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Viewing by month: June 2011
June 10, 2011 | Posted By Posted By David Lemberg, M.S., D.C.
Dr. Adina Roskies
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Dr. Adina Roskies is Associate Professor in the Department of Philosophy at Dartmouth College. Her areas of specialization are Philosophy of Science, Philosophy of Cognitive Science, and Philosophy of Mind.

Dr. Roskies was Project Fellow on the MacArthur Project in Law and Neuroscience from 2007 through 2010. Her recent publications include Neuroscientific challenges to free will and responsibility, published in Trends in Cognitive Sciences; “Neuroethics beyond genethics”, published in EMBO Reports; and Neuroimaging and inferential distance, published in Neuroethics.

In our 5-3-2011 BIOETHICS TODAY conversation, Dr. Roskies discusses

  • Free will and determinism
  • Compatibilism and incompatibilism
  • Neuroscience–the brain as a mechanism
  • Can the brain cause behavior?
  • Neuroscience, determinism, and moral responsibility
  • Neuroscience and the law

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 6, 2011 | Posted By Ricki Lewis, PhD

Early June marks the 30th anniversary of the reporting of the first AIDS cases, but it’s also an older medical anniversary – recognition that the drug diethylstilbestrol (DES) derailed development of the reproductive systems of a huge cohort of fetuses. I was one.

My mom, like millions of others, was handed “a vitamin” while pregnant with me in 1954, which in those days of medical paternalism, she never questioned. And so when I became a teenager, I began to drip, and was hauled off to the gyno. The verdict: Adenosis. The label: DES daughter. It was scary.

As an endocrine disrupter before the term was coined, DES, among other things, played havoc with the boundaries between tissues of the cervix, which prevented glands from vanishing on schedule. With the hormonal onslaught of adolescence, the errant glands went into overdrive. Fortunately, I didn’t have the otherwise rare cancer whose sudden appearance led to identifying the problem, as with AIDS. I also escaped the trademark DES small uterus, and my husband, a DES son, escaped XY-related problems. But my mom did die of breast cancer – another legacy of the “vitamin” thought to protect against pregnancy loss. And so far the DES Follow-up Study on the third generation – my three daughters – has revealed only a slight increase in ovarian cancer risk that is likely a statistical fluke awaiting larger numbers. 

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 3, 2011 | Posted By Danielle Holley, JD, MS

In 2010, the New York State legislature passed, after 17 years, the Family Health Care Decisions Act (FHCDA), codified in NY Public Health Law Art. 29-CC (2010).  This law provides a much-needed mechanism to make decisions for incapacitated individuals who have not appointed an agent under the health care proxy.  The law creates provisions to appoint a surrogate or allow physicians to make decisions for incapacitated individuals who have no one.  This is extremely important as most people have not appointed an agent to make decisions for them if they lose capacity.  The law also acknowledges emancipated minors and provides provisions for an emancipated minor to withdraw or withhold life-sustaining treatment.  The FHCDA also made an important step in allowing for decisions, including decisions regarding withdrawal or withholding of life-sustaining treatment, to be made based on the patient’s known wishes but if those are unknown, in the best interest of the patient, therefore not relying anymore on the higher standard of clear and convincing evidence.  

The FHCDA also recognizes an important mechanism, that of the Ethics Committee.  The law requires that each hospital and nursing home have an ethics committee, whether it is institutional or community-based, to assist in making decisions under certain circumstances.  The ethics review committee can be used to mediate disputes.  The law also gives binding authority for the Ethics Review Committee’s decision in two circumstances, including (1) when an attending physician objects to the surrogate’s decision to withdraw or withhold artificial hydration or nutrition, and (2) when an emancipated minor seeks to withhold or withdraw life-sustaining treatment.  Conferring binding authority thus allows the committee to be the arbitrator instead of resorting to a court proceeding, 

The law makes some important changes; however, it is very long and has a lot of provisions and checks.  To assist practitioners in the hospital in applying the law, we developed a set of algorithms.  The algorithms are a set of eight charts that lay out the provisions of the law.  These algorithms are intended to guide practitioners but do not cover all possible scenarios that may arise.  So far, it has been a great resource and guide for practitioners in facilitating the decision-making process for those who lack capacity.  

Click here to see the full publication.

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.

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ABOUT BIOETHICS TODAY
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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