Faculty Bibliography

With the use of technologically constructed hypoxic environments (TCHE) in soccer as our case, we propose four check points from which to evaluate new performance-enhancing technologies in sport. These are (I) Is the technology beneficial, (II) Is it safe, (III) Can fairness be assured, and (IV) Is the technology in line with the spirit of or rationale for sport? The use of TCHE is ambiguous. On the one hand, in situations with grave inequalities between teams due to lack of acclimatization of one team, TCHE can be an efficient means to even the playing field and out of concern for athlete welfare and health. On the other hand, if used as a pure performance-enhancing means to enhance the oxygen-carrying capacity of the blood independent of altitude, it belongs to a category of expert-assisted performance enhancement that may challenge athletic autonomy and the responsibility for one's own performance and, hence, the spirit of sport.

Investigators, sponsors, and institutional review boards have to decide when re-consent of clinical trials' participants must be obtained when new information becomes available. We present an algorithm to help in the decision-making process, which takes into consideration the kind of new information, the risk of exposure (patients could be on the treatment or in the follow-up phases), and the possibility of managing the case. Re-consent should be obtained in three of the eight possible situations.

Debates over vaccine mandates raise intense emotions, as reflected in the current controversy over whether to mandate the vaccine against human papilloma virus (HPV), the virus that can cause cervical cancer. Public health ethics so far has failed to facilitate meaningful dialogue between the opposing sides. When stripped of its emotional charge, the debate can be framed as a contest between competing ethical values. This framework can be conceptualized graphically as a conflict between autonomy on the one hand, which militates against government intrusion, and beneficence, utilitarianism, justice, and nonmaleficence on the other, which may lend support to intervention. When applied to the HPV vaccine, this framework would support a mandate based on utilitarianism, if certain conditions are met and if herd immunity is a realistic objective.

Myriad Genetics holds a patent on testing for the hereditary breast and ovarian cancer genes, BRCA1 and BRCA2, and therefore has a forced monopoly on this critical genetic test. Myriad launched a Direct-to-Consumer (DTC) marketing campaign in the Northeast United States in September 2007 and plans to expand that campaign to Florida and Texas in 2008. The ethics of Myriad's patent, forced monopoly and DTC campaign will be reviewed, as well as the impact of this situation on patient access and care, physician liability, and the future of DTC campaigns for genetic testing.

The most important area in which cancer care and bioethics intersect is in the care of the dying. It is in the shift toward according more control to patients, more choice in the setting in which death will come, and in the willingness to take palliative care and comfort care seriously that bioethics has most usefully interacted with cancer care in the past and is likely to continue to do so in the future.