Bios-Ethics and the Bios Emergency: Finding the Real Work.

This article presents a case for transforming traditional bioethics into "Bios-ethics." This exposition relies on three propositions: (1) the climate emergency is the "Bios emergency"; (2) in the Bios emergency, bioethics must be replaced by Bios-ethics; and (3) the top and overwhelming priority of Bios-ethics is to address the Bios emergency. Biocentrism, habitat, and environmental ethics are discussed in light of their contribution to the development of Bios-ethics, and potential lines of research in Bios-ethics are outlined. The urgency of undertaking substantive conceptual and practical innovations in response to our current danger is emphasized throughout.

Ethical Maxims for a Marginally Inhabitable Planet.

Bioethics has largely neglected the Anthropocene and its ethical challenges. This essay asks which ethical norms will serve us well in the face of the coming climate catastrophe. It sketches the climate changes likely for the year 2031 and offers six adaptive maxims, drawn from bioethics work in ICUs and hospices, to guide us through the devastation and transition following environmental and social collapse. These six maxims are: work hard to grasp the immensity of the change; cultivate radical hope; have a line in the sand; appreciate the astonishing opportunity of life at this time; train your body and mind; and act for the future generations of all species. Because we are already in an environmental collapse and the beginnings of social collapse, these maxims are relevant today as well as for the future.

Biocontaining: Purification, Restoration, and Meaning-Making.

Biocontaining during the recent Ebola outbreak served to affirm the social significance of biomedicine, even though it had little measurable effect on the pandemic itself. Taking up key insights of Mary Douglas and Victor Turner concerning the essential meaning-making tasks of culture, this article discusses how biocontaining as an activity contributed to the work of social reassurance and meaning-making in U.S. and global society during the crisis. The analysis is based in significant part on fieldwork done at the Nebraska Biocontainment Unit (NBU), study of NBU educational materials, and follow-up conversations with personnel staffing that unit.

Obstacles to Shared Expectations in a Burn Intensive Care Unit.

Critical care patients are dependent on the health care team and their family members to effect care goals that are consistent with their core values and wishes. This study aimed to identify and understand how obstacles to communication affect these two disparate groups. Ten burn intensive care unit (BICU) care team and 20 family members participated in in-depth semistructured interviews. A two-cycle coding, inductive analytical approach was used to derive three obstacle metathemes: family engagement, information exchange, and process transparency and standardization. However, care team and family members' themes within each metatheme were different. Although the thematic structure was derived inductively, our findings in retrospect appeared to be consistent with Law's four resistances associated with actor-networks. From this perspective, actor-network theory provides a plausible explanation for perceived obstacles and may, in the future, guide the development of interventions to improve shared agency across networks.

Essential Reading for Bioethicists in the Anthropocene Era.

The multiple emergencies of global heating require bioethicists to embrace the dormant, comprehensive bioethics legacy of Van Rensselaer Potter, moving beyond the current narrower focus of the field on medicine and health care. We recommend readings that expand the core literature of bioethics to address key environmental issues. These are Jessica Pierce and Andrew Jameton's The Ethics of Environmentally Responsible Health Care; Dale Jamieson's Reason in a Dark Time; and David Wallace-Well's The Uninhabitable Earth. Because efforts to mitigate climate disasters are likely to be only partially successful, we also recommend the teachings of late Roman Stoicism and core texts of Buddhism, which provide ethical wisdom likely to be needed in the multiple crises of the Anthropocene.

A Community-Oriented Approach to Questionnaire Development for Assessment of Oral Cancer Awareness Among Hispanic Migrant Farmworkers.

While disparities in the incidence, treatment, and mortality of oral cancer have been investigated in underrepresented groups, the Hispanic migrant farmworker population is understudied. A questionnaire was designed to assess oral cancer knowledge, awareness, and care-seeking behavior in this population. We aim to review this survey and outline its development.

Healing skills for medical practice.

It is well recognized that physicians' relationships with their patients can have healing effects, but the skills in this area of medical practice are understudied. This article reports on research designed to identify a core set of healing skills. The authors interviewed 50 practitioners, who were identified by their peers as "healers," representing both allopathic and complementary medicine and alternative medicine. Interviews were tape-recorded, transcribed, made anonymous, and analyzed independently, and differences were reconciled by discussion. Eight skills emerged as pivotal from the transcripts of these interviews: do the little things; take time; be open and listen; find something to like, to love; remove barriers; let the patient explain; share authority; and be committed. Mastery of these skills would provide enduring improvements in patient care and reaffirm medicine's calling as a healing profession.

In search of a good death.

Spirituality and storytelling can be resources in aging successfully and in dying well given the constraints of modern day Western culture. This paper explores the relationship of aging to time and the dynamic process of the life course and discusses issues related to confronting mortality, including suffering, finitude, spirituality, and spiritual closure in regard to death. And, finally, the role of narrative in this process is taken up.

Can Precision Medicine Reduce the Burden of Diabetes?

Precision medicine is a new health care concept intended to hasten progress toward individualized treatment and, in so doing, to improve everyone's opportunity to enjoy good health. Yet, this concept pays scant attention to opportunities for change in the social determinants that are the major drivers of health. Precision medicine research is likely to generate improvements in medical care but may have the unintended consequence of worsening existing disparities in health care access. For prevention, precision medicine emphasizes comprehensive risk prediction and individual efforts to accomplish risk reduction. The application of the precision medicine vision to type 2 diabetes, a growing threat to population health, fails to acknowledge collective responsibility for a health-promoting society.

Forcible Amputation in Delusional Patients: A Narrative Analysis of Decisional Capacity.

This case study concerns the predicaments faced by two women who each had been advised by her physicians to have a gangrenous foot amputated to prevent the potentially fatal spread of infection. In both cases, the determination of the patients' decisional capacity was a critical component in judging whether or not to honor their medical treatment decisions. The communicative complexity of navigating a double bind, a situation in which a person confronts a choice between two undesirable courses of action, is also discussed. The patients in these cases had no medically appropriate choice that also respected other valued outcomes, such as independence, a sense of dignity, or control over one's destiny. Taken together, these cases raise issues about the context-specific meaning of decisional capacity and its role in informed consent.

Victim of Abuse, or Bully? The Case of the 800-Pound Man.

Obesity in the United States has been declared both a disease and an epidemic. Physicians have thus been identified as the "experts" in managing weight loss, but they have few effective solutions to recommend except bariatric surgery. Most physicians and medical facilities are unprepared to manage the complex medical needs of obese patients, and most families are unprepared to manage the dietary issues in helping a family member lose weight, much less the physical, psychological, and interpersonal issues that surface. This case explores the medical, ethical, and communication challenges that arose in the case of a patient who weighed 800 pounds.

Ethical Analysis and Policy Recommendations Regarding Domino Liver Transplantation.

Due to the widening gap between supply and demand, patients who need a liver transplant due to metabolic disease may be asked to serve as domino liver donors-to have their native liver transplanted into another candidate. We here analyze the ethical problems surrounding informed consent for the implant and explant procedures in transplant candidates who will serve as domino donors, using the case of a child with maple syrup urine disease. We discuss the need for 2 distinct consent processes separated in time to ensure that potential domino donors (or their surrogates) give a truly voluntary consent. We propose a Domino Donor Advocate-based on the concept of the independent living donor advocate to help the patient and/or his or her surrogates consider the risks, benefits and alternatives. Finally, we evaluate the Organ Procurement and Transplantation Network policy regarding "therapeutic organ donation" and propose several modifications to ensure that the decision by the potential domino donor (and/or his or her surrogate) is voluntary and informed.

Assessing Oral Cancer Awareness Among Rural Latino Migrant Workers.

Latino migrant farm workers suffer significant health disparities, including poor oral health. The purpose of this research was to assess Latino migrant farm workers' OC awareness, including knowledge and care-seeking behaviors. A 42-item survey was developed. Trained, bilingual researchers verbally administered the survey to migrant farm workers in Hillsborough County, Florida. Frequencies and descriptive statistics were generated to report baseline data. The sample consisted of 53.7 % female respondents. The mean age for males and females respectively was 38.7 and 39.2. Most respondents had attended grade school; 6.7 % never attended school. Perceptions of cancer susceptibility were present; knowledge of OC risk factors, signs and symptoms was low. Participants were unlikely to seek preventive care. The results contribute to the limited studies regarding Latino migrant farm workers and oral cancer risk factor awareness and knowledge. Findings highlight factors influencing motivation and care-seeking behaviors, as well as provide guidance for development of educational materials.

Jet-launching structure resolved near the supermassive black hole in M87.

Approximately 10% of active galactic nuclei exhibit relativistic jets, which are powered by the accretion of matter onto supermassive black holes. Although the measured width profiles of such jets on large scales agree with theories of magnetic collimation, the predicted structure on accretion disk scales at the jet launch point has not been detected. We report radio interferometry observations, at a wavelength of 1.3 millimeters, of the elliptical galaxy M87 that spatially resolve the base of the jet in this source. The derived size of 5.5 ± 0.4 Schwarzschild radii is significantly smaller than the innermost edge of a retrograde accretion disk, suggesting that the M87 jet is powered by an accretion disk in a prograde orbit around a spinning black hole.

Ethical considerations in the treatment of head and neck cancer.

BACKGROUND: The second half of the 20th century saw not only important developments in medical science and technology, but also a rapid growth in the application of biomedical ethics in medical decision making. Withdrawal of treatment, allowing to die, informed consent, and patient autonomy are concerns that now comprise a part of the overall medical treatment, particularly in patients with head and neck cancers. METHODS: The author discusses ethical issues relating to disfigurement/dysfunction in head and neck cancer patients and examines the aspects of "principlism": autonomy, nonmaleficence, beneficence, and justice. Two case reports are presented to illustrate the ethical challenges that may confront physicians who treat head and neck cancer patients. RESULTS: Head and neck oncology generates unique problems relating to disfigurement and dysfunction. An algorithm that considers the patient's medical good and greater good, as well as the goods of others, can assist in arriving at appropriate ethical decisions. CONCLUSIONS: Bioethical decision making requires the integration of virtues with principles, followed by the application of these standards to each patient.