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Viewing by month: July 2013
July 31, 2013 | Posted By Marleen Eijkholt, PhD

You are mid 50ties, you have several university degrees from top universities, you have a PhD in Chemistry and are happily married. You seem to have a great life, but for one thing: while your legs are fully functioning, you do not want them. And it is not even that you just do not want them; you feel that they do not belong to you. They give you great suffering.

Earlier this week, the Huffington Post reports on Cloe Jennings who suffers from her healthy legs. Reportedly, she suffered from her legs since she was 4 years old and has held the desire to have them amputated or to be paralysed from that time. Jennings is raising money to travel to a surgeon who has offered to help 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.

July 25, 2013 | Posted By Benita Zahn, MS

The law in the United States is clear that once a person has completed their prison sentence and parole they are free to go on and live their lives. The state does not have continued control over them. While some might argue that for sex offenders and regulations regarding where they may live impinges on this, that narrow issue is not the focus of this paper. I will argue that castration, chemical or physical, is antithetical to our society. 

The eighth amendment prohibits cruel and unusual punishment. Mutilation would be considered cruel and unusual punishment and castration clearly falls under that banner. It involves a surgical procedure to remove the testicles or in women, the removal of their ovaries. One need to look no further than to realize physical castration to control sexual predators should not be permitted.    

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.

July 23, 2013 | Posted By Zubin Master, PhD

Mentoring is critical to a successful and delightful academic career. It can make the difference between being passionate about your research, teaching and scholarship to dreading going to the laboratory or office. In my experience working in both academic and public service sectors, I have seen my share of good and bad mentors and mentoring practices. A good mentor can inspire the mentee to work harder and strive for the best while a bad mentor can create an unfriendly and unstable environment and demotivate even the brightest of people. If left unresolved, a poor environment or a bad relationship can escalate problems leading to personal feuds and unethical behaviors. I am sure everyone reading this post will remember one or more times, perhaps even currently, someone in their lab, school or workplace who was a poor mentor and leader. Personally, I have had several amazing mentors throughout my career and several mentors that still drudge up bad memories. From personal experience and from hearing stories of friends and colleagues, it almost seems that everyone has encountered a bad mentor at least once in their academic career. Perhaps this is because everyone talks about the bad apples and never the good ones. Regardless, it seems reasonable that there poor mentors are out there in academia.

The classic book Adviser, Teacher, Role Model, Friend: On Being a Mentor to Students in Science and Engineering written by the National Academy of Sciences, National Academy of Engineering and the Institute of Medicine explains that ‘mentoring is a personal, as well as, professional relationship that develops over an extended period. Mentors take a special interest in helping another person develop into a successful professional.’ Mentoring permits someone with greater experience and knowledge to pass it on to the mentee and thus mentoring works at almost all levels from senior to junior students, post-doctoral fellows to graduate students, faculty to fellows and students, and senior faculty to junior faculty. There are many reasons why mentoring is important. A good mentor usually means a nurturing environment and a good mentor will serve to attract students, fellows and faculty, develop collaborations and strengthen their professional network, achieve self-satisfaction from mentoring, pass on knowledge and experience to the mentee, and advance the goals of academia – one of which is to educate and pass on knowledge and skills.

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.

July 18, 2013 | Posted By Paul Burcher, MD, PhD

Most practicing physicians learn the four principles of biomedical ethics at some point during medical school or residency training.  Despite the original intent of Tom Beauchamp and James Childress when they first described the four principles as co-equal in importance, we physicians tend to think first about patient autonomy and view it as the most critical of the four principles.  The least understood and appreciated of the four principles is nonmaleficence. (Even my word processor wants to change it to malfeasance, and so do many medical students I teach). 

The reason nonmaleficence is misunderstood, and therefore often ignored, is that the duty to “do no harm” seems impossible to follow.   Beauchamp and Childress are clear that harm is anything that counts as a setback to a patient—any pain or injury is therefore a harm—and practically everything we do to our patients is in some sense a harm.  The duty to nonmaleficence must be more complicated that simply doing no harm or it would be a duty to stop practicing medicine.\

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.

July 15, 2013 | Posted By Lisa Campo-Engelstein, PhD

Despite the fact that fertilization requires mutual, active participation by both eggs and sperm, gender roles are often projected onto reproductive biology, leading to the portrayal of eggs as passive and sperm as active. For example, the opening credits in the 1989 movie Look Who’s Talking portray a common perception of fertilization. As the Beach Boys’ song “I Get Around” plays in the background, we see sperm inside a women’s reproductive tract moving toward her egg. The scene is narrated by one of the sperm, though we can hear some of the other sperm talking. The narrating sperm tells the others, “Ok, follow me … I know where we’re going … I’ve got the map. Follow me kids, keep up.” Upon seeing the egg, the sperm says “I think I see something … this is it, this is definitely it … jackpot!” to which another sperm relies “Yee haw!” We then see a bunch of sperm on the outside of the egg, seeking entrance through the egg membrane – a difficult task as evidenced by the lead sperm stating, “kinda tough here.” The egg then envelopes one sperm as it cries “Ohhh, ohh, I’m in, I’m in.” In this scene, the egg is portrayed as passive, merely drifting along waiting to be discovered by the sperm, whereas the sperm is active, strong, and on a mission to reach the egg. 

A colleague and I were interested in seeing if this misperception of fertilization is limited to the media or if it is also seen in scientific writing. We analyzed science textbooks from the middle school to the medical school level to determine if fertilization in human reproduction is described in gender biased language regarding the sentence structure, amount of information provided for female and male processes/parts, and neutrality in describing female and male processes/parts.

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.

July 12, 2013 | Posted By Wayne Shelton, PhD

I have probably done several hundred clinical ethics consultations since I began doing them in the early 90’s. Though I have had some second thoughts about some of the recommendations I have made, by and large, I have usually been confident that they represented viable moral options, given the range of limited, mostly bad options that were available.  Thus, I rarely if ever thought of myself as anything but fully supportive of the recommendations made in ethics consultation.  That is, until a few months ago when I heard about a case from another ethics consultant at another location where the right ethical recommendation seemed apparent, yet somewhat problematic. The case shows the almost boundless, and at times problematic, latitude of the negative right to refuse treatment and to be left alone, even when others may be negatively affected by the decision. I thought the general fact pattern of this case would be worth discussing in this forum. 

The case involved a 40 year-old woman with full capacity who was near full term with twins. She was showing signs of pre-eclampsia, a condition “when a pregnant woman develops high blood pressure and protein in the urine after the 20th week (late 2nd or 3rd trimester) of pregnancy.” (National Library of Medicine) When this condition occurs, it is important to get the babies out as soon as possible; otherwise, both the mother and babies would be at risk of dying. So labor was induced and she was being prepared for delivery. But given that she was having twins there was the possibility of excess bleeding from hemorrhaging and other complications, so the patient was informed that a blood transfusion might be necessary. As it turns out based on her religious beliefs she stated she did not wish to be transfused with blood products and that she understood the consequence: she could possibly die. Her babies would in all likelihood be saved. Should the fact that two babies will not have a mother be counted as ethical considerations against respecting her right to autonomy? Given our current ethical environment, a patient with capacity has a right to refuse any and all medical treatments and interventions. Are there ever countervailing reasons to not honor a patient’s autonomous wishes in such a situation? Let’s proceed with the general facts of this case, as it gets even more complex.

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.

July 8, 2013 | Posted By Jane Jankowski, LMSW, MS

The long awaited DSM-V was finally released for clinical use in May 2013, and was welcomed with a storm of debate. The task force charged with the revising the manual note that the manual had not been updated for 20 years and required revision to reflect changes in scientific knowledge and clinical experience in an ever shifting social context. Whether or not the DSM-V will alter clinical practice may depend on how the manual is viewed by practitioners. 

One possible benefit of expanding the list of diagnoses in a psychiatric manual includes improving recognition of problematic behavior health issues by insurance companies who fund treatment for diagnosable problems. Expanding the diagnostic options may enhance access to beneficial services for many, and this could prove helpful to those who might not otherwise receive treatment. Practitioners in the US know all too well that a diagnosis is needed if the provider is going to be paid by an insurance company. It remains to be seen if the changes in the DSM-V affect payment to providers.

One point to consider in the reimbursement argument is that a diagnosis is not necessary for treatment because those in desperate need are not turned away, though ongoing therapy may be hard to find with or without a diagnosis. The downside of expanding the various diagnostic categories is that people may be less likely to be held accountable for behavior negative or even legal consequences, notably changes in the paraphilia categories. We must be vigilant that mental health does not become misused as an excuse for antisocial, illegal, or dangerous behaviors where it is inappropriate to do so. 

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.

July 5, 2013 | Posted By John Kaplan, PhD

Usually when I write about stupidity in Congress I wait a couple of months before doing it again. However, I cannot help myself. This is low hanging fruit and I have to pick it. This is “truth is stranger than fiction” type of stuff. You cannot make this up. In this blog post I would like to introduce the readers to Representative Michael Clifton Burgess M.D., republican representative from Texas’ 26th Congressional District. Dr. Burgess was born in December 1950. I mention this only because it was the same month I was born. He graduated with a Bachelors of Science from North Texas State University. He graduated from medical school at The University of Texas Health Science Center at Houston. He completed his residency in Obstetrics and Gynecology from Parkland Memorial Hospital in Dallas. He also completed a Masters degree in Medical Management from the University of Texas at Dallas. Dr. Burgess is the founder and chair of the Congressional Health Care Caucus, albeit it’s only member. This all suggests the likelihood that Dr. Burgess is smart. His recent statements seem to refute that likelihood.

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.

July 2, 2013 | Posted By Bruce D. White, DO, JD

Recall the June 7, 2013 New York Times article by Andrew Pollock titled “An Experimental Drug’s Bitter End”? The author reminds us again about how difficult it is for patients and those involved in their care to understand that new drug clinical trials are experiments and not therapeutic interventions.

The goals of researchers in conducting new drug clinical trials – experiments – are clearly not the same as the goals of a physician who prescribes an approved drug as a therapeutic modality. How better can we help patients and their families understand this primary goal of medical research? In clinical trials, when the experiment ends, the patient may worsen clinically, or the patient may get better clinically, and the improving patient probably will no longer have access to the perceived beneficial drug as a therapy option. Regardless, after sufficient data is collected – whether good or bad – the experiment ends.

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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