Tag: practice

Bioethics Blogs

Politics of Pain: Investigating the Ethics of Palliative Care as a Global Human Right

by Alix Masters

Within the last decade, strides have been made in the field of global health policy to extend the reaches of palliative care universally.  In 2014, the World Health Organization formally declared palliative care a global human right.[1] This development in global health policy is a positive one when we consider the medical politics of pain relief across racial difference.  Both in the United States and abroad, there is a long medical history of discriminatory practices against certain groups of people with regard to pain management—including withholding necessary pain medication altogether.  Therefore, in many ways the declaration of palliative care as a human right is a necessary step in ensuring all peoples, regardless of identity, have their pain taken seriously by the medical establishment and have their comfort made a medical priority.  When we consider how different cultures negotiate beliefs around death and pain relief, however, the issue of palliative care as a universal human right becomes more complex.  For example, countries with strong histories of Buddhist thought and culture have traditionally opposed the ideology of palliative care.[26]  In Buddhism, suffering is considered an inextricable part of life and masking this suffering through medical intervention is looked down upon.[2]  For example, Vietnam, a country with a culture strongly imbued with Eastern Buddhist values, has a long history of rejecting palliative care and pain medications in general.[26]  Due to this, the World Health Organization’ declaration that palliative care is a universal human right could also be understood as a Western organization blatantly ignoring Buddhist cultural traditions.  While the declaration of palliative care as a human right is important progress in many ways, it is also important that Western medicine not impose our values globally without consideration for the complex histories and belief systems of diverse cultures.

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

Harvey and Irma: Bioethics in Natural Disasters

by Craig Klugman, Ph.D.

This is a time of disaster. Last week Hurricane Harvey devastated Southeast Texas, a place where I did my doctoral studies. This week we are awaiting Hurricane Irma, the strongest hurricane to head toward South Florida in 25 years. My family lays in the path of that coming storm. I first became interested in natural disaster in 1989 when my college campus was jolted by a 7.1 earthquake in Northern California.

Bioethics has a role in responding to and preparing for these natural disasters. Most every state, large city and county, and most hospitals have been working on crisis standards of care plans. In 2009 and again in 2012, the Institute of Medicine recommended governments to undertake such planning. Many of us working in bioethics have been involved in these efforts. More specifically, we have been involved with developing ethical frameworks for decision-making, policy-making, and operations during emergency planning.

I worked with Texas during its planning for pandemic flu and for the last 3 years have been part of the ethics subcommittee of Illinois’ workgroup, most recently as chair. Similar groups have produced excellent reports in many places such as Delaware, North Carolina, Michigan, Minnesota, Tennessee, Texas and Toronto. They offer guidance and justification for a varied set of guiding principles and ethical frameworks. All of them hold certain core ideals in common.

First, all of the reports agree that transparency and open communication is essential. Planning needs to involve not only government officials, but also community members.

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

American Nurses Association Supports VSED

Too few medical associations have issued either practice guidelines or policies on VSED. Fortunately, the American Nurses Association issued a favorable position statement this summer. 


The ANA concludes: “VSED at the end of life is used to hasten death, and is a reflection of autonomy and the patient’s desire for control.”

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

Lifetime Achievement in Bioethics

Center for Practical Bioethics Founding Executive Myra Christopher Honored by American Society for Bioethics and Humanities 

Forty years ago, a young Johnson County, Kansas, homemaker stood by her mother’s grave and promised to spend the rest of her life working to ensure that those living with serious illness could have their wishes honored and values respected. That same year, her college philosophy professor introduced her to a new “movement” called bioethics that advocated for patients to actively engage in their own care. Following graduation, from 1984 through 2011, she served as founding executive director of the Center for Practical Bioethics in Kansas City.

On October 20, 2017, Myra Christopher’s four-decade journey will culminate in her acceptance of the 2017 Lifetime Achievement Award from the 1,800-member American Society for Bioethics and Humanities (ASBH) at the national association’s conference hosted in Kansas City.

Early in Christopher’s career at the Center for Practical Bioethics, she and her founding board faced challenges like court reporters, judges and lawyers appearing in hospital rooms to intervene on end-of-life decisions. Hospice care was, for the most part, still rare.

Unlike the half dozen academia-based bioethics centers that existed at the time, the vision for the Center was to create an independent, free-standing nonprofit that converts bioethics theory into services and resources to serve real patients, families, providers and policymakers facing real-life healthcare issues and crises in real time.

In recognition of Christopher’s role in achieving this vision, ASBH professionals from clinical and academic settings along with those from medical humanities throughout the country will present her with its most prestigious honor in afternoon ceremonies at the Sheraton Crown Center Hotel in Kansas City, Missouri.

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

Robotic Exoskeleton Could Be Right Step Forward for Kids with Cerebral Palsy

More than 17 million people around the world are living with cerebral palsy, a movement disorder that occurs when motor areas of a child’s brain do not develop correctly or are damaged early in life. Many of those affected were born extremely prematurely and suffered brain hemorrhages shortly after birth. One of the condition’s most common symptoms is crouch gait, which is an excessive bending of the knees that can make it difficult or even impossible to walk. Now, a new robotic device developed by an NIH research team has the potential to help kids with cerebral palsy walk better.

What’s really cool about the robotic brace, or exoskeleton, which you see demonstrated above, is that it’s equipped with computerized sensors and motors that can detect exactly where a child is in the walking cycle—delivering bursts of support to the knees at just the right time. In fact, in a small study of seven young people with crouch gait, the device enabled six to stand and walk taller in their very first practice session!

For people with cerebral palsy, crouch gait is now treated with a variety of approaches, often including wearing orthotic ankle braces that help to stabilize their legs. Still, about half of kids with cerebral palsy can’t walk by early adulthood. Their muscles simply can’t keep up with their growing bodies.

That’s led to development of many robotic training devices, though most are still restricted to use in a supervised clinical setting. In the new study, led by Thomas Bulea at the NIH Clinical Center in Bethesda, MD, the team wanted to develop a wearable system for potential home use to help keep more kids walking as they grow into adulthood.

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

Surrogacy opposed by leading English feminist. In Asia to find poor women who allowed themselves to be inseminated to provide children

Julie Bindel is an English lesbian feminist born in 1962, who British newspaper the “Independent” included on its 2010 list of the 101 most influential gay and lesbian people in Great Britain. Although she has not been an activist for same-sex marriage (because she believes that the State should not regulate these marriages), she says that she is indignant that some women are considered worthless or inferior. It is therefore clear to her that the surrogacy industry damages women and children, and she says that it should not be legalized in any country. She also warns that it can never be justified under the cover of “altruistic” cases, which are a mere trick to legitimize a million dollar business. She had been in India (see her statment *) and Cambodia visiting India’s surrogacy clinics to find out about the situation of poor women who allowed themselves to be inseminated and impregnated to provide children to “rich white Westerners”. She is now collaborating with the international platform “Stop Surrogacy Now” (surrogacy international campaign to avoid it), and together with other activists has visited Spain to ask that the country maintain its laws that do not recognize any type of gestational surrogacy (See HERE ).

  • I decided to visit four clinics in Gujarat, one of India’s most religious states – known as the country’s surrogacy capital – posing as a woman interested in hiring a surrogate and egg donor to gain access to those providing the services. I wanted to be able to speak from experience about the human rights abuses that result from the practice, and to become more involved in the international campaign to abolish it (The Guardian).

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

Transhumanism. Error of the gods and the power of man? A phylosofical approach

Technological progress urgently needs the emergence of moral progress so that the spark of reason does not consume the existence of humankind

The technical skills of humans have always been remarkable throughout history, so much so that, even now, the artifacts of classical antiquity leave us astounded at the ingenuity of man. Those who are familiar with the Antikythera mechanism (see video HERE) can attest to the fact that the complexity of this computing system, devised to calculate the movement of the stars, is staggering. The wonder that our creations elicit in us might make us think that the creative and technical ability that characterizes us has a divine origin.

It was Plato, among others, who described in his Protagoras, and put into the mouth of the famous Athenian sophist, the myth of the formation of man. In it, the gods forge the mortal races from other gods that have not yet finished forming in the elements of earth and fire. Thus, the gods command the brothers Prometheus and Epimetheus to capture these incomplete gods and divide their abilities to distribute them among the mortal races. Hence, the link of the mortal races with the gods is obvious according to the myth, because they are formed from the fragments of incomplete gods.

Epimetheus asks Prometheus to allow him to take charge of the formation of the new races, and distributes the fragmented abilities. His intention is to create a balance between the new beings so that they do not destroy each other. Those that enjoy some advantage over the rest are surpassed by others in another aspect.

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

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

Second International Conference on End of Life Law, Ethics, Policy, and Practice

There is less than two weeks until the Second International Conference on End of Life Law, Ethics, Policy, and Practice.  

This is a truly worldwide meeting of leading end-of-life policy and ethics academics and researchers in Halifax, Nova …

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

Beginning Your Medical Journey: Advice for First-Year Students

By Steve Goldstein

On August 19, 2017, I offered the keynote address at the Loyola University Chicago Stritch School of Medicine Class of 2021 White Coat Ceremony.  It was an honor to address this class, my first as dean.  I had welcomed the students during orientation when they were absorbing a great deal—rules, responsibilities, schedules, safety, organization– and met with them during discussions of a book we all read recounting the rich, complex career of pediatrician– events when they were in a focused, serious mood.  This day, however, the student’s were with their families and excited, bolstered by well-deserved pride, and filled with the shared mission of improving the world through the practice of medicine.  Below are the thoughts I shared in my address to the class as they began their formal training as first-year medical students…

Family, friends, alumni, faculty, and staff, I welcome you to the 2017 Loyola University Chicago Stritch School of Medicine White Coat Ceremony.  Class of 2021, I welcome you to the beginning of your careers in medicine.  I am delighted to be with you today.

As the students already know, the Class of 2021 is my first as dean– so, we begin this journey together.

You also know that I am a pediatrician, so you will forgive me if I continue to offer some practical guidance as I did last week– based on 40 years of experience since I sat where you are now:

Lesson one: no one is born an adult.
The corollary is this: no physician begins by being fully trained.

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.