http://www.bioethicscaribe.org.jm/forum/index.php Wed, 08 Sep 2010 18:14:06 -0400 Phorum 5.2.15a http://www.bioethicscaribe.org.jm/forum/read.php?2,173,173#msg-173 http://www.bioethicscaribe.org.jm/forum/read.php?2,173,173#msg-173 Published: 21 May 2010


A US biologist has stepped into the shoes of Baron Frankenstein by breathing life into a bacterium using genes assembled in the laboratory.
The creation of the "synthetic cell", described as a "landmark" by one British expert, is a 15-year dream come true for maverick genetics entrepreneur Dr Craig Venter.

It has major implications for genomics, including the manufacture of artificial organisms designed for specific tasks such as making vaccines or cleaning up pollution.

But experts recognise that as Mary Shelley demonstrated in her famous novel, there are potential dangers too. Synthetic life could, for instance, pave the way to terrifying biological weapons.

Dr Venter's researchers explain in the journal Science how they effectively "re-booted" a simple microbe by transplanting into it a set of genetic code sequences that were built from scratch.

The genome was copied from the blueprint contained in Mycoplasma mycoides, a simple bacterium that infects cattle and goats.

After first constructing short strands of DNA, the scientists used yeast cells as natural factory assembly lines.

The sequence was built in a step-by-step process. DNA repair systems in the yeast attached the pieces together, gradually lengthening the strands to finish up with a chromosome more than a million "letters" of genetic code long.

The final test came when the completed chromosome was transplanted into another bacterium, Mycoplasma capricolum, replacing its native DNA.

After a failed first attempt, the scientists brought the cells to life. Driven by the new genome, the bacteria took on the appearance and behaviour of M.mycoides, generating different proteins and multiplying.

Describing the achievement, Dr Venter said: "This is the first synthetic cell that's been made, and we call it synthetic because the cell is totally derived from a synthetic chromosome.

"This is an important step we think, both scientifically and philosophically.
It's certainly changed my views of the definitions of life and how life works."

To prove the recipient bacteria contained the synthetic genome, the scientists effectively signed their names in DNA.

Four of the DNA sequences included coded "watermarks" - strings of "letters" corresponding to the names of people involved in the project, an e-mail address, and some famous quotations.

Commenting on the breakthrough in Science, Professor Mark Bedau, editor of the journal Artificial Life, called it "a defining moment in the history of biology and technology".

US biologist Dr Jef Boeke, from Johns Hopkins University in Baltimore, Maryland, told the journal: "It represents an important technical milestone in the new field of synthetic genomics".

British expert Professor Paul Freemont, co-director of the EPSEC Centre for Synthetic Biology at Imperial College London, said: "The paper... is a landmark study that represents a major advance in synthetic biology.

"The applications of this enabling technology are enormous and one might argue this is a key step in the industrialisation of synthetic biology leading to a new era of biotechnology."

Dr Venter, who runs the J. Craig Venter Institute in Rockville, Maryland, came to fame when he controversially challenged publicly-funded scientists working on the international Human Genome Project, the first attempt to produce a complete map of the human genetic code.

He set out to construct his own private version of the human genome, using a different "short cut" method, and succeeded. The race ended in a dead heat when both versions were published simultaneously in Science in 2001.

Even before the human genome milestone, Dr Venter was working towards the creation of synthetic life.

The research published today marks the culmination of 15 years' effort at a total cost of around ]]> daarons BSEC Public Forum Thu, 20 May 2010 15:10:10 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,172,172#msg-172 http://www.bioethicscaribe.org.jm/forum/read.php?2,172,172#msg-172
By Kathleen Gilbert
PEORIA, Illinois, March 4, 2010 (LifeSiteNews.com)


- An Illinois senator is pushing legislation that would allow doctors to harvest organs from citizens who have not explicitly given consent for the procedure.

The Journal Star reported Monday that a hearing was scheduled this week for Sen. Dale Risinger's bill that would establish a "presumed consent" policy governing organ donation for individuals 18 and older.

"This is an important first step to getting a law in Illinois that helps us have more organ donors," said Risinger, a Republican. Risinger said he was open to public input suggesting revisions to the bill, and that it was not "in its final form."

Under the proposed legislation, individuals who wish to avoid donating their organs would have to explicitly opt-out of donating their organs prior to becoming incapacitated. If passed, the law would be the first of its kind in America.

Stephen Drake of the anti-euthanasia group Not Dead Yet pointed out the grave implications of such a bill, given the flexibility of the definition of brain death, which can vary from hospital to hospital.

Vital organs such as the heart become unusable after an extended period of complete cessation of bodily functions. Therefore, "brain death" is used as a parameter to determine when an individual is extremely unlikely to recover, even as functions such as the heartbeat continue, so that usable organs may be removed.

But the flexibility of that definition has raised considerable controversy.

"Most people assume that since the state they live in considers them a corpse if they're declared 'brain dead,' then the state also imposes some sort of uniform standards regarding how that determination should be made," wrote Drake.

"That's a comforting thought, but it's not the reality." Drake pointed to a 2008 article in the medical journal Neurology that discovered "wide disparities" in hospitals' determinations of brain death.

Drake also pointed to the well-known case of Zack Dunlap, who "miraculously" became responsive after being diagnosed brain dead, but minutes before his organs were to be harvested.

Prominent bioethics commentator Wesley Smith predicted that the legislation would only serve to breed mistrust between an already-strained doctor-patient relationship.

"Think about it: We already have bioethicists advocating for futile care theory, that is the right to refuse wanted life sustaining treatment based on quality of life judgmentalism, resource allocation, or both," wrote Smith on his Secondhand Smoke blog.

"Add in the motive for taking organs to this volatile field ]]> daarons BSEC Public Forum Tue, 11 May 2010 15:03:54 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,171,171#msg-171 http://www.bioethicscaribe.org.jm/forum/read.php?2,171,171#msg-171
by Steven Ertelt
LifeNews.com Editor
March 3, 2010
Washington, DC (LifeNews.com)

-- A bioethics expert is suggesting that women rethink possible plans to donate their eggs to fertility clinics for research or use in pregnancy. Jennifer Lahl of the Center for Bioethics and Culture Network says egg donation is potentially harmful for women.

Lahl says egg donation is a "risky business" and unlike a high-risk job where employees receive appropriate compensation for the dangers (think skyscraper window washing) the egg donation process is inherently risky, from beginning to end.

Stroke, organ failure, infection, cancer, loss of future fertility, and in rare instances, even death -- those are the risk Lahl says women could incur from participating.

"Sadly, longer-term risks remain a mystery, let alone properly understood, because of the lack of any long-term medical research or follow-ups on egg donors," the bioethics expert says.

While egg donation is sometimes seen as similar to organ donation, Lahl says that's not the case.

"In organ donation, the donor assumes risks to his own health in order to save a patient]]> daarons BSEC Public Forum Tue, 11 May 2010 14:51:59 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,162,162#msg-162 http://www.bioethicscaribe.org.jm/forum/read.php?2,162,162#msg-162 By MICHAEL HINKELMAN
Philadelphia Daily News

hinkelm@phillynews.com 215-854-2656

WHEN THE CHESTER County-based biopharmaceutical company Cephalon agreed to pay $425 million in 2008 to settle charges that it illegally marketed three of its drugs, the company was also required to tell the public how much money it paid doctors to tout its drugs.

Last month it did that. And it's a lot.

Cephalon, according to its Web site, paid 936 health-care professionals, mostly doctors, more than $9.1 million last year for speaking fees and consulting services.

The Frazer-based company, which last week reported 2009 revenues of almost $2.2 billion, became the latest drugmaker in recent weeks to disclose its financial ties to doctors amid calls by health-policy experts and lawmakers for more disclosure or even an outright ban on such relationships.

"Disclosure is fine, but we have to take it a step further and get these relationships [between doctors and drug companies] off the table," said Arthur L. Caplan, director of the University of Pennsylvania's Center for Bioethics. "The issue is not to allow doctors to become part of the marketing departments of drug companies because it's not good for patients and increases the cost of drugs."

About one in every five doctors is paid by the pharmaceutical industry, according to the Pew Prescription Project, a nonprofit watchdog group.

But Cephalon defends the practice as a way to educate doctors about the safe and appropriate use of their drugs.

According to Cephalon's Web site, their payments to doctors and other health-care professionals ranged from $63 to $149,900.

Nationally, of the 936 health-care professionals who were paid, 737 received payments of $10,000 or less, and 199 were paid between $20,000 and $150,000.

Some 32 health-care professionals in California, Florida, New York and Texas were among the highest paid.

Meanwhile, in the Philadelphia area, 34 health-care professionals ]]> daarons BSEC Public Forum Fri, 16 Apr 2010 11:54:44 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,161,161#msg-161 http://www.bioethicscaribe.org.jm/forum/read.php?2,161,161#msg-161 Countries responsible for Haiti]]> daarons BSEC Public Forum Fri, 29 Jan 2010 13:21:55 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,160,160#msg-160 http://www.bioethicscaribe.org.jm/forum/read.php?2,160,160#msg-160 By Gary Schwitzer | Friday, Jan. 22, 2010


I know that some people may not see any ethical conflict in physician-reporters like CNN's Sanjay Gupta, CBS' Jennifer Ashton and ABC's Richard Besser reporting on their own delivery of health care in Haiti.

But people who think a lot about these issues DO have concerns.

Media ethics guru Bob Steele of the Poynter Institute and DePauw University told the Los Angeles Times: "It clouds the lens in terms of the independent observation and reporting." Given that Gupta's story involved a child who ]]> daarons BSEC Public Forum Wed, 27 Jan 2010 12:29:40 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,159,159#msg-159 http://www.bioethicscaribe.org.jm/forum/read.php?2,159,159#msg-159 by Anita L. Allen

Anita L. Allen is the deputy dean, Henry R. Silverman professor of law, and professor of philosophy at the University of Pennsylvania Law School. She is an expert on privacy law, bioethics and contemporary values and is recognized for her scholarship about legal philosophy, women's rights and race relations.



When disaster strikes ]]> daarons BSEC Public Forum Wed, 27 Jan 2010 11:43:46 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,157,157#msg-157 http://www.bioethicscaribe.org.jm/forum/read.php?2,157,157#msg-157 daarons BSEC Public Forum Wed, 27 Jan 2010 10:58:39 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,156,156#msg-156 http://www.bioethicscaribe.org.jm/forum/read.php?2,156,156#msg-156

There are lots of assumptions made about the U.S. health care system and how it differs from say, the British nationalized model. In America, everyone has unfettered access to top-notch drugs, while the Brits ration their care, goes the stereotypes. That leads many critics of U.S. health reform efforts to assume the American system is just fine the way it is.

But a new study by Johns Hopkins researchers finds the perceptions aren't so. The study compares the two systems' access to the most expensive cancer medications and asks: Which is more fair? And which cancer patients are better off?

The study, appearing in Milbank Quarterly, compared the costs of 11 pricey cancer drugs. In the UK, seven are free to all patients, with no out-of-pocket costs. Four aren't because they aren't considered worth the limited benefit. If patients want those drugs, they need to pay up.

Here at home, people with insurance have some coverage of all 11 drugs--but the range of out of pocket costs are enormous, depending on the carrier.

Both systems involve a kind of rationing, concludes the study. And here's something that will make reform foes gasp: The issue isn't whether rationing is good or bad, argues the reports' author, Ruth R. Faden, director of the Johns Hopkins Berman Institute for Bioethics. That's because no system can provide patients every medication or intervention to every patient all the time, she writes.

"The issue is what we should do about extraordinarily expensive treatments, some of which do very little to improve how well or how long people live," said Faden in a statement. At the same time, she adds, "there is no ethically defensible reason why some Americans have access to expensive cancer drugs and some do not."


The British system seemed fairer and better able to deal with those wrenching end of life decisions, the authors found.

It's a thorny predicament -- but one every health care system needs to confront: who gets what drugs? Who gets denied? And how to deal with these decisions toward the end of life?

"We're managing health care costs by not allowing some people to be treated at all or forcing them to face financial ruin by getting treatment," Fade says. "Who has an extra $100,000? That's why people sell their homes. That's why people's kids don't go to college. There's probably no more anguishing kind of decision than what a patient and her family face at the end of life."


Posted by Kelly Brewington]]> daarons BSEC Public Forum Fri, 15 Jan 2010 10:32:29 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,152,152#msg-152 http://www.bioethicscaribe.org.jm/forum/read.php?2,152,152#msg-152 by Prof. Pierre Mallia



I was pleasantly surprised when Minister Dalli mentioned that one of the issues he will be concerning himself with on an EU level is the pharmaceutical industry. Indeed many are concerned with the high costs of medicine; but on the other hand one has to consider that this is a highly volatile field where research not only costs millions (and the investor wants a return on that research) but where patient safety is paramount when a drug is still under trial.

There was a time when most research was done by Universities and these obtained funds from the private sector. Nowadays the costs run so high that Universities can only contribute. Researchers working for private industries have had to be careful even with the contract they sign for sometimes they could not practice what was considered scientifically sound procedure ]]> daarons BSEC Public Forum Fri, 15 Jan 2010 05:00:56 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,151,151#msg-151 http://www.bioethicscaribe.org.jm/forum/read.php?2,151,151#msg-151 By Tudor Vieru, Science Editor

26th of November 2009, 07:01 GMT


Facilitated communication is the name given to a procedure in which a comatose patient, or someone who is otherwise significantly impaired, guides their hand over a touchscreen keyboard to type a message, while their hand is being held by someone else. This method came under increased criticism lately, when the case of the Belgian man that allegedly came out of a coma after more than 23 years surfaced. Those close to him say that he is leaving them messages through facilitated communication, but scientists warn that everything having to do with this method needs to be ]]> daarons BSEC Public Forum Sat, 09 Jan 2010 05:39:27 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,150,150#msg-150 http://www.bioethicscaribe.org.jm/forum/read.php?2,150,150#msg-150 November 20, 2009 ]]> daarons BSEC Public Forum Sat, 09 Jan 2010 05:23:18 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,149,149#msg-149 http://www.bioethicscaribe.org.jm/forum/read.php?2,149,149#msg-149 By DUFF WILSON
Published: November 17, 2009


Senator Charles E. Grassley wrote to 10 top medical schools Tuesday to ask what they are doing about professors who put their names on ghostwritten articles in medical journals ]]> daarons BSEC Public Forum Sat, 09 Jan 2010 04:27:26 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,145,145#msg-145 http://www.bioethicscaribe.org.jm/forum/read.php?2,145,145#msg-145 Sunday, November 08, 2009
By Maxim Lott


Among the thousands of Americans with leukemia and other serious health conditions who are on waiting lists for bone marrow donations, there are some who are willing ]]> daarons BSEC Public Forum Fri, 08 Jan 2010 14:27:01 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,144,144#msg-144 http://www.bioethicscaribe.org.jm/forum/read.php?2,144,144#msg-144 By Charles Lane


The Justice Department says it's backing off the prosecution of people who smoke pot or sell it in compliance with state laws that permit "medical marijuana." Attorney General Eric Holder says "it will not be a priority to use federal resources to prosecute patients with serious illnesses or their caregivers." Party hardy! I mean -- let the healing begin!

I don't think the federal government should be spending a whole lot of time on small-time druggies, and I'm undecided about legalizing pot, which enjoys 44 percent support among the general public, according to a recent poll. Recreational use is not the wisest thing -- and if my 12-year-old son is reading this, that means you! -- but it's no more harmful than other drugs (e.g., alcohol) and impossible to eradicate. On the other hand, I worry it's a gateway to harder stuff. So I think we probably should have an open debate about decriminalization.

But it should be a real debate, about real decriminalization, and not clouded -- pardon the expression -- by hokum about "medical marijuana." To the extent it puts the attorney general's imprimatur on the notion that people are getting pot from "caregivers" to deal "with serious illnesses" -- as opposed to growing their own or flocking to "dispensaries" just to get high -- the Justice Department's move is not so constructive.

I do not deny that for some people, including some terminal cancer patients and pain-wracked AIDS sufferers, marijuana is a blessed relief. Let 'em smoke, I say, just as the Justice Department has usually ignored such cases since long before Holder spoke up. But if you believe there is any scientific evidence that smoked marijuana has the multiplicity of therapeutic uses that advocates claim -- well, I've got a bag of oregano I'd like to sell you.

Usually, drugs have to pass exacting testing by the Food and Drug Administration before they go on the market. There's a good reason for this: we don't want people spending money on products that might be ineffective or actually harmful. In California and elsewhere, however, snake oil -- sorry, "medical marijuana" -- got on the market via a different route: popular referendum. The pot for sale in dispensaries is subject to none of the purity controls that actual pharmaceutical drugs must meet. Indeed, the new DOJ policy essentially recognizes a gray market for pot, leaving these supposedly seriously ill people at the mercy of their dealers -- I mean caregivers -- with respect to quality and efficacy.

What other substances should we handle this way? Cocaine? Laetrile? Didn't President Obama just sign a bill authorizing the FDA to regulate the nicotine content of tobacco? And I thought he promised to "restore science to its rightful place."

Under California's law, you don't even need a prescription to get pot (which would admittedly have been a problem, since the U.S. Drug Enforcement Agency controls who gets a prescription pad, and not many doctors would use theirs to prescribe an illegal drug). All it takes is a "written or oral recommendation" from a physician.

A few years ago, a California woman called Angel Raich took her defense of medical pot all the way to the Supreme Court. She lost on the legal issue, which had nothing to do with the medical effectiveness of pot. Along the way, though, she claimed that she was suffering from "life-threatening" weight loss (due to a chronic inability to hold down food, which her doctors could not explain). She also cited chronic pain from scoliosis, temporomandibular joint dysfunction, bruxism, endometriosis, headache, rotator cuff syndrome, uterine fibroids, and Schwannoma. The Latin names of these latter conditions might have snowed some judges, but physicians recognized each of them as a common, non-life-threatening problem for which conventional treatments were available. Raich listed a cornucopia of potent drugs, from Vicodin to Methadone, that she had tried previously and gotten no satisfaction.

This is not an isolated instance. According to a survey by NORML, the pro-"medical marijuana" organization, which can be expected to emphasize the desperate health of users, only 22 percent of California medical marijuana users suffer from AIDS-related disease. Most of the rest have more subjective maladies such as "chronic pain" or "mood disorders."

Raich's physician was Frank Lucido, a well-known Berkeley doctor and pro-pot activist -- he also makes money as an expert witness on "medical marijuana" -- whose Web site boasts that he was "investigated by the Medical Practices Board of California for cannabis evaluation practices in 2003, and fully exonerated." The case involved his recommendation of marijuana to treat attention deficit disorder in a 16-year-old boy, but, as I say, he was fully exonerated.

In a brilliant article (requires subscription) on this subject in the Hastings Center Report, a bioethics journal, lawyer and anesthesiologist Peter J. Cohen noted that "medical marijuana" groups have been notably passive about demanding FDA testing and approval for this purported elixir. Instead, they took their case to the people. As Cohen argued, this is no way to make health policy: "medical marijuana," he wrote, should be "subjected to the same scientific scrutiny as any drug proposed for use in medical therapy, rather than made legal for medical use by popular will." The "medical marijuana" movement may not be a threat to our civilization, but it is an insult to our intelligence.

Clarification: An earlier version of this posting said Angel Raich claimed that each of the medical conditions cited in her lawsuit was life-threatening. She asked me to explain that she only contended that one of her conditions -- chronic weight loss due to an inability to keep food down -- was life-threatening. I am happy to oblige. She is about to undergo an operation to reduce her Schwannoma, which is a benign brain tumor.

By Charles Lane | October 20, 2009; 5:56 PM ET]]> daarons BSEC Public Forum Tue, 24 Nov 2009 13:18:53 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,142,142#msg-142 http://www.bioethicscaribe.org.jm/forum/read.php?2,142,142#msg-142
University of Montreal researchers publish in Developing World Bioethics journal


Montreal, October 7, 2009 ]]> daarons BSEC Public Forum Thu, 19 Nov 2009 22:33:20 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,140,140#msg-140 http://www.bioethicscaribe.org.jm/forum/read.php?2,140,140#msg-140
Updated 10/8/2009 4:11 PM

To process life-and-death situations, families need information and time.



GUIDELINES FOR MAKING THAT CRUCIAL DECISION

Autonomy

A frail, unconscious elderly man needs his colon removed. The family disagrees on whether to authorize the surgery or turn instead to palliative care. They agree to the surgery, but the patient briefly rallies and refuses it.

"How do you honor his autonomy when a patient may not be thinking clearly or hasn't realized that he's going to die shortly, even with the surgery?" Curlin asks.

"You tell him the truth of his situation. If his decision accords with values and views he has expressed before, he can decline surgery.


Authority

An elderly woman with multiple organ system failure is dying. Doctors say that when she was first admitted, the family said she had a living will spelling out that she did not want aggressive treatment if she reached this point. Now, however, the family is refusing to look for or bring in the document.

"Can they insist aggressive treatment continue? Yes," Curlin says -- without documentation, they can.


Quality of life

A 2-year-old was born with such severe, chronic defects that she has lived all her life in a chronic-care facility. There, she is cherished by staff and visited often by family.

But she's frequently hospitalized with life-threatening complications. What should they do when she comes in with her fifth episode of pneumonia, requiring painful intubation?

Many on the medical staff want to strongly encourage the family to focus just on pain relief. But her mother wants the staff to "do everything." Do you respect the wishes of the mother?

"Yes," Curlin says. This baby, who has never formed a thought, still has a meaningful life -- meaningful to her mother.


FAITH & REASON

Join the conversation on religion, spirituality & ethics, led by too-fidgety-to-meditate reporter and blogger Cathy Lynn Grossman, who stays on top of the beat's most brain-stretching news and provocative views.

Or join the forum where you can share experiences and beliefs with other readers, debate, ask questions and conduct polls.


By Cathy Lynn Grossman, USA TODAY

An infant is born with no functioning brain. A teen is ravaged in a car wreck. A 90-year-old with dementia and pneumonia lies unconscious in intensive care.
Medical and moral decisions must be made. But there's no written directive for guidance. Family and physicians disagree. What now?

Every day, in a hospital somewhere in the USA, a group of strangers ]]> daarons BSEC Public Forum Thu, 19 Nov 2009 22:17:25 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,139,139#msg-139 http://www.bioethicscaribe.org.jm/forum/read.php?2,139,139#msg-139 Creating a Life to Save a Life

Read the case about the Spanish stem cell baby created specifically to save his brother's life. Do you agree with the parent's decision? Why or why not? What are the significant moral considerations in this case? What consideration is decisive for you?

Posted by dsm at 2:55 PM
Labels: PHI213 fall stem_cells creating_life
14 comments:
Heather said...
No, I do not agree with the parent]]> daarons BSEC Public Forum Thu, 19 Nov 2009 21:39:07 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,138,138#msg-138 http://www.bioethicscaribe.org.jm/forum/read.php?2,138,138#msg-138
Main Category: Alzheimer's / Dementia
Article Date: 02 Oct 2009 - 1:00 PDT



People with dementia, carers and doctors are not getting the support they need to deal with the ethical issues they face-a new report from the Nuffield Council on Bioethics reveals.

The authors call for better training for doctors, nurses and professional carers and emphasise the responsibility we all have to support people with dementia to live well.

The report highlights that it's not just the big decisions but also the ordinary things that cause distress, such as whether people with dementia should be given the freedom to carry on with potentially risky activities like cooking or driving. The report also looked at the acceptability of lying to people with dementia if it is seen to be for their benefit.

Neil Hunt, Chief Executive, Alzheimer's Society says,

'This report provides compelling evidence of the need for better public understanding of dementia, more support and greater investment in research.

Families, carers and professionals face a range of complex and distressing ethical issues when caring for a person with dementia. Decisions can be hugely emotional and there are no right or wrong answers. The Nuffield council recognises the need to combat stigma and emphasises how important it is to value the person with dementia and treat families as partners in care.

One in three people over 65 will die with dementia. We need to ensure that carers are supported in making difficult ethical decisions and people with dementia are involved in this process wherever possible.'

Sue Baker, who has a father with Alzheimer's disease has faced her own ethical dilemmas.

'As a carer it's pretty normal to have to make difficult choices on a regular basis but that doesn't make it any easier. When Dad was diagnosed with bowel cancer we chose not to tell him as having Alzheimer's disease was already more than enough for him to deal with and it would only have caused unnecessary pain. You have to look at your individual situation and act with the best interests of the person with dementia in mind.'

The report was released following a year's work involving consultations with experts, including Alzheimer's Society. Alzheimer's Society worked with its members to feed the experiences and views of people with dementia and their carers into this process.

Notes

Summary of key points from the report:

- Dementia is a medical condition but dementia services are often classed as social and not made available until a crisis point occurs. People with cancer would not be expected to wait for a crisis point and neither should people with dementia.

- People should have access to good quality assessment and support from the moment they or their families become concerned about symptoms

- Families should be treated as 'partners in care' by professionals.

- Risk assessments should be replaced by 'risk-benefit assessments' that take into account the quality of life of the person with dementia.

- The Equality & Human Rights Commission should highlight the legal duties of shops and restaurants to ensure people with dementia can use their services.

- Greater guidance is needed on how to apply mental capacity legislation and the process of appointing a welfare attorney should be easy and free.

- There should be more funding for dementia research, including research into how people with dementia can be supported to live well.

Source
Alzheimer's Society]]> daarons BSEC Public Forum Thu, 19 Nov 2009 20:47:55 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,135,135#msg-135 http://www.bioethicscaribe.org.jm/forum/read.php?2,135,135#msg-135 By Carol Forsloff.

Published Jun 30, 2009 by ]]> daarons BSEC Public Forum Thu, 15 Oct 2009 17:52:24 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,131,131#msg-131 http://www.bioethicscaribe.org.jm/forum/read.php?2,131,131#msg-131
With increased availability of advanced clinical technology, medical ethics dilemmas become more frequent. More and more, families and healthcare professionals have differing views on whether aggressive treatment should be instituted (or continued). Nursing homes are often faced with the dilemma of a non-responsive patient who doesn't have immediate family or caretakers to make end-of-life decisions.

Major medical centers have robust Medical Ethics Committees to advise and consult on these issues, comprised of experts in medicine, the law, religion, ethics and philosophy, etc. But the smaller hospital or nursing home (especially in remote areas)often doesn't have access to internal resources of this nature.

Telehealth is providing a valuable link to solve these problems, allowing small remote facilities to access Tele-Ethics consultations and education for professionals.

The Missouri Dept of Health developed a collaborative effort where rural nursing homes could access virtual ethics consultation via telephone, email and video conferencing. The Missouri Telehealth Network and the Long Term Care Ombudsman Office collaborated to facilitate communications between remote nursing homes an an academic medical center to provide consultations with a clinical ethicist.

Facilities without videoconferencing were given laptops with video cameras, and in 2006 the network provided 23 "portable ethics consultations". The technology was also used to conduct training for clinical personnel to increase their understanding of and comfort with challenging bioethics situations.

This targeted niche of distance education is another example of telehealth as a cost-effective means of improving patient care outside of physical borders.

Source: Fleming & Reynolds (2007), "Virtual clinical ethics consultation for long term care facilities." Presented at American Society for Bioethics and Humanities 9th Annual Meeting, October 2007, Washington DC.

For more information on ethics and telehealth, see www.ecri.org
Posted by Sheri Putnam at 2:28 PM]]> daarons BSEC Public Forum Tue, 14 Jul 2009 20:22:47 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,128,128#msg-128 http://www.bioethicscaribe.org.jm/forum/read.php?2,128,128#msg-128 daarons BSEC Public Forum Sun, 29 Mar 2009 02:57:05 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,127,127#msg-127 http://www.bioethicscaribe.org.jm/forum/read.php?2,127,127#msg-127
by Wesley J. Smith
January 14, 2009

LifeNews.com Note: Wesley J. Smith is a senior fellow at the Discovery Institute and a special consultant to the Center for Bioethics and Culture. His most recent book is the Consumer's Guide to a Brave New World.

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Each year at this time, I predict the coming year's happenings in the field of bioethics. Such prognostications do not require a crystal ball. It is merely a matter of being informed about current controversies, sniffing the air to see which way the wind seems to be blowing, connecting some dots, and making educated guesses about how things will turn out.

Alas, the bioethical events of 2009 are all too easy to foresee. While the recent election results were not determined by bioethical issues]]> daarons BSEC Public Forum Fri, 27 Mar 2009 18:14:50 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,122,122#msg-122 http://www.bioethicscaribe.org.jm/forum/read.php?2,122,122#msg-122


IMF International Monetary Fund
Working Paper No. 09/61: March 2009
Tsounta, Evridiki



Available online as PDF [37p.] at: [www.imf.org]
[www.imf.org]



"......Despite the increasing interest in universal health care, little is known about the optimal way to finance, design, and implement it. This paper attempts to fill this gap by providing some general policy recommendations on this important issue. While most of the paper addresses the Eastern Caribbean Currency Union (ECCU) countries, its policy implications are applicable to any country.



The paper finds that the best financing option is country-specific depending on a country's economic, cultural, institutional, demographic and epidemiological characteristics, as well as political economy considerations. However, taxation should be the primary financing source. It also concludes that an appropriate and realistic benefit package would need to be designed to ensure the system's financial viability.



Regarding the optimal way to implement universal health care, certain preconditions are needed, including sound public administration, a small informal economy, and a transparent health financing system that builds social consensus ..."



Contents

I. Introduction

II. What are the Available Financing Options for Universal Health Care?

III. The Challenges of Population Aging and the Epidemiological Transition

IV. What Would Be the Optimal Tax: General Taxation Versus Mandatory Payroll/ Social Security Contributions?

V. Providing Universal Coverage: A Single Provider or Numerous Providers?

VI. Designing the Benefit Package

VII. Preconditions for Successfully Implementing Health Care Reforms

VIII. Conclusions

References





* * *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics; Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]

"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings and interpretations included in the Materials are those of the authors and not necessarily of The Pan American Health Organization PAHO/WHO or its country members".
-----------------------------------]]> daarons BSEC Public Forum Wed, 25 Mar 2009 07:37:19 -0400 http://www.bioethicscaribe.org.jm/forum/read.php?2,114,114#msg-114 http://www.bioethicscaribe.org.jm/forum/read.php?2,114,114#msg-114
The face is visible in a way that internal organs are not. Further, it is visible in a way that is highly associated with one]]> daarons BSEC Public Forum Mon, 22 Dec 2008 08:14:52 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,113,113#msg-113 http://www.bioethicscaribe.org.jm/forum/read.php?2,113,113#msg-113 daarons BSEC Public Forum Fri, 05 Dec 2008 20:50:52 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,112,112#msg-112 http://www.bioethicscaribe.org.jm/forum/read.php?2,112,112#msg-112
As reported Sunday on MSNBC, high school kids break ethical boundaries frequently--including lying, cheating, and stealing. With 30% of students having stolen something from a store in the last year and 64% admitting to having cheated on a test, one has to wonder: why are our nation's youth okay with breaking the rules?

The MSNBC article quotes one administrator who blames it on the pressures and competition of growing up as a teen today. The researchers conducting the study have surmised that the reason for all this cheating and stealing is because there is a sense of moral acceptability for these behaviors, the standard "well if she can do it, why can't I?" line. This hypothesis is supported by the data that say that 93% of students say they are satisfied with their own ethical character.

However, what I find interesting, and missing, from this survey is any questioning about whether these respondents were ever caught or punished for their misdeeds. My hypothesis (untested as it is) is that high school students are willing to engage in unethical behaviors because they don't believe that there are any negative consequences attached--be they punitive or the long-term erosion of their moral character. "If I can get away with it, why not?" is the standard line I would guess is going through a good number of teens' heads these days.

Moreover, because they are still children, they don't think about the long-term effects of their behavior or conceive of any kind of universalization principle that would give them pause. I doubt very many teens have ever considered, "What would happen not just if I steal, but if everyone else around me also started stealing? What kind of world would we have?" That kind of navel gazing is sadly unlikely among teens who are more focused on driver's licenses and playing PlayStation 3 games than their moral fiber.

These results are troubling, for sure, and the real question remains can this trend be turned around? One has to hope so--otherwise this next generation is likely to suffer from a skewed sense of what is ethical, not just in school but in life.

Summer Johnson, PhD]]> daarons BSEC Public Forum Fri, 05 Dec 2008 20:36:52 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,110,110#msg-110 http://www.bioethicscaribe.org.jm/forum/read.php?2,110,110#msg-110
Posted on November 29, 2008 by Z Rana

The difference between what drug companies tell the government and doctors suggests that they]]> daarons BSEC Public Forum Fri, 05 Dec 2008 20:19:11 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,109,109#msg-109 http://www.bioethicscaribe.org.jm/forum/read.php?2,109,109#msg-109
By Brandon Keim March 31, 2008 | 10:49:50 AMCategories: Bioethics, Medicine & Medical Procedures

Since hitting the market in 2002 and 2004, heart disease drugs Vytorin and Zetia have racked up some $5 billion in sales.

Too bad they don't seem to work.

The drugs, manufactured by Merck and Schering-Plough, are supposed to block production of so-called bad cholesterol, then flush it from the body. They do, in fact, do this -- but without lowering heart disease. Older (and cheaper) drugs called statins appear to be just as effective, if not more so.

These findings, described yesterday in the New England Journal of Medicine, come from the ENHANCE trial, a long-term study of Zetia and Vytorin's effectiveness. Added to the first set of ENHANCE data-crunching, published in late January, they may spell doom for both the drugs and the medical assumption guiding their development.

"This seemingly rigorous and well-executed study ... contradicts our expectations," read an accompanying NEJM editorial by cardiologists Greg Brown and Allen Taylor, both of whom receive funding from Merck. "'Lower is better' has been the mantra with respect to LDL cholesterol for the past two decades."

They concluded, "The benefits of lowering LDL cholesterol may depend not only on 'how low you go' but also on 'how you get there.'"

As for getting there, the NEJM's editors were clear: diet, exercise and statins, an older class of cholesterol-lowering drugs that have been proven to reduce risks of heart attack and stroke. Their recommendations were immediately backed by an expert American College of Cardiology panel, who took the drastic step of telling people now using Zytorin and Zetia to get back on statins.

With Merck and Schering-Plough's stock prices hurting and public relations departments in full damage-control mode, Zetia and Vytorin may be finished. The debate over drug development in the U.S., however, is just getting started.

Critics say ENHANCE-like studies should be completed before a drug is approved, not after, and need to measure success with hard outcomes -- such as heart attacks prevented -- rather than soft surrogate markers, such as lowered cholesterol levels. Drug companies say such studies are expensive and impractical.

In a sense, both sides are right -- and for a just compromise, the U.S. might wish to look north. Another NEJM study found that in Canada, where direct-to-consumer drug advertising is banned, Vytorin and Zetia are prescribed four times less frequently than in the United States, where consumers were hit with a $200 million Vytorin advertising blitz.

Another piece of advice comes from Arthur Levin, director of the medical watchdog Center for Medical Consumers and member of numerous FDA safety panels. Said Levin in January, "You should be asking your doctor broad questions, particularly with newer drugs. If there is an older and better-understood drug, you shouldn't take a drug until it's been around for five to seven years, until we understand it better. You should always ask questions: what are my alternatives? What do you it to achieve, and what's the evidence?"]]> daarons BSEC Public Forum Fri, 05 Dec 2008 20:15:14 -0500 http://www.bioethicscaribe.org.jm/forum/read.php?2,107,107#msg-107 http://www.bioethicscaribe.org.jm/forum/read.php?2,107,107#msg-107
By Albert Weale - posted Thursday, 6 November 2008

The World Bank recently estimated that a doubling of food prices over the last three years could push 100 million people in low-income countries deeper into poverty. And the future does not look brighter. Food prices, although likely to fall from their current peaks, are predicted to remain high over the next decade.

As the world considers how to respond, the debate about genetically modified (GM) crops has inevitably reared its ugly head. ]]> daarons BSEC Public Forum Fri, 05 Dec 2008 17:23:47 -0500