Hot Topics: Justice

Blog Posts (26)

April 17, 2017

A Bioethics View of Executions in Arkansas

by Craig Klugman, Ph.D.

This week the state of Arkansas had planned to execute 8 death-row inmates in 4, back-to-back killings using lethal injection over 10 days.…

March 29, 2017

I am a refugee, an immigrant and an American

Our Managing Editor, Bela Fishbeyn published a very moving account of her experiences as an immigrant to the United States. This highlights the schizophrenic nature of our nation’s attitudes and history towards immigrants and refugees.…

March 17, 2017

Ethics of the Trump Budget: The Social Contract is Dead

by Craig Klugman, Ph.D.

President Trump released his blueprint for a 2018 federal budget. From an ethical standpoint, the President seems to operates from a Hobbesian standpoint—life is nasty, brutish and short.…

March 11, 2017

But at least we don’t have socialized medicine

I just read T. R. Teid’s 2009 book The Healing of America. It’s a timely read in light of the bar brawl over health care that’s brewing in the U.S. legislature this week. Of particular interest are his snapshots of the health care systems of the UK, France, Germany, Japan, Taiwan, Canada, and Switzerland, systems about which I held many cherished misconceptions. All of these countries... // Read More »
March 7, 2017

The Ethics of the New GOP Health Plan – Violating Justice & Solidarity

by Craig Klugman, Ph.D.

Whatever one may think of the Affordable Care Act (ACA), it began with noble intentions. The ACA was built on a philosophy of providing more people not only with access to health insurance but also with assistance to pay for it.…

February 21, 2017

Ethics, refugees, and the President’s Executive Order

by Nancy Kass, ScD
There are different political philosophies about the responsibilities of states regarding whether to accept refugees. While there is a political philosophy that might be called Nationalist in perspective that says, essentially, “Not my Problem,” the predominant philosophy globally is different.…

February 17, 2017

BioethicsTV: Mass Casualties & Triage

by Craig Klugman, Ph.D.

Chicago Med (Season 2; Episode 14). Over the last few years I have been working in the area of crisis standards of care.…

February 15, 2017

Beyond the Destination LVAD

There are many forms of life sustaining treatment available to patients thanks to advances in medical technology. When a person’s physiology weakens or fails, devices may be attached or implanted to take over for organs that can no longer bear the workload of processing, moving, or taking in the elements needed to keep a body alive. Conceptually, this is appealing to a society that is as averse to death as are those of us here in the US. But we still struggle to accommodate the range of needs that crop up when function is compromised. As an ethicist, the general trend in my work suggests that the more advanced the technology, the more questions it raises when it comes time to talk about halting the mechanical support. Among the more advanced tools for sustaining physiological function is the Left Ventricular Assist Device, or LVAD, which maintains the circulatory function for persons with severe heart failure.

There is little doubt that individuals who are eligible for the device can experience remarkable quality of life gains whether they move on to receive a heart transplant or receive the implant as a destination treatment. Recipients of LVADs can typically return to their daily activities, and enjoy a level of independence not previously possible for persons with otherwise lethal heart conditions. However, these patients are not just like everyone else when complications arise. Decisions about how best to manage long term care for persons who have LVADs can be unexpectedly complex, most notably when the patient lives outside a major metropolitan city center. In particular, securing services when such patients suffer non-cardiac health complications after having the device implanted can be difficult. Consider a patient who is stable with a destination LVAD who develops end stage renal disease and requires hemodialysis. Outpatient dialysis centers can be fearful about safely managing the ongoing dialysis treatment for a patient when they do not have experience with ventricular assist devices. The same may apply to residential care centers when a patient needs a period of rehab for an injury unrelated to the heart failure diagnosis. Perhaps the most challenging circumstance involving resources for LVAD patients who experience age related cognitive decline and need nursing home level care due to confusion, impulsivity, and routine self-care deficits. There are no clear restorative goals, but the need for custodial care can quickly exceed what was once possible at home, but the LVAD is usually unfamiliar to small town nursing homes and can be a barrier to securing long term residential care.

This issue raises an important justice question for LVAD candidates. Should consent for LVADS, when known to be destination devices, include information about the limitations in assuring other types of services? If so, how do we assure that this information is delivered in a way that does not discriminate against patients from more remote areas while favoring those who live near facilities that routinely care for LVAD patients? 

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.

February 13, 2017

Fallout: From Healthcare Equality to Existential Threat

by Jenji Cassandra Learn

This is the second in a series of personal articles about living as a trans-woman facing insurance denial, discrimination, and medical mistreatment in the current political environment.

February 6, 2017

A message of hope for inclusivity and equality

For many US citizens, as well as people around the world, the last few months have been difficult and disappointing given the results of the US presidential election. As a feminist bioethicist, I am particularly concerned about how the Trump administration will treat vulnerable and oppressed groups, such as women, individuals in the LGBTQ community, people of color, individuals with disabilities, Muslims and other religious minorities in the US, and poor individuals. I am also concerned that the Trump administration will erode people’s access to healthcare and that this will disproportionately affect these vulnerable and oppressed groups. Already, we have seen that one of Trump’s first actions is to start the process of repealing the Affordable Care Act.

It is easy to be disheartened during these challenging times, but I recently attended two events that gave me hope. First, on Friday, January 20, I attended and co-organized the fifth annual Capital District Feminist Studies Consortium Conference which was held at the Albany College of Pharmacy and Health Sciences. When we chose the date for this conference in the summer of 2016, we didn’t realize that we had scheduled the conference for Inauguration Day. Had the presidential election turned out differently, this may have affected our turnout, but as it stands, we had approximately 80 people in attendance, which is great for a local conference. A feminist conference was the perfect place to be on this Inauguration Day. In order to address some of Trump’s antifeminist and other biased comments and actions, the organizers put together an invited panel titled "Feminist Work in Non-Feminist Surroundings: Survival in Challenging Times." I participated in this panel to discuss why I had created the Capital District Feminist Studies Consortium in the first place and why its existence is so important moving forward. The other panelists – a lawyer, an artist, and a historian – also spoke about the need for women in public spaces and for feminist resistance.

The following day, Saturday, January 21, I attended the Women’s March in New York City, which also gave me hope. Though tired from a full day of participating in and moderating the conference, I was invigorated by the large (over 400,000 people) and supportive crowds (filling the streets of New York City According to estimates. Furthermore, there were sister marches in all 50 states and around the world. Approximately 5 million people marched in around 670 marches, making this the world’s largest demonstration. That so many people came together surrounding a message of inclusivity and equality is incredible and powerful.

Inspired by these two events, I will continue moving forward with hope, which will strengthen and support me as I continue to work, both in my professional and personal life, towards justice for all people, and particularly those who are vulnerable and oppressed. I hope you will join me.

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.

 

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Published Articles (4)

American Journal of Bioethics: Volume 17 Issue 4 - Apr 2017

Psychiatric Genomics and Mental Health Treatment: Setting the Ethical Agenda Camillia Kong, Michael Dunn & Michael Parker

American Journal of Bioethics: Volume 17 Issue 4 - Apr 2017

Psychiatric Genetics in a Risk Society Nicole Martinez-Martin

American Journal of Bioethics: Volume 16 Issue 11 - Nov 2016

The Ethics of Organ Donor Registration Policies: Nudges and Respect for Autonomy Douglas MacKay & Alexandra Robinson

American Journal of Bioethics: Volume 16 Issue 10 - Oct 2016

Governance of Transnational Global Health Research Consortia and Health Equity Bridget Pratt & Adnan A. Hyder

News (16)

April 13, 2017 9:00 am

US regulators test organs-on-chips for food safety monitoring (Nature)

The US Food and Drug Administration (FDA) has started testing whether livers-on-a-chip — miniature ‘organs’ engineered to mimic biological functions — can reliably model human reactions to food and foodborne illnesses. The experiments will help the agency to determine whether companies can substitute chip data for animal data when applying for approval of a new compound, such as a food additive, that could prove toxic. It is the first time a regulatory agency anywhere in the world has pursued organs-on-chips as an alternative to animal testing.

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 23, 2017 9:00 am

San people of Africa draft code of ethics for researchers (Science)

The San people of Southern Africa are among the closest living relatives of our hunting and gathering ancestors. Scientists have flocked to study their age-old rituals and ancient genetic fingerprints. Now, after more than a century of being scrutinized by science, the San are demanding something back. Earlier this month the group unveiled a code of ethics for researchers wishing to study their culture, genes, or heritage.

March 16, 2017 9:00 am

Should hospitals — and doctors — apologize for medical mistakes? (Washington Post)

Spurred by concerns about the “deny and defend” model — including its cost, lack of transparency and the perpetuation of errors — programs to circumvent litigation by offering prompt disclosure, apology and compensation for mistakes as an alternative to malpractice suits are becoming more popular.

February 27, 2017 9:00 am

U.S. researchers guilty of misconduct later won more than $100 million in NIH grants, study finds (Science)

Overall, 23 of the scientists (roughly 8% of sanctioned researchers) received NIH funding after receiving an ORI sanction. Of that group, 17 researchers won more than $101 million for 61 new projects. Thirteen continued to receive funding from NIH grants that had been awarded before being sanctioned.

February 23, 2017 9:00 am

How Silicon Valley Is Trying to Hack Its Way Into a Longer Life (Time)

Rather than wait years for treatments to be approved by federal officials, many of them are testing ways to modify human biology that fall somewhere on the spectrum between science and entrepreneurialism. It’s called biohacking, and it’s one of the biggest things happening in the Bay Area.

February 21, 2017 9:00 am

Harvard and M.I.T. Scientists Win Gene-Editing Patent Fight (The New York Times)

The Broad Institute in Cambridge, Mass., will retain potentially lucrative rights to a powerful gene-editing technique that could lead to major advances in medicine and agriculture, the federal Patent and Trademark Office ruled on Wednesday.

February 3, 2017 9:00 am

On 22 April, empiricists around the country will march for science (Science)

Some fear a demonstration led by researchers might only serve to paint scientists as an interest group, further politicizing scientific issues. And at least one veteran science lobbyist has urged organizers to make sure it’s a march for science, not scientists.

January 30, 2017 9:00 am

Journals invite too few women to referee (Nature)

Using a large data set that includes the genders and ages of authors and reviewers from 2012 to 2015 for the journals of the American Geophysical Union (AGU), we show that women were used less as reviewers than expected (on the basis of their proportion of membership of the society and as published authors in AGU journals). The bias is a result of authors and editors, especially male ones, suggesting women as reviewers less often, and a slightly higher decline rate among women in each age group when asked.

January 20, 2017 9:00 am

New Common Rule on the Federal Policy for the Protection of Human Subjects (Federal Register)

The departments and agencies listed in this document announce revisions to modernize, strengthen, and make more effective the Federal Policy for the Protection of Human Subjects that was originally promulgated as a Common Rule in 1991. This final rule is intended to better protect human subjects involved in research, while facilitating valuable research and reducing burden, delay, and ambiguity for investigators.

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