Dorothy E. Vawter

Use of placebo surgery in controlled trials of a cellular-based therapy for Parkinson's disease.

Surgical procedures are frequently introduced into general practice on the basis of uncontrolled studies that are less rigorous than those required for the approval of medical interventions.1 The s...

Are there really alternatives to the use of fetal tissue from elective abortions in transplantation research

Researchers believe fetal tissue can be easily transplanted into and cure people with incurable debilitating diseases such as Parkinsons disease. In 1988, the Reagan Administration stopped funding transplantation research of fetal tissue from induced abortions. An advisory panel later decided that it is an acceptable public policy as long as certain conditions a re met. Yet the Bush Administration continued the ban. In 1992, it erroneously claimed that transplantation research could use alternative sources of fetal tissue. 1 alternative is fetal tissue obtained from ectopic pregnancies. Yet spontaneously aborted ectopic pregnancies tend not to produce recognizable or viable in culture fetal tissue and if they do the tissue has been ischemic for days. Ectopic pregnancies requiring surgical sterilization tend to be morphologically abnormal. The only likelihood of viable fetal tissue form ectopic pregnancies is a fetus with myocardial contractility before surgery. The administration also recommended use of fetal tissue from spontaneous abortions but these fetuses often have a major chromosomal or other fatal defect. Researchers cannot use chromosomally abnormal fetal tissue since it growth, development, and function are unreliable. Expulsion of the necrotic fetus tends to occur a couple of weeks after death. The Bush Administration also proposed use of tissue from stillbirths but their tissue tends to be nonviable and the tissue, even if it were viable, is generally not at the developmental stage needed for transplantation. The placenta and yolk sac were other suggested alternatives, but the placenta is likely to be less immunogenic than embryonic tissue. It can help develop certain cell lines which produce insulin or neurotransmitters like dopamine, however. The yolk sac could replace fetal liver cells in transplantation. Nevertheless the only advantage of using the suggested alternatives is the perception of them raising less ethical concern than fetal tissue from an induced abortion.

Fetal Tissue Research and the Misread Compromise

The bill to restore federal funding for human fetal tissue research has been passed by the House and awaits Senate approval. But it requires women who are willing to donate fetal tissue to certify that they did not have an abortion with the intent to donate. It further requires researchers to keep the certifications on file and available for government audit. Both requirements spell trouble.

Health care workers' willingness to work in a pandemic

Malm and colleagues (2008) provide a valuable and compelling analysis of the effectiveness and feasibility of different strategies for establishing a duty to work during a severe pandemic. To encou...

Risks of Fetal Tissue Donation to Women

Treating the aborted fetus as a human cadaver is believed to be justified because it is respectful and protective of the fetus. In the United States, most states permit the donation and procurement of human fetal tissue for educational, research, or therapeutic purposes in accord with the Uniform Anatomical Gift Act (UAGA). These state laws specify the protections necessary for the fetal cadaver and the circumstances under which the next-of-kin may donate its remains. However, treating the woman who agrees to donate fetal tissue merely as one of the next-of-kin who may consent to donate the tissue of her deceased relative is disrespectful and leaves her vulnerable to harm. It overlooks both the risks that donating fetal tissue pose to her as well as the unique relationship that exists between a woman and a fetus. The cadaver donor framework, for example, does not require the woman’s consent before fetal tissue may be used; the consent of the father is considered sufficient. And, in any case, only minimal information is required to be disclosed to those deciding whether to donate the tissue of a deceased relative. The following are possible risks to a woman’s privacy and well-being associated with donating tissue for transplantation after elective abortion: Her blood may be tested for infectious agents such as HIV. The tissue may be labeled with an identifier that makes it possible to trace the woman who had the abortion and donated the tissue. Persons uninvolved in the woman’s care may have access to her clinic records to obtain information about her medical history. The abortion procedure may be modified in ways that prolong or intensify discomfort, or that increase the risks of physical harm to the woman. The living organ donor framework is more respectful and protective of the woman who is asked to donate fetal tissue than the cadaver donor framework. It acknowledges that the woman has a unique and privileged relationship with the fetus and that donation poses a variety of significant risks to the woman. Her respect and protection should be secured in the following ways: Her consent should be necessary; the father’s consent should never be sufficient. She should be informed of the proposed use of the tissue. She should be informed of the risks that donation poses to her privacy. She should be informed of the risks associated with testing her blood or urine to establish the quality of the tissue, labeling the fetal tissue with an identifier traceable to her, and tissue procurers or others not directly involved in her care gaining access to private information in her clinic record. She should be informed of any modifications of the abortion procedure and the associated risks to her well-being. She should be informed of the risks of prolonged or intensified discomfort as well as the risks of incomplete abortion or trauma to the cervix associated with any modifications, e.g., slowing the abortion procedure, decreasing the pressure of the suction, or increasing the dilatation of the cervix and the cannula. Neither the cadaver donor framework, nor the living organ donor framework, by itself captures the full range of obligations to both the fetus and the woman involved in fetal tissue transplantation. Combining these frameworks, however, so that they complement and constrain, rather than conflict with one another, will ensure that both the woman and the fetus are protected and respected.

Minnesota Pandemic Ethics Project Update

Readers of the article by Thomas and Young1 will be interested to know that the Minnesota Pandemic Ethics Project was completed in 2010. A broadly based panel developed frameworks for ethically rationing several types of health resources in a severe influenza pandemic: antiviral medications, N95 respirators, surgical masks, vaccines, and mechanical ventilators. The panel’s recommendations2 are distinguished by (1) the extensive public engagement used to develop its guidance3; (2) a realization that multiple ethical frameworks are required; (3) commitments to balance multiple ethical objectives in each ethical framework; (4) sustained attention to the needs, interests, and perspectives of socially vulnerable groups4; and (5) signaling when it may be appropriate to consider age and prioritize younger people before older people—especially children before adults—among groups who are at the same relative risk of morbidity and mortality. All told, more than 600 people participated in the project, including the general public, expert advisers from multiple disciplines, and stakeholders with particular professional and organizational perspectives. The Web site referenced in the article by Thomas and Young is no longer active. Final project reports are available at http://www.health.state.mn.us/divs/idepc/ethics.

Adequately Respecting and Protecting Fetal Tissue Donors and Their Next-of-Kin

Is it ethical to use the tissues of electively aborted fetuses for transplantation purposes, and if so, under what conditions? The answer depends on the respect and protection owed those involved in the donation of fetal tissue, and whether it is possible to implement policies to assure such respect and protection.

Fetal Tissue Transplantation and the Problem of Elective Abortion

Electively aborted fetuses are the most reliable and plentiful source of fetal tissue for transplantation into human recipients [1]. However, many ethical concerns have been raised by the transplantation of tissue from electively aborted fetuses. In this paper, we discuss four widely cited sets of concerns and objections: 1 The transplantation of tissue from an electively aborted fetus is morally inseparable from the morality of the elective abortion. 2 The transplantation of fetal tissue will cause an increased number of elective abortions. 3 The transplantation of fetal tissue will lead to the modification of abortion procedures. 4 The transplantation of fetal tissue will cause women to abort in order to donate.

Palliative Care Ethics: A Case Commentary on Discontinuing Interventions at the End of Life

Ms. Demir initially seeks to return home with hospice and continue to receive blood products and high-flow oxygen as long as her quality of life is satisfactory to her. In light of restricted options for community-based services, Ms. Demir opts for hospitalization in order to receive these interventions. The case of Ms. Demir raises more ethical uncertainties than outright ethical conflicts. Specifically, it raises unsettled ethics questions about medical futility, withholding palliative (vs. life-sustaining) interventions, and the palliative use of blood products.

Fetal Tissue Guidelines Depart from the Cadaver Donor Framework

259 It is widely held that human fetal tissue used in transplantation should be treated as any other human cadaver tissue. Treating the dead fetus as a cadaver is more respectful than treating it as a tissue specimen. However, despite the prevalence of references to the cadaver donor framework in several national fetal tissue guidelines, provisions that depart from this framework are frequently included. These departures provide both the fetus and the woman with respect and protection beyond that offered by the cadaver donor framework. The cadaver donor framework consists of the following: * Next-of-kin must give explicit written consent to the use of the tissue in education, research, or therapy * Consent disclosure may be minimal * Next-of-kin may base consent on their own interests, preferences, and values * Next-of-kin may designate recipients or specific use * One next-of-kin may veto anothers decision * Users must be involved in neither the care of the deceased nor in the determination of death * Tissue may not be bought or sold. Additional provisions for the fetus are of two types. The first stems from the belief that electively aborted fetuses deserve a respect unnecessary for other cadavers. For example: * Tissue may be used only for biomedical pur-poses/2/ * Information must be unobtainable by other means/1,2, * An institutional ethics committee must oversee the research/1-4/. The second type stems from the belief that the living fetus deserves special protection. The use of fetal tissue must be prevented from encouraging abortion for donation in ways considered unnecessary to prevent cadaver donation from encouraging suicide or murder. For example: * The woman must consent to abortion before discussing donation/2,4,5/ * The woman may not abort for purposes of donating tissue/1,2/ * The woman may not specify how tissue is to be used/2,5/ * The woman may not designate recipient /2,4,5/ * An intermediary should be used to transfer tissue and information between abortion provider and tissue user/2/ * Abortion providers and women should receive no inducements/2,4/. Additional provisions for women asked to donate tissue are of two types. The first stems from the belief that such women deserve respect that is unnecessary for next-of-kin in cadaver donation generally. For example: * The womans consent is necessary/1-5/ * The father cannot veto the womans decision /2,5/ * The woman must be given all information requested/1,4/. The second type stems from the belief that women …