Thursday, November 30, 2006

Epidemics and Physician Responsibility

"In the Line of Duty: SARS and Physician Responsibility in Epidemics" - This article was published in Medical Ethics Vol 13 Issue 2 Spring 2006 (Lahey Clinic Medical Ethics) as an edited transcript of a forum at Harvard Medical School in December 2005.

The guest speaker was Dr. William Ho, Chief Executive of the Hong Kong Hospital Authority at the time of the SARS epidemic in Hong Kong. He described the disadvantages and advantages at hand in the public hospitals. A disadvantage was that individual rooms and beds were unavailable; patients and nurses were in close confines in more than a thousand beds. An advantage was that all forty public hospitals use a uniform technology system that allowed similar definitions for illnesses.

Dr. Ho described the beginnings of the SARS epidemic starting with a mysterious disease in Guongzhou in the winter of 2002 that had symptoms similar to an atypical pneumonia. This was common in hospitals, so pinpointing an epidemic was difficult. Experts began to handle any community cases of pneumonia, but it was not until the hospital outbreak that anyone was positive they were dealing with an epidemic. Soon after the WHO labeled it as SARS and it became a public emergency.

At the Prince of Wales Hospital, the staff split into two teams. Those infected were labeled as "dirty" and remained on the respiratory ward, those not infected or "clean" switched wards. As the infection spread, the number of patients at the hospital was becoming over-whelming. Questions arose whether to discharge patients or accept new patients because of fear they would become infected or infect others.

Outside the hospital, community infection was spreading rapidly. Patients returning to populated housing blocks were putting those in that area at high risk of becoming infected. This lead to an ethical decision of whether or not to quarintine residents in these infected areas and to have family and those in close contact to report to clinics daily. Should those patients too afraid to seek medical treatment be charged with criminal offenses? The government stepped in and evacuated buildings like this one, sending residents to camps while they disinfected homes. Only buildings of those infected were released; no names.

Walter Robinson, MD, MPH, an assistant professor of pediatrics and medical ethics at Harvard then went on to discuss the aspect of medical staff being obliged to stay in the hospital in times of a crisis. When the HIV virus came to the US, many doctors refused to treat infected patients although there was never a greater risk than those of other infectious diseases such as Hepatitis B. It was only the stigma associated with the disease that scared physicians and patients. A long debated resulted in the AMA council on Ethical and Judicial Affairs concluding in 1987 that "a physician may not ethically refuse treatment to a patient whose condition is within the physician's current realm of competence."

Robinson went on to point out whether or not physician's have a moral obligation to treat the sick we live and work with when health care is not universal. I believe that if an epidemic was to occur in the US today or in the future, physicians would rise above the call of duty and moral obligations. Ethically this would be the "right" thing to do, regardless of whether they risked the chance of receiving the infection or not. Besides, they could very well get it outside the hospital, so they may as well do the morally justified action.

Tuesday, November 28, 2006

Preconception Care? Treating women as eternally prepregnant

An article in today’s New York Times quotes public health experts who tell women that they ought to start thinking in terms of “preconception care” as opposed to prenatal care if they want healthy babies. The reasoning is that by the time women know they are pregnant, it is already be too late to avert birth defects: “For many women the most important doctor’s visit may be the one that takes place before a pregnancy is conceived.” Last May folks at the division of reproductive health at the Centers for Disease Control and Prevention (CDC), advised that women ought to be treated, and treat themselves, as if they were about to conceive a child. But women are to be assured that not ALL women ought to be treated thus, only those between their first menstrual period and up until menopause.

Family planning, child spacing and encouraging young people to develop a reproductive life plan is sound advice given that in the US half of all pregnancies are unplanned and preparing for a healthy pregnancy can require behavioral changes that may take months. But a policy whose goal is safe uterine environments ought not to be centered on warning women that they could get pregnant at any time in their reproductive life so they had better act as if pregnancy was imminent. Sexual relationship education, birth control access, STD care, battered women’s safe houses, environmental and occupational safety, etc. etc. etc. factor in when considering what makes for a healthy pregnancy.

Thursday, November 23, 2006

Who or what are you thankful for this Thanksgiving?

With Thanksgiving coming up, I'm borrowing an idea from (my favorite spirituality site) -- please tell us who or what you are thankful for this Thanksgiving? Send me your thoughts at linda (at) and I'll be happy to post them for you or just enter a comment on this side --

I'll start: I am thankful for my colleagues at the Women's Bioethics Project, especially Kathryn Hinsch, for creating for forum and supportive atmosphere in which we can explore and discuss issues in women's bioethics -- and for bringing a incredible passion and enthusiasm to the field!

Happy Thanksgiving everyone!

[ From DeLila Bergan:
I'm thankful for my family and for their love and support, for their relatively good health, for our ability to pay the bills and put Thanksgiving dinner on the table, and for the opportunities we have been given to enjoy and to contribute in life. I'm thankful for the beautiful weather we're anticipating here for the holiday. On a more mundane note, I'm thankful for the appearance of apolitical shift that, should it continue in 2008, may permit us to make progress on issues of health care and social justice.]

Wednesday, November 22, 2006

Domestic Violence and Health Care

Women are less likely than men to be victims of violent crimes, but they are five to eight times more likely to be victimized by an intimate partner. A quarter to half of women around the world have suffered violence from an intimate partner, according the UNICEF’s report The Progress of Nations, 1997. Estimates range from 960,000 incidents of violence against a current or former spouse, boyfriend, or girlfriend per year, to 3.9 million women raped, and or physically assaulted, by an intimate partner per year. A 1998 Commonwealth Fun survey found that nearly 31% of American women report being physically or sexually abused by their husbands or boyfriends at some point in their lives. 30% of Americans say they know a woman who has been physically abused by her husband or boyfriend in the past year. The U.S. Department of Justice reported that 37% of women who were admitted to a hospital ER for violence related injuries were injured by a current or former spouse, boyfriend, or girlfriend.

The injuries are severe. Out of 218 women who came to an ER with injuries due to domestic violence 28% required admission, 13% required major treatment, and 40% had previous required medical care due to abuse. Besides the injuries sustained during abuse, physical and psychological abuse is linked to arthritis, chronic neck or back pain, migraines, stammering, problems seeing, sexually transmitted infections, chronic pelvic pain, stomach ulcers, spastic colon, and frequent indigestion, diarrhea, or constipation. 56% of women who have been abused are diagnose with a psychiatric disorder, 29% of all women who have attempted suicide were abused, 37% of abused women have depression, and 46% have anxiety disorders.

Children who have witnessed domestic violence are more likely to attempt suicide, abuse drugs and alcohol, run away from home, engage in teenage prostitution, and commit sexual assault crimes. 56% of men who abuse their wives frequently also assault their children. About $1,633 is spent for medical services provided to abused women, children, and older people per person per year, according to a study conducted at Rush Medical Center in Chicago. This amounts to a national cost of $857.3 million.

Domestic violence is hard to identify. Almost 92% of women who were physically abused did not discuss it with their physicians and about 57% did not discuss it with anyone. The Journal of the American Association found in 1999 that 10% of physicians screen new patients for intimate partner abuse, and 90% routinely screen during checkups. Accoridng to a survey 240,000 pregnant women, (about 6% of all pregnant women in the U.S.), are abused by men in their lives. Complications of pregnancy, including low weight gain, anemia, infections, first and second trimester bleeding, depression, suicide attempts, tobacco, alcohol, and drug use are significantly higher for abused women. Read more:

Tuesday, November 21, 2006

World Power: The Effect of Literacy on Health Outcomes

This article written by Susan Kendig, RNC, MSN, WHCNP, FAANP examines the relationship between the literacy of patients and their individual health outcomes. Kendig brings up the point that today, many Americans are "medically illiterate." In 1992 the National Adult Literacy Survery displayed results of a study, which showed that 40-44 million adults in America were reading at or below a 5th grade level. In addition to that, another 50 million Americans were classified as having marginal literacy skills. This meant that although able to read simple text, they were unable to understand lengthy, complex documents. Kendig chose to specifically look at women and illiteracy in the health care system. One specific case Kendig presents is of a woman who was sent by her gynecologist to a surgeon to have a problem "easily" fixed. After signing numerous consent forms and completing the surgery, the patient was informed at her post-op appointment that her uterus had been removed (Cordell, 2005). Another study conducted in 2004 showed results of female medicare recipients with lower literacy rates were at a higher risk of not having been exposed to a pap smear or a mamogram in over two years (DeWalt, Berkman, Sheridan, Lohr, and Pignone 2004). Other studies were conducted at numerous hospitals showing high percentages of patients who were unable to comprehend the instructions "take on an empty stomach." Simply directions such as these, seem to come easily to people for the most part. Unfortunatly, with an increasing elderly, unemployed, poverous, and muliticultural population the "medical illeteracy" rates are increasing at alarming rates. Kendig stresses little ways medical staff can help these patients when it comes to understanding and following through with medical instructions. It is sad that America has gotten to the point, where they can produce thousands of drugs which will save people's lives, yet these very people cannot read and understand the very means of administering these drugs. Hopefully, in the future America will be able to better provide medical information and education to those in most need of it. As for now, the medical world is responsible for helping these patients in order to increase patient health outcomes, which will lead to a better prognosis for most.

The Pro-Roe, Anti-Abortion, Pro-Contraception Crowd Speaks Up

E.J. Dionne, Jr. of the Washington Post writes about the search for middle ground on the abortion issue:
A group of 23 pro-choice and pro-life Democratic House members have introduced what they called the Reducing the Need for Abortion and Supporting Parents Act - an initiative that will work to reduce the number of abortions in America by both preventing unintended pregnancies and supporting pregnant women and new parents. This bill would enable pro-life and pro-choice advocates to find common ground -- It includes a remarkably broad set of programs aimed at reducing teen pregnancy, promoting contraception and encouraging parental responsibility. But it also includes strong measures to offer new mothers full access to health coverage, child care and nutrition assistance.

The public debate usually ignores the fact that abortion rates are closely tied to income. As the Guttmacher Institute has reported, "the abortion rate among women living below the federal poverty level . . . is more than four times that of women above 300 percent of the poverty level." The numbers are stark: 44 abortions per 1,000 women in the lower income group, 10 abortions per 1,000 women in the higher income group.

In other words: If you truly care about reducing the number of abortions, you have to care about the well-being of poor women.

There are moral and practical reasons for members of both parties, and combatants on both sides of the abortion question, to embrace this approach.

To read on click here.

Monday, November 20, 2006

Genetics & Health Interview

I'm plugging my own interview here, but hopefully also plugging the Genetics & Health website, which is always informative and engaging.

Sunday, November 19, 2006

New Drug Boosts Breast Cancer Survival

In an article in The Lancet, German researchers report that certain breast cancer patients who switch to the aromatase inhibitor drug anastrozole (Arimidex) after two to three years of treatment with tamoxifen live longer and are more likely to remain cancer-free. More from the Washington Post.

Saturday, November 18, 2006

Breast Implant Ban Lifted

Despite lingering safety concerns from some health advocates, the Food and Drug Associaton (FDA) lifted the ban on cosmetic use of silicone breast implants yesterday.

Despite testimony by Dr. Diana Zuckerman, President of National Research Center for Women & Families on the health risks associated with silicone breast implants and despite calls by Dr. Sidney Wolfe, chief of Public Citizen’s Health Research Group, to start a criminal investigation into Mentor Corporation's apparent failure to send the FDA data showing safety problems with their silicone gel implants, Dr. Daniel G. Schultz, director of the F.D.A.’s Center for Devices and Radiological Health, said that the agency’s review, had determined that their sale is in the best interest of women.

However, the FDA is requiring that manufacturers tell women that the implants "are not lifetime devices" and that most recipients will need at least one additional surgery to remove or replace their implants. The agency is requiring the makers, Mentor Corp. and Allergan Inc., to conduct an extensive study of at least 40,000 implant recipients over the next decade and provide their findings to the government. To read on, click here.

Editor's note [added Nov. 21, 2006]: This NY Times editorial explains that just because the implants were approved means that they are not risk-free.

Thursday, November 16, 2006

Genetic Destiny

HarperCollins Publishers is promoting a fake biotech company called Nextgencode (Tag line: “We own the genes. We control your destiny”).

The promotion includes a hyper-integrated online campaign comprising a fake Website, online videos and social networking to generate interest in Michael Crichton’s soon to be released book “Next.”

Given Crichton’s ability to quickly put his finger on the pulse of hot topics in popular science -The Andromeda Strain (about a scary virus), Jurassic Park (genetically engineered dinos) Prey (nanotech gone amuck) State of Fear (global warming = scientific conspiracy) etc, I think this book is likely to generate a great deal of interest in genetic engineering and questions of ethics.

The premise of the book seems to be that biotech companies are allowing us to control not only our genes but also our destiny. The main question that almost always underscores Crichton’s books, of course, is “Who controls whom?”


Extreme Preemies -- Who decides?

Art Caplan does a provocative article on MSNBC online about how the recommendations in the UK to let extreme preemmies die go to far -- but that the US has also gone too far in the past, in the opposite direction:

Is it right to let extreme preemies die?
British council recommendation goes too far — but so does U.S. law
By Arthur Caplan, Ph.D.
MSNBC contributor
Updated: 7:31 p.m. ET Nov 15, 2006

Can you name the only group in the United States that is required by law to accept medical treatment? It is newborn babies.

In 1985 Congress amended the laws governing support for child abuse and neglect programs to mandate that all infants born in the United States receive medical care. No matter how sick or disabled, all newborns, according to what became known as the Baby Doe law, must be treated. That is what makes the just-issued report by the Nuffield Council on Bioethics in England so startling.

The council, a private organization whose reports are very influential in Britain, argues premature babies born before 22 weeks gestation should not be given treatment to prolong their lives. The council was not arguing for any form of active killing. Its view is that since only 1 percent of infants born between 22 and 23 weeks of age survive long enough to leave the hospital, starting aggressive treatment on babies born at 22 weeks or younger is wrong.

The report is already drawing support from many pediatricians and neonatologists. It also drew the support of religious leaders including the Church of England (Anglican) House of Bishops and the Catholic Bishops’ Conference of England and Wales. (rest of the article here)

The case Art is referring to is Bowen v American Hospital Association, 106 S Ct 2101 (1986) -- In a 5-3 decision, the U.S. Supreme Court struck down Reagan Administration regulations (based upon the 1973 Rehabilitation Act and known as the Baby Doe Regulations) which were intended to prevent discriminatory non-treatment of handicapped newborn infants.
A difficult case, the Bowen Court viewed these rules as unnecessary to protect the rights of disabled infants and as interfering with parental rights to consent or refuse treatment based on what they deemed to be in their infants’ best interest.The Court relied heavily upon the right of parents to refuse treatment for their children. (Stevens, Powell, Marshall, Blackmun, Burger for plurality with White, O’Connor, Brennan dissenting.)

Although the law was struck down as unconstitutional, the enactment of the laws had a powerful effect on the public and how newborns are treated -- and since then Congress has enacted and re-enacted them -- Art pointed to an article by Loretta Kopelman entitled: Are the 21-Year-Old Baby Doe Rules Misunderstood or Mistaken?

[Thanks, Art]

Wednesday, November 15, 2006

What Bioethics Needs: More Lawyers

This is not the beginning of some annoying joke - I mean it. Over the last year, I've been impressed with the critical insights attorneys bring to bioethical issues.

I also had a terrific experience with young law students at the University of Minnesota yesterday. Laurel Kilgour, a UM student and one of the founders of their bioethics student organization, asked me to speak to their fledgling group. Normally, I would not fly nearly four hours to speak to a student group (even on their dime) but since one of the inspirations for starting WBP came from the scholarly work of Dr. Susan Wolf, I felt a debt of gratitude and decided to accept the invitation. Dr. Wolf is founding director of UM's innovative joint degree program in Law, Health and the Life Sciences.

We had a terrific turnout. I was impressed that these first and second year law students were very interested in the policy implications raised by bioethical issues. They asked complex and compelling questions. Frankly, their passion was contagious and I hope many continue to nurture their interest in bioethics. I'll say it again: We need more lawyers in the field.

P.S. They were the most polite audience I have ever addressed - Minnesota nice!

Education Development Center wins NIH contract to develop high school bioethics curriculum

According to a press release that just went out a few hours ago,
The National Institutes of Health (NIH) has awarded a two-year contract to Education Development Center (EDC) to develop a curriculum in bioethics to be used in high school biology courses. The curriculum materials will be created as a supplement to biology textbooks and, when completed, will be made available free to schools across the country. The Office of Science Education and the Department of Clinical Bioethics at NIH awarded the contract.

EDC researchers will work with a team of ethicists, scientists and teachers to develop instructional materials on topics of social importance in the life sciences. These are likely to include such subjects as the nature of bioethics, clinical trials, vaccination, genetic enhancement and genetic screening. The goal of these materials is to have students begin to develop their thinking about ethics and to relate their learning in biology to real life issues.

You can read the full press quote here.

I admit, my first thought is "oh, working with ethicists? Who?" I do think that who is involved will determine my enthusiasm for the project as a whole, simply becuase it has the potential to be either very good, or a nightmare.

End of Life Issues - Are we really prepared?

"The Last Word on the Last Breath" by Jan Hoffman, The New York Times, Oct. 10, 2006

The article was quite interesting and sadly all too true. In today's world it seems that no one wishes to discuss death or dying until often it is too late. Healthcare personnel are often the ones who bear the burden of society's silence on the issue of death. It isn't until attention is brought to the subject by the media as in the Nancy Cruzan case do we find ourselves thinking, "Perhaps I should write a will or at least let my wishes be known regarding my own death." But how many of us really carry out our intentions and have a will or advance directives written. I don't know if it is fear of dying or really our excuse of "being too busy" or "I'm healthy, nothing is going to happen".

Whatever it is, by not putting our wishes down in writing, we are indeed putting the burden of resuscitative measures on our loved ones and our healthcare providers. I am just as guilty as another and have not drawn up a will or advance directives because until now I really never gave it much thought. I know my husband and I have communicated our wishes to each other, but we haven't put them in writing.

As mentioned in the article, CPR was designed for use in sudden cardiac arrest. It was seen as a tool which provides one a chance for survival. It is taught as part of the American Heart Associations "Chain of Survival." It indeed can be very effective for sudden cardiac arrest and may provide a "second chance" for someone. However, when a person is gravely ill and the outcome is bleak, is it truly worth a "second chance" if all that means is more suffering. I really don't believe so. We need to be able to say enough. Let's just keep my loved one comfortable for how ever much time they have left. Often the family is trying to deal with their loved ones' illness and may not be able to provide an answer regarding DNR or CPR issues. Both families and patients need time to deal with the idea of death. I remember Dr. Elisabeth Kulber-Ross's books on Death and Dying and the stages of death a person and family go through on their journey - denial, anger, bargaining, depression and finally acceptance. I believe that where a person or family is on their journey will have an impact on their decision or lack of decision regarding a DNR issues.

Sadly without POLST (Physician Orders for Life Sustaining Treatment), Advance Directives, Living Wills, etc., if you should have a cardiac arrest while hospitalized, you will receive the latest that medicine has to offer related to resuscitative measures. Healthcare providers have no choice but to respond because to not respond could mean an expensive malpractice lawsuit. Hence, individuals really need to rethink about their view of how to deal with a life threatening illness and not leave issues of "what to do if… happens" to their family or loved ones. As stated earlier, I haven't filled out any Advance Directives or Living Will or even made a will, but as I near the half century mark, I see the need to have an open conversation with my children and husband and put my wishes in writing. Because remember, without anything in writing, treatment will be given no matter what the outcome. I would rather die at home with my family at my side than in a hospital bed connected to machines.

Article can be viewed at

The latest Word on Male Pregnancy

We've blogged about male pregnancy before, both here and there, but Stephen Colbert goes over-the-top in his appeal to those who opposed stem cell research to either put up or shut up:

The Ethics and Potentials of Womb Transplants

I think it's pretty obvious that we're fans of The Daily Show and The Colbert Report around here (the AJOB blog folks are equally guilty). That said, I will note I've been working on this post for a few days, and the fact that Colbert mentioned artificial wombs on the show this evening is just him being a thief. Honest.

That disclaimer out of the way, a news story crossed my desk over the weekend, but didn't appear to get picked up by anyone. Several outlets, including the New York Post and Australia's Herald Sun reported that American doctors at New York Downtown Hospital had won approval from their in-house ethics committee to perform a womb transplant when an appropriate candidate is found. They apparently have a lot of potential donors lined up (hmm).

Dr. Del Priore (of the New York Downtown Hospital) doesn't appear to be too concerned about the fact that there's only been a single rhesus monkey transplant done, and the womb was removed after 20 hours. The human womb transplant done in 2000, in Saudi Arabia, ended with the womb being removed after two artificially generated menstrual cycles due to a blood clot. Although there are these very limited results, Del Priore thinks that it would not be essential to do further research before offering the procedure to women, saying that face transplant surgeries went ahead in without being tested in non-human primates first.

This seems really problematic to me, though. The only reason you would transplant a womb into someone would be for the potential to carry a pregnancy to term - shouldn't we make sure that a transplanted womb can stay within a body for longer than 20 hours, or three months, without complications? Shouldn't we verify that a transplanted womb can actually carry a pregnancy to term with no complications, before cautiously and optimistically offering this procedure to women?

Furthermore, anyone undergoing a transplant has to take immunosuppressant drugs for life. The several stories reporting on this have said that the idea is for the womb to be transplanted, the woman to carry a pregnancy to term, and then have the womb removed so that she can stop taking the immunosuppressant drugs.

The little bit of digging I did on immunosuppressant drugs and pregnancy suggests that you'd need to be taking the drugs for about two years before they were at a low enough level where pregnancy is feasible, so long as you avoid certain known teratogenic medications and under close medical supervision. Still, the long term effects of immunosuppressant drugs on pregnancies and on the resulting children is unknown - and it seems more than irresponsible to advertise hope and willingness to do the transplant with intent to allow pregnancy without knowing all of the possible risks and costs.

What effect will the pregnancy have on the transplanted womb? Will the graft "stick", or will the growth of the uterus over the course of the pregnancy run the risk of the graft separating? What about rejection potential? Will it go up, requiring more medication? And of course, what about the entire concept of a non-vital transplant? Is this really a quality of life issue, and does it matter if it is? Should everyone have the option of carrying their own child to term, or if something causes the necessity of removal of womb, should we encourage those women/couples to look towards adoption or surrogacy? And if we start allowing non-vital transplants, what'll be next?

Any which way, it seems like way too contentious a surgery to advertise in the media and suggest will happen within the next year or two, when a willing volunteer is found. A lot more research, and a lot more dialogue about the ethics of it, should be had before we move forward to make it a medical reality.

Monday, November 13, 2006

Pimp My Pride; More on the 'pimping' of medical students

A guest post by Alice Herb on topic we had blogged about before:

Medical students are a special concern to me so when I recently read Barron Lerner’s essay in The New York Times, I hoped to get a clue about what happens to medical students in the course of their education. Dr. Lerner, a physician and historian, described what he believes to be a vanishing form of teaching known as “pimping.” This peculiarly named practice is one where students are peppered with questions about diseases, patients, identification of vital organs, etc. while on patient rounds or attending surgeries. As Dr. Lerner pointed out, these practices, depending on the personality of the attending senior physician, can in fact be educational but can also be humiliating, embarrassing and undermining.

I first encounter future medical students when I interview them for admission. At that time, while admittedly trying to make a good impression, they are nonetheless brimming with enthusiasm, idealistic and eager to learn how they can best help the ill and infirm and in the process “make a difference.” They have all spent an inordinate amount of time volunteering both in medical settings and in their communities. Their energy seems boundless. Yet by the time they are in their fourth year of medical school, I find that too many of the students have become cynical, uninterested in the human side of medicine and reluctant to sit still for something as unimportant as bioethics. What has happened to them? Is this what we do to our best and brightest? What is it in the medical school environment that graduates doctors who have lost or turned off human instincts? If we are to fix our health care system we need to remember to nurture the softer, more compassionate traits of our practitioners.

[Thanks, Alice!]

Cognitive Liberty in an Age of Neurotechnology

Top Bioethicists. Physicians & Psychologists to speak at UN Panel to discuss "Cognitive Liberty in an Age of Neurotechnology"

Contact: Ana Lita (212) 687-3324 |

IHEU - Appignani Center for Bioethics to host panel, Friday, Dec. 1, 2006

NEW YORK – On Friday, Dec. 1, 2006 a panel of leading bioethicists and physicians will discuss cognitive liberty at the United Nations, to be held on the 2nd floor of 777 UN Plaza in New York City, from 6:00 p.m. to 8:00 p.m.

Growing knowledge in the neurosciences, enhanced by exponential advances in pharmacology and neurotechnologies that monitor and manipulate the brain, is rapidly moving brain research and clinical applications beyond the scope of purely medical use.

These emerging neurotechnologies offer expanded intelligence, memory, and senses, giving us greater ability to understand and control our own minds. But they might also expand the avenues for possible coercion and invasion of mental privacy.

What, then, is the state of cognitive liberty today? What steps might be necessary to protect cognitive liberty, mental privacy and freedom of choice in light of these neurotechnologies?

Speakers include:

James Hughes Ph.D.
is the author of Citizen Cyborg: Why Democratic Societies Must Respond to the Redesigned Human of the Future. Dr. Hughes teaches Health Policy at Trinity College in Hartford Connecticut, and serves as Trinity's Associate Director of Institutional Research and Planning. He is the Executive Director of the World Transhumanist Association and its affiliated Institute for Emerging Technologies. Dr. Hughes will moderate the panel. Home page:

Elizabeth Phelps Ph.D. is currently a Professor of Psychology and Neural Science at New York University. Her laboratory has earned widespread acclaim for its groundbreaking research on how the human brain processes emotion, particularly as it
relates to learning, memory and decision making. Dr. Phelps is the recipient of the 21st Century Scientist Award from the James S. McDonnell Foundation and a fellow of the American Association for the Advancement of Science. Home page:

John P. Morgan M.D. is a physician and professor of pharmacology at the City University of New York Medical School. Dr. Morgan has published approximately 100 articles, book chapters and books, largely focused on the clinical pharmacology of psychoactive drugs. His latest book, Marijuana Myths, Marijuana Facts (The Lindesmith Center, New York, 1997) reviews the latest
scientific and medical research and debunks the common marijuana myths.
Home page:

Bradley Lewis MD, PhD teaches cultural studies at the Gallatin School at New York University, with affiliated appointments in the Department of Social and Cultural Analysis and the Department of Psychiatry. He is the author of numerous articles published in academic journals, is the cultural studies editor for The Journal of Medical Humanities, and author of Postpsychiatry: Theorizing Psychiatry, Prozac, and DSM.
Home Page:

The IHEU-Appignani Center for Bioethics promotes a human-centered approach to bioethical issues. For information, visit:

Sunday, November 12, 2006

Research that hangs on stem-cell politics

McGill scholar Abby Lippman speaks out in the Globe and Mail against the commercialization of women's eggs:

Your latest call for research cloning in Canada once again makes no mention of the serious concerns raised by the technique. Even if the promises by scientists and politicians of cures for patients and boosts to the economy were realizable, this approach to embryo stem cell research requires a continuous supply of fresh human eggs. To get these eggs, women must be given large doses of powerful hormones to hyper-stimulate the ovaries. This is not just uncomfortable, but potentially very risky.

Scientists have called research cloning a wildly inefficient process requiring hundreds of eggs to produce just a single clone. And to date, there have been no validated reports that this actually can happen.

The approach you urge is likely to mean paying women for eggs and the start of a commercial market. To avoid turning women into egg farms, let's continue to support research within the law.

Abby Lippman, PhD
Professor, McGill University
Chair, Canadian Women's Health Network

[Editor's Note: Thanks for letting us know about this, Abby!]

Friday, November 10, 2006

Kudos and Double Kudos!

Kudos to our board member, R. Alta Charo -- she was recently elected to the Institute of Medicine, an arm of the National Academies.
But she didn't stop there! She was also recently chosen as a fellow to the World Technology Network, along with Art Caplan and Jonathan Moreno, both of whom are also Women's Bioethics Project supporters! Way to go, girl! Way to go, guys!

Wednesday, November 08, 2006

Stem cell research and its powerful role in the elections

Michael J. Fox, a well known actor who is suffering from Parkinson's disease, appeared in a TV ad backing a pro stem cell research candidate, in a close race for a Senate seat. The ad, which is both emotional and difficult to watch, shows the actor shaking uncontrollably and highlights his deteriorating health condition. Fox's goal is to persuade the electorate in Missouri that by voting for the candidate who supports stem cell research they offer suffering people like himself a hope for recovery.

According to MSNBC, the Michael J. Fox ad stirred a strong response from voters in Missouri, where a constitutional amendment on the ballot would legalize embryonic stem cell research. The race in Missouri is very close and the incumbent republican senator is facing a tough battle mainly because his opponent, a democrat, is pro stem cell research while he is not.

Arthur Caplan, Director of the Center for Bioethics at the University of Pennsylvania, argues that stem cell research has become a focal point in heated Congressional races across the country (including New York, Florida, New Mexico and Virginia, among others) and democratic candidates are using their pro stance on this issue to gain ground against republicans, who in general oppose public funding for such research. What's noteworthy is the emergence of a powerful group that is backing the pro stem cell candidates and funding these multimillion-dollar TV ad campaigns. Caplan indicates that this is not a small interest group pushing a narrow agenda, rather a well organized effort by lobbyists from a broad set of disease and disability organizations, representing people suffering from cancer, paralysis, heart disease and various other illnesses. These groups have pulled together and with their significant money raising ability they are helping pro stem cell research candidates win important votes.

Furthermore, by focusing their efforts on the ethical arguments in favor of public funding for embryonic stem cell research, it seems these interest groups are changing the minds of politicians on both sides of the political spectrum. To this point, Congress, which was strongly against stem cell research in 2002, recently came close to overriding President Bush's veto which blocked public funding for such research. Therefore, through their access to significant funding, increasing lobbying power and sheer control of votes (as they represent a large constituency of people suffering from a broad set of diseases) these disease advocacy groups are putting stem cell research in the spot light and can significantly influence the outcome of elections on Nov. 7 and beyond.
Read more:

Editor's note: McCaskill Upsets Talent for Mo. Senate

Late Night Election Round-up

As it often does for me, curiousity over a couple of key ballot issues gave way to needing to see the reults before I could shut my brain off for bed (thus explaining being awake at 3:45am EST). Jim Fossett, of the AMBI/Rockefeller Institute Federalism and Bioethics Initiative, gave a great pre-election summary of races directly or indirectly influnced by the stem cell debate over at the AJOB editors blog, which I referenced frequently over the course of the evening.

I figured, since I'm up, it might be fun to beat Jim and the AJOB blog to the punch, and post a basic roundup of election results and key issues. Call it a little late night competition, all in the name of fun and insomnia.

In his great election roundup, Jim listed out a couple of the key Senate races where candidates had announced and different positions on stem cell research, but it was not likely to be the decisive issue of that state election. At last check*, four of those five races have gone to the pro-stem cell research candidate: Cardin (Maryland, D), Brown (Ohio, D), Klobucher (Minnesota, D), and Menendez (New Jersey, D). Virginia's Senate race was not yet called, but with 99% of districts reporting, Webb (D) had garnered 50% of the vote, with a lead of approximately 6500 votes. Close, likely to be challenged, but closer races have been called over the course of the night. (Since it is one of the last races to be called, and the result will tip the balance of power in the Senate, CNN and other sources are taking longer than otherwise normal to call the results in this race.)

And of course, Missouri was ground zero for stem cell politics this election, with McCaskill and Talent both weighing in on the issue, Amendment 2 over whether to allow stem cell research, and the now-infamous Michael J. Fox advertisement. Although I've not heard if he's conceded, yet, CNN and several other media outlets are calling the race close, but in McCaskill's favour. And maybe more importantly, in a very close race (51%/49%, with 97% of districts reporting), Missouri voted to allow stem cell research! This particular amendment result flipflopped over the course of the evening, and is the main reason I'm still awake at this hour - I became emotionally invested in finding out the result! What will be interesting is the research that will come out over the next couple of weeks, indicating whether or not Fox's advert did indeed get people out to vote.

In other key ballot issue news:
Banning Same Sex Marriage
Same sex marriage bans were on the ballot in eight states, with Colorado having two referendums, one to ban gay marriage and one to allow domestic partnership. To say the results are disappointing is an understatement:
  • Arizona, Proposition 107: Yes, 49%, No, 51%, 97% precincts reporting

  • Colorado, Referendum 43: Yes, 56%, No, 44%, 82% precintcs reporting

  • Idaho, Amendment 2: Yes, 65%, No, 35%, 72% precincts reporting
  • South Carolina, Amendment 1: Yes, 78%, No, 22%, 99% precincts reporting

  • South Dakota, Amendment C: Yes, 52%, No, 48%, 96% precincts reporting

  • Tennessee, Amendment 1: Yes, 80%, No, 20%, 98% precincts reporting

  • Virginia, Ballot 1: Yes, 59%, No, 43%, 99% precincts reporting

  • Wisconsin, Referendum 1: Yes, 59%, No, 41%, 95% precincts reporting

With Colorado banning gay marriage, in a separate referendum (#1) they also banned domestic partnerships, which would have legalized
domestic partnerships, providing same-sex couples the opportunity to obtain the legal protections and responsibilities granted to married couples under Colorado law. The measure specifies that domestic partnerships are not marriage and do not change the public policy of the state, which defines marriage as only the union of one man and one woman.
This particular referendum flipflopped back and forth as tallies came in, but finally seems to have settled on not passing, with 53% of the precincts voting no.

Affirmative Action
In controversial and interesting news, Michigan's Proposition Two, a proposed amendment to the state constitution to
"prohibit the University of Michigan and other state universities, the state, and all other state entities from discriminating against or granting preferential treatment based on race, sex, color, ethnicity or national origin."
was passed (58% yes, 42% no). This, of course, stemmed from a 2003 University of Michigan case (Grutter v. Bollinger) that went to the Supreme Court. The Supreme Court, to the public opposition of the Bush Administration, ruled in favour of affirmative action. Do our resident lawyers know if this proposition, being passed, can be challenged legally, or is this proposition a response to the Supreme Court ruling, in an effort to legally ban affirmative action?

In issues pertinent to women's health, California and Oregon both similar measures attempting to enact parental notification laws for minors seeking abortions. This was Proposition 85 in California, and Measure 43 in Oregon. They had similar language, both wanting to
prohibit abortion for a minor until 48 hours after a physician notifies her parent or legal guardian, except in cases of medical emergency or a parental waiver.
In addition, Measure 43 defined medical emergency to not include incest or rape. Neither of these passed, with voters in both states voting 54% no, 46% yes.

South Dakota's extremely controversial complete ban on abortion, signed into legislation by Gov. Rounds back in March as an intentional challenge to Roe v. Wade, was rejected by voters, with 55% voting no on Referendum 6 (ban on abortion). Interestingly, Gov. Rounds was not voted out of office for signing the legislation, but was instead voted back into office with nearly 70% of the vote.

I'm sure there were other very interesting races and issues in yesterday's election, but these are the things that caught my eye. Oh! And one other thing. While I was passing the time waiting for election results to come in, I decided to see if there was any truth to the truthiness of Stephen Colbert's claim that all of the Congressmen/women up for re-election who had appeared on The Colbert Report in the last year were re-elected. As you may or may not know, both Republicans and Democrats were strongly advised to not appear on Colbert's show, with to-be Speaker Pelosi's video clip advising fellow Democrats to avoid the show getting heavy rotation in most media outlets. And behold, there was indeed truth in the truthiness. Of the 26 Congressional districts that have been featured on the show and up for re-election, all 26 incumbents who appeared on the show were re-elected.

However, if you were a challenger featured in the Better Know a Challenger segment of the show (airing the last two months, as incumbents from both sides of the political spectrum avoided Colbert), the news isn't so good. Only one of the six challengers won their seat - so congratulations to New York's 19th Congressional District (the fightin' 19th!) John Hall (D) for bucking that particular trend. Good news for him, bad news for anyone hoping that there was an actual political bump to appearing on The Colbert Report.

*All facts and numbers in this post come from CNN's Election 2006 coverage, accessed around 03:45EST, unless otherwise noted. Most numbers are unlikely to change at this point, but several elections are close enough that they are likely to be challenged and ballots recounted in the next few days.

Tuesday, November 07, 2006

UK Scientists Ask for Permission to Create Chimeras

According to the BBC News, researchers from Newcastle University and Kings College, London, have asked the Human Fertilisation and Embryology Authority for permission to create embryos by fusing human DNA with cow eggs. These chimeric eggs would be used for embryonic stem cell research, destroyed after the stem cells are extracted. This appears to be their way around the short supply of human eggs to use in embryonic stem cell research, but the thing is, these would be chimeric embryos; they're saying 99.9% human. Does that other .1% matter?

While I can understand the idea of test runs before moving on to more valuable (rare) human eggs, I'm not necessarily convinced that this sort of test run needs to be done. We know the technology works, we know how to use it - what, entirely, is the point?

(Then again, I'm not convinced of the opposition argument by Calum MacKellar, of the Scottish Council on Human Bioethics, which basically says there is a line of separation between humans and animals, and to blur that line undermines the distinctions between the species, as well as running the risk of underming human dignity.)

Food. Lies and Videotape (or whatever medium you prefer)

Do you want lies with that? I love it when Hollywood displays a conscience -- this time, Hollywood tackles the ethics of the fast-food industry in their flick, Fast Food Nation:

Inspired by the bestselling book that exposed the hidden facts behind America's fast food industry, the movie traces the birth of an everyday, ordinary burger through a chain of riveting, interlocked human stories - from a hopeful, young immigrant couple who cross the border to work in a perilous meat-packing plant, to a teen clerk who dreams of life beyond the counter; to the corporate marketing whiz who is shocked to discover that his latest burger invention - "The Big One" - is literally full of manure and how he deals (or doesn't) with the lack of ethics in this field -- it unveils a provocative portrait of what lies inside that America is biting into.

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Imaging the Speaking of Tongues

The cat has my tongue this morning, so I'll let the NY Times say it:

A Neuroscientific Look at Speaking in Tongues
November 7, 2006, NY Times

The passionate, sometimes rhythmic, language-like patter that pours forth from religious people who “speak in tongues” reflects a state of mental possession, many of them say. Now they have some neuroscience to back them up.

Researchers at the University of Pennsylvania took brain images of five women while they spoke in tongues and found that their frontal lobes — the thinking, willful part of the brain through which people control what they do — were relatively quiet, as were the language centers. The regions involved in maintaining self-consciousness were active. The women were not in blind trances, and it was unclear which region was driving the behavior. To read more, click here...

Male Contraception -- an option in the works

All I can say is "Isn't it about time?":

Contraception as an Option for the Man
Published: November 7, 2006, NY Times

Ben Kleinman plans to marry next year, and already he looks forward to starting a family. But he knows, too, that there will come a day when he and his wife do not want more children, and that she may grow weary of shouldering the burden for contraception. To read more, click here...

Monday, November 06, 2006

Are 'Partial Birth' Abortions Ever Medically Necessary?

On Nov. 8, 2006, the U.S. Supreme Court revisits the Partial Birth Abortion issue again in the cases of Gonzales v. Carhart and Gonzales v. Planned Parenthood. The Supreme Court had addressed in this issue 2000, in Stenberg v. Carhart, where a 5-4 decision struck down a state statute in part because it contained an exception only in cases where a woman's life is in danger and did not allow a similar exception to protect a woman's health. Nebraska legislators have re-drafted the legislation to declare that 'partial-birth' abortions are never medically necessary, hoping that the Supreme Court will find this law to be constitutional. (Query: If a legislature declares something to be a fact, does that automatically make it true? Like if the legislature declared Omaha, Nebraska to be the center of the universe, does that make it so?)

The Pew Forum on Religion and Public Life has done a thorough job of delineating all the background on the partial-birth abortion issue, if you'd like to download the 12 page document.

And NPR interviews Obstetricians who challenge the notion that so-called 'partial birth' abortion is never medically necessary.

Sunday, November 05, 2006

Fox and Counter Fox revisited

Stephen Colbert on the Rush Limbaugh, Michael J. Fox Affair

too funny to pass up -- The Last Word on shameless Fox hunting on The Colbert Report (pronounced 'rapport').

Saturday, November 04, 2006

We're afraid it's come to this

At first it was an occasional hurtful/racist/sexist/hateful comment. We would pull the comment and hope for the best. Then the "crazy" bloggers found us, posting wild rants. We moved to a "moderated" comment format. But while we were protected from inappropriate comments, we lost the immediacy of the back and forth exchange that makes our bioethics community so powerful. We went back to an “unmoderated” system. But alas, the Internet stalkers have found us - last night we had six random postings in the space of a few minutes. We are going to reinstate the "moderated" comment option. We aren't the only blog with this challenge - implemented the same policy a few months ago. We'll do our best to "publish" comments quickly, but unfortunately, we are not always online. Thoughts?

Thursday, November 02, 2006

Should severly disabled kids be kept small, so that they are easier to care for?

I don't know what to think about this one -- I cannot imagine having to make such a decision and cannot imagine the tears and agony of these parents:
From Reuters:
6-year-old given hormones to stunt growth so parents can care for her.

New York - In a report published in a medical journal this month, two doctors describe a 6-year-old girl with profound, irreversible developmental disability who was given high doses of estrogen to permanently halt her growth so that her parents could continue to care for her at home.

The controversial growth-attenuation treatment, which included hysterectomy, was requested by the child's parents and initiated after careful consultation and review by an ethics committee.

In their report in the Archives of Pediatrics and Adolescent Medicine, Drs. Daniel F. Gunther and Douglas S. Diekema, both at the University of Washington in Seattle, explain the reasoning behind what they hope will generate a healthy debate.
To read on, click here.

Wednesday, November 01, 2006

No Kidneying Around

On the evening of September 26, 2006 I was sitting down to watch an episode of Nip/Tuck and the opening scene pertained to my ethics class. One of the characters was bought drinks, then drugged, and woke up to a phone call telling her she would be fine but that the medicine would wear off soon. As she looked down she noticed a large ice pack on her side, and sure enough her kidneys had been removed. Throughout the rest of the show they investigated other cases, stating that black market kidneys can often seel for as much as $200,000 or more. The kidneys were then shipped off to other countries such as India and Tokyo. Although, this seems very real it also lead me to think that they were playing up an urban myth. I researched it and found that there is an urban myth like this, and that the show might have been laying that up. However, kidney stealing is a SERIOUS I did my own research, and what I found didn't surprise me.
According to National Geographic News is 2002 doctors performed 24,900 life saving organ transplants. However, for every one person given a transplant another two people were put on a waiting list. Now, over 80,000 people in the US are waiting for organs. Every 14 minutes someone is added to that list, and in 2002 6,000 people died waiting for organ donations.
In December 2003, police broke up an international kidney trafficking ring. Brazilian police stated that people were being flown in S.Africa and having the removal surgery. Some of the participants paid up to an astounding amount of $100,000.
With Americans fearing death more than anything else it's not surprising the lengths that one would go to, to move their name up on that list. Or what they would do to come in contact with an organ in illegal ways. In the situation of money versus life, money doesn't appear to be a significant factor. People are doing what it takes, even going to other countries to have the surgery done. This makes me wonder, what about when it is our time to go? What if your body is saying no more? How do we take the natural courses of life into consideration when we can go out and buy more parts to fuel us? What about altruism? How are we to tell if people are really going to donate their organs for the joy they get in helping others or who is doing it for money? Prohibiting payment for organs allows allows us to ensure the quality of the organ and makes sure that it is a six out of six match. If we had every random person who needed the money donating organs who can tell what kind of "shape" they are in. Also, doesn't it make this society even less equal than in already is? The poor sell their kidneys or other organs and the rich pay absurd amounts for them, to save themselves or their poor children who may die inevitably due to their life plan. Are body parts not determining our net worth? There are so many questions that all have so many different answers.
I suppose I don't have a clear and concise answer to any of these questions that I posed, and although I have brainstormed an enormous amount and looked at many different angles of the situations, there is no right or wrong answer. How do you tell someone no, when they are dying? Or tell them "it is your time to go?" Or tell a loving father that because he doesn't make enough money he can't buy the kidney transplant for his daughter? You can't, just like I can't come up with an answer. All I can do is base it on the situation at hand. Each and every case needs to be looked at from every different angle and researched thoroughly. Each transplant needs to be done in a proper and ethical way. Selling kidneys for me only takes away from our self worth and makes us more of a piece of meat than society is already forming us into. If we can't do things the right way, why do them at all?

[Editor's Note: The BBC just published an article on Iran's Desperate Kidney Traders:
On streets and in town squares in Iran, young men and women can be seen holding signs offering their kidneys for sale.