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New in the Hastings Center Report May-June 2017

The Hastings Center

Defending Opioid Treatment Agreements: Disclosure, Not Promises
Joshua B. Rager and Peter H. Schwartz

To receive controlled pain medications for chronic pain, patients often must sign a "narcotic contract" or "opioid treatment agreement" in which they promise, among other things, not to give pills to others or use illegal drugs. While the aim is to address the widespread abuse and misuse of narcotic pain medication, critics argue that these agreements are ethically suspect, if not unethical. The authors conclude, however, that the most serious criticisms stem from a misunderstanding of the agreements' purpose. Specifically, that purpose is not to justify the system of monitoring and supervision but instead to disclose its requirements to patients. Joshua B. Rager is a medical student at the Indiana University School of Medicine. Peter H. Schwartz is a physician and the interim director of the Indiana University Center for Bioethics.

Other Voices:

Given the uncertainty regarding the safety and efficacy of opioid painkillers, as well as insufficient training for prescribers and inadequate patient education, Anita Ho proposes replacing OTAs with opioid treatment plans, which would promote mutual, collaborative, and shared decision-making on the most appropriate pain management program, one that would hold all parties accountable. Richard Payne, a physician, believes that physicians will continue to use OTAs as protection against litigation and sanctions by medical boards, at the expense of patients in pain.

How to Rethink the Fourteen-Day Rule
Sarah Chan

Recently, attention has been drawn to the basic principles governing the use of human embryos in research: specifically, the so-called 14-day rule, which stipulates that human embryos should not be allowed to grow in vitro past 14 days of development. For years, the 14-day limit was largely theoretical, since it was not possible to maintain embryos up to this point. But in the past year, research has suggested that growing embryos for a longer period might be feasible and scientifically valuable. At the same time, other research raises the possibility that pluripotent stem cells, including human PSCs, could be used to generate embryo-like structures in vitro, even "synthetic embryos," that might provoke moral concern but would not fall under most current embryo research policies. Any moves to change the 14-day rule must consider not just the implications for the use of embryos but also the potential impact of this model of bioethical governance of science. Sarah Chan is a chancellor's fellow at the University of Edinburgh.

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