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Author Archive: Craig Klugman

12/05/2017

#METOO Bioethics

by Craig Klugman, Ph.D.

In the December 4 episode of The Good Doctor, a medical resident is sexually harassed by her attending, who touches her when she is interacting with patients and asks her out to dinner. When she forcefully states that she is not interested in him, and has presented no signs that she is, he tells her to be careful because he could write her up for insubordination. Over the last month or so, women all over the country have posted #METOO on social media. This social activism is in response to very public reports coming to light of famous and powerful men with a history of sexual harassment of female co-workers and staff, or even minors (female and male) in their orbit.…

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12/01/2017

BioethicsTV (November 27-November 30): Apologizing & Autonomy

by Craig Klugman, Ph.D.

The Good Doctor (Season 1; Episode 9): How to Say I’m Sorry

A patient had a nodule removed from her vocal cord. Is it cancerous or benign? If cancerous, then her surgery will remove her vocal cords. If it’s benign then there is no surgery. The problem is that the sample is missing and time is running out. The hospital counsel tells the doctors that no matter what, they should not say “I’m sorry” to the patient. And of course, that is exactly what Browne does. Rather than calling her attorney, the patient is appreciative. Although “do not tell them you are sorry as it can be used as an admission of guilt in court” is traditional advice, the current literature actually suggests the opposite—saying “I’m sorry” can do more good than harm.…

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11/27/2017

New Raymond Chandler Story Eloquently Criticizes Patients as Dollars

by Craig Klugman, Ph.D.

This year has been a challenging one in the debate over what a U.S. health care system should look like. Front and center in this discussion sits the question of how do we pay for our health care—mandatory private insurance, single-payer, or free market approaches have all been touted and disparaged. This controversy is not new as laid out in a newly discovered Raymond Chandler short story. Chandler wrote “It’s all right—He only died” sometime between 1956 and 1958 after he had moved from the UK to California. The short piece was found in Chandler’s archives at the Oxford Bodleian Library.…

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This entry was posted in Featured Posts, Medical Humanities, professional ethics, Social Justice. Posted by Craig Klugman. Bookmark the permalink.

11/22/2017

BioethicsTV (November 20-22): The Good Doctor, Ill Behavior, Chicago Med

by Craig Klugman, Ph.D.

The Good Doctor (Season 1; Episode 8): Treating Hate
Browne is treating a patient brought into the ER who has been shot after he held up a convenience store. She soon discovers that the patient has a swastika tattoo. As a woman of color, she finds this abhorrent and her personal feelings quickly affect her treatment of the patient: When both her patient and another patient need surgery but only one OR is available, Browne immediately says that the other patient should get the room even though her patient is in greater need. Her attending says that Brown’s patient needs the OR more and he is brought to surgery.…

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11/21/2017

Attica Leprosy Study: Ethical Issues In What Little We Know

by Craig Klugman, Ph.D.

We are indebted to the inmates of the Attica Correctional Facility who participated in this study and to the warden and his administration for their help and co-operation. – (Bullock, Fields, and Brandiss 1972)

Like most bioethics instructors, I begin my classes with cases and studies to link the theoretical material to the applied world. When teaching research ethics, this means discussing examples such as Tuskegee, Nazi War experiments, Radiation Studies, MKUltra, Milgram, Stanford Prison, Willowbrook, Holmesburg, and more. Preparing this material often leads me to wonder two questions: “Will we discover another case of human research subjects abuse from our past” and “Will what we consider to be acceptable research today be viewed as abuse 40 years from now?”

The answer to the first question is a new revelation by author Heather Ann Thompson who wrote 2016’s Blood in the Water about the Attica prison uprising in 1971.…

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11/17/2017

BioethicsTV (November 12-17): Obligation to treat, assisting suicide, autonomy, and prejudice

Outlander (Season 3; Episode 9): Obligation to treat
In this time travel love story, Dr. Claire finds her ship crossing the Atlantic in the 1700s is stopped by a British Naval ship afflicted with “Ship’s Fever.” Her husband does not want her to go aboard the Navy vessel, fearing that she will be separated from him and be away from his protection. After listening to the symptoms, she thinks that the sailors suffer from typhoid fever. She explains to her husband that being from 1968, her inoculation makes her immune to that disease plus her oath as a physician requires her to help people in need.…

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11/14/2017

What is the purpose of Ethics Education?

by Craig Klugman, Ph.D.

Those of us who teach bioethics and ethics-in-general face a dilemma during every class session: How much of our own perspectives and analyses do we bring to the classroom? Is the role to be a mute facilitator—teaching students the mechanisms of ethical analysis but not judging the results of their conclusions—or to direct them to better arguments that might encourage them to accept our position on an issue? What is the goal of an ethics course: To teach how to think or to teach what to think? If we teach the former, then might students be led naturally to the latter?…

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11/04/2017

BioethicsTV (October 29-November 3): Decision-makers, Boundary Issues; Errors; and Double Effect

by Craig Klugman, Ph.D.

The Good Doctor (Season 1; Episode 6): Who Chooses; Experimental Treatment; Boundary Crossing; Hiding Errors

A bus crash carrying a wedding party leads to a mass casualty incident. The result is three ethical dilemmas. In the first, the unconscious groom has a shattered femur and a dying leg which would normally mean amputation. But Murphy decides that he can 3-D print a titanium femur bone to replace it. The procedure carries a 10% risk of death. The doctors ask if he has an advance directive or at least a medical power of attorney, which he does not.…

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11/01/2017

Rand Paul is About to Legislate Peer-Review: Scientists Need Not Apply

by Craig Klugman, Ph.D.

Senator and former Presidential candidate Rand Paul introduced S. 1973, a bill that would change how scientific grant proposals are reviewed. Besides eliminating the NSF oversight office, it would require that research proposals are reviewed by an office that includes non-scientific reviewers drawn from the community. The aim is to ensure that research is approved by the people who pay for it—non-scientist tax payer advocates. The advocate could not be a professional in academia, research, nor an expert on the topic under review.  Rand’s goal is to eliminate “silly research” and ensure that tax dollars deliver on useful research

More broadly, Rand is responding to a concern that the government funds research that is not applied, does not have a guaranteed return, and that is a “waste” of money.…

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10/27/2017

BioethicsTV (October 16-27, 2017): Maternal-Fetal Conflict, Trolley Car Dilemma & Lying

by Craig Klugman, Ph.D.

The Good Doctor (Season 1; Episode 4): Maternal-Fetal Conflict

Although the focus of this show is supposedly the neuro-different resident, what it does very well is pose and debate ethical issues. In this week’s episode, a fetus has a tumor that is 50% of his size. His mother desperately wants extra-uterine surgery to remove the tumor as this pregnancy follows 3 miscarriages. However, she has a clotting disorder and the surgery poses a very real risk of causing a heart attack or stroke. Her husband does not want her to have the surgery because he values having his wife alive and in his life.…

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