Begell House Inc.
Ethics in Biology, Engineering and Medicine: An International Journal
EBEM
2151-805X
5
2
2014
The Bioethics of Implantable Engineered Mechanisms in Orthopedic Surgery
95-105
10.1615/EthicsBiologyEngMed.2015013096
Sarani
Chatterjee
School of Chemical, Biological, and Environmental Engineering, Oregon State University, Corvallis, Oregon
Ravi
Balasubramanian
School of Mechanical, Industrial, and Manufacturing Engineering, Oregon State University, Corvallis, Oregon
Courtney
Campbell
Department of Philosophy and Religion, School of History, Oregon State University, Corvallis, Oregon
implant
ethics
engineered
mechanisms
orthopedic
surgery
The ethics of implant technology is a wide-ranging topic in the field of bioethics. This article intends to add to the ethical discourse of implant technology by addressing
a new class of implants applicable to orthopedic surgery. These new implants are engineered mechanisms that attach muscles to tendons and bones with the goal of improving postoperative joint function when compared with the state of the art of using sutures to connect biological
tissues. This technology has significant engineering and ethical issues including material and device design, determining the metrics to evaluate the implant, validating the procedure, and reducing risk. While considering these engineering issues, we will primarily focus on the following bioethical issues regarding the implants: How will hybridizing the human body, or
combining mechanistic and biological components, affect an individual's sense of self and cultural identity? What are the risks and benefits of using these implants and how do they affect a patient's decision to consent to the new procedure? What are the social justice issues of this
new implant technology?
Patients Are From Mars, Doctors Are From Venus: Patients Prefer Placebos and Paternalism; Doctors Don't
107-115
10.1615/EthicsBiologyEngMed.2015013217
Isabella
Guajardo
University of California, San Francisco, San Francisco VA Medical Center, 4150 Clement St., San Francisco, CA 94121
patient-centered care
shared decision making
autonomy
paternalism
online surveys
crowd sourcing
online research
Amazon Mechanical Turk
survey methods
Current medical ethics, law, and education all emphasize patient empowerment and shared decision making as a means of avoiding paternalism. But what if doctors are paternalistically deciding that patients may not choose paternalism by forcing them to be involved when they would rather just feel better and leave it to the professionals? Two separate surveys were administered to a cross section of adult Americans through Amazon's Mechanical Turk to measure attitudes toward paternalism in various scenarios. This review discusses the results of these surveys and how they may be implemented in order to better understand how to interact with patients in medical settings.
Unheard Voices of Willowbrook: A Bioethics Education Perspective on New York's Infamous State School, 1947−1987
117-129
10.1615/EthicsBiologyEngMed.2015013072
Obiora Nnamdi
Anekwe
New York City Department of Education, P.O. Box20828, New York, NY 10023
Willowbrook State School
mentally challenged
bioethics education
artistic symbolism
unethical study
I provide a historical background regarding Willowbrook State School's unethical human experimentation projects in order to illuminate ethical solutions and remedies to challenges in educating and medically treating those who are mentally challenged and/or physically disabled. In light of this perspective, I explain the impact of patients' unethical treatment at Willowbrook through a visual presentation of original photographs and archival representations as well as its historical relevance to bioethics, medical ethics, and health care ethics. By presenting Willowbrook through this lens, readers can metaphorically hear and feel the voices of the institution's former residents. I present a transformative argument for global healthcare ethics reform for the physically disabled and mentally challenged. In addition, my audience can learn from the Willowbrook experiments and its ethics framework in order to promote a culture of medical justice inherent in fair and equitable treatment for all patients.
Made-to-Measure Palliative Care: An Ethical Imperative for Growing Cultural Plurality in the United States
131-138
10.1615/EthicsBiologyEngMed.2015013247
Nathan A.
Boucher
Manhattan Physician Assistant Program, School of Health Sciences, Touro College & University System, 218-232 West 40th Street, 3rd Floor, New York, NY 10010; School of Public Health, The State University of New York Downstate Medical Center, Brooklyn
cultural competency
end of life
healthcare ethics
healthcare quality
Delivering culturally attuned palliative care, or noncurative support for the dying and those in need of serious symptom management, that is, "made-to-measure", is an ethical imperative, if that care is to be just. Differences in culture play a role in the way that people perceive the death and dying process. Standardized approaches to healthcare are not always congruent with a patient's cultural identification, and this can result in suboptimal care delivery that can affect patient outcomes as well as patients' and families' satisfaction with care. U.S. Census data indicate further rapid growth of racial and ethnic diversity, especially among those of Hispanic and Asian origins. In this review, six tiers of influence are identified and discussed as areas where change must occur to achieve system-wide improvements in the delivery of culturally attuned palliative care that is just. Affecting change on each of the identified tiers may achieve the most concrete changes toward improving culturally appropriate, made-to-measure, end-of-life, and palliative approaches to care. When clinicians and healthcare systems know more about the people whom they serve, they can provide the correct amount of care−impacting savings, expenditures, and health outcomes−and the correct approach to care that incorporates cultural values and is more ethically sound.
Ebola Virus Disease: A Case for Shared National and Global Responsibility in a Global Health Crisis
139-147
10.1615/EthicsBiologyEngMed.2015013270
Evaristus Chiedu
Obi
Department of Theology, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282
Ebola virus disease
national responsibility
global responsibility
global health crisis
global health inequalities
international human rights law
global health fund
The current outbreak of Ebola virus disease (EVD) has resulted in increased cases and deaths and has devastated West Africa, especially Liberia, Guinea, and Sierra Leone. The pandemic nature of EVD engenders a global health crisis that establishes the urgent need for shared national and global responsibility for dealing with this outbreak. Along with the broader issue of global health inequalities in healthcare resources and capacities, these West African countries are ill equipped to deal with the crisis. They significantly lack infrastructure, equipment, trained healthcare workers, and strong primary health systems. International human rights law is argued here as providing a theoretical framework for national and global responsibility in realizing the minimum essential level of the right to health, which includes treating EVD patients and consequently effectively controlling the outbreak in West Africa. A global health fund (GHF), rather than the current ad hoc solution of sporadic assistance from richer countries, is proposed as imperative and critical. An effective GHF rooted in the concept of financial sustainability would significantly enhance the realization of the right to health in general and in effectively controlling the EVD outbreak in West Africa in particular.
Ethics in Medical Research and the Low-Fat Diet-Heart Hypothesis
149-159
10.1615/EthicsBiologyEngMed.2015013331
Richard David
Feinman
SUNY Downstate Medical Center, Brooklyn, New York
Sara M.
Keough
Maryland University of Integrative Health, Laurel, Maryland
low fat
low carbohydrate
medical education
cholesterol
The diet-heart hypothesis holds that circulating cholesterol is a causal factor in cardiovascular disease (CVD) and that high-fat diets lead to high cholesterol. The idea has been the major philosophy in medicine and nutrition for 40 years; most government and private health agencies have counseled reduction in dietary fat, especially saturated fat and, as a corollary, have generally opposed the use of diets based on carbohydrate restriction. Despite its pervasive presence, most experimental tests of the diet-heart hypothesis, including large expensive clinical trials, have failed to show any significant benefit for CVD or for most other health problems, and theory and practice related to diet-heart have been the target of many critiques. At the same time, low-carbohydrate diets have shown consistent benefit for obesity, diabetes, and metabolic syndrome. It is argued that adherence to low-fat has caused demonstrable harm, to scientific principles, to the scientific literature, to medical education and, most important, has failed to offer effective options to the patient. Motivation for persistence in the face of contradictory evidence is unknown but, as it becomes increasingly clear that harm has been done, continuation on our current path will constitute an ethical problem.
Relevance of Genetic Resources Governance to Synthetic Biology
161-183
10.1615/EthicsBiologyEngMed.2015013272
Catherine
Rhodes
Institute for Science, Ethics and Innovation, Faculty of Life Sciences, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PL, UK
international law
regulation
synthetic organisms
In discussions of how to address synthetic biology within the Convention on Biodiversity, concerns have been expressed that synthetic biology is currently unregulated and that proceeding with work in the area is unethical unless a strict precautionary approach is applied to it. International governance of genetic resources is extensive, and because most of the inputs into and outputs from synthetic biology can be classified as genetic resources, it is clear that this is not an unregulated field. Existing rules may, however, need adaptation or guidance on their interpretation in this context and some additional rules may be needed. This article therefore examines the extent to which existing rules cover concerns associated with synthetic biology as an emerging technology, identifying any gaps and problematic areas. It will focus particularly on two areas: deliberate or unintentional release of synthetic genetic resources into the environment (including coverage of potential misuse), and ownership, access, and benefit sharing. It will argue that in areas that are well covered by existing regulations, proceeding with work in synthetic biology is not unethical, but that there are areas that need further consideration by the international community in relation to both synthetic biology and other novel and/or converging technologies.