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Biomedical subjects

J R Botkin

Publications and source records attributed to J R Botkin.

13 recordsLinked to original sources
PubMed1992

Carrier screening for cystic fibrosis: a pilot study of the attitudes of pregnant women.

We surveyed the attitudes of a consecutive sample of 306 pregnant Caucasian women toward carrier screening for cystic fibrosis. Of the 214 respondents, 98% said that screening should be offered before pregnancy, and 69% said they would accept carrier screening during pregnancy. Twenty-nine percent of the respondents indicated a willingness to terminate a pregnancy if the fetus were found to have cystic fibrosis. We conclude that carrier screening is of interest to pregnant women, although interest in terminating a pregnancy because of screening results may be limited.

Adolescent↗
PubMed1992

Selective abortion for familial Alzheimer disease?

Advances in human genetics will soon allow prenatal diagnosis of genetic conditions in the fetus that range from trivial to devastating. This commentary explores the concept of severity in genetic diseases and decisions regarding selective abortion. Familial Alzheimer disease is used as a model for the analysis of ethical issues raised by prenatal diagnosis and the subsequent termination of pregnancy. The genetics of the disease has yet to be elucidated, but this condition may be amenable to prenatal diagnosis in the near future, at least in some families. Abortion is a choice open to women in the United States; however, it is still desirable to discuss on purely ethical grounds pregnancy termination in the case of late-onset but severe diseases.

Abortion, Eugenic↗
PubMed1990

Prenatal screening: professional standards and the limits of parental choice.

Medicine has a strong tradition of respect for parental autonomy in reproductive decisions. As prenatal diagnostic technology develops, the physician's obligation to the prospective parents with respect to prenatal screening must be determined, and standards for disclosure of diagnostic capabilities and results must be developed. This article explores potential justifications for limits on parental choice in prenatal screening. Information about screening capabilities can be limited appropriately when resources do not exist to ensure accurate testing and counseling. Other policy limits to parental information and choice based on risk levels, cost-benefit analyses, or harms to the parent-child relationship cannot be established without broad consensus on complex ethical issues. Limits to parental choice may be more appropriately applied through the moral values of individual physicians in their provision of diagnostic services.

Abortion, Eugenic↗
PubMed1990

Ethical issues in human genetic technology.

The United States and several nations in the developed world have initiated efforts to map and sequence the human genome. The knowledge derived from these efforts will have a profound influence on the practice of medicine. This article reviews the technical developments in the field of human genetics and reviews the ethical issues relevant to the pediatrician in the application of this technology in prenatal screening, presymptomatic screening, carrier screening, and gene therapy. The complexity of these issues warrants caution in the clinical application of these tools and will require a better understanding of human genetics by health professionals and the public.

Ethics, Medical↗
PubMed1989

Hospital policy on advance directives. Do institutions ask patients about living wills?

Surveys have shown that a substantial proportion of the population has prepared an advance directive. The purpose of this exploratory study was to assess the existence and nature of hospital policy regarding these documents. A survey questionnaire was sent to 394 randomly selected hospitals in the United States. Of the 219 responding hospitals, 146 (67%) reported having a formal policy regarding advance directives. The large majority of those with a policy require the patient to notify the hospital of an advance directive, while only 4% of the respondents actively inquire about these documents. Hospitals in states with legislation that sanctions advance directives were significantly more likely to have a formal policy regarding these documents than hospitals in states without such legislation. Forty-six percent of the respondents reported having an ethics committee; however, the presence of an ethics committee was not significantly associated with the presence of a formal policy. Of the 69 hospitals that had both a formal policy and an ethics committee, only 30 (43%) reported that the policy had been reviewed by the ethics committee. Ethical and legal issues regarding hospital policy on advance directives are discussed. Hospitals should adopt formal policies to ask all adult patients at the time of admission whether they have prepared a living will, durable power of attorney, or similar document; and ethics committees should play a more active role in policy development.

Communication↗
PubMed1989

Informed consent for lumbar puncture.

Informed consent procedures are commonly employed prior to lumbar puncture. An understanding of the legal and ethical basis of informed consent is important in developing an acceptable approach to consent and in dealing with problems confronted when consent cannot be obtained. I review the current legal concepts in informed consent and their ethical foundation, and make recommendations to clinicians for obtaining consent for this common procedure in the ambulatory pediatric population.

Child↗
PubMed1988

The fire-safe cigarette.

Fires caused by cigarettes through the ignition of upholstered furniture and mattresses are a serious public health problem, accounting for more than 1500 deaths and 7000 serious injuries per year in the United States. Fire-resistant fabrics and stuffings, public education, and smoke detectors have had a limited impact on this problem. The federal government recently has completed a three-year study of possible modifications in cigarette design. The study has demonstrated the technical feasibility of product design changes that would substantially reduce the propensity of cigarettes to ignite fires. Legislation currently is pending in Congress and in three state legislatures to mandate a cigarette fire safety standard. This legislation deserves strong support by the medical profession.

Alcoholic Intoxication↗
PubMed1988

Anencephalic infants as organ donors.

Transplantation technology has been refined in recent years and now offers hope to pediatric patients with a variety of end stage disease processes. The lack of available donors for the smallest potential organ recipients has led to the suggestion that anencephalic infants be used as organ donors. This suggested policy is contrary to current law and raises fundamental ethical issues relating to the definition of death and the treatment of the dying. The technical issues in the potential organ supply from this source are described and the opposing ethical positions developing in this debate are discussed.

Aborted Fetus↗