Tag: viability

Bioethics Blogs

Artificial Intelligence and Medical Liability (Part II)

Recently, I wrote about the rise of artificial intelligence in medical decision-making and its potential impacts on medical malpractice. I posited that, by decreasing the degree of discretion physicians exercise in diagnosis and treatment, medical algorithms could reduce the viability of … 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 Blogs

Alice Street’s “Biomedicine in an Unstable Place: Infrastructure and Personhood in a Papua New Guinean Hospital” by Mackenzie Cramblit

Biomedicine in an Unstable Place: Infrastructure and Personhood in a Papua New Guinean Hospital

by Alice Street

Duke University Press, 2014, 204 pages

Social anthropologist Alice Street’s first book is an ambitious ethnography of personhood and recognition in Madang Hospital, an under-resourced provincial hospital in Papua New Guinea. The book shows how doctors, nurses, and patients endeavor to make themselves “visible” to others in order to initiate relations of care at multiple scales, while also emphasizing the uncertainties of diagnosis and treatment within an institution subject to perennial shortages of staff and supplies.

The book’s main section explores the treatment and experience of disease within the public ward of Madang Hospital. Street introduces the concept of “biomedical uncertainty” to describe how doctors must forego conclusive diagnosis and embrace a pragmatic approach to treating patients in an under-resourced setting. That this kitchen-sink method is the one best suited to the circumstances at Madang Hospital seems reasonable – after all, the doctors themselves say so. But Street’s optimistic claim that this “uncertainty…is another productive form that biomedical knowledge can take” and her apparent endorsement of what she terms “technologies of not knowing” feels out of step with the real ways doctors in this environment struggle to produce care amidst difficult constraints (111). What should be commended is the Madang doctors’ commitment to take action in spite of the prevailing biomedical uncertainty in their ward, not the uncertainty itself ­– the unenviable result of chronic resource shortages. It would seem essential to distinguish between this kind of uncertainty on the one hand and a positive strategy of diagnostic suppleness or nonclosure on the other.

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

New Technology Is Forcing Us to Confront the Ethics of Bringing People Back from the Dead

January 27, 2017

(Quartz) – The possibility of digitally interacting with someone from beyond the grave is no longer the stuff of science fiction. The technology to create convincing digital surrogates of the dead is here, and it’s rapidly evolving, with researchers predicting its mainstream viability within a decade. But what about the ethics of bereavement—and the privacy of the deceased? Speaking with a loved one evokes a powerful emotional response. The ability to do so in the wake of their death will inevitably affect the human process of grieving in ways we’re only beginning to explore.

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

Is It Time for Embryo Research Rules to Be Changed

January 18, 2017

(BBC) – Experts are renewing calls to allow experiments on embryos beyond 14 days of development, saying it would drive medical breakthroughs. Research on human embryos can only happen under a licence in the UK and it is currently illegal to keep them alive in laboratories for more than two weeks after fertilisation. Until recently, this cut-off was almost irrelevant in terms of viability since science had not found a way to physically support life in the lab beyond about a week. But researchers have found a way to chemically mimic the womb which would allow an early stage embryo to continue to develop for longer – at least 13 days after fertilisation, but potentially much 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.

Bioethics Blogs

Just What We Need: Slicker Infertility Marketing

The most unsettling line in the recent Forbes article on the ambitious infertility startup Prelude comes about halfway through. “The IVF industry in the United States,” writes Miguel Helft, “has everything private equity likes—scale (about $2 billion annually) and growth (more than 10% a year), along with being fragmented and having outdated marketing.” 

In an era with precious few opportunities for double digit returns, why not turn the reproductive health sector into the next big thing by furthering its consolidation and selling services using lifestyle content?  “Hey,” Prelude’s hipster-chic splash page calls out, “how’s your fertility doing?” 

If that piques your interest, scrolling down takes you on a kind of virtual stroll through the streets of Williamsburg, Wicker Park, or the Mission District, where you encounter edgily coifed, tatted, and bespectacled folk who presumably are spending as much time thinking about their reproductive fitness as they do their next Americano or Kimchi taco.  But you’ll find scant information about financial, psychological, or medical risks of egg retrieval (unless you count the presumed donor pictured alongside the quotation “I was worried about the discomfort, but seriously, it was no worse than a bikini wax—and for a much higher purpose”) or about failure rates after eggs are thawed and implanted.  Everything is upbeat and empowering, geared toward the “millennial mindset of health, wellness, and control.”

Prelude is targeting 20 to 30 year olds and the main product it’s selling them is their own eggs and sperm on ice.  The site proclaims, “If you are in your 20s or early 30s, there is no better time than now to bank your eggs and sperm.

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

A eulogy for the UK Donation Ethics Committee

Guest Post: David Shaw

Paper: The Untimely Death of the UK Donation Ethics Committee

Most people I know want to donate their organs after they die. Why wouldn’t they? If you have to die, you might as well do your best to save several other lives once you’re gone. But organ donation is a more ethically complex topic than many people realise. From Spring 2014 until April this year I was a member of the UK Donation Ethics Committee (UKDEC), which advised NHS Blood and Transplant and the various UK health departments on the ethics of organ donation and transplantation. The committee included doctors, lawyers, nurses, ethicists like me, and ‘lay’ members – ordinary members of the public. In my JME article, I discuss the committee’s work and why it came to an end.

UKDEC dealt with a wide variety of topics. We advised the Welsh Government on the ethical implications of a switch to ‘deemed consent’ to organ donation in Wales, undertook an analysis of the role of the family in donation, and engaged with ethnic minorities and religious groups to facilitate discourse about donation. Most of all, our work was important because we provided practical ethical guidance to healthcare professionals who were often unsure about the ethics and sometimes the legality of new developments in organ donation. Every year new technologies emerge that can enable donation where it was previously impossible, or which can improve the viability of donated organs. Sometimes doctors would approach UKDEC for our advice on their protocols that wished to make use of these new innovations.

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

Hi-Tech Discovery Promises IVF Relief from Emotional Toll

August 26, 2016

(The Australian) – Australian researchers have achieved a breakthrough in worldwide efforts to improve the success of IVF during the first cycle, potentially saving millions of dollars while reducing the emotional toll on women. The research at the University of Adelaide has been successfully trialled using a hi-tech digital ­imaging technique usually reserved for detecting cancer cells and mathematical modelling. By showing differences in the viability of embryos, otherwise not seen by the human eye under a microscope, the best can be ­chosen for implantation to significantly boost pregnancy success from the first cycle.

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

Law and Reality Half-Arrives in the Supreme Court’s Abortion Jurisprudence

(This blog post was originally published by Stanford Law School on June 27, 2016)

On June 27, in Whole Woman’s Health v. Hellerstedt, the Supreme Court, by a five to three vote, reversed the Fifth Circuit Court of Appeals and reinstated the decision of the district court invalidating two aspects of Texas’s restrictive abortion statute, H.B. 2.   Those provisions required all physicians at the clinic to have admitting privileges at an acute care hospital within 30 miles and further required that all abortion clinics meet all the requirements for outpatient (“ambulatory”) surgical centers.

The majority, in an opinion written by Justice Breyer (a Stanford graduate though he went somewhere back East for law school) refused to apply the standard used by the Court of Appeals, a look at whether there was an undue burden on women’s right to an abortion based almost entirely on unexamined assertions by the State’s lawyers. (The legislature made no findings, so these were not even “facts” allegedly found by it.) With this emphasis on “Law and Reality,” the majority had no difficulty finding that the statutes unduly burdened the abortion right, as the (non-existent) benefits of the legislature were vastly outweighed by its (substantial) costs.

I applaud this decision and wait, confidently, for its application to many of the other TRAP laws (Targeted Regulation of Abortion Providers) adopted by states as part of an anti-abortion strategy of “death by a thousand laws”. At the same time, I do wish the Court had been willing to take the next step toward Law and Reality.

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 New Edition of Journal of Genetic Counseling Is Now Available

May 26, 2016

Journal of Genetic Counseling (vol. 25, no. 3, 2016) is available online by subscription only.

Articles include:

  • “Reproductive Decision-Making in MMR Mutation Carriers after Results Disclosure: Impact of Psychological Status in Childbearing Options” by Jacqueline Duffour, et al.
  • “Survey of the Definition of Fetal Viability and the Availability, Indications, and Decision Making Processes for Post-Viability Termination of Pregnancy for Fetal Abnormalities and Health Conditions in Canada” by Danna Hull, Gregory Davies, and Christine M. Armour
  • “Sex Education and Intellectual Disability: Practices and Insight from Pediatric Genetic Counselors” by Carly Murphy, et al.

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

In Vitro Human Embryos and the 14 Day Rule

Research was published earlier today in Nature and in Nature Cell Biology reports that human embryos have been kept alive outside the womb for up to 13 days, right to the edge of a “fourteen day/development of the primitive streak” rule enshrined in both guidelines and some nations’ laws.  And already three authors, Insoo Hyun, Amy Wilkerson, and Josephine Johnston,  have called, also in Nature, for “revisiting” that rule.  At Nature’s request I wrote a short piece giving my views on this issue; with its permission, I am reposting a slightly modified version of it here. Somewhat unusually, for me, I am not in favor of opening up more possible research, at least not now, based on what I currently understand.  For “why,” see below.

.  .  .  .  .  .  .

When I was 8 years old my family drove to the Grand Canyon. At our last stop I begged my father to let us walk to the river: “It’s only a half hour away”. (I was probably off by about ten hours.) To get me back into our van, he promised me we would do that the very next time we went to the Grand Canyon. Oddly enough, in the next 37 years, he never took us back.

In the past few decades, bioscience has made several promises it couldn’t be called on. “No human germline engineering,” “no human reproductive cloning,” “no embryo research more than 14 day after fertilization.” None were possible at the time of the promises; all have started looking plausible in the last few years.

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.