Case 10 Culture (16June)

Your last case! Make good arguments!  Use your theories and readings, especially Macklin, to help you assess the case.

Case 13 Cochlear Implants (16June)

Is making a child hearing something that ought to happen, or something that the parents can ethically choose not to do?  Should parents be forced to authorize the surgery?  What the best analogy:  Is being hearing-impaired like having a cleft palate?  Like having a cosmetic birth defect?  Like not being immunized?  Like a boy not being circumcised?  Use your ethical theories and your readings to give rich, thoughtful responses and challenge each other.

Reflections on Philosophy & Ethics (16June)

Please comment on at least several if not all of these questions -- use separate posts if you like.   

• What have you learned in this course that surprised you?
• Would you take another course in philosophy if money/time weren't major barriers?  
• Do you have an understanding of the philosophical dimensions of the study of biomedical ethics?
• Have you developed an appreciation for the relevance of metaphysical, epistemological, and ethical questions in our daily lives?
• Have you improved in your skills of analysis and critique, as well as in written and oral communication due to this course?

Final Essays: thinking out loud (16 June)

An excerpt from your final exam to collectively consider here.  Respond to at least two of the points below:

v  How do you define health?

v  What does your ideal health care system look like? (Briefly sketch it out—what kinds of services should it provide?  Who is covered?  How is it paid for?).  You might consider what you saw in the Emperor of All Maladies -- the cost of treatment for cancer, and other high costs associated with medical care (we've seen some stories about it in our Current Events blog).

v  Kai Nielsen writes:  “If there is the need for some particular regime of care and the society has the resources to meet that need, without undermining structures protecting other at least equally urgent needs, then, ceteris parabus, the society if it is a decent society, must do so” (p. 652).  Do you agree with Nielsen?  Does his argument apply to the U.S.?  Explain.  Can a just society refuse to provide health care to all of its citizens?  Is health care a right, and if so, what kind?  For whom is it a right (citizens, military, the elderly, children, all, none?). 

June Current Events

Me & Earl & the Dying Girl -- a film review
http://www.nytimes.com/2015/06/12/movies/review-in-me-and-earl-and-the-dying-girl-a-comfort-zone-that-cannot-last.html?hpw&rref=movies&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

Brain Tumor’s Genetic Makeup Critical in Treatment, Research Finds
http://www.nytimes.com/2015/06/11/health/brain-tumors-genetic-makeup-critical-in-treatment-research-finds.html?

Saving Affordable Health Insurance - NYTimes.com
http://mobile.nytimes.com/2015/06/10/opinion/saving-affordable-health-insurance.html?referrer=

Federal Panel Backs Approval of New Drug to Fight Heart Attacks - NYTimes.com
http://mobile.nytimes.com/2015/06/10/health/cholesterol-levels-ldl-drugs-heart-attacks-fda-panel.html?emc=edit_th_20150610&nl=todaysheadlines&nlid=25414714&_r=0&referrer=
More genetics at work!

Global Diabetes Rates Are Rising as Obesity Spreads - NYTimes.com
http://mobile.nytimes.com/2015/06/08/health/research/global-diabetes-rates-are-rising-as-obesity-spreads.html?referrer=
Related to our HC Elsewhere

Blood Pressure Pills and Antidepressants Are Surprisingly Effective Against Ebola — NOVA Next | PBS
http://www.pbs.org/wgbh/nova/next/body/blood-pressure-pills-and-antidepressants-are-surprisingly-effective-against-ebola/?utm_source=facebook&utm_medium=pbsofficial&utm_campaign=nova_nextBy combing through already approved drugs, NIH researchers have stumbled upon a number of potentially effective Ebola fighters.

Finland is really good at keeping babies alive. Here's one reason why.
http://www.upworthy.com/finland-is-really-good-at-keeping-babies-alive-heres-one-reason-why?c=ufb1Parenting is really hard. Finland knows how to make it slightly easier.

Nigeria Female Genital Mutilation Outlawed
http://nigeria.aplus.com/a/nigeria-bans-genital-mutilation?utm_campaign=i102&utm_source=a61196&so=NdGYunjJqQgTHhSe734wxE&ref=ns"More than 130 million girls and women have experienced female genital mutilation or cutting ..."  Related to our Macklin reading for next week.

Rochelle Shoretz, Founder of Cancer Support Group, Dies at 42 - NYTimes.comhttp://mobile.nytimes.com/2015/06/03/nyregion/rochelle-shoretz-founder-of-cancer-support-group-dies-at-42.html?nlid=25414714&src=recpb&_r=0&referrer=
Related to Emperor of All Maladies videos.

The Health Care Supreme Court Case: Who Would Be Affected? - NYTimes.com
Sort of a Q&A about what could happen in the upcoming decision. Are you concerned about the pending decision?  Why?

http://www.nytimes.com/interactive/2015/03/03/us/100000003546814.mobile.html

Reflections on Facing Death film (16June)

Thinking about death & dying is philosophical thinking:  who am I? what will happen to me after I die?  what gave my life meaning, etc.  It can also give us a way to think holistically about biomedical ethics.  What did you see in the video that relates to class?  Are we fully addressing the needs of dying patients?  Critique our health care system:  what could we be doing better with respect to the dying?

Emperor of All Maladies (9June)

Watch at least the final episode, which discusses genetics.  Note what surprised you (in that or any episode -- be sure to explain clearly what episode & segments you are referencing)?  How does what you are viewing in the videos relate to what you've read for this week?  Be specific -- use examples from the videos and specific passages/quotes from the readings. (you might need to jot down notes while you are watching the videos for better recall)

Case 34 on Huntington's (9June)

For this case you *must* argue a position you disagree with.  On your honor!  Give your best argument for the position with which you disagree the most.  Use your ethical theories to help you.  Respond to at least 2 of your classmates -- keep them honest and make them work to defend their positions.  Good luck!

Follow-up/Ongoing conversation

I'm going to try this new post as a way to respond holistically to the prior week's posts.  Since I'm reading them after you've all posted, I'm missing the opportunity to be in the conversation and give feedback.  That's a problem with the asynchronous nature of online and especially blogging.  I'll date my responses so you know where I am and then we can try next week to have a meta-conversation about what we're learning and how our ideas about these topics in biomedical ethics are evolving.

So, some follow-up points.  29 May 15
1. Re: vulnerable patients and research.  I agree that vulnerable populations should only be involved in research if care is made to safeguard them.  But could you elaborate on informed consent?  If you're concerned with impoverished people in developing countries, are you similarly concerned with the impoverished, uneducated here?  Do you see such people at work?  Do you take extra steps to make sure that they are sufficiently educated for real informed consent?

2. Re: Codes of Ethics
Cindy and/or Shirley: could you elaborate on how you see the Codes being manipulated?
Donna, Cindy, Sherry: Interesting that you bring up the Nazis.  Our codes were in place after WWII, but American doctors and researchers continued to violate them.  I suppose this is what some of you mean when you say that the Codes can be manipulated.  So is it still important to have the Codes?  What do they do?

Case 38 Delayed Twinning (2June)

Be sure to apply your theories and applicable readings when analyzing this case.  Some of you should play devil's advocate.

Genetics videos (2June)

Hopefully you have some basic knowledge about genetics, and just need a refresher. Here are some basic videos for refreshment!

Genetics overview from National Geographic
https://genographic.nationalgeographic.com/science-behind/genetics-overview/ 

https://www.23andme.com/gen101/genes

https://www.youtube.com/watch?v=CBezq1fFUEA

this video shows 18 things to know about genetic it is the basics!!

https://www.youtube.com/watch?v=bVk0twJYL6Y

This video is titled "basic introduction to genetics" Sorry the guy is super boring..

https://www.youtube.com/watch?v=BQjuSk1OM4U

Bill Nye The Science Guy: Genes

https://www.youtube.com/watch?v=jMzH9E_cnqU

Titled "What is a gene?" 
https://www.youtube.com/watch?v=5MQdXjRPHmQ

Titled "Where do genes come from?" 
https://youtu.be/z9HIYjRRaDE

This is a decent video about three basic topics in Genetics!
https://www.youtube.com/watch?v=dEanu74zHkI&spfreload=10

This guy did a pretty good job of explaining it:
https://www.khanacademy.org/science/biology/her/heredity-and-genetics/v/introduction-to-heredity

Case 15 (26May)

Argue a position you don't necessarily actually believe in. Someone please start the conversation by saying something provocative!

Case 12 HIV & surgery (26May)

Apply your readings and ethical theories to this case.  Challenge each other by taking a different ethical theory stance.

Process/Course Content (ongoing)

Questions about what's happening with the course?  Don't understand an assignment?  Ask here!

HIV/AIDS (26May)

After reading the "Don't Tell" essay (pp. 116-9) in your textbook, and watching the videos on HIV/AIDS, discuss any of the following (you don't all have to discuss the same issues):

• the ethics of needle-exchange
• http://www.nytimes.com/2015/05/17/us/surge-in-cases-of-hiv-tests-us-policy-on-needle-exchanges.html  
• reposted from "April Current Events on this blog": Rural Indiana Struggles to Contend With H.I.V. Outbreak - NYTimes.com
  
  A serious epidemic of HIV not too far away. Should Indiana step up treatment? Continue its needle-exchange program? How should we combat i.v. drug use, especially when it occurs across multiple generations within many families?
  http://mobile.nytimes.com/2015/05/06/us/rural-indiana-struggles-to-contend-with-hiv-outbreak.html
   
• what is your obligation as a health-care professional to the dignity & protection/confidentiality of all, but especially vulnerable, patients like IV-drug users, homosexuals, prisoners, etc.?

• public health, especially protecting the blood supply
• http://www.npr.org/sections/codeswitch/2014/12/24/370937993/new-blood-donation-rules-would-still-exclude-many-gay-men 
• http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/QuestionsaboutBlood/ucm108186.htm 

Case 8: Nurse & Informed Consent (26May - for attendance)

Using your readings on informed consent, discuss this case and the questions at the end of the write-up.  Respond to at least 2 of your classmates.

Codes of Ethics (26May)

 What strikes you about the codes of ethics for research on human subjects?  What weren't you expecting?

After you read the Codes of Ethics in your text, look at your own Nursing Code of Ethics.  The Codes in your text relate to research on human subjects, but there is some overlap with your professional code of ethics.  Also look at the Hippocratic Oath.  Where's the overlap between all those?

Research on Human Subjects (26/27May)

Discussion Questions:
Answer each of the following and respond to 2 other posts by 27 May.
1) Regarding our readings on research with human subjects, do you think that these clinical trials on human subjects are ethical, or not? Explain.  Just pick 1-2 examples from the readings.
2) How would you address each of the criticisms that Brody discusses? (Do you agree or disagree?)
3) Pick an ethical perspective analyzed in this course, and assess a case from that perspective.  For this question, whomever gets to it first, gets to pick the example case (from a reading) to discuss :)

May current events (starting after12May)

Doctor: So much health care not healthy  http://www.cincinnati.com/story/opinion/contributors/2015/05/26/doc-regions-health-spending-whack/27959139/

Cincinnati, you're not getting a lot of value for your health care spending. Billboards point to the reason.

Doctoring, Without the Doctor By SABRINA TAVERNISEMAY 25, 2015http://www.nytimes.com/2015/05/26/health/rural-nebraska-offers-stark-view-of-nursing-autonomy-debate.html?emc=edit_th_20150526&nl=todaysheadlines&nlid=25414714&_r=0
A story about nurse practitioners in the rural West.

Review: ‘The Farewell Party’ Finds Laughs in Euthanasia - NYTimes.com
http://mobile.nytimes.com/2015/05/22/movies/review-the-farewell-party-finds-laughs-in-euthanasia.html?referrer= 

Map Reveals The Distinctive Cause Of Death In Each Statehttp://www.npr.org/sections/health-shots/2015/05/20/408011861/map-reveals-the-distinctive-cause-of-death-in-each-state  

Debating the Complications Involved in Saving Preemies - NYTimes.com
http://mobile.nytimes.com/2015/05/16/health/debating-whether-preemies-are-worth-fighting-for.html?referrer=

Rise in Suicide by Black Children Surprises Researchers - NYTimes.com

http://mobile.nytimes.com/2015/05/19/health/suicide-rate-for-black-children-surged-in-2-decades-study-says.html?referrer=

 
Review: In ‘Do No Harm,’ a Brain Surgeon Tells All - NYTimes.com
http://mobile.nytimes.com/2015/05/19/books/review-in-do-no-harm-a-brain-surgeon-tells-all.html?referrer=

Antibiotics Resurface as Alternative to Removing Appendix - NYTimes.com

http://mobile.nytimes.com/2015/05/19/health/antibiotics-resurface-as-alternative-to-removing-appendix.html?referrer=

 
The Case for Black Doctors - NYTimes.com

 http://mobile.nytimes.com/2015/05/17/opinion/sunday/the-case-for-black-doctors.html?referrer

The Last Day of Her Life - NYTimes.com

http://mobile.nytimes.com/2015/05/17/magazine/the-last-day-of-her-life.html?referrer=

When Sandy Bem found out she had Alzheimer’s, she resolved that before the disease stole her mind, she would kill herself. The question was, when?
 
Needle Exchanges: helps stop spread of disease or encourages drug use?
http://mobile.nytimes.com/2015/05/17/us/surge-in-cases-of-hiv-tests-us-policy-on-needle-exchanges.html?referrer=

Ethics in research
http://mobile.nytimes.com/2015/05/13/business/data-disclosure-leads-researchers-to-end-study-of-obesity-drug.html?referrer=