Thursday, April 21, 2005

Re-Direction of the Bioethics Dude Blog

OK Dudes and Dudettes, here's the deal:

  1. Bioethics Dude is swamped with work and essential life matters (e.g., exercise, sleep, readings, etc.) and this seriously impacts the frequency with which he can post matters of genuine substance (and if it doesn't have that, then why post?).
  2. There are numerous other blogs and websites (the links to which you'll find to the right, in the links section --I try to keep those limited to a few that are really good) out there that a) tend to post about the same hot issues when they arise, and b) in sum and given their massive number (aka the glut of blogging) offers sufficient overview of the field of bioethics.
  3. Given the above two, most of the time, I can contribute to the dialogue and my personal need to be informed by reading them and commenting within those blogs. Look for me there if you care...
Given the above three, posts will be infrequent (perhaps once a week, generally for Grand Rounds?) and will only cover issues at length which are of significant interest to me or the community. I figured, why add to the glut of info and blogs out there if I can't contribute anything of substance with necessary frequency!

So I encourage you to check back once a week or there abouts...if you do so less frequently, don't fret, the likelihood is that being informed of something a week or two late in this field will not kill you. At least info from this site won't: - ) It may just make you happier / more fulfilled a bit later. --BD

Tuesday, April 19, 2005

Drumroll Please....30th Grand Rounds!

Yup, 30. It's hosted at Living the Scientific Life, by GrrlScientist. Check it out!

The Papabile and Bioethics

I’m religiously ignorant, but have been remotely following news about the selection the next pope. For any readers who may be similarly ignorant, the following sites may be of some interest:

Papabile (a blog about the papabile (meaning potential candidates for popes, pl))
Detroit Free Press
Outside the Beltway (another blog with a slightly different perspective)

Cardinal Angelo Scola appears to have addressed some bioethical issues more than his colleagues, but I was unable to find any of his writings. If any readers know where I can get my hands on 'em, please let me know. Of course, who know's what is meant by bioethics, the term can be broadly construed...

Sunday, April 17, 2005

Chimeric Research -Take two (or three, but who's counting)

Following up on my post of 4/06/2005, here're some recent news items based on some element of Chimeric research:

1) NYT: The Other Stem-Cell Debate (hope the link works...it's been form than a week). This is really an excellent article that provides a more-or-less balanced description of the issue (I hated to say fair and balanced :- )

I still plan on analyzing the philosophical issues behind this, and actually by philosophical, it is becoming increasingly likely that this will be mostly an ontological assessment --but the Dude has been swamped lately, and so the more time consuming undertakings have been drydocked for a bit.

Majikthise Meme

Via Orac, the Dude has been invited to participate in the following meme, as promted by Majikthise:

Behold, the Caesar’s Bath meme! List five things that people in your circle of friends or peer group are wild about, but you can’t really understand the fuss over. To use the words of Caesar (from History of the World Part I), “Nice. Nice. Not thrilling . . . but nice."

So, here we go:


1) SUVs that don't touch an ounce of mud or nature's terrain.
2) Any show on the WB.
3) Karaoke. Even when I'm drunk, I'll only sing in the shower.
4) Gathering with a lot and a LOT of people.
5) Spectator sports. I just can't get into it.

That's it for the Dude; and thanks to Orac for the invite!

4/19: Forgot to invite folks, so here they are:

Thursday, April 14, 2005

Stupidest Auto Safety Campaign Ever

For this past year is...
drumroll...kinda late but finally checked it out...

ESUVEE.
You'll need flash to run it.

First, the Dude was totally perplexed by the commercial, expecting it to be a new type of SUV (and a damned hairy one). This was likely intended to draw-in the readers so that they would go to the site, however, I wonder what percentage actually do. For those who don't, the intent fails and they're not educated...of course, they're probably not educated anyway...

Second, the message promulgated (e.g., slowing down, not driving aggressively, etc.) will be a) nothing new to most folks, and b) not in any way in a format that will affect the readership/drivers of those automobiles. For example, what teenager or college sophomore will actually be swayed by something like that?! Something a hair's-breadth more cool than an after school special! And it's only cooler 'cause of the chewbacca-like hair..

Finally, who's the sponsor? and what likely lawsuit spurred this into existence? The ad states that it's brought to the public by the consumer protection agencies of all 50 states plus some of the territories, and the attorney general. Really?Would they really waste public $ on such things. Don't answer that...I would hope though that this is funded by or as a result of awards of suits brought on private parties. Perhaps, the makers of SUVs, tire manufacturers, etc...


Tuesday, April 12, 2005

Trouble with Diagnosis: Car Talk vs. Doctors

I was listening to Car Talk over the weekend (totally hooked on the show) and realized some familiarities between doctors making a diagnosis and Tom and Ray making a diagnosis over the phone. This comparison is likely to be nothing new, I’m sure many others have thought of it…I have as well, but for an irrelevant reason decided to post on it (basically, it’s a slow week for the intellect of the Dude, he’s just beat and is, frankly, more concerned about getting outdoors…plus, most thoughts focus on the law, not as much on bioethics.)

There is one part of the show where Tom and Ray call back listeners whom they provided advice to and ask whether the advice was right. For example, when you told us about the creaking and wheezing noises your 1984 Honda Civic (which was one of the ugliest cars Honda made...) was making every time you stopped, and we told you that it was a) a mule trapped in the undercarriage, b) likely to be the break rotor or the pads, was our advice right? and then the listener informs that c) they were right (there really was a mule in the undercarriage) or b) that no, actually it was the front shock absorbers that had been leaking shock fluid all over the driveway for the last two years and have now completely crapped out. Tom and Ray respond: So why the heck didn’t you also tell us that the front of your car bounced like a low-rider gone mad with hydraulics??!! I’d like the readers to know that this is not an actual scenario and that Tom and Ray are right most of the time.

Is this a common occurrence with patients or what? I don’t mean to reduce physicians to automobile mechanics, but the paradigm of obtaining information about symptoms and making an educated assessment of the likely causes (i.e., making a diagnosis) are very similar. The Patients/the Informant has a critical role in the dialogue that can do so much to abate or advance the alleviation of suffering. In both cases the following exist:

  • The patient or car owner provides subjective information, that is used as the primary basis for beginning the inquiry. I stress that it is used as the primary basis, as various diagnostic measures utilizing instruments are available to provide an objective measure of symptoms and underlying mechanisms. Of course, for common ailments (be they colds or infections, or squeaks and rattles) objective measures may not be used at all, may be used de minimus, or may not be used until later on.
  • Yeah, it’s true that it is not the car but the owner who is providing the info, whereas in most medical cases the patient can provide information about themselves, and yes, maybe in the future, cars will be able to provide that autoresponse, and yes, to a certain extent they do now. However, at present all that the sensors and fancy computers tell the mechanic is that there’s something relating to the brake system that is reporting error feedback in the front-left wheel. The mechanic then has to put together feedback info from the owner (e.g., rattling when braking under pressure) to narrow the scope of the inquiry into something relating to the Antilock Braking System –the mechanic, not the software/hardware of the automobile per se, did the narrowin’ of the scope. So in this regard, the analogy from car and owner reporting of symptoms to patient is still accurate. Not to mention cases in which the patient may be incapacitated in some dimension of cognitive/physical capacity and has to have a care-giver provide that info to the doctor…

All this, of course, is the typical black box phenomenon. The cause must be assessed from external or somewhat external symptoms. So in listening to the show and having been a patient during the course of my life and knowing others who have, I can say that the docs have been right most of the time, as have x and y. I do, however, wonder how right both parties have been, and just how right do they need to be? That is, if the ailment (mechanical or biological, or both if there is a varmint chewing up your fuse lines) disappears and the patient lives or the machine works well again, at times it’s not necessarily due to the assumed cause. It’s a complexity issue, as well as a causal or correlative one…but that’s just the amateur philosopher of science in me. Of course, some pragmatist patients and doctors/mechanics may not care either, and then again, those with an academic curiosity would.

Grand Rounds 29

Read it at: Grunt Doc.

Friday, April 08, 2005

Follow-up Articles in re Pharmacist Conscience Acts/Conduct

Some news developments on this, that I thought may be helpful to the readers in having it accessible in one entry (as this continues to be a topic of interest to the Dude and the community --even WNYC had a blurb on it recently; it aint' goin' away folks...):

  • My preliminary post on it, and the follow-up. I welcome comments, just please read those that have already been left by readers and my responses to them before commenting.
  • Arizona approves bill protecting pharmacists in denying by reason of conscience providing emergency contraceptives...I wonder how they will operationally handle this for those who need it in a fair and equitable manner?
  • Commentary on the Illinois reasoning and repercussion of a Conscience Act. (Arguing Pro)
  • Information on a survey being conducted of Kentucky pharmacists in order to obtain info on how frequent such requests are (and briefly mentions Illinois Gov. Blagojevich's directive to dispense such drugs without delay).
  • Commentary on the down-side of such clauses, specially addressing that the pharmacists actions may trump the decisions of the primary health care providers (e.g., doctors) and that pharmacists cannot act in that capacity; as well as the dangers in expanding conscience clauses to encompass pharmacists as well. I agree with the writer that pharmacists who cannot conduct their expected duties (and it is pretty clearly laid out what those are) should find another livelyhood, but the question that argument doesn't answer and hence feels insufficient on is how is that different from the primary health care workers? Is it that those jobs (i.e., those of the physicans) have a broader decisional scope and hence that somehow entitles them to conscience exceptions? The Dude mostly is on the side of pharmacists doing their job and if they can't then finding something else to do -as noted in my previous posts- but I do want to find a satisfactory reason for differentiating why conscience exeptions as such are not as neatly applicable to them. And thus far in the debate, no one has appeared to make that necessary distinction.

  • Further and once again, the articles don't address -certainly not sufficiently- how this is really going to be operationalized. If women need emergency contraception at 2 a.m. (and I think it's valid to remove an analysis of why she needs that prescription as that's not related to the prospective harm perceived by those acting per their conscience), and she has only several hours to take that emergency contraceptive, how will she readily be able to know which pharmacy to go to? How will such information be made available to the public so that the lay person can know that only pharmacy X can serve them?

    Cookie Monster Taken Over by Aliens and Eating Healthy?!

    Damn it to hell!!!! and, has it frozen over? Where's my youth gone? You know those things/concepts/experiences in life that you unconsciously take to be fundamental to confirming the reality of your existence and your values? You know what it feels like to have the rug pulled out form underneath them? No...well, apparently, the Cookie Monster is Switching to a Healthier Diet. Crap.


    Wednesday, April 06, 2005

    Chimeric Research

    I posted on Chimeric experiments earlier, and will be following up on this shortly (it's become an interest of the Dude's and some readers have come across the blog as a result of searches relating to that), with the following in mind:

    • To recap, the UK's Guardian posted an article on this, written by Jeremy Rifkin, that has continued to be transmitted to other newsmedia since then. Not to harp on Mr. Rifkin, but the article is full of ad hominems, appeals to pity, and other typical and worthless rhetorical tools. For example, in one brief paragraph does he address the benefits of the chimeric research, but in terms too general to do it justice, then proceeds onward in bashing the crap out of it without actually offering any material proof or rational argument.
    • The article has received some commentary (not enough in my opinion to place in fair light), and this one ties the gist of the responses together fairly well. Worth reading as it emphasizes that chimeric research isn't done for aimless experimental whim.
    The conflict appears to arise out of a sometimes misconception of what chimeric research is, slippery-slope arguments over what-if-some-scientist-created-some-pseudohuman-monstrosity, and how would current ethics deal with humanness attributions of such a creature, to some Edict Driven Approach about the unalterable value of human dignity and how such experiments trespass upon that.

    Meanwhile, the scientists pushing forward with such research make the claim that Chimeric experiments allow for effective testing of theories -more effective over current animal-only models by leaps and bounds- because: 1) animal testing is necessary as the types of tests needed would kill humans if it involved them, and 2) because of the discrepancy between human and animal biological make-up, the more human elements can be included in the biology of the animal, the more veracity the experiments will have.

    This is, of course, a brief overview of the issues and doesn't even begin to address the issue of how much biological make-up is needed for something (e.g., a chimp) to become something entirely different (e.g., a human with human consciousness).

    So what does philosophy have to say about this? Well, for that, you'll have to stay-tuned as I want to do a thorough enough of a job to provide a synopsis of the philosophical arguments, and then figure out where the Dude would stand on this issue. Look for it in the next couple of days...

    Orac Hosts Tangled Bank

    Orac hosts the Tangled Bank blog this week, which is a blog medical/science related carnival hosted by various folks. Worth checking out as Orac always has a unique approach to these things.

    Monday, April 04, 2005

    Motorcycle Diaries: Che Guevara as Doctor

    Finally got to watch Motorcycle Diaries over the weekend, which is the depiction of Che Guevara's journey from Argentina to the northern-most tip of South America in Venezuala on a motorcycle, some months before he is about to finish med school. The film is a really moving depiction of Che's development of what ended up to be a Marxist thought, but was during the period of his travels empathy toward the natives and the poor. The Dude got teary eyed...

    ...and is addressing it here because Che was a doctor (and an asthmatic) and treated lepers as a part of his residency. Some scenes in the movie made me think back to a series of posts that Dr. Bernstein wrote on Sympathy v. Empathy, and how Che’s beliefs shaped his approach to medical treatment. Making use of Dr. Bernstein’s post provides a good kick-off/foundation to this rant:

    Harry Wilmer (Wilmer HA. The doctor-patient relationship and issues of pity, sympathy and empathy. Br J Med Psychol 1968 Sep;41(3):243-8.):* Pity describes a relationship which separates physician and patient. Pity is often condescending and may entail feelings of contempt and rejection.* Sympathy is when the physician experiences feelings as if he or she were the sufferer. Sympathy is thus shared suffering.* Empathy is the feeling relationship in which the physician understands the patient's plight as if the physician were the patient. The physician identifies with the patient and at the same time maintains a distance. Empathetic communication enhances the therapeutic effectiveness of the clinician-patient relationship.

    Based on the above, Che had an inherent understanding of empathy (which is one of the likely reasons he was such an effective orator and leader) that enabled him to understand the human condition of his patients. This is perhaps best demonstrated by the scene in which upon entering the leper colony for the first time, and being instructed to wear gloves when dealing w/ the lepers as the nuns persisted in that unnecessary measure (leprosy is not transmittable when under treatment), Che rejects that order and shakes hands w/ his patients. He reaches out to them recognizing the dignity they deserve as human beings, not as mere patients. The movie drips with metaphorical scenes like the one above. For example, in another scene, Che swims across the river separating the health care workers from the lepers, in the midst of the night, to celebrate his birthday with his patients as well.

    It is, however, acts like that which make the Dude wonder whether Che crossed the line into sympathy and biased his professional judgment. I’m not sure, did he cross the line, did the patients receive the best care possible without being at the center of unnecessarily prolonged or conversely, abbreviated care? From the movie and his diary, it appears that he did not, that he was able to keep his role in perspective by maintaining a personal distance…but in the end it was the frustration of recognizing that distance and questioning its validity that led him to question the values of his environment and become a political leader. And by that, he did become sympathetic.

    What has begun stirring in my mind is whether it is that very presence that propelled him to action; i.e., that by being only empathetic he would not have been able to do the great things he did. The passion/fire people spoke of that was so evident in him and others like him was because of sympathy, not empathy.

    Clearly, there have been those great men and women in the past in the field of medicine and philosophy (and, yes, others; - ) that have pulled their fields along kicking and screaming to new heights who expressed that removed empathy, but sympathy doth a moving tale make and need not necessarily be a bad. Maybe it’s a Greek-drama thing, our attention’s and affections are attracted to the hero/heroin driven by sympathetic fire, destined to do great things, but knowing well that they’re not going to stick around forever…these people follow their passions without sacrifice and expire too soon because of that.
    Ignac Semmelweis and a herd of other great individuals led lives driven by sympathy and bettered the welfare of man, but at their own cost. I recall reading a chapter on Dr. Semmelweis which showed the effects sympathy had on his health. The chapter showed a picture of the doctor at age thirty looking as one should, and then in his mid-thirties looking closer to a man in his fifties. It is perhaps because of such cost that we are advised to be empathetic toward our fellow man (read as patient). Not solely due to the fact that sympathy will likely bias one’s professional judgment, as it need not, but because of the great detriment it has upon the person…


    *The Dude would like to note, in case anyone is wondering, that he is not a Communist, nor a Capitalist. He’s just Bioethics Dude.

    Friday, April 01, 2005

    U.K. Should Have Clinical Ethicists in Hospitals As Well

    An article appears in today’s British Medical Journal (BMJ) arguing for the presence of clinical ethicists in U.K. hospitals in order to provide more ethical guidance to doctors. The article points out several interesting items:

    1) Although doctors receive ethical training during the course of their education, that training is cursory and insufficient in providing them with a good foundation that may be used in assessing ethical dilemmas faced on a day-to-day basis. Further, there’s little time for doctors to receive more training while in school given the already long and exhausting education period.

    2) Although hospitals have Ethics Committees (EC), not all doctors feel comfortable enough or have time enough to approach these ECs. The article emphasizes that most novice doctors feel uncomfortable seeking out guidance as it reveals their ignorance.

    3) Most hospitals in the U.S. have full/part-time clinical ethicists in order to bridge the gap noted above, and to provide training and guidance to doctors and others on the front lines of health care.

    4) Based on these points, the article argues that U.K. hospitals should employ clinical ethicists.

    Some thoughts on these:

    In respect to point #1, I wonder if there are other venues that provide a crutch for ethical training while the doctors serve out their residency? That is, ought we not look at the larger picture, outside of formal training? So, although doctors don’t receive formal ethics training of the detail noted by the author, I’m sure they interact with more experienced doctors who provide them with guidance. Of course, I wouldn’t be surprised if these discussions occur only when presented with an ethical quandary…and thus, at times too late.

    I do, however, understand that there is no feasible way to increase the amount of ethical training doctors receive during their education. I wonder though, whether that training could be improved upon. Perhaps made to be more interactive by presenting students with situations that commonly occur in practice and have them decide in some dialectical method.

    Thursday, March 31, 2005

    For some fun: Create Your Own Deity

    The Philosophers' Magazine Online has a game where you can create your own deity. Well, OK, it's brief and it's not really a game, the Dude does find it somewhat fun --but, admittedly, he is biased...

    They have more games and quizzes also, including one on Shakespeare v. Britney Spears, and if anyone knows of something similar for bioethics, please let the Dude know.

    (What sucks is that more people who've completed the survey would take Britney's works w/ 'em to a desert isle than the works of Picasso, J. Austen, T. S. Eliot, and Miles Davis. Why people? Why?)

    Wednesday, March 30, 2005

    IRB Overdrive: Raagh!

    Lately, I’ve been somewhat irked by the actions of many IRBs that result in limiting research under the guise of protecting human subjects. I find many of these actions to be based on an overly paternalistic role –meaning that the IRB’s are making decisions to protect the subjects on such a level that they appear to be thinking for the subjects. I don't mean vulnerable populations either...

    How does this shift take place? Is there a shift, or are IRB's liability aversive (answer=yes) and that aversion clouds their judgement (answer=maybe)? Responding to the first question, I believe that during the course of reviewing research and going through the decision procedure for protecting human subjects (as laid out in the regulations: OHRP or FDA and a slew of guidance documents, IRB's are on the face of it concerned with protecting human subjects. However, when the research appears to make use of some atypical and novel approach, or involves subject populations that at first impression appear to be not within the stereotypical view of normal (e.g., sexual fetish communities), some IRB's switch over to include institutional liability in their review assessment. Such liabilities may include both legal and PR aspects. There are several problems that arise when this occurs:


    1) Loss of subjects' liberty:
    The problem with any IRB acting in such a way is of course that it limits the autonomy of subjects who are peferctly able to make determinations on their own regarding the risk/benefit ratio of the research. Of course, I'm assuming throughout that informed consent was provided, was comprehensive, and was free of coercion. Nothing in the regulations suggests this super-paternalism, if anything, it is contrary to the purpose and the ethical postulates that underly the regs. The principle of volunti non fit injuria (<--this will bring up a google search) reflecting pro and con arguments for it] is applicable here when combined with the comprehensive informed consent requirements layed out in the applicable regulations.
    By combining these two principles, the subject should be fully informed of the procedures, etc. of the research and is able to form a representative risk/benefit ratio of possible outcomes of participating in the research. As such, the choice to affirm or decline to participate and experience the resultant benefits/risks are theirs to bear. This was similar to HIV afflicted individuals making a push to being able to determine for themselves whether they wish to participate in experimental (read as unproven) drug trials.

    2) Stigmatization of the IRB:
    Other problems that may arise out IRB's acting under such a guise are that 1) researchers are likely to see that such liability factors were made during the review process and they're likely to believe that those decisions are not within the purview of the IRB, and 2) such actons are likely to stigmatize the IRB as some overbearing/beuoracractic body making caprcicious decisions...I'm not saying these perspectives are right, but I've seen at a couple of institutions and they stemmed for the IRB making such decisions (this shouldn't be anything new to those familiar with IRBs). There should be, and probably are, other bodies/departments in institutions that should consider this, and if necessary disapprove research, that may have some PR liability for the institution. Doing so would keep the role of the IRB alligned to its purpose, and portray the IRB to researchers as a body concerned with the protection of human subjects alone.

    Tuesday, March 29, 2005

    Follow-up News Articles Regarding pharmacists Rights to Refuse Prescription

    Some interesting articles on this issue...

    MD Senate Defeats Bill That Would Allow Emergency Contraception w/o Pharmacist


    Pharmacists' Rights at Front of New Debate

    CBS News even had something on this, though watered-down for TV...

    Background:

    Pharmacists For Life International is the organization that is cited in the Washington Post article appearing in the post above. Per my post on this, and the exchange in the comments section of that post, I don't generally agree with this, generally...







    Monday, March 28, 2005

    The Blog’s a Month Old; Reflections

    Well, it’s been a month since the Dude started posting, and here are some reflections and goals for the future:

    • The post that got the most comments, even recently, was in relation to the Pharmacist refusing to provide the prescription for contraceptives. The HealthLawProf Blog had new thoughts on it that reflected the Dude's.
    • I don't suppose it's been too bad thus far. Readership numbers on weekdays are around 40ish, and are mostly from the East coast.
    • Am continuing to find the groove and scope of the blog, especially in terms of whether to post longer and more comprehensive posts or shorter news bites w/ brief comments. In that regard, I welcome any reader's comments. I may tend toward longer and more comprehensive posts, which will result in my posting less frequently --perhaps 3-5 times per week. I feel that quick news bites can be found on most blogs and there's no reason to post additionally and add to the glut.
    • Possible future posts are to address chimeric research, whether IRBs are too paternalistic, and interesting health law reflections based on the 26 CDC Public Health Law Readings; I've read 8 so far.

    NJ Academy of Science: Science for Breakfast Program

    This Sunday the Dude will be judging scientific presentations provided by high school students interested in careers in science. The even is hosted by the New Jersey Academy of Science, check it out if you can! The keynote speaker will be Dr. Wise Young, Rutgers University, of the W.M. Keck Center for Collaborative Neuroscience, The Spinal Cord Injury Project.

    On the odd chance that you are a high school student and think you want to present, check the out info here on the program and how to submit proposals.

    Rutgers Professors' Research on End of Life Legal Issues

    I thought I'd post on some work that I'm aware that has/is taking place at RU about such issues (as they pertain to legal theory):


    1) Norman Cantor:

    The Relation Between Autonomy-Based Rights and Profoundly Disabled Persons (pdf)

    On Kamisar, Killing, and the Future of Physician-Assisted Death (pdf)

    2) David Frankford

    Publications listed at webpage




    Friday, March 25, 2005

    Information Regarding Advance Directives

    By now, I'm sure that most sites/blogs have suggested various cyberlocales where this info can be found, but I feel that this is also pretty good:

    NIH Nat'l. Library of Medicine: Advance Directives

    You'll still need to check with respect to state law. The Amer. Jo. of Bioethics Editor's Blog posted on that here (which is equally good).

    Art of Medical Quackery

    If any of you are near Philadelphia and have some time this weekend, check out an exhibit showcasing the visual art used by medical quacks. It will be showing at the Philadelphia Museum of Art. If you can’t check out the event but want to read some more on debunking quackery in a classy way, check out these blogs:

    Respectful Insolence

    Skeptics Circle (Recently hosted by Orac of above)

    Also, expect no posts from the Dude over the weekend. He'll be having dinner and all the festivities of Easter, as well as kayaking here, which appears to be an interesting place to go.

    Assessment of the Field of Play (3 of 3)

    Well, after some time spent researching organizations out there in the great cyberspace dedicated to bioethical views that the Dude was 1) not really familiar with; and 2) based on significantly different sets of ideals than the Dude believes in, the results are ready to post. I’m going to be referring to categorizational terms that I came up with in the first post on assessing the field of play.

    Before going on, I would also like to clarify that in posting this I in no way am bashing nor expressing allegiance to the other side. As expressed in that first post, my goal is to evaluate the ontology and the logical consistency of any bioethical argument before judging its merits, and to thereby stay as far away as possible from the emotional aspects –those can and usually do come later. However, I didn’t feel that it was fair for me to assume that 1) the readership (that one lone stranded individual) agrees with my take, and 2) what the hell else is out there, really? On what basis do people disagree on, and show at least a semblance of intellectual basis for these bioethical disagreements.

    The posts are organized in order of closest to the zero degree mark of Edict Driven Approach (EDA) (i.e., what many term to be conservative but I don’t use that term because it has become so nebulous and as stigmatizing as liberal) and moving toward center…so here we go:

    Center for Genetics and Society

    Their argument that the new human genetic technologies could lead to a neo-eugenics movement is, in my opinion, meant to inflame and persuade.

    Wesley J. Smith's Second Hand Smoke Blog

    Ethics and Public Policy Center (EPPC)

    Some interesting publications and comments there, but some do point to the neo-eugenics movement as well, and so I have the same opinion in re that as above. All-in-all, interesting because some arguments tend to be more academic.

    The New Atlantis

    Published by EPPC above, including articles by Leon R. Kass who makes some poignant arguments for having ethical determinations lead the way of science (worth checking out). I don’t wholly agree with as he is nearer to the fundamental Edict Driven Approach than I prefer to be, but he does nonetheless offer interesting arguments (notwithstanding bringing God into the fray, which, I don’t know, just sounds inappropriate to me. I realize that religion has a place in bioethics as a sizable portion of the citizenry is religious in one way or another, but I don’t think that a bioethicist ought to rely on God in making arguments…this is another topic though.)

    They do have a great quote that I feel should be noted:
    Conservatives and Liberals both believe in the virtues of modernity, often in identical ways. But they also offer competing visions of what progress is, where it leads, and what it requires. Conservatives want to send men to Mars, ban embryo research, curb weapons spending, and build hydrogen cars. Liberals want to keep human beings on earth, fund embryo research, curb weapons spending, and build hydrogen cars. The two political camps sometimes disagree about the respective roles of government and the private sector in promoting scientific and technological progress. And they sometimes disagree more profoundly about what it means to advance, with very different conceptions of what should be ‘off limits’ to scientific research and technological development. The machine in the garden distresses the liberals; the pipette in the embryo distresses conservatives.

    --Fall 2004/Winter 2005, Editorial, Science in the Public Square

    They have another article on the acorn and the tree argument vis-à-vis embryos and humans that is also worth a read. I’ve always thought that such argument confuse potentiality with actuality, but that too will be another topic explored later on in more detail.

    Center for Bioethics and Culture Network

    International Taks Force on Euthanasia and Assisted Suicide

    Discovery Institute

    Center for Bioethics and Human Dignity

    Do No Harm


    Keep in mind, I do not intend to at this time endorse or disapprove of the views expressed by the individuals/organizations above. This was mission to find basis for bioethical views I'm not familiar with.

    Schiavo's Renewed Motion Denied

    You can read the copy of Judge Whittemore's order here.

    Thursday, March 24, 2005

    Thoughts on the Law and Why Some People Despise It and Lawyers

    I was thinking last night about various ontological and metaphysical theories (I’m reading Kant’s Critique of Pure Reason, again, and again, and again…) and then somehow ended up with thoughts about the law, the legal system, and lawyers, and why most people seem to really not like one or all of these (towards the end of this rant, this will relate to issues about health care).

    The reason people seem to me to despise the law, its system of function, and find its actions capricious is because it is in its critiquing nature that it reveals how little we know about every so called truth/postulate. The system of inquiry (also known as the legal method) inevitably puts into doubt concepts that one side holds dear and fundamental to their core concept of self/identity, but fail on their own to explore the bounds of. This is not necessarily a fault of their own, most of us don’t deeply introspect our beliefs, and those who do, certainly don’t do it on all of them.

    But with the law, in the course of its quest for truth (I know, I know, whatever that means…but that ambiguity is kinda the point of this rant…), law points out the inconsistencies in our beliefs, and sheds light on how much we take on faith and how erroneous human knowledge gained through experience can be. If done right, it is in fact the ultimate expression of pragmatic skepticism. What makes the result of its inquiry so painful to those who were a part of it, is that one side is right and the other is wrong, and that this result is then perceived by many to be a universal truth about themselves and/or their ideals. In fact, the inquisitional process of the law in most cases bases its decisions on particulars, often what people hold to be minutia, to come up with a conclusion that is usually limited in scope. It is a system that tries to come up with conclusions via a mostly deductive process first, and then try to induce from that point onward as little as possible and with caution.

    In my experience, the perspective that the public holds does not at all sufficiently mirror the above, and so when they enter into a legal arena which will test their beliefs to determine if they’re right or wrong, they have a WHOLE different concept of what the dig is about than what will actually take place. They think that justice will be served, their justice, but don’t examine just how huge that concept is! I raise this issue on this blog because I believe that this misconception plays into one of the reasons for why the interplay between health and law is so controversial. That is, that individual beliefs are put into this sausage making mechanism that spits something out the other end that in the eyes of the lay person is now a bastardized representation of their beliefs and any conclusions which could have been drawn from those beliefs by them. Now, I don’t mean to knock the lay person –in a way, I’m actually envious as sometimes the unexamined life IS worth living –instead, I am emphasizing what I see to be a fundamental difference in the goals of the law and the values of the lay person bringing their conflict to the system.

    Does this mean that the law is not inherently based on making value determinations that are held by each party? I’m not sure…at this point I would argue that it is not, at least not necessarily, as it has to bridge and then analyze with reference to its own ontology, the values of the two parties respectively, and in the course of its determination, the values of any precedence it relies on. Because of this misconception, the parties involved in health related cases (yes, like Schiavo) walk away bitter in having their values vilified by the system. I’m not sure if this legal system or any other in fact is perfectly suited (whatever that would mean) to reconciling conflicting sets of values (perhaps that is something that could be apart of some definition of truth), but in general, I’m in awe of it because it does tend to produce results whose premises are just when considering the aggregate quality and quantity of the values in conflict.

    Wednesday, March 23, 2005

    Addenda to Previous Post on AAN's Definition of PVS

    For the juicy bits in the book cited below which relate to legal aspects of end of life, see:

    Informed Consent and End of Care Planning

    Living Wills

    Patient Self-Determination Act

    American Academy of Neurology Definition of Persistent Vegetative State (PVS)

    The American Acedemy of Neurology has made available this document (opens as a pdf) to provide guidance on defining this state (and a table listing recovery statistics). It's determinations are based upon a Subcommittee review of the issue approved in 1989 (granted, it's 16 years old...).

    Incidentially, you can check out a brief synopsis on how PVS is different than brain death as defined by the Harvard Ad Hoc Committee on Brain Death (1968, and chaired by none other than Henry Beecher) and the
    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Defining Death. For a more comprehensive (read as a lot longer) read: check out the IOM book Approaching Death: Improving Care at the End of Life (free reading from the Nat'l Ac. Press).

    Also, if anyone knows of a web site where I could get a copy of the Harvard's Cmmt's Report, please let me know:-)

    N. Eng. Jo. of Med Article on the Legal Issues in re Schiavo

    The N. Eng. Jo. of Med pre-released an article on legal issues in the Schiavo case and those like it written by G. Annas. The author differentiates erring on the side of life versus erring on the side of liberty. Good read.

    Tuesday, March 22, 2005

    The Dude Gets a Letter from an Admirer

    I received the following letter via email from Ms. Jackson at the firm of Batza & Associates that I thought others may find interesting, and I wonder how many got this letter (also, btw, the Dude is not a doctor of anything, nor has he ever played one on TV):

    Dear Dr.:

    I’m contacting you because I noticed your posting on CodeBlueBlog.

    I am working for the Gibbs Law Firm in Florida – they are the attorneys for the parents of Terri Schiavo and they are in a legal battle to prove to the court that Ms. Schiavo is not in a PVS state and that she could benefit from advanced medical testing and medical treatment. To this point, all Ms. Schiavo has received is a CT Scan, and this was done before 2000.

    The court is open to receiving guidance from medical professionals and so far we have had many doctors provide us with declarations that we have submitted to the court. We desperately need more declarations as soon as possible. If you would like to view examples of other declarations from medical professional, go to http://www.terrisfight.net/, and look under “Court Documents.”

    I’ve attached a declaration template that you could use to provide us with your medical opinions. You can then fax the declaration to us at (661) 799-3377. If you have any questions, please call me, Tracy Jackson, at (661) 312-9371 or (800) 901-5119, ext. 2.
    Tracy J. Jackson

    Batza & Associates
    23929 West Valencia Blvd., Suite 309
    Valencia, CA 91355
    Tel: (661) 799-7777 Fax: (661) 799-3377
    www.batza-associates.com


    Thank you!

    Tracy J. Jackson
    Batza & Associates
    23929 West Valencia Blvd., Suite 309
    Valencia, CA 91355
    Tel: (661) 799-7777
    Fax: (661) 799-3377
    http://www.batza-associates.com/

    ___________________________________________

    Well, Ms. Jackson, I did find your firm in the phone book, though I'm not sure about you or your firm's connection to the Schiavo case, but do you wonder whether the declaration you seek from medical professionals will be worth the paper it's printed on given that they have not had actual contact with the patient or had an opportunity to review her medical records?! Seems to like that would the first order of concern in any legal undertaking!

    BTW, here's a copy of the text of the declaration they sent me:
    DECLARATION OF [ ]

    I, [ ], have personal knowledge of the facts stated in this declaration and,

    if called as a witness, I could and would testify competently thereto under oath. I declare as

    follows:

    1. [ ]
    2. [ ]
    3. [ ]
    I declare under the penalty of perjury under the laws of the State of California that the
    foregoing is true and correct.

    Executed this day of 2005, in , California.





    ___________________________________
    [ ], Declarant



    What I love about the declaration is that it purports that the signer has first hand knowledge of whatever crap they may write down. Wow! How incredibly credible that will be in a court of law. I don't know...maybe it would work with Congress, but I'm not sure about the courts.

    If anyone wants to get in touch w/ Ms. Jackson, feel free to do so at: tjackson@batza-associates.com.

    Peter Singer on Euthanasia

    In his book chapter, Singer examines the euthanasia issue, and breaks it down into three types: Voluntary Euthanasia (VE) (the person is cognizant and aware at the time and chooses this option), Involuntary Euthanasia (IE) (the person is not cognizant and aware, but has at some time indicated that they wish to die and this action is carried out only in order to cease suffering), and Non-Voluntary Euthanasia (NVE) (this is the ethically controversial situation in which the person is no longer cognizant nor aware in order to make a choice).

    The gripping issues in NVE are that the intentions of the subject are not evident, which raises issues such as for whom is the death a benefit or harm, and under what circumstances does that benefit or harm take place (e.g., morphine in order to lessen the discomfort). Besides playing into the current Schiavo debate, this is also relevant when considering the Groningen Protocol I posted about earlier. Especially as in all these cases the subject is not capable of self-determination, does not have self-awareness, and does not possess any significant power of rationality. He utilizes spina bifida in a great way to shed light on the ethical issues that arise in NVE from a utilitarian perspective. And ultimately that is one of the best tools that one can use to begin an analysis of an ethically controversial dilemma; that is, what will bring the greatest amount of good to each member involved –there are, of course, limits to the utilitarian scope, as this is not a naïve theory (and a brief explanation on the nuanced aspects of utilitarianism can be found at the Wikipedia).

    He makes a great distinction between being biographically alive (i.e., cognizant and autonomous) and being alive solely on a biological level (i.e., all systems go except no awareness, in much the same way as a dreamless/experienceless night of sleep). This is best described in his own words:

    If they have no experiences at all, and can never have any again, their lives have no intrinsic value. Their life's journey has come to an end. They are biologically alive, but not biographically. (If this verdict seems harsh, ask yourself whether there is anything to choose between the following options: (a) instant death or (b) instant coma, followed by death, without recovery, in ten years' time. I can see no advantage in survival in a comatose state, if death without recovery is certain.) The lives of those who are not in a coma and are conscious but not self-conscious have value if such beings experience more pleasure than pain, or have preferences that can be satisfied; but it is difficult to see the point of keeping such human beings alive if their life is, on the whole, miserable.

    Note that while these words may prima fascia sound harsh (e.g., no value), this is for the sake of philosophical accuracy and those readers not familiar with this language should not be turned off by it –instead, feel free to comment and I will do my best to explain!

    He then goes on to make a distinction between killing and an omissive act (i.e., euthanasia by noted inaction). This distinction makes use of the double effect very well in a way to tease-apart the above, as this is highly controversial between the Edict Driven Approach folks and the Mechanistic Approach folks. What he points out very well is something that I struggled with while learning about the double effect: if I know the consequences of my actions, why am I not responsible for both outcomes? This, of course, is a difference between two schools of ethics: consequentialist and virtue ethics. Noting that the double effect is useless to the consequentialist school (and likely, to the utilitarian school therefore…). He offers that the best way to deal with the issue is to face it head on: admit that the goal is to cause a death as a way of minimizing suffering.

    As an aside, the Dude’s evening class resumed and so I’m unlikely to post on Tuesdays and Thursday…

    --Referenced: http://www.utilitarian.net/singer/by/1993----.htm

    Legal Decision in re Schiavo

    You can find Judge Whittemore's order here (pdf). It's fairly straightforward in its determination and legal rationale. Of course, I'm not sure why the Judge even reviewed it as the complaint has at best dubious legal basis...but really, what was he to do? It was best to review and provide a determination and avoid the political minefield by a wide acre or so...

    Monday, March 21, 2005

    Final Comment on the Schiavo Case

    After viewing the Congressional session and vote last night I completely lost interest in following anymore news about it. There is simply such a compendia of misinformation out there that both sides are following and getting into a tiffy about without actually examining the issue from the ground up that it is simply intellectually disgusting. Perhaps the ONLY benefit of having federal review will be that hopefully the court will look at the real basis for this issue (i.e., legal and factual) and make its objective determination --of course, I tend to be somewhat naïve/idealist in how these things go…and won’t even discuss how there isn’t a third bite of the apple in the legal system.

    Up to this point, the only ones who really have been privy to info that is necessary in making ANY moral judgment are the folks who were involved in the two trials (e.g., the judge). Just about everything that I heard last night was legally empty rhetoric aimed at appealing to the pity of the viewers –with whatever side of the isle they may agree with. Both sides stated and rephrased their central premise (as if talking more or louder will somehow endow it w/ more veracity and neither side has shown either a logically sound argument or support for its premises).

    The issue on both sides is about liberty. For the Edict Driven Approach it’s about the right to live (disregarding any distinction between living and humanness), and for the other side (somewhere near center actually or near the libertarian mark) is the right to choose to live or die. Keep in mind that neither side has shown what the medical condition of Ms. Schiavo is at present to corroborate their point, without which, the truthfulness of the statements fall apart. It’s the constant replay of that ambiguous and four year-old video clip.

    The fact-less banter is significant and all sides are generally guilty of this. For example, AJOB’s Blog posted an article --I believe on 03/16/05-- detailing that Ms. Schiavo has had MRI,s fMRIs, and CT scans done that show that her brain has necrotized. In a comment, a reader (“Thomas”) quoted an article from the National Review stating that she has only undergone a CT Scan and then detailing how poor the quality of that exam is. Two points, 1) AJOB then removed the post and all comments without mention (tisk-tisk, they should know better!), and 2), National Review’s comment is equally without merit as no one has shown that they have a credible source to the information. So, really, I mean it this time, no more posts on the Schiavo case. There is and will continue to be plenty of news/info out there, and good luck sifting through the muck of it all. For my own edification, I will only follow the legal basis from this point out and will instead post comments on those sites that provide this info. You can check previous posts for such sites.

    Sunday, March 20, 2005

    Legal History for the Schiavo Case

    I really didn't think that I would be posting so much on this issue (well, two posts...still, I don't want to add to the glut of stuff out there) but I came across a really good blog on the legal history for the Schiavo case: Abstract Appeal. I'm having a tough time weeding through the political crap or understandably emotionally veiled info out there in order to examine the legal basis for what's going on (e.g., the Congressional subpoena, why this isn't seen as clearly violating some article of the Constitution, etc.).

    For the most part and at least for now, it seems that Congress put together a legally worthless document with no basis for establishing their legal intent in re subpoena. Did they have an intern (e.g., Elle Woods) put the document together? Further, as Bioethics Dude's fiancee (a.k.a. Bioethics Babe?) pointed out, the subpoena was written by Congress' Committee on Government Reform. What the hell does the charge of that Committee have to do with this issue?! or, baseball for that matter...but the Dude would rather kayak than play ball:-)

    Saturday, March 19, 2005

    In Re Schiavo

    There's plenty of posts out there about this and many others have done better jobs than I could in amassing information...frankly, I also fear conflict as I do not have enough of this situation assessed and am fearful of putting my foot in my foot (in my opinion, many have already done so).

    Somewhere not near the Edict Driven Approach:
    Majikthise
    Art Caplan on MSNBC

    Nearer to the Edict Driven Approach:
    Second Hand Smoke
    terrisfight.org

    What a damned mess...and so little information of any veracity out there (e.g., the American Journal of Bioethics Editor's Blog had a post up (that disappeared and one that I hope they bring back) about what type of medical tests (e.g., MRI's, CAT, etc.) have been done in order to assess the physical condition of her brain, then a comment was posted by "Thomas" citing the National Review's claims that only a CAT scan was done and how inappropriate that is). Perhaps years later one can make a more informed historical analysis of this.

    Friday, March 18, 2005

    Assessing the Bioethics Field of Play - Part One

    I’m just not sure about what to call the various sides taking part in the discussion on bioethics. I’ve been a browsin’ and a browsin’ and findin’ a gol’ mine of stuff on beliefs I wasn’t familiar with (judao-christian driven approaches to bioethics) and it’s been rewarding, but am having even a tougher time of cataloging these beliefs.

    The recent labels (e.g., conservative, judao-christian, liberal, etc.) don’t seem to me to be doing any justice in conveying what the sides are really about. Clearly, there is some overlap between any group and the labels are simply a means of conveying the dominant theme, but once labeled, they tend to mislead. Applying the label liberal and then in the same document mentioning conservative automatically polarizes the concepts to an extent not entirely necessary. As Orac pointed out in a recent post, scientists hold religious beliefs as well that may not overly bias their judgment. So the difference in beliefs has to lie somewhere else…perhaps it’s a spectrum consisting of holding as central guiding principles the literal text of some belief system (e.g., bible in whatever version, the Koran, etc.) on one end and on the opposite side a non-teleological system of belief (i.e., mechanistic). But I don’t want to digress on the linguistic weakness inherent in any philosophical system building, we had Wittgenstein for that and I wouldn’t measure up to his ankles.

    In this vein, I’m having trouble labeling the sides involved in the bioethics field of play. No duh, huh? So on the one side, let’s call it the zero degree mark, we’ll have the Edict Driven Approach (EDA), then in the middle –covering a huge swath in the middle (absolute skeptics, natural theologians, me?)—will be the Moderates, and then finally, at the 180 degree mark we’ll have the Mechanistic Approach (MA).

    What are the prima fascia implications of this? So folks we’d list near the EDA spectrum would be Judaeo-Christians near the nadir mark (proximity near the zero degree mark is determined by reliance on the literal meaning), then near the zenith of the spectrum on the MA side, we’d have researchers doing research in se (e.g., cloning for the sake of cloning). So in my preliminary assessment of the bioethical field of play I have and will continue to ignore beliefs near the zero degree mark and near the 180 degree mark. I want to emphasize this as much as possible for the sake of future reading; that is, that most of the controversy is near the middle (e.g., loosely, say between the 60 to 120 degree mark).

    Some observations:

    -One degree of this spectrum I haven’t found anything on are Islamic interpretations of bioethics…
    -Man oh man, is the definition of human complex and so damned central to this whole controversy. I’ll cover some of it briefly later on in this vein when I provide some web sites and reflections, but also feel another theme coming on…:-)
    .......Right now I hate Blogger, this post was supposed to go up at noon YESTERDAY!

    Thursday, March 17, 2005

    Arthur Caplan to Testify Against Federal Review of Schiavo Case

    Quick FYI: CNS reported that Arthur Caplan would testify against the issue (he also put out a press release about it, but I couldn't locate it).

    OBEDIENCE: Stanley Milgram Film

    For those in the New Jersey area, the Rutgers Film Co-op will be showing the film on March 24, 2005 at 7 p.m.. Check out the site for details.

    White: The Color of Ethics

    What I really want to post about today is other white bioethics blogs that I’ve come across and have been suggested to me by other readers (thanks and keep suggesting please!); in a way, this is a fun means of starting out the assessment of the bioethics playing field as these sites do not have the same beliefs/ontology in common (besides making white the color theme, and being concerned about bioethics):

    American Journal of Bioethics Editor’s Blog

    The Examining Room of Dr. Charles

    GrrrlScientist

    Respectful Insolence

    Saint Nate

    Shrinkette

    Wesley J. Smith

    Kinda gave up looking around further thereafter…1) blogger was too damn slow (this was supposed to be posted yesterday…), and 2) although I did find numerous other white-themed sites, they were not blogs, and will be noted later on for the next phase of the assessment of the field of play.

    Wednesday, March 16, 2005

    Quick News Bites

    Ouch:
    Two articles call for Kass's resignation, one by Ian Murray, and another appearing in the Washington Post's Washington in Brief.

    Ethics Before Research:
    Medical News Today summarizes an article that appeared in Ethics & Medicine arguing that ethical assessment of research should take place prior to commencing with the research. Besides this being a no-brainer, the article mentions chimeric research as an example of exploring the larger ethical issues before undertaking such research. One of the authors of the piece, Nancy L. Jones, is a SACHRP member and makes me wonder whether that committee will consider chimeric research -formally or otherwise.


    Tuesday, March 15, 2005

    Human Chimeric Experiments

    Friend of mine sent me a comment posted by Jeremy Rifkin appearing in Guardian about human chimeric research--for the most part, arguing against it. Honestly, the Dude has not thought about this at great length, but in the brief moments of examination is unclear on the ultimate purpose of such research and is somewhat understanding of the what may happen slippery-slope comments. It's also interesting to note that the U.S. Nat'l Academy of Sciences will be issuing guidelines on such research sometime next month.

    A side note, the Dude will be posting less posts per day in the next coming weeks...I'm trying to find time to do sufficient research on assessing the bioethics playing field...toward that end, feel free to post a comment on sites that you know of that have some definite bias (e.g., liberal, religious, secular, etc.) of bioethics.
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