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June 29, 2015 | Posted By Lisa Campo-Engelstein, PhD
Apple recently announced that they will update their health app, HealthKit, to include reproductive health. Many were critical of the original app because although it can track a wide range of health indicators, such as BMI, sleep, sodium intake, number of falls, etc., it neglected reproductive health. Specifically, it is problematic that the app includes some obscure health indicators, like selenium intake, but not menstrual cycle, which affects half of the population. While there are other apps that are specifically geared toward women's reproductive health, it is troubling that an iPhone app that comes standard with the phone would exclude something so central to women's health as menstruation. Some believe that the omission of reproductive health from HealthKit is due to the fact that the tech world, including Apple, is dominated by men.  

The new the updated app is a huge improvement because it includes a variety of reproductive health indicators like menstruation, basal body temperature, and spotting. The broad range of reproductive health indicators helps women keep track of their reproductive health in general and specifically for women looking to prevent pregnancy and for women looking to achieve pregnancy. This is an important addition because too often reproductive health is overlooked or not considered part of "real" healthcare. The addition of the reproductive health category in HealthKit technology not only acknowledges the reproductive health issues specific to many women, but also normalizes 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.

June 23, 2015 | Posted By Zubin Master, PhD

Earlier this year, the NIH proposed a new idea to help sustain the biomedical research workforce through an “Emeritus Award for Senior Researchers” and solicited feedback from biomedical scientists. The idea behind the Emeritus Award was to help senior investigators transition out of a position reliant on NIH support and to transfer the research to junior colleagues, or to close a lab down (Kaiser, 2015). The reason for creating such an award is to free up research money for younger and more junior researchers. But before going into what scientists thought about the Emeritus Award, I would like to describe the current system of research funding in the U.S.

There are several prominent papers and reports that indicate that the biomedical research system in the U.S. is in crisis (Alberts et al., 2014; NSF, 2014; Holleman and Gritz, 2013; NIH, 2012; Martinson, 2011; Martinson, 2007). I just gave a lecture a few months back at a Career Symposium at my college to biomedical graduate students. The symposium had a panel of biomedical science trained speakers discuss alternate careers for biomedical students.

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.

June 18, 2015 | Posted By Wayne Shelton, PhD

Let me say emphatically at the outset of this blog, as someone who has been a clinical ethics consultant for over 20 years, I am quite sure that clinical ethics consultations overall improve the quality of patient care and currently are an important, even essential, part of the providing excellent patient care in hospitals. Contemporary medicine is filled with value laden questions and issues that often can be effectively addressed by someone with expertise and training in clinical ethics. Having said this, I am still somewhat skeptical about clinical ethics consultation becoming a professional area of healthcare that parallels other professional areas like medicine, nursing, and social work. I think there are some special considerations about the field of clinical ethics consultation that makes its future status as a professional activity uncertain.

First of all it is well-known that CEC’s come from a variety of backgrounds and training—from philosophers to physicians to social workers to nurses and lawyers and on and on. People enter the field of clinical ethics consultations from very different disciplinary backgrounds and seemingly learn a common vocabulary and methodology of clinical ethics and a basic familiarity with and ability to function in the clinical setting. They learn this vocabulary in very different ways—some informally, some through short 1-2 week long intensives, some with certificate programs, some with master’s degrees, and some with 1-2 year long fellowships. No other area of healthcare work admits of such diversity. Though this is a positive feature in some ways by providing diverse perspectives in understanding value dilemmas, it creates a challenge of considerable controversy when we try to define the kind of educational training a future CEC should have. At the moment there seem to be many pathways into the field and no clear answer has emerged.

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.

June 15, 2015 | Posted By John Kaplan, PhD

Advancement of Science and John Bohannon is a scientist. It does not seem unreasonable that they should aspire to operate under practices contextual to those expected of scientists.

I raise this point now because John Bohannon has again engaged in a sting operation. In this operation the goal was to see if he could get flawed science not only accepted into scientific journals but could he also have it distributed by the press thereby having it read by millions. So, to make a long story short, he created a fake research institute (Institute of Diet and Health) for which he created a fake website. He engaged in these activities under the name Johannes Bohannon. He had two collaborators, Peter Onmeken and Diane Lobl who were preparing a television documentary on junk-science in the diet industry. They were ready as he wrote to “recruit research subjects, a German doctor to run the study, and a statistician friend to massage the data.” So they recruited subjects without ethical review and approval by an Institutional Review Board or Research Ethics Committee. They recruited these unwitting subjects by deception, exposed them to at least some discomfort and risk as there were blood sample taken. They completed their study with the “real” result of increased weight loss in subjects who ate bitter chocolate. At least it was a real study with inadequate number of subjects, massaged statistics and apparent failure to do any sort of correction for the large number of comparisons they made.

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.

June 9, 2015 | Posted By Jane Jankowski, DPS, LMSW

Clinicians striving to help patients achieve healthcare goals often encounter the perplexing dichotomy of the patient’s stated goals and preferences and actions to the contrary. Some of these challenges can be overcome with education and close follow up to help reinforce adherence to medical recommendations, but other times, these barriers are more enigmatic.

Take for example, a patient who requires hemodialysis to sustain life. She sometimes shows up for her outpatient dialysis, but more often does not show up and is admitted to the hospital for emergent dialysis several months in a row. In consultation with her providers she is adamant that she does not want to die, and knows that she needs the dialysis to remain alive. She is discharged, and the pattern continues. Liberal scheduling with the outpatient service, transportation, reminders are all offered. Psychological tests and support are provided, and yet, her action pattern of not adhering to the treatment plan continues. Again, she is advised it is acceptable to halt and she will be offered palliative care. She refuses, and says she wants to live and will sit for dialysis. What is her genuine preference? Should we honor these statements, or accept her actions as the more authentic expression of her wishes? Though this hypothetical example is quite familiar to renal care providers, the dynamic spans many scenarios leaving many practitioners with a dilemma about the practical limits of honoring verbalized wishes that are not supported by congruent actions.

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.

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

On May 7, 2015, The New York Times reported that Johnson & Johnson (New Brunswick, New Jersey) had asked Arthur Caplan, PhD, Professor of Bioethics at New York University School of Medicine to create a new panel “that will make decisions about patients’ requests for potentially lifesaving medicine, responding to an emotional debate over whether companies should allow desperately ill people to have access to the drugs before they are approved [by the FDA].” 

Compassionate use” experimental drugs have been available for some time. In the recent Ebola crisis, last year the FDA “allowed the makers of ZMapp, an experimental treatment, to be used on a handful of patients, but the company quickly exhausted its limited supply.” Of late, several states have enacted “Right to Try” statutes in an attempt to craft a legally-recognized right to early access to drugs still in clinical trials.

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 28, 2015 | Posted By Zubin Master, PhD

The American Society for Bioethics and Humanities (ASBH) is the leading U.S.-based society for many bioethicists and humanities scholars. ASBH’s mission is to promote “the exchange of ideas and fosters multidisciplinary, interdisciplinary, and interprofessional scholarship, research, teaching, policy development, professional development and collegiality among people engaged in clinical and academic bioethics and the medical humanities.” It achieves these goals by stimulating discourse through meetings, developing its own publications and even impacting policy and practice. One major achievement by ASBH is its attempt to standardize the practice of clinical ethics consultations by developing the Core Competencies in Health Care Ethics Consultation now available as a second edition. A second, equally important, achievement is ASBH’s annual meeting.

As with all annual conferences, ASBH has a call for abstracts for individual presentations and panel sessions among other venues. They have a process of peer review and selection for accepting abstracts either for individual oral presentations, posters, panel sessions, program workshops, and preconference workshops. What I have noticed is for the last two years, I have personally not had anything accepted at the ASBH annual meeting. In fact, of the few other times I have applied, I have only been accepted to present a poster. Being Canadian and entering the field of bioethics around 2004, I believe I have attended only two ASBH meetings, one of which was way back when ASBH had a joint meeting with the Canadian Bioethics Society and the last one in 2010. I do however submit similar abstracts of my research to other bioethics, science, and medical conference which results in its acceptance for a talk or poster, but this seems to be a rarer case at ASBH. Throughout the years, I have discussed why ASBH is so selective in its abstract selection process with my bioethics colleagues and all of them say the same thing – “it’s hit or miss with ASBH.” And after being rejected now two years in a row, I decided to inquire a bit more into why this may be the case.

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 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.  

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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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