In 1997, Benjamin Schreiber was convicted of first-degree murder and sentenced to life in an Iowa prison. In March 2015, Benjamin fell gravely ill. He developed kidney stones which “caused him to develop septic poisoning,” and was brought to the hospital in critical condition. Though Benjamin had a do-not-resuscitate (“DNR”) order in place, he was resuscitated five times. Once Benjamin became stable, the medical staff operated on and repaired organs that were damaged. In 2018, Benjamin filed a lawsuit seeking post-conviction relief, alleging that he should be released from prison. He contends that because he “momentarily died” in the hospital, he had satisfactorily served his life sentence. The Iowa Court of Appeals found this argument unpersuasive, stating that the Court “[did] not believe that the [Iowa] legislature intended…to set criminal defendants free whenever medical procedures during their incarceration lead to their resuscitation by medical professionals…” Benjamin also alleged a violation of his due process rights because the hospital did not respect his DNR. Court records confirm that Benjamin’s brother, who was at the hospital with Benjamin, instructed the hospital staff only to give him medicine to ease his pain, “but otherwise…let him pass.” The lower courts and the Iowa Court of Appeals did not address Benjamin’s due process argument. Though Benjamin’s argument that he should be released from prison was found to lack merit, it may be possible that Benjamin could recover in a civil action because he was resuscitated against his wishes.
The United States does not have a universal protocol for evaluating the viability of organs for donation. Instead, the country is divided into 58 independent zones, each with its own organ procurement organization (“OPO”). OPOs are responsible for: determining what organs are suitable for donation at the time of a person’s death; obtaining consent for their donation; and collecting and transporting the organs. Inconsistencies among the evaluation standards employed by the various OPOs create problems: each of the 58 OPOs employs independent standards in determining an organ’s viability for donation. Furthermore, no deterrence action is implemented for an OPO that allows usable organs to go to waste. Presently, OPOs lack a method for objectively evaluating their organ procurement programs. Rather, OPOs subjectively self-report their progress to the government. The resulting variance in the evaluation standards makes it difficult to accurately gauge and compare OPOs’ performances against one another. In addition, the government lacks protocols to effectively identify and issue accountability of poorly performing zones. Fortunately, this may change in the future. The Trump administration plans to implement stricter standards that would allow for a level-playing field on which it will become possible to compare OPOs and encourage performance improvement for those underperforming.
DNA testing has become increasingly widespread. The possibility of discovering a relation to a celebrity or uncovering an unknown heritage motivates some to purchase DNA testing kits through 23andMe or Ancestry DNA. However, few people realize that these simple tests bring about privacy concerns, whether the tests are done at home or at medical institutions. The results from DNA testing have a much wider use than just tracing your roots or confirming your identity. Anonymity is not secure, and family secrets can be unraveled. These genetic results can be used by law enforcement to track down criminals and/or by drugmakers to facilitate their latest discovery. And drugmakers are expending hundreds of millions of dollars to access patient DNA results to unlock disease insights and discover new drugs. Private deals between hospitals and drugmakers are a huge privacy concern. Agreements exist that bar such sharing of private data, but, when they enter into exclusive corporate agreements, hospitals do not always disclose when the data will be used. An issue that remains at the heart of healthcare is privacy – now that concern broadens to the ethics of genetic research.
Oxford University researchers have been creating and testing the MVA85A vaccine, meant to serve as a booster to the Tuberculosis (“TB”) vaccine. In the course of the research, it was discovered that the researchers falsely portrayed pre-clinical results of the booster in order to gain funding for clinical trials. The researchers misrepresented information in both applications for funding and in information given to parents whose children would receive the booster. They claimed that the booster was both safe and more effective at protecting against TB than the regular vaccine alone. The researchers also falsely claimed that the booster had been safely tested in multiple animal studies, which had never occurred. In fact, researchers at Stellenbosch University in South Africa later performed an animal study and the results did not support use of the booster as a way of increasing the effectiveness of the TB vaccine.
The misrepresentations made by the Oxford University researchers have raised questions about the safeguards in place for pre-clinical research. Unlike the extensive requirements for clinical trials, pre-clinical trials do not have to be registered with appropriate authorities, which increases the likelihood that errors and omissions go unnoticed. Many believe that a registry should be established for pre-clinical trials to provide proper oversight and ensure that unsafe drugs do not reach the marketplace.
After battling congestive heart failure and chronic obstructive pulmonary disease, former First Lady, Barbara Bush, has announced that she will no longer seek medical treatment and instead will focus on “comfort care.” Barbara Bush is 92 years old. Her announcement has sparked a debate about end-of-life care and decision-making.
Palliative care experts want to correct any misconceptions that people may have about Mrs. Bush’s decision and specifically want to disprove the “common myth about palliative care [that patients] are being denied medical help.” They explain that palliative care is a patient-centered approach that focuses on reducing a patient’s symptoms and making them as comfortable as possible as they near the end of their lives.
Many praise Barbara Bush for providing an honest perspective on her end-of-life care decision and encourage others to explore their health care options and discuss their wishes regarding palliative care with their health care providers, families and loved ones.
Health care providers must often ask their patients difficult questions about their preferences regarding end of life care. Patients or their legal representatives must ultimately decide how to answer these questions. In some states, however, the answers for patients with intellectual disabilities may be governed by state law rather than patients’ wishes.
Depending on the severity of a patient’s condition, a patient with intellectual disabilities is often deemed to lack capacity to make autonomous health care decisions. Generally, a legal representative is authorized to make health care decisions for such patients. Yet, in some states, the law imposes limitations on the type of decisions a legal representative can make when the patient has an intellectual disability. For example, in New Hampshire, a legal representative of a person with an intellectual disability cannot decline life-sustaining treatment, despite the fact that the patient may have indicated a wish not to receive such treatment. If a legal representative believes that a patient does not wish to receive life-sustaining treatment, the only option to ensure that the patient’s wishes are met is to petition a court to decline treatment, which can be an onerous legal process.
Many advocates for improving patient care believe that such approach can reduce the quality of palliative and end of life care that a patient with intellectual disabilities receives. They argue that states should amend their laws and follow a more patient-centered approach as followed in New York, which recently passed a law that allows legal representatives to withdraw life-sustaining treatment for a patient with intellectual disabilities if there is sufficient evidence to prove that such decision is consistent with the patient’s wishes.
On March 19, 2018, Mississippi Governor Phil Bryant signed an abortion bill into law that some say will likely be overturned. The new law places a ban on abortions after only 15 weeks of pregnancy, making it the shortest gestational age limitation on abortions in the U.S. The Governor has stated that the law will help make Mississippi the “safest place in America for an unborn child.” Opponents, however, are arguing that this unprecedented ban is unconstitutional and endangers the health care of women in Mississippi. The Center for Reproductive Rights, among the opponents, is characterizing the law as a “flagrant assault on reproductive rights” and is fighting to have it overturned. Similar laws that have attempted to be passed in other states were all overturned by the court system, which has consistently found that such short gestational age limitations create an undue burden for women seeking to have an abortion and, therefore, violate women’s constitutional right to an abortion.
Isaiah Haastrup suffered “catastrophic brain damage” at birth due to oxygen deprivation. At 11 months old, the infant was unable to move or breathe on his own, had a low level of consciousness, and did not respond to stimuli. He was placed on a ventilator to help him stay alive. Although Isaiah’s parents wanted to keep him on the ventilator as necessary for his condition to improve, the Hospital where he was being treated believed that his prognosis was weak and improvement was very unlikely. Thus, the Hospital sought legal action to discontinue Isaiah’s life support, despite his parents’ objections.
Justice MacDonald of the High Court in London passed his ruling on the matter with “profound sadness” and held that it was not in Isaiah’s best interest to continue his life-sustaining medical treatment. After the decision, the Hospital stated that it would transfer Isaiah to palliative care and work with and support his parents in ensuring that he obtains appropriate care.
The case echoes that of Charlie Gard who, in July 2017, was also 11 months old, and was terminally ill. His parents wanted to bring Charlie to the United States for an experimental treatment, but the High Courts in London were convinced that his condition would not improve and ordered that Charlie be taken off his ventilator.
After Arizona cancer survivor Ruby Torres divorced her husband, her ability to have children on her own depended on seven frozen embryos she had created with her ex-husband. Unwilling to financially support a child resulting from one of the embryos, Ruby’s ex-husband opposed her decision to conceive and a family court judge ordered that the embryos be donated to another couple based on a medical agreement that had been signed when Ruby first underwent in vitro fertilization.
New Arizona legislation, SB 1393, could present a solution to the type of challenges that were faced by Ruby and her ex-husband. The bill would remove all financial and parental responsibility from a spouse that does not want a frozen embryo, and would require clinics to store such frozen embryos for 99 years. While this bill may help women like Ruby use their frozen embryos to have a child, it also raises a number of ethical concerns. Mostly, it could create personal crises-of-conscience for those spouses who do not want a child bearing their DNA to be born with an ex-spouse. Critics of the bill are calling it a “back-door attempt” to create constitutional rights of personhood for “fertilized eggs, zygotes, embryos, and fetuses.”
The U.S. Food and Drug Administration (“FDA”) has been vocal about their efforts to curtail stem cell programs. Yet, in a surprising turn of events, the FDA commissioner, Dr. Scott Gottlieb, and the director of FDA’s Center for Biologics Evaluation and Research, Dr. Peter Marks, have recently co-authored a paper that promotes more accurate research regarding the use of stem cell therapy in medicine. The paper sets forth a detailed plan for assessing the effectiveness of stem cell therapy.
Stem cells have the abilities to mimic other cells in the human body, cells that may not be working properly or at all in patients with various diseases and, therefore, can have significant impacts on the outcome of health. Most promising about Drs. Gottlieb and Marks’ paper is that it opens the door for expanded use of stem cell therapy in the U.S. which was long thought to be closed. In short, it appears that stem cell programs will no longer be given a cold hard “no,” in both the medical and regulatory context.