A Second Chance.Nancy P. Blumenthal,James D. Mendez,Martin L. Smith &Beth Hyland -2013 -Hastings Center Report 43 (1):12-13.detailsMr. F. is a fifty‐year‐old father of two school‐aged daughters. Six years ago, he received a double lung transplant because he was suffering from interstitial lung disease, a fatal illness that causes suffocation by progressive scarring of the lungs. He is now experiencing chronic rejection of the transplant and is being considered to receive another. Without it, he is expected to survive only a year and a half. With it, his prognosis will improve, but the numbers are still not good. (...) Three years after his lung transplant, Mr. F. stopped attending his office visits. For a period of sixteen months he went without the studies and attention essential to posttransplant care. He stopped performing the required daily self‐monitoring of his lung function about eight months after his transplant, but he has maintained a regular exercise regimen. While lost to follow‐up, he continued to take his immunosuppressant medications, but he stopped taking medicine to control his high blood pressure because of its expense. (shrink)
Karin KRAUSE, Die illustrierten Homilien des Johannes Chrysostomos in Byzanz.Spätantike,Frühes Christentum,Byzanz. Reihe B: Studien und Perspektiven, 14.Nancy P. Ševčenko -2006 -Byzantinische Zeitschrift 99 (1):247-249.detailsThis fine new study amalgamates catalogue-type entries for a number of illustrated manuscripts of the homilies of John Chrysostom with a cogently written thesis. Only certain manuscripts have been chosen for full analysis (to this extent the title of the book is somewhat misleading): this is a study devoted primarily to the Chrysostom manuscripts of the 11th and 12th centuries that have some anthropomorphic figural illustration (as opposed to purely vegetal or zoomorphic illustration), with a special emphasis on miniatures which (...) are text-based, i. e. correspond in some precise way to the text they accompany. Earlier homily manuscripts (there are illustrated versions from the 10th century on), and manuscripts with full-page, non-text-based frontispiece illustrations such as the magnificent, oft-discussed imperial codex Paris, B. N. Coislin gr. 79, though included, are not the central concern of this book. Despite the fact that distinctions between anthropomorphic and non-anthropomorphic figural decoration, and between text-based and non-text based imagery are not likely ones that would have been drawn by the Byzantines themselves, the author's particular focus has the advantage of bringing into the scholarly arena a considerable number of unfamiliar works, here subjected to careful codicological, paleographical and stylistic analysis, and reproduced in superb color and black and white plates. (shrink)
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Experimental Treatment Oxymoron or Aspiration?Nancy M. P. King -1995 -Hastings Center Report 25 (4):6-15.detailsGiving up the increasingly troubled distinction between “experiment” and “treatment” would make it easier to focus on informed consent and harder to beg questions about uncertainty and shared decisionmaking in medicine.
RAC Oversight of Gene Transfer Research: A Model Worth Extending?Nancy M. P. King -2002 -Journal of Law, Medicine and Ethics 30 (3):381-389.detailsClinical gene transfer research has both a unique history and a complex and layered system of research oversight, featuring a unique review body, the Recombinant DNA Advisory Committee. This paper briefly describes the process of decision-making about clinical GTR, considers whether the questions, problems, and issues raised in clinical GTR are unique, and concludes by examining whether the RAC's oversight is a useful model that should be reproduced for other similar areas of clinical research.Clinical GTR is governed by the same (...) oversight system as most clinical trials, with a significant addition: the RAC. Like other research with human subjects, GTR, if it is affiliated with a federally funded institution, must be approved by an institutional review board whose activities are governed by the common rule, that is, the federal regulations for protection of human subjects in research. Like other research intended to produce a drug, device, or biologic to be marketed in the United States, GTR is also overseen by the Food and Drug Administration. (shrink)
Beyond the Medical Model: Retooling Bioethics for the Work Ahead.Nancy M. P. King,Gail E. Henderson &Larry R. Churchill -2021 -American Journal of Bioethics 21 (2):53-55.detailsThe three important target articles make a strong case for regarding racism as a public health crisis. Each calls for advocacy by the bi...
Accident & Desire: Inadvertent Germline Effects in Clinical Research.Nancy M. P. King -2003 -Hastings Center Report 33 (2):23-30.detailsGene therapy is still a very crude way of treating very complicated problems. It's hard to get new genes to go where they're needed, and hard to keep them from going where they're not wanted. The worst‐case scenario is that they find their way into a patient's germ cells—eggs or sperm—and end up harming the patient's offspring. Yet this possibility is hard to study in human trials, and would be hard to deal with in the clinic. It should, instead, simply (...) be avoided. Doing so requires fundamentally changing our approach to gene therapy. (shrink)
Transparency in Neonatal Intensive Care.Nancy M. P. King -1992 -Hastings Center Report 22 (3):18-25.detailsMedical teams care for severely premature infants under conditions of emergency and uncertainty that make parental involvement very difficult. Parents can be invited into a decisional relationship with the team that enables them to assess more fully the meaning of their child's illness.
Out of This World: re-grounding justice through science fiction.Nancy M. P. King &Larry R. Churchill -2023 -Perspectives in Biology and Medicine 66 (2):284-298.detailsABSTRACT:Good science fiction can be a successful vehicle for portraying justice. Science fiction can stimulate moral imagination in much the same way as the most effective justice theories, connecting the world in which we live with a range of alternative futures deliberately and creatively made plausible. A selective examination of classic and recent science fiction stories and novels provides contextual framing for considering questions of climate justice, virtuous personal action in the face of structural injustice, and the problem of what (...) justice means when some people are regarded as “other.” By connecting compelling images of individual responsibility with the complex challenges posed by striving for social justice, science fiction can also help render justice work appealing and achievable—an essential step that is reinforced in closing by a brief set of maxims. (shrink)
Bioethics reenvisioned: a path toward health justice.Nancy M. P. King -2022 - Chapel Hill: The University of North Carolina Press. Edited by Gail Henderson & Larry R. Churchill.detailsBioethics needs an expanded moral vision. It is now time for bioethics to take full account of the problems of health disparities and structural injustice that are made newly urgent by the COVID-19 pandemic and the effects of climate change.Nancy M. P. King, Gail E. Henderson, and Larry R. Churchill make the case for a more social understanding and application of justice, a deeper humility in assessing expertise in bioethics consulting, a broader and more relevant research agenda, and (...) greater appreciation of the profound health implications of global warming. (shrink)
Defining and Describing Benefit Appropriately in Clinical Trials.Nancy M. P. King -2000 -Journal of Law, Medicine and Ethics 28 (4):332-343.detailsInstitutional review boards and investigators are used to talking about risks of harm. Both low risks of great harm and high risks of small harm must be disclosed to prospective subjects and should be explained and categorized in ways that help potential subjects to understand and weigh them appropriately. Everyone on an IRB has probably spent time at meetings arguing over whether a three-page bulleted list of risk description is helpful or overkill for prospective subjects. Yet only a small fraction (...) of all the time and attention lavished on risk disclosure has been devoted to discussing whether and when potential benefit to subjects can reasonably be claimed and, if so, how it should be described in the consent form and process.Traditionally, IRBs and regulators have worked to ensure that clear lines can be drawn between research that, by definition, carries no potential for direct benefit — because it uses healthy volunteers or because it is not foreseeably focused on the development of treatments — and research that does have the development of effective treatments as its goal. (shrink)
(1 other version)Charting the future.Nancy Neveloff Dubler,Mayris P. Webber &Deborah M. Swiderski -2009 -Hastings Center Report 39 (6):23-33.detailsClinical ethics consultation has become an important resource, but unlike other health care disciplines, it has no accreditation or accepted curriculum for training programs, no standards for practice, and no way to measure effectiveness. The Clinical Ethics Credentialing Project was launched to pilot‐test approaches to train, credential, privilege, and evaluate consultants.
Frontiers of Research in Economic Theory: TheNancy L. Schwartz Memorial Lectures, 1983–1997.Donald P. Jacobs,Ehud Kalai,Morton I. Kamien &Nancy L. Schwartz (eds.) -1998 - Cambridge University Press.details'Leading economists presenting fundamentally important issues in economic theory' is the theme of theNancy Schwartz lectures series held annually at the J. L. Kellogg Graduate School of Management of Northwestern University. Reporting on lectures delivered in the years 1983 through 1997, this collection of essays discusses economic behavior at the individual and group level and the implications to the performance of economic systems. Using non-technical language, the speakers present theoretical, experimental, and empirical analysis of decision making under uncertainty (...) and under full and bounded rationality, the influence of economic incentives and habits, and the effects of learning and evolution on dynamic choice. Perfect competition, economic development, social insurance and social mobility, and negotiation and economic survival, are major economic subjects analyzed through our understanding of economic behavior. (shrink)
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Bioethics, Public Moral Argument, and Social Responsibility.Nancy M. P. King &Michael J. Hyde (eds.) -2011 - New York: Routledge.details_Bioethics, Public Moral Argument, and Social Responsibility_ explores the role of democratically oriented argument in promoting public understanding and discussion of the benefits and burdens of biotechnological progress. The contributors examine moral and policy controversies surrounding biomedical technologies and their place in American society, beginning with an examination of discourse and moral authority in democracy, and addressing a set of issues that include: dignity in health care; the social responsibilities of scientists, journalists, and scholars; and the language of genetics and (...) moral responsibility. (shrink)
An open letter to institutional review boards considering northfield laboratories' polyheme® trial.Ken Kipnis,Nancy M. P. King &Robert M. Nelson -2006 -American Journal of Bioethics 6 (3):18 – 21.detailsAt the time of this writing, a widely publicized, waived-consent trial is underway. Sponsored by Northfield Laboratories, Inc. (Evanston, IL) the trial is intended to evaluate the emergency use of PolyHeme®, an oxygen-carrying resuscitative fluid that might prevent deaths from uncontrolled bleeding. The protocol allows patients in hemorrhagic shock to be randomized between PolyHeme® and saline in the field and, still without consent, randomized between PolyHeme® and blood after arrival at an emergency department. The Federal regulations that govern the waiver (...) of consent restrict its applicability to circumstances where proven, satisfactory treatments are unavailable. Blood - the standard treatment for hemorrhagic shock - is not available in ambulances but is available in hospitals. The authors argue that the in-hospital stage of the study fails to meet ethical and regulatory standards. (shrink)
Key Information in the New Common Rule: Can It Save Research Consent?Nancy M. P. King -2019 -Journal of Law, Medicine and Ethics 47 (2):203-212.detailsInformed consent in clinical research is widely regarded as broken, but essential nonetheless. The most recent attempt to reform it comes as part of the first revisions to the Common Rule since it became truly “common” in 1991. This change, the addition of a “key information” requirement for most consent forms, is intended to support and promote a reasoned decision-making process by potential subjects. The key information requirement is both promising and problematic. It is promising because it encourages clarity and (...) honesty about research participation, creativity in information disclosure, and mutual learning through the investigator-subject relationship. It is problematic because those goals — which have remained aspirational since the beginning — may be difficult to achieve in what has become an excessively compliance-oriented regulatory regime. (shrink)
DEI Is Not Enough.Nancy M. P. King -2022 -Hastings Center Report 52 (3):3-3.detailsHastings Center Report, Volume 52, Issue 3, Page 3-3, May–June 2022.
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Strategy, Morality, Courage: Bioethics and Health Law afterDobbs.Nancy M. P. King,Christine Nero Coughlin &Beverly J. Levine -2024 -Journal of Law, Medicine and Ethics 52 (2):290-308.detailsOur paper examines what is required to protect and promote effective public discussion and policy development in the current climate of divisive disagreement about many public policy questions. We use abortion as a case example precisely because it is morally fraught. We first consider the changes made by Dobbs, as well as those which led up to the Dobbs decision, accompany it, and follow from it.
Nanomedicine First-in-Human Research: Challenges for Informed Consent.Nancy M. P. King -2012 -Journal of Law, Medicine and Ethics 40 (4):823-830.detailsFirst-in-human research has several characteristics that require special attention with respect to ethics and human subjects protections. At least some nanomedical technologies may also have characteristics that merit special attention in clinical research, as other papers in this symposium show. This paper considers how to address these characteristics in the consent form and process for FIH nanomedicine research, focusing principally on experimental nanotherapeutic interventions but also considering nanodiagnostic interventions.It is essential, as a starting point, to recognize that the consent form (...) and process are by no means the primary protectors of human subjects. Instead, consideration of the form and content of informed consent becomes relevant only after a clinical trial has been reviewed and deemed scientifically and ethically acceptable.Two convergent types of challenges to informed consent are posed by nanomedicine FIH research. First, some issues appear generally applicable to FIH research, but have specific nanomedicine implications. (shrink)
Who's Winning the IRB Wars? The Struggle for the Soul of Human Research.Nancy M. P. King -2018 -Perspectives in Biology and Medicine 61 (3):450-464.detailsOne of my favorite bioethics quotes is nearing 50 years old:Let us not forget that progress is an optional goal, not an unconditional commitment, and that its tempo in particular, compulsive as it may become, has nothing sacred about it. Let us also remember that a slower progress in the conquest of disease would not threaten society, grievous as it is to those who have to deplore that their particular disease be not yet conquered, but that society would indeed be (...) threatened by the erosion of those moral values whose loss, possibly caused by too ruthless a pursuit of scientific progress, would make its most dazzling triumphs not worth having.Despite its age, this invocation seems to me increasingly relevant as time... (shrink)
Othering and Health Justice.Nancy M. P. King -2022 -Perspectives in Biology and Medicine 65 (4):604-611.detailsABSTRACT:Bioethics needs to expand its vision. We must examine and interrogate the social and structural barriers that help traditionally privileged communities maintain minoritized groups as inherently inferior "others." Justice requires the field to look beyond the walls of hospitals, clinics, and medical academia to address and ameliorate the structural injustices that give rise to health disparities long before differential access to health services becomes an issue for underserved patients. Doing so means engaging in challenging multidisciplinary collaborations in order to understand (...) the sociohistorical complexities of health and illness, appreciate the factors that contribute to shaming and blaming those "others" who are not "us," and work to lessen the discomfort with uncertainty that impedes equity. All of this necessary work takes bioethics well beyond the well-trodden pathways of our usual scholarship and practice. But we simply have to reach higher to do health justice. (shrink)
Shaping Our Selves: On Technology, Flourishing, and a Habit of Thinking by Erik Parens.Nancy M. P. King -2016 -Kennedy Institute of Ethics Journal 26 (1):5-10.detailsIn Shaping Our Selves, Erik Parens offers both a personal history of bioethics and a cleverly clarifying lens to train on disputes in bioethics about emerging technologies. The question for readers is whether this lens, as useful as it is, leaves too much outside our field of vision. Parens, born in 1957, comes from the first wave of bioethics scholars—those of us who still mostly happened into bioethics as a field, before it was sufficiently well-established to be identified as a (...) career pathway. Bioethics enjoys a fascinating diversity of origin stories, and Parens’s is no exception. He began his studies at the University of Chicago’s pan-disciplinary Committee on Social Thought, one of a handful.. (shrink)