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10/29/2012

Patient Refusal to Leave the Hospital: And Now What?

The hospital and the life there leads to sometimes different views among patients. Most patients want to "get the job done" whatever the reason for admission was and what procedures were carried out, to feel better and get on the road to complete recov...

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This entry was posted in Health Care and tagged , . Posted by Maurice Bernstein. Bookmark the permalink.

10/24/2012

The October issue of AJOB is here!

This month’s issue includes a target article on whether or not to disclose research results from whole-exome sequencing to relatives of a family member who has died.  Such topics as genetic privacy, a duty to warn, policies in place to regulate such disclosure, clinical significance and boundaries come to the fore in light of this discussion.

Our second target article tackles surrogate decision making in the internet age.  Such concepts as social media and identity, the function of social media in decision-making, potential hazards and the online availability of one’s preferences are considered.

 

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This entry was posted in Featured Posts, Genetics and tagged . Posted by The American Journal of Bioethics. Bookmark the permalink.

10/24/2012

Your Brain in the Courtroom

Ross White

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This entry was posted in Health Care and tagged , . Posted by Susan Gilbert. Bookmark the permalink.

10/17/2012

Time to Change FDA’s Discriminatory Blood Donation Policy

A recent flurry of articles in the mainstream media (The Atlantic, CNN, Huffington Post) reflects yet another wave of protest against the Food and Drug Administration’s blood donation policy, which prohibits men who have had sex with men (MSM), even...

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This entry was posted in Health Care and tagged , . Posted by Susan Gilbert. Bookmark the permalink.

10/16/2012

A LATE QUARTET: Bioethics and Grief

A Late Quartet had its USA premiere at the Mill Valley Film Festival. It is directed by Yaron Zilberman and co-written with Seth Grossman. Set for release on November 2, 2012, it will be a force to contend with. Generally, I try not to be effusive when writing about films. In this case, I have to admit, I can't help myself. Of all of the films I've seen at the 35th Mill Valley Film Festival; this is the only one that moved me uncontrollably to tears. The feeling evoked is most reminiscent of the intimacy one feels when caring for individuals and their families at critical points in their lives, particularly births and deaths.  A Late Quartet is a story of passion in the context of both.

This is a smart script.  The characters represent instruments in the Quartet; two violins, a viola and a cello, in reality and in the story line. The characters entrances into the composition are guided by sheet music, at once familiar and seen as though for the first time.  Christopher Walken, who I had seen the day before in a perfectly wonderful performance with Al Pacino in Stand Up Guys, surpasses even himself. In this film, the full range of his sensitivities and skill are apparent.  For me, he will never again be a convincing gangster or grifter. Philip Seymour Hoffman, who defies type casting, plays a surprisingly warm, vulnerable husband, father and second violin. Wallace Shawn, the founder of the Quartet, finds himself spiraling out of control because he falls prey to his own personality.

This is a big film for the two women who co-star in it.  In a season with only a handful of strong women's characters, Catherine Keener and Imogeen Poots both play sharp crisp roles. They well reflect both strength and the texture of women stretching the boundaries of love in a way that is uniquely specific to our gender. These are women’s roles bearing the strengths of this century.

How is this film significant in terms of bioethics? Bioethics is an organized way of thinking about conflicts between; what we know about medicine, what individuals want for themselves and what the collective thinks the other two are worth. There is medicine in the storyline, as well as grief, life threatening challenges and autonomous wishes and the need for transcendence. This work takes its lead from the String Quartet No.14 in C♯ minor, Op. 131, by Ludwig van Beethoven, an atypical seven movement quartet that is intrinsically connected to death.  On his death bed, Schumann requested to hear it.  The film, like the quartet, looks at loss from multiple angles; loss of life, love, health, passion and creativity. However, the story emerges from this abundance of loss with perseverance of passion. Fore-shadowing prepares the viewer for each characters arc. Set in warm rooms and a small concert stage, A Late Quartet is both ambitious and elegant in the style of a true New York movie and its classical music scene. 

A device of bioethics is the examination of the stages of grief to resolve associated conflicts in the process. The classical view of grief is the Kubler-Ross 5: denial, anger, depression, bargaining and acceptance. Instead, the James Hallenbeck 5 identifies tasks to be tackled during the developmental stage of life's end. People who are dying and those who love them need to say and hear: I'm sorry, I forgive you, thank you, I love you and, when it's time, goodbye.  The idea is that without focus on these processes, transcendence is not possible. Transcendence is the goal of dying and loss. In A Late Quartet, the Hollenbeck 5 form the opus. 

Finally, a variation of the Hettle Rule is attributed to cellist Pablo Casal; seek what works well instead of what does not, as a vehicle for healing. If there is one film to see this year, it is the visually smart, emotionally accessible, musically astounding, A Late Quartet.

A Late Quartet (35 mm) directed by Yaron Zilberman. USA.  2012
scheduled for release on November 2, 2012.

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This entry was posted in Health Care and tagged . Posted by September Williams, MD. Bookmark the permalink.

10/14/2012

Patient Modesty: Volume 51

It is all about "spreading the word".  In all of these  previous 50 Volumes and literally thousands of postings on this blog, the observations of visitors regarding the inadequate state of preserving patient modesty by the medical caregivers&...

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This entry was posted in Health Care and tagged , . Posted by Maurice Bernstein. Bookmark the permalink.

10/12/2012

Health Care for Undocumented Immigrants: A Family Issue

Susan Gilbert

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This entry was posted in Health Care and tagged , . Posted by Susan Gilbert. Bookmark the permalink.

10/09/2012

For a Survivor, it’s Not Easy Being Pink

I am a breast cancer survivor and I am not a fan of the huge “pink” industry that has developed around breast cancer. We have ribbons, pins, and bands. We have races and walks. We even have our own month, October: National Breast Cancer Month. It

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This entry was posted in Health Care and tagged , . Posted by Susan Gilbert. Bookmark the permalink.

10/08/2012

SILVER LININGS PLAYBOOK: Mental Illness Meets a New Genre

One of the two opening films, at the 35th Mill Valley Film Festival, was Silver Linings Playbook. Both the director/screenwriter, David O. Russell and lead actor, Bradley Cooper, were available for the post screening Q & A. Silver Linings Play...

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This entry was posted in Health Care and tagged . Posted by September Williams, MD. Bookmark the permalink.

10/04/2012

Missing Reports: Research Biopsy in Cancer Trials


A growing number of drug trials are collecting tissue to determine whether the drug hits its molecular target.  These studies are called “pharmacodynamics.”  And in cancer, many pharmacodynamics studies involve collection of tumor tissue through biopsies.  These procedures are painful, and are performed solely to answer scientific questions.  That is, they generally have no diagnostic or clinical value.  As such, some commentators worry about their ethics.


In a recent issue of Clinical Cancer Research, my Master’s student Gina Freeman and I report on publication practices for pharmacodynamics studies involving tumor biopsy.  The basic idea is this: the ethical justification for such invasive research procedures rests on a claim that they are scientifically valuable.  However, if they are never published, it is harder to argue that they have a sound scientific justification.  So we set out to determine how frequently results are published, and reasons why some results are never reported. Briefly, we found that a third of promised analyses are not published- which is more or less in line with the frequency of nonpublication for trials in general.  We also find that researchers who perform pharmacodynamics studies regard reporting quality as fair to poor, and many perceive the most common reason for nonpublication to be “strategic considerations” (as in: result does not fit the narrative of the overall trial).


Does our article support a definitive statement about the ethics of research biopsy in cancer trials?  No.  But it does point to a number of ways that the ethical justification can be strengthened- and questions clinical investigators and ethics boards should be asking when designing and/or reviewing protocols involving research biopsy. (graphic: cole007 2011)

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This entry was posted in Health Care and tagged , . Posted by Jonathan Kimmelman. Bookmark the permalink.