Copyright (c) 2009 University of Pennsylvania All rights reserved. http://repository.upenn.edu/bioethics_papers Recent documents in Center for Bioethics Papers en-us Wed, 28 Oct 2009 23:19:42 PDT 3600 http://repository.upenn.edu/bioethics_papers/63 http://repository.upenn.edu/bioethics_papers/63 Tue, 27 Oct 2009 11:42:05 PDT Health reform is not in the details. Think I am wrong? How far did we get this summer wallowing around in claims about co-ops, public plans, death panels, rationing, and cost savings? Health reform is in the ethics. Arthur L. Caplan http://repository.upenn.edu/bioethics_papers/62 http://repository.upenn.edu/bioethics_papers/62 Wed, 27 May 2009 11:31:23 PDT Arthur L. Caplan http://repository.upenn.edu/bioethics_papers/61 http://repository.upenn.edu/bioethics_papers/61 Fri, 19 Sep 2008 12:06:40 PDT Debates over vaccine mandates raise intense emotions, as reflected in the current controversy over whether to mandate the vaccine against human papilloma virus (HPV), the virus that can cause cervical cancer. Public health ethics so far has failed to facilitate meaningful dialogue between the opposing sides. When stripped of its emotional charge, the debate can be framed as a contest between competing ethical values. This framework can be conceptualized graphically as a conflict between autonomy on the one hand, which militates against government intrusion, and beneficence, utilitarianism, justice, and nonmaleficence on the other, which may lend support to intervention. When applied to the HPV vaccine, this framework would support a mandate based on utilitarianism, if certain conditions are met and if herd immunity is a realistic objective. Robert I. Field http://repository.upenn.edu/bioethics_papers/60 http://repository.upenn.edu/bioethics_papers/60 Fri, 19 Sep 2008 08:23:50 PDT Justifying his proposal for "health savings accounts," which would allow individuals to set aside tax-free dollars against future healthcare needs, President Bush has said that "Health savings accounts all aim at empowering people to make decisions for themselves." Who could disagree with such a sentiment? Although bioethicists may be among those who express skepticism that personal health savings accounts will be part of the needed "fix" of our healthcare financing system, self determination has long been part of their mantra. Indeed, the field of bioethics played an important role in advancing this idea in the medical world when physician paternalism was regnant. Has its popularity caused it to become so vapid as to be ripe for misuse? Jonathan Moreno http://repository.upenn.edu/bioethics_papers/59 http://repository.upenn.edu/bioethics_papers/59 Thu, 23 Aug 2007 08:17:30 PDT Physicians treating newly incapacitated patients often must help navigate surrogate decision-makers through a difficult course of treatment decisions, while safeguarding the patient's autonomy. We offer guidance for intensive care physicians who must frequently address the difficult questions concerning disclosure of confidential information to surrogates. Three clinical vignettes will highlight the ethical challenges to physician disclosure of a critically ill patient's HIV status. Two key distinctions are offered that influence the propriety of disclosure: first, whether HIV infection represents a 'primary cause' for the patient's critical illness; and second, whether the surrogate may be harmed by failure to disclose HIV status. This balanced consideration of the direct duties of physicians to patients, and their indirect duties to surrogates and third-party contacts, may be used as a framework for considering other ethical obligations in the intensive care unit. We also provide a tabulation of individual US state laws relevant to disclosure of HIV status. Anthony T. Vernillo http://repository.upenn.edu/bioethics_papers/58 http://repository.upenn.edu/bioethics_papers/58 Fri, 08 Jun 2007 11:24:21 PDT The spring and summer of 1998 were seasons in the sun for institutional review board (IRB) aficionados. Rarely have the arcana of the local human subjects review panels been treated to so much attention in both the executive and the legislative branches of government, not only at the federal but also at the state level. And it looks as if the attention will continue for some time. The spate of interest is due to a series of coincidences: a powerful House of Representatives subcommittee held hearings after its chairman learned about the IRB system during a previous session on research in underdeveloped communities; the Department of Health and Human Services's Inspector General (DHHS-IG) released a report on IRBs; the National Institutes of Health (NIH) Office of Extramural Research completed a report on clinical trial monitoring; the National Bioethics Advisory Commission (NBAC) readied a report on research involving persons with mental disorders; the states of Maryland and New York completed studies of research with subjects who lack decision-making capacity; and advocacy groups protested a psychiatric research project involving inner city children. Jonathan Moreno http://repository.upenn.edu/bioethics_papers/57 http://repository.upenn.edu/bioethics_papers/57 Tue, 29 May 2007 12:49:51 PDT Medical research that involves human subjects presents what appears to be an intractable ethical problem: patients are exposed to risks in order to create valuable knowledge. A central goal of research is to produce knowledge that is "important," "fruitful," or that will have "value." Indeed, federal regulations require that research risks be reasonable in proportion to potential benefits, and in proportion to the importance of the knowledge to be gained (45 CFR 46.111(a)(z)). Moreover, one reason that subjects participate inresearch is to produce knowledge that will benefit others. Jonathan Moreno http://repository.upenn.edu/bioethics_papers/56 http://repository.upenn.edu/bioethics_papers/56 Tue, 29 May 2007 12:28:26 PDT On September 4, 2001, press reports indicated that the Defense Intelligence Agency of the U.S. Department of Defense (DOD) planned to reproduce a strain of anthrax virus suspected of being held in Russian laboratories. According to the same reports, the Central Intelligence Agency (CIA), under the auspices of Project Clear Vision, is engaged in building replicas of bomblets believed to have been developed by the former Soviet Union. These small bombs were designed to disperse biological agents, including anthrax. Government attorneys were said to be confident that, because these projects were designed to develop defensive measures, they were not in violation of the 1972 Biological and Toxin Weapons Convention. Jonathan Moreno http://repository.upenn.edu/bioethics_papers/55 http://repository.upenn.edu/bioethics_papers/55 Tue, 22 May 2007 08:32:02 PDT Ellen Fox and her colleagues (Fox, Myers and Pearlman 2007) have generated a rich set of data about ethics consultations in US hospitals that raise serious concerns about this mode of conflict resolution. Using the data they have collected, I want to highlight several issues that question the ethical legitimacy of the ethics consult service (ECS) model, and I want to argue that it may be time to replace ethics consultation with ethics mediation. Autumn Fiester http://repository.upenn.edu/bioethics_papers/54 http://repository.upenn.edu/bioethics_papers/54 Tue, 22 May 2007 08:21:29 PDT The paper in your April issue by Lai et al. entitled "Generation of cloned transgenic pigs rich in omega-3 fatty acids" (Nat. Biotechnol. 24, 435-436, 2006) perfectly captures the fundamental problem with American biotech research. That problem is that scientists pursue their research agenda to further scientific knowledge - all well and good - but when the project succeeds they invent problems for which their research results can be marketed as a solution. This unreflective move from 'pure science' to commercialization may end up as biotech's undoing. Autumn Fiester