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Author Archive: Craig Klugman

09/18/2014

A simple change? The IOM Report on “Dying in America”

by Craig Klugman, Ph.D.

Say there was a simple change that could be made to the health care system that would reduce cost, reduce demand, increase patient’s quality of life and satisfaction, address the whole patient and not just the disease, improve care coordination, and increase patient autonomy. All of this is possible, but it requires addressing the problem that in America we do not die as we want to.

This week the Institute of Medicine released its latest report,  Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Despite decades of efforts, the report shows that there has not been much change in how we die.…

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09/10/2014

Nana Cams: Personal Surveillance Video and Privacy in the Age of Self Embellishment

by Craig Klugman, Ph.D.

In David Eggers’ novel, The Circle, a fictional internet company creates and encourages users to videostream their lives. Wearing a small camera, people can share every experience of every day with whomever wants to follow them…except to the bathroom. The first streamers become instant celebrities and instant villians. The result is the end of privacy as anyone has known it. The upshot, according to the fictional company, is that if people know they are being watched (or might be being watched), people will behave more civilly. The echoes of Jeremy Bentham’s panopticon notwithstanding, at the end of the book the protagonist suddenly wonders if the recording of all lives comes at too high a cost.…

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09/04/2014

CRISIS ETHICS: Hope for the best, prepare for the worst

by Craig Klugman, Ph.D.

An Ebola epidemic rages through Western Africa. Civil unrest and terrorist turmoil rocks Syria/Iraq, Libya, Israel/Gaza, and Ferguson, Missouri. A 6.1 earthquake damages Napa and shakes the entire San Francisco Bay Area. All of these events are examples of crisis—a catastrophic disaster (natural or human-made) that disrupts the regular operating of a region.

In terms of health, a crisis is a “state of being that indicates a substantial change in health care operations and the level of care than can be delivered in a public health emergency, justified by specific circumstances” (IOM, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response 2012).

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08/21/2014

Suicide and Terminal Diseases: A Personal Choice and Rational Approach

by Craig Klugman, Ph.D.

My spouse and I have an ongoing conversation, really more of an argument, about one end-of-life scenario. I have stated on several occasions that being in my middle-40s, if I was struck by a serious disease (usually the disease in the scenario is cancer) with a less than 50 percent chance of survival (remission), and a course of treatment that is prolonged and painful, then I would choose not to receive treatment. Instead, I would do a lot of traveling (if able), visit with friends (if able), and then die comfortably.

I say this as a healthy, able-bodied person and as he is quick to point out, I can’t know how I would feel if I’m ever in such a situation.…

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This entry was posted in End of Life Care, Featured Posts and tagged . Posted by Craig Klugman. Bookmark the permalink.

08/12/2014

Lessons from France: Decision-Making At the End-of-Life

by Craig Klugman, Ph.D.

In the United States, the notion of autonomy is held in high regard. Since the development of patient’s rights in the early 1970s, the notion that an individual has the capacity of self-governance is a cornerstone of medical ethics and a standard of medical care. But that idea has not always been held. In the early and middle parts of the 20th Century, patients were often not told about terminal diagnoses. The joke about doctors curing through the words, “take two aspirin and call me in the morning” derives from the practice that patients were not only not told about their conditions, but were also given treatments without any discussion of what the drugs would do (or not do).…

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This entry was posted in Cultural, End of Life Care, Featured Posts, Media. Posted by Craig Klugman. Bookmark the permalink.

08/05/2014

The Ethics of Physician Drug Test: Why It’s a Bad Idea

by Craig Klugman, Ph.D.

Pilots do it. Train conductors, air traffic controllers, TSA agents, police offices, fire fighters, Olympic athletes and long haul truckers do it. In eleven states, some recipients of public aid even have to do it. So shouldn’t health providers have to do it?

“It,” of course is drug testing, often random and sometimes for suspicion of use. Jobs that are charged with taking care of the safety of the public (or sometimes that benefit from the public dole) are often drug tested throughout their careers to ensure that they are not using drugs. The presumption is that drug use means placing the public in danger.…

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This entry was posted in Cultural, Featured Posts, Health Regulation & Law and tagged , . Posted by Craig Klugman. Bookmark the permalink.

08/01/2014

Day or Night: Ethics Depends on Time

by Craig Klugman, Ph.D.

Is that shirt the cashier forget to ring up a bonus or do you point out the oversight? Do you report your peer for being an impaired physician or just look the other way when she drinks? Cut your $20 million pay as a CEO or “layoff” 10,000 workers?

When dealing with ethical issues like these your first step may be to watch the clock. A study published last year found that people are more moral in the afternoon than in the mornings. The reason is that everyday living tires us out and our will seeps away.…

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This entry was posted in Featured Posts, Human Subjects Research & IRBs, Media and tagged , . Posted by Craig Klugman. Bookmark the permalink.

07/10/2014

Time to Divorce Health Insurance & Employment

by Craig Klugman, Ph.D.

In my last blog, I talked about ideologically-backed corporate control of health care choices as a result of the U.S. Supreme Court’s Hobby Lobby decision. That piece has led to several conversations this past week, many of which have revolved around the question of how to fix the problem of employer theology limiting or curtailing choices, because nearly half of all people in the U.S. have health insurance through their employer.

The result of these conversations is a consensus that there are two health policy moves that can be made: Changing a law and changing a system.…

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07/01/2014

Enter the Corporate Congress: SCOTUS & FACEBOOK

by Craig Klugman, Ph.D.

PART 1: SCOTUS
One of the facts that hiring managers are taught is that you can never ask a potential employee about their religion (among other protected areas) unless the candidate brings it up. But after this week, any job candidate would be wise to ask their potential employer about his/her/its (in the case of corporations) religious beliefs.

Who one works for is increasingly determining not only what health care coverage you have but also what laws you have to follow and what legal protections you have. If an employer is a “closely held company” (a term that is not defined, but NPR estimates describes 90% of all companies), then they can legally discriminate against women’s reproductive health care.…

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06/27/2014

Fact vs. Fiction: Judge Upholds Barring Unvaccinated Children from Public Schools

by Craig Klugman, Ph.D.

Vaccination is one of the great success stories of public health. People who receive vaccinations against disease are far less likely to contract that disease. In 1900, 30.4% of all deaths from infectious disease were to children under the age of 5 and the top three causes of death were pneumonia, tuberculosis and diarrhea-enteritis. By 2010, the only infectious disease in the top ten list was influenza and pneumonia at 9th place. In 2012, 91.4% of adolescents are immunized for measles, mumps & rubella, 92.8% for Hep B, and many others. By the end of the 20th century, only 1.4% of deaths in children under age 5 were from infectious disease.…

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