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January 23, 2015 | Posted By Lisa Campo-Engelstein, PhD

Although life-saving, cancer treatments (e.g. radiation, chemotherapy, and surgery) can also lead to infertility in both women and men. Established reproductive technologies for women and men like gamete freezing and embryo freezing allow cancer patients to preserve their fertility in case they want to become biological parents in the future. 

Unfortunately, patients are frequently not adequately informed and sometimes not informed at all about fertility preservation. Some oncologists don’t consider fertility preservation to be an important issue, as they are more focused on saving the patients’ lives and see fertility preservation as a secondary consideration. Research has shown that even when oncologists refer their patients for fertility preservation they often do so based on social factors (they are more likely to refer wealthy, white, heterosexual, married patients) rather than purely on medical indications. Even when health care providers discuss fertility preservation with patients, many patients say that once they heard the word “cancer” as a diagnosis, they didn’t absorb much else from their initial conversation with their provider. 

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. 

January 19, 2015 | Posted By Wayne Shelton, PhD

Let’s say you are looking to buy a car. You think you might want to buy a Volvo so you go down to the Volvo dealer and check out the new models. But you are shocked by what you see. You realize that you really don’t need to spend $35 to $40,000, or more, on a new car, so you decide to visit the Subaru dealer. There you find very nice alternative models for thousands of dollars less. You are delighted to have a new Outback for about $27,000.

The above story is how private markets and market choices work for the vast majority of items that we purchase to meet most of our needs as human beings. However, it has become painfully obvious that healthcare is an area where the normal model of markets and market choices do not apply. I’ll use a personal example.

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. 

January 16, 2015 | Posted By Jane Jankowski, DPS, LMSW

The release of Cuban spy Gerardo Hernandez as part of a prisoner swap made headlines last month not only for the diplomatic implications for Cuba-US relations, but also for the questions surrounding assisted reproductive services for incarcerated persons. According to a brief report from NPR, Hernandez’s spouse wanted to have a child with her incarcerated husband and sought support from a sympathetic US senator to facilitate this expression of reproductive liberty. While this case includes an added layer of intrigue because of the impressive barriers that were overcome to secure the means and support for artificial insemination, the question of how we ought to consider the use of assisted reproductive technology for couples who wish to bear children despite one parent serving a life sentence.

While some children may be conceived where prisoners are permitted conjugal visits, Mr. Hernandez was in a federal prison where it is reported that such visits are not allowed. The only means for reproduction would be via assisted technology such as artificial insemination, a now basic intervention. What about other families who wish to raise children but without the connections or possibility for release? Is it ethical to support such endeavors when one parent will be able to contribute gametes and an occasional visit in a prison setting without freedom to participate in rearing the child? This is not such an easily answered question.

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. 

January 12, 2015 | Posted By John Kaplan, PhD

Late in 2013 I posted an entry to this blog which described PubPeer, the newly implemented system for post publication peer review. In that blog I raised the question whether this is a good idea compared to other opportunities for post publication commentary such as letters to the editor or even new publications which would either support or challenge previously published research. The system has been going for a bit over a year now and I thought it would be appropriate to revisit the question of promise or chaos.

One of my principal concerns related to the ability of anyone who met the qualifications to comment to jump in and comment. The necessary qualifications are quite easy to meet and quite arbitrary. Anyone who has been funded to do research by the National Institutes of Health (US) or the Wellcome Trust (UK) is considered qualified. I have no idea why someone funded by the National Science Foundation (US) or the National Research Council (Canada) is not qualified.  

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. 

January 8, 2015 | Posted By Bruce White, DO, JD

On December 22, 2014, JAMA Internal Medicine published an article online titled “Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings.” A note by the journal’s editor Rita F. Redberg, MD, MSc, a cardiologist, titled “Cardiac Patient Outcomes During National Cardiology Meetings” appeared the same day. [JAMA Intern Med. Published online December 22, 2014. doi:10.1001/jamainternmed.2014.6801] Also, the same day press reports appeared – among other news outlets – in The New York TimesLos Angeles Times, and on the Web pages of the Harvard Medical School commenting on these articles. The newspaper articles and press release titles are more tantalizing: “Do Heart Patients Fare Better When Doctors Away?”; “Some Heart Patients Do Better When the Cardiologist Is Away”; and “Startling Benefit of Cardiology Meetings.”

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. 


January 6, 2015 | Posted By Lisa Campo-Engelstein, PhD

Many professions require state or federal licensure, including hairdressers, teachers, accountants, and physicians. The main reason we have professional licensure is to protect the clients who seek out the services of these professionals. Licenses require that professionals meet a minimum standard of knowledge and skills to certify competence in their field. Even some leisure activities require licensure, especially those that are considered potentially dangerous, such as scuba diving and hunting. 

Some have suggested that parents should also be licensed as a way of protecting their children by ensuring that have a base minimum skill set and knowledge about good parenting. The typical response to this suggestion is an emphatic no. Why is our knee jerk reaction to the idea of licensing parents to be horrified when we aren't bothered by licenses for professional and leisure activities, some of which also involve placing the lives of others in their hands (e.g. a physician) or require developing a deeper connection between people (e.g. a teacher)? How and why is parenthood different from these other activities? 

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. 

December 22, 2014 | Posted By Zubin Master, PhD

Recently Dr. Christopher Thomas Scott of Stanford University wrote a great paper titled “The Case of Stem Cell Counselors” in Stem Cell Reports which draws parallels from the field of genetic counseling arguing for the need for stem cell counsellors (1). Scott outlines that due to increases in the number of stem cell trials combined with fraudulent therapies being offered around the world, the time is ripe for having counsellors help patients navigate the clinical stem cell research/therapy landscape. These experts can help patients identify and distinguish legitimate trials from unproven interventions, explain the risks, benefits and therapeutic options, and serve as a resource to provide them with educational information.

On a related topic, my colleagues and I at AMBI were going to write a paper arguing that clinical ethics consultants should be involved in countering the impact of stem cell tourism and serve as a resource for patients who are contemplating undertaking an unproven stem cell based intervention (SCBI). We thought that clinical ethics consultants are in a unique position to offer advice and counselling to patients seeking unproven SCBIs for a few reasons.

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. 

December 18, 2014 | Posted By Jane Jankowski, DPS, LMSW

I have never worked in a nursing home. As a kid, I participated in mandatory choir concerts or shortened segments of dance recitals at the local nursing home where we uncomfortably showcased our talents to an audience of mostly immobile, but very appreciative older adults. It smelled strange and I was afraid to eat the sugar cookies and drink the punch, as if they might contain the recipe to becoming so aged you had to live in this place in front of a TV, when not subjected to random performances from local children. My own grandparents did stuff like fishing, swimming, cooking, wood working, and gardening. I expected to be that kind of ‘old.’

As a discharge planner, I found myself tasked with placing frail patients into nursing homes. The popular ones (glossy websites and slick pamphlets) were usually full. When I asked about the reputation of others, a colleague shook her head and said, ‘green walls and urine.’ Though I grew accustomed to the task, it seems shameful there have not been more good options for our most senior adults.

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. 

December 15, 2014 | Posted By Wayne Shelton, PhD

The vast majority of developed nations in the world provide universal healthcare coverage for its citizens. The only developed nations that do not are “…a few still-troubled Balkan states, the Soviet-style autocracy of Belarus, and the U.S. of A., the richest nation in the world.” 

Yet the United States (US) has the most expensive healthcare system in the world, by far—there really isn’t a close second—spending just under 18% of GPD and around $8,500.00 per person on healthcare. One might assume that given that type of expense, we would be getting a lot more than other countries in return for our investment. According to the research provided by Mirror, Mirror, from the Commonwealth Fund, the US sadly underperforms and often fails relative to other developed countries on major measures of performance. 

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. 

December 11, 2014 | Posted By Dan Thompson, MD

The title of the article in the Journal of Medical Ethics asks this question.[1]  The authors from the University of Montreal consider this subject while the topic of “illegal aliens” or foreign nationals (FN’s) has been a hot topic in the United States.  They however attempt to answer the problem from an international perspective.  The FN that we hear about is usually in the country illegally, but may be in the country as a legal non-citizen, visitor, non-permeant resident, refuge claimant, resettled refugee and in rare cases a person detained by the government.

A patient who arrives at the emergency room requiring hemodialysis would likely rapidly be started on renal replacement therapy.  This is an emergency and since this is considered, an emergency there would likely not be a question about the provision of such therapy. What then about transplantation of a kidney?  Is renal transplantation an emergency treatment?  We usually consider transplantation to be a more economical form of treatment of the acute renal failure in the end, but the lack of long term funding for medical care of the FN puts a different spin on the subject. It is not just the procurement of the organ and the surgery but also provision of and management of the immunotherapy necessary to prevent rejection of the kidney and the technology to manage the therapy.   A foreign national that returns to their home country where there is not an infrastructure that can provide the drug therapy or monitoring will reject the kidney. There is a national issue of financing the care and the ethical and national issues of obtaining the organ.

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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