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.

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.

Who or what are you thankful for this Thanksgiving?

With Thanksgiving coming up, I'm borrowing an idea from Beliefnet.com (my favorite spirituality site) -- please tell us who or what you are thankful for this Thanksgiving? Send me your thoughts at linda (at) biomedlaw.com 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.]

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:

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.

Genetics & Health Interview

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

http://www.geneticsandhealth.com/2006/11/16/genetics-interview-25-dr-emilie-w-clemmens-of-the-womens-bioethics-project/

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.

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.

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?”

-Andie

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]

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 http://www.nytimes.com/2006/10/10/health

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:


http://www.comedycentral.com/motherload/index.jhtml?ml_video=78242

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.

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 | AnaLita@iheu.org


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: http://www.changesurfer.com/Hughes.html

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: http://www.psych.nyu.edu/phelpslab/

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: http://www.norml.org/index.cfm?Group_ID=5831

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: http://www.nyu.edu/gallatin/about/faculty-bios.html

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

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!]

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!