Bioethics and Medical Ethics Commons^™

Dead Men Reproducing: Responding To The Existence Of Afterdeath Children, Browne C. Lewis

Law Faculty Articles and Essays

The statutory mandates are a step in the right direction, but there is still work that needs to be done. The statutes should be amended to close certain loop holes and to ensure that the physician-facilitated suicide option is available to all of the patients who need it. Persons suffering from physical conditions that will lead to death within six months should not be the only persons permitted to exit gracefully. As long as the safeguards included in the statutes are followed, there is no good reason to prohibit persons suffering from irreversible and incurable physical diseases that lead to …

The Implications Of Post-Phase 1 And "Off-Label" Treatment Use Of Experimental Drugs: How Expansive Should Expanded Access Be?, Patricia J. Zettler

Faculty Publications By Year

No abstract provided.

The New Invention Creation Activity Boundary In Patent Law, Margo A. Bagley

Faculty Articles

This Essay identifies a new boundary in patent law - illegal or immoral invention creation activity - and explores the possible chal­lenges and opportunities it may facilitate. The boundary currently is neither robust nor extensive, and whether and under what cir­cumstances it should exist at all is open to debate.

Toward Credible Conflict Of Interest Policies In Clinical Psychiatry, Lisa Cosgrove, Harold J. Bursztajn

Counseling, School Psychology & Sport Faculty Publication Series

A recent letter to the American Psychiatric Association (APA) from Sen Chuck Grassley about the APA’s financial relationship with pharmaceutical companies raises concerns about undue industry influence. By instituting a disclosure policy for DSM-V, the APA took a halting first step in restoring public trust in the most influential text on psychiatric taxonomy in the world. Unfortunately, the APA’s efforts at creating a conflict of interest (COI) policy have failed to ensure that the process for revising diagnostic and therapeutic guidelines is one that the public can trust. The need for more safeguards was evidenced when the APA reported that …

Neuroscience And Health Law: An Integrative Approach?, Stacey A. Tovino

Faculty Articles

Clinicians and scientists use functional magnetic resonance imaging (fMRI) to map sensory, motor, and cognitive function and to study the neural correlates of a range of physical and mental conditions, behaviors, characteristics, and preferences. Due to its move outside the clinical and research contexts, fMRI raises a number of ethical, legal, and social issues that are being examined within the overlapping fields of neuroethics and neurolaw. The early neuroethics and neurolaw scholarship focused heavily on the implications of fMRI for evidence law, criminal law, criminal procedure, and constitutional law. Little attention has been paid, however, to the implications of advances …

Three Ways Of Looking At A Health Law And Literature Class, Jennifer Bard, Thomas Mayo, Stacey A. Tovino

Faculty Articles

The authors of this Article participated in a panel at the American Society of Law, Ethics & Medicine Conference in 2008 that examined the use of literary materials in law school to teach medical ethics (and related matters) in a law school setting. This Article and the panel on which it was based reflect views on how literature can play a valuable role in helping law students and medical students understand important legal and ethical issues and concepts in health law and bioethics. In Part I, Stacey Tovino introduces the parallel fields of “literature and medicine” and “law and literature” …

Increased Susceptibility Of Spinal Muscular Atrophy Fibroblasts To Camptothecin Is P53-Independent., Chia-Yen Wu, Ilsa Gómez-Curet, Vicky L Funanage, Mena Scavina, 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). The SMN protein is known to play a role in RNA metabolism, neurite outgrowth, and cell survival. Yet, it remains unclear how SMN deficiency causes selective motor neuron death and muscle atrophy seen in SMA. Previously, we have shown that skin fibroblasts from SMA patients are more sensitive to the DNA topoisomerase I inhibitor camptothecin, supporting a role for SMN in cell survival. Here, we examine the potential mechanism of camptothecin sensitivity in SMA fibroblasts.

RESULTS: Camptothecin treatment reduced the DNA relaxation activity …

Social Work Ethics Computer-Based Training Minnesota State University, Mankato Department Of Social Work, Rebecca Robinson-Wargelin

All Graduate Theses, Dissertations, and Other Capstone Projects

At the Community Behavioral Health Hospital, St.Peter (CBHH),a discussion was held regarding Ethics Continuing Education Hours(CEUs). The Minnesota Board of Social Work(MNBSW)and Minnesota State Statute 148D.130 require that Licensed Social Workers receive two hours of ethics-specific CEUsper licensure renewal. Through this discussion,it appeared that it would be beneficial to create an ethics computer-based training(CBT), which would be of no expense to State Operated Services(SOS)Social Workers.This option would also provide convenience for social workers, who as a majority,reside within rural areas.The CBT created is in accordance to requirements of the MNBSW and has an emphasis to include the National Association of …

Hematologic Effects Of Placental Pathology On Very Low Birthweight Infants Born To Mothers With Preeclampsia., Kelly J. Zook, Md, Amy B. Mackley, Rnc, Jennifer Kern, David A. Paul. Md

Department of Pediatrics Faculty Papers

OBJECTIVE: To investigate the effect of placental pathology on neonatal neutrophils, platelets, hematocrit and nucleated red blood cells in very low birthweight (VLBW) infants born to mothers with preeclampsia. STUDY DESIGN: Retrospective cohort study of infants with birthweight < 1500 g born to mothers with preeclampsia from july, 2002 to july, 2006 at a single level III neonatal intensive care unit. Placental pathology was reviewed for the presence of placental infarction and vasculopathy. Hematologic parameters from day of life 0, 1 and 2 were obtained. Statistical analysis included repeated-measures analysis of variance and multivariable analysis using logistic regression. RESULT: The study sample included 203 infants with estimated gestational age of 28+/-3 weeks; 45% had placental infarctions and 26% placental vasculopathy. Infants with neutropenia and thrombocytopenia did not have an increased occurrence of placental infarction or maternal vasculopathy but were more likely to be of small gestational age (SGA) and of lower gestational age compared with infants without neutropenia or thrombocytopenia. After multivariable analysis, gestational age and SGA remained associated with both neutropenia and thrombocytopenia whereas placental infarction and vasculopathy did not remain in the models. CONCLUSION: In our population of VLBW infants born to mothers with preeclampsia, placental pathology was common. There was no association of placental infarction or vasculopathy with neonatal neutropenia and thrombocytopenia. The data suggest that neonatal hematologic effects of maternal preeclampsia, if related to the placenta, are associated with factors other than placental histology.

Autistic Disorder Associated With A Paternally Derived Unbalanced Translocation Leading To Duplication Of Chromosome 15pter-Q13.2: A Case Report., David J Wu, Nicholas J Wang, Jennette Driscoll, Naghmeh Dorrani, Dahai Liu, Marian Sigman, N Carolyn Schanen

Department of Pediatrics Faculty Papers

Autism spectrum disorders have been associated with maternally derived duplications that involve the imprinted region on the proximal long arm of chromosome 15. Here we describe a boy with a chromosome 15 duplication arising from a 3:1 segregation error of a paternally derived translocation between chromosome 15q13.2 and chromosome 9q34.12, which led to trisomy of chromosome 15pter-q13.2 and 9q34.12-qter. Using array comparative genome hybridization, we localized the breakpoints on both chromosomes and sequence homology suggests that the translocation arose from non-allelic homologous recombination involving the low copy repeats on chromosome 15. The child manifests many characteristics of the maternally-derived duplication …

Reviewing Existing Knowledge Prior To Conducting Animal Studies, Andrew Knight

Experimentation Collection

Highly polarised viewpoints about animal experimentation have often prevented agreement. However, important common ground between advocates and opponents was demonstrated within a discussion forum hosted at www.research-methodology.org.uk in July–August 2008, by the independent charity, SABRE Research UK. Agreement existed that many animal studies have methodological flaws — such as inappropriate sample sizes, lack of randomised treatments, and unblinded outcome assessments — that may introduce bias and limit statistical validity. There was also agreement that systematic reviews of the human utility of animal models yield the highest quality of evidence, as their reliance on methodical and impartial methods to select significant …

Faecal-Centric Approaches To Wildlife Ecology And Conservation; Methods, Data And Ethics, C. T. Darimont, T. E. Reimchen, H. M. Bryan, P. C. Paquet

Ethics and Conservation Biology Collection

Abundant and commonly encountered in the field, wildlife faeces have long attracted scientists. Recent advances in molecular techniques, however, especially when coupled with creative study designs, can now yield a great variety of high quality data. Herein, we review the opportunities and challenges of faecal-centric approaches to address ecological and conservation questions using wolves of coastal British Columbia, Canada, as a case system. We begin by discussing methodological considerations, which should have broad applicability to any wildlife study system. We then summarize the extensive and unique variety of data that has emerged from our ‘facts from faeces’ approach with wolves, …

The Moral Justification For Journalism, Sandra L. Borden

Center for the Study of Ethics in Society Papers

Papers presented for the Center for the Study of Ethics in Society Western Michigan University

Ethical Decision-Making Regarding Multiple Relationships Between Therapist And Client, Diana Jochai

Loma Linda University Electronic Theses, Dissertations & Projects

The current study examined a new conceptual model of factors critical to a therapist’s decision-making process when faced with the potential of a nonsexual multiple relationship with a client. This new model was founded on the conceptual framework proposed by Street, Douglas, Geiger, & Martinko (2001) and integrated the components of the decision-making process and the individual and situational factors influencing those components identified in existing general conceptual models and specific behavioral guidelines. For the ethical decision-making process to begin, a practitioner must be able to recognize the presenting problem as an ethical dilemma (Brazerman, 1986; Jones, 1991; Street et …

Referral In The Wake Of Conscientious Objection To Abortion, Carolyn Mcleod

Philosophy Publications

Currently, the preferred accommodation for conscientious objection to abortion in medicine is to allow the objector to refuse to accede to the patient's request so long as the objector refers the patient to a physician who performs abortions. The referral part of this arrangement is controversial, however. Pro-life advocates claim that referrals make objectors complicit in the performance of acts that they, the objectors, find morally offensive. McLeod argues that the referral requirement is justifiable, although not in the way that people usually assume.

Mid-Atlantic Ethics Committee Newsletter, Fall 2008

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Heme Induces Endothelial Tissue Factor Expression: Potential Role In Hemostatic Activation In Patients With Hemolytic Anemia, Yamaja Setty, Suhita G. Betal, Jie Zhang, Marie J. Stuart

Department of Pediatrics Faculty Papers

Objectives: We explored the possibility that heme, an inflammatory mediator and a product of intravascular hemolysis in patients with hemolytic anemia including sickle cell disease, could modulate hemostasis by an effect on endothelial tissue factor (TF) expression.

Methods: Levels of TF mRNA, protein and procoagulant activity were measured in heme-treated endothelial cells. Results: Heme induces TF expression on the surface of both macrovascular and microvascular endothelial cells in a concentration-dependent manner, with 12-fold to 50-fold induction being noted (enzyme-linked immunosorbent assay) between 1 and 100 μm heme (P < 0.05). Complementary flow cytometry studies showed that the heme-mediated endothelial TF expression was quantitatively similar to that of tumor necrosis factor-alpha (TNF-α). Heme also upregulated the expression of TF mRNA (8-fold to 26-fold), protein (20-fold to 39-fold) and procoagulant activity (5-fold to 13-fold) in endothelial cells in a time-dependent manner. The time-course of heme-mediated TF antigen expression paralleled the induction of procoagulant activity, with antibody blocking studies demonstrating specificity for TF protein. Interleukin (IL)-1α, and TNF-α are not involved in mediating the heme effect, as antibodies against these cytokines and IL-1-receptor antagonist failed to block heme-induced TF expression. Inhibition of heme-induced TF mRNA expression by sulfasalazine and curcumin suggested that the transcription factor nuclear factor kappaB is involved in mediating heme-induced TF expression in endothelial cells.

Conclusions: Our results demonstrate that heme induces TF expression by directly activating …

Phosphatidylserine-Positive Erythrocytes Bind To Immobilized And Soluble Thrombospondin-1 Via Its Heparin-Binding Domain, Suhita G. Betal, Yamaja Setty

Department of Pediatrics Faculty Papers

Phosphatidylserine (PS)-dependent erythrocyte adhesion to endothelium and sub-endothelial matrix components is mediated in part via thrombospondin (TSP). While TSP exhibits multiple cell-binding domains, the PS-binding site on TSP is unknown. Since a cell-binding domain for anionic heparin is located at the amino-terminus, we hypothesized that PS-positive red cells (PS+ve-RBCs) bind to this domain. We demonstrate that both heparin and its low-molecular-weight derivative enoxaparin (0.5-50u/ml) inhibited PS+ve-RBC adhesion to immobilized TSP in a concentration-dependent manner (21-77% inhibition, P<0.05). Pre-incubation of immobilized TSP with an antibody against the heparin-binding domain blocked PS+ve-RBC adhesion to TSP. Antibodies that recognize the collagen- and the carboxy-terminal CD47-binding domain on TSP had no effect on this process. While pre-incubation of PS+ve-RBCs with TSP-peptides from the heparin-binding domain containing the specific heparin-binding motif KKTRG inhibited PS+ve-erythrocyte adhesion to matrix TSP (P<0.001), these peptides in the immobilized form supported PS-mediated erythrocyte adhesion. A TSP-peptide lacking the binding-motif neither inhibited nor supported PS+ve-RBC adhesion. Additional experiments show that soluble-TSP also interacted with PS+ve-RBCs via its heparin-binding domain. Our results demonstrate that PS-positive erythrocytes bind to both immobilized and soluble TSP via its heparin-binding domain and that both heparin and enoxaparin, at clinically relevant concentrations, block this interaction. Other studies have shown that heparin inhibited P-selectin- and soluble-TSP-mediated sickle erythrocyte adhesion to endothelial cells. Our results taken together with the previously documented findings provide a rational basis for clinical use of heparin or its low-molecular-weight derivatives as therapeutic agents in treating vaso-occlusive pain in patients with sickle cell disease.

Human Embryonic Stem Cell Research, Justice, And The Problem Of Unequal Biological Access, Mark Moller

Faculty Publications

No abstract provided.

Atypical Onset As Predictor Of Poor Outcome In Pediatric Systemic Lupus Erythematosus (Psle), A Taddio, E Rossetto, L Lepore, A C. Brescia, C Bracaglia, S Caminiti, E Cortis, D Rigante, A Stabile, M Montico, L Ronfani, C D. Rosé

Department of Pediatrics Faculty Papers

Poster Presentation.

Healing The Effects Of Medical Errors: A Vision Of Justice As Wholeness, Christiane Catharine Schubert

Loma Linda University Electronic Theses, Dissertations & Projects

Medical errors cannot be avoided completely even when employing the greatest care and applying the most sophisticated medical technologies. They occur when organizational, human, technical, or environmental factors lead to unintentional failures which result in recognizable physical, mental, spiritual, or social harm to patients. Until recently, the medical profession has responded with silence while patients remained uncompensated or resorted to the legal system. Professional distancing undermines transparency and patient safety while medical malpractice litigation ruptures the fragile relationships between patients and healthcare providers in whom patients trust. Philosophically, these responses draw on the framework of deontological liberalism, promoting notions of …

Reply To Joseph Ellin's Of All Professions, Prostitution Is The Oldest (Except Possibly For Teaching), Michael Davis

Center for the Study of Ethics in Society Papers

No abstract provided.

Volunteer Studies In Pain Research — Opportunities And Challenges To Replace Animal Experiments: The Report And Recommendations Of A Focus On Alternatives Workshop, C. K. Langley, Q. Aziz, C. Bountra, N. Gordon, P. Hawkins, A. Jones, G. Langley, T. Nurmikko, I. Tracey

Experimentation Collection

Despite considerable research, effective and safe treatments for human pain disorders remain elusive. Understanding the biology of different human pain conditions and researching effective treatments continue to be dominated by animal models, some of which are of limited value. British and European legislation demands that non-animal approaches should be considered before embarking on research using experimental animals. Recent scientific and technical developments, particularly in human neuroimaging, offer the potential to replace some animal procedures in the study of human pain. A group of pain research experts from academia and industry met with the aim of exploring creatively the tools, strategies …

Professions "Of All Professions, Begging Is The Best" A Paper By Michael Davis. Response By Joseph Ellin. Professor Davis' Reply, Center For The Study Of Ethics In Society

Center for the Study of Ethics in Society Papers

Michael Davis' original paper was presented to the Center of the Study of Ethics in Society Western Michigan University on October 4, 2007.

"Of All Professions Begging Is The Best" - Some Problems In The Study Of Professions, Michael Davis

Center for the Study of Ethics in Society Papers

Michael Davis' original paper was presented to the Center of the Study of Ethics in Society Western Michigan University on October 4, 2007.

Of All Professions, Prostitution Is The Oldest (Except Possibly For Teaching), Joseph Ellin

Center for the Study of Ethics in Society Papers

Response by Joseph Ellin to a paper by Michael Davis Professions "Of All Professions, Begging is the Best"

Infant Mortality In Delaware: The Need To Improve Maternal Health And Reduce Premature Births., David A. Paul. Md

Department of Pediatrics Faculty Papers

Delaware's high infant mortality rate continues to be driven by an increasing number of premature births. Premature birth is a complex problem with both social and medical roots. Based on the CDC road map, programs aimed at improving preconception health of women of childbearing age are blossoming in Delaware. In addition, Delaware's infant mortality rate can only be reduced if we are able to diminish disparities in health care delivery, and improve the social factors influencing infant mortality. These factors include diminishing family support, low high school graduation rate, poor housing, and a lack of health insurance.

Mid-Atlantic Ethics Committee Newsletter, Summer 2008

Mid-Atlantic Ethics Committee Newsletter

No abstract provided.

Enhancing Autonomy In Paid Surrogacy, Jennifer Damelio '06, Kelly Sorensen

Philosophy and Religious Studies Faculty Publications

The gestational surrogate – and her economic and educational vulnerability in particular – is the focus of many of the most persistent worries about paid surrogacy. Those who employ her, and those who broker and organize her services, usually have an advantage over her in resources and information. That asymmetry exposes her to the possibility of exploitation and abuse. Accordingly, some argue for banning paid surrogacy. Others defend legal permission on grounds of surrogate autonomy, but often retain concerns about the surrogate. In response to the dilemma of a ban versus bald permission, we propose a ‘soft law’ approach: states …

Exploiting A Research Underclass In Phase 1 Clinical Trials, Carl Elliott, Roberto Abadie

Department of Sociology: Faculty Publications

In November 1996, the Wall Street Journal reported that Eli Lilly was paying homeless alcoholics from a local shelter to participate in safety testing of new drugs at its trial site in Indianapolis.1 “These individuals want to help society,” asserted Lilly’s director of clinical pharmacology. The subjects, however, said they took part for easy money and free room and board. Although Lilly reportedly offered the lowest per diem in the business, it managed to attract poor subjects from all over the country.1 The medical director of the local Homeless Initiative Program said Lilly had created a “shadow economy” of paid …