SCHOLARLY COMMUNITY

AT WAR

​A Look at the Emotional Physician Experience During the Time of COVID -19

Every day on my way to high school, I would drive past the local Catholic hospital near my home. I had been in a few times but didn’t often stop to think about what went on inside. I mean, it’s full of sick people, but that’s all a hospital is, right? Then when the pandemic struck, I no longer drove past the hospital every day but would pass by occasionally with a slightly new sense of dread, and curiosity, at thoughts of the COVID-stricken world that must be inside. Phrases from the news like “hospitals overflowing” and “running out of respirators” came to mind, but I really had no picture of what this truly meant.

 

At the Wave After Wave lecture, I finally got a deeper sense of what this meant for those experiencing the full blow of the pandemic’s effects, health care providers. Having heard previous accounts of the grueling and emotionally tolling work of frontline workers during the thick of the pandemic, I did not expect to hear anything especially new from the panelists of this lecture. I was wrong. What had been missing from the endless news stories and previous accounts of pandemic-stricken hospital work was the deeply personal and emotional account- the storytelling that was truly the only way to help those of us not on the frontlines to understand the hurt and pain and utter exhaustion of treating patients during a pandemic. In her account of working as a physician during the beginning of the pandemic, Dr. Nicole Rae Van Buren described it as a “war,” beginning from her first realization of its potential destruction to the exhaustion she felt and wounds she took while on the battlefield.

 

As a member of her hospital’s bioethics committee, Van Buren was tasked with collaborating to create a revised visitation policy for the hospital, a job that required weighing the factors of patient, visitor, and worker safety while acknowledging families’ wishes to be with their loved ones. In the beginning of the pandemic, Van Buren recalled that the visitation policy was harsh; a vaccine had not been created yet, and scientists were trying to get an idea of just how dangerous the SARS-CoV-2 virus was, leading to the prohibition of visitors from the hospital. As a result, Van Buren was inundated with phone calls from family members who could not visit their ill loved ones, begging for information. As the outcomes of COVID-19 patients worsened, day after exhaustive day went by, and Van Buren continued to receive constant calls, her response became almost robotic: “Your loved one is dying... They’re not going to make it through COVID... No, you can’t come see them.” After having this conversation twenty to thirty times a day for six weeks, Van Buren finally got a call that took her to her breaking point. While Van Buren was speaking to a mother of young children whose husband was in the hospital, the woman detected the monotony of Van Buren’s voice and became distraught with anger. She unleashed her emotions, forcefully expressing her anger at Van Buren and the hospital and making Van Buren feel extremely guilty for this woman’s pain. After this, Van Buren broke down and backed out from working in the ward unit that she had been in for the past six weeks.

 

Van Buren also worked on the hospital’s triage crisis committee which involved deciphering a method of allocating scarce resources to be used in the event of having more patients than medical equipment could supply. This program used an algorithm to determine the recipients of medical equipment based on factors contributing to their ability to have the most fruitful outcome if they were given the equipment. The task of reducing patients to numbers in a spreadsheet was impersonal, but was a necessary step to prioritize them and work to save the most lives possible. Van Buren described the feeling of designing this program as being “weird to work so hard on something you hope you never have to use.” Fortunately, they did not need to use it. The closest she recalled her hospital to being in a situation of resource scarcity was when they were down to four ventilators; she got the “sickest feeling” in her stomach knowing that they would have needed to deprive patients of ventilators and prioritize others should they have run out.

 

The emotional toll that Van Buren and other physicians experienced during the COVID-19 surges and still today is consistent with the issue of physician burnout. Dr. Dike Drummond, physician and psychological coach for healthcare providers, describes burnout as “the constellation of symptoms that occur when your energy account has a negative balance over time,” specifically, a low physical, spiritual, and emotional energy (Drummond, 2015). In the everyday patient care setting, small traumatic experiences pile up to a state of burnout, such as how Van Buren’s difficult phone conversations piled up to compel her to leave work (Milleson, 2021). In Drummond’s words, the first law of physician burnout is, “You can’t give what you ain’t got.” With physician burnout being a clear negative state that exhibits itself primarily through personal physical, social, and emotional exhaustion, institutions seemed eager to put the burden of burnout on physicians themselves. Yet, as bioethicist Alex Dubov noted in a recent presentation on physician burnout, it is not a “personal issue” but, rather, a systemic one (Dubov, 2021). Van Buren recalled that, in response to physician complaints, institutions gave “a lot of lip service” and offered resources like yoga and meditation classes. Yet, as Dr. Cohn, bioethicist and co-presenter on the lecture panel, noted, these barren attempts at aiding physicians required time and energy to complete, which did not alleviate burnout. Instead, as discussed by Van Buren and Dubov, institutions need to take concrete steps to alleviate physician stress, such as giving time off work, hiring more workers, offering financial assistance, and ensuring employee access to basic necessities, including food, PPE, and scrubs.

 

While the COVID-19 pandemic wracked all our worlds, it truly struck those on the frontlines of the war, the health care workers. Yet, like any battle, it revealed our weaknesses-our chinks in the armor-not only on the personal, but on the systemic level. Let us recognize these and make concrete steps to take care of our toughest warriors who fight daily behind hospital walls- they deserve it.

This page was created by Bioethics undergraduate intern Clare Houston.

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Clare Houston is a sophomore in the class of 2024, studying Biology in the Frank R. Seaver College of Science and Engineering. 

 
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Neuralink is a company focused on creating a brain machine interface, or BMI. It was founded by Elon Musk in 2016 and announced to the public in 2017. Brain machine interfaces are a type of technology that allow the brain to directly communicate with a device. Neuralink is working to create a neural implant that will allow the brain to control computers and cell phones. The Neuralink BMI functions by implanting threads that contain thousands of electrodes into the brain. These threads are placed in neurons that reside in areas of the brain that control movement. The implantation process would occur through a surgery with a developing robotic system. The threads then connect to the Link, which is Neuralink’s brain implant. The Link records the brain’s information, processes it, and then relays the information to the chosen device that it is connected to. Neuralink has designed an application that will give the brain access to control the device. There have been no clinical trials conducted yet as this technology is still being created, although safety is at the forefront of the research design. The main goal of the Neuralink BMI and the Link is to give people with neurological disorders more freedom. For example, one benefit would be allowing paralysis patients the ability to better communicate and express themselves through technology. The Neuralink BMI is designed to be used as a medical device and with further research will bring assistance to those affected by neurological disorders.

This article was written by Bioethics Minor student Katherine Hansen

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Katherine Hansen is a second year undergraduate student at Loyola Marymount University, pursuing her Bachelors in Psychology with a Minor in a Bioethics.

 
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          Neurable is a Boston headquartered brain-computer interface (BCI) startup, which was founded in 2015 by researchers at the University of Michigan’s Direct Brain Interface Laboratory (UM-DBI)[1]. The startup has developed software that interprets an individual’s brain activity in order to control a wide variety of different technological interfaces. Their mission, as is that of the UM-DBI, is to create innovative assistive technologies that allow complete autonomous control regardless of one’s physical abilities[2].

          The application of their software and algorithms has taken many forms. They first came on the scene through a partnership with HTC in 2017[3], developing a demo of a fully-brain controlled virtual reality game. Since then, the company has expanded beyond the consumer VR into military and industrial training operations, as well as the growing market of wearable technology. Neurable has received over $9 million in Series A funding, most recently in 2019 in order to develop every-day consumer products like headphones and other functional devices[4].

          Expectations and demand for BCI products have always overshadowed what is currently available. Yet, it is this speculative curiosity from consumer technology, military, industrial, and medical sectors that has driven investment, and caused this industry to be valued at over $1.3 billion[5]. Early adoption in these fields could mean that expectations are nearing reality.

          Ethical debates have and will take place over the scope of these BCI devices and use of their data. In an age of the social contract between users and developers, where products are exchanged for personal data, one could expect what Neurable and other companies track to be highly valuable information to different actors. However, Adam Molnar, a co-founder of Neurable, has stated that no user data will be sold off by the company, only collected for improvement of the user experience[6]. This step seems necessary given the nature of the brain activity data they are collecting, and will hopefully cause other BCI companies to join them in this pledge.

This article was written by Bioethics Minor student Brennan Sandor

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Brennan Sandor is a fourth year undergraduate student at Loyola Marymount University, pursuing his Bachelors in Psychology with a Minor in a Bioethics.

 

Artificial Intelligence 

            The term “artificial Intelligence” (known colloquially as A.I.) invokes many images: robotic friends that converse as they make life convenient, pre-crime departments subduing future criminals, mechanical experts surpassing their masters in their chosen field, computer uprisings by thinking machines, and so forth. In reality, A.I. represents a novel technological paradigm which has its own constraints, misconceptions, and potentials, but very few formal approaches towards its moral implications. As with all technologies ever developed, A.I. poses as many constructive as destructive potentials, but the actual future can be swayed in one or the other direction depending upon how scientists, policymakers, and consumers apply the technology at their disposal. One observation from the nascent field of nanoethics offers promise.

            Most importantly, A.I. must be understood as a technology and not through the mythos of science fiction, which is not yet fact. “Artificial intelligence” is defined as any and all computational technology meant to replicate human intelligence and cognitive processes to complete tasks which otherwise would require human critical thinking ability, oftentimes encompassing autonomous programming (Bali 1; de Saint Laurent 736). Towards this end, two other distinct processes are involved to ensure that a program can mimic human learning and adaptive capacities. Machine learning refers to algorithms designed to analyze statistical inputs to generate predictive outputs; i.e. a program which can learn with, or without, human supervision (Gandhi et al. 1403; Ergen 6). A subset of machine learning is deep learning, which is meant to replicate neurological process through artificial neural networks (ANN) which have multiple layers of input/output nodes (Ergan 6; de Saint Laurent 737). Essential to machine learning at all levels is an iterative process where an algorithm is fed raw data relevant to its function, and “learns” how to process desired patterns in the dataset to make predictions towards a targeted goal (Ergan 6). In short, a far cry from the sentient machines of “Star Wars” fame, A.I. is—at its most basic—a statistical engine that predicts outcomes that otherwise would be overwhelmingly demanding in terms of human resources, time, and combined skill (e.g. if a tree’s roots will endanger water lines, or when a seemingly healthy patient might have a heart attack).

            The potential of basic A.I. is seemingly unlimited. The 2016 victory of Google DeepMind’s AlphaGo over Korean Go champion Lee Sedol showcases the potential of A.I. to solve human problems faster than humans themselves (Bali 1). ANNs are being tested for the potential to resolve biological conundrums which have stumped human experts, such as predicting protein functions, while others have been successful in image recognition and automated translation (de Saint Laurent 737; Fa et al. 2). Others have been used in the healthcare industry, processing patient data to diagnose, prognosticate, and prescribe treatments (Weng et al, Lo-Ciganic et al). Each case offers promise, and the danger of abuse. Overreliance on A.I. conclusions could lead to misdiagnoses, patient misconceptions of their conditions, and machine prejudice based on demographic inputs. Similar worries stem from A.I. data corruption, faulty learning, or sabotage, which can easily go unnoticed in an otherwise autonomous program. This is especially salient when one considers the ongoing problem that the autonomy of machine learning, even under supervision, can lead to predictions with statistical justifications which elude human experts, making mistakes impossible to ascertain (de Saint Laurent 737).

            The challenge issued to developers and users of A.I.: how to go from here?

            Bert Gordjin offers a pragmatic scheme whereby the “ethical desirability” of A.I. research and use may be delineated without recourse to Precautionary or Proactionary postures. Although his “balanced view” was developed to address nanoethics, it is impartial to practice and can be reapplied to any field of research. He asks three simple yet critical questions for researchers and users which are meant to guide them as they refine the new technology:

 

  1. What are the goals sought by research into A.I.”?

  2. Will the research in question actually contribute to the realization of these goals?

  3. Are the foreseeable ethical issues concomitant with research and development of A.I. surmountable, if not justifiable?

 

As it stands, A.I. research is a free-for-all: there is no consensus as to the actual goals of developing intelligence-like qualities in computer algorithms. What is the ultimate objective of A.I.? Is it further scientific development? Profit? Convenience? The creation of sentient machines to become fellow citizens, or to solve problems too complex for human to solve (assuming they can be solved at all)? Are these objective morally worthwhile and are the risks greater than the reward? Who will pay the moral price for a mistake?

            Unless these questions are answered, and a consensus achieved, the world will not be ready for the implications of A.I., and those uninvolved in its development will likely pay the price. One must rise above myth and misconception, above utopianism and technophobia, and consider how this new technology will affect them and everyone they know in their own lives. Towards this end, one important question to compliment the Gordjin inquiry might be this: Will A.I. help humanity attain something that would be utterly inaccessible otherwise?

This article was written by Bioethics Alumnus Andres Elvira

 
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 Covid-19 has quickly become the most urgent health crisis faced worldwide since the 1918 Spanish flu pandemic. The Covid-19 pandemic has, to date, infected 51.2 million people and killed 1.27 million people worldwide.[1] In the United States alone, 1.3 million people have been infected and 240 thousand people have died.[2] An end to Covid-19 can only be possible with the arrival of a vaccine.[3] As Dr. McMillan stated in her presentation, pharmaceutical companies have stopped previous research trials to put all of their resources into formulating a vaccine. However, there is the issue as to whether or not a Covid-19 vaccine can be mandated while upholding the principles of bioethics. Logistically, mandating a vaccine might prove unrealistic, as evidenced by the reluctance of a large part of our population that refuse to wear state mandated masks. There is also another part of the population that is concerned about the legitimacy of a Covid-19 vaccine that has been pushed through trials so quickly. While my opinion can only be hypothetical for these reasons, I believe that a mandated Covid-19 vaccine upholds the three principles of bioethics: autonomy, beneficence, and justice.

 

Autonomy is commonly known as the respect for persons principle, or more clearly defined as self-rule that is free from both limitation and control. One may argue that mandating a vaccine is a direct violation of bodily autonomy. However, in all 50 states, there are varying laws mandating that children cannot attend schools without receiving specific vaccines.[4] There are medical, religious, and even personal exemptions to vaccines, but these exemptions are rare. Per the CDC, in the 2018-2019 school year, 94.7% of all kindergarten-age children received the immunizations required to attend school in their state.[5] Mass immunizations required by schools have eradicated numerous childhood diseases. Autonomy should not only concern protecting one’s body, but rather about protecting all bodies. Mandating vaccines in schools protects the bodily autonomy of the student body as whole. If schools mandate the Covid-19 vaccine, this would be a start to ensuring the bodily autonomy of the whole population in the future.

 

Beneficence is defined as bringing the most benefit to the population and preserving welfare to the most reasonable extent. A mandated Covid-19 vaccine will bring the most benefit to not only the high-risk population, but the population as a whole. According to the CDC, 45.4% of the US adult population is considered high risk for Covid-19 due to chronic conditions.[6] This is almost half of the adult population in the United States. Health care workers face high exposure to the virus every day. Between the months of March and May, up to 6% of all Covid-19 hospitalizations across 13 states were health care workers.[7] A mandated vaccine will provide the benefit of relief to the health care workers who put their lives in danger to care for their patients.

 

Justice is the focus on the fair distribution of social goods in a society. Here, the good which requires distribution is the Covid-19 vaccine. Mandating a vaccine means that all members of a society must have access to it. Covid-19 disproportionately affects minorities and those of lower socioeconomic status.[8] This demographic has less access to health care, creating the possibility of members of this demographic being forced to pay for the vaccine out of pocket. Besides mandating the vaccine, I believe that justice includes providing the vaccine to this disproportionately affected demographic at little to no cost.

 

Although logistically unrealistic, the best way to uphold the principles of bioethics and bring a complete end to the Covid-19 pandemic is through a mandated vaccine. A mandated vaccine will uphold bodily autonomy, bring the most benefit to the population, and provide justice through its distribution to all.

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[1] The New York Times, “Covid World Map: Tracking the Global Outbreak,” The New York Times, 11 November 2020, https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html

[2] The New York Times, “Covid in the U.S.: Latest Maps and Case Count,” The New York Times, 11 November 2020, https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html.

[3] Anita Heywood, “Elimination of Covid-19: what would it look like and is it possible?” The Lancet, 6 August 2020, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30633-2/fulltext.

[4] CDC, “Vaccination Laws,” CDC, U.S. Department of Health & Human Services, 28 February 2018, https://www.cdc.gov/phlp/publications/topic/vaccinationlaws.html.

[5]  Ranee Seither et al., “Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten – United States, 2018-19 School Year,” CDC, U.S. Department of Health & Human Services, 17 October 2019, https://www.cdc.gov/mmwr/volumes/68/wr/mm6841e1.htm#suggestedcitation.

[6]  Mary Adams et al., “Population-Based Estimates of Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States,” CDC, U.S. Department of Health & Human Services, 19 July 2020, https://dx.doi.org/10.3201/eid2608.200679.

[7] Reed Abelson, “Nurses are at High Risk for Covid Among Health Care Workers, C.D.C. Says,” The New York Times, 26 October 2020, https://www.nytimes.com/2020/10/26/health/covid-nurses-.html.

[8] Carlos Del Rio, “Covid-19 and its Disproportionate Impact on Racial and Ethnic Minorities in the United States,” Contagion Live, 14 August 2020, https://www.contagionlive.com/view/covid19-and-its-disproportionate-impact-on-racial-and-ethnic-minorities-in-the-united-states.

Upholding the Principles of Bioethics with a Mandated Covid-19 Vaccine 

This article was written by Bioethics Minor student Katherine Hansen

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Katherine Hansen is a second year undergraduate student at Loyola Marymount University, pursuing her Bachelors in Psychology with a Minor in a Bioethics.

 
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     RADICAL BIOETHICS:

  DISABILITY,

               DIFFERENCE,

  & DESIDERATA

To read Bioethics Institute Director Dr. Dell'Oro's lecture introduction, click here.

THE 2019 O'MALLEY CHAIR LECTURE

In her October lecture, “Radical Bioethics: Disability, Difference, and Desiderata,” Prof. Iozzio argues that too few people register a thought concerning the global prevalence disability. As a result of this unrecognizable concern, too few people without immediate experience of or any regular encounter with persons with disability remain unaware of this largest and most diverse minority of people across the globe (WHO estimates 15+% of Earth’s human population). To unsettle any complacence, she rehearses the likelihood of able-bodied/able-minded persons joining this minority as they age or, if not by accident, then by diagnosis of Alzheimer’s Disease, arthritis, depression, diabetes, heart disease, mental illness, multiple sclerosis, Parkinson’s, and other conditions. Further, as no geographic location is immune from this prevalence, particularly in relation to the vicissitudes of contemporary life—for example, travel, trudgery, terrorism—both poverty and place of residence increase and exacerbate the vulnerability to being born with or acquiring a disability in one’s lifetime. Her focus on “Radical Bioethics” proposes one response to a dearth of theo-ethical and bioethical reflection on a critical concern for this population and for the requirements of justice that have been largely ignored in matters of care for the support and development of basic human functioning capabilities that are available in the common good. In this vein she advocates for a distribution of those goods with a preferential safeguard for persons and communities of people with disability.

 

Prof. Iozzio offers an approach to disability as another

instance of diversity in a world of fecund creativity. She

recognizes that, while bioethics has been slow to engage

a universal design approach in its adjudication of cases,

a growing number of academics including scholars with

disability in the humanities and social sciences vigorously

have been studying disability and the experiences of

people with disability for 25 years. Finally, her desiderata

includes analysis in bioethical, philosophical, and

religio-theo-ethical reflection on the subject of disability

and on the ways in which people with disability ought to be

where they are presently excluded as critical participants

in and rightful recipients of the commonweal: the common

goods of health, education, recreation, employment,

commerce, social & political affairs, & religious observance.

-Abstract written by Professor Mary Jo Iozzio                             TO READ MORE ABOUT PROF. IOZZIO, CLICK HERE.

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VIEW ENTIRE LECTURE BELOW

ADDITIONAL RESOURCES

JUDITH HEUMANN

Heumann helped to lead a groundbreaking protest called the Section 504 sit-in -- in which disabled-rights activists occupied a federal building for almost a month, demanding greater accessibility for all.

This page was created by Bioethics intern Kayla Chang, and Bioethics graduate student Cara Crew.

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Kayla Chang is a Philosophy major with a Bioethics and Chinese minor at Loyola Marymount University. She is interested in pursuing a career in policy-making for medical research. Kayla is an undergraduate intern for the Bioethics Institute.  

To read her thoughts on the lecture, click here.

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Cara Crew is a second-year

graduate student at the Bioethics Institute. She is the Craves Scholar and manages the content for the Bioethics Hub website.

 
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Addiction and Mental Health, 

                the Need of a New Perspective

PERSONAL COMMENTARY

Historically, the United States has grappled with difficult concepts surrounding addiction and mental illness. What drives addiction, what causes mental anguish, how to legislate substances that cause addiction, how to provide appropriate care for addicts and mental health sufferers, and perhaps the most complex and ignored, how to acknowledge the humanity of those suffering from addiction or from a mental illness? Current approaches for treating both populations seem to be fraught with economic, political, logistic, medical and moral challenges. These entanglements are not only effecting the individual who suffers, but profoundly affecting our society

By Cara Crew

One prominent theory ties addiction and substance abuse issues with mental illness and vice versa [i]. This dual diagnosis has provoked cultural misconceptions of addicts and mental illness, resulting in a convoluted understanding of this sufferer. Thus, negatively conflated attitudes towards mentally ill and addicted populations have been embedded in the cultural fabric of the U.S., and altered ethical possibilities for nuanced treatment and care [ii]. In a western society that obsesses over perfect health, we tend to imbue pejorative judgement on those who suffer from any malady; chronic, infectious, physiological and psychological. Addicts and mental health sufferers bear the stigma of a diminished moral status, in need of medical and policy-driven assistance.

Let's frame the conversation of addiction as it's playing out in our current opioid public health crisis. Over the last few decades, U.S. jurisprudence regarding opioid use has oscillated between restrictive and lenient policies. Imposing limits for healthcare providers has resulted in fear of prescribing. Shifting the focus away from those who require personalized care and tapering plans, which increased illicit drug use, overdose and death [iii]. On the other hand, lenient U.S. policies provoked drug manufacturers to systematically abuse policy, releasing billions of opioid drugs into circulation. This laid the groundwork for a highly addictive drug to become rampantly misused among millions of individuals in the U.S. [iiii]. What seems to be discounted in these policy-backed pendulum swings, is a fundamental understanding of an individual’s phenomenological human experience with their addiction. Opioid addiction is a subjective experience and the potential and probable connection to some type of mental illness, anguish or condition complicates U.S. law and subsequent treatment practices.

Prescription Drugs

"Our nation is in the midst of mental health epidemic, and we must address the comorbidity of mental illness, suicide and addiction."

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VIDEO CONTENT

 

 

 

 

 

 

 

 

 

 

Turning to mental health, reports of mental illness and suicide rates have increased in the United States. The Centers of Disease Control states that death by suicide has gone up in nearly every state since 1999; and that mental health issues are the leading contributor [v]. Recently, a study published by the American Psychological Association found that the “iGen generation” (age 14-23) reports higher levels of emotional distress, depression and anxiety, contributing to the highest statistical U.S. record of young people committing suicide [vi]. These researchers state the reason for the sharp incline of suicides among iGen, is strongly tied to heavy use of digital communication and social media. While in older adults, main factors for suicide and suicidal ideation are relationship issues, substance abuse and depression [vii]. Whatever is causing these extreme spikes in psychological isolation and suicide is subjective to these sufferers. Our nation is in the midst of mental health epidemic, and we must address the comorbidity of mental illness, suicide and addiction. The extremely dire outlook the statistics show on these concurrent crises, indicates a cry for a deeper ethical evaluation.

 

Reconciling notions of societal shame associated with addiction and mental illness must begin with a basic shift in our dialogue. We must look towards uncovering a fundamental acceptance of the subjective nature of an individual's experience with their own illness. How can our pluralistic society understand addiction qua addiction and mental illness qua mental illness through our various biased political, cultural, religious, and medical lenses? How can we uncover ethically nuanced care in lieu of neglect, criminalization and contemptuous perceptions, to find compassion for the human person and their experience? Addicts and mental health sufferers are part of an ongoing commingled moral dilemma, and the statistics exemplify that the existing means of addressing treatment, care, and prevention is failing. We must find assistance through a new lens. There is an ethical imperative for guiding appropriate support and care for those who suffer enmeshed in the field of bioethics. Bioethics is not a siloed philosophy. Bioethics is multidisciplinary, where the tenents of law, medicine, anthropology, and humanities collaborate to ground subjective guidance from various moralities and experiences. These complimentary approaches seek to offer insight and forge new paths toward humane, compassionate, and legislatively sound care. Bioethicists should be a voice in the moral discourse as we address this epidemic and try to care for the addicts and mental health sufferers who live among us.

 

Johann Hari, "The Opposite of Addiction is Connection"

Click Here for Various TED talks on, "The Struggle of Mental Health"

"One Nation Under Stress" 

Trailer for HBO Documentary

ABOUT THE AUTHOR

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Cara Crew is a second year graduate student and a research fellow for the Bioethics Institute at LMU. She is passionate about ethical and bioethical issues surrounding mental and behavioral health.

ADDITIONAL CONTENT

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Read the Atlantic's "Have 

Smartphones

Destroyed a Generation?" 

Here

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Listen to Sam Harris "The Problem with Addiction" with Psychologist

Sally Satel

Here

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Monsignor Vincenzo Paglia

President of the Pontifical Academy for Life

On September 3rd, the Bioethics Institute had the honor to host a special event with the Vatican's Monsignor Vincenzo Paglia, President of the Pontifical Academy for Life (PAV). Monsignor Paglia held a lecture on the topic: “Toward a Global and Environmental Responsibility: Pope Francis and the Renewed Agenda for Bioethics.”

 

Monsignor Paglia accepted the invitation from the Bioethics Institute Director Dr. Roberto Dell’Oro, also an academic at PAV. Monsignor Paglia stopped briefly in Los Angeles to graciously visit LMU and expound upon cultural growth, before heading to meet with Microsoft CEO in Seattle, Washington.

To read Monsignor Paglia's remarks from September 3rd, please click here.

To visit the Pontifical Academy for Life's coverage of the event, please click here

 
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On April 11th, The Bioethics Institute hosted Ana Iltis, PhD, the President-Elect for the American Society of Bioethics and Humanities, as she commented on the compelling nature of bioethics in the United States. The evening began with a screening of the award-winning short documentary “62 Days” (29 minutes)  which tells the story of a Texas emergency medical technician, Marlise Munoz, who dies from a brain embolism when she is 14 weeks pregnant. Texas law required the hospital to attach Mrs. Munoz to life-sustaining machinery, despite her written Advanced Directive indicating she did not want this and against the wishes of her husband and other immediate family. The film documents the public debate and court battle that unfolds over 62 days. Dr. Iltis used this as a spring board into reflection on American notions of autonomy, rights of women and fetuses, and the complicated nature of regulated social norms.

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Images (from right to left):  Harvard Medical School Center for Bioethics, "The Ethics of 'Making Babies,'" 62daysmovie.com "When Marlise Died, The Battle for Her Life Began"

Ana Iltis

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Image: news.wfu.edu "Dining Dilemmas Give WFU Students Food for Thought from Dining Room to Treatment Room

   

Ana S. Iltis, PhD is a Professor of Philosophy and the Director of the Center for Bioethics, Health, and Society at Wake Forest University. She is also the President-Elect of the American Society for Bioethics and Humanities. She has a PhD in Philosophy from Rice University and is the cofounder and coeditor of Narrative Inquiry in Bioethics and a senior associate editor of The Journal of Medicine and Philosophy. Prior to joining the faculty of Wake Forest University, she was an Associate Professor of Health Care Ethics and PhD Program Director in the Center for Health Care Ethics at St. Louis University. She also taught research ethics in the Department of Medicine at Washington University in St Louis. Her work focuses predominantly on the ethical conduct of human research, and she is currently studying the ethical dilemmas of transplantation as well as implications of revising the 14-day limit on embryo research.  

The Lecture

In her lecture entitled, “Pregnant, Yet Dead: Autonomy and the Right to Life in the Strange Case of Marlise Muñoz,” Dr. Ana Iltis discusses a variety of ethical and legal considerations surrounding the case of Marlise Muñoz. Marlise Muñoz was kept on life support (against her previously indicated wishes) because she was 14 weeks pregnant at the time she was declared brain dead. She was kept on life support largely due to the Texas statute that requires pregnant women to remain on life sustaining treatment no matter the stipulations of their advanced directives. Because this statute predominantly determined the outcomes of the case, Dr. Iltis focuses her discussion on the ethical considerations and complexities of advanced directives and laws regarding end of life care. She goes into particular detail on the Texas Advanced Directives Act and addresses whether or not it should have applied to Marlise. She goes on to discuss the neurological criteria for brain death and how it applies to complicated cases wherein there may be exceptions or objections to this manner of declaring death. Dr. Iltis then addresses the role anticipated outcomes should play when deciding whether or not to maintain a deceased woman’s body for fetal gestation purposes, such as the potential for fetal anomalies and the likelihood of a live birth. Finally, she discusses the complexities and considerations that must be made when dealing with advanced directives and how to proceed when they are either absent or unclear.

Watch the full lecture here:

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A Legal Perspective...

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Image: socialdifference.columbia.edu "Jenny Gumer"

Jennifer Gumer is an attorney practicing in the litigation department of Gibson Dunn and Crutcher in Los angeles. She received her Juris Doctorate from New York University, School of Law and her Master’s in Bioethics from Columbia University. We interviewed Jennifer to hear her thoughts on the legal matters concerning Marlise’s case. 

You can watch the interview here!  —>

Emma Koeppen

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Emma Koeppen is an English major at Loyola Marymount University. She plans to pursue a minor in Bioethics and attend law school upon graduation. She has a particular interest in the field of healthcare law and psychology, and hopes to be able to combine these interests in future career endeavors. She is an undergraduate intern for the Bioethics Institute.

Read Emma's thoughts on the lecture here

This page was created by LMU's Bioethics Institute's Craves fellow, Mia Loucks and the Institute's undergraduate intern, Emma Koeppen.

The Pregnancy Exclusion in Advance Directives: Are Women's Constitutional Rights Being Violated?

By Katie Rinkus

 

“Unmanned? The Bodily Harms and Moral Valor of Drone Warfare.” 

To read Dr. Nicholas Brown's article click here 

In February 2013, former Secretary of Defense Leon Panetta announced that the Department of Defense would begin awarding the Distinguished Warfare medal to U.S. combat drone pilots. Panetta noted that these medals would outrank the Bronze Star—an honor awarded to service members who have demonstrated “heroic achievement in connection with military operations against an armed enemy” [1]. 

    The publication of these awards sparked immense controversy among U.S. citizens—in particular U.S. Veteran groups, many of whom expressed adamant opposition to this new system of ranking. Much of their contestations were made on the grounds that remote drone pilots do not risk their lives in the way that other, on-site combatants do, and are therefore unworthy of such commendatory titles. 

    Some scholars have elaborated on this critique, proposing that drone pilotry, given its remote nature, requires no courage at all; for courage emerges through one’s encounter with an impending risk of bodily injury and what such risk can we afford to drone pilots stationed thousands of miles from the site of their targets?

    For Dr. Nicholas Brown, Professor of Theological Studies at Loyola Marymount University, it is precisely this method of risk/courage attribution that renders these arguments insufficient. Namely, to reduce the emergence of courage as originating exclusively through exposure to physical harm supposes an erroneous dichotomy between the mind/body and its experience of pain. We experience harm as a unified self, not, as the aforementioned scholars suggest, as divided corporeal-cerebral entities. Thus, when we consider the extensive psychological distress experienced by drone pilots, we begin to see the immense moral valor and valiant courage the position requires.     

Related Content

Documentary: "National Bird"
Gaining Perspective: Recommended Reading
Interview: Will Roper and Autonomous Drones

Australian bioethicist Robert Sparrow discusses empathy, video games, PTSD, and drone warfare. [read more]

Video Game Violence and PTSD?

Brown generates a great deal of his argument addressing the claims of Christian Enemark in his book "Armed Drones and the Ethics of War: Military Virtue in a Post-Heroic Age"[2]. In the book, Enemark discusses the long-established implications of “just” warfare. For Enemark, these implications entail a mutual risk shared between participating agents. For Enemark, it is only through this mutual exposure to potential bodily injury and physical harm that courage is acquired.

“…The use of military drones does in fact constitute a qualitatively new form of combat that cannot be entirely subsumed under the penumbra of the just war tradition…it requires probing and answering some more fundamental questions, questions like what is courage? How does one demonstrate courage in the context of combat, and what kind of practices and skills are both essential to and commensurate with the flourishing of that particular kind of courage”[3].
Gaining Perspective: Other Opinions
Gaining Perspective: Recommended Reading

Given this brief synopsis of Enemark’s argument, it is evident why Enemark would so adamantly dismiss the plauditory titles attributed to drone pilots. In drone warfare, pilots often operate thousands of miles from the site of their targets, thereby depleting the mutually-shared risk Enemark views as essential to the “just” war tradition and destroying what Enemark sees as an intrinsic connection between courage and embodiment [4].

“What drone warfare thus brings into sharper focus then is that the trauma of combat does not lend itself to a strict bifurcation between the nominal and the corporeal. Indeed drone pilots experience and process the harms of warfare as psycho-somatic wholes. That their trauma takes place in a location thousands of miles away from a physical battlefield makes the pain of their suffering no less real, nor any less severe”[5].
To see a list of references used for this article click here.
Read More:

Neuroethics:

What it is, Does--

and Perhaps Should Do

Dr. James Giordano

Neuroethics is a field that addresses (1) the putative neuro-cognitive processes involved in moral thought and action (what has been referred to as the “neuroscience of ethics”), and (2) ethical, legal and social issues generated by brain research and its various applications in medicine, society and the military/political sphere (i.e.- “the ethics of neuroscience”). These are not mutually exclusive. Engaging the science of anything should obligate recognizing the ethics of how such work is conducted and used, and neuroscience – and neuroethics – are no 

different. In this way, neuroethics can be regarded as (1) a branch of ethics that emphasizes issues particular to brain science and its clinical and social uses; (2) a domain of bioethics and/or biomedical ethics, given the specific focus upon brain research and its clinical employment as aspects of the life and/or biomedical sciences; (3) a distinct discipline, defined by the uniqueness of the brain and the implications of this uniquity.

      I hold that neuroethics is actually a combination of all of these concepts and activities.  The late Edmund Pellegrino considered neuroethics to be a “hyphenated ethics” in which the prefix subject (in this case things “neuro” in their focus and utilization) is analyzed using the methods of ethics.  This is certainly accurate enough.  I posit that if we were to create a taxonomy in which “General ethics” sits in a top tier, biomedical ethics would assume a secondary tier (obtaining both research and clinical ethics), and neuroethics would occupy a position beneath it. To be sure, neuroethics addresses both research- and clinically-focal issues, inclusive of the ways that information and tools of neuroscience (e.g.-diagnostic methods and criteria, and various interventions) are used or misused within society.

     Here, neuroethics starts to come “full circle” in that it can – and arguably should – guide and direct a realistic, pragmatic approach to the discernment and use of neuroscience in any context (including how we study the neural bases of morality, ethics and law, and how we use such information).  And the circle can be completed because once we’ve ascertained the probity of neuroscientific methods and veridicality of its outcomes, neuroethics might then enable something of a meta-ethical view, given that brain science affords insight to moral predispositions, cognition and actions (inclusive of the moral and ethical ways we view, conduct and use brain research).

"The need for neuroethical engagement is now so very important, not only given the rapid pace and expanding scope of neuroscience, but because of the ever increasing use, broad visibility and availability of the brain sciences in the social milieu."

Further Reading:

Giordano J, Becker K, Shook JR. On the “neuroscience of ethics” – Approaching the neuroethical literature as a rational discourse on putative neural processes of moral cognition and behavior. Neurol Neuromed 1(6): 32-36 (2016).

Giordano J, Shook JR. Minding brain science in medicine: On the need for neuroethical engagement for guidance of neuroscience in clinical contexts. Ethics Biol Engineer Med 6(1-2): 37-42 (2015).

Stein DJ, Giordano J. Global mental health and neuroethics. BMC Medicine 13(1); (2015)

Avram M, Giordano J. Neuroethics: Some things old, some things new, some things borrowed...and to do. AJOB-Neuroscience 5(4): 1-3(2014).

Giordano J. The human prospect(s) of neuroscience and neurotechnology: Domains of influence and the necessity – and questions – of neuroethics. Human Prospect 4(1): 1-18 (2014).

Giordano J. Neuroethics- two interacting traditions as a viable meta-ethics? AJOB-Neuroscience 3(1): 23-25 (2011).

Giordano J, Olds J. On the interfluence of neuroscience, neuroethics and legal and social issues: The need for (N)ELSI. AJOB-Neuroscience 2(2): 13-15 (2010).

A Bibliography of Neuroethics 2010-2016, see:

Buniak L, Darragh M, Giordano J. A four part working bibliography of neuroethics: Part 1: Overviews and reviews – defining and describing the field and its practices. Phil Ethics Humanities in Med 9 (9); (2014).

Darragh M, Buniak L, Giordano J. A four part working bibliography of neuroethics: Part 2 - Neuroscientific studies of morality and ethics. Phil Ethics Humanities in Med  10 (1); (2015).

Martin A, Becker K, Darragh M, Giordano J. A four part working bibliography of neuroethics: Part 3 – “The ethics of neuroscience”. Phil Ethics Humanities in Med  11 (2); (2016).

Becker K, Shook J, Darragh M, Giordano J. A four part working bibliography of neuroethics: Part 4 – Ethical issues in clinical and social applications of neuroscience. Phil Ethics Humanities in Med  12 (1) (2017).

Immigration, Health Care, and the Duty to Rescue: The Ethical Challenges of an Open Society

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            Bioethics rests on classical medical-ethical questions about individual physician-patient relationships, but there is growing, urgent relevance to social, global and even environmental problems. The current immigration crisis is of global proportion and suggestive of the notion of “global bioethics.” What ethical challenges does immigration generate for a liberal society that claims to be “open?” As we face immigration and the massive movement of peoples, is there such a thing as a social “duty to rescue”? In the 2018 Annual Bioethics Lecture, Dr. Michael A. Rodriguez, Dr. Cecilia González-Andrieu, and Dr. Roberto Dell’Oro set out to answer these questions. Watch and read their answers below.  

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The 2018 Annual Bioethics Lecture

"Immigration, Health Care, and the Duty to Rescue: The Ethical Challenges of an Open Society." 

Wednesday, October 24th, 2018 at Loyola Marymount University 

Michael A. Rodriguez, PhD, MPH

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"Michael Rodriguez" photograph from UCLA Blum Center

Professor and Vice Chair in the Department of Family Medicine at the David Geffen School of Medicine at UCLA, Director of the UCLA Blum Center on Poverty and Health in Latin America and Co-Director of the Center of Expertise on Migration and Health. 

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Roberto Dell'Oro, PhD

Director, The Bioethics Institute, Professor of Theological Studies, Department of Theological Studies at Loyola Marymount University

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Cecilia González-Andrieu, PhD

Associate Professor of Theological Studies at Loyola Marymount University

"Cecilia González-Andrieu" photograph from Women's Lifestyle Magazine

 Our undergraduate Craves intern, Charlotte Cheng, goes behind the scenes to interview Dr. Cecilia González-Andrieu. In the interview, Dr. González-Andrieu discusses her position on healthcare as a basic human right. 

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Charlotte Cheng

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Charlotte Cheng is a Political Science major at Loyola Marymount University pursing medicine. She is interested in the nexus of health care and immigration because of her personal experiences as a first-generation American and college student. Charlotte is an undergraduate intern for the Bioethics Institute.  

Resources Below

"International-Flag" photograph from The Daily Toast

America Magazine: The Jesuit Review Podcast featuring Dr. Cecilia González-Andrieu

How can theology speak to the immigrant debate?

 

ONE: Decision Making, Rationing, and the Imperiled Neonate

by Jared Howes

“Tied to machines that make me be. . . I cannot live. I cannot die.”[1]

"The use of advance lifesaving technology  may create, for the first time, situations where a patient is either suspended between life and death, or is left with heavy physical or mental impairment."
Relevant Content

Read Arras's "Toward an Ethic of Ambiguity" on The Hastings Center Report...[read more]

Click here to preview Richard C. Sparks' "To Treat or Not to Treat: Bioethics and the Handicapped Newborn"

Official Music Video: Metallica "One"

About the author...

Jared Howes is in his first year of the Bioethics Masters program at LMU. He is currently working on a paper concerning the ethics of neuromarketing in healthcare settings. He is also researching intra-Catholic conflicts within specific countries for Fr. Thomas Rausch of LMU's Theology department. 

         When James Hetfield and Lars Ulrich of the American metal band Metallica penned the hit song “One”, in 1988, they probably were not thinking about bioethics. Demonstrating the horrors of warfare through the terrible quality of life a maimed soldier experiences post lifesaving treatment, they unwittingly tapped into a major ethical issue facing the medical community; while medical technique and technology had made tremendous progress in recent decades, medical ethics had lagged behind resulting in a gap.[2] The use of advance lifesaving technology may create, for the first time, situations where a patient is either suspended between life and death, or is left with heavy physical or mental impairment.[3] Many see the erosion of patient’s quality of life as such a burden that it would be better to euthanize them than allow for such a cruel and dreadful existence to persist. Compounding the problem are cases involving imperiled newborns who receive lifesaving treatment in the neonatal intensive care unit (NICU). This compounding is influenced by the emotional reality of the patient being a newborn who hasn’t yet had a chance to live life, form value systems, or ponder advance directives; and the clinical reality that such patients, lacking both capacity and legal competency, must rely on surrogates to determine their fate.

     There has been much debate within the field of bioethics on what factors should be used in determining whether an imperiled infant will or will not receive lifesaving care. Two polar views have emerged. On one side is vitalism, which demands everything be done to save the life of an imperiled infant, and on the other side a libertarian autonomy, leaving the decision solely up to the parents.[4] Other theories lie on a spectrum between these two extremes. In this essay I will answer three questions: At what level should decisions of healthcare rationing be made? What criteria should be employed for determining the treatment of an imperiled newborn? And who ultimately decides the fate of an imperiled newborn? There exists a diverse corpus of literature about these questions, and certainly the sheer amount is beyond the scope of this essay. Therefore, I have chosen two main ethical theories to form the basis of my argument; quality of life models and personalist morality. In addition to presenting differing scholars from within each theory, I will borrow heavily from the tradition of Christian discernment to inform my conclusion. I do not intend my choice of included models or specific authors as a rejection of other theories but merely a practical limitation.[5]       

Click here to read Jared's entire paper.    

 

On October 18, 2017, Dr. Kevin FitzGerald delivered a lecture at the LMU campus on genomic medicine and its ethical implications within healthcare settings. Genomic medicine is a field of medicine that uses genomic information to better address medical needs (assess medical risks, make a diagnosis, etc.). Advances in genomic technology have raised many questions regarding what constitutes a “healthy” individual. To explore this concept, we asked a bioethicist, a clinical ethicist, and a sociologist to share their views. Here are their responses…

Who is healthy?

Who is not?        

Who decides?

With advances in genomic medicine and genetic engineering, the concept of “good health” has shifted.  What, in your opinion constitutes a ‘healthy’ individual? A ‘healthy’ population? How does the likelihood of developing a certain disease, and/or the ability to genetically eliminate this likelihood, influence your answer? 
Q:
A:
"The shift from a symptomatic to a genetic paradigm of medicine raises a host of ethical questions. The case of genetic testing is exemplary: most medical tests are designed to diagnose actual symptoms; genetic tests, in turn, can predict potential diseases, thus triggering new issues that touch upon respect for personal autonomy, the demands of non-maleficence, and the challenges of social beneficence. 
 

Still, central to the shift of paradigms in question is a deeper puzzlement of a meta-ethical nature: it concerns the definition of “health” and “disease,” now made equivocal by the fact that predisposition to a disease may coexist with the lack of symptoms associated with illness. 

On the face of it, such an apparent contradiction seems to pose an intractable problem.  In reality, it throws into relief, once more, the need to distinguish scientific explanation of disease and phenomenological understanding of illness. Of course, genetics deepens the explanatory power of medicine, relative to the etiology of disease as objective entity, but it leaves intact our understanding of illness as subjective appropriation of the latter. 

Such appropriation remains contingent upon an attribution of meaning, ultimately socially defined, in which “being healthy” represents a condition of personal integration, irreducible to functional definitions.  To “be healthy” is to “be whole,” but to be whole is to be able to function in a web of relativities that makes disease, including the one defined by a genetic predisposition, livable, rather than paralyzing.  

Genetic medicine challenges society to rethink the holistic character of health, and to pay renewed attention to the conditions that make possible both the personal integration of illness, and the communal responses to the demands of solidarity such integration entails."

 
                                             -Dr. Roberto Dell'Oro

Roberto Dell'Oro is the director of the Bioethics Institute and professor in the Department of Theological Studies at Loyola Marymount University. Dr. Dell'Oro teaches in the areas of bioethics, fundamental moral theology, and ethical theories, with special interest in anthropological themes at the crossroads of theology and philosophy. 

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A:

Dr. Joseph Raho is a clinical ethicist at the UCLA Health System Ethics Center in Los Angeles. He is also a member of three ethics committees at the hospital and lectures regularly for the "core ethics curriculum" at UCLA. 

"Throughout history, our understanding of what it means to be “healthy” has shifted (see Badash et al.2017, pp. 1-4). The contemporary concept of health is fraught with different interpretations. Should the concept relate exclusively to an individual’s physical and mental well-being or, alternatively, should it also include the social, environmental, and economic dimensions of health? With recent advances in genomic medicine and genetic engineering, our understanding of health may be shifting yet again.

 

In my opinion, an individual can be considered “healthy” to the extent that he or she is able to live a life that is generally free of impairment, whether physical or mental. Our health is experienced subjectively as a state of equilibrium that goes unnoticed until we become unwell (Gadamer 1996). Our health is connected intimately with our well-being and quality of life. We usually enlist the assistance of a physician when we become unable to cope with the disruption that is caused by illness. We seek to be comforted, healed, and made whole again. It is this disruption to one’s self that renders one unwell or unhealthy. That a person has a propensity toward a particular disease would not in itself render him or her unhealthy (unless, of course, the prospect engendered such stress or anxiety for the individual that it rose to the level of mental disturbance).

 

As a clinical ethicist, I generally encounter persons who have complex acute medical (or surgical) needs. In many instances, the patient is too ill to make decisions for herself and so it will be the patient’s family who must decide about how aggressive medical or surgical intervention should be. These are life-altering decisions. The question we must always ask ourselves is the following: What is the likelihood, given the patient’s diagnosis and prognosis, that he or she will return to some level of health, even seriously compromised health? Will medical or surgical intervention allow the patient to achieve important goals; maintain social interaction with family and friends; remain free of pain and other symptoms? Or, alternatively, will such intervention merely forestall an inevitable decline or perpetuate a state of chronic poor health?"

                                   

                                                                                                                                        -Dr. Joseph Raho

References:

 

Badash, Kleinman, Barr et al., “Redefining Health: The Evolution of Health Ideas from Antiquity to the Era of Value-Based Care,” Cureus(2017) 9(2): e1018.

 

Gadamer, The Enigma of Health: The Art of Healing in a Scientific Age(Stanford, Stanford University Press: 1996).

Dr. Rachel Washburn is a Professor of Sociology at Loyola Marymount University. She works specifically in medical sociology and is currently researching debates about the human health harms of pesticide exposure in the US. 

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A:

"The definition of “good health” is constantly undergoing modification as a result of a variety of factors, ranging from findings of scientific research to shifts in cultural ideals and the economy. Today, our understanding of “good health” is largely shaped by the notion of risk. Over the last several decades, biomedical research has been increasingly oriented around searching for earlier and earlier indicators of potential disease and/or disorder. In this context, “good health” no longer means being free of the visible or felt signs of disease, but rather having a low risk profile. A “healthy” individual is one whose lifestyle conforms to current medical and public health guidance and who is free of other risk factors. This definition holds for populations as well, given that risk factors are usually first identified at the population level. Developments in genomic medicine do not play a major role in my answer. They merely contribute to the elaboration of risk."
                                  -Dr. Rachel Washburn
 
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