April 28, 2016 | Posted By Wayne Shelton, PhD

Much of American history can be described as the struggle to expand the moral community in which an increasing number of human beings are seen as having basic rights under the constitution. We forget sometimes that though the inclusion of all people was perhaps implied in our early documents, as in “We hold these truths to be self-evident, that all men are created equal…” from the Declaration of Independence, it has taken historical time and struggle to come closer to realizing that ideal. This struggle has been the quest for recognition of more and more individuals not assumed initially to have the right to vote and exercise control over their lives, which included African Americans, women, minorities, and more recently the LGBT community. The growing recognition of more and more individuals as being full fledged citizens has been a slow, often painful, birthing process of freedom, in the sense of unleashing human potential and possibilities, within the democratic process.

 

The recent uproar over the Anti-LGBT law passed in North Carolina is a reminder of how difficult it is for many states and communities to accept and accommodate historically marginalized people into the mainstream of society. This law was a quick reaction by the right wing North Carolina legislature and governor to an ordinance passed in Charlotte, similar to what other cities around the country are doing, allowing transgender people to use restrooms according to their gender identity. Perhaps this law also should be seen as a reaction to the Supreme Court ruling in 2015 legalizing same-sex marriage, which has been propelling society toward greater openness and acceptance of LGBT life styles, integrating them into the mainstream. Many who favor the Anti-LGBT law claim that individuals born as male, but are now identifying as female, could pose a risk to women and girls in public bathrooms, though there seems to be no substantial evidence whatsoever of such a risk. My sense is that the individuals who support this law in fact are using risk as a smokescreen in attempting to preserve what they perceive as waning values and norms in society: In the name of conservatism they hang on to an exclusionary vision of society that no longer fits the conditions of expanding freedom and opportunity.

 

 

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 11, 2016 | Posted By Bruce White, DO, JD

In the March 18, 2016, AMA Wire Practice Perspective entitled “When Patient Satisfaction Is Bad Medicine” , Drs. Joan Papp (Case Western Reserve University) and Jason Jerry (Cleveland Clinic) make the argument that the institutional drive for higher patient satisfaction scores on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questionnaires may be contributing to the opioid prescription drug crisis nationwide. They note the results of an Ohio State Medical Association-Cleveland Clinic Foundation survey 1,100 Ohio physicians:

… 98 percent of the physicians who participated reported that they felt increased pressure to treat pain, and 74 percent reported that they felt an increased pressure to prescribe opioids because of the perverse pain management incentives in the patient satisfaction surveys.

Additionally, 67 percent of respondents “agreed that, in general, physicians in the United States over-prescribe controlled substances to treat pain.” Drs. Papp and Jerry pointed to HCAHPS questions 2 and 3 specifically that may be a factor:

(1) “During this hospital stay, did you need medicine for pain?” Patients can answer “yes” or “no.” (2) “During this hospital stay, how often was your pain well controlled?” Patients can answer “never,” “sometimes,” “usually” or “always.” (3) “During this hospital stay, how often did hospital staff do everything they could to help you with your pain?” Patients can answer “never,” “sometimes,” “usually” or “always.”

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 7, 2016 | Posted By BENITA ZAHN, DPS

The recent story of the failed uterine transplant had a decidedly American flavor. Let me explain.

In Sweden there have been 9 successful uterine transplants. The first recipient delivered a healthy baby boy, by cesarean section, in September 2014. Three more babies have been born since then. Not one of the families have been identified publicly. In Sweden the surgery and blessed event are personal, no media splash.

Not so here in the states. A 26 year old woman named Lindsey, last name not provided, underwent the uterine transplant at Cleveland Clinic on February 24, 2016. On March 7 she was literally, rolled out, for the TV cameras to celebrate the surgery. Sadly, a day later the transplant failed due to some, as of this writing, undisclosed complication. Within 24 hours Lindsey went from the bright lights to the darkness of despair when her hope for carrying a baby was dashed.

But in the American way every accomplishment is displayed for the public, playing out like a made for TV movie or any other reality program. I’m sure Lindsey had to sign a stack of papers to have the surgery attesting to her understanding of the risks. Her informed consent was probably scrutinized line by line by the IRB. But was her appearance for the media part of that? And if so, did anyone take the time to help her understand the ramifications of sharing this part of her life? Sure, she chose not to share her last name. Laughable, frankly. Did she really think that by not sharing her full name her privacy would be protected despite having her face, clear as a bell, appear on 50 inch, HD television screens across the country?

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 1, 2016 | Posted By Lisa Campo-Engelstein, PhD

In March, the Indiana legislature passed and the Indiana governor signed into law HB 1337, a bill that bans abortions for women seeking them based solely on certain characteristics of the fetus, such as race, sex, and disability. Specifically, the bill:

 “Prohibits a person from performing an abortion if the person knows that the pregnant woman is seeking the abortion solely because of: (1) the race, color, national origin, ancestry, or sex of the fetus; or (2) a diagnosis or potential diagnosis of the fetus having Down syndrome or any other disability. Provides for disciplinary sanctions and civil liability for wrongful death if a person knowingly or intentionally performs a sex selective abortion or an abortion conducted because of a diagnosis or potential diagnosis of Down syndrome or any other disability.”

As I have discussed in a previous blog, sex selection is a frequent occurrence in certain countries, such as India and China, where there is a strong preference for sons. Yet, there is little to no evidence that sex selection abortion is commonplace in the US. Abortion based on the race of the fetus is similarly rare in the US. While the purpose of any law is to prohibit actions it deems unethical or contrary to social norms, regardless of their frequency, due to limited time and resources, it makes sense to focus on bills that address common occurrences or things that are so morally repugnant that the state must take a stand. The main motivating factor for this bill does not seem to be avoiding discrimination based on sex and race, but rather trying to undermine legal access to abortion. Indiana is one of only five states that does not have a hate crime law and it recently rejected another attempt to pass hate crime legislation. It seems odd, and even contradictory, that Indiana is so worried about discrimination against fetuses, but not against legal persons.

 

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. 

March 30, 2016 | Posted By John Kaplan, PhD

Those of you who have followed my blog posts know that I sometimes express my views about education. I have argued for the value of broad-based education and in particular I have advocated both that scientists should receive quality education in the humanities and that those in the humanities should receive quality education in science. Now I am ready to again argue for inclusion of broad educational requirements and in particularly disagreeing with a man named Andrew Hacker who has, for some years now, argued against the required teaching of algebra. Andrew Hacker is a professor emeritus of political science at Queens College of the City University of New York.  Mr. Hacker notes that some students drop out of both high school and college and that others fail courses. These contentions are most certainly factually correct. But Mr. Hacker than goes on, with an amazing disregard for citing actual evidence, to identify mathematics in general, and algebra courses in particular as the reason for students who fail to complete or succeed in their education. In an opinion piece published in 2012 by the New York Times. Hacker argues that making mathematics education mandatory is a barrier in developing young talent and a major obstacle to their continued education. He claims without data or attribution that eight million high school and college students struggle with algebra every day. He indicates that one in four fails to finish high school and again without data or attribution indicates that “Most of the educator’s I’ve talked with cite algebra as the major academic reason.” Not this educator. He does cite the agreement of a teacher named Shirley Bagwell of Tennessee who is apparently another anti-algebra crusader.

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. 

March 24, 2016 | Posted By Wayne Shelton, PhD

Who could be against life? Ancient natural law theory in the Catholic tradition tells us that human beings desire to live, and that life is good, therefore humans have an obligation to live and not kill other human beings. This ancient wisdom has been instilled into western ways of moral thinking. So, who could not be prolife in terms of how we place value on all individual human life?

Who could be against human freedom? Individual human beings should be free to live peacefully in accordance with their own values and life goals. This is a basic tenet of democracy that has shaped moral and political thinking in the West for the past four centuries. So, who could not be against the exercise of free choice, especially about something so basic as having control over our bodies?

The two value perspectives contained in the prior two paragraphs, all things equal, are eminently reasonable and most ethically unproblematic. These two value positions represent two fundamental principles of ethics—the intrinsic value of all individual human lives and the right of free individuals to govern their own lives and bodies—that guide us in living an ethical life and making ethical decisions. It is when these fundamental principles come into direct conflict that a serious, a near irresolvable, ethical conflict arises. There is no greater direct conflict of these two ethical principles than right of women to have an abortion. It is commonly assumed that one is either on one side of this moral abyss or the other and the twain shall never meet. It seems to me one of the central tasks of ethical reflection on this issue is to find as much meaningful middle ground as possible. In this brief blog I’ll offer a few ideas in this regard, which advocates on either extreme will likely find unsatisfactory.

 

 

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.


March 18, 2016 | Posted By Valerye Milleson, PhD

When I first moved to Albany several months ago in pursuit of the exciting and glamorous life of a clinical ethics fellow, I brought with me only a handful of my earthly possessions; if the Fates have their way with me, I will likely leave with even less.

During this past month, in the late-night hours one night I awoke from my slumber to discover that while I had slept the majority of my basement apartment had been transformed into a bog. Yes, I was experiencing wintery real-life application of the law of thermal expansion as it applies to dihydrogen monoxide (i.e., a water pipe burst). After an emergency call to my landlord, I proceeded with my own separation of sheep from goats: what could be saved and salvaged was transported to the little dry land remaining in my now water-logged kingdom, while those items clearly destined to doom and decay were left languishing amidst the advancing liquid army. Few of my books survived, but among them was one I thought quite fitting to the circumstances: Marcus Aurelius’ Meditations.

Essential reading for any good Stoic (and, to my mind, useful if not essential reading for all human beings), Meditations, and the ancient words of wisdom it contains, helped me to navigate through and reflect upon my experience of the flood and its corresponding aftermath. Some choice morsels include:

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.

March 15, 2016 | Posted By Lisa Campo-Engelstein, PhD

Whereas quality of life issues for cancer patients used to minimized, and sometimes even ignored, today there is more of a focus on cancer patients’ quality of life post-cancer. One such quality of life issue is oncofertility, which is fertility preservation for cancer patients. In many places, oncofertility is, or is becoming, the standard of care for cancer patients. But should it be offered to all patients? What about patients who have a very bad prognosis?

Fertility preservation for patients with a poor prognosis raises a host of ethical issues. Providers may worry that discussing fertility preservation will give patients false hope about their prognosis. In other words, these patients may feel their providers deceived them by mentioning fertility preservation, leading them to believe that their prognosis is not as bad as they originally thought.

Yet, at the same time, pursuing fertility preservation may be a source of hope and happiness for patients during difficult times. It may furnish them with mental and physical strength, making them even more motivated to survive for the sake of their potential future children. Additionally, these patients, and their families, may feel a degree of inner peace knowing that part of their lives will continue on in the reproductive material even if they are never used.

 

 

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.

 


March 10, 2016 | Posted By Jane Jankowski, DPS, LMSW

According to the American Society of Addiction Medicine, drug overdose is the leading cause of accidental death in the US with close to 50,000 deadly overdoses in 2015 alone.  Opioid addiction accounted for nearly 20,000 of these and heroin alone was a factor in just over 10,500 deaths. The magnitude of opioid abuse related hospitalizations, sales of prescription pain killers and deaths have increase exponentially between 1999 and 2008 according to ASAM. Increased access to Narcan (naloxone) to reverse life threatening effects of opioid for first responders has now expanded to making Narcan available to the general public as well. In some areas, Narcan can be purchased without a prescription by family members and friends who expect they may need to quickly rescue a loved one. While I support this program because it can and will likely save lives, it does not address the need for effective rehabilitation of persons who suffer the all-consuming and devastating effects of opioid addiction. Regulations which will allow persons with opioid addictions to be detained involuntarily in health care setting are also being discussed, but pose some dilemmas as well.

 

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.

March 4, 2016 | Posted By Wayne Shelton, PhD.

As a philosopher who works in a large health science center where the scientific method and perspective reign supreme, it is common to hear comments about the abstract and ideal nature of philosophy. As though those who think about human problems from a philosophical perspective do so from an abstract, insular perspective with little or no practical impact. Though I hear such dismissive comments about philosophy less often than I used to, say 20 or more years ago, I sense there is still a commonly held view that those who think from a philosophical perspective as not well oriented to practical affairs. And with some justification do people have this view of philosophy.

 

As I have written in previous blogs, philosophy has long and even proud part of its tradition for being, well, useless. If we assume that the basis of philosophical truth and wisdom lay in some ultimate, objective form that only those who think in certain ways can grasp, then knowledge becomes privileged to the philosophical few as an end it itself. This type of Platonic philosophical truth quickly divides the here and now inferior world from the more exclusive understandings of reality. Because of this basic influence of Platonic philosophy, much of the history of philosophy in the Western tradition has been focused on the search for a rational, objective basis of truth, value, and reality. Not surprisingly, the goal has not been reached. But the quest continued through most of last century and philosophical got its more or less justified reputation for being an insulated, esoteric, and detached form of intellectual activity. Put bluntly, philosophers, with a few exceptions, rarely got their hands dirty in the real world of practical activity.

 

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.

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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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