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Posts Tagged ‘ethics

Science Policy Around the Web – November 20, 2018

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By: Andrew Wright, B.S.

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Source: Wikimedia

 

Habitat Loss Threatens All Our Futures, World Leaders Warned

Recent reports have suggested that humanity has only 12 years to avoid catastrophic environmental collapse due to 1.5C of industrial warming. While solutions to the threat of runaway climate change have been given a new sense of urgency by these findings, there exists a commensurate and oft less visited issue, that of rapid declines in global biological diversity. Driven primarily by agricultural land conversion of terrestrial and marine ecosystems (via forest clearing and river damming, respectively), vertebrate species have declined by 60% on average since 1970 according to the World Wildlife Fund’s most recent Living Planet Report . While this decline appears strongest in South and Central America and in freshwater habitats, the report joins a compendium of literature suggesting holistic declines in biodiversity among birds, insects, fish, and terrestrial vertebrates as part of an ongoing anthropogenic mass extinction event.

To address some of the issue, the UN Convention on Biological Diversity (CBD) is currently meeting in Sharm El Sheikh, Egypt to discuss progress on the Aichi biodiversity targets for 2020.  These targets came out of The Convention on Biological Diversity, a multilateral treaty signed in 1992 focused on preserving biodiversity, sustainable use of biological resources, and equitable sharing of resources. The Aichi biodiversity targets specified that people would be aware of risks to biodiversity, and that biodiversity values would be adopted by public, private, and governmental entities by 2020. Given the rapidity, intensity, and ubiquity of the decline in species, most, if not all, of these targets will likely be missed. As such, the delegates from the 196 signatory nations will also work on creating new biodiversity targets to be finalized at the next CBD meeting in China.

Since a comprehensive solution seems necessary given the increasingly global nature of trade, authors of the new targets hope to garner a greater deal of international attention, and intend to make the case that government commitment to reversing or pausing biodiversity loss should receive equivalent weight as action on climate change.

(Jonathan Watts, The Guardian)

The Ethical Quandary of Human Infection Studies

The United States has greatly improved its ability to soundly regulate the ethics of clinical studies since the infamous malfeasance of the Tuskegee syphilis study. Most significantly, the National Research Act of 1974 established the Institutional Review Board to address how to adequately regulate the use of human subjects by adhering to the principles of respect for persons, beneficence, and justice.

The National Research Act provided a substantial step forward and provided a clear requirement for universal informed consent. However, the expansion of clinical studies to new international regions of extreme poverty, due in part to the influx of private money from large charitable organizations, has come with novel ethical considerations. In these newly explored populations where income, education, and literacy levels may be lower, emphasis is now being place on how to recruit volunteers without implicitly taking advantage of their circumstances.

One area of concern is compensation levels. While compensation in a malaria infection study in Kenya was tied to the local minimum wage, the number of volunteers recruited far surpassed expectations. This may have been due to the fact that payment during this study was guaranteed and consistent, in contrast to local work.

Aware of the concern, two of the largest private medical research funding organizations, the Bill and Melinda Gates foundation and the Wellcome Trust have recently instituted ethical guidelines putatively reinforcing the principle of beneficence, placing special emphasis on maximizing benefits over risk. It is an open question whether these protections will be sufficient, but at the very least it is important that rules to be put in place proactively rather than as a reaction.

 

(Linda Nordling, Undark/Scientific American)

 

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November 20, 2018 at 11:58 am

Science Policy Around the Web – October 19, 2018

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By: Ben Wolfson, Ph.D.

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Source: Pixabay

Climate Change

 

Climate Change prompts a rethink of Everglades management

The Florida Everglades is a large area of tropical wetlands that has received significant attention due to the degradation of its unique ecosystem by urban development. The Everglades were designated a World Heritage Sitein 1979 and Wetland Area of Global Importancein 1987, and in 2000 Congress approved the Comprehensive Everglades Restorative Plan (CERP) to combat further decline and provide a framework for Everglades restoration.

For the past 18 years, these efforts have been directed towards curtailing damage from urbanization and pollution. However, as outlined in a congressionally mandated report released on October 16th by the National Academies of Science, Engineering, and Medicine, new strategies may be necessary. In the biennial progress report, an expert panel called for CERP managers to reassess their plans in light of new climate change models. The report focuses on the 7 centimeters of sea level rise seen since 2000, and points out that Southern Florida is especially at risk from climate change and is expected to experience a 0.8-meter rise in sea level by the year 2100.

It is clear that as more is learned about the realities of climate change, the goals and methods of conservation projects are shifting, and past strategies must be adapted to fit the realities of a warming world.

(Richard Blaustein, Science)

Animal Research

NIH announces plan for chimp retirement

 

In 2015, the NIH announced that it would no longer support biomedical research on chimpanzees, two years after pledging to significantly reduce the numbers of chimpanzees used in research. These decisions were made based on a combination of reduced demand for chimpanzees in research and the designation of captured chimpanzees as an endangered species in 2015.

On Thursday October 18th, the NIH announced the next step in the process of retiring research chimps. While research was stopped in 2015, many of the chimpanzees had nowhere to go and remained housed at laboratories. One federal chimpanzee sanctuary, Chimp Haven, exists in Keithville, Louisiana, however lack of space and the difficulty of relocating some animals has slowed their transition to better habitats.

In the Thursday announcement NIH director Francis Collins outlined the guidelines for future chimpanzee relocation. These include streamlining medical records and determining whether chimpanzees are physical healthy enough to be relocated. Many of the chimpanzees are at an advanced age, meaning they have developed chronic illnesses similar to those experienced by humans. However, Collin’s emphasized that there must be a more acute medical problem for relocation not to take place. In addition both the research facility and Chimp Haven must agree that the former research chimpanzees are capable of being relocated, and disagreements will be mediated by a panel of outside veterinarians.

Collins additionally stressed that while transfer to Chimp Haven is the ideal outcome for all retired chimps, those housed at NIH-supported facilities do not live isolated in cages or in laboratories and are housed in social groups with appropriate species-specific accommodations.

The development of these clear guidelines will expediate chimpanzee relocation while emphasizing chimpanzee health and comfort.

(Ike Swetlitz, Statnews)

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October 19, 2018 at 3:25 pm

Science Policy Around the Web – May 1, 2018

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By: Liu-Ya Tang, PhD

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source: pixabay

Artificial Intelligence

With €1.5 billion for artificial intelligence research, Europe pins hopes on ethics

While artificial intelligence (AI) brings convenience to modern life, it may cause some ethical issues. For example, AI systems are generated through machine learning. Systems usually have a training phase in which scientists “feed” them existing data and they “learn” to draw conclusions from that input. If the training dataset is biased, the AI system would produce a biased result. To put ethical guidelines on AI development and catch up with the United States and China in AI research, the European Commission announced on April 25 that it would spend €1.5 billion to AI research and innovation until 2020.

Although the United States and China have made great advances in the field, the ethical issues stemming from AI may have been neglected as both practice “permissionless innovation”, said Eleonore Pauwels, a Belgian ethics researcher at the United Nations University in New York City. She spoke highly of Europe’s plan, which is expected to enhance fairness, transparency, privacy and trust. But the outcome is still unknown. As said by Bernhard Schölkopf, a machine learning researcher at the Max Planck Institute for Intelligent Systems in Tübingen, Germany, “We do not yet understand well how to make [AI] systems robust, or how to predict the effect of interventions”. He also mentioned that only focusing on potential ethical problems would impede the AI research in Europe.

What are the reasons why the AI research lags behind the United States and China? First of all, Europe has strong AI research, but a weak AI industry. Startup companies with innovative technologies, which are oftentimes risky, cannot receive enough funds as the old industrial policies favor big, risk-averse firms. So the commission’s announcement underscores the importance of public-private partnerships to support new technology development. The second reason is that salaries are not high enough to keep AI researchers in academia as compared to the salaries in the private sector. To solve this problem, a group of nine prominent AI researchers asked governments to set up an intergovernmental European Lab for Learning and Intelligent Systems (ELLIS), which would be a “top employer in machine intelligence research” and offer attractive salaries as well as “outstanding academic freedom and visibility”.

(Tania Rabesandratana, Science)

Public health

Bill Gates calls on U.S. to lead fight against a pandemic that could kill 33 million

Pandemic diseases, mainly caused by cholera, bubonic plague, smallpox, and influenza, can be devastating to world populations. Several outbreaks of viral diseases have been reported in scattered areas around the world, including  the 2014 Ebola epidemic, leading to growing concerns about the next wave of a pandemic. During an interview conducted last week, Bill Gates discussed the issue of pandemic preparedness with a reporter from The Washington Post. Later, he gave a speech on the challenges associated with modern epidemics before the Massachusetts Medical Society.

The risk of a pandemic is high, as the world is highly connected and new pathogens are constantly emerging as consequences of naturally occurring mutations. Modern technology has brought on the possibility of bioterrorism attacks. In less than 36 hours, infectious disease and pathogens can travel from a remote village to major cities on any continent to become a global crisis. During his speech, Gates cited a simulation done by the Institute for Disease Modeling, which estimates that nearly 33 million people worldwide could be killed by a highly contagious and lethal airborne pathogen like the 1918 influenza. He said “there is a reasonable probability the world will experience such an outbreak in the next 10-15 years.” The risk becomes higher when local government funding for global health security is not adequate. The U.S. Centers for Disease and Prevention is planning to dramatically downsize its epidemic prevention activities in 39 out of 49 countries, which would make these developing countries even more vulnerable to the outbreaks of infectious diseases.

Gates expressed this urgency to President Trump and senior administration officials at several meetings, and he also announced a $12 million Grand Challenge in partnership with the family of Google Inc. co-founder Larry Page to accelerate the development of a universal flu vaccine. He highlighted scientific and technical advances in the development of better vaccines, antiviral drugs and diagnostics, which could provide better preparation for, prevention of and treatment of infectious disease. Beyond this he emphasized that the United States needs to establish a strategy to utilize and coordinate domestic resources and take a global leadership role in the fight against a pandemic.

(Lena H. Sun, The Washington Post)

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May 1, 2018 at 5:53 pm

Science Policy Around the Web – March 6, 2018

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By: Cindo O. Nicholson, Ph.D.

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source: pixabay

Artificial Intelligence & Ethics

Artificial intelligence could identify gang crimes-and ignite an ethical firestorm

Today, many industries and our favorite gadgets use some form of artificial intelligence (AI) either to make better predictions on user/consumer behavior. AI is also being adopted by police departments to highlight areas where crime is likely to occur thus helping patrol officers prevent crimes before they occur (i.e. predictive policing). Recently at the Artificial Intelligence Ethics & Society (AIES) conference in New Orleans LA, researchers presented a new algorithm that could classify crimes as gang-crimes based on partial information. In particular, the new algorithm can identify gang crimes using only 4 pieces of information: the primary weapon used, the number of suspects, the neighborhood and location (street corner vs. alley for example) where the crime took place.

Many agree that the findings presented (published by the AIES) could change the way the police approach and respond to crimes by classifying the crime beforehand as gang-related. However, not all in attendance were convinced that the new algorithm would be any better than an officer’s intuition and experience. In fact, there were those who believed that there could be unintentional, negative consequences of relying on such an algorithm. A point of contention at the conference was the appearance that the research team did not give sufficient consideration to whether the training data was controlled for bias, or what would happen if individuals were misclassified as gang members.

AI is a powerful technology, and its use can be applied to solve problems in fields like ecology and conservation, public health, drug development, and others. However, like all powerful technology its development must keep pace with its regulation, and the consideration of its potential misuses and unintended consequences.

(Matthew Hutson, Science Magazine)

Science Education

Florida’s residents could soon get the power to alter science classes

The possibility that the public can make recommendations on what instructional materials are used in science classes is moving closer to reality. Two education bills are being considered by Florida’s legislature that would grant Florida’s residents the means to recommend what instructional materials are used in the classrooms of schools in their district.

The education bills being considered would add to a law enacted in June 2017 that grants Florida’s residents the right to challenge the topics educators teach students. In particular, the bills under consideration will allow Florida’s residents to review instructional materials used in class, and suggest changes to the materials. However, the final decision on whether recommendations from residents are accepted would still rest with the school board.

Among the concerns of the scientific community is that these laws would provide a mechanism for creationists, climate-change deniers, and flat-earth proponents (commonly referred to as “flat-earthers”) to insert their non-scientific viewpoints into scientific lesson plans. On the other hand, State Representatives in support of these bills contend that highlighting different viewpoints are important and would allow for debate and drawing one’s own conclusions.

While engaging the public on the content of educational curricula could have its merits, it could have negative consequences when public opinion overrides curricula that have been developed from knowledge gained and refined by rigorous, scientific interrogation over several decades. If more education bills that allow the public to challenge instructional materials are going to be approved, it will be imperative that individuals with scientific backgrounds be a voice of reason on school boards.

(Giorgia Guglielmi, Nature Magazine)

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March 7, 2018 at 11:28 am

Science Policy Around the Web – February 9, 2018

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By: Rachel Smallwood Shoukry, PhD

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source: pixabay

Ethics

Big tobacco’s offer: $1 billion for research. Should scientists take it?

A controversial debate has arisen in recent years about whether scientists should accept funding from sources that have interests at odds with improving the human condition and promoting health. Specifically, should researchers accept research money from tobacco companies? This practice used to be generally accepted up until a couple of decades ago, but as the harmful effects of smoking have become more clear, as well as evidence of the tobacco industry’s attempts to cover-up and misdirect the public from becoming aware of those effects, the scientific community has become reluctant to partner with “big tobacco” and is more aware of conflicts of interest.

The tobacco company Philip Morris International (PMI), makers of Marlboro and other cigarette brands, is looking to invest in research of illegal cigarette trade and smuggling. It recently established a partnership with the University of Utrecht (UU) in the Netherlands to investigate this phenomena, but UU has now pulled out of the deal after a large amount of backlash. However, PMI is still looking to fund research on the tobacco industry, setting up the potential for more controversy.

There is additional concern about this possibility due to PMI’s funding of the Foundation for a Smoke-Free World. The foundation has stated that its goals are related to smoking cessation and preventing smoking deaths through several approaches. However, many fear that the foundation is simply a front for PMI to be able to distribute funds under a better-sounding name while continuing to fund research that can be presented in a misleading way to distract from legitimate health concerns. Several top institutions have denounced the Foundation for a Smoke-Free World for using PMI’s funds, and many have vowed that they will not seek grants from or collaborations with the foundation.

Proponents of allowing the funding via the tobacco industry are interested in research of cigarette alternatives aimed at harm reduction, arguing that little is known about their long-term health implications. They say there is little funding outside of the tobacco companies for these types of studies and don’t know where else to turn. They are also worried about the climate surrounding the topic, after the response UU received when accepting research dollars from PMI. But opponents do not believe that PMI and other companies are seeking harm reduction or to hide the truth about tobacco’s health effects through their research activities and marketing tactics. This ethical debate is sure to continue as PMI disclosed that it has had over 50 applications for funding.

(Martin Enserink, Science)

NSF

US science agency will require universities to report sexual harassment

The NSF has announced it will implement a new requirement that institutions receiving grants must report grant-funded investigators who have sexual or other types of harassment claims against them and whether they were put on leave pending investigation. Many are welcoming this step as movement toward a code of conduct that has been called-for in recent years. It is also coming on the heels of several research initiatives into sexual harassment in STEM fields and other organizations implementing policies to expose and prevent harassment. Although the #MeToo movement only brought sexual harassment claims to the forefront of our culture a few months ago, the STEM field had its own bombshell revelation followed by the unveiling of many stories of sexual harassment a couple of years ago when a renowned astronomer resigned after an investigation revealed years of sexual misconduct and harassment. This new policy is also likely related to the US Congress commissioning the Government Accountability Office to look into sexual harassment by individuals funded by federal scientific agencies.

The notice the NSF sent out also directs the recipient institutions to have clear policies on what constitutes harassment and what is appropriate behavior, as well as giving clear instructions to students and employees on how to report harassment. The institutions themselves will be responsible for conducting investigations and deciding repercussions. Until now the NSF has had an option to voluntarily report sexual misconduct of award recipients, but it was rarely used. The notice states that the NSF can remove the responsible personnel from the grant or even suspend or terminate the grant following the mishandling of a report.

Despite the general positive view of this attempt by the NSF to deter harassment and establish serious consequences, some have expressed concerns at the potential implications and logistics of implementation. It was suggested that this step may discourage universities from undertaking investigations of sexual harassment, since universities benefit from grant money and reputation just as the investigators do. Another aspect to consider is that universities have different policies on sexual harassment and misconduct, and what may be allowable at one institution may be a severe breach at another. It was not immediately clear from the notice how decisions will be made with regard to the grant following investigations. While perhaps not perfect, this policy by the NSF is a first step in the right direction to ensuring everyone can pursue their scientific endeavors in a harassment-free environment.

(Alexandra Witze, Nature)

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February 9, 2018 at 4:01 pm

Science Policy Around the Web – January 30, 2018

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By: Kelly Tomins, BSc

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By RedCoat (Own work) [CC-BY-SA-2.5], via Wikimedia Commons

Cloning

Yes, They’ve Cloned Monkeys in China. That Doesn’t Mean You’re Next.

Primates were cloned for the first time with the births of two monkeys, Zhong Zhong and Hua Hua, at the Chinese Academy of Sciences in Shanghai. Despite being born from two separate mothers weeks apart, the two monkeys share the exact same DNA. They were cloned from cells of a single fetus, using a method called Somatic Cell Nuclear Transfer (SCNT), the same method used to clone over 20 other animal species, beginning with the now infamous sheep, Dolly.

The recently published study has excited scientists around the world, demonstrating the potential expanded use of primates in biomedical research. The impact of cloned monkeys could be tremendous, providing scientists a model more like humans to understand genetic disorders. Gene editing of the monkey embryos was also possible, indicating scientists could alter genes suspected to cause certain genetic disorders. These monkeys could then be used a model to understand the disease pathology and test innovative treatments, eliminating the differences that can arise from even the smallest natural genetic variation that exists between the individuals of the same species.

Despite the excitement over the first cloning of a primate, there is much work to be done before this technique could broadly impact research. The efficiency of the procedure was limited, with only 2 live births resulting from 149 early embryos created by the lab. In addition, the lab could only produce clones from fetal cells. Now it is still not possible to clone a primate after birth. In addition, the future of primate research is uncertain in the United States. Research regarding the sociality, intelligence, and DNA similarity of primates to humans has raised ethical concerns regarding their use in research. The US has banned the use of chimpanzees in research, and the NIH is currently in the process of retiring all of its’ chimps to sanctuaries. In addition, there are concerns regarding the proper treatment of many primates in research studies. The FDA recently ended a nicotine study and had to create a new council to oversee animal research after four squirrel monkeys died under suspicious circumstances. With further optimization, it will be fascinating to see if this primate cloning method will expand the otherwise waning use of primate research in the United States.

The successful cloning of a primate has additionally increased ethical concerns over the possibility of cloning humans. In addition to the many safety concerns, several bioethicists agree that human cloning would demean a human’s identity and should not be attempted. Either way, Dr. Shoukrat Mitalipov, director of the Center for Embryonic Cell and Gene Therapy at the Oregon Health & Science University stated that the methods used in this paper would likely not work on humans anyways.

(Gina Kolata, New York Times)

Air Pollution

EPA ends clean air policy opposed by fossil fuel interests

The EPA is ending the “once-in always-in” policy, which regulated how emissions standards differ between various sources of hazardous pollutants. This policy regards section 112 of the Clean Air Act, which regards regulation of sources of air pollutants such as benzene, hexane, and DDE. “Major sources” of pollutants are defined as those that have the potential to emit 10 tons per year of one pollutant or 25 tons of a combination of air pollutants. “Area Sources” are stationary sources of air pollutants that are not major sources. Under the policy, once a source is classified as a major source, it is permanently subject to stricter pollutant control standards, even if emitted pollutants fall below the threshold. This policy was intended to ensure that reductions in emissions continue over time.

The change in policy means that major sources of pollution that dip below the emissions threshold will be reclassified as an area source, and thus be held to lower air safety standards. Fossil fuel companies have petitioned for this change for years, and the recent policy change is being lauded by Republicans and states with high gas and coal production. The EPA news release states that the outdated policy disincentives companies from voluntarily reducing emissions, since they will be held accountable to major source standards regardless of the amount of emissions. Bill Wehrum, a former lawyer representing fossil fuel companies and current Assistant Administrator of EPA’s Office of Air and Radiation, stated reversing this policy “will reduce regulatory burden for industries and the states”. In contrast, environmentalists believe this change will drastically increase the amount of pollution plants will expel due to the softening of standards once they reach a certain threshold. As long as sources remain just below the major source threshold, there will be no incentive or regulations for them to lower pollutant emissions.

(Michael Biesecker, Associated Press)

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January 30, 2018 at 3:30 pm

Science Policy Around the Web – January 26, 2018

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By: Jennifer Patterson-West, Ph.D.

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source: pixabay

Drug Pricing

At $850,000, price for new childhood blindness gene therapy four times too high, analysis says

Advances in medicine have greatly shifted the prognosis of many diseases. Heart disease is still the leading cause of death in the United States, nevertheless, deaths due to cardiovascular disease have declined by over 50% since the 1950s. This sharp decline correlates with the introduction of the first beta blocker in 1964, which could effectively lower high blood pressure. Diseases, such as childhood leukemia, AIDS, and hepatitis C, that were once considered a death sentence are now being treated.

However, these advances come at a cost.  In 2014, the Tufts Center for the Study of Drug Development (CSDD) released a report estimating the cost to develop a new drug to be $2.5 billion. With the high cost of drug development, it is not surprising that drug prices are soaring in all sectors. Pharmaceutical price hikes have sparked significant controversy due to the financial stress they put on patients. Last year, Mylan Pharmaceuticals increased the cost of an EpiPen by 500% fueling the debate on instituting government control on drug pricing in the U.S. The pricing of a new gene therapy for blindness at $850,000  has once again sparked this debate.

Advocates of price control point to Europe, where drug pricing is already bureaucratically controlled. In Europe and elsewhere, many drugs are available at a fraction of the cost. Prices in these countries have been significantly reduced by the implementation of external price referencing (EPR). In this system, Drugs are categorized into classes based on therapeutic effect and a reference point is set for each drug class.  This system follows the logic that manufacturers have considerable pressure to minimize cost when there are good alternatives.

Opponents of price control underscore a widening gap in the innovation of new drugs between the United states and Japan and Germany, where drug price controls have been enacted over the past few decades. It has been proposed that price control inadvertently limits the funds pharmaceutical companies direct to research and development. Pharmaceutical development comes with a high risk for investors, therefore, without the incentive of high profits, it is speculated that investors would move to other sectors of industry, such as high technology. Despite these odds, investment into research and development by the global pharmaceutical industry is only second to the tech industry.

(Andrew Joseph, STAT News)

Ethics

When A Tattoo Means Life Or Death. Literally

In the United States, an advanced directive or living will is the standard way that individuals inform medical professionals of the treatments they would like to receive if they are dying or permanently unconscious. These forms can provide instructions regarding the use of machines to maintain life, feeding tubes, and intravenous fluids, “do not resuscitate” (DNR) orders, as well as organ and tissue donation preferences. Do not resuscitate (D.N.R.) means that doctors will not intervene with CPR or advanced cardiac life support (ACLS) if a patient stops breathing or their heart stops. Nevertheless, under this advisement, patients will continue to receive palliative care to mitigate pain or other physical symptoms.

These legal documents give patients control over their health care when serious illness may impair their judgement or overwhelm their ability to make a decision.  Although, if a patient arrives at a hospital unconscious or alone these directives may not be communicated to the medical staff. For this reason, individuals have taken to wearing their medical preferences on their body predominately in the form of a bracelet or necklace.

A recent case study reported an instance where a 70-year-old man arrived at the University of Miami hospital unconscious without an advance directive on file. The patient had a tattoo stating “do not resuscitate” with his signature across his chest. The tattoo gave doctors pause regarding how to proceed when the patient stopped breathing. Their initial reaction was to disregard the tattoo and provide necessary care since the alternative was an irreversible path. The legal recognition of the tattoo’s directive was uncertain. After reviewing the patient’s case, Dr. Kenneth Goodman, an expert medical ethicist advised the medical staff to honor the tattoo. Fortuitously, this decision was subsequently supported by a D.N.R. on file with the Florida Department of Health.

In contrast, a separate case study reported a patient with a D.N.R. tattoo that specified that it did not reflect his current preference for end-of-life care. These two cases left doctors uncertain about how to respond in future cases and emphasized the need for a central database containing advanced directives that is accessible to medical professionals.

Some states have established electronic databases for advanced directives. These states include New York, Oregon, Utah, West Virginia, and California. Residents of other states are recommended to file their living will at a private registry, such as the U.S. living will registry. In all cases, the usefulness of these registries is limited by a hospital or doctor’s use of the service.  With decentralized registries, it is inefficient for medical staff to search for a patient’s living will, especially when rapid response is necessary.  For this reason, many hospitals rely on an internal system containing patient records. A careful discussion of standard practices for obtaining documentation or recognizing physical identification of D.N.R. needs to be established among the American Medical Association so that medical staff can rapidly respond to a patient’s medical needs and wishes.

(Rebecca Hersher, NPR)

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January 26, 2018 at 5:23 pm