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Author Archive: Craig Klugman

10/16/2014

The Great Ebola Race: An appeal to honor the common good

by Craig Klugman, Ph.D.

In the time of the black plague, people with symptoms were often placed into separate areas. The sick and symptomatic were separated from the general populace.

When ships came into harbors they were often kept there for weeks until it was assured that they did not carry disease with them.

Cities would close their gates to travels to prevent anyone from arriving who might bring disease as well as to protect travelers from disease when it raged within.

When immigrants passed through Ellis Island with symptoms of infectious diseases they were kept on the island until they were better or sent back home.…

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10/14/2014

Why we ignored Ebola until recently

by Craig Klugman, Ph.D.

Ebola burst onto the scene in 1976 when a thirty-old man arrived at the Yambuku Mission Hospital in Zaire complaining of severe diarrhea. He left the hospital two days afterwards and was never found again. In the days and weeks that followed, people who were patients or care providers at this facility when he was there all died after experiencing dehydration, fever, vomiting, diarrhea, and bleeding everywhere. The death rate was staggering, as over 80% of affected patients did not recover.

Since then, the CDC reports there have been 34 distinct outbreaks of the five strains of Ebola.…

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10/01/2014

A Primer on Ebola: Ethics, Public Health, and Panic

by Craig Klugman, Ph.D.

Ebola is in the news a lot with the diagnosis of the first case on U.S. soil (excluding the 4 cases of health workers who were repatriated from West Africa after falling ill with the disease). Lots of information is flying around the internet and the news media. The ethics of outbreaks is not a new topic and has been written about extensively in this blog as well as elsewhere. Experts in public health ethics have addressed this issue thoroughly.

Below are some thinking points about Ebola to help put the situation into perspective and to provide some points for reflection.…

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09/30/2014

Dollars to Doctors: Sun Rises on Sunshine Act’s Open Payments Database

by Craig Klugman, Ph.D.

Today, Tuesday, September 29, the Centers for Medicare and Medicaid Services will release most of the Open Payments database. The public will now have access to the monetary value of gifts, marketing, and payments for clinical testing made by the pharmaceutical industry to physicians. The database is being rolled out 12 days later than planned and with one-third of the 2013 data unavailable until June 2015: There have been some glitches including mix-up of names and wrong provider and license numbers entered.

The Open Payment database is a part of the Sunshine Act, a provision of the 2010 Affordable Care Act.…

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09/24/2014

Sophie’s Choice: Can Machines Do Any Better?

by Craig Klugman, Ph.D.

In the 1979 novel Sophie’s Choice by William Styron, the reader meets a Holocaust survivor who was forced in the camps to choose which of her two children would die immediately. Making the choice led to a life of alcoholism, depression, and self-destructive behavior. One interpretation of this novel, later made into an Academy Award winning film (1982), is that having choose whether a loved one lives or dies is a spirit-wrenching decision.

And yet, everyday, health care providers and bioethicists ask legally appointed health care power of attorneys and other designated surrogates to decide whether an incapacitated patient has surgery, receives a feeding tube, is resuscitated, or is intubated.…

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

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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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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