Bioethics and Medical Ethics Commons^™

The Challenge Of Communicating Cardiovascular Risk Information To Our Patients., Samuel S Gidding

Department of Pediatrics Faculty Papers

Each of the major cardiovascular risk factors presents unique challenges to the clinician caring for children.  Dyslipidemia and hypertension are silent and require measurement; the challenge is first risk classification and then communicating strategies for treatment, with attendant cost, in the absence of perceptible disease morbidity.  Obesity and physical inactivity, while generally obvious to the patient, require change in lifestyle for successful management; the challenge is to convince the patient to make that change.  Diabetes mellitus is a significant disease requiring complex management strategies for the patient to execute; the challenge is to add cardiovascular risk reduction strategies to the …

Evaluation Of The Reproductive And Developmental Risks Of Caffeine., Robert L Brent, Mildred S Christian, Robert M Diener

Department of Pediatrics Faculty Papers

A risk analysis of in utero caffeine exposure is presented utilizing epidemiological studies and animal studies dealing with congenital malformation, pregnancy loss, and weight reduction. These effects are of interest to teratologists, because animal studies are useful in their evaluation. Many of the epidemiology studies did not evaluate the impact of the "pregnancy signal," which identifies healthy pregnancies and permits investigators to identify subjects with low pregnancy risks. The spontaneous abortion epidemiology studies were inconsistent and the majority did not consider the confounding introduced by not considering the pregnancy signal. The animal studies do not support the concept that caffeine …

An Evaluation Of Hospital Breastfeeding Policies In The Philadelphia Metropolitan Area 1994-2009: A Comparison With The Baby-Friendly Hospital Initiative Ten Steps., Andrea Crivelli-Kovach, Esther K Chung

Department of Pediatrics Faculty Papers

OBJECTIVE: The purpose of this study was to describe current breastfeeding policies and practices among Philadelphia, PA metropolitan hospitals and changes in their policies and practices over time.

METHODS: In-person group interviews were conducted to obtain a composite picture of actual breastfeeding policies and practices. One questionnaire per hospital was completed based on responses from group consensus. Twenty-five hospitals providing maternity care were contacted. Information was obtained from personnel representing different areas of maternity services. Hospitals were classified according to the degree to which they were implementing the Ten Steps to Successful Breastfeeding.

RESULTS: Mean breastfeeding rates at suburban hospitals …

Pregnant Women As Research Participants: Why Is Additional Protection Required?, Kyoko Wada

Research Day (Arts & Humanities, FIMS, and Education)

Today, blanket exclusion of pregnant women from research participation is not endorsed; however, a tendency still remains to exclude pregnant women from participating in research. This exclusion results in insufficient data to guide clinical practice for pregnant women, and hence adds risks to pregnant women and fetuses (Lyerly et al. 2007, 2008, 2009; Baylis 2010; Goldkind et al. 2010).

Proteomic Assessment Of A Cell Model Of Spinal Muscular Atrophy., Chia-Yen Wu, Dosh Whye, Lisa Glazewski, Leila Choe, Douglas Kerr, Kelvin H Lee, Robert W Mason, Wenlan Wang

Department of Pediatrics Faculty Papers

BACKGROUND: Deletion or mutation(s) of the survival motor neuron 1 (SMN1) gene causes spinal muscular atrophy (SMA), a neuromuscular disease characterized by spinal motor neuron death and muscle paralysis. Complete loss of the SMN protein is embryonically lethal, yet reduced levels of this protein result in selective death of motor neurons. Why motor neurons are specifically targeted by SMN deficiency remains to be determined. In this study, embryonic stem (ES) cells derived from a severe SMA mouse model were differentiated into motor neurons in vitro by addition of retinoic acid and sonic hedgehog agonist. Proteomic and western blot analyses were …

Update - March 2011, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- Quid Pro Quo, Quid Vadis - Conflict of Interest Policy of Loma Linda University School of Medicine
-- San Bernardino - A Case Study in Environmental Justice
-- Editorial

[ Claritás - Clarity in Ethics Essay Contest - Health Care: Business or Service? ]
-- First-place 2009 graduate essay winner, Mark Warren, School of Medicine, Loma Linda University
-- Second-place 2009 undergraduate essay winner, Sidney E. Irving, School of Nursing, Loma Linda University

-- 2009 Contributor's Convocation: A New View
-- 2010 Contributor's Convocation: Ethics in the Inland Empire
-- Ethics Alumni Updates

The Pulmonologist's Role In Caring For Pregnant Women With Regard To The Reproductive Risks Of Diagnostic Radiological Studies Or Radiation Therapy., Robert Brent

Department of Pediatrics Faculty Papers

Radiography of the chest, head, neck, teeth, or extremity exposes the embryo or ovary to insignificant exposures of radiation except when radionuclides are utilized. In some instances, there is no exposure at all. Pulmonologists are fortunate with regard to the specific studies they request to provide clinical care because most of the diagnostic tests do not directly expose the uterus (embryo) or ovary. This article discusses radiation risks and their evaluation and pregnancy-related issues in diagnostic radiological studies.

Organs Watch: Possibilities And Perils For Public Anthropology, Roberto Abadie

Department of Sociology: Faculty Publications

Recent technological advances in biomedicine have introduced new therapeutic possibilities but have also contributed to the emergence of a global market for human bodies and body parts. For example, artificial modes of human reproduction created a market for eggs, semen, and surrogate wombs. In addition, organ transfer generated a demand for kidneys and half livers. The whole body has become a valuable commodity as professional research subjects venture into the economy of Phase I Clinical Trials, testing drug safety for pharmaceutical companies. In the process, the trade has become a deeply unequal one in which poor, vulnerable, and easily exploited …

Does Treatment Of Premature Labor With Terbutaline Increase The Risk Of Autism Spectrum Disorders?, Patricia Rodier, Richard K Miller, Robert L Brent

Department of Pediatrics Faculty Papers

Beta-adrenergic agents have been used in pregnant women for the treatment of premature labor and for the treatment of asthma. Concerns have been expressed that exposure to terbutaline, a beta-2 adrenergic agonist, may increase the risk of autism spectrum disorders (ASDs) in the offspring. This hypothesis deserves critical review, given the number of patients exposed to the drug in the last two decades. The results are important to both the obstetricians and patients who weigh the risks and benefits of interventions and to the pediatricians who counsel the families of affected children.

Bad News About Bad News: The Disclosure Of Risks To Insurability In Research Consent Processes, Victoria Smith Apold, Jocelyn Downie

Articles, Book Chapters, & Popular Press

One of the phenomena associated with research is “incidental findings,” that is, unexpected findings made during the research, and outside the scope of the research, which have potential health importance. One underappreciated risk of incidental findings is the potential loss of the research subject's insurability; or if a research subject fails to disclose incidental findings when applying for insurance, the insurance contract may be voidable by the insurer. In this article, we seek to explain the insurability risks associated with incidental findings and to make recommendations for how researchers and research ethics committees should address the issue of disclosure of …

Mid-Atlantic Ethics Committee Newsletter, Winter 2011

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

The Hippocratic Myth: Why Doctors Are Under Pressure To Ration Care, Practice Politics, And Compromise Their Promise To Heal, Frank Pasquale

Faculty Scholarship

Not many policymakers or scholars can write with the authority of Gregg Bloche. Bloche is not only a law professor, but a physician, who knows his way around a hospital. Throughout The Hippocratic Myth, Bloche cements his authority in the mind of the reader by relating stories of his experience as a clinician. In each of these stories, his humane and insightful approach as psychiatrist shines through. I do not say this to imply that Bloche uses his book to brag about his own abilities. Rather, these fluently-written passages strike one as the work of one of those rare practitioners …

The Harmful, Nontherapeutic Use Of Animals In Research Is Morally Wrong, Nathan Nobis

Experimentation Collection

It is argued that using animals in research is morally wrong when the research is nontherapeutic and harmful to the animals. This article discusses methods of moral reasoning and discusses how arguments on this and other bioethical issues might be defended and critiqued. A basic method of moral argument analysis is presented and used to show that common objections to the view that “animal research is morally wrong” fail: ie, common arguments for the view that “animal research is morally permissible” are demonstrably unsound or in need of defense. It is argued that the best explanations why harmful, nontherapeutic research …

Self-Harm In Laboratory-Housed Primates: Where Is The Evidence That The Animal Welfare Act Amendment Has Worked?, Jonathan Balcombe, Hope Ferdowsian, Debra Durham

Animal Welfare Collection

The 1985 amendment to the United States Animal Welfare Act (AWA) to promote psychological well being of primates in the laboratory represents an acknowledgment of an important welfare problem concerning nonhuman animals. How effective has this amendment been? Perhaps the best-known contributor to psychological distress in primates in the laboratory is nonsocial housing; yet, available analyses suggest that little progress has been made in avoiding single-caging of these animals. Another way to assess psychological well being is to examine rates of self-abusive behavior in laboratory primates. If the AWA has been effective, then post-AWA self-harm rates might be lower than …

Ada Constitution & Bylaws (2011), American Dental Association

Constitution & Bylaws

The ADA Commons Constitution & Bylaws archival collection comprises printed issues of the American Dental Association's Constitution and Bylaws. The collection also includes the ADA Charter and the ADA Code of Ethics issued 1924-1946.

Medical Errors, Jennifer Spall

3690: A Journal of First-Year Student Research Writing

Overview: Time of Death: 5:07 p.m. – Proceeding the solemn afternoon of February 22nd 2003, the Santillian family listened on as doctors told them that their cherished loved one was officially pronounced brain dead and would soon have to be taken off life support. Two weeks prior to this, seventeen-year-old Jesica Santillian received the thrilling news that she had finally been matched with a heart-lung donor and would be admitted to Duke University Medical Center in early February for a double-organ transplant. After years of living in pain brought on by her failing organs, Jesica was supposed to be one …

Bioethics And Human Rights: Toward A New Constitutionalism, George P. Smith Ii

Scholarly Articles

No abstract provided.

Biobanking Newborn Bloodspots For Genetic Research Without Consent, Sandra J. Carnahan

Journal of Health Care Law and Policy

No abstract provided.

Researchers Without Borders?: Limiting Obligations Of Ancillary Care Through The Rescue Model, Michael R. Ulrich

Student Articles and Papers

With the expansion of clinical research in developing countries, there is a need to explain obligations that researchers have to their subjects beyond those required by the study protocol. This paper outlines a model founded on the duty to rescue that provides ethical clarification of the obligations of ancillary care.

Ada Code Of Ethics (January 2011), American Dental Association

Code of Ethics

The ADA Code of Ethics has three main components: The Principles of Ethics, the Code of Professional Conduct and the Advisory Opinions. Contents may also include: Amendment to ADA Principles of Ethics and Code of Professional Conduct and Insert for the ADA Principles of Ethics and Code of Professional Conduct. The most current issue is available on the ADA’s website.

Acute Renal Failure Requiring Renal Replacement Therapy In The Intensive Care Unit: Impact On Prognostic Assessment For Shared Decision-Making, Robert F. Johnson Jr., Jillian Gustin

Peer Reviewed Articles

A 69 year-old female was receiving renal replacement therapy (RRT) for acute renal failure (ARF) in an intensive care unit (ICU). Consultation was requested from the palliative medicine service to facilitate a shared decision-making process regarding goals of care.

Clinician responsibility in shared decision-making includes the formulation and expression of a prognostic assessment providing the necessary perspective for a spokesperson to match patient values with treatment options. For this patient, ARF requiring RRT in the ICU was used as a focal point for preparing a prognostic assessment. A prognostic assessment should include the outcomes of most importance to a discussion …

The Law And Politics Of Embryo Research In America, O. Carter Snead

Journal Articles

The moral, legal, and public policy dispute over embryonic stem cell research (and related matters, such as human cloning) is the most prominent issue in American public bioethics of the past decade. The primary moral question raised by the practice of embryonic stem cell research is whether it is defensible to disaggregate (and thus destroy) living human embryos in order to derive pluripotent cells (stem cells) for purposes of basic research that may someday yield regenerative therapies. This essay will explain the legal and political dimensions of the embryonic stem cell debate as it has unfolded at the national level …

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

Faculty Scholarship

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 …

Refractory Pain, Existential Suffering, And Palliative Care: Releasing An Unbearable Lightness Of Being, George P. Smith Ii

Scholarly Articles

Since the beginning of the hospice movement in 1967, “total pain management” has been the declared goal of hospice care. Palliating the whole person’s physical, psycho-social, and spiritual states or conditions is central to managing the pain which induces suffering. At the end-stage of life, an inextricable component of the ethics of adjusted care requires recognition of a fundamental right to avoid cruel and unusual suffering from terminal illness. This Article urges wider consideration and use of terminal sedation, or sedation until death, as an efficacious palliative treatment and as a reasonable medical procedure in order to safeguard the “right” …