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Blog Posts (3835)

February 20, 2017

“Docs v. Glocks”: Gag rule lifted

The American Academy of Pediatrics, the AMA, and the American Academy of Family Physicians all encourage their members to ask parents about firearms, in the same spirit as they ask about automobile restraints, swimming pools, and other factors that relate to the health of their patients.  If parents report that there are firearms in the […]
February 19, 2017

UK Court Ruling for Clinicians in Medical Futility Dispute

As we explained in Chest last year, UK courts have issued dozens and dozens of published opinions in medical futility conflicts.  This provides significant guidance and clarity as to how these cases should be resolved.   The latest of these ...
February 18, 2017

Advance Care Planning and its Detractors

The default mode of our technologically advanced medicine is to use our technology. Nowhere is this more true than close to the end of life. And our technology is really impressive; with it, we can keep chests going up and down and hearts beating for a long, long time. The troubling thing is that there are many people who would rather not have lots of... // Read More »
February 18, 2017

Becoming Mr. Buckley: Intimate End-of-Life Portrait

CBC News has a compelling story on photographer Dan Culberson's moving photo essay of father-in-law's battle with cancer.
February 17, 2017

Part I: LOVING and Bioethics The Right to Marry

LOVING - Official Trailer from Mill Valley Film Festival on Vimeo.

Courtesy Focus Films

LOVING was the closing night film of the 39th Mill Valley Film Festival. Jeff Nichols is its writer/director. At 38 years old, born in Little Rock, Arkansas, Nichols is a master at breaking stereotypes about cultures, especially those below the Mason Dixon Line.  

LOVING is based on the lives of Mildred  and Richard Loving. The portrayals by Ruth Negga and Joel Edgerton in the title roles is an exquisitely intimate, internal portrait. The main characters met young, fell in love in a poor rural neighbor of Virginia where races interacted socially. The love aspect of the story is prominent but the underclass nature of interracial life in the region is equally as strong. In 1958, the couple were forbidden to marry because their state was among many with anti-miscegenation laws.  

Nichols’ LOVING is as much about class— working poor—as it is about race. As long as Mildred and Richard kept within the constraints of the geo-social ‘Bottoms’ the state powers would not care. They weren’t so much jailed because Mildred was Black while Richard White but because they dared want their love and children legitimated. Anti-miscegenation laws stemmed, above all else not from morality but economics—controlling who could own property, historically determined by parentage. The law they violated was a vestige of slavery in their state.

LOVING, the feature length fictional film, evolved from director Nichols’ admiration for a documentary made years before. Nichols LOVING defies the Hollywood Film industries tendency to make heroism only a characteristic of overtly  “charismatic people.” LOVING is a work that celebrates that every day, ordinary people do the impossible. 

The Lovings were interested in living their lives. Referred by Attorney General Robert Kennedy’s office to the American Civil Liberties Union(ACLU) at Mrs. Loving’s initiation, the couple left the lawyers to the legal job. While the Loving’s tended their own work, raising a family.


The ACLU fought and won Loving V Virginia in the supreme court in 1967 — near ten years after the birth of the couple’s first child. The case was won based  on Virginia’s anti-miscegenation law  being in violation of the  Fourteenth Amendment to the United States Constitution which, provides equal protection under the law — including the right to marry. 

The Fourteenth Amendment was one of the Restoration amendments after the US Civil war. The Restoration Amendments among other things legally dismantled the economic system of slavery. The Loving case was fought  nearly 100 years after the slavery emancipation proclamation.

Loving v Virginia was proceeded and followed by many other legal presidencies adjudicated by the supreme court and supported by The Fourteenth Amendment including, Brown v. Board of Education (1954) regarding racial school segregation, Roe v. Wade (1973) about abortion, Bush v. Gore (2000) regarding the 2000 presidential election, and Obergefell v. Hodges (2015) regarding same-sex marriage.The foot prints of the Fourteen Amendment are also solidly ensconced in the Universal Declaration of Human Rights in its 16th Article —The right to marriage and Family.

Why is this film important to Bioethics?  The Lovings predicament is a cautionary tell about historical abuse of scientific process in supporting anti-miscegenation practices. LOVING also identifies a victory for the strength of persistent struggle — particularly one having an influence on the understanding not only of humanity but the moral obligations of scientist to do good work, and to monitor its moral implications. 

LOVING is a gentle film—not designed to be a blockbuster but one which will stand the test of time.  


Loving (2016) Trailer:  https://youtu.be/9QYEwlzpa9A

Loving V. Virgina  Interacial and Mixed  documentary HBO Trailer  https://youtu.be/h62ZBiHNJoM trailer

The Constitution of the United States http://constitutionus.com


The Universal Declaration of Human Rights http://www.un.org/en/universal-declaration-human-rights/declaration-human-rights/ 
February 17, 2017

Part II: LOVING, Bioethics and How Miscegenation became a ‘thing’

Photo Courtesy of Mill Valley Film Festival

Long Before Jeff Nichols, writer/director, chose to make the film LOVING (2016),  about a heroic couple of modest means striking a blow for the maintenance of humanity—by ending anti-miscegenation laws in the USA—The field of Eugenics had to be born and the term  ‘miscegenation’ coined. Miscegenation laws were present in many states  of the USA into the 1960s, in defiance of the 14th amendment to the United States Constitution and  the Declaration of Human Rights. 
Modern “bioethics” emerged from the documentation of the atrocities associated with both WWI and WWII, and the manipulation of science and technology to serve ‘evil’ rather than beneficence, autonomy and justice. The film Loving speaks to the need to carefully consider the obligations of science. There is no evil science, just bad science and immoral applications. In particular, scientist, and physicians (who are all ultimately researchers) should at least read the Nuremberg Code. The document is a page long with only ten points. 

How did Anti- miscegenation laws come about? Let’s be clear, they were an economic mechanism to oppress slaves and other underclass people and prevent their owning property. This begs the question of how miscegenation became ‘a thing.’

Philosophy and the applied sciences used to be one school—and still were in the 1800s. Philosophy, was not separated from maths, astronomy, medicine and engineering. The footsteps of philosophy still drive scientific method —theory, hypothesis, proof and argument. Francis Galton was born into that time of interface and development of knowledge. Oddly Galton,  a  latter day Renaissance thinker in the  model of Da’Vinci, is attributed with coining the words miscegenation and eugenics. And yes, Galton started out in Medicine, circa 1838. 

In agriculture miscegenation was defined as the “interbreeding of two different species.” Galton’s Cousin Charles Darwin had published the Origin of the Species in the 1850s. Gregor Mendel an Austrian monk had observed variation in pea plants during the same period. Most biology students learned that Mendel is considered the father of genetics. From those works came Galton’s leap implying that human beings’ external appearance could make them different species. 

Galton was a Sociologist, Psychologist, Scientist, Geographer, and Statistician. He looked for proof of the patterns of his cousin and the monk in other aspects of the world — looking for a primary pattern in nature which was repeated. That is what good science does. When you think of Galton, think—regression from the mean — that was among his many contributions or to some of us—tortures. The mathematical models of Mendel for peas and other plants were being extrapolated and converted into statistics applied to human beings.

What came first, racism or the science?  The essence of scientific integrity is not only honesty in hypothesizing, recording and reporting but coming to unbiased conclusions. Galton began considering ‘lessor social' attributes to be apparent in people who looked one way and not another. The espousing that conclusion, for a statistician, had to be an unfounded extrapolation. But he likely knew that even then. 

In 1863, the science of separation, and its conclusions espoused by Galton, was rejected by some as a political tool deciding who should receive the benefits of a society. The difference between animals and people was thought to be decided by humanist to be  “the soul.”  Perhaps the soul is a more nebulous concept than that ‘a scientific certainty’—but also one less likely to bastardize the scientific process. Nonetheless, it was the soul which  ended slavery in the USA and many other parts of the world.  

The post civil war Reconstruction Amendments to the United States Constitution, codified the belief that all “men” were created equal. That was adjusted in the 1900's to include women. The devil remains in the detail. However, it was the 14th amendment, which  applied to the winning of Loving v. the State of Virginia, and the drafting of the Universal Declaration of Human Rights. This was generations after Galton, Mendel and Darwin.

What is the lesson? Bioethical conflicts often coincide with historically poor scientific understanding, or abuses. However, they coexist with equal and opposite reactions — leaps of moral and scientific process.  Thinking  about how the film LOVING,  based on the lives of Mildred and Richard Loving,end of Anti-miscegenation laws in the United States. Remember, LOVING is a film  not only about law, but about the debunking of archaic, if ever valid, science.




Galton Memories of My Life, https://www.google.com/search?client=safari&rls=en&q=Galton+Memories+of+My+Life+(London:+Methuen,+1908),+pp.+22+-+47.&ie=UTF-8&oe=UTF-8
February 17, 2017

Ethics & Society Newsfeed: February 17, 2017

Politics Trump Ethics Monitor: Has The President Kept His Promises? To track Trump’s ethics-related promises, NPR checked debate transcripts, campaign speeches and press conferences Trump’s South Florida estate raises ethics questions Ethics questions and possible conflicts surrounding President Donald Trump’s frequent trips to his sprawling Mar-a-Lago property, especially in regards to the invitation of Japanese Prime … More Ethics & Society Newsfeed: February 17, 2017
February 17, 2017

How Well Do Americans Meet Dietary Requirements?

A JAMA study shows that even though Americans are eating more nuts and whole grains than they used to (see previous post), they aren’t coming CLOSE to meeting dietary requirements: Changing what people eat takes a long time!

The post How Well Do Americans Meet Dietary Requirements? appeared first on PeterUbel.com.

February 17, 2017

Religion and Futility in the ICU

The University of Oxford Faculty of Philosophy are hosting an event on Monday, May 8, 2017:  "Religion and Futility in the Intensive Care Unit."  This is a half-day seminar exploring issues around religion, pluralism and medical ethics.

A child is critically ill in the intensive unit. Doctors believe that the child’s prognosis is very poor and that treatment should be withdrawn. However, her parents do not agree. They say that it is contrary to their religion to stop treatment.

How often is religion a source of disagreement about treatment in intensive care? What are the views of major religions about withdrawing treatment in intensive care?

Should religious requests for treatment be treated differently from secular requests? Should religious preferences for treatment count in a child? Should religious views be accommodated when providing scarce and expensive medical resources?

Guest Speaker
  • Professor John Paris S.J. (Professor of Bioethics, Boston College)

Speakers/ Panel Participants
  • Joe Brierley
  • Sarah Barclay
  • David Jones
  • John Wyatt
  • Siddiq Diwan
  • Dominic Wilkinson

February 17, 2017

BioethicsTV: Mass Casualties & Triage

by Craig Klugman, Ph.D.

Chicago Med (Season 2; Episode 14). Over the last few years I have been working in the area of crisis standards of care.…

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Published Articles (40)

AJOB Primary Research: Volume 8 Issue 1 - Feb 2017

When are primary care physicians untruthful with patients? A qualitative study Stephanie R. Morain, Lisa I. Iezzoni, Michelle M. Mello, Elyse R. Park, Joshua P. Metlay, Gabrielle Horner & Eric G. Campbell

American Journal of Bioethics: Volume 17 Issue 2 - Feb 2017

CPR and Ventricular Assist Devices: The Challenge of Prolonging Life Without Guaranteeing Health David Magnus & Danton Char

American Journal of Bioethics: Volume 17 Issue 1 - Jan 2017

Tracking U.S. Professional Athletes: The Ethics of Biometric Technologies Katrina Karkazis & Jennifer R. Fishman

American Journal of Bioethics: Volume 17 Issue 1 - Jan 2017

A Framework for Unrestricted Prenatal Whole-Genome Sequencing: Respecting and Enhancing the Autonomy of Prospective Parents Stephanie C. Chen & David T. Wasserman

American Journal of Bioethics: Volume 17 Issue 1 - Jan 2017

Modern Pregnancies and (Im)Perfect Babies Stephanie A. Kraft

American Journal of Bioethics: Volume 16 Issue 12 - Dec 2016

A Broader Understanding of Moral Distress Stephen M. Campbell, Connie M. Ulrich & Christine Grady

American Journal of Bioethics: Volume 16 Issue 12 - Dec 2016

Moral Distress in Clinical Ethics: Expanding the Concept Alyssa M. Burgart & Katherine E. Kruse

American Journal of Bioethics: Volume 16 Issue 11 - Nov 2016

Diagnosis by Documentary: Professional Responsibilities in Informal Encounters Alistair Wardrope & Markus Reuber

American Journal of Bioethics: Volume 16 Issue 11 - Nov 2016

The Ethics of Organ Donor Registration Policies: Nudges and Respect for Autonomy Douglas MacKay & Alexandra Robinson

American Journal of Bioethics: Volume 16 Issue 11 - Nov 2016

Autonomy by Default Cass R. Sunstein

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News (2067)

February 13, 2017 9:00 am

Senate confirms Price to lead HHS (Science)

Price now takes the helm of a $1 trillion government department that includes the National Institutes of Health (NIH), the Centers for Disease Control and Prevention, and the Food and Drug Administration (FDA). Most visibly, he will be charged with overseeing the repeal and replacement of the Affordable Care Act, also known as Obamacare, that Republicans have promised.

January 24, 2017 9:00 am

With executive order, Trump tosses a ‘bomb’ into fragile health insurance markets (Washington Post)

The practical implications of Trump’s action on Friday are harder to decipher. Its language instructs all federal agencies to “waive, defer, grant ­exemptions from or delay” any part of the law that imposes a financial or regulatory burden on those affected by it. That would cover consumers, doctors, hospitals and other providers, as well as insurers and drug companies.

January 13, 2017 9:00 am

Successful Ebola vaccine will be fast-tracked for use (BBC News)

Trials conducted in Guinea, one of the West African countries most affected by an outbreak of Ebola that ended this year, show it offers 100% protection. The vaccine is now being fast-tracked for regulatory approval.

January 9, 2017 9:00 am

Fact-checking Congress’s fetal tissue report (Science)

They interviewed senior physicians from Planned Parenthood, who spoke bluntly about their provision of fetal tissue from legal abortions for medical research

December 23, 2016 9:00 am

Abortion Is Found to Have Little Effect on Women’s Mental Health (The New York Times)

Some states require women seeking abortions to be counseled that they might develop mental health problems. Now a new study, considered to be the most rigorous to look at the question in the United States, undermines that claim.

December 12, 2016 9:00 am

Ohio’s new abortion law is an assault on Roe. Here’s why it won’t work. (Washington Post)

So have Ohio lawmakers made the right bet on what will happen once Trump is in the White House — namely, that a new Supreme Court lineup could overturn Roe?

November 16, 2016 9:00 am

Too many people are being told they have a vitamin D deficiency (Washington Post)

Doctors are warning about vitamin D again, and it’s not the “we need more” news you might expect.

November 11, 2016 8:00 am

Colorado passes medical aid in dying, joining five other states (Denver Post)

Colorado passed a medical aid in dying measure Tuesday that will allow adults suffering from terminal illness to take life-ending, doctor-prescribed sleeping medication.

November 10, 2016 10:52 am

U.S. watchdog told Medicare, Medicaid that EpiPen was misclassified in 2009: senator (Reuters)

The internal watchdog at the U.S. Department of Health and Human Services warned the office tasked with administering federal health insurance programs that Mylan NV’s EpiPen was improperly classified as a generic drug in 2009, Senator Charles Grassley said on Tuesday.

November 7, 2016 8:00 am

Putting Sugary Soda Out of Reach (NY Times)

Can public health officials force Americans to break their soda habit?

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