Michael A. Grodin

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.

The OHRP and SUPPORT - Another view

A group of physicians, bioethicists, and scholars in allied fields agrees with the Office for Human Research Protections about the informed-consent documents in SUPPORT.

Recognition of nonaccidental injury.

Intentional injuries may be grossly underrecognized and underreported. The authors review the literature, provide guidelines for recognizing intentional injuries, and address the problem of identifying intentional injuries. Prevention of these injuries is also addressed and the need for further study is stressed.

Children as participants in medical research

The use of children in research raises the questions about proper justification, assessment of benefit in relation to risk, ability to consent, compensation, and the just selection of subjects. Although substantive and procedural standards have evolved, subpopulations of vulnerable children created new challenges and concerns.

Meta medical ethics : the philosophical foundations of bioethics

Preface. 1. Introduction: the Historical and Philosophical Roots of Bioethics M. Grodin. 2. The Principled Approach: Principles, Rules and Actions R. Devettere. Commentary R. Truog. 3. The Communitarian Perspective: Autonomy and the Common Good T. Shannon. Commentary R. Potter. 4. The Dominance of American Law (and Market Values) over American Bioethics G. Annas. Commentary J. Paris. 5. Medical Stories: Narrative and Phenomenological Approaches M. Montello. Commentary L. Forrow. 6. North American Bioethics: the Feminist Critique M. Farley. Commentary A. Asch. 7. From the Self to the Other: Building a Philosophy of Medicine A. Tauber. Commentary A. Speight. Index.

Decisionmaking Regarding the Initiation of Tube Feedings in the Severely Demented Elderly: A Review

lderly patients suffering from irreversible dementia who fail spoon feedings may become malnourished and dehydrated. Decisions regarding the initiation of tube feedings must be made. We compare and contrast this decisionmaking process to that of the withdrawal of tube feedings from patients in persistent vegetative states. We examine the substance and process of decisionmaking including the limits of the principles that inform this process, autonomy and beneficence. We contend that families are the most appropriate surrogate decisionmakers for incapacitated elders. A uniformity in outcomes of the decisionmaking process is not the goal. Instead, tolerance for a plurality of outcomes is necessary. The roles of physicians, nurses, other caregivers, and institutions in the decisionmaking process are described. We outline the important elements in developing guidelines for decisionmaking regarding the initiation of tube feedings in severely demented elders.

Medicine and Human Rights: A Proposal for International Action

An international medical tribunal should be established with power to impose criminal sanctions against physicians who are guilty of crimes against humanity.

Dehydration, diabetic ketoacidosis, and shock in the pediatric patient.

Therapy for dehydration is guided by the weight and body surface area of the patient. This state can be prevented if early signs are recognized. The recently adopted regimen for treating diabetic ketoacidosis consists of constant infusion of small doses of insulin. This regimen is easy to follow and permits close monitoring of the relationship of dose to effect. Shock is managed by oxygenation and replacement of volume deficits.

A 12-year audit of IRB decisions.

Institutional review boards (IRBs) are inter-disciplinary committees mandated by the federal government to review all research protocols that involve human subjects developed in institutions receiving federal funds. The purpose of the IRB is to protect those subjects from unnecessary risk or from risks that outweigh potential benefits. At Boston City Hospital, a study was conducted of the decision-making process of the hospitals IRB over a 12-year period (from 1973-1984) to determine empirically the types of research protocols reviewed, problems frequently addressed, actions taken, and the consistency of the decision-making process.

Health Professionals and Lethal Injection Execution in the United States

Since the advent of lethal injection as a method of execution there has been an increasing escalation of executions in the United States. While most health professions have issued position statements that officially denounce the participation of their members, the actual involvement of health professionals in executions has increased. We found that guidelines regarding the limits or ethical parameters of physician participation in executions by lethal injection have been ignored by state legislatures, have been ineffective in influencing public opinion, and have been largely unenforced because professional associations have neither the power to revoke a health professionals license nor the ability to prevent its members from violating its guidelines. In addition, there are broader ethical implications in the use of an overdose of drugs to effectuate the death penalty and simply refusing to participate does not address such issues. Lethal injection execution is a violation of medical ethics because it utilizes medical skills and knowledge to give judicial homicide the appearance of painless clinical competence and humanity, which in turn has insulated such executions from constitutional scrutiny and public attack. We maintain that, because all other methods have routinely been acknowledged to be painful and cruel, without lethal injection, the death penalty in the United States would be unlikely to survive. Therefore, the complicity of the health professions in this continued violation of human rights extends beyond the actual participation of licensed practitioners.