The COVID-19 pandemic swept through New York City swiftly and with devastating effect. The crisis put enormous pressure on all hospital services, including the clinical ethics consultation team. This report describes the recent experience of the ethics consultants and Columbia University Irving Medical Center during the COVID-19 surge and compares the case load and characteristics to the corresponding period in 2019. By reporting this experience, we hope to supplement the growing body of COVID-19 scientific literature and provide details of the (...) human toll the virus took on our hospitals and communities. We also aim to highlight the role of the clinical ethics consultant as well as areas of policy and law that may need to be addressed in order to be better prepared for a future public health crisis. (shrink)

The term dual use technologies refers to research and technology with the potential both to yield valuable scientific knowledge and to be used for nefarious purposes with serious consequences for public health or the environment. There are two main approaches to assessing dual use technologies: pragmatic and metaphysical. A pragmatic approach relies on ethical principles and norms to generate specific guidance and policy for dual use technologies. A metaphysical approach exhorts us to the deeper study of human nature, our intentions, (...) goals, values ideals and social relations when considering dual use technology. Use of science and technology (S and T) is determined by two components of human nature: human intentions and choices. We have drawn a distinction between specific measures, goals and intentions with respect to technologies in order to show that moral judgment about technologies must precede their use. Understanding of our intentionality and values, and our moral ideals, as a measurable, tangible part of the real world is important for the prevention of any possible harm from S and T. In the context of dual use technologies, we stress the importance of three main understandings of human nature: vulnerability, responsibility and narrative identity. These can become a strong ontological “antidote” to technology’s poisoning of modern man. Each new technology can be measured and compared with man’s values, traditions and societal norms. This can be done bearing in mind the concept that human nature is not dualistic, but pluralistic. A system of ethical principles that includes the principles of good intentions, the correspondence of goals and means, the balancing of risks and benefits, simplicity, and contextuality, will help ensure that technologies are more humanistic and friendly to human beings. (shrink)

Children in foster care are considered a “vulnerable population” in clinical care and research, with good reason. These children face multiple medical, psychological, and social risks that obligate the child welfare and healthcare systems to protect them from further harms. An unintended consequence of the “vulnerable population” designation for children in foster care is that it may impose barriers on tracking and studying their health that creates gaps in knowledge that are key to their receipt of medical care and good (...) outcomes. These gaps in knowledge have implications for justice, beneficence, and maleficence and serve to undermine “protection” of this population. Here we review the challenges of research regarding children in foster care, particularly medically complex children, and offer specific recommendations to include children in foster care in medical research. (shrink)

The pursuit of genetic knowledge has such emotional, social, scientific, and financial importance that it has been compared to the divine quest for the Holy Grail, and to the calamity of opening Pandora's Box. Therefore, it comes as no surprise that the recent announcement of a completed blueprint for the human genome has fueled calls for both increased research and increased precautions. This new era, which holds the potential promise of advances in medicine, agriculture and other areas, also requires the (...) careful investigation of a myriad of issues. Those issues such as informed consent, patenting, privacy, and confidentiality, have been explored in at least some detail. Others, such as equity, mutual respect, empowering education, consensus building, and planning for long-term survival, have not been as fully examined, nor have they been as comprehensively integrated into mainstream thinking. To facilitate this, we need to implement an ethical approach that leads us to ask critical questions about the appropriate use of our new tools. (shrink)

Der Artikel untersucht einen Fall, in dem jemand von einem Mediziner die Offenlegung der Resultate eines Gentests seines verstorbenen Vaters verlangt. Die vorläufigen Ergebnisse der Studie des Mediziners lassen auf ein um 10% erhöhtes Risiko für Darmkrebs in Verbindung mit der Beschaffenheit eines der Gene des Vaters schließen. Dieser Fall wirft Fragen im Hinblick auf zumindest drei unterschiedliche Aspekte auf: die Offenlegung von Informationen mit geringem Aussagewert; die Offenlegung von Untersuchungsergebnissen gegenüber unmittelbaren Abkömmlingen der Testperson; und die Offenlegung von Untersuchungsergebnissen (...) nach dem Tod der Testperson.Der vorliegende Artikel kommt zu folgenden Ergebnissen: Testresultate mit geringem Aussagewert sollten den Testpersonen auf Anforderung zugänglich gemacht werden; unter bestimmten Umständen sollten genetische Informationen Familienmitgliedern gegenüber offengelegt werden, auch ohne die Zustimmung der Testperson; obwohl die Rechte und Verantwortlichkeiten im Zusammenhang mit der Verpflichtung, das Vertrauensverhältnis gegenüber dem Patienten zu bewahren, normalerweise mit dem Tod des Patienten nicht verringert oder gar aufgehoben werden, könnten im vorliegenden Fall doch bestimmte Faktoren zu einer Verschiebung der Balance hin zu einer Offenlegung der Information führen; und gibt es zu diesem Fall eine Reihe von Varianten, in denen der Mediziner wegen eines Zusammenspiels zwischen den genannten Faktoren berechtigterweise die Testresultate des Vaters dem Sohn gegenüber offenlegen kann. This article explores a case in which a son asks researchers to disclose his deceased father's genetic test results. The preliminary results of the researchers' study suggest a 10% increase in risk of colon cancer associated with the presence of gene. The case raises issues related to at least three distinct policy areas: the disclosure of/ow-value information, the disclosure of research results to immediate biological relatives of research subjects, and the disclosure of research results after the death of a research subject. The article concludes the following: low-value test results should be made available upon request to research subjects, in some circumstances genetic information may be revealed to family members without the subjects' consent, while the rights and responsibilities associated with the obligation to maintain subjects' confidentiality may not generally diminish or end upon their death, certain factors in this case may shift that balance in favor of disclosure, and in this case, because of the interplay between the factors, there are a number of scenarios in which the researchers could justifiably disclose the father's test results to the son. (shrink)