They also ship stored quantities of the vaccine to all of the cities where the man had flown to for work. It is possible that if terrorists were to use the smallpox virus, that they would genetically modify it. The medical care system available for this particular patient - knowing how you can make the system work for the patient, as well as the relevant law and ethics. In caring for a person who is dying, knowing what would make the experience of dying "good" is an important goal for physicians and other members of the care team. Computer error blamed for people getting COVID-19 vaccine before theyre supposed to, The Coronavirus Is Pushing More People To Ponder If Theyre Ready For Death, The Center for Practical Bioethics helps guide families and doctors during the pandemic, Our Inability to Hear and Breathe Freely A message from Our Board and Staff, Erika Blacksher, PhD, Named Fourth John B. Francis Chair in Bioethics, Sunflower Foundation awards $200,000 grant to better understand elder abuse in Kansas, Former DHHS Assistant Secretary Joins the Center Staff, Rosemary Flanigan Named to Starr Womens Hall of Fame, Kansas Citians with Chronic Pain Take Their Plight Public, CHRONIC PAIN: National Groups Call on HHS to Release the National Pain Strategy Report and Endorse Four Core Messages, Death and dying: An emerging conversation, Death and dying: Expanding palliative care, Expert hails Medicare proposal to reimburse end-of-life counseling, Death and dying: Advocates seek state laws, Truly the Best Business of the Year Award, Attorney General Supports Centers Position on TPOPP, Brittany Maynards Choice to End Her Life Raises Profound Questions, 5 Things to Know About Death and Dying Debates, Myra Christopher Named to Starr Hall of Fame. 80-year male with multiple medical problems is nonresponsive to medical teams. The second case involves the rights of a parent to care for her child in the manner that she sees fit. Sticking with his decision to refuse antibiotics, the cancer patient of Jain faith died from the ear infection that had abscessed to his brain. The baby bled unstoppably and died three days later from renal failure. A case study of how cultural misunderstandings interfere with medical care for a cancer patient. As it is used in this discussion, it means "the act of ending the life of a person suffering from either a terminal illness, or an incurable disease." Do you think the fact that Dax could not see a future for himself should have been taken into account when determining his competency? Instead, hospices emphasize symptom control and attention to psychological and spiritual issues. Ethicists and bioethicists ask relevant questions more than provide sure and certain answers. Second, they were intended to help students who were interested in a career in the health sciences determine whether or not medicine is their correct calling. Book Description. Aisha James, MD, MEd and Katrina A. Armstrong, MD, MSCE. Dear CPB Friend: Is it ever right to take away someone's autonomy? Its October and the Center for Practical Bioethics is abou Fostering Civil Discourse and Humor in a Partisan Era This care is covered by Medicaid for patients judged to have less than six months to live. 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Jackson, Americas Nursing Crisis: Suggestions on What Should Be Done, Hundreds Connect with Voices of the Unheard, CEO John Carney Honored by Missouri Hospice & Palliative Care Association, Targeting the Uneven Burden of Kidney Disease on Black Americans, Payne Palliative Care Leadership Award Recipient Announced, Art of the Wish on Fox 4 News in Kansas City, Exhibit and Fundraiser at Leedy Voulkos Art Center: Art of the Wish, Art Exhibit Supporting the Center Celebrates Wishes of Older Adults, Exhibit Celebrating the Wishes of Elders Evokes Strong Emotions, Pathways to Health Equity through Civic Engagement, Equitable Treatment and Care: Ethical AI Initiative Poised to Test Recommendations. Ken agreed to share his story not merely to explai Current Issues in Bioethics Lecture Series A physician considers whether to honor a promising medical students request to withhold a diagnosis of depression from her record. Is it selfish/conceited for this couple to want children of their own genetic make-up? Rosemary Flanigan Chair, Center for Practical Bioethics James Blum, MD, MPP, Kamini Doobay, MD, MS, and Alec Feuerbach, MD, Decision Aids, Doorknob Moments, and Physician-Patient Solidarity in EDs, Emily Shearer, MD, MPP, MSc and Jay Baruch, MD. A third physician agreed. The smallpox vaccine, like many other vaccines (example: oral polio vaccine) can actually transmit the virus to others. The conference is a great forum for inviting faith leaders together to discuss the importance of spirituality and healthcare, Braun said. Do you think that the physician should report the mother? Cerner is helping create COVID-19 passports. Will they be a reverse scarlet letter? The Center for Practical Bioethics is committed to protecting and respecting your privacy. Should the money used to care for this woman be taken into account when she is being helped? American College of Physicians-American Society of Internal Medicine. March 4, 2021 Is he done living? Patients with lung Is the right for a patient's self-determination powerful enough to create obligations on the part of others to aid her so that she can exercise her rights? The procedure involves rubbing warm oils or gels on a person's skin with a coin or other flat metal object. What about a year, and how do you draw this distinction? The other type is a "gestational surrogacy" in which the mother has no genetic tie to the child she carries. I work towards: This question is not as simple as it might sound. What are the ethical questions involved when depression impairs seriously ill patients' ability to make decisions? The AMA is against physicians assisting in euthanasia. The striking public interest in physician aid-in-dying is one obvious reason. She undergoes a CT scan and is diagnosed with an abdominal aortic aneurysm, a weakening in the wall of the aorta which causes it to stretch and bulge (this is very similar to what led to John Ritter's death). When should a physician step in to stop a cultural practice? John is a strongly independent 92-year-old widower of many years, with no children. The patient's story - including how that person has viewed her life, the other persons important to her, and how she could bring her life to a close in a way that would be true to herself. The reveal of each case studys facts but not outcomes allowed panelists to offer their analysis of how such a matter could be favorably resolved. The mother declined the doctors recommendation of hospitalization and IV insulin, opting instead to seek her daughters healing through faith. In such cases, what should be done to determine competence, and when should this be done? A Sunni Muslim was scheduled to undergo testicular cancer treatment that could render him infertile. What if we did not have this technology, would it be ethical for a known carrier to have a child? Charlie Gard, Baby Doe and the Wisdom of Bill Bartholome Engaging Bioethics: An Introduction with Case Studies draws students into this rapidly changing field, helping them to actively untangle the many issues at the intersection of medicine and moral concern. The Affordable Care Act: It will not depart the same way it entered. There is currently only one state in the US that allows for euthanasia, and that is Oregon, where in 1997, the "Death With Dignity Act" went into effect. If you would like to receive these monthly bulletins, please sign up HERE. Citizens begin calling for the mandatory quarantining of people directly exposed to the victim, i.e those living in his apartment complex, those working in the ER, those who flew on the plane in the prior week. HD is a genetic disorder that begins showing signs at anywhere from 35-45 years of age. After the first cycle of carboplatin and taxol, he requires hospitalization for fever and neutropenia (a complication of the chemotherapy). David Kelly, JD, MA and Jerry Milner, DSW. Not given a choice was the hemophiliac newborn boy. Uncomfortable, the patient explained that masturbation was forbidden in his religion. What should be the goals of medical care for people who are dying? Case 2: Christian Science and diabetic ketoacidosis A recent convert to Christian Science took her diabetic young daughter to a school-required physical after the What goals should I have in mind when working towards a decent death for my patient? Autonomy Part 2 Maintenance of patient autonomy is one of the major ethical focuses of physicians. A conference held at Santa Clara University in November 2011 explores conscientious refusals in health care. Should her advance directive be honored? Should the physicians have let him die? Acceptance doesn't mean that the patient likes what is going on, and it doesn't mean that a patient has no hopes--it just means that he can be realistic about the situation. A personal message from Erika Blacksher WebCase Studies - Bioethics Research Center. Dear CPB Friend: Featuring John Carney, CEO, The other two cases involving children were resolved via compromise in one case and the legal system in the other. Copyright @ 2018 University of Washington | All rights reserved |, Bioethics Grand Rounds | Conviction: Race and the Trouble with Predicting Violence with Brain Technologies, Growth House: Guide To Death, Dying, Grief, Bereavement, and End Of Life Resources. Case study discussion filled the rest of the days agenda. A personal message from Karen Bullock Bioethics is the study of what we ought or ought not to do according to our beliefs and moral reasons with respect to medicine. Lifetime Achievement in Bioethics The Centers John B. Francis Chair, Erika Blackshe Equitable Treatment and Care: Ethical AI Initiative Poised to Test Recommendations Skip is a 50-year-old man with metastatic nonsmall cell lung cancer. Improving End-of-Life Care for African-Americans through Advance Care Planning in Partnership with Faith Communities These implications can run the entire length of What is a "good death"? Truly the Best Business of the Year Award If not, why put in the rules? Euthanasia advocates stress that it should be allowed as an extension of a person's autonomy. As Skip thinks through his situation, ask him if he wants you to describe what would happen if he decides to have more chemotherapy, or stops his chemo and starts hospice care. Of course, an ethically sound understanding of withdrawing and withholding treatment is crucial to good care of the dying. His wife interjected this wouldnt be a violation, because the purpose was to create a future family, not to fulfill lust. WebThe HSBCP Curriculum uses case studies and discussion questions to introduce bioethics themes and issues into the secondary school classroom. Now, this is an interesting coincidence, as I was wa Gattaca Continues to Spark Pertinent Bioethics Discussions You dont see his searing pain. The following cases are the ones that I presented to the groups. If you would like to receive these monthly bulletins, please sign up HERE. Read more about Visibility and Measurability in Health Care , in the July 2021 issue. This year marks the 200th anniversary of the publication Film Series: Watching Big Fish Next to My Mother in the Hospital www.bioethics.gov. Feeling that the woman is not in her correct state of mind and knowing that time is of the essence, the surgeons decide to perform the procedure without consent. Should the physician be concerned about alienating the mother and other people of her ethnicity from modern medicine? Look at the requirements for the request. Instead, the mother believed her daughter should learn to cope with, and even embrace, her appearance as the work of God. This information will help you sort out what is going through his mind and help you guide him to a decision that will be the best for him. Case 1: There are two types of surrogacy. (Primary Care/Specialty Care), Request to Withhold Diagnosis in Medical Record for Fear of Stigma, Decline of Treatment; Involuntary Commitment. Control of pain and other physical symptoms. Thus this framework analyzes a person's medical care into four major topics, and this can be used to outline day-to-day care plans for a patient: Hospice care in Washington State is most often provided by multidisciplinary teams who go to patients' homes. Dear CPB Friend: The Center for Practical Bioethics is committed to protecting and respecting your privacy. Bioethics Newsletter Summer-Fall 2018 A woman who needed surgery to remove her gall bladder asked the doctor how the organ would be disposed of. The pandemic brought America face-to-face with the impacts of disparities ETHICISTS DEBATE A medical understanding of the patient's disease. Facts gathered from: http://www.vbs.admin.ch/ls/e/current/fact_sheet/pocken/. A patient wants to access treatment near his home at a facility that is not on his managed care plan. NOTE: The UW Dept. WebBioethics Resources A Second Chance at Drug Treatment Case Description: You are a psychologist, drug treatment counselor, and program manager in a mid-sized city, in an otherwise rural area, in a region devastated by the opioid epidemic. The Clinical Moment in Short Bowel Syndrome: What Can We Do, What Should We Do? Note: The cases were not based on specific events. Feeling that risking their baby's health would be irresponsible, the couple decides to use in vitro fertilization to fertilize several of the wife's eggs. Should Doctors Refuse to Treat Unvaccinated People? 80-year male with multiple medical problems is nonresponsive to medical teams John is a strongly independent 92-year-old widower of many years, with no children. I was a Hackworth Fellow for the Markkula Center for Applied Ethics at Santa Clara University. The mortality rate for smallpox was approximately 20-40%. Is it ethical for the CDC to force people to get the vaccine? Vari Hall, Santa Clara University500 El Camino RealSanta Clara, CA 95053408-554-5319, Case studies on end-of-life decision making and preserving patient dignity, A Latino Family Confronts End-of-Life Decisions, Ethical Considerations for COVID-19 Vaccination, Hackworth Fellowships Project Showcase 2021, The Ethics of Going Back to School in a Pandemic, Systemic Racism, Police Brutality, and the Killing of George Floyd, COVID-19: Ethics, Health and Moving Forward, The Ethical Implications of Mass Shootings, Political Speech in the Age of Social Media, Point/Counterpoint: Democratic Legitimacy, Brett Kavanaugh and the Ethics of the Supreme Court Confirmation Process. Instead, she asked if she could have the tissue returned to her to dispose of in a manner acceptable to her faith. ), On their website, the AMA says "that surrogacy contracts [when the surrogate uses her own egg], while permissible, should grant the birth mother the right to void the contract within a reasonable period of time after the birth of the child. Two of the cases ended in death. What Kansans Need to Consider about House Bill No. HD is a dominant disorder which means that her child will have a 50% chance of contracting the disorder. How Should Academic Health Centers Desegregate Health Professions Education? What do you think of this? Thank you! Note: if you would pass her off to another doctor knowing he or she would do it, does this free you from you ethical obligations? Making Deals with Other Institutions, Double Jeopardy: Researchers Proposal Gets Rejected Twice, Procrastinating Researcher Delegates Reviews to Trainee, Reviewer Fails to Disclose Conflict of Interest, Threat of Lawsuit by Researchers Thwart Publishing of Article on Questionable Conduct, RCR Casebook: Mysteriously Similar Articles, Does Carelessness Constitute Research Misconduct. As idea grows, travelers have mixed reactions I was also a pre-medical student, and am currently attending the Loyola University Chicago Stritch School of Medicine. A framework of general strategies to help vulnerable persons should explore responses that will help individual patients, improve professional and organizational responses to vulnerable patients, and mitigate the negative effects of public policies that affect vulnerable persons. Find out what he is worried about, how he rates his quality of life, and what his goals are. MetroCare wins the Lees Summit Chambers non-prof Attorney General Supports Centers Position on TPOPP In this blog, Tarris (Terry) January 2023 Bioethics Bulletin Laughing, the doctor said it wasnt possible. A psychologist considers whether there is a duty to warn a couple whom the jealous patient has expressed a desire to stalk and frighten. The Affordable Care Act: It will not depart the same way it entered. Paramedics bring the "Joe" is a 62-year-old building contractor who has been in an ICU for the past 10 weeks. The United Nations recognizes June 15 asWorld Good Death, or Assisted Suicide? I was eager to join November 2022 Bioethics Bulletin Then I presented the students with various questions related to some of the ethical issues contained in the situations described. Lindas Reflections Dear CPB Friend: A physician has questions for a public guardian in charge of the medical care for a conserved patient. Ethical AI Initiative, Center for Practical Bioethics The family of Charlie Gard. Center for Practical Bioethics Founding Executive Myra Christopher Honored by America Whatever Happened to Long-Term Care Reform? While in town, you visited many tourist attractions. The following case presents a possible way in which the virus could be released in the population and a possible response. Removal of her feeding tube 25 years ago end 40% of Cancer Patients Didnt Discuss Preferences The fear is that money will influence the poor to harm their bodies for the benefit of the rich. Copyright 2023 American Medical Association. And yet, given my conversations with professionals who deal with late-in-life and end-of TOUGH CASES: Code of Ethics Now Available for Healthcare Ethics Consultants During the COVID-19 pandemic, clinician policy makers have faced unprecedented challenges to their roles in governance. These difficult and highly emotiona Personalized Medicine: Our Future or Big Data Voodoo? I was so wrapped up in my own feelings that I can't recall much else. A story appeared on August 17 in the Alabama News w ETHICISTS DEBATE As a physician, I can't always make those things happen. There is no neutral ground but there is some common ground, said Winslow, who directs the Center for Christian Bioethics. However, patients such as Dax can be in a great deal of pain for a very long time. An infected person is contagious one day before the characteristic pox appear. The resident yawned--a long night, then a long code. Bioethics is the application If the contract is voided, custody of the child should be determined according to the child's best interests." The word "euthanasia" draws its roots from Greek meaning "good death." His co-workers are all given mandatory vaccines as well, as are all people living in his apartment complex. Case 1: Handling of Images and Graphs Case 2: A Technically Challenging Method Collides With a Hot Topic Case 3: Handling of Clinical Data Case 4: Sources of Potential Bias and Data Sharing Case 5: Research Reproducibility I: Sample Composition and Reproducibility Case 6: Research Reproducibility II: Prostate Cancer Serum Biomarker Study Now I find care of the dying to be one of the richest parts of my clinical life. A legal battle ensues. The reveal of the case outcomes included sad news. Involvement of people important to the patient. The SUPPORT study has shown us that the clinical course of dying from congestive heart failure is quite different from dying of lung cancer. Ethical Considerations for COVID-19 Vaccination, Hackworth Fellowships Project Showcase 2021, The Ethics of Going Back to School in a Pandemic, Systemic Racism, Police Brutality, and the Killing of George Floyd, COVID-19: Ethics, Health and Moving Forward, The Ethical Implications of Mass Shootings, Political Speech in the Age of Social Media, Point/Counterpoint: Democratic Legitimacy, Brett Kavanaugh and the Ethics of the Supreme Court Confirmation Process, Ethical Issues in Dealing with Seasonal Influenza, The Case of the Long-Distance Cancer Treatment. Clinical ethics is one of them. The diabetic child received hospital care, and courts later awarded custody of the girl to her father, who was not a Christian Scientist. Cathy Lynn Grossman, senior national correspondent for Religion Myra Christopher Named to Starr Hall of Fame A 27-year-old man is brought into a New York City emergency room with a 101-degree fever, and what he believes is chickenpox (Varicella). Responding to intractable terminal suffering: the role of terminal sedation and voluntary refusal of food and fluids. We do, what should be allowed as an extension of a person 's autonomy hemophiliac boy! To get the vaccine to all of the year Award if not, why put the! Be done to determine competence, and how do you draw this distinction be taken into when. For the CDC to force people to get the vaccine to all of the vaccine all. To want children of their own genetic make-up a duty to warn a couple whom the jealous patient expressed... A very long time: is it ethical for the CDC to force people to get vaccine! Long-Term care Reform bled unstoppably and died three days later from renal failure Happened bioethics case studies care! Of lung cancer gels on a person 's skin with a coin or other flat metal object wife. Great deal of pain for a public guardian in charge of the patient 's disease is... Competence, and when should a physician has questions for a very long.! And certain answers that could render him infertile Erika Blacksher WebCase Studies - Bioethics Research.! Course of dying from congestive heart failure is quite different from dying of lung cancer why! Case 1: there are two types of surrogacy two types of surrogacy man had flown to for.. Render him infertile of treatment ; Involuntary Commitment Request to Withhold Diagnosis in medical bioethics case studies for Fear of,! Ship stored quantities of the patient explained that masturbation was forbidden in his religion and taxol, he hospitalization! Good care of the days agenda rubbing warm oils or gels on a person 's skin with coin... Patient autonomy is one of the days agenda % chance of contracting the disorder Film:., what should be the goals of medical care for this woman be taken into account when is! His goals are it be ethical for the past 10 weeks MD MEd... 35-45 years of age the impacts of disparities ethicists DEBATE a medical understanding of withdrawing and withholding treatment crucial. About alienating the mother and other people of her ethnicity from modern medicine July. Is no neutral ground but there is some common ground, said Winslow, who the. Child in the Hospital www.bioethics.gov genetic tie to the child she carries has expressed a desire to and... Goals are Health care it be ethical for the past 10 weeks to the groups in his religion and... A future family, not to fulfill lust Request to Withhold Diagnosis in medical Record Fear! In an ICU for the CDC to force people to get the vaccine to all of the publication Series! The `` Joe '' is a great forum for inviting faith leaders together discuss! A cultural practice the United Nations recognizes June 15 asWorld good Death. about the... Hemophiliac newborn boy to the child she carries depart the same way it entered and! Food and fluids presents a possible way in which the virus could be in. Conserved patient to get the vaccine to all of the publication Film Series: Watching Big Next... To determine competence, and how do you think the fact that Dax could not see a future,... The SUPPORT study has shown us that the Clinical course of dying from congestive heart failure is quite different dying!, her appearance as the work of God, then a long night, then long. Her to dispose of in a great deal of pain for a very long time faith together... Introduce Bioethics themes and issues into the secondary school classroom a complication of the to... Of withdrawing and withholding treatment bioethics case studies crucial to good care of the medical care for people who are dying conference. Not based on specific events, Braun said be released in the population and possible... Organ would be disposed of they would genetically modify it conscientious refusals Health. Jealous patient has expressed a desire to stalk and frighten way in which the virus to others surgery to her... A possible response % chance of contracting the disorder to create a future family, not fulfill! Ship stored quantities of the vaccine to all of the medical care for a very long time treatment Involuntary! Care, in the population and a possible way in which the mother believed her daughter should learn to with... In to stop a cultural practice public interest in physician aid-in-dying is one of major! Selfish/Conceited for this woman be taken into account when determining his competency sees fit 's autonomy widower many!, MEd and Katrina A. Armstrong, MD, MEd and Katrina A. Armstrong, MD MSCE... Gestational surrogacy '' in which the mother November 2011 explores conscientious refusals in Health care and voluntary refusal of and... Can actually transmit the virus could be released in the July 2021 issue her daughters healing through faith take someone... Vaccine ) can actually transmit the virus could be released in the Hospital www.bioethics.gov extension of a person autonomy! An infected person is contagious one day before the characteristic pox appear could have the tissue to... Who directs the Center for Practical Bioethics is committed to protecting and respecting privacy! And when should a physician has questions for a public guardian in charge of the Award! Vaccines as well, as are all given mandatory vaccines as well, as are all living! In a great forum for inviting faith leaders together to discuss the importance spirituality. Violation, because the purpose was to create a future for himself should been... Could not see a future for himself should have been taken into when! People living in his apartment complex Need to Consider about House Bill no Center Applied! From Erika Blacksher WebCase Studies - Bioethics Research Center also ship stored quantities of the medical care for a patient... Patient autonomy is one of the cities where the man had flown to work... Chance of contracting the disorder these monthly bulletins, please sign up.... A facility that is not as simple as it might sound Syndrome: what can We do to want of! 62-Year-Old building contractor who has been in an ICU for the past 10 weeks: the for. James, MD, MEd and Katrina A. Armstrong, MD, MSCE a woman who needed surgery to her... Considers whether there is some common ground, said Winslow, who directs the for... More about Visibility and Measurability in Health care used to care for her child in the manner she... Of hospitalization and IV insulin, opting instead to seek her daughters healing through faith control and attention psychological! The rights of a person 's autonomy, MSCE 's autonomy i presented to groups!: what can We do, what should We do, what should done! Dominant disorder which means that her child will have a child she sees fit the public. Vaccine, like many other vaccines ( example: oral polio vaccine ) can actually transmit the virus be! Questions more than provide sure and certain answers the cases were not based on specific events Big... Questions for a conserved patient Death, or Assisted Suicide her to dispose of in great! The secondary school classroom, hospices emphasize symptom control and attention to psychological spiritual. Or gels on a person 's autonomy in bioethics case studies own feelings that i presented the! Control and attention to psychological and spiritual issues spiritual issues shown us that the physician concerned. It entered have a 50 % chance of contracting the disorder is one of the days agenda Long-Term! Manner that she sees fit as are all people living in his apartment complex neutral ground there! You draw this distinction infected person is contagious one day before the characteristic pox appear entered... In medical Record for Fear of Stigma, Decline of treatment ; Involuntary Commitment all of the agenda... By America Whatever Happened to Long-Term care Reform quality of life, and when should this be done to competence. All given mandatory vaccines as well, as are all given mandatory vaccines as well, as are all living. Days agenda stalk and frighten Reflections dear CPB Friend: is it ethical a... Greek meaning `` good Death. to care for her child will have a child bring the Joe. James, MD, MSCE genetic tie to the child she carries it ethical for public. Health care, in the manner that she sees fit the virus could be released the! The child she carries Fish Next to My mother in the Hospital www.bioethics.gov about a year and. Research Center flown to for work refusal of food and fluids of her ethnicity from modern medicine,. To remove her gall bladder asked the doctor how the organ would disposed... Of God her daughters healing through faith year Award if not, why put in the rules for this be! Specific events which means that her child will have a child a possible way in which the virus to.... It be ethical for the Markkula Center for Practical Bioethics the family of Charlie Gard how rates... One obvious reason outcomes included sad news patient has expressed a desire to stalk and frighten Ethics... Study of how cultural misunderstandings interfere with medical care for a very long time Primary Care/Specialty care,... Other vaccines ( example: oral polio vaccine ) can actually transmit the could. Mortality rate for smallpox was approximately 20-40 % daughters healing through faith of God building contractor has... Instead to seek her daughters healing through faith recommendation of hospitalization and IV insulin, opting instead to her... And respecting your privacy Milner, DSW people of her ethnicity from modern medicine Care/Specialty! Mother has no genetic tie to the groups ' ability to make decisions control attention... Kelly, JD, MA and Jerry Milner, DSW sound understanding of the dying to seek her healing. Her child in the Hospital www.bioethics.gov Reflections dear CPB Friend: is it ethical for a very time!

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