Tag: values

Bioethics Blogs

‘A bit of a compromise’: Coming to terms with an emergency caesarean section by Terena Koster

During the midwife-hosted antenatal class Cath attended in a private hospital in Cape Town, South Africa, where she would eventually give birth, pregnant women were encouraged to name the kind of birth they wanted. They were presented with three options: “natural all the way with no medication”, “natural but open to medication”, or “elective caesarean”. The ‘choice’ women were expected to make featured as an important point of concern in their antenatal care and in their preparations for birth.

Hannah, a participant in the class, recalls a particularly striking moment when the midwife went around the room and pointed at each of the participants and asked, “Who is your gynae”. She went on to predict diverse birth outcomes, irrespective of participants’ stated intentions to birth vaginally. For Hannah this was an “eye opening” experience. A first time mother, she was now invited into a highly politicised birthing environment. Hannah had been uncertain about what kind of birth she wanted, but at 8 months pregnant she had decided on a ‘natural’ birth as opposed to a ‘caesarean’, with the caveat that in the event that an emergency caesarean section was a likely outcome, she would proactively opt for an elective caesarean.

At 39 weeks and near the end of her pregnancy, she found herself sitting opposite her obstetrician who told her there was “a real threat of the umbilical cord wrapping around [the baby’s] neck as she … drop[s] down,” adding that because the baby was “so big” there was “a high likelihood of [Hannah] tearing”. For the first time, the obstetrician instructed her to make a birthing decision: to continue trying for a vaginal birth or to opt for an elective caesarean section.

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

Press Release – “Vale Charlie” Prof Julian Savulescu

Vale Charlie

At some point in all of our lives, we have to let go. One can only admire Connie Yates and Chris Gard who fought so hard for Charlie.

 

However, we should continue to question the original decision, and the way in which these decisions are made. Even if it is too late for Charlie now, we should improve how we make these decisions for the future.

Back in January, there was an option for a trial of treatment that had some chance of success, a world leading doctor willing and able to provide it, and, by April, the funds had been raised to achieve it without public funds. There were also the means to control and minimise Charlie’s suffering. I believe that a limited trial of treatment was in Charlie’s interests back then, given the only alternative for him was death.

 

Doctors opposed this because of the low chance of success combined with fears that the extra time in life support would be too painful.

 

4 months of the legal process has left us with no trial of treatment, and no chance now for Charlie. Yet Charlie had to go through all the suffering (and more) of being kept alive on life support.

 

No-one wanted this outcome. No-one believes this outcome was in Charlie’s best interests. There has got to be a better process. It has been traumatic for all the doctors, who have genuinely had Charlie’s interests at heart, and Connie and Chris, but most of all Charlie.

It has also raised other issues.

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

All the Difference in the World: Gender and the 2016 Election

by Alison Reiheld

ABSTRACT. In this paper, I analyze multiple aspects of how gender norms pervaded the 2016 election, from the way Clinton and Trump announced their presidency to the way masculinity and femininity were policed throughout the election. Examples include Hillary Clinton, Donald Trump, Barack Obama, and Gary Johnson. I also consider how some women who support Trump reacted to allegations about sexual harassment. The difference between running for President as a man and running for President as a woman makes all the difference in the world.

 

IMAGE DESCRIPTION: This image shows Donald Trump on the left and Hillary Clinton on the right. Trump’s eyes are narrowed, his brow furrowed. He looks serious, and there is no hint of a smile. On the right, Clinton has a composed look with a slight, close-mouthed smile, her eyes open to a typical degree. Both are white and have greying blonde hair.

The May 21, 2007 cover of TIME magazine showed a close-up image of Mitt Romney’s face with the cover tagline “. . . he looks like a President . . .”, the first of many such claims. In 2011, as Texas Governor Rick Perry geared up for a run at the presidency, Washington Post opinion writer Richard Cohen said that Perry “actually looks like a President” (Cohen 2011). The term, here, is used as praise. Yet the power of its use as an epithet when people fail to look adequately presidential cannot be understated. During the primaries for the 2016 election, while watching Republican candidate Carly Fiorina, Donald Trump said in front of a reporter, “Look at that face!

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

Revising the Ethical Framework for Deep Brain Stimulation for Treatment-Resistant Depression

By Somnath Das

Somnath Das recently graduated from Emory University where he majored in Neuroscience and Chemistry. He will be attending medical school at Thomas Jefferson University starting in the Fall of 2017. Studying Neuroethics has allowed him to combine his love for neuroscience, his interest in medicine, and his wish to help others into a multidisciplinary, rewarding practice of scholarship which to this day enriches how he views both developing neurotechnologies and the world around him. 

Despite the prevalence of therapeutics for treating depression, approximately 20% of patients fail to respond to multiple treatments such as antidepressants, cognitive-behavioral therapy, and electroconvulsive therapy (Fava, 2003). Zeroing on an effective treatment of “Treatment-Resistant Depression” (TRD) has been the focus of physicians and scientists. Dr. Helen Mayberg’s groundbreaking paper on Deep Brain Stimulation (DBS) demonstrates that electrical modulation an area of the brain called subgenual cingulate resulted in a “sustained remission of depression in four of six (TRD) patients” These patients experienced feelings that were described as “lifting a void,” or “a sudden calmness.” (Mayberg et al. 2005). The importance of this treatment lies in the fact participants who received DBS for TRD (DBS-TRD) often have no other treatment avenues, and thus Mayberg’s findings paved the way for DBS to have great treatment potential for severely disabling depression. 

Image courtesy of Wikimedia Commons
Because DBS involves the implantation of electrodes into the brain, Dr. Mayberg and other DBS researchers faced intense scrutiny following publication of their initial findings regarding the ethics of using what to some seems like a dramatic intervention for TRD.

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

CHARLIE GARD: 37 European deputies stand against the European Court of Human Rights decision

In an open letter, 37 Eurodeputies support Charlie Gard and his parents and demand the respect of the right to live (see original letter signed at Strasbourg and titled, Charlie Gard must be given right to life, human dignity)

After the decision of the British Courts and of the European Court of Human Rights, the support provided by parenteral respiratory, nutrition and hydration assistance to Charlie Gard, the 10-months-old baby suffering from mitochondrial encephalopathy, can be suspended. This will lead to the certain death of the child. 37 European deputies[1]  have signed an open letter to express their “concern about the scandalous outcome of Charlie’s case, which violates the most fundamental European values, in particular, the right to live, the right to human dignity and to personal integrity”. In this case, they denounce “the approval of the successive courts to interrupt his supportive care, including nutrition and hydration”, ending with the European Court of Human Rights (ECHR), last recourse for Charlie Gard’s parents.

The European signatory deputies condemn a shameful behaviour which violates “the values of our civilised society” when a country “does not act in the best interest of its people”. They have committed themselves to oppose such practices with a firm “no”. (Genethiques informs you)

Eurodeputies stand against European Court of Human Rights names,

[1] The signatory deputies: Miroslav Mikolášik MEP, Luigi Morgano MEP, Laurentiu Rebega MEP, Laima Andrikiene MEP, Elisabetta Gardini MEP, Ivan Štefanec MEP, Lara Comi MEP, Marijana Petir MEP, Lorenzo Fontana MEP, Nicola Caputo MEP, Tunne Kelam MEP, Marek Jurek MEP, Beatrix von Storch MEP, Franc Bogovič MEP, Patricija Šulin MEP, Pavel Svoboda MEP, György Hölvenyi MEP, Michal Boni MEP, Jan Olbrycht MEP, Zbigniew Kuzmiuk MEP, Jadwiga Wiśniewska MEP, Thomas Mann MEP, Annie Schreijer-Pierik MEP, Daniela Aiuto MEP, Alojz Peterle MEP, Branislav Škripek MEP, Enrico Gasbarra MEP, Anna Záborská MEP, Arne Gericke MEP, Steven Woolfe MEP, Mylene Troszczynski MEP, Lars Adaktusson MEP, Remo Sernagiotto MEP, József Nagy MEP, Pál Csáky MEP Marek Plura MEP, Robert Jaroslaw Iwaszkiewicz MEP.

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

CHARLIE GARD: 37 European deputies stand against the European Court of Human Rights decision

In an open letter, 37 Eurodeputies support Charlie Gard and his parents and demand the respect of the right to live (see original letter signed at Strasbourg and titled, Charlie Gard must be given right to life, human dignity)

After the decision of the British Courts and of the European Court of Human Rights, the support provided by parenteral respiratory, nutrition and hydration assistance to Charlie Gard, the 10-months-old baby suffering from mitochondrial encephalopathy, can be suspended. This will lead to the certain death of the child. 37 European deputies[1]  have signed an open letter to express their “concern about the scandalous outcome of Charlie’s case, which violates the most fundamental European values, in particular, the right to live, the right to human dignity and to personal integrity”. In this case, they denounce “the approval of the successive courts to interrupt his supportive care, including nutrition and hydration”, ending with the European Court of Human Rights (ECHR), last recourse for Charlie Gard’s parents.

The European signatory deputies condemn a shameful behaviour which violates “the values of our civilised society” when a country “does not act in the best interest of its people”. They have committed themselves to oppose such practices with a firm “no”. (Genethiques informs you)

Eurodeputies stand against European Court of Human Rights names,

[1] The signatory deputies: Miroslav Mikolášik MEP, Luigi Morgano MEP, Laurentiu Rebega MEP, Laima Andrikiene MEP, Elisabetta Gardini MEP, Ivan Štefanec MEP, Lara Comi MEP, Marijana Petir MEP, Lorenzo Fontana MEP, Nicola Caputo MEP, Tunne Kelam MEP, Marek Jurek MEP, Beatrix von Storch MEP, Franc Bogovič MEP, Patricija Šulin MEP, Pavel Svoboda MEP, György Hölvenyi MEP, Michal Boni MEP, Jan Olbrycht MEP, Zbigniew Kuzmiuk MEP, Jadwiga Wiśniewska MEP, Thomas Mann MEP, Annie Schreijer-Pierik MEP, Daniela Aiuto MEP, Alojz Peterle MEP, Branislav Škripek MEP, Enrico Gasbarra MEP, Anna Záborská MEP, Arne Gericke MEP, Steven Woolfe MEP, Mylene Troszczynski MEP, Lars Adaktusson MEP, Remo Sernagiotto MEP, József Nagy MEP, Pál Csáky MEP Marek Plura MEP, Robert Jaroslaw Iwaszkiewicz MEP.

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

Speaking with: Julian Savulescu on the ethics of genetic modification in humans

Could genetic engineering one day allow parents to have designer babies? Tatiana Vdb/flickr, CC BY

What if humans are genetically unfit to overcome challenges like climate change and the growing inequality that looks set to define our future?

Julian Savulescu, visiting professor at Monash University and Uehiro professor of Practical Ethics at Oxford University, argues that modifying the biological traits of humans should be part of the solution to secure a safe and desirable future.

The University of Melbourne’s William Isdale spoke to Julian Savulescu about what aspects of humanity could be altered by genetic modifications and why it might one day actually be considered unethical to withhold genetic enhancements that could have an overwhelmingly positive effect on a child’s life.


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William Isdale does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.

Source: The Conversation, Academic rigor, journalistic flair. The ConversationThe Conversation

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

Innovation for End-of-Life Communication in the ICU

A recent article in the American Journal of Respiratory and Critical Care Medicine offers great advice on communication in the ICU.


This is important, because “once the family has expressed a choice, it is much harder to talk them out of it an the process becomes contentious rather than shared.” Small tweaks to the words we use can make a big difference.


“Family meetings in the ICU aim to facilitate preference sensitive treatment decisions through shared decision making. To elicit information about patient preferences the Society of Critical Care Medicine endorses questions like ‘what would she want?’”


“However use of the word ‘want’ may be particularly problematic as it encourages surrogates to express desires that are not grounded in the clinical context. Although it is common practice to ask what a patient might want, this question can lead to worse decision making and less exchange of information about patient’s values.”


“Attention to word choice is important. To improve surrogate decision making, clinicians should ask family members what their loved one might say or think about the patient’s health state.”

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 Blogs

Burke, Briggs and Wills: Why we should not fear the judgment in Charlie Gard

In a blog post today, Julian Savulescu argues that in a parallel adult version of the highly controversial Charlie Gard case, a UK court might thwart an unconscious patient’s previously expressed desire for self-funded experimental medical treatment. He finds the Gard decision deeply disturbing and suggests that we all have reason to fear the Charlie Gard judgment.

I respectfully beg to differ.

Julian’s thought experiment of the billionaire ‘Donald Wills’ is not analogous to the real Charlie Gard case, his analysis of the UK legal approach to best interests cases for adults is potentially mistaken, his fear is misplaced.

Wills and Gard

Thought experiments are an important tool in philosophy and medical ethics. They enable us to analyse our intuitive responses to ethical questions. Comparing parallel cases – for example as James Rachels did in his now famous 1975 paper ‘Active and Passive Euthanasia’ – can helpfully identify factors that are relevant to ethical analysis, as well as factors that aren’t relevant. However, like scientific experiments, thought experiments need to be carefully designed. Otherwise they can mislead.

Julian imagines a wealthy adult patient, Donald Wills, who has a rare mitochondrial illness very similar to Charlie Gard. While Wills’ wife has identified a potential treatment and requested that he be transferred overseas for an experimental treatment, the imaginary court, in a decision parallel to the Gard case, finds that this treatment would not be in Donald’s best interests. The judge denies the request and Donald’s treatment is withdrawn.

However, in a divergence from the Gard case, Julian tells us that Wills

“wishes to live as long as possible.

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.