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Robert D. Truog [61]Robert Truog [14]
  1. The Toughest Triage — Allocating Ventilators in a Pandemic.Robert D. Truog, Christine Mitchell & George Q. Daley - 2020 - New England Journal of Medicine.
    The Covid-19 pandemic has led to severe shortages of many essential goods and services, from hand sanitizers and N-95 masks to ICU beds and ventilators. Although rationing is not unprecedented, never before has the American public been faced with the prospect of having to ration medical goods and services on this scale.
     
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  2.  89
    Is It Time to Abandon Brain Death?Robert D. Truog - 2012 - Hastings Center Report 27 (1):29-37.
    Despite its familiarity and widespread acceptance, the concept of “brain death” remains incoherent in theory and confused in practice. Moreover, the only purpose served by the concept is to facilitate the procurement of transplantable organs. By abandoning the concept of brain death and adopting different criteria for organ procurement, we may be able to increase both the supply of transplantable organs and clarity in our understanding of death.
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  3.  25
    Spheres of Morality: The Ethical Codes of the Medical Profession.Samuel Doernberg & Robert Truog - 2023 - American Journal of Bioethics 23 (12):8-22.
    The medical profession contains five “spheres of morality”: clinical care, clinical research, scientific knowledge, population health, and the market. These distinct sets of normative commitments require physicians to act in different ways depending on the ends of the activity in question. For example, a physician-scientist emphasizes patients’ well-being in clinic, prioritizes the scientific method in lab, and seeks to maximize shareholder returns as a board member of a pharmaceutical firm. Physicians increasingly occupy multiple roles in healthcare and move between them (...)
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  4.  52
    Changing the Conversation About Brain Death.Robert D. Truog & Franklin G. Miller - 2014 - American Journal of Bioethics 14 (8):9-14.
    We seek to change the conversation about brain death by highlighting the distinction between brain death as a biological concept versus brain death as a legal status. The fact that brain death does not cohere with any biologically plausible definition of death has been known for decades. Nevertheless, this fact has not threatened the acceptance of brain death as a legal status that permits individuals to be treated as if they are dead. The similarities between “legally dead” and “legally blind” (...)
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  5.  35
    The Problems With Fixating on Consciousness in Disorders of Consciousness.David Fischer & Robert D. Truog - 2017 - American Journal of Bioethics Neuroscience 8 (3):135-140.
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  6.  95
    Brain Death - Too Flawed to Endure, Too Ingrained to Abandon.Robert D. Truog - 2007 - Journal of Law, Medicine and Ethics 35 (2):273-281.
    The concept of brain death has become deeply ingrained in our health care system. It serves as the justification for the removal of vital organs like the heart and liver from patients who still have circulation and respiration while these organs maintain viability. On close examination, however, the concept is seen as incoherent and counterintuitive to our understandings of death. In order to abandon the concept of brain death and yet retain our practices in organ transplantation, we need to either (...)
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  7.  31
    Is ‘best interests’ the right standard in cases like that of Charlie Gard?Robert D. Truog - 2020 - Journal of Medical Ethics 46 (1):16-17.
    Savulescu and colleagues have provided interesting insights into how the UK public view the ‘best interests’ of children like Charlie Gard. But is best interests the right standard for evaluating these types of cases? In the USA, both clinical decisions and legal judgments tend to follow the ‘harm principle’, which holds that parental choices for their children should prevail unless their decisions subject the child to avoidable harm. The case of Charlie Gard, and others like it, show how the USA (...)
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  8.  38
    Brain Death — Too Flawed to Endure, Too Ingrained to Abandon.Robert D. Truog - 2007 - Journal of Law, Medicine and Ethics 35 (2):273-281.
    The concept of brain death was recently described as being “at once well settled and persistently unresolved.” Every day, in the United States and around the world, physicians diagnose patients as brain dead, and then proceed to transplant organs from these patients into others in need. Yet as well settled as this practice has become, brain death continues to be the focus of controversy, with two journals in bioethics dedicating major sections to the topic within the last two years.By way (...)
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  9.  68
    Rethinking the Ethics of Vital Organ Donations.Franklin G. Miller & Robert D. Truog - 2008 - Hastings Center Report 38 (6):38-46.
    Accepted medical practice already violates the dead donor rule. Explicitly jettisoning the rule—allowing vital organs to be extracted, under certain conditions, from living patients—is a radical change only at the conceptual level. But it would expand the pools of eligible organ donors.
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  10.  40
    Microethics: The Ethics of Everyday Clinical Practice.Robert D. Truog, Stephen D. Brown, David Browning, Edward M. Hundert, Elizabeth A. Rider, Sigall K. Bell & Elaine C. Meyer - 2015 - Hastings Center Report 45 (1):11-17.
    Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case‐based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from (...)
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  11. Moral fictions and medical ethics.Franklin G. Miller, Robert D. Truog & Dan W. Brock - 2009 - Bioethics 24 (9):453-460.
    Conventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life-sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life-sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of medication. We argue that the differential moral assessment of these two practices (...)
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  12.  36
    The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President's Council on Bioethics.Franklin G. Miller & Robert D. Truog - 2009 - Kennedy Institute of Ethics Journal 19 (2):185-193.
    In lieu of an abstract, here is a brief excerpt of the content:The Incoherence of Determining Death by Neurological Criteria: A Commentary on Controversies in the Determination of Death, A White Paper by the President’s Council on Bioethics*Franklin G. Miller** (bio) and Robert D. Truog (bio)Traditionally the cessation of breathing and heart beat has marked the passage from life to death. Shortly after death was determined, the body became a cold corpse, suitable for burial or cremation. Two technological changes in (...)
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  13.  72
    In Favour of Medical Dissensus: Why We Should Agree to Disagree About End‐of‐Life Decisions.Dominic Wilkinson, Robert Truog & Julian Savulescu - 2015 - Bioethics 30 (2):109-118.
    End-of-life decision-making is controversial. There are different views about when it is appropriate to limit life-sustaining treatment, and about what palliative options are permissible. One approach to decisions of this nature sees consensus as crucial. Decisions to limit treatment are made only if all or a majority of caregivers agree. We argue, however, that it is a mistake to require professional consensus in end-of-life decisions. In the first part of the article we explore practical, ethical, and legal factors that support (...)
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  14.  8
    Brain Death at Fifty: Exploring Consensus, Controversy, and Contexts.Robert D. Truog, Nancy Berlinger, Rachel L. Zacharias & Mildred Z. Solomon - 2018 - Hastings Center Report 48 (S4):2-5.
    This special report is published in commemoration of the fiftieth anniversary of the “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” a landmark document that proposed a new way to define death, with implications that advanced the field of organ transplantation. This remarkable success notwithstanding, the concept has raised lasting questions about what it means to be dead. Is death defined in terms of the biological failure of the organism to (...)
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  15.  23
    Conscientious of the Conscious: Interactive Capacity as a Threshold Marker for Consciousness.David B. Fischer & Robert D. Truog - 2013 - American Journal of Bioethics Neuroscience 4 (4):26-33.
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  16.  12
    Lessons from the Case of Jahi McMath.Robert D. Truog - 2018 - Hastings Center Report 48 (S4):70-73.
    Jahi McMath's case has raised challenging uncertainties about one of the most profound existential questions that we can ask: how do we know whether someone is alive or dead? The case is striking in at least two ways. First, how can it be that a person diagnosed as dead by qualified physicians continued to live, at least in a biological sense, more than four years after a death certificate was issued? Second, the diagnosis of brain death has been considered irreversible; (...)
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  17.  17
    Beyond the Apnea Test: An Argument to Broaden the Requirement for Consent to the Entire Brain Death Evaluation.Erin Paquette, Joel Frader, Seema Shah, Robert C. Tasker & Robert Truog - 2020 - American Journal of Bioethics 20 (6):17-19.
    Volume 20, Issue 6, June 2020, Page 17-19.
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  18.  49
    Death, Dying, and Organ Donation: Reconstructing Medical Ethics at the End of Life.Franklin G. Miller & Robert D. Truog - 2011 - Oxford University Press.
    This book challenges fundamental doctrines of established medical ethics. It is argued that the routine practice of stopping life support technology causes the death of patients and that donors of vital organs (hearts, liver, lungs, and both kidneys) are not really dead at the time that their organs are removed for life-saving transplantation. Although these practices are ethically legitimate, they are not compatible with traditional medical ethics: they conflict with the norms that doctors must not intentionally cause the death of (...)
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  19.  17
    Ethical Issues in the Transition to ECMO as a Destination Therapy.Samuel N. Doernberg, Derek R. Soled & Robert D. Truog - 2023 - American Journal of Bioethics 23 (6):18-20.
    Childress et al. (2023) present the case of a patient with capacity who requests to stay on extracorporeal membrane oxygenation (ECMO) indefinitely and highlight the ethical challenges associated w...
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  20.  50
    Are organs personal property or a societal resource?Robert D. Truog - 2005 - American Journal of Bioethics 5 (4):14 – 16.
  21.  47
    Withholding and Withdrawing Life-Sustaining Treatment and the Relevance of the Killing Versus Letting Die Distinction.Robert D. Truog & Andrew McGee - 2019 - American Journal of Bioethics 19 (3):34-36.
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  22. Categorized priority systems: a new tool for fairly allocating scarce medical resources in the face of profound social inequities.Tayfun Sönmez, Parag A. Pathak, M. Utku Ünver, Govind Persad, Robert D. Truog & Douglas B. White - 2021 - Chest 153 (3):1294-1299.
    The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), and equal access may (...)
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  23.  13
    The price of our illusions and myths about the dead donor rule.Robert Truog - 2016 - Journal of Medical Ethics 42 (5):318-319.
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  24.  27
    Futility - from hospital policies to state laws.Robert D. Truog & Christine Mitchell - 2006 - American Journal of Bioethics 6 (5):19 – 21.
  25.  51
    Medically Inappropriate or Futile Treatment: Deliberation and Justification.Cheryl J. Misak, Douglas B. White & Robert D. Truog - 2016 - Journal of Medicine and Philosophy 41 (1):90-114.
    This paper reframes the futility debate, moving away from the question “Who decides when to end what is considered to be a medically inappropriate or futile treatment?” and toward the question “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?” It offers a pragmatist moral epistemology that provides us with a clear justification of why it is important to take best standards, norms, and physician judgment seriously and a clear (...)
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  26.  21
    Ethical climate in contemporary paediatric intensive care.Katie M. Moynihan, Lisa Taylor, Liz Crowe, Mary-Claire Balnaves, Helen Irving, Al Ozonoff, Robert D. Truog & Melanie Jansen - 2021 - Journal of Medical Ethics 47 (12):14-14.
    Ethical climate (EC) has been broadly described as how well institutions respond to ethical issues. Developing a tool to study and evaluate EC that aims to achieve sustained improvements requires a contemporary framework with identified relevant drivers. An extensive literature review was performed, reviewing existing EC definitions, tools and areas where EC has been studied; ethical challenges and relevance of EC in contemporary paediatric intensive care (PIC); and relevant ethical theories. We surmised that existing EC definitions and tools designed to (...)
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  27.  13
    Ventilator Allocation Protocols: Sophisticated Bioethics for an Unworkable Strategy.Robert D. Truog - 2021 - Hastings Center Report 51 (5):56-57.
    Hastings Center Report, Volume 51, Issue 5, Page 56-57, September‐October 2021.
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  28.  30
    An apology for socratic bioethics.Franklin G. Miller & Robert D. Truog - 2008 - American Journal of Bioethics 8 (7):3 – 7.
    Bioethics is a hybrid discipline. As a theoretical enterprise it stands for untrammeled inquiry and argument. Yet it aims to influence medical practice and policy. In this article we explore tensions between these two dimensions of bioethics and examine the merits and perils of a “Socratic” approach to bioethics that challenges “the conventional wisdom.”.
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  29.  15
    Personhood and the Debate about the Beginning and End of Life.Robert Truog & Jin K. Park - 2024 - American Journal of Bioethics 24 (1):20-23.
    In this commentary, we take up Jennifer Blumenthal-Barby’s (2024) important argument to depart from claims about personhood in bioethics. First, we want to extend Blumenthal-Barby’s critique of the...
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  30.  31
    Brain death and the anencephalic newborn.Robert D. Truog & John C. Fletcher - 1990 - Bioethics 4 (3):199–215.
  31.  63
    Brain death: justifications and critiques.Robert D. Truog & Franklin G. Miller - 2012 - Clinical Ethics 7 (3):128-132.
    Controversies about the diagnosis and meaning of brain death have existed as long as the concept itself. Here we review the historical development of brain death, and then evaluate the various attempts to justify the claim that patients who are diagnosed as brain dead can be considered dead for all legal and social purposes, and especially with regard to procuring their vital organs for transplantation. While we agree with most commentators that death should be defined as the loss of integration (...)
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  32.  27
    Neonatal Decision-Making: Beyond the Standard of Best Interests.Robert D. Truog & Sadath A. Sayeed - 2011 - American Journal of Bioethics 11 (2):44 - 45.
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  33.  15
    Medically Inappropriate or Futile Treatment: Deliberation and Justification.Cheryl J. Misak, Douglas B. White & Robert D. Truog - 2015 - Journal of Medicine and Philosophy:jhv035.
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  34.  27
    "The truth about" donation after cardiac death".Robert D. Truog & Thomas I. Cochrane - 2006 - Journal of Clinical Ethics 17 (2):133-136.
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  35.  21
    Forgoing Medically Provided Nutrition and Hydration in Pediatric Patients.Lawrence J. Nelson, Cindy Hylton Rushton, Ronald E. Cranford, Robert M. Nelson, Jacqueline J. Glover & Robert D. Truog - 1995 - Journal of Law, Medicine and Ethics 23 (1):33-46.
    Discussion of the ethics of forgoing medically provided nutrition and hydration tends to focus on adults rather than infants and children. Many appellate court decisions address the legal propriety of forgoing medically provided nutritional support of adults, but only a few have ruled on pediatric cases that pose the same issue.The cessation of nutritional support is implemented most commonly for patients in a permanent vegetative state ). An estimated 4,000 to 10,000 American children are in the permanent vegetative state, compared (...)
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  36.  14
    Of Slide Rules and Stethoscopes: AI and the Future of Doctoring.Robert D. Truog - 2019 - Hastings Center Report 49 (5):3-3.
    Historically, the practice of medicine has been a physically intimate endeavor. Physicians have used their hands to palpate and reveal the secrets hidden within the body. Smelling the breath for the ketosis of diabetes or tasting the skin for the saltiness of cystic fibrosis were among the physician's essential practices. Today, perhaps the most defining characteristic of a brilliant clinician is the ability to synthesize many images—from electrocardiograms, ultrasounds, CT scans, and so forth—into a coherent picture that can guide our (...)
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  37. Withholding and withdrawing life-sustaining treatments.Robert D. Truog - 2014 - In Timothy E. Quill & Franklin G. Miller (eds.), Palliative care and ethics. New York: Oxford University Press.
     
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  38.  53
    When Does a Nudge Become a Shove in Seeking Consent for Organ Donation?Robert D. Truog - 2012 - American Journal of Bioethics 12 (2):42-44.
    The American Journal of Bioethics, Volume 12, Issue 2, Page 42-44, February 2012.
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  39. Cases from the Harvard Ethics Consortium.Christine Mitchell & Robert Truog - 2002 - Journal of Clinical Ethics 13 (2):146-146.
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  40.  19
    Case Study: Mistrust, Racism, and End-of-Life Treatment.Eric L. Krakauer & Robert D. Truog - 1997 - Hastings Center Report 27 (3):23.
  41.  18
    Futility in Pediatrics: From Case to Policy.Robert D. Truog - 2000 - Journal of Clinical Ethics 11 (2):136-141.
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  42.  8
    Research involving the recently deceased: ethics questions that must be answered.Brendan Parent, Olivia S. Kates, Wadih Arap, Arthur Caplan, Brian Childs, Neal W. Dickert, Mary Homan, Kathy Kinlaw, Ayannah Lang, Stephen Latham, Macey L. Levan, Robert D. Truog, Adam Webb, Paul Root Wolpe & Rebecca D. Pentz - forthcoming - Journal of Medical Ethics.
    Research involving recently deceased humans that are physiologically maintained following declaration of death by neurologic criteria—or ‘research involving the recently deceased’—can fill a translational research gap while reducing harm to animals and living human subjects. It also creates new challenges for honouring the donor’s legacy, respecting the rights of donor loved ones, resource allocation and public health. As this research model gains traction, new empirical ethics questions must be answered to preserve public trust in all forms of tissue donation and (...)
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  43. The Incoherence of Determining Death by Neurological Criteria: Reply to John Lizza.Franklin G. Miller & Robert D. Truog - 2009 - Kennedy Institute of Ethics Journal 19 (4):397-399.
    Human life and death should be defined biologically. It is important not to conflate the definition of death with the criteria for when it has occurred. What is distinctively "human" from a scientific or normative perspective has nothing to do with what makes humans alive or dead. We are biological organisms, despite the fact that what is meaningful about human life is not defined in biological terms. Consequently, as in the rest of the realm of living beings, human beings die (...)
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  44.  6
    Expanding the Horizon of Our Obligations in the Clinician‐Patient Relationship.Robert D. Truog - 2017 - Hastings Center Report 47 (4):40-41.
    Johan Brännmark's article “Patients as Rights Holders,” in this issue of the Hastings Center Report, squarely identifies some important problems with the way we in clinical practice conceive of our obligations to our patients. As a solution, he helpfully suggests augmenting our focus on autonomy and informed consent with a broader menu of considerations drawn from the literature on human rights. Respect for autonomy is, of course, one of the hallowed principles of bioethics. In our traditional understanding, our patients deserve (...)
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  45.  16
    The Conversation Around CPR/DNR Should Not Be Revived—At Least for Now.Robert D. Truog - 2010 - American Journal of Bioethics 10 (1):84-85.
  46.  18
    Triage in the ICU.Robert D. Truog - 1992 - Hastings Center Report 22 (3):13-17.
    Some patients in intensive care units are too sick to derive much benefit from being there, while others are too well to require the technology and skills offered. When ICU resources are scarce, they may ethically be withdrawn from either sort of patient in favor of one more likely to benefit from the care.
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  47.  25
    Life Support, Suicide, and Euthanasia in Disorders of Consciousness.Thomas I. Cochrane, Robert D. Truog & Joseph T. Giacino - 2016 - American Journal of Bioethics Neuroscience 7 (1):44-45.
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  48. It is reasonable to reject the diagnosis of brain death.Robert Truog & James Fackler - forthcoming - The Journal of Ethics.
     
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  49.  43
    It Is Time to Abandon the Dogma That Brain Death Is Biological Death.Franklin G. Miller, Michael Nair-Collins & Robert D. Truog - 2021 - Hastings Center Report 51 (4):18-21.
    Drawing on a recent case report of a pregnant, brain‐dead woman who gave birth to a healthy child after over seven months of intensive care treatment, this essay rejects the established doctrine in medicine that brain death constitutes the biological death of the human being. The essay describes three policy options with respect to determination of death and vital organ transplantation in the case of patients who are irreversibly comatose but remain biologically alive.
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  50.  15
    Going All the Way: Ethical Clarity and Ethical Progress.Franklin G. Miller & Robert D. Truog - 2012 - American Journal of Bioethics 12 (6):10-11.
    The American Journal of Bioethics, Volume 12, Issue 6, Page 10-11, June 2012.
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