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Author Archive: Craig Klugman

06/16/2016

Dear Professional Organizations…It’s Not Me, It’s You

by Craig Klugman, Ph.D.

Dear Professional Organizations,

Being an active member of my profession is important for both my personal mission and my professional career. I enjoy coming to your meetings and finding myself among those who speak my scholarly language. At such gatherings I learn about new ideas, network with current, former and potentially new collaborators, and sometimes (when looking) find out about new opportunities for jobs, funding, and publishing. And yes, my university expects me to attend these events in order to share my work, to network, and to help with increasing the visibility and reputation of the institution.…

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This entry was posted in Featured Posts, Institutions, Centers, Funding and tagged , , . Posted by Craig Klugman. Bookmark the permalink.

06/08/2016

BioethicsTV: Grace and Frankie Kill Their Friend

by Craig Klugman, Ph.D.

The Netflix series Grace and Frankie ended its second season with an end-of-life dilemma. The show has been hailed for its portrayal of active, interesting, and vibrant older characters and its embracing of families of all sizes, types, and colors.

Episode 11 introduces Babe, Frankie’s best friend and a free spirit who has spent her life traveling the world and collecting people. We learn that she lived life to its fullest and never shied away from a chance for adventure. Then we learn that she has metastatic stage 4 cancer. Having gone into remission from a previous cancer, Babe has decided that she has wrung every last drop out of life and rather than go through the pain of treatment or the agony of a slow death, she wants a party.…

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

06/01/2016

Deliberating Over Ending Two Species When We Are Bringing Tens of Thousands to the Brink of Extinction

by Craig Klugman, Ph.D.

One of the first news articles I ever wrote in journalism was as an intern at Stanford Magazine. This piece was on research into a human vaccine that would do nothing for us, but would kill any mosquito who happened to bite an inoculated person. The researcher’s ethical question at the time was whether anyone would consent to getting a vaccine that does nothing for her or his personal health.

Twenty-five years later, and this month Smithsonian Magazine published an article on CRISPR-9 gene-editing techniques that will allow for the eradication of mosquitoes.  A group of scientists introduced a mutation into female mosquitoes that caused infertility—the mutation spread to 75 percent of that specific mosquito specie’s population.…

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This entry was posted in Environmental Ethics, Featured Posts, Genetics, Public Health and tagged , . Posted by Craig Klugman. Bookmark the permalink.

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

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

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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This entry was posted in Featured Posts, Health Care, Informed Consent and tagged , , . Posted by Craig Klugman. Bookmark the permalink.

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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