DMEJ
Duke Medical Ethics Journal
Spring 2024 Blog Highlights
Pranav Kannan • January 22
01100100 01100001 01110100 01100001 (data) -- has become increasingly valuable as we enter the information age. In healthcare systems, these lines of binary could hold sensitive information about the patient, including medical history, social security, and medical care. Due to this importance, healthcare systems apply stringent cybersecurity measures to ensure their patients' data remains in the right hands [4]. Unfortunately, the number of cyberattacks and information breaches in hospitals has increased since 2012 to around 700 nationwide cyber attacks in 2022 alone [5]. This has catastrophic effects such as losing patient health data which could affect patient care and could lead to a massive scale of identity theft and fraud​
Mariana Bouchan • February 5th
"Orthopedics is one of many captivating surgical specialties, focusing on preventing, diagnosing, and treating musculoskeletal system diseases and injuries. It is no surprise that there is a long trajectory toward becoming an orthopedic surgeon: 4 years of undergrad, 4 years of medical school, and at least 5 years of residency. While advancements have been made in regards to gender equality in the field of medicine, with women comprising over half of the medical students in the United States, orthopedic surgery remains a significant outlier. Orthopedics is one of the most popular yet least diverse medical subfields and has struggled to obtain adequate female representation. This specialty has the lowest representation of female providers, which highlights an alarming rate of marginalization. Despite ongoing efforts to improve gender diversity, a recent study predicts that orthopedic surgery will take 217 years to achieve gender parity, matching the 36.3% of practicing female physicians in the U.S. "
Bowen Kim • February 5th
"“Who is in your will?” As we all grow older, we have substantial posthumous decisions that need to be made. However, dramatic enhancements in end-of-life care have elicited the question: “Do you want your sperm or egg to be collected?” As highlighted in the New York Post, Sanni Liu gave birth to her daughter two years after her husband’s death.(1) This was only possible due to emerging technology that aided in the preservation of Liu’s husband’s sperm. However, the technology surrounding posthumous sperm and egg retrieval raises an ethical conversation."
Will Sun • February 18th
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It's a familiar story that any avid science fiction fan has read: a person freezes their body and wakes up thousands or even millions of years in the future, stranded in an alien and frightening world. While this is far from happening any time soon, the roots of the technology to make cryopreservation a possibility are slowly becoming a reality.
Today, for a fee of 200,000 euros and a monthly membership fee of 25 euros, the biotech company Tomorrow Bio will transport one’s body in dry ice insulation to a facility in Switzerland, where they will freeze the body in liquid nitrogen under temperatures of -196°C [1]. As preservation technology and anatomical knowledge continue to advance, hundreds of new biotech companies are attempting to make cryopreservation, the science of cooling and preserving biological tissue, a reality."
Leah Kim • February 27th
"Imagine that you are the presiding judge of this courtroom, reviewing the case of Horacio Estrada-Elias⎯a 90-year-old inmate serving a life sentence for a nonviolent marijuana trafficking crime [1]. When you read about his crime, you are doubtful about his character. Yet, your eyes also linger on his spotless disciplinary record in prison. You then look at his medical records: “less than 18 months to live.” He has requested for a compassionate release.
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Now, what decision should you make? Do you maintain “justice” for those who have suffered from his crime by keeping the sentence and letting him die in prison? Or do you allow him to spend the last 18 months of his life outside of prison on supervised release?"
Jack Ringel • February 27th
Every day, 17 people across the world die waiting for a life-saving organ transplant. In fact, there are currently more than 100,000 people waiting for an organ donation in the United States alone (1). Organ Donation Euthanasia (ODE) seems to be a possible solution that could help provide more suitable organs for transplantation. ODE involves performing an organ extraction of a terminally ill anesthetized patient (2). This process may increase the quality and quantity of organs available for donation. However, there is an important ethical consideration surrounding this process. Unlike traditional euthanasia, the terminally ill patient does not die due to purposefully administered drugs, but rather as a result of the removal of organs to be donated. Given that this process saves a life at the expense of another, is Organ Donation Euthanasia ethical?
Annie Vila • Feb 27
"A man in his 60’s walked out of Barnes-Jewish Hospital in July of 2023 with a brand new liver, saving him from his liver cancer and cirrhosis caused by hepatitis C.1 Who does he have to thank for this? While Dr. Adeel Khan and his trusted team of surgeons worked relentlessly to plan and execute a life-saving liver transplant, the true hero of this story may be the robot who performed the actual surgery
Matthew Ahlers • February 27
"The age-old question of how to cheat death has vexed humans for centuries. However, modern day science has shed light on the possibilities of increasing the maximum lifespan. The general consensus among Americans today is that longevity comes from exercise, a healthy diet, and practicing good self-care. Scientific evidence supports the notion that physical activity contributes to increased longevity [4], and a nutritious diet is associated with a remarkable 20% decrease in mortality [5]. While these facts are widely known, the intriguing prospect arises – could newly-developed pharmaceuticals pave the way for individuals to surpass the centenarian mark (living past 100)?"
Claire Williams • March 1st
"Since the emergence of human existence, global healthcare institutions have been tailored to the community and geographic area in which they have served. Despite this cultural diversity, one role has remained unchanged: the physician’s responsibility to do no harm and save lives at all costs. With the increasing popularity of medical aid in dying (MAiD), the purpose of physicians has shifted away from these fundamental values of medicine to heal and promote human well being (1). This change not only discourages entrance into medical fields, but threatens adverse effects for physicians being forced into these complex ethical situations. Kenneth Stevens, Professor in Radiation Oncology at the University of Oregon, cites the feelings of physicians asked to aid in this process as “suddenness, powerlessness, and isolation” (1). These effects are further exacerbated in cases of pressure on and intimidation of doctors, which presents them with a moral conflict between their personal belief and duty in their occupation. In a study conducted to examine physician attitudes versus willingness to perform euthanasia-related procedures, only 13% of physicians who thought the practice should be legalized or decriminalized reported that they would be unequivocally willing to perform it themselves (3). These results suggest a large discrepancy between endorsement and practice of MAiD that is a result of a conflict of duties: “the duty to preserve life on one hand and the duty to relieve suffering on the other hand” (2). "
Nishka Dalal • March 4th
"Throughout various forms of media, but especially in cartoons/animations: the depiction of someone collapsing suddenly and another character rushing to blow into their mouths and push on their chest is quite common. Typically, this simple sequence of events results in a quick, heroic revival. However, the truth is that CPR—cardiopulmonary resuscitation—is not nearly that simple. While almost 65% of Americans claim that they have received CPR training at some point in their lives(1), when it comes time to put those skills into practice, a large portion of these individuals simply don’t. "
Navya Gautam • March 4th
"This question has sparked numerous debates around the process of Physician-Assisted Suicide (PAS). PAS involves a physician providing a competent, terminally ill patient with the means to end their own life [1]. At the heart of the controversy surrounding PAS is a clash of fundamental ethical principles: the respect for autonomy versus the sanctity of life.
Anna Chen • March 4th
"It’s ingrained in physicians to save lives. They dedicate their entire career to helping and healing others. However, this role is called into question when it comes to the topic of physician-assisted suicide. According to WebMD, physician-assisted suicide is defined as when “a doctor gives a patient a prescription for a lethal dose of medication that they can use to end their life when they’re ready”. Patients seeking this procedure have to meet certain criteria, which includes: being 18 or older, being of mentally sound mind, having a terminal illness with a prognosis of less than 6 months to live, and being able to ingest the medicine themselves. Additionally, patients have to gain approval from multiple doctors and affirm this request multiple times (1). "
Navya Gautam • March 4th
In 2018, Andy Jurtschenko received a standard procedure: a heart transplant (1). But after 24 hours, Jurtschenko hadn’t woken up. After investigation by a neurologist, Andy was found to have suffered immense brain damage and would likely remain in a vegetative state for the rest of his life. Faced with a difficult decision, Andy’s children requested a do-not-resuscitate order (DNR), which mandates physicians must not administer emergency care if one’s heart stops beating or breathing ceases (2). Yet, the primary physicians declined their request only eventually relenting after immense pushback. Later, Andy recovered consciousness – but in limited form. Andy’s story is one of many that reveals the ethical dilemmas of DNRs.
Camille Krejdovsky • March 20
"Aging has been a topic of both scientific and philosophical debate throughout history. In her book “Coming of Age”, the existentialist philosopher Simone de Beauvoir writes, “I am incapable of conceiving infinity, and yet I do not accept finity. I want this adventure that is the context of my life to go on without end.”[1] The tension between the finite nature of the human lifespan and the search for eternality is similarly reflected in aging research developments and the search for mechanisms of “reverse aging”."
Meera Patel • March 20th
"As our bodies age and mortality looms nearer, many Americans find themselves traveling to the nearest hospital for care. From the 20th century to the 21st century, hospital deaths surged dramatically [1]. However, for the first time in over a century, that trend has reversed. The number of individuals dying in hospitals has decreased, indicating a growing preference for dying at home or in alternative facilities [1]."
Raphael Lee • March 24th
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The cultural expectation of familial responsibility for eldercare among minority groups, such as Asian Americans and Hispanic families, contrasts with the predominant American narrative of independence and self-reliance in retirement. The traditional American model often emphasizes financial planning and reliance on retirement savings while many minority cultures place a greater emphasis on familial bonds and intergenerational support. These cultural norms shape expectations around retirement and eldercare, placing a significant burden on their adult children to provide physical, emotional, and financial support for their parents as they age.
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This burden can be particularly challenging for adults who are already navigating their own financial responsibilities, career aspirations, and caregiving duties for their own children. Balancing these competing demands can lead to stress, burnout, and financial strain, impacting the well-being and quality of life for both caregivers and their aging parents."
Sarah Croog • November 26
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Extensive research has shown that socioeconomic status impacts health along a gradient: those with less financial resources and social capital have poorer health outcomes compared to those who stand towards the top of the gradient. While this has been researched for decades, discussion on the relationship between socioeconomic status and the quality of end-of-life care patients receive is somewhat lacking but increasingly pertinent. As life expectancy in the United States increases, so does the prevalence of chronic conditions, creating urgency in the discussion of equitable palliative care (1).
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George Nathanial • November 26
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In July 2022, 84-year-old retired entrepreneur James O’Brien broke his hip following a fall at his home in rural New Mexico (1). Upon being wheeled to the hospital to receive treatment, Mr. O’Brien—who was already dying of heart failure and advanced lung disease—declined to receive surgery for his injury, choosing to “die comfortably” rather than suffer from post-surgical complications. The physicians tasked with caring for Mr. O’Brien, however, attempted to go against his wishes, calling his daughter Jennifer with the expectation that she would convince Mr. O’Brien to accept a hip operation. Ultimately, Jennifer opted to support her father’s decision instead and placed him in a local hospice where he would spend the final months of his life. Although James O’Brien died in the way that he desired, thousands of other end-of-life patients are not given the same liberties; specifically, those who are rendered incapable of making their own medical decisions often become subjected to undergoing invasive treatments that cause them to die painfully rather than peacefully (2). This article analyzes the underlying causes and ethical consequences of the administration of aggressive end-of-life medical care."
Marshlee Eugene • April 1st
"Palliative care is a special type of medical care for people who are seriously ill, that has the goal of alleviating and managing symptoms in a way that maximizes comfort and improves quality of life by catering to a patient's needs. Despite this being an option for patients, many are unaware of this option and fail to request it. Combined with the failure of some providers to inform their patients about palliative care, we see that overall it is not as popular. In a study conducted by the University of Pennsylvania, they were curious to see how making palliative care consults a default option for hospital patients would increase the number of people who decide to use palliative care."
