by David Magnus and Danton Char
The woods decay, the woods decay and fall,
The vapours weep their burthen to the ground,
Man comes and tills the field and lies beneath,
And after many a summer dies the swan.
Me only cruel immortality
Consumes: I wither slowly in thine arms
(Alfred, Lord Tennyson “Tithonus” lines 1–6)
It’s fitting that the ethical challenges raised in this, our Valentine’s Day issue, resonate in a mythic love story. Eos, titan of the dawn, fell in love with a mortal man, Tithonus. Because she could not bear to lose him, she pleaded with Zeus to grant him immortal life but forgot to ask for immortal youth, so he withered, unable to die but too fragile to live.…
by David Magnus, Ph.D.
This issue of the American Journal of Bioethics contains two extremely important Target Articles in the history of clinical ethics consultation. The first presents the eagerly awaited results of the ASBH attestation pilot, while the second provides a detailed account of the development and application of the VA National Center for Ethics Consultation quality assessment tool that aims to evaluate the quality of an ethics consultation by analysis of documentation.
Together, these articles mark an important step in the development of standards and tools for those of us engaged in clinical ethics consultation. As the authors of both articles and many of the commentaries point out, ethics consultation can literally make a difference of life and death for patients, and it is imperative that we find ways of ensuring quality.…
by David Magnus, PhD and Norm Rizk, MD
This issue’s target article by Kirby (2016) raises an incredibly important and challenging set of issues: Whether, when, and how should limits be placed on patient access to intensive medical care? What are limits of shared decision making? Is bedside rationing ever appropriate? Kirby’s move away from bedside rationing to a mesolevel approach is novel and interesting. However, as some of the commentaries note, the question of whether there are limits to what will be offered to patients and their families often has to be made at the bedside.
Consider the following cases:
- An 84-year-old man with altered mental status, severe aortic stenosis, congestive heart failure, coronary artery disease, and chronic kidney disease presents with increased difficulty breathing.
David Magnus, Ph.D.
When my wife (a librarian) was first working at an academic library I learned a lot about collection development, including how librarians decided which journals they would subscribe to. 25 years ago, there were reference publications that provided librarians with information about what the “top” journals in each field were. In philosophy, information was available that described which journals a library should have if they only had space for a small number of journals. Most of those reference publications were weak on methodology and lacked transparency in their process. They have largely vanished, replaced by more rigorous methodologies such as those developed by ISI to measure the value of journals as a tool to help librarians make collection development decisions.…
David Magnus, Ph.D.
John Lantos, MD weighs in on the SUPPORT study. He points out that the work of self-appointed “watch-dogs” such as Public Citizen and the Alliance for Human Research Protection are a danger to bioethics.
“Their criticism of this important trial also discredits bioethics. Bioethics, at its best, advocates for the most vulnerable patients and criticizes doctors and researchers who put those patients at risk. In this instance, OHRP and Public Citizen have, in the name of bioethics and advocacy, criticized clinical investigators who were trying to prevent the use of harmful and unvalidated treatments and, instead, endorsed an anti-intellectual, unscientific approach to medical innovation for the most vulnerable patients.”…
David Magnus, Ph.D.
The New England Journal of Medicine ‘s web site has the early publication of an editorial about the controversy over the SUPPORT study of oxygen saturation levels in premature infants. This excellent editorial is accompanied by a letter to the editor by some of the investigators involved in the study and a Perspective article by Arthur Caplan and yours truly (David Magnus). The biased and misleading reporting by most of the media on this has been striking. Hopefully other journals and journal editors will join AJOB and NEJM and attempt to correct the misinformation campaign.…
David Magnus, PhD
When we go to the doctor and they recommend a treatment, we like to believe that there is good evidence that it is the best treatment available. The reality is that there are often several treatment options (different drugs, different dosing, different procedures) and which treatment you get may depend upon who your doctor is (Dr. A is sure drug X is better while Dr. B thinks drug Y is better—though neither view is well supported by the evidence). A really honest and knowledgeable physician might flip a mental coin to decide which treatment option to provide (all of which we call “clinical judgment”).…