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Author Archive: Craig Klugman

05/27/2016

Why America Needs Bioethics Right Now

by Craig Klugman, Ph.D.

From the title, you probably assumed I’m going to talk about the fast changing pace of medical technology, whether we should be working on human embryos, claims that scientists will be able to do head transplants within 2 years, or even whether the Olympics should be postponed because of Zika. This blog has also paid attention to some of the orphan issues of bioethics: public health, social justice, health disparities, climate change and medicine in war, torture and guns. My interest today, though, is not on the content of bioethics, but rather on its methods of discourse.…

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05/25/2016

Few Patients Understand Their Cancer: Time to Change Our Approach

by Craig Klugman, Ph.D.

I have a slide that I use when teaching my students about clinical ethics: “80% of ethics consults are about communication.” The only evidence base I have for this statement is a 2005 Norwegian study with a very small subject pool. A more recent study identified communication issues in 45-51% of all cases.  Thus, I was not surprised to see an ABC News piece earlier this week, “Just 5% of Terminally Ill Cancer Patients Fully Understand Prognosis, Study Finds.”  

Of course that turns out not to be the whole story. In pre-intervention interviews with patients, only 5% of oncology patients could correctly answer four questions about their illness: Recognizing the disease was incurable, knowing the “advanced stage of their disease,” acknowledging a short life expectancy, and acknowledging they have a terminal illness.…

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05/20/2016

BioethicsTV: Week of May 20 – Assisted suicide, public health crisis management, and making promises

Chicago Med
In its first season finale (episode 18), Dr. Downey arrives in the emergency department in distress—he is bleeding from his liver as a side effect from his cancer treatment. When he does not awake from the anesthesia, Dr. Rhodes, his protégé, suspects a stroke during surgery. A CT scan shows that Downey did not have a stroke, but rather has a large, inoperable brain tumor—his cancer has metastasized. We are told that his future prognosis is grim and that he is in unrelievable pain. Instead, he asks Rhodes to help him die. This request is a reference back to episode 11 when Rhodes removed a patient’s LVAD at the patient’s request and Choi accuses him of performing an assisted suicide.…

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05/13/2016

BioethicsTV: Paternalism (again) on Chicago Med

by Craig Klugman, Ph.D.

Our favorite television dramas this week were light on bioethics issues with the exception of Chicago Med (season 1; episode 17 “Withdrawal”) that continues to explore bioethical issues. This week the theme was arrogant paternalism—residents and fellows believing that only they know what is in the best interest of the patient.

The first storyline concerns a patient brought into the ED in the throes of alcohol withdrawal. He is a frequent flyer patient and has not had a drink in 2 days. Dr. Halstead (resident) believes that what is best for the patient is to help him through withdrawal so he can quit drinking and enter recovery.…

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05/12/2016

Euthanasia for Reasons of Mental Health

by Craig Klugman, Ph.D.

An article in the (UK) Daily Mail this week focused on a Dutch woman who chose euthanasia “after doctors decided her post-traumatic stress and other conditions were incurable.” Under Dutch euthanasia laws, a physician can end a patient’s life with a lethal injection for mental suffering. Her life was ended last year.

Euthanasia is when a physician delivers the substance that ends a patient’s life. This is distinct from physician/doctor/provider-assisted suicide (often called aid-in-dying) where a physician makes the means to end life available (often through a prescription) but the patient must ingest the life-ending medication.…

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05/06/2016

BioethicsTV: Mistaken diagnosis, patient battery, “work-arounds,” and trans-gender patient health

by Craig Klugman, Ph.D.

A look at the ethical and professionals issues raised in medical dramas this week: Chicago Med and Heartbeat.

Chicago Med

This new show is always good for presenting challenges in professionalism and bioethics. This week (season 1; episode 16) is no exception as the fictional hospital finds itself in the middle of a surprise Joint Commission visit (though they often refer to the organization as “jay-koh” it’s previous abbreviation). One of the storyline this week deals with a retired neurologist and her husband with Lewy Body syndrome. She diagnosed him originally and took him to see two specialists who confirmed her diagnosis.…

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05/05/2016

“And Death Shall Be No More”

by Craig Klugman, Ph.D.

Two years after John Donne’s death, the Holy Sonnets were published. In Sonnet 10, Donne speaks about the end of death: “Death, thou shalt die.” Although a metaphorical conceit referring to eternal life in heaven, the poem takes on new meaning in the age of regenerative medicine.

Since the 1968 ad hoc Harvard committee on defining death, brain death has been defined as the “irreversible loss of all functions of the brain, including the brainstem.” If a new project is successful that definition may have to be revised or deleted.

Bioquark (US) and Revita Life Sciences (India) have received human subjects approval from the NIH to reverse brain death and regenerate the brains of 20 patients.…

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05/03/2016

BioethicsTV: Containment Fails to Go Viral

by Craig Klugman, Ph.D.

The CW network began airing a “limited” series (what used to be called a mini-series) drama about a bio-terrorism outbreak in the city of Atlanta. Similar to the far superior film Contagion, this television show explores how lives change and the tough decisions that are made in an epidemic.

Containment demonstrates many of the real tools public health has for controlling an epidemic of little known origin and lacking cure or vaccine: closing public places, compulsory leave at businesses, cordon sanitaire, curfews, sanitation, isolation, price controls, quarantine, screening, surveillance, testing, and travel restrictions.

Like all good ethics, I’ll begin with some definitions: Although there are several definitions for these terms, for our purposes here, quarantine is separating exposed persons who are symptom free.…

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04/29/2016

BioethicsTV: Boundaries are Black and White on Grey’s

by Craig Klugman, Ph.D.

Reaching back to its roots, Grey’s Anatomy in its 12th season has been investigating more professional and ethical challenges in medicine. The April 28th episode (Season12: Episode 21) focused on questions of boundaries of why physicians should not treat their loved ones.

The first story was about a resident dating a former patient. Since the key term is former such a move may not be a pragmatic choice, but it does not violate professional boundaries (unless the physician is a psychiatrist in which case the APA says it may never be okay to date a former patient).…

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04/26/2016

BioEthicsTV: A night of consent issues on ChicagoMed

by Craig Klugman, Ph.D.

On this week’s episode of ChicagoMed (Season 1; Episode 15) issues of consent was the main focus. The first major storyline concerned a 16-year-old in abdominal pain who enters the ED with her father, a heroin addict. Although in pain and in need of a diagnostic endoscopy, the patient refuses any and all medications: She fears that even one dose will turn her into the addict that her father has been for her entire life. The doctors try the endoscopy without anesthetic or pain medications and they are unable to get through the procedure. Dr. Charles, the psychiatrist, does a capacity examination of the patient and finds that not only is she rational and reasonable, but given her father’s history, she has reason to be wary.…

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This entry was posted in Clinical Ethics, Featured Posts, Informed Consent, Reproductive Medicine and tagged , . Posted by Craig Klugman. Bookmark the permalink.