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Friday, January 25, 2019

Quiz Jan 29

Clinical Ethics. But let's first revisit whatever we didn't get to last time pertaining to "perspectives" (for instance, Plato's Euthyphro, the bioethical significance of the Biblical tale of Abraham and Isaac, et al)... and I just heard a fascinating episode of the Hidden Brain podcast exploring ways in which the convergence of different perspectives fuels creativity, including scientific creativity.

1. (T/F) Dignity, respect, and confidentiality are among the aspects of the clinical relationship which emphasize the importance of trust. 

2. What (according to most recognized oaths and conventions) must always be the deciding factor guiding professional decisions? 

3. The idea that the doctor always knows best is called what? 

4. Is a diagnosis of mental illness grounds for establishing a patient's lack of capacity to render competent consent to treatment? 

5. What general principle allows breach of confidentiality? 

6. What term expresses the central ethical concern about "designer babies"? What poet implicitly expressed it?

7. Why have organizations like the WHO opposed any form of organ trading?

8. Besides the Kantian objection, what other major ethical issue currently affects regenerative medicine?

9. What does palliative medicine help recover?

10. What would most of us consider an unwelcome consequence of not retaining the acts/omissions distinction with respect to our response to famine (for example)?

DQ


  • How do you generally go about establishing trust in a new relationship? Do such general considerations apply equally to the clinical relationship? How does "professionalism" relate to trust?
  • Considering the "demented professor" (81) and other instances of patients whose expressed "best interests" may conflict with a clinician's therapeutic impulses: how important is the patient's present happiness, in influencing your clinical evaluation?
  • What's wrong, if in fact the doctor does possess more accurate information and more relevant experience, with treating the patient after the analogy of parent and child?
  • What would Dr. House do about patients who make (in his opinion) foolish decisions regarding their care? Would you hire him to work in your hospital?
  • Under what circumstances would you NOT violate confidentiality and inform a patient's partner that they were HIV positive?
  • What concept is more relevant in evaluating the ethical status of abortion: viability, humanity, personhood, maternal rights, or... ?
  • What do you think of Thomson's violinist analogy (91-2)?
  • Can a baby really have five parents (as opposed to five co-progenitors)? How do you define parenthood?
  • Should surrogacy, organ trafficking, and transplant tourism be regulated? How, and by whom? 
  • Do you think our society has a healthy attitude towards mental illness? Is it possible to declare a politically and ideologically neutral standard of sanity?
  • How would you counsel patients who insist they no longer value their "quality of life" and refuse potentially effective treatment and medication?  
  • Can the medical profession ever fully embrace the concept of ars moriendi, the art of dying?
  • Can you imagine ever facilitating a suicide, professionaly or personally?
  • Is there anything wrong with displaying cadavers in a museum exhibit (as in "Bodies: The Exhibition")? What guidelines should be followed?

==
Nurse Charged With Sexual Assault of Woman in Vegetative State Who Gave Birth
A nurse at a Phoenix nursing home who had been assigned to care for a woman in a vegetative state who was raped and later gave birth to a child was charged on Wednesday with sexual assault, the police said.

Detectives at the Phoenix Police Department took the nurse, Nathan Sutherland, 36, in for questioning in the case on Tuesday, the police said, and collected a DNA sample from him that matched that of the child, a boy who was born on Dec. 29. Mr. Sutherland was booked on Wednesday morning at the Maricopa County Jail on one charge of sexual assault and one charge of vulnerable adult abuse, the police said.

“Through a combination of good old-fashioned police work, combing through evidence, talking to people and following up on information, combined with the marvels of DNA technology, we were able to identify and develop probable cause to arrest a suspect,” Jeri L. Williams, the Police Department’s chief, said at a news conference on Wednesday.

Detectives started to focus on Mr. Sutherland because he was among the medical staff members at the nursing home, Hacienda HealthCare, who were assigned to care for the woman around the time last year that the police believe she was assaulted. The woman had been at the nursing home since 1992 and since then had been in the same condition, unable to communicate or move, according to medical records. A lawyer for the family on Wednesday said they were aware of the arrest but had no comment... (continues)
==
Also of interest:

Drug Shortages Forcing Hard Decisions on Rationing Treatments...In a survey of cancer doctors conducted in 2012 and 2013, 83 percent of respondents who regularly prescribed cancer drugs reported having been unable to provide the preferred chemotherapy agent at least once during the previous six months. More than a third of them said they had to delay treatment “and make difficult choices about which patients to exclude,” according to a letter published in The New England Journal of Medicine.

The threat of future shortages in children’s treatments is serious enough that Dr. Peter Adamson, who leads the Children’s Oncology Group, the largest international group of children’s cancer researchers, assigned his organization to set priorities. “We’ve been forced into what we think is a highly unethical corner,” he said in an interview...
==
Scientists create a part-human, part-pig embryo — raising the possibility of interspecies organ transplants
http://wapo.st/2k85Wt3

http://www.nytimes.com/2017/01/26/science/chimera-stemcells-organs.html?smprod=nytcore-iphone&smid=nytcore-iphone-share
Human stem cells could be implanted in an early pig embryo, making a chimera with human organs suitable for transplant.

http://www.nytimes.com/2017/01/26/opinion/mr-trumps-gag-rule-will-harm-global-health.html?smprod=nytcore-iphone&smid=nytcore-iphone-share
The president has greatly expanded a policy restricting federal aid to health organizations abroad that talk to women about abortion.
==
The Struggle to Conceive With Frozen Eggs
Brigitte Adams caused a sensation four years ago when she appeared on the cover of Bloomberg Businessweek under the headline, “Freeze your eggs, Free your career.” She was single and blond, a Vassar graduate who spoke fluent Italian, and was working in tech marketing for a number of prestigious companies. Her story was one of empowerment, how a new fertility procedure was giving women more choices, as the magazine noted provocatively, “in the quest to have it all.” (continues, WaPo)
==
Does living forever sound ideal? These 5 new books will change your mind.Aside from Betty White, the examples of immortality are not encouraging. The ancient Greeks — who, by the way, are all dead now — sang a particularly harrowing tale of Tithonus. He was that prince who got to live forever but kept aging, which is why you should try to stay out of the sun as much as possible when you are young. Centuries later, Christianity promised everybody eternal life, but where and how you might be spending it was a matter of fiery debate. (continues, WaPo)==

Would you like to live forever? Some billionaires, already invincible in every other way, have decided that they also deserve not to die. Today several biotech companies, fueled by Silicon Valley fortunes, are devoted to “life extension” — or as some put it, to solving “the problem of death.”

It’s a cause championed by the tech billionaire Peter Thiel, the TED Talk darling Aubrey de Gray, Google’s billion-dollar Calico longevity lab and investment by Amazon’s Jeff Bezos. The National Academy of Medicine, an independent group, recently dedicated funding to “end aging forever.”

As the longevity entrepreneur Arram Sabeti told The New Yorker: “The proposition that we can live forever is obvious. It doesn’t violate the laws of physics, so we can achieve it.” Of all the slightly creepy aspects to this trend, the strangest is the least noticed: The people publicly championing life extension are mainly men.

Not all of them, of course. In 2009, Elizabeth Blackburn received the Nobel Prize for her work on telomeres, protein caps on chromosomes that may be a key to understanding aging. Cynthia Kenyon, the vice president for aging research at Calico, studied life extension long before it was cool; her former protégée, Laura Deming, now runs a venture capital fund for the cause. But these women are focused on curbing age-related pathology, a concept about as controversial as cancer research. They do not appear thirsty for the Fountain of Youth.

Professor Blackburn’s new book on telomeres couldn’t be clearer. “Does our research show that by maintaining your telomeres you will live into your hundreds?” it says. “No. Everyone’s cells become old and eventually we die.” Ms. Kenyon once described her research’s goal as “to just have a healthy life and then turn out the lights.” Even Ms. Deming, a 23-year-old prodigy who worked in Ms. Kenyon’s lab at age 12, points out that “aging is innately important to us.”

Few of these experts come close to matching the gaudy statements of the longevity investor and “biohacker” Dave Asprey, who has told journalists, “I decided that I was just not going to die.” Or those of Brian Hanley, a microbiologist who has tested an anti-aging gene therapy he developed on himself, who claimed: “There’s a bunch of things that will need to be done to achieve life spans into at least hundreds of years. But we’ll get there.” Or of the 74-year-old fashion mogul Peter Nygard, who during a promotional clip receives injections of his own stem cells to reverse his aging while declaring: “Ponce de León had the right idea. He was just too early. That was then. This is now.”

I came across Mr. Nygard’s ode to human endurance three years ago while beginning research on a novel about a woman who can’t die, and watching that video allowed me to experience something close to life extension. As Mr. Nygard compared himself to Leonardo da Vinci and Benjamin Franklin while dancing with a bevy of models — or as a voice-over explained, “living a life most can only dream of” — nine minutes of YouTube expanded into a vapid eternity, where time melted into a vortex of solipsism.

At that time I was immersed in caring for my four young children, and this paean to everlasting youth seemed especially stupid. I recall thinking that if this was eternal life, death didn’t seem that bad.

But now, as powerful men have begun falling like dominoes under accusations of sexual assault, that video with its young women clustered around an elderly multimillionaire has haunted me anew. As I recall my discomfort with the proclamations of longevity-driven men who hope to achieve “escape velocity,” I think of the astonishing hubris of the Harvey Weinsteins of the world, those who saw young women’s bodies as theirs for the taking.

Much has been said about why we allowed such behavior to go unchecked. What has remained unsaid, because it is so obvious, is what would make someone so shameless in the first place: These people believed they were invincible. They saw their own bodies as entirely theirs and other people’s bodies as at their disposal; apparently nothing in their lives led them to believe otherwise.

Historically, this is a mistake that few women would make, because until very recently, the physical experience of being a woman entailed exactly the opposite — and not only because women have to hold their keys in self-defense while walking through parking lots at night. It’s only very recently that women have widely participated in public life, but it’s even more recently that men have been welcome, or even expected, to provide physical care for vulnerable people.

Only for a nanosecond of human history have men even slightly shared what was once exclusively a woman’s burden: the relentless daily labor of caring for another person’s body, the life-preserving work of cleaning feces and vomit, the constant cycle of cooking and feeding and blanketing and bathing, whether for the young, the ill or the old. For nearly as long as there have been humans, being a female human has meant a daily nonoptional immersion in the fragility of human life and the endless effort required to sustain it.

Obviously not everyone who provides care for others is a saint. But engaging in that daily devotion, or even living with its expectation, has enormous potential to change a person. It forces one to constantly imagine the world from someone else’s point of view: Is he hungry? Maybe she’s tired. Is his back hurting him? What is she trying to say?

The most obvious cure for today’s gender inequities is to put more women in power. But if we really hope to create an equal society, we will also need more men to care for the powerless — more women in the boardroom, but also more men at the nurses’ station and the changing table, immersed in daily physical empathy. If that sounds like an evolutionary impossibility, well, it doesn’t violate the laws of physics, so we can achieve it. It is surely worth at least as much investment as defeating death.

Perhaps it takes the promise of immortality to inspire the self-absorbed to invest in unsexy work like Alzheimer’s research. If so, we may all one day bless the inane death-defiance as a means to a worthy end.

But men who hope to live forever might pause on their eternal journey to consider the frightening void at invincibility’s core. Death is the ultimate vulnerability. It is the moment when all of us must confront exactly what so many women have known all too well: You are a body, only a body, and nothing more.

Dara Horn is the author, most recently, of the novel “Eternal Life.”
==
An old post-
Bioethics today is about the ways our vision of issues and outcomes may be occluded, blurred, or otherwise compromised by our respective points of view or perspectives. Of course this is not unique to bioethics, all human comprehension is subject to bias by the attenuation of culture, gender, religion, ideology, experience, the absence of experience, greed, egoism, and on our list could go. It is in our nature to see what we've seen, to see what we want to see, to see through a glass darkly. Without corrected vision the people perish.

Our native tendency to frame experience incorrectly, conformable to our own pre-vision and hence occlusive of other ways of seeing and clinically intervening, is a constant challenge to the fair-minded ethicist. Bioethical philosophers across the perspectival spectrum presume to prescribe corrective frames, but inattention to the varieties of sight is a constant hazard. Here's a link to a good little essay on the subject, from esteemed bioethicist Arthur Caplan: "When Religion Drumpfs Medicine."

We should play with this metaphor. As a lifetime wearer of framed corrective lenses, I can attest to the temporary excitement of a new prescription, or even just a stylish new frame to house the old set of lenses. The trick is always to find frames that hold up through every season of wear, that don't grow tiresome, and that justify the expense of change. (My wife returned from Costco one day reporting that the same frames she'd found at the Eye Doc's were $100s cheaper there.) Sometimes new lenses in the old frame suffice, sometimes you just need a new look.

So, some of the perspectives we'll try to focus and reframe today: attitudes and assumptions around HIV/AIDS, especially as occluded by miseducation; violence as a public health issue; "feminist critiques" of contingently-drawn, historically-conditioned categories of masculinity and femininity, locked into patriarchal institutions and practices that discriminate against women; misogyny; marginalization; advocacy; embodiment; empowerment; relational autonomy; metaphysical dualism; care; furor therapeuticus; female genital mutilation; "Asian bioethics"; Plato's Euthyphro; Abraham & Isaac; Buddhism; and more.

How do you get that "new look"? I always like to suggest trying the John Rawls Original Position/Veil of Ignorance frames. Some of us can wear them.

One more indulgence, before discussion: the snarly TV doc Gregory House was suggested by a student last semester as a good example of how some practitioners seem driven less by the patient's best care than by their own egoism. But, getting the diagnosis and treatment right regardless of motive and ego still seems the most important thing. Doesn't it? Maybe you can find & share links to other YouTube moments illustrative of good and bad medical-ethical practice.

Also of interest:
HHS nominee skirts questions about impact of Drumpf’s executive order on ACA

President Drumpf’s choice for health secretary declined Tuesday to promise that no Americans would be worse off under Drumpf’s executive order to ease provisions of the Affordable Care Act — and distanced himself from the president’s claim to have an almost-
finished plan to replace the law.

At a testy Senate confirmation hearing on his nomination to lead the Department of Health and Human Services, Rep. Tom Price (R-Ga.) sought to play down the influence he would have on reshaping the health-care system along conservative lines, while attempting to deflect accusations from Democrats about his ethics.

He repeatedly flashed his long-standing distaste for federal insurance standards and other government strategies to guide medical care. And although he embraced certain policies popular within the GOP, such as special insurance pools for patients with preexisting medical conditions, he steered clear of other ideas he has supported, including the transformation of Medicaid from an entitlement program for lower-income people to a set of block grants to states.

By the time the hearing ended after four hours, the Senate Finance Committee’s partisan divisions appeared as bitter as they had at the beginning, with the Republicans aligned solidly behind the nominee despite sharp Democratic attacks on his investment and legislative practices.

Chairman Orrin G. Hatch (R-Utah) praised Price as a singularly qualified nominee and took broad swipes at Senate Democrats, saying they were tearing at the fabric of the chamber as an institution with their attempts to undercut Drumpf’s Cabinet ­choices.

The committee’s ranking Democrat, Sen. Ron Wyden (Ore.), countered that Price, if confirmed, would “take America back to the dark days when health care was for the healthy and the wealthy.” Focusing on the private investments in health-care companies that could have benefited from bills Price sponsored, Wyden said that “it is hard to see this as anything but a conflict of interest and an abuse of position.”

[Who is Tom Price?]

A fresh allegation Tuesday was that Price underreported to the committee and the Office of Government Ethics the value of shares he holds in an Australian company, Innate Immunotherapeutics. Price, who purchased some of that stock through a discounted, private offering, attributed the under­reporting to “a clerical error” and a misunderstanding of the question.

“The reality is that everything that I did was ethical, above­board, legal and transparent,” Price said — a message Republicans sought to reinforce throughout the hearing.


Democrats targeted most of their questioning on the direction that Price, if confirmed, would try to take the health-care system. Price demurred repeatedly.

For instance, he sidestepped a series of questions about the effects of the sweeping order Drumpf issued just hours after his ­swearing-in that directed agencies to lift or soften federal rules implementing aspects of the ACA. Price declined to commit that no one would be harmed, that no one would lose insurance coverage or that the regulations would be rewritten only after a plan exists to replace the 2010 health-care law.

He similarly deflected a question about whether the new administration would try to stop enforcement of the ACA’s individual insurance requirement prior to a replacement plan.

See how your coverage could be impacted by four prominent plans proposed by RepublicansVIEW GRAPHIC 

“I commit to working with you,” Price finally told Wyden after reiterating that his goal is to ensure all Americans have an opportunity for access to health insurance. The ACA’s goal is universal coverage.

“We didn’t get an answer,” Wyden retorted.

Price also skirted questions by Sen. Sherrod Brown (D-Ohio) about Drumpf’s statements the weekend before his inauguration that the health-care plan he was completing would provide “insurance for everybody.”

Brown asked: “President Drumpf said he’s working with you on a replacement plan for the ACA, which is nearly finished and will be revealed after your confirmation. Is that true?”

Price replied: “It’s true that he said that, yes.”

The packed hearing room broke into laughter.

Brown persisted: “Did the president lie about this, that he’s not working with you?”

The nominee gave an oblique answer, saying, “I’ve had conversations with the president about health care.”

[HHS nominee’s mix of investments, donations, legislations keeps raising questions]

Tuesday’s hearing was the more significant of two appearances Price has made in the past week on Capitol Hill because the Finance Committee has jurisdiction to vote on his nomination. A date has not been set.

Democrats’ numerous attacks on Price in the past week prompted Sen. Johnny Isakson (R-Ga.), who officially introduced Price to his Finance Committee colleagues, to say, “I feel like I’ve been asked to be a character witness in a felony trial in the sentencing phase of a conviction.” WaPo
==
Faith-Based Decisions: Parents Who Refuse Appropriate Care for Their Children
Adam Lovell*, an active 2 ½ -year-old boy, was healthy until the day his parents took him to the local emergency department for vomiting and a suspected case of acute gastroenteritis. To the physicians, Adam appeared lethargic and was responsive only to painful stimulus. A blood culture was obtained, and other laboratory tests were performed. The blood culture later grew a meningococcus. Within hours "purple splotches" appeared on his face, legs, and trunk. Adam was diagnosed with meningococcemia and was started on appropriate antibiotics and steroids administered intravenously. Adam was intubated to stabilize his airway and transported to the County Memorial Hospital. On arrival, his perfusion was poor and blood pressure low. The tips of all his digits were dark blue; purpura (purple splotches) were present over most of his trunk, feet, and hands in a "stocking-glove" distribution. Intravenous fluid boluses and vasoactive drug infusions were administered. Adam's parents consented to multiple blood component therapy to treat a coagulopathy. Adam was also treated for respiratory failure related to meningococcal sepsis with both conventional and high frequency mechanical ventilation for the first 11 days of hospitalization.

At 10 days, Adam had well demarcated patches of dry, devitalized tissue (dry gangrene) on both of his feet, his left hand, and the fingers of his right hand. An eschar was present on the posterior surface of his right thigh. Ulcerated areas of skin were present in the perineal region. Consulting surgeons talked to his parents about the risks, benefits, and alternatives of amputation and debridement of portions of both of Adam's feet, his left hand, and the fingers of his right hand. The Lovells consented to the debridement and surgical treatment and signed the consent form. Shortly thereafter the family's minister came to the hospital and prayed with Adam's parents for God to restore life to the devitalized tissues. Soon afterward, the Lovells rescinded consent to surgical treatment and communicated that they wished to allow time to elapse so that God could heal Adam's dead and injured tissues. When the physician and the surgeon told Adam's parents that infection and sepsis would be inevitable without treatment, they agreed verbally that, in the event of sepsis, amputation should be performed.

Over the ensuing 2 ½ weeks, physicians met with the Lovells and vigorously attempted to persuade them to proceed with Adam's amputation and debridement of dead tissues. Mr. and Mrs. Lovell remained adamant that an expectant approach be maintained. During this time neither sepsis nor wet gangrene, which would have offered absolute indication for surgical intervention, occurred. Despite the best efforts of the family and staff, many hours elapsed where Adam remained quiet and alone in his bed. He would cry and appeared to be sad. At times he cried out "hand" while gazing at his outstretched and mummified hands. During visits, the Lovells read the Bible to Adam and assured him that God would direct his hands and feet to re-grow. The Lovells asserted to the staff that Jesus had arisen from the dead and shown himself to believers, and that God would revitalize Adam's dead tissues. Both family-associated and hospital-based clergy were regularly present to expand opportunities for mutual understanding of religious and medical issues. Adam's parents were repeatedly confronted with the ever-present and increasingly imminent reality that Adam needed amputations to prevent new onset of sepsis and to avoid possible death from sepsis.

After almost a month in the pediatric intensive care unit, Adam began to experience fevers and his white blood cell counts increased; both signs were indicative of developing infection. Therapy with topical and systemic antibiotics was continued and modified. His parents were informed of the changes and of the increasing need to consent to surgical therapy. In an effort to reinforce the inescapable need for surgical therapy, the physicians consulted with a burn surgeon at a neighboring institution by telemedicine. The surgeon confirmed that amputation was unavoidable. These communications were shared with the Lovells, who nevertheless, were not dissuaded from insisting upon further observation. Despite considerable effort to understand and support the parents by their own family members, by the medical staff, by social service, by psychology and by clergy (hospital and family), a clear impasse had been reached. The Division of Social Services (DSS) was engaged to evaluate the case for a possible claim of medical neglect against Adam's parents. With the possibility of the child's custody being assumed by DSS, the parents signed consent for amputation and debridement. The mother signed consent because "only death would take my baby from me." The family requested that a "hands-on" surgical evaluation be performed at another medical facility. This request was granted. Expedited transfer was made, surgical intervention was deemed necessary by the receiving surgeon and amputation and debridement followed within 2 days.
(continues)
==
Letting them die: parents refuse medical help for children in the name of Christ
The Followers of Christ is a religious sect that preaches faith healing in states such as Idaho, which offers a faith-based shield for felony crimes – despite alarming child mortality rates among these groups
Mariah Walton’s voice is quiet – her lungs have been wrecked by her illness, and her respirator doesn’t help. But her tone is resolute.

“Yes, I would like to see my parents prosecuted.”

Why?

“They deserve it.” She pauses. “And it might stop others.”

Mariah is 20 but she’s frail and permanently disabled. She has pulmonary hypertension and when she’s not bedridden, she has to carry an oxygen tank that allows her to breathe. At times, she has had screws in her bones to anchor her breathing device. She may soon have no option for a cure except a heart and lung transplant – an extremely risky procedure.

All this could have been prevented in her infancy by closing a small congenital hole in her heart. It could even have been successfully treated in later years, before irreversible damage was done. But Mariah’s parents were fundamentalist Mormons who went off the grid in northern Idaho in the 1990s and refused to take their children to doctors, believing that illnesses could be healed through faith and the power of prayer.

As she grew sicker and sicker, Mariah’s parents would pray over her and use alternative medicine. Until she finally left home two years ago, she did not have a social security number or a birth certificate.

Had they been in neighboring Oregon, her parents could have been booked for medical neglect. In Mariah’s case, as in scores of others of instances of preventible death among children in Idaho since the 1970s, laws exempt dogmatic faith healers from prosecution, and she and her sister recently took part in a panel discussion with lawmakers at the state capitol about the issue. Idaho is one of only six states that offer a faith-based shield for felony crimes such as manslaughter.

Some of those enjoying legal protection are fringe Mormon families like Mariah’s, many of whom live in the state’s north. But a large number of children have died in southern Idaho, near Boise, in families belonging to a reclusive, Pentecostal faith-healing sect called the Followers of Christ... (continues)
Posted by at 13 comments:

Thursday, January 24, 2019

Eradicating disease

        The other day, a coworker and I were engaging in a deep conversation about life. One of the topics we arrived at was the question "is it right for mankind to exterminate disease (and if so, is it our obligation)". We were unable to finish this conversation, but a topic in the reading stimulated more thought on this matter. In the reading, an excerpt from the WHO details that HIV/AIDS is the leading cause of death in women of reproductive age. In my evolution class, we talked about HIV/AIDS to great length, and it makes an interesting case for the aforementioned question about exterminating disease.
   
        HIV is unique among viruses and bacteria in that its rate of mutation (and therefore evolution) is exceptionally high. Unbeknownst to this fact, scientists were stumped by HIV's aptitude in thwarting medication over time by becoming immune. These days, people with HIV undergo treatment via multiple medications that decrease the host's viral load to manageable levels, and the lifespan of the afflicted is similar to that of the average human. At this moment we are managing the disease, but should we stop there?

       Humans have been able to extend their lifespan by mitigating natural threats that would otherwise lay us low far earlier. To contend with the elements, we erected homes and shelter. To contend with hunger we have developed complex agricultural/production techniques to provide. We manage these threats, but we can not eliminate them. Disease provides us with a unique situation where it is within our power now (i.e. the elimination of polio, and CRISPR editing granting HIV immunity) to potentially completely remove these threats for human betterment. My coworker posed an argument that just because some animal (let's say a lion) is a potential threat to human life, doesn't give us the right to exterminate them completely. I agree and disagree to a point. Animals are a biological life form that very directly influence human survival. We have mitigated the risk of animal related death to very low levels, so there is no need for such drastic, self-detrimental action. Also, HIV is not technically alive. Viruses cannot replicate without a host, etc, etc.

      I'm curious as to what others think of the questions at the center of my ramble. Should we make strides to eradicate disease? Is it an obligation? Should we stop at managing disease, and leave the risk of the disease evolving beyond our control?
Posted by at 8 comments:

Wednesday, January 23, 2019

Garrison Keillor's doctor-search

Waiting for snow, hoping, praying

It has snowed a smidge in Minneapolis and I went to church Sunday to give thanks for it and ask for more. The TV weatherman talks about who might be “hit by” a snowstorm and who might “escape,” as if the flakes carry an infectious disease, but snow is light, it does not hit anybody so that you’d feel it, and true Minnesotans love a snowstorm, the hush of it, the sense of blessedness, as Degas loved the female form and Cezanne cared about apples. I thank God for all three, apples, women, and snow, and also for my good health.
 I am an old man chained to a computer and I get less exercise than your average statue in the park, meanwhile I avoid vegetables in favor of peanut butter and bacon sandwiches, I seldom wash my hands and often rub my eyes, my daily water intake is less than that of a small lizard, and yet I feel pretty darned good, knock on wood, whereas certain people I know who lead exemplary lives of daily workouts and hydration and veganism complain of insomnia, sharp stabbing pains, exhaustion, gassiness, and memory loss, so where is the justice, I ask you. How is it that the wicked prosper and the righteous suffer?
The answer is: I have an excellent doctor. I searched high and low for one, eliminating those with WASPy names like Postlethwaite or Dimbleby-Pritchett and those with old names (Amos, Portia, Naomi, Elijah) who maybe don’t know about antibiotics. I scratched very young doctors (Sean, Amber, Jared, Emerald) who maybe don’t understand geriatrics. I eliminated doctors who, when I called to inquire about an appointment, I was put on hold and heard flute music. I nixed doctors who had tassels on their shoes or whose M.D. degrees came from schools in Tahiti or Tijuana. And by the time I found a doctor, medical science had taken great leaps forward in the treatment of sedentary dehydrated germ-ridden men like me, so here I am.
Read the rest of the column >>>
Posted by at 3 comments:

Tuesday, January 22, 2019

Quiz Jan 24

Let's begin by revisiting the comments and questions we didn't quite get to last time, beginning with the question of CRISPR. What do you think are the formative sources of your own perspective(s) on such issues?
==

 1. Chapter 3 begins by asking if our bioethical perspective ("vision") is skewed by _____... (a) cultural assumptions, (b) gender bias, (c) religious faith, (d) all of the above

2. What's the leading global cause of death among women of reproductive age?

3. (T/F) The "feminist critique" says bioethics has been dominated by culturally masculine thinking.

4. What ethical perspective did Nel Noddings (supported by Carol Gilligan's research) describe as the "feminine approach"?

5. What's a furor therapeuticus?

6. Does Campbell consider the outlawing of female genital mutilation culturally insensitive?

7. What's allegedly distinctive about "Asian bioethics"?

8. What western ethical preconception is "somewhat alien" in the eastern dharmic traditions?

9. What gives Buddhists and Hindus a "whole new perspective" on bioethical issues?

10. What does Campbell identify as a "tension in the Christian perspectives" on bioethics?

DQs:

  • How do you think your own attitudes and assumptions about gender, religion, etc. influence your Bioethical perspective?
  • What do Plato's Euthyphro and the Biblical story of Abraham & Isaac suggest to you about the place of religion in addressing biotethical issues? (61-2)
  • What is Buddhism's bioethical relevance? (69)
  • How should medical professionals treat and care for children whose parents object to medical intervention on religious grounds?
  • Is it best for caregivers to try and limit their personal knowledge of patients' particular perspectives, beliefs, identities (religious, political, cultural etc.) so as to avoid conscious or unconscious bias in treatment, or does this unduly sacrifice the humane dimension of medical practice?
  • Post your DQs

"The most interesting and important thing about you"

 Pragmatism
Lecture 1: The Present Dilemma in Philosophy

In the preface to that admirable collection of essays of his called 'Heretics,' Mr. Chesterton writes these words: "There are some people - and I am one of them -who think that the most practical and important thing about a man is still his view of the- universe. We think that for a landlady considering a lodger, it is important to know his income, but still more important to know his philosophy. We think that for a general about to fight an enemy, it is important to know the enemy's numbers, but still more important to know the enemy's philosophy. We think the question is not whether the theory of the cosmos affects matters, but whether, in the long run, anything else affects them."

I think with Mr. Chesterton in this matter. I know that you, ladies and gentlemen, have a philosophy, each and all of you, and that the most interesting and important thing about you is the way in which it determines the perspective in your several worlds. You know the same of me. And yet I confess to a certain tremor at the audacity of the enterprise which I am about to begin. For the philosophy which is so important in each of us is not a technical matter; it is our more or less dumb sense of what life honestly and deeply means. It is only partly got from books; it is our individual way of just seeing and feeling the total push and pressure of the cosmos...

William James, Pragmatism Lecture 1, continues
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How to Stop Rogue Gene-Editing of Human Embryos? Scientists Differ
Some U.S. researchers knew of a Chinese scientist’s intentions to implant edited embryos but were unable to stop him. Now scientific institutions are trying to devise global safeguards.

A year ago, Dr. Matthew Porteus, a genetics researcher at Stanford, received an out-of-the-blue email from a young Chinese scientist, asking to meet.

A few weeks later, the scientist, He Jiankui, arrived in his office and dropped a bombshell. He said he had approval from a Chinese ethics board to create pregnancies using human embryos that he had genetically edited, a type of experiment that had never been carried out before and is illegal in many countries.

“I spent probably 40 minutes or so telling him in no uncertain terms how wrong that was, how reckless,” Dr. Porteus said in a recent interview.

Dr. Porteus did not report Dr. He’s intentions to anyone, because he thought he’d talked him out of it and it wasn’t clear where to report the plans of a scientist in China. Neither did two other American scientists Dr. He confided in... (continues)
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Can a Nice Doctor Make Treatments More Effective?
Connecting with patients doesn’t just make them think someone cares. It can make a difference for health outcomes.

In the age of the internet, it’s easier than ever to pull together lots of information to find the best doctor. And if you’re like most patients, the metric you probably rely on most is the doctor’s credentials. Where did she go to school? How many patients has he treated with this condition?

You might also read some Yelp reviews about how nice this doctor is; how friendly and how caring. But all that probably seems secondary to the doctor’s skills; sure, it would be great to have a doctor whom you actually like, but that’s not going to influence your health the way the doctor’s competence will.

But our research in the psychology department at Stanford University suggests that this view is mistaken. We found that having a doctor who is warm and reassuring actually improves your health.

The simple things a doctor says and does to connect with patients can make a difference for health outcomes... (continues)
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Harm Principle

I have learned a little bit about the Harm Principle throughout my philosophical educational journey. I always felt like the Harm Principle was a principle, because we use it “numerous practical conclusions in bioethics” as explained in the chapter of Moral Thoeries, that  needs to be further discussed within communities. One thing that has always puzzled me was the criminalization in voluntary euthanasia. Now bare with me, the only thing I have to really to reference was a Hollywood movie. I understand it doesn’t give me validation but I would love to hear your opinion as well as criticism. In the movie Me Before You (SPOILER ALERT) please don’t read ahead if you are looking forward to watching this movie (although you are pretty late


The main character suffered from a motorcycle accident and is left paralyzed from the neck down. Because of the effect this he has become more vulnerable to other illnesses and to sum it up he lives a very painful life. He has made the decision to participate in voluntary euthanasia however it is illegal here in the US, thus he has to go to a different country in order to go through this medical procedure.

My question here is: why is this illegal? The only reasoning I can think of is some kind of religious morality viewpoint: I find that this happens to be the case in many cases such as the discussion of aboration as well. Whether the fetus is considered a baby or not, whether you are using the principle of autonomy or not.
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Parents or Goverment: Who's in Charge of this Child's Life?

I brought up this story in class and everyone was eager to hear the details of the situation. I did some digging for everyone and the whole situation is not easier to hear the second time round. This story is difficult to listen to, mainly because it isn’t over yet. Many families feel that the UK’s system of health care is lacking in a lot of departments and their choices are heavily scrutinized by the public and the government that funds them. This is complicated, messy, and unfortunately there is no fix for the families already affected. We can, however, look at the situation and hopefully build a structure to assist all parties involved.

So, because we do not live in the same country as the situation, I did some research for everyone. After a crash course through a summary of years of history, politics, and legalese, I think I have the gist. The National Health Service(NHS) is a government funded system that provides most of the services the public needs for free. According to the British Medical Association, “NHS services cover everything from antenatal screening and routine treatments for long-term conditions, to transplants, emergency treatment and end-of-life care.” Other services are supplemented by a small fraction of a private system that can be paid out of pocket or by a companies insurance plan an individual gets from work, this seems to be for unusual treatment and does not need to be used on a daily basis.  As cut and dry as this may look, there is a lot of issues with the system over all. Between a deficiency in medical professionals, a misuse of the services by the public, or simply not enough funding for the equipment required to run a hospital, changes might need to be on the way. As a public system, they are responsible for everyone’s health in the UK, meaning standards should be fair and equal for everyone in theory. With the background out of the way, let's talk a bit about the family in question, the Evans.

Alfie Evans was a toddler born in the UK in May of 2016, and was admitted to a hospital due to seizures in December of the same year. By 2018, the doctors were talking to the parents about the next steps as Alfie was almost constantly in a vegetative state and only responded to touch. It was in the hospital’s opinion that it was cruel to keep the boy on life support. Alfie’s parents, and eventually a large amount of people, including the Pope, disagreed and took the case to court. In cases in the UK where parents and medical professionals differ in opinion, the government can intervene on behalf of the child’s safety, called the 1989 Children’s Act, with the implication that the courts will act in the best interest of the child. In spite of the favor of the public and the coverage that the family had garnered, the courts agreed that life support would be inhumane to continue and even with appeals all the way to the Supreme Court that Alfie was unable to go home or to a hospital in Italy where his parents had doctors waiting to assist them with their son. Alfie died in the hospital on April 28th 2018, of a chest infection and a degenerative neurological condition, possibly Mitochondrial DNA depletion syndrome (MDS).

I remember reading about this at the time and being conflicted. The spirit of the courts was to create the least amount of pain for this child but the parents were insistent as well. The parents thought that giving their son another shot at life was the right thing to do, no one wants to give up on their children. In researching, I tried to find articles that showed both sides, domestic and abroad. I found it interesting that the domestic discussions were fairly nonpartisan, showing both sides as equal, including the Sun, a notorious tabloid in the UK. Vox and CNN both talked more about the accusations of neglect or abuse on the part of the hospital. Potentially, the reactions of the hospital were logical but care and empathy need to be expected for the parents too. One thing was consistent with all of the articles, support was in favor of Alfie’s survival over all.

Personally, I am in a hard place. If the doctors were correct, Alfie was lacking a majority of the grey matter he needed to grow and survive past his first few years of life. At the same time, I cannot imagine any parent easily making the choice to end their only child’s life, or prolonging pain. The nature of degenerative neurological diseases is cruel, either it prevents life from starting, or it slowly takes the freedom from a person. It is for this reason I support the eventuality of genetic therapy, not because people should live longer, but because people should get to live in the first place. I also support legislation like Charlie’s Law, one promoted by the parents of another child that had a similar situation with the healthcare system and courts.

I look forward to everyone’s thoughts and below are the links to the articles I used.

The UK Healthcare System

An Introduction to the NHS

How the NHS works

The history of the NHS in charts

British toddler Alfie Evans not allowed to leave country, UK court says


The controversy surrounding the death of British toddler Alfie Evans, explained


Who was Alfie Evans and what was the row over his treatment?


Tot’s Battle: Who are Alfie Evans parents Kate James and Tom Evans, when did they have another baby and when did Alfie die?

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My Thoughts on Kant's "Categorical Imperatives"

Kant's "Categorical Imperatives" are brought up and discussed thoroughly throughout today's reading. Of Kant's many views that are brought up in this chapter, there are a couple I would like to discuss and present my thoughts on.

To begin with, Kant's though that our duty is always to tell the truth no matter the consequences to ourselves or towards others. I personally disagree with this statement in that sometimes it is necessary to tell a lie or even a half-truth. For example, when the truth could put other people or even a society at risk, I believe it should not be told as it would cause greater harm than telling a simple lie even if it does mean abandoning our duty in Kant's view. Another example is based on the fact that humans are emotional creatures in which a truth, small or large, could be detrimental to another's mental health and I believe it is our duty as a part of society to help others and do what we can to increase the overall satisfaction and happiness within our society.

Although, I mostly disagree with Kant's views, this next view is one I strongly agree with and believe it should always be upheld: humanity should be treated as an end and never as a means. If society and governmental officials were to only treat humans as a means to an end, there would be no purpose in even coming to that end in my opinion. Even if humans were to be treated as a means to gain a specific end, an advancement in medical technology for example, the subjects would also needed to be treated as an end as well as they should only be required to participate if they volunteer in the prospect of bettering their own or other's lives who may be in the same situation as them.

These are only a few of Kant's views with "Categorical Imperatives". If anyone would like to discuss these or others, I would love to hear about your opinions on the matter.
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