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Capps B.,Dalhousie University | Bailey M.M.,National University of Singapore | Coker R.,London School of Hygiene and Tropical Medicine | Lederman Z.,Center for Biomedical Ethics | And 3 more authors.
Bioethics | Year: 2015

Pandemic plans recommend phases of response to an emergent infectious disease (EID) outbreak, and are primarily aimed at preventing and mitigating human-to-human transmission. These plans carry presumptive weight and are increasingly being operationalized at the national, regional and international level with the support of the World Health Organization (WHO). The conventional focus of pandemic preparedness for EIDs of zoonotic origin has been on public health and human welfare. However, this focus on human populations has resulted in strategically important disciplinary silos. As the risks of zoonotic diseases have implications that reach across many domains outside traditional public health, including anthropological, environmental, and veterinary fora, a more inclusive ecological perspective is paramount for an effective response to future outbreaks. © 2015 John Wiley & Sons Ltd.

Chong S.-A.,Institute of Mental Health | Campbell A.,Center for Biomedical Ethics | Chee M.,National University of Singapore | Liu J.,Genome Institute of Singapore | And 5 more authors.
Early Intervention in Psychiatry | Year: 2011

Aim: This paper describes the rationale, aims and development of the Singapore Translational and Clinical Research in Psychosis, which is a 5-year programme. Methods: The authors provide a selective review of the pertinent findings from the clinical, neuropsychological, genetics and neuroimaging studies on high-risk population and how they were factored in the hypotheses and design of this translational clinical research programme. Results: This programme, which draws upon the previous work of various groups and the experience of the investigators of this consortium, comprises three interlinked studies. The first is a genome-wide association and copy number variation analysis using the diagnostic phenotype of schizophrenia and cognitive phenotypes, and a joint genome-wide analysis performed by combining our data with other datasets to increase the power to detect genetic risk factors. The second is a prospective study of a large group of individuals who are assessed to be at ultra-high risk of psychosis, and the third is a randomized controlled trial to improve neurocognition in patients with schizophrenia. Conclusion: The convergence of various factors including the unique structured characteristics of the Singaporean society, the presence of political will with availability of funding and the established research infrastructure make it possible to accrue the sample size for adequate power to elucidate biomarkers of disease risk and resilience. © 2011 Blackwell Publishing Asia Pty Ltd.

Aulisio M.P.,Case Western Reserve University | Aulisio M.P.,Center for Biomedical Ethics | Arora K.S.,Case Western Reserve University | Arora K.S.,MetroHealth Medical Center
HEC Forum | Year: 2014

This paper argues that the type of conscience claims made in last decade's spate of cases involving pharmacists' objections to filling birth control prescriptions and cases such as Ms. Means and Mercy Health Partners of Michigan, and even the Affordable Care Act and the Little Sisters of the Poor, as different as they appear to be from each other, share a common element that ties them together and makes them fundamentally different in kind from traditional claims of conscience about which a practical consensus emerged in the 1980s and 1990s. This difference in kind is profoundly significant; so much so, we contend, that it puts them at odds with the normative basis for protecting conscience claims in United States health care settings in the first place, making them illegitimate. Finally, we argue that, given the illegitimacy of these contemporary claims of conscience, physicians and other health professionals must honor their well-established standing obligations to provide informed consent and refer or transfer care even if the service requested or needed is at odds with their own core moral beliefs - a requirement that is in line with the aforementioned practical consensus on traditional claims of conscience. © 2014 Springer Science+Business Media Dordrecht.

PubMed | Center for Biomedical Ethics
Type: Journal Article | Journal: Medical humanities | Year: 2011

This paper discusses various justifications for including medical humanities and art in healthcare education. It expresses concern about portrayals of the humanities and art as benign and servile in relation to medicine and the health professions. An alternative is for the humanities to take a more active role within medical education by challenging the assumptions and myths of the predominant biomedical model. Another is to challenge quiescent notions of the arts by examining examples of recent provocative work and, to this end, the paper considers the work of performance artists Stelarc and Orlan who have subjected their bodies to modifications and extensions. Their work challenges, and potentially undermines, conceptions of the body, medicine, and humanitys relationship with technology. Similarly, other artists, working with biological cultures, have raised controversial issues. Recent work of this kind defies easy understanding and resists being pressed into the service of medicine and other health professions for educational purposes by opening up topics for exploration and discussion without providing unitary explanatory frameworks. The paper goes on to discuss the implications for medical education if this is the approach to the arts and humanities in healthcare education. It suggests that there needs to be a shift in the foundational assumptions of medicine if the arts and humanities are to contribute more fully.

PubMed | Center for Biomedical Ethics
Type: Journal Article | Journal: Public understanding of science (Bristol, England) | Year: 2012

In December 2006, the Australian Parliament liberalized regulation governing stem cell research. This decision and preceding legislative review generated considerable public debate, which centred on objections to the deliberate creation and destruction of human embryos for research purposes. This paper draws on qualitative research conducted on the public debate surrounding this policy episode. The aim of this research was to examine how science and scientific knowledge are mobilized by participants in these debates to support their arguments. Data were collected from 109 newspaper opinion editorials as well as 23 in-depth interviews and examined using qualitative content and thematic analysis. Results of this analysis depict science as a rhetorical, moral and political resource that provides opportunities for participants to gain legitimacy, negotiate meaning and assert authority in the public domain. The mobilization of science in public discourse is discussed along with suggestions that are aimed at encouraging greater transparency and inclusiveness in public debates around contested science and emergent technologies.

The researchers believe that work on what are called chimeric embryos is vital to advance our understanding of early human development, further our ability to accurately model devastating diseases and facilitate drug testing to ensure that potential therapies are safe and effective. "Currently, it is impossible to accurately recapitulate human development in vitro, and there is no ethical method to obtain post-implantation stage human fetal tissue for isolating tissue and organ stem cells for regenerative medicine," they wrote. The seven Stanford authors of the letter include Irving Weissman, MD, who directs Stanford's Institute for Stem Cell Biology and Regenerative Medicine, and David Magnus, PhD, director of Stanford's Center for Biomedical Ethics. The letter also was co-authored by four prominent scientists from other research institutions across the country. It will be published in Science Nov. 6—the same day a workshop will be held at the NIH to discuss the restrictions and deliver new research guidelines. "By eliminating federal funding for all aspects of this research, the NIH casts a shadow of negativity toward all experiments involving chimera studies regardless of whether human cells are involved," said assistant professor of medicine Sean Wu, PhD, MD, one of the senior authors of the letter. Weissman is the other co-senior author. "The current NIH restriction serves as a significant impediment to major scientific progress in the fields of stem cell and developmental biology and regenerative medicine and should be lifted as soon as possible." At issue is the growing field of research that seeks to understand how human pluripotent stem cells, which can become any cell type, may integrate and contribute to the development of a nonhuman animal, such as a laboratory mouse. Pluripotent stem cells can be isolated from human embryos or created in a lab from adult human cells, in which case they're known as induced pluripotent stem cells. Once obtained, these versatile cells can be injected into an early-stage animal embryo and studied as the embryo develops into an adult animal. Tracking where these cells go and how they function in the growing embryo and the adult animal can help researchers understand early stages of human development that can't be studied any other way. (Although researchers can and do study the development of fertilized human eggs, the study period is restricted to only a few days after fertilization for ethical reasons.) Furthermore, if cells from a person with a heritable disease, like sickle-cell disease, are used, it may be possible to generate an animal with the same disease for further experimentation or for testing to ensure drug safety before use in humans. Finally, if an animal is engineered to lack the ability to create a specific organ, such as a pancreas or liver, it may be possible for the human pluripotent stem cells to step up and develop an entirely human organ in that animal for study—or even for transplantation. However, such studies have prompted ethical concerns, and in October the NIH abruptly suspended its funding of "research in which human pluripotent cells are introduced into nonhuman vertebrate animal pre-gastrulation stage embryos while the agency considers a possible policy revision in this area." The agency is hosting the Nov. 6 workshop of researchers and bioethicists from around the country to consider issuing new guidelines about the research. Authors say concerns not supported by studies The authors of the letter believe that concerns about the research are not supported by previous studies, and argue that an ongoing dialogue among scientists and bioethicists is sufficient to ensure the research is conducted in an ethically responsible manner. "Much of the bioethical concern in regard to human/non-human chimerism arises from the possibility of chimeric animals harboring human neurons and germ cells. Can human neural cells co-exist with those from animals and establish 'humanized' cerebral anatomy and circuitries? Furthermore, would such chimeras be elevated to a higher metaphysical state and 'think' more like us? Current scientific data have not supported such possibilities, despite hundreds of xenotransplant studies introducing human neurons into the mouse brain," they wrote. The researchers also cited current restrictions by the National Academy of Medicine and the National Research Council against breeding animals in which human pluripotent stem cells were implanted during development. These rules aim to prevent any possible transmission of human genes via the sperm or egg of the animal. They also pointed to the stricture against using nonhuman primates, which are considered too similar to humans, for such studies as reasonable boundaries for chimeric research. "Ultimately, we believe that human/nonhuman chimerism studies in pregastrulation embryos hold tremendous potential to improve our understanding of early development, enhance disease modeling, and promote therapeutic discovery," they wrote. Explore further: A method to identify human induced pluripotent stem cells in the lab using a tumor rejection antigen More information: "Lift NIH restrictions on chimera research," by A. Sharma et al. Science,

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