Bioethics and Medical Ethics Commons^™

Including A Chaplain And Culturally Sensitive Notary In End-Of-Life And Earlier Difficult Healthcare Issues, John Stonestreet

Journal of Health Ethics

Would patients and families benefit from a Doctor Body Cam? Linked from www.DoctorBodyCam.com, this article explores innovations providing accountability for ethical communication surrounding major healthcare decisions. One of the greatest challenges physicians face is living up to their own ideals, let alone others’ expectations, for high-stakes doctor-patient/family communication, especially at the end of life. From emotional strains to time limitations, a multiplicity of factors obfuscates the pursuit of excellence in this vital endeavor. Evidence suggests that, like nearly every other sector of healthcare and society, African American patients and families are most likely to get the short end of the …

A Call For Liberty And Justice For All: Unraveling The Complexities In 2021, Dr. Sheila P. Davis

Journal of Health Ethics

This Preface summarizes the articles in this issue. Seven articles are presented with center on liberty and justice for all populations discussed.

"I Felt What Was Happening In Our Country [Usa] With Race Was So Much Scarier Than The [Covid-19] Virus.” Black Lives Matter Protesters’ Beliefs And Practices During The Covid-19 Pandemic, Evelyn Arana-Chicas, Brooke D. Jones, Francisco Cartujano-Barrera, Ana Paula Cupertino

Journal of Health Ethics

This study describes the COVID-19 prevention practices and beliefs of Black Lives Matter protesters in the U.S. Participants completed a survey on following COVID-19 guidelines and answered interview questions. Twenty participants were enrolled. Mean age was 29 and most were female (80%) and black (75%). Participants almost always wore their masks (75%) and washed their hands (85%) while protesting. Most reported rarely social distancing (55%) and not being concerned about COVID-19 (55%). Themes included: 1) Fighting for social justice, 2) Protesting is more important than COVID-19, 3) Unable to social distance, 4) Masks mostly worn, 5) Protests sparked global movement, …

Health Inequality As A Socially Created Complex System, Michele Battle-Fisher

Journal of Health Ethics

Brought to light by COVID-19, and the Black Lives Matter and Twitter #BlackBioethics movements, bioethics as a discipline has not intentionally accounted for distributive justice in its scholarship. Modern society exhibits gross disparities that affect marginalized populations who suffer amid social, financial, physical and emotional stressors. While marginalized groups that are underserved are not monoliths, disparity persists in disadvantaged communities regardless of social and economic strata. Disparity is the epitome of injustice. The overemphasis on proximal determinants demonstrates ill placed overemphasis on personal culpability whilst ignoring systemic factors that result in structural injustice. The sciences of complexity and systems thinking …

An Ethical Comparison Of The Covid-19 National Disease Control Performance Of China, Canada And The U.S. In The First Year Of The Pandemic, George A. Gellert, Gabriel L. Gellert

Journal of Health Ethics

Objective: First year government pandemic control performance is compared in China, Canada and the USA to understand the ethical bases of different population outcomes achieved.

Methods: Comparative analysis of ethical underpinnings and implications of pandemic performance includes degree of authoritarian power deployed to mitigate disease spread; benefits of single payer health care; impact of socioeconomic, racial/ethnic and health care inequities; anti-government sentiment/distrust; national leadership engagement; and science denial.

Results: National COVID-19 response efforts vary according to the extent to which they leveraged autocratic tactics, from China whose highly autocratic first year pandemic performance was emulated, through liberal democracies like Canada …

Sexual Minority Rights Are Not Just For The West: Health And Safety Considerations In Africa, Robert Scott Stewart Ph.D., Dionne Van Reenen Ph.D., Richard Watuwa Ph.D.

Journal of Health Ethics

In a recent article, C.O. Akpan argues that it is “unnatural for a man to sleep with a man as with a woman, and the idea of marriage in this sense is an abomination” (“The morality of same-sex marriage: How not to globalize a cultural anomie,” Online Journal of Health Ethics, 13(1), 2017, p. 9). Arguments in favor of same sex marriage, he claims, are “driven and motivated by the human right fad” (p. 9) that is inappropriate for African countries.

We argue that the specific arguments Akpan employs against the morality of homosexuality and same-sex marriage are flawed. Our …

Is There A Doctor In The House? Medical Ethics And The Doctoral Honorific, Kenneth R. Pike, M. Scott Moore

Journal of Health Ethics

The proliferation of professional doctorates has reinvigorated debate over the use of the doctoral honorific. Doctorate holders are often addressed as “doctor” in academic contexts, but idiomatic American English associates “doctor” with physicians—licensed clinicians with doctoral degrees in medicine. The possibility of patient confusion has historically justified proscription of the doctoral honorific by others, including nurses, but recently such proscriptions have been withdrawn. An examination of history, language, and ethical reasoning leads us to conclude that, in the context of patient interaction, clinicians should eschew the doctoral honorific entirely. We think it appropriate for professionals to rely on training-pathway titles …

Open Letter To All Readers, Reviewers, And Authors, Dr. Sheila P. Davis

Journal of Health Ethics

Open Letter for all Readers, Reviewers, and Authors of the Online Journal of Health Ethics

Winners And Losers In The American Political Debates Of The Nation’S Health: An Ethical And Moral Dilemma, Dr. Sheila P. Davis

Journal of Health Ethics

The third and final issue of the Online Journal of Health Ethics for 2020 presents two poignant articles that are rankled with current health ethics and moral issues as the world races to a resolve for the COVID pandemic. There appears to be no easy, quick-fix solutions to the pandemic that has claimed over 1.11 million lives worldwide in this first wave. The Gellert article addresses his view of the U.S. government’s political response and the Gunn article presents an ethical perspective of the emerging promised vaccine to halt the virus.

An Epidemiological View Of The 2020 U.S. Presidential Election: Covid-19 And The Ethics Of Science Denial, George A. Gellert Md, Mph, Mpa

Journal of Health Ethics

COVID-19 is exploiting U.S. political and cultural polarization in the first presidential election to be driven by epidemiology and public health. Medical science is on the ballot as Americans’ views on economic re-opening fracture according to party affiliation. The difference between pro aggressive versus incremental re-opening, mask wearing and social distancing is rooted in respect for, or denial of, the science of epidemiological pandemic disease control. Political leaders at multiple levels, and in particular the president, have politicized the wearing of face masks and so intentionally obscured and misinformed the public regarding the objectively and scientifically proven value of these …

Euthanasia Of The Coronavirus - Covid-19, Sheila P. Davis

Journal of Health Ethics

At the time of this editorial, COVID-19, aka the Novel Coronavirus, has wrecked havoc and left in its path of destruction, death, unemployment, the instability of nation’s economies, misery, uncertainty, despair, and a fear regarding what the new tomorrow will look like. And, perhaps more importantly, the question of who will be here tomorrow lingers. Now classified as a pandemic, this virus has resulted in over 1,381,014 cases worldwide with 78,269 deaths to date. Presently, Louisiana and Detroit are emerging as the next hot spots behind New York as the fastest rate of increase for COVID-19 cases in the world. …

The George Floyd Of Healthcare, Sheila P. Davis, Phd, Fnp-C, Faan, Lsm-Bc, Gary Davis, Md

Journal of Health Ethics

Authors explore the infamous murder of an unarmed black man, George Floyd, and juxtaposition it to systemic racial practices in healthcare as documented by the Institute of Medicine Report: Unequal Treatment. The current COVID-19 pandemic is presented as a situation which has the potential to ignite unresolved discriminatory healthcare practices. Proposed are policies which could possibly mitigate this phenomenon.

Tuskegee Syphilis Study Not America's Only Medical Scandal: Chester M. Southam, Md, Henrietta Lacks, And The Sloan-Kettering Research Scandal, Leonard F. Vernon

Journal of Health Ethics

The words “human medical experimentation” conjure up visions of Nazi medicine, which has come to exemplify the worst evils in the history of humankind. Places like Auschwitz and Dachau, where human life was cheap and test subjects plentiful were used as laboratories.

In 2010 the US government apologized to Guatemala for allowing U.S. doctors to infect Guatemalan prisoners and mental patients with syphilis 65 years earlier, while acknowledging dozens of similar experiments in the United States. These included studies that often involved making healthy people sick. such as in the Tuskegee syphilis study.

These experiments were often life threatening and …

Summer 2020 Ethical Issues, Dr. Sheila P. Davis

Journal of Health Ethics

Summer 2020 Ethical Issues in the Online Journal of Health Ethics

Patient Advocacy: A Tool For Resolving Ethical Issues For Patients That Use The Emergency Department For Chronic Care Management, Lawanda Baskin

Journal of Health Ethics

The current state of scientific knowledge on using the emergency department (ED) for chronic care management indicates that using the ED for chronic care management creates health disparities and burdens healthcare systems. Ethical concerns also arise because patients use the ED for chronic care management. This article discusses health literacy, self-care behaviors, and social support and the presence of patient suffering, nonmaleficence, and beneficence in patients who seek care for chronic care management in the ED. Patient advocacy as a tool to lessen these ethical issues is further discussed. Eighty-six participants were used in a cross-sectional correlational predictive study. Findings …

Ethical Guidelines For The Treatment Of Patients With Suspected Or Confirmed Novel Coronavirus Disease (Covid-19), Peter A. Depergola Ii

Journal of Health Ethics

This white paper provides basic ethical guidelines for treating patients with suspected or confirmed coronavirus disease (COVID-19). It responds to the need from healthcare organizations to address the moral considerations inherent to caring for this patient population, particularly in the context of scarce resource allocation, the imposition of limits to individual freedoms, and de facto social distancing. These guidelines are not narrowly prescriptive, but recognize the need of decision makers to transform this guidance into specific decisions. Ethical decision making assumes that such judgments will be based on current scientific knowledge, that effectiveness of interventions is carefully assessed, and that …

Presumed Consent And Priority Allocation Systems For Organ Donation Legislation In The United States: Making The Moral Case, Anna K. Shapiro, Peter A. Depergola Ii

Journal of Health Ethics

In recent decades, developed nations, such as the United States, have seen the gap between the demand and the supply of transplantable organs widen, despite national campaigns intended to promote donor registration. This organ shortage crisis has deprived thousands of a basic quality of life and has caused a substantial increase in the cost of alternative medical care such as dialysis. In an attempt to address the shortage, some countries have instituted explicit “opt-out” and “priority allocation” policies that operate under the principle of presumed consent and offer higher priority on transplantation lists to registered donors. This paper seeks to …

Allocation Of Resources And Health Professionals’ Burden During The Covid-19 Pandemic: Reflections On Advanced Directives, Informed Consent And Social Perception In Mexico, Karen Herrera-Ferrá, Leonardo Souza-García, Antonio Muñoz-Torres

Journal of Health Ethics

One of the main problems in the COVID-19 pandemic is the insufficient availability of resources. This deficiency has resulted in emotional and moral burdens of health professionals. Decisions are having to be made as to who will live and who will die. Moreover, given the global impact of this pandemic, negative impacts are heightened in low and middle-income countries such as Mexico.

Authors focus on two issues related to, but not exclusive, to the Mexican healthcare system in an attempt to partially address scarce resources and health professionals’ burden. First, is the empowerment of patients’ autonomy through the incorporation of …

The Cura Personalis Of Healthcare Delivery: Ethical Reflections On Internal Medicine, Peter A. Depergola Ii

Journal of Health Ethics

In this essay, the author explores the meaning of care for the whole person, and underscores the mission of compassion as being willing to meet patients at their suffering point.

Managing Endings In The Beginning: Ethical Reflections On Neonatal Intensive Care, Peter A. Depergola Ii

Journal of Health Ethics

In this essay, the author examines the difficult task of determining quality of life for seriously-ill newborns, and highlights the narrative vitalism so often characteristic of those forced to make end-of-life decisions on behalf of those whose lives have just begun.

Dignity And The Life Worth Living: Ethical Reflections On Pediatric Intensive Care, Peter A. Depergola Ii

Journal of Health Ethics

In this essay, the author navigates the terrain of proxy decision making, and uncovers the hidden tendency of some clinicians to reduce quality of life to physical capability.

The Moral Obligation Of Bearing One Another’S Burdens: Ethical Reflections On Surgical Intensive Care, Peter A. Depergola Ii

Journal of Health Ethics

In this essay, the author analyzes the nature of curing and healing, and offers practical steps for managing families who request medically contraindicated interventions.

Healing Without Curing: Ethical Reflections On Palliative Care Medicine, Peter A. Depergola Ii

Journal of Health Ethics

In this essay, the author evaluates the nature of hope in the chronically ill, and emphasizes the many lessons dying individuals can teach us about living.

The Truths That Make Us Free: Ethical Reflections On Reproductive Endocrinology, Peter A. Depergola Ii

Journal of Health Ethics

In this essay, the author surveys the concept of therapeutic privilege, and addresses the temptation to respond to biographical questions with biological answers in the context of personal meaning-making.

The Morality Of Medical Miracles: Ethical Reflections On Pediatric Oncology, Peter A. Depergola Ii

Journal of Health Ethics

In this essay, the author investigates the practical ethics of miraculous healings, and proposes a four-step approach for working with parents who, for religious reasons, refuse life-saving treatment for children.

Informed About Informed Consent: A Qualitative Study Of Ethics Education, Rocksheng Zhong, John K. Northrop, Puneet K.C. Sahota, Henry B. Glick, Anthony L. Rostain

Journal of Health Ethics

Informed consent is a foundational concept in modern medicine. Despite physicians’ ethical and legal obligations to obtain informed consent, no standard curriculum exists to teach residents relevant knowledge and skills. This paper presents a qualitative study of residents at one academic medical center. The authors conducted focus groups with trainees in the Departments of Internal Medicine, Emergency Medicine, and Ob/Gyn and analyzed their responses using rigorous qualitative methods. Four themes emerged: First, participants agreed that informed consent and decision-making capacity were relevant in many clinical situations. Second, participants varied widely in their understandings of consent. Third, current resident training was …

Hippocratic Values In An Era Of Nuclear Asymmetry: Should U.S. Public Health Prepare For Nuclear War With North Korea?, George A. Gellert

Journal of Health Ethics

Objectives: Advancements in North Korean nuclear weapons have heightened tensions and increased risk for nuclear war. U.S. public health agencies are investing resources in nuclear attack preparation. Analyses assess the impact and value of existing protective public health strategies for limited nuclear exchange.

Methods: Projections of fatality/injury from a North Korean nuclear strike within North Asia and explosive impact mapping are used to assess the potential impact of an attack on major U.S. urban centers.

Results: A nuclear strike on the 20 largest U.S. urban centers would place 38.1% of Americans at risk. With 1-3 missiles of 250 kiloton yield …

Introduction: Notes From The Bedside, Sheila P. Davis

Journal of Health Ethics

No abstract provided.

Living With Productive Discomfort: Ethical Reflections On Critical Care Medicine, Peter A. Depergola Ii

Journal of Health Ethics

In this essay, the author considers the theme of deaths and resurrections in light of uncertain outcomes, and captures the pressure on ethicists to always know “the right thing to do.”

The Bionic Brain: Pragmatic Neuroethics And The Moral Plausibility Of Cognitive Enhancement, Peter A. Depergola Ii

Journal of Health Ethics

The seemingly infinite possibilities of contemporary neuroscience span from the augmentation of memory, executive function, appetite, libido, sleep, and mood, to the maturation and development of emotional health and personality. These prospects hint at the capacity to alter neurocognitive conceptions of reality. They also mark the unavoidable inculcation of nuanced individual responses, perhaps radical, to these “tailor- made” perceptions. Hence, there exists certain neuroethical, and even more generally, existential risks within this fascinating and expeditious enterprise. The primary question in the context of present-day neurotechnology is not what can be done, but what should be. To that end, this paper …