Holiday Reading: Emory First Year Graduate Neuroscience Students Write about Neuroethics!

Catching up on your holiday ethics readings?  Why not ring in the New Year with some neuroethics?

This year, Emory's First Year Neuroscience Graduate Students were asked to write a blog post for the Neuroethics portion of their Neuroscience and Communications Course.

These posts were delivered in 4 weekly installments on The Neuroethics Blog hosted by Emory's Neuroethics Program. Students wrote commentaries on the following four neuroethics articles. To read the blogs click on the installment number.

Installment 4/4
Neuroethics: Give memory-altering drugs a chance Nature 476, 275–276 (2011)

Interested in the Ethics of Health Care?

The Health Care Ethics Consortium of Georgia (HCECG) is a network of health care professionals and health care organizations, which provides professional ethics education, consultative services for health care professionals, and serves as partnership for practical ethics research. Consortium members share a common interest in bringing ethics analysis to patient care and organizational issues. The Consortium was started in 1994 following a 3 year planning period funded by the Emory University Center for Ethics and the Georgia Humanities Council. Faculty and staff at the Emory Center for Ethics provide leadership for the Consortium.  

Faculty involved in the Consortium have been significantly involved in the public policy process in Georgia. In 2010 Kathy Kinlaw, Associate Director for the Center for Ethics and Director for the Consortium, led a working group in the drafting of Senate Bill 367, which created a process for consent for surgical or medical treatment for a patient who 1) does not have decision making capacity and 2) who lacks a family member or other surrogate authorized under Georgia law. The bill was signed by the Governor in the summer of 2010 and has been very helpful in identifying other individuals who are able to provide consent for treatment for those patients who can no longer make decisions for themselves. The Consortium continues to track implementation of the new law.

Each year the Consortium also hosts several educational workshops and an annual interdisciplinary conference. The March 2012 conference will address Mixed Messages:  Ethical Tensions in Healthcare Conversations. 

HCECG Director - Kathy Kinlaw

The Consortium welcomes your involvement.  Let us know what issues you are interested in.  (www.hcecg.org)

VISUALIZE RIGHTS ATLANTA Connects Human Rights with Art Communities

Crowd gathers at Auburn Ave Research Library for Visualize Rights Atlanta 2011

The room was filled with people.  One could hear the greetings, the well wishes, and the laughs of the group all blend together into an indistinguishable melody.  We were pleasantly surprised by the turnout and were proud to be a part of such an event.  The event was VISUALIZE RIGHTS ATLANTA –a community arts show by artists, community organizations, and activists illustrating and celebrating the Universal Declaration of Human Rights.  The event was organized by Human RightsAtlanta.  What began as a coalition to commemorate the 60^th Anniversary of the UDHR, has become an annual tradition.  Now in its fourth year, the group continues to use human rights as a framework to build connections in the city. 

I had the pleasure of meeting one of the founding members of Human Rights Atlanta at an Ethics @ the Movies screening several weeks ago.  After learning about their Visualize Rights project and being extended an invitation to participate, I was thrilled to connect the work of the Center for Ethics and the Ethics & theArts Initiative with it.  For the Center’s contribution, I elicited the help of local artist Dane Jefferson.  It was with Dane that I produced the documentary film 17 Degrees Ain’t Nothing and with whom the Center for Ethics partnered to produce the marketing material for the world premiere of the Testament of the Heart series.

WE ARE NOT ALL DRY YET by Carlton Mackey and Dane Jefferson

For this show we created a mixed media piece titled, We Are Not All Dry Yet.  It illustrates Article 7 of the UDHR that affirms, “All are equal before the law and are entitled without any discrimination to equal protection of the law”.  The piece combines photography, text, and painting to express the significance of this right in the context of the continent of Africa and what, to us, have been violations of this right.  At the center of the piece is a red umbrella.  Under the umbrella is a mosaic of photographic images representing people of the African descent that were taken during my travels throughout the continent of Africa and the United States.  Surrounding the mosaic are stylized raindrops overlaid with text that highlight unique instances where citizens faced institutionalized, systematic abuse at the hands of authorities (law).  Some of these instances include apartheid in South Africa, anti Gay laws in Uganda, and the systematic use of rape as an act of war in parts of the Congo. The raindrops are intentionally abstract in shape, texture, and color.  Dark hues of gray, brown, and blue make up the drops creating the feel of, in essence, a storm of violations and misconduct.  While those under the umbrella are symbolically protected from the storm by Article 7 (written on the umbrella), we are reminded by the text under the umbrella that we are not ALL dry yet.

Set in the context of the continent of Africa but certainly visible throughout the world, we are aware of the struggle to uphold the Universal Declaration.  While it is an ideal and worthy of being upheld and celebrated, we know that it will take our collective effort to make it a full reality.  Through events like this which seek to raise the universal consciousness of the community about both a written declaration of human rights and the struggle to defend them and through the utilization of art to convey these messages across the boundaries of race, class, sex, I am hopeful that that day will soon come.

Arts Café Showcases Social Justice and Young Musicians

Hamzat Sani performs at 3rd Annual Ethics Art Cafe

The third annual Ethics Art Café event, co-hosted by the Center for Ethics and WonderRoot and organized by the Ethics and the Arts Society, was a fundraiser for Voices in the Treetops. The Ethics in the Arts Society is a pillar of the Ethics and the Arts Initiative and is led by Mariangela Jordan, Sabrina Bernstein, and Robert Grabowitz. 

Voices in the Treetops' music program
supports young Burmese refugees

Jordan was excited about using this year's Cafe to offer support to Voices In the Treetops and its founder Paula Larke.  The program offers music classes to 30-45 students in the Clarkston area, a majority of whom are refugees. "Larke is so dedicated", Jordan recounts, "she brings her personal instruments for the students to use and share".  

Voices in the Treetops Performers

 She went on to explain that Voices in the Treetops “goes beyond offering the students a hobby. There are very difficult social problems when it comes to refugees and especially refugee youth. They live in impoverished parts of the city where they share spaces with gangs and are sometimes victims of gang violence.” She says the music program is one of the few safe spaces that the youth have in the community to call their own.                                                                                               

 Jordan highlighted the successes of the event by saying, “all of the people who were invited, the artists and poets, engaged their art for social change.”  Jordan constructed the line-up out of some of her personal connections in the art community.  Her hope was that new relationships could also be forged because of the event.  Jordan stated that her charge was not just to donate money but to raise general awareness about important groups in the community utilizing the power of art to address relevant social issues.

Photos courtesy of Stephanie Gibson

 Video produced by Mariangela Jordan - President, Ethics & the Arts Society

Researcher on Ethical Tensions of Sickle Cell Disease Selected as "Ebony Magazine's Annual Power 100"

Friend of the Center for Ethics, Melissa Creary, recently made Ebony Magazine's Power 100 List. The Power 100 List also includes President Barack Obama, Michelle Obama, and Soledad O'brien to name a few.

Melissa Creary, one of Ebony's Power 100

Creary is a graduate student in Emory's  ILA (Graduate Institute of Liberal Arts) and recently was the Graduate Teaching Assistant for Professor Arri Eisen's Course held at the Center for Ethics: Science and the Nature of Evidence: Truth, Mind, & Body.

Creary is well-known as a leading researcher in the field of sickle cell research and, when she's not busy being a full-time graduate student, she also works at the Centers for Disease Control as a Health Scientist in the Division of Blood Disorders. Creary is, indeed, a powerhouse of energy and drive, and her drive comes straight from the heart. "My life’s passion is to raise awareness of the disease and to help increase quality of life for people who have it," says Creary. 

Sickle cell disease is a genetic blood disorder that causes red blood cells to change shape (to a crescent shape or sickle shape). This change in blood cell shape obstructs normal blood flow and can result in a range of symptoms from mild to fatal. These symptoms include fatigue, pain, anemia, and stroke to name a few. There currently is no cure for sickle cells disease. Sickle cell disease has a history of a host of ethical issues including tensions for health care providers as they attempt to manage symptoms such as the fickle, intermittent nature of pain associated with the disease; genetic testing and selection of embryos negative for sickle cell disease; as well as its link to race and health care disparities. Scientists believe that sickle cell incidence is more prevalent in people of African descent because the trait was protective against Malaria. 

Distribution of the sickle-cell trait shown in pink and purple

Historical distribution of malaria (no longer endemic in Europe) shown in green

Modern distribution of malaria

Creary was diagnosed at age 3 with sickle cell. "Although there have been many challenges, I have always thought of my disease as a blessing. It has molded my life and made me who I am."

Creary is coordinating a symposium entitled Sickle Cell Disease:  Equity and Ethics for the Spring to include a keynote address and panel discussion on bioethics in sickle cell disease including the racialization of the disease, social determinants, public policy, treatment and care.  Confirmed participants include Dr. Carlton Haywood, Jr. from the Johns Hopkins University and Dr. Camara P. Jones from the Centers for Disease Control and Prevention.  The symposium is co-sponsored by the Program for Science and Society, the Race and Difference Initiative, the Institute of Liberal Arts and the Center for Ethics.  Stay tuned for more information! 

--Karen S. Rommelfanger, PhD
Emory Center for Ethics, Neuroethics Program

Up at night: Dr. Helen O. Williams Reflects on Resident Work Hours

Image from Cover Story of Winter 2011 Emory Health Magazine

The proceeding reflection by Dr. Helen Williams is in dialogue with the cover story of the Winter 2011 Issue of Emory Medicine Magazine. The issue is about shift rules for residents and interns at teaching hospitals. It remains to be seen whether or not the new rules achieve their intended result. 
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A few weeks ago I was sitting in the physicians work area at 2 AM. I was waiting for the delivery of a high risk preterm infant that was expected to be imminent. I passed the time catching up on some charting and reading an article, and as I sat there, I was struck by the fact that I was all by myself. My residents had previously said goodnight and scurried off to their call rooms for a nap. It was ironic to me that they felt the need to sleep; after all, this was only a 12 hour shift for them. I would round on the unit the next morning and continue caring for patients until 4pm, when my partner would come for sign-out. And yet they slept and I didn’t; they had a call room and I didn’t. In that moment I felt like an old soul from a different generation even though I have only been an attending physician for 4 years. Sure this wasn’t walking uphill both ways in the snow, but I could claim the medical equivalent of that feat, having trained to a large degree before the enforcement of the physician duty hours.

The duty hours are certainly not a bad thing. Thanks in large part to the efforts on a bereaved father who also happened to be a journalist; the dangerous work habits of resident physicians were exposed. Indeed, at one time it was not atypical for residents to work continuously for 36 hours and clock 110 hour work weeks. Tired physicians made errors; sometimes life threatening errors. Tired physicians crashed their cars on their way home from work, making them a danger to themselves and others. Tired physicians also weren’t very nice people; they cut corners, they neglected their personal obligations, they could be curt and unpleasant. With public pressure mounting and the legislature ready to step in, the Accreditation Council for graduate medical education (the governing body that is responsible for residency training) opted for self-regulation and in 2003 limitations on physician work hours were made mandatory. Since then the regulations have been reviewed and rewritten and in many respects have become even more restrictive as to the length of time resident physicians are permitted to work. In most residency programs ‘call’ has disappeared and shift-work has taken its place. Nevertheless, the schedules for physicians outside of training and for nurse practitioners and physician assistants have not changed.

However, the effects of the duty hours have not all been positive. Many were shocked to discover that the incidence of medical errors did not fall after the implementation of resident physician work hours. One explanation for this was related to the need to transfer care between many more physicians – two or three in a 24 hour period. Errors could result from these often hurried “hand-offs” when details of a patient’s condition are not well relayed. Still others raised concerns that although our residents were well-rested, they were in fact not as well trained. Particularly in surgical specialties, it was an undeniable fact that residents have less opportunity to hone their skills due to limited opportunities. Concerns also were raised because of a phenomenon known as ‘work compression.’ Residents now had a limited time to complete a number of different tasks. In order to fit it all in, sitting and chatting with a patient was the first thing to go. What then, of all the free time we had now carved out? The intention was in large part to give our residents more time to read and study. In actuality, residents were becoming more like the rest of the workforce; claiming their free time as exactly that - ‘free’ time. Residents were having a life outside work!

Those of us who catch ourselves lamenting the ‘good old days’ usually share one common observation. We are concerned that the duty hours have changed our residents’ work ethic and, at times, excessively shifted the emphasis from caring for patients to caring for ourselves. When I talk to a family about a life-changing diagnosis and no resident is present to hear my approach, I worry, will they know what to say when their turn comes. I worry that their hours have caused them to miss procedural opportunities and interesting lectures. I worry that they are ill-prepared for their work life outside of residency. I worry that efficiency is over-emphasized at the expense of the interpersonal. It is not the endless hours of fatigue for which we are nostalgic, but rather the simple moments spent listening and holding someone’s hand because there is nowhere else that you need to be. And ironically, if you spend enough time thinking about how medicine has changed, it may well keep you up at night.  

Dr. Helen Oribella Williams is a physician in pediatrics, neonatal and perinatal medicine, Assistant Professor in the School of Medicine at Emory, and student in the Master of Arts in Bioethics degree program housed at the Center for Ethics.

Does Occupy have an anthem? It might now.

Atlanta student and activist songwriter Ariel Root Wolpe is part of the musical movement. Her song “Occupy” has gotten positive reviews from listeners around the city.

A Philadelphia native studying religion and music at Emory University, Wolpe said she was motivated to write the song after hearing “all the negativity the movement was getting.”

Read the Complete Article on CNN News Blog

Ethics & the Arts Initiative Partners with Human Rights Atlanta for VISUALIZE RIGHTS

The Ethics & the Arts Initiative joins 29 other community organizations, Atlanta artists, and activists for VISUALIZE RIGHTS ATLANTA -a community art show illustrating and celebrating The Universal Declaration of Human Rights.  

Carlton Mackey, Ethics & the Arts Initiative Chair, partnered with local artist Dane Jefferson to illustrate Article 7 (Right to Equality Before the Law).  The two created a 31' x 34.5' mixed media piece titled "We Are Not All Dry Yet".

In the end, art representing 30 Atlanta organizations and all 30 UDHR articles will be on display to celebrate Human Rights Day!  See below for list of organizations.

Opening reception: Saturday, December 10th
Location: Auburn Avenue Research Library
101 Auburn Avenue, NE, Atlanta, GA 30303

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(Article chosen by organization listed)

1.           Right to Equality                                         (Georgia Undocumented Youth Alliance)

2.           Freedom from Discrimination                         (Spark Reproductive Justice Now & Feminist Outlawz) 

3.           Right to Life, Liberty, Personal Security                 (Hispanic News Service) 

4.           Freedom from Slavery                                 (BLOCS)

5.           Freedom from Torture and Degrading Treatment (Georgians for Alternatives to the Death Penalty - GFADP)

6.           Right to Recognition as a Person before the Law (Occupy Atlanta)

7.           Right to Equality before the Law (Ethics & the Arts Initiative)

8.           Right to Remedy by Competent Tribunal (Center for Pan Asian Community Services, Inc)

9.           Freedom from Arbitrary Arrest and Exile        (Amnesty International, Atlanta local group 75)

10.         Right to Fair Public Hearing (Eugene Cooke)

11.         Right to be Considered Innocent until Proven Guilty (Fahamu Pecou Art)

12.         Freedom from Interference with Privacy, Family, Home and Correspondence (Karen Cleveland)

13.         Right to Free Movement in and out of the Country (Georgia Latino Alliance for Human Rights)

14.         Right to Asylum in other Countries from Persecution (Refugee Family Services Afterschool Program)

15.         Right to a nationality and Freedom to Change Nationality (Youth Empowered for Success Program at RFS)

16.         Right to Marriage and Family (Georgia Equality)

17.         Right to Own Property (Patricia Lacrete)

18.         Freedom of Belief and Religion (iWonder Media Group)

19.         Freedom of Opinion and Information (International Center of Atlanta)

20.         Right of Peaceful Assembly and Association (Georgia Peace and Justice/Atlanta)

21.         Right to Participate in Government and Free Elections (OCA-Georgia)

22.         Right to Social Security (9 to 5 Atlanta)

23.         Right to Desirable Work and Join Trade Unions (Teamsters Local 728)

24.         Right to Rest and Leisure (Jobs with Justice Atlanta)

25.         Right to Adequate Living Standard (Joe Tsambiras)

26.         Right to Education                                 (Georgia Safe Schools Coalition)

27.         Right to Participate in the Cultural Life of the Community (WonderRoot)

28.         Right to a Social Order that Articulates this Document (US Human Rights Network)

29.         Community Duties Essential to Free and Full Development (Colleen Hackett)

30.         Freedom from State or Personal Interference in the above Rights (International Action Center)

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Purpose: Human Rights Atlanta began nearly four years ago as a coalition to commemorate the 60th Anniversary of the Universal Declaration of Human Rights. Since then, it became an annual tradition to commemorate the Universal Declaration of Human Rights on its adoption date of December 10th, known as International Human Rights Day. For our fourth celebration, HRA desires to continue this tradition with a special initiative designed to further network groups using the human rights framework in our city, building connections that lead to a stronger movement, mutual respect and coalition-building. The proposed art show also provides an opportunity for organizations to celebrate their work and publicize positive initiatives in our city.

Center for Ethics Monthly Clinical Ethics Seminar

 

New Uses of Public Health Surveillance Data

to Improve HIV Care and Reduce Transmission:

The Ethical Challenges of Innovation

Leonard Ortmann, PhD

Public Health Ethicist, Office of Scientific Integrity

Office of the Associate Director of Science, Office of the Director

Centers for Disease Control and Prevention

and

Patricia Sweeney, MPH

HIV Incidence and Case Surveillance Branch

Division of HIV/AIDS Prevention

Centers for Disease Control and Prevention

 Date: Thursday, December 15, 2011

Time: 5:00 p.m. – 6:00 p.m.

Location: Center for Ethics, Seminar Room 162

Monitoring linkage, retention, and success of care with HIV surveillance data is critical to public health efforts to prevent HIV in the U.S.  Viral suppression achieved with antiretroviral therapy benefits both the individual by reducing morbidity and mortality and the population by reducing HIV transmission.  Innovative public health activities to follow-up with individuals or their care providers that utilize HIV surveillance data have been proposed.  For example, surveillance data can be used to assist care providers in prioritizing patients for follow-up who have been out of care or are receiving care elsewhere. Use of public health information exchange with collaborating facilities to  provide clinic alerts for persons who have not received their diagnosis or have dropped out of care have also been proposed.  However, these innovative interventions based on emergent science also create ethical challenges.  We will examine ethical challenges of using surveillance data for the monitoring the care and retention in care of individuals against the backdrop of HIV exceptionalism and the National HIV/AIDS Strategy.

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**The Center’s Clinical Ethics Seminars are held monthly – 4^th Thursday of every month (except November and December which will be the 3^rd Thursday).

Emory University Center for Ethics,1531 Dickey Drive, Atlanta, GA 30322

SPOTLIGHT ON ETHICS: Dr. Arri Eisen discusses Tibet, Buddhism, Science, and Teaching

Watch the latest release of our SPOTLIGHT ON ETHICS film series. We interviewed Dr. Arri Eisen about his work with the Emory-Tibet Science Initiative. Dr. Eisen, senior lecturer in Biology and the Graduate Institute for Liberal Arts, speaks of the impact that teaching Tibetan Buddhists has had on the way he teaches.


Special Thanks to Dr. Eisen for sharing your innovative ideas and fascinating stories with us.


Series Produced by Carlton Mackey
Filmed and Edited by Cate Powell
Dharamsala Footage by Carol Beck