Tag: suffering

Bioethics Blogs

Aid in Dying Case Arguments to be heard in New York Court of Appeals Tuesday, May 30

The right of terminally ill, mentally competent adults to achieve a more peaceful death is at stake in Myers v. Schneiderman, now before the New York Court of Appeals, New York’s highest state court. 


Oral arguments will be held on May 30 at 2:30 PM in Albany. The proceedings of the court will be webcast live here.  


The appeal seeks to reverse lower court decisions that dismissed the case prior to trial. The case, brought by patients, doctors, End of Life Choices New York, and its Clinical Director, seeks to establish the right of terminally ill patients to receive a prescription for medication which they can self ingest to achieve a peaceful death if confronted by suffering they find unbearable. 


The court has before it two sets of arguments: first the court is asked to determine the reach of New York criminal law; plaintiffs allege it does not reach this conduct. Second, if the court finds the criminal statute does outlaw aid in dying it will consider whether guarantees of liberty, privacy and autonomy conferred by the New York State Constitution protect it.

Source: bioethics.net, a blog maintained by the editorial staff of The American Journal of Bioethics.

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

Sex and gender. New findings, new controversy

‘Patients who had undergone sex reassignment surgery at his hospital, stated that the problems presented by patients before the surgery had not been resolved, at either human relationship, work or emotional level.’

Introduction

Sex and gender. Dr. Lawrence S. Mayer, an epidemiologist specialising in Psychiatry, and Dr. Paul R. McHugh, said to be the most important American psychiatrist of the last half century, have recently published a study entitled “Sexuality and Gender” in the journal The New Atlantis (see HERE), which offers an exhaustive review of more than five hundred scientific articles related with this matter. “I was alarmed to learn that the LGBT community bears a disproportionate rate of mental health problems compared to the population as a whole”, says Dr. Mayer, one of the authors of the article. 1

Background

In November 2014, Dr. McHugh had already published a report on the website First Things2, in which he explained his decision as head of the Psychiatry Department at John Hopkins hospital in Baltimore, US, to no longer propose any sex reassignment surgery, in view of the negative findings that he obtained after a retrospective examination of patients who had undergone the procedure.

In the current article, the authors looked at studies published in recent years, in an attempt to establish statistically significant, well-proven evidence. Compared to other related studies, which often offer contradictory results on the topic, this one is distinguished by the large amount of data from many different sources, which gives it special credibility, as well as the backing of its indisputably eminent authors.

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

Agreement and disagreement about experimental treatment. The Charlie Gard Appeal

by Dominic Wilkinson and Julian Savulescu

@Neonatalethics

@juliansavulescu

Tomorrow, the UK Court of Appeal will review the controversial case of a British infant, Charlie Gard. Charlie’s parents are appealing a recent High Court decision that gave doctors permission to withdraw his life support. They have raised money for Charlie to travel to the US for an experimental medical treatment.

 

Best Interests

The legal decision for Charlie will be based upon an assessment of his best interests. He has a rare genetic disorder affecting his muscles and his brain. He has been on life support since last October and has been progressively deteriorating. A neurologist in the USA has suggested that experimental nucleoside treatment might, in theory, offer some benefit, though it has never previously been tried in this situation.

The central ethical question is whether it would be best to provide the experimental treatment and continue intensive care for Charlie for several months more, or to withdraw treatment and allow him to die. How should we weigh up the risks and benefits of those two alternatives?

We have previously written about this difficult question. In a pair of editorials in the Lancet medical journal, we expressed different points of view. Dominic Wilkinson argued that the proposed course of treatment would do more harm than good. In his view, it is likely that Charlie would experience pain and discomfort from continued treatment; it is also unlikely, given what is known about it, that Charlie would benefit from nucleoside treatment. In contrast, Julian Savulescu argued that it is not clear that continued mechanical ventilation in intensive care is so terrible a life that it would not be worth living.

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 Very Early Embryo & Its Moral Signifiance

by Andrew J. Prunty

As technology and biological research continue to develop in the twenty-first century, it is necessary to address and further define the ethical considerations of embryonic research and the appropriate rights that may limit the extent of human research on zygotes, blastocysts, and fetal scientific advancement. Because the area of harvesting embryonic stem cells remains significantly undefined, both legally and morally, there are vastly different opinions between researchers and bioethicists, mainly because of ethical limitations, on the rights that should be granted to cells with the potential to develop into human beings and the consequences of neglecting significant scientific research or advancement.

Current laws in the United States differ at the federal and state level, but there is no consistency in recognizing human embryos as humans, or affording them the same legal rights granted to a child; in fact, legal precedent actually detracts certain rights from developing embryos, favoring a human’s ability to destroy a potential human being (i.e. Roe v. Wade[i]) or the categorization of embryos as property (i.e. Davis v. Davis[ii], A.Z. v. B.Z.[iii], Marriage of Dahl[iv], or Reber v. Reiss[v]). These case law samples suggest the courts’ inability to reach a conclusion as to what is the status of an embryo.

The debate is not only circumscribed to matters of research, but to fundamental controversial and intertwined issues of bioethics such as: when life begins, embryonic stem cells, fetal rights, abortion, et cetera. All these topics are contentious and when one topic arises, they begin to comingle.

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

Aid in Dying Court Appeal Comes to New York Court of Appeals May 30; Strong, Diverse and Growing Support in Amicus Briefs

The right of terminally ill, mentally competent adults to achieve a more peaceful death is at stake in Myers v. Schneiderman, now before the New York Court of Appeals, NY’s highest state court.  Oral arguments will be held in Albany on May 30.


The appeal seeks to reverse lower court decisions that dismissed the case prior to trial.  The case seeks to establish the right of terminally ill patients to receive a prescription for medication which they can self ingest to achieve a peaceful death if confronted by suffering they find unbearable.


Wide support for the plaintiffs is demonstrated by a multitude of amicus briefs submitted to the court by diverse parties representing patients and their loved ones, medical, religious and civil liberties organizations as well as national legal associations.  Two of these organizations are supporting the legalization of aid in dying as an amicus for the first time.


Kathryn Tucker, Executive Director of End of Life Liberty Project, and co-counsel in the case, said, “We are very pleased to see a large number of important voices joining us in seeking reversal of the lower court dismissal of the case. It is especially interesting to note the appearance of new voices not previously involved in aid in dying cases.”


Ms. Tucker noted, “Two new ‘friends’ of end of life liberty are stepping forward in Myers. For the first time in a case seeking to establish access to aid in dying, a state chapter of the National Academy of Elder Law Attorneys (NAELA) is participating as an amicus in support of patients and physicians.

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

Aid in Dying Court Appeal Comes to New York Court of Appeals May 30; Strong, Diverse and Growing Support in Amicus Briefs

The right of terminally ill, mentally competent adults to achieve a more peaceful death is at stake in Myers v. Schneiderman, now before the New York Court of Appeals, NY’s highest state court.  Oral arguments will be held in Albany on May 30.


The appeal seeks to reverse lower court decisions that dismissed the case prior to trial.  The case seeks to establish the right of terminally ill patients to receive a prescription for medication which they can self ingest to achieve a peaceful death if confronted by suffering they find unbearable.


Wide support for the plaintiffs is demonstrated by a multitude of amicus briefs submitted to the court by diverse parties representing patients and their loved ones, medical, religious and civil liberties organizations as well as national legal associations.  Two of these organizations are supporting the legalization of aid in dying as an amicus for the first time.


Kathryn Tucker, Executive Director of End of Life Liberty Project, and co-counsel in the case, said, “We are very pleased to see a large number of important voices joining us in seeking reversal of the lower court dismissal of the case. It is especially interesting to note the appearance of new voices not previously involved in aid in dying cases.”


Ms. Tucker noted, “Two new ‘friends’ of end of life liberty are stepping forward in Myers. For the first time in a case seeking to establish access to aid in dying, a state chapter of the National Academy of Elder Law Attorneys (NAELA) is participating as an amicus in support of patients and physicians.

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 Obligation To Provide Universal Healthcare Coverage: The need for moral imagination

Healthcare is indeed complicated, in case anyone with a
speck of knowledge about it ever thought otherwise. There are many ways to
organize a healthcare system, as is evident from all the various ways advanced
industrial societies around the globe provide healthcare to their citizens.
Questions about the extent to which the private insurance system versus the
government is involved brings us back to protracted debates about the legitimate
role of government and whether or not citizens have a basic right to healthcare,
or should healthcare be assumed to be one more market service which individuals
may elect to use or not? Sadly, in the United States these questions often are
framed in abstract terms appealing to general ideological values and goals that
shape and limit the range of viable policy options. What I want to emphasize in
my blog today is the need for moral imagination—what’s it like to be in the
shoes of those who are suffering, and often without health insurance, and
without a job?  This is a first step we
all must take before we can weigh our moral obligations to provide healthcare
to everyone.

Before the passage of the Affordable Care Act (ACA) there
were over 45 million uninsured Americans who did not have access to a primary
care physician. That number has been reduced by about 18 million, but now we at
risk of seeing this number rise again with the possibility of a repeal of the
ACA and passage of a GOP led alternative. The Congressional Budget Office
(CBO), a politically independent agency, estimated that if the American
Health Care Act had past would eventually lead to 24 million people loosing
their health care insurance by 2026.

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 Obligation To Provide Universal Healthcare Coverage: The need for moral imagination

Healthcare is indeed complicated, in case anyone with a
speck of knowledge about it ever thought otherwise. There are many ways to
organize a healthcare system, as is evident from all the various ways advanced
industrial societies around the globe provide healthcare to their citizens.
Questions about the extent to which the private insurance system versus the
government is involved brings us back to protracted debates about the legitimate
role of government and whether or not citizens have a basic right to healthcare,
or should healthcare be assumed to be one more market service which individuals
may elect to use or not? Sadly, in the United States these questions often are
framed in abstract terms appealing to general ideological values and goals that
shape and limit the range of viable policy options. What I want to emphasize in
my blog today is the need for moral imagination—what’s it like to be in the
shoes of those who are suffering, and often without health insurance, and
without a job?  This is a first step we
all must take before we can weigh our moral obligations to provide healthcare
to everyone.

Before the passage of the Affordable Care Act (ACA) there
were over 45 million uninsured Americans who did not have access to a primary
care physician. That number has been reduced by about 18 million, but now we at
risk of seeing this number rise again with the possibility of a repeal of the
ACA and passage of a GOP led alternative. The Congressional Budget Office
(CBO), a politically independent agency, estimated that if the American
Health Care Act had past would eventually lead to 24 million people loosing
their health care insurance by 2026.

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.