It has been a very busy week at the Supreme Court. Three days of arguments on the various challenges to the Patient Protection and Affordable Care Act each merited front-page coverage in The New York Times. SCOTUSblog, the blog of the Supreme Court, received more than 800,000 hits in three days, which was more than the site has received in its first 4 years of existence. Regardless of the court's final ruling (expected on June 28th), the active engagement in our robust democratic politics of so many Americans and interested parties worldwide bodes well for the future of our way of life. Separation of powers, first described and promulgated by John Adams (second president of the United States) in his treatise, Thoughts on Government, Applicable to the Present State of the American Colonies, is alive and well.

It's easy to experience the ebbing of America's power. Our national political scene is a toxic partisan shambles. We have been severely depleted — our blood and treasure have been unthinkingly squandered in 10 years of geopolitically useless war in Iraq and Afghanistan. We are beset by real threats to our welfare and continued existence . . .

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

On Monday, March 26th, 2012, the Supreme Court will begin hearing arguments on National Federation of Independent Business v. Sebelius and two linked cases, the lawsuits against the Patient Protection and Affordable Care Act (ACA; signed into law by President Obama on 3/23/2010). The court announced on February 21st that it would hear 6 hours of arguments over 3 days, an historic and unprecedented amount of time. The last time the Supreme Court heard more than 2 hours of arguments was when it considered the McCain-Feingold campaign finance law in 2003.

At issue in the cases before the Supreme Court is the constitutionality of federal involvement, interference, or interposition (depending on who's doing the interpreting) regarding activities of private citizens and activities of the states. The question of constitutionality of the ACA relates specifically to the Commerce Clause (U.S. Constitution Article 1, Section 8, Clause 3). The Commerce Clause states "Congress shall have power to regulate commerce with foreign nations, and among the several states, and with the Indian tribes". As with all clauses of the Constitution, the Commerce Clause must be interpreted and applied. The Supreme Court is the final arbiter and interpreter of all such applications, declaring the constitutionality (or lack thereof) of congressional and state legislation.

The challenges to the ACA state that the federal government has exceeded its constitutionally enumerated powers. The Tenth Amendment states "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people." The challenges suggest that the ACA attempts to wield a federal power that does not exist under the Constitution and attempts to interfere with powers appropriately "reserved" to the states and to "the people". The challenges assert that it is the right of a citizen, rather than a prerogative of the federal government, to determine whether she will purchase health insurance. The challenges also assert that the federal government cannot dictate how a state conducts its Medicaid program.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

We need less medical care, not more. We need more preventive services and more patient education, not more high-technology crisis care. Specifically, we need more primary care physicians.

Most informed citizens are aware that in the U.S., per capita expenditures on health care are the highest in the world. Each American spends an average of $8100 per year, representing a substantial proportion of annual income. The total U.S. health care burden of $2.5 trillion (in 2009) is 17.6% of our gross domestic product.

These numbers need to come down, but costs continue to rise. A long-term solution is available, one that doesn't involve structural changes in how health care services are bought and paid for. [Such structural change is critically important, but vested interests continue to severely dominate the U.S. political landscape.] The specific long-term solution involves focusing on primary care.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

If we were not capable of autonomous thought and merely accepted and acted on what others told us, the future prospects of our communities, nations, and race would be bleak indeed. Fortunately, a few humans are capable of independent thinking, creativity, insight, and innovation. Every "benefit" of modern existence is a direct result of independent thinking in the form of scientific activity. Those of us who live in developed nations would be very hard-pressed to get through a day without readily available electricity and running water. Imagine living without automated transportation. Imagine living without television or cinema. Imagine living without a computer.

The study, investigation, and application of mathematics, physics, chemistry, and biology, and their combined disciplines such as engineering, agriculture, and architecture, have given us the world we inhabit. And yet in the United States close to half the population is being trained daily to believe that science is a bad thing.

For example, the theory of evolution (a classical example of the scientific method) has been under attack for several decades. A Gallup Poll conducted two years ago, around the time of the 200th anniversary of Darwin's birth, revealed that only 39% of Americans "believe in the theory of evolution". Twenty-five percent did not believe in the theory and 36% had no opinion.

Of course, in order to be able to assess the value of a scientific theory, even from a high-level view, one has to have the ability to assemble facts and be able to recognize associations and connections among disparate threads and competing explanations. Sadly, it seems that such abilities, formerly mastered in grade school, are no longer accessible to the majority of our fellow citizens.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

"Do no harm." This is the foundation of medical ethics. When interacting with a physician, the patient expects that the treatment she receives will not unknowingly cause more harm than the disease or disorder which brought her to the doctor's office. Presumably, the process of informed consent prepares the patient for untoward outcomes.

But the complexity of medical practice increases ongoingly and time spent with individual patients continues to diminish. To any reasonable observer these trends make no sense and are, intuitively, contradictory. Obviously, as a decision-making process becomes more complex, more time would necessarily be required to arrive at a meaningful solution. A highly correlated, direct relationship should obtain. In stark contrast to what would reasonably be expected, overall medical complexity and overall time spent in direct patient contact now have an inverse relationship.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

For 500 years science has built an ever-increasing knowledge base, proceeding in fits and starts and yet moving inexorably toward improved explanations of the universe in which we live. But science has reached a crossroads. Thus society, too, is similarly positioned.

Years ago, during the Enlightenment and the subsequent Industrial Revolution, Nature as such was vast and apparently infinitely replenishable. It was inconceivable that harm was being done to the environment on a large scale.

But as Inigo Montoya remarks to Vizzini in The Princess Bride, "You keep using that word [inconceivable]. I do not think it means what you think it means."

What was inconceivable then is now, appallingly, very conceivable. The outcomes of many scientific fields of inquiry have the potential to destroy the biosphere.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

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Dr. Ricki Lewis is a science writer with a Ph.D. in genetics. Her newest book, The Forever Fix: Gene Therapy and the Boy Who Saved It, a narrative nonfiction book from St. Martin’s Press, is arriving in stores on March 13.

In our wide-ranging interview, Dr. Lewis discusses

• How gene therapy can extend a child’s life, in some cases by years
• Issues encountered in deciding whether a child should enroll in a gene therapy trial
• How participants should be chosen for clinical trials
• How problems with the informed consent process initially derailed gene therapy
• "Therapeutic misconception"
• How gene therapy may benefit patients with Parkinson's disease and macular degeneration

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.