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Female genital cutting (FGC) has wide acceptance in many cultures across the globe despite gender-related and more general human rights concerns raised by the practice. This chapter presents a case study on a healthy 5-year-old female patient scheduled for surgical correction of clitoral phimosis. Physicians must understand the potential medical sequelae of FGC to make reasoned decisions about whether or not to participate in the procedure. Immediate adverse outcomes of FGC include pain, post-operative infection, shock, tetanus, hemorrhage, and death. Whether an anesthesiologist should participate in FGC depends on his or her interpretation of ethical considerations. Mostprofessional societies provide only guidance, without a binding effect on members.Physician participation in FGC may prevent some health consequences but also perpetuates objectionable social practices. Physicians' decisions to participate in FGC currently rely on personal judgments, weighing adverse medical and psychological consequences against potential cultural benefits and harms.
In 1991, the University of Pittsburgh Medical Center (UPMC) implemented a policy that permitted the recovery of organs from cadavers pronounced dead using standardized cardiac criteria (Non-Heartbeating Cadavers or NHBC). This policy allowed families that had made a decision to forgo life sustaining treatment to then request organ donation. This entailed taking the patient to the operating room, discontinuing therapy (typically but not necessarily a ventilator), and after the patient is pronounced dead, procuring organs.
Research involving the dead has not been regulated, and little, if any, institutional oversight has been provided. As a result, the numbers and types of research projects involving the dead are at best poorly characterized and at worst, unknown. The University of Pittsburgh instituted a mechanism for oversight of such research in June 2002. In this article, we report the experience of that oversight body, the Committee for Oversight of Research Involving the Dead (CORID), during its first 18 months.
The first reported successful kidney transplantation occurred in 1954, between twins. Since then, organ donation and transplantation has become less a medical marvel than a common expectation of patients with a variety of diseases resulting in organ failure. Those expectations have caused demand for organs to skyrocket far beyond available supply, fueling an organ shortage and resulting in over 60,000 patients on transplant waiting lists. In this special issue, our contributors attempt to shed new light on some of the many old ethical questions raised by transplant in the contemporary context of extreme scarcity.
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