The morality of freedom

Frances Mei Hardin, MD, MSMA member since 2017, is in the Department of Otolaryngology, University of Missouri, Columbia, Missouri. Above, she is shown as MSMA Physician of the Day at the Missouri Capitol in 2018.

Contact: ude.iruossim.htlaeh@fnidrah






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Disclaimer

This article was not sponsored by Easton bats, Headspace, Calm, Sycamore Creek Farms, Pilot, or Casamigos, but if any of these institutions would like to reach out, I’ll be available.

What We Owe To Each Other.

Informed Consent. Legal Theory and Clinical Practice

https://revistas-colaboracion.juridicas.unam.mx/index.php/rev-facultad-derecho-mx/article/download/26243/23625

Newcomb Hohfeld, Wesley: Fundamental Legal Conceptions as Applied in Judicial Reasoning

The central idea behind this book is that we lack consensus on principles for allocating medical resources, and in the absence of such a consensus we must develop and rely on a fair decision-making process for setting limits on health care The authors provide an analysis of the current situation, reviewing typical solutions, before describing their own approach The audience for the book is global since the problem of limited resources cuts across all types of health care systems whether or not they have universal coverage In its first edition Setting Limits Fairly stimulated considerable work on setting priorities in health care The second edition includes a new chapter on the international response to accountability for reasonableness and two new chapters on applications of the approach in developing countries and in human rights approaches to health Available in OSO:

Setting Limits Fairly: Learning to share resources for health

Despite the fact that psychedelics were proscribed from medical research half a century ago, recent, early-phase trials on psychedelics have suggested that they bring novel benefits to patients in the treatment of several mental and substance use disorders. When beneficial, the psychedelic experience is characterized by features unlike those of other psychiatric and medical treatments. These include senses of losing self-importance, ineffable knowledge, feelings of unity and connection with others and encountering 'deep' reality or God. In addition to symptom relief, psychedelic experiences often lead to significant changes in a patient's personality and worldview. Focusing on the case of psilocybin, we argue that the peculiar features of psychedelics pose certain novel risks, which warrant an enhanced informed consent process-one that is more comprehensive than what may be typical for other psychiatric medications. We highlight key issues that should be focused on during the consent process and suggest discussion prompts for enhanced consent in psychedelic psychiatry. Finally, we respond to potential objections before concluding with a discussion of ethical considerations that will arise as psychedelics proceed from highly controlled research environments into mainstream clinical psychiatry.

https://jme.bmj.com/content/medethics/47/12/807.full.pdf

Ethics and ego dissolution: the case of psilocybin.

Two Models of Legalization of Psychedelic Substances: Reasons for Concern.

Objective: Some commentators argue that informed consent for clinical research should be an on-going process, which begins, rather than ends, with participants' initial consent. Lacking, however, are empirical data on whether there is a need for 'ongoing consent'. Design: Two self-administered surveys - a baseline survey at initial consent and a follow-up survey 2-3 years later - to assess whether participants remain informed over time. Methods: Respondents were adults with HIV disease from Argentina, Brazil and Thailand enrolled in a long-term clinical trial. Results: Respondents overall were well informed at baseline. At follow-up, many reported being not informed about aspects of the study central to their on-going participation. With respect to the possibility of withdrawal, 38.5% of respondents at follow-up reported being 'not at all' informed. At follow-up, 71.1 % wanted more information. Yet, 62.8% had not asked any questions during the entire study. Reasons for not asking questions included not having an opportunity (16.4%) and not knowing whom to ask (15.5%). Conclusions: The standard consent process resulted in participants being well informed at enrollment. Yet, this process was not sufficient to keep them informed about aspects of the study central to their on-going participation. In addition, participants who wanted more information often did not ask for it. These findings provide empirical support for recommendations that clinical trials should consider including a process of 'on-going consent'.

/pdf/empirical-evaluation-of-the-need-for-on-going-consent-in-4l0yi7dc9g.pdf

Empirical evaluation of the need for 'on-going consent' in clinical research.

Several prominent writers including Norman Daniels, James Sabin, Amy Gutmann, Dennis Thompson and Leonard Fleck advance a view of legitimacy according to which, roughly, policies are legitimate if and only if they result from democratic deliberation, which employs only public reasons that are publicised to stakeholders. Yet, the process described by this view contrasts with the actual processes involved in creating the Affordable Care Act (ACA) and in attempting to pass the Health Securities Act (HSA). Since the ACA seems to be legitimate, as the HSA would have been had it passed, there seem to be counterexamples to this view. In this essay, I clarify the concept of legitimacy as employed in bioethics discourse. I then use that clarification to develop these examples into a criticism of the orthodox view-that it implies that legitimacy requires counterintuitively large sacrifices of justice in cases where important advancement of healthcare rights depends on violations of publicity. Finally, I reply to three responses to this challenge: (1) that some revision to the orthodox view salvages its core commitments, (2) that its views of publicity and substantive considerations do not have the implications that I claim and (3) that arguments for it are strong enough to support even counterintuitive results. My arguments suggest a greater role for substantive considerations than the orthodox view allows.

https://jme.bmj.com/content/medethics/44/6/416.full.pdf

Legitimacy in bioethics: challenging the orthodoxy

Debates about the ethics of health care and medical research in contemporary pluralistic democracies often arise partly from competing religious and secular values. Such disagreements raise challenges of balancing claims of religious liberty with claims to equal treatment in health care. This paper proposes several mid-level principles to help in framing sound policies for resolving such disputes. We develop and illustrate these principles, exploring their application to conscientious objection by religious providers and religious institutions, accommodation of religious priorities in biomedical research, and treatment of patients' religious views in doctor-patient encounters. Given that no sound set of guiding principles yields precise solutions for every policy dispute, we explore how morally sound democracies might deliberatively resolve such policy issues, following our proposed principles. Taken together and carefully interpreted, these principles may help in guiding difficult decision making in the indefinitely large realm where government, medical providers, and patients encounter problems concerning religion and medicine.

Religious Accommodation in Bioethics and the Practice of Medicine

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