Attending to social vulnerability when rationing pandemic resources.

Pandemic plans are increasingly attending to groups experiencing health disparities and other social vulnerabilities. Although some pandemic guidance is silent on the issue, guidance that attends to socially vulnerable groups ranges widely, some procedural (often calling for public engagement), and some substantive. Public engagement objectives vary from merely educational to seeking reflective input into the ethical commitments that should guide pandemic planning and response.

Scientific and ethical issues related to deep brain stimulation for disorders of mood, behavior, and thought.

Context: A 2-day consensus conference was held to examine scientific and ethical issues in the application of deep brain stimulation for treating mood and behavioral disorders, such as major depression, obsessive-compulsive disorder, and Tourette syndrome.

Objectives: The primary objectives of the conference were to (1) establish consensus among participants about the design of future clinical trials of deep brain stimulation for disorders of mood, behavior, and thought and (2) develop standards for the protection of human subjects participating in such studies.

Results: Conference participants identified 16 key points for guiding research in this growing field.

Ethical considerations in pandemic influenza planning.

Although the timing and severity of the next influenza pandemic is impossible to predict, there is broad agreement that one will occur. Preparation is vital to mitigating its effects. A severe influenza pandemic like that which began in 1918 would be unlike other disasters in nature, scale, and duration.

Allocating pandemic influenza vaccines in Minnesota: recommendations of the Pandemic Influenza Ethics Work Group.

A public-private, multidisciplinary work group developed recommendations for rationing vaccines in Minnesota during a worst-case influenza pandemic. The recommendations encompass an ethical framework of principles, goals, and strategies. The primary goal is to maximize Minnesotans' chances of surviving both the pandemic and the years immediately thereafter and to limit two major causes of death: (a) influenza and complications of influenza, and (b) disruption of basic health care, public health, and public safety infrastructures.

Studying neurosurgical implants for Parkinson disease: a question of design.

North American researchers' perspectives on designing neurosurgical implant studies for Parkinson disease (PD) challenged the custom of holding surgical trials to less stringent evidentiary standards than other clinical studies. Researchers supported placebo surgery-controlled trials. The framework they used to design and evaluate studies both of deep brain stimulation and cellular implants for PD may be applicable to a broad range of surgical implants for other disorders.

A phased consent policy for cord blood donation.

This article focuses on ethical and policy questions concerning when consent may be sought for the collection and donation of cord blood. It reviews the advantages and disadvantages of alternative times for securing consent, challenges common objections to seeking consent during labor or after collection, and describes a phased consent process--a process that permits consent during early labor to the ex utero collection of cord blood followed by after-consent collection to donation. The phased consent policy attends to the unique characteristics of cord blood collection and donation, respects donors and their families, maximizes the number and diversity of cord blood units collected, preserves the relationship between providers and patients, and preserves public trust in cord blood and other types of tissue banking.

A model for improving coverage policy decisions.

Reasoned and defensible coverage decisions are essential for a fairer and more efficient healthcare system. Because healthcare resources are finite, coverage decisions should be informed by economic evaluations and made from a perspective that attends to the interests of both individuals and the population enrolled in a plan as a whole. Coverage decisions for all healthcare interventions should follow a 2-step procedure that consists of (1) the relatively impartial and objective assessment of an intervention's eligibility for coverage and (2) the distinctively value-laden determination (for which the enrolled population's values and preferences should take priority) to cover, conditionally cover, or not cover an intervention.

Ethical and policy issues in human fetal tissue transplants.

A review of human fetal tissue policies over the past 40 years reveals an increasing awareness that the use of this tissue raises unique ethical and policy issues. Initially it was believed that the use of fetal tissue was no different from using any other abandoned surgical waste specimen. Then state laws were passed requiring fetal tissue to be treated with the same respect and protection as tissue obtained from cadaver donors generally.