March 15, 2016 | Posted By Lisa Campo-Engelstein, PhD

Whereas quality of life issues for cancer patients used to minimized, and sometimes even ignored, today there is more of a focus on cancer patients’ quality of life post-cancer. One such quality of life issue is oncofertility, which is fertility preservation for cancer patients. In many places, oncofertility is, or is becoming, the standard of care for cancer patients. But should it be offered to all patients? What about patients who have a very bad prognosis?

Fertility preservation for patients with a poor prognosis raises a host of ethical issues. Providers may worry that discussing fertility preservation will give patients false hope about their prognosis. In other words, these patients may feel their providers deceived them by mentioning fertility preservation, leading them to believe that their prognosis is not as bad as they originally thought.

Yet, at the same time, pursuing fertility preservation may be a source of hope and happiness for patients during difficult times. It may furnish them with mental and physical strength, making them even more motivated to survive for the sake of their potential future children. Additionally, these patients, and their families, may feel a degree of inner peace knowing that part of their lives will continue on in the reproductive material even if they are never used.

 

 

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 10, 2016 | Posted By Jane Jankowski, DPS, LMSW

According to the American Society of Addiction Medicine, drug overdose is the leading cause of accidental death in the US with close to 50,000 deadly overdoses in 2015 alone.  Opioid addiction accounted for nearly 20,000 of these and heroin alone was a factor in just over 10,500 deaths. The magnitude of opioid abuse related hospitalizations, sales of prescription pain killers and deaths have increase exponentially between 1999 and 2008 according to ASAM. Increased access to Narcan (naloxone) to reverse life threatening effects of opioid for first responders has now expanded to making Narcan available to the general public as well. In some areas, Narcan can be purchased without a prescription by family members and friends who expect they may need to quickly rescue a loved one. While I support this program because it can and will likely save lives, it does not address the need for effective rehabilitation of persons who suffer the all-consuming and devastating effects of opioid addiction. Regulations which will allow persons with opioid addictions to be detained involuntarily in health care setting are also being discussed, but pose some dilemmas as well.

 

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 4, 2016 | Posted By Wayne Shelton, PhD.

As a philosopher who works in a large health science center where the scientific method and perspective reign supreme, it is common to hear comments about the abstract and ideal nature of philosophy. As though those who think about human problems from a philosophical perspective do so from an abstract, insular perspective with little or no practical impact. Though I hear such dismissive comments about philosophy less often than I used to, say 20 or more years ago, I sense there is still a commonly held view that those who think from a philosophical perspective as not well oriented to practical affairs. And with some justification do people have this view of philosophy.

 

As I have written in previous blogs, philosophy has long and even proud part of its tradition for being, well, useless. If we assume that the basis of philosophical truth and wisdom lay in some ultimate, objective form that only those who think in certain ways can grasp, then knowledge becomes privileged to the philosophical few as an end it itself. This type of Platonic philosophical truth quickly divides the here and now inferior world from the more exclusive understandings of reality. Because of this basic influence of Platonic philosophy, much of the history of philosophy in the Western tradition has been focused on the search for a rational, objective basis of truth, value, and reality. Not surprisingly, the goal has not been reached. But the quest continued through most of last century and philosophical got its more or less justified reputation for being an insulated, esoteric, and detached form of intellectual activity. Put bluntly, philosophers, with a few exceptions, rarely got their hands dirty in the real world of practical activity.

 

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 1, 2016 | Posted By Bruce White, DO, JD

Senator Edward (Ed) John Markey (D.-Mass.) announced on January 24, 2016, that he was exercising one of his prerogatives as a United States Senator and placing a hold on the confirmation vote for Food and Drug Commissioner nominee Robert Califf, MD.  President Obama nominated Dr. Califf on September 15, 2015, to succeed Margaret Hamburg, MD, who left the position last year Interestingly, Dr. Califf won unanimous approval by the Senate Committee on Health, Education, Labor, and Pensions. However, Senator Markey questions Dr. Califf’s fitness to serve not because he lacks credible individual qualifications, but because he is upset with the way the agency deals with prescription opioid medicine approvals, and specifically the manner in which the F.D.A. handled adding a label indication for the narcotic pain killer OxyContin (Purdue Pharma LP) to treat children’s pain.

 

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.

February 19, 2016 | Posted By John Kaplan, PhD

Each day when I start work checking my email is among the first things I do. This is really a three step process. First I go to my quarantined email to see whether I need to salvage anything or if I can just press the “delete all” function.  This is the spam quarantine set up by my employer which uses some kind of rubric to prescreen my email for spam and save me from it. Usually I can just click that “delete all” button but occasionally there is a real email in there so I always look through it. For some reason this rubric often identifies email from my adult children as spam, especially if they send it from their workplace. Of course sometimes, in its wisdom, it does not quarantine such email so I cannot really figure out how it selects.

After viewing the quarantined email I scan through my non-quarantined email. Here I find a lot more spam which seems to me to be just like what was quarantined but was not. This further confuses me about how the spam filter works. But all is good now as I have reduced the remaining email to a reasonable and manageable amount. I need to make an aside here that I do not really like the term spam for junk email because I remember eating it as a kid and rather liking it.

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.

February 12, 2016 | Posted By Claire Horner, JD, MA

When patients lack capacity, physicians look to family and friends to step in and provide consent for treatment on behalf of the patient. These surrogates, whether they were appointed by the patient as their health care agent or become health care surrogates by default under state law based on their relationship to the patient, have the right to receive information related to the care and treatment of the patient and have the corresponding responsibility to make health care decisions for the patient based on either the patient’s previously expressed wishes or her best interests.  What they don’t have, however, is the right to control and direct every minute aspect of the patient’s care in the hospital.  It would take several blog posts to discuss the conflicts that occur between surrogates and health care providers because of this (such as DNR orders, barriers to discharge, and demands for certain medications, to name a few), but perhaps the most concerning example of surrogate over-reach is the issue of inadequate pain management.

The use of pain medication can be difficult for both patients and providers, especially with the rate of opioid abuse in this country. Patients and their families are often afraid of the possibility of addiction, while physicians are reticent to prescribe narcotics for fear of misuse.  Whether or not a patient is a “drug-seeker” is a common question that arises when physicians are deciding what to prescribe. However, in the context of terminal illnesses – particularly at the very end of the illness – the shift in focus from curative to palliative care highlights the need for sufficient pain control in the face of nearly intractable pain.  It is in this context that denial of pain medication, or poor pain management, is most clearly an ethical issue.

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.

February 10, 2016 | Posted By Lisa Campo-Engelstein, PhD

The New York Times recently reported that physicians will soon undertake the first penis transplants in the U.S. The goal of this procedure is to restore everyday functionality as well as sexual functioning for men with genitourinary injuries, which are injuries involving loss of part of all of the penis and/or testicles. The donated penis will come from a deceased donor, with that donor’s permission. Penis transplants have only taken place in China in 2006, where the procedure failed due to the recipient psychologically rejecting the transplant, and in South Africa in 2014, where the procedure was successful. 

For the time being, this procedure will be limited in the U.S. to men who lost their penis in military service. In the last 15 years, over 1300 men have suffered genitourinary injuries in Afghanistan or Iraq, mainly due to homemade bombs. Almost all of these men are under 35 years old.

One objection to penis transplantation is that it is not life-saving. While it is true that penis transplants are not life-saving, much of modern medicine focuses on improving quality of life (e.g. glasses for poor vision, over the counter medication for the common cold, physical therapy for back pain, assisted reproductive technologies for infertility, etc.). While a genitourinary injury may not be visible to others, the effect on the individual can be devastating. For many men, the penis is a symbol of his masculinity and not having “normal” genitals can impair his gendered and sexual identity. As I have discussed in my published research,

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.

February 5, 2016 | Posted By Bruce White, DO, JD

An article that appeared in the Journal of the American Medical Association on January 4, 2016, written by Johns Hopkins Institute of the History of Medicine and Bloomberg School of Public Health professors Jeremy A. Green, Gerard Anderson, and Joshua M. Sharfstein recommended that the Food and Drug Administration (FDA) act to improve access to approved generic drugs that are becoming scarce because of a lack of competition. It’s surprising that respected historians and health policy educators believe that the FDA should have any such governmental role. As highly regarded as they are, the authors appear neither to fully understand FDA and drug regulation history or health care delivery competition oversight. The FDA has never had statutory authority to regulate drug prices, period. And, they rightly shouldn’t have.

The FDA exists to protect the public safety, health, and welfare by assuring that drugs marketed in the US are safe and effective. The reasonableness of the prices for these drug products is of no concern to the FDA as a regulatory body. In the general scheme of federal oversight, fair business and trade practices are the responsibility of the Federal Trade Commission (FTC) and the Civil and Criminal Divisions of the Department of Justice. These governmental authorities are responsible for the enforcement of the anti-competition and antitrust laws. The FDA has enough to do already; drug pricing should be left in the regulatory hands that are charged with this duty without involving the FDA. There’s no real value of involving the FDA here, except perhaps to muddle the waters more.

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.

February 2, 2016 | Posted By Jane Jankowski, DPS, LMSW

Since 2001, the Health Insurance Portability and Privacy Act (HIPPA) has been in place to provide assurances that private health information would be protected and to offer standards for disclosing person health information. Despite accountability to federal standards, serious breaches still occur. What is surprising is how often such missteps take place despite such safeguards, and why. 

HIPPA is characterized by the Department of Health and Human Services as follows:

“The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records and other personal health information and applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically.  The Rule requires appropriate safeguards to protect the privacy of personal health information, and sets limits and conditions on the uses and disclosures that may be made of such information without patient authorization. The Rule also gives patients rights over their health information, including rights to examine and obtain a copy of their health records, and to request corrections.” 

The implication is that there are serious consequences for breaches in privacy that either intentionally or unintentionally discloses private health information without permission from the patient. And this is sometimes true, but not as true as we might expect. Major security breaches at national insurance carriers or healthcare centers are likely to make the national news reports, however, individuals who experience unauthorized disclosures of private health information are finding they have little recourse. 

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 28, 2016 | Posted By Claire Horner, JD, MA

Gestational surrogacy contracts have been in the news again recently as a gestational surrogate reports that the intended father, having discovered that she is expecting triplets, is demanding that she undergo selective reduction to abort one of the fetuses.  Situations such as these, while often not reported, are not necessarily uncommon.  In 2013, a gestational carrier was offered $10,000 to abort when a second trimester ultrasound discovered congenital heart and brain abnormalities.  Despite a well-established Constitutional right to privacy that includes a pregnant woman’s right to procure – or refuse – an abortion, surrogacy contracts routinely include provisions that not only prohibit a surrogate from having an abortion unless there is a medical need, but also give the intended parents sole discretion to determine whether the surrogate should abort where there is evidence of a physical abnormality or other issue.  Such provisions have not been tested in court, but would almost certainly be unenforceable based on the surrogate’s Constitutionally-protected right to reproductive autonomy.


In India, where there is an estimated $400 million surrogate tourism industry, women agree to be surrogates in exchange for $5,000-7,000, which is far more than they could make otherwise.  In many clinics, surrogates live in dormitories for the duration of the pregnancy and their food and medical care is provided by the clinic.  There are also reports that some clinics have policies against pregnancies of 3 or more fetuses – meaning that selective reduction may occur as a matter of course to reduce the number of fetuses to 2 or 1.  If this is in fact happening, are the surrogates (or even the intended parents) aware of what is happening?  Are they given a voice in the medical care and treatments they receive?  Or are the decisions made by the intended parents or the clinic, and simply imposed on the surrogate?


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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