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Author Archive: Craig Klugman

About Craig Klugman


by Craig Klugman, Ph.D.

Medical School Interviewer: “If you could, please tell me why you decided to apply to medical school and pursue a career in medicine?”

Applicant: “So that I could refuse to treat the godless heathens.”

Interviewer: “Under U.S. rules, that is your right. Welcome to Med School.”

Under a new rule, the Trump Administration has strengthened a religious liberty clause that protects health care workers who refuse to perform procedures or treat patientsthat violate their religious beliefs. The rule allegedly attempts to protect these health care providers from having to perform abortions, sterilizations, assisted suicide, global health, hearing screening, vaccination, mental health treatment, and even to follow an advance directiveif that legal and safe procedure violates their moral conscience, even if inaction would result in the death of the patient.…

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by Craig Klugman, Ph.D.

Exploring bioethical issues in television medical dramas

New Amsterdam (Season 1; Episode 19): Privatizing the VA; The Resident (Season 2; Episode 22): Organ buying; Grey’s Anatomy(Season 15; Episode 23): Insurance Fraud

New Amsterdam (Season 1; Episode 19): Privatizing the VA

A veteran has a stroke while driving and injures a police officer. We learn that the driver was diagnosed two years earlier with bladder cancer, which has led to his current stroke. He could not get treatment because the VA closed the urology division in a rush toward privatization. The voucher to get care elsewhere only covers 75% of the cost of care and the patient cannot afford the rest.…

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by Craig Klugman, Ph.D.

In the last few years, the hospital where I serve on the ethics committee has seen a dramatic uptick in the number of patients placed on extracorporeal membrane oxygenation (ECMO). ECMO is an amazing technology because it can maintain a body even after “severe neurologic impairment or multiorgan failure”. With its ability to replace heart and lung function, a body can be maintained long after the heart, lungs, and even brain have failed.

In ECMO, the machine replaces the lungs (and sometimes the heart). The blood circulates outside the body where it oxygenates and releases carbon dioxide and then returns to the body.…

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by Craig Klugman, Ph.D.

Now that you have submitted your taxes, it’s time to consider your death. April 16th is National Health Care Decisions Day, an annual effort to encourage people to think about their end of life care choices and to engage in conversation with others.

In August, I wrote about my attempts in revising and rewriting my end-of-life planning documents including my last will and testament, but mostly focusing on my dissatisfaction with current advance directive forms that require you to make broad choices and really do not speak to who the person is. I talked about my effort to create a narrative advance directive, one that speaks to who I am as a person, what I value in life, and what an acceptable quality of life is for me.…

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by Craig Klugman, Ph.D.

One of the first lessons of professionalism that I was taught, and that I teach my students, is that health care values transparency and honesty. I, and many others, teach that health care providers should admit when they make mistakes and say “I’m sorry” (I know that many of the lawyers out there may disagree). The idea of transparency is also purportedly behind a new Department of Health and Human Services rule that drug ads on television must include the price of the drug (though there are lots of loopholes and prices do vary by region and insurance plan).…

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by Craig Klugman, Ph.D.

In my critical studies of bioethics undergraduate capstone class, the very last lecture examines the question of whether a person must be ethical to be an ethicist. Can a person who is personally abhorrent (say a murderer, someone who cheats on their taxes, etc.) professionally practice as a bioethicist? In general, the students end up believing that to be a professional ethicist, one must be a person of ethical character, which would be reflected in their personal life. A recent study by two graduate students asked this same question of ethics professors in German-speaking universities. They conclude, “While ethicists showed stronger normative attitudes, they did not differ in their moral behavior or attitude-behavior consistency.” In other words, ethicists may expect more in regards to normative behavior, but they do not act better than anyone else.…

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by Craig Klugman, Ph.D.

When I was growing up I recall parents talking about chicken pox parties where parents would arrange to expose their children to a person with an active infection. The idea was to have their kids get sick at a specific time that was convenient to the family. I came down with the disease naturally, the day before I was supposed to leave on the big 5thgrade school trip to a dude ranch. I did not get to go on the trip.

Since then, a vaccine for varicella (varicella-zoster virus) allows children to avoid this disease.…

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The Resident (Season 2; Episode 17)
Austin’s mentor, Abe, may have been shot in the chest. If he is saved, he may be able to identify who did it (or did he try suicide?). A second patient is Evan, an engineering student initially diagnosed with mono but whose lungs are failing. ECMO is a last ditch effort to try and keep each alive and give their lungs a chance to heal. The hospital has two machines, but only one is available. How to decide who gets it? Bell suggests transferring one of them to a different hospital, but both are too sick and he closest machine is a day’s drive.…

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by Craig Klugman, Ph.D.

Being at a university on the quarter system means that my academic calendar is different than most faculty’s. So as many are returning from spring break, I spend mine grading the term that has just ended and preparing for the one that is about to begin. I recently received a message from my university administration suggesting that we look at open source books for the classes starting in a week. According to a University of California white paper, the cost of textbooks creates stress for 89% of students. Nearly half of students have not purchased a textbook even though they knew they needed it.…

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by Craig Klugman, Ph.D.

An article has sent shockwaves through the bioethics and end-of-life care worlds: A 78-year-old man who was unable to breathe makes his way to the hospital where he is informed in the middle of the night via a telemedicine robot that “he would likely die within days.” The physician appeared on a tablet -like screen attached to a mobile unit and delivers the bad news. An Associated Press article has been published in multiple news outlets with the article headline, “Man learns he’s dying from doctor on robot video at California hospital”. The title has been reproduced in most news outlets, but a tagline has differed: NBC wrote, “The man’s granddaughter said she was stunned to hear from a doctor on a video screen that her grandfather didn’t have long to live.” The Denver Postsaid, ““It should be done by a human.” California man learns he’s dying from doctor on robot video”.…

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