bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disaster Response or Response as Disaster?
Authors: Baruch Jay 
Published: October 2014

AbstractOn September 1, 2005, Memorial Hospital was on “survival mode.” Hurricane Katrina had felled the levees of New Orleans, submerging a modern city with floodwaters of biblical proportions, tasking physicians and nurses to make morally sound decisions under unprecedented conditions, where, as one physician stated, “[T]he laws of man and the normal standards of medicine no longer applied” (p. 9). In Five Days at Memorial, Sheri Fink, a Pulitzer Prize‐winning journalist, resists the urge to assign easy blame or take a position. Instead, she weaves together the perspectives of a cast of people tested by this catastrophe and constructs a tapestry of experiences that isn't neat and comforting but disturbing, compelling, and admirable all at once.
Personal Statement to Personal Physician: Bait and Switch?
Authors: Breen James O. 
Published: October 2014

AbstractIn our family medicine program, applicants' personal statements largely speak to the value of trusting, continuous doctor‐patient relationships. They give poignant examples of patient interactions that have allowed the applicants to experience the privilege of the intimacy with which patients relate to their doctors. Whatever their true motivations for choosing family medicine, the relational values expressed in the personal statement are the ones we celebrate and incentivize in the residency selection process. However, after donning their freshly pressed white coats, new interns in family medicine hear different definitions of value applied to their chosen specialty.
Neuroimaging and Psychiatry: The Long Road from Bench to Bedside
Authors: Mayberg Helen S. 
Published: October 2014

AbstractAdvances in neuroscience have revolutionized our understanding of the central nervous system. Neuroimaging technologies, in particular, have begun to reveal the complex anatomical, physiological, biochemical, genetic, and molecular organizational structure of the organ at the center of that system: the human brain. More recently, neuroimaging technologies have enabled the investigation of normal brain function and are being used to gain important new insights into the mechanisms behind many neuropsychiatric disorders. This research has implications for psychiatric diagnosis, treatment, and risk assessment. However, with some exceptions, neuroimaging is still a research tool—not ready for use in clinical psychiatry.
Clinical Use of Placebos: Still the Physician's Prerogative?
Authors: Barnhill Anne 
Published: October 2014

AbstractThe American Medical Association's Code of Ethics prohibits physicians from giving substances they believe are placebos to their patients unless the patient is informed of and agrees to use of the substance. Various questions surround the AMA policy, however. One of these has to do with what should be disclosed. The AMA holds that any treatment that the physician believes is a placebo should be identified as such to the patient. But consider a more restrictive policy that requires physicians to defer to the medical community's consensus view about which treatments have a specific effect on the condition being treated. In light of the ethical goals that the AMA identifies—namely, concerns about patient trust, autonomy, and benefit—there are potential advantages to the more restrictive policy.
Research Misconduct Involving Noncompliance in Human Subjects Research Supported by the Public Health Service: Reconciling Separate Regulatory Systems
Authors: Bierer Barbara E. , Barnes Mark 
Published: October 2014

AbstractOver the past three decades, two separate federal regulatory structures have emerged, each seeking to assure separate aspects of the integrity and ethics of research conducted using federal funding. One set of regulations is described in the Public Health Service Policies on Research Misconduct and relates to research misconduct, defined as consisting of fabrication of data or results, falsification of data and results, or plagiarism, in accordance with the federal‐wide definition adopted by the Office of Science and Technology Policy. The second set of regulations, set forth in the Department of Health and Human Services regulations on the protection of human subjects (known as the “Common Rule”), prescribes a set of ethical and procedural protections for research involving human subjects.These two sets of research regulations are distinguished from each other by having different foci of enforcement, priorities of protection, oversight officials, oversight procedures, seizure of evidence, standards of proof, expectations of privacy, and appeal procedures for researchers who are subject to adverse findings and penalties. These differences are significant and fundamental. They complicate the process of compliance for institutions and researchers, who are expected to adhere to both sets of standards for the same federally funded research activities in research with human subjects. Compliance is especially complicated when suspected violations of both sets of standards must be investigated and resolved concurrently. This document represents an effort to provide institutions and individuals with practical suggestions as they try to comply with both sets of regulations.
Why Guidance Comes from the Research Community
Authors: Wright David E. 
Published: October 2014

AbstractThe good news is that our uniquely American formula for research regulation has worked well, on the whole, by placing the first‐line administration of the regulations with peers in the institutions and by minimizing the size of the federal oversight agencies and generally limiting intrusive oversight to serious matters. The bad news has been lack of regulatory coordination, both in the federal government and at research institutions. This is the problem addressed in this supplement in the report by Barbara Bierer and Mark Barnes.
The Organ‐That‐Must‐Not‐Be‐Named: Female Genitals and Generalized References
Authors: Rodriguez Sarah B. , Schonfeld Toby L. 
Published: October 2014

AbstractThe reference to the vagina as “it” or “down there” is symptomatic of two larger cultural problems: not naming the vagina when speaking about the vagina, and conflating the vagina with the external female genitalia. The euphemisms and obfuscating language have implications both for lay understandings of female bodies and for the practice of health care. Granting and using a name gives both the named and the namer power and legitimacy.
Health Disparities among LGBT Older Adults and the Role of Nonconscious Bias
Authors: Foglia Mary Beth , Fredriksen‐Goldsen Karen I. 
Published: October 2014

AbstractThis paper describes the significance of key empirical findings from the recent and landmark study Caring and Aging with Pride: The National Health, Aging and Sexuality Study (with Karen I. Fredriksen‐Goldsen as the principal investigator), on lesbian, gay, bisexual, and transgender aging and health disparities. We will illustrate these findings with select quotations from study participants and show how nonconscious bias (i.e., activation of negative stereotypes outside conscious awareness) in the clinical encounter and health care setting can threaten shared decision‐making and perpetuate health disparities among LGBT older adults. We recognize that clinical ethicists are not immune from nonconscious bias but maintain that they are well situated to recognize bias and resulting injustice by virtue of their training. Further, we discuss how clinical ethicists can influence the organization's ethical culture and environment to improve the quality and acceptability of health care for LGBT older adults.
Child Safety, Absolute Risk, and the Prevention Paradox
Authors: Schwartz Peter H. 
Published: October 2014

AbstractImagine you fly home from vacation with your one‐and‐a‐half‐year‐old son who is traveling for free as a “lap child.” In the airport parking lot, you put him into his forward‐facing car seat, where he sits much more contentedly than he did in the rear‐facing one that was mandatory until his first birthday. After he falls asleep on the way home, you transfer him to his crib without waking him, lowering the side rail so you can lift him in more easily.Many parts of this idyllic parenting picture are deemed unacceptably risky according to recent child safety proposals. While these proposals all aim to improve child safety, their possible impact is unclear because there has been little discussion of the absolute risk and risk reduction involved in each. And while precise figures are lacking, rough estimates indicate that the magnitudes are quite small. I will argue that this risk and benefit data raises important questions about the proposals, including whether parents might reasonably believe that the small absolute risk reduction offered by the proposed changes does not justify the attendant burdens. This possibility—termed the “prevention paradox” in other contexts—highlights ethical and theoretical challenges in this area of public health.
The Scholar at Work
Authors: Murray Thomas H. 
Published: October 2014

AbstractMy thirteen years as president of Hastings have been rich in solidarity. Now for some solitude, and a new adventure: Cynthia and I will relocate to Cape Cod, a place rich in family memories. I'll explore the roads and trails on my bicycle and, if I can become a competent kayaker, the waterways. Some of my best thinking has come while riding. I'll have a study there, a place to think and write. I will continue to support the initiatives we've begun at the Center, especially bioethics in the public interest and the flourishing of bioethics internationally.The challenge is to balance solitude and solidarity. Next year I'll be the Terry Visiting Scholar at Yale, a wonderful chance to discuss ideas with students and faculty there. I'm considering other opportunities to share what I've learned and to learn from others. To everyone, thanks for your patience, wisdom, and support. May your next adventure be surprising and fulfilling.
The Honesty Effect
Authors: Crigger Bette‐Jane , Wynia Matthew K. 
Published: October 2014

AbstractAnne Barnhill focuses her article in this issue on the American Medical Association's ethics policy governing clinical use of placebos, but the implications of her analysis are deeper, touching on how physicians should make judgments about which interventions to offer patients in the process of shared decision‐making. The bottom line is that, even if an undisclosed placebo might be marginally more effective for a particular patient in the short term, over the long haul the integrity of the patient‐physician relationship relies on doctors being honest with their patients. Even when it comes to placebos, honesty remains the best policy.
Exploring the Limits of Autonomy
Authors: Volpe Rebecca L. , Levi Benjamin H. , Blackall George F. , Green Michael J. 
Published: October 2014

AbstractMr. Galanas, an eighty‐six‐year‐old man, intentionally shot himself in the chest and abdomen. Surprisingly, the bullet damaged only his distal pancreas and part of his colon, requiring a diverting colostomy to prevent leakage of bowel fluids into his abdomen. After being admitted, he lies intubated in the intensive care unit awaiting surgery to repair his colon. He is responsive but does not demonstrate clear decision‐making capacity. He grudgingly accepts pain medications but refuses antibiotics and antidepressants. He has a living will that gives his wife durable power of attorney and also explicitly states a desire to refuse all medical interventions if he is permanently unconscious or in an end‐stage condition. Mrs. Galanas reports frequent conversations in which her husband said he would not want to be sustained on life support. She also says that he often mentioned he would not want an ostomy bag—a likely, albeit temporary, outcome of the proposed surgery.His physicians are nervous about withholding medical interventions when Mr. Galanas's injury is the result of a suicide attempt and his prognosis is good. Should the care team surgically repair his injured colon, regardless of the patient's capacity, his advance directive, and his wife's statement that he would not want surgery or other life‐sustaining treatment?
Dr. Douchebag: A Tale of the Emergency Department
Authors: BARUCH JAY M. 
Published: October 2014

Abstract“I'm not afraid of dying,” he says, despite his plea on arrival. “Listen up, douchebag. Are you calling my cousin or what?”The emergency department might be the only sphere of human exchange where one party—patients (and sometimes family)—are permitted to insult, threaten, and even spit at the very people on whom they depend for help, while the offended parties—physicians, nurses, and other health care providers—must not only tolerate the abuse, but treat their tormentors.Does the ED's collective duty to greater numbers of patients demand a revised ethos of tough love for extreme cases of misbehavior? Can we ask these patients to leave without legal recourse after extending genuine, compassionate efforts to participate in their care—barring evidence of a medical explanation for their toxic comportment or a mental illness that puts them at risk of harming themselves or others?
Who Is “Too Sick to Benefit”?
Authors: Courtwright Andrew 
Published: October 2014

AbstractIntensive care units provide focused, aggressive medical intervention to critically ill patients. Physicians responsible for ICU triage must decide which patients are sick enough to require this level of care and which can be managed on the general wards. While some patients are too well for the ICU, intensivists increasingly rely on another category, “too sick to benefit,” when denying ICU admission, even if beds are readily available. Recent studies indicate that between 19 and 37 percent of patients refused ICU admission were declined because they were thought too sick to benefit from it, suggesting that physician use of this category is common in ICU triage.The idea of being too sick to benefit may seem paradoxical given that ICUs exist to treat the sickest of the sick. There is, however, increasing awareness that some diseases progress despite maximal intervention. Although there have been systematic attempts to define these diseases—most notably during the medical futility debates of the 1980s and early 1990s—there is little evidence about which conditions make a patient too sick to benefit from ICU admission. In the absence of a clear understanding of which diseases progress despite maximal care, ICU triage under the category “too sick to benefit” is currently done on a case‐by‐case basis. Contemporary decisions about who is too sick to benefit thus raise a number of ethical issues about what constitutes standard of care, the role of health care providers' judgments of quality of life in triage, and the just allocation of resources.Addressing these ethical concerns requires us to better define the population of critically ill adults who are too sick to benefit—a conceptual and empirical project. In this article, I recommend employing a diagnostic concept from the neonatal literature: namely, a lethal disease.
The Ethics of Vaginal Birth after Cesarean
Authors: Charles Sonya 
Published: October 2014

AbstractThe decline in providers and facilities that will allow a trial of labor after cesarean forces many women to choose a repeat cesarean. The choice is frequently not much of a choice, however, since the full range of options are often not on the table. This limited “choice” violates obstetricians' obligations both to respect patients' autonomy and to offer them good care. There has been a vigorous but so far not very fruitful debate in the last few years about the lack of access to a trial of labor after cesarean. Some recently released documents express concern about the limited access women have to clinicians and facilities willing to offer a trial of labor after cesarean. But access is likely to remain a problem for the foreseeable future.
Seeking the unseen
Authors: Solomon Mildred Z. 
Published: October 2014

AbstractWhen Dan Callahan and Will Gaylin began The Hastings Center, they saw and sought to study the unseen. They were among the very first to recognize that remarkable advances in biomedical technology were generating questions our society had never before faced. As I take the helm of The Hastings Center forty‐plus years later, it's now my job to be sure we see, name, grapple with, and act on today's questions. Over the next two years, the Center will engage its scholars, our Fellows, other bioethicists, scientists, social science and humanities scholars, health care policy‐makers, and key stakeholders such as journalists, educators, and patients in defining today's set of critical questions.
Too Sick
Authors: Kaebnick Gregory E. 
Published: October 2014

AbstractThis issue of the Report is bookended by two pieces that take contrasting although perhaps compatible positions on medical care for those in dire straits. At the end of the issue is an article that considers whether patients may be denied admission to intensive care units on grounds that they are too sick to benefit. We think of ICUs as reserved for the sickest of the sick, notes author Andrew Courtwright, but in fact, “too sick to benefit” is an increasingly common reason given for not putting a patient in the ICU. Meanwhile, the first essay in the book tells the story of a man whose physician more or less told him he was too sick to benefit (under some understanding of the idea) and should opt for death.
Reality Checks
Authors: Dworetz April R. 
Published: October 2014

AbstractGiving up on our dreams is not easy. I am a neonatologist, and I often watch the parents of my patients wish for the impossible. They come to the NICU with their own stories, their own expectations, and their own values. They have had nine long months to imagine their perfect child and often struggle with learning to accept the hand they have been dealt and the child they really have.Neonatology and geriatrics have a lot in common. Both specialties treat patients who cannot describe their symptoms. Both deal with family members who are serving as surrogate decision-makers. These family members often wrestle with end‐of‐life issues, and they share a tendency to sometimes base their decisions on emotions rather than on the best interests of the patients involved. I know this, but I didn't really understand it until I lived it.
America's Drug Problem
Authors: Philpott Sean 
Published: October 2014

AbstractAmerica has a serious drug problem. The problem is not abuse of prescription stimulants by students cramming for the SATs, nor is it the recent spate of violent attacks associated with the use of so‐called bath salts. Rather, the problem is a shortage of critical medicines. The American Society of Health System Pharmacists reports that over two hundred drugs are in short supply. The frequency and number of drug shortages are also increasing steadily, as seen in a recent Food and Drug Administration study that found that the number of reported drug shortages has nearly tripled, from sixty‐two in 2005 to 178 in 2010. There are few quick solutions to the crisis, and the long‐term effect of pending legislation and regulatory changes is unclear.
Scholarly Discussion of Infanticide?
Authors: Garasic MirkO D. 
Published: October 2014

AbstractI feel the urge to express my solidarity with Alberto Giubilini and Francesca Minerva, the authors of the much‐discussed article “After‐Birth Abortion: Why Should the Baby Live?” that appeared in the Journal of Medical Ethics in February. Both their argument and, more sadly, they themselves suffered a violent attack by people who obviously do not consider freedom of expression an important value. Censorship does not fit well with the mission of scholarship—particularly when the scholarship depends on a method of speculation and hypothetical argument, as in the case of philosophy and bioethics—and the level of hatred and extremism expressed about the article seem out of proportion. Having said this, though, I want to consider why publishing the article was nonetheless inappropriate.
The Affordable Care Act Survives, for Now
Authors: Hall Mark A. 
Published: October 2014

AbstractThe new millennium is still very young, so it is too early to declare National Federation of Independent Business v. Sebelius1 the health law “case of the century,” but that title would not be hyperbolic. Never before have we seen a case of such monumental importance for how health care is financed and delivered in the United States. At the Supreme Court, no decision has been more closely watched and more anxiously awaited since Bush v. Gore in 2000. In the balance was the fate of President Obama's signature piece of domestic legislation, one that affects nearly every aspect of the largest segment of our economy, and so is perhaps the most important piece of social legislation since the New Deal. To no one's surprise, the decision was announced at the very end of the Court's term and was split five to four.What was very surprising, however, was the Court's embrace of the tax power defense of the individual mandate. And what was outright shocking was a seven‐to‐two majority in favor of finding the Medicaid expansion unconstitutional unless states are allowed to opt out of the expansion.The case holds great significance not only for the fate of the Patient Protection and Affordable Care Act—and, thus, for the nation's health care public policy—but also for constitutional doctrine that applies much more broadly than in the health care arena.
A Mutual Aid Society?
Authors: Jost Timothy Stoltzfus 
Published: October 2014

AbstractIn her classic 1993 article, “The Struggle for the Soul of Health Insurance,” Deborah Stone contrasted the principle of mutual aid—“the essence of community” in the face of sickness—and the principle of actuarial fairness, under which “each person should pay for his own risk.” Stone claimed that “in most societies sickness is widely accepted as a condition that should trigger mutual aid,” while in the United States, a competitive insurance industry fosters in people “a sense of their difference, rather than their commonalities, and their responsibility for themselves only, rather than their interdependence,” leading to the fragmentation of “communities into ever‐smaller, more homogeneous groups” and “the destruction of mutual aid.”The United States has, as Stone observes, long been an outlier in its approach to financing care for sickness. Over the past half century, we have developed mutual aid‐based programs to care for some, but most Americans have had to pay the “actuarially fair” cost of their care, either as individuals or as employee groups. Mutual aid has existed only on a limited scale. The Affordable Care Act is the most comprehensive attempt to date to remedy this situation.
Justice Roberts's Health Care Stewardship
Authors: Nichols Len M. 
Published: October 2014

AbstractThe issues before the Supreme Court, arising as they did out of multiple cases and divergent appellate court rulings, were quite complex, and its final decision will be parsed rather differently by lawyers, health policy wonks, and economists (or metaphysical philosophers, in Chief Justice John Roberts's memorable phrase). This essay will focus on one singular element: did the final ruling enhance or detract from our collective power to exercise stewardship over our health care resources?Clearly Americans diverge on key features of a desirable society and on the wisdom of using government to achieve even mutually desirable goals. But before politics settles the fate of the Affordable Care Act (and perhaps also the federal role in health policy for the foreseeable future), we should focus on what the Court has allowed us to consider: if we want it to, federal power may constitutionally be marshaled to compel insurers to end discrimination against the sick and to offer more transparent products so the marketplace will better serve consumers.