During the recent election season, a handful of male Republican politicians made some now infamous comments about rape. The common theme in all these comments was implicitly or explicitly blaming and/or holding women responsible for rape (e.g. Missouri Rep. Todd Akin asserted that victims of “legitimate rape” rarely get pregnant) while ignoring or condoning men’s role in rape (e.g. Wisconsin state Rep. Roger Rivard stated that “some girls rape easy”). 

While these comments are problematic for a number of reasons, I want to point out how they are grounded in false and gendered views of biology. Specifically, these comments echo biological determinism: the belief that our biology determines our desires, characteristics, and actions. Because women have so few eggs (approximately 500 in total compared to the millions of sperm men produce daily), women need to be selective in who they choose to have sex with. They should limit sexual encounters to men who they think would make the best fathers; that is, men who would produce the best genetic offspring and who will be able to provide for the offspring. Moreover, since women will be responsible for childrearing, they should be careful to pick men who will make this investment worthwhile. Women’s passive sexual “nature”—i.e. their weak libido—is thought to aid them in making good choices about mates. In contrast, men have no reason to be selective. In fact, because they have so many sperm and because they are not responsible for childrearing, they have no constraints on whom to have sex with. If we accept there is a “biological” urge to procreate, then men are “naturally” inclined to have sex with as many women as they can.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

Giving bad news is a difficult thing to do. Receiving bad news is hard, too, but is perhaps a close second to hearing a complicated, vague version of the same set of facts. In healthcare, the failure to disclose pertinent facts in clear, uncomplicated language and verify the information is understood is harmful to the recipient of this information, but also to the provider, who must often untangle the resulting misunderstandings later on.  Families and patients who find they are asking "Why didn’t someone tell me?" may be on the receiving end of an attempt to give bad news.

I tend to think of these vague communication moments as 'dodges.' Rather than stating "I believe your Aunt Lila’s condition will not improve and we need to talk about what kind of care she would want" is instead a listing of diagnoses, medications, lab values, and a review of body systems, surgical options, and statistical probabilities. This type of encounter shifts the focus from the overall prognosis to the details, which though factual, obscure the big picture of a patient who is not expected to recover. Avoiding a frank disclosure of the fact that a patient is doing poorly doesn’t help the patient, and does not help anyone make informed decisions. But it serves a purpose in the moment. Sidestepping the straightforward presentation of bad news may avert or postpone the experience of delivering upsetting news and witnessing the emotional suffering of others who hear it. I get it. It is stressful and distressing to be the source of often devastating news. Yet, we must keep in mind that the news itself is the source of the upset, and the bearer of the news need not feel morally culpably for the facts. The old adage applies, 'it’s not what you say, it is how you say it.' We owe it to medical providers to give them adequate practice and training in delivering bad news as well as opportunities to observe experienced practitioners talk with patients and families when critical conversations are held.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

This blog will have two parts. In this first entry, I present will discuss a recent case of stem cell fraud and the subsequent blog entry will discuss possible lessons to learn appearing next month.

The tale begins when Woo-Suk Hwang, a once celebrated hero of South Korea, claimed to have made the first, patient-specific human embryonic stem cell (hES) line through a technique called somatic cell nuclear transfer (commonly referred to as research or therapeutic cloning). This study was soon after proven to be fraudulent. Not to get into too many details, but this technique requires obtaining ova from women providers, enucleating its genetic material, and placing the nucleus from a somatic cell and parthenogenically activating the egg. This initiates embryonic development and at about day 3-4 of development (where the embryo is at the blastocyst stage), hES cells can be isolated from the inner cell mass of blastocysts. This incredible feat in stem cell research was published in Science in 2004 and another study in 2005. In 2006, Hwang was discredited for fabricating results and after an investigation, he was convicted for embezzlement and bioethical allegations. He embezzled approximately 830 million won (US $700,000) of government funds and apparently used 2,200 eggs obtained from his female postgraduate students and junior researchers. All wasted!

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

At the end of the article “Disability and narrative: new directions for medicine and the medical humanities” Rebecca Garden states, “However, rather than ‘coping with’ or ‘overcoming’ their impairments, many disabled people see their impairments as integral to their lives.”  This may have been the most important, and overlooked, message regarding new directions in medicine for working with people with disabilities.  I would like to share a personal story that illustrates this point.

I’ve been short all my life, but always just too tall to be considered disabled.  When I lived in China, every adult was always trying to get me to grow, like I had a choice in the matter.  They’d either bring up the fact that I can’t get a job since there’s a height requirement for pretty much every occupation (I wanted to be a teacher and the height requirement for that was the ability to reach the top of the chalkboard) or they’d have these false hopes and reassured me over and over again that I simply have one last growth spurt to hit (at that time, I was visiting family and already 18 years old).  I was fine with my height and the incessant chatter was extremely discouraging and annoying.  When I came to America and learned that most civilian jobs had no height requirement, I was so happy to be leaving the Chinese thinking regarding height impairment.  Here, in the land of accessibility ramps, being short would not affect my life style and I can go into any career that I’d like.  I will no longer hear people sigh at me or look down upon me, no pun intended. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

The issue of physician suicide has been on the public agenda in the United States for the past 25 years or more. Legitimate worries about medical overtreatment, unnecessary suffering and loss of dignity have motivated a growing number of Americans to consider this issue more favorably. People are rightly concerned about loosing control over what happens to them once they enter the hospital when the are very sick and risk dying. Instead of being at the mercy of technological forces beyond their control, free individuals want to have a say over how they make the final exit from life. The key factor, in my opinion, is more about self-control than it is about actually the strong desire to take a lethal dose of medications at the time of the patient’s choosing. But let’s be clear what we are talking about. 

Oregon was the first state to legalize physician-assisted suicide, which occurred in 1994 in the Death With Dignity Act. This law gives patients with capacity facing a clearly diagnosable terminal illness within 6 months or less to live the right to receive (and the right of the physician to prescribe) a prescription for a lethal dose of medication for the expressed purpose of ending their lives at the time of their choosing. Because we have had many years to collect empirical data about the effects of this law, we can use Oregon as a case study. As of 2011, 935 people have had prescriptions and 596 have died from ingesting medications they received based on this law. For about 90% of these patients, the primary concern about end of life care was “loss of autonomy”, but “inability to make life enjoyable” and “loss of dignity” were also major concerns. Moreover, based on the data, there is no evidence of any kind of abuse to any particular segment of the population, as some feared might happen. In fact the utilization rate of hospice care is up.  Following Oregon, Washington and Montana also have legalized physician-assisted suicide and we will have to wait and see the data of these laws continue to yield generally positive results. But overall the data gathered so far supports physician-assisted suicide a beneficial service. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

Almost everyone now must have heard about the New England Compounding Pharmacy tragedy that has been unfolding over the past month. The Centers for Disease Control and Prevention in Atlanta (CDC) numbers the present death toll at 28 and total reported cases at 377 from 19 states. Untold thousands of patients may have been injected with contaminated medicines. The New York Times has called this situation “one of the worst public health drug disasters since the 1930s.” 

Already there are more calls for stricter regulations and controls for compounded medicines that enter interstate commerce. The New York Times reported on November 2, 2012, that Representative Edward J. Markey (D-Mass.) will be introducing a bill to oversee compounding pharmacies with wide-scale operations be regulated as “manufacturers” by the Food and Drug Administration (FDA). Calls for greater regulation of compounding pharmacies are not new; the FDA has been attempting greater control for at least the last 20 years.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

I recently received a mass mailing from the American Association for the Advancement of Science (AAAS), an organization that I am a member of.  On the envelope was the statement: “The future of science is at stake.”This seemed pretty dire so I opened the envelope to learn more. The letter was about the possible consequences to science research and development funding as a result of the Budget Control Act of 2011. The Budget Control Act of 2011 is the result of the inability to develop a budget compromise and dictates sequestration of discretionary defense and domestic funding in the absence of such a compromise. It is the act popularly characterized as the “fiscal cliff”. While many are primarily concerned about one side of the budget or the other those who recognize the importance of research and development funding need to be concerned with both. Research and development funding will not only be hit hard by cuts to the domestic funding for budgets of the National Institutes of Health and the National Science foundation but also significant funding through the Department of Defense for biomedical research as well as aerospace and communications. Additional funding cuts to science are likely in the domestic research and development funding which is included in the NASA budget as well as the Departments of Energy and Agriculture. As suggested in the letter there is indeed much at stake. However, the fiscal cliff is not what I thought of when I saw the dire warning on the envelope. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit ourwebsite.

Famous folk have been writing about their genome sequences for a few years now. But when I received two such reports at once last week – about genetics researcher Ron Crystal, MD, and a hypothetical (I think) story about President Obama, I knew it was time to take action.

Or, in my case, inaction.

After writing ten editions of a human genetics textbook and lots of articles, you’d think I’d be first in line to get my genome sequenced. But I prefer ignorance.

The quest to know ourselves by our DNA sequences began in the late 1980s, with the conception of the human genome project, and reached a milestone with the actual genome sequencing.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

When former President Bill Clinton spoke at the Democratic National Convention, he argued that we must put aside ideologies to “get things done.’”  The implementation of the Affordable Healthcare Act (ACA) is challenging Republican governors on exactly this point, and their responses are not uniform.  Jan Brewer, governor of Arizona outspoken critic of President Obama and the ACA, has begun planning for, and implementing the healthcare exchanges that states must create under the rules of the legislation.  States that fail to plan for exchanges will have exchanges created for them by the federal government. Six states with Republican governors have decided not to create exchanges, and may also not accept additional money from the federal government to expand Medicaid coverage along the lines set out by the ACA.

Is this just politics as usual, or is there an ethical dimension to this partisan debate?  I would argue that to fight against Obamacare to the detriment of the health of a state’s citizens—the poorest of the states citizens—is a violation of a politician’s duty to beneficence.  Uninsured patients suffer a preventable harm from the lack of access to healthcare, a harm that is now being remediated by the ACA, but only if only states will fully implement its policies.