The lack of data authentication and integrity guarantees in the Domain Name System (DNS) facilitates a wide variety of malicious activity on the Internet today. DNSSec, a set of cryptographic extensions to DNS, has been proposed to address these threats. While DNSSec does provide certain security guarantees, here we argue that it does not provide what users really need, namely end-to-end authen...

BACKGROUND Brain death is strictly defined medically and legally. This diagnosis depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. The diagnosis can only be made, however, in the absence of intoxication, hypothermia, or certain medical illnesses. CASE PRESENTATION A patient with severe hypoxic-ischemic brain injury met the three cardinal neurological...

Human trafficking is a pervasive problem that exceeds the capacity of social and organizational resources to restrain and for which guidelines are inadequate to assist medical professionals in responding to the special needs of victims when they present as patients. One obstacle to appropriate disagreement with an inadequate status quo is the lure of group cohesion. "Groupthink" is a social psy...

It is the JME's 40th anniversary and my 20th anniversary working in the field. I reflect on the nature of bioethics and medical ethics. I argue that both bioethics and medical ethics together have, in many ways, failed as fields. My diagnosis is that better philosophy is needed. I give some examples of the importance of philosophy to bioethics. I focus mostly on the failure of ethics in researc...

The DOMINO study group has published the report of its ‘futility study’ of minocycline treatment in HD. Minocycline and a placebo pill were tested over 18 months. A futility study is designed to make it relatively easy for a drug to be recommended for larger studies, but minocycline treatment wasn’t promising enough and the study authors found that further trials with minocycline were “not warr...

Challenging issues confront emergency physicians routinely when performing cardiopulmonary resuscitation. Ethical issues surrounding resuscitation may include issues of futility, withholding or withdrawing interventions, advance directives, family presence, practising procedures on the newly dead, palliative care, and communication. Principles of bioethics can be valuable in assessing and debat...

End-of-life decision-making is a complex process that can be extremely challenging. We describe a 42-year-old woman in an irreversible coma without an advance directive. The case serves to illustrate the complications that can occur in end-of-life decision-making and challenges in resolving difficult futility disputes. We review the role of advance directives in planning end-of-life care, the r...

The R package gset calculates equivalence and futility boundaries based on the exact bivariate non-central t test statistics. It is the first R package that targets specifically at the group sequential test of equivalence hypotheses. The exact test approach adopted by gset neither assumes the large-sample normality of the test statistics nor ignores the contribution to the overall Type I error ...