Bioethics and Medical Ethics Commons^™

Removable Discontinuity: Crispr, Gene Drives, And Bioethics, Emily Dunnahoe

Undergraduate Research Conference

This paper questions whether bioethical scrutiny has been devoted to the ethical dilemmas that have arisen with advancements of CRISPR-Cas 9 gene editing techniques, particularly its use in conjunction with gene drive applications. Therefore, the trend of genetic research using both gene drives and CRISPR-Cas 9 systems must be established, while also simultaneously observing the trend of bioethical scholarly works. The tabulation of all articles from 2012 to 2015 from selected genetic journals yielded a significant increase in articles relating to CRISPR, while no articles were found in their selected bioethical counterparts for the same period. Similarly, no significant CRISPR/gene …

The Ethical Viability Of In Vitro Fertilization, Jack Hamilton

Dialogue & Nexus

In vitro fertilization is considered from multiple ethical positions and whether or not it is limited to disease prevention or used for genetic enhancement. The first can be in line with most ethical theories provided time and resources are allowed for the technology to be provided for all. The latter seems to devalue humans and remove compassion for the disenfranchised.

Passive Euthanasia, Jennifer Hulett, Madeline Peterson

Dialogue & Nexus

The controversy of passive euthanasia (e.g. the withholding or withdrawing of life-sustaining treatments in patients that are either disabled or terminally ill) has been long-debated because, it has been argued, passive euthanasia violates the physician’s Hippocratic Oath to do no harm to the patient. This withholding or withdrawal can include one or more of the following: ventilators, feeding tubes, and life support. In this paper we will explore the major debate points of passive euthanasia in light of four ethical theories: utilitarianism, virtue ethics, Kantian, and evolutionary ethics.

Commentary: Care Is A Noun And A Verb, Peter G. Holub

Internet Journal of Allied Health Sciences and Practice

Care is a living word that binds us to our patients and to each other. The desire to care for others is the motivation for everything we do. Whether healthcare system or health care provider or health-care reform, the singular mission is patient care. The motto for healthcare is Cum scientia caritas (Latin for scientific knowledge applied with care). The only challenge to this most rudimentary tenet for caring depends on how we define care.

The Unifying Power Of Education, Keagan Potts, Jenji Learn

Center for the Study of Ethics in Society Papers

• Without Expertise or Experience: Philosophizing When Your Students Know You Know Nothing
• Segregated Students — Segregated Society: The Primacy of Education in Ending Hate
• Combatting Emerging Resegregation: Teaching Those in Power to Empower

Genomic Contraindications For Heart Transplantation., Danton S. Char, Gabriel Lázaro-Muñoz, Aliessa Barnes, David Magnus, Michael J. Deem, John Lantos

Manuscripts, Articles, Book Chapters and Other Papers

Genome sequencing raises new ethical challenges. Decoding the genome produces new forms of diagnostic and prognostic information; however, the information is often difficult to interpret. The connection between most genetic variants and their phenotypic manifestations is not understood. This scenario is particularly true for disorders that are not associated with an autosomal genetic variant. The analytic uncertainty is compounded by moral uncertainty about how, exactly, the results of genomic testing should influence clinical decisions. In this Ethics Rounds, we present a case in which genomic findings seemed to play a role in deciding whether a patient was to be listed …

Children’S Exposure To Environmental Toxins: Socioeconomic Factors And Subsequent Effects On Mental Health And Function, Dorothy L. Mcleod

Center for the Human Rights of Children

The physical environment in which children live, including the air they breathe and the water they drink, has a profound influence on their development. While children need many chemicals and nutrients to physically grow and develop normally, others, such as those deemed environmental toxins (e.g. pesticides, lead, mercury, and illicit substances) act instead as a threat to healthy development. These chemicals may have highly toxic effects, and while they are a threat to all individuals, they affect infants and children most severely. In order to provide an introduction to the issue of toxin exposure and mental health outcomes, to highlight …

Corporate Social Responsibility In The Health Care Sector, Dina Siniora

Graduate Student Research Symposium

The challenge for the health care sector is to continually explore ways to ensure that the welfares of individual patients remain the utmost primacy and simultaneously promote health care equity via corporate socially responsible activities (CSR). There is an essential need to truly embrace CSR and ethical principles that would promote equal distribution of health care resources. Relevant CSR activities would be achieved by making the most significant health problems in a given society a priority of health care organizations. CSR in health care applied to hospitals and pharmaceutical companies should promote shared values and common ethical principles in new …

Ethical Concerns When Minors Act As Standardized Patients., Erwin Jiayuan Khoo, Robert Schremmer, Douglas S. Diekema, John Lantos

Manuscripts, Articles, Book Chapters and Other Papers

When minors are asked to assist medical educators by acting as standardized patients (SPs), there is a potential for the minors to be exploited. Minors deserve protection from exploitation. Such protection has been written into regulations governing medical research and into child labor laws. But there are no similar guidelines for minors' work in medical education. This article addresses the question of whether there should be rules. Should minors be required to give their informed consent or assent? Are there certain practices that could cause harm for the children who become SPs? We present a controversial case and ask a …

Donation After Brain Circulation Determination Of Death, Anne L. Dalle Ave, James L. Bernat

Dartmouth Scholarship

Background:

The fundamental determinant of death in donation after circulatory determination of death is the cessation of brain circulation and function. We therefore propose the term donation after brain circulation determination of death [DBCDD].

Results:

In DBCDD, death is determined when the cessation of circulatory function is permanent but before it is irreversible, consistent with medical standards of death determination outside the context of organ donation. Safeguards to prevent error include that: 1] the possibility of auto-resuscitation has elapsed; 2] no brain circulation may resume after the determination of death; 3] complete circulatory cessation is verified; and 4] the cessation …

Newborn Sequencing In Genomic Medicine And Public Health., Jonathan S. Berg, Pankaj B. Agrawal, Donald B. Bailey, Alan H. Beggs, Steven E. Brenner, Amy M. Brower, Julie A. Cakici, Ozge Ceyhan-Birsoy, Kee Chan, Flavia Chen, Robert J. Currier, Dmitry Dukhovny, Robert C. Green, Julie Harris-Wai, Ingrid A. Holm, Brenda Iglesias, Galen Joseph, Stephen F. Kingsmore, Barbara A. Koenig, Pui-Yan Kwok, John Lantos, J Steven Leeder, Megan A. Lewis, Amy L. Mcguire, Laura V. Milko, Sean D. Mooney, Richard B. Parad, Stacey Pereira, Josh E. Petrikin, Bradford C. Powell, Cynthia M. Powell, Jennifer M. Puck, Heidi L. Rehm, Neil Risch, Myra Roche, Joseph T. Shieh, Narayanan Veeraraghavan, Michael S. Watson, Laurel K. Willig, Timothy W. Yu, Tiina Urv, Anastasia L. Wise

Manuscripts, Articles, Book Chapters and Other Papers

The rapid development of genomic sequencing technologies has decreased the cost of genetic analysis to the extent that it seems plausible that genome-scale sequencing could have widespread availability in pediatric care. Genomic sequencing provides a powerful diagnostic modality for patients who manifest symptoms of monogenic disease and an opportunity to detect health conditions before their development. However, many technical, clinical, ethical, and societal challenges should be addressed before such technology is widely deployed in pediatric practice. This article provides an overview of the Newborn Sequencing in Genomic Medicine and Public Health Consortium, which is investigating the application of genome-scale sequencing …

Feticide And Us Law, Gerard V. Bradley

Journal Articles

That abortion kills someone with a right-to-life has become easier to see since Roe v. Wade. Progress in scientific research and medical practice has made both birth and viability unrealistic criteria for demarcating between human life, which demands moral respect, and merely “potential life” which does not have moral or legal equivalency with maternal interest. The Eighth Circuit recently criticized the use of viability as a litmus test because it “tied a state’s interest in unborn children to developments in obstetrics, not to developments in the unborn.” The near-ubiquity of sonograms has probably done more than intellectual arguments to …

Surrogate Pregnancy After Prenatal Diagnosis Of Spina Bifida., Lynnette J. Mazur, Mary Kay Kisthardt, Helen H. Kim, Laura M. Rosas, John Lantos

Manuscripts, Articles, Book Chapters and Other Papers

Some pregnancies today involve infertile individuals or couples who contract with a fertile woman to carry a pregnancy for them. The woman who carries the pregnancy is referred to as a "gestational carrier." The use of such arrangements is increasing. Most of the time, these arrangements play out as planned; sometimes, however, problems arise. This article discusses a case in which a fetal diagnosis of spina bifida led the infertile couple to request that the gestational carrier terminate the pregnancy, and the gestational carrier did not wish to do so. Experts in the medical and legal issues surrounding surrogacy discuss …

A Survey Of Ethics Training In Undergraduate Psychology Programs At Jesuit Universities, Thomas G. Plante, Selena Pistoresi

Psychology

Training in ethics is fundamental in higher education among both faith-based and secular colleges and universities, regardless of one’s academic major or field of study. Catholic colleges and universities have included moral philosophy, theology, and applied ethics in their undergraduate curricula for generations. The purpose of this investigation was to determine what, if anything, Jesuit college psychology departments are doing to educate psychology majors regarding ethical issues. A survey method was used to assess the psychology departments of all 28 Jesuits colleges and universities in the United States. A total of 21 of the 28 schools responded and completed the …

Repealing The Aca Without A Replacement — The Risks To American Health Care, Barack Obama

United States Public Health Resources

Health care policy often shifts when the country’s leadership changes. That was true when I took office, and it will likely be true with President-elect Donald Trump. I am proud that my administration’s work, through the Affordable Care Act (ACA) and other policies, helped millions more Americans know the security of health care in a system that is more effective and efficient. At the same time, there is more work to do to ensure that all Americans have access to high-quality, affordable health care. What the past 8 years have taught us is that health care reform requires an evidence-based, …

Ethical Imperatives Of Timely Access To Orphan Drugs: Is Possible To Reconcile Economic Incentives And Patients’ Health Needs?, Rosa Rodriguez-Monguio, T. Spargo, Enrique Seoane-Vazquez

Pharmacy Faculty Articles and Research

Background

More than 6,800 rare diseases and conditions have been identified in the US, which affect 25–30 million Americans. In 1983, the US Congress enacted the Orphan Drug Act (ODA) to encourage the development and marketing of drugs to treat rare diseases and conditions. This study analyzed all orphan designations and FDA approvals since 1983 through 2015, discussed the effectiveness of incentives for the development of treatments for rare diseases, and reflected on the ethical imperatives for timely access to orphan drugs.

Methods

Study data were derived from the Food and Drug Administration (FDA) Orange Book and the Office of …

Developing Morally Sensitive Policy In The Nicu: Donation After Circulatory Determination Of Death, Michael Van Manen, Nicole Kain

The Qualitative Report

Policy development is an important activity for the practice of healthcare. Policies, after all, may cultivate common practices and ensure that best available evidence is employed in clinical decision making. Qualitative research and individuals with expertise in qualitative research methods have much to offer policy makers. We were confronted with the situation of developing policy for donation after circulatory death (DCD) for our newborn intensive care program. Due the moral-ethical complexities surrounding DCD, and the limited experience with DCD in this context, we approached policy development from an iterative design perspective employing qualitative methods. We describe our experience in employing …

Mid-Atlantic Ethics Committee Newsletter, Winter 2017

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Ada Constitution & Bylaws (2017), 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.

Legalization Of Euthanasia And Physician-Assisted Dying: Condemnation Of Physician Participation, Samira Mazloom, Alireza Hamidian Jahromi, Bahar Bastani

Journal of Health Ethics

The topic of physician-assisted dying has always been a controversial topic raising a strong ethical dilemma. Currently six states in USA (Oregon, Vermont, Washington, Montana, California, Colorado) have developed regulations legalizing physician-assisted dying (medical euthanasia). We propose that physicians, because of their Hippocratic oath, should be exempted of participating in it. We suggest experts in professional assisted dying (“Euthanasia Specialists”) be ethically and to some degree medically trained to perform such a task when deemed appropriate.

Whose Preferences Matter? A Patient-Centered Approach For Eliciting Treatment Goals, Nananda F. Col, Andrew J. Solomon, Vicky Springman, Calvin P. Garbin, Carolina Ionete, Lori Pbert, Enrique Alvarez, Brenda Tierman, Ashli Hopson, Christen Kutz, Idanis Berrios Morales, Carolyn Griffin, Glenn Phillips, Long H. Ngo

Department of Psychology: Faculty Publications

Background. Patients facing a high-stakes clinical decision are often confronted with an overwhelming array of options. High-quality decisions about treatment should reflect patients’ preferences as well as their clinical characteristics. Preference-assessment instruments typically focus on pre-selected clinical outcomes and attributes chosen by the investigator. Objective. We sought to develop a patient-centered approach to elicit and compare the treatment goals of patients with multiple sclerosis (MS) and healthcare providers (HCPs). Methods. We conducted five nominal group technique (NGT) meetings to elicit and prioritize treatment goals from patients and HCPs. Five to nine participants in each group responded silently to one question …

Procedural Due Process And Intramural Hospital Dispute Resolution Mechanisms: The Texas Advance Directives Act, Thaddeus Pope

Faculty Scholarship

Increasingly, clinicians and commentators have been calling for the establishment of special adjudicatory dispute resolution mechanisms to resolve intractable medical futility disputes. As a leading model to follow, policymakers both around the United States and around the world have been looking to the conflict resolution provisions in the 1999 Texas Advance Directives Act (TADA).

In this article, I provide a complete and thorough review of the purpose, history, and operation of TADA. I conclude that TADA is a commendable attempt to balance the competing goals of efficiency and fairness in the resolution of these time-sensitive, life-and-death conflicts. But TADA is …

Human Dignity As A Normative Standard Or As A Value In Global Health Care Decisionmaking, George P. Smith Ii

Scholarly Articles

Dignity is seen commonly as an ethical obligation owed to human persons. The dimensions of this obligation in today's post secular society, are -- however -- subject to wide discussion and debate; for, the term, human dignity, and its preservation, defies universal agreement. Yet, its preservation -- together with the prevention of indignity -- should be a guiding principle or at least a vector of force in a wide range of issues in health care management ranging from embryo research and assisted reproduction to biomedical enhancement, and the care of the disabled and the dying. In clinical medicine, safeguarding the …

Science As Speech, Natalie Ram

All Faculty Scholarship

In April 2015, researchers in China reported the successful genetic editing of human embryos using a new technology that promised to make gene editing easier and more effective than ever before. In the United States, the announcement drew immediate calls to regulate or prohibit
outright any use of this technology to alter human embryos, even for purely research purposes. The fervent response to the Chinese announcement was, in one respect, unexceptional. Proposals to regulate or prohibit scientific research following a new breakthrough occur with substantial frequency. Innovations in cloning technology and embryonic stem cell research have prompted similar outcries, and …

Repugnance Management And Transactions In The Body, Kieran Healy, Kimberly D. Krawiec

Faculty Scholarship

Researchers have made progress in understanding the role of repugnance in transactions involving the human body. Yet, often, the focus remains on exchange between individuals and how they mentally cope (or not) with repugnance. But these exchanges also entail a “vertical” dimension in which organizational and state actors both directly manage repugnance and also limit the repugnance management tools available to the marketplace. Analyzing repugnance and its management as an organizational and regulatory problem, in addition to an individual one, suggests that a single, harmonized system of exchange in bodily goods is unlikely to emerge with the passage of time.

Organ Entrepreneurs, Kieran Healy, Kimberly D. Krawiec

Faculty Scholarship

The supply of human organs for transplantation might seem an unlikely place to begin thinking about entrepreneurship. After all, there is no production market for human organs and, with the surprising exception of Iran, legal rules around the world make the sale of human organs for transplantation a criminal offense. Yet entrepreneurs have been present throughout the history of organ transplantation — a history of the active exploration, innovation, and management of a potentially very controversial exchange at the seemingly clear boundaries that separate giving from selling, life from death, and right from wrong.

This article explores the role of …

The Significance Of Injustice For Bioethics, Leslie P. Francis

Utah Law Faculty Scholarship

In my judgment, applied ethics is ineluctably non-ideal and partial compliance theory. It’s ethics in the context of unjust institutions and conduct. Theorizing or teaching about concepts such as autonomy in abstraction from this recognition is misleading. Instead, questions such as how to realize autonomy should be framed in the context of incomplete justice. There’s much to be learned from the past nearly 50 years of discussions of justice to help with this enterprise, but they are too little known or discussed in much contemporary bioethics.

Medical Futility And Religious Free Exercise, Teneille R. Brown

Utah Law Faculty Scholarship

A tragic scenario has become all too common in hospitals across the United States. Dying patients pray for medical miracles when their physicians think that continuing treatment would render no meaningful benefit. This situation is unfortunately referred to as “medical futility.” In these cases, physicians, who are less likely than their patients to rely on God as a means of coping with major illness, are at an impasse. Their patients request everything be done so that they can have more time for God to intervene, but in the physician’s professional experience, everything will probably do nothing. What is the physician …

Integrating A Code Of Professional Conduct And Ethics: An Action Research Approach, Ciara Kissane

Theses

A new version of the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (NMBI, 2014a) was published in 2014. A nurse’s fitness to practice, and the associated patient experience, is determined by the extent to which the nurse accords with the duties outlined in the Code. Professional misconduct among members of the nursing profession has been highlighted within recent reports and enquiries. The failure to act on unethical care is also a feature. The literature suggests that Codes are poorly understood and can be problematic to integrate in practice. This study sought to; explore the impact …

A Deliberate Departure: Making Physician-Assisted Suicide Comfortable For Vulnerable Patients, Browne C. Lewis

Law Faculty Articles and Essays

This Article is divided into four parts. Part I discusses the history and evolution of the "right to die movement" in the United States. The current legal landscape in the United States is examined in Part II. In Part III, I analyze some of the relevant ethical concerns caused by the availability of physician-assisted suicide. My analysis primarily focuses on the Oregon statutes because it is the oldest physician-assisted suicide law in the United States and has served as a model for laws in the United States and abroad. For example, Lord Falconer's Bill, which was defeated by the British …