Life Extension Research: An Analysis of Contemporary Biological Theories and Ethical Issues

Many opinions and ideas about aging exist. Biological theories have taken hold of the popular and scientific imagination as potential answers to a "cure" for aging. However, it is not clear what exactly is being cured or whether aging could be classified as a disease. Some scientists are convinced that aging will be biologically alterable and that the human lifespan will be vastly extendable. Other investigators believe that aging is an elusive target that may only be "statistically" manipulatable through a better understanding of the operational principles of systems situated within complex environments. Not only is there confusion over definitions but also as to the safety of any potential intervention. Curing cell death, for example, may lead to cell cancer. The search for a cure for aging is not a clearly beneficial endeavour. This paper will first, describe contemporary ideas about aging processes and second, describe several current life extension technologies. Third, it analyses these theories and technologies, focusing on two representative and differing scientific points of view. The paper also considers the public health dilemma that arises from life extension research and examines two issues, risk/benefit ratio and informed consent, that are key to developing ethical guidelines for life extension technologies.     

Ethical Issues Related to Managed Care: An In-Depth Discussion of an Occupational Therapy Case Study

To discern effects of purposefulness on cardiovascular and neural responses, heart rate and electroencephalographic recordings were taken in 31 children performing purposeful and nonpurposeful activities of equal duration and cardiopulmonary workload. Heart rate increased from resting levels during both purposeful (p = .001) and nonpurposeful (p = .01) activities, but the level of increase was the same for both (p = .30). Similarities in heart rate during purposeful and nonpurposeful activities suggest that purposefulness might not influence heart rate response in children. Encephalographic recordings did not show a higher beta-wave activity quotient during purposeful activity (p = .33).     

Simulated Patient Studies: An Ethical Analysis

Context: In connection with health care reform, the U.S. Department of Health and Human Services commissioned a “mystery shopper,” or simulated patient study, to measure access to primary care. But the study was shelved because of public controversy over “government spying” on doctors. Opponents of the study also raised ethical concerns about the use of deception with human subjects without soliciting their informed consent. Methods: We undertook an ethical analysis of the use of simulated patient techniques in health services research, with a particular focus on research measuring access to care. Using a case study, we explored relevant methodological considerations and ethical principles relating to deceptive research without informed consent, as well as U.S. federal regulations permitting exceptions to consent. Findings: Several relevant considerations both favor and oppose soliciting consent for simulated patient studies. Making research participation conditional on informed consent protects the autonomy of research subjects and shields them from unreasonable exposure to research risks. However, scientific validity is also an important ethical principle of human subjects research, as the net risks to subjects must be justified by the value to society of the knowledge to be gained. The use of simulated patients to monitor access is a naturalistic and scientifically sound experimental design that can answer important policy‐relevant questions, with minimal risks to human subjects. As interaction between researchers and subjects increases, however, so does the need for consent. Conclusions: As long as adequate protections of confidentiality of research data are in place, minimally intrusive simulated patient research that gathers policy‐relevant data on the health system without the consent of individuals working in that system can be ethically justified when the risks and burdens to research subjects are minimal and the research has the potential to generate socially valuable knowledge.     

Surrogacy: Ethical and Legal Issues

Surrogacy refers to a contract in which a woman carries a pregnancy “for” another couple. Number of infertile couples from all over the World approach India where commercial surrogacy is legal. Although this arrangement appears to be beneficial for all parties concerned,there are certain delicate issues which need to be addressed through carefully framed laws in order to protect the rights of the surrogate mother and the intended parents.     

The Commercialization of Human Stem Cells: Ethical and Policy Issues

The first stage of the human embryonic stem(ES) cell research debate revolved aroundfundamental questions, such as whether theresearch should be done at all, what types ofresearch may be done, who should do theresearch, and how the research should befunded. Now that some of these questions arebeing answered, we are beginning to see thenext stage of the debate: the battle forproperty rights relating to human ES cells. The reason why property rights will be a keyissue in this debate is simple and easy tounderstand: it costs a great deal of money todo this research, to develop new products, andto implement therapies; and private companies,researchers, and health professionals requirereturns on investments and reimbursements forgoods and services. This paper considersarguments for and against property rightsrelating to ES cells defends the followingpoints: (1) It should be legal to buy and sellES cells and products. (2) It should be legalto patent ES cells, products, and relatedtechnologies. (3) It should not be legal tobuy, sell, or patent human embryos. (4) Patentson ES cells, products, and related technologiesshould not be excessively broad. (5) Patents onES cells, products, and related technologiesshould be granted only when applicants statedefinite, plausible uses for their inventions. (6) There should be a research exemption in EScell patenting to allow academic scientists toconduct research in regenerative medicine. (7)It may be appropriate to take steps to preventcompanies from using patents in ES cells,products, and related technologies only toblock competitors. (8) As the field ofregenerative medicine continues to develop,societies should revisit issues relating toproperty rights on a continuing basis in orderto develop policies and develop regulations tomaximize the social, medical, economic, andscientific benefits of ES cell research andproduct development.     

Ethical Issues in Human Reproduction Technology:

No abstract available for this article.     

Children From Assisted Reproductive Technology: The Psychological Issues and Ethical Dilemmas

Outcome research for children from ART is described. Anxieties in IVF parenting can be identified as lying in the ambivalent or critical attitudes of some community and religious groups to ART provisions, or in parents' concerns to preserve personal privacy. How to tell the child about IVF causes concern. Issues when parenting is of multiple births are not covered in this paper. In donor conception families, the infertility of one partner can cause imbalance in the parenting commitment with distancing of the social father from the child, or an obsessive concern for them. Unresolved feelings of anger, shame and guilt about infertility can adversely affect family relationships in other ways. Keeping the use of donated gametes secret, which is almost universal, protects the infertile adult, preserves the anonymity of the donor, but deprives the child of information about their origins and of 50% of their family medical and genetic history. Research studies of family functioning, the experience of families who tell their children and the retrospective life histories of Dl adults are described and used to argue the urgent need for change in this area in medical practice and legislation.     

An Ethical Analysis of International Health Priority-Setting

Health care systems throughout the developed world face ‘crises’ of quality, financing and sustainability. These pressures have led governments to look for more efficient and equitable ways to allocate public resources. Prioritisation of health care services for public funding has been one of the strategies used by decision makers to reconcile growing health care demands with limited resources. Priority setting at the macro level has yet to demonstrate real successes. This paper describes international approaches to explicit prioritisation at the macro-governmental level in the six experiences most published in the English literature; analyzes the ways in which values, principles and other normative concepts were presented in these international priority setting experiences; and identifies key elements of a more robust framework for ethical analysis which could promote meaningful and effective health priority setting.     

Ethical Issues in Medicine: A House Officer's Views

A 35-year-old woman was brought to the emergency department after she had been found comatose in her apartment. The patient had insulin-dependent diabetes mellitus and had had previous hospitalizations for ketoacidosis. She also had a history of multiple psychiatric diagnoses and had been taking an unspecified psychotropic drug.

The patient was unresponsive except to painful stimuli. Her pulse was 70 bpm and regular; blood pressure, 107/68 mm Hg; respirations, 10 per min; and temperature, 36.6°C. Her skin was warm and dry; the mucous membranes were also dry. Reflexes were sluggish but symmetrical. The ECG is shown.     

Ethical Issues in Research and Publication

Ethical considerations inherent in the process of research and publication represent one issue of particular concern to professionals. Members of a profession usually are guided by a code of ethics that specifies standards for practice. However, rarely do professional preparation programs sufficiently prepare students to deal with the concerns associated with research and professional publication. The authors address three specific areas of concern for health educators: the student-professor relationship, joint authorship, and ethics in publishing. Potential problems are discussed, and implications for the profession are cited.     

个案研究:一次失败的医院并购

1999年11月，Hershey医疗中心(HMC：Hershey Medical Center)与Geisinger健康系统(Geisinger：Geisinger Health System)宣布他们之间的并购失败。前车之鉴，后事之师。通过这次失败，我们应该注意到以下四个在医疗机构并购中须加以重视的因素：     

Multiple Gestations: Some Public Policy Issues

Multiple gestations, or multifetal pregnancies,raise a number of significant policy questionsconcerning the well being of women and the wellbeing of the children fetuses might become.Important questions for feminists pertain notonly to multifetal pregnancy itself, but alsoto the medical interventions associated withthese pregnancies. In this paper, we addressthe questions of how many embryos should betransferred in assisted reproduction, how manyfetuses should remain in a multiple gestation,who should make these decisions, and the needto protect women from overexposure to exogenoushormones. Although we focus on assistedreproduction in the United States, we believethat our suggestions are applicable to othercountries where the technology is comparable.     

多胎妊娠106例临床分析

目的:了解多胎妊娠发生率、孕妇合并症及围生儿结局相关因素。方法;回顾分析2000年1月~2004年12月多胎妊娠106例,了解发生率、年龄、孕周、合并症、分娩方式、围产儿结局及相关因素。结果:本院2000年1月~2004年12月住院分娩总数12 155例,多胎妊娠106例,发生率8.72‰,(其中双胎妊娠103例,发生率8.47‰、3胎妊娠3例,发生率0.25‰),年龄20~37岁,平均27.85岁,初产妇83例,占78.30%,经产妇23例,占21.70%。流产史26例,占24.53%。孕周28~40周,平均35.48周,其中28~36周50例,占47.17%,为同期的8.2倍,(P<0.01)。合并症主要是早产、胎膜早破、妊高征及贫血。分娩方法剖宫产占85.85%。围生儿215个,体重900~3 350 g,平均2 301.75 g,低体重儿122个,占56.74%,围生儿死亡10例,纠正围生儿死亡率32.56‰。为同期的4倍(P<0.01)。结论:多胎妊娠时孕妇并发症多,早产发生率及围生儿死亡率高,属高危妊娠范畴。临床上应高度重视加强孕期监测和管理,积极防治早产,适时终止妊娠。放宽剖宫产指征,提高新生儿管理技术,确保母婴安全。     

供精人工授精技术的伦理思考

伴随着精子冷冻技术的进步以及精子库的成立,供精人工授精技术日趋成熟,造福了许多不育症夫妇,但同时也带来一系列伦理方面的争论。当下的伦理争论热点主要集中在精液来源、捐精次数的限制、供精者年龄的限定、跨国供精人工授精、受者的选择权、供受者匿名及子代知情权等6个方面。通过对比国内外现行法律法规,结合目前社会现象,对上述伦理问题进行剖析和探讨,进而提出相应的观点和建议：精液来源应根据供者身体状况而非身份地位选择;捐精次数可适当提高;供精者年龄区间可适当下调;跨国供精人工授精尚不具备运行基础;受者的选择权应谨慎对待;供受者匿名制度应继续坚持。     

The Business Case for Preconception Care: Methods and Issues

Only a limited number of economic evaluations have addressed the costs and benefits of preconception care. In order to persuade health care providers, payers, or purchasers to become actively involved in promoting preconception care, it is important to demonstrate the value of doing so through development of a “business case”. Perceived benefits in terms of organizational reputation and market share can be influential in forming a business case. In addition, it is standard to include an economic analysis of financial costs and benefits from the perspective of the provider practice, payer, or purchaser in a business case. The methods, data needs, and other issues involved with preparing an economic analysis of the likely financial return on investment in preconception care are presented here. This is accompanied by a review or case study of economic evaluations of preconception care for women with recognized diabetes. Although the data are not sufficient to draw firm conclusions, there are indications that such care may yield positive financial benefits to health care organizations through reduction in maternal and infant hospitalizations. More work is needed to establish how costs and economic benefits are distributed among different types of organizations. Also, the optimum methods of delivering preconception care for women with diabetes need to be evaluated. Similar assessments should also be conducted for other forms of preconception care, including comprehensive care.