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Alden March Bioethics Institute

Detailed Research and Scholarly Works


The faculty, staff and students of Alden March Bioethics Institute are actively engaged in both empirical and conceptual research and scholarly activities. Currently active areas of such research include bio-banking, research on human subjects, clinical ethics and clinical ethics consultation, stem cell ethics, international bioethics, medical education, pharmacy ethics, responsible conduct of research, as well as  sexual , reproductive and obstetrical ethics.

 

Biobanking and Research Involving Humans

Biobanking involves the collection and storage of biological samples and health and lifestyle information.

Dr. Zubin Master’s research focuses on the ethical and legal issues of biobanking and biorepository research. Generally, samples and information are collected prospectively for a study and banked (stored) for future use as new genes and biomarkers are discovered. Biobanking research is thus a powerful platform because it builds on the labor of others and the recollection of samples and information from potentially thousands of people does not have to be performed for each new study. However, biobanking also alters many of the traditional research ethics practices including informed consent, withdrawal, participant control, and the protection of individual privacy. Work done here has been to examine patient and public perceptions, and the perceptions of academic scholars including health lawyers, bioethicists, privacy experts, and scientists on the ethical, legal, and scientific issues related to biobanking.

Dr. Master is also interested in the governance of research ethics as it relates to multisite ethics review. A growing number of clinical research protocols involve many principal investigators performing a study at multiple institutions. Our current model of research ethics review requires that local ethics boards review the research protocol, the informed consent process, and analyze the benefits and risks of research. Yet several reports have shown that the local review of multisite research causes delays, hampers patient and staff recruitment, and causes unnecessary changes in research that may not necessarily better protect participants. Dr. Master’s research in this area focuses on examining the perceptions of a range of stakeholders including scientists conducting research and local research ethics board personnel (i.e., chairs, reviewers and administrators) on the advantages/disadvantages of multisite ethics review and various reform strategies to make the process more efficient. His work done in this area also employs conceptual and empirical bioethics methods.

Publications

Caulfield, T., et al. 2014. A review of the key issues associated with the commercialization of biobanks. Journal of Law and the Biosciences 1(1):94-110.  doi:10.1093/jlb/lst004. http://jlb.oxfordjournals.org/content/1/1/94.full.pdf+html.

Master, Z., Campo-Engelstein, L. and Caulfield, T. 2014. Scientists’ perspectives on consent in the context of biobanking research. European Journal of Human Genetics. In Press.

Master, Z., Claudio, J.O., Rachul, C., Wang, J. Minden, M. and Caulfield, T. 2013. Cancer patient perceptions on biobanking research. BMC Medical Genomics 6:8. doi:10.1186/1755-8794-6-8.

Master, Z. and Resnik, D.B. 2013. Incorporating exclusion clauses in informed consent for biobanking. Cambridge Quarterly of Healthcare Ethics (22)2: 203-212.

Master, Z., Nelson, E., Murdoch, B. and Caulfield, T. 2012. Biobanks, consent, and claims of consensus. Nature Methods (9)9:885-888.

Master, Z. Ries, N. and Caulfield, T. 2011. Balancing efficiency and the protection of research participants: Canadian allergy/asthma researchers’ perspectives on the ethics review of multi-site health research. Journal of Clinical Research and Bioethics 2(5):104e. doi:10.4172/2155-9627.1000104e.

 

Clinical Ethics and Clinical Ethics Consultation

The founding faculty of the Alden March Bioethics Institute, from its origins in the Center for Medical Ethics, Education and Research in 1994 has staffed the clinical ethics consultation service at The Albany Medical Center Hospital since its inception. Thus, clinical ethics, clinical ethics consultation, and their role in medical education continue to be an important area of focus both for professional service and research.

Drs. John Balint and Wayne Shelton published an article on the physician-patient relationship in JAMA in 1996 entitled, Regaining the initiative: Forging a new model of the patient-physician relationship, which has been widely discussed. Drs. Balint and Shelton explored many other topics since then including organ transplantation and medical futility. AMBI faculty in more recent years have been leaders in examining the ethical issues in discharge planning. In 2007 Dr. Shelton was a co-author with Robert Swidler and Terease Seastrum on a target article in AJOB entitled Difficult hospital inpatient discharge decisions: Ethical, legal and clinical practice issues; those same authors joined Jane Jankowski as lead author in 2009 to publish a paper entitled, For lack of a better plan: A framework for ethical, legal and clinical challenges in complex inpatient discharge planning, which was published in HEC Forum.

In 2009 Dr. Wayne Shelton co-authored a paper with Dr. Bob Orr entitled, A process and format for clinical ethics consultation which was published in the Journal of Clinical Ethics. More recently, with Dr. White as the lead author, along with Wayne Shelton and Jane Jankowski as co-authors, a paper accepted as a target article at AJOB develops a model written examination to assess the ASBH healthcare ethics core knowledge competencies.

Professor Jane Jankowski has published an array of articles related to specific topics within clinical ethics. Palliative care has always been a widely discussed topic both in medical school and bioethics graduate course discussions. Jane Jankowski has taken a leadership role in this area at AMBI; she has a paper forthcoming entitled “Professional Boundary Issues in Pediatric Palliative Care” which will appear in the American Journal of Hospice and Palliative Care. The types and nature of professional boundary issues that arise in this multidisciplinary emerging specialty are explored. She has also recently co-authored a piece on suicide and terminal illness with Dr. Lisa Campo-Englestein, and co-authored an article on assessing core competencies for providing clinical ethics consultation, both for the American Journal of Bioethics.
Drs. Shelton and White have long suggested that it is important for professionals who use clinical ethics skills in practice to validate the impact of their services for the institutions they serve. Research based on insights gained from many years of ethics consultations in the ICU led to the implementation of a research project in 2006 that introduced a new role in the ICU: the Family Support Coordinator (FSC). The purpose of this new role was to help the ICU team coordinate the care of the most at-risk families, based on the medical severity of the patient. Research to determine the impact of this role was conducted over two-and-a-half years using a pre- and post- study design. The results which were published in Critical Care Medicine in 2010 show that the FSC had a significant impact on a wide range of family satisfaction issues, and decreased length of stay and cost of care. Dr. Shelton directed this project and he has continued to refine the study methodologies for further research.

Dr. White and colleagues studied the impact of early identification of legally authorized representatives for patients who lacked capacity in the neuro-intensive care units in a large teaching hospital. For what were identified by objective criteria as “the sickest of the sick” admitted to the units, the average length of stay was almost 21 days in the 100 patient pre-intervention cohort. The team designed a one-page form for use by nurses to help identify surrogate decision makers during the first four days of hospitalization when indicated. The team trained all of the 220 primary nurses in how to best use the instrument during a four-hour mandatory continuing education program that emphasized basic clinical ethics principles and practices, intuitive conflict management techniques, and sensitivity to intercultural and spiritual differences. After using the form for nine months in the unit, the team collected and analyzed data about the post-intervention cohort of 100 patients. There were statistically significant differences in length of stay (about 16 days) and hospital charges (about $65,000 less). This study was published in the Journal of Clinical Ethics in 2012.

In Revitalizing Informed Consent and Protecting Patient Autonomy: An Appeal to Abandon Objective Causation, published in the Oklahoma Law Review, Professor Tenenbaum explains why informed consent laws fail to perform their function of protecting patients’ interests in receiving the information they need to exercise their personal preferences. In all but four states, a patient cannot prevail on an informed consent claim without proving objective causation. That standard forces the courts to focus on the hypothetical preferences of a reasonable person, rather than on the values and priorities of the individual patient. The article argues that informed consent laws must perform their essential role of protecting patient autonomy, traces the history of informed consent, and shows why informed consent laws are ripe for change. It recommends adopting a subjective causation standard and explains why this standard is an attractive option.

Professor Tenenbaum also published "Using Informed Consent to Reduce Preventable Medical Errors" in Annals of Health Law. In this article, she advocates using the informed consent process to provide patients with the information they need to assist in preventing medical errors. Patients and their families are the ideal candidates to reduce medical errors because they are strongly motivated to reduce mistakes and the informed consent process is an efficient vehicle to convey this information because the process is already in place, making it a convenient and inexpensive route to the patient. The article focuses on chemotherapy and prescription drugs because both areas of practice have very high error rates and, with little effort, patients could have an enormous impact in reducing these errors. There is also evidence that giving patients the additional information they need to help reduce medical mistakes will result in improved patient compliance with treatment protocols, better patient outcomes, and fewer malpractice claims.

After many years of doing ethics consultations in the ICU, Dr. Wayne Shelton was principal investigator on a research project in 2006 that introduced a new role in the ICU: the Family Support Coordinator. The purpose of the Family Support Coordinator (FSC) was to help the ICU team coordinate the care of the most at-risk families, based on the medical severity of the patient. Research to determine the impact of this role was conducted over 2 ½ years using a pre- and post- study design, which culminated in a paper published in Critical Care Medicine (2010 May;38(5):1315-20). The results show that the FSC had a significant impact on a wide range of family satisfaction parameters, including physician communication.  More recently, Dr. Shelton joined Dr. Crystal Moore from Skidmore College on a study in the Medical ICU to confirm the results of the prior Surgical ICU results in another adult ICU unit; the results in fact were confirmatory and were published in Critical Care Nursing Quarterly in 2012.

Dr. Shelton has done several other empirical research studies in the Medical ICU including one focusing on those patients that stay beyond 6 days, and for whom there is no plan for discharge. These cases—which often do not receive focused attention—constitute the highest risk for ethical conflicts and extended lengths of stay. The study was initiated to examine the impact of a brief ethics intervention using a pre- and post- research design. The intervention was studied and used as a proactive measure to determine if a critical ethical assessment in each case can identify issues in advance. The research question based on which data was being collected is: Can such an intervention help reduce and possibly preclude conflict down the road, and reduce length of stay? Data was also collected on the impact of this intervention on the caregivers, including physicians and nurses, to determine if they find this service helpful to their work.

Dr. Paul Burcher did his dissertation for his PhD in philosophy on the doctor-patient relationship, suggesting that we need to move beyond models of care that place patient autonomy at the center of the relationship, and that instead we need a more flexible, nuanced approach to patient care grounded in the story and context of each individual patient encounter.  He has published on physician empathy and emotional intelligence, the ethics of dealing with non-compliant patients, and the history of the doctor-patient relationship.

Publications

White, B., Jankowski, J. and Shelton, W. 2014. Structuring a Written Examination to Assess ASBH Healthcare Ethics Consultation Core Knowledge Competencies. American Journal of Bioethics (14)1: 5-17.

Tenenbaum, E. 2012. Revitalizing Informed Consent and Protecting Patient Autonomy: An Appeal to Abandon Objective Causation. Oklahoma Law Review (64):697-758.

Tenenbaum, E. 2012. Using Informed Consent to Reduce Preventable Medical Errors. Annals of Health Law (21):11-19.

Jankowski, J. 2013. Professional boundary issues in pediatric palliative care; American  Journal of Hospice and Palliative Medicine (31)2: 159-163.

Jankowski, J. and Campo-Engelstein, L. 2013. Suicide in the context of terminal illness. American Journal of Bioethics (13)3: 13-14.

Burcher, P. 2012. The Patient-Doctor Relationship:  A Historical and Philosophical Perspective. Encyclopedia of Human Biology:  Bioethics, 3rd ed.  Elsevier:  Philadelphia.

Burcher, P. 2012.  The Non-Compliant Patient:  A Kantian and Levinasian Perspective.  The Journal of Medicine and Philosophy (37)1: 74-89.

Hatler, CW., Grove, C., Strickland, S., Barron, S. and White, BD. 2012. The effect of completing a surrogacy information and decision-making tool upon admission to an intensive care unit on length of stay and charges. Journal of Clinical Ethics (23)2:129-38.

Moore, C.D. and Shelton, W. et al. 2012. The effect of a family support intervention on physician, nurse and family perceptions of care in surgical, neurological and Medical ICU’s. Critical Care Nursing Quarterly (35)4:378-387.

Burcher, P.  2011. Emotional Intelligence and Empathy: Its Relevance in the Clinical Encounter.”  Patient Intelligence (3):1-6.

Shelton, W. 2010. Critical Care Medicine 38(5):1315-20.

Shelton, W., Moore, CD., Socaris, S., Gao, J. and Dowling, J. 2010. The effect of a family support intervention on family satisfaction, length-of-stay, and cost of care in the intensive care unit. Critical Care Medicine (38)5:1315-20.

Jankowski, J., Seastrum, T., Swidler, R. and Shelton, W. 2009. For lack of a better plan: a framework for ethical, legal, and clinical challenges in complex inpatient discharge planning; HEC Forum (21)4: 311-326.

Qualtere-Burcher, P.  2009. The Just Distance: Narrativity, Singularity, and Relationality as the Source of a New Biomedical Principle. Journal of Clinical Ethics (20)4:299-309.

Orr R. and Shelton, W. 2009. A process and format for clinical ethics consultation. Journal of Clinical Ethics (20)1:1-11.

Swidler, R., Seastrum, T. and Shelton, W. 2007. Difficult hospital inpatient discharge decisions: Ethical, legal and clinical practice issues. American Journal of Bioethics (Target Article) (7)3: 23-8.

 

Embryos, Parthenotes, and Stem Cells Ethics

The ethics of stem cell research focus on a range of issues including the moral status of human embryos, the physical and social harms to women, justice, hyping science, and the premature commercialization of science.

Dr. Zubin Master’s research on the ethical issues of stem cell research concentrates on the clinical translation and commercialization of stem cell research and how this may affect scientific integrity. The stem cell research environment has been evolving to move from basic research to performing research with clear translational and commercialization goals. The hype surrounding stem cell research and its recent translation and commercialization agenda has contributed to the premature commercialization of stem cell sciences including creating a range of stem cell products being sold in the market place. This includes stem cell beauty products, vitamins and veterinary treatments. Yet inadequately tested for safety or efficacy, stem cells are also being sold to patients as potential treatments for a range of diseases and injuries. This is commonly known as “stem cell tourism.” Stem cell tourism is a term used to describe the internet-based, direct-to-consumer advertised industry where clinics worldwide are offering untested stem cell interventions as bonafide therapies for payment. Dr. Master’s research in this area focuses on identifying strategies to stop stem cell tourism, and to create educational material for patients in order to better inform them. This work uses conceptual and empirical bioethics methods and involves US and international collaborators.

Dr. Master’s previous work in this area concentrated on ethical issues related to the moral status of human embryos and the physical and social harms to women as ova providers for stem cell and cloning research. Dr. Campo-Engelstein has also examined some of the ethical issues involving the use of embryos for scientific research. In particular, she has analyzed the scientific and ethical differences between embryos and parthenotes (unfertilized eggs that begin developing like embryos). The Dickey-Wicker Amendment, passed by Congress, conflates embryos and parthenotes and does not permit federal funding for research that involves the destruction of embryos or parthenotes. Dr. Campo-Engelstein has examined this ban and its ethical implications for science and society.

Publications

Carol A. Tauer, Zubin Master and Lisa Campo-Engelstein. "Embryo Research." Bioethics. Ed. Bruce Jennings. Vol. 2. 4th ed. Farmington Hills, MI: Macmillan Reference USA, 2014. p923-935.

Zarzeczny, A., Caulfield, T., Ogbogu, U. Bell, P., Clark, M. Crooks, V., Hyde-Lay, R., Kamenova, K., Master, Z., Rachul, C. Snyder, J., Toews, M., Zoeller, S. 2014. Professional Regulation – A Valuable Tool in Responding to Stem Cell “Tourism”. Stem Cell Reports. Revisions In Press.

Master, Z. and Resnik, D.B. 2013. Promoting public trust: ESCROs won’t fix the problem of stem cell tourism. American Journal of Bioethics (13)1:53-55.

Master, Z., and Sipp, D. 2013. A role patient advocacy in countering the premature commercialization of stem cell interventions. The Monitor (27)5: 26-30.

Master, Z., Zarzeczny, A., Rachul, C. and Caulfield, T. 2013. What’s Missing? Discussing stem cell translational research in educational information on stem cell “tourism”. Journal of Law, Medicine & Ethics (41)1: 254-268.

Campo-Engelstein, L., Rodriguez, S., Tingen, C., and Woodruff, T.K. 2012. Conceiving ethical gamete and embryo research in a post-Dickey Wicker United States.” Science and Public Policy 39(1): 129-132. doi: 10.3152/030234212X132146035318.

Master, Z, and Crozier, G.K. 2012. The ethics of moral compromise for stem cell research policy. Health Care Analysis (20)1:50-65.

Master, Z. and Ogbogu, U. 2012. Stem cell tourism in the era of personalized medicine: what we know, and what we don’t know. Current Pharmacogenomics and Personalized Medicine (10)2:106-110.

Campo-Engelstein, L., Rodriguez, S., Tingen, C. and Woodruff, T.K. 2011. “Practical parthenote policy and the practice of science.” American Journal of Bioethics (11)3: W1-2. doi: 10.1080/15265161.2011.563162.
 
Master, Z. and Resnik, D.B. 2011. Stem cell tourism and scientific responsibility. EMBO Reports (12)10: 992-995.

Master, Z. and Crozier, G. 2011. Symbolism and sacredness of human parthenotes. American Journal of Bioethics (11)3:37-39.

Rodriguez, S., Campo-Engelstein, L, Tingen, C. and Woodruff, T.K. 2011. “An obscure rider obstructing science: the conflation of parthenotes with embryos in the Dickey-Wicker Amendment.” American Journal of Bioethics 11(3): 20-8. doi: 10.1080/15265161.2010.546472.

Tingen, C., Woodruff, T.K., Rodriguez, S. and Campo-Engelstein, L. 2010. “Politics and parthenotes.” Science 330(6003): 453. doi: 10.1126/science.1196881.

 

International Bioethics

Dr. Campo-Engelstein is interested in international bioethics, especially the ethical issues unique to assisted reproductive technologies on the global scale and for both “developed” and “developing” countries. She has spent time in Costa Rica, analyzing the health care system and how race influences its implementation.

Publications

Campo-Engelstein, L. and Meagher, K.M. 2011. “Costa Rica’s ‘white legend’: how racial narratives undermine the values of the health care system.” Developing World Bioethics 11(2): 99-107. doi: 10.1111/j.1471-8847.2011.00301.x.
 
Fleetwood, A. and Campo-Engelstein, L. 2010. “The impact of infertility: why arts should be a higher priority for women in the global south” in Oncofertility: Ethical, Legal, Social, and Medical Perspectives 156: 237–248. doi: 10.1007/978-1-4419-6518-9_18
 
Sreenivas, K. and Campo-Engelstein, L. 2010. “Domestic and international surrogacy: implications for cancer survivors” in Oncofertility: Ethical, Legal, Social, and Medical Perspectives 156: 135–152. doi: 10.1007/978-1-4419-6518-9_10.

 

Medical Education

Medical education has been and remains a core area of research interest for AMBI faculty members.

Dr. Wayne Shelton has published a number of papers in this area including "Can virtue be taught?" which appeared in Academic Medicine in 1999 and a book he co-edited along with Nuala Kenny in 2006 entitled, Lost virtue: Professional character development in medical education. Dr. Shelton also has a paper forthcoming in Perspectives in Biology and Medicine entitled A new look at medicine and the mind-body problem: Can Dewey’s pragmatism help medicine connect with its mission; this paper explores the disconnects in medicine and medical education due the effects of Cartesian legacy of mind-body dualism and offers a new model based on John Dewey’s philosophical pragmatism.

Drs. Shelton and White and Professor Tenenbaum have just published a report about the new Better Doctoring continuing medical education (CME) program for physicians in the New York State Bar Association Health Law Journal. The article is titled "An Innovation in Continuing Medical Education: Online, Remedial Education for Physicians Following a Professional Violation or Incident." The article describes the 25-hour CME course, which focuses on medical ethics basics and the disciplinary process, and includes six video vignettes in which participants are asked to react to hypothetical patient scenarios that highlight ethical and professional dilemmas. The program is believed to be the first in the nation that offers online remedial medical ethics education to physicians who are asked to take an ethics course dealing with unprofessional conduct.

Publications

Shelton, W. 2014. A new look at medicine and the mind-body problem: Can Dewey’s pragmatism help medicine connect with its mission. Perspectives in Biology and Medicine (56)3:422-441.

Shelton, W., White B. and Tenebaum, E. 2013. An innovation in continuing medical education: Online, remediation education for physicians following a professional violation or incident. NY Law Review (18)2:36-39.

Kenny, N. and Shelton, W. 2006. Lost Virtue: Professional Character Development in Medical Education. Elsevier.

Shelton, W. 1999. Can virtue be taught? Academic Medicine (74)6: 671-74.

 

Pharmacy Ethics

Pharmacy ethics is an emerging field in bioethics that examines the ethical issues in pharmacy.

Dr. White has recently completed a chapter styled "Healthcare Ethics and Pain Management in Palliative Medicine" that will appear in a text titled The Art and Science of Palliative Medicine, edited by Drs. Julie G. Pilitsis (Albany Medical College) and John C. Peppin (University of Kentucky). It will be published by AME Publishing Company in early 2014. Dr. White's chapter focuses on several cases highlighting ethical dilemmas that involve both physicians and pharmacists in assuring superior patient care: controlling pain in a sickle cell anemia patient in crisis; treating pain symptoms during natural childbirth; terminally sedating a three-year-old child with terminal cancer; and successfully managing pain in a 96-year-old man with metastatic colon cancer. The topics deal specifically with pain medicine dilemmas at the intersection of law, ethics, medicine, pharmacy, and public policy. This chapter continues discussions that Dr. White began in his 2007 medicine and pharmacy ethics and law casebook, Drugs, Ethics, and Quality of Life.

Publications

White, BD. "Healthcare Ethics and Pain Management in Palliative Medicine" that will appear in a text titled The Art and Science of Palliative Medicine, edited by Drs. Julie G. Pilitsis (Albany Medical College) and John C. Peppin (forthcoming).

Tenenbaum, Evelyn M., 2007, Memory-Altering Drugs: Shifting the Paradigm of Informed Consent, American Journal of Bioethics 7:40-42

White, BD. 2007. Drugs, Ethics, and Quality of Life. Hawthorne Press.

 

Responsible Conduct of Research

The responsible conduct of research (RCR) (a.k.a. research integrity) captures a range of ethical norms and practices such as honestly conducting and reporting research and providing due credit during publications, among other ethical practices.

RCR captures areas such as research fraud, publication ethics, authorship, peer review, mentoring among others. Although much research on research integrity focuses on the natural and applied sciences, Dr. Master is specifically interested in issues of research integrity as it relates to multi and interdisciplinary teams and has thus far has focused his work on the responsible conduct of bioethics research. Because bioethics is a diverse, interdisciplinary field, it makes a good model for studying how research integrity works in such settings. Much of the work surrounding research integrity in bioethics focuses on issues surrounding authorship and publication ethics, peer review, and conflicts of interest.

In addition, Dr. Master is interested in the governance of research integrity. This interest started while he was working for the Canadian federal government, where he developed Health Canada’s Scientific Integrity Framework consisting of a policy, a mechanism to address allegations of scientific misconduct, and an educational and outreach component. His research interests in this area focus on the national governance of research integrity in Canada and abroad. The research here also uses conceptual and empirical bioethics methods and involves collaborators in the US and Canada.

Publications

Smith, E., Hunt, M. and Master, Z. 2014. Authorship ethics in global health research partnership between researchers from low and middle income countries and high income countries. BMC Medical Ethics. 15:42. doi:10.1186/1472-6939-15-42.

Master, Z. 2014. Relevance of case-based studies in workshops on RCR for diverse audiences. Office of Research Integrity Newsletter 22(2):6-8.

Master, Z. and Resnik, D.B. 2013. Hype and public trust in science. Science and Engineering Ethics (19)2:321-335.

Resnik, D.B. and Master, Z. 2013. Policies and initiatives aimed at addressing research misconduct in high income countries. PLOS Medicine: 10(3): e1001406. doi:10.1371/journal.pmed.1001406.

Master, Z. 2012. The ethics and governance of research integrity in Canada. Health Law Review (20)3:5-14.

Master, Z.. McDonald, M. and Williams-Jones, B. 2012. Promoting research on research integrity in Canada. Editorial. Accountability in Research (19)1:47-52.

Master, Z. 2011. Responsible conduct of bioethics research. Accountability in Research (18)2:102-119.

Resnik, D.B. and Master, Z. 2011. Criteria for authorship on conceptual publications in bioethics. American Journal of Bioethics (11)10:17-21.

Resnik, D.B. and Master, Z. 2011. Authorship policies in bioethics journals. Journal of Medical Ethics (37)7:424-428.

 

Sexual, Reproductive, and Obstetrical Ethics

Our faculty members research a range of interesting and important topics within the fields of sexual, reproductive, and obstetrical ethics. Professor Tenenbaum studies legal and ethical matters related to sexual activity among individuals with dementia. Dr. Campo-Engelstein explores the ethical concerns raised by contraception and assisted reproductive technologies, especially oncofertility. Dr. Burcher examines ethical and philosophical issues in labor and delivery.

Dr. Campo-Engelstein is interested in ethical issues surrounding contraception. She examines how gender norms have shaped who is held responsible for and trusted with contraception. She is particularly concerned with how our current contraceptive arrangement is a justice issue, one that inhibits and/or enhances individual’s reproductive autonomy. Although reproductive ethics has mainly focused on women, Dr. Campo-Engelstein believes it is important to include men in these discussions and so much of her work on contraception analyzes men’s role and how it may change if new male contraceptives are developed.

Dr. Campo-Engelstein also focuses on the topic of oncofertility, which is concerned with fertility preservation and reproductive options for cancer patients. Oncofertility relies upon both established (e.g. sperm freezing) and experimental (e.g. ovarian tissue transplantation) types of assisted reproductive technologies. These technologies raise a host of ethical questions, such as whether there is a right to biologically reproduce, whether it is ethical to offer fertility preservation to patients with a poor cancer prognosis, and whether there is an ethical difference between treatment-induced and naturally occurring infertility. 

Professor Evelyn Tenenbaum published To Be or To Exist: Standards for Deciding Whether Dementia Patients in Nursing Homes Should Engage in Intimacy, Sex, and Adultery, in the Indiana Law Review.  The article examines the practical, legal, and ethical problems confronting nursing homes when dealing with sexual relationships between nursing home residents with dementia and the various standards that could be used to determine whether individual relationships should be allowed to continue. The article demonstrates that traditional standards used for making medical decisions for demented patients in nursing homes, such as substituted judgment and the best interests test, are inadequate for making decisions regarding intimacy and sexual relationships. Substituted judgment focuses on critical interests, or values held before the resident became incompetent, and does not adequately address the fact that values and circumstances change during the many years that a resident may live with dementia. Best interests focuses on the resident’s experiential or pleasurable experiences and ignores the values the resident created and nurtured while rational - values that may include religious convictions and loyalty to family. The article proposes that nursing homes employ a new balancing test that takes into account the critical interests, or former values, held by the demented resident and also gives weight to the current experiential interests or needs of the patient for intimacy and sex.
 
Professor Tenenbaum published a follow-up article on intimate relationships between demented nursing home residents in the Temple Political and Civil Rights Law Review. This article, entitled Sexual Expression and Intimacy Between Demented Nursing Home Residents: Balancing the Current Interests and Prior Values of Heterosexual and LGBT Residents, addresses the advantages and disadvantages of using advance directives to control future sexual relationships in nursing homes and discusses the legal and ethical challenges facing nursing homes in ensuring that gay and lesbian elders are provided the same opportunities for sexual expression and intimacy as other residents in the home.

Dr. Burcher is a practicing Obstetrician/Gynecology on faculty at Albany Medical College with eighteen years of clinical experience.  He has published several articles on ethical issues in obstetrics on such topics as birth plans, home birth, and cesarean section on maternal request during labor.  He is currently involved in an empirical research study identifying the causes of maternal regret after cesarean section during labor, with the goal of seeking interventions to reduce regret and patient dissatisfaction. He has also done philosophical work in obstetrics and has a book chapter on the phenomenology of “communal pushing”—when support people for a woman in labor find themselves involuntarily pushing with her.

Publications

Campo-Engelstein, L. and N. Johnson. Revisiting “The Fertilization Fairytale:” An Analysis of  Gendered Language Used to Describe Fertilization in Science Textbooks from Middle School to Medical School. Cultural Studies of Science Education 9.1 (March 2014).

Campo-Engelstein, L. “Paternal-Fetal Harm and Men’s Moral Duty to Use Contraception:  Applying the Principles of Nonmaleficence and Beneficence to Men's Reproductive Responsibility.” Medicine Studies 4.1 (May 2014). 

Jankowski, J. and Burcher, P. 2013. Home Birth of Infant with Anticipated Congenital  Anomalies: A Case Study and Ethical Analysis of Provider Obligations.  The Journal of Clinical Ethics.  (under review).

Tenenbaum, E. 2013. The Union of Contraceptive Services and the Affordable Care Act Gives Birth to First Amendment Concerns. Albany Law Journal of Science and Technology (23):539-580.

Tenenbaum, Evelyn. 2009. To Be or To Exist: Standards for Deciding Whether Dementia Patients in Nursing Homes Should Engage in Intimacy, Sex, and Adultery. Indiana Law Review (42):675-720.

Tenenbaum, E. 2012. Sexual Expression and Intimacy Between Demented Nursing Home Residents: Balancing the Current Interests and Prior Values of Heterosexual and LGBT Residents. Temple Political and Civil Rights Law Review (21):459-483.

Cheyney, M.,  Burcher, P. and Vedam, S. 2014. A Crusade against Home Birth. Birth (41)1: 1-4.

Cheyney, M., Everson, C. and Burcher, P. 2014. Homebirth Transfers in the United States: Narratives of Risk, Fear, and Mutual Accommodation. Qualitative Health Research 24(4): 443-456.

 Burcher, P. 2013. The Ulysses Contract in Obstetrics:  A Woman’s Choices Before and During Labor.  The Journal of Medical Ethics (39):27-30.

Burcher, P., Gabriel, J., Campo-Engelstein, L. and Kiley, K. 2013. The Case Against Cesarean Delivery on Maternal Request in Labor. Obstetrics & Gynecology (122)3: 684-687.

Campo-Engelstein, L. 2013. “Raging hormones, domestic incompetence, and contraceptive indifference: narratives contributing to the perception that women do not trust men to use contraception.” Culture, Health and Sexuality 15(3): 283-95. doi: 10.1080/13691058.2012.752106.

La Chance-Adams, S. and Burcher, P. 2013.  Chapter 4. Communal Pushing:  Childbirth and Intersubjectivity.  In Feminist Phenomenology and Medicine.  Edited by Kristin Zeiler and Lisa Krall.  SUNY Press.

Rodriguez, S., Campo-Engelstein, L., Clayman, M., Knapp, C., Quinn, G., Zoloth, L. and Emanuel, L. 2013. “Pathways toward the future: points to consider for oncofertility oversight.” Journal of Cancer Survivorship 7(1): 140-5. doi: 10.1007/s11764-012-0255-5.
 
Rodriguez, S., Campo-Engelstein, L. and Emanuel, L. 2013. “Fertile future? potential social implications of oncofertility.” Journal of Clinical Oncology 31(6):665-7. doi: 10.1200/JCO.2012.44.0990.
 
Campo-Engelstein, L. 2012. “Competing social norms: why women are responsible for, but ultimately not trusted with contraception.” International Journal of Applied Philosophy (26)1: 67-84. doi: 10.5840/ijap20122616.
 
Quinn, G.P., Stearsman, D.N., Campo-Engelstein, L. and Murphy, D. 2012. “Preserving the right to future children: an ethical case analysis.” American Journal of Bioethics 12(6): 38-43. doi: 10.1080/15265161.2012.673688.
 
Campo-Engelstein, L. 2011. “Gametes or organs? How should we legally classify ovaries used for transplantation in the U.S.?” Journal of Medical Ethics 37(3): 166–170. doi: 10.1136/jme.2010.038588.
 
Campo-Engelstein, L. 2011. “No more larking around! Why we need long-acting, reversible male contraceptives.” Hasting Center Report 41(5): 22-26. doi: 10.1353/hcr.2011.0110.
 
Gardino, S., Rodriguez, S. and Campo-Engelstein, L. 2011. “Infertility, cancer, and historical and changing gender norms.” Journal of Cancer Survivorship 5(2): 152-7. doi: 10.1007/s11764-010-0166-2.
 
Rodriguez, S. and Campo-Engelstein, L. 2011. “Conceiving wholeness: women, motherhood, and ovarian transplantation, 1901 and 2004.” Perspectives in Biology and Medicine 54(3): 409-16. doi: 10.1353/pbm.2011.0036.
 
Basco, D., Rodriguez, S. and Campo-Engelstein, L. 2010. “Insuring against infertility: expanding state infertility mandates to include fertility preservation technology for cancer patients.” Journal of Law, Medicine & Ethics 38(4): 832–839. doi: 10.1111/j.1748-720X.2010.00536.x.
 
Campo-Engelstein, L. 2010. “Consistency in insurance coverage for iatrogenic conditions resulting from cancer treatment including fertility preservation.” Journal of Clinical Oncology 28(8): 381–388. doi: 10.1007/978-1-4419-6518-9_29.

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