Do You Have a Bioethics Question? If So, Ask Me
Since I started this blog in July 2004, this is currently my 479th posting. A great number of different topics have been covered in these past 3 years. It is interesting and rewarding to discover that despite the popularity of certain topics such as patient modesty, circumcision of male infants and "I hate doctors", there is still daily visitation to a host of other topics going all the way back to the earlier days of this blog And that is what I would say is understandable and appropriate considering the extent of the discipline of bioethics in our modern world.
What I wanted to pose with this posting was the offer my visitors an opportunity to ask me questions about ethical issues in medicine or biology that I haven't really covered in the past threads. Make this a thread consisting as a potpurri of everything you would like to know and perhaps I have an idea of an answer or will try to look it up. However, everyone should realize that bioethics answers are really individual views or consensus opinions. There are no rigorous scientific studies but opinions based on previous declared ethics principles, previous cases, the law and even personal opinion. But give it a try. ..Maurice.
posted by Maurice Bernstein, M.D. @ 7:02:00 PM
10 comments
10 Comments:
What are the ramifications of getting pregnant, so that the new born can save another child or parent?
What about pregnancy after a tubal ligation? You can get the procedure reversed, but if that does not work what about fertility treatments?
"What are the ramifications of getting pregnant, so that the new born can save another child or parent?" No ethical problem. Children are still loved by their parents even if they are born by "accident" and not for a "reason". Read this topic already discussed here in January 2007.
With regard to tubal ligation and fertility treatments, what is the ethical issue? ..Maurice.
I meant, is it moral to want something that you had already decided you did not want i.e. a pregnancy and then proceed with whatever means necessary to conceive? I am not sure if this is a moral right or wrong but still, where do we draw the line on who 'qualifies' for fertility treatments. Should you try IVF if you got your tubes tied in your twenties and now in your 40s decide for whatever reason that you want children?
Thanks for the explanation. I would hope that there isn't any moral directive against changing one's mind as one grows up or as the content of one's life changes. As long as changing one's mind doesn't cause harm to another person then there is nothing ethical to contemplate. If my visitors can think of exceptions to this view, please express them. ..Maurice.
Someone attempted to post here today a long and detailed description of a confict of interest issue involving a cancer research center. The reason I can't allow it to be posted here is simply because institutions and others are named or virtually named and there are apparent accusations made. It would be ethically unfair to discuss the details here based on only one side of the issue and to have institutions or others named without a simultaneous opportunity for a response by the other side.
If the author of this post desires, please briefly summarize in general terms and without naming names the ethical question being asked. The answer, if I or any other visitor might respond, should not be considered an ethical consensus and used for some legal or quasi-legal benefit.
The purpose of this blog is to stimulate general discussion of ethical issues and not to be a resource for the resolution of private ethical conflicts. ..Maurice.
Dear Dr. Bernstein & friends,
What do you think: to work or not to work in an SIF?
Ah yes, indeed, not yet a familiar abbreviation in the US... and yet, a very needed type of health care facility, given the epidemics of various nasty infectious diseases (among a slew of issues) and their prevalence among generally reviled groups (I understand that a popular American medical term is GOMER - for "get out of my ER").
We are talking specifically about a "Safe Injection Site" (well, it is saFER than a ditch in the back alley), that is a professionally
supervised and purpose-built street level facility where addicts can bring and inject illegal drugs using government funded sterile rigs.
Add sirens and flashing lights here.
Yes, it is in a practically invisible country that borders on
the US (well, these days, which one DOESN'T border on the US?!
could be anywhere!) and has, uh, intensely, uh, friendly relations with that great Union, and does not want to be bombed or have its lovely trade relations shook up.
I'm not even sure there is much of a real BIO-ethical dilemma here, what with prestigious journals and researchers having established consensus that this is a Good Thing (sorry, Martha) and the surrounding community generally supporting it, and US practitioners calling for SIFs to be built there, too.
BUT, but... the darn thing is still officially stuck in a legal
limbo. The "War on Drugs" is still on and illegal drugs very much a criminal matter. So in practice, while two SIF facilities are in fact operating here without drama and, ho-hum, SAVING LIVES etc.
etc., politically it remains regional just-do-it versus federal
yes-Mr-Bush-SIR, how-high-SIR?
With obvious potential career and uh, possibly incarceration and/or travel issues attached, if some bigwig has a bad hair day, how does a health care worker handle walking into that? Perspectives?
Cheers & thanks,
Can-Doo
Can-Doo, can you be a bit more specific as to which country you are writing about and what is the interest of U.S. practitioners to have these facilities constructed in that counry? ..Maurice.
Dr. Bernstein,
Of the 50 or so Safe Injection Sites in the world so far (many big-city mayors love them), to my knowledge only two are in North America, both of them in Canada. Neither has significant direct participation by U.S. practitioners - sorry I was
unclear. Although they attract intense attention, both pro (from
U.S. clinicians and policy advocates who want to do same in US because "War on Drugs" is long lost) & con (U.S. politico-penal
establishment who benefit from appearing tough on crime).
One tiny facility operates as adjunct to HIV/AIDS/palliative
unit, with no official (federal) permission, fueled by local
government chutzpah plus reference to duty to care and lawyers
loading guns with constitutional court challenge - basically
"come and get us if you dare".
Other more substantial facility is in busy skid road area and
operates under TEMPORARY "research" exemptions to federal law on controlled substances, although meaningful research phase is
long past and extremely favourable results long published in many prestigious journals. So it works and it cares for its patients and community - yet the Canadian federal level definitely wants to shut it down, and there is clear evidence of pressure from Washington.
U.S. interests in this? Well let me see... no, no oil at that
address, but the need for a functioning approach to severe
addiction is, I understand, also widely felt below the 49th, and
SIFs are certainly an important piece of that. So if entrenched
and dysfunctional U.S. "War on Drugs" FAITH were to be eclipsed
by, gasp, FACT plainly visible just across the undefended border
- it might make it hard to refuse trying in the States as well.
On the other hand, though, imagine the severe blow to the penal-industrial complex and the enormous and still growing U.S.
prison system - if Stateside practitioners were actually allowed the tools necessary for turning a spectacular disaster (hard drug addiction and related horrors) into just another manageable public health problem.
Even Hollywood would no longer be the same (what, addicts not just crazed, criminal monsters worthy of a horrible death in a filthy ditch? BOOOring). And how would the Afghan poppy growers feed their families?
No, no, on reflection, we must crush all SIFs in North America,
I am sure you agree! Geneva - shmeneva!
But seriously, what kinds of ethical dilemmas would you see in
this, e.g. for a health care worker starting there - and how to
deal?
Thanks!
Can-Doo
Is it ethical for hospital staff to not make note in the MRs of drugs used such as fentanyl especially when they have said the patient was alert x3 and able to give consent? Wouldn't this point to the staff covering up the fact the patient was high and was able to understand and freely give consent? If hospital staff failed to recognize a patient was high, isn't that another issue within itself as they could easily overdose the patient? Is it ethical to give a patient morphine, fentanyl, and versed and then say after those have been injected the patient was able to consent? Doesn't fentanyl make a person feel content and agreeable while high? Wouldn't it be safe to say that someone under the effects of fentanyl would most likely be agreeable to anything as many crimes are committed while people are under the influence of drugs because drugs are known to change a person's though process? Wouldn't you say this is a danger of EHRs because it allows the clicking of phrases they know they should have be using but didn't. It also encourages them to blindly click even hours after an event actually occurred which if they are human, they too may not remember the events as they actually happened.
To administer a rapid action mind altering drug to a patient who has had the capacity to make their own informed decisions in a clinical situation about the administration without the patient's understanding the need, purpose or effects short term or longer term would not only be unethical but also very likely illegal. ..Maurice.
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