New System Might Increase Organ Donations

Could Changing the Way People Volunteer Increase Organ Donations?


According to a Gallup poll, 83 percent of Americans understand the benefits of organ donation and approve of the practice but only 28 percent have granted written consent to release their organs if they die. Since 1995, more than 45,000 people have died waiting for an organ donor.
Avoiding the Question
Some say the problem lies in a reluctance to make what can be a very uncomfortable decision. They say a new opt-out system, which would assume people are donors unless they specify otherwise, could dramatically increase the number of donors and save lives. A similar example lies in the do-not-call telemarketing system, where it is assumed telemarketers may call people at home unless they add their names to a do-not-call list.
But because releasing your organs to medicine after death can be such a profound decision, critics say adopting a similar opt-out system for organ donation would also introduce all kinds of ethical land mines.
Numbers from some European countries show that forcing people to confront the decision can make a big difference.
In several countries, including Austria, Belgium, France, Hungary, Poland, Portugal and Sweden, authorities assume everyone is willing to be a donor — with the approval of family after death — unless they say otherwise in written form. In those countries, 85 percent to 99 percent of people are on paper as willing donors and actual donations are higher by about 56 percent.

Troops returning home with hearing loss???

Majority soldiers and Mariens caught in roadside bombings and firefights in Iraq and Af. are coming home in epidemic numbers with permanent hearing loss and ringing in their ears. hearing damage still number 1 disability in the war. the numbers are staggering. One major explanation given is the insurgency's use of fearsome weapon the Pentagon didn't fully anticipate, powerful roadside bombs. Their blasts cause violent changes in air pressure that can rupture the eardrum and break bones inside the ear. Also, much of the fighing consists of ambushes, bombings are firefights, which come suddenly and unexpectedly, giving soldeirs no time to use their military issued hearing protection.
In addition, some servicemen on patrol resfuse to wear earplugs for fear of dulling their senses and missing sounds that can made the difference between life and death.
The Navy and Maries have begun buying and distributing state of the art earplugs, know as Quiet pro" that contain digital processors that block out damaging sound waves from gunshots and explosions and still allow users to hear everyday noises. The cost about $600 a pair.
My common is.... if there isn't a War, then we don't have to cost that money to treat this medical problem.... War doesn't create money, maybe later on for "oil", but for now, it cost more money for medical treatment...

The living will

There is no age limit for anyone to become severely ill. Anyone can be faced with a life threatening illness or an accident at any age and can become in a state that cannot speak for themselves. In such situations our life will be in the hands of others. We might be put to death when we wished to be resuscitated or we might be kept alive with life-supporting machines when we wished to be dead. A living will can save anyone from such a dilemma. With a living will we can make the final decisions for ourselves in a life ending situation without depending on others mercy.

Living will is a part of advance directives which tells the doctors what kind of care anyone wish to have in an end of life situation. The abscense of a living will can create unwanted turmoils in the families. The best examble is Terry Schiavo's case in Florida. 41 year old Terry Schiavo, after creating an intense legal conflict and a vast press coverage died in 2005 two weeks after the removal of her feeding tube which had kept her alive since 1990. There was no clear evidence for what her real wish was. The husband says that she mentioned sometimes during their married days that she never wanted to live with the help of life supporting machines. He might be true or might be lying for his own interests. He had some conflicts of personal interests in a large malpractice settlement money and also he was living with a girlfriend whom he cannot marry as long as Terry Schiavo was alive. Since she did not put anything in writing in the form of a living will only she knew what her real last wishes were. I cannot even imagine myself something like this happening to me. I do not think anyone would want to have the court to decide for their fate. With a living will anyone can make their own final decisions by themselves and also can spare their families from tearing apart trying to decide what is the best fate for them.

pro-choice and pro-life, who wins?

As the debate on abortion between the pro-choice and pro- life takes a political direction, the focus drifts from the subjects of abortion and the impact the process of abortion impresses upon the lives of the women that undergo the process to that of justifying and condemning. In a study done in Zealand and published in the Journal of Child Psychology and Psychiatry in 2006, it was established that abortion has effect on women's mental health. The researchers concluded that "Abortion in young women may be associated with increased risks of mental health problems" Even though women's rights and decision for an abortion are protected by autonomy and right to privacy, echoes of condemnation from the society may lead to a life of guilt and self-condemnation.
In the 'Aftermath of Abortion trauma', by Joanne Angelo, a research in Finland found the rate of suicide in women the year after an abortion to be nearly six times greater than the suicide rate after live birth and significantly higher than the suicide rate in the general population of women of childbearing age.
The united States in an effort to address the dynamic of the issue of abortion has put emphasis on providing women with information prior to an abortion. In some pregnancy center clinics an ultrasound is used so that the women can visualize the fetus before the abortion is done. In a clinic in North Carolina, six teenagers out of eight changed their minds when they saw the movement of the fetus. This is not without controversy as the the pro-choice view it as a way to inflict fear and guilt by the pro-life supporters. As the division between the pro-choice and pro-life continues, there are no winners, but there could be losers; the women that live with the guilt or condemnation of abortion in the rest of their lives, or those that end it all by committing suicide.

Life vs. patient vs. HMO

At the end of 2007, there is a big case in LA county. 17 years old is diagnosed hepatocarcinoma and need liver transplant, usually liver transplant isn't happened with this age. it is a rare case. All the MD agreed to do prior authorization with Cigna insurance. Cigna failed to comply with MD's request, not only one MD, all hemo& oncologist MD in addition to internal medicine, family practice, pulmonary critical care MD.After 4 months Cigna continued to deny all MD's request for all the treatment. Cancer levels start to reach to stage 3.??? Family's member start to require more attention from law maker (house representative, county supervisors, and state senator), include CMA- california medical Association.Patient passed away 1 day after Cigna's approved for her medical treatment.So, the question arrived is why insurance company is too late for approving for her medical treatment. Patient is paying insurance due very on time. The case is reaching to bioethics committees law firm in Los Angeles county.
An insurance company that initially refused to pay for a liver transplant for a 17-year-old Northridge girl who died in a hospital should face criminal charges and pay civil damages,Cigna HealthCare "literally, maliciously killed" Nataline Sarkisyan, attorney Mark Geragos told reporters in downtown Los Angeles.
Sarkisyan's 21-year-old brother, Bedros, told reporters that UCLA had a liver available for transplant, but they could not perform the procedure because of Cigna's refusal to cover it. The girl's father, Krikor Sarkisyan, held a photograph of his daughter, and with his eyes wet with tears, cried out. "They took my daughter away from me!" "The Cigna people, they cannot make people's decision if they (are) going to life or die," he said through a heavy accent. "Doctors ... they all signed the papers. ... Cigna denied it two times." Cigna insurance initially declined to pay for the transplant for Nataline Sarkisyan because her plan did not cover "experimental, investigational and unproven services," her doctors said. The denial promAbout 15 minutes into the rally, Cigna announced it would approve the transplant.pted nationwide protests, including a rally outside Cigna's Glendale offices.
CIGNA released the following statement: "Our deepest sympathies are with Nataline's family. Their loss is immeasurable, and our thoughts and prayers are with them. We deeply hope that the outpouring of concern, care and love that are being expressed for Nataline's family help them at this time."

The Moral and Ethical Physician

The moral and ethical foundation of our society has dual personalities: that which the average human being carries and that which is carried by a professional, in this specific case, by a physician.

There is a great amount of conflict as professionals to not make decisions based on our own personal morals and ethics. Instead we have to make a decision as a provider, educator, and a healer. It is our job to provide our patient with the best of our capabilities.

Always keep in mind that when a client approaches you as their physician, they have a level of dependency towards you to help with their illnesses, problems, and/or fears. If we are consistent with our professional moral principles and accepted code of conduct, then act on what you believe to be correct, but always making sure that your patient has the appropriate resources to meet their care.

As the Modern Hippocratic Oath States:

“I will not be ashamed to say “I know not, nor will I fail to call in my colleagues when the skills of another are needed. I will remember that I remain a member of society with special obligation to all my fellow human beings, those sound of mind and body as well as the infirm.”

Yenima Martin
UHSA Medical School 2008

The Impaired Medical Professional

The Impaired Medical Professional

Alcohol and drugs abuse, often categorized together as “substance abuse” and addiction, is a common problem in our society as a whole. It is prevalent among the general population and therefore it stands to reason that it would also be prevalent among various occupations within a population. Thus, all people and occupations are represented, including the health care worker.

We often think of our health care professionals, including doctors and nurses as being exemplary and above such “vices”. Although the exact figures are unknown, the medical profession suffers along with the general population in this area. In fact, the prevalence of chemical dependence for medical professionals may even exceed the public. The reasons for this may have to do with the stress of the job and the long hours worked, coupled with the relative easy access to “pharmaceutical grade” drugs, whose use do not carry the stigma of “street drugs”.

The ethical question arises when we are forced to consider what to do with such impaired medical professionals. Are such folks to be treated as common criminals that do not get a pass just because they are members of a “noble” profession? Or are they to be treated as a still valuable and “salvageable” resource, who with proper treatment can return to the medical field not only functional, but with a “unique perspective” that may serve their patients and co-workers. In order to properly answer those kinds of questions, one has to decide what chemical dependence is about. Are such chemically dependent people bad deserving censure and punishment, or are they sick needing treatment? Or is the situation even that black and white? The problem, is of course, complicated by the fact that mistakes made by a medical professional who is impaired, can cost the life of a patient and therefore, by necessity a lower tolerance is usually applied.

Fortunately, much precedent has been set in today’s work setting. There have been many impaired professionals who have been confronted with their addiction and forced (usually) or somehow coerced into treatment. Many, if not most, of these individuals have received the proper treatment and returned to the field of medicine to function productively. This return to work is almost always contingent upon joining a professional recovery organization that monitors the practitioner. Typically, meetings of the 12 step variety and random drug screens are mandatory for an extended period (usually five years), once return to work is allowed. The combination of follow up care and random drug screening has proved to cut down on the relapse rate. Therefore, with proper recognition and treatment, the impaired medical professional, who may have been scorned and summarily dismissed in earlier days, can be given a second chance. Thus, public safety is preserved and a very valuable resource in the form of a medical professional is salvaged.

Culling Embryos

So, this wonderful guy asks me out on a date. We meet at an Italian restaurant with great atmosphere in NYC and right after our appetizers reach the table he asks “Are you sickle cell trait?” Great conversation for a first date, huh? I answer no, but he continues to tell me that he really likes me and he is sickle cell trait so he needs to be sure that I’m not. Scary, I’m trying to enjoy the live music and he is planning our possible future as parents! But I assured him that I did not have the trait and sure enough we were married a year later.

For about two years the New York Times has been running a series of articles on how the genetic information we have unraveled from DNA thus far has been impacting varying levels of society. They are all very interesting – including the most recent one on how genetic testing is raising insurance cost fears in the United States (link at bottom of blog). Another trend has been the use of in vitro fertilization (IVF) techniques, not to aid infertile couples, but to allow couples to literally choose which embryo they want to keep and discard the others. There are couples who choose their baby based on very superficial characteristics, like sex, height, likeliness to be thin or eye color. I won’t discuss any those choices because I truly cannot understand how anyone can create and discard life based on eye color and feel that it is totally ok. More importantly, there are couples who feel compelled to use IVF in hopes of ensuring their offspring are free of genetic disorders that may make them sick one day. My question: when did being sick translate to mean that you don’t deserve to live or don’t deserve a chance at life?

It certainly seems to me that the further medical technological advances are made is the more disregard we have for the sanctity of life. Now that children with Down’s syndrome are able to grow into adult hood and have productive lives it chosen to abort them and try again for a “normal” baby. Very recently it was found that a severely autistic teen, labeled as mentally retarded, had somehow managed to teach herself how to type and has revealed just how intelligent she really is. Her autism just made it extremely difficult to communicate, but now via typing she has written a few papers on what it’s like having severe autism. Our notion is that people with an illness have a poor quality of life, but without even realizing it our society is saying illness takes away your right to live. One of the potential mothers’ from the article said afterwards she felt like she allowed the other embryos to drown in the ocean and chose the one who happened to be a better swimmer…

Sometimes avoiding passing on certain genetic diseases to your children is as simple as asking a few questions before getting into a relationship. Other times, it’s not that easy. A close friend of mine had sickle cell disease. Neither of his parents knew they were carriers until his first crisis when he was a toddler. He died at 19 just when he was beginning his first year of college. He didn’t have a “normal life” and everyone said that he died so young, but his life wasn’t any less meaningful then my own or anyone elses. I remember him being so vibrant and smart. Even if he was just discharged from the hospital he’d be back in church at the next service. After his funeral his mom told me that even if she knew he had this disease when she was pregnant she would have still chosen to have him regardless of how strenuous it had been on the family. This said it is often the parents who don’t want to have to deal with having a sick child why they make certain decisions. In the article I mentioned one of the fathers said he’s happy knowing that his “daughter won’t ever be sick,” that he won’t ever have to stay up all night by her hospital bed wondering if she’s going to live.

Of course there is an argument to be made for diseases that are lethal. However my opinion is that it is selfish and irresponsible to KNOW that you have an Autosomal dominant LETHAL disease like Huntington’s and still have children. It may seem harsh, but I personally would simply adopt. There are millions of children around this planet and in the United States who need a safe and supportive home. If you fall into this unfortunate situation and you want children, why not offer them yours?

Culling Embryos posted by Octavia
UHSA Medical Student

http://topics.nytimes.com/top/news/national/series/dnaage/index.html

please go through some of the articles at the above link they are very well written and present important, current and relevant issues on DNA technology, thanks.

No Food for Thought

No Food for Thought


Don’t throw away that New Year’s resolution to lose weight just yet. If law makers in Mississippi have their way, you might need to really stick to that diet if you visit their state. Legislation was recently introduced that would band restaurants from serving obese people. Bill No. 282 contains the key to the future of the obese in Mississippi. Restaurants would keep a scale there to measure your BMI and if >30, could refuse to serve an obese customer. I suppose legislators equate this to refusing alcohol to someone who has had too many drinks.

Obesity is a disease that affects approximately 60 million people in the United States. With the increase in pre-packaged foods, the increased number of fast food restaurants, and lack of activity; the number of obese people in America has had a steady rise since the 1960’s. No wonder we have an obesity epidemic in the United States. Food is everywhere-on television, vending machines and on busy roadways with potential traveling customers. Food is involved in just about every fiber of our daily lives. If you couple this with a life of sitting behind desks and cars, you have a recipe for obesity.

Well, whose fault is it? This is difficult to answer given that people are free and can make the choice to eat healthier foods. We live in culture where the environment has dictated a lack of activity. With the advancement of technology, it has made us more sedentary. We have remote televisions, elevators, and fast foods. There are even cars set up to hold our food. In addition, it is cheaper to buy a burger for a dollar versus buying a six dollar salad at the salad bar. It costs more to eat healthier.

Obesity, however, does not come without a cost. Obese people run the risk of chronic deadly conditions such as cancer, type 2 diabetes, hypertension and heart disease. So, why do we still over eat knowing that obesity can cause these conditions? And this is the question that lawmakers have probably asked themselves and the reason for the proposed bill.

Mississippi has found themselves at the top of the list of the fattest people in the country. This has happened for the third year. There has been an increase in death rates from cardiovascular diseases and cancer for which obesity was a factor. Mississippi also holds the record of being the first state to record an obesity rate at over 30%.

As a result, law makers have decided to take matters into their own hands. If this legislation is passed, it would be enacted this summer. For the restaurants that do not adhere to this law, they would be sited and probable fined. The department would monitor compliance and have the power to revoke violators' permits. "I was trying to shed a little light on the number one health problem in Mississippi," co-sponsor Republican Rep. John Read of Gautier, a former pharmaceutical company sales representative, told the Associated Press, acknowledging that at five feet, 11 inches (1.8 meters) and 230 pounds (104 kilograms), he might get the restaurant boot under his own bill.
This is certainly discrimination and stereotyping against obese people to say the least. If an obese person walks into a restaurant, will that person be stopped at the door? How do we know this person does not want to order a salad? Now we are policing people on the lowest level. Will that customer need to carry around a doctor’s note confirming they are indeed on a diet? Where will it end? Will it extend to grocery stores as well? There are many other causes for obesity. Will this individual need to carry proof that their obesity is due to steroid medications? We would just be looking at people and judging them according to their weight. So, I guess this would lead to the hiring of only skinny waiters and waitresses; which would be another form of discrimination against the obese.
There are many other ways to help obese people over come this disease besides policing their restaurant visiting habits.

Although some law makers in Mississippi state that the bill will never reach the committee and onto the floor of the legislature for a vote; just the thought that someone proposed this is very disturbing. I don’t’ believe this will be the last if this debate. As a country, we are constantly battling racial and social discrimination, but we have not come to real terms with our discrimination of over weight people. Look at how some airline companies want to charge double fair for an obese person if they require two seats. Obese people have been the target of discrimination for many years because their problem is perceived to be controllable. With a law like this, overweight people would continue to suffer across the board. The introduction of this bill this has sparked a dialogue about the obesity epidemic. However, it has given someone else the ammunition to continue the attack on the obese people of America.

Healthcare Proxy and Advance Directives

Healthcare Proxy means “appointing someone to make healthcare decisions for you in the event that you are unable to so yourself”. This has to be in writing. Appointing a healthcare proxy is a big problem for many of us and our patients. This could be due to any of several reasons. The primary one being that “nothing will happen to me”, another is that we do not like to discuss death. It can also be that we have many loved ones (especially children) that we don’t want to offend any by just appointing only one, and in some cases, we just assume that our spouse or parent is automatically our healthcare proxy. In the rare cases where one appoints a proxy, there is no documentation giving the appointed proxy legitimacy because it is not written on paper. Unfortunately, not taking the time to make this important decision and taking the necessary action brings unimaginable suffering to the patient, rips the family apart and places the healthcare practitioners in very awkward position. Many of us hope to live to ripe old age and die peacefully in our sleep, or have a massive heart attack and die instantly, while others don’t even want to think about death at all. The inevitable truth is that we all will die one way or another someday.
Advance directive on the other hand is making one’s wishes known about end-of-life care. In the rare cases that people appoint a proxy, they fail to make their wishes known and this leaves the proxy with a lot of burden as to what decisions to make. This also has ripped families apart. Make your wishes known. Do you want life support or not? Under what conditions?
I work in the medical intensive care unit in a hospital where people die in life support or under circumstances that require decisions of end-of-life issues. It is sad to witness the fights, struggle for power and even accusations that go on among family members at the bedside of a dying patient because there is no appointed proxy or advance directives. There have been cases where the spouse or one child doesn’t want to let go, but another wants to end the patient’s suffering. People accuse one another of not caring about the dying one or of wanting to torture the patient. In some cases, it becomes a power contest. Sometimes others just want to be vindictive for whatever reason. But the issue remains, that a decision has to be made as to the course of care. The question becomes, “who is making this decision for you?” Is it in your best interest?
One particular case involved a man who was separated (not divorced) from his wife for seven years. He lived with his fiancée of seven years in one state and his estranged wife lives in another. Shortly after his separation, he was diagnosed with cancer, his fiancée was with him during his treatments, remissions and relapses. In his final days, he became unconscious and was put on life support. He did not appoint his fiancée as proxy and because she was not his wife, she could not make decisions for him. The hospital has to wait for the wife who hasn’t seen this man in the seven years of his illness to make decisions for him. She wanted everything done. She never showed up at the hospital. This man had to be resuscitated each time his heart stopped (which was several) while the fiancée cried that “he never wanted any of this, please let him go”. Of course the wife’s wishes have to be carried out.
It is important that patients make these decisions when they are in good health and of sound mind. In most states, it doesn't have to involve a lawyer but it has to be signed and notorized. Find out what is acceptable in your state. Physicians are in a better position to educate their patients on this important decision. I understand how difficult it will be for a patient to go for his annual physical and his doctor is talking to him about making end-of-life decisions. However, it is a decision that has to be made and patients cannot make it unless they are aware of it. As individuals too, we have to make these decisions because physicians die too. Let us educate ourselves, our family members and most importantly our patients on the need for appointing a healthcare proxy and having advance directives in writing. It saves everyone the pain and agony of uncomfortable decisions.

ETHICAL ISSUES SURROUNDING ABORTION

Abortion is the most difficult and controversial moral topic in today’s society. Many people view abortion as a murder of unborn children. On the other hand, some people view it as freedom for women. We need to listen to both sides, even if that is difficult to do. Both sides have negative and positive moral insights, even if ultimately these insights are outweighed by the insights of the other side. There are two principal morals we need to consider; first, the moral status of the fetus. Is the fetus a person? At what age in its development does it becomes a person? Conception? First trimester? Birth? Secondly, the right of the pregnant woman, does the pregnant woman have the right to decide if she is going to carry the baby to term or not? As we consider these difficult issues, it is imperative to distinguish two other questions. Is abortion morally wrong or should abortion be illegal? These are distinct issues because not everything that is immoral is necessarily illegal. For instance, it is immoral to be unfaithful on your marriage but it is not illegal. Another argument that is usually advanced against abortion is the fact that the fetus is an innocent person. It is morally wrong to end the life of an innocent person; therefore, it is morally wrong to end the life of a fetus. Much of the debate in regard to abortion has been centered on whether the fetus is a person or not. If the fetus is a person then it has the right that belongs to persons, including the right to life. In my view, women have the right of privacy, ownership of their body, treatment, and right to self-determination. Therefore, I am not against it or for it because everyone has they own freedom and belief.

HPV VACCINE FOR CHILDREN

HPV VACCINE FOR YOUNG CHILDREN

Human papillomavirus (HPV). Vaccine is a vaccine that is focuses on certain sexually transmitted type of human papillomavirus. HPV is known to cause cervical cancer and genital worst. We have now discovered 100 types of HPV about 37 of them are caused by sexual contact. According to the centers for disease control, HPV infection is now common world wild among adults. It is estimated that at the age 50, more than 80% American women would have contacted at least one strain of HPV.

Two years ago, the Texas governor wanted to legislate a mandatory HPV vaccine for young girls in Texas, ages 10 years and above. It was a highly controversial issue in Texas. If the legislation has passed, all 6 grade girls will be vaccinated with HPV vaccine by the state. I am against the vaccination of ten years old girls with HPV vaccine, here are few of my reasons, I am against the government or the state making health care decision for our children. I think is the place of the parent to make that decision for their children. I am not against the consented adult women, for they will have no one to blame if any thing goes wrong inn the near future. What if in few years we found out we were wrong? I don’t know if we have enough statistics to prove the efficacy of this vaccine in human, or any possible side effects that may be detrimental to the young girls. I think if we are worried about the contacting the sexually transmitted disease like HPV we should have massive educational programs for children and their parents. Education can be duplicated, and no side effect it will help more children than the vaccine. If we can stop our children from having early sex that we help prevent the cervical cancer. At the age of 9, 10 the child tissue is not matured any sexual intercourse may traumatize the young tissues; the virus can easily penetrate and cause the cancer.

HPV vaccine should be given to the adult women who are responsible their own decision; the children’s health care decision should be made by the parent who is responsible for their well being. Government or state should not be making our children’s health care decisions. I do not think young people are the Wright population to focus on when the issue is controversial. We need to study the a little more on adults, may while we educate our young girls to avoid early sex, a good education program is ever lasting and can be duplicated. I also think that letting our children take vaccine at that age, we are given them the go ahead to have sex, you now protected.

Jibao L. Musa

UHSA Antigua

"SILLICON WOMB " FOR BETTER EMBRYOS.

"SILICON WOMB " FOR BETTER EMBRYOS

LONDON: A team of UK researchers will soon be conducting trials of a "silicon womb" inserted into a woman's own womb which incubates embryos to provide a more naturalenvironment. The research team led by Simon Fishel, at UK fertility group CARE Fertility, in Nottingham, UK, hopes that this new device may produce better quality embryos and reduce the need to harvest so many eggs from infertile women. Usually, a standard In Vitro Fertilisation (IVF) involves the eggs harvested from a woman to be fertilised in the lab where they are allowed to develop in an incubator for 2 to 5 days. Then the doctors pick up the healthiest embryos to be transferred into the uterus. But, the new device, developed by Swiss company Anecova, allows embryos created in the lab to be incubated inside a perforated silicon container inserted into a woman's own womb. After a few days, the doctors recover the capsule and select some embryos for implantation in the womb. The new device is a step ahead from the standard IVF that requires changing the growth medium of the embryos incubated in the lab, every few hours to provide new nutrients and get rid of waste, while the new device provides a more natural environment. The silicon capsule used measures about 5 millimetres in length and less than a millimetre in width having perforated walls with 360 holes, each around 40 microns across. When the embryos have been transfered inside, the ends of this tube are sealed and the container is connected to a flexible wire that holds the device inside the uterus. It has a thread that trails through the cervix for its recovery later on. A small trial on the device has already been conducted in Belgium and according to Fishel, the results were encouraging but not conclusive. CARE’s trial will be conducted on 40 women, each of whom will be having between 8 and 12 eggs harvested, then half their embryos incubated in the lab, and the other half inside the new device. "We will be able to directly compare the results of the in vitro and in vivo techniques," said Fishel. He also added that women will be made pregnant using only the healthiest embryos no matter which technique produced them. After 2 days, half of the devices used will be removed and the embryos will be tested for genetic defects. The rest will remain in place for 4 days, then it will be possible to assess the more mature embryos visually. According to Fishel, the new device could do away with some of the guesswork out of incubating embryos. "We don't really know the full ambient conditions of the reproductive tract. It is also a dynamic environment that changes constantly, and we can't replicate that," he said. He thought that embryos grown in the device will be more resilient, which implies that fewer eggs may need to be harvested from women to achieve a successful pregnancy. The majority of IVF techniques need the woman to stimulate egg production by taking hormones, which can sometimes lead to dangerous side-effects. However, he confessed that the Anecova capsule will not be placed exactly at the place where an early embryo would naturally develop, inside one of the fallopian tubes. An embryo normally spends around 7 days travelling down the tube towards the womb. "It's a lot closer to a fallopian tube than a plastic tray, but this new device is not an artificial fallopian tube. The trials will tell us whether the environment in the womb will do instead," said Laurence Shaw from the Bridge Centre fertility clinic in London and a spokesman for the British Fertility Society.
After reading the article, I thought what an amazing thing to do , a step further from IVF ,is it not amazing that the embryo will be placed in the capsule ,incubated and tested for genetic defects.My main concern is what the effects of the reasearch will have on the women being used .This is a newly tested techinque , I guess we all will have to wait and see how this advancement works out in the future.
This technique will further make it possible to have a higher probability of pregnancy with the capsule implant ,because it can be monitored and embryo growth can be confirmed ,vs the IVF , which in some cases the embryo does not form well after implant and another IVF is required. This silicon capsule insert is more like in vitro vs in vivo, which I think will be more cost efficent and less stressful on the woman who can go to the Doctor knowing that she has a higher probability of having the embryo form and grow to term. Verses the IVF which has a lower probability and once failed can cause severe emotional stress on the mother.

Reference:
Article from The Times Of India.

Ethical Implications of a Patient's Right to Refuse Treatment

Following the delivery of her child, a patient is bleeding heavily and her obstetrician proposed and received approval for a dilation and curettage to take out the piece of the placenta which had been retained. However the bleeding continued, consent was then sought to give the patient a blood transfusion and it was denied based on religious belief. After an emergency court hearing in which the procedure was approved by a judge, the patient received the transfusion, recovered and was discharged.
This is the case of Stanford versus Vega in Connecticut 1996. Person’s rights to refuse care or life saving treatment have been the paramount of autonomy, and great burden and moral conflict to health care personal who have sworn the oath of beneficence and nonmaleficence.
Melissa Ann Rowland in Salt Lake City is still in jail for criminal homicide with charges stemming from depraved indifference to human life and child endangerment because she refused c-section to save lives of her twin babies contrary to doctor’s advice. Although Melissa eventually consents to c-section but then it was too late, one of the babies died.
The possibility that a patient and people empowered by the patients to speak on their behalf, can refuse life saving treatment for themselves or the patient, and be allowed to do so is becoming dangerous ground for those who have taken personal and professional oaths to save lives. Most human beings are capable of making informed decisions if the are given the ability and knowledge to do so. These decisions are not always acceptable to everyone. In the case of the patient it may be a religious reason, or reason based on fear of the outcome of treatment or on a lack of consensus on the part of physicians. Whatever the reason may be, the number of patients choosing not to undergo treatment is on the rise, and mirroring that increase is the dilemma faced by healthcare providers. The underlying basis of beneficence is that a person should do right unto others and prevent harm. This principle is most sacred in a healthcare facility. However, a patient’s autonomy however crazy sounding or harmful to them is to be respected. Patient’s autonomy shall be upheld at all times. Patient consent is the principle that anyone over the age of 18 has the right to accept or decline all physical interventions, from operations and injections, to help with getting dressed. Providing that a person is competent (that they understand what is going on and the consequences of their actions) and that they are acting voluntarily, the decisions of adults about physical intervention cannot be overridden or ignored. Nurses and doctors can suggest treatment, but should answer the patient's questions and provide a balanced, full picture of the options and their consequences. In both two cases, patient’s autonomy has been severed, patient right was denied for good reasons. While there are laws that states what circumstances a person’s wishes should be respected irrespective of the outcome (permanent injury to invite all in or even death). Health care providers must battle not only their personal desires to save (or attempt to save) a patient’s life, but they must also contend with the legal parameters that govern healthcare operations. In the health care industry there is an ever increasing predicament as to a patient’s right to refuse life saving care. While the patient’s right to refuse treatment is not a new occurrence, nor is the resulting legal action that is usually taken when a patients requests are ignored. Despite the principles of deontology, kentanism and beneficence that guide health care provider, heath care providers should thrive to protect and respect patient’s right to refuse treatment.

Genetic Testing: When does life start?

Based on what you know about pre- implantation diagnosis, do you think that, given a negative outcome, destroying the other blastomeres is taking the life of the baby?

The Blastomere Biopsy is a matter of performing the procedure IVF which has been done for many years and the process is very accurate. By performing the procedure, would allow a couple the opportunity to make a more informed decision as to whether or not they want to proceed with the implantation. In addition, the only other issue with the Blastomere Biospy would probably be a Bioethical one due to the method in which the Blastomeres are disposed of, and why, if not implanted into the uterus.

If given a negative outcome, I do not think by destroying the remaining blastomeres is taking the life of a baby for various reasons. First of all, I believe life starts after the baby is born. A blastomere does not contain any cognitive processes. In addition the blastomere may contain such gross chromosome abnormalities the fetus probably could not survive pass the first trimester if implanted; therefore, leading to a spontaneous abortion. The cells have yet to become a fetus nothing has been implanted into the uterus. I view it as simple cell division in a lab and nothing else.

MALE PREGNANCY-HOW FAR SHOULD WE GO?

Male pregnancy – how far should we go?
Before enrolling into this class I never knew that there was research being done on male pregnancy. This surprised me and gave me lots of questions to contemplate. My first response was, why? If God created women with everything needed to carry out a pregnancy why interfere with nature? Who’s money will be spent on this research just to see if it can be done? Then, is it ethical and morally correct?

The Beijing doctor –doctor Chen Huanran, one of China's most-prominent sex change surgeons -- says he has developed the technology to impregnate a man, and now he wants to use his technique to help his transsexual patients have children of their own.

Chen, who works at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, said he has already lined up four men for the procedure. An internet discussion of his "male mother" project has caused hundreds of men around the country to volunteer for swollen ankles, morning sickness, and the many other joys of pregnancy. Would the procedure be safe? Aren't men missing a really important component, the uterus?
While getting a man pregnant is not quite as easy as impregnating a woman, it is just wrong. First, the man would have to be injected with female hormones to prepare him for the pregnancy. Then the embryo would be implanted, through a laparoscopy in the man's abdomen, near the omentum, a fatty, blood-rich tissue that hangs in front of the intestines. The baby would be delivered, at term via Casearan section.
I feel that it is dangerous, not only for the man, but especially for the embryo that will be implanted. What are the long term effects on human health and environment? What are the personal, social and cultural consequences? Male pregnancy is too ridiculous. It is against human nature. If a man wants a child, he can adopt one. There are so many kids that need homes. We, as health care providers, should be working to improve the quality of life. If there were no other options for having children, it might be a viable solution, but with so many more safe and proven ways for a couple to have children I can find no reason to proceed with the time, talent, medical resources and let’s not forget to mention, millions of dollars on research to fix something that isn’t broken. We surely have not run out of cancers to cure, prosthesis to develop, genetic and aging illnesses that could be prevented or cured, etc. Let’s spend our dollar for high yield, maximum impact research and discourage (i.e. cut off funds) for research that is just someone’s ticket to fame, regardless of human life.
Feb 29,2008
Sabina,R

A LOOK AT XENOTRANSPLANTATION

A LOOK AT XENOTRANSPLANTATION
End-stage organ failure is one of the most highly publicized, controversial public health issues facing the industrialized world today. There is a worldwide shortage of organs for clinical transplantation and sadly, many patients who are listed to receive new organs die while waiting.
Xenotransplantation is the transplantation of organs, tissues or cells between different animal species including humans. There have been advances in understanding the mechanisms of organ transplant rejection. Such discoveries have allowed for reasonable consideration to the usage of organs from other species, such as pigs, specifically engineered to minimize the risk of serious rejection. Also, the use of pig tissue as an alternative to human tissues will eliminate human organ shortages. Other procedures, some of which are being investigated in early clinical trials, aim to use cells or tissues from other species to treat life-threatening illnesses such as cancer, AIDS, diabetes, liver failure and Parkinson's disease.
Xenotransplantation, however, raises many novel medical, legal and ethical issues. Medical concerns partly center on organ rejection, but also include the possible risk of infection. Organisms in host animals may be transferrable to humans and crossover of disease from species to species will therefore be a risk. The effects of xenotransplantation on the human gene pool and possible long-term genetic problems offer a note of caution. Equally, any permanent alteration to the genetic code of animals is a cause for concern.
Should we develop technologies which would allow us to use the organs of other animals in human beings? There are arguments both for and against, but most people really aren't very aware of them. This is unfortunate, because the time when it will be possible to perform such transplants is fast approaching. The first xenotransplants were failures, but things are changing, and usage will be radically increased before we know and we need to be equipped to handle the debate.
There are very good reasons for seriously considering the idea of using organs from other animals. The biggest of these is the fact that almost all of the major problems involved with human-to-human transplants would be eliminated. We wouldn't need to wait until a person is nearly dead before doing a transplant.The surgery could be done earlier when the patient is healthier and has a better chance of surviving. We also would not need to wait until another person has died to find an organ, meaning we don't need to debate when someone has "really" died and when to remove their organs. Also, the transplanted organs do not have to travel several hours from person to person which means that they will be fresher and healthier. The quality of the organs would also be better. In addition, organs will be more plentiful, eliminating concerns about availability and even eliminating some of the cost. Organs for infants would become available, saving even more human lives. These considerations have room for debate and promote continuing dialogue on the ethical, moral, and economic benefits.
Given all of these benefits, is it a realistic possibility to use the organs from other animals. There have been attempts to use primate organs, but those haven't worked as well. One would think that primate organs would be the best candidates, and for a number of different reasons that might be true. However, primates are difficult, time consuming, and costly to rise. Moreover, being primates, people are uncomfortable with killing them for organs. The same is not true of pigs. Pigs breed quickly, grow quickly, and are already consumed for food in large quantities. Moreover, their physiology is close to human physiology, thus they are among the best candidates for non-human organs in large quantities and good quality. The are some health issue related to xenotransplantation of pigs. Such concerns are the transmission of many viruses that humans do not have at this point but can acquire via transplants of the pig animal organs. Consequences may include infections such as influenza, bacterial infections and retroviruses carried naturally by pigs. Here another ethical and medical question rises, “Could it mutate into something which is not neutral, as with pigs, but which is instead harmful?” Yes, that is a possibility.
We just don't know what will happen. We can't. So what do we do? We could save hundreds of thousands of lives if we are able to use pig organs in xenotransplants. We could kill millions the same way, however. How do we weigh the risks? How do we balance the interests of those who would be saved against those who might die? These questions and more create the ethical dilemma in using xenotransplantation. Until we have a consensus with the general public and the scientific world, the use of xenotransplantation will be placed on hold.

Ethics and law
February, 2008

Challenges to Medical Autonomy

Along the line of decision making doctors have always argued that the only person who can evaluate the work of a doctor is a fellow doctor. However, medical autonomy has been increasingly challenged in recent years. The effectiveness of medical treatments has been challenged as the number of court cases increase and when the cost of imdemnity insurance becomes almost unaffordable the societal consequences are far reaching.
We are at the point now when the determination of terminal illness is not soley a medical decision, but rather a hybrid medical, ethical, social, political and legal determination. It is clear that hospital admistrators/managers and health insurance companies have exerted a certain amount of control over doctors. Managers can direct funding from one medical specialty to another; or from hospitals to community-based practitioners. Challenges have also come from the professionalization of other 'paramedical' occupations, especially nursing, which has developed into a more autonomous profession with its own professors of nursing in many universities.

The medical profession is also acutely aware of how the profession as a whole is represented in factual and fictional media. Doctors may still be heroes in fiction, but intense public attention has been given to the villains. Their power to promote stereotypes,as protraying people with mental illness as violent, helps us understand how the media sometimes represent health and illness. The media has breeched taboos to put important and vital issues on the public agenda,in the case of aids, bowel and testicular cancer. It has to be credited with provoking debate on the ethics of scientific and medical developlents and keeping a focus on stem cell research. Medical practioners can with ease suggest behavioural changes to their patients based on what is 'on the news'.

Within medicine, there have been attempts to change the heirarchical structure of the profession and to embrace complimentary therapies such as homepathy and accupunture. The new strides in transgenics, gene therapy and the gamot of genetic engineering will provide many opportunities for collaborative efforts.

HUMAN CLONING: DESTINY AND RESPONSIBILITY

In the sixteenth century, the Reformed theologian John Calvin wrote this about childbirth:
Although it is by the operation of natural causes that infants come into the world ... yet therein the wonderful providence of God brightly shines forth. This miracle, it is true, because of its ordinary occurrence, is made less account of by us. But if ingratitude did not put upon our eyes the veil of stupidity, we would be ravished with admiration at every childbirth in the world.'
Four centuries later, we find that infants do not always come into the world through "the operation of natural causes." The miracle of childbirth has already moved beyond "ordinary meaning" through such procedures as in vitro fertilization. Now that we face the possibility of human life springing not from a fertilized egg but from a clone, we are making great account (some would say too much account) of this possible new way for infants to come into the world. Many people wonder whether this is indeed a miracle for which we can thank God or an ominous new way to play God ourselves. At the very least, it represents the ongoing tension between faith and science.
On the one hand, the church has sometimes taken an overly antagonistic opposition to scientific advances, so that Galileo was charged with heresy for supporting the seemingly unbiblical Copernican notion that the earth revolves around the sun. Darwin's theory of evolution (which apparently even frightened him a bit) is still opposed by some Christians who want equal time given to "creationism." Such examples remind us that the church must not assume that faith requires protection by being shrouded in ignorance. We should be able to celebrate human accomplishments, including accomplishments in genetic research, as the result of divinely bestowed gifts of knowledge and technical skill.
On the other hand, the church rightly understands that sin can lead us to use scientific advances for extremely evil purposes. We can never support the pursuit of knowledge for its own sake apart from asking serious moral questions about the implications of that which we seek to know. To date, we have not been able to keep up with the moral and legal implications of adoption, much less of the dilemmas presented by artificial means of reproduction. We certainly are not yet morally, legally, or spiritually prepared to tend to the difficult issues that would arise if human cloning became a reality.

Proper Health Care Before Money

Proper Health Care Before Money?

As I am reflecting on the present health care system of our country, the United States of America, I came down to one and only conclusion. The conclusion is that we are living in a free market economy. If it is the case, the purpose of every private health insurance or health care institution is to make money. When I say making money, I mean making money at all cost. Maybe, there is nothing wrong with that if freedom or too much leeway is given to those private institutions. Simply with the thinking of making money no matter what, I feel a burning pain in my chest. Why is it an alarming issue? Is there any issue to it? Or, am I making it more than what it is? Well, consider this! It was reported, at the beginning of 2004, nearly 50 million Americans were without health insurance, and the number kept growing higher together with increased number of unemployment.

Millions more have had only partial, inadequate health care coverage. More than eighteen thousand people die in America every year as a direct result of not having access to health care. Beyond that, it was reported that those million people who could afford to pay health insurance were paying more than $100,000 for the hospital stays for their elderly parents in their final days before they died. Four years later, the condition cannot be less alarming than before.

As a reminder to the article 25 of the Universal Declaration of Human Rights that states: Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. The idea behind the article 25 is excellent on the paper, not in practice to those it tends to affect financially.

It must be understood, in every civilized country, the rule of law has to be the turning point for its people. Further, civil instructions and moral values are to be the guided accordingly. Those qualities, I may say, are to be taught and reinforced at home, school, and in public enterprises. With normal practice, we will recognize our duty to other people who breathe and have similar needs as we do. In my humble opinion, I believe, it is unethical and immoral to refuse to give medical care to a sick individual on the basis that individual does not have health insurance, or even deny health insurance to an individual because that individual has a pre-medical condition.

I, sincerely, think no one chooses to be an advocate of illnesses. It is an unfortunate course of life, everyone has to face. To conclude, as un-American I may sound, medical care to every individual needs to be top priority, not money. As the old saying, money is a good servant but is an evil master. We need to value and invest in people more than material objects we can leave in a second. And, as a powerful industrial nation, we must strive to understand that the world exists because of our existence. I do not mean to say it in a trivial way. What I am saying is that without any basic understanding of where we are and what we need to do to foster a sense a well-being in our people, all across the board, we are set to continue with the same egocentric attitude that will remain in existence for centuries to come.

Ronet Jean, MS. PT., MHC

Medical Student, UHSA

School of Medicine to the World, Antigua.