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Topic: Distributive Justice
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 9, 2014 | Posted By Bruce D. White, DO, JD

On August 30, 2014, cardiovascular drug researchers managing the PARADIGM-HF Study and its Committees announced that they were terminating their Phase III trial of LCZ696 because of observed “overwhelming benefit.” As reported in The Daily Mail: “Thousands of lives could be saved by a new drug for heart failure that researchers claim outperforms the current best treatments. … Research on more than 8,000 patients found that it saved 20 per cent more lives than the current ‘gold standard’ treatment – the ACE inhibitor enalapril.” The findings were announced at the annual meeting of the European Society of Cardiology and published the same day in the The New England Journal of Medicine. In a news release, the Switzerland-based Novartis International AG – the drug manufacturer sponsor – said that it would submit an FDA application to market the drug in the US by the end of 2014. Novartis anticipates submitting a similar application to the European Union by early 2015.

Analysts say “that [the new drug] might cost $7 a day in the United States, or about $2,500 a year. Existing [standard] drugs are generic, costing as little as [$48 a year] … .”

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.

August 4, 2014 | Posted By Bruce D. White, DO, JD

In December 2013, the FDA approved Sovaldi® (sofosbuvir, Gilead Sciences, Inc.) for treatment of hepatitis C. A truly wonderful medical breakthrough, the oral drug effectively cures 90% of patients who take it correctly. The online physician resource Web site Medscape has referred to this drug as a “game changer.” Clearly it will change the health care delivery game in any number of ways.

But the miracle comes with a catch: the cost is prohibitive. The full treatment course is so expensive that very few can afford it even with good health insurance. Each pill costs about $1000; patients will need to take the medicine once a day for about 12 weeks for a full course. The total cost will be about $90-120,000 per patient. Many are asking how is it possible to justify the cost? Is this fair?

Of course, the principal difficulty at first glace is that the costs will strain the system to a degree never before seen with the introduction of a new drug. The strain may break the bank. Recently Reuters has reported that one Florida health insurer – WellCare Health Plans – has sustained significant corporate losses attributable to the fact that Florida requires insurers to prove sofosbuvir to Medicaid patients. It has been reported that 47 state Medicaid programs are covering the drug, and about half have some form of preauthorization. Illinois Medicaid has recently changed its preauthorization criteria to provide the drug only to those patients with advanced liver disease, and to those who can tolerate interferon as an adjunctive treatment, and to exclude individuals with a history of alcohol or drug abuse. It has been projected that drug availability to California residents alone will add $18 billion to health care costs in one year.

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

The ongoing VA scandal is indeed unfortunate and sad. In a speech on May 30, 2014, in Washington, DC, Eric K. Shinseki apologized for the “systemic, totally unacceptable lack of integrity” shown by some administrators in managing the Veterans Administration health care system hospitals and clinics. Within hours of the apology, Secretary Shinseki resigned.

It is clear that the trouble within the VA has been brewing for some time. The fuse that set off this latest explosion may have been whistleblower claims that managers at the Phoenix VA Medical Center were keeping two sets of books which logged wait times for veterans seeking primary care appointments. There are allegations that some of the delays resulted in veteran deaths. Acting VA Inspector General Richard J. Griffin issued a preliminary report confirming that Phoenix VA administrators had manipulated wait times possibly to assure more favorable annual performance reviews and higher bonuses and compensation for staff.  The unethical behavior by those entrusted with the care of our veterans is inexcusable.

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 28, 2014 | Posted By Marleen Eijkholt, PhD

Amber is a 70 year old woman. She is doing poorly. She has metastasized cancer, multiple co-morbidities and a pressure ulcer. Apart from her ulcer, she has no acute care needs that condone her to the hospital. Some predict that she is likely to pass over in 3 months. With the right type of medications Amber could go home. However, the pressure ulcer medications that she needs cost about 200 dollars a day and she does not have the right type of insurance to pay for this. As a result, she is confined to a hospital bed. 

Amber has always contributed diligently to society. She worked from age 17 in a bank and paid her taxes diligently. Amber and her husband, who died 3 years ago, raised 3 children and lived in a town upstate New York. They used to take holidays on the West-Coast, where Amber has a family summer home.  This house belonged to her great grand-mother and has been in her family for 120 years. All of Amber’s family is attached to this house.

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 7, 2014 | Posted By Bruce White, DO, JD

New York Times article by Katie Thomas published on December 16, 2013 led with this sentence: “The British drug maker GlaxoSmithKline will no longer pay doctors to promote its products and will stop tying compensation of sales representatives to the number of prescriptions doctors write, its chief executive said Monday, effectively ending two common industry practices that critics have long assailed as troublesome conflicts of interest.” Might one ask: Are these really conflict of interests problems?

conflict of interest (so sometimes, conflict of interests) is often defined as: “a set of circumstances that creates a risk that professional judgment or actions regarding a primary interest will be unduly influenced by a secondary interest.”  In a short introduction to conflicts of interests, written for a business ethics class at the McCombs School of Business at the University of Texas at Austin, Dr. Lamar Pierce (Associate Professor of Strategy, Olin Business School, Washington University, St. Louis) said:

Incentives are pervasive in every aspect of society. People are rewarded for taking certain actions, and not rewarded for taking others. Workers are paid for their effort and productivity, salespeople are paid for their sales, and small business owners are rewarded with profits for successful ventures. So long as these incentives are well-understood by everyone, they work reasonably well. They motivate effort, performance, and social welfare. But sometimes, individuals have incentives that conflict with their professional responsibilities, often in ways that are not transparent to the public or in their own minds. These conflicts of interest produce serious economic and social problems.

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 7, 2014 | Posted By Bruce White, DO, JD

The events playing out in Children’s Hospital and Research Center Oakland as I write this blog are tragic and very sad.

On December 9, 2013, thirteen-year-old Jahi McMath underwent a complex tonsil and soft tissue surgery at Children’s Hospital. Physicians had recommended the surgery because she suffered from pediatric obstructive sleep apnea. Surgeons removed her tonsils, adenoids, uvula, soft palate, and extra sinus tissues. Her family reported that she felt fine after the surgery and even asked for a Popsicle because her throat hurt.

However a few days after the surgery, Jahi began to bleed profusely from her mouth and nose, and she subsequently suffered a cardiac arrest. She never regained consciousness after the arrest, and on December 12, 2013, her condition was such that the doctors were able to determine death by neurological criteria. When the doctors advised the family that they planned to withdraw life-sustaining medical interventions because Jahi was now dead, the family objected. At this point – as was reported by one news agency – the mother, Nailah Winkfield, said, “I just looked at the doctor to his face and I told him you better not touch her.”  

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 19, 2013 | Posted By Wayne Shelton, PhD

There are some ominous social and political trends currently in American society on which the field of bioethics should focus more attention. In this informal and admittedly polemical blog, I would like to briefly explore a couple of them.

Governors from about half of the states, mostly from the Tea Party GOP, have invoked their constitutional right to deny healthcare coverage to individuals in their states who make less that 138% of the federal poverty level. These governors calmly claim that pragmatism, not politics, is the basis for their decision to refuse their states the opportunity to participate in the Medicaid expansion program under the Affordable Care Act (ACA). It’s just too costly and the Medicaid program is broken, so they say.

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 12, 2013 | Posted By Bruce White, DO, JD

A July 28, 2012 article in The New York Times by Anne Lowry and Robert Pear titled “Doctor Shortage Likely to Worsen with Health Law” was recently updated with a follow-up report about Medicaid expansion by Abby Goodnough in a piece titled “Medicaid Growth Could Aggravate Doctor Shortage.” 

Many report that there’s not enough doctors now. It may be curious and rhetorical, but why would anyone suspect that there’s not going to be doctor shortages of some degree – in the very near future – if Medicaid expands by 9 million new persons and the Affordable Care Act (ACA) adds another 30 million or so newly-insured patients to those already covered by some plan. How could this not have been anticipated? It must have been factored into the ACA equation. In the same way that legislators should have realized that some insured would not be able to “keep their coverage” once the new health law was to take effect.

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 14, 2013 | Posted By Bruce White, DO, JD

Enrollment with the new Affordable Care Act [ACA] exchanges appears to be off to a bad start. It may be that by the time the insurance exchanges and plans take effect early next year, all the glitches may be worked out. However, even at this relatively late date, many questions remain unanswered. Some of the more distressing unanswered questions relate to the availability of expensive medicines

According to The New York Times, several of the states administering exchanges have yet to release information about drug formularies or fully explain which drugs might be excluded. Of the few states that have released this kind off information, some have options that will require patients to pay as much as 50 percent of the costs of the most expensive drugs covered. Of course, there’s no guarantee that some drugs will be included at all.

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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