Tag: standards

Bioethics Blogs

Fordham University’s Dr. Celia Fisher on Reversal of the Goldwater Rule

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The American Psychoanalytic Association announced earlier this month that members of the association no longer need to abide by the long-established “Goldwater Rule” named after 1964 presidential candidate Barry Goldwater. The rule, which can be found in Section 7.3 of the American Psychiatric Association’s (APA) Ethics Code, cautions against most psychiatrists and other mental health professionals offering opinions about an individual publicly – including the President of the United States.

According to Dr. Celia Fisher, Professor of Psychology and Director of the Fordham University Center for Ethics Education, this decision “elevated political and economic considerations above ethical principles.”

In an interview with Fordham News, Dr. Fisher stated, “Revising ethical standards to address a particularly problematic political figure or to condone the publication of a book does not reflect well on the association.  The public should be aware that the American Psychoanalytic Association organization does not represent the field of psychiatry per se, but a group of professionals who practice a particular therapeutic orientation within the mental health profession known as psychoanalysis.”

“Responsible diagnosis in psychoanalysis, as in other mental health fields, relies on assessment techniques that are characterized by interactions with and analysis of patient responses to specific established questions. A professionally and ethically responsible diagnosis cannot be determined in the absence of such interactions or assessments. For example, although the American Psychological Association has not adopted a “Goldwater Rule”, the importance of appropriate assessments are intrinsic in its ethics code, which forbids psychologists from providing opinions of the psychological characteristics of individuals if they have not “conducted an examination of the individuals adequate to support their statements or conclusions”.

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 Sessions at ASBH 2017

The 2017 ASBH
conference
 in October 2017 includes over 400 workshops, panels, and
papers in bioethics and the health humanities.  Here are ones that pertain
to end-of-life issues.


THURSDAY, OCTOBER 19


THU 1:30 pm:  End-of-Life Care and Decision-Making in the ICU – Limited
English Proficiency as a Predictor of Disparities (Amelia Barwise)


Importance: Navigating choices in predominantly English-speaking care settings
can present practical and ethical challenges for patients with limited English
proficiency (LEP). Decision-making in the ICU is especially difficult and may
be associated with disparities in health care utilization and outcomes in critical
care. 


Objective: To determine if code status, advance directives, decisions to limit
life support, and end-of-life decision-making were different for ICU patients
with LEP compared to English-proficient patients. 


Methods: Retrospective cohort study of adult ICU patients from
5/31/2011-6/1/2014. 779 (2.8%) of our cohort of 27,523 had LEP. 


Results: When adjusted for severity of illness, age, sex, education, and
insurance status, patients with LEP were less likely to change their code
status from full code to do not resuscitate (DNR) during ICU admission (OR,
0.62; 95% CI, 0.46-0.82; p


Conclusion: Patients with LEP had significant differences and disparities in
end-of-life decision-making. Interventions to facilitate informed
decision-making for those with LEP is a crucial component of care for this
group.


THU 1:30 pm:  “But She’ll Die if You Don’t!”: Understanding and
Communicating Risks at the End of Life (Janet Malek)


Clinicians sometimes decline to offer interventions even if their refusal will
result in an earlier death for their patients. For example, a nephrologist may
decide against initiating hemodialysis despite a patient’s rising creatinine
levels if death is expected within weeks even with dialysis.

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

Common ground in ethical debates

On 7/10/17, Janie Valentine posted a review of the new book, Why People Matter, edited by John Kilner. Recently while I was on vacation I had the chance to read it and found the basic concept of the book very interesting. It begins with the idea that people on opposite sides of many of the ethical debates in our society actually have common ground that they agree on which can be used to engage each other in a constructive way. I heartily agree with that idea and would suggest that one area of common ground is that those interested in moral and ethical issues agree that morality is important and that there are ethical standards that should influence how we live. That is good place to start. Dr. Kilner and his co-authors are more specific in suggesting that the concept that people matter, that they have moral significance and should be treated with respect, is an underlying concept that people on both side of many currently debated issues use to support their positions. That is also a very good place to start.

From that starting place the authors look at five common ways of looking at the world and moral issues and show that there are some problems with supporting the common idea that people matter within those ways of seeing the world. They contrast that with the robust support for the significance of people with in a Christian view. I was particularly impressed by the reviews of utilitarianism, individualism, and naturalism by Gilbert Meilaender, Russell DiSilvestro and Scott Rae.

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

Trump is Gross: Taking Political Taste (and Distaste) Seriously

by Shelley Park 

ABSTRACT. This paper advances the somewhat unphilosophical thesis that “Trump is gross” to draw attention to the need to take matters of taste seriously in politics. I begin by exploring the slipperiness of distinctions between aesthetics, epistemology, and ethics, subsequently suggesting that we may need to pivot toward the aesthetic to understand and respond to the historical moment we inhabit. More specifically, I suggest that, in order to understand how Donald Trump was elected President of the United States and in order to stem the damage that preceded this and will ensue from it, we need to understand the power of political taste (and distaste, including disgust) as both a force of resistance and as a force of normalization.

My 5-year-old granddaughter refers to foods, clothes, and people she does not like as “supergross.” It is a verbiage that I have found myself adopting for talking about many things Trumpian, including the man himself. The gaudy, gold-plated everything in Trump Towers; his ill-fitting suits; his poorly executed fake tan and comb-over; his red baseball cap emblazoned with “Make America Great Again;” his creepy way of talking about women (including his own daughters); his racist vitriol about Blacks, Muslims and Mexicans; his blatant over-the-top narcissism; his uncontrolled tantrums; his ridiculous tweets; his outlandish claims; his awkward hand gestures and handshakes; the disquieting ease with which he is seduced by flattery; his embarrassing disregard for facts; his tortured use of language; his rudeness toward other world leaders; the obsequious manner in which other Republicans are treating the man they despised mere months ago; the servility of many Democrats in the face of a military–industrial coup.

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

Jahi McMath – Evidence that She Is Now Alive Considered by Court Today

Later today (California time), is a hearing on the Motion for Summary Adjudication of Plaintiff Jahi McMath’s First Cause of Action for Personal Injuries, filed jointly by all defendants (“Defendants”) on March 23, 2017.


Judge Stephen Pulido has posted his tentative ruling. I have pasted that below.   



Defendants and for Plaintiffs McMath et al. (“Plaintiffs”) shall be prepared to address, among other things, the following: 



(1) The supporting and opposition papers are “heavy” on discussion of the various medical diagnoses and opinions but “light” on discussion of the applicable legal standards for the court to apply. For example, though Defendants include a collateral estoppel argument, there is only one paragraph addressing it on the last page of Defendants’ memorandum, with a single case cite as to the general application of collateral estoppel, and this issue is not identified in the Notice of Motion. Is this a separate basis of the motion, and if so, have Defendants given proper notice of this? Which facts in the Separate Statement of Undisputed Material Facts (“UMF”), if any, are material to this issue? 



(2) The Notice of Motion states that the motion “is made on the grounds that Jahi McMath lacks standing to sue for personal injuries because she was pronounced deceased in accord with California law in December 2013. The undisputed material facts establish that no mistakes were made in the determination of McMath’s brain death in December 2013, and the diagnosis of McMath’s brain death was made in accord with the accepted medical standards required by California law.”

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

Charlie Gard, the New England Journal of Medicine, and the Limits of “Conscience”

I would venture that most bioethicists would agree it would be ethically permissible to remove life support and active care from little Charlie Gard, and let him die.   The hospital in Britain where he has been receiving his care wants to do that, and the courts agree.  But why do they insist on this action when his parents want to transfer him for another try at experimental treatment, have raised the money, and reportedly have a center in the US willing to accept him for such an attempt?

I can think of two reasons.  One is a frank utilitarian insistence on limiting costs.  It has been publicly charged that is precisely the motive for this and similar recent cases in the U.S.

Or it could be that those caregivers who argue against the futility of such care do so on conscience grounds.  This is at least a more charitable reading.

But if that is the case, then might we not ask:  on what grounds do such conscience concerns mandate blocking the wishes of the baby’s parents—setting aside just how quickly the futility of further care would be evident?  It is commonly argued that practitioners who wish not to provide abortions or participate in assisted suicide retain a professional obligation to refer to someone who will perform the procedure in question.

So why don’t we demand that the British hospital actively refer Charlie’s parents to another facility?  Just wondering…

Maybe the parents in this case are the ones appealing to conscience, but, in the view of the medicolegal authorities, wrongly so. 

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

Editor-in-Chief Journal of Medical Ethics

The Institute of Medical Ethics and BMJ are looking for the next Editor-in-Chief who can continue to shape the Journal of Medical Ethics into a dynamic resource for a rapidly evolving field. Candidates should be active in the field, keen to facilitate international perspectives and maintain an awareness of trends and hot topics. The successful candidate will act as an ambassador for the journal supporting both pioneering authors and academics publishing their first papers. The candidate will also actively promote and strengthen the journal whilst upholding the highest ethical standards of professional practice. The editor will work with IME to promote research and scholarship in medical ethics and attend IME board meetings regularly.

International and joint applications are welcomed. Interviews will be held in December 2017. Term of office is five years; the role will take 12-15 hours a week. Contact Richard Sands (rsands@bmj.com) for more information and to apply with your CV and cover letter outlining your interest and your vision for the future development of the journal.

Application deadline: 31 October 2017; Interviews: December 2017

Start date: 1 June 2018 (handover from February 2018)

About Journal of Medical Ethics

Journal of Medical Ethics launched in 1975 and has since become a leading international journal that reflects the whole field of medical ethics. Publishing Original Research, Extended Essays, Current Controversies, Feature articles, Review articles and more, the journal is relevant to health care professionals, members of clinical ethics committees, medical ethics professionals, researchers and bioscientists, policy makers and patients.

The journal regularly publishes special collections on current hot topics and key conversations in the field including: Circumcision, DSM-5, Stem cell derived gametes and Withholding artificial nutrition & hydration.

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

A medical, legal and ethical approach of paediatric euthanasia in Belgium

We believe it interesting to refer to an article published in JAMA (311, 1963-1964) last May, which discussed various aspects of paediatric euthanasia en Belgium.

On 13 February 2014, the Belgian Parliament approved an amendment to the Act regulating euthanasia in Belgium, in order to legalise euthanasia in children with serious illnesses. The amendment in question, supported by the majority of Belgians and recently signed into law by King Philippe, will allow euthanasia in children who are permanently in severe pain. As in all cases of euthanasia, parental consent will be required, and it will exclude children with intellectual disabilities or mental illnesses and must be approved by a multidisciplinary medical team, who will carefully assess the mental capacity of these children.

The approval of this law marks the culmination of the gradual acceptance of euthanasia in Belgium. To date, the Netherlands, Belgium and Luxemburg are the only countries in the European Union in which euthanasia is legal.

Euthanasia for adults has been legal in Belgium since May 2002, unlike paediatric euthanasia. A preliminary study examining the opinion of physicians on child euthanasia showed that 69% were in favour of legalising it.

In March 2005, recognising that euthanasia in children was rising, without the due legal protection, doctors from the University of Groningen in the Netherlands published practice guidelines for euthanasia in severely disabled newborns. This document is in favour of the legalisation of active euthanasia in children “with a hopeless prognosis who experience […] unbearable suffering”. The protocol specifies that terminating the life of these children may be acceptable if four requirements are met: a) the presence of hopeless and unbearable suffering; b) the consent of both parents; c) consultation with physicians; and d) that the procedure for terminating the life of these children be in accordance with medical standards.

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

Rethinking the Belmont Report? Yes!

Some bioethicists link the beginnings of our field to the Nazi Medical experiments and the Nuremberg Trial (Annas). Whether this is the beginning of bioethics is debatable, but without a doubt, research ethics has been a central topic in the field. In fact, the very first federal bioethics commission laid out the principles of research ethics in the Belmont Report. Later, the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research recommended to the President and Congress that a uniform framework and set of regulations should govern human subjects research.  This effort reached fruition under The Federal Policy for the Protection of Human Subjects or the “Common Rule” that was issued in 1991.  Since then, there have been no major changes to the regulations – until now.  After a five-year process and thousands of comments, the new “final rule” was released on January 19th, 2017.  The July 2017 issue of the American Journal of Bioethics addresses these changes.  In addition to our usual open peer commentaries, we are posting a number of blog posts written in response to the AJOB target article.


by Emily Caldes, MA, CIP and Jennifer B McCormick, Ph.D., MPP

As noted by Friesen, Kearns, Redman and Caplan in their review of the Belmont Report, the Belmont Commission tackled the difficult task of distinguishing research from practice. The report defines research activities as those intended to develop or contribute to generalizable knowledge, and it defines practice as activities intended to enhance the well-being of particular individuals or groups of individuals.

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

Companies Announce Support for SDG 14 Implementation

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June 2017: Private companies continue to announce support for Sustainable Development Goal 14 (life below water) implementation. Albertsons Companies and Calysta are the latest to relay how they will help the international community meet targets on oceans. Their initiatives focus on sustainable fisheries and aquaculture, in particular, and join announcements from other industry players like Dell, Adidas and the New Plastics Economy, which address marine plastic pollution.

Albertsons Companies, one of the largest US supermarket companies, announced its support for SDG 14. It joined the Seafood Task Force and signed on to the pledge on Committing to Social Responsibility in Global Fisheries and Aquaculture, a voluntary commitment made by the private sectors, NGOs and the UN, during the UN Ocean Conference. The Seafood Task Force, a multi-stakeholder alliance that is combating human rights and environmental issues in seafood supply chains, was initially formed to address issues of forced labor, illegal fishing and human trafficking in Thailand’s seafood supply chains, and aims to serve as a model for global supply chains. Albertsons Companies has already established a Responsible Seafood Policy, which lays out standards that the top wild and farmed seafood products sold by the company are expected to meet.

Calysta, a company that produces sustainable products to improve global food security, pledged to support SDG 14 by advancing technology to promote sustainable aquaculture, which is the world’s fastest growing food production system and is increasing demand for new protein sources. Calysta produces FeedKind protein, a sustainable, traceable and natural feed ingredient that does not rely on wild fish catch.

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.