Tag: bioethics

In a modern day Typhoid Mary case, Arizona has opted to quarantine a man infected with extreme drug resistant tuberculosis (XDR-TB) — in the local county hospital’s Ward 41, the section set aside for sick criminals. Robert Daniels has been locked up there since last summer, and is going to be there…indefinitely. He says that he’s being denied showers, has to clean with wet wipes, and has had his television, radio, personal phone and computer, etc, removed. He is effectively in solitary confinement, visited only by the medical personal who make sure he takes his medication. And I have to wonder — this really the least restrictive method of protecting the public? While I can understand having to remove someone who’s a serious threat to the community during treatment, is (effectively) a jail cell the appropriate place? Why do the Phoenix hospitals not have isolation rooms outside their criminal ward? What are they planning on doing during a major outbreak of any massively contagious disease — toss out the inmates and take over the cells? And why is he being denied a television, radio, personal phone and computer, and etc? It’s not like XDR-TB is going to attach itself to an email and infect the world…

There is an interesting discussion of a ruling by the European Court on Human Rights in this article by Jerome Amir Singh that suggests how to determine if forced quarantine and isolation are reasonable and justified measures (a topic Matthew Wynia wrote on in the January issue of AJOB). The courts ruled with the applicant in a Swedish case where the public health officials wanted to lock up a man who’d spread HIV after being told (basically) to knock it off, saying that “any such detention must be in compliance with both the principle of proportionality and the requirement that there be an absence of arbitrariness such that other less severe measures have been considered and found to be insufficient to safeguard the individual and the public.”

The Arizona XDR-TB case is clearly flunking some of the most basic requirements of confinement for a public health matter. Singh (et al) say that

The use of legally sanctioned restrictive measures for the control of XDR-TB should not obscure the fact that being infected is not a crime. A strong reciprocal obligation is borne by authorities so wishing to invoke these measures. Those who are isolated require humane and decent living conditions. In fact the restriction of their liberties is more for a collective good than for their own. Thus every effort must be made to ensure conditions of living that preserve dignity.

I’m pretty sure being locked up in a cell, no human contact, no mirror, no shower, no forms of entertainment, etc, for an indefinite period of time, is about the furthest you can possibly get from preserving dignity.

-Kelly Hills

Originally posted on the American Journal of Bioethics Editors Blog.

Not to be left out of the recent slew of video posts, I offer “Hold Your Breath”, a new film from the Program in Bioethics and Film at Stanford’s Center for Biomedical Ethics (whew, long title). A documentary by Maren Grainger-Monsen, Hold Your Breath looks at multi-cultural miscommunication in medicine. From the website,

After fleeing Afghanistan in 1979, Mohammad Kochi settled in Fremont, California and raised his family. Just when life seems to be getting easier for Kochi, he is diagnosed with an aggressive, life-threatening cancer. When Mr. Kochi rejects chemotherapy and instead embarks on a pilgrimage to Mecca, his doctor fears that family members acting as interpreters have misinformed Kochi about the gravity of his disease.Meanwhile, Kochis daughter, Noorzia, blames a culturally insensitive health care system for her fathers rapidly declining health.

This haunting documentary exposes the poignant clash between ancient Islamic traditions and contemporary medical technology through intimate moments of anguish, frustration and hope.

There are screenings across the country, and select PBS stations will also be airing the documentary this month. For those of us unlucky enough to live in markets without either, a short video clip can be seen here.

[With thanks to Rebecca Garden and Audrey Schafer!] — Kelly Hills
[and thanks for the heads up from Maren Grainger-Monsen! – Glenn]

Originally posted at the American Journal of Bioethics Editors Blog.

An article in the late February issue of Time Magazine on evidence-based medicine and why it might be a bad thing for doctors to fully rely on it reminded me of what has to be my hands-down favourite journal article, ever. Now four years old, it’s critique of evidence-based medicine is still one of the sharpest I’ve ever seen. From the BMJ website: Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials.

A Dr. Gordon Smith and Ms. Jill Pell decided to “determine whether parachutes are effective in preventing major trauma related to gravitational challenge,” utilizing prominent sources to analyze the data available, sans any actual randomized trial. Their conclusion is an argument I’ve heard against evidence-based medicine many times now, but never quite so succinctly as this:

As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

– Kelly Hills

[ed: please welcome guest blogger Kelly Hills, student in the Alden March Bioethics Institute MS in Bioethics program and doctoral student in the AMBI joint degree program being “taught out” by Albany Med/UGC and UAlbany Department of Philosophy; Kelly blogs for the Women’s Bioethics Project blog as well as keeps her own blog about ‘academia as an extreme sport’, chronicles of the [mis]adventures of an academic in training to work in bioethics. She is also working at AMBI in the Scholar slot and recently co-authored a Nature Medicine review essay on transplantation in the black communities of America. Welcome Kelly, who joins Stuart Rennie, John Robertson and others along with your editors.]

Originally posted at the American Journal of Bioethics Editors Blog.

South Carolina appears poised on the brink of approving legislation that will require women to view ultrasound images prior to abortion. While all three (yes, that’s right, all three) abortion clinics in South Carolina perform ultrasounds to determine the age of the fetus, the law would require women to view the images, with the probable exemption of rape and incest victims.

Why? According to the bill’s sponsor, Republican Rep. Greg Delleney,

She can determine for herself whether she is carrying an unborn child deserving of protection or whether its just an inconvenient, unnecessary part of her body and an abortion fits her circumstances at that time.

South Carolina law already requires the ultrasound, as well as doctor counseling of the age and development of the fetus, as well as alternatives to abortion. This is nothing more than a bald-faced attempt at intimidation and emotional manipulation of someone who is already in a vulnerable position.

The thing that baffles me the most is, what? You’re going to suddenly see an ultrasound image and decide that no, all the reasons you have for an abortion have flown out the window, and really it’s a great time to be a mother, hooray? Are we suddenly going to see social services increase in funding? Are we going to have outstanding health care, job retraining, free and good state-sponsored child-sitting services? Is South Carolina going to suddenly take away every single obstacle that exists to bearing and caring for a child, so that the only barrier remaining is whether or not a woman thinks this is the right time for her, without consideration to financial/economic concerns?

Yeah, that’s what I thought.
-Kelly Hills

Originally posted on the American Journal of Bioethics Editors Blog.

This week, Time’s senior religion writer David Van Biema looks at whether or not there is a case to be made for secular education of the Bible and whether or not there is a place for Biblical literacy, especially in our high schools.

Van Biema interviewed Boston University’s Stephen Prothero, who gives one of the more convincing reasons why it actually would be a good idea to have this secular edudcation:

In the late ’70s, [students] knew nothing about religion, and it didn’t matter. But then religion rushed into the public square. What purpose could it possibly serve for citizens to be ignorant of all that?

The ignorance — ignorance that Van Biema notes is as problematic with self-described evangelicals as it is with anyone else — leads us to a place where people are unable to critically examine public policy platforms for their hidden religious agenda. This has been on my mind lately, given that a lobbyist for a large and influential religious group freely admitted to me and the students we were talking to that part of her job is to remove the religion from the policy she lobbies for — that is, she (and many people with the same job across this country) is specifically trying to advance her religious group’s beliefs via secular language.

It’s a hidden agenda, one that favours secrecy to get what one wants, couched in language that tries to mask religious belief for social concern and looking out for the best interest in society. And we need to give people the critical skills to examine platforms for these hidden agendas — and without a familiarity in the religious texts that are driving the agenda, the goal seems lost.

-Kelly Hills

Originally posted at the American Journal of Bioethics Editors Blog.