Bioethics and Medical Ethics Commons^™

Errors In Converting Principles To Protocols: Where The Bioethics Of Us Covid‐19 Vaccine Allocation Went Wrong, William F. Parker, Govind C. Persad, Monica E. Peek

Sturm College of Law: Faculty Scholarship

For much of 2021, allocating the scarce supply of Covid-19 vaccines was the world's most pressing bioethical challenge, and similar challenges may recur for novel therapies and future vaccines. In the United States, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) identified three fundamental ethical principles to guide the process: maximize benefits, promote justice, and mitigate health inequities. We argue that critical components of the recommended protocol were internally inconsistent with these principles. Specifically, the ACIP violated its principles by recommending overly broad health care worker priority in phase 1a, using being at least seventy-five …

Righting Health Policy: Bioethics, Political Philosophy, And The Normative Justification Of Health Law And Policy, D. Robert Macdougall

Publications and Research

In Righting Health Policy, D. Robert MacDougall argues that bioethics needs but does not have adequate tools for justifying law and policy. Bioethics’ tools are mostly theories about what we owe each other. But justifying laws and policies requires more; at a minimum, it requires tools for explaining the legitimacy of actions intended to control or influence others. It consequently requires political, rather than moral, philosophy. After showing how bioethicists have consistently failed to use tools suitable for achieving their political aims, MacDougall develops an interpretation of Kant’s political philosophy. On this account the legitimacy of health laws does …

How To Compromise On Saving The Most Lives: A Commentary On Hellman And Nicholson, “Rationing And Disability”, David Wasserman

Washington and Lee Law Review Online

Deborah Hellman and Kate Nicholson’s “Rationing Disability” is a skillfully integrated analysis of the legal and ethical challenges of avoiding disability discrimination in setting priorities for the allocation of scarce lifesaving resources. Their analysis goes beyond the important but narrow question of what it means to wrongfully discriminate against people with disabilities in this context to the broader question of how to find a principled compromise between the consequentialist goals of public health and the potentially conflicting public value of “equal concern and respect” for each person. I will focus on this broader issue.

I agree with much …

Student Pharmacists’ Emotional Responses And Coping During The Covid-19 Pandemic, Hannah E. Johnson, Deaundre Bumpass, Aric Schadler, Jeffrey Cain

Journal of Wellness

Introduction: Health professions students, including student pharmacists, have been impacted by the coronavirus disease 19 (COVID-19 pandemic) as schools have transitioned to remote learning and cancelled milestone events. During times of crises, media consumption and hobby participation also impact well-being. The adverse emotional responses and coping strategies of student pharmacists amidst the COVID-19 pandemic have not been evaluated, nor have factors that may contribute to emotional responses. The purpose of this study is to determine Doctor of Pharmacy students’ emotional responses and coping precipitated by the COVID-19 pandemic, and the influence of media use, working status, and participation in hobbies. …

The Ratio Method: Addressing Complex Tort Liability In The Fourth Industrial Revolution, Harrison C. Margolin, Grant H. Frazier

St. Mary's Law Journal

Emerging technologies of the Fourth Industrial Revolution show fundamental promise for improving productivity and quality of life, though their misuse may also cause significant social disruption. For example, while artificial intelligence will be used to accelerate society’s processes, it may also displace millions of workers and arm cybercriminals with increasingly powerful hacking capabilities. Similarly, human gene editing shows promise for curing numerous diseases, but also raises significant concerns about adverse health consequences related to the corruption of human and pathogenic genomes.

In most instances, only specialists understand the growing intricacies of these novel technologies. As the complexity and speed of …

Advance Care Planning Within Individualized Care Plans: A Component Of Emergency Preparedness, Heather L. Church, Christina Marsack-Topolewski, Jacqueline M. Mcginley, Victoria Knoke

Developmental Disabilities Network Journal

Federally-legislated Medicaid requirements for recipients with intellectual and/or developmental disabilities (IDD) to have a person-centered plan (PCP) do not specifically require that advanced care plans (ACP) be a component of the plan. However, coronavirus disease 2019 (COVID-19) has provided a salient reminder of the importance of incorporating ACP within the PCP for people who have IDD. As demonstrated by situations arising from COVID-19, emergencies and crises can dramatically alter access to care for people with IDD. This paper synthesizes results from an environmental scan related to ACP for adults with IDD. Findings suggest that the use of ACP, particularly when …

Mid-Atlantic Ethics Committee Newsletter, Fall 2021

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Lessons Learned From The Hiv/Aids Pandemic And Access To Medicines For Covid-19 Treatment, Thalia Le

Independent Study Project (ISP) Collection

There is an imminent need to address the healthcare disparities in accessing all COVID-19 medicinal products in developing countries. While logistical issues like inadequate production facilities such as the lack of vaccines administration capacity, storage issues, gap between supply and demand as well as vaccine hesitancy can certainly play a part in impeding COVID19 medicines distribution, patent monopolies and intellectual property protection laws further exacerbated the problem, especially when vaccines were at its early stages of authorization. Historical and contemporary case studies of efforts to challenge patents on HIV AVRs treatment provide a useful lens through which we may glean …

How Analogizing Socio-Legal Responses To Organ Transplantation Can Further The Legalization Of Reproductive Genetic Innovation, Myrisha S. Lewis

Faculty Publications

The Nobel Foundation emphasized the significance of genetic innovation to society, science, and medicine by awarding the 2020 Nobel Prize in Chemistry to “the CRISPR/Cas9 genetic scissors.” This Article focuses on “reproductive genetic innovation,” a term that includes cytoplasmic transfer, mitochondrial transfer, and germline or heritable gene editing techniques that are all categorized as “experimental” in the United States. These techniques all use in vitro fertilization, a legal and widely available practice. Yet reproductive genetic innovation has resulted in controversy and numerous barriers including a recurring federal budget rider, threats of federal enforcement action, and the unavailability of federal funding. …

Emergency Medicine Shift Factors Causing The Most Stress Among Emergency Medicine Residents, Mohamad Moussa, Kristen Hayden, Chia-Hao Shih, Sadik Khuder, Zayd Safadi, Connor Parsell

Journal of Wellness

Introduction: Past studies demonstrate that stress and anxiety affect emergency medicine physicians, but the causal factors identified are usually from sources outside the work shift. We attempt to show the relationship between intrinsic factors of a work shift and anxiety perceived by residents, while also examining differing gender responses.

Methods: In 2018, a cross-sectional survey of emergency medicine residents in the United States was distributed anonymously through the Emergency Medicine Residents Association. The survey consisted of demographic questions, novel questions identifying intrinsic factors, and the Generalized Anxiety Disorder 7-item (GAD-7) scale. Spearman correlation, independent t-test, and multivariate analysis of variance …

Demographics, Activities, And Environmental Factors Impact Burnout In A National Survey Of Emergency Medicine Residents, Nicole Battaglioli, Tim P. Moran, Simiao Li-Sauerwine

Journal of Wellness

Introduction: Burnout in emergency medicine and in residency training has been well-described. The impact of demographic, individual, and programmatic factors on burnout have not previously been determined in a national survey of emergency medicine residents. This study aimed to identify personal and environmental factors impacting resident burnout in a national sample of emergency medicine residents.

Methods: A prospective Emergency Medicine Resident Wellness Survey was administered in 2017. We surveyed respondents on demographic, personal, and environmental factors; each respondent also completed the Maslach Burnout Inventory - Human Services Survey. Linear regressions were used to identify variables associated with the Maslach Burnout …

Session 2: Access To Health And Health Services Panel - The Covid-19 Experience, Annette Clark, Wendy Chalres, Dan Laster, Anna Santos Rutschman, Madhavi Sunder, Margret Chon

SITIE Symposiums

COVID-19 has had a massive impact on the U.S. and the world regarding health care and health care access. Improving access has been the topic of scholarship for many years. It took the COVID- 19 pandemic to bring these issues to the forefront of public discussion. Inequities in public health access, not only domestically but globally, have become apparent in the light of COVID-19. This expert panel addresses the inequities of vaccines worldwide and the concept of vaccine sharing programs. It also explores the role that intellectual property plays in these equity issues and some of the risks inherent in …

Nebraska Public Guardianship Of Unbefriended Patients: A Preliminary Review Of Health Outcomes And Cost Savings, Emily N. Berzonsky

Capstone Experience: Master of Public Health

Unbefriended patients often experience an extended length of stay in the hospital while their medical providers await legal appointment of a public guardian to make their medical decisions. The medically unnecessary days the unbefriended patient spends in the hospital equates to high costs for the hospital, but more importantly, negative health outcomes for the patient. The purpose of this study is to provide literature and data to support recommendations for possible changes in Nebraska’s public guardianship appointment process. A literature review seeks to answer: (1) What is the median hospital length of stay for an unbefriended patient without a guardian …

Corruption In Capsules: How It Is Legal For Companies To Put Harmful Ingredients In Vitamins And Dietary Supplements, Emily Leggiero

English Department: Research for Change - Wicked Problems in Our World

The vitamin and supplement industry has increased exponentially in profits as well as potential products on the market since the turn of the century. However, these products are not regulated, nor do they undergo any premarket clinical research or testing. Public health is compromised by vitamins and supplements that are available for American consumption that is disproportionately unregulated to their chemically similar counterparts. This wicked problem is facilitated through the combination of historical legislative definitions that has since been distorted for corrupt administrative gain through the allotment of corporate expenditures. Company disbursements are made to the same policymakers that create …

Mid-Atlantic Ethics Committee Newsletter, Spring 2021

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

A Literary Analysis Of The Origin Of Human Embryonic Stem Cells, Its Advancements, Philosophical, Ethical, Sociocultural, And Political Aspects; An Investigation Of The Underlying Attributes That Affect One’S Views On Hesc Research To Resolve Turkey And Brazil’S Hesc Policy, Religious, And Cultural Conflicts, Haleema Shamsuddin

Honors Scholars Collaborative Projects

Human embryonic stem cells (hESCs) are cells derived from 5-day human embryos and are self-renewing cell lines that change into any type of cell in the body, a trait called pluripotency. hESCs have almost unlimited clinical and medical research potential. Despite the great therapeutic promise of hESC research, it comes with a controversial ethical debate due to its involvement with the destruction of the human embryo. The central argument revolves around the question of whether or not these human embryos should be ascribed equal moral status to fully developed humans. This thesis aims to analyze the origin and advancements of …

Public Health And History: Vaccination Regulation In The Northeastern States, Kate Campbell

Student Research

In 1905 Henning Jacobson went before the United States Supreme Court in Jacobson v. Massachusetts and argued that his constitutional right to liberty was infringed upon when compulsory vaccination laws were introduced. When mandatory vaccination laws were introduced in Cambridge, Massachusetts there was another deadly smallpox epidemic racing through the northeastern states. Government officials believed that the best way to control the disease and ultimately stop the spread was through government intervention. The Supreme Court ultimately ruled that as a citizen of the United States it is often times necessary to give up some forms of liberty in order to …

Suspicion Encoded: Women Of Color And Biometric Technology In The United States, Lilith A. Saylor

sprinkle: an undergraduate journal of feminist and queer studies

This paper explores the commodification of privacy through biometric technology in the United States. It examines the impact of this technology on poor women of color (WOC), arguing that poor WOC face intersectional discrimination based on the convergence of sex, race, and class in their identities. I highlight the unique and powerful intrusion of biometric technology into the lives of poor WOC, and argue that the connection between data and the physical body created through biometric data has formed an environment in which the state wields unrestricted control in all spheres over the privacy of poor WOC.

"As Long As I'M Me": From Personhood To Personal Identity In Dementia And Decision-Making, James Toomey

Elisabeth Haub School of Law Faculty Publications

As people, especially older people, begin to develop dementia, we confront ethical questions about when and how to intervene in their increasingly compromised decision-making. The prevailing approach in philosophically-inclined bioethics to tackling this challenge has been to develop theories of “decision-making capacity” based on the same characteristics that entitle the decisions of moral persons to respect in general. This Article argues that this way of thinking about the problem has missed the point. Because the disposition of property is an identity-dependent right, what matters in dementia and decision-making is an individual’s personal identity with their prior self, not their moral …

How To End Our Stories: A Study Of The Perspectives Of Seniors On Dementia And Decision-Making, James Toomey

Elisabeth Haub School of Law Faculty Publications

Because dementia can cause individuals to make decisions that they otherwise would not, the law needs a mechanism to determine which decisions are entitled to the respect of the legal system and which may be overridden by others. In the philosophical literature, three primary theories for how to make this determination have been offered. First, "Cognitivism" posits that whether a decision should be recognized is a function of the mechanical functioning of the individual's brain at the time the decision is made. Second, "Essentialism" holds that decisions should be recognized so long as they are consistent with the cluster of …

Getting Real: The Maryland Healthcare Ethics Committee Network’S Covid‑19 Working Group Debriefs Lessons Learned, Norton Elson, Howard Gwon, Diane Hoffmann, Adam M. Kelmenson, Ahmed Khan, Joanne F. Kraus, Casmir C. Onyegwara, Gail Povar, Fatima Sheikh, Anita J. Tarzian

Faculty Scholarship

No abstract provided.

Neither “Post-War” Nor Post-Pregnancy Paranoia: How America’S War On Drugs Continues To Perpetuate Disparate Incarceration Outcomes For Pregnant, Substance-Involved Offenders, Becca S. Zimmerman

Pitzer Senior Theses

This thesis investigates the unique interactions between pregnancy, substance involvement, and race as they relate to the War on Drugs and the hyper-incarceration of women. Using ordinary least square regression analyses and data from the Bureau of Justice Statistics’ 2016 Survey of Prison Inmates, I examine if (and how) pregnancy status, drug use, race, and their interactions influence two length of incarceration outcomes: sentence length and amount of time spent in jail between arrest and imprisonment. The results collectively indicate that pregnancy decreases length of incarceration outcomes for those offenders who are not substance-involved but not evenhandedly -- benefitting white …

Animal Sentience: History, Science, And Politics, Andrew N. Rowan, Joyce M. D'Silva, Ian J.H. Duncan, Nicholas Palmer

Animal Sentience

This target article has three parts. The first briefly reviews the thinking about nonhuman animals’ sentience in the Western canon: what we might know about their capacity for feeling, leading up to Bentham’s famous question “can they suffer?” The second part sketches the modern development of animal welfare science and the role that animal-sentience considerations have played therein. The third part describes the launching, by Compassion in World Farming, of efforts to incorporate animal sentience language into public policy and regulations concerning human treatment of animals.

Heeding The Call Of Covid-19, David Wiebers, Valery Feigin

Animal Sentience

We are grateful to all of our commentators. They have provided a wide range of valuable perspectives and insights from many fields, revealing a broad interest in the subject matter. Nearly all the commentaries have helped to affirm, refine, expand, amplify, deepen, interpret, elaborate, or apply the messages in the target article. Some have offered critiques and suggestions that help us address certain issues in greater detail, including several points concerning industrialized farming and the wildlife trade. Overall, there is great awareness and strong consensus among commentators that any solution for preventing future pandemics and other related health crises must …

Is Germline Gene Editing Exceptional?, Myrisha S. Lewis

Faculty Publications

Advances in gene editing have recently received significant scientific and media attention. Gene editing, especially CRISPR-Cas9, has revived multiple longstanding ethical debates, including debates related to parental autonomy, health disparities, disability perspectives, and racial and economic inequalities. Germline, or heritable, gene editing generates several newer, neglected bioethical debates, including those about the shared human germline and whether there is a "line" that humans should not cross.

This Article addresses several interrelated ethical and legal questions related to germline gene editing. Those questions address why, if at all, germline gene editing needs to be regulated and, if germline gene editing needs …

Adolescent Medical Decisionmaking Rights: Reconciling Medicine And Law, Doriane Lambelet Coleman, Philip M. Rosoff

Faculty Scholarship

Dennis Lindberg came into his aunt’s care when he was in the 4th grade because his parents struggled with drug addiction and could not provide for him. At thirteen, he was baptized in his aunt’s faith as a Jehovah’s Witness. Just days after he turned fourteen, on November 6, he was diagnosed with acute lymphoblastic leukemia.

The prognosis was that Dennis had a 75% chance of cure with standard oncology treatment. Consistent with the requirements of his new faith, however, Dennis told his doctors, “I do not want to be treated if the requirement is that I would have to …

An Australian Conundrum: Genomic Technology, Data, And The Covidsafe App, David Morrison, Patrick T. Quirk

Pace International Law Review

This paper examines the difficulties that have arisen in Australia in the use of its contact-tracing app. We examine the privacy implications around the use of the app, the wider economic imperative, and the balancing of those concerns against the health threat of the COVID-19 pandemic. We posit that default options are superior in times of emergency and rather than begging for the adoption of lifesaving technology, we suggest that the evidence gathered by behavioral economists provides an apposite and powerful alternative worthy of consideration.

The Crossroads Of Wellness And Second Victim Syndrome: Identifying Factors That Alter The Pathway Of Caregiver Recovery Following An Unanticipated Adverse Patient Outcome, Kimia Zarabian, A. Katharine Hindle, Ivy Benjenk, Anita Vincent, Jamil M. Kazma, Benjamin Shambon, Raymond Pla, Eric Heinz

Journal of Wellness

Introduction: Second Victim Syndrome (SVS) describes the phenomenon in which a caregiver experiences a traumatic psychological and emotional response to an adverse patient event or medical error. Using quantitative survey analysis, we aim to better understand the personal factors that affect SVS development and recovery.

Methods: Caregivers at a small urban academic medical center who had experienced an adverse patient event in the past six months were invited to take part in this institution-wide, voluntary, quantitative, cross-sectional study. Three surveys were administered; the Holmes-Rahe Life Stress Inventory (HRLSI) was used as a surrogate to measure stressful life events. The …

The Ethical Challenge For Hipaa’S Privacy Rule In The Genomics Era Of Data Analytics., Reem Shinawi

Electronic Theses and Dissertations

The thesis of this dissertation focuses on the Ethical Challenge for HIPAA’s Privacy Rule in the Genomics Era of Data Analytics. Data Analytics in Genomic Medicine challenges the individuals’ right to privacy. Hence, a balance is needed between the previous centrality of individual privacy and the need for population information to make breakthroughs in Genomic Medicine using Data Analytics. Such a problem demands regulatory solutions. And such solutions require the collaboration of professionals. Genomic Medicine is a field that deals with sensitive genetic information in both medicine, and research, it is essential to view it through HIPAA as it is …

Bioethics: Ethical Considerations Of Ventilator Triage During A Pandemic, Susannah J. Gleason, William J. Keegan

Georgia State University Law Review

In the midst of the COVID-19 pandemic, hospitals across the country faced unprecedented volumes of patients seeking treatment related to the respiratory complications of the virus. As a result, states were forced to reassess existing scarce resource allocation guidelines to appropriately accommodate the high demand. This Peach Sheet analyzes the ethical considerations implicated in enacting and following these guidelines when treating patients, specifically in the context of ventilator triage in response to the COVID-19 pandemic.