The Hastings Center Report table of contents for September-October 2010

Essays

Title: The Prospects for Personalized Medicine

Author: Shara Yurkiewicz

Summary: Ten years after the release of a working draft of the human genome, major changes have made their way into medical practice, the marketplace, research, and policy.

Title: Personalized Medicine’s Ragged Edge

Author: Leonard M. Fleck

Summary: The phrase “personalized medicine” has a built-in positive spin. But little attention has been given to some challenging issues of justice it raises. Some people will clearly benefit a lot, some people will clearly not benefit at all, and many people will benefit somewhat.

Title: Personalized Cancer Care in an Age of Anxiety

Testing provides a few crystal balls.

Author: Susan Gilbert

Summary: To get an idea of how personalized medicine could reshape patient care in the years ahead, one need only look at how it is beginning to reshape the care of patients with cancer, where it has gained its firmest foothold.

Title: A Patient’s Experience

When personalized medicine means less medicine.

Author: Marian Fontana

Summary: All cancer survivors know where they were when they were told they had cancer. I was forty-three years old, exercised five days a week, and ate organic vegetables. How could I have cancer? A tickertape of questions scrolled across my mind.

Title: Wanted: Human Biospecimens

Traditional informed consent doesn’t fit this research.

Author: Karen J. Maschke

Summary: Collecting and using tissue, blood, urine, and other human biospecimens for various types of research is not new. But for personalized medicine to realize its potential, researchers will need thousands more of these samples for genetic studies — which raises a host of ethical questions, some of them new to human subjects research.

Title: Direct-to-Consumer Genetic Tests and the Right to Know

Author: Ronni Sandroff

Summary: Dealing with genetic knowledge is new for many of us, although families with devastating hereditary diseases such as cystic fibrosis and Tay-Sachs have dealt with it for decades. The editor of Consumer Reports on Health looks at what consumers want and need to know.

Articles

Title: Hospice and Physician-Assisted Death: Collaboration, Compliance, and Complicity

Authors: Courtney S. Campbell and Jessica C. Cox

Summary: A survey finds that most hospices in Oregon, the first state to legalize physician-assistance in dying, either do not participate in or have limited participation in requests for such assistance. Both legal and moral reasons are identified.

Title: Can We Improve Treatment Decision-Making for Incapacitated Patients?

Authors: Annette Rid and David Wendler

Summary: Clinical practice relies on patients to make their own treatment decisions, typically in consultation with a clinician. This approach poses a dilemma for incapacitated patients, such as those with advanced Alzheimer disease, especially when it is unclear which treatment the patient prefers and which treatment best promotes the patient’s clinical interests. The authors consider ways to improve current practice.

At Law

Title: The National Individual Health Insurance Mandate

Author: Lawrence O. Gostin

Summary: On March 23, 2010, President Obama signed into law the nation’s first comprehensive health care reform bill. Within weeks, twenty states filed lawsuits challenging the constitutionality of its most politically charged feature — an individual mandate. The law remains controversial because it compels people to purchase coverage they choose not to have, raising the question whether Congress can lawfully and ethically require individuals to contract with, and transfer money to, a private party.

Book Review

Title: Populations, Public Health, and the Law

Author: Wendy E. Parmet

Reviewed by: James G. Hodge, Jr.

Exploring Communal Health through Law

In Populations, Public Health, and the Law, Wendy E. Parmet offers something few other legal or policy scholars have produced during the modern “renaissance” in the field of public health law: an account of the need for fundamental change in how lawmakers and policymakers view the role of law in protecting population health.

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