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May 19, 2015 | Posted By Lisa Campo-Engelstein, PhD

In my last blog, I discussed some of the problems with the definition of infertility, including that it is based mainly on women's bodies, which implies that men are less likely or not likely to be infertile, and it is based on heterosexual activity, which implies that single individuals and/or individuals in the LGBTQ community cannot experience infertility. I also distinguished between physiological infertility (i.e. infertility due to a biological condition such as low sperm count or blocked tubes) and social infertility (i.e. situational infertility, such as whether one has a partner and if so, if that partner is fertile and together one and one’s partner have the “right” parts to reproduce biologically). In this blog, I want to reflect more on that it means to be infertile and how the role social desire (i.e. the social desire to have biological children) plays in diagnosing this condition.

Imagine two women with the same exact circumstances: they are both 30 years old, in long term heterosexual relationships, and have been having unprotected sex regularly for the last 3 years. The only difference is that one woman, Jessica, wants to have biological children, while the other woman, Katie does not. Should they both be classified as infertile? How does their desire to have or not have biological children shape their medical diagnosis? Should their partners be labeled as infertile too? Does it matter whether Jessica and Katie are physiologically or socially infertile in classifying them as infertile? Does their partners’ interest in having biological children or lack thereof factor into determining if Jessica and Katie are infertile?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.  

May 14, 2015 | Posted By Wayne Shelton, PhD

As a clinical ethics consultant and bioethics professor for many years, it still amazes me that one of the most common problematic features of our healthcare system is the tendency to over treat patients to the point of causing harm and wasting financial resources. The question is, why?

The question, why do physicians generally over treat patients in the U.S., must be approached in light of the fact that we spend more per capita and more overall, about 16% of GDP, on healthcare and get far worse outcomes than do countries like Canada and Western European countries who spend far less of their GDP on healthcare. But to be fair, before we blame physicians entirely for making poor judgments about treatment options, it is important to keep in mind that the U.S. is big, diverse nation with complex social and economic issues where creating efficient systems of healthcare is both practically and politically challenging. Also the U.S. spends more on medical research than most other countries, which still benefits patients everywhere. But what is most uniquely American is an economic system designed by politicians first and foremost for creating wealth for investors and that provides, generally speaking, efficient markets for consumer goods and services. But, whatever the virtues of American capitalism in creating efficient markets, it does not hold true for healthcare.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.  

May 11, 2015 | Posted By Jane Jankowski, DPS, LMSW

In the most recent issue of The Journal of Clinical Ethics, authors Genes and Appel explore the ethical considerations at play when physicians might use the internet to gather patient information. They conclude, correctly I believe, that there are circumstances in which accessing information about a patient supports beneficent efforts to provide quality care, even in non-emergent circumstances. Rather than damaging the doctor patient relationship, an informed provider is better equipped to support the patient’s best interests if loved ones can be located, presentation of information can be confirmed as factual or not, and the context of this patient’s needs can be more fully understood by the care team.

Social media, such as the now ubiquitous Facebook, is often considered a forum where people may express thoughts and feelings they fail to articulate in person. Consider the posts of an angry or despondent partner after the end of a relationship. Should commentary become threatening – to self or others – this is considered cause for concern and these comments are taken as valid expressions that warrant immediate emergency intervention. Text messages carry the same weight as spoken words, and are preserved in electronic format to be shared by the recipient at will. Failing to consider such communications as part of the purview of healthcare providers could lead to harm for the patient or others. While these expressions might not be quickly discoverable by physicians, they can, in some instances, be lifesaving components adding to the overall clinical picture. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.  

May 8, 2015 | Posted By John Kaplan, PhD

I recently read a paper written by my colleagues at Alden March Bioethics Institute entitled “In Particular Circumstances Attempting Unproven Interventions and Circumstances is Permissible and even Obligatory”. 

I do not entirely agree with my colleagues. I do not disagree that there are some very limited circumstances in which unproven interventions are warranted nearly all of which are in the research or compassionate use context. The recent Ebola crisis is an example of that where the use of monoclonal antibodies against the Ebola virus was consistent with theory and prior scientific precedent. However we must balance that against the harm done. The consumption of available ZMapp antibody in compassionate use likely precluded the opportunity to conduct clinical trials in a timely manner to determine if it actually did provide any benefit. Had it been used to prove efficacy it could have justified the investment necessary to prepare it large quantity and let future physicians and patients make informed decisions on its use. Moreover the manner in which the compassionate use was implemented, nearly exclusively available to US and European health care workers and barely any availability to Africans could hardly be considered just. During the next Ebola outbreak we may be faced with the same circumstances because we still do not really know its efficacy. There is now enough ZMaap available to conduct trials and these have been initiated but there may not be enough patients available to conduct them.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.  

May 4, 2015 | Posted By Bruce White, DO, JD

With the recent success of the blockbuster drug Sovaldi© (Gilead Sciences, Inc.), the manufacturer’s stock price has quintupled in the last four years. This supports the views of some that pharmaceutical prices in America should be subject to greater government scrutiny and controls like other industrialized countries.

High profits within the pharmaceutical industry are nothing new. “Historically [before the recent recession], the drug industry in America has been the top performing [sector] in terms of return on revenues (average 18.6%) and return on assets (average 17.7%) compared to 4.9% and 3.9% respectively for median companies in the Fortune 500 industries.” 

The extremely high costs of drug research and development (R&D) are often cited as the principal rationale for allowing an above average return and minimizing government price controls. However, studies have shown that “[as t]o the question of whether pharmaceutical drugs costs are justified by R&D, the answer is no. Pharmaceutical firms do indeed invest money in R&D, as do other production and service firms, but this investment does not account for their large ongoing profit, which ranges from 2.5 to 37 times the non-pharmaceutical industry average over time.”

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

April 24, 2015 | Posted By Jane Jankowski, DPS, LMSW

I am a lousy gardener. Just this year I am considering a small attempt at growing a few vegetables organically in my backyard. Maybe it was the long winter, maybe it is a drive to live more sustainably, maybe it is the challenge of overcoming decades of plant growing failures. After carefully selecting a few packets of easy to grow seeds and starting a few slow-growers inside, I have turned my attention to creating the best growing environment for these fragile plants. Part of this effort includes learning how to create compost from kitchen and yard waste materials. While I search for a suitable compost bin to take position behind the garage, I am diligently collecting fruit cores, egg shells, coffee grounds, and discarded greens in airtight containers in my fridge. Researching my options, I stumbled across an article that had me doing a double take, “A Project to Turn Corpses Into Compost” in the New York Times online. I gasped in horror. Could this possibly be an ethical option for burial? Could this be legal? Was this environmentally safe? Was this a joke?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

April 20, 2015 | Posted By Lisa Campo-Engelstein, PhD
The concept of infertility seems relatively straightforward, yet there are many myths, confusions, and disagreements regarding who counts as being infertile. According to the World Health Organization (WHO), infertility is "a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”Like many definitions of infertility, this one is based on a woman's body since she is the one who experiences pregnancy. However, this definition may make it more difficult to understand and recognize male factor infertility.Indeed, defining infertility based solely on a woman's ability to achieve pregnancy reinforces the myth that women are more likely to be infertile than men. In reality, women and men are equally likely to be infertile. The National Institutes of Health (NIH) definition of infertility is more inclusive: “the inability of a woman or man to conceive a child or the inability of a woman to carry a pregnancy to term.”

Another concerned with the WHO definition of infertility is that it is based on being in a heterosexual relationship.According to this definition and many others like it, people can only be considered infertile if they engage in "regular unprotected sexual intercourse." This definition does not explicitly state that this it is referring to heterosexual intercourse, which is problematic. Given the narrow scope of this definition, how then should we diagnose infertility in lesbian and gay couples and heterosexual individuals who are singleand not engaging in regular unprotected sexual intercourse.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

April 16, 2015 | Posted By Maggie Kirby

We are always pleased to support the activities of young scholars who are interested in bioethics. This link is a timeline of the Supreme Court case Gonzales vs. Oregon. It was prepared by Ms. Maggie Kirby who attends high school at U-32 in Vermont. It does a terrific job of documenting this important bioethics case and binging awareness to the ongoing debate about physician-assisted suicide. Great work Maggie! 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

Previous Posts

April 14, 2015 | Posted By John Kaplan, PhD
April 2, 2015 | Posted By John Kaplan, PhD
March 26, 2015 | Posted By Zubin Master, PhD
March 10, 2015 | Posted By Jane Jankowski, DPS, LMSW
March 4, 2015 | Posted By Bruce White, DO, JD
February 26, 2015 | Posted By Zubin Master, PhD
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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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