Professionally responsible counseling when a fetal anomaly is diagnosed by ultrasound

© The Author(s). 2020. Ethics plays an essential role in the clinical management of pregnancies complicated by fetal anomalies diagnosed by ultrasound. Utilizing the prima facie ethical principles of beneficence and respect for autonomy, this paper first explicates the ethical concept of the fetus as a patient. This ethical concept provides the basis for a comprehensive approach to counseling pregnant women about the management of pregnancies complicated by fetal anomalies. Practical, ethically justified guidance is given for counseling about decisions both before and after viabilities

Teaching Professional Formation in Response to the COVID-19 Pandemic.

In response to the COVID-19 pandemic, the Association of American Medical Colleges has called for a temporary suspension of clinical teaching activities for medical students. Planning for the continued involvement of learners in patient care during this pandemic should include teaching learners professional formation. The authors provide an ethical framework to guide such teaching, based on the ethical principle of beneficence and the professional virtues of courage and self-sacrifice from professional ethics in medicine. The authors show that these concepts support the conclusion that learners are ethically obligated to accept reasonable, but not unreasonable, risk. Based on this ethical framework, the authors provide an account of the process of teaching professional formation that medical educators and academic leaders should implement. Medical educators and academic leaders should embrace the opportunity that the COVID-19 pandemic presents for teaching professional formation. Learners should acquire the conceptual vocabulary of professional formation. Learners should recognize that risk of infection from patients is unavoidable. Learners should become aware of established ethical standards for professional responsibility during epidemics from the history of medicine. Learners should master understandable fear. Medical educators and academic leaders should ensure that didactic teaching of professional formation continues when it becomes justified to end learners\u27 participation in the processes of patient care; topics should include the professionally responsible management of scarce medical resources. The COVID-19 pandemic will not be the last major infectious disease that puts learners at risk. Professional ethics in medicine provides powerful conceptual tools that can be used as an ethical framework to guide medical educators to teach learners, who will bear leadership responsibilities in responses to future pandemics, professional formation

ETHICAL DIMENSIONS OF THE FETUS AS A PATIENT

Objective: To describe the ethical concept of the fetus as a patient and identify its implications for the deliberative practice of perinatal medicine.Methods: We describe secular medical ethics and its two fundamental principles, beneficence and respect for autonomy. We articulate the ethical concept of the fetus as a patient on the basis of the ethical principle of beneficence.Results: In the deliberative practice of perinatal medicine guided by the ethical concept of the fetus as a patient, the perinatologist should always identify and balance beneficence-based obligations to the fetal patient and beneficence-based and autonomy-based obligations to the pregnant patient. Directive counseling is appropriate when the fetus is a patient. Non-directive counseling is appropriate when the fetus is not a patient.Conclusion: Counseling pregnant women about the clinical management of their pregnancies should always identify and balance beneficence-based obligations to the fetal patient and beneficence-based and autonomy-based obligations to the pregnant patient.

Absence of a Zero Temperature Vortex Solid Phase in Strongly Disordered Superconducting Bi Films

We present low temperature measurements of the resistance in magnetic field of superconducting ultrathin amorphous Bi films with normal state sheet resistances, $R_N$, near the resistance quantum, $R_Q={\hbar\over {e^2}}$. For $R_N<R_Q$, the tails of the resistive transitions show the thermally activated flux flow signature characteristic of defect motion in a vortex solid with a finite correlation length. When $R_N$ exceeds $R_Q$, the tails become non-activated. We conclude that in films where $R_N>R_Q$ there is no vortex solid and, hence, no zero resistance state in magnetic field. We describe how disorder induced quantum and/or mesoscopic fluctuations can eliminate the vortex solid and also discuss implications for the magnetic-field-tuned superconductor-insulator transition.Comment: REVTEX, 4 pages, 3 figure

First Astronomical Use of Multiplexed Transition Edge Bolometers

We present performance results based on the first astronomical use of multiplexed superconducting bolometers. The Fabry-Perot Interferometer Bolometer Research Experiment (FIBRE) is a broadband submillimeter spectrometer that achieved first light in June 2001 at the Caltech Submillimeter Observatory (CSO). FIBRE'S detectors are superconducting transition edge sensor (TES) bolometers read out by a SQUID multiplexer. The Fabry-Perot uses a low resolution grating to order sort the incoming light. A linear bolometer array consisting of 16 elements detects this dispersed light, capturing 5 orders simultaneously from one position on the sky. With tuning of the Fabry-Perot over one free spectral range, a spectrum covering Δλ/λ= 1/7 at a resolution of δλ/λ ≈ 1/1200 can be acquired. This spectral resolution is sufficient to resolve Doppler-broadened line emission from external galaxies. FIBRE operates in the 350 µm and 450 µm bands. These bands cover line emission from the important star formation tracers neutral carbon [Cl] and carbon monoxide (CO). We have verified that the multiplexed bolometers are photon noise limited even with the low power present in moderate resolution spectrometry

Quantum superconductor-metal transition in a proximity array

A theory of the zero-temperature superconductor-metal transition is developed for an array of superconductive islands (of size d) coupled via a disordered two-dimensional conductor with the dimensionless conductance g>>1. At T=0 macroscopically superconductive state of the array with the lattice spacing b>>d is destroyed at g < g_c \approx 0.1 ln^2(b/d). At high temperatures the normal-state resistance between neighboring islands at b=b_c is much smaller than h/4e^2.Comment: RevTeX, 7 pages, 2 eps figure

Professionally responsible coronavirus disease 2019 vaccination counseling of obstetrical and gynecologic patients

© 2021 Elsevier Inc. The development of coronavirus disease 2019 vaccines in the current and planned clinical trials is essential for the success of a public health response. This paper focuses on how physicians should implement the results of these clinical trials when counseling patients who are pregnant, planning to become pregnant, breastfeeding or planning to breastfeed about vaccines with government authorization for clinical use. Determining the most effective approach to counsel patients about coronavirus disease 2019 vaccination is challenging. We address the professionally responsible counseling of 3 groups of patients—those who are pregnant, those planning to become pregnant, and those breastfeeding or planning to breastfeed. We begin with an evidence-based account of the following 5 major challenges: the limited evidence base, the documented increased risk for severe disease among pregnant coronavirus disease 2019-infected patients, conflicting guidance from government agencies and professional associations, false information about coronavirus disease 2019 vaccines, and maternal mistrust and vaccine hesitancy. We subsequently provide evidence-based, ethically justified, practical guidance for meeting these challenges in the professionally responsible counseling of patients about coronavirus disease 2019 vaccination. To guide the professionally responsible counseling of patients who are pregnant, planning to become pregnant, and breastfeeding or planning to breastfeed, we explain how obstetrician-gynecologists should evaluate the current clinical information, why a recommendation of coronavirus disease 2019 vaccination should be made, and how this assessment should be presented to patients during the informed consent process with the goal of empowering them to make informed decisions. We also present a proactive account of how to respond when patients refuse the recommended vaccination, including the elements of the legal obligation of informed refusal and the ethical obligation to ask patients to reconsider. During this process, the physician should be alert to vaccine hesitancy, ask patients to express their hesitation and reasons for it, and respectfully address them. In contrast to the conflicting guidance from government agencies and professional associations, evidence-based professional ethics in obstetrics and gynecology provides unequivocal and clear guidance: Physicians should recommend coronavirus disease 2019 vaccination to patients who are pregnant, planning to become pregnant, and breastfeeding or planning to breastfeed. To prevent widening of the health inequities, build trust in the health benefits of vaccination, and encourage coronavirus disease 2019 vaccine and treatment uptake, in addition to recommending coronavirus disease 2019 vaccinations, physicians should engage with communities to tailor strategies to overcome mistrust and deliver evidence-based information, robust educational campaigns, and novel approaches to immunization