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November 26, 2014 | Posted By John Kaplan, PhD

When I was a young scientist (quite some time ago) there was a joke that seemed to be circulating about how our older established colleagues conducted science. This was a somewhat cynical exercise motivated, at least in part, by professional jealousy. The joke went on to say that one could establish a fact by writing two papers. In the first paper the author speculates that something might be true. In the second paper the author says that the previously speculated thing is true, and references the paper containing the original speculation. In fact I have rarely seen this actually done. But as I write blog I have an example sitting in front of me on my desk. It is especially intriguing that this paper was written by an individual who maintains that “most published research findings are false”.

The paper in question was published just last month with the rather presumptuous title: “How to make more published research true”.  This, of course, is a statement predicated on the presumption that much published research is false. Indeed the author says in the first paragraph, referring to scientific research, that “Many new proposed associations and/or effects are false or grossly exaggerated” and refers to two previously published papers both single author papers by him.

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.

November 24, 2014 | Posted By Zubin Master, PhD

Paolo Bianco and colleague Douglas Sipp wrote a very provocative and interesting piece recently published in the journalNature (http://www.nature.com/news/regulation-sell-help-not-hope-1.15409)discussing a movement to permit stem cell medicines, among others, to be sold in the market without the requirement to show much safety and efficacy data permitting the market to determine safety and effectiveness of compounds. Here, patients would basically pay to obtain products and also be research subjects. Certain powerful groups are calling for the deregulation of clinical medicine as a business model to bring innovative products to the marketplace. But before I begin explaining what Bianco and Sipp discuss, we need to cover the current system of regulatory oversight of medical products.

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.

November 20, 2014 | Posted By Lisa Campo-Engelstein, PhD

In the last couple of years, the media has reported women undergoing uterus transplantations. Just last month, the media reported that the first baby was born from a transplanted uterus. While the woman’s identity remains unknown, she is a 36 year old Swedish woman who was born with ovaries, but not a uterus. She and her partner underwent IVF to produce embryos that could then be transferred into the transplanted uterus. This donor is a friend of hers who is 61 years old and had experienced menopause seven years beforehand. The quality of a woman’s uterus does not diminish over time, so she is able to successfully carry a pregnancy event postmenopausally (it is the quality and quantity of her eggs that leads to infertility and eventually menopause).  Both the woman and the baby are doing fine, according to media reports. However, the baby was born prematurely at 32 weeks because the women developed preeclampsia and the fetal heart rate became abnormal. It is not clear from the media reports whether the development of preeclampsia was related to the uterus transplantation.

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.

November 17, 2014 | Posted By Wayne Shelton, PhD

Let me emphatically state at the outset of this short blog: I have always thought the elective termination of pregnancy (ETOL) was a serious moral issue. As I have taught students over the years on this topic, to fully appreciate the moral conflict around abortion (or any other moral conflict) one must be willing to put oneself in the middle of two important value positions. In other words, one must be willing to hold and take seriously in one’s mind simultaneously two opposing thoughts or value positions in order to weigh them fairly.  

Though I don’t think that a fetus is a person with a personal or social identity, it is biologically human—and that alone is a relevant piece of moral information. The fetus has a unique genetic code and has the potential to grow to full term into a new baby and eventually grow into a child, adolescent, and adult human being. Because a fetus has the potential to become a full-fledged member of the human community, all things equal, we should not destroy it. But rarely in human life are all things equal.

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.

November 13, 2014 | Posted By Michael Brannigan, PhD

Reminders of our finitude always lurk close by, like Ezekiel Emanuel's article in last month's Atlantic, "Why I Hope to Die at 75." The head of the Clinical Bioethics Department at the National Institutes of Health gives reasons for not living beyond 75: inevitable decline, disability, incapacity, and diminishment of "creativity, originality, and productivity." According to Emanuel, we wish to be remembered for our good years, prior to decline.

There are grains of truth here. Many of us "die" well before we are officially declared dead. I've seen patients kept alive for far too long in permanent vegetative states, while family dynamics, emotions, finances and scarce medical resources are depleted. We pay a high price for medical "progress." I also know thriving, vibrant elderly, themselves significantly disabled and incapacitated.

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.

November 11, 2014 | Posted By Jane Jankowski, DPS, LMSW

In Peter D. Kramer’s New York Times piece published in the ‘Couch’ section on October 18, 2014 (Why Doctors Need Stories) he affirms the experience of learners, educators, and researchers in his arguments that a case vignette can provide a kind of instruction that cannot be duplicated by data collection alone. While we do still need evidence based material to assure safety and efficacy of treatments, the case study offers contextual material that makes the evidence come to life.

As a Clinical Ethicist each clinical encounter is rich with substantive information that is part of an individual or family story intersecting with the healthcare setting. When invited to provide input, support, or recommendations in any given case, the most informative elements of any case are the story of the patient. What was before, what is now, and what the future may require is different for each patient, and I am often awed by the ‘before.’ The contextual landscape of each story is often where we come to understand the psychosocial factors that weigh heavily in how a patient, family, or community interacts with the healthcare community. Hard data is not as useful as hearing the story that belongs to the 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.

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

The cover story of the October 27, 2014, issue of PEOPLE Magazine featured Brittany Maynard, a 29-year-old Oregon woman with terminal brain cancer. In the article, Ms. Maynard announced that she would end her life on November 1, 2014, on her own terms, availing herself of the physician-assisted suicide option under the 1997 OregonDeath With Dignity Act (DWDA). As planned, and according to her own schedule and timetable, she died peacefully at home – surrounded by family and friends – on Saturday, November 1. She had signaled earlier in the week that she might delay taking her own life, but in the end, it occurred as she originally planned.

In electing assisted suicide, Ms. Maynard said, “I’m choosing to put myself through less emotional and physical pain.” She continued, “I don’t want to die, but I’m dying. My cancer is going to kill me, and it’s a terrible, terrible way to die. … When I look at both options I have to die [dying from the cancer versus dying from an overdose], I feel this [a fatal dose] is far more humane.” But rethinking the possibilities after developing a rather extensive plan in orchestrating one’s death with a terminal illness is not that unusual either. Roughly 40% of those who obtain the lethal doses of medicine under Oregon’s DWDA in the end die not from suicide but disease. According to an article in The New Atlantis, written to report a 10-year experience under the DWDA, author Courtney Campbell wrote, “In ten years, 541 Oregon residents have received lethal prescriptions to end their lives; of this number, 341 patients actually ingested the drugs.”

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.

November 3, 2014 | Posted By Luke Gelinas, PhD

Recently prominent bioethicists have voiced disagreement over whether it could be ethical to test experimental Ebola vaccines in placebo-controlled randomized trials.  Such trials would involve taking a group of people currently infected with Ebola and randomizing half of them to an arm that receives the experimental vaccine (plus, let us assume, the best current standard of care for Ebola), and the other half of them to an arm that receives a placebo instead of the vaccine (plus the same standard of care).  

The main worry with these trials is that it is unethical to give Ebola-sufferers a placebo when an experimental vaccine is available that holds the prospect of benefit. (The prospect of benefit is typically inferred from success in trials with animals; at least one experimental vaccine, ZMapp, has showed notable efficacy at preventing deadly disease in macaque monkeys inoculated with a virulent strain of Ebola.)  As a prominent group of bioethicists recently pointed out, conventional care for Ebola “does not much affect clinical outcomes,” resulting in a mortality rate as high as 70%.  “When conventional care means such a high probability of death,” they continue, “it is problematic to insist on randomizing patients to [a placebo arm] when the intervention arm holds out at least the possibility of benefit.”  Moreover, they insist, “none of us would consent to be randomized in such circumstances.” 

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.

Previous Posts

October 30, 2014 | Posted By Thomas Andersen, PhD
October 27, 2014 | Posted By Zubin Master, PhD
October 23, 2014 | Posted By Lisa Campo-Engelstein, PhD
October 21, 2014 | Posted By Jane Jankowski, DPS, LMSW
October 13, 2014 | Posted By Wayne Shelton, PhD
October 10, 2014 | Posted By John Kaplan, PhD
October 6, 2014 | Posted By Bruce D. White, DO, JD
October 2, 2014 | Posted By Jane Jankowski, DPS, LMSW
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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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