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June 16, 2014 | Posted By Lisa Campo-Engelstein, PhD

In a recent blog, I asserted that assisted reproductive technology (ART) should be a higher priority for the global South because of the severe health, social, and economic effects infertility can have on women there. The most common response to this claim is that resources should first be devoted to treating and preventing life-threatening conditions, such as malaria and HIV/AIDS, rather than conditions that are perceived as merely social and/or psychological. The same response is often used when people suggest that ART should receive higher priority in the global North. Whereas many global North countries provide national health coverage for ART, the US does not. However, there has been movement toward coverage for ART in the US in the last couple of decades and currently 14 states require health insurance companies to cover ART (though there is a wide range of what is covered and under what circumstances). Unfortunately, oncofertility (fertility preservation for cancer patients) is not covered in any of these state laws.

While I understand the argument that limited healthcare resources should be dedicated to the most "pressing" conditions, it is also important to recognize the potential side effects of choosing not to provide coverage for oncofertility and other types of ART. One concern with the lack of coverage for ART is that it reinforces socioeconomic inequalities. The primary users of ART are white, educated, middle- and upper-class not because this group is the most likely to be infertile, but because they are the most likely to be able to afford the high cost of ART out-of-pocket expenses. Cancer patients from lower socioeconomic backgrounds are unlikely to have the large amount of disposable funds (the average cost for one cycle of IVF is around $12,400) for fertility preservation treatment. While “traditional” infertility patients can save their money over a period of time in order to be able to afford ART, cancer patients need to preserve their fertility before their cancer treatment commences and thus they need to be able to immediately provide the cash for fertility preservation treatment in order for it to occur. 

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.

June 12, 2014 | Posted By Wayne Shelton, PhD

For over a decade the faculty of the Alden March Bioethics Institute has been designing and developing simulated cases for our graduate students who wish to learn the core skills of clinical ethics consultation. The model that we use is called “mock consultations”, which provides students the opportunity to perform an ethics consultation on a simulated case from the beginning when the request is made, to data collection, interviewing key players in the case, and on to case analysis the final recommendation.

In the process of developing simulated cases we have made every effort to make them as real to life as possible. All of the cases we use are from ethics consultation cases that have been deidentified and made into anonymous teaching cases. We have benefitted immensely from working closely with Albany Medical College’s (AMC) Patient Safety Clinical Competence Center (PSCCC). Those involved in medical education will recognize the importance of simulated cases using standardized patients (SP) and the role they play in training new doctors to communicate effectively with patients and families.

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. 

June 10, 2014 | Posted By Jane Jankowski, DPS

No one seems to know what the answer is to keeping costs down in healthcare but grand efforts have been undertaken to find someone to blame. Some of the targets are patients, others are providers, and sometimes the insurers are dragged into the fray as well. The rhetoric is tired and worn on both ends.  Is it the folks with chronic diseases like diabetes? Is it the folks who need dialysis? The smokers? The patients who do not follow the doctors’ advice and stay sick and expensive? The people who want ‘everything done’ at the end of life? Is it the doctors who acquiesce to patient demands or the laws that obligate them to do so? Do doctors order too many expensive tests, bleeding insurance system? Is it the liability insurance that must cover them if they fail to order a test? Maybe it is the insurance companies paying high salaries to executives while handing down ever-shrinking reimbursements pressing institutions to find new ways to eek out enough income to sustain an operating budget. Newer to this menu are penalties for staying in the hospital too long and coming back too soon. This latest addition to the list is perhaps among the most absurd.

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. 

June 6, 2014 | Posted By Bruce D. White, DO, JD

The ongoing VA scandal is indeed unfortunate and sad. In a speech on May 30, 2014, in Washington, DC, Eric K. Shinseki apologized for the “systemic, totally unacceptable lack of integrity” shown by some administrators in managing the Veterans Administration health care system hospitals and clinics. Within hours of the apology, Secretary Shinseki resigned.

It is clear that the trouble within the VA has been brewing for some time. The fuse that set off this latest explosion may have been whistleblower claims that managers at the Phoenix VA Medical Center were keeping two sets of books which logged wait times for veterans seeking primary care appointments. There are allegations that some of the delays resulted in veteran deaths. Acting VA Inspector General Richard J. Griffin issued a preliminary report confirming that Phoenix VA administrators had manipulated wait times possibly to assure more favorable annual performance reviews and higher bonuses and compensation for staff.  The unethical behavior by those entrusted with the care of our veterans is inexcusable.

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.

June 3, 2014 | Posted By John Kaplan, PhD

The essence of responsible conduct of research is to assure that science concerns itself with the identification and clarification of objective truth.  I have spent some time this past week trying to read a recent study by Fanelli and Ioannidis entitled “US studies may overestimate effect sizes in softer research” published in the Proceedings of the National Academy of Science

 This is a statistical paper, written densely, but still mostly understandable even to a mere scientist such as myself. Many of you have probably heard of John Ioannidis. He has gained prominence by doing theoretical analysis of the studies of others and using his results to conclude that most biomedical research is wrong or at least biased. I may be wrong, or at least biased, but I have come to believe upon reading this work that Dr. Ioannidis is wrong and maybe biased 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

May 29, 2014 | Posted By Marleen Eijkholt, PhD

Imagine you or your partner want to take your placenta home after birth. You feel that the placenta is part of your (partner’s) body and you should be allowed to take it home.  Maybe to eat it: ‘I ate my wife's placenta raw in a smoothie and cooked in a taco’ (Guardian 30 April 2014) or to bury it for cultural reasons, as protection of the soul and the newborn (LA times 31 December 2013). In Oregon you are legally allowed to take it home. In some hospitals elsewhere, you are not. Imagine that due to circumstances, you end up in a hospital that prohibits you from obtaining the placenta. What’s next?

Requests to take placentas home after birth are increasing. Human placentophagy is on the rise. Kim Kardashian spoke about it in her soap series not too long ago.  Newspapers are full of stories about placentas, their use and ability, and significant amounts of websites discuss the pros and cons of bringing placentas home. Different sources report on the alleged benefits of eating your placenta and other reasons to take it home. The public exposure to this ‘appetite’, its context and the rise in requests, raise concerns about prohibitive practices. Prohibitive policies are likely to come under increased scrutiny. My question in this context: What about eating placentas, what about policies prohibiting this?

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.

May 27, 2014 | Posted By Paul Burcher, MD, PhD

In recent years there has been a push to teach professionalism to medical students, and this is in part a response to a perceived decrease in respect for physicians by the general public.  Much of the emphasis on teaching professionalism has been on treating patients with respect, and placing the needs of the patient over our own needs.  I support this effort, but I would like to emphasize a different aspect of professionalism that seems to get less attention: the relationship we have with our colleagues.  The duty of professionalism arises because medicine is a profession—we profess an oath to become members, we perform a task held in high regard by the public, and we promise to self-regulate.  Given that this is the nature of medicine, we can easily now say something about how we must treat our colleagues to best uphold our oath and to best maintain the reputation of our vocation.  For Aristotle, a virtue is often found as the mean between two excesses which are vices, and I think this model is appropriate for determining the virtuous, professional way we should treat our colleagues:  show respect, but do not protect incompetence or misbehavior. Put another way, we have dual duties to respect our colleagues, but also to protect our patients.  When these duties come into conflict, patients must come first, but we must also remember that failing to respect colleagues has negative effects on both the status of our profession, and on patient care itself.

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.

May 22, 2014 | Posted By Jane Jankowski, DPS

The seventh annual National Healthcare Decisions Day (NHDD) was held on April 16th of this year, and events at national, state and local levels were held to educate people about the importance of advance care planning and encourage participants to complete advance directives. Providing resources and information that drives home the message about how important it is to let others know one’s preferences for healthcare and end of life care is intended to promote conversation and documentation of these wishes which are then implemented when the individual is no longer able to express preferences for themselves. But does it do enough to generate interest in those who prefer to avoid such unpleasantries?

Repeated studies show that advance directive completion rates are low in the US. People simply do not like to talk about end of life, and it is not clear that the NHDD, however well intended, is making the topic any more palatable. Designating a day to recognize the importance of advance directives is an important start, and the materials are often excellent. Five wishes, for example, gives a carefully crafted set of questions to help people thoughtfully consider what matters most to them when it comes to medical intervention, particularly in the end of life context. Still, this only works if people come to the table for the conversation.

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.

May 16, 2014 | Posted By Zubin Master, PhD

Last month, I discussed bias in academia and more specifically in the workplace. Just to recap, there are several studies that show bias in peer review and bias or favoritism in the workplace. Much of the bias may be unconscious or what is considered “hidden bias” and is not shown overtly. In this month’s blog, I propose three steps to reduce bias in the workplace.

The solutions proposed here are geared towards academic work environments at the departmental level in one of the three settings: 1) professors or research scientists running a lab or a research group who supervise research assistants, students, fellows and staff; 2) department directors/heads; and 3) members and chairs of committees charged with the selection of candidates for awards, prizes, and positions. While I am not applying these steps to the peer review of grants or publications, some of the points may be helpful to reduce bias in peer review processes.

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.

May 12, 2014 | Posted By Wayne Shelton, PhD

Recently, the Governor of Tennessee signed into law a bill, SB 1391, which criminalizes a woman who has had a baby with drug-related complications.  As a result babies born with addictions due to drug use by the mother during pregnancy will be grounds for the mother being charged with aggravated assault, which could result in sentence of up to 15 years in prison for the mother. The concerns of the state legislators who promoted and passed this bill were over a condition in newborns called neonatal abstinence syndrome (NAS).  This condition results from exposure to addictive drugs while in the mother’s womb. In 2013 the Tennessee state Health Department reported 921 babies born with NAS and 278 cases so far in the past four months. The stated goal of the law was to reduce the number of babies born with this condition. But is criminalizing drug use during pregnancy, in this first of its kind state law, the most effective way of accomplishing this goal?

It is important to note that the bill was passed against the strong objections of women’s rights groups as well as health care and addiction specialty groups. First of all these experts agree that cause more harm to babies as pregnant women will be afraid to seek medical care.

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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