarianism: What should I do, when what I do makes no difference? By Fergus Peace

This essay received an Honorable Mention in the Graduate Category of the Oxford Uehiro Prize in Practical Ethics 2017

Written by University of Oxford student, Fergus Peace

  1. The Problem of Cumulative Impact

In large, integrated societies, some of the most important moral challenges we face can only be resolved by large-scale collective action. Global poverty and climate change are problems which won’t be solved unless large numbers of people act to address them.

One important part of our response to these problems is to avoid fallacious ‘futility thinking’, a cognitive bias which makes people less likely to act when they see the problem as being too large for them to solve. You aren’t going to end world poverty alone, but that doesn’t mean there’s nothing you should do about it. Your individual donations can make an enormous difference.

Other problems, however, are more philosophically and practically challenging. Sometimes morally significant outcomes are driven by an aggregate which your individual action is powerless to meaningfully affect. In these cases, it’s not just that your individual action won’t completely solve the problem: it won’t do any moral good at all.

Consider a few examples.

  • Voting: No election of any real size is decided by a margin of one vote, so it’s true of your vote that it makes no difference: if you don’t vote and your candidate loses, your vote wouldn’t have made them win; if you do vote and they win, withdrawing your vote wouldn’t have made them lose.
  • Vegetarianism: Butchers don’t respond to every small change in their customers’ purchasing; wholesalers don’t respond to every change in one butcher’s purchasing; abattoirs and farms don’t respond to every change in wholesale orders.

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

Improving End-of-Life Care for African-Americans through Advance Care Planning in Partnership with Faith Communities

Leslie McNolty

The Center for Practical Bioethics has worked on end-of-life issues and advance care planning for more than three decades. Over the years, we’ve been enlightened and encouraged by the six reports that the National Academy of Medicine has issued on palliative and end-of-life care in the USA. These reports clearly establish that palliative care and hospice are essential to address suffering and quality care for the seriously and terminally ill. Research also shows that improving shared decision-making processes, such as advance care planning, provide a path to greater satisfaction for families experiencing the death of a loved one. We know that individuals who complete advance directive documents are more likely to have their preferences for end-of-life care respected — particularly the preference to die at home in hospice care. 

We also noticed with increasing alarm that African-Americans typically do not share in the benefits of advance care planning, palliative care and hospice care to the same extent that white Americans do. Statistics from the National Hospice and Palliative Care Organization consistently show severe underutilization of hospice by African-Americans – whites make up more than 80% of hospice utilization on a national level, with African-American utilization at about 8%. This disparity in hospice and palliative care utilization is particularly striking because African-Americans die at excessive levels from chronic diseases. 

Barriers and Opportunities

Unfortunately, there are significant barriers to implementing advance care planning tools in African-American communities. Many harbor a deep distrust of the traditional healthcare system stemming from egregious ethical violations in the past. Furthermore, African-Americans, who according to Pew Research Studies are know the most religious racial group in the USA, have significant religious concerns about advance care planning.

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

Are Incentives Corrupting? The Case of Paying People to be Healthy.

Written by Dr Rebecca Brown

Financial incentives are commonplace in everyday life. As tools of states, corporations and individuals, they enable the ‘tweaking’ of motivations in ways more desirable to the incentiviser. A parent may pay her child £1 to practice the piano for an hour; a café offers a free coffee for every nine the customer buys; governments offer tax breaks for homeowners who make their houses more energy efficient. Most people, most of the time, would probably find the use of financial incentives unobjectionable.

More recently, incentives have been proposed as a means of promoting health. The thinking goes: many diseases people currently suffer from, and are likely to suffer from in the future, are largely the result of behavioural factors (i.e. ‘lifestyles’). Certain behaviours, such as eating energy dense diets, taking little exercise, smoking and drinking large amounts of alcohol, increase the risk that someone will suffer from diseases like cancer, heart disease, lung disease and type II diabetes. These diseases are very unpleasant – sometimes fatal – for those who suffer from them, their friends and family. They also create economic harms, requiring healthcare resources to be directed towards caring for those who are sick and result in reduced productivity through lost working hours. For instance,the annual cost to the economy of obesity-related disease is variously estimated as £2.47 billion£5.1 billion and a whopping $73 billion (around £56.5 billion), depending on what factors are taken into account and how these are calculated. Since incentives are generally seen as useful tools for influencing people’s behaviour, why not use them to change health-related behaviours?

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.