Center Professor Dr. Leonard Fleck has a new article in the January 2018 issue of Cambridge Quarterly of Healthcare Ethics. The article, “First Come, First Served in the Intensive Care Unit: Always?,” was written by Dr. Fleck and Timothy F. Murphy.
Abstract: Because the demand for intensive care unit (ICU) beds exceeds the supply in general, and because of the formidable costs of that level of care, clinicians face ethical issues when rationing this kind of care not only at the point of admission to the ICU, but also after the fact. Under what conditions—if any—may patients be denied admission to the ICU or removed after admission? One professional medical group has defended a rule of “first come, first served” in ICU admissions, and this approach has numerous moral considerations in its favor. We show, however, that admission to the ICU is not in and of itself guaranteed; we also show that as a matter of principle, it can be morally permissible to remove certain patients from the ICU, contrary to the idea that because they were admitted first, they are entitled to stay indefinitely through the point of recovery, death, or voluntary withdrawal. What remains necessary to help guide these kinds of decisions is the articulation of clear standards for discontinuing intensive care, and the articulation of these standards in a way consistent with not only fiduciary and legal duties that attach to clinical care but also with democratic decision making processes.
The full text is available online through Cambridge University Press (MSU Library or other institutional access may be required to view this article).
Center Assistant Professor Dr. Laura Cabrera is co-author of a new open peer commentary in the September issue of The American Journal of Bioethics. The article, “Environmental Neuroethics: Bridging Environmental Ethics and Mental Health,” was written by Adam J. Shriver (University of British Columbia), Laura Cabrera, and Judy Illes (University of British Columbia).
The full text is available online via Taylor & Francis (MSU Library or other institutional access may be required to view this article).
Center Assistant Professor Dr. Devan Stahl and Center Director Dr. Tom Tomlinson are the co-authors of a new article in Nature Reviews Clinical Oncology, titled “Is there a right not to know?”
Published online on April 4, the article addresses whether a patient with advanced illness or incurable disease has a right not to “hear the bad news.” Drs. Stahl and Tomlinson write that this question “raises fundamental questions concerning patient autonomy and the duties of health-care professionals.”
The full text is available on the Nature Reviews Clinical Oncology website.
Center Assistant Professor Dr. Devan Stahl has a new book review published in NanoEthics, titled “Building Better Humans? Refocusing the Debate on Transhumanism.”
Building Better Humans? Refocusing the Debate on Transhumanism [Hava Tirosh-Samuelson and Kenneth L. Mossman (eds) 2012 (Peter Lang, Frankfurt) ISBN 9783631635131 520 pp.] is the third volume of the Peter Lang series Beyond Humanism: Trans- and Posthumanism.
The full text is available online ahead of print on the Springer website (MSU Library or other institutional access may be required to view this article).
Center Assistant Professor Dr. Laura Cabrera has a new article in the open-access journal Frontiers in Sociology, titled “Reframing human enhancement: a population health perspective.”
The article is part of the research topic ELSI in Human Enhancement—ELSI stands for “ethical, legal and social implications.” Dr. Cabrera is a topic editor for ELSI in Human Enhancement, along with Dov Greenbaum of Yale University.
The dominant understandings on human enhancement, such as those based on the therapy-enhancement distinction or transhumanist views, have been focused on high technological interventions directly changing biological and physical features of individuals. The individual-based orientation and reductionist approach that dominant views of human enhancement take have undermined the exploration of more inclusive ways to think about human enhancement. In this perspective, I argue that we need to expand our understanding of human enhancement and open a more serious discussion on the type of enhancement interventions that can foster practical improvements for populations. In doing so, lessons from a population health perspective can be incorporated. Under such a perspective, human enhancement focus shifts from changing the biological reality of individuals, to addressing environmental factors that undermine the optimal performance of individuals or that can foster wellness. Such a human enhancement perspective would be consistent with a population health approach, as it pursues more equitable and accessible interventions, on the path to addressing social inequality. Human enhancement does not need to be only about high-technological interventions for a selected group of individuals; rather it should be a continuous project aiming to include everyone and maximize the public benefit.
The full article text is available on the Frontiers in Sociology website.
Center Assistant Professor Dr. Karen Kelly-Blake is a co-author of an article in the April 2017 issue of the American Journal of Preventive Medicine. The article, “Correlates of Patient Intent and Preference on Colorectal Cancer Screening,” is co-authored by Masahito Jimbo, MD, PhD, MPH, Ananda Sen, PhD, Melissa A. Plegue, MA, Sarah T. Hawley, PhD, MPH, Karen Kelly-Blake, PhD, Mary Rapai, MA, Minling Zhang, BS, Yuhong Zhang, BS, and Mack T. Ruffin IV, MD, MPH.
From 2012 to 2014, a total of 570 adults aged 50–75 years were recruited from 15 primary care practices in Metro Detroit for a trial on decision aids for colorectal cancer screening. The article discusses the results of that trial. The full article text is available on the ScienceDirect website (MSU Library or other institutional access may be required to view this article).
An ethics case by Center Professor Dr. Leonard Fleck and co-author Marion Danis, MD, was published in the February 2017 issue of the AMA Journal of Ethics. Their commentary is titled “How Should Therapeutic Decisions about Expensive Drugs Be Made in Imperfect Environments?”
Clinicians must inevitably make therapeutic decisions under nonideal conditions. They practice in circumstances that involve incomplete evidence. They deliver care in health care systems that are complex and poorly coordinated. Each of the patients that they take care of is unique while research offers evidence regarding relatively homogeneous populations of patients. Under these circumstances, many parties—medical scientists, reviewing agencies, insurers, and accountable care organizations—can and should contribute to optimizing the development, approval, funding, and prescription of therapies—particularly expensive and marginally beneficial therapies. In aggregate, they should aspire to achieve a pattern of fair, cost-effective therapeutic decisions to ensure a sustainable health care system. Here we offer some suggestions regarding decisions that physicians might pursue to facilitate fair and cost-effective patient care.
Visit the AMA Journal of Ethics website to read the full article.
Center Assistant Professor Dr. Marleen Eijkholt is the co-author of an article in the April 2017 issue of the Journal of Emergency Medicine. The article, “Enabling Donation after Cardiac Death in the Emergency Department: Overcoming Clinical, Legal, and Ethical Concerns,” is co-authored by Michael Dailey, MD, Sean P. Geary, MD, Stefan Merrill, MD, and Marleen Eijkholt, PhD.
Background: In light of the growing gap between candidates for organ donation and the actual number of organs available, we present a unique case of organ donation after cardiac death. We hope to open a discussion regarding organ procurement from eligible donors in the prehospital and emergency department setting.
Case: This case study, involving an otherwise healthy man who, after suffering an untimely death, was able to successfully donate his organs, highlights the need to develop an infrastructure to make this type of donation a viable and streamlined option for the future.
Discussion: Given the departure from traditional practice in United States transplantation medicine, we bring forth legal and ethical considerations regarding organ donation in the emergency department. We hope that this case discussion inspires action and development in the realm of transplant medicine, with the aim of honoring the wishes of donors and the families of those who wish to donate in a respectful way, while using our medical skills and technologies to afford candidates who are waiting for organs a second chance.
Conclusions: We believe that this case shows that donation after cardiac death from the emergency department, while resource-intensive is feasible. We recognize that in order for this to become a more attainable goal, additional resources and systems development is required.
The full article text is available on the ScienceDirect website (MSU Library or other institutional access may be required to view this article).
Center Assistant Professor Dr. Devan Stahl has an article in the March 2017 issue of the Journal of Medical Humanities, titled “Caretaking through Art: A Sibling Story.” The article is co-authored by artist Darian Goldin Stahl, Dr. Stahl’s sister.
Available online first on October 1, 2016, the article is now published in a special issue of the journal: “Caregiving, Kinship, and the Making of Stories” (edited by Carol Schilling and Mark Osteen). The article is available in full on the Springer website (MSU Library or other institutional access may be required to view this article).
Read more about Dr. Stahl and Darian Goldin Stahl’s work together: Seeing illness in art and medicine: a patient and printmaker collaboration.
A commentary by Center Assistant Professor Dr. Laura Cabrera was recently published in AJOB Neuroscience, titled “Is External Pressure Really the Key Objection Against Neurosurgery for Imprisoned Psychopaths?”
Dr. Cabrera addressed two main issues contained in Dietmar Hübner and Lucie White’s argument found in their research article “Neurosurgery for Psychopaths? An Ethical Analysis.” The first one regarding the claim that employing deep brain stimulation (the technique that Hübner and White focused on) for forensic purposes is still “in an early phase of design and discussion.” The second addressing Hübner and White’s claim regarding voluntary informed consent. In particular, Dr. Cabrera argues that the issue of external pressure is not a key objection to support that psychopaths’ informed consent is not voluntary.
Dr. Cabrera’s commentary is available to read online through Taylor & Francis Online.