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Author Archive: Steven Miles


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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The 2017 Common Rule and the Clinical Ethics of Prolixity

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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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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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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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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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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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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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Kaci Hickox: Public health and the politics of fear

Steven H Miles, M.D.

Kaci Hickox is a nurse who went to Sierra Leone with Doctors without borders to treat the emergency with Ebola. She is professionally brave, articulate and well trained. Sierra Leone, with 5000 cases, is one the epicenters of the Ebola epidemic.[1] [2] She was last exposed to patient care on October 21.[3] On Friday October 24, she returned to the United States, entering at Newark International Airport in New Jersey. There she was met by a disorganized set of officials who tried to determine what to do with her. She was repeatedly interviewed. Her temperature on arrival was normal but was repeated several times using a forehead scan thermometer, which will give falsely high readings of persons under stress.…

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Military Doctors and Deaths by Torture: When a Witness Becomes an Accessory

Guest Blog Post: Steven Miles, M.D.

This blog post will appears as an Editorial in this May’s upcoming issue of AJOB

A Case (and Context)

The Medical Practitioner Tribunal Service in the United Kingdom recently revoked a physician’s license for failing to report treating a man who had been tortured and for failing to safeguard vulnerable detainees. The physician was serving with the UK military in Afghanistan. Baha Mousa, a prisoner, was brought to him with extensive signs of severe physical trauma.  Soldiers told him that the man had sustained trauma. The physician knew that there were other prisoners and was apparently within earshot of their cries for help.[i]  The physician led a competent but unsuccessful attempt at resuscitation.…

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