George J. Annas

HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy.

1 RS Expert Consensus Statement on the Management of ardiovascular Implantable Electronic Devices (CIEDs) in atients nearing end of life or requesting withdrawal of therapy his document was developed in collaboration and endorsed by the American College of Cardiology ACC), the American Geriatrics Society (AGS), the American Academy of Hospice and Palliative edicine (AAHPM); the American Heart Association (AHA), the European Heart Rhythm ssociation (EHRA), and the Hospice and Palliative Nurses Association (HPNA).

Patient Autonomy and Incidental Findings in Clinical Genomics

Returning genetic incidental findings without patient consent is misguided. Exome and whole-genome sequencing are rapidly moving into clinical application to aid diagnosis and treatment. However, a startling statement by the American College of Medical Genetics and Genomics (ACMG) may prove to be a stumbling block (1). Rather than reconfirming well-established principles of patient autonomy and informed consent that have long applied in medical genetics and in medical practice more broadly, ACMG recommends an abrupt change.

WOMEN AND CHILDREN FIRST

In the lore of the sea there are few events that have so exemplified heroism and self-sacrifice as the acts of the soldiers and sailors of the British ship Birkenhead when it sank in 1852. The sold...

Bioterrorism, Public Health, and Civil Liberties

In the wake of the September 11, 2001, terrorist attacks, the Centers for Disease Control and Prevention proposed a model act for the states that specifies steps to be taken to contain an epidemic resulting from a bioterrorist attack. The act would grant broad powers to the states in the event of public health emergencies arising from bioterrorism. Annas discusses the trade-off between civil liberties and the need to protect the health of the public in the event of bioterrorism. His underlying premise is that the model act, despite being revised in December 2001, goes too far.

HRS Expert Consensus Statement on remote interrogation and monitoring for cardiovascular implantable electronic devices

DavidSlotwiner,MD, FHRS, FACC(Chair),Niraj Varma,MD,PhD, FRCP(Co-chair), JosephG.Akar,MD,PhD, George Annas, JD, MPH, Marianne Beardsall, MN/NP, CCDS, FHRS, Richard I. Fogel, MD, FHRS, Nestor O. Galizio, MD, Taya V. Glotzer, MD, FHRS, FACC, Robin A. Leahy, RN, BSN, CCDS, FHRS, Charles J. Love, MD, CCDS, FHRS, FACC, FAHA, Rhondalyn C. McLean, MD, Suneet Mittal, MD, FHRS, Loredana Morichelli, RN, MSN, Kristen K. Patton, MD, Merritt H. Raitt, MD, FHRS, Renato Pietro Ricci, MD, John Rickard, MD, MPH, Mark H. Schoenfeld, MD, CCDS, FHRS, FACC, FAHA, Gerald A. Serwer, MD, FHRS, FACC, Julie Shea, MS, RNCS, FHRS, CCDS, Paul Varosy, MD, FHRS, FACC, FAHA, Atul Verma, MD, FHRS, FRCPC, Cheuk-Man Yu, MD, FACC, FRCP, FRACP From the Hofstra School of Medicine, North Shore Long Island Jewish Health System, New Hyde Park, New York, Cleveland Clinic, Cleveland, Ohio, Yale University School of Medicine, New Haven, Connecticut, Boston University School of Public Health, Boston, Massachusetts, Southlake Regional Health Centre, Newmarket, Ontario, Canada, St. Vincent Medical Group, Indianapolis, Indiana, Favaloro Foundation University Hospital, Buenos Aires, Argentina, Hackensack University Medical Center, Hackensack, New Jersey, Sanger Heart & Vascular Institute, Carolinas HealthCare System, Charlotte, North Carolina, New York University Langone Medical Center, New York City, New York, University of Pennsylvania Health System, Philadelphia, Pennsylvania, The Arrhythmia Institute at Valley Hospital, New York, New York, Department of Cardiovascular Diseases, San Filippo Neri Hospital, Rome, Italy, University of Washington, Seattle, Washington, VA Portland Health Care System, Oregon Health & Science University, Knight Cardiovascular Institute, Portland, Oregon, Johns Hopkins University, Baltimore, Maryland, Yale University School of Medicine, Yale-New Haven Hospital Saint Raphael Campus, New Haven, Connecticut, University of Michigan Congenital Heart Center, University of Michigan Health Center, Ann Arbor, Michigan, Brigham and Women’s Hospital, Boston, Massachusetts, Veterans Affairs Eastern Colorado Health Care System, University of Colorado, Denver, Colorado, and Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.

The health care proxy and the living will

American medicine is awash in forms: insurance forms, disability forms, informed-consent forms, and forms for various examinations, to name just a few. Forms can help make the practice of medicine ...

Human Rights and Maternal-Fetal HIV Transmission Prevention Trials in Africa

The human rights issues raised by the conduct of maternal-fetal human immunodeficiency virus transmission trials in Africa are not unique to either acquired immunodeficiency syndrome or Africa, but public discussion of these trials presents an opportunity for the United States and other wealthy nations to take the rights and welfare of impoverished populations seriously. The central issue at stake when developed countries perform research on subjects in developing countries is exploitation. The only way to prevent exploitation of a research population is to insist not only that informed consent be obtained but also that, should an intervention be proven beneficial, the intervention will be delivered to the impoverished population. Human rights are universal and cannot be compromised solely on the basis of beliefs or practices of any one country or group. The challenge to the developed countries is to implement programs to improve the health of the people in developing countries both by improving public health infrastructure and by delivering effective drugs and vaccines to the people.

Waste and Longing — The Legal Status of Placental-Blood Banking

Waste is not always what it seems. In his Cold War novel Underworld, for example, Don DeLillo explores the multifaceted qualities of waste. “Waste,” he notes, “is the secret history, the underhisto...

Drafting the Genetic Privacy Act: Science, Policy, and Practical Considerations:

0 nly 27 percent of Americans in a 1995 Harris poll said they had read or heard “quite a lot” about genetic tests. Nonetheless, 68 percent said they would be either “very likely” or “somewhat likely” to undergo genetic testing even for diseases “for which there is presently no cure or treatment.” Perhaps most astonishing, 56 percent found it either “very” or “somewhat acceptable” to develop a government computerized DNA bank with samples taken from all newborns, and their names attached to the samples.’ This does not necessarily mean the public is unconcerned about genetic privacy. More likely it means that the public is still uninformed about the risks associated with genetic testing, and has not thought at all about the risks involved in storing identifiable DNA samples. A central question presented by genetic screening and testing is whether the genetic information so obtained is different in kind from other medical information (such as family history and cholesterol levels), and, if so, whether this means that it should receive special legal protection. Genetic information can be considered uniquely private or personal information, for at least three reasons: it can predict an individual’s likely medical future for a variety of conditions; it divulges personal information about one’s parents, siblings, and children; and it has historically been used to stigmatize and victimize individuals. The highly personal nature of the information contained in one’s DNA can be illustrated by thinking of DNA as containing an individual’s coded “future diary.”2 A diary is perhaps the most personal and private document an individual can create. It contains a person’s innermost thoughts and perceptions, and is usually hidden and locked to assure its secrecy. Diaries describe the past. The infor-

23andMe and the FDA

Because of a warning from the FDA, 23andMe has stopped marketing its personal genome service. Now, a dialogue about key issues in genomic testing could result in clear standards for the industry, including requirements for informed consent and disclosure of results.