Penn Center for Bioethics

The Penn Center for Bioethics / Department of Medical Ethics was a leader in bioethics research and its deployment in the ethical, efficient, and compassionate practice of the life sciences and medicine. The Center had over 20 senior fellows and eleven associates with appointments in a number of University of Pennsylvania schools and departments including medicine, law, nursing, business, education, philosophy, psychology, sociology, religious studies, public policy, and public health. Five full-time faculty held primary appointments in the Department of Medical Ethics.

Activities of the Center / Department focused on empirical, interdisciplinary research. Projects were devoted to key issues such as genetic testing and engineering, informed consent, human subject research, end-of-life care, reproductive technologies, patenting, resource allocation, vaccine ethics, and transplantation. Faculty members spoke at community meetings, testified before Congress and the United Nations, and provided commentary to journalists. The Center sponsored public lectures, symposia, and workshops on timely ethical issues.

The Center / Department's education mission included a Master of Bioethics program; an undergraduate bioethics concentration; teaching in the medical school; teaching and advising in other schools within the University of Pennsylvania; continuing and executive education courses, conferences, and seminar; clinical consultation; and a high school bioethics program.

 

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  • Publication
    The "Difficult" Patient Reconceived: An Expanded Moral Mandate for Clinical Ethics
    (2012-05-01) Fiester, Autumn
    Between 15%-60% of patients are considered “difficult” by their treating physicians. Patient psychiatric pathology is the conventional explanation for why patients are deemed “difficult.” But the prevalence of the problem suggests the possibility of a less pathological cause. I argue that the phenomenon can be better explained as responses to problematic interactions related to healthcare delivery. If there are grounds to reconceive the “difficult” patient as reacting to the perception of ill treatment, then there is an ethical obligation to address this perception of harm. Resolution of such conflicts currently lies with the provider and patient. But the ethical stakes place these conflicts into the province of the ethics consult service. As the resource for addressing ethical dilemmas, there is a moral mandate to offer assistance in the resolution of these ethically charged conflicts that is no less pressing than the more familiar terrain of clinical ethics consultation.
  • Publication
    Bioethics and the Brain
    (2003-06-01) Foster, Kenneth R; Wolpe, Paul Root; Caplan, Arthur L.
    Microelectronics and medical imaging are bringing us closer to a world where mind reading is possible and blindness banished - but we may not want to live there. New ways of imaging the human brain and new developments in microelectronics are providing unprecedented capabilities for monitoring the brain in real time and even for controlling brain function. The technologies are novel, but some of the questions that they will raise are not. Electrical activity in the brain can reveal the contents of a person's memory. New imaging techniques might allow physician to detect devastating diseases long before those diseases become clinically apparent. And researchers may one day find brain activity that correlates with behavior patterns such as tendencies toward alcoholism, aggression, pedophilia, or racism. But how reliable will the information be, how should it be used, and what will it do to our notion of privacy? Meanwhile, microelectronics is making access to the brain a two-way street. The same electrical stimulation technologies that allow some deaf people to hear could be fashioned to control behavior as well. What are the appropriate limits to the use of this technology? Ethicists are only now beginning to take note of these developments in neuroscience.
  • Publication
    A Taxonomy of Value in Clinical Research
    (2002-12-01) Moreno, Jonathan
    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.
  • Publication
    Protecting Subjects' Interests in Genetics Research
    (2002-04-01) Merz, Jon F; Magnus, David; Cho, Mildred K; Caplan, Arthur L.
    Biomedical researchers often assume that sponsors, subjects, families, and disease-associated advocacy groups contribute to research solely because of altruism. This view fails to capture the diverse interests of many participants in the emerging research enterprise. In the past two decades, patient groups have become increasingly active in the promotion and facilitation of genetics research. Simultaneously, a significant shift of academic biomedical science toward commercialization has occurred, spurred by U.S. federal policy changes.
  • Publication
    Creating Fido's Twin: Can Pet Cloning be Ethically Justified
    (2005-08-01) Fiester, Autumn
    Taken at face value, pet cloning may seem at best a frivolous practice, costly both to the cloned pet's health and its owner's pocket. At worst, its critics say, it is misguided and unhealthy - way of exploiting grief to the detriment of the animal, its owner, and perhaps even animal welfare in general. But if the great pains we are willing to take to clone Fido raise the status of companion animals in the public eye, then the practice might be defensible.
  • Publication
    Genetics and Education: The Ethics of Shaping Human Identity
    (2002-10-01) Ravitsky, Vardit
    This paper suggests an analogy between education and genetic interventions as means of shaping the identity of children and future adults. It proposes to look at issues discussed in the philosophy of education as a possible source of insight for ethical guidelines regarding future genetic interventions. The paper focuses on situations of conflict between parents and state regarding the authority to determine the child's best interests. It describes the current formulation of the conflict in the literature as lacking the crucial element of the child's right to a cultural identity. It argues that this element is a necessary component in an ethical analysis of the child's best interests in a multicultural, liberal society which respects diversity. The paper therefore proposes a better model for the moral evaluation of identity-shaping decisions and offers some implications of this model for genetics.
  • Publication
    All Gifts Large and Small
    (2003-07-01) Katz, Dana; Caplan, Arthur L.; Merz, Jon F
    Much attention has been focused in recent years on the ethical acceptability of physicians receiving gifts from drug companies. Professional guidelines recognize industry gifts as a conflict of interest and establish thresholds prohibiting the exchange of large gifts while expressly allowing for the exchange of small gifts such as pens, note pads, and coffee. Considerable evidence from the social sciences suggests that gifts of negligible value can influence the behavior of the recipient in ways the recipient does not always realize. Policies and guidelines that rely on arbitrary value limits for gift-giving or receipt should be reevaluated.
  • Publication
    Mediation and Advocacy
    (2012-01-01) Fiester, Autumn
  • Publication
    What Mediators Can Teach Physicians about Managing 'Difficult' Patients
    (2015-03-01) Fiester, Autumn
    Between 10% and 12% of patients are considered difficult by their treating physicians,1 indicating a widespread problem. Many physicians report feeling at a loss to know how to effectively manage challenging patient interactions.2 In extreme cases, physicians resort to refusing to treat hostile patients or dismissing them from their clinical practice.
  • Publication
    Successes and Failures of Hospital Ethics Committees: A National Survey of Ethics Committee Chairs
    (2002-01-01) McGee, Glenn E; Spanogle, Joshua P; Caplan, Arthur L.; Penny, Dina; Asch, David A.
    In 1992, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) passed a mandate that all its approved hospitals put in place a means for addressing ethical concerns. Although the particular process the hospital uses to address such concerns—ethics consultant, ethics forum, ethics committee—may vary, the hospital or healthcare ethics committee (HEC) is used most often. In a companion study to that reported here, we found that in 1998 over 90% of U.S. hospitals had ethics committees, compared to just 1% in 1983, and that many have some and a few have sweeping clinical powers in hospitals.