Duties and Obligations to Treat Pain

Richard Payne, MD

What are the duties and obligations of physicians to treat pain? Richard Payne, MD talks about it in this edition of the Bioethics Channel.

Dr. Payne is professor of medicine and divinity at Duke Divinity School, Duke University, and the Esther Colliflower Director of the Duke Institute on Care at the End of Life.

Link to podcast here.

Balancing Act: Breaking Stalemates in Clinical Research

Peter Ubell, MD
The American Journal of Bioethics
February 2011

Recent debates over prominent research studies illustrate that controversy can be easily created rather than dispelled by clinical trials, with many clinicians choosing not to use the proven therapy until they receive more convincing evidence of its superiority.

In such situations, we propose that a new standard of equipoise be used to guide decisions about the ethical justifications for research trials—a standard of behavioral equipoise. Under behavioral equipoise, a trial is potentially justifiable if it addresses behavioral resistance to prior scientific evidence.

Podcast: Ethical Stalemates in Clinical Research, Peter Ubell, MD, The Bioethics Channel

Part II: The Ethics of Sterilizing "P"

The case in Britain--and Summer's reply--is an interesting one for us ethicists, especially for those of us who distinguish a personal from a social or institutional ethic. I love to argue with Summer.

I propose that society would be best served by P's not being sterilized at the instigation of the court. My reasoning may be devious--but what is done by an official body has far reaching consequences, and I would hope that no nation would begin a practice of involuntary eugenics on a class of people which the state itself would define.

I agree that the woman is incompetent and ought not bear more children but why are not less drastic measures applicable? Specifically, Summer, why do you descry the use of an IUD?

-- Rosemary Flanigan

Rosemary, I love to argue with you too. So let me say that I have the same concerns about an IUD as I would with any form of birth control--whoever is caring for "P" (given that she has no decision-making capacity, one can assume she probably requires a caregiver of some kind) has to ensure that she in fact has adequate birth control to prevent unwanted pregnancy.

We must consider "P" and her overall well-being. She may not want to undergo tubal ligation--but how likely is she to want to go to have repeated IUDs or Norplant or Depo or whatever they might elect to try as a method of birth control.

If we are in agreement that P should not be reproducing (whether one is a eugenicist or not), then it is simply a question of how to render her unable to become pregnancy. Reversability is not a concern as her mental status is not going to change and thus the rationale for her sterilization is the same.

The rationale, as I said in my blog post, is NOT about her genetics or mental deficiencies, but the consequence of those deficiencies. She cannot care for her own children, and maybe herself. The fact is that if she is not made unable to reproduce she is likely to keep having children for whom she cannot care. Whether that obligation falls to her family or to the state, it is a burden upon P, her family, and her society that can be prevented, and should be.

I know we all reel at the notion of "sterilization" because of our own American history with eugenics and the case of Carrie Buck, but we have to acknowledge that sometimes (unlike in the case of Carrie Buck) denying those without capacity the ability to reproduce is actually in their best interests, and secondarily the interests of society as well.

-- Summer McGee

Links:

UK Court Mulls Sterilizing Mentally Disabled Woman, Associated Press, February 15
Blog: Eugenic or Not, Sterilization Makes Sense for "P", Summer McGee, PhD, Bioethics.net, February 17, 2011

The Ethics of Sterilizing "P"

The Associated Press
February 15, 2011

Some critics questioned whether the radical step was necessary and worried about the precedent it would set.

"This is eugenics if they are doing this because she's mentally disabled," said George Annas, chair of the department of health law and bioethics at Boston University. "This decision needs to be made based on the person's best interests, not the best interests of society or her caregivers."

Link to story here.

Blog: Eugenic or Not, Sterilization Makes Sense for "P", Summer McGee, PhD, Bioethics.net, February 17, 2011

Biomedical and Environmental Bioethics

Richard Randolph, PhD
The Bioethics Channel

February 11, 2011

Biomedical bioethics and environmental bioethics are separate and distinct. Should the two be joined? Richard Randolph thinks so, and he says why in this conversation with Lorell LaBoube on the Bioethics Channel.

Dr. Randolph is an associate professor of bioethics at the Kansas City University of Medicine and Biosciences.

Link to podcast here.

Wrong-headed for Feds to Fund and Find New Drugs?

Terry Rosell, DMin

Rosemary Flanigan Chair

February 11, 2011

I recently received an email from someone concerned after reading an article in the New York Times. (Article here.)

Quoting the article, "The Obama administration has become so concerned about the slowing pace of new drugs coming out of the pharmaceutical industry that officials have decided to start a billion-dollar government drug development center to help create medicines."

The article goes on to say that this initiative by NIH director Francis Collins will necessitate restructuring/"downgrading" of one of the 27 institutes and centers, namely, the National Center for Research Resources (NCRR), which will become by October the National Center for Advancing Translational Sciences (NCATS).

This marks a shift from the NIH's traditional focus on basic research, says the Times. But Collins reportedly is frustrated that corporate pharma is not investing enough in development of new drugs that were promised as a result of his Human Genome Project. Most of the concerns I read (on the "Complaint Blog" set up in reaction to this move click here) are raised by current grant recipients of the NCRR, especially those with CTSA (Clinical and Translational Science Award) money.

They worry that the non-pharmaceutical dimensions of their research, or those aimed at community engagement, will get lost in a drug-focused NCATS. Other institutions still hoping to receive CTSA grants likely worry that the NCRR funding source will dry up or be siphoned off to the new initiative. Legitimate worry.

I'm wondering if there are other, moral reasons to lodge complaints about Collins' plan. Is it wrong-headed for the feds to fund and find new drugs? Or ought this be no more controversial than any other federal reallocation plan in which some vested interests get divested while others finally hit the jackpot? Is there any valid reason to think, as one complainant writes, that "the N.I.H. is not likely to be very good at drug discovery, so why are they doing this?”

Others note that it is moving far too quickly from idea to implementation, with too little opportunity for public comment.The NYT journalist notes that "Dr. Collins has been predicting for years that gene sequencing will lead to a vast array of new treatments, but years of effort and tens of billions of dollars in financing by drug makers in gene-related research has largely been a bust."

Hence their hesitation to invest there.

So is this NIH action motivated more by political p.r. than scientific-therapeutic interests? One aimed at shoring up the director's pet project and reputation, perhaps? Is it a public shot in the arm to renew interest and excitement in the promises of genomic research?

Motives matter oftentimes, but do they here? If NIH funding via a new NCATS were to produce, finally, some new pharmaceutical breakthrough, would anyone be complaining?Yet there is something about this plan that creates in me a sense of (ethical?) unease. Somebody help me locate the source, please. Thanks.

Don't Let Anyone Stop Talk about End of Life Wishes

Art Caplan
MSNBC
February 7, 2011

Tossing aside irresponsible rhetoric about death panels, euthanasia, health-care rationing and throwing grannies on ice floes, the cancer experts say candid conversations are the key to ensuring comfort and dignity in the final days.

Links:

Don't let anyone stop talk about end-of-life wishes, Art Caplan, MSNBC, February 7
End of Life Scare 2011, John Carney, The Bioethics Channel

Sabbaths of Hope 2011

Sue Lewis
Terry Rosell

February 4, 2011

The initiative is called Sabbaths of Hope, aimed at enabling clergy and other faith leaders to address clinical depression in their communities. It’s in its fourth year and it’s time for an update in this edition of the Bioethics Channel.

Lorell LaBoube visits with Sue Lewis, CEO and President of the Mental Health Association of the Heartland, and Terry Rosell, Rosemary Flanigan Chair at the Center for Practical Bioethics.

To listen to the podcast click here.

Caplan Discusses Ghosts of Bioethics' Present, Past and Future

Our friend Summer McGee at bioethics.net passes this along.

L2

On Point of Inquiry, Art Caplan discusses how bioethics has "come of age" and what questions are likely to engage the field in the future. The interview with Chris Mooney is one not to miss.

For more click here.

Top 10 Podcasts: January 2011

The Bioethics Channel continues to serve as an important venue for discussion of bioethics issues. If you would like to suggest a topic or speaker, please do so by emailing llaboube@practicalbioethics.org.

Regards,

Lorell R. LaBoube

Director of Communications/Center for Practical Bioethics

Producer and Host/The Bioethics Channel

Top 10 The Bioethics Channel

January 2011

Medical Ethics and the Law, Annette Prince
Doctor, would you prescribe a pill please?, Matthew Wynia, MD
Developing independent senior living, Kelley Hrabe and Jeremy Whitt
Healthcare and social justice from the Heartland to Haiti, Helen Emmott
Aging and access to service, Brent Never, PhD
End of life scare 2011, John Carney
Systems Reform and Innovation, Karen Miller, PhD and Robert St.Peter, MD
Medical Tourism and Bariatric Surgery, Jeremy Snyder
Religion and Medicine: Compatible?, John Lantos, MD and Farr Curlin, MD
Terry Schiavo Lives On, John Carney

Adoption in the Facebook Age

Glenn McGee, PhD

KCUR Radio

January 31, 2011

Facebook and other modern communication technologies are allowing people to reconnect after many years of silence. In fact, those who are adopted have found their birth parents - and vice versa.

But is that a good thing?

In this edition of Up to Date, bioethicist Glenn McGee of the Center for Practical Bioethics talks about adoption in a high-tech age. We'll look at adopted children and parents reconnecting, how assisted reproductive technologies like egg and sperm donation are changing the face of adoption, and recent adoption news in Missouri.

Link to the program here.