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Khush KK, Bernat JL, Pierson RN, Silverman HJ, Parent B, Glazier AK, Adams AB, Fishman JA, Gusmano M, Hawthorne WJ, Homan ME, Hurst DJ, Latham S, Park CG, Maschke KJ, Mohiuddin MM, Montgomery RA, Odim J, Pentz RD, Reichart B, Savulescu J, Wolpe PR, Wong RP, Fenton KN. Research opportunities and ethical considerations for heart and lung xenotransplantation research: A report from the National Heart, Lung, and Blood Institute workshop. Am J Transplant 2024:S1600-6135(24)00211-9. [PMID: 38514013 DOI: 10.1016/j.ajt.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/10/2024] [Indexed: 03/23/2024]
Abstract
Xenotransplantation offers the potential to meet the critical need for heart and lung transplantation presently constrained by the current human donor organ supply. Much was learned over the past decades regarding gene editing to prevent the immune activation and inflammation that cause early organ injury, and strategies for maintenance of immunosuppression to promote longer-term xenograft survival. However, many scientific questions remain regarding further requirements for genetic modification of donor organs, appropriate contexts for xenotransplantation research (including nonhuman primates, recently deceased humans, and living human recipients), and risk of xenozoonotic disease transmission. Related ethical questions include the appropriate selection of clinical trial participants, challenges with obtaining informed consent, animal rights and welfare considerations, and cost. Research involving recently deceased humans has also emerged as a potentially novel way to understand how xeno-organs will impact the human body. Clinical xenotransplantation and research involving decedents also raise ethical questions and will require consensus regarding regulatory oversight and protocol review. These considerations and the related opportunities for xenotransplantation research were discussed in a workshop sponsored by the National Heart, Lung, and Blood Institute, and are summarized in this meeting report.
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Affiliation(s)
- Kiran K Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
| | - James L Bernat
- Department of Neurology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Richard N Pierson
- Department of Surgery and Center for Transplantation Sciences, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Henry J Silverman
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Brendan Parent
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Alexandra K Glazier
- New England Donor Services, Waltham, Massachusetts, USA; School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Andrew B Adams
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jay A Fishman
- Transplant Infectious Disease and MGH Transplant Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Gusmano
- College of Health, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Wayne J Hawthorne
- Department of Surgery, Westmead Hospital, University of Sydney, Westmead, New South Wales, Australia
| | - Mary E Homan
- Department of Theology and Ethics, CommonSpirit Health, Chicago, Illinois, USA
| | - Daniel J Hurst
- Department of Family Medicine, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Stephen Latham
- Interdisciplinary Center for Bioethics, Yale University, New Haven, Connecticut, USA
| | - Chung-Gyu Park
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Muhammad M Mohiuddin
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robert A Montgomery
- NYU Langone Transplant Institute, NYU Langone Health, New York, New York, USA
| | - Jonah Odim
- Transplantation Branch, Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Rebecca D Pentz
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bruno Reichart
- Department of Cardiac Surgery, Ludwig-Maximillian University, Munich, Germany
| | - Julian Savulescu
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul Root Wolpe
- Center for Ethics and Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Renee P Wong
- Heart Failure and Arrhythmias Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kathleen N Fenton
- Advanced Technologies and Surgery Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, and Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Rahimzadeh V, Fogarty J, Caulfield T, Auñón-Chancellor S, Borry P, Candia J, Cohen IG, Covington M, Lynch HF, Greely HT, Hanlon M, Hatt J, Low L, Menikoff J, Meslin EM, Platts S, Ravitsky V, Ruttley T, Seidler RD, Sugarman J, Urquieta E, Williams MA, Wolpe PR, Donoviel D, McGuire AL. Ethically cleared to launch? Science 2023; 381:1408-1411. [PMID: 37769066 DOI: 10.1126/science.adh9028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Rules are needed for human research in commercial spaceflight.
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Affiliation(s)
- Vasiliki Rahimzadeh
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer Fogarty
- Translational Research Institute for Space Health, Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Timothy Caulfield
- Faculty of Law and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jessica Candia
- Component Office of Human Research Protections, Air Force Medical Readiness Agency, Department of the Air Force, Falls Church, VA, USA
| | - I Glenn Cohen
- The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, Cambridge, MA, USA
| | - Marisa Covington
- Office of Research Assurance, Office of the Chief Health and Medical Officer, National Aeronautics and Space Administration, Houston, TX, USA
| | - Holly Fernandez Lynch
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Henry T Greely
- The Center for Law and the Biosciences, Stanford University, Stanford, CA, USA
| | - Michelle Hanlon
- Center for Air and Space Law, University of Mississippi, Oxford, MS, USA
| | - James Hatt
- Space Policy Division, Office of Commercial Space Transportation, Federal Aviation Administration, Washington, DC, USA
| | | | - Jerry Menikoff
- Centre for Biomedical Ethics, National University of Singapore, Republic of Singapore
| | | | - Steven Platts
- Human Research Program, NASA Johnson Space Center, Houston, TX, USA
| | - Vardit Ravitsky
- School of Public Health, University of Montreal, Montreal, Canada
- Harvard Medical School, Boston, MA, USA
| | | | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Jeremy Sugarman
- Berman Institute of Bioethics and Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Emmanuel Urquieta
- Translational Research Institute for Space Health, Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Michael A Williams
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Dorit Donoviel
- Translational Research Institute for Space Health, Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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Martin DE, Harris DCH, Jha V, Segantini L, Demme RA, Le TH, McCann L, Sands JM, Vong G, Wolpe PR, Fontana M, London GM, Vanderhaegen B, Vanholder R. Ethical challenges in nephrology: a call for action. Nat Rev Nephrol 2020; 16:603-613. [PMID: 32587403 DOI: 10.1038/s41581-020-0295-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 12/14/2022]
Abstract
The American Society of Nephrology, the European Renal Association-European Dialysis and Transplant Association and the International Society of Nephrology Joint Working Group on Ethical Issues in Nephrology have identified ten broad areas of ethical concern as priority challenges that require collaborative action. Here, we describe these challenges - equity in access to kidney failure care, avoiding futile dialysis, reducing dialysis costs, shared decision-making in kidney failure care, living donor risk evaluation and decision-making, priority setting in kidney disease prevention and care, the ethical implications of genetic kidney diseases, responsible advocacy for kidney health and management of conflicts of interest - with the aim of highlighting the need for ethical analysis of specific issues, as well as for the development of tools and training to support clinicians who treat patients with kidney disease in practising ethically and contributing to ethical policy-making.
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Affiliation(s)
- Dominique E Martin
- School of Medicine, Deakin University, Geelong Waurn Ponds Campus, Geelong, VIC, Australia.
| | - David C H Harris
- University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Vivekanand Jha
- George Institute for Global Health, UNSW, New Delhi, India
- University of Oxford, Oxford, UK
- Manipal Academy of Higher Education, Manipal, India
| | - Luca Segantini
- International Society of Nephrology, Brussels, Belgium
- European Society for Organ Transplantation - ESOT c/o ESOT, Padova, Italy
| | - Richard A Demme
- Renal Division and Department of Medical Humanities and Bioethics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Thu H Le
- Nephrology Division, Department of Medicine, University of Rochester School of Medicine, Rochester, NY, USA
| | - Laura McCann
- American Society of Nephrology, Washington, DC, USA
| | - Jeff M Sands
- Renal Division, Emory University School of Medicine, Atlanta, GA, USA
| | - Gerard Vong
- Center for Ethics, Emory University, Atlanta, GA, USA
| | | | - Monica Fontana
- European Renal Association - European Dialysis and Transplant Association, Parma, Italy
| | - Gerard M London
- Manhes Hospital, Nephrology Department GEPIR, Fleury-Mérogis, France
| | | | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, University Hospital, Corneel Heymanslaan 10, B9000, Gent, Belgium
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Antommaria AHM, Gibb TS, McGuire AL, Wolpe PR, Wynia MK, Applewhite MK, Caplan A, Diekema DS, Hester DM, Lehmann LS, McLeod-Sordjan R, Schiff T, Tabor HK, Wieten SE, Eberl JT. Ventilator Triage Policies During the COVID-19 Pandemic at U.S. Hospitals Associated With Members of the Association of Bioethics Program Directors. Ann Intern Med 2020; 173:188-194. [PMID: 32330224 PMCID: PMC7207244 DOI: 10.7326/m20-1738] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has or threatens to overwhelm health care systems. Many institutions are developing ventilator triage policies. OBJECTIVE To characterize the development of ventilator triage policies and compare policy content. DESIGN Survey and mixed-methods content analysis. SETTING North American hospitals associated with members of the Association of Bioethics Program Directors. PARTICIPANTS Program directors. MEASUREMENTS Characteristics of institutions and policies, including triage criteria and triage committee membership. RESULTS Sixty-seven program directors responded (response rate, 91.8%); 36 (53.7%) hospitals did not yet have a policy, and 7 (10.4%) hospitals' policies could not be shared. The 29 institutions providing policies were relatively evenly distributed among the 4 U.S. geographic regions (range, 5 to 9 policies per region). Among the 26 unique policies analyzed, 3 (11.3%) were produced by state health departments. The most frequently cited triage criteria were benefit (25 policies [96.2%]), need (14 [53.8%]), age (13 [50.0%]), conservation of resources (10 [38.5%]), and lottery (9 [34.6%]). Twenty-one (80.8%) policies use scoring systems, and 20 of these (95.2%) use a version of the Sequential Organ Failure Assessment score. Among the policies that specify the triage team's composition (23 [88.5%]), all require or recommend a physician member, 20 (87.0%) a nurse, 16 (69.6%) an ethicist, 8 (34.8%) a chaplain, and 8 (34.8%) a respiratory therapist. Thirteen (50.0% of all policies) require or recommend that those making triage decisions not be involved in direct patient care, but only 2 (7.7%) require that their decisions be blinded to ethically irrelevant considerations. LIMITATION The results may not be generalizable to institutions without academic bioethics programs. CONCLUSION Over one half of respondents did not have ventilator triage policies. Policies have substantial heterogeneity, and many omit guidance on fair implementation. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Armand H Matheny Antommaria
- Ethics Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, University of Cincinnati School of Medicine, Cincinnati, Ohio (A.H.A.)
| | - Tyler S Gibb
- Program in Medical Ethics, Humanities & Law, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan (T.S.G.)
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas (A.L.M.)
| | - Paul Root Wolpe
- Center for Ethics and School of Medicine, Emory University, Atlanta, Georgia (P.R.W.)
| | - Matthew K Wynia
- University of Colorado Center for Bioethics and Humanities, Schools of Medicine and Public Health, and UC Health System, Aurora, Colorado (M.K.W.)
| | - Megan K Applewhite
- Alden March Bioethics Institute and Department of Surgery, Albany Medical College, Albany, New York (M.K.A.)
| | - Arthur Caplan
- Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York (A.C., T.S.)
| | - Douglas S Diekema
- Departments of Pediatrics and Bioethics & Humanities, University of Washington School of Medicine, Seattle, Washington, Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington (D.S.D.)
| | - D Micah Hester
- Department of Medical Humanities & Bioethics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas (D.M.H.)
| | - Lisa Soleymani Lehmann
- VA New England Healthcare System, Bedford, Massachusetts, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts (L.S.L.)
| | - Renee McLeod-Sordjan
- Division of Medical Ethics, Department of Medicine, Northwell Health System, New Hyde Park, New York, Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies, Hofstra University, Hempstead, New York (R.M.)
| | - Tamar Schiff
- Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York (A.C., T.S.)
| | - Holly K Tabor
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California (H.K.T., S.E.W.)
| | - Sarah E Wieten
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California (H.K.T., S.E.W.)
| | - Jason T Eberl
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, St. Louis, Missouri (J.T.E.)
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Abstract
Over time, ethical judgments evolve, but so do the phenomena they are applied to. For example, plagiarism is a modern concept. Before the early eighteenth century, works did not generally have references or acknowledgments, and ideas were freely exchanged. As writing became an occupation, copying others' words became "unethical." As cut and paste, music mash-up, and other technological forms of exchange make copying the works of others simple, the idea of plagiarism is eroding, and perhaps will eventually even be discarded. The same may be true with privacy. As with plagiarism, it was not really until the eighteenth century that our modern idea of privacy was established. To younger generations, raised on social media, online life is predicated on trading personal information for access. The undermining of former standards of privacy may suggest that privacy may also eventually become an outmoded concept.
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McGuire AL, Aulisio MP, Davis FD, Erwin C, Harter TD, Jagsi R, Klitzman R, Macauley R, Racine E, Wolf SM, Wynia M, Wolpe PR. Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force. Am J Bioeth 2020; 20:15-27. [PMID: 32511078 DOI: 10.1080/15265161.2020.1764138] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing policies for pandemics differ by institution, health system, and applicable law. Most seem to agree that a patient's ability to benefit from treatment and to survive are first-order considerations. However, there is debate about what clinical measures should be used to make that determination and about other factors that might be ethically appropriate to consider. In this paper, we discuss resource allocation and several related ethical challenges to the healthcare system and society, including how to define benefit, how to handle informed consent, the special needs of pediatric patients, how to engage communities in these difficult decisions, and how to mitigate concerns of discrimination and the effects of structural inequities.
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Affiliation(s)
| | | | - F Daniel Davis
- Center for Translational Bioethics and Health Care Policy
| | | | | | | | | | | | - Eric Racine
- Institut de recherches cliniques de Montréal, Université de Montréal, McGill University
- McGill University
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8
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Wolpe PR. Neuromarketing and AI-Powerful Together, but Needing Scrutiny. AJOB Neurosci 2019; 10:69-70. [PMID: 31225785 DOI: 10.1080/21507740.2019.1618414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/08/2019] [Indexed: 06/09/2023]
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Rommelfanger K, Jeong SJ, Ema A, Fukushi T, Kasai K, Ramos K, Salles A, Singh I, Amadio J, Bi GQ, Boshears PF, Carter A, Devor A, Doya K, Garden H, Illes J, Johnson LSM, Jorgenson L, Jun BO, Lee I, Michie P, Miyakawa T, Nakazawa E, Sakura O, Sarkissian H, Sullivan LS, Uh S, Winickoff D, Wolpe PR, Wu KCC, Yasamura A, Zheng JC. Neuroethics Questions to Guide Ethical Research in the International Brain Initiatives. Neuron 2018; 100:19-36. [DOI: 10.1016/j.neuron.2018.09.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/28/2018] [Accepted: 09/11/2018] [Indexed: 01/20/2023]
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Wolpe PR. Emerging ethical issues in neurosurgery. Virtual Mentor 2015; 17:1-32. [PMID: 25759875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Trimper JB, Wolpe PR, Rommelfanger KS. When "I" becomes "We": ethical implications of emerging brain-to-brain interfacing technologies. Front Neuroeng 2014; 7:4. [PMID: 24575002 PMCID: PMC3921579 DOI: 10.3389/fneng.2014.00004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 01/25/2014] [Indexed: 11/30/2022]
Affiliation(s)
- John B Trimper
- Department of Psychology, Emory University Atlanta, GA, USA
| | - Paul Root Wolpe
- Neuroethics Program, Center for Ethics, Emory University Atlanta, GA, USA ; Departments of Medicine and Pediatrics, Emory University Atlanta, GA, USA
| | - Karen S Rommelfanger
- Neuroethics Program, Center for Ethics, Emory University Atlanta, GA, USA ; Department of Neurology, Emory University Atlanta, GA, USA
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Hagan LM, Wolpe PR, Schinazi RF. Treatment as prevention and cure towards global eradication of hepatitis C virus. Trends Microbiol 2013; 21:625-33. [PMID: 24238778 DOI: 10.1016/j.tim.2013.09.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/13/2013] [Accepted: 09/25/2013] [Indexed: 02/06/2023]
Abstract
The availability of curative, direct-acting antiviral drugs against hepatitis C virus (HCV) sparks an ethical call for HCV eradication and provides essential tools to spearhead the effort. Challenges include increasing awareness of the chronic hepatitis C epidemic, garnering sufficient public, private, and governmental financial will to invest in the necessary resources, developing pangenotypic drug regimens for global application, and mitigating ethical concerns. To achieve these goals, stakeholders including clinicians, public health professionals, legislators, advocates, and industry can employ a variety of strategies such as increasing HCV screening, implementing treatment as prevention, and improving linkage to care, as well as developing innovative pricing and payment solutions, stimulating innovation through local drug development in high-prevalence regions, continuing vaccine development, and creating efficiencies in the marketing and distribution of educational materials and drug treatments.
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Affiliation(s)
- Liesl M Hagan
- Center for AIDS Research, Emory University School of Medicine and Veterans Affairs Medical Center, Atlanta, GA 30322, USA
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Meltzer CC, Sze G, Rommelfanger KS, Kinlaw K, Banja JD, Wolpe PR. Guidelines for the ethical use of neuroimages in medical testimony: report of a multidisciplinary consensus conference. AJNR Am J Neuroradiol 2013; 35:632-7. [PMID: 23988754 DOI: 10.3174/ajnr.a3711] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY With rapid advances in neuroimaging technology, there is growing concern over potential misuse of neuroradiologic imaging data in legal matters. On December 7 and 8, 2012, a multidisciplinary consensus conference, Use and Abuse of Neuroimaging in the Courtroom, was held at Emory University in Atlanta, Georgia. Through this interactive forum, a highly select group of experts-including neuroradiologists, neurologists, forensic psychiatrists, neuropsychologists, neuroscientists, legal scholars, imaging statisticians, judges, practicing attorneys, and neuroethicists-discussed the complex issues involved in the use of neuroimaging data entered into legal evidence and for associated expert testimony. The specific contexts of criminal cases, child abuse, and head trauma were especially considered. The purpose of the conference was to inform the development of guidelines on expert testimony for the American Society of Neuroradiology and to provide principles for courts on the ethical use of neuroimaging data as evidence. This report summarizes the conference and resulting recommendations.
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Affiliation(s)
- C C Meltzer
- From the Departments of Radiology and Imaging Sciences (C.C.M.)
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Wolpe PR. The Oys of Yiddish. Am J Bioeth 2013; 13:1-2. [PMID: 23641834 DOI: 10.1080/15265161.2013.793128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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15
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Wolpe PR. Gifts and obligations: the living donor as storyteller. Narrat Inq Bioeth 2012; 2:39-44. [PMID: 24406766 DOI: 10.1353/nib.2012.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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16
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Wolpe PR. Science needs a universal symbol. New Sci 2012. [DOI: 10.1016/s0262-4079(12)60039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Wolpe PR. The research subject as identified problem. Am J Bioeth 2011; 11:1-2. [PMID: 21480061 DOI: 10.1080/15265161.2011.571499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
Detection of deception and confirmation of truth telling with conventional polygraphy raised a host of technical and ethical issues. Recently, newer methods of recording electromagnetic signals from the brain show promise in permitting the detection of deception or truth telling. Some are even being promoted as more accurate than conventional polygraphy. While the new technologies raise issues of personal privacy, acceptable forensic application, and other social issues, the focus of this paper is the technical limitations of the developing technology. Those limitations include the measurement validity of the new technologies, which remains largely unknown. Another set of questions pertains to the psychological paradigms used to model or constrain the target behavior. Finally, there is little standardization in the field, and the vulnerability of the techniques to countermeasures is unknown. Premature application of these technologies outside of research settings should be resisted, and the social conversation about the appropriate parameters of its civil, forensic, and security use should begin.
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Vernillo AT, Wolpe PR. Property and privacy paradigms of "marketable spit": an ethical and legal counterpart to blood? J Can Dent Assoc 2010; 76:a51. [PMID: 20719097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Major advances in the testing of oral fluid (e.g., saliva) may lead to the diagnosis and treatment of previously undiagnosed conditions and may enable dentists to manage oral disease more effectively. Such use of another body fluid, blood, is already well established. Blood is a complex tissue that has been extensively researched and is now used for a wide variety of diagnostic tests. It is also regarded as a form of property with ethical and legal dimensions. If saliva is to fulfill a similar role, it should perhaps be granted those same protections. This paper advances the concept that saliva should be considered a form of property, possibly within personal biological materials law. The emerging potential for the development of marketable products from oral fluids raises the issue of protecting the research participant's ethical and legal rights. In particular, violation of privacy and genetic discrimination may arise from the testing of salivary DNA. Respect for autonomy requires that the clinician inform a patient or research participant about his or her rights to property and privacy as these may pertain to oral fluid.
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Affiliation(s)
- Anthony Thomas Vernillo
- Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, NY 10010-4086, USA
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Wolpe PR. Sir John Maddox and the ethics of heresy. Am J Bioeth 2009; 9:1-2. [PMID: 19998143 DOI: 10.1080/15265160903031979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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22
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Wolpe PR. Disciplining bioethics. Am J Bioeth 2008; 8:1-2. [PMID: 18759169 DOI: 10.1080/15265160802248542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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23
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Abstract
The development of a successful lie detector has been a dream of governments and law enforcement since ancient times. A Hindu Veda written around 900 B.C.E. suggests a strategy for detecting lying behavior in suspects:A person who gives poison may be recognized. He does not answer questions, or they are evasive answers; he speaks nonsense, rubs the great toe along the ground, and shivers; his face is discolored; he rubs the roots of the hair with his fingers; and he tries by every means to leave the house … .Six hundred years later, the Greeks were attempting to detect lies by feeling the suspect's pulse. What is interesting about both the early Hindu and Greek examples is that the methods employed were empirical; the interrogators were looking for physiological changes in the body that corresponded to the mental state in question.
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Sankar P, Wolpe PR, Jones NL, Cho M. How do women decide? Accepting or declining BRCA1/2 testing in a nationwide clinical sample in the United States. Public Health Genomics 2006; 9:78-86. [PMID: 16612057 PMCID: PMC1317096 DOI: 10.1159/000091484] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To examine the role of the practitioner, informed consent, and genetic counseling in genetic testing decisions and to assess their relative influence on women's decision to have clinical BRCA1/2 testing. METHODS Qualitative study using in-depth open-ended interviews with 68 women who had considered clinical BRCA1/2 testing. RESULTS Slightly less than half of the women who had considered BRCA1/2 testing were found to have had a clear and preexisting desire to test or not to test, irrespective of practitioner attitude or advice. CONCLUSION The decision to accept or decline genetic testing is the result of a complex process that goes beyond interactions between health care providers and patients, indicating a caution against exclusive reliance on informed consent or counseling encounters.
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Affiliation(s)
- Pamela Sankar
- Center for Bioethics, University of Pennsylvania, Philadelphia, PA 19104, USA.
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25
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Abstract
Science is a powerful force for change in modern society. As the professionals at its helm, scientists have a unique responsibility to shepherd that change with thoughtful advocacy of their research and careful ethical scrutiny of their own behavior.
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Affiliation(s)
- Paul Root Wolpe
- Department of Psychiatry and Center for Bioethics, University of Pennsylvania School of Medicine, Philadelphia, 19104, USA.
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26
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Abstract
PURPOSE Concern over stigma as a consequence of genetic testing has grown in response to the recent increase in genetic research and testing resulting from the Human Genome Project. However, whether a genetic or hereditary basis necessarily confers a stigma to a condition remains unexamined. METHODS We performed a qualitative interview study with 86 individuals with one of four conditions: deafness or hearing loss, breast cancer, sickle cell disease, and cystic fibrosis. The first two groups were divided approximately between people who ascribed their conditions to a genetic or hereditary cause and those who did not. RESULTS Respondents interpreted genetic or hereditary causes and nongenetic causes in a variety of ways. Subjects with breast cancer reported the most consistently negative interpretation of genetic cause. This response concerned future ill health, not an enduring sense of stigma. Deaf and hard of hearing subjects provided the most consistently positive comments about a genetic or hereditary basis to their condition, casting familial hearing loss as a vital component of group and individual identity. Respondents with sickle cell disease and cystic fibrosis offered similar and positive interpretations of the genetic cause of their condition insofar as it meant their conditions were not contagious. CONCLUSIONS Although some subjects report feeling stigmatized as a result of their condition, this stigmatization is not uniformly associated with the condition's cause, genetic or otherwise. Instead, stigma emerges from a variety of sources in the context of the lived experience of a particular condition.
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Affiliation(s)
- Pamela Sankar
- Center for Bioethics, University of Pennsylvania, 3401 Market Street, Philadelphia, PA 19104, USA
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27
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Sankar P, Wolpe PR, Jones NL, Cho M. How do women decide? Accepting or declining BRCA1/2 testing in a nationwide clinical sample in the United States. Community Genet 2006. [PMID: 16612057 PMCID: PMC1317096 DOI: 10.1159/0000xxxxx] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the role of the practitioner, informed consent, and genetic counseling in genetic testing decisions and to assess their relative influence on women's decision to have clinical BRCA1/2 testing. METHODS Qualitative study using in-depth open-ended interviews with 68 women who had considered clinical BRCA1/2 testing. RESULTS Slightly less than half of the women who had considered BRCA1/2 testing were found to have had a clear and preexisting desire to test or not to test, irrespective of practitioner attitude or advice. CONCLUSION The decision to accept or decline genetic testing is the result of a complex process that goes beyond interactions between health care providers and patients, indicating a caution against exclusive reliance on informed consent or counseling encounters.
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Affiliation(s)
- Pamela Sankar
- Center for Bioethics, University of Pennsylvania, Philadelphia, Pa
| | - Paul Root Wolpe
- Center for Bioethics, University of Pennsylvania, Philadelphia, Pa
| | - Nora L. Jones
- Center for Bioethics, University of Pennsylvania, Philadelphia, Pa
| | - Mildred Cho
- Center for Biomedical Ethics, Stanford University School of Medicine, Palo Alto, Calif., USA
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28
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Abstract
Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these 2 needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.
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Affiliation(s)
- Amitai Ziv
- The Chaim Sheba Medical Center, Tel-Hashomer, Israel
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29
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Affiliation(s)
- Susan G Wynn
- The Bells Ferry Veterinary Hospital, 6410 Hwy 92, Acworth, GA 30102, USA
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30
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Abstract
Detection of deception and confirmation of truth telling with conventional polygraphy raised a host of technical and ethical issues. Recently, newer methods of recording electromagnetic signals from the brain show promise in permitting the detection of deception or truth telling. Some are even being promoted as more accurate than conventional polygraphy. While the new technologies raise issues of personal privacy, acceptable forensic application, and other social issues, the focus of this paper is the technical limitations of the developing technology. Those limitations include the measurement validity of the new technologies, which remains largely unknown. Another set of questions pertains to the psychological paradigms used to model or constrain the target behavior. Finally, there is little standardization in the field, and the vulnerability of the techniques to countermeasures is unknown. Premature application of these technologies outside of research settings should be resisted, and the social conversation about the appropriate parameters of its civil, forensic, and security use should begin.
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31
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Wolpe PR, Robinson WM. Dialogue: Bioethics in space. Med Ethics (Burlingt Mass) 2005; 12:10-1. [PMID: 15856605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Paul Root Wolpe
- Center for Bioethics, Department of Psychiatry, Medical Ethics, and Sociology, University of Pennsylvania, USA
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32
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Farah MJ, Wolpe PR. Monitoring and manipulating brain function: new neuroscience technologies and their ethical implications. Hastings Cent Rep 2004; 34:35-45. [PMID: 15281725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Martha J Farah
- Center for Cognitive Neuroscience, University of Pennsylvania, USA
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33
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Farah MJ, Wolpe PR. Monitoring and Manipulating Brain Function: New Neuroscience Technologies and Their Ethical Implications. Hastings Cent Rep 2004. [DOI: 10.2307/3528418] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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34
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Farah MJ, Illes J, Cook-Deegan R, Gardner H, Kandel E, King P, Parens E, Sahakian B, Wolpe PR. Neurocognitive enhancement: what can we do and what should we do? Nat Rev Neurosci 2004; 5:421-5. [PMID: 15100724 DOI: 10.1038/nrn1390] [Citation(s) in RCA: 273] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Martha J Farah
- Center for Cognitive Neuroscience, University of Pennsylvania, 3720 Walnut Street, Philadelphia, Pennsylvania 19104, USA.
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35
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Wolpe PR. Religious responses to neuroscientific questions. NEUROETHICS-NETH 2004. [DOI: 10.1093/acprof:oso/9780198567219.003.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
This chapter explores the three areas where neuroscience challenges religion. First, in religion's ethical response to neuroscientific findings; secondly, how religion responds to the claims of some neuroscientists that current research refutes ideas such as ensoulment; and finally, through the field that has come to be known as neurotheology, the neuroscientific study of the religious impulse itself.
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36
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Abstract
Medical training must at some point use live patients to hone the skills of health professionals. But there is also an obligation to provide optimal treatment and to ensure patients' safety and well-being. Balancing these two needs represents a fundamental ethical tension in medical education. Simulation-based learning can help mitigate this tension by developing health professionals' knowledge, skills, and attitudes while protecting patients from unnecessary risk. Simulation-based training has been institutionalized in other high-hazard professions, such as aviation, nuclear power, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost, lack of rigorous proof of effect, and resistance to change. Recently, the international patient safety movement and the U.S. federal policy agenda have created a receptive atmosphere for expanding the use of simulators in medical training, stressing the ethical imperative to "first do no harm" in the face of validated, large epidemiological studies describing unacceptable preventable injuries to patients as a result of medical management. Four themes provide a framework for an ethical analysis of simulation-based medical education: best standards of care and training, error management and patient safety, patient autonomy, and social justice and resource allocation. These themes are examined from the perspectives of patients, learners, educators, and society. The use of simulation wherever feasible conveys a critical educational and ethical message to all: patients are to be protected whenever possible and they are not commodities to be used as conveniences of training.
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Affiliation(s)
- Amitai Ziv
- The Chaim Sheba Medical Center, and Israel Center for Medical Simulation (MSR), Tel-Hashomer, Israel
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37
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Wolpe PR. Bioethics, the genome, and the Jewish body. Conserv Jud 2003; 54:14-25. [PMID: 12735298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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38
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Wolpe PR. Not just how, but whether: revisiting Hans Jonas. Am J Bioeth 2003; 3:vii-viii. [PMID: 14744305 DOI: 10.1162/152651603322614373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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39
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Abstract
Emerging neurotechnologies, including psychopharmaceuticals, brain stimulation, implantable brain chips, transcranial magnetic stimulation, and brain imaging raise a number of ethical questions. One of the most contentious is the proper role of these technologies in improving or increasing mental and neurological traits and skills in those with no identifiable pathology. The "enhancement" debate centers around a number of concerns and philosophical approaches to the proper role of medicine, therapeutics, and desirable human qualities. Arguements for and against neurological enhancement are reviewed, and historical and social perspectives are offered.
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Affiliation(s)
- Paul Root Wolpe
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA.
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40
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Wolpe PR. What's a good doctor and how do you make one? We are trying to make doctors too good. BMJ 2002; 325:711; author reply 711. [PMID: 12358021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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41
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Wolpe PR. The neuroscience revolution. Hastings Cent Rep 2002; 32:8. [PMID: 12362529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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42
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Lo B, Albert MS, Hyman S, Parens E, Wolpe PR, Mobley W. Ethics and the practice of brain science. Cerebrum 2002; 4:64-6. [PMID: 16619416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Bernard Lo
- Program in Medical Ethics, University of California, San Francisco, CA, USA
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43
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Wolpe PR. The freelance bioethicist, chapter one. Camb Q Healthc Ethics 2001; 8:118-9. [PMID: 11645147 DOI: 10.1017/s0963180199001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It was a hot summer night, the kind where the air
is so thick it seems to ooze into your lungs. I heard a
knock on the door. “Come in,” I complained.
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45
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Wolpe PR. Conspiracy of silence: medical research and moral obligation. Bull Park Ridge Cent 2000:5-6. [PMID: 15744911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- P R Wolpe
- Center for Bioethics, University of Pennsylvania, USA
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46
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47
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Wolpe PR. Reply to Barbara Pfeffer Billauer's "On Judaism and genes. Kennedy Inst Ethics J 1999; 9:167-174. [PMID: 11657326 DOI: 10.1353/ken.1999.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The response of Barbara Pfeffer Billauer to my article "If I Am Only My Genes, What Am I? Genetic Essentialism and a Jewish Response" highlights the conflict between a sociological understanding of religion and the resistance to such analysis from within a faith tradition. Ms. Billauer makes three main points; the first strangely credits to me, and then attacks, an argument the article takes great pains to refute, but does so to emphasize the faith's prescient guidance in matters scientific. The second attempts to rebut my critical analysis of the tensions inhernet in Jewish views of the body with an insistence that Judaism so perfectly balances the relation between the sacred and profane that there is not now, and never was, the slightest tension between corporeality and divinity in the Jewish corpus. The third uses my article as vehicle for her to expound on an interesting but tangential formulation of three Jewish terms. In all, the need to defend her interpretation of Judaism's solutions to the problems the article raises results in un-self-critical and ahistorical theorizing, making the utility of her arguments in a discussion of the sociology of religion unsatisfactory.
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48
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49
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Abstract
It was our purpose to determine the characteristics of practitioners in the United States who were among the first to inquire about and use the BRCA1 and BRCA2 (BRCA1/2) genetic tests outside of a research protocol. Questionnaires were mailed to all practitioners who requested information on or ordered a BRCA1/2 test from the University of Pennsylvania (UPenn) Genetic Diagnostics Laboratory (GDL) between October 1, 1995 and January 1, 1997 (the first 15 months the test was available for clinical use). The response rate was 67% of practitioners; 54% (121/225) were genetic counselors, 39% (87/225) were physicians or lab directors. Most physicians were oncologists, pathologists, or obstetrician/gynecologists, but 20% practiced surgery or internal or general medicine. Fifty-six percent (125/225) had ordered a BRCA1/2 test for a patient; most of the rest had offered or were willing to offer testing. Of those who had offered testing, 70% had a patient decline BRCA1/2 testing when offered. Practitioners perceived that patients' fear of loss of confidentiality was a major reason for declining. Nearly 60% of practitioners reported that their patients had access to a genetic counselor, but 28% of physicians who ordered a BRCA1/2 test reported having no such access, despite the GDL's counseling requirement. The proportion of physicians reporting no access to genetic counselors for their patients increased from 22.4% in the first half of the study to 50% in the last half. Many practitioners have an interest in BRCA1/2 testing, despite policy statements that discourage its use outside of research protocols. Practitioner responses suggest that patient interest in testing seems to be tempered by knowledge of potential risks. An apparent increase in patient concern about confidentiality and inability to pay for testing could indicate growing barriers to testing. Although most practitioners reported having access to counseling facilities, perceived lack of such access among an increasing proportion of practitioners indicates that lab requirements for counseling are difficult to enforce and suggests that an increasing proportion of patients may not be getting access to counseling.
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Affiliation(s)
- M K Cho
- Center for Biomedical Ethics, Stanford University School of Medicine, California, USA
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50
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Abstract
For decades, all federally funded research involving human subjects has been subject to regulations that require the informed consent of the subject and oversight by the local institution. These regulations last underwent major revision in 1981 and have remained unchanged despite significant changes in the nature of clinical science, the financial sources of research support, and the institutional environment in which clinical research is conducted. In the intervening years, doubt has evolved as to whether the regulations currently in place adequately protect the welfare and rights of research subjects in today's clinical research environment and whether the costs, in terms of time, bureaucracy, and delay, are justified by the level of protection afforded. The Human Research Ethics Group, administered by the Center for Bioethics at the University of Pennsylvania Health System, extensively reviewed the status of existing human subjects protections with the aim of making recommendations to improve and reform the regulations. Here, we present recommendations constituting a consensus of the group members for reform in 3 key areas: protecting subject populations with special needs and vulnerabilities, oversight by institutional review boards, and regulatory policy.
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Affiliation(s)
- J Moreno
- Center for Bioethics, University of Pennsylvania Health System, Philadelphia 19104-3308, USA
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