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Blog Posts (1513)

January 24, 2015

5th International Conference on Advance Care Planning and End-of-Life Care (ACPEL)

The 5th International Conference on Advance Care Planning and End-of-Life Care (ACPEL) will be held from 9 to 12 September 2015 in Munich, Germany.  The Call for Abstracts is open until 15 Feb 2015. Already booked sessions include: Does the plan...
January 23, 2015

Patient Modesty: Volume 71

I would like to start out this Volume 71 with a basic question to help define what is understood as physical modesty and how it applies to this issue as experienced by patients within the medical system. Is modesty of an individual only related to how ...
January 23, 2015

The Power of Free

The Atlantic recently reproduced a figure showing just how much people like things when they are free. Specifically, they looked at health interventions and show that people are more likely to take up these interventions, or products, when they don’t … Continue reading
January 23, 2015

The Need for Patient Navigators for Fertility Preservation

<p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">Although life-saving, cancer treatments (e.g. radiation, chemotherapy, and surgery) can also lead to infertility in both women and men. Established reproductive technologies for women and men like gamete freezing and embryo freezing allow cancer patients to preserve their fertility in case they want to become biological parents in the future. </span></p> <p style="line-height: 19.0400009155273px;">Unfortunately, patients are frequently not adequately informed and sometimes not informed at all about fertility preservation. Some oncologists don’t consider fertility preservation to be an important issue, as they are more focused on saving the patients’ lives and see fertility preservation as a secondary consideration. Research has shown that even when oncologists refer their patients for fertility preservation they often do so based on social factors (they are more likely to refer wealthy, white, heterosexual, married patients) rather than purely on medical indications. Even when health care providers discuss fertility preservation with patients, many patients say that once they heard the word “cancer” as a diagnosis, they didn’t absorb much else from their initial conversation with their provider. </p> <p style="line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">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 <a style="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong><span style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span></p>
January 23, 2015

Death Test: Criteria for Screening and Triaging to Appropriate ALternative Care (CRISTAL)

Australian critical care physician Ken Hillman and health services researcher Magnolia Cardona-Morrell have just published a new checklist in BMJ Supportive and Palliative Care:  "Development of a Tool for Defining and Identifying the Dying Patient in Hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)."

The goal is to develop an evidence-based screening tool to identify elderly patients at the end of life and quantify the risk of death in hospital or soon after discharge.  The Telegraph calls it a "death test."


This should minimize prognostic uncertainty and avoid potentially harmful and futile treatments.  After all, an unambiguous checklist may assist clinicians in reducing uncertainty patients who are likely to die within the next 3 months and help initiate transparent conversations with families and patients about end-of-life care. 


January 23, 2015

The “End of Life Option Act” Introduced in the California Senate

Today California Senate Bill SB 128 was introduced.  It is described in the press as being comparable to Oregon’s law.  Its status can be followed here.  Apparently (I am betraying my weak knowledge of the civics of my home state here) it is first referred to the California Senate Rules Committee for committee assignment.    I have just downloaded the text and have not studied... // Read More »
January 22, 2015

WOMAN'S BREAST MILK: SHOULD IT BE UP FOR SALE?





In case you didn't know, a woman's breast milk is a commercially but also a nutritionally valuable commodity at least as an example supported by Medolac Labs and Mother's Milk Cooperative.  This milk is said to be needed by hospitalized pre-term infants whose mothers are not yet lactating.  I read about it in an article in the  Michigan State University Bioethics website  on lactation and  the laws and actions which have been taken including commodification of the woman's milk.

A scholarly article on the subject of the sale of mother's milk was written in the Winter 2009 issue of the Nevada Law Journal 

The sale of organs for transplant is not approved in the United States, only donation.  The question arises as to whether it is ethical to have lactating women provide their breast milk for sale. Is breast milk analogous to a solid organ?

Can or should the same arguments regarding the value, availability and ethics of "selling" apply to both breast milk and kidney?   (You can read more on the issue of the selling of solid organs for transplant in my blog thread "Organ Donation: Who, How, Why and also What are the Ethics (5))"

How about comparing selling the mother's milk to the legal commodification of eggs and sperm or blood elements?


A physician ethicist has reassured me on this topic:


"Maurice, ...

There are American markets for buying and selling human body parts, including blood, plasma, platelets, breast milk, hair, sperm, and unfertilized eggs. The National Organ Transplant Act bans compensation for organs, including livers, kidneys, and bone marrow. Flynn v. Holder adds the acquisition of hematopoietic stem cells from circulating blood to the list of acceptable activities.


An ethical analysis suggests that the key characteristics of these acceptable market-based donations of human body products are:

– The donated stuff can with time be regenerated.

– The injury to the donor is minimal and commensurate with the sale price.

– The risks to the donor of more serious morbidity and mortality are minimal."


And then, of course, there is the long history of "wet nursing" when other women took on the task of nursing a child if the mother was unable to do so.


To my visitors: Do you find any arguments against the selling of the milk obtained from a  lactating mother and, if you do, what are they?  ..Maurice.


Graphic: Migrant Mother, Dorothea Lange, Library of Congress / Public Domain / Wikimedia Commons







January 22, 2015

Should North Carolina Expand Medicaid?

My home state of North Carolina is one of a number of states that refused to expand Medicaid, even though the Affordable Care Act stipulates that the federal government will cover the majority of expenses associated with such expansion. Here … Continue reading
January 22, 2015

A Better Death: End of Life Care: Doctors, Machines and Technology Can Keep Us Alive, but Why?

The Vancouver Sun has just published the first of a significant 3-part series on "A Better Death": "End of Life Care: Doctors, Machines and Technology Can Keep Us Alive, but Why?"
January 21, 2015

Infertility, ethics, and fairy tales

This weekend my wife and I went to see the movie version of the musical Into the Woods. The music was done beautifully and the characters were casted and acted well, but I left disturbed by the ethics presented in the story. For those who have not yet seen the musical I will attempt to comment on it without spoiling it for you. The plot... // Read More »

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Published Articles (17)

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

American Journal of Bioethics: Volume 13 Issue 9 - Sep 2013

An Ethical Analysis of Mandatory Influenza Vaccination of Health Care Personnel: Implementing Fairly and Balancing Benefits and Burdens Armand H. Matheny Antommaria

American Journal of Bioethics: Volume 13 Issue 9 - Sep 2013

Vaccine Mandates Are Justifiable Because We Are All in This Together John D. Lantos and Mary Anne Jackson

American Journal of Bioethics: Volume 13 Issue 8 - Aug 2013

Treating Patients as Persons: A Capabilities Approach to Support Delivery of Person-Centered Care Vikki A. Entwistle & Ian S. Watt

American Journal of Bioethics: Volume 13 Issue 8 - Aug 2013

Justice Between Age Groups: An Objection to the Prudential Lifespan Approach Nancy S. Jecker

American Journal of Bioethics: Volume 13 Issue 8 - Aug 2013

Global Aging and the Allocation of Health Care Across the Life Span Norman Daniels

News (1975)

January 20, 2015 7:16 pm

Fight threatens thousands of Californians' health coverage

A contract dispute between health insurance provider Blue Shield of California and the Sutter Health network of doctors and hospitals is threatening to force nearly 280,000 consumers in Northern and Central California to find new doctors.

September 23, 2014 1:55 pm

More patients could wear regular clothing in hospital: study

Although doctors say many patients in hospitals could be wearing their own clothing below the waist, and most want to, a majority still don’t, according to a small Canadian study.

September 15, 2014 5:14 pm

Insurance giants creating massive database of patient records

Two of California’s largest health insurers are partnering to create a massive database of patient medical records.  But the system faces significant technological challenges and privacy concerns.

September 11, 2014 2:54 pm

Health Reform Watch: Study finds fewer deaths after MA health reform

In this edition of Health Reform Watch: Harvard Asst. Professor Ben Sommers explains his widely-quoted study showing a measurable drop in adult deaths in Massachusetts in the wake of the state’s health reform program, the model for the Affordable Care Act.

September 8, 2014 6:47 pm

Top U.S. health adviser wants end to partisan fighting over Obamacare

President Barack Obama’s top health adviser on Monday called for an end to partisan bickering over Obamacare, saying the public and businesses are sending a clear message to Washington that it is time to move on with implementing the law.

August 11, 2014 1:31 pm

Ethical questions emerge over who gets Ebola drug

In a development that raises a host of ethical issues, Spain announced it had obtained a scarce U.S.-made experimental Ebola drug to treat a Spanish missionary priest infected with the killer virus.

July 30, 2014 5:10 pm

Calif. Considers Bilingual Drug Labels

This week California’s Board of Pharmacy will discuss new regulations that would require all pharmacies in California to provide translated labels on prescription drug bottles.

July 22, 2014 3:23 pm

Pregnancy doesn’t drive women doctors out of surgical training

A new study disputes a common stereotype that women who become pregnant during surgical training often drop out of those training programs.

June 18, 2014 2:52 pm

Stroke 'selfie' helps save Canadian woman's life

“The sensation is happening again,” Stacey Yepes tells the camera. “It’s all tingling on left side.”

June 16, 2014 4:37 pm

U.S. health care system ranks last among 11 industrialized nations

Even though it’s the most expensive, the United States’ health care system ranks last among 11 industrialized nations in a new study that examines factors such as quality, efficiency and access to care

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