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An End in and of Themselves
February 5, 2018
A current student of the Bioethics Program takes a look at the Kantian ideal and the realities of cadaveric dissection while also reflecting on the somewhat problematic end of life of a grandfather.
The Limits to Conscience
January 22, 2018
Last week the Trump administration created a new entity within the Department of Health and Human Services (DHHS) called the Conscience and Religious Freedom Division. It was one of several steps the President has taken recently to expand religious freedom protections for health care workers who object to performing procedures like abortion and gender reassignment surgery. Is there a place for conscientious refusal in medicine? What is the danger of this new division?
Paris is Burning
June 30, 2017
Earlier this month, President Trump finally honored one of his many (often contradictory) campaign promises. He formally withdrew the United States from the 2015 Paris Climate Accord. America is now one of only three countries in the world who are not party to this landmark agreement, joining Syria and Nicaragua in refusing to work collaboratively to combat the threat of global climate change. Has the Trump Administration’s decision doomed all hopes and condemned the world to an apocalyptic future of runaway climatic change?
Remembering the 49+
June 15, 2017
This past Monday represented the one-year anniversary of the Pulse nightclub massacre in Orlando, Florida. Forty-nine people died and 53 were injured in what was the worst mass shooting in modern US history. The victims’ only crime was that they were members or supporters of the lesbian, gay, bisexual and transgender (LGBT) community. They were singled out and murdered by a lone gunman motivated by homophobia and hatred. Unfortunately, reports of gun violence and mass shootings are becoming increasingly routinized in the United States. Although correlation is not causation, it is easy to see the links between this increase in violence and the current political climate.
Should We Cure Genetic Diseases?
June 7, 2017
In "Trying to Embrace a 'Cure'," (New York Times, June 4, 2017), Sheila Black notes that in the near future there may be a treatment that could amount to a cure for the genetic illness she and two of her children have -- X-linked hypophosphatemia or XLH. But Ms. Black is ambivalent about the prospect. Although she acknowledges the potential benefits both to individuals and to society, the issue is, for her, complex.
Silence = Death
May 18, 2017
On Monday, Trump announced a new policy called Protecting Life in Global Health Assistance. That policy expands the scope of the Global Gag Rule. Also known as the Mexico City Policy, the restrictions of the Global Gag Rule now apply to nearly $9 billion in global health funding provided annually by federal agencies like the State Department and the Department of Defense, in addition to the $600 million in family planning support that is provided by USAID. By denying funds to family planning clinics that provide information or referrals for abortions, the Global Gag Rule already leaves millions of poor women without access to reproductive health and family planning services. Trump’s Protecting Life in Global Health Assistance policy will make that already tragic situation worse.
She Ain’t Hefty™, She’s My Mother
May 4, 2017
A recent development in medical technology, an artificial womb known as a Biobag, is the first successful demonstration of an artificial womb. It is essentially a large Ziploc™ bag that encloses the fetus and bathes it in a protective solution similar to the amniotic fluid inside the uterus. Used only in the laboratory with lambs so far, researchers hope that Biobag-like technology can soon be used in the clinic to provide care and treatment for premature infants. Yet despite the potentially miraculous advance in treating prematurity that the Biobag represents, there are many condemning the research, making overt or oblique reference to Aldous Huxley’s novel Brave New World. So are we one step closer to Huxley’s dystopia as these critics claim?
(Non) Free Will and Bioethics
May 1, 2017
Philosophers, religious thinkers, and laymen alike have pondered on the notion of ‘the freedom of the will’ for thousands of years. In the so-called Western ethical tradition it seems to have a more or less unequivocal meaning: conscious adult individuals without particular mental illnesses are free in choosing their moral norms and actions. But what if all these convictions, legal regulations and ethical frameworks are based on a profoundly faulty foundation – the assumption that the human will is in fact free? And if free will does not exist, how could physicians respect it?
E-H-ARRGH: The Frustrating Costs and Benefits of the Electronic Health Record
April 28, 2017
The concept of electronic medical recordkeeping was first introduced in the late 1960’s but it did not really become established until this century. Electronic Health Records (EHRs) are expected to provide a number of benefits, data forthcoming as to how effectively EHRs meet these goals. But what about the implicit hazards that the use of EMFs carries?
April 7, 2017
The 2018 federal budget battle has barely begun and already critics – including myself – are questioning the wisdom of Trump’s proposal to drastically cut key agencies like the US Department of State, Health and Human Services, and the Environmental Protection Agency in order to build a wall that no one wants, to buy fighter jets that no one needs, and to give tax breaks that no one earned.
SHEEFs, Sentience, and the 14-Day Rule
March 31, 2017
Embryo research, made possible by IVF, raised the question of the moral status of human embryos. Are human embryos human subjects, who are entitled to stringent protections? Or are they clumps of cells that can be used in research, so long as the permission of their creators is obtained? The 14-day rule was agreed upon, which specifies that experiments with human embryos must not let them develop beyond 14 days. Now a new development in stem cell research, the creation of "synthetic embryos", has raised the question of whether or not SHEEFs should be protected by the same kinds of restrictions as IVF, or non-synthetic, embryos.
The First Cut is the Deepest
March 23, 2017
Last week, President Trump publicly unveiled his 2018 budget proposal. If left unchanged, that financial blueprint would increase US federal defense spending by more than $50 billion, while also appropriating billions more to bolster immigration enforcement and build a 2,000 mile-long wall along the US border with Mexico. A self-proclaimed deficit hawk, the President would offset those increased expenditures will sharp cuts to the US Departments of State, Energy, Health and Human Services, and the US Environmental Protection Agency. In sharp contrast to campaign trail promises to boost the economy, create jobs, and protect Americans at home and abroad, however, Trump’s 2018 budget is likely to do the exact opposite. Consider, for example, the proposal to cut nearly $6 billion from the US National Institutes of Health (NIH).
The Problem with Binary
March 10, 2017
Throughout his raucous 2016 campaign, President Trump repeatedly claimed that he would be an ardent defender of the lesbian, gay, bisexual and transgender (LGBT) community. Despite this, since gaining the nomination and later the presidency, Donald Trump has largely kowtowed to the more homophobic wings of his party. By taking these positions publicly, the Trump administration has emboldened anti-LGBT advocates and led conservative lawmakers to push for increasingly restrictive regulations. What does this mean for the future of transgender rights?
Drop the Kleenex and Put Your Hands Up
February 9, 2017
Unbeknownst to most, the federal government is planning to expand greatly the power of the US Centers for Disease Control and Prevention (CDC) to detain people who are suspected of carrying a dangerous communicable illness. Also known as quarantine – the detention, isolation and even forcible treatment of those potentially exposed to a infectious disease like tuberculosis or Ebola is one of the most powerful and one of the most contentious tools in the public health arsenal. Will giving the CDC greater authority and power to detain people on public health grounds actually prevent new outbreaks of infectious disease in the US? Or will this only serve to further chip away at our already eroded civil liberties and rights?
Human Breast Milk Sharing—Limited Regulation with Social Justice Implications
February 1, 2017
Knowing the great benefits of human breast milk, many parents who are unable to produce enough themselves have good reason to seek out private breast milk donors. There are, however, risks associated with private human breast milk sharing. Furthermore, for those families looking to receive a donation the competition is fierce. If families cannot find a donor on the unregulated market, they could turn to a milk bank. Sounds like a great option except, milk banks charge receiving families as much as $15 per 6 ounces of pasteurized breast milk. Families of limited means and resources, then, face a series of obstacles. So how can every child be provided the benefits of breast milk even if their family lacks the ability to pay the associated costs?
The significance of 37
January 30, 2017
Mitochondrial gene transfer (MGT) is a new technique that might help us eradicate mitochondrial diseases by combining the healthy mitochondrial from one woman with the nuclear genes from another woman, resulting in baby having genes from two mothers. Despite the obvious advantage of avoiding serious hereditary conditions from abnormal mitochondrial genes, there are reasons to be concerned and cautious.
A Public Cervix Announcement
January 27, 2017
In a study published in this month’s issue of the journal Cancer, scientists found that a woman’s risk of dying from cervical cancer was much higher than originally suspected. What is particularly disturbing is we now know that those previously estimated death rates are wrong, and that the racial disparity is much more worse than we assumed. This is particularly troubling for a number of reasons, most notably because cervical cancer is largely preventable. So why are so many women still dying of cervical cancer, particularly black women at significantly higher rates than white women?
Kidnapped at Birth
January 23, 2017
The question of 'who are the real parents?' can arise in a range of contexts. The law has traditionally regarded genetic ties as the determining factor. Other courts have placed less emphasis on genetic connection and more on intention. Still others would argue that biology, whether genetic or gestational, is not the sole factor in determining who is a parent. Surely someone who takes care of and has responsibility for a child, who loves and is loved by that child, has as much claim to be a parent as someone who is biologically related. More importantly, it seems wrong to deprive children of the people in their lives who have played significant parental roles. But what about the recent news of eighteen year old Alexis Manigo learning that Gloria Williams, the woman who raised her, has been charged with kidnapping her when she was eight hours old? Would a best interest analysis have applied were she still a minor today?
Horse-drawn miscarriage: a case study on culture, pregnancy, and overriding parental requests to limit treatments
January 19, 2017
Patient autonomy is a well-established principle in both U.S. law and Western medical ethics. When patients have decision making capacity, they decide to accept or decline medical interventions based on of their own goals and values. When medical decisions are made on behalf of children, the best interests standard replaces autonomy. Because children usually lack settled goals and values, the decision about medical care should be made in light of the best decision for the child. Within the context of early pregnancy, the mother’s autonomous preferences are legally recognized as sufficient to make decisions to continue or to terminate the pregnancy. Once the fetus reaches the stage of viability, however, things get a bit more complicated.
The Breast Intentions Are Fraught With Disappointment
January 12, 2017
Breast cancer is one of the leading causes of cancer death among American women, second only to lung cancer. Nearly 250,000 new cases are detected each year in the United States, and over 40,000 women die annually from the disease. Breast cancer is a public health crisis, and one that deserves a strong, concerted and well-reasoned response. The problem, however, is that current public health messages about breast cancer screening and treatment are disjointed at best and dangerous at worst.
Having a Baby at 50
January 9, 2017
Pop star Janet Jackson, who turns 51 this coming May, gave birth to her first child last week. She and her husband have allegedly been working with a fertility specialist for some time. Many people react with horror, or even disgust, to the idea of this. However, people have had similar emotional reactions to interracial and same-sex marriage. Rather than relying on emotion, I propose the following framework for evaluating reproductive technologies: procreative liberty and procreative responsibility.
A New Hope for Mental Illness
January 3, 2017
Both Carrie Fisher and George Michael – just like far too many celebrities and average folk -- struggled with addiction. Moreover, it wasn’t just alcoholism that Carrie Fisher struggled with. She was also an outspoken advocate for other mental illnesses, courageously sharing her own experience with bipolar disorder. Carrie herself believed that her years-long battle with addiction was a result of her undiagnosed bipolar disorder. Along with other well-deserved epithets, 2016 will be remembered as the year that the mental health community lost a remarkable advocate. Despite Ms. Fisher’s untimely passing, however, there is still “a new hope”.
Means to an End
December 16, 2016
According to a recent survey of nearly 8,000 Americans, over two-thirds do not have an Advance Directive, Living Will, Health Care Proxy or similar document. They don’t because they don’t know about them or because they assume their families already know their end-of-life wishes. Unfortunately, the few studies that have looked at the accuracy of family decision-making have also found that most health care proxies might as well just guess what their loved one wants. Surrogate accuracy is only slightly above chance, with rates of accuracy running about 50-65%. This is largely because too many people avoid conversations about end-of-life planning. Talking about death is difficult even under the best of circumstances, let alone our own end-of-life wishes. We all expect to live for decades more. But life is unpredictable, and the only thing that is certain is that none of us get out of it alive. While it might be difficult to contemplate our own mortality, we owe it to those that we love to make sure that they know what we want when the inevitable comes.
Leadership. Commitment. Hype.
December 1, 2016
Today is World AIDS Day. It is, in fact, the 29th annual World AIDS Day, which is held every year on December 1st to honor the 35 million people who have died from the disease and to support the 40 million who currently live with HIV/AIDS. The theme for this year’s event, at least according to the US federal government? “Leadership. Commitment. Impact.” Yet support for HIV prevention and treatment efforts has been slipping for years. Will our newly-elected politicians show true leadership and commitment to the fight against HIV/AIDS? Or will it be the usual self-serving and ideologically-motivated efforts to promote themselves and enrich their donors? If so, will the hard-won gains that we’ve made since HIV was first discovered soon be lost?
Under The Knife
November 11, 2016
I nearly died last month. This is not an exaggeration. For someone who considers himself to be healthier than most men his age, this was a terrifying experience. For a bioethicist who reads, writes and teaches about clinical care, this was also a very humbling experience. I learned a lot about what it means to be a patient, lessons that will undoubtedly influence my own research and writing about modern medical policies and practices. In particular, there are five lessons that I want to share.
The Age of the Superbug
September 22, 2016
Just yesterday, the United Nations General Assembly held a day-long meeting in New York City to discuss one of the most deadly threats to human health since the bubonic plague: antibiotic-resistant bacteria. Worldwide, an estimated 750,000 people died from antibiotic-resistant infections in 2015. Within just a couple of decades, that number is expected to increase by nearly 1500%, yielding over 10 million “superbug”-related deaths annually by 2050.
How to Die in California
August 26, 2016
As we begin to debate the issue of physician aid-in-dying more and more publicly, there are valid concerns that need to be respected and addressed. Moreover, blunt discussions on the issue of death itself need to be had, by talking with our friends, families and physicians about what a ‘good death’ means for each of us, by planning for the inevitable with our loved ones and our lawyers, and by exploring and expanding alternative end-of-life treatment options like hospice and palliative care. This is what represents the true legacy of women like Brittany Maynard and Betsy Davis.
Blame It On Russia … and Rio
August 11, 2016
As tomorrow marks the mid-point of the 2016 Summer Olympic Games in Rio de Janiero, Brazil, controversy surrounding the presence (and exclusion) of Russian athletes at this year’s Games continues.
The Invisible Woman
July 28, 2016
At the 2016 Democratic National Convention in Philadelphia, there was one speech in particular that stood out to me: the speech given by disability rights advocate Anastasia Somoza. Anastasia described some of the challenges of living, “in a country where 56 million Americans with disabilities so often feel invisible.” This social invisibility of which she speaks is but one example of the overt and covert discrimination which those with disabilities experience every day.
Welcome to Cleveland. Please Set Your Watch Back 100 Years.
July 14, 2016
The Republican National Committee Platform Committee has drafted a staunchly conservative political platform that outlines their vision for America. To be presented to the delegates of the Republican National Convention for approval on Monday, the fact that the platform itself is politically conservative should come as no surprise. What’s surprising about the GOP’s 2016 platform is this: it is an ultra-reactionary platform that runs counter to a century of progress in civil rights, ignores some of the basic premises of our Nation’s founding and previous Republican philosophies, and outwardly ignores conclusive data on public health and climate change.
No Forgiveness in Florida
June 16, 2016
Like so many others around the world, this past weekend my husband and I watched in disbelief as the deadliest mass shooting in American history unfolded in Orlando. What started out for many as a joyous evening of drinking and dancing turned into a horrifying morning of chaos and mayhem after a deranged gunman used a legally obtained semiautomatic rifle to kill 49 people and wound 53 others at a popular gay nightclub called Pulse. In the four days since the shootings, we still know little about the gunman’s motives. However, the opportunistic motives of so many others capitalizing on this tragedy are clear.
Five Ring Circus
June 2, 2016
In a mere 65 days, almost 10,000 athletes from 204 countries will gather in Rio de Janeiro for the start of the 2016 Summer Olympic Games. An additional 500,000 spectators are expected to file into Rio’s athletic venues, walk its crowded streets, tour its famous monuments and seamy favelas, and frolic on its fabled beaches. Over a hundred thousand more – athletes, staff and tourists – will visit Rio the following month for the 2016 Paralympic Games. At the same time, we have the spread of a disease that remains unchecked, a mosquito-borne virus that is now epidemic in Brazil. Should current rates of transmission remain unchanged, we can predict that thousands of Olympic athletes and spectators will be infected with Zika. Given that it’s not a question of if but when Zika becomes a global crisis, will the World Health Organization (WHO) act responsibly and respond to protect the public health?
Zeroing in on Zika
May 19, 2016
The Zika virus was first identified as a serious health threat during an outbreak of that virus in Brazil. Although most of the people who became sick with Zika only developed a mild illness, at the same time Brazilian health authorities also noted a sudden increase in the number of children born with a rare birth defect known as microcephaly. Experts are now raising concerns about the possibility of an outbreak of Zika in the United States and Southern Europe. Despite all this, Congress has largely failed to act. Do we have any reason to believe they’ll move swiftly before a full-fledged outbreak, or will they continue to risk the nation’s health by playing “politics as usual”?
May 6, 2016
Transgendered men and women have some of the highest rates of drug addiction, alcohol abuse, domestic violence and suicide. One study found that over 40% of transgendered men and women attempt to take their own lives. This is a rate of suicide that is more than 10-times the national average, and can be directly attributed to the rampant transphobia that permeates American society.
The Weight of the World
April 21, 2016
According to a new study published in the medical journal The Lancet last week, the number of people in the world who are clinically obese has increased six-fold over the last four decades. Should this trend continue unabated, over one-fifth all adults worldwide will be obese by 2025. Another two-fifths of the world’s adult population will be considered overweight. The public health and economic implications of this are staggering.
In The Eyes Of The Beholder?
April 7, 2016
As Americans, we constantly judge ourselves and we constantly judge others according to largely unrealistic and entirely artificial expectations of physical perfection. But these expectations are not universally shared. They vary from culture to culture, from generation to generation, and from era to era.
The Whiter the Bread
March 15, 2016
A recent study suggests that a diet rich in white bread, bagels, potatoes and other high glycemic index foods greatly increases a non-smokers risk of lung cancer. Do we all need to give up our favorite carbohydrate-laden foods, or are the results this study nothing but smoke and mirrors?
A Smack Upside the Head
December 3, 2015
Concussions are one of the most frequent traumatic brain injuries, occurring more than 1.5 million times a year in the United States alone.
Let Them Eat Bacon!
November 5, 2015
Of all the things in this world that are likely to kill us, bacon should be the least of our worries. Don't let the media, the WHO, or your vegan friends try to convince you otherwise.
Reconsidering Cancer Screening Programs
October 22, 2015
Screening saves lives, but not everyone needs to be screened. And not everyone needs to be screened early and often
Frozen on the Dock of the Bay
October 8, 2015
Yet another dispute by a divorced couple over what to do with their frozen embryos is in the news. This one may lead to new legal rules over how to decide such cases.
Accessibility: Americans with Disabilities Act (ADA) and Human Subjects Research
September 17, 2015
In research in general and medical research specifically, Internet-based research is booming. But is research in the digital era accessible?
A Question of Conscience
September 10, 2015
The problem with conscience claims and religious freedom laws is this: they upset a long-standing balance between religious liberty and civil rights.
A Delicate Balancing Act
August 27, 2015
Restricting the use of sex selection technologies would only lead to further erosion of our reproductive liberties.
Wrongful Birth and Wrongful Life
August 24, 2015
At present, wrongful life suits should be recognized as the only recourse for some children to get the medical care and services they need.
Remedies for South Korea: Stopping MERS Before it Starts
August 11, 2015
Although the response was criticized as excessive, at least US government officials made sure that Ebola was kept under control and contained. The MERS case in South Korea case was somewhat opposite. Loose quarantine and lack of timely control and containment of MERS increased public exposure to the disease.
Sean Philpott-Jones: The ADA And What's Next
July 30, 2015
The twenty-fifth anniversary of the Americans with Disabilities Act is something we should all celebrate, while still looking for ways to improve the way that our society treats those living with disabilities.
Sean Philpott-Jones: Giving Drug Users a Shot in the Arm
July 16, 2015
The new heroin epidemic isn't a criminal issue. Rather, it's a public health problem. We need to stop treating addiction as a crime and start treating it as an illness.
8/12 Webinar: Research on Human Embryos: The Global Perspective
July 13, 2015
Drs. Joanna Rozynska and Sean Philpott-Jones will present the webinar, "Research on Human Embryos: The Global Perspective" on Wednesday, August 12, from noon-1 pm ET.
A Glossip v Gross Injustice
July 2, 2015
Regardless of what you may think about the death penalty, the Eighth Amendment is quite clear. All prisoners, no matter how heinous their crimes, have the inalienable right to be free of “cruel and unusual punishments.”
Frozen Embryos: Legal Standards and Moral Grounds
June 19, 2015
Last May, the dispute between Nick Loeb and actress Sofia Vergara over the frozen embryos they created received much media attention. A new case in Chicago has recently been reported. Both cases highlight the need for a way to resolve such disputes, ideally without resort to the courts.
X-ing out Title X
June 18, 2015
Earlier this week, the US House of Representatives Committee on Appropriations released its 2016 budget proposal for funding the Department of Health and Human Services. As part of that proposal, the Republican-dominated Committee recommended eliminating funding for the Title X family planning program.
There's Something About Caitlyn
June 9, 2015
I want to caution us all against thinking that Ms. Jenner's experience is typical. It's not. Her story is not representative of the challenges and barriers that most transgendered individuals face.
Sometimes Losing a Patient Feels Great
June 2, 2015
When a long-time patient comes in to tell me that they had a transplant, I don’t want the celebration to end.
Patents Over People
May 21, 2015
Approximately 150 million worldwide are infected with hepatitis C virus, with most of those living in poorer regions of the world, particularly Asia and Africa.
Deciding What Happens to Frozen Embryos
May 8, 2015
What happens when a couple who created frozen embryos splits up, and one of them wants to pursue reproduction with the embryos?
Love (and Sex), Canadian Style
May 7, 2015
It's time we started acting like adults (or Canadians) and mandate that our public schools provide comprehensive sex education to all adolescents.
iRB: Apple Heads into Medical Research
May 5, 2015
Apple is venturing into health care and medical research in a novel way, by introducing a software platform that allows for researchers and developers to use Apple products in conducting medical research.
Inconsistencies about Circumcision
April 21, 2015
The decision for circumcision should be treated like any other elective medical procedure for a child—it should be a joint decision by both parents.
Residual Dried Blood and New Born Screening in Minnesota
April 14, 2015
Parents who have questions about their state's newborn screening program practices should consult with their primary care provider or state’s newborn screening program office.
What's the Matter with Indiana?
April 9, 2015
So long as conservative politicians continue their efforts to defund Planned Parenthood, continue their ideological opposition to needle exchange programs, and continue to prioritize the needs and goals of their corporate donors over the health and welfare of their own citizens, outbreaks will continue to occur.
Guatemala, the GDR and Research Ethics Policy Development
March 31, 2015
The way to ensuring the protection of human research subjects in transitional countries is most likely to be a long and difficult one, as it involves efforts to reshape some basic elements of society.
How to Get A Head in Life
March 27, 2015
An Italian scientist, Sergio Canavero, claims that he is two years away from performing the world’s first human head transplant, in which the head of one person would be grafted onto the body of a newly deceased person.
Happy Birthday Obamacare!
March 26, 2015
Those on the right might have ideological objections to Obamacare. Some of these objections might even be valid. But if you’re going to spend most your time repeatedly trying to repeal this successful law, instead of tackling other looming crises like immigration reform and student debt, at least have the courage to stand up for your convictions and back them with concrete arguments and supporting data.
Will Ariadne Lead Us Through the Maze of End-of-Life Healthcare?
March 23, 2015
About four years ago, Susan D. Block, M.D. posted a blog on Harvard Business Review’s website as part of a series of writings focusing on innovation in health care. In her blog, she bemoaned the “lousy job” doctors do in communicating with patients when it becomes apparent that additional treatment and technology will fail to stave off death.
Should Medical Staff ‘Google’ Patients?
March 16, 2015
On several occasions, a new admission or psychiatric consultation has been accompanied by patient information that was “googled” by nursing or consulting practitioners. On some occasions, the ‘googled’ information has admittedly been helpful for refining diagnosis and management. On other occasions, it has seemed unnecessary for patient care.
March 12, 2015
One thing we never thought would be an increasingly scarce resource, at least in the medical setting, was privacy.
Understanding the Latino Patient with Cancer
March 6, 2015
To achieve a culturally competent treatment is to understand the Latino culture and demonstrate respect for their differentiating traits while they are in treatment.
When Doctors Discriminate
February 26, 2015
It would also be illegal to refuse a patient based on race, religion or gender. Sadly, this is not the case for sexual orientation or gender identity.
The Man Who Mistook His Life For A Hat
February 25, 2015
Author Oliver Sacks recently announced in the New York Times that metastasized tumors were found in his body. His diagnosis is terminal in the near future. Dr. Sacks decided to forgo aggressive treatments – choosing the quality of his life over its quantity.
The Carter v. Canada Conundrum: Next Steps for Implementing Physician Aid-in-Dying in Canada
February 19, 2015
We applaud the February 6, 2015 Supreme Court of Canada’s (SCC) unanimous ruling in Carter v. Canada (Attorney General), 2015 SCC 5. The Court found the criminal prohibition of assisted death to be in violation of section 7 of the Canadian Charter of Rights and Freedoms, which guarantees the right to life, liberty and security of the person. Now that the ruling has been handed down, the more difficult task of defining the legal and ethical parameters of who can consent to PAD and what obligations physicians have to honor such requests must begin.
The Importance of History for Bioethics: It is What it Was
February 16, 2015
In my participation on hospital ethics committees and IRBs, when encountering situations that lack clear guidance, I have noted that those who make the strongest cases often tell stories based on first- or second-hand experience, rather than recite principals and rules.
How to Die in Canada
February 12, 2015
We need to have a thoughtful and respectful discussion about dying, about the rights of the terminally ill, and about the role that physicians should play in helping patients attain a peaceful death. And we should watch the Canadian experiment carefully (and the experience of Montana, New Mexico, Oregon, Vermont, and Washington), and learn from their success and mistakes.
V-Ticket to Ride
January 29, 2015
It's time for clinicians, public officials, and politicians to take a stand on vaccination, and take a stand against the claim that personal liberty trumps public safety.
The Case of Cassandra C: Finding Clarity and Responsibility as a Mom and a Bioethicist
January 21, 2015
Cassandra C., is a teen with Hodgkin's lymphoma who refused treatment but was forced into receiving it by a Connecticut Supreme Court ruling.
It's the Little Things That Matter
January 13, 2015
Beyond the discussions of treatment options,, there are a number of issues that clinicians need to consider.
Sean Philpott-Jones: A Cold Day's Concern About a Warming Planet
January 6, 2015
What concerns me the most about global climate change is the effect it will have on patterns of disease and illness, both here in the United States and overseas.
Sean Philpott-Jones: Physician, Torture Thyself
December 22, 2014
We now know that CIA staff physicians and psychologists were involved in almost every interrogation session. This is in direct violation of all known codes of medical ethics.
Does A Just Society Use the “R” Word?
December 16, 2014
Healthcare spending in the U.S. is expected to grow by more than 5 percent annually over the next ten years.
Protecting Transgender Students
December 4, 2014
Two nights ago, the Shenendehowa Board of Education voted 4 to 2 in favor of a new policy designed to protect the rights and safety of transgender students.
Striking the Balance Between Population Guidelines and Patient Primacy
November 26, 2014
Breast cancer is the second leading cause of cancer death among North American women.
Where Social Justice Fits in Medical Decision-Making
November 24, 2014
The current healthcare reimbursement system curtails treatment choices for Americans by narrowing networks, imposing strict guidelines for coverage or setting deductibles that are so high as to restrict to care.
Cheaper by the Dozen
November 6, 2014
As a bioethicist, I appreciate the fact that the American public has become deeply engaged in a number of important health policy debates. For example, should local, state and national agencies forcibly quarantine travelers coming from countries affected by the Ebola virus? Should public and private companies be required to provide employees with health insurance plans that include oral contraceptives if doing so runs counter to the religious beliefs of the owners? Should terminally ill cancer patient Brittany Maynard have the right to end her own life (which she did this past Saturday)?
Fear and Loathing in Liberia
October 23, 2014
Two weeks ago, I wrote a commentary decrying the current hysteria in the US over Ebola. It was ironic, I argued, that so many people were demanding the federal government take immediate steps to address the perceived threat of Ebola while simultaneously ignoring the real public health threats that we face.
Let Harrison Bergeron Dance
October 13, 2014
All I can think of when reading the case of Indian sprinter Dutee Chand is Harrison Bergeron, protagonist of a 1961 short story by author Kurt Vonnegut. For those of you who don’t know who Dutee Chand is, she is a Indian sprinter who was banned from the 2014 Commonwealth Games because her testosterone level was “too high”. Unlike other athletes who use banned substances to achieve this, Ms. Chand’s testosterone levels were not artificially elevated. She was not “doping” by taking testosterone supplements, and there are no accusations of her “not being a woman”. She simply produces high levels of testosterone naturally.
October 9, 2014
Public concern about Ebola reached a fever pitch this past week, no pun intended, following the revelation that a patient in Dallas was infected with this deadly virus. Returning from a recent trip to Liberia, where thousands of people have died from Ebola since the epidemic began last December, Thomas Eric Duncan (who died shortly after this commentary was recorded for NPR) developed symptoms shortly after arriving in the United States. Public health officials in Texas are now tracking and quarantining the 38 people who had contact with Mr. Duncan after he became ill.
The FDA Flexes Its Muscles on Testosterone
October 1, 2014
In 2002, Solvay Pharmaceuticals developed a new marketing strategy that characterized the natural decline in testosterone production associated with normal male aging as a medical problem, termed low-T. The ultimate objective was to encourage physicians to prescribe testosterone to otherwise healthy patients to combat the effects of normal male aging, such as low energy and libido.
Tackling the Problem of Domestic Violence
September 25, 2014
The National Football League is in for a rough season, both on and off the field. In the past month, for example, America’s most popular sport has been rocked by allegations that league officials and team owners willfully ignored evidence that the Baltimore Raven’s star running back Ray Rice beat his then-fiancée unconscious in an Atlantic City elevator.
Extending the Zadroga Act
September 11, 2014
Thirteen years ago today, Americans watched in horror as planes hijacked by Al Qaeda-backed terrorists slammed into the World Trade Center, the Pentagon and a vacant field outside of Shanksville, Pennsylvania. Many of us lost friends and family. Nearly 3,000 people were killed that day, including 2,753 who died when the World Trade Center’s Twin Towers fell. The actual death toll associated with 9/11, however, is much higher.
Can Social Media Save Us from the “Spiral of Silence?”
September 9, 2014
Studies suggest that, before the advent of the Internet, we are unlikely to share minority or unpopular viewpoints with our co-workers, friends and relatives. This inclination creates, in essence, a “Spiral of Silence.” But does the Internet provide a remedy to the “Spiral of Silence,” by encouraging online discussion of viewpoints that may be unpopular? Contrary to the hopes of social media advocates, new research finds that social media may not provide a voice to those who feel uncomfortable expressing minority viewpoints in face-to-face relationships.
The Boys in the Ban
August 29, 2014
For over 30 years now, the United States Food and Drug Administration (FDA) has banned blood donations from gay and bisexual men. It is a lifetime ban. Currently, no man who has ever had sex with another man can donate blood in the US. The same is true for tissue donations. Just last year, for example, the FDA refused to accept for donation the eyes of an Iowan teen after learning that the boy was gay. When 16-year-old Alexander Betts committed suicide after months of bullying at the hands of classmates because of his sexual orientation, just a few months after he signed up as an organ donor, his family honored one of his last wishes by donating his organs and tissues. But while his heart, lungs, kidneys and liver were used to save the lives of six other people, the donation of his eyes was rejected because “tissue from gay men carries an increased risk of sexually transmitted diseases, including HIV/AIDS.”
Taking the Icy Plunge (Or Not)
August 21, 2014
There’s an epidemic that is sweeping this country. It’s not Ebola, despite all of the hype and misinformation about that disease that has dominated the news in the past two weeks. Rather, I’m talking about the ice bucket challenge. Anyone who has watched television in the last couple of weeks has seen this: newscasters, celebrities and athletes like Matt Lauer, Martha Stewart and Nick Swisher being doused with a bucket of ice water in the name of charity. The goal of the ice bucket challenge is to raise money and awareness about amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease).
The Early Bird Get the Ethics?
August 20, 2014
Does early to bed and early to rise, make a man healthy, wealthy and more ethical? Earlier research suggested a “morning morality effect”: that people are more ethical early in the morning, becoming less so as they “wear out as a day wears on.” Not so fast, researchers now say. New research casts doubt on conceptions that night owls are less ethical than their early rising lark counterparts. Instead, a better predictor for ethical behavior takes into account the “fit” between one’s chronotype — night owl or morning lark — and the time of day when ethical behavior is implicated.
Sean Philpott: Taking The Icy Plunge (Or Not)
August 15, 2014
The goal of the ice bucket challenge is to raise money and awareness about ALS, also known as Lou Gehrig's disease. If you want to help those living with ALS, dunking a bucket of cold water over your head is not the way to do it.
Big Bad Ebola
August 12, 2014
Last week Ebola came to the United States, it came on a specialized plane in the form of two medical missionaries. The conversation since has revolved around whether or not bringing them home for treatment was wise and/or just.
Media Sensationalism and Medical Practice: Doctors Are Examining Your Genitals for a Good Reason
August 11, 2014
There have been so many stories about bad behavior by doctors, so perhaps I should not have been surprised by the recent and blaring headline on the American Journal of Bioethics’ website: Doctors Are Examining Your Genitals for No Reason! Oh dear, I thought, not another doctor taking advantage of a patient. But when I opened the article (the original was published in Slate), I saw nothing of the sort. In fact, instead of doctors taking advantage of patients, doctors were being pilloried for taking good care, recommended care, and appropriate standard-of-care-kind of care of their patients.
My Slate Article on the Importance of Replicating Science
July 31, 2014
I have a long article in Slate (with Union psychology professor Chris Chabris) on the importance of replicating science. We use a recent (and especially bitter) dispute over the failure to replicate a social psychology experiment as an occasion for discussing several things of much broader import, including:
Care or Kickbacks?
July 24, 2014
In the complicated world of HMOs and referrals, some health care systems have started enforcing “continuity of care” policies that keep patients within that hospital system.
Sean Philpott: She Ain't Heavy, She's My Brother
July 22, 2014
Actress Laverne Cox made history last week as the first transgender actress to be nominated for an Emmy.
The Curious Case of Hobby Lobby
July 3, 2014
The consequences of the Court’s expected but ill-considered decision on the Hobby Lobby case are likely to be far-ranging and precedent-shattering.
How an IRB Could Have Legitimately Approved the Facebook Experiment—and Why that May Be a Good Thing
June 30, 2014
For one week in January 2012, Facebook altered the algorithms it uses to determine which status updates appeared in the newsfeed.
You Can’t Fix What Ain’t Broke: Combating the Dangers of Reparative Therapy
June 19, 2014
Reparative therapy is wrong and should be bannedbanned for everyone, not just for teenagers as California, New Jersey and (hopefully) New York have done.
Living With HIV/AIDS Should Not Be A Crime
June 5, 2014
It is unreasonable to continue to require HIV-infected people to disclosure their serostatus to sexual partners if they have undertaken the necessary precautions that makes transmission exceedingly unlikely.
Justina Pelletier’s Less-Than-Sweet 16
June 1, 2014
Justina Pelletier was transferred to a facility in Connecticut, after he Massachusetts Department of Children and Families (MA DCF) took custody of her two years prior. Even though there have been positive developments, the case as a whole is still very concerning.
Your Doctor Has a DNR Order, But Not for the Reasons You’d Think
May 30, 2014
To advocate for more, and better, discussions about CPR, DNR, and code status is not to advocate for wresting control away from patients and limiting their lives. It is instead empowering them to make better, more informed decisions about treatments that align with their personal values.
Alzheimer’s Disease: The Forgotten Epidemic
May 22, 2014
Our Congressional leaders are too focused on cutting costs, including slashing the federal budget that supports biomedical research, to recognize the looming crisis. Alzheimer’s will remain an overlooked and forgotten epidemic until it is to late intervene.
Will Bioethicists Support Hunger Strike Death? A response to Wesley J. Smith
May 19, 2014
Physicians that manage the health of detainees are not engaging in political discourse; rather, they are simply doing their jobs as outlined by their profession.
Mandatory Organ Donation: Ethical or Outrageous?
May 16, 2014
With passionate advocates making the case to individuals we can raise the number of willing organ donors without compromising the donation process
The Botched Execution of Clayton Lockett: Is Lethal Injection Painless and Humane?
May 8, 2014
There should be immediate moratorium on the use of the death penalty until we can prove that our current methods of lethal injection are indeed humane and pain free. Otherwise we are condemning thousands of inmates to a fate worse than death.
Death Panels are Back, and They Want to Pay Grandma to Die
April 28, 2014
The myth of the “Death Panels” almost derailed health care reform in the Summer of 2009. We need to increase the number of patients with advance directives, and Senator Tom Coburn’s proposa that would actually pay eligible Medicare beneficiaries $50 if they complete an advance directive is a good one to try.
Income Inequality and Health: Can the Poor Have Longer and Better Lives?
April 24, 2014
The Affordable Care Act will help address some of the current inequities in our health care system. Until we attack the fundamental issue of poverty and the income gap, however, we are probably just putting a small bandage on a large and gaping wound.
Being Wrong is Unacceptable: The Continued Saga of Justina Pelletier
April 21, 2014
In any DCF case there should be a harm analysis and abuse, willingly or unwillingly inflicted by the government agency on the child needs to be addressed and appropriately handled. It does no good to move a child, like Justina Pelletier, from a potentially harmful environment into a definitely harmful one.
Pint-Sized Pot and Hospice Hallucinations: The Role of Illicit Drugs in Medicine
April 20, 2014
All forms of drugs are in need of social reclassification and should be put into a single category: drugs. From there we can rebuild how we interact with them. Sometimes, as it turns out, the most ethical choice could also the most illegal.
Sorry Kid, But Your Mom’s in Jail for Having You
April 15, 2014
The Tennessee legislature voted to approve a bill that criminalizes drug use in pregnancy. Mothers can now be charged with criminal assault if a child is born addicted, harmed or dies as a result of pre-natal use of narcotics.
What Price Immortality? Privately Funded Projects and the Prolongation of Life
April 11, 2014
No less than three privately funded projects seeking the prolongation of human life have been publicized in the past year. The 2045 Initiative, dubbed “the Avatar Project”, is arguably the most futuristic and non-traditional of the three projects.
New Tools for HIV Prevention: Why I am a Truvada Whore
April 10, 2014
Truvada is a lifesaver, both in terms of preventing the spread of HIV and in prolonging the lives of those living with HIV/AIDS. We should be encouraging its use, not disparaging it.
Health Disparities: They’re Not Just for Patients Anymore
April 10, 2014
Health disparity can be viewed as a sort of volatility risk of the healthcare system: as the difference in health among various groups of patients increases, so does the possibility (or likelihood) than people within the system will be treated more unjustly or unfairly. This leads to likely further social disparities, increasing the likelihood that these groups will not be able to manage their health effectively.
If Hobby Lobby Wins, We All Lose
April 9, 2014
No corporation should make health care decisions for its employees. Hobby Lobby should abide by the provisions of the ACA, or get out of the way of its employees by paying the “penalty” tax, increasing wages if it must, and allowing employees to select their own plans from the insurance exchanges.
Whose Business Is It If You Want a Bee To Sting Your Penis? Should IRBs Be Policing Self-Experimentation?
April 4, 2014
It’s one thing to require a neutral third party to examine a protocol when there are information asymmetries between investigator and subject, and when the protocol’s risks are externalized onto subjects who may not share much or any of the expected benefits. Mandatory review of self-experimentation takes IRB paternalism to a whole other level.
When Doctors Disagree: Parental Rights and Disputed Pediatric Diagnoses
April 1, 2014
Parents should be allowed to disagree with a diagnosis and to have their child treated by the medical professional of their choice. If the child is in danger of abuse or neglect by a family member criminal charges should be filed along with the request for custody by the hospital or state. I
Rated NC-17: Why Voluntary Euthanasia of Children is Dead Wrong
March 30, 2014
The terminally ill child who has “had enough” should certainly be involved in decisions to forgo further aggressive or life-prolonging treatments. Killing him at his request, no matter how ill he is, is surely not the right course of action.
Forgiving Fred Phelps
March 27, 2014
By taking the same rhetoric and opinions spouted by many ‘good Christians’ to the extreme — through slogans like “God Hates Fags” and “Thank God for Dead Soldiers” — the Westboro Baptist Church showed just how pervasive and perverse homophobic attitudes are. It’s possible that many of the recent advances in gay rights wouldn’t have been achieved without Fred Phelps, founder of the Westboro Baptist Church, who died on March 19, 2014.
16 and Pregnant: The Tragic Case of Rennie Gibbs
March 20, 2014
I cannot say that a better health care system, or better schools that teach responsible sexuality, or better access to abortion, or any other broad factor could have avoided this scenario. But I do envision a situation in which we do have all of those things, and I imagine if this would then be a ‘cautionary tale’ for others. Instead, in reality, I fear that it represents ‘more of the same’.
I Heard It Through the Grapevine: Ethical and Legal Considerations of HIV Disclosure
March 19, 2014
Breach of confidentiality is obviously not a problem that exists only in rural or small communities, but in this case it sure seems like it was exacerbated by it.
Barbie’s Dream Body
March 18, 2014
Blondie Bennett though, has always dreamed of becoming a real life Barbie doll. She says that she was obsessed with Barbie as a kid and has modeled her life after the doll.
Reefer Madness: Why US Federal Policies on Medical Marijuana Don’t Make Sense
March 13, 2014
It’s time to change the federal approach to medical marijuana. There’s no reason why marijuana is Schedule 1 controlled substance or why federal agents routinely shut down dispensaries that sell the drug to patients.
Opening the Black Box
February 27, 2014
It doesn’t make sense that we rely on such “natural experiments” rather than collect the necessary safety and effectiveness data by conducting controlled clinical trials using informed and willing participants. It’s time for us the reconsider existing guidelines on the inclusion of pregnant women in clinical trials: the mothers and their children deserve better
The Pelletier Family and Boston Children’s Hospital: The Battle Continues
February 24, 2014
Justina is a 15 year old girl diagnosed with Mitochondrial Disease at Tuft’s hospital. Last week marked the one year point in the Pelletier Family’s battle with the Massachusetts Department of Children and Families, DCF, and Boston Children’s Hospital, BCH. One glaring question cannot be ignored: If BCH is correct in their new diagnosis, and their new treatment path is working, why, after a year on this new plan, have we seen Justina’s condition decline instead of improve?
State Pregnancy Exclusions are Bad Law
February 5, 2014
Marlise Munoz’s body should not have been callously and forcibly used by the state as a means for fetal ends, and nor should any other pregnant woman’s body, whether she is dead or alive.
Doctor Knows Best?
February 3, 2014
Christina was taken to a pysch word after her husband killed himself and their 14 year old son. Christina’s story raises some questions about the doctor/patient relationship in a mental health setting. What rights do psych patients have? How can we best assess their capability to make decisions? What is the line where involuntary commitment becomes necessary?
Why Is Brain Death Death? A Thought Experiment
January 30, 2014
For now, and for the foreseeable future, brain death is a criterion of death. It’s up to those of us who work in health care, ethics, and law to speak with clarity when communicating on this topic to the media, to courts, to bereaved families, and to our colleagues.
Keep Your Head in the Game
January 30, 2014
The real problem is the continued reluctance of the NFL and other professional leagues to take the problem of concussions seriously, rather than treat it as a PR problem to be solved.
Musing about Munoz
January 27, 2014
The most important lesson might be the one that the Quinlan court taught us in 1976: do not go to court, keep these decisions at the bedside, and if you need help, ask for ethics involvement.
Would Marlise Munoz’s Fetus Have Survived? Should It Have?
January 27, 2014
It is not the case that a situation like the Munoz case (at least “like” it in terms of gestational age at onset of maternal brain death) has never resulted in the birth of a healthy child; nor is it the case that, had the hospital and the Munoz family only allowed Marlise’s body to remain hooked up to the ventilator for a few more weeks, all would necessarily have been well. We would do well to be more epistemically modest the next time such a case arises.
Fetuses, Organs and Brain-Death
January 26, 2014
Our reasons for such conscription in the case of organs’ harvesting are much more compelling than in the case of Marlise Muñoz if we take into account the fatal prognosis of the fetus, the experimental character of the continuation of pregnancy in a brain-dead woman, and the better expectations that we might nowadays have when we transplant organs.
The Concept of Brain Death and the Tragic Cases of Marlise Munoz and Jahi McMath
January 26, 2014
It should be recognized that we have limited medical resources, and that the medical care going toward a patient who is already dead could be used to benefit someone with desperate need
Physician Authority to Make the Determination of Death: Why It Matters
January 26, 2014
There are several reasons why, to those involved in clinical ethics, that the fact that physicians are losing the authority to determine that a person has died, matters.
Reasonable Accommodation to Objections to a Brain Death Determination: Religious Principle Versus Disputed Diagnosis
January 26, 2014
Something as basic as defining death has to be the rule for all. In keeping death as a diagnosis made by a physician, but giving special status to religious/moral objections, New York got it right.
The Munoz Tragedy: A First Step in the Right Direction
January 25, 2014
Judge Wallace was right to reject the application of the TADA and order the withdrawal of the machinery. Whatever the political climate on the abortion issue may be in Tarrant County, perhaps the DA can decide that given the hospital’s concession that the fetal isn’t viable, he doesn’t have to appeal the district court’s ruling.
JPS Hospital’s Statutory Interpretation Argument on Appeal
January 25, 2014
The literal text of the pregnancy clause in the Texas Advance Directives Act does not apply to Munoz. But an appellate court might hold that this is an extraordinary case that requires looking beyond the literal text.
Marlise Munoz and Medical Decisions After Death
January 25, 2014
New Jersey permits people to reject brain death on the basis of their religious beliefs and insist that death be declared only upon the loss of all cardiac function. Other states also should allow people to make the same choice and to reject brain death for non-religious reasons as well. In Ms. McMath’s case, her parents should be able to choose between brain death and cardiac death on her behalf.
Introducing an Online Symposium on the Munoz and McMath Cases
January 25, 2014
Two high-profile, rapidly evolving cases involving death by neurological criteria — better known as “brain death” — raise vexing and sometimes novel legal, ethical, and medical questions at the edges of life and death.
When Tragedy Turns Tragic
January 21, 2014
We as a society need to accept our mortality and acknowledge that we need to be able to have open and honest conversations about death. Such conversations can do nothing but clarify our own individual perspectives – and enrich our collective social understanding – about death.
Rage Against the Dying of the Light
January 16, 2014
Everyone has an opinion of what a ‘good death’ is, and that opinion should be respected and honored. So long as that is achieved, there is no right or wrong way to die.
Hospital v. Parent
January 13, 2014
Jahi McMath is a 13 year old girl from Oakland California who went in for a routine tonsillectomy on December 9th, 2013. While recovering from surgery Jahi went into cardiac arrest, she was placed on ventilator support, but was shortly thereafter pronounced brain dead.
Manufacturing a Vaccine Controversy
December 19, 2013
The vast majority of studies show that vaccines are extremely safe and protect against a variety of dangerous diseases. The benefits of vaccination clearly outweigh the risks. That’s the news story the networks should be promoting, rather than giving anti-vaccination alarmists the opportunity to continue their campaign of misinformation and misdirection.
We Have Met The Enemy and He Is Us
December 6, 2013
The perception that HIV/AIDS is no longer a serious threat is a dangerous one. Despite the remarkable gains for the last two decades, we are all still at risk. AIDS is as much of a public health crisis as it was when the first cases were identified over 30 years ago. We need to continue to raise awareness and fund prevention programs.
Princeton Meningitis Vaccination: Experiment vs Public Health Emergency
November 22, 2013
Princeton University is plagued by an outbreak of type B bacterial meningitis, a disease that has a 10% mortality rate in a college-age population. The first and only vaccine against this form of meningitis, Bexsero®, was approved last year. The US Food and Drug Administration (FDA), however, has not approved the vaccine for use in the US. Consequently, Princeton’s trustees are seeking emergency authorization from the US Centers for Disease Control and Prevention (CDC) to use the vaccine.
Media Myths about Mammograms
November 21, 2013
Universal screening programs, as promoted by Ms. Robach and her producers at Good Morning America, are not the answer. Such programs save few lives and come at great cost, despite what media reports might suggest.
The Dark Days
November 16, 2013
Doctors should not put the full responsibility on the family on whether or not to take a relative off life support, it should be a doctor and family team decision.
Punishing the Promoters
November 7, 2013
We need to encourage the Justice Department to demand increasingly larger penalties for illegally marketed drugs— in the range of $20, $30 or even $40 billion. These fines must substantially affect, or even eliminate, the profit that these companies earn from promoting inappropriate or unsafe use of drugs like Risperdal. Until then, it will simply be business as usual.
October 24, 2013
Stop asking for the latest and greatest drug simply because you saw a commercial for it while watching the evening news: newer doesn’t always mean better. And stop assuming that the drug your doctor recommends is the best choice: inquire about alternatives, including low-cost generics, and ask why they are or are not right for you.
My Last Lesson with Dad
October 20, 2013
The medical community can and should take steps to aid in American’s understanding and acceptance of death as a part of life. Modern medicine is full of amazing advances, but we should also be more honest about its limitations.
October 10, 2013
The only Americans who remain safe during the government shutdown are the politicians themselves, most of who are comfortably ensconced in gerrymandered districts that ensure continued re-election despite universal disgust with their partisan hijinks. The rest of us are at risk, whether we know it or not.
Criminalizing Bone Marrow Donation
October 5, 2013
On October 2, in the midst of the government shutdown—either HHS somehow managed to convince itself that the rule was “necessary for the protection of life” or, more likely, it had already been scheduled for printing—HHS quietly published a Notice of Proposed Rulemaking. The proposed rule would effectively moot the recent Ninth Circuit case of Flynn v. Holder by criminalizing the compensation of bone marrow donors, even when the life-saving stem cells are extracted through a newer, minimal risk procedure.
My L.A. Times Op-Ed: In Defense of the Evidence-Based Nudge
October 1, 2013
In short, we say that nudges are good, especially compared to the alternatives, but only if they’re done right.
Feeding the Poor is a SNAP
September 26, 2013
If Congress really wants to reduce the number of people receiving food stamps, the proposed cuts to SNAP are not the way to go. Rather, they should focus on more fundamental problems with the US economy: income inequity, stagnant incomes, and minimum wage laws that fall far below an actual living wage.
Three’s a Crowd
September 18, 2013
When you talk about genetically modifying humans (which is what we are talking about here), you open some very scary doors. If a person’s genetics can be modified to correct a genetic disease at conception, could they be modified to ensure the child will be tall? Or, to ensure she will have blue eyes? The potential is “designer children,” or children whose genetic makeup has been specifically chosen.
Do Androids Smoke Electronic Cigarettes?
September 13, 2013
E-cigarettes are a good thing in that they seem to help some smokers cut back or eliminate tobacco use. But their use by children and young adults could lead to nicotine addiction, which is a bad thing. At a minimum, the FDA needs to regulate them more tightly to ensure that they are as safe as possible for nicotine-addicted adults and to prevent their use by children.
Much Ado About UNOS
August 29, 2013
Given the fundamental structural problems with access and delivery of health care in the US, the system is just about as good as it can get. Until every American has comprehensive health insurance, and until that insurance also covers associated costs of care and treatment (like moving expenses for transplant candidates), the wealthy will have a greater chance to get scarce resources like organs. For now, the rest of us will simply have to rely on luck and bake sales.
August 25, 2013
Different, but equal, no one of us is more important than another. We have become a self-absorbed, self-obsessed culture, constantly on social media glorifying our own lives.
Land of the Free and Home of the Germs
August 15, 2013
We should devote more and more resources to public health as the frequency of illnesses and outbreaks declines – that means that those programs are working. We need to start rewarding those public health victories rather than responding to public health failures.
August 10, 2013
In total, 13 MLB players were suspended for purchasing performance-enhancing drugs (PEDs) through a Miami clinic. As fans we insist that our favorite sports get faster, better, and more exciting every year. We must choose: do we want a pure, clean, wholesome sport with potentially fewer home runs, and less excitement, or do we accept the use of PEDs?
Cracking the Health Code
July 25, 2013
Until we address the social and economic problems that affect our health, America will remain the sick cousin of the developed world.
Hunger Games: Guantanamo Bay
July 16, 2013
Several inmates in Guantanamo Bay are being force fed after going on a hunger strike. These forced feedings should not be happening because our military and our country are being manipulated by the prisoners at Guantanamo Bay.
In Sickness and In Health
July 11, 2013
One thing that supporters and opponents of legalizing same-sex marriage can agree on is this: the institution of marriage matters. The federal rights, benefits and privileges denied to same-sex couples until last month are important.
Take a Breath
July 1, 2013
Sarah is a 10 year old Cystic Fibrosis patient who was in desperate need of a lung transplant. The current transplant waiting list rules state that children under the age of 12 can receive lungs from an adult donor only if those lungs are not needed for an adult or adolescent in the same geographical area.
June 27, 2013
As a society, we are already obsessed with media-constructed but often unattainable notions of beauty and health. Pathologizing obesity compounds this problem.
June 23, 2013
Over the years the rise in autism cases has been blamed on vaccinations, fluoride, GMOs in food, and now pollution. Vaccination is probably the best known theory of autism cause.
On Being Amish
June 22, 2013
A 43-year-old pregnant woman (Mrs. M) is admitted to a rural hospital, with increased blood pressure and heart rate. She was found to have severe preeclampsia and prolonged preterm premature rupture of her membranes (PPROM), likely more than eighteen hours.
Look Before You Leap
June 15, 2013
Last week a US Food and Drug Administration (FDA) Advisory Committee recommended that restrictions on the diabetes drug, Avandia, be lessened. GlaxoSmithKline, the developer of Avandia, insisted that they had a study being performed that showed no increased risk of heart failure and had a superior design to the data analysis study.
Of DNA and Databases
June 7, 2013
Making decisions based on what we know about DNA today is never a good idea, genetics and manipulation of genes is an ever changing field and we need to be making decisions into the future
Death, Taxes and Medical Records
June 3, 2013
The Internal Revenue Service (IRS) is being charged with the illegal search and seizure of 60 million medical records from about 10 million Americans. The unauthorized seizure of medical records is a major concern.
Sweeping Sand Under the Rug
May 30, 2013
For 22 years now, sick veterans have been told that they are crazy, accused of being hypochondriacs, or denied benefits because their condition is not related to wartime service. It may turn out that none of that is true. Rather, the government may have sacrificed the health and well-being of military veterans in order to save a couple of bucks.
Printing New Parts
May 28, 2013
3-D print technology holds great promise for medicine, as ethical concerns often arise with limited organs available to donate. It remains to be seen how this can help alleviate this vital but scarce resource, but it will at least will improve medicine in the very near future.
What a Wonderful World It Would Be …
May 26, 2013
Patient advocacy and interacting well with patients is a vital, but often lost art in medicine.
Unintended Consequences: Obstruction of Patient Choice
May 19, 2013
Oregon was the first state to legalize aid-in-dying. Since 1998 it has implemented “Death With Dignity (DWD),” which allows eligible terminally ill people to end their lives peacefully with a legal prescription.
Kudos to This American Life
May 17, 2013
Huntington’s can cause behavioral and mood changes, including irritability, aggression and belligerence. It can also cause (less often) psychosis. But even if Huntington’s causes one with the disease to murder, or somehow contributes to the murder, it is in no way typical of the Huntington’s population as a whole.
Lara Croft: Cancer Activist
May 16, 2013
Actress Angelina Jolie revealed publicly that she had undergone a prophylactic double mastectomy — removal of both breasts — in order to reduce her risk of developing cancer.
The Law, Ethics and Science of Re-identification (An Online Symposium)
May 15, 2013
Over the course of the last fifteen or so years, the belief that “de-identification” of personally identifiable information preserves the anonymity of those individuals has been repeatedly called up short by scholars and journalists.
On Physician Assisted Dying
May 14, 2013
The Vermont state House approved a Senate amendment that provides legal protection and a strict protocol for physicians to follow. It permits physicians to prescribe a legal dose of medication with the knowledge that the patient will take the full dose with the intent to die. Insert here: your choice of words or phrase to illustrate your support or criticism.
Portrait of a Litterer
May 9, 2013
Heather Dewey-Hagborg is an American information-artist who, for her latest project, roams the streets of New York looking for cigarette butts, chewed gum, or strands of hair. She extracts DNA and has the DNA analyzed in a lab for certain genetic characteristics). From these results she uses a computer program and 3D printer to create a 3-demensional image of the person’s face.
On Hunger Strikes
May 3, 2013
In a strictly medical setting, if a patient refuses a treatment, there is a medically ethical obligation to pause and reconsider patient’s goals; if he has capacity, we should honor patient’s right to refuse. If the patient doesn’t have capacity, we still can’t do something to someone that doesn’t want it.
Fight or Flight
May 2, 2013
The sequester is bad policy. A game of political chicken gone awry, it has had a negative impact on a variety of largely successful federal programs.
This American Life and Stigma
April 19, 2013
People with HD are much more likely to be the victims of violence.Thanks to highly popular portrayals of HD like that in “Dr. Gilmer and Mr. Hyde,” the public has associations with HD that the already-horrible reality of the disease doesn’t bear out as typical, and they will likely project those associations on those with or at-risk for the disease.
We’re All Mad Here.
April 18, 2013
Diagnosing and treating mental illness is a challenge, but it’s a challenge that the American Psychiatric Association’s new guidelines fail to meet.
A Suicide Attempt, Part 2
April 17, 2013
We are obligated by the principles of beneficence (doing good- preserving life in this case) and non-maleficence (avoiding harm- potentially allowing a person to die who may not really want to) to be more confident.
Patenting the Building Blocks of Life
April 16, 2013
Imagine a world in which useful inventions, such as drugs, are immediately freely available to all. This world may seem attractive, but the process of invention is often costly and fraught with risk of failure.
A Suicide Attempt, Part 1
April 9, 2013
Bonnie tried to kill herself. . The cerebral palsy has taken away many parts of her life. Once the medical team gets involved, an interesting thing happens. It becomes very, very hard to convince us to honor that last wish.
Stripped for Parts
April 8, 2013
By changing the conversation and making adoption a decision to be praised and honored in our society we could decrease the overall number of abortions and fix a bit of the confusion in our society about life.
Bright Shiny Things
April 4, 2013
Not that we are facing an epidemic of attention deficit disorders in the US, but that we are likely facing an epidemic of pathologization. What is normal childhood behavior has become, for harried parents, teachers and physicians, a medical condition to be treated with drugs.
April 2, 2013
In the medical community, we should make a concerted effort to better understand and recognize the emotional needs of patients.
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