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February 24, 2014 | Posted By Lisa Campo-Engelstein, PhD

There is a cultural perception that women are very likely to cause fetal harm, reflected in limitations on women’s participation in clinical trials and certain jobs, public service announcements telling women not to drink alcohol while pregnant, and extensive media coverage of ‘‘crack babies.’’ The long history of the medical realm treating women’s bodies as weak, permeable, and inherently diseased contributes to the worry that women’s bodies will ‘‘infect’’ fetuses. Men’s bodies, in contrast, are as seen as stable, bound, and healthy; therefore, they are not a risk to fetuses. However, this belief is scientifically inaccurate. Men’s behaviors and characteristics can cause paternal-fetal harm. For instance, paternal smoking and drinking can result in an increased chance of birth defects and low birth weight. Paternal use of illegal drugs (such as cocaine, hashish, opium, and heroin) can also lead to fetal health problems because of abnormal sperm. Additionally, older paternal age has been associated with a higher risk of children with autism, Down syndrome, and schizophrenia.  

Despite these scientific facts, there is little public and academic discussion of men and fetal harm, which implies that men do not (or cannot) cause such harm. The cultural narrative that men are not causally or ethically responsible for fetal harm has been reified in law, policy, medicine, and the media.  Even the language we use to discuss reproduction and childcare minimizes the role men play in reproduction. The verb “to father” is synonymous with ‘‘to sire’’ and refers to impregnating a woman, that is, the one time event of fertilization. In contrast, “to mother” refers to constant caregiving and nurturing. 

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 20, 2014 | Posted By Wayne Shelton, PhD

Over the past few decades, clinical ethics consultations have become an important component in providing quality care in cases where there are value conflicts that must be resolved before viable goals of healthcare can be accomplished. With the development of this service and its acceptance as a necessary part of patient care, questions arise as to how and when will clinical ethics consultation be recognized as a specialized professional service comparable to medicine, nursing, social work and pastoral care? For physicians, nurses, social workers, and chaplains there are well-established pathways for practitioners to take in each of these areas in order to be recognized as fully qualified professionals. There is no such pathway to date for those individuals who provide clinical ethics consultations. For those of us who have been involved in this area it is interesting to reflect upon the vast improvements made in providing clinical ethics consultations and whether the field is ready for professionalization.

I recall my early years of training in medical ethics as a graduate student in philosophy at the University of Tennessee. As part of the requirements for the PhD in philosophy with a concentration in medical ethics, students had to spend 3 months at the Health Science Center in Memphis where we participated in intensive internship in medical ethics. At that time I was fortunate to have one of the early pioneers in medical ethics as a mentor, Professor David Thomasma, who was beginning to do clinical ethics consultations. During the 1970’s philosophers and others in fields pertaining to ethics were being invited to enter the medical setting to help physicians and nurses grapple with some of the ethical dilemmas that were becoming more evident with the increasing use of dialysis machines and mechanical life supports. There seemed to be an assumption, perhaps naïve in retrospect, that philosophers like professor Thomasma and others had some special understanding of ethical issues that would shed light on the emerging medical ethical dilemmas and therefore would be in a position to give helpful advice.

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 17, 2014 | Posted By Bruce White, DO, JD

Last month, a New Mexico trial court judge ruled that a terminally ill patient had a constitutionally protected right to aid in dying from a physician without risking criminal prosecution for assisted suicide. Judge Nan G. Nash of the Second District Court in Albuquerque based her opinion in the New Mexico Constitution: “This court cannot envision a right more fundamental, more private or more integral to the liberty, safety and happiness of a New Mexican than the right of a competent, terminally ill patient to choose aid in dying.” Thus, the state became the fifth to permit physician-assisted suicide, following Oregon (1997, approved by voter referendum), Washington (2006, approved by voter referendum), Montana (2009, allowed by state supreme court opinion), and Vermont (2013, enacted by the state legislature).

The case was brought by two oncologists (Drs. Katherine Morris and Aroop Mangalik) who asked the court to clarify the state’s assisted suicide law and allow them write a lethal dose of a drug for a 49-year-old patient (Aja Riggs) with advanced uterine cancer. Critical to the case may have been the December trial testimony from the patient: “I don’t want to suffer needlessly at the end.”

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 13, 2014 | Posted By Jane Jankowski, LMSW, MS

During a long cold drive home a couple weeks ago, there was a broadcast on NPR about efforts to help promote the survival of the rare northern spotted owl. The controversy has not centered on the importance of saving the spotted owl, but on whether or not it is ethically acceptable to hunt the barred owl which has moved into territory thereby dangerously threatening the spotted owl population. The barred owl is also an “at risk” species, but has been thriving in the northwestern forests where the spotted owls had fed, bred, and nested.  The government faced a “Sophie’s choice” (Shogran 2014, NPR),  and reluctantly accepted the morally disturbing decision to kill 3600 barred owls in order to try to help the spotted owl maintain a sustainable population.  This distressing environmental dilemma serves as a unique analogy for responsible business decisions related to healthcare. We can turn to business ethics here, which offers the “precautionary principle” (Weber 2001, 134) whereby avoiding harm and meeting the needs of a community requires that if any deleterious action is going to be taken, the proponents of the activity must establish that safety is the intent and there is no other way to accomplish the task than to inflict some degree of harm. Though the cause of reduced numbers of spotted owls and the migration of barred owls is related to man’s stripping timber from the natural habitats of each, the solution needs to balance the competing interests in the existing ecosystem. Similarly, people seeking healthcare in the US are not to blame for the economic woes of our system but it seems compromises from everyone will be needed in order to assure a basic level of service for all.

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, 2014 | Posted By John Kaplan, PhD

I have written before on the subject of stupidity in government. In most cases I have focused on the federal government and, in particular, the parts of congress that make science policy including the funding and regulation of those agencies in the federal government which fund scientific research. However, the stupidity of government is not limited to the federal. Today I will discuss the stupidity governing several states regarding what is allowed to pass as scientific education. Unlike scientific research where most public financial support and policy oversight comes from the federal government, the public support for education and education policy comes primarily from the states. Chris Kirk writing in Slate has recently described the state-by-state distribution of publically funded education that includes the teaching of creationism in science curricula.

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 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.

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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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