Latest news with #bioethics
Forbes
5 days ago
- Health
- Forbes
Raiders' Release Of Christian Wilkins May Conflict With Medical Autonomy Provided For In CBA
Photo byOn July 24, the Las Vegas Raiders reportedly released defensive tackle Christian Wilkins, a six-year veteran with whom the Raiders signed a four-year, $110 million contract prior the 2024 season, $82.75 million of which was guaranteed. The Raiders were reportedly unhappy with the progress on Wilkins' recovery from a foot injury suffered last season, including a disagreement with Wilkins about whether additional surgery was needed. The Raiders' position – and the related voiding of Wilkins' contract – potentially runs afoul of player protections in the collective bargaining agreement (CBA) between the NFL and NFLPA, resulting in a grievance filed by the NFLPA. Bioethical Considerations The situation raises serious bioethical concerns. Bioethics refers to the application of ethics – the philosophical discipline pertaining to notions of right and wrong – to the fields of medicine and healthcare. Bioethical analyses are generally conducted through the lens of specific principles, the most commonly-recognized being respect for autonomy, non-maleficence (the duty to avoid harm), beneficence (the duty to do good), and justice. Of most relevance to Wilkins' situation is the concept of autonomy. As described by leading bioethicists Tom Beauchamp and James Childress, '[p]The Raiders' apparent insistence that Wilkins have another surgery despite his preference otherwise appears to run afoul of the principle of autonomy, i.e., the right to control what is done to one's own body. The Raiders' actions could be viewed as self-serving, or at a minimum paternalistic (a question that has arisen with Miami Dolphins quarterback Tua Tagovailoa). Who Decides? The Raiders' position also raises legal issues, as evidenced by the NFLPA's grievance. Specifically, Section 6 of Article 39 of the CBA protects a player's right to receive a second medical opinion from a doctor of his choice and at the team's expense after having been first examined by the team's doctor. That provision also provides that a 'player shall have the right to follow the reasonable medical advice given to him by his second opinion physician with respect to diagnosis of injury, surgical and treatment decisions, and rehabilitation and treatment protocol, but only after consulting with the Club physician and giving due consideration to his recommendations.' This provision is generally understood to provide players with the ultimate right to choose their own course of treatment, consistent with the principle of autonomy. Additionally, if surgery is required, players are permitted to utilize an appropriately qualified surgeon of their choosing. The right of NFL players to control their medical treatment is not an approach shared by all sports leagues. While MLB also permits players to make the final decision about their treatment, the NBA, NHL and MLS CBAs provide the clubs with the right to determine a player's course of treatment. (See here for a report I co-authored in 2017 comparing the health-related policies and practices of the different leagues.) Indeed, this right was a major issue for NHL players in their recent CBA negotiations with the league after a dispute between Jack Eichel and the Buffalo Sabres concerning treatment for a neck and back injury. Whether such a right is now provided for in the recently agreed to CBA has not been publicly revealed and the NHLPA did not immediately respond to a request for comment. The Value Of A Guarantee The NFLPA is also likely taking the position that the Raiders' release of Wilkins violated his contract, including specifically the $35.2 million remaining in guaranteed compensation. Portions of NFL player contracts can be 'guaranteed' in a variety of ways. Under the standard NFL player contract, a player's contract can be terminated if: (1) 'at any time, in the sole judgment of Club, Player's skill or performance has been unsatisfactory as compared with that of other players competing for positions on Club's roster…, [or (2)] during the period any salary cap is legally in effect…, in Club's opinion, Player is anticipated to make less of a contribution to Club's ability to compete on the playing field than another player or players whom Club intends to sign or attempts to sign, or another player or players who is or are already on Club's roster, and for whom Club needs room.' Player contracts frequently provide that they will continue to receive some portion of their pay despite these two termination rights, known as 'skill' and 'cap' guarantees. Additionally, player contracts also frequently guarantee that a player will continue to receive his pay despite having suffered an injury. While the player's contract and CBA generally require a player to be paid their salary for so long as they are physically unable to provide their services because of an on-field injury, the duration of the injury and the required payment are frequently a subject of dispute and resolved through a process known as an Injury Grievance. An injury guarantee avoids this uncertainty and offers the player broader protection against release as a result of an injury. ESPN's report indicates that the Raiders' reason for the release was because Wilkins had failed 'to maintain his physical condition to play.' Wilkins and the NFLPA undoubtedly believe that the real reason for his release stems from Wilkins' on-field injury and that failing to continue paying him will violate injury guarantees in his contract. The dispute will now be resolved before a neutral arbitrator. In the meantime, Wilkins is free to sign with another club. And in the event Wilkins prevails in his grievance, the Raiders will likely claim that any pay Wilkins received from another club should offset any amounts owed by the Raiders. The Raiders did not respond to request for comment and the NFLPA declined to comment about Wilkins' situation.
New York Times
02-06-2025
- General
- New York Times
A Merciful Death
I grew up in the '80s and '90s and remember being fascinated by the controversy around Jack Kevorkian. He was a Michigan doctor who argued that sick people should be allowed to die on their own terms rather than suffer through a grueling illness. Was he a traitor to his oath to 'do no harm'? Or was he an angel of mercy, letting victims of disease exercise one last bit of agency over their failing bodies? Kevorkian, who went to prison for helping dozens of people with 'physician-assisted suicides,' seemed so radical at the time. Now his ideas are commonplace. Ten states and lots of Western nations have assisted-dying laws. But they're mostly built for people with a life-ending diagnosis. Canada is trying something more. There, a patient can have a state-sanctioned death if she is suffering — but not necessarily dying — from an illness. For the cover story of yesterday's New York Times Magazine, Katie Engelhart followed one woman's journey to die. It's a nuanced portrait of a person racked with pain and a tour of some controversial bioethics. I spoke with Katie about the difficulty in knowing what's right and what's wrong when people suffer. Your story has so much intimate detail about the struggles of the main character, Paula Ritchie. How did you get her to confide in you? Paula was, in her own words, 'an open book.' The first time I called her, we talked for nearly three hours. She had applied for medical assistance in dying, or MAID, after suffering a concussion, which led to dizziness and insomnia and pain that never went away. I knew that Paula would be an interesting case study, in large part because of the complexity — the messiness, really — of her life. She was the kind of patient whom opponents of MAID worry about. Paula had a mix of physical and psychiatric conditions: chronic pain, chronic fatigue, bipolar disorder, depression. She had a history of childhood trauma. She lived below the poverty line. She was very lonely. You watched Paula die. I was moved, reading about her last moments. What was it like to see that? I was trying to be as small a presence as possible in the room. I sat in a folding chair at the foot of her bed. As a reporter, the experience was doubly intense: I was there to do a job — to gather information — but I was also experiencing the moment as a human being, sitting in a room full of suffering. I said very little to Paula and she said very little to me, although she did briefly reach for my hand as she was getting ready for her injections. Want all of The Times? Subscribe.
The Guardian
22-05-2025
- Health
- The Guardian
Key takeaways: RFK Jr's ‘Maha' report on chronic disease in children
Donald Trump's health secretary and long-time vaccine skeptic Robert F Kennedy Jr presented a highly anticipated report on children's health this week. The 'Maha commission' report, referring to the 'Make America Healthy Again' movement, was required by a presidential executive order in February. The report focuses on chronic disease among children. The 68-page report broadly summarizes five areas affecting children's health, with a focus on ultra-processed foods, environmental chemical exposure, lack of physical activity, 'overmedicalization,' and 'capture' of regulatory agencies. It notably omits some of the most common causes of chronic disease and death in children, insinuates there could be harms where there is lack of evidence, and avoids discussing how Republicans have already changed the health system in ways researchers believe are harmful. Art Caplan, professor of bioethics at New York University's Grossman School of Medicine, told the Guardian that the report has 'interesting ideas about health and children's health and crackpot fringe tin-hat-wearing nonsense – it's got it all'. Here are five of the key takeaways from the report. The most common causes of death among children are car crashes and firearms accidents. The report ignores these issues, as well as behaviors that often start in adolescence and lead to chronic disease in adulthood, such as smoking and alcohol use. It also criticizes water fluoridation, without mentioning its protective effects against cavities. Also, absent from the report is a discussion of how the administration has already changed the health department in ways that advocates argue will benefit industry and could exacerbate chronic disease. For instance, Kennedy eliminated two smoking prevention offices at the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) in what one former regulator told Stat was 'the greatest gift to the tobacco industry in the last half century'. He also eliminated a world-leading sexually transmitted disease laboratory. In another example, one of the nation's leading researchers of ultra-processed foods quit his 'dream job' after facing what he described as censorship from the administration (the health department reportedly asked him to return). In a similar vein, the Trump administration cut a program that delivered local whole foods to schools soon after taking office, in spite of Kennedy calling for healthier school meals. The report is roughly broken up into five sections focusing on ultra-processed foods, environmental chemical exposures, children's mental health, 'overmedicalization' and 'corporate capture' of regulators by the industries they are supposed to oversee. Kennedy has harped on many of the issues listed in the report for months in public appearances and even though his defunct presidential campaign – especially including ultra-processed foods and obesity. Although some of these concerns may find bipartisan support – such as the focus on 'forever chemicals' such as PFAS – it also pushes into areas where the science is unsettled. For instance, the report mentions that high levels of fluoride are potentially associated with reduced IQ, but does not mention its well established protective effects against cavities – the most common chronic condition in children according to the National Institute of Dental and Craniofacial Research. Similarly, the report argues that the childhood vaccine schedule is causing concern among parents for,'their possible role in the growing childhood chronic disease crisis' – without citing evidence that vaccines are linked to any specific chronic disease. Even before the report was published, congressional lawmakers were being bombarded by calls from agricultural and chemical lobbyists wary of how the report would criticize their products – and indeed it did. One of the report's sections questions whether 'crop protection tools' including 'pesticides, herbicides and insecticides' could harm human health. It then specifically name-drops glyphosate, the key ingredient in Roundup, and atrazine, a common herbicide. That is sure to make for strange political bedfellows and consternation within the Republican party. Similarly, the report cites synthetic dyes and ultra-processed foods are potentially harmful. Chemicals and food additives have been issues of concern for decades on the left. However, the Maha movement has also catalyzed opposition to them on the right. The commission's members are made up of the heads of intersecting agencies, including Kennedy at the Department of Health and Human Services, and the heads of the departments of agriculture, housing, education, veterans affairs and the Environmental Protection Agency among others. However, the exact authors of the report are unknown. This contrasts with Kennedy's repeated promise at his confirmation hearing that his health department would practice 'radical transparency'. The work of the 'Maha' commission was reportedly spearheaded by senior Kennedy adviser Calley Means, a former food lobbyist and healthcare entrepreneur who rose to prominence as a Maha truth-teller. Means co-wrote a bestselling book with his sister, current US surgeon general nominee Casey Means, which blames many of America's ills on sedentary lifestyle and poor diet. One of the key issues the report identifies is the influence of food, pharmaceutical and chemical companies on American policy. They are monied and powerful. As a result, getting real change through Congress is certain to be tough – especially in an administration devoted to reducing regulations.
New York Times
16-05-2025
- Health
- New York Times
When a Vaccine Safety Trial Becomes Unethical
The Department of Health and Human Services last week announced a new standard for testing the safety of vaccines, a 'radical departure from past practices.' All new vaccines will be evaluated against a placebo, an inert look-alike that serves as a point of comparison, the department said. Health Secretary Robert F. Kennedy Jr., as well as many anti-vaccine groups, has long argued that placebo-controlled trials were the only way to fully understand vaccine side effects. To scientists who have spent their careers evaluating vaccines, the plan did not seem so radical. New vaccines are often tested against a placebo in clinical trials. One researcher has created a crowdsourced spreadsheet of more than a hundred examples. But it also concerned vaccine experts that Mr. Kennedy seemed not to recognize the circumstances when placebo groups are neither ethical nor practical. The idea is widely accepted by scientists and enshrined in ethics frameworks for medical research. 'He's asking for something that's not ethical,' said Arthur Caplan, a leading bioethicist at the New York University Grossman School of Medicine. Why Are Placebos Used in Vaccine Trials? Randomized placebo-controlled trials are often described as the 'gold standard' of research: they allow scientists to tease out whether the effects they observe result from the drug itself or some other factor, such as the expectation of treatment. Patients in trials of drugs for depression or pain, for example, often report feeling better even if they haven't received the treatment — the so-called placebo effect. In vaccine trials, researchers also use placebos, often shots of a saline mixture, to help quantify behavioral and psychological changes that might arise from participants knowing whether or not they received the real vaccine. Had some participants during the Covid-19 vaccine trials known they didn't get the actual vaccine, for example, they might have avoided the virus by staying home, potentially skewing data about infection rates. Similarly, simply believing that they have gotten the real shot can make trial subjects more attuned to possible side effects and more likely to report them. One study found that nearly a third of participants who received a harmless placebo during Covid vaccine trials reported side effects, most commonly headaches and fatigue. Why Don't Some Trials Include Placebos? Placebo-controlled trials, which may last years and cost tens of millions of dollars, are not always feasible or necessary, especially for vaccines that are updated every year, like the flu shot. 'By the time you're done with that trial, it would be two years later and your vaccine is already outdated,' said Dr. Daniel Salmon, director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health. 'Pragmatically, it's just not possible.' Instead, updated flu shots — which are only slightly tweaked each year — are tested in animals to see whether they produce an immune response similar to earlier versions of the vaccine, which have extensive safety and efficacy data. There are also ethical reasons why using a placebo may not be appropriate. Perhaps the clearest example comes from the polio vaccine trial in 1954. Hundreds of thousands of children had volunteered, eager for a chance at protecting themselves against a devastating disease that was sweeping through classrooms and communities, causing irreversible paralysis and death. More than 200,000 of those children were randomly assigned to the placebo group, receiving doses of saline water instead of the vaccine. By the end of the trial, 16 of those children had died of polio. All of the children who received the vaccine survived. Bioethicists and scientists believe that the saline shots were ultimately necessary to prove the vaccine's effectiveness. And since there was no alternative vaccine or treatment at the time, the children assigned to the placebo were not at higher risk than the average American primary schooler. But institutional review boards, which are charged with evaluating the ethics of medical studies before they start, carefully weigh the experimental benefits of using a placebo against their responsibility to protect the participants in the trial. 'It is better to do a randomized, placebo-controlled trial,' said Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia. 'But there is a certain cruelty to that.' How Are Vaccines Tested Without a Placebo? In general, review boards abide by the principle that placebos are not appropriate if there is a 'proven intervention' that already exists that has an established record of safety. In those cases, researchers will compare the new vaccine with the standard of care. For example, during the development of the first vaccine for HPV, a sexually transmitted virus that causes nearly all cases of cervical cancer, researchers compared its efficacy and safety with that of a placebo. The vaccine was a huge success. The shot reduced the risk of cervical cancer by 70 percent. Years later, when researchers developed a vaccine that they believed would protect against five additional types of the virus, they could not ethically test it against a placebo. Doing so would have meant withholding a safe and very effective vaccine from half the participants. Instead, scientists measured how much more effective the new HPV shot was than the original vaccine. Michael Osterholm, an epidemiologist at the University of Minnesota, said offering a saline shot in such a scenario would be akin to running an experiment in which 'half the parachutes opened and half did not.' The same logic often applies to clinical trials for new cancer medications, which commonly enroll patients undergoing chemotherapy and radiation as a control group, rather than a placebo. 'It's going to be a little harder to see the effect because you're getting some benefit from the control group,' said Dr. Caplan, the bioethicist. 'But it's wrong to say, 'Well, sorry, you have to die faster if you're assigned to the placebo.''
Forbes
16-05-2025
- Business
- Forbes
Unlocking the value of senior leadership in today's workforce.
Warren Buffett proves that seasoned leadership can pay dividends. When Warren Buffett stunned investors by revealing plans to retire at year‑end, questions about the right time to step aside resurfaced — and they're hardly new. The passing of Pope Francis at 88 prompted similar reflection: his pontificate was defined by empathy, adaptability and clear vision well into advanced age. Together, these events underscore that value of senior leadership — life experience often amplifies cognitive agility, physical wellbeing and emotional intelligence. With breakthroughs in longevity medicine — from senolytics to personalized gene therapies — today's senior leaders aren't just brimming with wisdom; they're poised to lead well into their eighth decade. The good news: your decades of experience aren't just valuable — they've given you a unique professional edge that only comes with time. Institutions from the Vatican to corporate boardrooms have long debated how to balance vigor and judgment. Pope Francis challenged the notion that age alone limits impact. In high‑stakes roles — whether governing nations or steering Fortune 500 companies — years of accumulated insight can guide better decisions, provided leaders maintain health and stay mentally sharp. Many older professionals aren't done contributing — but the workplace, it seems, isn't done discriminating against them because of persistent ageism, according to a new University of Washington study led by a prominent bioethicist. Ageism isn't just bias or intergenerational tension — it's a clash over scarce resources. As populations age globally, younger generations increasingly perceive older adults as economic burdens, competing for pensions, jobs and social benefits. Studies reveal that when pension systems strain under demographic shifts (e.g., fewer workers supporting more retirees), resentment grows. Multigenerational workplaces must address this tension head-on. The Business Cost of Letting Seniors Go In relationship-driven industries like advertising, forcing out experienced talent carries steep consequences. Seasoned creative directors leverage decades of institutional knowledge and deep client trust — qualities that pay dividends in both creativity and consistency. Broader workforce studies back this up: a Gallup‑based SmartBrief analysis found that teams including older workers are 21 percent more productive. Moreover, workplaces with members 55 and older experience 37% less absenteeism and turnover. Reducing absenteeism and turnover of just one employee can save a business between $7,400 to $31,700, depending on the job and industry. Ad agencies lose not just this wisdom but profit margins too, paying premium freelance rates for the same talent they let go. The irony? These older professionals understand the 50+ demographic controlling 70% of U.S. wealth better than junior teams, yet youth-obsessed agencies frequently miss the mark with age-blind campaigns that stereotype or ignore lucrative older consumers. Financial Headroom and Transferable Skills According to AARP, older workers may have a number of advantages that allow them to find new opportunities. They may have accumulated assets that give them the financial stability to devote time and resources to a new career path. They may also have the deep experience and transferrable skills that take time to develop. How Senior Talent is Rewriting the Rules America's seniors are redefining retirement. A 2021 Census Bureau report reveals a striking trend: Workforce participation among adults 75+ surged in 36 states between 2010 and 2019 — with no declines anywhere. Even in the 65-74 age group, gains outpaced losses dramatically, rising in 25 states while dipping in just two. This isn't a blip; it's a seismic shift in how older Americans view work, longevity, and purpose. New data from Bain & Co. reveals older workers will claim 150 million roles by 2030 — and they're just getting started. With the 55+ workforce 4x larger than in the 1980s and better educated, smart employers are racing to recruit from this overlooked talent pool. Every 80-year-old is Different Importantly, age tells only part of the story. At 80, some people still helm multinational corporations — closing complex deals with laser focus — while others defy expectations by training for 10K races. Yet many octogenarians face lapses in memory or mobility that limit their independence. With maturity comes deep domain expertise and seasoned judgment, but there's a real risk of clinging to outdated practices if you're not actively engaged in continuing education. Think of the JAMA review as a reality check — most physicians with decades of experience saw their performance decline, while only a small subset continued to improve with age. In business terms, even the most seasoned leaders can slip into outdated routines if they stop learning — the fix is to pair hard‑won experience with regular peer reviews, continuous training and outcome audits, ensuring institutional knowledge stays fresh and leaders stay ahead of the curve. The Cognitive Dividend of Challenging Work Neuroscience now confirms that mentally stimulating work protects cognitive health. According to Harvard Health, people with cognitively stimulating jobs had a 23% lower risk of developing dementia compared with those whose jobs were not considered stimulating. Neurology Advisor's review of long‑term studies shows that mentally demanding work slows cognitive decline and delays dementia across memory, executive and language functions. For knowledge industries, this creates a compelling case: retaining senior talent isn't just about experience — it may actively slow brain aging through continued professional challenges. Retirement Is a Bad Business Investment Mandating exit ramps based solely on age is both unfair and economically short‑sighted. With life spans stretching longer, many older professionals possess the drive, mental agility and networks to deliver exceptional value. Rather than blanket policies, organizations ought to adopt: Pope Francis proved that octogenarians are the new fiftysomethings. Start measuring readiness by agility and insight — today's 65 may feel like tomorrow's 45. What will your organization do next? Recognizing the value of senior leadership means seeing health, adaptability and demonstrated competence as far richer metrics than a calendar age. By valuing the strengths of all generations, businesses and institutions can tap a wellspring of experience, cultivate stronger pipelines and redefine leadership for an aging world.
