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Perspectives in Biology and Medicine

Sophie Delaunay
In Renée C. Fox's 2014 book Doctors Without Borders: Humanitarian Quests, Impossible Dreams of Médecins San Frontières, the author explores the ethos of the medical organization, shedding a candid light on its internal culture and its struggles to define and defend its conception of humanitarian action. Through blogs from field workers, numerous testimonies of staff, and extracts from internal gatherings, Doctors Without Borders reveals a side largely unknown to the public and rarely presented in bibliographies of humanitarianism...
2016: Perspectives in Biology and Medicine
Abraham M Nussbaum
While physician-writers and medical humanists both characterize contemporary deaths as train wrecks, they sometimes disagree about what causes such consistent wreckage. In Being Mortal (2014), the surgeon-writer Atul Gawande attributes the wreckage to forces that so reduce aging and dying persons' autonomy that they prevent those persons from being themselves. For the leading medical humanists in Dying in the Twenty-First Century (2015), edited by Lydia Dugdale, it is our emphasis on autonomy over interdependence that causes contemporary death and dying to go off the rails...
2016: Perspectives in Biology and Medicine
Efrat Lelkes
For freshly minted MDs, residency represents a period of transition from being a medical student to becoming a physician. This evolution is often fraught. Continuity clinic-a mandatory component of pediatric residency training-can be a battleground for this tribulation. This essay explores the author's journey from the first days of her continuity clinic to the last. The author recounts her struggles, her fears, her certainty of being an imposter, and her steps towards becoming a pediatrician.
2016: Perspectives in Biology and Medicine
Jack Conrad
Recent studies show that people who live in a fear-based existence from childhood change not only psychologically or spiritually, but even biologically. This essay relates the story of a family in the Emergency Room at a children's hospital. Over a few days, this family affects everyone they encounter. The staff witness a family trapped in a web of poverty, abuse, and generationally destructive behavior, and they wonder about the overtaxed support structures that not only fail to serve, but that may well promise additional tragic generations to come...
2016: Perspectives in Biology and Medicine
Annemarie Goldstein Jutel
The moment at which a person receives a life-threatening diagnosis is replete with drama. The life-altering impact of putting a name to disease preoccupies clinicians and social scientists, but also infuses creative work. This paper describes the use of the diagnostic moment in fiction. Using Ian McEwan's Saturday, Anna Funder's All That I Am, Arthur Hailey's The Final Diagnosis, Téa Obreht's The Tiger's Wife, and myriad others, I show how diagnosis is variably the subject, the trigger, and the frame for narratives...
2016: Perspectives in Biology and Medicine
Elizabeth Reis, Matthew W McCarthy
An intersex condition is one in which an individual is born with atypical male or female external genitalia, gonads, hormones, or chromosomes. Older terms, such as pseudohermaphroditism and hermaphroditism, are controversial, leading the Lawson Wilkins Pediatric Endocrine Society (LWPES) and the European Society for Paediatric Endocrinology (ESPE) to propose in 2006 the expression "disorders of sex development" (DSD), a contentious term in its own right, to define congenital conditions in which development of chromosomal, gonadal, or anatomical sex is atypical...
2016: Perspectives in Biology and Medicine
Joseph Loscalzo
Hippocrates' first aphorism presents a structurally simple but conceptually complex series of observations on the art and science of medicine. Its principles are timeless, relevant to physicians in antiquity as well as in the current era. This article analyzes Hippocrates' aphorism in light of Galen's and others' commentaries on it and interprets the principles espoused by Hippocrates in light of the perennial challenges of the practice of medicine.
2016: Perspectives in Biology and Medicine
Carole R Baskin, Robert A Gatter, Mark J Campbell, James M Dubois, Allison C Waits
Can scientists self-regulate effectively? The controversial select agent regulations, the recent implementation of U.S. dual-use research of concern policies, the funding moratorium on gain of function experiments, and the 2014 incidents at the Centers for Disease Control and Prevention all seem to suggest that the answer is a resounding "no." Yet history tells us that it is feasible. In this comprehensive history of the first iteration of the National Institutes of Health (NIH) Recombinant DNA Guidelines, we examine the principles, thoughts, and behaviors that resulted in successful self-regulation of scientific research for the past four decades and how engagement of scientists made it possible...
2016: Perspectives in Biology and Medicine
Franklin G Miller
Should there be a legal option of physician-assisted death? If so, what criteria should define its scope and limits? Answers to these questions are contested and controversial. In this essay I examine considerations for and against making physician-assisted death available for individuals of advanced age who are not terminally ill but find their lives no longer worth living.
2016: Perspectives in Biology and Medicine
Ben Kotzee, Alexis Paton, Mervyn Conroy
In the field of medical virtue ethics, the concept of phronesis, or practical wisdom, plays a crucial role. In recent years a number of important theoretical questions have been identified in this regard: (1) is phronesis more akin to thinking or theorizing, or to feeling and intuiting? (2) can phronesis be communicated and explained, or is it individual and personal? and (3) is phronesis needed in all decision-making in medicine, or only in the making of decisions that are ethically fraught? In this paper we argue that, while these questions have received attention on the theoretical level, empirical investigation has the potential to shed light on these questions from the perspective of medical practice in the real world...
2016: Perspectives in Biology and Medicine
Marta Spranzi
Patients' values and choices sometimes conflict with health-care providers' professional integrity. Increasingly, health-care teams face requests for care they deem inappropriate, particularly around decisions near the end of life. Professional standards are useful in some ways, but are insufficient from an ethical point of view. Indeed, it can be important to remember that patients' values do not necessarily lose their legitimacy when they conflict with physicians' professional integrity. By examining a paradigmatic clinical ethics consultation case, this essay explores a possible way to address situations in which doctors' integrity and patients' values clash...
2016: Perspectives in Biology and Medicine
Tod Chambers
While a substantial amount of work has been done on the metaphors used in bioethics (such as the body as "property" or the ethics consultant as "engineer"), this essay focuses on the manner in which metaphors reside at the core of various bioethics theories. Drawing upon Stephen Pepper's (1942) notion that philosophical positions are expressions of specific "root metaphors" (similarity, machine, organism, act), the essay will look at the way theories such as principlism, rule-based ethics, casuistry, and phenomenological ethics are also grounded in particular root metaphors...
2016: Perspectives in Biology and Medicine
Spencer Phillips Hey, Brianna Barsanti-Innes
The emerging paradigm of precision medicine strives to leverage the tools of molecular biology to prospectively tailor treatments to the individual patient. Fundamental to the success of this movement is the discovery and validation of "predictive biomarkers," which are properties of a patient's biological specimens that can be assayed in advance of therapy to inform the treatment decision. Unfortunately, research into biomarkers and diagnostics for precision medicine has fallen well short of expectations. In this essay, we examine the portfolio of research activities into the excision repair cross complement group 1 (ERCC1) gene as a predictive biomarker for precision lung cancer therapy as a case study in elucidating the epistemological and ethical obstacles to developing new precision medicines...
2016: Perspectives in Biology and Medicine
Scott Y Kim
Fifty years after Beecher's landmark article, an old question is being debated anew: is it ethical to conduct clinical research without consent? This paper provides a systematic analysis of this question. First, it describes five clinical trials that have either been conducted (or proposed) without the subjects providing consent. Second, it reviews a number of conditions that are often provided to justify bypassing of consent and finds that only some of them qualify as necessary conditions for bypassing consent...
2016: Perspectives in Biology and Medicine
Christine Grady, Anthony S Fauci
In his famous 1966 New England Journal of Medicine article, Henry Beecher concluded that a critical safeguard for protecting human participants, more reliable than informed consent, was the "presence of an intelligent, informed, conscientious, compassionate, responsible investigator." This article examines Beecher's appeal to reliance on the "virtuous" investigator in light of the critical role that investigators play in research ethics and the systems of research protections that have been developed since Beecher's writing...
2016: Perspectives in Biology and Medicine
Jonathan D Moreno
Henry Knowles Beecher, an icon of human research ethics, and Timothy Francis Leary, a guru of the counterculture, are bound together in history by the synthetic hallucinogen lysergic acid diethylamide (LSD). Both were associated with Harvard University during a critical period in their careers and of drastic social change. To all appearances the first was a paragon of the establishment and a constructive if complex hero, the second a rebel and a criminal, a rogue and a scoundrel. Although there is no evidence they ever met, Beecher's indirect struggle with Leary over control of the 20th century's most celebrated psychedelic was at the very heart of his views about the legitimate, responsible investigator...
2016: Perspectives in Biology and Medicine
John Lantos
Henry K. Beecher was a pioneer of research ethics and a prominent whistleblower with regard to ethically problematic studies. Most of his work focused on research in adults, not children, but he did speculate about the implications of his ethical concerns for research in minors. This paper reviews Beecher's response to Krugman's studies of hepatitis at the Willowbrook State School and the debate that Beecher's article stimulated between Ramsey and McCormick. That debate shaped the terms that were used in current federal regulations for research in children...
2016: Perspectives in Biology and Medicine
Franklin G Miller
Henry Beecher is an iconic figure in research ethics, best known for blowing the whistle on unethical clinical research in 1966. This article traces the evolution of Beecher's view on consent to research and juxtaposes these views with his own practices relating to informed consent in the conduct of clinical research. Additionally, critical examination of Beecher's conception of informed consent as an ideal has important implications for contemporary research ethics.
2016: Perspectives in Biology and Medicine
Alexander Morgan Capron
The modern history of experimentation with human beings is notable for its ethical lacunae, when even the clearest directives fail to prevent violations of subjects' rights and welfare. One such lacuna occurred during the 25 years between 1947, when the Nuremberg Code was articulated in the judgment passed on the men who had performed medical experiments in the Nazi concentration camps, and 1972, when the revelation of the 40-year-long Tuskegee Syphilis Study shocked the public and pushed Congress to adopt legislation that eventually transformed the governance of human subjects research...
2016: Perspectives in Biology and Medicine
E C Fox
The value and belief questions with which bioethics deals have social, cultural, moral, and societal implications that are not confined to certain spheres of biology and medicine, health and illness, and the delivery of medical care. And yet, throughout its history, the field has continued to be focused on a narrow array of medically associated phenomena to which it has applied a limited set of ethical precepts that originate in Western and American philosophical thought. It has done so in an intellectual atmosphere that has not been characterized by vigorous debate...
2016: Perspectives in Biology and Medicine
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