Art Caplan New Op-Ed: When Does Human Life Begin?

Art Caplan has a new Op-Ed on The Council for Secular Humanism about when human life begin.

From the piece:

“When does human life begin? For those in the “personhood” movement in the United States, there is no doubt about when that happens—it is at conception, when the sperm meets the egg. The personhood movement has gained a foothold among antiabortion activists who are looking to pass laws that define embryos as people with full rights. Personhood advocates aim to outlaw all abortions, along with in vitro fertilization, embryonic stem-cell research, and emergency contraception. Granting embryos personhood would also mean that someone who killed a pregnant woman at any stage in her pregnancy would be at risk of prosecution for a double homicide. And in those states that restrict a woman’s right to utilize a living will if she is pregnant, no living will could apply from the moment of conception..”

Read the full article.

Art Caplan: Facebook Experiment Used Silicon Valley Trickery

Art Caplan has a new opinion piece on NBCNews about a recently published study in The Proceedings of the National Academy of Sciences, where a  Facebook scientist teamed up with two academics to subtly tweak the news feeds of nearly 700,000 Facebook users.

From the piece:

“The question of whether or not an experiment is ethical hinges upon the question of “informed consent.” Generally, this means that a subject in a study needs to have basic information about the study he’s participating in, understand the nature of the experiment and its risks and benefits, and have the ability to withhold his consent without fear of harm or retribution.

The authors of the study argue that they obtained subject consent: Their manipulation of Facebook users’ emotions was “… consistent with Facebook’s Data Use Policy, to which all users agree prior to creating an account on Facebook, constituting informed consent for this research.” This is nonsense; it’s not informed consent. It is an old Silicon Valley trick for systematically eliminating the legal rights of its customers.”

Read the full article.

Art Caplan Says Vasectomy Has No Place in Plea Deal

Art Caplan has a new opinion piece on NBCNews on the controversy over the case of Jessie Herald, in which he was offered a plea bargain that involved sterilization for a reduced sentencing. From the piece:

Jessie Lee Herald was facing five years or more in prison after a crash in which police and prosecutors said his 3-year-old son was bloodied but not seriously hurt. But Herald cut a deal. Or more accurately, the state agreed to reduce his sentence if he would agree to be cut. Shenandoah County assistant prosecutor Ilona White said she offered Herald, 27, of Edinburg, Virginia, the opportunity to get a drastically reduced sentence if he would agree to a vasectomy. It may not be immediately clear what a vasectomy has to do with driving dangerously and recklessly. It shouldn’t be. There is no connection.

Read the full article.

Caplan on Teens and Vaccines

Art Caplan, and his coauthor Dorit Rubinstein Reiss, have a guest column over at Daily Kos on the NY bill that would allow adolescents to receive treatment – including preventive treatment like vaccines for HPV – against a sexually transmitted disease without their parents’ or guardians’ knowledge or consent. Take a look.

Chip and Fish: Inadvertent Spies

Art Caplan has authored a new opinion piece on Bioethics.net on the issue of “chipping” human beings. From the piece:

There has been a great deal of fingerpointing, second-guessing and recrimination over the decision by the President to exchange five former Taliban leaders for the American soldier, Bowe Bergdahl.  “You’ve just released five extremely dangerous people, who in my opinion … will rejoin the battlefield,” Senator Marco Rubio, R-Fla., and likely Presidential candidate told Fox News.  Senator John McCain, R-AZ, told ABC news and many other outlets that he would never have supported the swap if he’d known exactly which prisoners would be exchanged given their former high roles in battling the U.S. in Afghanistan.

Put aside for a second whether the five Taliban leaders that were flown to Qatar for Bergdahl are now too old and too long removed from Taliban affairs to resume anything close to their old roles.  Presume, instead, they will eagerly resume where they left off prior to their capture, attacking Americans and others they see as hindering Taliban goals for Afghanistan.  Is it possible that the U.S. did something to these men before letting them go in the swap—surreptitiously implanting them with microchips so that they could be tracked or traced?

Read the full article.

Art Caplan: “Was Sarah Murnaghan Treated Justly?”

Art Caplan has coauthored a new opinion piece in the journal Pediatrics on the controversy over the case of Sarah Murnaghan, in which a federal judge ordered the Secretary of Health to place a pediatric patient on the adult transplant list to increase her chances of receiving a donor organ. From the piece:

Lung transplantation is a potentially life-saving procedure for patients with irreversible lung failure. Five-year survival rates after lung transplantation are >50% for children and young adults. But there are not enough lungs to save everyone who could benefit. In 2005, the United Network for Organ Sharing developed a scoring system to prioritize patients for transplantation. That system considered transplant urgency as well as time on the waiting list and the likelihood that the patient would benefit from the transplant. At the time, there were so few pediatric lung transplants that the data that were used to develop the Lung Allocation Score were inadequate to analyze and prioritize children, so they were left out of the Lung Allocation Score system. In 2013, the family of a 10-year-old challenged this system, claiming that it was unjust to children. In the article, we asked experts in health policy, bioethics, and transplantation to discuss the issues in the Murnaghan case.

Read the full article.

Art Caplan on ‘Right to Try’ Law: More Cruel Than Compassionate

Art Caplan has a new opinion piece up at NBC News on Colorado’s new “right to try” law, which “expands access to experimental medications, making it legal for the terminally ill to seek access to drugs that have not yet received FDA approval.” From the article:

Colorado has become the first state to enact a so-called “right to try” law that expands access to experimental medications, making it legal for the terminally ill to seek access to drugs that have not yet received FDA approval. Many others are considering doing the same thing.

Politicians know a surefire winning issue when they see one. Sounds like a great idea? The truth is, such laws are utterly inadequate for helping the dying and the desperate. They would better be described as “right to beg” laws — a right which, sadly, the terminally ill already have and already use in social media campaigns.

Read the full article.

Art Caplan on handshakes in medical settings

Art Caplan has a new opinion piece up at NBC News on the suggestion, in a recent JAMA article, that handshakes should be banned in healthcare settings. From the article:

Now, the handshake ban might make sense if it were not for the fact that the constant touching of microbe-laden things by providers and patients is likely to go on and, handshake or not, they are still likely to fist bump, shoulder pat, rub noses or whatever else they think shows love, care and concern for one another.

Health care has gotten very sterile and impersonal as more technology appears, less time is set aside for talking and more health providers find themselves chained to their computers or handheld medical devices. While not every culture values a handshake, many do, and putting the kibosh on grip and grinning just adds to the perception that caring and curing are heading down different highways.

Read the full article.

Art Caplan: Condoms Should Be Encouraged, Not Used as Evidence

Art Caplan has a new opinion piece up at NBC News on the increasing use of condoms as evidence of a crime by police in the United States. From the article:

Why do we shoot ourselves in the foot when it comes to public health? The latest example of what not to do in the war against disease comes from the world of sex: All over the United States, police and prosecutors are discouraging safer sex by using the possession of condoms as evidence of a crime.

For decades, police officers have been regularly confiscating condoms from people they believe are engaged in prostitution to either justify an arrest or to use as evidence at trial. District Attorneys routinely mention the number of condoms a person had on them when arrested to help cinch prostitution charges.

Prostitutes are far more likely to be infected with HIV and other sexually transmitted diseases than are the general population. That is why health departments spend a lot of money distributing condoms and trying to convince sex workers to use them.

Read the full article.

Art Caplan on “Pediatric Euthanasia in Belgium: Disturbing Developments”

Art Caplan has coauthored a new piece in JAMA on problems with Belgium’s new law allowing terminally-ill children and their families to choose euthanasia. From the article:

The Belgian pediatric euthanasia law seeks to respect the moral status of children as agents who possess the nascent capacity for self-determination. Specifically, the law requires the medical team to demonstrate a patient has the “capacity for discernment,” indicating that he or she understands the consequences of a choice for euthanasia.

What the law does not consider, however, is that adults choose euthanasia for reasons that go beyond pain. For adults, the decision to end their life can be based upon the fear of a loss of control, not wanting to burden others, or the desire not to spend their final days of life fully sedated. These desires might be supported by the experience they have had witnessing a loved one express a loss of dignity or because they understand what terminal sedation is and wish to refuse it. Children, however, lack the intellectual capacity to develop a sophisticated preference against palliative interventions of last resort. Instead, in the case of the new Belgian law, children seem to be asked to choose between unbearable suffering on the one hand and death on the other.

This possibility causes the Belgian euthanasia law to fall short of the standard required for valid assent. The criterion related to the “capacity for discernment” runs the risk of ignoring the fact that children and adolescents lack the experiential knowledge and sense of self that adults often invoke—rightly or wrongly—at the end of their lives.

Read the full article.

It’s Doctors’ Duty to Promote Gun Safety With Patients

Art Caplan has a new opinion piece up at Medscape: “It’s Doctors’ Duty to Promote Gun Safety With Patients.” From the article:

There is a huge problem with guns in the United States, and there are many things that public health can do, and many things that doctors should do to try to minimize the threats that guns pose to children, families, and all of us. One of the leading problems with guns is that we don’t educate children to know what to do when they find a gun or see a gun. So, if a 5- or 6-year-old sees a gun, we need a program that teaches that child that if you see a gun, walk away, get out of the area, and then tell an adult. That is a public health program. It’s something that school nurses could do. It’s something that pediatricians should talk about with their child patients. It’s something that families should hear about. We need a campaign. Vivek Murthy, the Surgeon General candidate, thinks that it is an appropriate thing to do. Apparently, the NRA doesn’t.

You can watch or read the full piece on the Medscape website (access requires a login and password, but registration is free).

Art Caplan: #SaveJosh? Maybe, but What about the Rest?

Art Caplan has a new opinion piece up at MSNBC on the #SaveJosh social campaign that is seeking to get a young cancer patient access to an experimental drug under compassionate use policies. From the article:

If Josh were 67 instead of 7, he would already be out of luck. Those who are not very cute get less attention in their pursuit of unproven drugs. If Josh had parents who did not understand how to use social media, he would already be out of luck. If Josh did not have sharp, well-connected doctors, he would already be out of luck. But he is not in any of these categories, so he may yet get the drug.

All of which is to say, this is no way to handle requests from desperate patients, parents or families to try to save themselves or their loved ones from imminent death by giving them access to unproven, experimental drugs. We need an equitable compassionate use policy for everyone in this country.

Read the full article.

Caplan: Three-Parent Babies Are an Ethical Choice

Art Caplan has a new op-ed out on the three-parent baby issue.  Here’s an excerpt:

In my view, trying the technique to fix a terrible disease even with risks of failure makes ethical sense. The FDA may ask for more studies in monkeys, but that really wont settle the safety issue in humans. Given the severity of mitochondrial diseases it is worth trying the technique.

The big worry is not so much safety, but where will allowing this form of genetic engineering lead. If we let doctors try to repair defective eggs today, who is to say they won’t be trying to make superbabies or designer babies tomorrow by transferring other genes into eggs?

The answer to that is that how far we go in engineering future generations through genetic manipulations is up to us. We can enact laws and treaties that say yes to gene therapies but no to cosmetic genetic engineering. Holding families hostage by saying they cannot try to repair broken genes to treat diseases because we worry that we cannot put steps or handrails on the slippery slope to designer babies seems wrong to me.

Take a look here.

Blogger Twitter Round-Up

By Parker Davis

This week’s twitter round up features a variety of topics from our contributors, from the chemical imbalance theory to infant mortality rates and IVF conception rates.

Frank Pasquale tweeted an article from The Star about the shift of the chemical imbalance theory related to mental illness from an agreed upon medical principle to simply another tactic used by marketers for pharmaceutical companies.

Art Caplan shared two updates regarding current rates of flu vaccination. The first was a retweet of a map graphic showing the “rate of nonmedical vaccine exemptions by state,” and the second was an update based on the records of the Immunization Action Coalition regarding the “now more than 400 organizations with mandatory flu” vaccines for health care workers.

Amitabh Chandra tweeted an update of the infant mortality rates of Pakistan versus India: “In 1960, India and Pakistan had the same infant mortality rate (155/1000). Today, Pakistan’s is 71/1000, which is what India had in 1995.” He also tweeted a Wikipedia article regarding infant mortality driving child mortality.

Stephen Latham tweeted a link to his blog reporting on “US IVF Conceptions at All-time High” which discusses the potential effects of not insuring people for assisted reproduction and encouraging implantations of multiple embryos.

Richard Epstein tweeted several times about the contraceptive mandate including links to the John Batchelor Show online.

Twitter Round-Up 2/12

This week’s twitter round up features a variety of topics from our contributors from the hunger crisis in America to the contraceptive mandate and the Lancet/Oslo Commission on Global Governance for Health.

Frank Pasquale tweeted an article from MSNBC about the millions of residents of New York suffering from hunger and the American hunger crisis overall (2/12).

Art Caplan was a guest of Southern California Public Radio, where he discussed the proposal in Rhode Island to mandate flu shots for children from 6 months to 5 years enrolled in preschool or daycare.

In response to a New York Times article about Medicaid expansion, Amitabh Chandra tweeted in support of allowing Medicaid beneficiaries to buy insurance on an exchange.

Stephen Latham tweeted a link to his blog responding to the Lancet/Oslo Commission on Global Governance for Health.

Richard Epstein tweeted his article in “Defining Ideas” about the contraceptive mandate and his view on the strength of the classical liberal case versus the religious case against the law.

Art Caplan: Mandating Flu Shots Is the Moral Choice

Art Caplan has a new piece at NBC News online arguing that the Rhode Island Department of Health is right to propose a new policy mandating that “all children between 6 months and 5 years of age would have to be vaccinated against the flu before entering daycare or preschool.” From the piece:

Not only is the ACLU inexcusably wrong about the value of flu vaccination for young children, it is way off the mark on the issue of liberty. The Rhode Island law is not about protecting kids. It is trying to prevent infected kids from killing or making other kids sick, especially those with asthma or immune diseases. It is trying to prevent killing grandma by infecting her, killing pregnant women’s fetuses or striking dead the neighbor who is getting chemotherapy or is post an organ-transplant who encounters an infected baby or child at the supermarket, train station or movie theater. Continue reading

Art Caplan on “Accepting Brain Death”

Art Caplan has a new piece, co-authored with David C. Magnus, Ph.D. and Benjamin S. Wilfond, M.D., in the NEJM, addressing the legal and medical reasons for accepting brain death as death. From the article:

Over the past several decades, brain death has become well entrenched as a legal and medical definition of death. It is clearly defined by the neurologic community [...], standards for diagnosis are in place, and it is established in law. It has become the primary basis of organ-procurement policy for transplantation. Ironically, the other standard for defining death, irreversible cessation of circulation, lacks consensus about diagnosis.

The concept of brain death has periodically come under criticism.4  Continue reading

Art Caplan: Pregnant and dead in Texas: A bad law, badly interpreted

Art Caplan has published a new op-ed piece in the LA Times addressing the case of Marlise Munoz, the brain-dead, pregnant Texas woman from whom doctors are refusing to withdraw “life-sustaining treatment” despite her family’s wishes. The hospital where Munoz argues that it cannot withdraw such treatment because of a Texas law forbidding the removal of such treatments from a pregnant patient. Caplan argues:

Given the clarity of this statutory language, it is hardly surprising courts have determined it inapplicable after a determination of death. For example, in a similar case in Houston, a Texas court ordered a hospital to continue treatment for a comatose Tammy Martin, who was then 15 weeks pregnant. But the court reversed the order, a few weeks later, once Martin had been declared dead.

Not only does the Texas law not apply, it is almost certainly unconstitutional.  Continue reading

Art Caplan: ‘Life support’ is wrong for brain-dead pregnant woman

Art Caplan has a new piece at NBC News online weighing in on the case of Marlise Munoz, the pregnant Texas woman who was declared brain dead by doctors several weeks ago and yet is being kept on “‘life support’ technology” against her family’s wishes. Based on their reading of a Texas law that bans the withdrawal of such machines in cases where the patient is pregnant — regardless of advance directives or the family’s wishes — the hospital claims it has no choice. Caplan argues:

The hospital, however, is very confused. If Marlise is dead, then the Texas law does not apply. Even the legislature of Texas cannot compel continued use of medical interventions on a dead body. “Life support” technology need not be continued if the patient is dead. Erick Munoz made that case in his lawsuit against John Peter Smith Hospital.

“In fact, Marlise cannot possibly be a ‘pregnant patient’ — Marlise is dead,” the suit says. “To further conduct surgical procedures on a deceased body is nothing short of outrageous.”

But even if Marlise were alive — assuming she has either a terminal or irreversible condition — the hospital has the choice to do the right thing ethically, follow the wishes of her husband and family and stop intervening.

Read the full article.

 

Art Caplan on Brain Death, Death, and the McMath Case

Art Caplan has weighed in again, in a piece at Time.com co-authored with David Magnus, on the ongoing McMath case, in which 13-year-old Jahi McMath’s parents are fighting to keep her on life-support despite doctors’ diagnosis of brain death. From the article:

Concepts matter in medicine. This could not be more obvious than in the utter confusion on display over the concepts of ‘brain death’ and ‘life support technology’ that has resulted in two dead bodies being kept on ventilator support in California and Texas.  Continue reading