Tag: prevalence

Bioethics Blogs

Global health porn: the case of Extreme Doctors

The last few years have seen a growing interest in the ethics of short-term medical missions in the developing world. Global health initiatives and programs in many universities often involve such missions, where medical students or faculty travel to a faraway lands (relatively resource-constrained, with high disease prevalence and fragile health infrastructure) and provide certain medical services, for awhile. These missions certainly enhance the prestige and attractiveness of Western medical institutions and schools of public health, and can improve the CV’s of those who participate in them. But those working in the field know such missions, particularly when embedded in longstanding partnerships, can also do some good. They also know that such missions can raise a number of serious ethical challenges that need to be addressed in advance, carefully thought through and continuously managed.

These ethical challenges include: students or doctors practicing beyond their competence; inadequate follow-up care for interventions that are provided, particularly for chronic conditions; disruption of local health systems and patient expectations; lack of correspondence between services provided and local health priorities; cultural clashes between Western views of medical need and local conceptions of health and disease. And so on. Further, since medical care is being dispensed by wealthy individuals and organizations to patients and communities that are relatively poor, questions about exploitation are never far away: who really benefits, or benefits the most, from these ‘exchanges’? How can such missions, however well-intentioned, avoid taking unfair advantage of the vulnerable? Efforts have been spent on developing ethical guidance, and while there are best practices for short-term global health missions out there, all this is clearly a work in progress.

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 Spending Grows Faster for Pets than Humans

A new paper from the National Bureau of Economic Research asks “Is American Pet Health Care (Also) Uniquely Inefficient?”


The abstract:  “We document four similarities between American human healthcare and American pet care: (i) rapid growth in spending as a share of GDP over the last two decades; (ii) strong income-spending gradient; (iii) rapid growth in the employment of healthcare providers; and (iv) similar propensity for high spending at the end of life. We speculate about possible implications of these similar patterns in two sectors that share many common features but differ markedly in institutional features, such as the prevalence of insurance and of public sector involvement.”



Among other findings:  In the last month of life, spending on the humans’ health care was more than twice what it was during a “regular” month.  For dogs, it was nearly 3.5 times higher.  (HT: Washington Post)

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 – October 2016 by Livia Garofalo

Here is our “In the Journals” roundup for October. In addition to a rich selection of abstracts, also of interest this month are a Special Issue of Osiris on the “History of Science and Emotions” and two recent articles by Fernando Vidal on brains in literature and cinema (linked below). Enjoy!

 

Theory & Psychology 

Desire, indefinite lifespan, and transgenerational brains in literature and film

Fernando Vidal 

Even before the brain’s deterioration became a health problem of pandemic proportions, literature and film rehearsed the fiction of brain transplantations that would allow an aging person to inhabit a younger body, so that successive surgeries may result in that person’s immortality. Such fiction makes the brain operate like an immaterial soul that does not undergo physical decline. This article examines that fiction as elaborated in Hanif Kureishi’s The Body and several films in connection with older fantasies that articulate desire, eternal youth, and personal immortality, with philosophical discussions about brain and personhood, and with people’s assimilation of neuroscientific idioms into their views and practices of personal identity. In conclusion it discusses how, in contrast to philosophical approaches that tend to focus on self-consciousness, first-person perspectives, and individual autonomy, fiction may contribute to direct attention to relationality as constitutive of personhood.

SubStance 

Frankenstein’s Brain: “The Final Touch”

Fernando Vidal 

 

Critical Public Health

A critical examination of representations of context within research on population health interventions

Jean Shoveller, Sarah Viehbeck, Erica Di Ruggiero, Devon Greyson, Kim Thomson and Rodney Knight

Research that fulsomely characterizes context improves our understanding of the processes of implementation and the effectiveness of interventions to improve the health of populations and reduce health inequalities.

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

People Are Tougher on Poor, Pregnant Opioid Addicts Than Well-Off Ones

November 2, 2016

(Vox) – Prescription opioid misuse among pregnant women poses especially difficult issues given the complex medical challenges of addiction treatment and pain management during pregnancy, the possibility of harm to the developing fetus, and the unique legal and ethical sensitivities arising in any potentially coercive intervention involving pregnant women. The prevalence of such disorders among pregnant women appears to have also increased by roughly a factor of four since 1999.

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

Hospitals Struggle to Address Terrifying and Long-Lasting ‘ICU Delirium’

October 17, 2016

(STAT News) – Recognizing the prevalence of the problem, doctors and nurses across the country are now pushing an ambitious campaign to change practices in intensive care units to reduce cases of “ICU delirium” — a sudden and intense confusion that can include hallucinations, delusions, and paranoia. Anywhere from a third to more than 80 percent of ICU patients suffer from delirium during their hospital stay. And one-quarter of all ICU patients suffer from post-traumatic stress disorder once they leave, a rate that’s comparable to PTSD diagnoses among combat veterans and rape victims. Patients with ICU delirium are less likely to survive and more likely to suffer long-term cognitive damage if they do.

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

Weighty Choices: Ethical Challenges of Addressing Eating Disorders

STUDENT VOICES | CHYNN PRIZE FIRST-PLACE WINNER 

By: Geena Roth

In certain situations, the moral or ethical decision is obvious, but more often than not, there are a number of complicating factors.  Almost all decisions we make will affect more than just ourselves, forcing us to weigh our own morality against another’s autonomy.  This is particularly true in the case of medical interventions for the sake of another’s health.

Anyone who has been a part of a long-distance friendship knows that there are very few things more exciting than the prospect of getting to see your friend in person for the first time since parting.  That excitement is somewhat marred, however, when your friend has so drastically changed that you literally do not recognize them.  The summer between my sophomore and junior years of high school, my family moved cross-country from Texas to Indiana, forcing me to leave my best friend behind.  We of course kept in touch via text and phone calls, but between the time change and our equally busy schedules, we rarely if ever had the chance to video chat.  Combine that with the fact that she is largely an abstainer from social media, and the result was that I hadn’t seen a picture of my friend in a year, at which point I was flying back to Texas to visit her and our other friends.  When my plane landed, I grabbed my things and rushed down the escalator to baggage claim, not realizing that I had looked my friend in the face and kept on walking because I did not recognize her. 

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

Conference Report: “Biopolitics and Psychosomatics: Participating Bodies” by Alev Sen

Biopolitics and Psychosomatics: Participating Bodies

8 July 2016, University of Cambridge

Conveners:
Darin Weinberg, University of Cambridge
Monica Greco, Goldsmiths, University of London
Robbie Duschinsky, University of Cambridge
Michael Schillmeier, University of Exeter

Introduction

Can we think of our living bodies as involving forms of social intelligence, agency, and power? And if so, how might this proposition transform the ways in which we consider the possibilities and politics of patient participation? These were the questions at the core of the intellectual agenda of the conference “Biopolitics and Psychosomatics: Participating Bodies”, held on 8 July 2016 at the Centre for Research in the Arts, Social Sciences and Humanities (CRASSH) at the University of Cambridge. The event—co-convened by Monica Greco (Goldsmiths), Darin Weinberg and Robbie Duschinsky (University of Cambridge) and Michael Schillmeier (University of Exeter)—aimed to reclaim the term ‘psychosomatic’ from the reductive and polemical forms of engagement in which it is often caught, and use it as a springboard for reframing questions of agency, embodiment, responsibility, power and choice in the context of current challenges facing state-sponsored service provision in Europe and the US.[1] The spirit of the conference was explicitly exploratory, more concerned with creating space for a new type of conversation than to provide direct answers to the many questions raised. Despite a last-minute cancellation by Laurence Kirmayer, who was scheduled to deliver the closing keynote, the conference proved successful, stimulating discussion and debate about these important and timely questions, on practical, political and intellectual levels.

After Darin Weinberg’s welcome address Monica Greco’s introduction outlined the multiple connotations of the term ‘psychosomatic’ and the striking contrast between them.

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

Neuroimaging in Predicting and Detecting Neurodegenerative Diseases and Mental Disorders

By Anayelly Medina

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris of Summer 2016.

Anayelly is a Senior at Emory University majoring in Neuroscience and Behavioral Biology. 

If your doctor told you they could determine whether or not you would develop a neurodegenerative disease or mental disorder in the future through a brain scan, would you undergo the process? Detecting the predisposition to or possible development of disorders or diseases not only in adults but also in fetuses through genetic testing (i.e. preimplantation genetics) has been a topic of continued discussion and debate [2]. Furthermore, questions regarding the ethical implications of predictive genetic testing have been addressed by many over the past years [4,8]. However, more recently, neuroimaging and its possible use in detecting predispositions to neurodegenerative diseases as well as mental disorders has come to light. The ethical questions raised by the use of predictive neuroimaging technologies are similar to those posed by predictive genetic testing; nevertheless, given that the brain is the main structure analyzed and affected by these neurodegenerative and mental disorders, different questions (from those posed by predictive genetic testing) have also surfaced.

Computerized Axial Tomography (CAT), Positron Emission Tomography (PET) and radioactive tracers, Magnetic Resonance Imaging (MRI), and Functional Magnetic Resonance Imaging (fMRI) are all current neuroimaging technologies used in the field of neuroscience. While each of these technologies function differently, they ultimately all provide information on brain functioning or structure. Furthermore, these neuroscientific instruments have, in recent years, been used to explore the brain in order to determine predictive markers for neurodegenerative diseases and mental disorders, such as Parkinson’s disease, Schizophrenia, Huntington’s disease, and Alzheimer’s disease [1,9,11,12].

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 Stain of the Spotless Mind: Policy Recommendations for Memory Erasure

By Peter Leistikow
This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris of Summer 2016.

Peter Leistikow is an undergraduate student at Emory University studying Neuroscience and Sociology. When he is not doing research in pharmacology, Peter works as a volunteer Advanced EMT in the student-run Emory Emergency Medical Service.
Over the course of 15 years, psychologist Dan McAdams studied how Americans describe their lives. Specifically, McAdams wanted to know what kind of life narratives were associated with lives high in “generativity;” that is, a concern for and commitment to promoting the well-being of future generations. He ultimately discovered that generative adults had narrative identities that emphasized redemption, such as a second chance or delivery from suffering (McAdams 2006).

The observation that it might be essential to have overcome adversity, reaping all the lessons and baggage it entails, in order to become a compassionate, mature adult is especially important in light of new developments in the field of dampening or even erasing memories. This alarming area of research warrants a further examination by policymakers, and it is the recommendation of this briefing that decisive limitations should be imposed on access to this technology.
Image courtesy of Flikr

Memories were not always considered malleable; it was not until the 1960s that experiments in rats challenged the ideas that memories could be subjected to further modification, given the right conditions (Singer 2009). Fearful memories are made when emotionally salient events are labeled by the amygdala in the brain as emotionally significant and sent to the hippocampus for consolidation, strengthening synaptic connections into what will become a memory (Lu 2015).

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

Health Care Decision Making for Unbefriended, Incapacitated Adults: A Value-Committed Policy Transfer Analysis

Despite the scope and prevalence of the problem, there is not much literature
addressing the problem of incapacitated unrepresented patients.  One new 21-page article nicely summarized the issues.

This article then zeroes in to assess two innovative approaches.  Texas permits clergy to serve as default surrogates.  Florida permits social workers.

The authors write:  “These mechanisms allow for surrogate or proxy consent for medical treatment not otherwise covered by emergency consent procedures. Moreover, this mechanism supports timely health care decisions for patients who otherwise are subject to institutional ad hoc approaches to consent for non-emergent treatment or judicial processes such as guardianship or emergency treatment orders.”

“Although of benefit to the patient, default surrogate or proxy mechanisms for unbefriended, incapacitated patients carry implicit benefits in the form of economic gains to health care organizations that come from facilitating timely health care decisions. These gains may come in the form of expediting  hospital discharges. . . .  In essence, the mechanisms to facilitate health care decision making for unbefriended, incapacitated patents function as a double-edged sword: vulnerable patients benefit from a health care agent to facilitate medical care decision making and entities (e.g., for-profit hospitals, state resources) realize economic gains from alternatives to guardianship.”

“Therefore, it is imperative to acknowledge these competing interests when surrogate and proxy health care decision makers for unbefriended, incapacitated adults are selected such that competing interests are  minimized.”

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.