Where the World Finds Bioethics Tue, 13 Oct 2015 20:34:53 +0000 en-US hourly 1 Finding Dead Bodies [EOL in Art 155] Tue, 13 Oct 2015 10:30:00 +0000 0 Human Subjects Research “Vulnerability” Tue, 13 Oct 2015 03:21:07 +0000 by J.S. Blumenthal-Barby, Ph.D., MA

Revisions are being suggested to the Federal Policy for the Protection of Human Subjects through the Notice of Proposed Rulemaking (NPRM). The changes being suggested are numerous (helpful summaries can be found here and here My aim is not to review those changes, but to point out a curious conceptualization of vulnerability affirmed in the NPRM.

Consider the following section (regarding conditions for IRB approval) of the original regulations:

46.111(b) – When some or all of the subjects are likely to be vulnerable to coercion or undue influence, such as children, prisoners, pregnant women, mentally disabled persons, or economically or educationally disadvantaged persons, additional safeguards have been included in the study to protect the rights and welfare of these subjects.…

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A Body With Bullet Holes and the Right to Arm Ourselves Mon, 12 Oct 2015 14:54:00 +0000 Colleen Farrell

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Look Dad – I’m an Economist! Mon, 12 Oct 2015 13:58:25 +0000 I recently spoke with a reporter about a new effort, by Medicare, to persuade dialysis centers to care for a wider range of primary care health needs for people with kidney failure. I’ll give you a teaser for that article … Continue reading

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Kevorkian "Nearer My God to Thee" [EOL in Art 154] Mon, 12 Oct 2015 10:00:00 +0000 0 An F.D.A. Commissioner With Ties to the Pharmaceutical Industry? Heaven Forbid? Mon, 12 Oct 2015 04:10:18 +0000 0 THE ASSASSIN AND BIOETHICS: Death and Destruction vs. Peonies and Silk Sun, 11 Oct 2015 16:41:00 +0000 The Assassin was one of  the three opening night films at the 2015 Mill Valley Film Festival. Taiwanese filmmaker Hou Hsiao Hsien is no stranger to the Cannes festival awards. This film won him the Cannes 2015 Best Director. Attraction to the screen narratives of ‘assassins’ raises clear bioethical concern during pervasive aggression at home and abroad. The Assassin differs from others in its genre. It does not titillate with the brutality of cold blooded murder. Instead, The Assassin may demonstrate a filmic antidote for the desensitization of screen violence.

The original assassins are thought, by some, to have been mercenaries, in Persia, from the sect of Shia Islam, in the period between the 9th and 10th century. This sect worked against the Sunni Islam who controlled that empire. Assassins were tools of barons who held no independent army.

Though set in the Chinese context, and created by a man, The Assassin has a profoundly feminist sensibility. The assassin of this film’s interest is a woman born in a ninth century imperial court. It is a profoundly feminist approach to story telling. Her mother rejects imperial control and escapes, knowing the action will likely cost her life and that of her daughter. Before her death, the fleeing mother arranges her daughter’s care by an aunt and uncle. The imperial powers eventually wish to conquer the geographical region where the child has been fostered, again risking her death. For the child’s protection her surrogate parents place her in the care of a ‘nun.’ The Nun’s machinations train the child as an assassin. We meet the girl in young adulthood, were she is driven by her filial longings to break away from her heinous training.

The ‘Assassin Genre’ usually depicts an innocent, extracted from their family’s stability and values, being co-opted by an evil power. The plethora of large and small screen versions of this theme includes screen works ranging from The Borne Identity to more recent television shows like Complications and Blindspot. Malleability of unformed systematic reasoning, when faced with moral conflict, is often essential to training in the Assassin Genre, as in life. —Think child soldiers, street gang members, late adolescents in the military,  and fascists masquerading as religious extremist.

Bioethics is an applied ethics concerned with science and technology affecting the biosphere and it is inclusive of medical ethics. The underpinning principles of bioethics  are beneficence, autonomy and justice. Ethical sense generally comes from two separate mechanisms. The first is through principles, drilled into a person as in religion, academia and professions. The second approach to enhancing morality is ‘casuistry.’   Casuistry imparts moral understanding through cases or stories. However, it is not just the Aristotelian narrative plot curve that generates the organized portrayal of ethical dilemmas. Particularly in the case of film, the way in which stories are told influences meaning.

Greek drama analysis might argue that depicting an assassin's journey allows viewers to work through feelings of loss of connectedness. But screen science is a technology, incidentally facilitating art, and can be held to the standard bioethical scrutiny as are other technologies. Does the technology do good?  Does it interfere with the viewers autonomy or enlightened self interest? Are the burdens and benefits of this technology equitably distributed between the most and least vulnerable persons?

Clinically, film can be used to  intentionally manipulate emotion and physiology. Think Clock Work Orange. Other examples include use of film to desensitize persons with, say, arachnophobia. The retina can’t tell the difference between a real spider unless the mind clarifies the matter.  Our movie memory is stored  in the same places as our real experiences. ‘Suspension of disbelief’ is required to watch a film.

If the arachnophobe believes a film spider is real, then the clinical matter is training them to sublimate the emotional and physiologic response during repeated exposures. Eventually, the sublimation becomes automatic. If a viewer suspends believes the screen violence is real, there should be a mechanism to train them to abhor that violence.

Among the tenants of bioethics, and especially clinical medical ethics, is that those who know a field best have increased ethical obligation within that field. Film master Hou Hsiao Hsien’s gives a new twist to reversing the desensitization to violence.That’s a good thing since drilling principles into young minds doesn’t seem to be working.  He uses the juxtaposition of heinous acts with extraordinary beauty. He directs  viewers’ minds to be afraid of violence, initially because it waste time better used for more intimacy with the pleasing aesthetic of this filmmakers’ world. We beg, “Let her walk through that field just one more time!”

Though presaged by the elegance portrayed in many martial arts films, Hou Hsiao Hsien's film Assassin has left the ‘kick’ genre in the dust. The Assassin is not about killing, but demonstrates escape from horrid depictions by pushing prayers for peonies and silk.
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OPO too Aggressive in Determinations of Death Sun, 11 Oct 2015 10:30:00 +0000 The director of South Florida's Organ Procurement Organization has stepped down.

The Miami Herald reports that Michael Goldstein's methods have drawn complaints in the past. "While he was medical director for the New York Organ Donor Network . . . he was named in a 2012 lawsuit [that] accused Goldstein and the organ bank’s leaders of pressuring staff to aggressively pursue brain death determinations for hospital patients in order to increase donations."

In Florida, "doctors and nurses at some of the 81 South Florida hospitals where LAORA recovers organs have complained of the agency’s aggressive procurement methods . . .  including allegations that the agency’s staff pressured family members to consent to donations . . . ."

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"Liminal Space" [EOL in Art 153] Sun, 11 Oct 2015 10:00:00 +0000 0 Decision Making for Unrepresented Patients Webinar Sat, 10 Oct 2015 16:25:00 +0000 0 "The Last Day" [EOL in Art 152] Sat, 10 Oct 2015 10:00:00 +0000 0 Money Spent Treating Sick Elderly Should Be Spent on Children Fri, 09 Oct 2015 23:58:00 +0000 0 Modernizing Human Subjects Research Protections: Legally Authorized Representatives and Consent Capacity Fri, 09 Oct 2015 15:07:21 +0000 0 Absolutely Hilarious Nudge! Fri, 09 Oct 2015 14:15:53 +0000 Here is a hilarious effort by Utah Valley State presumably to either keep people from crashing into each other while they text on the stairway, or more likely to show them how stupid it is to be engaging in that … Continue reading

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Deeply Superficial Fri, 09 Oct 2015 11:10:24 +0000 0 Chris Picco Singing Blackbird [EOL in Art 151] Fri, 09 Oct 2015 08:30:00 +0000 0 At Risk of Financial Ruin Thu, 08 Oct 2015 13:45:06 +0000 According to figures from the Kaiser Family Foundation, one of the best sources of reliable health policy information, the majority of Americans will have to exhaust all their “liquid assets” to cover medical expenses, if they reach the maximum out-of-pocket … Continue reading

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Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life Thu, 08 Oct 2015 12:35:00 +0000 0 Hayley West "I Remember You" [EOL in Art 150] Thu, 08 Oct 2015 08:30:00 +0000 0 2015 Mill Valley Film Festival Thu, 08 Oct 2015 06:44:00 +0000 Bioethics and the Mill Valley Film Festival

Bioethics Screen Reflections Supports the California Film Institute 38th Mill Valley Film Festival ( From October 8, 2015 to October 18, 2015 we will screen/review the following films:

The Assassin 
A Light Beneath Their Feet
Son of Saul (Saul Fia)
Here Is Harold (Her er Harold)
Love Between the Covers
Beasts of No Nation
Creative Control
A Perfect Day
Paper Tigers
In Defense of Food

A special focus will follow bioethical issues reflected in the 38th Mill Valley Film Festival category of “Mind the Gap”  which considers the relatively small number of women able to earn a living in the film industry, despite the large percentage of talent and skill women represent in the field.  

Follow along with us over the month of October. Mill Valley Film Festival programmers have proven to be among the most savvy in the field. Their online film notes can guide direct viewing for the year even, if you are not able to attend. But, do try to join us. Often the world, continental and USA premieres  offered become the most highly awarded films of their release years. 

We will keep you posted 

@Bioethicsscreen  and @MVFilmfest
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Is It Fair to Reward Medicaid Patients for Doing What They’re Supposed to Do? Wed, 07 Oct 2015 17:29:54 +0000 Most conservatives agree that Medicaid costs are too high. Most liberals agree that Medicaid patients should receive necessary medical care for free. And both conservatives and liberals agree that we should embrace ways to encourage Medicaid patients to obtain important … Continue reading

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Briefing Now Complete in Brain Death Dispute before Nevada Supreme Court Wed, 07 Oct 2015 14:36:00 +0000 0 Physician Aid in Dying – Legal History Worldwide Wed, 07 Oct 2015 13:33:00 +0000 0 Caring for people and animals Wed, 07 Oct 2015 12:39:30 +0000 Read More »]]> 0 "Fragility" [EOL in Art 149] Wed, 07 Oct 2015 09:30:00 +0000 In "Fragility" Elpida Hadzi-Vasileva fills the central atrium of Fabrica’s building, a former church,  with a series of delicate veils: rising from floor to ceiling, diffusing the light, obscuring the way forward. Two narrow passages, carefully pierced through the veined walls, invited us in. At the centre of the work one clear viewpoint toward the filtered light from the main window was revealed, an experience the artist compared to the flash of light reportedly observed when close to death.

"Fragility," like much of the artist’s work over the past decade, re-appropriated animal viscera. In this instance caul fat, a membrane that holds the vital organs together, was transformed from a perishable waste product of the pork industry into a sublimely beautiful translucent material via a lengthy chemical process akin to embalming.

Beyond its sensory impact, much of the pleasure in the work lay in understanding its inherent contradictions: the disconnect between the initial state of the material and its aesthetically pleasing result; the artist’s need to witness decay and her effort to halt it, and her desire to bury the viewer in a corporeal labyrinth whilst all the time suggesting a dimension beyond the physical.

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8th Annual Pediatric Bioethics Conference (Nov. 6 in Jacksonville, FL) Wed, 07 Oct 2015 08:30:00 +0000 0 The 2015 Quality of Death Index Wed, 07 Oct 2015 03:53:00 +0000 0 State of the Armed Union Tue, 06 Oct 2015 17:57:52 +0000 by Craig Klugman, Ph.D

In the first 274 days of 2015, there were 294 mass shootings (yes, that is more than 1 per day). As a nation, there were over 39,000 gun incidents leading to 10,104 deaths and 20,544 injuries so far in 2015.

For points of comparison

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Making an Example of Martin Shkreli Tue, 06 Oct 2015 14:54:00 +0000 Nicole Dubowitz]]> 0 Wake Up to Dying Project [EOL in Art 148] Tue, 06 Oct 2015 08:00:00 +0000 0 Elective or life-saving? Catholic hospitals and the ban on tubal ligation Tue, 06 Oct 2015 01:10:53 +0000 0 Your Biology is in My Technology Mon, 05 Oct 2015 22:48:12 +0000 by Craig Klugman, Ph.D.

The PBS series Open Mind has been on television for nearly 60 years. The program “is a thoughtful excursion into the world of ideas.” The December 30 episode was an interview with Dr. Maria Freire, President of the Foundation for the National Institutes of Health. The host of this show, Alexander Heffner, asked AJOB and BIOETHICS.NET to share this interview, about which he said, “it’s among our most fascinating conversations.”

The conversation is about exploring is about the intersection of biology and technology, harnessing big data to learn about human health and find cures for human disease.…

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California Enacts End of Life Option Act Mon, 05 Oct 2015 19:55:00 +0000 0 Modernizing Human Subjects Research Protections: A Plan for Return of Results Mon, 05 Oct 2015 18:30:44 +0000 0 Minnesota Compassionate Care Act – Listening Session Mon, 05 Oct 2015 16:59:00 +0000 0 The Future of Disease – in One Picture Mon, 05 Oct 2015 14:13:47 +0000 Here are some projections on what illnesses Medicare enrollees are experiencing now, and what they will be experiencing 20 years from now, courtesy of the Brookings Institute:

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UK Court Permits Clinicians to Stop Life Support over Muslim Parents’ Objections Mon, 05 Oct 2015 10:00:00 +0000 0 Welcome Nell into her New Home [EOL in Art 147] Mon, 05 Oct 2015 08:00:00 +0000 0 New Case – Andrea Lago v. Santiago Hospital Sun, 04 Oct 2015 21:37:00 +0000 0 Endings [EOL in Art 146] Sun, 04 Oct 2015 08:30:00 +0000 0 Jane Burton – Child 1 [EOL in Art 145] Sat, 03 Oct 2015 10:00:00 +0000 0 End-of-Life Remains Major Issue in Ethics Consults Sat, 03 Oct 2015 08:30:00 +0000 0 Helming the bioethics ship of state Fri, 02 Oct 2015 17:51:23 +0000 by Arthur Caplan, Ph.D.

10/2/15   The President issued an executive order extending the term of the Presidential Commission for the Study of Bioethical Issues (PCSBI) through September, 2017

This is a very interesting announcement since the last day Barack Obama will be the President of the United States is January 20, 2017.   Astute observers will note that the Commission will be advising a new President for nine months, perhaps longer. While there has been a good deal of speculation about who that next President will be, there has, sadly, been far from adequate attention paid to who the next leaders of the commission would be under a new President.…

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So Much for the Job Killing Effects of Obamacare Fri, 02 Oct 2015 13:01:26 +0000 Despite passionate warnings that the Affordable Care Act would demolish the American economy, things haven’t exactly turned out that way. Here is evidence Dan Diamond circulated a while back. Dan is someone I suggest you follow on Twitter if you … Continue reading

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Art of Death Conference and Exhibition [EOL in Art 144] Fri, 02 Oct 2015 09:30:00 +0000 0 Treating Cancer: Doing Nothing is Also a Choice Fri, 02 Oct 2015 09:00:00 +0000 James Salwitz, a New Jersey oncologist recently colorfully observed: "Too many times patients are dragged away to receive therapy after therapy, until they are wasted, decrepit and dead."

Unfortunately, this is not always easy to convey to patients.  Dr. Salwitz had told his patient:  “You do not have to do anything. There is no law or rule requiring you to undergo aggressive therapy.”  But the patient heard those words and said, to himself, “Dr. Salwitz is giving up on me.” The patient's trust in Dr. Salwitz was gone and he transferred his care to another physician.

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PAS and Conscience? Thu, 01 Oct 2015 23:43:35 +0000 Read More »]]> 0 Modernizing Human Subjects Research Protections: Changing the Landscape of Biospecimen Research Thu, 01 Oct 2015 17:43:37 +0000 0 Action Movies Create Couch Potatoes Thu, 01 Oct 2015 13:43:30 +0000 0 Is it ethical for parents to create a savior sibling? Thu, 01 Oct 2015 10:10:53 +0000 0