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Blog Posts (3029)

April 29, 2016

A Bit More about the Minimal Genome

Earlier this week, Mark McQuain posted a nice summary of the recently-published work by J. Craig Venter’s group to identify a “minimal genome” for a type of bacterium, the mycoplasmas, which are, as the group points out, “the simplest cells capable of autonomous growth.”  Mark wondered aloud what the implications would be for our understanding of what it is to be human—how many genes do... // Read More »
April 28, 2016

Expanding The Moral Community: Why is it so hard?

Much of American history can be described as the struggle to expand the moral community in which an increasing number of human beings are seen as having basic rights under the constitution. We forget sometimes that though the inclusion of all people was perhaps implied in our early documents, as in “We hold these truths to be self-evident, that all men are created equal…” from the Declaration of Independence, it has taken historical time and struggle to come closer to realizing that ideal. This struggle has been the quest for recognition of more and more individuals not assumed initially to have the right to vote and exercise control over their lives, which included African Americans, women, minorities, and more recently the LGBT community. The growing recognition of more and more individuals as being full fledged citizens has been a slow, often painful, birthing process of freedom, in the sense of unleashing human potential and possibilities, within the democratic process.

 

The recent uproar over the Anti-LGBT law passed in North Carolina is a reminder of how difficult it is for many states and communities to accept and accommodate historically marginalized people into the mainstream of society. This law was a quick reaction by the right wing North Carolina legislature and governor to an ordinance passed in Charlotte, similar to what other cities around the country are doing, allowing transgender people to use restrooms according to their gender identity. Perhaps this law also should be seen as a reaction to the Supreme Court ruling in 2015 legalizing same-sex marriage, which has been propelling society toward greater openness and acceptance of LGBT life styles, integrating them into the mainstream. Many who favor the Anti-LGBT law claim that individuals born as male, but are now identifying as female, could pose a risk to women and girls in public bathrooms, though there seems to be no substantial evidence whatsoever of such a risk. My sense is that the individuals who support this law in fact are using risk as a smokescreen in attempting to preserve what they perceive as waning values and norms in society: In the name of conservatism they hang on to an exclusionary vision of society that no longer fits the conditions of expanding freedom and opportunity.

 

So what some see as waning values and norms, others see as moral progress toward more robust democratic ideals and values. This inherent, historical struggle of opposing social and political forces has resulted with unexpected rapidity in the social and legal acceptance of gays and lesbians in the past 20 years in the United States. Most young people today especially those living in metropolitan areas, like Charlotte, where cultural diversity is a daily reality, readily accept that people naturally have different sexual orientations and gender identities, which people should be free to express in their lives. This liberal openness to diversity likely stems from the fact that they live in the midst of, and have normal interactions and friendships with, people of diverse sexual orientations and gender identities, which prompts them to look upon them as neighbors and as normal people. On the other hand, my guess is that many of the advocates of the Anti-LGBT Bill in North Carolina have little or no contact (of which they are aware) and no or limited relationships with LGBT individuals. Also, part of the resistance to greater inclusion of the LGBT community could be stem from the anxiety of having to recognize one’s own uncomfortable feelings and inclinations about sexuality and gender.

 

An additional factor to explain the reluctance of many self-identified conservatives to accept alternative sexual and gender orientations may be related to religion. Particularly, in the “bible belt” regions, regardless of whether or not they are followed by church leaders and members, clear notions of basic moral norms of right and wrong are assumed. Sadly, religious morality has been historically integrated with and used to justify a range of regional cultural values and norms—even heinous ones such as the use of Christianity to justify the institution of slavery. But in fairness even many Christians outside the bible belt follow Catholic natural law theory based on certain features about human nature from which basic norms are predicated about what is “normal” as well as “right” and “wrong” in a content rich, objective sense. In short, the point is if one believes that members of the LGBT community are engaging in a personal life style that is assumed to be inherently immoral, a barrier to inclusion is created.

 

So we in America today are in the midst of a culture war between conservative communities in rural and smaller towns on the one side espousing religious assumptions about human nature (which affects how they perceive risks) and liberals celebrated diversity in more progressive, metropolitan areas on the other. Advocates on either side of this divide bring to bear ideas and theories in an effort to convince others of their position. However, my sense is that articulating arguments to defend the root moral assumptions of either side is unlikely to change the minds of individuals on the other side. The result seems to be communities of individuals living in parallel universes with alternate moral vocabularies who “talk at” each other. Though I am for a liberal, moral vocabulary to account for moral progress within the democratic process, the real change that many of us liberals seek really is at the emotional, and even spiritual, level relating to how human beings are able to show empathy and respect for their fellow human beings in their communities.

 

We know human identity is based largely on social identity within a particular group or groups related to broad social categories such as religion, race, ethnicity, social class, etc. and to more specific ones such as professions, sports teams, political parties, etc. One of the inherent features of social identity is that individuals have a sense of self-identity by virtue of their group affiliations, which is also defined in terms of groups with which they are not affiliated and to which they stand in opposition. When group identities become rigid, to the point of engendering animus toward other groups, barriers are created which can marginalize the rights of individuals in those groups. But through exposure to, and openness to personal relationships with, individuals outside one’s own group, group identity becomes more flexible and open to change—this is an inner change of heart and disposition toward others.

 

Perhaps many of those who self-identify as conservatives in North Carolina who favor the Anti-LGBT law, and who also are predominantly Christian, should remember the ministry of the central character of their faith tradition. The thrust of Jesus’ ministry as defined by scholars like John Dominic Crossan is one of radical inclusion and hospitality. Jesus spent his time interacting with, eating with, and drinking wine with those on the margins of society who were outcasts and viewed as unclean and dangerous according the prevailing hygiene laws. His message to these people was that they too can be included in the moral community and be loved like all others. This is a robust message of compassion and love.

 

Ultimately, struggle for expanding inclusion can only succeed when opponents of bills like the Anti-LGBT Bill are able to show members of the LGBT community the kind of compassion and love Jesus showed to those on the margins of society in his day. The struggle of inclusion really is the struggle to expand what one thinks of as the moral community, or more simply, the neighborhood.

 

 

 

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

April 28, 2016

More Coverage of Our Research on Out-Of-Pocket Cost Conversations

Here is a nice summary of our research, published by an excellent reporter at The American Journal of Managed Care: A new qualitative study of clinical meetings between physicians and patients pointed out certain behavioral concerns that stand in the … Continue reading

The post More Coverage of Our Research on Out-Of-Pocket Cost Conversations appeared first on PeterUbel.com.

April 28, 2016

This Is How Prince’s Death Begins Conversation About Addiction

Myra Christopher
INTRODUCTORY NOTE FROM MYRA CHRISTOPHER
Lynn Webster, author of the blog below, is a member of Pain Action Alliance to Implement a National Strategy (PAINS) Steering Committee. He is also one of the most authoritative and committed experts in the United States working on both pain and addition. PAINS has been benefitted tremendously from his involvement in our efforts to “transform the way pain is perceived, judged and treated.” 
Over the last couple of years, PAINS has come to understand the importance of embracing the need for dramatic change in the way two diseases – chronic pain and substance abuse disorders, especially opioid addiction -- are addressed, and that by advocates focused on both working together, we are far more likely to improve the health and well-being of all Americans.  
Although relationship the between these two public issues is not yet clearly understood, there is without question a correlation between the two. Unfortunately, these two patient populations have often been pitted against one another by the media and fear-mongers for personal or political advantage. PAINS has attempted to reach out to those focused on opioid addiction and to neutralize some of the ill-will between those focused on pain and those focused on addiction.  
These efforts are  gaining some traction with people of goodwill – no matter their primary locus of concern; PAINS is committed to this work because we are confident that there are shared values and common ground upon which we can collaborate.
We are grateful to Dr. Webster for allowing us to post a blog he wrote shortly after the sudden death of one of America’s great artists, Prince. We believe it  makes a compelling case for what PAINS is trying to do. 

The Conversation Is About Compassion and Addiction


Lynn Webster, MD
When I published my recent blog, Prince and Why We Need More Compassion About Addiction, I began by saying that we didn’t yet know why Prince died. The facts weren’t in, and I didn’t want to draw conclusions until I had more information.
I still don’t have all the facts about the circumstances surrounding Prince’s death. I wasn’t Prince’s physician during his lifetime, and I had no opportunity to look at his medical records either before, or after, his death.
All I know about Prince’s death is what you know. Some entertainment media outlets (TMZVariety, and more) initially reported that Prince was treated with naloxone, which is the antidote for opioids including heroin, in the days before his death. An autopsy (in which I had no participation) was conducted on Prince’s remains, and according to CNN, it could be weeks before we know why the beloved musical icon is no longer with us.
Several of my colleagues and friends posted a link to my blog on their social networks, and they told me they were surprised to see that some of their supporters had reacted swiftly and furiously. For example, Jan Favero Chambers, President/Founder of the National Fibromyalgia & Chronic Pain Association, was gracious enough to post a link to my blog on her Facebook page.
Among the negative comments she shared with me was this one:
“Jumping the gun a bit. We don’t know the cause of death. Respect his memory, by not posting this.”
If you look at the comments below my original blog, you’ll find someone raised an objection there, too:
“Why are you using Prince to draw people into this article? Do you know his medical history? Have the autopsy results come back? Please school me on your knowledge,” reads the comment.

Empathize, Don’t Blame, People in Pain or With Addiction

As I said in my response to that comment, part of my life’s work is to teach people to empathize with, and not blame, people in pain or with addiction. The untimely death of a beloved musical icon provides an opportunity to test our ability to demonstrate compassion. That is why I blogged about it.
I blogged about the death of Prince not because I jumped to conclusions about how he died. As I wrote then, I didn’t know any more about the cause, or causes, of his death than anyone else who hadn’t treated him or viewed his medical records.
But what I did know is that we, as members of society, had experienced a communal loss. While that’s tragic and sad, it provides us with one benefit: an opportunity to compassionately discuss the difficult topic of addiction and related issues.
Since TMZ, Variety, and other entertainment media had linked Prince’s death with naloxone, which is the antidote for opioids including heroin, I believed (and I still believe) that it was a good time to discuss addiction.

Addiction Is a Disease, Not a Character Flaw

Addiction is a disease, and yet it frequently elicits anger and judgment rather sympathy and support. This is true for everyone, famous or not, with addiction.
I don’t know whether Prince was one of the people with addiction. But what I do know is that, as an addiction specialist, I treated thousands of people with addiction over the years. My professional background qualifies me to make the observation that it’s wrong to deny compassion to the people in various stages of the disease of addiction.
When we blame people with addictions for the choices that led to their addictions, we overlook the fact that addiction is a complex problem. Because there are so many factors involved in addiction, it’s inaccurate and unfair to point a finger at an individual and say, “This disease is your fault.”
It is true that we all own some agency for our decisions, but once the disease of addiction is firmly rooted, the power to choose is stolen by the brain.
My concern was that, if the medical evidence supported the conclusion that Prince died of addiction, the outpouring of devotion that his memory had inspired would turn to rage against him. That, in my opinion, would be a shame, because the people we care about — whether they are family members, friends, colleagues, or celebrities whom we’re unlikely to meet in person — are as worthy of our love in their sickness as they are when they enjoy their full health.
To me, the death of Prince represents an opportunity to begin a discussion about why we negatively judge anyone who is sick. It provides us all with an opportunity to open up our hearts and listen to people in pain and with addiction.
And, most of all, it gives us a chance to feel compassion toward all people, sick or healthy, famous or anonymous, rich or destitute, gifted performer or shy wallflower, and friend or stranger. We’re all members of the same tribe, the human race, and we’re all entitled to love and understanding during every stage of our lives — whether we make good choices or bad choices, and whether we enjoy the happiness of success and health or the difficulties of sickness and even death.
April 28, 2016

Cross-Cultural Perspectives on Brain Death (video)

Check out this recent presentation at Harvard comparing East and West perspectives on brain death.  
April 27, 2016

Israel Stinson - Video Purporting to Disprove Brain Death

April 27, 2016

Bioquark Questions Irreversibility of Brain Death

Bioquark claims that death may not be irreversible. The mission of the ReAnima Project is to focus on clinical research in subjects who have recently met the Uniform Determination of Death Act criteria, but who are still on cardio-pulmonary support. ...
April 26, 2016

Five Current Brain Death Cases in California

As of the end of last week, there were five brain death cases in California. 1.  Jahi McMath's federal lawsuit against the state of California seeking to revoke her death certificate. Parents of Alan Sanchez 2.  Jahi McMath's state me...
April 26, 2016

Transnational Reproduction: Race, Kinship and Commercial Surrogacy in India

Wednesday, April 27, 12:15 – 1:30 p.m. | Walsh Library Special Collections room Join us for a lunchtime lecture and discussion led by Daisy Deomampo, Ph.D. (assistant professor of anthropology, Fordham). Her research focuses on the intersection between technology, gender, health … Continue reading
April 26, 2016

Online Summer JD Health Law Classes - HIPAA Privacy, Medical Marijuana, Compliance Institute

Starting in about one month are three wholly online summer classes for JD credit: HIPAA Privacy Medical Marijuana Law: State Regulation in the Shadow of Federal Prohibition Health Care Compliance Institute Apply here today.

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Published Articles (22)

American Journal of Bioethics: Volume 16 Issue 1 - Jan 2016

Professional Judgment and Justice: Equal Respect for the Professional Judgment of Critical-Care Physicians David Magnus & Norm Rizk

American Journal of Bioethics: Volume 15 Issue 10 - Oct 2015

Do Patients Want to Participate in Decisions About Their Own Medical Care? John D. Lantos

American Journal of Bioethics: Volume 15 Issue 4 - Apr 2015

Ideology and Microbiology: Ebola, Science, and Deliberative Democracy Joseph J. Fins

American Journal of Bioethics: Volume 15 Issue 2 - Feb 2015

Collectivizing Rescue Obligations in Bioethics Jeremy R. Garrett

American Journal of Bioethics: Volume 15 Issue 2 - Feb 2015

Rethinking the Rescue Paradigm Kayhan Parsi

American Journal of Bioethics: Volume 14 Issue 9 - Sep 2014

Addressing Dual Agency: Getting Specific About the Expectations of Professionalism Jon C. Tilburt

American Journal of Bioethics: Volume 14 Issue 7 - Jul 2014

The Principle of Equivalence Reconsidered: Assessing the Relevance of the Principle of Equivalence in Prison Medicine Fabrice Jotterand & Tenzin Wangmo

American Journal of Bioethics: Volume 14 Issue 6 - Jun 2014

Patient and Citizen Participation in Health: The Need for Improved Ethical Support Laura Williamson

American Journal of Bioethics: Volume 14 Issue 2 - Feb 2014

Ethical Review of Health Systems Research in Low- and Middle-Income Countries: A Conceptual Exploration Adnan A. Hyder, Abbas Rattani, Carleigh Krubiner, Abdulgafoor M. Bachani & Nhan T. Tran

American Journal of Bioethics: Volume 14 Issue 2 - Feb 2014

Connecting Health Systems Research Ethics to a Broader Health Equity Agenda Bridget Pratt

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News (2007)

April 27, 2016 8:00 am

Letters Telling Women About Breast Density Are Often Too Darn Dense (NPR)

Over the past decade, states have passed laws intended to help women understand the results of their breast cancer screening mammograms if they have dense breasts. But those notifications can be downright confusing and may, in fact, cause more misunderstanding than understanding.

April 19, 2016 8:53 am

Study Backs Pancreas Cell Transplants for Severe Diabetes

Transplants of insulin-producing pancreas cells are a long hoped-for treatment for diabetes — and a new study shows they can protect the most seriously ill patients from a life-threatening complication of the disease, an important step toward U.S. approval.

April 13, 2016 10:11 am

IBM and American Cancer Society Want to Create the Ultimate Cancer Advisor

IBM and the American Cancer Society are launching a new partnership that will combine the power of Big Blue’s cognitive computing platform, Watson, with the wealth of cancer research and patient support services provided by the non-profit organization.

April 5, 2016 10:11 am

The disturbing reason some African American patients may be undertreated for pain

African Americans are routinely under-treated for their pain compared with whites, according to research. A study released Monday sheds some disturbing light on why that might be the case.

March 30, 2016 11:12 am

Is Ebola Hiding in the Eyes of Survivors?

Some West Africans who have beat the deadly disease are now going blind—and doctors, unsure if treatment would unleash the virus back into the population, are powerless to help them.

March 17, 2016 8:33 am

New CDC Guidelines Seek Doctors' Help In Fighting Opioid Epidemic

In an effort to curb America’s deadly opioid crisis, federal health officials are urging doctors to largely avoid prescribing highly addictive painkillers like OxyContin and Vicodin when treating patients for chronic pain.

March 16, 2016 1:33 pm

'Difficult' patients may tend to get worse care, studies find

What happens to medical care when the patient is a jerk?  Dutch researchers asked the question in two new studies, and the answer should make grumps think the better of their bad behavior: “Disruptive” patients may get worse care from physicians.

March 8, 2016 12:51 pm

No Paid Sick Leave Means Workers Skip Medical Care

U.S. workers without paid sick leave are more likely to keep going to work when they’re sick and to forgo medical care for themselves and their families, compared to workers who do get paid for sick days, according to a new study.

January 20, 2016 6:29 pm

Breast cancer screening recommendations clarify science but muddy political waters

The experts who sparked a passionate debate over the value of mammograms as a tool to screen for breast cancer are doubling down on the recommendations that earned them the ire of cancer groups, women’s groups and a large contingent in Congress.

January 7, 2016 6:31 pm

Does cancer screening save lives? Unclear, researchers say

Bigger studies are needed to tell whether cancer screening really saves lives, according to a new analysis.

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