Murray Joseph Casey, M.D., M.S., MBA, Ph.D., FACOG, FACS, Value-Based Costing of Anti-Cancer Drugs: An Ethical Perspective Grounded in Catholic Teachings on Human Dignity and the Common Good, 36 Issues L. & Med. 44 (2021)
Americans have benefited from a declining cancer incidence and improving prognosis over the past two decades, during which time rising prices for anti-cancer drugs have proportionally outstripped rising expenditures for overall cancer care and total national health expenditures. To meet the economic challenges, remedies have been proposed to base compensation on relative survival measurements perhaps taking into account associated drug toxicities, disabilities, and disease progression. While there are advantages for knowing the economic costs determined from so-called, “value-based” methodologies, it must be recognized that the measured values are impersonal, incomplete, and always biased. This article examines value-based costing of anti-cancer drugs in an individual and societal framework and advocates grounding decisions regarding cancer care and pharmaceutical costs on the ethical principles of human dignity and the common good.
Chad D. Cummings, Transhumanism: Morality and Law at the Frontier of the Human Condition, 20 Ave Maria L. Rev. 216 (2022)
Transhumanism is not new, and its moral and legal concerns have already taken root. While the terminology may be novel, transhumanism as a philosophy and its constituent technologies trace their heritage not to the horrific legacy of eugenics but instead to the advent of plastic surgery and other noble quality-of-life endeavors in the mid-twentieth century. Those technologies and their influence on personhood are familiar, and their threads have already been woven into law--most especially, though not exclusively, in torts.
The impact of transhumanism will not terminate there. As technological developments continue at a geometric pace, transhumanist issues will expand into other domains of law, striking at what is perhaps the most elemental topic in all jurisprudence: personhood. To comport with a universal, objective view of morality, transhumanism should not attempt to effectuate a change in human nature or to extinguish it by supplanting natural law with manmade ideals. Nor should its practitioners enter a Faustian compact by substituting their human worth for technological novelty or some other perceived temporal benefit.283 Legal practitioners and moral thinkers should actively encourage a moderate form of transhumanism, or at the very least, tolerate it so long as it *259 serves “the moral growth of man.”284 Its advocates must concede that human freedom is not an end unto itself, cannot be a source of values, and will serve immoral ends when unhinged from the immutable natural law--all while recognizing that “[h]uman freedom and God's law are not in opposition; on the contrary, they appeal one to the other.”285 In summation, practitioners should reject any form of transhumanism--and probably every form of posthumanism--that prizes technological development as its own end or that would seek to “leave the human body behind.”286 In any event, tests of the degrees of worthiness based on the functionality of an individual's capabilities must be avoided under any circumstance, respecting the dignity inherent in each person's life while maintaining “the relationship between human beings and the state,” carefully avoiding the trap of commoditizing human life by “making the former just tools at the service of the latter.”287
Thoughtful practitioners have an opportunity--even an imperative--to recognize the timeliness of this topic and advocate for well-reasoned, moral outcomes. The alternative--acquiescence by inaction--is unacceptable. By cultivating an awareness and interest in this topic now, attorneys will be better equipped to address the subject intelligently, empowered to argue against decisions that are morally repugnant, and advocate for those outcomes which protect and honor the unalienable, immutable worth of the most vulnerable minority of all: the individual.288
Lucien J. Dhooge, Nonmedical Exemptions to Public School Vaccination Mandates in the Post-Pandemic World: Solutions Within Existing State Frameworks, 20 Ind. Health L. Rev. 23 (2023)
The article examines issues relating to nonmedical exemptions to vaccination as a condition of public-school attendance. The article contends that the public health impacts of exemptions may be mitigated through the application of existing state frameworks relating to procedural tightening, counseling and persuasion, assessments of sincerity and good faith, the application of public emergency laws, and transparency. The article identifies best practices in each of these frameworks. The article concludes that nonmedical exemptions are unlikely to be eliminated. As such, public health and educational authorities must act to prevent further erosion of the benefits associated with vaccination.
Deirdre T. Little et. al., Covid-19 Vaccination: Guidance for Ethical, Informed Consent in A National Context, 36 Issues L. & Med. 127 (2021)
This Guidance addresses the essential elements of informed consent to novel, provisionally registered COVID-19 vaccines which conform to the current definition of an investigational vaccine namely, lacking requirements for approval for full registration.1 First, it addresses the ethical obtaining of informed consent in a setting of short and long term knowns and unknowns, by structuring the personal nature of informed consent into its twelve component parts. Second, as a guidance for family physicians, it explores reasonable medical concerns arising for individuals from both knowns and unknowns about COVID-19 disease and vaccines.
M. S. Marta , Calçada, M.S. & Anderson M. R. Alves, Ph.D., Hormonal Contraceptives and Post-Fertilization Effects, 37 Issues L. & Med. 29 (2022)
Hormonal contraceptives are widely used for birth control and therapeutic purposes. The mechanism of action proposed for these compounds can be found in several scientific journals published to date. The present work consists in a scoping review of a convenience sample of papers regarding the mechanisms of action of each of the three main classes of hormonal contraceptives available. Different parameters and biological consequences associated with their use were also reviewed. Based on these data, we evaluated the probability of embryo loss due to the use of hormonal contraceptives. Evidence indicates the probability of embryo loss due to post-fertilization effects.
Richard S. Myers (FN1), Euthanasia, Ethics and Public Policy by John Keown, 18 Ave Maria L. Rev. 35 (2020)
The publication of the second edition of John Keown's study of euthanasia is an important development.2 Euthanasia, Ethics and Public Policy: An Argument Against Legalisation was first published in 2002.3 Much has happened since that time. In the new edition, Keown does an admirable job of updating the earlier work. The second edition provides a wealth of information and critical analysis of the issues involved. The work is marked by a sophisticated analysis of the legal issues and by an acute understanding of the actual practice of assisted suicide and euthanasia in those jurisdictions that have legalized these practices. His analysis should inform the ongoing debate about these practices. In this reviewer's estimation, Keown makes a compelling case against their legalization. This second edition deserves a wide readership.
Michal Pruski, Ph.D., M.A., M.Sc., Alta Fixsler: Medico-Legal Paternalism in Uk Paediatric Best Interest Decisions, 37 Issues L. & Med. 81 (2022)
The case of Alta Fixsler, where a judge ruled that withdrawing life sustaining care was in her best interest rather than transferring her to Israel, as her parents wanted, is the latest in a series of controversial paediatric best interest decisions. Using this case, as well as some other recent cases, I argue that the UK exhibits a high degree of medico-legal paternalism in best interest decisions, even though paternalism seems to be ubiquitously negatively perceived in medical ethics. Firstly, I explain what I mean by medico-legal paternalism and defend my claim that this phenomenon is present in the UK. I then argue that at least philosophically (rather than legally) such a situation is impossible to justify in a secular state and that how we treat paediatric best interest decisions is very different from other areas of medical law. Lastly, I discuss proposals that aim to rectify this situation.
Tara Sander Lee, Ph.D., Maria B. Feeney, Ph.D., Kathleen M. Schmainda, Ph.D., James L. Sherley, M.D., Ph.D., and David A. Prentice, Ph.D., Human Fetal Tissue from Elective Abortions in Research and Medicine: Science, Ethics, and the Law, 35 Issues L. & Med. 3 (2020)
Since the U.S. Supreme Court issued its landmark decision in 1973 to legalize abortion, over 60 million preborn have been killed by elective abortion. While alive in the womb, these preborn are abandoned and not protected under current law. But once aborted, their body parts are a highly esteemed and prized commodity amongst certain members of the scientific community. Moral discourse is disregarded for the sake of science. The public have been lulled and lured into believing that this practice must continue in order to understand and develop cures for some of the most debilitating diseases of our day. But they are mistaken. This practice is not necessary, especially in light of numerous noncontroversial alternatives. Here, we expose and consider the false and misleading claims regarding human fetal tissue (HFT) in research from scientific, legal, and ethical points of view. We endeavor deeply to understand the depth of the injustice in this practice and what forces promote and maintain it; and by revealing and understanding these forces, we set forth how these inhumane practices can be ended. An accurate portrayal of the history of HFT use in research is provided, along with a close examination of the current state of this practice under existing laws. The serious societal implications are also discussed, which will worsen beyond comprehension if these practices are allowed to continue. The timeliness of this information cannot be overstated, and a thorough understanding is paramount for anyone who desires to know the facts about HFT in research and medicine and its detrimental impact for humanity.
Darrin Schultz, The Undesirables: The Transformation of American Eugenics from Sterilization to Abortion, 20 Ave Maria L. Rev. 296 (2022)
When the Court finally decides to address the question of anti-eugenic abortion bans, perhaps the Court will, at long last, be informed by Justice Scalia's simple solution to its unworkable abortion jurisprudence: “We should get out of this area, where we have no right to be, and where we do neither ourselves nor the country any good by remaining.”222 If Justice Scalia is not persuasive, my hope is Judge Erikson will be: We are...remarkably variant in our talents, abilities, strength, and weakness. The human person has...a capacity to love and be loved that is at the core of human exsistence. Each human being possesses a spirit of life that at our finest we have all recognized is the essence of humanity. And each human being is priceless beyond measure.
Frederick J. White III, M.D., FACC, FCCP, MBA, HCEC-C, The Prioritization of Life-Saving Resources in A Pandemic Surge Crisis, 35 Issues L. & Med. 99 (2020)
The COVID-19 pandemic has engendered a national discussion regarding scarce life-saving medical resources. These discussions often turn on allocation, reconfiguration, and reallocation of resources during the surge crisis of a declared emergency. Protocols to address these issues are being widely promulgated. From the standpoint of biomedical ethics, the principal concerns in these discussions should center on duty, justification, legality, and underlying moral standards. In this article the author explores general concepts of prioritization and crisis standards of care, physician duties and the conflict of those duties, the problematic nature of reallocation, and legitimate responses to the extreme absolute scarcity of surge crisis.
