Tag: trends

Bioethics Blogs

In Defense of a Physician’s Right of Conscientious Objection

Guest post by Cheyn Onarecker, MD

In their recent “Sounding Board” piece in the New England Journal of Medicine (subscription required), Ronit Stahl, PhD, and Ezekiel Emanuel, MD, PhD, denounce the rights of physicians and other health care professionals to opt out of certain procedures because of a moral or religious belief. The interests and rights of the patient, they state, should always trump those of the clinician. The only role for conscientious objection, in their view, is a limited one, when the appropriateness of a treatment or procedure is being debated.

Once a professional society determines that a treatment is acceptable, the physician must comply or get out of medicine altogether. Stahl and Ezekiel lament that the American Medical Association (AMA) and other medical societies support conscience rights, but, I believe the arguments they advance to eliminate such rights are not convincing and would jeopardize the future of medicine.

First, although the well-being of patients is one of the primary goals of medicine, there has always been a balance between the needs of patients and physicians. Otherwise, physicians would work 24 hours a day, with no time off for family, friends, or other pursuits. Physicians would be expected to respond to all patient requests, day or night. The question is not whether physicians should put patients’ needs above their own, but where the line should be drawn between the needs of the patient and the physician. In emergencies, a patient’s needs triumph, but other situations are not always so clear. When it comes to requests for treatments that violate a physician’s deepest moral convictions, no physician should be forced to cross over the line.

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

Ten years since the discovery of iPS cells. The current state of their clinical application

Photo Neurons derived from human iPS cells Stem Cells Australia

Background

Few biomedical discoveries in recent decades have raised so many expectations as the achievement of adult reprogrammed cells or induced pluripotent stem (iPS) cells.1

Pluripotent cells are obtained from adult cells from various tissues that, after genetic reprogramming, can dedifferentiate to a pluripotency state similar to that of embryonic cells, which allows for subsequent differentiation into different cell strains.2,3

In our opinion, this discovery is relevant not only to biomedical issues but also to ethical ones, given that iPS cells could replace human embryonic stem cells (see HERE) – whose use raises numerous ethical problems – in biomedical experimentation and in clinical practice. However, after the last 10 years, the use of iPS cells has still not been clarified. A number of expectations have been met, but other mainly clinical expectations are still far from being achieved.

Current research limitations with iPS cells

There is a notable low efficacy in the techniques employed for obtaining a sufficient proportion of iPS cells, which represents a difficulty in its clinical application.4  Another limitation is the incomplete reprogramming, which depends on the type of cell employed,5 and the problems of mutagenesis resulting from inserting exogenous transcription-factor coding genes, which can cause tumors in the employed cells used.6 Recent studies aim to mitigate this effect.7 A clinical trial for treating macular degeneration with retinal pigment epithelium cells derived from autologously obtained iPS cells has recently been halted.8 After an initially successful experience with the first treated patient, the genetic sequencing of the iPS cells obtained from the second patient revealed mutations in 3 different genes, one of which was classified as oncogene in the Catalogue of Somatic Mutations in Cancer.

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

Analytics and the Prevention of Suicide

Greg Horne describes how data on social media can be used to identify and concentrate resources on groups who are at risk of suicide.

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Suicide is the second leading cause of death among youth in Canada. According to Statistics Canada, in 2011, it accounted for approximately 20% of the deaths of people under the age of 25. The Canadian Mental Health Association claims that among 15 – 24-year-olds the percentage of deaths caused by suicide is even higher, a frightening 24%– the third highest in the industrialized world. Recent reports also suggest that the suicide rates for First Nations and Inuit youth in Canada are from five to eleven times higher than the National average. Yet, despite these disturbing statistics, it is difficult, if not impossible, for health care providers (or friends and family) to identify whether a young person plans to injure themselves or die by suicide.

The warning signs leading up to a suicide can be easy to miss. For example, consider the recent spate of suicides at the University of Guelph. Was there a possibility of identifying the warning signs of increasing mental health issues at the University? Were there indications of a potential spike in suicides?

Some warning signs may be found online. Many people use social platforms like Facebook and Twitter to post detailed personal information about their health and their mental wellbeing. This information could help to identify groups who are at risk of self-harm or suicide.

SAS Canada, a data management, software development, and analytics company, is using a new artificial intelligence software solution to identify social groups that are at increased risk of suicide.

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

E-H-ARRGH: The Frustrating Costs and Benefits of the Electronic Health Record

April 28, 2017

by Jami Starr, MD, Clarkson University Bioethics Policy Certificate 2017

E-H-ARRGH: The Frustrating Costs and Benefits of the Electronic Health Record

 The concept of electronic medical recordkeeping was first introduced in the late 1960’s but it did not really become established until this century. Electronic Health Records (EHRs) are expected to provide a number of benefits, including: ability to track data over time, monitoring use of interventions (i.e. vaccinations), and identifying patients in need of preventive screening. Data are forthcoming as to how effectively EHRs meet these goals. What is clear, however, is that it is third party payers profit from EHRs as a result of improvements in claims processing.

The use of EHRs carries implicit hazards with respect to confidentiality. It seems no cyber security system today is impenetrable.  We have witnessed multiple breaches in the past few years involving government agencies, major retail chains, and financial institutions. If a hospital database were hacked, not only would pertinent demographics be exposed (social security numbers, insurance policies, etc.) but also personal information about diagnoses, socioeconomic circumstances, and the like.  While this is a risk with paper medical records as well, the rapid and potentially widespread dissemination of information though a computer data system is far more menacing in scope.  In most clinical settings where EHRs are employed, paper charts have been eliminated and patients do not have an option as to how personal data are maintained.  Vulnerability has been increased de facto by reliance upon this new medium.

Aside from the issues related to cyber security, there are start-up costs related to productivity, burnout and physician-patient relationships.

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

Subjectivity After the Subject by Sadeq Rahimi

One: Whither The Subject?

It has been exactly 8 years since I wrote the introductory installment of a mini-series on political subjectivity for Somatosphere. When I wrote on political subjectivity at the time, aside from exploring and communicating ideas, a good part of my agenda was to help propagate the concept of political subjectivity in cultural and medical anthropology –the notion that politicality is not something that some people do, but something that is intertwined with meaning and meaning making, and hence defines the very experience of subjectivity that makes us human beings.  As I write this here to initiate what I am hoping to become a follow up set of posts on subjectivity and its future, ‘political subjectivity’ is no longer a new construct nor in need of propagation.  There are numerous books and articles on the topic, and the discussion has moved forward to create intriguing inquiries such as hauntology, and the relationship between intergenerational transmission of affective patterns and political subjectivity.

For me, this has been a satisfying development to see, despite an acute awareness of the fact that this progression is by no means simply a fruit and consequence of intellectual desire and efforts of individuals like myself, but in some eerie sense, the inevitable outcome of much larger historical, technological and geopolitical movements.  Satisfaction aside, in other words, these years have given me the fascinating opportunity of witnessing the incredible ways in which these broad global patterns of movement have given rise to specific intellectual trends, and have pushed specific philosophical, anthropological and psychological questions to the forefront.

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

How Machine Learning May Help Tackle Depression

By detecting trends that humans are unable to spot, researchers hope to treat the disorder more effectively. Depression is a simple-sounding condition with complex origins that aren’t fully understood. Now, machine learning may enable scientists to unpick some of its mysteries in order to provide better treatment

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

Functional neo-Aristotelianism as a way to preserve moral agency: A response to Dr William Casebeer’s lecture: The Neuroscience of Moral Agency

Written by Dr Anibal Monasterio Astobiza

Audio File of Dr Casebeer’s talk is available here: http://media.philosophy.ox.ac.uk/uehiro/HT17_Casebeer.mp3

 

Dr. William Casebeer has an unusual, but nonetheless very interesting, professional career. He retired from active duty as a US Air Force Lieutenant Colonel and intelligence analyst. He obtained his PhD in Cognitive Science and Philosophy from University of California, San Diego, under the guidance and inspiration of Patricia and Paul Churchland, served as a Program Manager at the Defense Advanced Research Projects Agency from 2010-14 in the Defense Sciences Office and helped to established DARPA’s neuroethics program. Nowadays, Dr. William Casebeer is a Research Area Manager in Human Systems and Autonomy for Lockheed Martin’s Advanced Technology Laboratories. As I said, not the conventional path for a well known researcher with very prominent contributions in neuroethics and moral evolution. His book Natural Ethical Facts: Evolution, Connectionism, and Moral Cognition (MIT Press) presented a functional and neo-Aristotelian account of morality with a clever argument trying to solve G. E. Moore´s naturalistic fallacy: according to Casebeer it is possible to reduce what is good, or in other words morality, to natural facts.

In his public lecture of 14 February 2017, held at the Lecture Theatre, Oxford Martin School, Oxford, entitled “The Neuroscience of Moral Agency (Or: How I Learned to Love Determinism and Still Respect Myself in the Morning”, Dr. William Casebeer resubmitted the case for a functional neo-Aristotelianism  model for agency that defends a compatibilist view of free will: to accept determinism as viable but still hold moral concepts true.

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

Biofinance: Speculation, Risk, Debt, and Value from Bios: A conference report by Danya Glabau

How does the financialization of life itself figure as a new means of producing value in modern technoscience? That is the question that motivated Kirk Fiereck to convene the panel “Biofinance: Speculation, Risk, Debt, and Value from Bios” at the 2016 American Anthropological Association meeting in Minneapolis, Minnesota this November. Fiereck, panelists Melina Sherman, Danya Glabau, and Emily Xi Lin, discussant Kristin Peterson, and chair David Pederson, offered new ways to think about how financialized life is a source of value, and what this means for the ethics and practice of biomedicine in sites throughout the globe.

In writing this conference report, Fiereck, Sherman, and Glabau each contributed short comments about their talks, which were edited together in the unified first half of this report. The second half includes further reflections that we have attributed to each scholar individually as a way to illustrate the diverse, possibly divergent, uses of “biofinance” as a concept.

 

The Papers

Melina Sherman opened the panel with, “Biofinancial Investments and Disinvestments: Examining the U.S. Opioid Epidemic,” which focused on the cultural and institutional construction of pharmaceutical markets – in particular, the market for prescription painkillers. Markets, especially those situated within the bioeconomy – an economic space in which capital is organized through life (bios) in its various forms – constitute the broader context in which biofinancial practices are situated. Her paper explored the ways in which the selective investments and divestments of federal regulators and opioid consumers condition the growth of this market. The market for prescription opioids is a good example of what Sherman calls an “addiction market” (see also Lovell, 2006), where addiction (understood as a destructive attachment – in this case, of a person to a prescription drug) is built-in to the cultural and economic processes that drive market formation and growth.

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

Googling PAS

While researching physician assisted suicide legislation this past week, I noticed something odd when I Googled the topic. After I typed “physician assisted” into Google, the search engine’s autocomplete function suggested searches related to “physician assisted death.” I then started to type out “physician assisted suicide,” but as soon as I typed the “s,” all suggestions disappeared. Out of curiosity, I visited Google Trends to… // Read More »

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.