Tag: statutes

Bioethics Blogs

Obamacare as Superstatute

By Abbe R. Gluck I am have always been a partial skeptic about Eskridge and Ferejohn’s “superstatute” theory—their groundbreaking argument that certain statutes are special because they transform and entrench norms beyond the rights embodied in the statute itself. Some … Continue reading

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

Legal status of human-animal chimeras – hybrid embryos

In addition to the biomedical problems raised by human-animal hybridization, there are also objective legal problems.

A recent article in the Journal of Medical Ethics (2014; 40, 284-285) reviewed this topic following a debate in the United Kingdom (UK) House of Lords in December 2012. The underlying problem is to determine whether hybrids containing human biological material, mainly DNA, should be considered partially human and if so, what their legal status should be.

See our Special Report New advances and challenges in the production of human-animal chimeras

The Human Fertilisation and Embryology Act 2008 (HFE Act 2008) regulates the legal aspects of human-animal hybrids. These hybrids refer to any embryo containing human nuclear or mitochondrial DNA as well as animal nuclear or mitochondrial DNA, but in which the animal DNA is not predominant. Other categories of hybrids can be legally regulated by the “Animal Act 1986”.

However, deciding which of the two categories into which hybrid embryos should fall is not that easy.

The English Health Minister, Lord Darzi of Denham, stated that hybrid embryos should be regulated by human statutes when they are considered to be “predominantly” human, which is not easy to determine. In fact, a chimeric embryo in which non-human cells were initially predominant could continue to develop into a hybrid in which human cells predominate.

Lord Darzi also stated that chimeric embryos that are “functionally” predominantly human should also be considered as human. However, the term “functionally human” is ambiguous, which complicates the issue of its legal status.

It was therefore concluded that the UK parliament needs to more definitively determine the legal status of embryos containing human and animal genetic material, following an extensive, in-depth debate that must take into account public opinion on this matter.

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

Medical Futility and Religious Free Exercise

University of Utah law professor Teneille Brown has just posted a copy of “Medical Futility and Religious Free Exercise” recently published in First Amendment Law Review.


“A tragic scenario has become all too common in hospitals across the United States. Dying patients pray for medical miracles when their physicians think that continuing treatment would render no meaningful benefit. This situation is unfortunately referred to as ‘medical futility.’”


“In these cases, physicians, who are less likely than their patients to rely on God as a means of coping with major illness, are at an impasse. Their patients request everything be done so that they can have more time for God to intervene, but in the physician’s professional experience, everything will probably do nothing. What is the physician to do?”


“The conundrum is a modern one: medical technologies such as breathing machines and dialysis units can support human bodies almost indefinitely when many of our organs fail. But is there any limit on this technological imperative?”


“Every state and the U.S. Constitution recognize that a patient has the legal right to refuse unwanted treatment, even if it is life-sustaining. However, there is no corresponding constitutional right to demand specific treatments. Further, most states have passed so-called ‘medical futility statutes.’ These statutes make it explicit that physicians have immunity from negligence claims if a physician refuses to offer futile treatment, so long as particular statutory safeguards are met.”


“Even if there is no general legal entitlement to medical care and physicians may be immunized from negligence claims, can the invocation of a state’s medical futility statute violate free exercise under state RFRAs, or the U.S.

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

Dear Mr. President: It’s Time for Your Bioethics Commission

by Craig Klugman, Ph.D.

Last week, seven Democratic members of the U.S. House Representatives sent a letter to the White House asking President Trump to appoint a director to the Office of Science and Technology Policy (OSTP), position that normally serves as the presidential science advisor. The impetus for writing the letter was a communication from the Deputy National Science Advisor that two hoax reports, that tried to undermine climate change, were circulating through the West Wing as “science.” The Congresspersons state “Where scientific policy is concerned, the White House should make use of the latest, most broadly-supported science…Relying on factual technical and scientific data has helped make America the greatest nation in the world.” Among the signers are a PhD in math and a PhD in physics. They hold that the U.S. faces strong questions that revolve around science, both opportunities and threats, and the need for a scientist who can understand and explain the importance of objective fact to the chief executive is essential.

This article led me to think that the U.S. also faces a lot of issues regarding health and medicine and their impact on society. Consider the task of creating a new health plan, CRISPR/CAS-9, in vitro gametogenesis, the threat of Zika, extra uterine gestational systems, legalized marijuana, digital medicine—pharmaceutical computing for treating disease, head transplants, and DYI science are among the bioethical issues that will effect policy in the coming few years. Thus, it is time for President Trump to call for his Presidential Bioethics Commission.

The last bioethics advisory body ended in January 2017, although many of the staff are still winding down the office and archiving the many reports and papers produced.

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 Right to Die The Law of End-of-Life Decisionmaking – 2nd 2017 Supplement

For decades, Wolters Kluwer has been publishing an annual supplement for The Right to Die: The Law of End-of-Life Decisionmaking.  This year, we are moving to a semi-annual plan.  So, there will soon be a second 2017 update, the “2017-2 Supplement.”


Highlights of this extra supplement cover the most recent legal developments—judicial cases, legislation, and news accounts of important legal proceedings that are not officially reported—concerning end-of-life decisionmaking. Some (and there are many more) specific important matters covered in the supplement include:

  • The passage of statutes authorizing medical aid-in-dying in two more states, bringing the total number of jurisdictions in which the practice is legal to seven.
  • The passage of statutes explicitly criminalizing or otherwise prohibiting aid-in-dying in two more states.
  • The passage of statutes authorizing default surrogate priority lists in two more states.
  • An innovative Montana statute authorizing physician decisionmaking for incapacitated unrepresented patients with no surrogate, agent, or guardian.
  • The passage of a statute authorizing a POLST program, bringing the total number of jurisdictions formally authorizing or regulating POLST to thirty-three. 
  • A Kansas statute forbidding the institution of a DNR order for a minor without consent from the parent or guardian. 
  • The passage of statutes in four states both forming palliative care and quality of life task forces and directing health departments to promote both professional and consumer palliative care education.
  • A strong statement of support for autonomy through advance directives from the California Court of Appeals as it awarded attorneys’ fees to a governmental agency that challenged the end-of-life decisionmaking of a husband, with his wife as agent, supported by the health providers involved in his care. 

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 Right to Die The Law of End-of-Life Decisionmaking – 2nd 2017 Supplement

For decades, Wolters Kluwer has been publishing an annual supplement for The Right to Die: The Law of End-of-Life Decisionmaking.  This year, we are moving to a semi-annual plan.  So, there will soon be a second 2017 update, the “2017-2 Supplement.”


Highlights of this extra supplement cover the most recent legal developments—judicial cases, legislation, and news accounts of important legal proceedings that are not officially reported—concerning end-of-life decisionmaking. Some (and there are many more) specific important matters covered in the supplement include:

  • The passage of statutes authorizing medical aid-in-dying in two more states, bringing the total number of jurisdictions in which the practice is legal to seven.
  • The passage of statutes explicitly criminalizing or otherwise prohibiting aid-in-dying in two more states.
  • The passage of statutes authorizing default surrogate priority lists in two more states.
  • An innovative Montana statute authorizing physician decisionmaking for incapacitated unrepresented patients with no surrogate, agent, or guardian.
  • The passage of a statute authorizing a POLST program, bringing the total number of jurisdictions formally authorizing or regulating POLST to thirty-three. 
  • A Kansas statute forbidding the institution of a DNR order for a minor without consent from the parent or guardian. 
  • The passage of statutes in four states both forming palliative care and quality of life task forces and directing health departments to promote both professional and consumer palliative care education.
  • A strong statement of support for autonomy through advance directives from the California Court of Appeals as it awarded attorneys’ fees to a governmental agency that challenged the end-of-life decisionmaking of a husband, with his wife as agent, supported by the health providers involved in his care. 

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 Right to Die The Law of End-of-Life Decisionmaking – 2nd 2017 Supplement

For decades, Wolters Kluwer has been publishing an annual supplement for The Right to Die: The Law of End-of-Life Decisionmaking.  This year, we are moving to a semi-annual plan.  So, there will soon be a second 2017 update, the “2017-2 Supplement.”


Highlights of this extra supplement cover the most recent legal developments—judicial cases, legislation, and news accounts of important legal proceedings that are not officially reported—concerning end-of-life decisionmaking. Some (and there are many more) specific important matters covered in the supplement include:

  • The passage of statutes authorizing medical aid-in-dying in two more states, bringing the total number of jurisdictions in which the practice is legal to seven.
  • The passage of statutes explicitly criminalizing or otherwise prohibiting aid-in-dying in two more states.
  • The passage of statutes authorizing default surrogate priority lists in two more states.
  • An innovative Montana statute authorizing physician decisionmaking for incapacitated unrepresented patients with no surrogate, agent, or guardian.
  • The passage of a statute authorizing a POLST program, bringing the total number of jurisdictions formally authorizing or regulating POLST to thirty-three. 
  • A Kansas statute forbidding the institution of a DNR order for a minor without consent from the parent or guardian. 
  • The passage of statutes in four states both forming palliative care and quality of life task forces and directing health departments to promote both professional and consumer palliative care education.
  • A strong statement of support for autonomy through advance directives from the California Court of Appeals as it awarded attorneys’ fees to a governmental agency that challenged the end-of-life decisionmaking of a husband, with his wife as agent, supported by the health providers involved in his care. 

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

DC Court Allows Guardian to Withdraw Life Support WITHOUT Evidence of Patient Wishes

D.C. Superior Court Judge Russell Canan

The Superior Court of the District of Columbia has issued an innovative order in an end-of-life treatment conflict.


In June 2014, YP suffered cardiac arrest following a drug overdose.  Clinicians later determined that YP’s brain injury was profound and severe.  YP’s daughter and guardian wanted to withdraw life support.  But YP’s siblings from Panama objected.  


The court ruled in favor of the guardian.  This order is interesting, because DC statutes provide that a guardian “shall not have” the power to consent to stopping life-sustaining treatment “unless it appears the incapacitated person would have consented.”  


As the court observes, this statute seems to mandate a substituted judgment standard.  If there is zero evidence the the patient’s wishes (as in this case), then it seems that a guardian may not consent  to stopping life-sustaining treatment.


The court found this result absurd and instead elected to follow the majority of jurisdictions that permit use of an objective best interest standard when there is insufficient evidence for a decision maker to exercise substituted judgment.

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 ethnographic case: series conclusion by Emily Yates-Doerr

Editors note: This entry concludes the series “The Ethnographic Case” which ran every other Monday between June 2015 and July 2016. The bookCase, which holds 27 cases, can be accessed here.

One day, early on in the series, we received two submissions. Their similar anatomy was striking. Each featured a medical waiting room. Someone entered the space with a gift for the clinical personnel, the gift was accepted, and something shifted in the resulting care.

In Aaron Ansell’s case, set within gardens of an informal clinic in Piauí, Brazil, the gift was a small satchel of milk. Rima Praspaliauskiene’s was set in a Lithuanian public hospital and the gift was a rich chocolate cake. Aaron, who works and teaches on legal orders, analyzed the exchange as a challenge to hospital norms of equalitarianism. He helped us to see how the give-and-take of milk interrupts the requirements of a deracinated liberal democracy, offering instead the warm sociality of personal affinity. Rima, who focuses on medical care and valuing, used the object of the cake to query the social scientist’s impulse to explain why people do what they do. She shows us how this impulse may rest upon the linearity and equivalence of rational calculation, uncomfortably treating sociality as a commodity.

The juxtaposition of these submissions is emblematic – a case, if you will – of something we have seen throughout this series: the art of ethnographic writing resides in a relation between what is there and what is done with it.

Beginnings

We might trace the origin of the series to a business meeting at the AAAs, when we offered the idea of “the ethnographic case” for a Somatosphere series.

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

Court Hearing on Constitutionality of Texas Advance Directives Act

This Friday, the Harris County, Texas District Court will hear arguments on a motion for summary judgment concerning the constitutionality of the dispute resolution provisions in the Texas Advance Directives Act.  

Interestingly, this week, the Texas Attorney General filed an amicus brief supporting the plaintiff/family.  The Attorney General explained that its responsibility is to “defend the constitutional rights of Texas citizens, even from state statutes.”

I have made much the same procedural due process arguments here and here.  More recently, I expanded these arguments for the Saint Louis Journal of Health Law and Policy (in press).  And I warned the Virginia Joint Commission on Health Care about repeating these problems in their planned statutory amendments.

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.