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Topic: Ethics and Morality
October 17, 2012 | Posted By Zubin Master, PhD

Stem cell tourism is a pejorative term used to describe clinics that offer under or untested stem cell interventions to patients with debilitating diseases. This includes Parkinson’s disease, multiple sclerosis, ALS, blindness, cancer, cerebral palsy, spinal cord injury and many others. We used to think about stem cell tourism as potential patients traveling to clinics from countries like the US, UK, Canada and Australia to countries with lax regulations, but this simply is not the case anymore. There are several clinics within the US that offer under or untested stem cell interventions, some of which are being challenged by the FDA. The stem cell tourism market is an internet-based, direct-to-consumer market. There is a lack of scientific evidence and clinical research supporting the claims made by clinics in regards to the efficacy of these so-called “treatments”. The evidence sold to patients are testimonials by other patients saying how great they feel and how it has helped them and given hope. This is further fueled as some public perception studies indicate that several patients are frustrated and seem to distrust their domestic healthcare, research and regulatory system. So why offer these therapies? Well for starters, stem cell providers could make a ton of money (ranging from $5,000 to $30,000), especially because sometimes patients require repeated treatments. The market has more recently attracted celebrity types including several high profile athletes, Hollywood stars, and even a US State Governor.

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, 2012 | Posted By Wayne Shelton, PhD

The modern era in the West marks the beginning of a new way of understanding the purpose of a social system and how people fit in to it. The transition to the modern world was from a medieval world that was perceived to have inherent ends and truths, based on Aristotelian metaphysics and Catholic moral theology, that provided authoritative answers to fundamental questions about the nature of ultimate reality, knowledge, human nature and morality. In Europe during the 15th and 16th centuries, the radical political turmoil, stemming from the Protestant Reformation, and a growing sense of the rights of humans were leading philosophers like Hobbes (1588-1679), Locke (1632-1704) and Rousseau (1712-1778) to articulate a fundamentally new type of social and political system. Instead of the divine rights of kings to assert complete rule over subjects, which created an obligation for subjects to obey those divine rights, there emerged the concept that the social and political order should be structured so as to protect and preserve the natural rights of human beings qua citizens. This new understanding of how to understand society and individuals—later called social contract theory—provided the conceptual underpinnings of the eventual emergence of democratic systems: The idea that the social system should be structured in a manner so as to allow individual citizens to be free to live according to their life goals and values within the limits of respecting those same rights of others. This meant that individual citizens should agree to give up some of their rights, e.g. to steal and kill, for the larger benefit of living safely and in a manner of one’s own choice. 

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 ourwebsite.

July 12, 2012 | Posted By Wayne Shelton, PhD

Those of us who work in clinical ethics focus most of our intellectual energy on addressing ethical dilemmas in individual cases. Clinical ethics allows little time for armchair reflection. The urgent cases presented to us require fairly quick decisions. That is, if we are to be helpful, we have to find thoughtful ways to analyze ethical questions and reach prudent recommendations. But even for clinical ethicists, it is worthwhile from time to time to take a step back and consider the historical philosophical context in which we work and the challenges it poses for ethical reflection and judgments.

Clinical ethics has been criticized by some not having an adequate basis on which to give substantive answers to pressing ethical questions in medicine. I want to show how this concern is not only, not a problem, but is a sign of progress. First a little background about the state of contemporary western ethics as expressed in one of the most important critiques of philosophical ethics and morality in the past 100 years.

In his 1981 work entitled After Virtue, Alasdair McIntyre claims the actual moral world in which we live is in “a state of grave disorder”. The concepts and terms we use in contemporary ethical discourse, he believes, are nothing more than fragments of prior conceptual schemes that have largely lost their moral import. Even worse, we use ethical discourse in talking about obligation, rights and duties without fully realizing the lost moral orders in which these words once had their original meaning. This is a concerning charge for clinical ethicists since much of our daily work involves using just these kinds of terms. Do we have a clear grasp of what our moral terms mean and how they are being used?

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 29, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

There appears to be hope for America, as a society, a democracy, and a nation. On Thursday, 6/28/2012, as everyone knows, the Supreme Court upheld the constitutionality of the Affordable Care Act (ACA) by a 5–4 vote. Much was at stake, not the least of which was the possibility of affordable health care for all Americans. But beyond this extremely important outcome, the very nature of our democracy was in play, as well as the potential success or failure of the American political enterprise.

For example, lack of affordable health care for every American diminishes our national enterprise in all sectors.

There are other important considerations involved in how the attack on the ACA played out, including the continuing degradation of our use of language. For example, the Supreme Court justices are consistently characterized as “conservative” or “liberal”. This is an immediate problem, as their individual identities are subsumed in the right vs. left dichotomy. But the meanings of the epithets are also lost. To be conservative means to uphold tradition. To be liberal means to uphold progress. However when justices hold their ideologies closely, neither tradition nor progress receive a fair evaluation. As Hannah Arendt states in Between Past and Future, “the very quality of an opinion, as of a judgment, depends upon the degree of its impartiality”. Ideology is not impartial, and Supreme Court opinions have long appeared to be based on politics rather than justice. Obviously, such a state of affairs is a major problem for a democratic society.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 27, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

“Human speech is like a cracked kettle on which we tap crude rhythms for bears to dance to, while we long to make music that will melt the stars.” — Gustave Flaubert, Madame Bovary

“The chances of factual truth surviving the onslaught of power are very slim indeed … ” — Hannah Arendt, Between Past and Future

Although this may be more apparent than real, it seems as if the lying and the lies are increasing in frequency on the national level. Politics has long been characterized as a blood sport, but the escalation of vicious contentiousness since 2008 is unusual and extreme. Factual truth has been cast aside, casually thrown to the wind as if one were systematically ripping the petals off a roadside wildflower and tossing them into the air as so much refuse. The losers are the public, of course, the citizens who depend on the government for sound fiscal policies, welfare for those unable to care for themselves, and protection in the form of national defense.

None of this is a surprise. As Arendt states in her essay “Truth and Politics”, modern ideologies “ openly proclaim them to be political weapons and consider the whole question of truth and truthfulness irrelevant”. Further, “it may be in the nature of the political realm to deny or pervert truth of every kind”. As the nature of truth as such is limiting (in other words, it is what it is) , politicians will naturally bend the truth to fit their purposes. As citizens, we need to be on our guard and strive to identify factual truth or the lack thereof in political pronouncements. But such activity requires substantial effort. Thinking is required, as is the concomitant ability to simultaneously hold two contrasting concepts or points of view in mind. A broad education is required, as is a good facility with language. Sadly for us, most of these requirements and capabilities are now in short supply.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 21, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

It was bound to happen. Last week, Nature reported that a Hungarian company “certified” that a member of parliament did not haveJewish or Roma heritage. It seems we have not come very far at all from the hatreds and behaviors that led to the Nazi atrocities of the 1930s and 1940s. But, of course, 70 years is the merest blip compared to 10,000 or more years of fear of the other.

Is this a problem of science as such? Or is it a problem related to what it means to be a human being, that notorious “riddle, wrapped in a mystery, inside an enigma”? Or is this virulent distortion of scientific progress merely what can be expected when the fruits of scientific research are placed in human hands? Modern science was born, asserts Hannah Arendt in her essay The Concept of History, when attention shifted from the search after the “what” to the investigation of “how”. Historically, science was concerned with exploring the natural world. Scientists such as Aristotle categorized, catalogued, and examined phenomena. The overall goal was to improve understanding of man’s place in creation. Investigation of the “how” was activity of an entirely different sort. Now scientists began to pull things apart in attempts to understand how things work.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 19, 2012 | Posted By Michael Brannigan, PhD

Does the case for terminal sedation actually weaken the case against physician-assisted suicide?

Terminal sedation, more clinically referred to as "palliative sedation," is a legally sanctioned alternative to physician-assisted suicide, a last resort in palliative treatment. It involves inducing and maintaining unconsciousness in a terminally ill patient until the patient dies, and is often accompanied by withholding or withdrawing medical feeding and hydration.

For example, if, in my advanced cancer, I experience intolerable pain, delirium, dyspnea or distress, to alleviate these unmanageable symptoms I let my physician sedate me into unconsciousness until I die. Sort of like undergoing anesthesia before surgery, without waking up.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 14, 2012 | Posted By Posted By David Lemberg, M.S., D.C.
Dr. Robert Klitzman Am I My Genes
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Dr. Robert Klitzman is the author of the recently released “Am I My Genes: Confronting Fate and Family Secrets in the Age of Genetic Testing”, published by Oxford University Press. He is Professor of Clinical Psychiatry and the Director of the Masters of Bioethics Program at Columbia University. Dr. Klitzman co-founded and for five years co-directed the Columbia University Center for Bioethics, and is the Director of the Ethics and Policy Core of the HIV Center.

In our wide-ranging interview, Dr. Klitzman discusses

  • The impact of genetic testing on patients with Huntington’s disease, breast cancer and ovarian cancer, and alpha-1 antitrypsin deficiency
  • The implications of recent genetic breakthroughs for these people and their families
  • Ethical issues involved in genetic testing, including disclosing results to family and friends, disclosing results to employers and insurers, whether to have children, whether to screen embryos, and privacy concerns
  • How to confront fatalism, anxiety, and despair
  • How to prepare, ethically and personally, for the likelihood of readily available genetic testing in the near future

Dr. Klitzman also discusses his previous book, When Doctors Become Patients, published by Oxford University Press.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

June 4, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

Ethics as a foundation of human affairs is fast disappearing from our world. The litany of human selfishness, crassness, and sheer bad behavior is unending. Whether the topic is Wall Street robber barons betting against securities they sold to clients (who naively trusted their “bankers” and purchased the recommended financial instruments in good faith) or the venality and mendacity of congressional “representatives” whose true loyalty is to those who fill their campaign war chests rather than to the citizens who elected them and foolishly count on their wisdom and judgement, the public arena and daily news cycle are replete with cautionary tales of failed trust.

So it can't be a surprise that our own brief period of prominence is seemingly bereft of any substantive ethical framework. Ethics provides solutions to every problem humanity is facing. The problem is that ethics is in short supply. Implicitly, thinking is in very short supply. This assertion is awfully ironic, as the primary difference between humans and all other species is self-knowledge. Humans know that we know. But if we don’t know much, we’re not going to be able to help ourselves. Now more than at any time in history, our survival advantage depends on our being able to take care of each other. But we have never done a very good job of that. Not even close.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

May 2, 2012 | Posted By Michael Brannigan, PhD

The year is 2029. After discussing schedules, I've picked early afternoon April 28 as my day. That works for most of us. My wife will have returned from her conference. My sisters can fly in after their dance recital. My brother rescheduled his interviews.

Cousins can drive in from the coast. Some nieces and nephews can't make it, but that's all right. They're busy. Dr. Landis assured us it would be brief. I'll just take the pill the good doc gives me and fall quickly asleep, peacefully, forever. No pain. I'm doing what's right. It is better for all of us.

As we face dying's three dreads — pain, abandonment, helplessness — what is the practical allure of physician-assisted suicide?

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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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