Bioethics Publications

  • Federal "Right to Try" Bill: Wrong on the Law, and Wrong For Patients

    Lisa Kearns, Beth Roxland – Alumna

    The Hill – June 28, 2016

    On June 16, Jordan McLinn, a seven-year old boy who suffers from Duchenne muscular dystrophy, joined other patients, their advocates, and members of Congress at a rally on the Capitol lawn in support of a federal “right to try” bill. At first blush, the Trickett Wendler Right to Try Act (S. 2912) would grant McLinn and other dying patients an automatic right to pre-approval, or “compassionate,” access to experimental drugs that appear promising in early testing but that have not yet completed clinical trials and been approved by the FDA. Unfortunately, the new federal bill, like similar state laws, is both legally ineffective and ethically troubling.

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  • Ethics of Advances in Human Embryonic Stem Cell Research

    Matthew Dias – Student

    Ampersand – June 16, 2016

    For several decades, scientists have reasoned that stem cells—and human embryonic stem cells (hESC) especially—have the potential to improve human health. In particular, research indicates that the properties unique to hESC (e.g., plasticity, potency) can benefit our understanding of, and approaches to, regenerative medicine and embryology. For instance, understanding how these cells might (i) mitigate or treat diseases such as Alzheimer’s, Parkinson’s, cancer, and diabetes, and (ii) produce vital insights into human development, is a priority within the scientific research enterprise, but one whose methodologies and ethics should be thoroughly monitored and reviewed in accordance with advances in medicine.

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  • Ethics for Ethicists? The Professionalization of Clinical Ethics Consultation

    Rachel Yarmolinsky – Alumna

    AMA Journal of Ethics – May 5, 2016

    Professionalism and codes of ethics are intrinsically tied. As professions establish themselves, their members write codes of ethics to help define the professions and who can be a considered a professional. The codes explain why and how professions are deserving of trust, establish standards with specific guidelines for ethical practice, and designate who will have the authority to enforce standards. Do clinical ethicists need a code of ethics?

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  • Ethical Issues in the Use of Extracorporeal Membrane Oxygenation in Controlled Donation After Circulatory Determination of Death

    Anne Dalle Ave – Student

    American Journal of Transplantation – March 3, 2016

    The use of donor extracorporeal membrane oxygenation (ECMO) to improve graft outcomes by some controlled donation after circulatory determination of death (cDCDD) programs raises ethical issues. We reviewed cDCDD protocols using ECMO and the relevant ethical literature to analyze these issues. It is not obvious if ECMO in cDCDD improves graft outcomes. In our opinion, ECMO implemented before death can interfere with end-of-life care and damage bodily integrity. By restoring systemic circulation, ECMO risks invalidating the preceding declaration of death, if brain and cardiac perfusion is not adequately excluded because of malfunction or misplacement of the supra-diaphragmatic aortic occlusion balloon. The use of ECMO is not compatible with the acronym DCDD, since circulation is restored after the determination of death. Because of these deficiencies, we conclude that other techniques are preferable such as rapid recovery or in situ cold infusion. If ECMO is performed, it requires a specific informed consent and transparency.

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  • Ethics Consultation Quality Assessment Tool: A Novel Method for Assessing the Quality of Ethics Case Consultations Based on Written Records

    Robert A. Pearlman, Mary Beth Foglia, Ellen Fox, Jennifer H. Cohen, Barbara L. Chanko, and Kenneth A. Berkowitz – Faculty

    The American Journal of Bioethics – February 25, 2016

    Although ethics consultation is offered as a clinical service in most hospitals in the United States, few valid and practical tools are available to evaluate, ensure, and improve ethics consultation quality. The quality of ethics consultation is important because poor quality ethics consultation can result in ethically inappropriate outcomes for patients, other stakeholders, or the health care system. To promote accountability for the quality of ethics consultation, we developed the Ethics Consultation Quality Assessment Tool (ECQAT). ECQAT enables raters to assess the quality of ethics consultations based on the written record. Through rigorous development and preliminary testing, we identified key elements of a quality ethics consultation (ethics question, consultation-specific information, ethical analysis, and conclusions and/or recommendations), established scoring criteria, developed training guidelines, and designed a holistic assessment process. This article describes the development of the ECQAT, the resulting product, and recommended future testing and potential uses for the tool.

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  • NPRM Public Comment Deadline Has Passed—Implications for Revisions to the Common Rule and the Future of Human Subjects Protections

    Matthew Dias – Student

    Ampersand – February 8, 2016

    The January 6, 2016 closure of the public comment period for revisions to the Common Rule concluded several contentious months in the bioethics world.

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  • NASH is the 21st Century's Looming Public Health Threat

    Kira Peikoff – Student

    Newsweek – January 30, 2016

    "According to liver experts, NASH is a silent public health time bomb that may soon overload our health care system with hospital admissions....Doctors say its incidence has exploded in the last two decades thanks in part to the growing prevalence of obesity."

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  • An Analysis of Heart Donation After Circulatory Determination of Death

    Anne Laure Dalle Ave, David Shaw, James L Bernat – Student

    Journal of Medical Ethics – January 22, 2016

    Heart donation after circulatory determination of death (DCDD) has provoked ethical debate focused primarily on whether heart DCDD donors are dead when death is declared and when organs are procured.

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  • CPR Survival Rates Can Differ Greatly by City

    Kira Peikoff – Student

    The New York Times – December 7, 2015

    If you have a stroke, your odds of survival are similar whether you are in Boston or Boise. But not so if you fall victim to cardiac arrest.

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  • Can Clinicians Maim Healthy Organs? The Case of Jewel Shuping

    Matthew Dias – Student – November 5, 2015

    This October, reports surfaced that a psychologist deliberately blinded a North Carolina woman named Jewel Shuping, per her request. Thirty-year-old Shuping suffers from Body Integrity Identity Disorder (“BIID”), a psychiatric condition in which individuals experience an overwhelming, lifelong desire to develop a disability—most often by amputating a limb but sometimes by maiming an organ.

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