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Author Archive: Steven Miles

07/07/2017

The 2017 Common Rule and the Clinical Ethics of Prolixity

Some bioethicists link the beginnings of our field to the Nazi Medical experiments and the Nuremberg Trial (Annas). Whether this is the beginning of bioethics is debatable, but without a doubt, research ethics has been a central topic in the field. In fact, the very first federal bioethics commission laid out the principles of research ethics in the Belmont Report. Later, the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research recommended to the President and Congress that a uniform framework and set of regulations should govern human subjects research.  This effort reached fruition under The Federal Policy for the Protection of Human Subjects or the “Common Rule” that was issued in 1991. 

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05/01/2017

Remarks on Retirement: A Career in Medicine & Bioethics

by Steven Miles, MD

The following remarks were delivered on April 27, 2017 upon Steven Miles’ retirement

Bioethics is not scholastic theorizing. It must venture outside the walls of Academic Health Centers to speak on behalf of marginalized and silenced people including those without access to affordable health care, prisoners and enemies, nursing home residents and refugees. Bioethics is about our ethos—how we live.

No one who reveres Universities ever really leaves. I set out as an itinerant emeritus carrying a backpack stuffed with University’ values and tools.

  • The practice of medicine has been my liberal arts education. Intimate moments with those in profound despair schooled me.

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02/16/2017

The 2017 Common Rule and the Clinical Ethics of Prolixity

by Steven H. Miles, MD

Bioethicist Steven Miles suggest that making the new Common Rules regulations easy to read is as important as the content

The new Common Rule to protect human subjects has an extraordinarily large and diverse audience.[i] The new Rules defines the obligations of an enormous number of personnel at the National Institutes of Health as well as virtually any other government agency engaged in research with human subjects. The Rules define the requisite knowledge, training, and work of staff who oversee and conduct clinical research in the United States. The Rules are a template for institutions in other countries, including those that don’t use English as a primary language.…

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02/03/2017

The 2017 Common Rule and the Clinical Ethics of Prolixity

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09/25/2016

Assisting Persons in Hospice to Cast Early Absentee Ballots

by Steven H. Miles, MD

A friend of mine is dying of metastatic cancer. She does not have long to live; she will possibly die before the end of this year. Throughout her life, she actively participated in civic life. She donated her time and money to charities and political campaigns. She did not shirk a call to jury duty as many do. Disability from her illness has constrained her public life. She watches television when she is not too tired. She follows a prominent local race and a race for national office. This week, I will take her to city hall to cast her ballot for the 2016 election.…

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03/21/2016

Military Suicide Capsules and Medical Ethics

by Steven H. Miles, MD

In December 2013, a Hearing Panel for the Health Professions Council of South Africa found Wouter Basson MD culpable for unprofessional conduct because of his work to produce chemical weapons, to medically assist rendition by commandos (kidnappings), and to provide cyanide containing suicide capsules to Special Forces’ operatives leaving for clandestine meetings. I served as an expert witness for the prosecution in the Basson matter in the area of medical ethics and military medicine.

The French philosopher-sociologist Emile Durkheim (1858-1917) is partly responsible for the confusion about strategic military suicide. He defined suicide as “all cases of death resulting directly or indirectly from a positive or negative act of the victim himself, which he knows will produce this result.” He did not distinguish a soldier whose actions entail accepting the high probability (or even certainty) of death in order to accomplish some task from actions in which the soldier’s chooses to die during the course of a military operation.…

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02/29/2016

Unadorned: My Testament

by Steven Miles, MD

Many of you in the Bioethics community know me as a physician-ethicist. Early in my career, in the 1980s, I was prominent in the ethics and practice of end-of-life care. I published extensively on that topic before moving on to other topics. As an internist and geriatrician, I had decades of experience in hospitals, clinics, nursing homes and hospices. As a physician who disproportionately worked with dying persons, I have a greater than normal skepticism of the utility of aggressive technology and heightened insights into the nature of institutionalized life.

At sixty-six years of age, I am not currently ill excepting for incrementally increasing mild chronic diseases—harbingers of the approaching cold front.…

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10/30/2015

Medical Ethics and School Football

by Steven H. Miles, MD and Shailendra Prasad, MD, MPH

This is a special pre-print posting of an editorial scheduled for the January 2016 issue of the American Journal of Bioethics.

Health professionals should call for ending public school tackle football programs. We disagree with the perspective and the argument of a recent report by the American Academy of Pediatrics (AAP) that supports the current organization of reforms of youth tackle football.

About 1.1 million students play on junior and high school football teams. Another three million play in non-school programs. Youth football is slowly dying. The number of players on junior and high school football teams has fallen 2.4% over the last 5 years.…

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07/15/2015

The American Psychological Association Interrogation Policy and Dr. Gerald Koocher, AAAS Fellow

by Steven Miles, M.D. 

A recent 542-page report describes a damning collaboration between the American Psychological Association (APA) and the Department of Defense (DoD) and other government intelligence agencies. In essence, the APA rewrote the ethics code to allow psychologists to design and monitor interrogational torture.[i] The APA Presidential Task Force on Psychological Ethics and National Security (PENS) said that the interrogational psychologists’ client was the interrogational command and not the prisoners’ wellbeing. The aim of this policy was to authorize and shelter psychologists who devised plans that included waterboarding, sleep deprivation, food restriction, use of threatening dogs, solitary confinement, use of restraining stress positions, etc.…

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03/13/2015

A Tribute to John Arras

by Steven Miles, MD

It is hard to believe that John Arras has died. John was one of the younger creators of modern bioethics. He died at age 69. He was my teacher although I am less than five years his junior.

John was the rare spirit of teaching. Although broadly read, he used his erudition to counsel and inspire rather than to boast or intimidate. He avoided the spartan liturgy of four principles in his elegantly constructed and simply stated arguments that spoke to heart and mind. He insisted on taking on the hard stuff like access to health care and rationing and justice and the neglected corners of medicine rather than confining himself to the well trodden dilemmas of end of life intensive care.…

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