Bioethics and Medical Ethics Commons^™

Revising The Common Rule: Prospects And Challenges, Leslie Henry

Leslie Meltzer Henry

The annual Bioethics and Law Roundtable, jointly sponsored by the Law & Health Care Program at the University of Maryland Francis King Carey School of Law and the Johns Hopkins Berman Institute of Bioethics, convened in April 2012 to address "Human Subjects Research Regulations: Proposals for Reform." This paper serves as the introduction to the seven papers presented at the symposium that discuss the prospects and challenges of revising the Common Rule.

Harms And Responsibilities Associated With Battery-Operated Implants (Boi): Who Controls Postmortem Explantation?, Katrina Bramstedt

Katrina A. Bramstedt

The postmortem issues raised by battery-operated implants (BOI) are complex and issues of consent, setting (clinical vs research), and environmental risks have received little attention in bioethics literature. Analyzing the issues, the following are argued: (1) Patients receiving BOIs should sign a consent form that includes a requirement for postmortem explant of the device; (2) BOI consent forms should require the explanted devices be returned to their manufacturers for Returned Product Analysis; (3) Failure to explant and analyze devices from the research setting fails the research goal of generation of knowledge for the benefit of future patients; (4) Failure to …

Informed Consent For Facial Transplantation, Katrina Bramstedt

Katrina A. Bramstedt

Here, we outline the ethical presentation of patients’ informed consent.

The Silence Of Good Samaritan Kidney Donation In Australia: A Survey Of Hospital Websites, Katrina Bramstedt, Sameer Dave

Katrina A. Bramstedt

It is common for living donor candidates to use the Internet as a tool to enhance their decision-making process. Specifically, the websites of transplant hospitals can potentially be a vital source of information for those contemplating living donation. In an effort to explore the low incidence of Good Samaritan kidney donation (donations to strangers) in Australia, two raters conducted a nine-attribute website content analysis for all hospitals which participate in these transplants (n = 15). Overall, the concept of living donation is relatively silent on Australian hospital websites. Only four hospitals mention their living donor program, and only one mentions …

Family Refusals Of Registered Consents: The Disruption Of Organ Donation By Double-Standard Surrogate Decision-Making, Katrina Bramstedt

Katrina A. Bramstedt

Some countries such as Australia, Spain, Norway, Italy and Canada allow next of kin to override the consent of registered organ donor candidates if they personally do not concur with the donation desire of their relative. This form of surrogate decision-making represents a double standard in terms of the principle of substituted judgment (the surrogate's duty). Further, double-standard surrogate decision-making in the setting of organ donation is a slippery slope to unethical surrogate decision-making while patients are alive. Concerns about family distress and donor candidate revocation of consent can still be managed without permitting double-standard surrogate decision-making.

Review Of Ourselves Unborn: A History Of The Fetus In Modern America, By Sara Dubow, Rose Holz

Women's and Gender Studies Program: Faculty Publications

With the publication of the Bancroft Prize-winning Ourselves Unborn, Sara Dubow offers a long overdue analysis and historicization of what has become a central feature in battles over reproductive rights: the fetus. Drawing upon legal and legislative records as well as educational tracts, museum exhibits, medical textbooks and journals, personal memoirs, and the popular press, Dubow traces what she calls “fetal stories” (4) in America from the late nineteenth century through the early twenty-first. In so doing, she persuasively reminds her readers the following: First, that our understanding of the fetus is not simply a product of biology or theology. …

Can Acute Dermal Systemic Toxicity Tests Be Replaced With Oral Tests? A Comparison Of Route-Specific Systemic Toxicity And Hazard Classifications Under The Globally Harmonized System Of Classification And Labelling Of Chemicals (Ghs), Nigel P. Moore, David J. Andrew, Donald L. Bjerke, Stuart Creton, David Dreher, Thomas Holmes, Pilar Prieto, Troy Seidle, Tim G. Rowan

Experimentation Collection

Acute systemic toxicity data (LD50 values) and hazard classifications derived in the rat following oral administration and dermal application have been analysed to examine whether or not orally-derived hazard classification or LD50 values can be used to determine dermal hazard classification. Comparing the oral and dermal classifications for 335 substances derived from oral and dermal LD50 values respectively revealed 17% concordance, and indicated that 7% of substances would be classified less severely while 76% would be classified more severely if oral classifications were applied directly to the dermal route. In contrast, applying the oral LD50 values within the dermal classification …

Update - June 2013, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- Will You Be a Provider or a Professional?
-- The Jack Provansha Bioethics Lecture Opens LLU School of Medicine Alumni Convention
-- From the Director - One Generation to the Next
-- Animal Rights: A Call to Commitment
-- Vegetarianism: The Interface of Science & Values
-- Bioethics at the Alumni Postgraduate Convention
-- Obamacare and the Future of Loma Linda
-- Center's Bioethics Grand Rounds: Poetry at the Bedside

Hannah Arendt And Pregnancy In The Public Sphere, Katy Fulfer

Future Directions in Feminist Phenomenology

No abstract provided.

Feminist Bio-Phenomenology, Christina Schües

Future Directions in Feminist Phenomenology

No abstract provided.

To The Bitter End: Disparities In End-Of-Life Care, Alberto Coustasse, Theresa Quiroz, Sue G. Lurie

Alberto Coustasse, DrPH, MD, MBA, MPH

Although technological advancements have provided the means to sustain life and provide care regardless of whether the treatment is appropriate and compassionate given the condition of the patient, bioethical, legal, and moral concerns related to disparities in care still arise in the United States. These concerns call into question the necessity to continue life-sustaining or palliative care treatments when patients and/or families are faced with end-of-life decisions. This study will focus on various historical, clinical cultural, and ethical issues that have placed this dilemma into a controversial public spectrum, by using case studies retrieved from referenced literature, which illustrate disparities …

Fertility Preservation Technologies For Women: A Feminist Ethical Analysis, Angel Petropanagos

Electronic Thesis and Dissertation Repository

In this dissertation I examine ethical issues that concern fertility preservation (FP) technologies for women from a feminist perspective. FP technologies involve the removal, cryopreservation and subsequent storage of reproductive materials for future use. The aim of these technologies is to preserve the option of future genetic reproduction. FP technologies have been developed in the cancer context because infertility is one of the long-term side-effects of many cancers or cancer therapies. Many FP technologies are still experimental, but some technologies are becoming available to healthy women who wish to guard against age-related infertility. Although FP technologies are expanding women’s reproductive …

Exploring Parental Experiences And Decision-Making Processes Following A Fetal Anomaly Diagnosis, Ramona L. Fernandez

Electronic Thesis and Dissertation Repository

Often the first indication that something may be wrong in a seemingly normal pregnancy occurs during the first detailed ultrasound appointment between 16 and 20 weeks gestation. Even the most tentative suspicions of fetal anomalies is jarring. Parent’s default reality of a normal pregnancy and a ‘perfect child’ changes to one of risk factors and the possibility of an ‘unhealthy child’. This study begins with the realization of this first loss in a series of losses that follow for parents as they grapple with diagnostic information to be able to make informed medical decisions regarding their fetus and pregnancy. The …

Addressing Conscientious Objection Of Rural Canadian Nurses And Physicians, Natasha T. Morton

Electronic Thesis and Dissertation Repository

This thesis considers how conscientious objection of a nurse or physician in a rural setting should be addressed when that objection is based on a centrally held value or belief, and considers whether current strategies are morally sufficient. Current literature fails to specifically consider the complexity and challenge facing health care professionals with limited support, time, and resources who encounter conscientious objection in the rural environment. Conscience and conscientious objection are explicitly defined based on a literature survey, and reflective equilibrium is used to assess evidence from law, policy, and published sources. The author concludes that current strategies fail to …

Shots For Tots?, Eric A. Feldman

All Faculty Scholarship

By endorsing the use of a vaccine that makes the experience of puffing on a cigarette deeply distasteful, Lieber and Millum have taken the first few tentative steps into a future filled with medical interventions that manipulate individual preferences. It is tempting to embrace the careful arguments of “Preventing Sin” and celebrate the possibility that the profound individual and social costs of smoking will finally be tamed. Yet there is something unsettling about the possibility that parental discretion may be on the cusp of a radical expansion, one that involves a new and unexplored approach to behavior modification.

Diffusion Of Polst Education In Maine: Successes, Challenges, And Opportunities, Mary Lou Ciolfi

Muskie School Capstones and Dissertations

POLST, Physicians Orders for Life Sustaining Treatment originted in Oregon in the 1990's and is a vehicle for recording patient health care choices near the end of life as actionable physician orders so choices are honored with greater clarity and frequency at the point of care. This capstone is about educating and encouraging clinicians and the public to engage in conversations surrounding POLST.

The Pluripotency Proposition: A Biological And Ethical Case For The Utilization Of Hipscs In Place Of Hescs, Drew Dickson

Senior Honors Theses

Human embryonic stem cell (hESC) research has spurred ethical controversy ever since it became feasible in 1998. The reason for this is due to the fact that hESC research requires the destruction of a human embryo, thereby causing the cessation of life for that developing human. Despite this unavoidable consequence, many advocates of hESC research hold to the belief that the embryo is not actually a human person, and therefore deem the destruction of the embryo as justifiable. Many advocates of hESC research also have pointed to the unprecedented medical potential of hESCs to argue in favor of their case. …

When Evil Met Science: Nazi Medicine And Eugenics, Ashley Corey

Honors Theses

During World War II, millions of innocent people were murdered in Nazi Germany. For Hitler and his followers, having a pure race meant having a strong, unified country, and Germany took this idea to extreme and disturbing lengths. Corruption filled the government at all levels. As physicians were the only people authorized to run the gas chambers, traditional healers became death symbols. The Nazis and their physicians used their power to manipulate and murder for the collective goals of the country, as well as the personal gains that came with the high-end job titles. As I reveal the history and …

Malpractice Claims For Endoscopy, Lyndon V. Hernandez, Dominic Klyve, Scott E. Regenbogen

Mathematics Faculty Scholarship

AIM: To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure.

METHODS: We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars. Time series analysis was performed to assess changes in the total value of claims for each type of procedure over time.

RESULTS: There were 1901 endoscopy-related closed claims against …

Ethical Considerations Of Genetic Presymptomatic Testing For Huntington's Disease, Alberto Coustasse, Alicia Pekar, Andrew Sikula Sr., Sue Lurie

Alberto Coustasse, DrPH, MD, MBA, MPH

The aim of this literature review was to determine if there is adequate ethical justification for presymptomatic genetic testing on potential Huntington's disease patients. Huntington's disease is a neurological genetic disorder characterized by midlife onset which consists of cognitive, physical, and emotional deterioration. Although genetic testing has traditionally been guided by the principle of autonomy, severe psychological consequences such as depression, anxiety, survival guilt, and suicide have complicated the ethical issue of providing a presymptomatic yet definitive diagnosis for an incurable disease. An analysis of available articles yielded inconclusive findings, namely due to insufficient evidence, self-selection bias of test participants, …