Faculty Bibliography

The success of deep brain stimulation (DBS) for movement disorders and the improved understanding of the neurobiologic and neuroanatomic bases of psychiatric diseases have led to proposals to expand current DBS applications. Recent preclinical and clinical work with Alzheimer's disease and obsessive-compulsive disorder, for example, supports the safety of stimulating regions in the hypothalamus and nucleus accumbens in humans. These regions are known to be involved in addiction and overeating associated with obesity. However, the use of DBS targeting these areas as a treatment modality raises common ethical considerations, which include informed consent, coercion, enhancement, threat to personhood, and manipulation of the reward center. Pilot studies for both of these conditions are currently investigational. If these studies show promise, then there is a need to address the ethical concerns related to the initiation of clinical trials including the reliability of preclinical evidence, patient selection, study design, compensation for participation and injury, cost-effectiveness, and the need for long-term follow-up. Multidisciplinary teams are necessary for the ethical execution of such studies. In addition to establishing safety and efficacy, the consideration of these ethical issues is vital to the adoption of DBS as a treatment for these conditions. We offer suggestions about the pursuit of future clinical trials of DBS for the treatment of addiction and overeating associated with obesity and provide a framework for addressing ethical concerns related to treatment.

Despite novel medications and other therapeutic strategies, addiction to psychotropic substances remains one of the most serious public health problems worldwide. In this review, beginning with an introduction of deep brain stimulation (DBS), we highlight the importance of the nucleus accumbens (NAc) in the context of the reward circuitry and addictive behavior. We will provide a short historic overview of other neurosurgical approaches to treat addiction and describe the experimental and preclinical data on DBS in addiction. Finally, we call attention to key ethical issues related to using DBS to treat addiction that are important for future research and the design of clinical trials.

Experts agree that influenza vaccination of health-care personnel (HCP) is the best method of preventing nosocomial outbreaks. Because voluntary uptake among HCP has not achieved recommended levels, hundreds of health-care facilities and twenty states have implemented mandatory vaccination programs. How- ever, employee unions assert that unilateral changes to working conditions violate established principles of collective bargaining. In this article, we argue that mandatory vaccination in the health-care context is supported by ethics, science, and law. We examine nosocomial influenza outbreaks and how hospitals have attempted to curb infections through mandatory HCP influenza vaccination policies. We also explore employee unions' administrative and legal chal- lenges to the requirements. Finally, we suggest an approach to resolving the dispute between HCP labor representatives and health-care facility management. [PUBLICATION ABSTRACT]

Caplan talks about Ariel Sharon's brain activity. Sharon was the eleventh prime minister of Israel, serving from 2001 to 2006. He has been diagnosed as being in a persistent vegetative state since suffering first a minor stroke and then another massive one on Jan 4, 2006. A respirator and a feeding tube have kept him alive for seven years at Sheba Hospital in Tel Hashomer, Israel. Last January, a team of doctors and neuroscientists from Israel's Soroka University Medical Center was hired to subject the now eighty-four-year-old Sharon to a series of sophisticated brain scans. The team showed the former prime minister pictures of random houses, which he would not be expected to be familiar with. Then they flashed a picture of his own house before his eyes. When the images of his own home were shown, areas of his brain "lit up" with activity. Similarly, his brain "fired up" in response to hearing family voices but not when nonsensical gibberish sounds were played for him

The NY SAFE Act requires individuals who own a handgun or an assault rifle to recertify their permits every 5 years; limits the capacity of ammo clips to 7 shots; clarifies and broadens the definition of assault weapons to restrict their sale; and requires nearly all gun transfers between private parties to be conducted through a federal firearms licensee, subject to a federal National Instant Criminal Background Check. There has long been a legal obligation in most states, generated by the famous 1976 Tarasoffcase in California, that mental health care professionals disclose a threat of violence to an identifiable third party if they think the threat is credible and the act imminent

Here, Caplan says if there is any silver lining in the ignorant, and grossly offensive statements offered about rape by the failed candidates for Senate in the recently concluded election, Missouri's Congressman Todd Akin and Indiana's Richard Mourdock, it is that they may have finally shown both the folly and the moral dodginess inherent in efforts by conservative fundamentalists to posit God's hand in every act, no matter how horrific or awful. They do this both in situations where misery besets an individual and where tragedy overwhelms a group and both are ethically disgusting. He adds he is inclined to think that the best explanation for hurricanes, floods, and other calamities is coincidence often compounded by poor human choices. To paraphrase Abraham Lincoln, there is a lot of prayer going on with mixed messages being sent, and God cannot satisfy everyone. Perhaps someday, fervent religious leaders will come to see that linking pregnancies resulting from rape and the destruction of a city to divine will and retribution is a very dicey and highly unethical thing to do

In this text, we present and elaborate ethical challenges in transplant medicine related to organ procurement and organ distribution, together with measures to solve such challenges. Based on internationally acknowledged ethical standards, we looked at cases of organ procurement and distribution practices that deviated from such ethical standards. One form of organ procurement is known as commercial organ trafficking, while in China the organ procurement is mostly based on executing prisoners, including killing of detained Falun Gong practitioners for their organs. Efforts from within the medical community as well as from governments have contributed to provide solutions to uphold ethical standards in medicine. The medical profession has the responsibility to actively promote ethical guidelines in medicine to prevent a decay of ethical standards and to ensure best medical practices.