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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.

September 23, 2014 | Posted By Zubin Master, PhD

What is the role of public education and stem cell tourism? What type of education is available to patients, caregivers and the public? Can public education actually change people’s minds such that they won’t undergo an unproven stem cell-based intervention (SCBI)? These are the questions I will discuss here. But first, let’s just give a brief description of stem cell tourism and outline some of the proposals discussed to stop this industry.

The “Stem Cell Tourism” Industry and Ways to Curtail the Market

Briefly, “stem cell tourism” is a term used to describe an Internet-based, direct-to-consumer advertised industry where patients receive unproven SCBIs for a range of diseases and injuries. Many clinics offering unproven SCBIs are in countries with lax regulations and enforcement. However, these clinics are also increasingly popping up in highly regulated countries like the U.S., U.K. and Australia. The term “stem cell tourism” is misleading because patients may not necessarily need to travel a great distance to receive such interventions, and focuses on patient behaviors instead of others involved in this market including regulatory agencies and the providers offering them. Moreover, there are some real risks to stem cell tourism. Beyond patients being financially exploited, there are several reports of tumors, lesions, tremors, other problems, and even deaths of individuals receiving unproven SCBIs. And there seems to be a stem cell “treatment” for just about every disease and injury, no matter how severe or benign if the patient can pay anywhere from $8,000-$30,000. Clinics advertise for serious conditions such as heart disease, stroke, MS, Parkinson’s disease, ALS, and spinal cord injury among many others. You might have also heard of major NFL stars receiving SCBIs for sports injuries, movie stars receiving anti-aging stem cell treatments, and even a U.S. Governor receiving stem cells for chronic back pain. The fact that celebrities and public figures are receiving untested SCBIs is likely to make it seem that they are safe and effective and only bolsters the market. Yet there are very few bonafide stem cell treatments out there. While more clinical trials using stem cells are underway (1), it will become increasingly difficult for patients to discern between a legitimate clinical study and a fraudulent intervention. And because of all the hype, ethical issues, and misconduct scandals having to do with stem cell research, having patients become injured due to an unproven SCBI is not only bad itself of course, but also can seriously stifle the stem cell field.

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 19, 2014 | Posted By Ricki Lewis, PhD

In recent weeks, there’s been talk of three types of genetic testing transitioning from targeted populations to the general public: carrier screens for recessive diseases, tests for BRCA mutations, and non-invasive prenatal testing (NIPT) to spot extra chromosomes in fetuses from DNA in the maternal bloodstream.

Are these efforts the leading edge of a new eugenics movement? It might appear that way, but I think not.

When I began providing genetic counseling 30 years ago at CareNet, a large ob/gyn practice in Schenectady, NY, few patients were candidates for testing: pregnant women of “advanced maternal age” (35+), someone with a family history of a single-gene disorder or whose ethnic background was associated with higher prevalence of a specific inherited disease. Their risks justified the cost and potential dangers of the tests.

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 16, 2014 | Posted By Wayne Shelton, PhD

Ok, I realize I am being somewhat provocative. But there is a real and very serious issue, which I am groping to address in a more precise manner.

In my last blog I described the contemporary moral setting from a philosophical perspective as one in which no single substantive normative moral perspective can resolve moral questions, such as the boundaries of human life and the scope of individual rights, with final moral authority. This is just to say, more simply and obviously when we reflect upon it, that in democratic, secular America, ethics, both philosophically and practically, becomes inextricably linked to public discourse in politics and public policy.

When bioethicists ask questions and make arguments about abortion, physician assisted suicide, stem cell research and cloning, and many other similar issues that pertain to questions about the value of human life in relation to both individual rights and societal goals, we have no privileged moral authority from which to draw. As bioethicists we engage in procedural, persuasive discourse, based on conventional moral principles that most often conflict, which is why there is moral dilemma or problem requiring analysis and prioritization. Our purpose in defending a particular moral position is to win assent from others. In short, for a bioethicist to promote a moral position, it is implicitly an attempt to build a consensus among readers and listeners that will hopefully impact public opinion about a particular moral problem or question. Moreover, to the extent these questions have public policy ramifications, and practically all do, it means that moral discourse is also oriented to effect change and function as a medium in which bioethicists often speak as advocates about how moral options should be framed as public policy positions in a democratic society. 

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 11, 2014 | Posted By John Kaplan, PhD

The answer, it seems, is quite a number of people. The question that we really need to address is why. Are these concerns rational, are they science based, should they provide the basis for public policy? People have been using selective breeding and hybridization techniques for thousands of years to alter the genetic makeup of both plant and animal agricultural products. Neil Tyson Degrasse made the point very clearly and effectively that almost nothing we grow agriculturally has been unchanged from the plants and animals living naturally. They have all been altered by the intentional action of human beings. Selective breeding, of course, has significant differences from what is currently characterized by the term genetic modification which is done using the techniques of molecular biology to insert genetic material. But they do establish the principle that most people are happy to eat food products which have been genetically altered by people. That sweet red apple you had for lunch or the fattened cattle which produced your juicy hamburger do not exist in nature.

The techniques of genetic engineering which can be used to insert genetic material into the genome of a cell permitted the alteration of crops that resist pests requiring less use of pesticides. They allow selective herbicide resistance allowing the use of minimally toxic or nontoxic  herbicides as well as no till farming which diminishes erosion and reduces use of fossil fuels. They have also been able to use these techniques to add essential nutrients to address widespread dietary deficiencies. An example of this is the development of golden rice, the genetic modification of rice to produce vitamin A. These are good things.

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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