blog.bioethics.net

a Nature Top 50 science blog from the American Journal of Bioethics

"Just Say No!" To Organs from Suicide Victims?

According to Wesley Smith on his SHS blog, "Suicidal people need help in living, not reasons to die." Profound statement indeed. Yet, Smith goes on, "to prevent people from using the pretext of organ harvesting as a justification for their suicides, we need to make it very clear that their organs will not be so used..." and therefore the organ transplant community must come out against the use of organs suitable for transplant from those who have terminated their lives.

Smith's argument amounts to little more than a call for OPOs to "Take a Stand Against Suicide!" yet ignores the fact that tens of thousands die each year waiting for an organ. Those who die waiting on a transplant list have no other choice they can make--and yet those opting for suicide, as sad and troubling as that choice may be, can benefit those who are suffering in organ failure.

And while it would be truly disturbing if a person willingly killed him- or herself to provide organs to others, this mentally disturbed individual opting for suicide for all the wrong reasons would, I'm certain, be rare indeed.. For those individuals who are so beset by mental anguish, pain and other symptoms that they want no longer to live for these reasons in and of themselves, there can be no good reason why organs harvested and given to others would be morally objectionable. While such suicides are a tragedy, should we simply compound the harm of that choice by denying those suffering from organ failure the chance to live?

Show me the data that says those committing suicides are actively thinking about the organ recipients they could benefit, and then we can talk, Wesley. Otherwise, your argument is nothing but simple moralizing and judgmental thinking about the suicidal dressed up in concern for their welfare.

Summer McGee, PhD

This April in AJOB: Research Subjects as Problems and Mandatory HIV Testing

Today, the April issue of The American Journal of Bioethics is now online.

This month, the journal features two target articles addressing controversial ideas--one in the world of clinical research, the other in the worlds of healthcare and public health.

As Sarah Edwards explains in her Target Article, "Assessing the Remedy: The Case for Contracts in Clinical Trials", one of the biggest problems for getting adequate clinical trial data is the freedom of research participants to withdraw at any time. She argues, provocatively, that contracts for clinical trial participants might address this issue--and still be ethical.

Celada et al raise the issue in their Target Article as to whether mandatory HIV testing for healthcare workers can be morally justified. Their analysis of the 2006 CDC recommendations regarding said testing concludes that "opt-out" HIV testing in healthcare settings is not morally problematic itself, but that there are important issues regarding implementation and procedure that could raise such issues and that must be anticipated and handled appropriately.

To read more about these important health care and research issues, visit bioethics.net.

Summer Johnson McGee, PhD

Also, stay tuned for next month when AJOB launches its new current topics in bioethics column "Trending"!

Women's Health Shouldn't Be Partisan--But It Is!

As Donna Shalala writes on the Huffington Post today: "health of our women should not be a partisan preference", but as we all know the politics of women's health continues to plague access to reproductive health services, equitable access to health services generally, and more broadly remind us that there is still a critical gap between males and females in regard to health in our country.

So why is it a partisan issue? Because women's health is so frequently reduced to reproductive health (read: abortion) and because what is easier to ignore than HIV testing and contraceptives for the conservatives who believe that neither would be necessary if we abstained from those behaviors that require them.

But women's health, as Shalala points out, is so much more than the health of ovaries and hormones. Cardiovascular health, BMI, and mental health are critical aspects of women's health. Healthy hearts, healthy weight and healthy minds are non-partisan and should not be the exclusive domain of men. Equity matters and depoliticizing women's health matters most of all.

Summer Johnson McGee, PhD

Religious Belief Makes You Fat?

According to a story in the L.A. Times Booster Shots blog, it would appear that religious belief is strongly correlated with packing on the pounds. Perhaps it's all those church picnics with fried chicken and potato salad.

According to data presented at the American Heart Association's meeting in Atlanta this week, younger adults who score high for religiosity were 50% more likely to be obese at mid-life compared to those low on the religious belief scale. Even controlling for some of the most important biological and social determinants for obesity (race, education, income and initial BMI), the relationship remains.

Of course, this isn't an argument against religious belief or even an argument that religion is hazardous to your health. It's a correlation. But the important question is what OTHER features of those who are highly religious result in obesity later in life? There is some causal factor that we just don't understand yet.

But based on this data you can bet that there's going to be an easy way to read the Bible on the treadmill coming your way soon or perhaps a merging of Bible study with Weight Watchers meetings.

Summer Johnson McGee, PhD

Paul Root Wolpe Talks @ TED

According to AJOB Neuroscience Editor, Paul Root Wolpe, it's time to question the bioengineering of animals, our brains and more. Check it out.

Summer Johnson McGee, PhD

Caplan's Legal Liability for Lax Vaccination

This week Arthur Caplan has made a highly provocative argument in his MSNBC Breaking Bioethics column: Anyone harmed by the New Mexico woman who had measles while traveling on an airplane should sue her for damages. Why? Because her infectious disease could have been easily prevented had she opted for a vaccine.

Ultimately, I'm not sure whether Caplan is advocating a simple "duty to vaccinate" argument or whether there is something special about measles that would not apply to influenza, meningitis, varicella, or even HPV vaccines. If this is a broad sweeping argument, the duty to vaccinate against all infectious diseases is likely to meet with considerable criticism from the anti-vaccination crowd.

But i'm also not sure that Caplan is wrong. Particularly for highly infectious diseases like measles, this seems right. Plus, he's going to make a lot of lawyers very very rich if they heed his arguments.

To read the column, click here.

Summer Johnson McGee, PhD

Docs Who Give Bad Tweet: Unprofessional or Just Uneducated?

Social networking among physicians is raising concerns for a variety of obvious reasons--it challenges our standard ways of thinking about the physician-patient relationship which for the most part has been confined to the exam room. Now social networks open up physicians and patients to each other in entirely new ways--some of which researchers suggest are not altogether positive.

According to a recent study published in the February 9th issue of JAMA, out of "5,156 "tweets" sent by 260 U.S. physicians, each with 500 or more followers, last May, researchers found that 3 percent were unprofessional." (See story at Businessweek.com)

What does this really mean? Approximately 150 tweets, less than 1 tweet per physician on average, contained content that was profane, sexually explicit, discriminatory, or potentially violating of patient privacy. This is problematic, of course, on its face. But what truly matters however is whether among these 260 twittering physicians is whether there were just a few bad eggs who repeatedly were unprofessional or was it in fact that more than half of the sample unprofessionally tweeted?

This matters because we all know that a few outliers can really skew a sample based on percentages. Moreover, there is nothing to suggest that these docs are truly bad eggs--perhaps they are just uneducated about Twitter, how to use it, and what the bounds of professional conduct are for social networking. The first profession-wide standard for social networking was just released by the AMA in late 2010.

Moreover, what has to be distinguished is whether these Twitter users were posting tweets in a professional capacity, or it just so happened that they could be identified as physicians who ALSO had a Twitter account. I do not think that the authors of the JAMA article would want to argue that all physicians must act with propriety at all times. To suggest such would mean that a doctor could never tell or hear a dirty joke among friends or drink alcohol to excess simply because he or she is a doctor. What matters for Twitter and other social networking sites is whether the user is online qua physician or simply as him or herself and how that activity effects their professional lives.

Thus, what matters is WHO is reading their tweets. Twitter, unlike Facebook, is much more difficult to manage in terms of knowing people's true identities and thus who is "following" whom. Patients who "follow" their doctors on Twitter may do so under an alias a physician may never be able to recognize. Then if patients read inappropriate posts (regardless of whether the doctor was tweeting in a professional or personal capacity), it could create a rift in the physician-relationship for which the physician cannot be held responsible. This is perhaps the biggest moral issue with physicians using Twitter--but it is not captured by estimating that 3% of some portion of physicians on Twitter post inappropriate material. Whether patients see that material or not is a much bigger problem--and one for which we do not have a way to answer.

Without massive efforts to education physicians about how to use social media appropriately, there are bound to be violators of medical professionalism and ethics. But I don't think we should hold physicians' feet to the fire just yet about their lack of professionalism online--not until we have had ample opportunity to teach them about the boundaries between the professional and the personal online, how social networking can both benefit and harm the physician-patient relationship, and until we know more about whether this problem is the result of just a few uninformed or inappropriate Twitterers or is endemic to physicians in the world social networking.

Summer McGee, PhD

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