Faculty Bibliography

Borderline personality disorder (BPD) is a complex mental disorder that straddles the line between psychosis and neurosis. As such, questions about the moral and legal responsibility of persons with BPD are especially vexing. Persons suffering with borderline personality disorder typically are impulsive and suffer from impaired volition. They also lack a stable sense of self. Nonetheless, persons with borderline personality disorder often hold long-term, stable preferences-often related to discontinuing particular problematic behaviors-and have a degree of capacity that we argue creates prima facie conditions for holding them ethically and legally responsible. However, this limited capacity often falls short in smoothly accommodating day-to-day relationships. We argue that while a certain degree of accommodation is appropriate for persons with BPD, the diagnosis of BPD does not by itself provide sufficient grounds for voiding responsibility for criminal acts. Using a hierarchical theory of autonomy recognizing first- and second-order volition, we propose a sliding scale be used to ascertain the degree to which a person with BPD should be exculpated weighing the graveness of the act against an estimation of the congruence of second- and first-order volitions.

he left ventricular assist device originated as a means to provide temporary circulatory support for patients suffering from end-stage heart failure. The device was originally intended to serve as a bridge to cardiac transplantation. Increasingly, however, the left ventricular assist device is being utilized as a destination therapy for those patients who are not candidates for heart transplantation. It is this utilization as a destination therapy that raises additional significant ethical concern related to the risks and benefits of the devices, factors influencing quality of life, and consequences pertaining to end-of-life care

On Tuesday, a federal advisory panel, the National Science Advisory Board for Biosecurity, recommended that university scientists who have submitted articles on how to modify a flu virus to two very prestigious journals delete critical information from them before publishing. The papers describe how to alter bird-flu virus to be more infectious and potentially nastier

Among the obstacles to the success of vaccination programs is the apparent recent increase in hesitancy and outright resistance to the recommended vaccination schedule by some parents and patients. This article reviews the spectrum of patient or parental attitudes that may be described as vaccine refusal, explores related ethical considerations in the context of the doctor-patient relationship and public health, and evaluates the possible responses of physicians when encountering resistance to vaccination recommendations. Health care providers should view individuals hesitant about or opposed to vaccines not as frustrations or threats to public health, but as opportunities to educate and inform.

BACKGROUND: The indications for deep brain stimulation (DBS) are expanding, and the feasibility and efficacy of this surgical procedure in various neurologic and neuropsychiatric disorders continue to be tested. This review attempts to provide background and rationale for applying this therapeutic option to obesity and addiction. We review neural targets currently under clinical investigation for DBS-the hypothalamus and nucleus accumbens-in conditions such as cluster headache and obsessive-compulsive disorder. These brain regions have also been strongly implicated in obesity and addiction. These disorders are frequently refractory, with very high rates of weight regain or relapse, respectively, despite the best available treatments. METHODS: We performed a structured literature review of the animal studies of DBS, which revealed attenuation of food intake, increased metabolism, or decreased drug seeking. We also review the available radiologic evidence in humans, implicating the hypothalamus and nucleus in obesity and addiction. RESULTS: The available evidence of the promise of DBS in these conditions combined with significant medical need, support pursuing pilot studies and clinical trials of DBS in order to decrease the risk of dietary and drug relapse. CONCLUSIONS: Well-designed pilot studies and clinical trials enrolling carefully selected patients with obesity or addiction should be initiated.

Dr. Conrad Murray has been found guilty of involuntary manslaughter in the death of Michael Jackson. It hardly could have been otherwise. The mere fact that Murray used a highly dangerous and difficult to manage drug, propofol, to treat Jackson's insomnia showed that he was acting in an irresponsible way. Even highly trained anesthesiologists in hospitals know they have to be extra careful with that drug