The Most Debatable Content Per Column Inch

By AMWA Journal posted 09-25-2018 12:17


Tamara Ball, MD
Everyday Ethics Section Editor

everyday_ethics_blog.jpgAfter a long period of dormancy, a new ethics column, “Everyday Ethics”, premiered in Fall of 2017 (AMWA Journal. 2017;32(3):120-123). “Another Ethics Column?” described ethics as critical to the survival of our profession and introduced 2 foundational tools, the AMWA Code of Ethics and the RIGHT Model.

Beyond the premier, I chose to focus less on how we work, and more on the bioethical issues inherent in the groundbreaking subjects upon ­which we work. As skills to alter biologic processes are refined, methods for delivering health care are updated, and manipulations of the life’s building blocks are mastered, there is no shortage of contentious issues!

“The Ethics of Genetics” (AMWA Journal. 2017;32(4):182-184) explored key questions, including the advisability of DNA manipulation in cells that die with the host vs. cells that can be passed to future generations. What genes are “fair game” and who makes that decision?  Presently, dangerous off-target consequences are poorly characterized. An in utero repair of the mutation causing cystic fibrosis would likely be advisable, while modifications to change eye color, height, or intelligence might be unacceptably risky. What societal and economic changes might result as this technology becomes widely available, and how might they differ if manipulation were only available to the wealthy?

Standards of care are increasingly shaped by very large randomized trials that demonstrate statistically significant responses to treatment yet often produce negligible effect on outcome. The Summer 2018 column (Sample Size: Ethical Considerations, AMWA Journal. 2018;33(2):88-89) asked whether there is a place for small studies that demonstrate very dramatic effects. The most extreme example was the rabies vaccine, which was widely adopted after saving the lives of 2 dog-bite victims. After such impressive results, is a randomized trial even ethical?

Other “hot topics” have been or will be covered in Everyday Ethics, the Journal section with the most debatable content per column inch.