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Author Archive: Craig Klugman

02/24/2017

Good facts, calm deliberation, and wise counsel

by Craig Klugman, Ph.D.

“Facts do not cease to exist because they are ignored” – Aldous Huxley, Proper Studies (1927)

A recent exchange on the bioethics listserv began with a panicked message that the Presidential bioethics commissions website (bioethics.gov) has gone dark. A flurry of messages asked what this might mean for bioethics and for meaningful moral discourse in the Trump administration. Soon, cooler heads prevailed explaining that Georgetown retains the repository of all of the several commissions and that the website came down on January 20, at the transition of power. When there is a transition of administration, it is standard (in the internet age) for websites to come down from old programs and to change while new staff and programs are instituted.…

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This entry was posted in Ethics, Featured Posts, Philosophy & Ethics, professional ethics, Science and tagged . Posted by Craig Klugman. Bookmark the permalink.

02/24/2017

BioethicsTV: Substituted Judgment

by Craig Klugman, Ph.D.

On Grey’s Anatomy (Season 13, Episode 14) two cases lead to questions about who makes decisions for patients. In the first story, a young woman wanders into the ED disoriented and talking about snakes in a hat to denote to the viewer that she has a mental illness and lacks capacity. She is filthy, homeless, and lacks identification. The woman collapses because her very old pacemaker malfunctions. Two cardiologists in the room agree that she needs the surgery and this is all that the viewer sees of consent. There is no interaction with social work or calls to the police to identify her, to look for missing persons reports, or to circulate her image and description.…

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02/17/2017

BioethicsTV: Mass Casualties & Triage

by Craig Klugman, Ph.D.

Chicago Med (Season 2; Episode 14). Over the last few years I have been working in the area of crisis standards of care. In fact, just today I presented the conclusion of 3 years of work on an ethics white paper to the state of Illinois crisis standards of care task force leadership. Serendipitously, tonight’s episode of Chicago Med dealt with a limited mass casualty situation: A multiple car pile-up on a freeway brings a large number of patients to the hospital. However, there is a major snowstorm and there is no chance of additional personnel or supplies coming to the hospital.…

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02/13/2017

The Death of Aid-in-Dying in DC

by Craig Klugman, Ph.D.

I recently gave a talk to a local chapter of a national physicians’ health care group where I was talking about what end of life could look like under a single payer health care system. Several of the attendees were advocates of aid-in-dying and were hoping I was going to talk about that issue as well. I did not as there was so much else to talk about regarding proposals for health care plans to replace the ACA and comparing death and dying in the US with countries that have a single-payer system (In short, no one is great at it; we aren’t doing so badly in comparison, and having a single payer system does not correlate with having good end of life).…

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02/03/2017

A Solution In Search of A Problem: Streamlining the FDA

by Craig Klugman, Ph.D.

A professional association for regulatory affairs posted an article on Wednesday reporting Trump’s comments “calling for a massive overhaul of US Food and Drug Administration (FDA) regulations.” Trump issued an executive that called for reducing the number of federal regulations (for each new one created, two must be retired). And he met with the heads of pharmaceutical companies, where he said that he plans to cut taxes, FDA regulations and approval times. He also criticized the companies for selling drugs that were too expensive. The two events combined suggest that Trump will try to reduce the FDA and its power.…

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This entry was posted in Clinical Trials & Studies, Featured Posts, Pharmaceuticals, Politics and tagged . Posted by Craig Klugman. Bookmark the permalink.

01/30/2017

Bioethics and the Problem of Silent Neutrality in the age of Trump

by Craig Klugman, Ph.D.

One of the most contentious of all issues in bioethics has been whether as a profession, we should take a stand against issues. Arguments have raged on both sides of the issue. The American Society for Bioethics & Humanities (ASBH) only takes stands on issues of academic freedom. The thinking, as I’ve seen it, is that bioethics has something to offer all political perspectives and by not taking stands on issues, we are more likely to help further conversations among people on  all parts of the political spectrum.

This stance has been tested: When as a nation we learned that torture was regularly being practice by our military some took offense, but only Steven Miles spoke out and resigned from the organization for not taking a stand.…

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01/26/2017

Two Wrongs Do Not Make A Right

by Craig Klugman, Ph.D.

A draft of a new executive order that would re-open CIA black site prisons (facilities outside the United States where more torturous forms of interrogation are not prohibited) and restart the use of enhanced interrogation techniques (which many consider to be torture) was made public on Wednesday. Trump also publicly stated that he believes torture works and thus thinks it should be reinstated.

Trump’s justification for torture is that without it “we’re not playing on an even field.” He said that since terrorists will torture people, we need to be able to do the same. Mr.…

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This entry was posted in Ethics, Featured Posts, Justice and tagged , , , , , , . Posted by Craig Klugman. Bookmark the permalink.

01/24/2017

Can Science Survive in a Communications Blackout: Restricting Speech Violates Scientific Ethics

by Craig Klugman, Ph.D.

That good ethics begins with good facts is an oft-heard mantra and was my first lesson when I began conducting clinical ethics consults 20 years ago. In the clinic, good facts come from many sources such as talking to health care providers, patients and families and from looking at test results. Empirical facts come from good science whether that is social science, bench science, health science, or theoretical science to name a few. The sharing of scientific facts, studies, and results is at the heart of the scientific enterprise. Sharing your work allows for peer-review, for confirmation of the work, for challenges to other’s work, and for furthering the progress of other scientists.…

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01/19/2017

New Common Rule Regs Mean New Training for IRB Members

by Craig Klugman, Ph.D.

Yesterday, the Department of Health & Human Services released the long-awaited, and debated, new Common Rule. Many of the proposals that were released in earlier versions for public comment did not make their way into the rule. All IRB members will also need to undergo training to incorporate the new rules into their reviews. Most of the changes have a deadline of 1 year (January 2018) for enactment.

Though many experts in research ethics will be writing on this in great detail, I offer a brief synopsis of the changes here. However, keep in mind that the incoming administration has suggested they may rollback all executive orders made by the Obama administration in its last few months, if not during the entire Obama presidency.…

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01/17/2017

The Future of Health Insurance May Look A Lot Like Our Past

by Craig Klugman, Ph.D.

This week marks the transition of power from President Obama to President-elect Trump. One issue that has been high on Trump’s list of policy changes is a repeal and replace of the Affordable Care Act (a.k.a. Obamacare). The Republicans and Trump seem split in how to go about this. Some Republicans want to repeal immediately with a replacement to come in the future; others want to vote for repeal but have it take effect only after a replacement; Trump want both repeal and replace to happen quickly and simultaneously.

Last week, both Houses of Congress passed rules in a budget resolution that would permit the ACA to be repealed with only a majority vote rather than two-thirds.…

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