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December 9, 2016

Futility Disputes - An Interminable and Intractable Failure of Medical Decision Making

Check out this video of Bob Truog presenting "Futility Disputes - An Interminable and Intractable Failure of Medical Decision Making" at the Children's Mercy Kansas City 2016 Pediatric Bioethics Symposium.   This presentation frames and places th...
December 8, 2016

Don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse? Then don’t ask them if they are “trying” to conceive


One of the first questions a newly married straight couple often gets from well-meaning friends and family is “when are you going to start trying?” For those of you who are wondering what this question is getting at, it is asking them if they are going to start to try to get pregnant. It is interesting to analyze the language used here. People typically talk about “trying” without ever specifying what they are in fact trying to do. Part of the reason for this may be because people assume the meaning is obvious from the context, such as “they’ve been trying for six months but haven’t gotten pregnant yet.” Another reason probably has to do with our societal discomfort talking about sex.

We use general and vague terms to imply that we are talking about sex, but often don’t feel comfortable out right discussing it. For example, the birth control pill is generally just referred to as “the pill.” There is still shame and stigma surrounding sex, particularly for women and sexual minorities, so it may be easier and safer for a woman to talk about being on “the pill,” even though everyone knows what she is referring to, than to overtly announce that she is using contraception.

Even though we as a society may not feel comfortable explicitly discussing sex, we still feel that it is our business. From a legal perspective, look at how carefully reproductive medicine is regulated. For instance, certain reproductive procedures (e.g. abortion and sterilization) can require waiting mandatory periods – something that is not common in other areas of nonelective medicine. In the social realm, family, friends, and even strangers feel they have the right to comment on a pregnant woman’s behavior, such as by telling her what she should and should not eat or drink.

Returning to the topic of “trying,” family, friends, and again even strangers often have no qualms about asking women about whether they are trying to conceive. This is especially the case for straight women who are recently married and women who are perceived as being near or at the end of their “biological clock.”

Asking women whether they are “trying” is problematic on many levels. First, it assumes that all women want to become pregnant with genetically related children. While this may be true for many women, it is not true for all women. There is already enough social pressure on women in our pronatalist society to have biological children so people should avoid adding to this pressure. Second, asking people if they are “trying” is just a euphemism for asking them if they are having regularly scheduled unprotected vaginal penile penetrative intercourse, which is usually not considered an appropriate topic, especially among strangers. It is typically seen as impolite to discuss sex under certain circumstances or with certain people and discussing reproductive sex (that is, sex for which one of the purposes is reproduction) should not be treated differently.

To summarize, if you don’t feel comfortable asking others if they are having regularly scheduled unprotected vaginal penile penetrative intercourse, then don’t ask them if they are “trying” to conceive.



 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.

December 8, 2016

End of Life Care for Infants, Children and Young People with Life-limiting Conditions: Planning and Management

NICE has just released new guidance: "End of Life Care for Infants, Children and Young People with Life-limiting Conditions: Planning and Management."

The Guideline covers the planning and management of end of life and palliative care in for infants, children and young people (aged 0–17 years) with life-limiting conditions. 

It aims to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives.

December 7, 2016

TEDxFordhamUniversity: Lesson in Bioethics Given by Golden Girls | Dr. Elizabeth Yuko

As one of the most groundbreaking sitcoms of all time, The Golden Girls introduced a range of bioethical issues on the show regarding medicine, the human body and women’s health. In this TEDx Talk, Dr. Elizabeth Yuko, a Fordham University Center for Ethics Education  fellow and adjunct professor, discusses how influential Golden Girls was, and still is, … More TEDxFordhamUniversity: Lesson in Bioethics Given by Golden Girls | Dr. Elizabeth Yuko
December 7, 2016

Holy Life Expectancy!

Look at this trend in life expectancy, U.S. vs other developed countries, as a function of healthcare spending: Keep in mind, I DO NOT think life expectancy is a good way to judge the quality of healthcare or the efficiency … Continue reading

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December 7, 2016

Assisted Suicide: the Musical

If you are in London next month, check out "Assisted Suicide: the Musical" at the Southbank Centre

There are many good reviews, including this one. "Opinion polls would have you believe that the majority of the UK population believe it’s a humane choice to legalise assisted suicide for terminally ill or disabled people, but Liz Carr and many other disabled people disagree."

"Confronting the lack of creative work exploring this most topical taboo, Liz Carr and other performers express an important and often unheard perspective through the medium of musical theatre."

December 6, 2016

Lessons Learned from a Beatbox Heart

By Tim Lahey Two days ago, Jimmy stuck a used needle into the soft skin of his forearm, and released 20 milligrams of black tar heroin and a bolus of bacteria into his blood. The bacteria floated from vein to artery as he nodded, eventually sticking themselves to the ragged edge of his aortic valve.  […]
December 6, 2016

Oliver Wendell Holmes on Death (audio from 1931)

Here is a recording of Oliver Wendell Holmes commenting about death in 1931 on his 90th birthday.  He retired from the court just a few weeks later. 

"In this symposium my part is only to sit in silence. To express one’s feelings as the end draws near is too intimate a task. But one thought that comes to me as a listener-in. The riders in the race do not stop short when they reach the goal. There is a little finishing canter before coming to a standstill. There is time to hear the kind voice of friends and to say to oneself that the work is done."

"But just as one says that, the answer comes: The race is over, but the work never is done while the power to work remains. The canter that brings you to a standstill need not be only coming to rest. It cannot be while you still live, but to live is to function. That is all there is. And so I end with a line from a Latin poet, who uttered the message more than fifteen-hundred years ago, Death, death, plucks my ear, and says, ‘Live. I am  coming.'"  (HT: John Blackman)

December 5, 2016

Looking Back at the Bioethics Commission’s Blog

Throughout its tenure, the Bioethics Commission has maintained an active digital presence to connect with a global audience. A major component of this has been through its blog. This final blog post reflects on the role the blog has played in disseminating the Bioethics Commission’s work.
December 5, 2016

Jahi McMath Defendants Seek to Unseal Transcripts

For three years, the family of Jahi McMath has made numerous public claims that she is alive.  

The medical defendants in her malpractice lawsuit now want to rebut those claims by using evidence presented during hearings in December 2013.  But those records are under seal.  The family opposes the defendants' joint motion, citing Jahi's right to confidentiality.  A hearing is scheduled for December 13, 2016.

Furthermore, for those wanting to "catch up" on what this case is all about, the plaintiffs’ opposition brief provides a nice recap of the medical malpractice claims.  It also provides a recap of the evidentiary basis that Jahi is now alive.  Highlighting is mine.

"Here, based upon medical experts' evaluations of Jahi since Judge Grillo's ruling in 2013, she no longer fulfills standard brain death criteria, due to her ability to specifically respond to stimuli. The distinction between random cord-originating movements and true responses to command is crucial to diagnosis of brain death. Jahi is capable of intermittently responding intentionally to a verbal command."

"Additionally, the international team of  medical experts who gathered to observe, test and analyze Jahi's unprecedented progress in the fall of 2014 saw evidence of brain activity in the EEG.  They observed the brain activity increase and become 'readily identifiable  and profound' when Jahi's mother spoke to Jahi.  A long and thorough MRI was conducted in which they 'unequivocally saw the presence of brain structure including the evidence of ribbons in the brain."

"This is critical as it showed that the brain, although damaged, was there structurally.'  Nine months after Jahi was declared brain dead, the experts 'would have expected to see her brain had liquefied. It clearly was not.' Additionally, the experts looked for evidence of blood flow.  'Blood flow was clearly evident. This does not happen if a patient is brain dead.'"

"In overruling Defendants' demurrer to Plaintiffs' personal injury claim, this Court has properly rejected Defendants' argument that once their physicians opined in December 2013 that Jahi was brain dead for the purpose of removing life support, her death became static, fixed and permanent, and Jahi is absolutely precluded from alleging and proving that she is, in fact, alive."

"To the contrary, her condition has changed dramatically since Judge Grillo's ruling in December 2013 - among other changes, there are vast areas of structurally and relatively preserved brain, tests demonstrate intracranial blood flow consistent with the integrity of the MRI and inconsistent with brain death, and Jahi underwent menarche (her first ovulation cycle) and began breast development."