Bioethics and Medical Ethics Commons^™

Addressing The Ethical, Legal, And Social Issues Raised By Voting By Persons With Dementia, Jason H. Karlawish, Richard J. Bonnie, Paul S. Appelbaum, Constantine Lyketsos, Bryan James, David Knopman, Christopher Patusky, Rosalie A. Kane, Pamela S. Karlan

Jason Karlawish

This article addresses an emerging policy problem in the United States participation in the electoral process by citizens with dementia. At present, health care professionals, family caregivers, and long-term care staff lack adequate guidance to decide whether individuals with dementia should be precluded from or assisted in casting a ballot. Voting by persons with dementia raises a series of important questions about the autonomy of individuals with dementia, the integrity of the electoral process, and the prevention of fraud. Three subsidiary issues warrant special attention: development of a method to assess capacity to vote; identification of appropriate kinds of assistance …

The Capacity To Vote Of Persons With Alzheimer’S Disease, Paul S. Appelbaum, Richard S. Bonnie, Jason Karlawish

Jason Karlawish

OBJECTIVE: The right to vote can be abrogated when persons become incompetent to cast a ballot. This applies particularly to people with Alzheimer’s disease, who at some point will lose capacity. A 2001 federal court decision offered the first clear criteria (“Doe voting capacity standard”) for determining voting competence, focused on understanding the nature and effect of voting and on the ability to choose. This article explores how persons with Alzheimer’s disease perform on these criteria. METHOD: The Doe standard was operationalized in a brief questionnaire, along with measures of appreciation and reasoning about voting choices. Performance was assessed in …

Anorexia/Bulimia, Transcendence, And The Potential Impact Of Romanticized/Sexualized Death Imagery, Heather D. Schild

Center for the Study of Ethics in Society Papers

Presented November 10, 2014. Papers presented for the Center for the Study of Ethics in Society Western Michigan University

End Of Life Ethics: Hospice And Advance Directives, Thomas Kehr

CedarEthics: A Journal of Critical Thinking in Bioethics

It has been said, “Everybody will die, but very few people want to be reminded of that fact” (Handler, 2000, p.28). Perhaps this is the reason so few adults have advanced directives. Even after the 2005 public debate over the Terry Schiavo case, it has been calculated that two-thirds of Americans adults have not completed advance directives (Morhaim & Pollack, 2013).

Americans are united in desiring that their wishes be honored. Sister Nancy, a senior Catholic Nun, had completed her living will. After a medical episode and hospitalization she was furious that hospital emergency physicians had not honored her advanced …

Why Christians Are Afraid Of Removing Artificial Nutrition And Hydration, Lynley G. Turkelson

CedarEthics: A Journal of Critical Thinking in Bioethics

On 31 March 2005, Terri Schiavo passed away, amidst the grief, consternation, and outrage of many Americans. In our desire to live forever and “be like God” (Genesis 3:5), human beings have created death-defying technologies. However, these technologies have led to many ethical dilemmas, in part because bioethics has been influenced insidiously by a cultural transhumanism that denies our fundamental human nature and mortality. Many Christians have embraced a transhumanist view of technology, leading to an unhealthy vitalism at the end of life. In this paper, I will demonstrate this flawed view, using the persistent vegetative states (PVS) as an …

Ethical Duties In Ectopic Pregnancy, Josephine Hein

CedarEthics: A Journal of Critical Thinking in Bioethics

Ectopic pregnancy is occurring at an increasing frequency in the United States due to a rise in sexually transmitted disease, fertility treatments such as in vitro fertilization, smoking, stress, and drug use. An ectopic pregnancy (EP), from Latin roots meaning “out of place,” is a pregnancy that does not correctly implant into its normal location in the endometrium of the uterus. Instead, the developing embryo implants in the fallopian tube, the cervix, the ovaries, or the abdominal or pelvic cavity. EPs today constitute about 2% of all pregnancies, of which 97% implant in the fallopian tube. A ruptured EP can …

Mid-Atlantic Ethics Committee Newsletter, Fall 2014

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Documenting Mass Rape: Medical Evidence Collection Techniques As Humanitarian Technology, Jaimie Morse

Genocide Studies and Prevention: An International Journal

Aim: Emerging global networks of human rights activists, doctors, and nurses have advocated for increased collection of medical evidence in conflict-affected countries to corroborate allegations of sexual violence and facilitate prosecution in international and domestic courts. Such initiatives are part of broader shifts in human rights advocacy to document human rights violations using rigorous, standardized methodologies. In this paper, I consider three principal forms of medical evidence to document sexual violence and their use in these settings: the patient medical record, the medical certificate, and the sexual assault medical forensic exam (commonly known as the “rape kit”).

Methods: Combining archival …

Regulating The Placebo Effect In Clinical Practice, Tracey Chan

Tracey E Chan

Recent research and ethical analysis have forced a clinical and ethical reappraisal of the utility of placebos in medical practice. The main concern of ethics and law is that using placebos in health care involves deception, which is antithetical to patient autonomy and trust in the physician-patient relationship. This paper reviews the various, more nuanced scientific conceptions of the placebo effect, and evaluates the ethical and legal objections to deploying placebos in clinical practice. It argues that the placebo effect may be legitimately accommodated on the basis that it does not engage the requirement for material or quasi-fiduciary disclosures of …

Evaluation Of Awarded Grant Applications Involving Animal Experimentation, Michael W. Fox, M. Andrea Ward, Andrew N. Rowan, Barbara Jaffe

Andrew N. Rowan, DPhil

The potential benefits of animal research are accepted by most. However, painstaking care must be applied to the approach and design of the research to ensure the best possible chance of achieving the research objectives and to minimize both physical and psychological distress to the animals. Consideration should be given not only to transport and housing conditions, but also to practices used in the laboratory. Adequate reasons must also be given as to why the research is necessary.

Public concern over the use and care of laboratory animals in biomedical programs contributed to the passage of the Animal Welfare Act …

The Separation Of Politics And Science, Joanna K. Sax

Joanna K Sax

This article proposes that scientific inquiry regarding questions of fact should have an autonomous zone that is protected from politics. Although many scholars promote the idea that science is politicized, little empirical data exists to support this conclusion. This article contains an empirical study that demonstrates that the public received inaccurate information in the debate over a highly politicized and controversial area of scientific inquiry, embryonic stem cell research. This article utilizes the data from the empirical study and public choice theory to explain that there are process defects; this economic model can help explain, but cannot be used to …

Considering A New Paradigm For Alzheimer’S Disease Research, Gillian R. Langley

Experimentation Collection

Using Alzheimer’s disease as a case study, this review argues that it might be time to consider a new paradigm in medical research and drug discovery. The existing framework is overly dependent on often unvalidated animal models, particularly transgenic mice. Translational success remains elusive and costly late-stage drug failure is common. The conventional paradigm tends to overlook species differences and assumes that animal-based findings are generally applicable to humans. Could pathways-based research using advanced human-specific models probed with new tools, including those of systems biology, take centre stage? The current transition in chemical toxicology to a 21st-century paradigm could be …

An Efficient Standardized Method Of Maintaining Quality Assurance In Therapeutic Treatment Record Keeping, Kelsey Michael Bradshaw

UNLV Theses, Dissertations, Professional Papers, and Capstones

Quality assurance (QA) within the field of mental health is the practice of monitoring and reviewing services to ensure adherence to specified standards of care. Agents within State governments and various organizations influence record keeping procedures through ethical guidelines and law. For instance, client records must be maintained for all clients receiving mental health services, including informed consent, releases of information, treatment plans, and progress notes. Accurate and timely record keeping procedures assure quality mental health services. However, professionals sometimes err in the maintenance of client records, which can have a negative impact on services, clients, and practitioners. To assist …

Strategic Focus On 3r Principles Reveals Major Reductions In The Use Of Animals In Pharmaceutical Toxicity Testing, Elin Törnqvist, Anita Annas, Britta Granath, Elisabeth Jalkesten, Ian Cotgreave, Mattias Öberg

Application of Alternative Methods Collection

The principles of the 3Rs, Replacement, Reduction and Refinement, are being increasingly incorporated into legislations, guidelines and practice of animal experiments in order to safeguard animal welfare. In the present study we have studied the systematic application of 3R principles to toxicological research in the pharmaceutical industry, with particular focus on achieving reductions in animal numbers used in regulatory and investigatory in vivo studies. The work also details major factors influencing these reductions including the conception of ideas, cross-departmental working and acceptance into the work process. Data from 36 reduction projects were collected retrospectively from work between 2006 and 2010. …

Evaluation Of Academic Scientists’ Responses To Situations That Pose A Conflict Of Interest, Joanna K. Sax

Joanna K Sax

The industry-academy relationship has many benefits, but it also has potential drawbacks, including potential conflicts of interest (e.g., when the profit motives of a private company unduly influence academic responsibilities). To date, policies intended to regulate or manage financial conflicts of interest appear to be unsatisfying and inadequate. The present study examined predictors of the responses of academic scientists and clinicians to hypothetical situations in which financial and other conflicts of interest may arise. Academic scientists and clinicians at five medical schools completed an anonymous survey that included vignettes that posed a potential conflict of interest. Participants indicated the likelihood …

Financial Conflicts Of Interest In Science, Joanna K. Sax

Joanna K Sax

This article proposes that an analysis of behavior may be utilized to create an effective policy addressing financial conflicts of interest. Importantly, this article focuses on the academics that conduct basic science. An understanding of the background of the public-private interaction is critical to fully appreciate the rise of the financial conflicts of interest in biomedical science. Part II of this Article describes the rise of financial conflicts of interest and the types of harms that can occur in the absence of effective policy to regulate financial conflicts of interest. Part III describes the current system addressing conflicts of interest, …

Access To Prescription Drugs: A Normative Economic Approach To Pharmacist Conscience Clause Legislation, Joanna K. Sax

Joanna K Sax

The goals of this Article are two-fold: (1) to explain that pharmacist conscience clause legislation may be expanded to areas concerning controversial biomedical research; and (2) to demonstrate that welfare economics can be applied to analyze pharmacist conscience clause legislation. Regarding the first goal, the broad language of existing and proposed conscience clause legislation creates an umbrella that allows a pharmacist to escape liability for refusing to fill a prescription for almost any type of medication. With respect to the second goal, this Article applies welfare economics to demonstrate that pharmacist conscience clauses are a part of tort law and …

When Harvard Said No To Eugenics: The J. Ewing Mears Bequest, 1927, Paul A. Lombardo

Faculty Publications By Year

James Ewing Mears (1838-1919) was a founding member of the Philadelphia Academy of Surgery. His 1910 book, The Problem of Race Betterment, laid the groundwork for later authors to explore the uses of surgical sterilization as a eugenic measure. Mears left $60,000 in his will to Harvard University to support the teaching of eugenics. Although numerous eugenic activists were on the Harvard faculty, and who of its Presidents were also associated with the eugenics movement, Harvard refused the Mears gift. The bequest was eventually awarded to Jefferson Medical College in Philadelphia. This article explains why Harvard turned its back …

Review Of "Truly Human Enhancement: A Philosophical Defense Of Limits ", James Mcbain

Faculty Submissions

Review of "Truly Human Enhancement: A Philosophical Defense of Limits" by Nicholas Agar.

Marx V. Flanigan: A Discussion On Abortion, James Fallin

CedarEthics: A Journal of Critical Thinking in Bioethics

Dr. Richard Flanigan looked up from the magazine he had been perusing. Several cancellations at the women’s center that afternoon left him with some free time before his next appointment. Flanigan felt disgust for the young women who had called that morning to say they had a change of heart about the procedure. Oh well! So what if a few easily swayed teens fell for the pro-life rhetoric? With the free time, he sat down at the receptionist’s desk, preparing to while away the hour with some light reading. An older man, with a bushy beard and dressed in old …