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  1.  1
    Is the Pace of Biomedical Innovation Slowing?Arturo Casadevall - 2018 - Perspectives in Biology and Medicine 61 (4):584-593.
    In 1985, when I graduated from medical school, I thought that medicine in 2018 would be more advanced than it is today. Coloring that view were the dizzying medical advances made from 1950 to 1980, three decades that were Figure 1 Major biomedical advances as a function of the time perhaps the most innovative period in modern medicine. Recent times have seen fewer revolutionary advances, although remarkable progress continues to be made in certain areas, including imaging of disease, the treatment (...)
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  2.  11
    Spinning the Genome: Why Science Hype Matters.Timothy Caulfield - 2018 - Perspectives in Biology and Medicine 61 (4):560-571.
    Genetic research attracts significant attention from the popular press, and often these representations are less than ideal, skewing toward hyperbole and promises of near-future benefits. Indeed, revolutionary language has permeated public discourse since the start of the Human Genome Project in the early 1990s. If the near constant parade of enthusiastic headlines is to be believed, we have been in the midst of a "genetic revolution" for over three decades, yet, the promised revolutionary changes never fully materialize, at least not (...)
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  3.  1
    Control of Cardiovascular Disease in the 20th Century: Meeting the Challenge of Chronic Degenerative Disease.Richard S. Cooper - 2018 - Perspectives in Biology and Medicine 61 (4):550-559.
    The scientific understanding of common chronic disease began in the mid-19th century, driven in large part by the development of the modern autopsy. For cardiovascular disease, the recognition that rigid plaques were obstructing muscular arteries, especially in the coronary arteries, provided a mechanism to explain what had been a mysterious "chest pain–sudden collapse" syndrome. The origin of these plaques was totally obscure, however, and they were given the descriptive name of "atherosclerosis," or "hardened porridge" in Greek. Not until 50 years (...)
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  4.  3
    Precision Medicine Approaches and the Health of Populations: Study Design Concerns and Considerations.Sandro Galea & Salma M. Abdalla - 2018 - Perspectives in Biology and Medicine 61 (4):527-536.
    Discovery science in health over the past two decades has embraced, with considerable enthusiasm, the potential of two movements: precision medicine and the ascent of big data. Each of these developments has been suggested to hold substantial promise both to advance our health science and to lead to the development of approaches that can improve health.Precision medicine—emerging naturally from the Human Genome Project almost two decades ago—promises to use genomic and molecular approaches to identify the causes of disease particular to (...)
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  5.  4
    The Tension Between Big Data and Theory in the "Omics" Era of Biomedical Research.Sui Huang - 2018 - Perspectives in Biology and Medicine 61 (4):472-488.
    [Without a theorising], a man might as well go into a gravel-pit and count the pebbles and describe the colours. How odd it is that anyone should not see that all observation must be for or against some view if it is to be of any service!Recent years have seen a steady shift of funding programs in biomedical research towards data collection, analysis, and management and its computational analysis. A sizable majority of new major funding opportunity announcements call for assembling (...)
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  6.  6
    Public Funding for Genomics and the Return on Investment: A Public Health Perspective.Ayaz Hyder - 2018 - Perspectives in Biology and Medicine 61 (4):572-583.
    Irecall vividly my initial excitement at the accomplishments of the Human Genome Project. That excitement was short-lived and diminished steadily over the next decade as I came to realize that the HGP was just another nail to be hit by the metaphoric hammer of genome-sequencing technology. To this day, I see this trend in many other spheres of public health and biomedical science. I take responsibility for using this same approach of "hammer" and "nail" in my own research program, where (...)
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  7.  5
    Biological Reductionism Versus Redundancy in a Degenerate World.Michael J. Joyner, Laszlo G. Boros & Gregory Fink - 2018 - Perspectives in Biology and Medicine 61 (4):517-526.
    The definition of precision medicine has continued to evolve, partly in response to criticism of the original concept. However, whatever the definition or current state of the brand, it fundamentally relies on a putatively tight linkage between genotype and complex human traits. If such a linkage is truly robust, then it should be possible to predict the occurrence of complex traits, both good and bad. If such prediction is possible, it should also be feasible to intervene to prevent or preempt (...)
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  8. Announcement From Perspectives in Biology and Medicine.Martha Montello - 2018 - Perspectives in Biology and Medicine 61 (4):465-466.
    Beginning with this issue, the "Review Essays" section of the journal has been renamed "Critical Assessments." The new name more accurately describes not only the content of the section but also the journal's methods of assessment. Submissions to the section are peer reviewed; published essays are catalogued and indexed like the rest of the content of Perspectives in Biology and Medicine.Where many journals publish reviews on the assets and liabilities of newly published books, the Critical Assessments section of Perspectives in (...)
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  9.  1
    Editors' Introduction to the Special Issue.Nigel Paneth & Michael J. Joyner - 2018 - Perspectives in Biology and Medicine 61 (4):467-471.
    Any human enterprise that consumes billions of dollars, especially when those dollars are those of citizen tax payers, should be subject to at least occasional scrutiny and stock-taking. This Special Issue of Perspectives in Biology and Medicine is an attempt to do just that: to ask whether the massive investment of money, equipment and human scientific talent that has been poured into studying the human genome under the assumption that this enormous scientific endeavor will advance human health has been worth (...)
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  10.  2
    Human Molecular Genetics Has Not Yet Contributed to Measurable Public Health Advances.Nigel Paneth & Sten H. Vermund - 2018 - Perspectives in Biology and Medicine 61 (4):537-549.
    The molecular genetic age can be said to have begun with the letter in Nature in 1953 by Watson and Crick, describing the helical structure of DNA. Some outstanding scientific work preceded that discovery, including especially the recognition by Chargaff of base-pair complementarity, but no discovery quite captured the imagination of the biomedical world as a few understated words by Watson and Crick in their famous one-page paper: "It has not escaped our notice that the specific pairing we have postulated (...)
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  11.  1
    What—If Anything—Sets Limits to the Clinical Ethics Consultant's "Expertise"?Giles Scofield - 2018 - Perspectives in Biology and Medicine 61 (4):594-608.
    Given how long bioethics has been around, how long bioethicists have devoted themselves to tackling ethical issues, how much work has gone into professionalizing the practice of clinical ethics consultation, how often bioethicists have either testified as experts in court proceedings or attached their names to amicus curiae briefs, and how ubiquitously they are present throughout the clinical, research, administrative, and other dimensions of health care, one would have thought that a convergence of opinion would exist on what it is (...)
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  12.  2
    Reductionism, Organicism, and Causality in the Biomedical Sciences: A Critique.Ana M. Soto & Carlos Sonnenschein - 2018 - Perspectives in Biology and Medicine 61 (4):489-502.
    It would be ahistorical to ridicule vitalists. When one reads the writings of one of the leading vitalists like Driesch one is forced to agree with him that many of the basic problems of biology simply cannot be solved by a philosophy as that of Descartes, in which the organism is simply considered a machine…. The logic of the critique of the vitalists was impeccable.At the turn of the new millennium, concomitant with the development of the evo-devo and eco-devo disciplines (...)
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  13. Infertility Comics and Graphic Medicine.Sathyaraj Venkatesan & Chinmay Murali - 2018 - Perspectives in Biology and Medicine 61 (4):609-621.
    In a heart-wrenching TEDx Beacon Street talk entitled "A Journey Through Infertility: Over Terror's Edge", Camille Preston narrates her traumatic journey through infertility. Although she is now the mother of a child, Preston's characterization of infertility as "over terror's edge" and as "a journey" finds a graphic expression in Paula Knight's The Facts of Life, Emily Steinberg's Broken Eggs, and Phoebe Potts's Good Eggs. Unlike Preston, these authors do not give birth to a child; however, they authentically portray the tribulations (...)
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  14.  1
    Genetic Pointillism Versus Physiological Form.Kenneth M. Weiss - 2018 - Perspectives in Biology and Medicine 61 (4):503-516.
    Matter as such produces nothing, changes nothing, does nothing; and however convenient it may afterwards be to abbreviate our nomenclature and our descriptions, we must most carefully realize in the outset that the spermatozoon, the nucleus, the chromosomes or the germ-plasma can never act as matter alone, but only as seats of energy and as centres of force.Science is a human endeavor that is rarely if ever just about science: it is also a social, political, and economic enterprise. As such (...)
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  15.  3
    A Critical Appraisal of Moerman's "Meaning Response".Marco Annoni & Charlotte Blease - 2018 - Perspectives in Biology and Medicine 61 (3):379-387.
    Shamans, healers, and doctors have always known that patients may improve even if no real therapy is administered. In the Charmides, Plato noted that to soothe a headache, one needed "a kind of leaf, which required to be accompanied by a charm, and if a person would repeat the charm at the same time he used the cure, he would be made whole; but that without the charm would be of no avail". Similarly, more than two millennia later, Thomas Jefferson (...)
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  16.  3
    Consensus in Placebo Studies: Lessons From The Philosophy of Science.Charlotte Blease - 2018 - Perspectives in Biology and Medicine 61 (3):412-429.
    A common observation in placebo studies is that definitional disagreement is rife. Philosopher and historian of science Robin Nunn recently argued that "Nobody who came and saw the placebo has conquered its definition". Nunn insists that "the placebo construct conceals more than it clarifies," and that we need to prepare for "a post-placebo paradigm". Pronouncements that disagreement is endemic are often the prologue for new definitions of placebo and "placebo effect": for example, in the opening of a recent philosophical paper (...)
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  17.  2
    Editors' Introduction to Special Section on Meaning Response and the Placebo Effect.Charlotte Blease, Marco Annoni & Phil Hutchinson - 2018 - Perspectives in Biology and Medicine 61 (3):349-352.
    Over 200 years ago, doctors' most effective tools were typically not found in their medical bags. Indeed, most treatments in the history of medicine have, until relatively recently, caused more harm than good. Prior to the biomedical revolution in the late 19th century, doctors' most reliable and effective instruments of healing were their skills of communication with patients and an aptitude for a positive and supportive bedside manner. Bearing out this portrait of medicine, Thomas Jefferson, writing in 1807, noted that (...)
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  18. Meaning and an Overview of the Placebo Effect.Howard Brody - 2018 - Perspectives in Biology and Medicine 61 (3):353-360.
    In 1964, anesthesiologists at Harvard Medical School studied a group of patients about to undergo major abdominal surgery. Half the patients got the standard preoperative visit. The other half received an enhanced visit dealing with postoperative pain. That half were told that pain is normal and expected, that they would receive medications as ordered by their physicians, that they could also use several self-help techniques to relieve pain, and that nurses and physicians would be standing by to assist them if (...)
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  19.  2
    The Meaning Response, "Placebo," and Methods.Phil Hutchinson & Daniel E. Moerman - 2018 - Perspectives in Biology and Medicine 61 (3):361-378.
    Is there a response, which is not accounted for by regression to the mean, natural history, the Hawthorne effect?The term placebo comes to us from the Latin for "I shall please," indicating that the phenomenon known as the "placebo effect" or "placebo response" has been familiar to medical practitioners for a number of centuries, at least. As we reached the mid-20th century and randomized controlled trials became a central feature of medical research, the use of controls and blinding in those (...)
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  20.  2
    Open-Label Placebo: Reflections on a Research Agenda.Ted J. Kaptchuk - 2018 - Perspectives in Biology and Medicine 61 (3):311-334.
    Until recently, the medical community assumed that placebos required either concealment in randomized controlled trials or deception in clinical practice to elicit placebo effects. Henry Beecher emphasized this orthodoxy, when he stated that placebo pills only work "as long as it is not detected as a placebo by the subject or the observer" and therefore, patients "believe it [is a drug] and consequently the expected results occurs". The time was ripe for such ideas: Norman Vincent Peale's The Power of Positive (...)
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  21.  1
    Who's Winning the IRB Wars? The Struggle for the Soul of Human Research.Nancy M. P. King - 2018 - Perspectives in Biology and Medicine 61 (3):450-464.
    One of my favorite bioethics quotes is nearing 50 years old:Let us not forget that progress is an optional goal, not an unconditional commitment, and that its tempo in particular, compulsive as it may become, has nothing sacred about it. Let us also remember that a slower progress in the conquest of disease would not threaten society, grievous as it is to those who have to deplore that their particular disease be not yet conquered, but that society would indeed be (...)
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  22. Reining in the Placebo Effect.Franklin G. Miller - 2018 - Perspectives in Biology and Medicine 61 (3):335-348.
    The placebo effect, in recent years, has been the focus of extensive scientific inquiry and public fascination, as reflected in articles in the news media. Authors writing about placebo effects often mention the goal of harnessing the placebo effect for the benefit of patients in clinical practice. This suggests that the placebo effect is like a powerful horse, which needs to be put in harness in order to do useful work. However, developing an accurate understanding of what has been labelled, (...)
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  23.  1
    200 Years After Frankenstein.Christopher Nowlin - 2018 - Perspectives in Biology and Medicine 61 (3):430-449.
    Mary Shelley's Frankenstein celebrates its 200th anniversary this year, and it is arguably more relevant than ever. In his preface to the 1992 edition of Shelley's classic work, Maurice Hindle notes that the novel, subtitled The Modern Prometheus, blends two mythical narratives, that of Prometheus as the Titan provocateur who stole fire from Zeus and gave it to humankind for their survival, and that of Prometheus as a "plasticator, a figure who creates and manipulates men into life". Both story lines (...)
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  24.  2
    The Placebo Phenomenon: A Narrow Focus on Psychological Models.Nathalie Peiris, Maxie Blasini, Thelma Wright & Luana Colloca - 2018 - Perspectives in Biology and Medicine 61 (3):388-400.
    One of the most successful physicians I have ever known, has assured me, that he used more bread pills, drops of colored water, and powders of hickory ashes, than of all other medicines put together. It was certainly a pious fraud.Clinicians and other health-care practitioners have known for hundreds of years that different procedures with unclear mechanisms of action or efficaciousness can still result in subjective improvement of clinical symptoms. Many scholars have attempted to define the placebo effect. This has (...)
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  25. What Are the Benefits of a New Placebo Language?Andrew Turner - 2018 - Perspectives in Biology and Medicine 61 (3):401-411.
    Acommon theme in placebo studies is that the terms placebo and "placebo effects" are confusing, misleading, and sloppy, and that there are no agreed definitions. Indeed, many authors treat the conceptual difficulties raised by placebos as a call to action and propose new definitions and reconceptualizations, or even propose abandoning the term altogether. The promise of these approaches is that a new language and new metaphors for thinking about placebo phenomena may deliver clinical, ethical, and methodological advances. However, the nature (...)
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  26.  5
    More Than One Way to Measure? A Casuistic Approach to Cancer Clinical Trials.Mattia Andreoletti - 2018 - Perspectives in Biology and Medicine 61 (2):174-190.
    In recent years, science and technology have made great progress towards a better understanding of fundamental biological mechanisms of the diseases. Physicians, relying just on their own clinical experience, have long recognized that each patient is different from every other patient in many aspects. It is a matter of simple facts that many patients die without responding to any treatment, while others with the same disease survive. In oncology, the variability of treatment response has been a long-standing problem. Nowadays, thanks (...)
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  27.  6
    Failure in Science and Why It Is a Good Thing.Karim Bschir - 2018 - Perspectives in Biology and Medicine 61 (2):301-310.
    For centuries, if not millennia, philosophers have been debating the question of how science works and what it essentially is. Many have claimed that science is fundamentally characterized by the application of a specific method: the scientific method. What constitutes this method precisely, has been the subject of an extensive debate. In the 17th century, scholars like Francis Bacon or Isaac Newton advocated a strongly empiricist and inductivist method for science. According to this method, general empirical statements must be derived (...)
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  28.  5
    Should the Euthanasia Act in Belgium Include Minors?Raphael Cohen-Almagor - 2018 - Perspectives in Biology and Medicine 61 (2):230-248.
    In all actions concerning children, whether undertaken by public or private social welfare institutions, courts of law, administrative authorities or legislative bodies, the best interests of the child shall be a primary consideration.In 2014, Belgium Became the first country in the world to allow euthanasia of minors, irrespective of their age. This article explores whether this legislation enhances minors' rights or negates them.Do minors have capacity for agency? Are they able to make decisions concerning life and death? Can minors understand (...)
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  29.  14
    There Is No "Obstetrical Dilemma": Towards a Braver Medicine with Fewer Childbirth Interventions.Holly M. Dunsworth - 2018 - Perspectives in Biology and Medicine 61 (2):249-263.
    I never set out to prove anyone wrong. What I am about to describe started just over a decade ago when I simply wanted to learn more about what fascinates me most, which is human evolution. Where it goes, I hope, is towards ongoing efforts to improve maternity and childbirth care, particularly when it comes to supporting physiologic birth.As a freshly minted PhD in biological anthropology and a postdoctoral researcher, I had the spark and the freedom to look into the (...)
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  30.  5
    The Epistemological Weight of Randomized-Controlled Trials Depends on Their Results.Ryan F. Flanagan & Olaf Dammann - 2018 - Perspectives in Biology and Medicine 61 (2):157-173.
    Biomedical research and study design have recently been examined in detail by philosophers of science, who, like biomedical researchers, are concerned with the ability to accurately represent causal relationships through scientific study and apply these relationships to improve the health of individuals and populations. Epistemology—defined by the OED as "the theory of knowledge, especially with regard to its methods, validity, and scope, and the distinction between justified belief and opinion"—is fundamental to these concerns. In particular, philosophers of science and biomedical (...)
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  31. Joining the Club.Abraham Fuks - 2018 - Perspectives in Biology and Medicine 61 (2):279-293.
    Medical students gather lessons from what they observe and experience in the hospital and the clinic. The daily, generally undocumented events constitute significant formative influences on the developing identities of these nascent physicians. These experiences shape the students' attitudes towards their patients, help form their own identities, and affect their confidence in their chosen profession. And yet, these critical pedagogical forces rarely come to the attention of their teachers, who remain unaware of the powerful formative features of the clinical learning (...)
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  32.  5
    Nitric Oxide, Normal Science, and Lessons Learned by a Marginally Prepared Mind.Michael J. Joyner - 2018 - Perspectives in Biology and Medicine 61 (2):191-200.
    In this essay I share some of the lessons I have learned over the last 25 years studying how the vascular endothelium via nitric oxide contributes to the regulation of the cardiovascular system in humans. My motivation for this effort is that in an era of molecular reductionism in biomedical research I believe that the lessons from the vascular endothelium and NO are instructive in a larger sense. These discoveries might also be among the "last" big biomedical discoveries made by (...)
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  33.  1
    The Weight of a Term: "Substantial Evidence" and Buried Data.Stewart Justman - 2018 - Perspectives in Biology and Medicine 61 (2):201-214.
    It's common knowledge that published medical findings tell only part of the story, the other part consisting of unpublished records of negative trials, sometimes of the same agents. No one, of course, knows precisely how much lies below the waterline, but informed estimates suggest that as many as half of all trials undertaken remain unreported —a percentage sufficient to cast a shadow over the entire corpus of published medical research. The effect is incalculable. That negative findings of trials of cancer (...)
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  34.  2
    Hard Words From the Wards: Images of Violence and Violation in Hospital Poetry.Marilyn McEntyre - 2018 - Perspectives in Biology and Medicine 61 (2):294-300.
    The Program for Medical Humanities at UC–Berkeley recently hosted a small conference composed largely of health professionals and humanities scholars to reflect on "violence in medicine." The topic itself is unsettling: coupling the two words seems at best oxymoronic and at worst darkly suggestive. The conversation ranged from forms of malpractice and exclusion to ways we normalize questionable protocols and treatments. One of the issues that repeatedly arose was the ways in which patients can emerge from clinical encounters and hospital (...)
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  35.  1
    Global Bioethics: A Story of Dreams and Doubts From Bengal.Bob Simpson - 2018 - Perspectives in Biology and Medicine 61 (2):215-229.
    This article is about the dream of a global bioethics. It touches upon some big issues concerning how progress in biomedicine and biotechnology might best be linked to justice and human flourishing in all parts of the world and not just in the global North. More specifically, however, it is about disappointment and regret when this dream is placed alongside the realities of living and working in a resource-poor setting in the global South. The essay focuses on a narrative account (...)
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  36.  3
    Humanity and "Ordinary Abuse": Learning From Hospital Patients' Letters of Complaint.Marta Spranzi - 2018 - Perspectives in Biology and Medicine 61 (2):264-278.
    In 2009, an influential and remarkable report to the French highest health authorities written by Claire Compagnon, a patients' advocate, and Véronique Ghadi, a legal scholar, has brought to public attention a phenomenon that had gone unnoticed in medical ethics: the report's authors called it "ordinary abuse".1 They argue that the term describes a widespread and invisible form of mistreatment in the hospital setting, which they distinguish from abuse proper, a phenomenon, they argue, which is far less common and controversial. (...)
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  37.  1
    Between the Local and the Global: Evaluating European Regulation of Stem Cell Regenerative Medicine.Christine Hauskeller - 2018 - Perspectives in Biology and Medicine 61 (1):42-58.
    The history and context of the public policy regarding stem cell research in the European Union are complex. The regulations respond to and aim to realize political and economic goals across a large region that is culturally diverse, as well as addressing moral judgments on a contested emerging area of research. This history and context are relevant for the arguments developed here in relation to autologous stem cell research and how it is affected by those regulations.The EU is currently an (...)
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  38.  1
    "I Sleep, But My Heart Is Awake": Negotiating Marginal States in Life and Death.Margaret C. Hayden & Stephen D. Brown - 2018 - Perspectives in Biology and Medicine 61 (1):106-117.
    In the outpatient ultrasound suite of a major urban medical center, the mood is somber. A young woman lies tense and anxious. Pregnant for the first time, she has experienced early first-trimester bleeding. The radiologist relates the ultrasound findings: there has been a small hemorrhage, but there is a six-week-size fetus with normal cardiac activity. Translation: the baby is alive! The woman quietly sobs, happy but apprehensive.Across the drive, in the main hospital building, a young boy lies unresponsively comatose in (...)
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  39. Vulnerabilities and the Use of Autologous Stem Cells for Medical Conditions in Australia.Tereza Hendl - 2018 - Perspectives in Biology and Medicine 61 (1):76-89.
    Recent years have seen the proliferation of a global industry selling stem cell–based interventions. SCBIs are being marketed around the globe in both low- and high-income countries, including Australia, China, India, Japan, Mexico, and the United States. Per capita, Australia has one of the highest prevalence of clinics selling stem cell products per capita, and its drug regulator, the Therapeutic Goods Administration, has excluded autologous stem cells, which are obtained from the patient's own body, from the regulation of biological drug (...)
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  40.  2
    Conditional Approvals for Autologous Stem Cell–Based Interventions: Conflicting Norms and Institutional Legitimacy.Tsung-Ling Lee & Tamra Lysaght - 2018 - Perspectives in Biology and Medicine 61 (1):59-75.
    Regulators around the world are coming under pressure from patients, clinicians, and industry groups to streamline the market approval process for highly novel biomedical technologies, including stem cells and regenerative medicine products. The rationale for streamlining this process centers on the perceived failures of regulatory systems to encourage biomedical innovation and provide patients with timely access to potentially beneficial yet experimental therapies. Critics claim that the process of generating scientific evidence in phased clinical trials is too costly, time-consuming, and poorly (...)
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  41.  2
    The Need for Beneficence and Prudence in Clinical Innovation with Autologous Stem Cells.Wendy Lipworth, Cameron Stewart & Ian Kerridge - 2018 - Perspectives in Biology and Medicine 61 (1):90-105.
    In recent years, there has been a rapid growth in the use of autologous stem cell-based interventions to treat a wide range of medical conditions, including those for which there is limited evidence of safety and efficacy. One justification for this growth in the use of unproven interventions is that clinicians should be free to innovate, as long as consumers are adequately informed about risks and benefits. In this essay, we systematically refute the strong claim that consumer and clinician autonomy (...)
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  42.  3
    Off the Charts: Medical Documentation and Selective Redaction in the Age of Transparency.Matthew William McCarthy, Diego Real de Asua, Ezra Gabbay & Joseph J. Fins - 2018 - Perspectives in Biology and Medicine 61 (1):118-129.
    A 47-year-old woman with a history of anxiety disorder is admitted to the hospital for shortness of breath. On the third day of hospitalization, she asks her physician for a copy of all documents pertaining to her care. What expectation should she have for full disclosure? Are there limits on her access to her medical records and do her physician's concerns about professional privilege matter?The virtues of transparency in medicine have been well described. As proponents of transparency, we favor patient (...)
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  43.  2
    The Futurist and Historian Will See You Now.Scott H. Podolsky - 2018 - Perspectives in Biology and Medicine 61 (1):147-155.
    Luke Fildes's iconic painting The Doctor, first exhibited in 1891, has long served as a symbol of the caring, priest-like physician, watching over a sick child as the child's parents place their faith in his ministrations, technologically meager as they may be. As physicians acquired more visible and potent interventions—x-rays, antibiotics, the complex infrastructure of the hospital itself—the 19th-century British scene depicted by Fildes of an individual doctor's watchful waiting would be appropriated by the likes of the American Medical Association (...)
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  44.  3
    Challenges in the Regulation of Autologous Stem Cell Interventions in the United States.Douglas Sipp - 2018 - Perspectives in Biology and Medicine 61 (1):25-41.
    The global industry engaged in direct-to-consumer marketing of unproven stem cell-based interventions has undergone sweeping changes over the past decade. Two of the most striking developments in recent years have been the emergence of stem cell marketing businesses in highly developed nations, such as the United States, Japan, and Australia, and the industry's convergence on a much narrower range of supposedly therapeutic cell types than in the past. The greatest number of businesses advertising unproven uses of stem cells in English (...)
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  45.  1
    Editors' Introduction to the Special Section on Ethics, Policy, and Autologous Cellular Therapies.Jeremy Sugarman & Tamra Lysaght - 2018 - Perspectives in Biology and Medicine 61 (1):1-6.
    Bioethical, legal, and professional discussions concerning human stem cell science have moved away from the contentious, and possibly irreconcilable, debates about human embryos to other sources of pluripotent stem cells. While there is an array of ethical and legal issues associated with all types of pluripotent stem cells, in recent years complex issues have arisen with regard to the premature use of somatic or "adult" stem cells. Of particular concern is the global emergence of an industry selling products and services (...)
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  46.  5
    The US Direct-to-Consumer Marketplace for Autologous Stem Cell Interventions.Leigh Turner - 2018 - Perspectives in Biology and Medicine 61 (1):7-24.
    When journalists and health researchers address the subject of patients in the United States undergoing unproven stem cell–based interventions, they have historically crafted narratives about "stem cell tourism" to facilities located in such countries as China, India, Mexico, Panama, and Thailand. These latter nations often are depicted as jurisdictions where clinics providing access to SCBIs operate without meaningful oversight, relevant regulations are nonexistent or have significant loopholes, and regulatory bodies are underfunded, understaffed, corrupt, or otherwise unable to provide effective oversight (...)
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  47.  6
    Virtue, Vice, and "Voracious" Science: How Should We Approach the Ethics of Primate Research?Rebecca L. Walker - 2018 - Perspectives in Biology and Medicine 61 (1):130-146.
    From the late 1950s through the early 1970s, Harry F. Harlow's primate laboratory at the University of Wisconsin–Madison undertook a series of studies on infant rhesus macaque monkeys that gained the attention of both animal welfare advocates and the scientific community.1 Establishing one of the first primate research laboratories in 1932, Harlow began his career as a primate researcher by studying primate learning capabilities and shredding previous assumptions within psychology that primates were restricted to the conditioned learning of a rat. (...)
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  48.  5
    Aging as Problem and as Mystery.David Barnard - 2018 - Perspectives in Biology and Medicine 60 (4):464-477.
    On December 31, 1877, the English novelist George Eliot made her last entry in the notebook in which she had kept her diary for the past 16 years. She was a few weeks past her 58th birthday; one year past the triumphant publication of Daniel Deronda, her last major work of fiction; and three years away from her death, from kidney disease, in December 1880. As she was accustomed to do, Eliot used the last day of the year to look (...)
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  49.  8
    Social Determinants of Health at Older Ages: The Long Arm of Early and Middle Adulthood.Lisa F. Berkman & Yenee Soh - 2018 - Perspectives in Biology and Medicine 60 (4):595-606.
    The pervasive effects of early childhood experiences on health at older ages, documented with methods from life course epidemiology, have served to refocus many public health efforts towards understanding the impact of both cumulative disadvantage and what are known as "sensitive periods" and "critical periods" in shaping health trajectories. While the impact of early childhood experiences has been well-studied, much less attention has been focused on other periods of the life course that might also serve as critical junctures in shaping (...)
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  50.  4
    Where Has It Gone?: Writing, Loss, and Old Age.Daniel Callahan - 2018 - Perspectives in Biology and Medicine 60 (4):497-502.
    I have spent a good portion of my professional life studying old age as a social, cultural, and economic problem. I had not, however, paid much attention to my own old age, creeping stealthily up on me. What began as a whisper in my early 80s became, by my 87th birthday this year, a loud clamor—insisting on being noticed and accelerating at a rapid rate. It is now obvious to myself and others close to me that I am falling apart, (...)
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  51.  3
    No Country for Old Men: Four Challenges for Men Facing the Fourth Age.Thomas R. Cole & Ben Saxton - 2018 - Perspectives in Biology and Medicine 60 (4):607-614.
    "That is no country for old men." So declared William Butler Yeats in "Sailing to Byzantium", a poem picturing "the young in each other's arms." Almost 80 years later, Cormac McCarthy titled his 2005 novel No Country for Old Men to emphasize the plight of Ed Tom Bell, an aging sheriff who retires when faced with violence, drug trafficking. and moral chaos in a small West Texas town. As the lawman of Terrell County, Texas, for over 30 years, Bell has (...)
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  52.  9
    Cognitive Aging: What We Fear and What We Know.I. I. Dan G. Blazer - 2018 - Perspectives in Biology and Medicine 60 (4):569-582.
    Among the abilities people fear they will lose as they age, the most frequently reported is "staying sharp". The fear of being afflicted with Alzheimer's disease and other dementing disorders, which will clinically impact 10 to 12% of the population between the age of 65 and death, is the major concern. Despite the fear of losing their minds, most persons will not develop Alzheimer's disease. So why does the fear of losing mental acuity top the AARP list?One reason is that (...)
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  53.  2
    Modern Death Retold.Joseph B. Fanning - 2018 - Perspectives in Biology and Medicine 60 (4):615-620.
    For almost a decade, I have taught an undergraduate course on death and dying and have served as an ethics consultant in an academic medical center where I support patients and families navigating difficult end-of-life decisions. Chapters from Elisabeth Kübler-Ross's On Death and Dying, Sherwin Nuland's How We Die, and Atul Gawande's Being Mortal are required reading in my course because these physician-writers offer detailed, firsthand stories that help readers imagine the places and faces of dying patients and their families. (...)
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  54.  2
    Editor's Introduction to the Special Issue.Muriel R. Gillick - 2018 - Perspectives in Biology and Medicine 60 (4):457-463.
    With great fanfare, the first baby boomer turned 65 on January 1, 2011, ushering in the new, gray society. We—I'm one of the 76 million baby boomers—were expected to transform aging: better educated, healthier, reared in an era of unprecedented prosperity, committed to individual autonomy, we would singlehandedly turn retirement from a time of decline, disability, and despair into a period of travel, adventure, and personal growth. If we did become ill, despite regular exercise, a wholesome diet, and a goodly (...)
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  55.  2
    Merchants of Health: Shaping the Experience of Illness Among Older People.Muriel R. Gillick - 2018 - Perspectives in Biology and Medicine 60 (4):530-548.
    Modern gerontology has debunked the myth of old age as a period of inevitable decline. But what science has not been able to change is the reality that old age often is a time of illness and disability, particularly for the oldest old—those over age 85. The vaunted compression of morbidity hasn't happened; while the period of decline before death may have shrunk, it hasn't vanished. The trajectory in the last phase of life is rarely a precipice, with older people (...)
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  56.  1
    A Tale for Our Times: From the Bronx to Chicago in 76 Years.Martha Holstein - 2018 - Perspectives in Biology and Medicine 60 (4):583-594.
    As a feminist scholar, I hold dear the idea that the personal is the political—that is, we alone cannot solve certain problematic features of our lives, especially those features that are widely shared, such as gender, and that our stories are sources of moral and practical knowledge. In this essay, I tell my own story, not because it is necessarily generalizable to all women, not even to women of my age, but because I hope it will deepen awareness of the (...)
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  57.  3
    "Losing My Self": A Poet's Ironies and a Daughter's Reflections on Dementia.Sharon R. Kaufman - 2018 - Perspectives in Biology and Medicine 60 (4):549-568.
    I think that Alzheimer's disease and all neurological disabilities of this kind, degenerative conditions, are of the most intense intellectual interest and importance … because these people are taking us to places we would rather not think about and what these people have to say—to the degree that they can say anything at all—should teach us something about what a person is, what human identity is.What could it mean in general to say that possible ways to be a person can (...)
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  58.  5
    Primary Prevention with a Capital P.S. Jay Olshansky & Bruce A. Carnes - 2018 - Perspectives in Biology and Medicine 60 (4):478-496.
    The first longevity revolution began in the middle of the 19th century, accelerated through the first half of the 20th century, and led to the first and only quantum leap in human life expectancy.In the 20th century alone, life expectancy at birth in most developed nations rose by about 30 years. The first three quarters of the century were notable for gains made at younger and middle ages, and in the last quarter century, old age mortality declined. Nothing in history (...)
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  59.  1
    Organizing Eldercare for Geographic Communities.Sarah Slocum & Joanne Lynn - 2018 - Perspectives in Biology and Medicine 60 (4):519-529.
    About half of Americans who live past age 65 will develop a long-lasting severe disability associated with aging and will require long-term services and supports for an average of two years. This eventuality is surprising to most Americans, despite the increasingly common experience of neighbors and family needing long-term assistance with self-care and daily tasks. Many people believe that serious disability simply won't happen to them or their family, and they avoid making plans to deal with the caregiving or financing (...)
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  60.  2
    Serving the Very Sick, Very Frail, and Very Old: Geriatrics, Palliative Care, and Clinical Ethics.Alexander K. Smith & Guy Micco - 2018 - Perspectives in Biology and Medicine 60 (4):503-518.
    How can we provide the best care for the growing population of older adults, many of whom are either very frail or very sick? The traditional medical model of care is focused on treatment of single diseases. This can work well for pneumonia, cancer, or diabetes in younger patients. It does not, however, work as well for frail older adults who have accumulated multiple chronic conditions and disabilities. These elders often depend on family or paid caregivers to provide assistance with (...)
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  61.  6
    Resolving Family-Clinician Disputes in the Context of Contested Definitions of Futility.Gabriel T. Bosslet, Bernard Lo & Douglas B. White - 2018 - Perspectives in Biology and Medicine 60 (3):314-318.
    We appreciate the opportunity to respond to Schneiderman and colleagues’ opinions on the recent Multiorganization Policy Statement, “An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units”. We will first point out three areas in which Schneiderman and colleagues seem to perceive a disagreement where there is none, then we will respond to their main criticisms of the Multiorganization Policy Statement. In doing so, we will point out areas in which we believe Schneiderman and (...)
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  62.  2
    Getting Past Words: Futility and the Professional Ethics of Life-Sustaining Treatment.Allan S. Brett & Laurence B. McCullough - 2018 - Perspectives in Biology and Medicine 60 (3):319-327.
    In this issue of Perspectives in Biology and Medicine, Schneiderman and colleagues critique a recent multi-society policy statement—developed by the American Thoracic Society and endorsed by four other organizations—entitled “Responding to Requests for Potentially Inappropriate Treatment in Intensive Care Units”. The focus of Schneiderman’s critique is the Multiorganization Policy Statement’s choice of the term “potentially inappropriate” to describe a class of interventions that clinicians should resist providing for patients near the end of life, even when patients or their families request (...)
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  63.  7
    Futility: Definition and Goals.Howard Brody - 2018 - Perspectives in Biology and Medicine 60 (3):328-330.
    A recent statement from multiple critical care societies appropriately focuses on communication and negotiation as the major approach to the sorts of cases that have previously been labeled with the term futility. Unfortunately, the statement persists in addressing futility in a way that I have argued is unsatisfactory. Schneiderman, Jecker, and Jonsen now respond to the statement and make a number of helpful points. However, in a few ways, I also find their response off target. I will address the key (...)
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  64.  2
    Futile Treatment and Conquering Death.Daniel Callahan - 2018 - Perspectives in Biology and Medicine 60 (3):331-335.
    Not long ago I was called by my brother’s doctor. He wanted to know if I would accept his judgment that the respirator for my brother should be turned off. Vince, age 81, had contracted West Nile virus, normally treated successfully in 99% of cases, but often lethal in 1%. My brother was in that 1%, with a fast onset of the disease and a no less rapid decline into a coma, all in one day. There was no pain or (...)
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  65.  6
    Who Will Teach Us to Die?: Reflections on Futility and Finitude.Larry R. Churchill - 2018 - Perspectives in Biology and Medicine 60 (3):336-339.
    Schneiderman, Jecker, and Jonsen have written an eloquent essay that both defends the concept of medical futility and describes their own candidate for a practical, working definition. Whether they have provided the best such definition I cannot say, but they are surely right to claim that some such concept is needed—for doctors to practice, for patients to receive good care, for family and friends of the patient to understand and prepare for what is happening, and for society to trust what (...)
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  66.  4
    The Brutal but Utile Truth of "Futile".Arthur R. Derse - 2018 - Perspectives in Biology and Medicine 60 (3):340-344.
    What term is most appropriate in describing the limits of medicine? That depends on who determines the limits and the bases on which those limits are delineated and communicated. Schneiderman, Jecker, and Jonsen critique two recent policy statements by critical care providers—Bosslet et al. and Nates et al. —for their rejection of the use of the term futile for treatment. Both statements recommend using the adjective inappropriate for the problematic treatment, rather than futile, based on the lack of consensus of (...)
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  67.  1
    Futility, Inappropriateness, Conflict, and the Complexity of Medical Decision-Making.Chris Feudtner & Pamela G. Nathanson - 2018 - Perspectives in Biology and Medicine 60 (3):345-357.
    ... and the baby has a large VSD. Otherwise appears well, gaining weight, smiling. No apnea, never been on ventilator. Local cardiac surgeon refused to operate, saying that surgery would be inappropriate. Have reached out to other centers, and some state that they never perform what they said was “futile” heart surgery on children with Trisomy 18, while other sites say they have and will continue to perform these operations. Can someone explain to me what is going on? In the (...)
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  68.  1
    Futility, the Multiorganization Policy Statement, and the Schneiderman Response.Robert L. Fine - 2018 - Perspectives in Biology and Medicine 60 (3):358-366.
    “Futility of futilities,” said Kohelet, “futility of futilities, all is futile!” Once again we are exploring futility, a concept understood by humanity at least from the beginning of the written word. Our oldest written story, the Epic of Gilgamesh, reminds us of the futility of chasing immortality. At least a millennium later, yet still in ancient times, the Book of Kohelet teaches that all human pursuits, not only the pursuit of immortality, are futile or vain—terms once used synonymously. The ancient (...)
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  69.  3
    "Futility" as in English or "Futilities" as in French: A Valuable Semantic Misunderstanding?Véronique Fournier - 2018 - Perspectives in Biology and Medicine 60 (3):367-372.
    In the French language, it sounds very odd indeed to associate the word futility with serious things, and especially with medicine. The term is most often used to speak of “frivolities,” such as trinkets or any other bling-bling. “On parle à Paris et on ne pense guère, la journée se passe en futilités”, Voltaire wrote in a 1765 letter ; or “De cette indigne classe où nous rangent les hommes, de borner nos talents à des futilités”, said Molière in his (...)
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  70.  2
    Mediative Fluency and Futility Disputes.Samantha F. Knowlton & Joseph J. Fins - 2018 - Perspectives in Biology and Medicine 60 (3):373-382.
    It is generally agreed that physicians should not provide futile interventions, for the obvious reason that an intervention without utility causes harm without benefit. However, despite efforts to standardize a definition, there is a lack of universal consensus as to what constitutes “futility.” Two recent policy statements object to the terminology of futility based on the lack of a universal definition. Schneiderman, Jecker, and Jonsen object to the proposed alternative terminology of “inappropriate.” These differing opinions about the most apt terminology (...)
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  71.  5
    Futile and Potentially Inappropriate Interventions: Semantics Matter.Alexander A. Kon - 2018 - Perspectives in Biology and Medicine 60 (3):383-389.
    Recently, five major critical care professional organizations in North America and Europe published a consensus policy statement on how intensive care unit clinicians should respond to patient or surrogate requests for potentially inappropriate treatments. Subsequently, the Society for Critical Care Medicine, the largest multidisciplinary critical care organization and one of the authors of the Multiorganization Policy Statement, issued a companion statement defining futile and potentially inappropriate interventions. These statements support previous work published by the SCCM Ethics Committee 20 years ago. (...)
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  72.  3
    Intractable Disagreements About Futility.John Lantos - 2018 - Perspectives in Biology and Medicine 60 (3):390-399.
    It used to be futile to try to save babies born at 23 weeks. It isn’t anymore. It used to be futile to try to keep patients with end-stage congestive heart failure alive. It isn’t anymore. Futility is a moving target. Thus, it is not surprising that doctors, patients, and families often disagree about which treatments are efficacious or futile, appropriate or inappropriate, obligatory or obligatorily withheld. The goalposts keep moving. Yesterday’s impossibility is today’s routine. Why should a patient believe (...)
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  73.  16
    Medical Futility and "Brain Death".Franklin G. Miller - 2018 - Perspectives in Biology and Medicine 60 (3):400-402.
    I’m writing to underscore one point, which should be obvious, but which all too often has been neglected in the literature on medical futility. The futility of an action or an intervention is always relative to some goal. Consider the classical example of futility: carrying water in a sieve. If your goal is to transport a quantity of water without spilling some or all of it, then it is futile to do so by placing it in a sieve. But we (...)
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  74.  2
    The True Abuse of Futility.Laura Miller-Smith - 2018 - Perspectives in Biology and Medicine 60 (3):403-407.
    Futility has indeed been abused. The term has been applied and misapplied, defined and redefined, molded and remolded until the real meaning is no longer understood. When a word loses its meaning, it loses its power. The reason that the term is no longer clear is because attempts have been made to include scenarios under the banner of futility that do not truly fit. From my perspective as a pediatric critical care physician, the majority of troublesome cases are not questions (...)
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  75.  2
    Criterialism Versus Deliberativism.Cheryl Misak - 2018 - Perspectives in Biology and Medicine 60 (3):408-414.
    I was one of the group that produced “An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Futile and Potentially Inappropriate Treatments in Intensive Care Units”. I do not write on that group’s behalf, but rather from two distinct perspectives which converge onto one view. First, I am a philosopher who thinks about our most pressing questions, such as how to make treatment decisions when a life is coming to an end. From that perspective, three of us from the group (...)
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  76.  2
    Introduction to the Special Issue.Martha Montello - 2018 - Perspectives in Biology and Medicine 60 (3):293-294.
    In the summer of 2017, much of the world was riveted by the case of Charlie Gard, a baby in London whose parents wanted an experimental treatment and whose doctors thought that further treatment would be futile. The case worked its way through the British courts and, eventually, was even heard by the European Court of Human Rights. Pope Francis and President Trump weighed in. If nothing else, the case revealed how controversial the issues around medical futility and shared decision-making (...)
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  77.  9
    Medical Futility and Involuntary Passive Euthanasia.Michael Nair-Collins - 2018 - Perspectives in Biology and Medicine 60 (3):415-422.
    Conflicts surrounding the provision of life-sustaining treatment create difficult ethical and interpersonal challenges for providers, patients, and families or other surrogates alike. These conflicts implicate a constellation of ethical concepts, including distributive justice, harms and wrongs to patients, fiduciary obligations to patients, standards for surrogate decision-making, and medical futility. Recently, several critical care societies published a policy statement on conflicts at the end of life, and advocated for a new concept, “potentially inappropriate treatment”. They argued that in some circumstances, after (...)
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  78.  2
    Medical Futility and Potentially Inappropriate Treatment: Better Ethics with More Precise Definitions and Language.Thaddeus Mason Pope - 2018 - Perspectives in Biology and Medicine 60 (3):423-427.
    Like the authors of some of the other responses to Schneiderman, Jecker, and Jonsen, I too was one of the group that produced “An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Futile and Potentially Inappropriate Treatments in Intensive Care Units”. Furthermore, ethical and legal issues surrounding futile and potentially inappropriate medical treatment have been a primary focus of my scholarship for more than a decade. Schneiderman, Jecker, and Jonsen offer a strong critique of the Multiorganization Statement, but they do (...)
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  79.  11
    The Abuse of Futility.Lawrence J. Schneiderman, Nancy S. Jecker & Albert R. Jonsen - 2018 - Perspectives in Biology and Medicine 60 (3):295-313.
    Two recent policy statements by providers of critical care representing the United States and Europe have rejected the concept and language of “medical futility,” on the ground that there is no universal consensus on a definition. They recommend using “potentially inappropriate” or “inappropriate” instead. As Bosslet and colleagues state: The term “potentially inappropriate” should be used, rather than futile, to describe treatments that have at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing (...)
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  80.  2
    The Concept of Futility: Recognizing the Importance of Context.Robert D. Truog - 2018 - Perspectives in Biology and Medicine 60 (3):428-432.
    As a member of the committee that authored the Multiorganization Policy Statement under discussion, I fully endorse the response of Bosslet and my colleagues to the provocative article by Schneiderman, Jecker, and Jonson. In addition, I would like to offer some thoughts about how the different positions reflected here may be at least partially reconciled by considering the different contexts in which the word and the concept of futility may be invoked. The main thrust of the classic paper by Schneiderman, (...)
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  81.  7
    End-of-Life Futility Conversations: When Language Matters.Connie M. Ulrich - 2018 - Perspectives in Biology and Medicine 60 (3):433-437.
    Caring for seriously ill patients and their families during times of extreme stress is a privilege, but it can also bring much sadness and ethical turmoil for everyone involved, particularly at end of life. Patients and their families and the nurses and physicians who care for them are uniquely bonded together as they discuss, discern, and deliberate on some of the most heart-wrenching life and death decisions any patient, parent, family member, or partner can make. Shifting from a curative mode (...)
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  82.  2
    Why Some "Futile" Care Is "Appropriate": The Implications for Conscientious Objection to Contraceptive Services.Robert M. Veatch - 2018 - Perspectives in Biology and Medicine 60 (3):438-448.
    Schneiderman, Jecker, and Jonsen disagree with two recent policy statements of professional medical organizations over whether to call some medical interventions “inappropriate” or “potentially inappropriate” that have previously been labelled “futile.” I would agree that inappropriate is a hopelessly ambiguous term that should not be used in the long-running debate, more normally referred to as the futility controversy. I find, however, that Schneiderman, Jecker, and Jonsen end up with the same policy conclusion as the two policy statements. When patients or (...)
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  83.  3
    Nurturing Futility in the NICU: The Dutch Perspective.A. A. Eduard Verhagen - 2018 - Perspectives in Biology and Medicine 60 (3):449-455.
    In 2015, the ATS/AACN/ACCP/ESICM/SCCM published an official policy statement about responding to requests for potentially inappropriate treatments in intensive care units. The Multiorganization Statement aims to provide guidance for clinicians to prevent and manage disputes about patients with advanced critical illness. Recommendations 2 and 3 focus on terminology and suggest an alternative set of words to define and to help manage medical futility. Recommendations 1 and 4 focus on conflict resolution strategies and the development of new policies or legislation about (...)
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