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Blog Posts (1528)

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


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 »
January 21, 2015

Managing Conscientious Objections in Intensive Care Medicine

I was delighted to be a part of this ad hoc subcommittee of this American Thoracic Society Ethics and Conflict of Interest Committee that developed An Official Policy Statement: "Managing Conscientious Objections in Intensive Care Medicine."  It was just published in the American Journal of Respiratory and Critical Care Medicine 191(2): 219–227.

"Intensive care unit (ICU) clinicians sometimes have a conscientious objection (CO) to providing or disclosing information about a legal, professionally accepted, and otherwise available medical service. There is little guidance about how to manage COs in ICUs."

"The policy recommendations are based on the dual goals of protecting patients’ access to medical services and protecting the moral integrity of clinicians. Conceptually, accommodating COs should be considered a “shield” to protect individual clinicians’ moral integrity rather than as a “sword” to impose clinicians’ judgments on patients."

"The committee recommends that: 

  1. COs in ICUs be managed through institutional mechanisms
  2. Institutions accommodate COs,  provided doing so will not impede a patient’s or surrogate’s timely access to medical services or information or create excessive hardships for other clinicians or the institution
  3. A clinician’s CO to providing potentially inappropriate or futile medical services should not be considered sufficient justification to forgo the treatment against the objections of the patient or surrogate
  4. Institutions promote open moral dialogue and foster a culture that respects diverse values in the critical care setting."

January 21, 2015

What Causes Couch Potatoes To Eat So Many Potato Chips?

Do you eat when you’re bored? So do I. Then again, I eat when I’m not bored, too. So the real question is: do we all eat more when we’re bored than, say, when we’re highly entertained? The answer, according … Continue reading
January 20, 2015

The Bioethics Commission’s Meeting 20 Milestone

This February will mark an important milestone for the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission); the Bioethics Commission will hold its 20th public meeting. The 2-day meeting will be held February 5-6, 2015, in Washington, D.C. Since President Obama issued the Executive Order establishing the Commission on November 24, 2009, it […]
January 20, 2015

VSED & Complexities of Choosing an End Game for Dementia

On the front page of today's Science section of the New York Times, Paula Span has an important story, " Complexities of Choosing an End Game for Dementia."

Can you specify in advance of severe dementia, "triggering conditions" to ensure that nobody tries to keep you alive by spoon feeding or offering liquids?

Can people who develop dementia use VSED (“voluntarily stopping eating and drinking”) to end their lives by including such instructions in an advance directive?

January 19, 2015

Involvement of ICU Families in Decisions: Fine-tuning the Partnership

Elie Azoulay and colleagues in Paris has just published "Involvement of ICU Families in Decisions: Fine-tuning the Partnership" in the Annals of Intensive Care. I have written a lot about the resolution of intractable end-of-lif...