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Blog Posts (4592)

September 22, 2017

Another (Un)Health Care Bill Forced onto Us

by Craig Klugman, Ph.D.

Americans still tend to think of human rights violations as abridgments of free speech and religion, and extreme crimes against humanity, such as slavery, torture, and arbitrary detention.

September 22, 2017

Ethics & Society Newsfeed: September 22, 2017

Politics Donald Trump’s Lies and Obstruction Will End His Presidency, Ex-Ethics Chief Says “A former White House ethics chief says that Donald Trump would likely be impeached if it is proven he sought to obstruct justice by firing ex-FBI Director James Comey in hopes of ending his investigation into Russian meddling in the 2016 election.” Public … More Ethics & Society Newsfeed: September 22, 2017
September 22, 2017

Ethics As An Evolving Activity: The Need To Remain Vigilant

Working as an ethicist in a professional work environment, you quickly realize that any ethical advice worth giving to practitioners must always be relevant to real problematic, human situations. Ethics must make a difference. Elucidating one’s obligations in particular problematic situations enhances insight and confidence in working through troubling value-laden dilemmas both in individual circumstances, as in clinical ethics, and also with regard to larger social problems at the macro policy level. Most ethical solutions are provisional recommendations, i.e. always amenable to revision based on new data, based on ethical reasoning in light of the particularities of each case that may ameliorate an impasse and often helps decrease suffering: Ethics helps make the little corner of the world with which it deals a little better off.

Though I am laying out a pragmatic ethical framework, I want to be clear that ethical principles are essential to ethical problem solving. Following Kant but with a pragmatic twist, the foundation of ethics is the duty to treat each individual human being with respect and, as much as possible, to be fair to everyone. This duty reflects the two fundamental moral principles of respect for autonomy and justice. In the application of the principle of individual autonomy, respect is expressed toward human individuals in concrete situations. For the principle of justice, respect is expressed toward a community or society or connected individuals. Elucidating the pragmatic approach further, ethical principles are not viewed as absolute, quasi-religious truths that exist independent of human experience but rather grounded in human experience.

Ethical principles from this perspective are repositories of wisdom gained through reforms primarily in the democratic process of extending the moral community by recognizing more individuals as full moral agents and guaranteeing them the rights of full citizenship. Thus, the way one thinks about ethics today in contemporary America is deeply connected to, and in a real sense grows out of, the historical process of democratic politics. Just think of the bedrock principle of medical ethics, respect for autonomy and how this notion evolved historically within the legal process and the key court cases on informed consent for the past 100 years or more. Think of the political reform movements in civil, feminist, and consumer rights, etc. movements during the 1960’s. Think of the lessons learned from the abuses of human subjects research that came to light after WWII the Nuremberg Trials. Finally, think of the violations of human research described by Henry Beecher in 1966 in an article from the New England Journal of Medicine, which led to the creation of greater protection of human subjects in research. All of these and other historical events helped to give rise to a full-blown concept of individual autonomy as well as the rights of all patients and subjects to voluntary informed consent. To reiterate, ethical principles emerge historically from real human experience, not from out of the blue sky above, based on meaningful progress in the respectful and fair treatment of all human beings as full moral agents.

The larger point I am getting to is that the ethical and moral life of humans as individuals cannot be separated from the life of humans as they struggle together in community, in groups, pursuing their own interests within the political process over and against the interests of others within a legal and political process. The moral options available for individuals are always framed within the confines of a certain collective or institutional order. From this pragmatic perspective, it follows that the very integrity of ethics as an essential dimension of human life that is dependent on the integrity of the political order. Does it treat all people fairly or does it attempt to exclude and deny certain individuals their basic rights to participate in the democratic process? Think of the current commission on voter fraud investigating non-existent problems in the election process, which may result in tighter voting restrictions that will greatly impact populations not likely to vote for the current administration. Is there a commitment to truth (with a little “t”), as in empirical truth, the institution of scientific research as the principal arbiter of scientific claims, and in general to relate facts of ordinary experience? Think about the denial of the claims from climate science research or the claim made by a presidential candidate that he saw Muslims cheering at the dreadful site of 9/11. Is there commitment to treat each other with a basic respect in our interactions and dealings on the public stage? Think of all the name-calling, derogatory comments, and incitements to violence during the last presidential campaign, which has continued up to the present in the current administration. I could go on, but you hopefully get the point.

Those of us who work in areas of applied ethics must be deeply concerned about state and direction of our political process and collective life as a society. This way of thinking about ethics should cause us considerable pause as we witness the current pattern of political events in our country. Up to the present we should be grateful for the ethical framework that has emerged in the tradition that we have inherited. But there is no guarantee that we will remain so lucky. We cannot allow ourselves to reach the point, as past philosophical ethics has done, to think of ethics as an isolated, academic enterprise. It is not. It is a practical, living, and evolving, historically contingent institution of which we must be responsible stewards. That means it is important that ethicists and all concerned citizens vigilant of what is happening in politics and the larger society. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and a Graduate Certificate in Clinical Ethics. For more information on AMBI's online graduate programs, please visit our website.  

September 22, 2017

Lawsuit Challenging Texas' Futile Care Law Goes before Judge

Later today, there is a major hearing in a lawsuit challenging the constitutionality of the dispute resolution provisions in the Texas Advance Directives Act.  The Houston Chronicle provides good, balanced background. I have arg...
September 22, 2017

Dying in the Americas 2018

Another major end-of-life policy conference is scheduled from March 21 to 25, 2018 outside Las Vegas, Nevada. Confirmed Keynote Speakers: Dr. Zubin Damania - health care pioneer in new ways of considering healthcare delivery and conversations. Zdogg...
September 22, 2017

7 Pathways to Legalize Medical Aid in Dying

Today, I am participating in a law review symposium at the University of New Mexico.  My presentation is "Legal History of Medical Aid in Dying: Physician Assisted Death in U.S. Courts and Legislatures."   I review 7 pathways to legaliz...
September 21, 2017

UK Drops Judicial Permission Requirement to Stop CANH for PVS patients

Justice Peter Jackson In contrast to most Western jurisdictions, families and clinicians in the UK needed court permission withdraw nutrition from a patient in a permanent vegetative state.  A new ruling yesterday holds that such permission is ...
September 21, 2017

The Benefits of High Health Care Expenditures

I write frequently about the high costs of healthcare, in the U.S. and in many other parts of the world. And in general, I believe strongly that most developed countries need to look seriously at how they’re spending healthcare dollars, … Continue reading

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September 20, 2017

Half of Healthcare Spending: For 1/20th of the People

It is not unfair that we spend more on medical care for some people than others. After all, some people are sicker than others. If there’s anything unfair, it’s probably the uneven distribution of illness and disability. That said, the … Continue reading

The post Half of Healthcare Spending: For 1/20th of the People appeared first on

September 20, 2017

End of life decision making and the family

When we discuss the ethics of end of life decision making our focus is commonly on how we can best respect the autonomy of the patient and how we should weigh the benefits and burdens of a treatment for the patient when that person is unable to make his or her own decisions and has not previously made decisions about the treatment that may be... // Read More »

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Published Articles (57)

AJOB Primary Research: Volume 8 Issue 3 - Sep 2017

Membership recruitment and training in health care ethics committees: Results from a national pilot survey Anya E. R. Prince, R. Jean Cadigan, Warren Whipple & Arlene M. Davis

American Journal of Bioethics: Volume 17 Issue 8 - Aug 2017

Saving or Creating: Which Are We Doing When We Resuscitate Extremely Preterm Infants? Travis N. Rieder

American Journal of Bioethics: Volume 17 Issue 8 - Aug 2017

What We Do When We Resuscitate Extremely Preterm Infants Jeremy R. Garrett, Brian S. Carter & John D. Lantos

American Journal of Bioethics: Volume 17 Issue 7 - Jul 2017

A Proposed Process for Reliably Updating the Common Rule Benjamin E. Berkman, David Wendler, Haley K. Sullivan & Christine Grady

American Journal of Bioethics: Volume 17 Issue 7 - Jul 2017

At Last! Aye, and There's the Rub Alexander M. Capron

American Journal of Bioethics: Volume 17 Issue 7 - Jul 2017

Modernizing Research Regulations Is Not Enough: It's Time to Think Outside the Regulatory Box Suzanne M. Rivera, Kyle B. Brothers, R. Jean Cadigan, Heather L. Harrell, Mark A. Rothstein, Richard R. Sharp & Aaron J. Goldenberg

American Journal of Bioethics: Volume 17 Issue 6 - Jun 2017

When Respecting Autonomy Is Harmful: A Clinically Useful Approach to the Nocebo Effect John T. Fortunato, Jason Adam Wasserman & Daniel Londyn Menkes

AJOB Primary Research: Volume 8 Issue 2 - Apr 2017

Perspectives of IRB chairs on the informed consent process Eugene I. Kane III & Joseph J. Gallo

AJOB Primary Research: Volume 8 Issue 2 - Apr 2017

Growing an ethics consultation service: A longitudinal study examining two decades of practice Christine Gorka, Jana M. Craig & Bethany J. Spielman

AJOB Primary Research: Volume 8 Issue 2 - Apr 2017

Adolescent oncofertility discussions: Recommendations from a systematic literature review Dorit Barlevy, Bernice S. Elger, Tenzin Wangmo & Vardit Ravitsky

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News (2080)

September 21, 2017 9:00 am

As Federal Government Cuts Obamacare Ads, Private Insurer Steps Up (NPR)

Open enrollment for Affordable Care Act insurance doesn’t start for another six weeks. But the quirky insurance startup Oscar Health is launching an ad campaign Monday aimed at getting young people to enroll.

September 5, 2017 9:00 am

F.D.A. Approves First Gene-Altering Leukemia Treatment, Costing $475,000 (The New York Times)

The Food and Drug Administration on Wednesday approved the first-ever treatment that genetically alters a patient’s own cells to fight cancer, a milestone that is expected to transform treatment in the coming years.

July 5, 2017 10:00 am

For Parents of U.K. Infant, Trump’s Tweet Is Latest Twist in an Agonizing Journey (The New York Times)

The long journey for Connie Yates and Chris Gard, whose infant son, Charlie, cannot breathe or move on his own, appeared to have come to an end last week. The courts had ruled that the baby’s rare genetic condition was incurable and that the only humane option was to take him off life support. The couple announced that they were getting ready “to say the final goodbye.” Then Pope Francis and President Trump weighed in, offering statements of support and thrusting a global spotlight onto a heart-rending case that has become a cause célèbre in Britain.

June 20, 2017 10:58 am

Trump ‘simply does not care’ about HIV/AIDS, say 6 experts who just quit his advisory council (Washington Post)

The first hints of an uncertain future for the Presidential Advisory Council on HIV/AIDS came last year, when Donald Trump’s presidential campaign refused to meet with advocates for people living with HIV, said Scott Schoettes, a member of the council since 2014. That unease was magnified on Inauguration Day in January, when an official White House website for the Office of National AIDS Policy vanished, Schoettes said. Last week, he and five others announced they were quitting the Presidential Advisory Council on HIV/AIDS, also known as PACHA.

June 6, 2017 9:00 am

Superantibiotic is 25,000 times more potent than its predecessor (Science)

The world’s last line of defense against disease-causing bacteria just got a new warrior: vancomycin 3.0. Its predecessor—vancomycin 1.0—has been used since 1958 to combat dangerous infections like methicillin-resistant Staphylococcus aureus. But as the rise of resistant bacteria has blunted its effectiveness, scientists have engineered more potent versions of the drug—vancomycin 2.0. Now, version 3.0 has a unique three-pronged approach to killing bacteria that could give doctors a powerful new weapon against drug-resistant bacteria and help researchers engineer more durable antibiotics.

June 5, 2017 9:00 am

Unsafe delivery of measles vaccine kills 15 children in South Sudan (CNN)

In a remote village in South Sudan, 15 children died from severe toxicity caused by contaminated measles vaccines, government health investigators said Thursday. The National Adverse Events Following Immunization Committee, supported by the World Health Organization, and UNICEF vaccine safety experts examined the cases and those of 32 other children who suffered fever, vomiting and diarrhea.

May 1, 2017 9:00 am

Human vaccine data release jump-starts biotech’s bid for RNA drugs (Science)

The executive team at Moderna raised a cheer today after publishing their first early snapshot of human efficacy data that demonstrate their messenger RNA tech works — at least on the first try. The biotech tested their H10N8 flu vaccine on a small group of 31 subjects, looking at their response in two different measures. All demonstrated a sufficient immune response to fight off the virus in the first measure, and all but 3 in the second, for a total of 23 who received the vaccine.  None of the 8 subjects who received a placebo responded.

April 10, 2017 9:00 am

First medical diagnosis often incomplete or outright wrong, study finds (The San Diego Union-Tribune)

When your doctor gives a diagnosis of a complicated disease, it often pays to get an independent second look, according to a study from Mayo Clinic published Tuesday.

April 3, 2017 9:00 am

Donald Trump believes the solution to the opioid crisis is talk (Vox)

President Donald Trump will soon sign an executive order to tackle what he’s called the “total epidemic” of opioid abuse and addiction. The main objective of the order is to create a commission that’s tasked with publishing a report on what to do about America’s deadliest drug crisis ever.

March 28, 2017 9:00 am

Dying patients want easier access to experimental drugs. Experts say that’s bad medicine (Watertown Daily Times)

DeBartoli walks with difficulty and falls frequently. He’s losing his ability to breathe on his own. Now the 55-year-old from Tracy, Calif., has pinned his hopes on an experimental drug made by Genentech — and a new “right-to-try” law that allows desperate patients to take medications before they’ve been fully vetted by the Food and Drug Administration. The measure’s newest fan is President Donald Trump, who said the FDA’s caution in granting dying patients access to some medications had “always disturbed” him. But for all its populist appeal, the push for right-to-try laws has raised the ire of ethicists, drug safety experts and a former FDA commissioner.

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