Up@dawn 2.0

Thursday, May 12, 2016

A bioethicist's "last lecture"

Glenn McGee (@glenn_mcgee)
Here is my last lecture, or at least this is what I would say if I could only give one more. I hope you enjoy it: youtube.com/watch?v=evYuZD…

Thursday, May 5, 2016

Misconception of Vaccines in the Anti-Vaccination Movement

            The purpose of this post is to inform the reader about common misconceptions of vaccines that some of the anti-vaccination public falsely rally behind.  In short, vaccinations are a preparation of killed microorganisms, living attenuated organisms, or living fully virulent organisms that is administered to produce or artificially increase immunity to a particular disease. No licensed American physician prescribes the use of vaccines containing fully virulent organisms, as it will most likely result in the virus infecting the patient resulting in the patient exhibiting the disease. This is not an option for most diseases. Live, attenuated viruses are a weakened version of the virus that will not cause the disease, unless the vaccine is not prepared properly. The overwhelming majority of vaccines are killed, purified. This killed, purified virus can in no way result in infection and disease. In most cases, no infectious material is present in a killed, purified vaccination and the immune response is triggered by the viral capsule and antigens (none infectious material).
            This leads into one of the big reasons individuals are anti-vaccination on a small scale and do not get annual vaccinations such as the flu shot. As you know, the flu changes early, so that our immunity induced the previous year is already null in our bodies combating of the disease. We require annual vaccination to combat the every changing virus. However, most individuals have the belief that every year they receive the flu from the flu shot. This is impossible as killed, purified vaccinations can in no way cause the illness for which it is designed to prevent. It is possible, though highly unlikely, for a patient to contract the virus when receiving the vaccines live, attenuated version, but this version is given as a mist instead of a shot and is virtually never used by doctors. In actuality, patients contract a minor disease with flu like symptoms before getting the vaccine. When symptoms appear due to the disease patients commonly attribute this to the vaccine. The flu is actually a very serious illness that doesn’t just leave you feeling crummy for two days. 36,000 people die and more than 200,000 are hospitalized by the flu yearly in the U.S. alone. Please take the time to get the vaccination yearly.
            Another issue the public has with vaccinations are the number that infants need to receive in one doctors visit. There are many reasons for the vaccination schedule being as it is. Firstly, we want to vaccinate our children as quickly as possible because unvaccinated children are at risk of being infected by a life ending and debilitating illness. Secondly, the vaccinations follow a pattern of about every three months. Parents remember to come to a doctors visit if it is for multiple different things, one of which is vaccinations. If vaccinations are separated, often parents miss appointments as they do not deem one vaccination as important or just forget to attend. This is shown by the irregularity of the schedule in which a hepatitis booster shot is not given at the same timing as any other shot. For this reason, it is the most missed shot on the CDC schedule. It is best to get three vaccinations done at one time to save time for more enjoyable activities. Finally, the schedule is in place with follow up shots placed at times critical for obtaining optimal immunity response. This schedule has been reviewed and established by professionals, and even though three shots is a lot for one baby in a single afternoon, the schedule is recommended for a reason. Please talk in length with a virologist if you wish to follow a non-CDC proscribed regiment.
            There are many other misconceptions that can be talked about in this article such as how vaccines had been fraudulently linked to autism, how they contain harmful ingredients, and treat non-existent viruses. However, as I am well over my word count, I will leave these up to you to research. I am happy talking about some of the lesser argued topics that vaccine and non-vaccine supporters both debate. Just please, no matter what side of the argument you believe in, do you research and find scientifically proven data that supports your claim. Do not just believe the catchy slogan posted on a Facebook wall or celeb tweet.

            Thank you for reading.

Hospice part two

My last post I discussed my interaction with Hospice.
With this post I will just discuss questions and then myths and facts about Hospice that I learned through my experience.

What does hospice really do?
How do I know when it’s time for end-of-life care?
When should hospice be called?
Where is hospice care provided?
Are all hospices the same?
Can my pain and symptoms be controlled at home?
Does Hospice provide 24-hour in-home care?
Can I live alone and still receive Hospice services?
Can a hospice patient choose to return to curative treatment?
Can I go back to the hospital and still receive hospice care?
Is the decision for hospice care giving up hope or waiting to die?
Does hospice do anything to bring death sooner?
Do I have to be homebound to receive hospice services?
Does hospice provide support to the family after the patient dies?
These are all common questions about Hospice. 

What does hospice really do?
Hospice provides specialized care services (patient care including symptom management, emotional support, spiritual support and psychosocial intervention), addressing issues most important to the patient’s needs and wants at the end of their life focusing on improving the individual’s quality of life.

When should hospice be called?
Hospice should be called at any time the patient has been diagnosed with a life-limiting illness. It is appropriate to discuss all of the patient’s care options, including hospice.

Is the decision for hospice care giving up hope or waiting to die?
No. Hospice is about living. Hospice strives to bring quality of life and comfort to each patient and their family. Our successes are in helping a patient and family live fully until the end. Often patients will feel better with good pain and symptom management. Hospice is an experience of care and support, different from any other type of care.

Myth: Hospice care is only for cancer patients
Truth: Hospice care is for all patients with a terminal illness with a prognosis of 6 months or less including but not limited to: Alzheimer’s, cardiac disease, ALS, stroke, liver disease.

Myth: Hospice is just for the elderly
Truth: Hospice is for all age groups during their final stages of life, including children and adults of all age groups.

Myth: Hospice is just for the patient
Truth: Meeting the needs of the patient and family is a top priority. The family unit is at the center of all decision making. Hospice recognizes that it takes many caregivers to meet the unique needs of each patient.


These are just some of the things that I learned with my experience with Hospice 

Wednesday, May 4, 2016

Owing Health to Our Neighbors

We owe our health to our neighbors. This, to me, feels part of a basic human duty; rather, I would go as far to say that it is a privilege. We can do what we can to give our neighbors health as they do the same for us, what better way to improve lives and work together than this simple statement. Unfortunately, that is not the case in most scenarios today, specifically when it comes to vaccines. So it then comes to how can we convince the rest of the world that this is a necessary course of action. We can look at some examples of how looking after one another, or even working together can produce positive effects, then understand why this is necessary.
            Alone, many animals are easily stalked and attacked by predators, leading to technique of predators separating singles out of a herd as a method of attack. Together, however, they are able to outnumber the predators with brute force or strength and protect one another. This is the case with vaccines and herd immunity. If everyone is vaccinated, producing immunity, then there is no host for a disease. Even if a vaccine is mostly ineffective, if given to everyone, a virus or sickness has trouble bouncing around and eventually dies out. There are also some exceptions for people who can’t take the vaccine for medical reasons or who the vaccine doesn’t fully work who are still susceptible, but because of herd immunity, they are protected from the virus being unable to reach them regardless. The problem is when fully capable people don’t have the vaccine. They not only expose themselves, but those who physically can’t take the vaccine.
 
            There is a case saying that these vaccines may cause harm themselves in very few cases, and if this were true there would be a reasonable claim. However, any of these claims have been proven false numerous times. There have only been very few cases that would even begin to link vaccines to sickness, and these are are not truly connected to vaccines. There is no real case as to why anyone would avoid vaccines. Rather, vaccines have helped the world by getting rid of nasty diseases that have ravaged the world for a long period of time, as seen in the graphic above.
            It is important for people to know the risks they put onto others by refusing vaccines. There is no real circumstantial evidence that they can cause illness and their proven success at eradicating diseases are irrefutable. It is easy for people to partake in certain activities that are proven to be harmful to themselves and still do them, and that is okay because it doesn’t effect anyone else. They understand the risks and are willing to endure them for something they are passionate about or enjoy doing. What is hard for me to grasp is that when they can do something that helps themselves as well everyone around them, there are some people who choose to take the safe route. To truly convince others, it is necessary for they themselves to look into the facts for themselves, on both sides, to understand what is true and what is necessary.
            Taking this class has allowed me to see the importance of looking into things through research and through introspection as well. It is important to understand that one’s own viewpoint isn’t the only one, and there are other views that likely make more sense and more valid. My biggest take away is to step back and look at situations from every possible angle before making rash assumptions.


Tuesday, May 3, 2016

Perfect Athletes?


           In my last post, I discussed the subject of designer babies and a society filled with perfect humans. In this post, I would like to specifically address the ethics of performance enhancements used in athletics. Some of these enhancements include transfusions, hormone injections, genetic modifications, and altitude training. First, I would like to give some background information on some of the enhancements that athletes use.

A type of transfusion that some athletes use to enhance performance is blood doping. Blood doping is the act of increasing the amount of “energy-fueling” oxygen in one’s blood. This performance enhancement began in the 70s and was banned in the 80s. This assists athletes because when exercising one uses more oxygen than normal. If one increases the amount of oxygen in their blood, they will be able to compete for longer without feeling drained. 

               
Another type of enhancement is hormone injections. These are more commonly known as steroids. A common steroid is erythropoietin. Erythropoietin is a protein produced by the kidneys that stimulates red blood cell production. This is similar to blood doping because it also increases the amount of oxygen in the athlete’s blood. Athletes also use genetic modifications, also known as gene doping, to increase athletic performance. Athletes will attempt to cheat by altering their genes to build muscle and boost oxygen levels in the blood, similar to the other enhancements. Genetic modifications are becoming more popular in the sports industry, specifically Olympic swimming because it is nearly impossible to detect.

I believe that transfusions, hormone injections, altitude training, and genetic modifications do not share the same ethical status. Transfusions, hormone injections, and genetic modifications are not ethical because they all involve adding foreign enhancements to one’s body to increase athletic performance. I believe that altitude training does not create an ethical problem. If an athlete lives in the mountains and trains in a higher altitude, it will be easier for them to compete at a lower altitude, however that athlete is still training. He or she is just at an advantage because they live in a high-altitude environment. Another example of this would be a track runner that trains on a beach. It is harder to run in the sand, just as it is harder to breathe in high altitudes. Therefore, the track runner will have an advantage because it will be easier to run on the track.


I do not believe that it is clear where we should draw the line between "natural gifts" and artificial enhancements. With the technology we have today, it is hard to distinguish who has a natural talent and who is “gene doping” or getting transfusions. I do agree with the advancement of medical science, because I believe it is important for humans to continue to learn more about our species. The medical and genetic advancements that are in our near future are interesting, however I feel that we, as humans, should be careful when dealing with perfecting our race, as well as our sports. Eventually sports will lose value and humans will lack individuality.  

Human Reproductive Cloning Pt. 2


In the last post, we discussed the background history of reproductive cloning, basic scientific knowledge, cloning techniques, and the purpose of reproductive cloning. In this post, I will focus on the pros and cons of human reproductive cloning, as well as the ethical issues associated with it.

 


 

Pros of Human Reproductive Cloning

 

1.    It can eliminate defective genes

·               Scientists believe that genetic illness can one day be a leading cause of death. When humans are reproduced, it damages their DNA lines, which creates defective and mutated genes. This problem could be resolved my cloning healthy human cells.

2.    The “Next Step” in Reproductive technology

·               Couples who are infertile, would be giving the chance to produce clones of themselves. Couples who have lost children, could be given a chance to replace their loved ones. While also people who are considered to be a “genius” could be cloned, so they world has more people who think the way they do.

3.    Can eliminate infertility

·               Infertility could be eliminated because scientists would be able to take cloned cells to create a younger twin of a father or a mother. Infertile couple would not have to go through the depression stage of not having children. They would be able to have their own families without enduring painful procedures to treat infertility.

4.    It can cure disorders

·               It can help cure certain disorders by replacing damaged tissues and organs within the human body. Scientist believe that human cloning can completely transform the way many disorders are being performed.

 

Cons of Reproductive Cloning

 

1.    It can reduce individuality

·               Although human clones would have their own brand new set of life, researchers believe you still loss a sense of having your own individual personality.

2.    It can cause a divide among people

·               Human reproductive cloning could potentially divide people, normal people from “perfect” people. It could create a societal division where “perfect” clones can be treated in a different way than those who are naturally born.  

3.    It has a lot of failure

·               90% of human cloning attempts have been labeled as a “failure” meaning the DNA is put at risk during the attempt. Human DNA can be contaminated. The implications of what happens with the Reproductive process when it goes wrong, is still unclear. This is not good and could lead to problems that are not able to be resolved.

 

Ethical Issues

 

·               Some people who have religious beliefs are against the process of cloning humans. They believe that it results in man becoming the creator instead of the higher power. Most people who value their religious belief disagree with this technology.
 

·               People also say that a clone is not a “real person”, the clone is not “natural” and the clone is “playing the God”


·               Another ethical issue is health risks to the mother. Telemetric differences can occur, as well as abnormal gene expression patterns. 98% of mammalian cloning has resulted in miscarriages, stillbirths and deformities. Safety in reproductive cloning would also result in unethical experimentation of women.

 

There are also several other ethical issues associated with human reproductive cloning. Below is a debate discussing human reproductive cloning.

 

 

Commidified Breast Milk: From a Ethical View (Part 2)

In my first blog post I discussed the ethical concern of who was receiving pumped breast milk.  For this post I want to focus on the person actually supplying the breast milk. As a mother and a devout, card carrying, soap box dragging feminist this is a very touchy issue, mainly because I can go either way. Many believe that having a market for breast milk might exploit those who struggle economically by having them choose to sell their breast milk for additional income while receiving formula for their child using government assistance. Others believe that it is the woman's choice and therefore we can't dictate what she does with her breast milk, including in the scenario that I just mentioned.

I have two children (pictured above because every mom tries to sneak in a picture of her kids to show off their cuteness) and I was blessed with the ability to breastfeed them both. I adored being able to feed them and I was lucky that I never struggled to provide breast milk for them, in fact, I had an over abundance and chose to donate. Could I have sold it? Absolutely, but I chose to seek out other women who desperately needed the milk and didn't have the funds to pay for it through a hospital. Anyone have a problem with that? Probably not.

But what if I were poor? That's where we run into a tricky ethical issue. As a feminist I want to scream, "You go mama! Sell that liquid gold and make some money!" while at the same time saying, "You are not a cow! You are reinforcing gender, social, and economic inequalities!" See the dilemma?

So know that we have a established the dilemma lets talk about the solution. The other problem is that there isn't one. There are advocacy groups that address both sides of this argument, a few are the NABADonateMilk, and the BMBFA. When most people think about breastfeeding advocacy groups they imagine a group of women going into an establishment that asked a breastfeeding mother to cover up and staging a "nurse" in or protest, but mostly they are just trying to look out for the mothers. The executive director of BMBFA made the following statement when an Oregon based pharmaceutical company offered to pay women for their breast milk, "...it reeks of exploitation." Below is a news story were these exact concerns are addressed.

Because of the nature of this ethical issue, there will likely never be a clear cut solution or agreement on how commodifying breast milk should be addressed, but that doesn't mean we should stop talking about it.

Reflecting on the texts we've read this semester, I think the most important thing for health-care providers and caregivers to know and remember is that we are all different. We all have a different back story and different needs (physically, emotionally, and mentally) and our care should be as tailored to who we are and our needs as possibly.

Stem cells: The Great Debate

First Installment: http://bioethjpo.blogspot.com/2016/04/physician-assisted-suicide-death-with.html


One notable area of discussion is the therapeutic advancements for treatment of declining health and disease through the implementation of stem cell treatment.  Stem cells are biological cells that can differentiate into specialized cells and divide to produce more stem cells. 
Doctors, presidents and researchers have debated this exciting, yet contentious cure with an uneasy resolution.  Human cloning has sparked discontent nationwide.  Specifically, the Bush administration promoted an embryo protectionist position with executive order restricting federal funding.
Stem cells have the potential to mirror the 206 cell types in our human body.  Scientists predict one day that stem cells will be able to duplicate entire organs and serve as transplants.  In this year, a micro heart muscle was created from stem cells.  Furthermore, in May 2016, a news release states researchers are presently altering skin cells chemically into heart and brain cells through the advent of stem cells.
Adult stem cells are found in nearly every tissue and serve as a remedy in tissue regeneration.  The key proponent for bioethics is the usage of these cells in the destruction of human embryos for their vital stem cells.  Most Americans view an embryo as a human life with great moral value and with a strong ethical need for protection.  This is my personal sentiment.
There is intense bioethical issues with human stem cells for research.  The collection and use of somatic (adult) stem cells from aborted fetuses and umbilical cord blood is ongoing.  Stem cells taken from the umbilical cord just after birth involve the least risk with autologous harvesting.  These cells are obtained from one’s own body. Yet the most intense debate is on the human embryonic stem that has the capacity to evolve into different types of human tissue.    
Since 1998, these cells have been cultured from embryos giving voice to ethical judgement.   Pro-life and religious organizations have been a major force driving the policy on the future of stem cells.  This ethical dilemma will be ongoing for decades to come.
To advance stem cell science, there are alternative means of studying and utilizing the properties of stem cells.  Pluripotent (iPS) stems cells are identified as curative and do not use the destruction to human embryos.  Also, stem cells from already-deceased embryos are a possible option.  Moreover, stem cells obtained from living embryos by non-destructive biopsy and stem cells obtained from somatic cells are a future option.
Pluripotent cells are dermal fibroblasts genetically engineered to behave like normal stem cells.  Under the Obama administration, the bioethical stance is to lean toward how stem cell research can go forward instead of whether it can be conducted. 
Only recently has there been in place professional guidance for scientists to translate basic stem cell research into effective clinical applications for patients.  Today, uniform standards for cell processing and manufacture must be agreed upon by the international community of researchers, stem cell banks and regulators.  Standards for pre-clinical testing using animal models must be clarified before the human clinical trials begin, and fair procedures for enrolling humans in early stem cell clinical trials must be fully reviewed.
There is no immediate solution to the ethical application of stem cell usage in curing our many ailments in a large world of seven billion humans.  The magic in the properties of these cells is both encouraging and perplexing.  Political support will be a strong influence to allow this study to go forward.  It is definite that stem cells are restorative to our health and an option to explore with intense viability.  

Useful Link: http://www.mayoclinic.org/tests-procedures/stem-cell-transplant/in-depth/stem-cells/ART-20048117