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01/01/2014

The Year in Bioethics That Was

by Craig Klugman, Ph.D.

Happy New Year. The ending of one year and the beginning of another is often a time for reflection, for reviewing the year that has passed and for making plans/predictions for the year to come. 2013 was the first full year of the re-launch of the bioethics.net editor’s blog as well.

Ten bloggers in addition to myself worked for us this year and we are thankful for their contributions: Maurice Bernstein, Arthur Caplan, Jennifer Chevinsky, Nanette Elster, Ellen Fox, Jessica Jerome, David Magnus, Steven Miles, Kayhan Parsi, and Thaddeus Pope. Their insights, reporting, and reflection on the big topics and ideas of this past year helped enrich the bioethics conversation.

The eleven bloggers posted 96 original blogs on a wide variety of topics. While, most of the posts are complex, bringing together more than one topic, for the purpose of looking at the themes in the 2013 blogs, each post could only be placed in one category.

  • Health Policy/Politics/ACA – 23 posts
  • Research – 13 posts
  • End-of-life 11 posts
  • Medical Practice – 10 posts
  • Social Justice – 7
  • Clinical Ethics – 6 posts
  • Media/Literature/Art – 6 posts
  • Confidentiality – 5 posts
  • Torture – 5 posts
  • Informed Consent – 3 posts
  • Education – 3 posts
  • Environment – 2 posts
  • Infertility – 1 post
  • In memorium – 1 post

In a year that saw politically divided dialogue on the Affordable Care Act it comes as no surprise that the Health Policy/Politics theme was the most common. Issues in research and end-of-life are perennial favorite bioethics topics. To my pleasant surprise, social justice issues ranked 5th on the list, no doubt in part to do with the national conversation of health care affordability and insurance coverage this year as well as increasing awareness of the wealth gap and its affect on health.

Now this reflection is hardly a scientific look at the major bioethics topics in the year. Topics are not assigned to bloggers and do not come from some random topic generator. This analysis reviews one blog site and thus shows more the interests of the bloggers, the stories that were in the public mind, and the reports issued by government and professional agencies. There are big bioethics stories that we likely didn’t cover at all. For example, the blog site Bioedge lists its top ten bioethics stories of 2013, most of which are about eugenics and euthanasia, topics not discussed in the bioethics.net blog. And neither source discussed the recent national bioethics commission decision to greenlight testing an anthrax vaccine in children (because anthrax is a potential bioterrorism agent, not because more children are spending time around sheep).

In the coming year I imagine that the big issues will remain somewhat similar. With the final rollout of the Affordable Care Act, I predict the conversation will be about how difficulties with physician access (just because most people have insurance now does not mean there are enough physicians or even enough physicians that take their insurance). Some of the debate will be on private companies wishing to be exempt from certain parts of the law (court cases about the ACA contraception mandate and required coverage of employees are in process. A New Year’s Eve “gift” from Justice Sotomayer put a stay on the contraception mandate). In fact, I suspect there will be conversations about how a single payer system could eliminate a lot of the administrative difficulties of the ACA, such as the website roll out, the confusing array of plans, and the wasteful spending on duplicative administrative structures. End-of-life issues will also be a hot topic, in part because of the greying of the American population and in part because of the politicized nature of dying policy: Jahi Munoz’s mother was just granted an extension of the stay preventing a hospital from removing the ventilator on this brain dead child. As discussed in his most recent post on this blog, Arthur Caplan mentions a Pew Forum survey that shows political affiliation is the only predictor to whether a person believes in science. Thus, this year may see an increasing conflict between science and faith as this is the basis of most challenges to the ACA and as the country becomes increasingly more polarized.

Given the number of restrictive abortion laws passed this year and the number of court challenges, this issue will likely rise in the rankings. One trend that appeared specifically in two blogs this year but was referred to in others is the question of privacy. In an age of drones, big data, and government surveillance of the internet and all communication, the issue of privacy should take center stage in the bioethics conversation.

Another potential topic is the increasing generation battle. As fewer people are able to retire, they stay in their jobs longer meaning that there are fewer opportunities for young people to find a place in the workforce. The improvement in the economy that has supposedly been happening has lifted the boats of the upper classes and those who are older. Those who are poor and who are younger still find recession level like conditions. Our increasing gaps in politics, in opportunity, in wealth, and in power will become increasingly tense issues in our society.

From all of the bloggers at bioethics.net, we wish you a happy and healthy new year.

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