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October 23, 2014 | Posted By Lisa Campo-Engelstein, PhD

A few weeks ago, I attended the annual Oncofertility Consortium conference where Dr. Angel Petropanagos and I presented our poster “Teen Boys and Fertility Preservation: An Ethical Analysis.”  The vast majority of discussions about fertility preservation (FP), particularly FP for “social” (aka nonmedical) reasons, are focused on women in part because FP for women raises more ethical issues.  For instance, egg freezing carries more health risks and is generally less effective than sperm freezing. Furthermore, whereas sperm freezing has been an established method of FP for decades, it was only two years ago that the American Society for Reproductive Medicine lifted the experimental label from egg freezing.

Yet, even established technologies can raise ethical concerns when used in vulnerable groups, such as children. Our research project examines the ethical issues FP raises when used by teenage boys.  In order to undergo sperm freezing, males must produce a sperm sample and this is usually done through masturbation. However, discussions about masturbation can be embarrassing and difficult for adolescent males (as well as for healthcare providers), particularly if they have never masturbated or never masturbated and achieved an ejaculation. Some parents and healthcare providers place a high value on preserving patients’ future option of genetic reproduction, but FP discussions with teen males can be especially challenging due to the sensitive and private nature of sexuality and reproduction. 

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.

October 21, 2014 | Posted By Jane Jankowski, DPS, LMSW

The clerkship years of medical school expose students to a range of specialties medical practitioners may select as an area of advanced study during residency. Pediatrics, surgery, general medicine, radiology, psychiatry, and more are part of the array of educational exposures students gain from during these rotations. As an educator facilitating discussion groups which provide the opportunity for reflection, questioning, and connecting expectations to the actual experiences, I have found that there are gaps in understanding the roles of other personnel that are essential to the physician role, but not always well defined. As we strive to encourage future physicians to do their best to understand that the business of medicine takes a small village of practitioners in order to work best, we do too little to help them learn the perspective of these other providers. Lectures and readings may offer some insight, but the street-level day to day operations may be a bit of a mystery. I propose clerkship years include time spent working alongside professionals beyond physicians such as pharmacists, billing specialists, security guards, social workers, lab technicians, and visiting nurses. While learners may not be able to fully walk in the shoes of other essential staff members, but being alongside another who is willing to teach and share the tasks, the struggles and rewards of their position. Many med students will someday be in position to lead large groups of staff members in clinics, hospitals, and private offices. Recognizing the unique roles, strengths, and limitations of the non-physicians who contribute to the day to day operations of our vast healthcare industry will help build well rounded doctors who are prepared to be effective leaders. 

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.

October 13, 2014 | Posted By Wayne Shelton, PhD

As I have been saying in recent blogs, most of what we do in clinical ethics, but also in most areas of bioethics, is procedural ethics. That is when we are faced with an ethical dilemma, our approach, whether consciously or unconsciously is usually to try to reach a reasonable compromise or consensus among the key participants that are in conflict consistent with well-established values and principles. This tendency reflects an obvious reality about the nature of contemporary ethics that we often ignore: in the current Western moral setting, our only viable methodology for resolving value laden disputes, whether at the micro level in clinical ethics or macro level in healthcare policy, is to attempt to craft an agreement or consensus among those with a say. Whether we are dealing with patients and families at odds with their physician on how to define the goals of care in the hospital setting or trying to build a consensus of opinion among voters in the political arena, we assume there are no final, authoritative moral answers that avail themselves to us. Whether we like it or not, we humans must figure out ethical dilemmas for ourselves and learn to get along.

Yet the idea of procedural ethics remains very worrisome for many people, including such bioethicists and Tristram Engelhardt, Jr. He believes that procedural ethics, such much of what we do in clinical ethics, is not really ethics in because it is based on convention and legalistic type standards. For him ethics worthy of the name must flow from a content-rich, canonical moral tradition that provides moral authority to our everyday ethical and moral judgments. The prototype ethical tradition was the medieval Christian Natural Law perspective grounded in Aristotelian philosophy. Aristotle assumed the inherent order and intelligibility of the cosmos, which also permeated his understanding of ethics. Humans, like all natural things, had a natural function, which was to be rational. But rational did not mean to that ethics was about finding intellectual or theoretical basis for right action according to rational rules in order to know and perform one’s duty—this was Kant’s (1724-1804) ethics during the 18th century following the rise of modern science. For Aristotle, the question was, how can one live and embody the good life; so rationality in this sense meant internal harmony between emotions and decision-making that resulted in well-established habits or states of character. This means finding in all of one’s activities the balance between excess and deficiency, or what he called the “mean”. Over time, forming the right habits according to the mean in all areas of life lead to excellence and happiness or what he called the good life. This was the natural fulfillment of the human function in practical terms consistent with the ancient Aristotelian.

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

October 10, 2014 | Posted By John Kaplan, PhD

When the Affordable Care Act, commonly referred to as Obamacare was under consideration there was an unrelenting partisan attack against both the proposed legislation and the president who proposed it. We were told that millions would lose insurance coverage, that the cost of medical care would skyrocket, and that government bureaucrats would be interfering with the health care relationship between us and our physicians. We were told that death panels would be making decisions to end the life of the elderly and infirm. We were told all sorts of things that were so ridiculous that I cannot recall them. The fact is we were told lies. Interestingly and importantly none of these things have occurred. The Affordable Care Act was designed to increase the extent of medical insurance coverage and the corresponding access to health care permitted by insurance coverage. The Affordable Care Act was also designed to slow the growth of health care costs. While it is true that there were initial technical glitches in its rollout, now a year after people could begin to enroll, and still only months after the initiation of most of its provisions it is clearly apparent that it is doing just what it was designed and implemented to do. Yes, the Affordable Care Act, Obamacare, is a success.

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

October 6, 2014 | Posted By Bruce D. White, DO, JD

The September 24, 2014, issue of USA Today carried a story titled, “Anti-Addiction Groups Want FDA Chief to Resign: Activists Say Agencies Policies Have Led to Epidemic of Painkiller Abuse.” The first sentence of the news report says: “Anti-addiction activists are calling for the Food and Drug Administration’s top official to step down, saying the agency's policies have contributed to a national epidemic of prescription painkiller abuse.” ABC News reported the story that same day with the lead, “Anti-Addiction Groups Call for New FDA Chief.” In the written ABC News commentary, the hype may be characterized in one inflammatory sentence: “In a letter released Wednesday, more than a dozen groups ask the Obama administration’s top health official to replace FDA Commissioner Dr. Margaret Hamburg, who has led the agency since 2009. The FDA has been under fire from public health advocates, politicians and law enforcement officials since last October, when it approved a powerful new painkiller called Zohydro [ZOHYDRO™ ER (hydrocodone bitartrate) extended release capsules, Zogenics, Inc.)], against the recommendation of its own medical advisers.” Both the print and newscast reports came from an Associated Press report written by Matthew Perrone about a controversy that has been brewing for sometime. The activists’’ letter to Secretary of Health and Human Services Sylvia Burwell is available online and states their position clearly. 

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.

October 3, 2014 | Posted By Paul Burcher, MD, PhD

I was at a conference last week in medical ethics, and I was surprised by, or perhaps appalled at, the attitude displayed by many of the philosophers regarding the importance of medical knowledge in medical ethical decision making. Several of them proudly announced a total ignorance of the medical issue they were speaking on, and also showed no interest in what I would call “real world” implications of their conclusions.  Although I have a PhD in philosophy, I am not a philosopher in the sense that I am capable of, or interested in, spinning arguments from “thin air” with no grounding in medical facts, and no implications for real medical practice.  Medical ethics must begin in real life issues and problems, and end with equally real and meaningful conclusions that can be applied, and sometimes even empirically tested. 

This is not to say that philosophers cannot make good, or even great, medical/clinical ethicists. But they need to begin with a healthy respect for the way in which the “facts on the ground” inform the ethical decision-making.  A brief example illustrates my point.  In Hilde Lindemann Nelson’s famous article explaining narrative ethics, she discusses the case of Carlos and Consuela. Carlos is an HIV positive gang member wounded in gang violence, who is recovering from his injuries in a hospital.  He is now ready for discharge, but needs dressing changes at home.  He wants his sister Consuela to do the dressing changes, but he insists that she not be told about his HIV status.  While Dr. Lindemann Nelson uses this case to make several excellent points about the limitations of principle based ethics, one aspect of the question, crucial to any ethical reasoning on the case, is obviously the transmissibility of HIV infection through dressing changes.  This “fact” is an essential aspect that underpins any ethical judgment regarding the case.  The conflict between patient confidentiality and duty of nonmaleficence (toward Consuela) pivots in part on the fact that HIV is not readily contagious, and simple universal precautions should make the risk to Consuela essentially nil.

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

October 2, 2014 | Posted By Jane Jankowski, DPS, LMSW

Who decides when a problem is worthy of clinical attention? Symptoms may prompt individuals to seek medical attention, but part of this recent review of the Prozac revolution (selling-prozac-as-the-life-enhancing-cure-for-mental-woes )in the US suggests that public perception of medication for some problems was launched into a new era when Prozac hit the market in 1987. Truly revolutionary in its ability to target serotonin in order to treat depression, the additional impact of rolling out Prozac was the perhaps unintended consequence of marketing drugs to address issues which enhance people’s daily life.

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.

September 25, 2014 | Posted By Lisa Campo-Engelstein, PhD

One of the more controversial parts of the Affordable Care Act (ACA) is the mandate that insurance companies cover contraception. As seen in the Hobby Lobby case, the argument is often boiled down to two conflicting sides: women who want the right to receive contraception without a co-payment and employers don’t want to provide contraception due to their religious convictions. Men’s right to receive contraception without a co-payment is missing from the ACA and the larger debate about the right to contraception. I wonder, however, how this public discussion would be different today if there were more types of male contraceptives and men were expected to assume more responsibility for contraception. 

It is worth noting that women’s association with contraceptive responsibility is a relatively recent phenomenon. Before the “contraceptive revolution” of the 1950s and 1960s, which lead to the development of hormonal and long-acting contraceptives, notably the pill, men actively participated in many forms of contraception. One reason for this is that contraceptive use was tied to the act of sex itself or to the timing of sex; therefore men had to be involved. All of the available contraceptives were used during sex, such as condoms, diaphragms, sponges, and withdrawal; immediately following sex, like douches; or were related to the timing of sex, as in the case of the rhythm method. 

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

September 23, 2014 | Posted By Zubin Master, PhD
September 19, 2014 | Posted By Ricki Lewis, PhD
September 16, 2014 | Posted By Wayne Shelton, PhD
September 11, 2014 | Posted By John Kaplan, PhD
September 9, 2014 | Posted By Bruce D. White, DO, JD
September 4, 2014 | Posted By Luke Gelinas, PhD
August 27, 2014 | Posted By Ricki Lewis, PhD
August 19, 2014 | Posted By Lisa Campo-Engelstein, PhD
August 14, 2014 | Posted By Jane Jankowski, DPS, LMSW
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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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