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Viewing by month: January 2014
January 30, 2014 | Posted By Marleen Eijkholt, PhD

When people asked my ethical opinion about Marlise Munoz’s case, the brain dead woman who was kept on support for her fetus, I believe they expected a quick answer: this is wrong. Clinical or medical ethicists are often called for a quick answer: this is right or this is wrong. However, answers about why X is right or why X is wrong do not come quickly. Often there are many rights and many wrongs in a story. My answer why it is unethical to keep Mrs Munoz on support is the result of a sum of rights and wrongs. In my opinion the ‘rights’ are less weighty than the ‘wrongs’, and I will set my arguments out below.

Marlise Munoz was 14 weeks pregnant when her husband found her unconscious and brought her to the hospital. The hospital found that she fulfilled the criteria of brain-death, but did not declare her brain death yet (according to the latest reports) . They kept her on ventilator and nutritional support and argued this was required under Texas law, suggesting that it was not allowed to withhold or withdraw life-sustaining treatment from a pregnant patient.

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 27, 2014 | Posted By Michael McNichol and Zubin Master, PhD

Since the discovery of human embryonic stem cells in 1998, many promises have been made by individuals and groups about the potential of stem cell research to revolutionize the practice of regenerative medicine. Yet to date, very little has been seen in terms of novel therapies in the clinic. Because of the substantive economic investments made in stem cell research in order to realize the promise they can offer, greater efforts to translate stem cell research into medicines has ensued. However, many factors might impede the clinical translation of stem cell research. In this blog, we briefly highlight the ethical and scientific issues surrounding the successful translation and commercialization of stem cell research.

The process of clinical translation begins with preclinical research using in vitro systems and animal models to show proof-of-principle and demonstrate safety and efficacy of a potential therapeutic. For example, if a stem cell is to be transplanted into a patient to treat a degenerative disease, then the type of stem cell that is being used must show that it can successfully treat a similar disease in animals prior to testing the product in humans. There are many reasons for using appropriate animal models that mimic human diseases: low cost, reproductive cycle, number of offspring, genetic similarity, similarity in the manifestation of the disease in humans, and ease of handling. However, there are many limitations to animal models that do not result in direct translation in humans, meaning what may work in animals may not at the end of the day be effective in people. While we choose animals as models to mimic human disease, the biology of animals is still significantly different than humans and thus may simply not translate 100%. This issue is difficult to get around. 

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 23, 2014 | Posted By Lisa Campo-Engelstein, PhD
When we think about organ transplantation, the organs that usually come to mind are the heart, or possibly the kidney, the most commonly transplanted organ. Transplantations are generally regarded as necessary to the life of the person receiving the transplant or to physiologically improving that life: the transplant is seen as making the recipient “whole” once more. The idea of wholeness that a transplant renders can extend beyond the physiological to the individual, the familial, and the cultural; this can be seen dramatically in the case of ovarian transplantation. The donor ovary, and with it the potential of restored fertility and the hope of pregnancy and thus motherhood, is a surgical means to make her whole.

Stephanie Yarber entered menopause for no apparent reason at age 14. Her identical twin sister, Melanie Morgan, maintained her fertility and donated eggs to Yarber. However, after at least two failed IVF cycles in her early 20s,Yarber was broke. Through her research on infertility treatment, she stumbled across Dr. Sherman Silber’s work on testicle transplants and discovered that his practice focused on infertility problems in both men and women. Thinking that a similar gonadal transplant could be possible in women, Yarber called Silber to ask if he thought an ovary transplant was “a crazy idea.” Silber, who had been considering the possibility of an ovarian transplant since the testicle transplant, jumped at the opportunity to try this procedure, telling Yarber “I’ve been waiting for your call for 30 years.”
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 16, 2014 | Posted By Jane Jankowski, LMSW, MS

Our society is once again grappling with the challenges presented when medical technology (e.g. mechanical ventilation) is used to sustain physiological function in the absence of brain function. How we should define death, and who should be allowed to decide, is part of a very public debate in the wake of the Jahi McMath case out of Oakland, California and the Munoz case in Texas (NY Times). Though this is hardly a new issue for bioethics, the reality is that there is a clearly a chasm between the acceptance of brain death criteria as a sufficient definition of death.

The acceptance of brain death criteria in the 1980s as a legally and medically sanctioned definition of death was established in response to the controversy surrounding the obligation to sustain a patient’s respiratory function despite the absence of any brain function. When this irreversible loss of brain function occurred it was widely agreed there was no benefit to any further medical intervention and machines could be turned off, organs harvested, and the loved ones could move forward with processing the traumatic loss.  If a patient was brain dead, this was dead enough to qualify as no longer living. What drives the resistance to this definition? That the life function of circulation of blood and a beating heart continues indeed suggests the body is still alive.

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 13, 2014 | Posted By Marleen Eijkholt, PhD

Understanding death is difficult. And this issue is an everyday occurrence for clinical ethicists. In questions around withdrawal of life support, or a shift towards comfort care if a patient’s death is imminent, such misunderstanding is a recurring problem. The case of Jahi McMath, which I will deal with later illustrates this. Death is not necessarily a flat line on a screen. Especially when machines interfere, the blibs and curves on the screen keep going. Also death might not mean a total absence of reflexes, such as reflexes to stimuli might not necessarily mean that something is alive or has consciousness.

In the clinic, I cannot necessarily rely on analogies from nature to explain that someone is no longer ‘alive’, for fear of being insensitive about loved ones. But in this blog I can draw on such analogies to illustrate my case. If you behead a chicken (for compassionate or consumerist reasons), it will continue to jump around for a couple of minutes until it bleeds out. This does not mean that the chicken is still alive after you beheaded it. The jumps are a response of the autonomic nervous system and come from a jolt of adrenaline. Similarly, a ‘sensitive-plant’ or the ‘mimosa pudica’ will retract its leaves after you touch it. It moves. See here. I don’t think that this means the plant is alive like a human being or that it ‘understands’ your touch. The retraction of the leaves is a natural reaction. Its movement does not imply consciousness. Finally, during winter time, the breaks of my bike contract and they push on the wheel. This makes it harder for me to cycle. During summer time the breaks expand and cycling is not a problem. The breaks of my bike respond to the weather, but I would not call them ‘alive’.  

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 10, 2014 | Posted By Wayne Shelton, PhD

The case of the 13 year-old California girl, Jahi McMath, declared brain dead following a tonsillectomy has created another media frenzy. This is truly a tragic story. Apparently Jahi underwent tonsil surgery and two other procedures on December 9, 2013 to help her better manage sleep apnea. Following the surgery she was awake but shortly thereafter went into cardiac arrest and was placed on a ventilator. By December 11, physicians made a medical determination of brain death.

From the parent’s point of view, one can only imagine the shock and disbelief they have been experiencing. Their young child went to a major medical center where highly skilled physicians were going to perform what was assumed to be relatively low risk procedures. Jahi had apparently had some worries herself about not waking up following anesthesia. Like all supportive, loving parents they assured she was in good hands and no doubt reminded her of how important it was to have these procedures done in order to deal with what could be a life threatening medical condition in sleep apnea. They fully expected she would be fine and return to normal. Instead, she is on a mechanical breathing machine, which is supporting her breathing and heartbeat, and her physicians now say she’s dead.

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.

January 2, 2014 | Posted By John Kaplan, PhD

In the good old days when I spent most of my time as a practicing biomedical research scientist it was pretty clear to me what qualified as a scholarly communication. Such communications consisted of submissions of presentations to meetings of scholarly academic societies; submissions and presentations of original research to journals; presenting seminars; and writing the occasional review articles, book chapters, or even books. Now that I spend much of my time as a bioethicist it is no longer so clear to me. It is probably important to note that the uncertainty I feel about this is probably only partly attributable to the difference in discipline and may indeed be primarily due to the emergence of our modern-day online communications including the blogging and social media culture.

The communication you are reading now is a blog, only a blog, not a scholarly communication. Al least I am pretty sure that is the case. I cite no evidence. I reference lightly if at all. I write what I want. I am merely expressing my opinions. I am not really accountable to anyone for what I say here. I can write it in minutes or hours, not weeks or months. This all sounds to me that this is not a scholarly publication. Yet I have read in both blogs and on social media such as facebook and twitter people raising questions about the distinction. (Please note that I did not reference my statement, further evidence that this is not a scholarly publication.) I have seen questions which ask how are blogs and scholarly writings different if indeed they are different. I have seen writers ask if blogs should be included in one’s Curriculum Vita as a publication. Please note that this will not be posted in my Curriculum Vita because it is, again, only a blog.

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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