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Kennedy Institute of Ethics Journal

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https://www.readbyqxmd.com/read/29628452/an-ethical-analysis-of-the-support-trial-addressing-challenges-posed-by-a-pragmatic-comparative-effectiveness-randomized-controlled-trial
#1
Austin R Horn, Charles Weijer, Jeremy Grimshaw, Jamie Brehaut, Dean Fergusson, Cory E Goldstein, Monica Taljaard
The SUPPORT trial highlights ethical challenges raised by comparative effectiveness randomized controlled trials (ceRCTs) involving one or more usual care interventions. Debate about the SUPPORT trial has focused on whether study interventions posed "reasonably foreseeable risks" to enrolled infants and, thereby, reflects a preoccupation with U.S. regulations. As ceRCTs are conducted globally, our analysis of the SUPPORT trial is grounded in internationally accepted ethical principles. We argue that the central ethical issue raised by the SUPPORT trial is the following: should the SUPPORT trial interventions be conceptualized as practice, or research? The answer to this question has important implications for "downstream" ethical requirements-including whether the usual care interventions in ceRCTs require research ethics committee review, undergo harm-benefit analysis, and are included in informed consent documents-and it is antecedent to the development of ethical guidance for ceRCTs...
2018: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/29628451/assessing-rehabilitation-eligibility-of-older-patients-an-ethical-analysis-of-the-impact-of-bias
#2
Josephine Najem, Priscilla Lam Wai Shun, Maude Laliberté, Vardit Ravitsky
Hospitalized older patients are more vulnerable to physical or cognitive functional decline. Inpatient rehabilitation programs improve significantly their functional status and may prevent their admission to nursing homes. While inpatient rehabilitation institutions have established admission criteria that can be seen as objective, the risk of bias remains and raises the question of equitable access for more vulnerable populations such as older patients. This paper reviews some established eligibility criteria for inpatient rehabilitation by examining a framework used in Montreal, Québec, Canada for assessing rehabilitation eligibility and by applying this framework to a case study...
2018: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/29628450/support-for-voluntary-euthanasia-with-no-logical-slippery-slope-to-non-voluntary-euthanasia
#3
Steven Daskal
This paper demonstrates that acceptance of voluntary euthanasia does not generate commitment to either non-voluntary euthanasia or euthanasia on request. This is accomplished through analysis of John Keown's and David Jones's slippery slope arguments, and rejection of their view that voluntary euthanasia requires physicians to judge patients as better off dead. Instead, voluntary euthanasia merely requires physicians to judge patients as within boundaries of appropriate deference. This paper develops two ways of understanding and defending voluntary euthanasia on this model, one focused on the independent value of patients' autonomy and the other on the evidence of well-being provided by patients' requests...
2018: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/29628449/ethical-guidelines-for-genetic-research-on-alcohol-addiction-and-its-applications
#4
Audrey R Chapman, Adrian Carter, Jonathan M Kaplan, Kylie Morphett, Wayne Hall
Research on the genomic correlates to addiction raises ethical issues in a number of different domains. In this paper, we evaluate the status of genetic research on alcohol dependence as background to addressing the ethical issues raised in conducting research on addiction and the application of that research to the formulation of public policies. We conclude that genetic testing is not yet ready for use in the prediction of alcohol dependence liability. Pharmacogenetic testing for responses to treatments may have more clinical utility, although additional research is required to demonstrate utility and cost-effectiveness...
2018: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/29628448/editorial-note
#5
Rebecca Kukla
No abstract text is available yet for this article.
2018: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/29307881/what-makes-health-care-special-an-argument-for-health-care-insurance
#6
L Chad Horne
While citizens in a liberal democracy are generally expected to see to their basic needs out of their own income shares, health care is treated differently. Most rich liberal democracies provide their citizens with health care or health care insurance in kind. Is this "special" treatment justified? The predominant liberal account of justice in health care holds that the moral importance of health justifies treating health care as special in this way. I reject this approach and offer an alternative account...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/29307880/can-the-brain-dead-be-harmed-or-wronged-on-the-moral-status-of-brain-death-and-its-implications-for-organ-transplantation
#7
Michael Nair-Collins
The majority of transplantable human organs are retrieved from patients declared dead by neurological criteria, or "brain-dead." Since brain death is considered to be sufficient for death, the procurement of vital organs is not considered to harm or wrong such patients. In this essay I argue that this is not the case. After distinguishing welfare, experiential, and investment interests, and defining precedent autonomy and surviving interests, I argue that brain-dead patients can be, and many are, harmed and wronged by organ procurement as currently practiced...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/29307879/the-obligation-to-provide-information-where-valid-consent-is-not-needed
#8
Tom Walker
Accounts of consent in medical ethics typically assume that consent plays the same role irrespective of the type of treatment. In this paper I argue that this assumption is false. Because of this, obligations to provide information to patients that stem from the need for consent to be valid will not apply to all types of treatment. This does not mean that there are no reasons to provide such information. The second part of the paper maps out what these reasons are and argues that they are grounded in the obligation of beneficence and a duty to warn, not in considerations of respect for autonomy...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/29307878/disabled-by-design-justifying-and-limiting-parental-authority-to-choose-future-children-with-pre-implantation-genetic-diagnosis
#9
Joseph Stramondo
Often, ethical analysis of Pre-Implantation Genetic Diagnosis occupies one of two positions in a moral dichotomy. On the one hand, we have a deep suspicion of the technology as directly leading to eugenics, which is assumed to be a negative consequence; and on the other, we have a vigorous enthusiasm for the technology as a means toward creating better offspring, where "better" is assumed to mean, at minimum, non-disabled. For my part, I eschew both of these positions and attempt to break this dichotomy wide open by maintaining that future parents are not morally required to use PGD to select some vision of an objectively "best" child, but should be permitted to use PGD to select embryos according to their own conception of the good life, even if that conception of the good life includes disability...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/29307877/editorial-note
#10
Rebecca Kukla
No abstract text is available yet for this article.
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/28989168/-queer-family-values-and-reciprocal-ivf-what-difference-does-sexual-identity-make
#11
Amanda Roth
In this paper I employ the case of "reciprocal IVF" (R-IVF)-in which a female-female couple uses in vitro fertilization to allow one woman to be the genetic mother and the other the gestational mother of their child(ren)-to illuminate the role sexual identity might productively play in bioethics. Bioethicists who have taken up this issue have largely focused on the moral permissibility and availability of the technology, and so defend R-IVF through analogy to commonly accepted different-sex uses of IVF...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/28989167/a-defense-of-the-risks-of-daily-life
#12
Ariella Binik
Research examining the safe and effective treatment of diseases and disorders affecting children offers one of the best prospects for improving the medical treatment of children. But the inclusion of children in research raises difficult ethical questions, among them: To how much risk is it permissible to expose children in research? Various thresholds have been proposed to constrain research risks that do not offer children the prospect of direct medical benefit. These proposals include limiting research risks to (1) the risks of routine medical examinations, (2) the risks of participation in charitable activities, (3) the risks of family life, and (4) the risks-of-daily-life...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/28989166/a-theoretical-foundation-for-the-ethical-distribution-of-authorship-in-multidisciplinary-publications
#13
Elise Smith
In academia, authorship on publications confers merit as well as responsibility. The respective disciplines adhere to their "typical" authorship practices: individuals may be named in alphabetical order (e.g., in economics, mathematics), ranked in decreasing level of contribution (e.g., biomedical sciences), or the leadership role may be listed last (e.g., laboratory sciences). However, there is no specific, generally accepted guidance regarding authorship distribution in multidisciplinary teams, something that can lead to significant tensions and even conflict...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/28989165/the-role-of-doctors-in-hunger-strikes
#14
Yechiel Michael Barilan
In its Malta Declaration, The World Medical Association prohibits force-feeding of hunger strikers as "degrading and inhuman," even when this is the only way to save their lives. The European Court of Human Rights ruled that lifesaving force-feeding is compatible with the state's duty to protect the lives of prisoners. To understand how such extreme divergence of opinions has become possible, this paper offers a critical examination of the social history of prisoners' hunger strikes, the philosophy of nonviolence, and the debate on its medicalization...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/28989164/editorial-note
#15
Rebecca Kukla
No abstract text is available yet for this article.
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/28736424/disability-bioethics-from-theory-to-practice
#16
Rosemarie Garland-Thomson
No abstract text is available yet for this article.
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/28736423/choosing-disability-visualizing-care
#17
Rachel Adams
This article explores how visual images of dependency and care reflect and reinforce perceptions of people who are ill, disabled, or otherwise dependent, those who sustain them, and the meaning of the work they do. Scenes of care are a valuable index for understanding cultural assumptions about who is deserving of care, how and where care should be given, and who is obligated to serve as a giver of care. It positions these images in the context of the emphasis, within the disability rights movement, on independence...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/28736422/choosing-accommodations-signed-language-interpreting-and-the-absence-of-choice
#18
Teresa Blankmeyer Burke
This paper carves out a topic space for discussion about the ethical question of whether input from signing Deaf consumers of interpreting services ought to be included in the provision of signed language interpreter accommodations. The first section provides background about disability accommodations and practices, including how signed language interpreting accommodations are similar and dissimilar to other kinds of disability accommodations. In the second section, I offer a personal narrative of my experience as a Deaf academic who has been excluded from the interpreter selection process, highlighting some of the harmful consequences of such exclusion...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/28736421/pathological-disabled-transgender-the-ethics-history-laws-and-contradictions-in-models-that-best-serve-transgender-rights
#19
Lance Wahlert, Sabrina Gill
This article addresses the precarious place of transgender and gender non-cis persons in relation to their discrimination-protections in recent legal, medical, and ethical policies in the United States. At present, there exists a contradiction such that trans persons are considered "pathological" enough that they are included in the latest iteration of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) as "gender dysphoric," but they are not included in the category of "disabled" under the Americans with Disabilities Act (ADA)...
2017: Kennedy Institute of Ethics Journal
https://www.readbyqxmd.com/read/28736420/better-parenting-through-biomedical-modification-a-case-for-pluralism-deference-and-charity
#20
David Wasserman
In this paper, I will argue that the moral assessment of the prenatal selection and postnatal modification biotechnologies requires a nuanced approach, which pays close attention to the variety of sometimes conflicting parental roles and reasons involved in decisions for and against their use. I will focus on several related but distinct reasons that parents have, or give, for modifying existing children or selecting future children. Many of these reasons are expressed in terms of more effective parenting. Because there is a plurality of legitimate parental goals, I will conclude that assessing parental interventions requires us to adjudicate conflicts or tradeoffs among those goals...
2017: Kennedy Institute of Ethics Journal
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