The Huffington Post recently published a blog by bioethicist and philosopher Rory E. Kraft, Jr. titled “Pregnancy as Harm?” As a friend and former colleague of Dr. Kraft, he and I have had numerous conversations about pregnancy as harm and we have presented on a conference panel together on this very topic. However, it seems—based in part on my students’ reactions and discussions I’ve had with people who don’t work in the field of reproduction—that most people find the idea of pregnancy as harm as counterintuitive or oxymoronic. 

Pregnancy is generally understood as a beautiful, special, and maybe even magical time in a woman’s life. And while it no doubt is for many women, it can simultaneously be harmful. For example, pregnancy can entail various nontrivial, though not life-threatening, discomforts, such as weight gain, back pain, edema, and morning sickness. Furthermore, pregnancy can lead to life threatening conditions, such as gestational diabetes and hypertension, and in many parts of the developing world pregnancy related complications are the leading cause of death for women in their prime. In addition to being painful, giving birth can also cause harms, like hemorrhaging, internal tearing, placental abruption, and nerve damage to the pelvic structures. In addition to physical harms, pregnancy and childbirth also have the potential to lead to mental health problems. Since being pregnant changes women’s hormone levels, it can affect women’s emotional well-being and their overall psychological balance. 

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.

We are pleased to announce the approval of the Doctorate of Professional Studies, with a concentration in Clinical Ethics Consultation, by the New York State Education Department. This program is, to our knowledge, the first online program of its kind to offer advanced level training in the knowledge and skills of clinical ethics consultation for qualified applicants. The new program is designed specifically for working, health care professionals who possess a master’s degree in bioethics, or equivalent, and who seek a fellowship level, advanced training in clinical ethics consultation. Students will use their professional work environments as the clinical training ground as they complete advanced fellowship courses related to clinical ethics consultation and mediation, elective courses and a doctoral research project.

The fellowship courses include clinical practica in coordination with AMBI faculty and agreed upon mentors at the student’s home institutions.  At the end of the program, graduates will have a portfolio of 32 case consultation reports and will have demonstrated advanced level mastery of the ASBH Core Competencies in Clinical Ethics Consultation.

For more information, visit our website or contact Wayne Shelton at sheltow@mail.amc.edu or 518-262-6423.

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

As the world knows, obesity has become a public health epidemic over the last several years in the United States, with over 35% of US adults falling into the obese category.  But when public health experts and lawmakers try to “do the right thing” by forcing people to engage in healthier behavior, are they going too far?

In a June 8th article on CNN.com, Harriet Washington believes that the ban on sugary drinks that New York City mayor Michael Bloomberg has proposed is the wrong way to go about encouraging healthy eating and drinking habits.  She also disagrees with “sin taxes,” stating that they often have unintended consequences.  In the sugary beverages ban proposal, restaurants, street carts, and movie theaters would not be able to sell any sugary drinks over 16 ounces.

While I don’t necessarily support an outright ban of sugary drinks, I do think that, for the most part, taxes imposed on items (such as those for tobacco and alcohol) are a great step toward  discouraging people from partaking in these unhealthy behaviors and increasing state revenue at the same time.  Many states have implemented a tax on sugary beverages in recent years, and many others have tried, but failed, for a soda tax to catch on.  Mayor Bloomberg even proposed a soda tax in 2009 for NYC, yet this proposal was eventually abandoned and never came to fruition.

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.

My mother-in-law’s arms look like she’s been in a fight. The bruises don’t hurt, but they’re embarrassing. They’re likely due to the drug Plavix, a trade-off for preventing clots. But we don’t know if the drug is actually helping, because she started it before the FDA urged physicians to use a pharmacogenetic (PGx) test to distinguish patients likely to respond to the drug from “poor metabolizers,” who won’t. And no one’s thought to test her since.

The original Plavix genetic test identified mutations in the CYP2C19 gene. More recent versions assess seven other genetic variants that affect metabolism of the drug. On June 29, the University of Florida Academic Health Center announced that it would use the wider genetic test to screen all cardiac catheterization patients for response to Plavix. And in the future, they’ll check additional DNA variants in the samples. According to the press release from the university, “researchers … will collect results for the other 249 gene variations to continue investigating which ones might be clinically actionable and become the basis for additional PGx tests for other treatments such as warfarin and statins.”

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.

Around 10% of all people diagnosed with cancer are in their reproductive or pre-reproductive years (under age 45). This means that, each year, approximately 133,000 women, men, and children who are diagnosed with cancer are at risk for infertility due to the very treatments (e.g. chemotherapy, radiation, and surgery) that can save their lives. Given improved survivorship rates, fertility concerns have emerged as an important quality of life issue to cancer survivors and their families. Oncofertility, a new and interdisciplinary field at the intersection of cancer and fertility, is working to address potential infertility as a result of cancer treatment. 

Although more cancer patients are being offered and are using fertility preservation technology (FTP), its cost and the lack of insurance coverage for it are often the major reasons given by oncologists for why they do not provide information on fertility preservation options to their patients. One method of ensuring people in their reproductive years or children who are diagnosed with cancer have access to and insurance coverage for FPT is to create a legal mandate requiring insurance companies to cover FTP for cancer patients. 

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.

Those of us who work in clinical ethics focus most of our intellectual energy on addressing ethical dilemmas in individual cases. Clinical ethics allows little time for armchair reflection. The urgent cases presented to us require fairly quick decisions. That is, if we are to be helpful, we have to find thoughtful ways to analyze ethical questions and reach prudent recommendations. But even for clinical ethicists, it is worthwhile from time to time to take a step back and consider the historical philosophical context in which we work and the challenges it poses for ethical reflection and judgments.

Clinical ethics has been criticized by some not having an adequate basis on which to give substantive answers to pressing ethical questions in medicine. I want to show how this concern is not only, not a problem, but is a sign of progress. First a little background about the state of contemporary western ethics as expressed in one of the most important critiques of philosophical ethics and morality in the past 100 years.

In his 1981 work entitled After Virtue, Alasdair McIntyre claims the actual moral world in which we live is in “a state of grave disorder”. The concepts and terms we use in contemporary ethical discourse, he believes, are nothing more than fragments of prior conceptual schemes that have largely lost their moral import. Even worse, we use ethical discourse in talking about obligation, rights and duties without fully realizing the lost moral orders in which these words once had their original meaning. This is a concerning charge for clinical ethicists since much of our daily work involves using just these kinds of terms. Do we have a clear grasp of what our moral terms mean and how they are being used?

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.

Historically, palliative care has not been associated with pediatrics. In western societies children are expected to outlive their parents, and we prefer to avoid the sad reality that kids do sometimes die. This social dismay could, in part, explain why the development of palliative care programs for children has lagged behind the adult programs. Not to be confused with Hospice, palliative care is a medical specialty which focuses on symptom management for patients with serious, often life threatening, illnesses. Admission to most Hospice programs requires a six month maximum life expectancy, whereas palliative care may be offered alongside curative treatments to alleviate burdensome side effects and symptoms. In the US, the passage of The Patient Protection and Affordable Care Act of 2010 has improved access to end of life care for children because the legislation permits concurrent coverage of medical treatment and Hospice services. Though a significant step forward, gaps in service may remain because children can live longer with serious illnesses and not meet the six month life expectancy criteria required for admission to a Hospice program. A better prognosis ironically leaves them without access to Hospice’s aggressive symptom management and compassionate, holistic care model. Pediatric palliative care services are emerging to meet the needs of children who have life limiting conditions, but are not expected to die in six months or less. Perhaps the most important feature is that palliative service can be provided alongside treatments for serious illnesses with very good prognoses. 

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.

In an opinion piece by Thomas Stossel, the Harvard physician and researcher argues that financial conflicts of interest between academic research investigators and industry are “unequivocally beneficial” and that the concern that these may cause bias is a “mania”.  Dr. Stossel seems to be on a crusade in this regard having written numerous similar opinion pieces published in industry supported blogs, Forbes, and the Wall Street Journal and has even started an organization (Association of Clinical Research and Educators) for the purpose of advancing his viewpoint. Dr. Stossel is the brother of well known libertarian and Fox News commentator John Stossel and seems to be expressing a similar libertarian view on biomedical research. Especially interesting considering the apparent strength of his beliefs is his recent publication in Nature Biotechnology in which he claims to prove that those who hold an opposing point of view are biased.

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.

The Wednesday, June 27, issue of the Washington Post reported that the U.S. Senate passed a bill empowering the Food and Drug Administration (FDA) to collect about $6 billion over the next five years in new “user fees.” The bill passed the Senate 92 to 4 and now goes to the White House for President Obama’s signature.

The bill for the first time requires generic drug manufacturers to make payments to the FDA as part of the drug approval, manufacturing, and marketing process. “Innovator” (or what old-timers might recall as “ethical” or “brand name”) pharmaceutical manufacturers have been paying similar user fees since the passage of the Prescription Drug User Fee Act (PDUFA) of 1992. The user fees were seen as a “private industry” approach with manufacturers being required to shoulder some of the drug regulatory and safety processes costs. Generic manufacturers will contribute about $300 million annually. In return, the FDA has agreed to help speed the approval process for generics.

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.

The decision by the Supreme Court affirming the Patient Protection and Affordable Care Act (ACA) caused many who follow health care closely to breathe a sigh of relief. About 32 million more Americans will now have access to health care insurance. One sticking point that worried many of us was the mandate in the bill requiring everyone to purchase health care. It was frustrating this past March to hear in the oral arguments comparing a requirement for citizens to buy broccoli to a requirement to buy health care, as though both are the same type of market commodities. Many on the right, such as Judges Scalia, Thomas and Alito, expressed concerns that the mandate to require everyone to buy health care was a unconstitutional, a violation of the commerce clause; whereas, many others see health care as a basic public good, which unlike broccoli, everyone requires or will require sooner or later. Fortunately, a legal consensus was reached in the ruling, with Chief Justice John Roberts moving over into the majority in the 5-4 vote. In their ruling, the mandate was not viewed as an expansion of the commerce clause, but rather as a tax, which congress has a right to impose. Regardless of the final legal justification of the ruling, many of us are pleased that the most important piece of health care legislation since Medicare and Medicaid in 1965 is now the law of the land.

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.