Search

The articles in this issue of the Journal of Medicine and Philosophy explore emerging technologies, medical innovations, and shifting moral norms, expanding present discussions around topics in bioethics both old and new. Some question whether novel definitions of death and harm change the moral permissibility of killing, particularly at the hands of a physician. Others question how increased or decreased abilities affect responsibility and achievement. Another illustrates how rhetorical appeals to character have been used to justify otherwise morally illicit actions within the clinic. Together, these articles shed new light on topics in the field of bioethics. [ABSTRACT FROM AUTHOR]

While some countries are moving toward legalization, euthanasia is still criticized on various fronts. Most importantly, it is considered a violation of the medical ethics principle of non-maleficence, because it actively seeks a patient's death. But, medical ethicists should consider an ethical alternative to euthanasia. In this article, we defend cryocide as one such alternative. Under this procedure, with the consent of terminally-ill patients, their clinical death is induced, in order to prevent the further advance of their brain's deterioration. Their body is then cryogenically preserved, in the hope that in the future, there will be a technology to reanimate it. This prospect is ethically distinct from euthanasia if a different criterion of death is assumed. In the information-theoretic criterion of death, a person is not considered dead when brain and cardiopulmonary functions cease, but rather, when information constituting psychology and memory is lost. [ABSTRACT FROM AUTHOR]

Introduction Acute Compartment Syndrome (ACS) is a severe trauma caused by elevated intra-muscle-compartment pressure (ICP). The current standard method for diagnosis is to insert a needle into the muscle sterilely under anesthesia. However, to secure the environment is sometimes not easy and leads to delays in diagnosis. Recently, we have focused on shear wave ultrasound elastography (SWE) as an alternative, which can be done concisely in unclean environment and without anesthesia. We would like to report the usefulness of SWE for ACS diagnosis using 2-pedal walking turkey model recently developed in our lab. Materials and Methods A total of 32 1-year-old Bourbon turkeys were used. 5% solution of chicken albumin was infused continuously into the tibialis cranialis (TC) muscle using IV pump. The ICP was increased stepwise from 0 to 50 mmHg. During the rising of ICP, the correlation between values of SWE (kPa) and ICP (mmHg) was measured. After the ICP reached 50 mmHg, half of the turkeys were maintained at this pressure for 2 hours and the rest for 6 hours. After infusion, a fasciotomy was performed on the half turkey. Half of the turkeys were euthanized after 2 weeks and the rest after 6 weeks. SWE of TC muscle and walking gait data on turkeys using a portable walkway system were measured weekly until euthanasia. At euthanasia, isometric tetanic muscle force (ITF) tests to TC muscle and histological evaluations were performed. Results SWE value (kPa) was highly significantly correlated to the actual ICP (mmHg) (R2 = 0.91). Stance of ACS side leg were significantly extended, and swing of the control side shortened from the second to the third week after ACS in the 6 hours infusion-no-fasciotomy group (P  < 0.05*). ITF was significantly reduced mainly in the 6 hours infusion group (P  < 0.05*). Histological evaluation revealed that in the 6 hours infusion and 6 weeks survival group, both the muscle fiber and intercellular distances were significantly expanded (P  < 0.05). Conclusion SWE seems to be a substitute measure of ICP in diagnosing ACS. With regard to our in vivo ACS model using turkey, survival at 50 mmHg ICP for 6 hours and 6 weeks post ACS would be an appropriate situation. [ABSTRACT FROM AUTHOR]

Introduction Exposure to high doses of ionizing radiation can result in hematopoietic acute radiation syndrome. Currently, there is no radiation medical countermeasure approved by the U.S. FDA which can be used before radiation exposure to protect exposed individuals. Here we aimed to evaluate the therapeutic potential of an aqueous suspension of synthetic genistein nanoparticles (BIO 300) as a radioprotectant in a pilot efficacy study using a nonhuman primate model of total body irradiation. Materials and Methods Eight rhesus macaques were divided into two groups; four received vehicle and four received BIO 300 Injectable Suspension 24 h before 5.8 Gy total-body irradiation. Survival, blood cell counts, blood chemistry, and clinical parameters were monitored over the 60 days of the study. Tissues were collected at necropsy 60 days post-irradiation or from animals that met unscheduled euthanasia criteria and subjected to histopathological analysis. Tissues analyzed included the duodenum, jejunum, ileum, sternum, lung, heart, liver, kidney, spleen, gut-associated lymphoid tissue, and urinary bladder. Results In this pilot study, all BIO 300 Injectable Suspension treated animals survived to day 60, while only 50% of the vehicle-treated animals survived. We found that BIO 300 Injectable Suspension did not mediate an improvement in blood cell counts (e.g. neutrophils, platelets, white blood cells). However, BIO 300 Injectable Suspension treated animals had a lower incidence of fever and febrile neutropenia, were able to better maintain their body weight post radiation exposure, and exhibited less anemia and faster recovery from anemia. Histopathological analysis revealed that BIO 300-treated animals had less irradiation-induced damage to the sternum and other tissues compared to vehicle controls. Conclusions BIO 300's mechanism of action is complex and protection against irradiation is attainable without much improvement in the complete blood count (CBC) profile. BIO 300's mechanism for radioprotection involves multiple biological pathways and systems. [ABSTRACT FROM AUTHOR]

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection. [ABSTRACT FROM AUTHOR]

The controversy over the equivalence of continuous sedation until death (CSD) and physician-assisted suicide/euthanasia (PAS/E) provides an opportunity to focus on a significant extended use of CSD. This extension, suggested by the equivalence of PAS/E and CSD, is designed to promote additional patient autonomy at the end-of-life. Samuel LiPuma, in his article, "Continuous Sedation Until Death as Physician-Assisted Suicide/Euthanasia: A Conceptual Analysis" claims equivalence between CSD and death; his paper is seminal in the equivalency debate. Critics contend that sedation follows proportionality protocols for which LiPuma's thesis does not adequately account. Furthermore, sedation may not eliminate consciousness, and as such LiPuma's contention that CSD is equivalent to neocortical death is suspect. We not only defend the equivalence thesis, but also expand it to include additional moral considerations. First, we explain the equivalence thesis. This is followed by a defense of the thesis against five criticisms. The third section critiques the current use of CSD. Finally, we offer two proposals that, if adopted, would broaden the use of PAS/E and CSD and thereby expand options at the end-of-life. [ABSTRACT FROM AUTHOR]

Existing studies of policy diffusion rely on quantitative or qualitative methods depending on the number of cases and the policy at hand. Studies of diffusion in Canada, for instance, almost exclusively use qualitative techniques due to the limited number of subnational units. In this article, we explore whether machine learning techniques can complement qualitative approaches in these contexts. In 2015, the Canadian federal government decided to impose the legalization of cannabis and gave the provinces and territories a short time frame to develop and implement legislation. Previous qualitative research on this case found that within-province policy development was more salient than interprovincial diffusion. Using a plagiarism detection software, we find limited evidence of exact matches between provincial legislation, but a cosine score approach reveals significant similarities across provinces. These results suggest that computational and qualitative techniques together should be used where possible to identify and analyze policy diffusion in certain contexts. [ABSTRACT FROM AUTHOR]

This article examines whether political parties reward the parliamentary activity of members of parliament (MPs) through candidate selection processes. Previous research on this question provides mixed evidence. Moreover, studies often disregard potentially unequal effects among different kinds of MPs. Using new data on all members of the Belgian Chamber of Representatives between 1995 and 2019 (N = 1108), this contribution shows that several types of parliamentary activity indeed matter both for MPs' general renomination as well as for their claim to realistic list positions. Furthermore, our study provides evidence that parliamentary activity matters more for the reselection of newcomers than for experienced MPs. [ABSTRACT FROM AUTHOR]

Humane euthanasia techniques in the swine industry have long been a consideration among veterinarians and animal caretakers. The use of mechanical blunt force trauma (MBFT) with a non-penetrating captive bolt (NPCB) gun has become a novel means of humanely euthanizing suckling pigs. MBFT is intended to deliver a percussive blow on the frontal bone and is known to consistently generate immediate insensibility upon application. MBFT is reported to cause abrupt, tonic movements post-application. The tonic movements can be graphically challenging and distressful to animal caretakers leading to aversion to this method of euthanasia. These negative outcomes in combination with the lack of caretaker preparation/ training utilizing MBFT can influence the ability of the caretaker to make timely euthanasia decisions, which can negatively impact pig welfare. Animal caretakers have reported emotional and mental limitations when performing MBFT euthanasia on-farm. Insufficient work has been done to understand how MBFT euthanasia and training programs can impact the perspective of animal caretakers on this method of euthanasia, particularly in the Spanish-speaking workforce. The present study explores a recent transition in a large vertically integrated swine production system in the United States from carbon dioxide (CO2) gas euthanasia to MBFT as the primary method of euthanasia in suckling piglets. The objective of this study was to identify the mental, emotional, and practical challenges of Spanish-speaking caretakers who participated in a formal training on conducting euthanasia using MBFT. A total of 257 animal caretakers participated in the survey. Logistic regression showed that knowledge of the Common Swine Industry Audit (CSIA) increased the likelihood of immediate euthanasia (3.09 times, P < 0.003) and acceptance of euthanizing animals meeting criteria (3.17 times, P < 0.008). Prior employment in meat processing (4.53 times, P < 0.003) and the poultry/egg industry (4.06 times, P < 0.028) increased the likelihood of performing euthanasia for piglets that met criteria. Males were more likely than females to feel comfortable with performing euthanasia (2.01 times, P < 0.017). Previous experience in sow farms correlated with a preference for others identifying sick or injured piglets (2.01 times, P < 0.024) and reluctance to euthanize (3.40 times, P < 0.003). A Mann-Whitney U Test compared beliefs on CO2 (Group A; GA) vs. MBFT (Group B; GB) euthanasia. GA (n = 159) unanimously preferred CO2, differing significantly from Group B (n = 98; U = 5,841.50, P <.001). Similarly, respondents aware of the CSIA (GA, n = 193) differed significantly from those unaware (GB, n = 64) in their approach to identifying and euthanizing piglets (U = 4,621.00, P <.001). This study identifies the mental, emotional, and practical challenges faced by Spanish-speaking caretakers transitioning to MBFT euthanasia, highlighting the significance of training/support programs in enhancing welfare practices. [ABSTRACT FROM AUTHOR]

The article discusses the discovery of a collection of photographs belonging to Johann Niemann, an SS officer who worked at the Aktion T4 "euthanasia" centers and the Aktion Reinhard camps, including Sobibór. The collection was found by German historian Hermann Adams and acquired by the United States Holocaust Memorial Museum (USHMM). The publication of the collection, titled "From 'Euthanasia' to Sobibór: An SS Officer's Photo Collection," provides historical context and personal perspectives, shedding light on the everyday experiences of the perpetrators and the visual landscape of the camps. The collection offers valuable insights into the history of the Holocaust and the lives of German perpetrators. [Extracted from the article]