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Author Archive: Maurice Bernstein, M.D.

About Maurice Bernstein, M.D.

01/20/2018

Difficult Patient vs Difficult Doctor

One cannot ignore the potential for conflictive behavior as a potential in medical patient-physician relationships (and indeed associated with other individuals in the medical system interacting with patients and patients interacting with them.) This behavior can be disruptive to attain important professional relationships and effective diagnosis and treatment. 

The following is a brief analysis of the dynamics associated with such behavior and hopefully toward resolution as researched and written by a first year medical student.  The obvious goal, hopefully, is resolution of potential conflicts to promote a therapeutically effective doctor-patient relationship.  My visitors' views on this issue are welcome.  ...Maurice.

                   DIFFICULT PATIENT VS DIFFICULT DOCTOR
                                                           
                                           Surabhi Reddy
                                   First Year Medical Student

A doctor’s worst nightmare? A patient that is impatient, inattentive, rude, and demanding. A patient’s worst nightmare? A doctor that is impatient, inattentive, rude, and demanding. A so-called “difficult patient” or “difficult doctor” represent two sides of the same coin, with similar behavioral and communicative factors causing conflict. Occasionally, the difficult relationship may culminate in a
messy outburst – as recently seen in a violent altercation between a Gainesville doctor and patient.1  The duality of the patient-physician relationship allows us to examine (from both perspectives) what underlying actions and issues initiate the conflict – and eventually focus on mediation and resolution. Addressing the “difficult” nature of these parties is a vital first step towards creating positive patient-physician relationships and health outcomes.

You may hear the phrase “difficult patient” offhandedly thrown around in a physician’s lounge – a blanket term like “problem child” or “one of those” that draws universal understanding but little clarity on the specifics of the interaction. Physicians characterize 15-20% of all patients as “difficult.”2,3 Such encounters point to a strong association between the “difficult” characterization and patient mental disorder – namely, depression, panic disorder, and anxiety.2,3 Doctors note these patients are either 1) not interested in a medical opinion whatsoever, or 2) have repetitive, non-specific complaints.However, it was also noted that difficult patients are hard to describe and characterize as a group.4 Mental health does not preclude a difficult interaction. In a series of interviews, physicians described “difficult” as conversational issues such as patients being “violent, demanding, aggressive, rude and [seeking] secondary gain.”5 Physicians describe their primary motivations as the desire to solve medical problems and help others – and anything that stymies this process sadly draws the label “difficult.”

The onus is not completely on the patient, however. One study points out that the difficulty may stem from the doctor’s work style, belief system, and/or cultural barriers.5 The more experienced a family medicine physician is, the less likely he/she is to characterize a patient as “difficult” – suggesting that there is a burden on the doctor to develop the interpersonal skills to handle the interaction. Collectively, physicians that report high frustration with patients are those that are younger, work longer hours, and have symptoms of depression, anxiety, and stress.6 While physicians often characterize patients as difficult, patients are less likely to describe their physician as so. In most studies, patients are evaluated for their “satisfaction,” which includes many aspects of their medical care, including perceived expectations, the underlying medical condition, and other members of the healthcare team. This may also reflect the power dynamic between patient and physician. Patient complaints may be dismissed, once again, as the patient being “difficult” - leaving the physician immune to criticism.

The difficult patient-physician relationship involves both behavioral (mental disorders, stress) and communicative (rude and aggressive language) factors from both parties. Ultimately, cooperative relationships stem from respect, empathy, and patience. As one physician stated in his interview, “First of all, what I have learned with the years is being empathetic toward [patients].” Taking the time to understand another’s perspective can go a long way in making the difficult into easy.5



Sources

1.       Bever, Lindsey. (2017). A doctor shouted at a sick mother to 'get the hell out.' Now he's under criminal investigation. Washington Post.
2.       Hahn, S. R., Kroenke, K., Spitzer, R. L., Brody, D., Williams, J. B., Linzer, M., & Verloin deGruy, F. (1996). The difficult patient. Journal of general internal medicine, 11(1), 1-8.
3.       Jackson, J. L., & Kroenke, K. (1999). Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Archives of Internal Medicine, 159(10), 1069-1075.
4.       Koekkoek, B., van Meijel, B., & Hutschemaekers, G. (2006). " Difficult patients" in mental health care: a review. Psychiatric Services, 57(6), 795-802.
5.       Steinmetz, D., & Tabenkin, H. (2001). The ‘difficult patient' as perceived by family physicians. Family practice, 18(5), 495-500.

6.       Krebs, E. E., Garrett, J. M., & Konrad, T. R. (2006). The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data. BMC health services research, 6(1), 128. 


 GRAPHIC: From Google Images.

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01/20/2018

Difficult Patient vs Difficult Doctor

One cannot ignore the potential for conflictive behavior as a potential in medical patient-physician relationships (and indeed associated with other individuals in the medical system interacting with patients and patients interacting with them.) This behavior can be disruptive to attain important professional relationships and effective diagnosis and treatment. 

The following is a brief analysis of the dynamics associated with such behavior and hopefully toward resolution as researched and written by a first year medical student.  The obvious goal, hopefully, is resolution of potential conflicts to promote a therapeutically effective doctor-patient relationship.  My visitors' views on this issue are welcome.  ...Maurice.

                   DIFFICULT PATIENT VS DIFFICULT DOCTOR
                                                           
                                           Surabhi Reddy
                                   First Year Medical Student

A doctor’s worst nightmare? A patient that is impatient, inattentive, rude, and demanding. A patient’s worst nightmare? A doctor that is impatient, inattentive, rude, and demanding. A so-called “difficult patient” or “difficult doctor” represent two sides of the same coin, with similar behavioral and communicative factors causing conflict. Occasionally, the difficult relationship may culminate in a
messy outburst – as recently seen in a violent altercation between a Gainesville doctor and patient.1  The duality of the patient-physician relationship allows us to examine (from both perspectives) what underlying actions and issues initiate the conflict – and eventually focus on mediation and resolution. Addressing the “difficult” nature of these parties is a vital first step towards creating positive patient-physician relationships and health outcomes.

You may hear the phrase “difficult patient” offhandedly thrown around in a physician’s lounge – a blanket term like “problem child” or “one of those” that draws universal understanding but little clarity on the specifics of the interaction. Physicians characterize 15-20% of all patients as “difficult.”2,3 Such encounters point to a strong association between the “difficult” characterization and patient mental disorder – namely, depression, panic disorder, and anxiety.2,3 Doctors note these patients are either 1) not interested in a medical opinion whatsoever, or 2) have repetitive, non-specific complaints.However, it was also noted that difficult patients are hard to describe and characterize as a group.4 Mental health does not preclude a difficult interaction. In a series of interviews, physicians described “difficult” as conversational issues such as patients being “violent, demanding, aggressive, rude and [seeking] secondary gain.”5 Physicians describe their primary motivations as the desire to solve medical problems and help others – and anything that stymies this process sadly draws the label “difficult.”

The onus is not completely on the patient, however. One study points out that the difficulty may stem from the doctor’s work style, belief system, and/or cultural barriers.5 The more experienced a family medicine physician is, the less likely he/she is to characterize a patient as “difficult” – suggesting that there is a burden on the doctor to develop the interpersonal skills to handle the interaction. Collectively, physicians that report high frustration with patients are those that are younger, work longer hours, and have symptoms of depression, anxiety, and stress.6 While physicians often characterize patients as difficult, patients are less likely to describe their physician as so. In most studies, patients are evaluated for their “satisfaction,” which includes many aspects of their medical care, including perceived expectations, the underlying medical condition, and other members of the healthcare team. This may also reflect the power dynamic between patient and physician. Patient complaints may be dismissed, once again, as the patient being “difficult” - leaving the physician immune to criticism.

The difficult patient-physician relationship involves both behavioral (mental disorders, stress) and communicative (rude and aggressive language) factors from both parties. Ultimately, cooperative relationships stem from respect, empathy, and patience. As one physician stated in his interview, “First of all, what I have learned with the years is being empathetic toward [patients].” Taking the time to understand another’s perspective can go a long way in making the difficult into easy.5



Sources

1.       Bever, Lindsey. (2017). A doctor shouted at a sick mother to 'get the hell out.' Now he's under criminal investigation. Washington Post.
2.       Hahn, S. R., Kroenke, K., Spitzer, R. L., Brody, D., Williams, J. B., Linzer, M., & Verloin deGruy, F. (1996). The difficult patient. Journal of general internal medicine, 11(1), 1-8.
3.       Jackson, J. L., & Kroenke, K. (1999). Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Archives of Internal Medicine, 159(10), 1069-1075.
4.       Koekkoek, B., van Meijel, B., & Hutschemaekers, G. (2006). " Difficult patients" in mental health care: a review. Psychiatric Services, 57(6), 795-802.
5.       Steinmetz, D., & Tabenkin, H. (2001). The ‘difficult patient' as perceived by family physicians. Family practice, 18(5), 495-500.

6.       Krebs, E. E., Garrett, J. M., & Konrad, T. R. (2006). The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data. BMC health services research, 6(1), 128. 


 GRAPHIC: From Google Images.

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12/25/2017

Patient Modesty: Volume 83

And the discussion about inequality in certain aspects of medical attention and behavior by the medical system toward male patients continues..For those arriving here prior to reviewing Volume 82, you may want to go to Volume 82 to refresh yourself on ...

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This entry was posted in Health Care and tagged . Posted by Maurice Bernstein, M.D.. Bookmark the permalink.

12/25/2017

Patient Modesty: Volume 83

And the discussion about inequality in certain aspects of medical attention and behavior by the medical system toward male patients continues..For those arriving here prior to reviewing Volume 82, you may want to go to Volume 82 to refresh yourself on ...

Full Article

This entry was posted in Health Care and tagged . Posted by Maurice Bernstein, M.D.. Bookmark the permalink.

12/23/2017

The 1000th Thread!


This is the 1000th presentation to my bioethics blog since starting on Google Blogspot.com in 2004.
There has been many topics covered. Though comments by the visitors has always been encouraged and, since as a "discussion blog", comments leading to discussions I have felt was the definitive function here. Virtually none of the thread topics have gone unread and most have had some commentary, some with mainly particularly strong and emphatic opinions http://bioethicsdiscussion.blogspot.com/2013/01/should-pathologists-be-physicians.html, some with extensive up to 12 years long continued discussion http://bioethicsdiscussion.blogspot.com/2017/10/patient-modesty-volume-82.html, still there have been some with no visitor response http://bioethicsdiscussion.blogspot.com/2005/01/public-good-vs-money-in-pockets-or.html. It is interesting to understand why such differences have occurred.
Though most of the topics were bioethics as related to the subject of medical care, an occasional topic was related to plants http://bioethicsdiscussion.blogspot.com/2014/06/can-tree-experience-hurt-if-it-can-do.html and animals  http://bioethicsdiscussion.blogspot.com/2012/04/spending-lot-of-money-on-your-sick-dog.html.
Nevertheless, it is the multitude of issues regarding human medical ethics which has dominated this blog.  In  my opinion, a great listing and summarization of those issues was and is being presented by Wikipedia https://en.wikipedia.org/wiki/List_of_medical_ethics_cases and is reproduced below (courtesy of published permission for reproduction by Wikimedia).
I want, in this 1000th thread posting, to thank all those who have participated to, by their comments and input made this blog more interesting and dynamic than if my thoughts were simply just a "list". It is the "back and forth" of  discussion which makes a commentary written by one person something dynamic and much more useful and of value.   Best wishes to all and a happy upcoming New Year.  ..Maurice.  Graphic: Use of Picasa 3

List of medical ethics cases

From Wikipedia, the free encyclopedia

Some cases have been remarkable for starting broad discussion and for setting precedent in medical ethics.

Contents

  [hide] 

·         1Research

·         7References

Research[edit]

Research

case

country

location

year

summary

1880s

Psychosurgery (also called neurosurgery for mental disorder) has a long history. During the 1960s and 1970s, it became the subject of increasing public concern and debate, culminating in the US with congressional hearings. Particularly controversial was the work of Harvard neurosurgeon Vernon Markand psychiatrist Frank Ervin, who wrote a book entitled Violence and the Brain in 1970.[1] The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in 1977 endorsed the continued limited use of psychosurgical procedures.[1][2]Since then, a few facilities in some countries have continued to use psychosurgery on small numbers of patients. In the US and other Western countries, the number of operations has further declined over the past 30 years, a period during which there have been no major advances in ablative psychosurgery.[3]

United States

1920s

Controversial psychiatrist Henry Cotton at Trenton State Hospital in New Jersey became convinced that insanity was fundamentally a toxic disorder and he surgically removed body parts to try to improve mental health.[4]

United States

Iowa

1939

The Monster Study is the name given to a stuttering experiment performed on orphan children in Davenport, Iowa in 1939. It was conducted by Wendell Johnson at the University of Iowa. The research began with the selection of 22 subjects from a veterans' orphanage in Iowa. None were told the intent of the research, and they believed that they were to receive speech therapy. The study was trying to induce stuttering in healthy children. The experiment became national news in the San Jose Mercury News in 2001, and a book was written. On 17 August 2007, six of the orphan children were awarded $925,000 by the State of Iowa for lifelong psychological and emotional scars caused by six months of torment during the Iowa University experiment. Although none of the children became stutterers, some became self-conscious and reluctant to speak.[5] A spokesman for the University of Iowa called the experiment "regrettable".

Medical Experimentation on Black Americans[6]

United States

Various

Occurred over many decades

There has been a long history of medical experimentation on African Americans. From the era of slavery, when atrocities were committed on black women by J. Marion Sims, to the present day, Black Americans have been unwitting subjects of medical experimentation.[7][8] Author Harriet Washington argues that "diverse forms of racial discrimination have shaped both the relationship between white physicians and black patients and the attitude of the latter towards modern medicine in general".[9]

In the 1960s, Ionia State Hospital, located in Ionia, Michigan, was one of America's largest and most notorious state psychiatric hospitalsin the era before deinstitutionalization. Doctors at this hospital diagnosed African Americanswith schizophrenia because of their civil rightsideas. See The Protest Psychosis.

Plutonium injections

United States

1945-1947

Eighteen people were injected with plutoniumby Manhattan Project doctors. None of the patients was told what was going on, and the doctors did not ask for their consent. See Eileen Welsome's book The Plutonium Files.[10]

United States

1946

German medical doctors went on criminal trial for Nazi human experimentation. See The Years of Extermination.

U.S./
Guatemala

1946-48

The syphilis experiments in Guatemala were United States human experiments conducted in Guatemala from 1946 to 1948. The experiments were led by physician John Charles Cutler. They were done during the administration of American President Harry S. Truman and Guatemalan President Juan José Arévalo.[11]

Doctors infected soldiers, prostitutes, prisoners, and mental patients with syphilisand other sexually transmitted diseaseswithout the informed consent of the subjects, and treated most subjects with antibiotics. This resulted in at least 83 deaths.[12] In October 2010, the US formally apologized to Guatemala for conducting these experiments.

United States

New York State

1950s

More than 1200 homeless men from Lower Manhattan were convinced with promises of food and shelter to have their prostates biopsied by a Dr. Perry Hudson. They were not informed of possible side effects, i.e., rectal tearing and impotence. The homeless were targeted for these biopsies because the biopsies were painful and untested, and less vulnerable populations would not volunteer.

Radioactive iodine experiments

United States

1950s

The U.S. Atomic Energy Commission has a history of involvement in experiments involving radioactive iodine. In a 1949 operation called the "Green Run," the AEC released iodine-131and xenon-133 to the atmosphere, which contaminated a 500,000-acre (2,000 km2) area containing three small towns near the Hanford site in Washington.[13] In 1953, the AEC ran several studies on the health effects of radioactive iodine in newborns and pregnant women at the University of Iowa. Also in 1953, the AEC sponsored a study to discover if radioactive iodine affected premature babies differently from full-term babies.[14] In another AEC study, researchers at the University of Nebraska College of Medicine fed iodine-131 to 28 healthy infants through a gastric tube to test the concentration of iodine in the infants' thyroid glands.[14]

United States

1951

A product derived from a cancer patient's specimen, HeLa is the cornerstone of an industry. Cancerous tissue was taken from her without her consent.

United States

Philadelphia

1951-1974

Clinical non-therapeutic medical experiments on prison inmates was conducted at Holmesburg Prison in Philadelphia from 1951 to 1974 under the direction of dermatologistAlbert Kligman.[15]

Canada

1957–1964

The Allan Memorial Institute is known for its role in the Project MKULTRA run by the CIA. The Agency's initiative to develop drug-induced "mind control" techniques was implemented in the institute by its then-Director Donald Ewen Cameron.

UK mental institutions

UK

1960s

In the 1960s, there was abuse and inhumane treatment of psychiatric patients who were hidden away in institutions in the UK. Barbara Robb documented her difficult personal experience of being treated at Ely Hospital. She wrote the book Sans Everything and she used this to launch a campaign to improve or close long stay facilities. Shortly after, a long stay hospital for the mentally handicapped in Cardiff was exposed by a nurse writing to the News of the World. This exposure prompted an official inquiry, which was highly critical of conditions, staff morale, and management. At the same time Michael Ignatieff and Peter Townsend both published books which exposed the poor quality of institutional care.[16]

United States

1961

The Milgram experiment on obedience to authority figures was a series of notable social psychology experiments conducted by Yale University psychologist Stanley Milgram, which measured the willingness of study participants to obey an authority figure who instructed them to perform acts that conflicted with their personal conscience.[17] The detailed findings are discussed in his 1974 book, Obedience to Authority: An Experimental View.[18] The experiments were controversial, and considered by some scientists to be unethical and physically or psychologically abusive. Psychologist Diana Baumrind considered the experiment "harmful because it may cause permanent psychological damage and cause people to be less trusting in the future." [19]

1962-1979

Controversial Australian psychiatrist Harry Bailey treated mental patients via deep sleep therapy and other methods at a Sydney mental hospital. He has been linked with the deaths of 85 patients.[20] He committed suicide before he could be punished.

Soviet Union, Romania,
Hungary,
Czechoslovakia, Yugoslavia and China

1960s to 1980s

Psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience.[21]:6 In the period from the 1960s to 1986, abuse of psychiatry for political purposes was reported to be systematic in the Soviet Union and other Eastern European countries.[22]:66 Political abuse of psychiatry also takes place in the People's Republic of China.[23] Psychiatric diagnoses such as the diagnosis of "sluggish schizophrenia" in political dissidents in the USSR were used for political purposes.[24]:77

United States

1971

The Stanford prison experiment was a study of the psychological effects of becoming a prisoner or prison guard. The experiment was conducted in August 1971 by a team of researchers led by psychology professor Philip Zimbardo.[25] Participants took on the roles of prisoners and guards in a mock prison situated in the basement of the Stanford psychology building. Some of the prisoners were subjected to psychological torture. Many of the prisoners passively accepted psychological abuse, and Zimbardo himself permitted the abuse to continue. Two of the prisoners quit the experiment early and the entire experiment was abruptly stopped after only six days. Certain portions of the experiment were filmed and excerpts of footage are publicly available.

United States

1970s

Human radiation experiments were directed by the United States Atomic Energy Commissionand the Manhattan Project. In Nashville, pregnant women were given radioactive mixtures. In Cincinnati, some 200 patients were irradiated over a period of 15 years. In Chicago, 102 people received injections of strontium and cesium solutions. In Massachusetts, 74 schoolboys were fed oatmeal that contained radioactive substances. In all of these cases, the subjects did not know what was going on and did not give informed consent.[10] The government covered up most of these radiation mishaps until 1993, when President Bill Clinton ordered a change of policy. The resulting investigation was undertaken by the Advisory Committee on Human Radiation Experiments. See The Plutonium Files.

United States

1972

A 40-year experiment conducted by the U.S. Public Health Service withheld standard medical advice and treatment from a poor minority population with an easily treatable disease. The experiment targeted black male farmers who were told they needed to be treated for 'bad blood',[26] some of whom had previously encountered syphilis. Others were intentionally given syphilis during the course of the experiment. In addition to many fatalities, some children were born with congenital syphilis due to the study.

United States

1976

Researchers commercialized a patient's discarded body parts. The man did not authorize the use of his bodily tissues or fluids, and researchers did not obtain informed consent. He did not want his donation to generate commercial profit for private entities.

1980s

Eugene Ellsworth Landy was an American psychologist and psychotherapist best known for his unconventional 24-hour therapy as well as ethical violations concerning his treatment of Beach Boys co-founder Brian Wilson in the 1980s. In 2015, Landy's relationship with Wilson was dramatized in the biographical filmLove & Mercy.

United States

1987

A school had been infecting disabled children in experiments for years.

Canada, United States

12 psychiatric centers

1994–2001

SmithKlineBeecham, known since 2000 as GlaxoSmithKline, conducted a clinical trial from 1994 to 1997 in 12 pychiatric centers in North America to study the efficacy of paroxetine(Paxil, Seroxat), an anti-depressant, on teenagers. The trial data suggested that the drug was not efficacious and that the paroxetine group were more likely to think about suicide. The paper that wrote up the study was published in 2001, osensibly authored by a group of academics, but actually ghostwritten by the drug company. The article downplayed the negative findings and concluded that paroxetine helped with teenage depression. The company used this paper to promote paroxetine for teenagers. The ensuing controversy led to several lawsuits, including from the parents of teenagers who killed themselves while taking the drug, and intensified the debate about medical ghostwriting and conflict of interest in clinical trials. In 2012 the US Justice Department fined GlaxoSmithKline $3 billion for several violations, including withholding data on paroxetine, unlawfully promoting it for adolescents, and preparing a misleading article about study 329. New Scientist wrote in 2015: "You may never have heard of it, but Study 329 changed medicine."[27]

Death associated with psychotropic drugs

United States

1998

In 1998, 60-year-old Donald Schell went to see his doctor complaining of difficulty sleeping. He was diagnosed with an anxiety state and placed on Paxil, an SSRI anti-depressant. Within 48 hours of being put on Paxil Schell killed his wife, daughter, infant granddaughter, and himself. Tim Tobin, Schell’s son-in-law, took legal action against SmithKline (now GlaxoSmithKline). The Tobin case was heard in Wyoming from May 21 to June 6, 2001. The jury returned a guilty verdict against SmithKline and awarded Tobin $6.4 million.[28][29][30][31]This was the first guilty verdict returned against a pharmaceutical company regarding adverse behavioral effects of a psychotropic drug.[28]

United States

2002

Courtney is a former pharmacist who owned and operated Research Medical Tower Pharmacy in Missouri.[32] In 2002, he was convicted of pharmaceutical fraud and sentenced to federal prison.[32]

United States

2003

Patients donated tissue samples, which researchers subsequently used in a plan to generate profit.

GlaxoSmithKlinehuman experiments

Various

2004–2012

In 2004 GlaxoSmithKline (GSK) sponsored at least four medical trials using Hispanic and black children at New York's Incarnation Children's Center. Normally trials on children require parental consent but, as the infants were in care, New York's authorities held that role. Experiments were designed to test the “safety and tolerance” of AIDS medications, some of which have potentially dangerous side effects.[33]

In 2006, GSK and the US Army were criticized for Hepatitis E vaccine experiments conducted in 2003 on 2,000 soldiers of the Royal Nepalese Army. It was said that using soldiers as volunteers is unethical because they "could easily be coerced into taking part."[34]

In January 2012, GSK and two scientists who led the trials were fined approximately $240,000 in Argentina for "experimenting with human beings" and "falsifying parental authorization" during vaccine trials on 15,000 children under the age of one. Babies were recruited from poor families that visited public hospitals for medical treatment. Fourteen babies allegedly died as a result of the trials.[35]

Death from prescription drugs

United States

2006

Rebecca Riley, the daughter of Michael and Carolyn Riley of Massachusetts, was found dead in her home at age four, her lungs filled with fluid, after prolonged exposure to various medications. The medical examiner's office determined the girl died from "intoxication due to the combined effects" of prescription drugs. Police reports state she was taking 750 milligrams a day of Depakote, 200 milligrams a day of Seroquel, and .35 milligrams a day of Clonidine. Rebecca had been taking the drugs since the age of two for bipolar disorder and ADHD, diagnosed by child psychiatrist Kayoko Kifuji of the Tufts-New England Medical Center.[36]

University of MinnesotaResearch Participant Dan Markingson

United States

Minnesota

2004

University of Minnesota research participant Dan Markingson committed suicide in May 2004 while enrolled in an industry-sponsored pharmaceutical trial comparing three FDA-approved atypical antipsychotics: Seroquel (quetiapine)Zyprexa (olanzapine), and Risperdal (risperidone). Writing on the circumstances surrounding Markingson's death in the study, which was designed and funded by Seroquel manufacturer AstraZeneca, University of Minnesota Professor of Bioethics Carl Elliott noted that Markingson was enrolled in the study against the wishes of his mother, Mary Weiss, and that he was forced to choose between enrolling in the study or being involuntarily committed to a state mental institution.[37] Further investigation revealed financial ties to AstraZeneca by Markingson's psychiatrist, Dr. Stephen C. Olson, oversights and biases in AstraZeneca's trial design, and the inadequacy of university Institutional Review Board (IRB)protections for research subjects.[38] Although a 2005 FDA investigation appeared to clear the university, greater awareness of the case stemming from Elliott's 2010 article in the magazine Mother Jones resulted in a group of university faculty members sending a public letter to the Board of Regents urging an external investigation into Markingson's death.[39]

Termination of mechanical ventilation and life support[edit]

case

country

location

year

summary

United States

2008

A hospital wished to withhold treatment from someone whom it judges to have no chance of living.

United States

2008

The parents of a brain-dead boy wanted to keep him on life support.

United States

2007

Prison officials question whether to force-feed inmates who are on hunger strike.

United Kingdom

2017

After losing a UK Supreme Court case, the parents of Gard, 10 months, petitioned the EU Court in France, and lost the final appeal. They wanted the hospital to allow them to travel to the U.S. for an experimental therapy that may have provided some temporary benefit but likely would not have improved his neurological condition, due to a mitochondrial DNA depletion disease (the treatment is nucleoside bypass therapy). At the least, they wanted for the hospital to continue to provide advanced life support palliative care for their son—respiration, nutrition, hydration—or to send him home on life support to eventually die, but those requests were also denied and support will be turned off.

United States

2005

The hospital removes life support from an unconscious immigrant from Eritrea against her family's wishes. The family are in a foreign country and unable to travel.

2010

A man seems to be in a persistent vegetative state, and after 23 years a communication test is conducted.

United States

Texas

2004

An infant is removed from life support against his mother's wishes.

United States

1992

The mother of an anencephalic baby wishes to keep the child on life support perpetually.

United States

2004

Parents wish to keep a child on life support.

United States

2005

A family wishes to keep life support for a man in a persistent vegetative state.

United States

1984

A boy dies at age 12 after living a lifetime with highly unusual medical care in a sterile environment.

United States

2013

A teenaged woman is declared brain-dead and her family wishes to maintain her body on mechanical ventilation perpetually.

Withholding life-prolonging medical treatment[edit]

Withholding life-prolonging treatment

case

country

location

year

summary

United States

1983

The parents of a child born with horrible birth defects request the right to refuse treatment and keep the child off life support.

Australia

1989

Parents and doctors agreed to withhold life-prolonging measures of severely disabled newborn baby, including surgeries and medication, while Right to Life activists claimed the baby was murdered.[40]

Informed consent to medical treatment[edit]

Informed consent to medical treatment

case

country

location

year

summary

Germany

2011

Informed consent and involuntary sex reassignment in the case of an adult intersex woman.

England

1985

The right of minors to request contraception from their doctor without parental consent.

Person wishes for assisted suicide[edit]

Assisted suicide

case

country

location

year

summary

2007

A couple request the legal right to commit suicide together, although only the husband was ill.

United States

1973

A man who suffered severe burns requests the right to die.

Italy

2007

A man in pain requests a legal right to die.

Canada

1991

A woman requests a right to assisted suicide.

Spain

1998

For 29 years a man requests his right to assisted suicide.

India

2011

A court case debates the right to die for a woman in a persistent vegetative state for 37 years.

Italy

2006

A patient requests a legal right to die.

Person wishes for euthanasia for another[edit]

Euthanasia of another

case

country

location

year

summary

United States

2008

A parent is charged with critically harming his child who is on life support. If the child dies, the parent may be charged with murder. At question was whether parents should be legally allowed to make medical decisions for children they have allegedly abused.

England

1993

Bland was the first patient in English legal history to be allowed to die by the courts through the withdrawal of life-prolonging treatment.

United States

2002

A mother euthanizes her adult sons to relieve their suffering from Huntington's disease.

United States

1990

The parents of a woman in a persistent vegetative state request the right to remove her life support equipment.

1992

Parents receive permission to remove the life support from a woman in a persistent vegetative state for 17 years.

United States

2009

A sister is charged with euthanizing her brother after he has medical problems.

United States

Michigan

1994

A medical doctor advocates for assisted suicide and the right to die.

Canada

1993

A man euthanizes his child who has lived for years in pain.

United States

New Jersey

1976

A 21-year-old girl is in a persistent vegetative state. Her parents wish to remove her from artificial respiration.

United States

2005

A woman is in a persistent vegetative state. Her husband wishes to remove her life support. Her parents wish her to remain on life support.

United States

2013

A woman is declared brain-dead by her physician. Her husband and family wish to remove life support. The hospital persists in keeping her on life support because it claims it cannot legally withdraw life support from a pregnant patient.

References[edit]

1.      Jump up to:a b Mashour, G.A.; Walker, E.E.; Martuza, R.L. (2005). "Psychosurgery: past, present and future". Brain Research Reviews. 48 (3): 409–18. doi:10.1016/j.brainresrev.2004.09.002PMID 15914249.

2.      Jump up^ Casey, B.P. (Mar 2015). "The surgical elimination of violence? Conflicting attitudes towards technology and science during the psychosurgery controversy of the 1970s". Science in Context. 28 (1): 99–129. doi:10.1017/S0269889714000349PMID 25832572.

3.      Jump up^ Sachdev, P.; Chen, X. (2009). "Neurosurgical treatment of mood disorders: traditional psychosurgery and the advent of deep brain stimulation". Current Opinion in Psychiatry. 22 (1): 25–31. doi:10.1097/YCO.0b013e32831c8475PMID 19122531.

8.      Jump up^ Nelson, Alondra (7 January 2007). "Unequal Treatment. Medical Apartheid"The Washington Post.

12.    Jump up^ "Guatemalans 'died' in 1940s US syphilis study"BBC News. 29 August 2011. Retrieved 29 August 2011.

13.    Jump up^ Goliszek, Andrew (2003). In The Name of Science. New York: St. Martin's Press. pp. 130–131. ISBN 978-0-312-30356-3.

14.    Jump up to:a b Goliszek, Andrew (2003). In The Name of Science. New York: St. Martin's Press. pp. 132–134. ISBN 978-0-312-30356-3.

15.    Jump up^ Richardson, Theresa (2001). "Acres of skin: human experiments at Holmesburg Prison. A true story of abuse and exploitation in the name of medical science". Canadian Journal of History. 36 (1): 184–186.

17.    Jump up^ Milgram, Stanley (1963). "Behavioral Study of Obedience". Journal of Abnormal and Social Psychology. 67 (4): 371–78. doi:10.1037/h0040525PMID 14049516. as PDF. Archived 2011-06-11 at the Wayback Machine.

18.    Jump up^ Milgram, Stanley (1974). Obedience to Authority; An Experimental View. Harpercollins. ISBN 0-06-131983-X.

19.    Jump up^ Baumrind, Diana (1964). "Some Thoughts on Ethics of Research: After Reading Milgram's "Behavioral Study of Obedience". American Psychologist. 19: 421–423. doi:10.1037/h0040128.

20.    Jump up^ Kaplan, Robert (2009). Medical Murder: Disturbing Cases of Doctors Who Kill. Allen & Unwin. ISBN 1741765773.

21.    Jump up^ Semple, David; Smyth, Roger; Burns, Jonathan (2005). Oxford handbook of psychiatry. Oxford: Oxford University Press. p. 6. ISBN 0-19-852783-7.

24.    Jump up^ Katona, Cornelius; Robertson, Mary (2005). Psychiatry at a glance. Wiley-Blackwell. p. 77. ISBN 1-4051-2404-0.

26.    Jump up^ "Tuskegee Study - Timeline". NCHHSTP. CDC. June 25, 2008. Retrieved December 4, 2008

27.    Jump up^ "New look at antidepressant suicide risks from infamous trial"New Scientist, 16 September 2015.

28.    Jump up to:a b Anne Thompson (July 9, 2001). "Paxil Maker Held Liable in Murder/Suicide". Lawyers Weekly USA.

31.    Jump up^ Philip J. Hilts (June 8, 2001). "Jury Awards $6.4 Million in Killings Tied to Drug". The New York Times.

32.    Jump up to:a b Draper, Robert (June 8, 2003). "The Toxic Pharmacist"New York Times. Retrieved 2010-08-31.

33.    Jump up^ UK firm tried HIV drug on orphans The Observer, Sunday 4 April 2004

34.    Jump up^ Andrews, J.R. 2006. Research in the Ranks: Vulnerable Subjects, Coercible Collaboration, and the Hepatitis E Vaccine Trial in Nepal. Perspectives in Biology and Medicine 49(1):35–51

35.    Jump up^ GSK fined over vaccine trials; 14 babies reported dead Buenos Aires Herald 1 Aug 2012.

36.    Jump up^ Kirk, S. A., Gomory, T., & Cohen, D. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. Transaction Publishers. pp. 218–219.

37.    Jump up^ Elliott, Carl (September–October 2010). "The deadly corruption of clinical trials. One patient's tragic, and telling, story". Mother Jones. Retrieved 4 August 2017.

39.    Jump up^ "Markingson letter". U of M Board of Regents. November 29, 2010. Retrieved 4 August 2017.

40.    Jump up^ Hagan, Kate (14 August 2010). "Doctors tread ethical minefield, 21 years on". The Age. Retrieved 4 August 2017.

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12/23/2017

The 1000th Thread!


This is the 1000th presentation to my bioethics blog since starting on Google Blogspot.com in 2004.
There has been many topics covered. Though comments by the visitors has always been encouraged and, since as a "discussion blog", comments leading to discussions I have felt was the definitive function here. Virtually none of the thread topics have gone unread and most have had some commentary, some with mainly particularly strong and emphatic opinions http://bioethicsdiscussion.blogspot.com/2013/01/should-pathologists-be-physicians.html, some with extensive up to 12 years long continued discussion http://bioethicsdiscussion.blogspot.com/2017/10/patient-modesty-volume-82.html, still there have been some with no visitor response http://bioethicsdiscussion.blogspot.com/2005/01/public-good-vs-money-in-pockets-or.html. It is interesting to understand why such differences have occurred.
Though most of the topics were bioethics as related to the subject of medical care, an occasional topic was related to plants http://bioethicsdiscussion.blogspot.com/2014/06/can-tree-experience-hurt-if-it-can-do.html and animals  http://bioethicsdiscussion.blogspot.com/2012/04/spending-lot-of-money-on-your-sick-dog.html.
Nevertheless, it is the multitude of issues regarding human medical ethics which has dominated this blog.  In  my opinion, a great listing and summarization of those issues was and is being presented by Wikipedia https://en.wikipedia.org/wiki/List_of_medical_ethics_cases and is reproduced below (courtesy of published permission for reproduction by Wikimedia).
I want, in this 1000th thread posting, to thank all those who have participated to, by their comments and input made this blog more interesting and dynamic than if my thoughts were simply just a "list". It is the "back and forth" of  discussion which makes a commentary written by one person something dynamic and much more useful and of value.   Best wishes to all and a happy upcoming New Year.  ..Maurice.  Graphic: Use of Picasa 3

List of medical ethics cases

From Wikipedia, the free encyclopedia

Some cases have been remarkable for starting broad discussion and for setting precedent in medical ethics.

Contents

  [hide] 

·         1Research

·         7References

Research[edit]

Research

case

country

location

year

summary

1880s

Psychosurgery (also called neurosurgery for mental disorder) has a long history. During the 1960s and 1970s, it became the subject of increasing public concern and debate, culminating in the US with congressional hearings. Particularly controversial was the work of Harvard neurosurgeon Vernon Markand psychiatrist Frank Ervin, who wrote a book entitled Violence and the Brain in 1970.[1] The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in 1977 endorsed the continued limited use of psychosurgical procedures.[1][2]Since then, a few facilities in some countries have continued to use psychosurgery on small numbers of patients. In the US and other Western countries, the number of operations has further declined over the past 30 years, a period during which there have been no major advances in ablative psychosurgery.[3]

United States

1920s

Controversial psychiatrist Henry Cotton at Trenton State Hospital in New Jersey became convinced that insanity was fundamentally a toxic disorder and he surgically removed body parts to try to improve mental health.[4]

United States

Iowa

1939

The Monster Study is the name given to a stuttering experiment performed on orphan children in Davenport, Iowa in 1939. It was conducted by Wendell Johnson at the University of Iowa. The research began with the selection of 22 subjects from a veterans' orphanage in Iowa. None were told the intent of the research, and they believed that they were to receive speech therapy. The study was trying to induce stuttering in healthy children. The experiment became national news in the San Jose Mercury News in 2001, and a book was written. On 17 August 2007, six of the orphan children were awarded $925,000 by the State of Iowa for lifelong psychological and emotional scars caused by six months of torment during the Iowa University experiment. Although none of the children became stutterers, some became self-conscious and reluctant to speak.[5] A spokesman for the University of Iowa called the experiment "regrettable".

Medical Experimentation on Black Americans[6]

United States

Various

Occurred over many decades

There has been a long history of medical experimentation on African Americans. From the era of slavery, when atrocities were committed on black women by J. Marion Sims, to the present day, Black Americans have been unwitting subjects of medical experimentation.[7][8] Author Harriet Washington argues that "diverse forms of racial discrimination have shaped both the relationship between white physicians and black patients and the attitude of the latter towards modern medicine in general".[9]

In the 1960s, Ionia State Hospital, located in Ionia, Michigan, was one of America's largest and most notorious state psychiatric hospitalsin the era before deinstitutionalization. Doctors at this hospital diagnosed African Americanswith schizophrenia because of their civil rightsideas. See The Protest Psychosis.

Plutonium injections

United States

1945-1947

Eighteen people were injected with plutoniumby Manhattan Project doctors. None of the patients was told what was going on, and the doctors did not ask for their consent. See Eileen Welsome's book The Plutonium Files.[10]

United States

1946

German medical doctors went on criminal trial for Nazi human experimentation. See The Years of Extermination.

U.S./
Guatemala

1946-48

The syphilis experiments in Guatemala were United States human experiments conducted in Guatemala from 1946 to 1948. The experiments were led by physician John Charles Cutler. They were done during the administration of American President Harry S. Truman and Guatemalan President Juan José Arévalo.[11]

Doctors infected soldiers, prostitutes, prisoners, and mental patients with syphilisand other sexually transmitted diseaseswithout the informed consent of the subjects, and treated most subjects with antibiotics. This resulted in at least 83 deaths.[12] In October 2010, the US formally apologized to Guatemala for conducting these experiments.

United States

New York State

1950s

More than 1200 homeless men from Lower Manhattan were convinced with promises of food and shelter to have their prostates biopsied by a Dr. Perry Hudson. They were not informed of possible side effects, i.e., rectal tearing and impotence. The homeless were targeted for these biopsies because the biopsies were painful and untested, and less vulnerable populations would not volunteer.

Radioactive iodine experiments

United States

1950s

The U.S. Atomic Energy Commission has a history of involvement in experiments involving radioactive iodine. In a 1949 operation called the "Green Run," the AEC released iodine-131and xenon-133 to the atmosphere, which contaminated a 500,000-acre (2,000 km2) area containing three small towns near the Hanford site in Washington.[13] In 1953, the AEC ran several studies on the health effects of radioactive iodine in newborns and pregnant women at the University of Iowa. Also in 1953, the AEC sponsored a study to discover if radioactive iodine affected premature babies differently from full-term babies.[14] In another AEC study, researchers at the University of Nebraska College of Medicine fed iodine-131 to 28 healthy infants through a gastric tube to test the concentration of iodine in the infants' thyroid glands.[14]

United States

1951

A product derived from a cancer patient's specimen, HeLa is the cornerstone of an industry. Cancerous tissue was taken from her without her consent.

United States

Philadelphia

1951-1974

Clinical non-therapeutic medical experiments on prison inmates was conducted at Holmesburg Prison in Philadelphia from 1951 to 1974 under the direction of dermatologistAlbert Kligman.[15]

Canada

1957–1964

The Allan Memorial Institute is known for its role in the Project MKULTRA run by the CIA. The Agency's initiative to develop drug-induced "mind control" techniques was implemented in the institute by its then-Director Donald Ewen Cameron.

UK mental institutions

UK

1960s

In the 1960s, there was abuse and inhumane treatment of psychiatric patients who were hidden away in institutions in the UK. Barbara Robb documented her difficult personal experience of being treated at Ely Hospital. She wrote the book Sans Everything and she used this to launch a campaign to improve or close long stay facilities. Shortly after, a long stay hospital for the mentally handicapped in Cardiff was exposed by a nurse writing to the News of the World. This exposure prompted an official inquiry, which was highly critical of conditions, staff morale, and management. At the same time Michael Ignatieff and Peter Townsend both published books which exposed the poor quality of institutional care.[16]

United States

1961

The Milgram experiment on obedience to authority figures was a series of notable social psychology experiments conducted by Yale University psychologist Stanley Milgram, which measured the willingness of study participants to obey an authority figure who instructed them to perform acts that conflicted with their personal conscience.[17] The detailed findings are discussed in his 1974 book, Obedience to Authority: An Experimental View.[18] The experiments were controversial, and considered by some scientists to be unethical and physically or psychologically abusive. Psychologist Diana Baumrind considered the experiment "harmful because it may cause permanent psychological damage and cause people to be less trusting in the future." [19]

1962-1979

Controversial Australian psychiatrist Harry Bailey treated mental patients via deep sleep therapy and other methods at a Sydney mental hospital. He has been linked with the deaths of 85 patients.[20] He committed suicide before he could be punished.

Soviet Union, Romania,
Hungary,
Czechoslovakia, Yugoslavia and China

1960s to 1980s

Psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience.[21]:6 In the period from the 1960s to 1986, abuse of psychiatry for political purposes was reported to be systematic in the Soviet Union and other Eastern European countries.[22]:66 Political abuse of psychiatry also takes place in the People's Republic of China.[23] Psychiatric diagnoses such as the diagnosis of "sluggish schizophrenia" in political dissidents in the USSR were used for political purposes.[24]:77

United States

1971

The Stanford prison experiment was a study of the psychological effects of becoming a prisoner or prison guard. The experiment was conducted in August 1971 by a team of researchers led by psychology professor Philip Zimbardo.[25] Participants took on the roles of prisoners and guards in a mock prison situated in the basement of the Stanford psychology building. Some of the prisoners were subjected to psychological torture. Many of the prisoners passively accepted psychological abuse, and Zimbardo himself permitted the abuse to continue. Two of the prisoners quit the experiment early and the entire experiment was abruptly stopped after only six days. Certain portions of the experiment were filmed and excerpts of footage are publicly available.

United States

1970s

Human radiation experiments were directed by the United States Atomic Energy Commissionand the Manhattan Project. In Nashville, pregnant women were given radioactive mixtures. In Cincinnati, some 200 patients were irradiated over a period of 15 years. In Chicago, 102 people received injections of strontium and cesium solutions. In Massachusetts, 74 schoolboys were fed oatmeal that contained radioactive substances. In all of these cases, the subjects did not know what was going on and did not give informed consent.[10] The government covered up most of these radiation mishaps until 1993, when President Bill Clinton ordered a change of policy. The resulting investigation was undertaken by the Advisory Committee on Human Radiation Experiments. See The Plutonium Files.

United States

1972

A 40-year experiment conducted by the U.S. Public Health Service withheld standard medical advice and treatment from a poor minority population with an easily treatable disease. The experiment targeted black male farmers who were told they needed to be treated for 'bad blood',[26] some of whom had previously encountered syphilis. Others were intentionally given syphilis during the course of the experiment. In addition to many fatalities, some children were born with congenital syphilis due to the study.

United States

1976

Researchers commercialized a patient's discarded body parts. The man did not authorize the use of his bodily tissues or fluids, and researchers did not obtain informed consent. He did not want his donation to generate commercial profit for private entities.

1980s

Eugene Ellsworth Landy was an American psychologist and psychotherapist best known for his unconventional 24-hour therapy as well as ethical violations concerning his treatment of Beach Boys co-founder Brian Wilson in the 1980s. In 2015, Landy's relationship with Wilson was dramatized in the biographical filmLove & Mercy.

United States

1987

A school had been infecting disabled children in experiments for years.

Canada, United States

12 psychiatric centers

1994–2001

SmithKlineBeecham, known since 2000 as GlaxoSmithKline, conducted a clinical trial from 1994 to 1997 in 12 pychiatric centers in North America to study the efficacy of paroxetine(Paxil, Seroxat), an anti-depressant, on teenagers. The trial data suggested that the drug was not efficacious and that the paroxetine group were more likely to think about suicide. The paper that wrote up the study was published in 2001, osensibly authored by a group of academics, but actually ghostwritten by the drug company. The article downplayed the negative findings and concluded that paroxetine helped with teenage depression. The company used this paper to promote paroxetine for teenagers. The ensuing controversy led to several lawsuits, including from the parents of teenagers who killed themselves while taking the drug, and intensified the debate about medical ghostwriting and conflict of interest in clinical trials. In 2012 the US Justice Department fined GlaxoSmithKline $3 billion for several violations, including withholding data on paroxetine, unlawfully promoting it for adolescents, and preparing a misleading article about study 329. New Scientist wrote in 2015: "You may never have heard of it, but Study 329 changed medicine."[27]

Death associated with psychotropic drugs

United States

1998

In 1998, 60-year-old Donald Schell went to see his doctor complaining of difficulty sleeping. He was diagnosed with an anxiety state and placed on Paxil, an SSRI anti-depressant. Within 48 hours of being put on Paxil Schell killed his wife, daughter, infant granddaughter, and himself. Tim Tobin, Schell’s son-in-law, took legal action against SmithKline (now GlaxoSmithKline). The Tobin case was heard in Wyoming from May 21 to June 6, 2001. The jury returned a guilty verdict against SmithKline and awarded Tobin $6.4 million.[28][29][30][31]This was the first guilty verdict returned against a pharmaceutical company regarding adverse behavioral effects of a psychotropic drug.[28]

United States

2002

Courtney is a former pharmacist who owned and operated Research Medical Tower Pharmacy in Missouri.[32] In 2002, he was convicted of pharmaceutical fraud and sentenced to federal prison.[32]

United States

2003

Patients donated tissue samples, which researchers subsequently used in a plan to generate profit.

GlaxoSmithKlinehuman experiments

Various

2004–2012

In 2004 GlaxoSmithKline (GSK) sponsored at least four medical trials using Hispanic and black children at New York's Incarnation Children's Center. Normally trials on children require parental consent but, as the infants were in care, New York's authorities held that role. Experiments were designed to test the “safety and tolerance” of AIDS medications, some of which have potentially dangerous side effects.[33]

In 2006, GSK and the US Army were criticized for Hepatitis E vaccine experiments conducted in 2003 on 2,000 soldiers of the Royal Nepalese Army. It was said that using soldiers as volunteers is unethical because they "could easily be coerced into taking part."[34]

In January 2012, GSK and two scientists who led the trials were fined approximately $240,000 in Argentina for "experimenting with human beings" and "falsifying parental authorization" during vaccine trials on 15,000 children under the age of one. Babies were recruited from poor families that visited public hospitals for medical treatment. Fourteen babies allegedly died as a result of the trials.[35]

Death from prescription drugs

United States

2006

Rebecca Riley, the daughter of Michael and Carolyn Riley of Massachusetts, was found dead in her home at age four, her lungs filled with fluid, after prolonged exposure to various medications. The medical examiner's office determined the girl died from "intoxication due to the combined effects" of prescription drugs. Police reports state she was taking 750 milligrams a day of Depakote, 200 milligrams a day of Seroquel, and .35 milligrams a day of Clonidine. Rebecca had been taking the drugs since the age of two for bipolar disorder and ADHD, diagnosed by child psychiatrist Kayoko Kifuji of the Tufts-New England Medical Center.[36]

University of MinnesotaResearch Participant Dan Markingson

United States

Minnesota

2004

University of Minnesota research participant Dan Markingson committed suicide in May 2004 while enrolled in an industry-sponsored pharmaceutical trial comparing three FDA-approved atypical antipsychotics: Seroquel (quetiapine)Zyprexa (olanzapine), and Risperdal (risperidone). Writing on the circumstances surrounding Markingson's death in the study, which was designed and funded by Seroquel manufacturer AstraZeneca, University of Minnesota Professor of Bioethics Carl Elliott noted that Markingson was enrolled in the study against the wishes of his mother, Mary Weiss, and that he was forced to choose between enrolling in the study or being involuntarily committed to a state mental institution.[37] Further investigation revealed financial ties to AstraZeneca by Markingson's psychiatrist, Dr. Stephen C. Olson, oversights and biases in AstraZeneca's trial design, and the inadequacy of university Institutional Review Board (IRB)protections for research subjects.[38] Although a 2005 FDA investigation appeared to clear the university, greater awareness of the case stemming from Elliott's 2010 article in the magazine Mother Jones resulted in a group of university faculty members sending a public letter to the Board of Regents urging an external investigation into Markingson's death.[39]

Termination of mechanical ventilation and life support[edit]

case

country

location

year

summary

United States

2008

A hospital wished to withhold treatment from someone whom it judges to have no chance of living.

United States

2008

The parents of a brain-dead boy wanted to keep him on life support.

United States

2007

Prison officials question whether to force-feed inmates who are on hunger strike.

United Kingdom

2017

After losing a UK Supreme Court case, the parents of Gard, 10 months, petitioned the EU Court in France, and lost the final appeal. They wanted the hospital to allow them to travel to the U.S. for an experimental therapy that may have provided some temporary benefit but likely would not have improved his neurological condition, due to a mitochondrial DNA depletion disease (the treatment is nucleoside bypass therapy). At the least, they wanted for the hospital to continue to provide advanced life support palliative care for their son—respiration, nutrition, hydration—or to send him home on life support to eventually die, but those requests were also denied and support will be turned off.

United States

2005

The hospital removes life support from an unconscious immigrant from Eritrea against her family's wishes. The family are in a foreign country and unable to travel.

2010

A man seems to be in a persistent vegetative state, and after 23 years a communication test is conducted.

United States

Texas

2004

An infant is removed from life support against his mother's wishes.

United States

1992

The mother of an anencephalic baby wishes to keep the child on life support perpetually.

United States

2004

Parents wish to keep a child on life support.

United States

2005

A family wishes to keep life support for a man in a persistent vegetative state.

United States

1984

A boy dies at age 12 after living a lifetime with highly unusual medical care in a sterile environment.

United States

2013

A teenaged woman is declared brain-dead and her family wishes to maintain her body on mechanical ventilation perpetually.

Withholding life-prolonging medical treatment[edit]

Withholding life-prolonging treatment

case

country

location

year

summary

United States

1983

The parents of a child born with horrible birth defects request the right to refuse treatment and keep the child off life support.

Australia

1989

Parents and doctors agreed to withhold life-prolonging measures of severely disabled newborn baby, including surgeries and medication, while Right to Life activists claimed the baby was murdered.[40]

Informed consent to medical treatment[edit]

Informed consent to medical treatment

case

country

location

year

summary

Germany

2011

Informed consent and involuntary sex reassignment in the case of an adult intersex woman.

England

1985

The right of minors to request contraception from their doctor without parental consent.

Person wishes for assisted suicide[edit]

Assisted suicide

case

country

location

year

summary

2007

A couple request the legal right to commit suicide together, although only the husband was ill.

United States

1973

A man who suffered severe burns requests the right to die.

Italy

2007

A man in pain requests a legal right to die.

Canada

1991

A woman requests a right to assisted suicide.

Spain

1998

For 29 years a man requests his right to assisted suicide.

India

2011

A court case debates the right to die for a woman in a persistent vegetative state for 37 years.

Italy

2006

A patient requests a legal right to die.

Person wishes for euthanasia for another[edit]

Euthanasia of another

case

country

location

year

summary

United States

2008

A parent is charged with critically harming his child who is on life support. If the child dies, the parent may be charged with murder. At question was whether parents should be legally allowed to make medical decisions for children they have allegedly abused.

England

1993

Bland was the first patient in English legal history to be allowed to die by the courts through the withdrawal of life-prolonging treatment.

United States

2002

A mother euthanizes her adult sons to relieve their suffering from Huntington's disease.

United States

1990

The parents of a woman in a persistent vegetative state request the right to remove her life support equipment.

1992

Parents receive permission to remove the life support from a woman in a persistent vegetative state for 17 years.

United States

2009

A sister is charged with euthanizing her brother after he has medical problems.

United States

Michigan

1994

A medical doctor advocates for assisted suicide and the right to die.

Canada

1993

A man euthanizes his child who has lived for years in pain.

United States

New Jersey

1976

A 21-year-old girl is in a persistent vegetative state. Her parents wish to remove her from artificial respiration.

United States

2005

A woman is in a persistent vegetative state. Her husband wishes to remove her life support. Her parents wish her to remain on life support.

United States

2013

A woman is declared brain-dead by her physician. Her husband and family wish to remove life support. The hospital persists in keeping her on life support because it claims it cannot legally withdraw life support from a pregnant patient.

References[edit]

1.      Jump up to:a b Mashour, G.A.; Walker, E.E.; Martuza, R.L. (2005). "Psychosurgery: past, present and future". Brain Research Reviews. 48 (3): 409–18. doi:10.1016/j.brainresrev.2004.09.002PMID 15914249.

2.      Jump up^ Casey, B.P. (Mar 2015). "The surgical elimination of violence? Conflicting attitudes towards technology and science during the psychosurgery controversy of the 1970s". Science in Context. 28 (1): 99–129. doi:10.1017/S0269889714000349PMID 25832572.

3.      Jump up^ Sachdev, P.; Chen, X. (2009). "Neurosurgical treatment of mood disorders: traditional psychosurgery and the advent of deep brain stimulation". Current Opinion in Psychiatry. 22 (1): 25–31. doi:10.1097/YCO.0b013e32831c8475PMID 19122531.

8.      Jump up^ Nelson, Alondra (7 January 2007). "Unequal Treatment. Medical Apartheid"The Washington Post.

12.    Jump up^ "Guatemalans 'died' in 1940s US syphilis study"BBC News. 29 August 2011. Retrieved 29 August 2011.

13.    Jump up^ Goliszek, Andrew (2003). In The Name of Science. New York: St. Martin's Press. pp. 130–131. ISBN 978-0-312-30356-3.

14.    Jump up to:a b Goliszek, Andrew (2003). In The Name of Science. New York: St. Martin's Press. pp. 132–134. ISBN 978-0-312-30356-3.

15.    Jump up^ Richardson, Theresa (2001). "Acres of skin: human experiments at Holmesburg Prison. A true story of abuse and exploitation in the name of medical science". Canadian Journal of History. 36 (1): 184–186.

17.    Jump up^ Milgram, Stanley (1963). "Behavioral Study of Obedience". Journal of Abnormal and Social Psychology. 67 (4): 371–78. doi:10.1037/h0040525PMID 14049516. as PDF. Archived 2011-06-11 at the Wayback Machine.

18.    Jump up^ Milgram, Stanley (1974). Obedience to Authority; An Experimental View. Harpercollins. ISBN 0-06-131983-X.

19.    Jump up^ Baumrind, Diana (1964). "Some Thoughts on Ethics of Research: After Reading Milgram's "Behavioral Study of Obedience". American Psychologist. 19: 421–423. doi:10.1037/h0040128.

20.    Jump up^ Kaplan, Robert (2009). Medical Murder: Disturbing Cases of Doctors Who Kill. Allen & Unwin. ISBN 1741765773.

21.    Jump up^ Semple, David; Smyth, Roger; Burns, Jonathan (2005). Oxford handbook of psychiatry. Oxford: Oxford University Press. p. 6. ISBN 0-19-852783-7.

24.    Jump up^ Katona, Cornelius; Robertson, Mary (2005). Psychiatry at a glance. Wiley-Blackwell. p. 77. ISBN 1-4051-2404-0.

26.    Jump up^ "Tuskegee Study - Timeline". NCHHSTP. CDC. June 25, 2008. Retrieved December 4, 2008

27.    Jump up^ "New look at antidepressant suicide risks from infamous trial"New Scientist, 16 September 2015.

28.    Jump up to:a b Anne Thompson (July 9, 2001). "Paxil Maker Held Liable in Murder/Suicide". Lawyers Weekly USA.

31.    Jump up^ Philip J. Hilts (June 8, 2001). "Jury Awards $6.4 Million in Killings Tied to Drug". The New York Times.

32.    Jump up to:a b Draper, Robert (June 8, 2003). "The Toxic Pharmacist"New York Times. Retrieved 2010-08-31.

33.    Jump up^ UK firm tried HIV drug on orphans The Observer, Sunday 4 April 2004

34.    Jump up^ Andrews, J.R. 2006. Research in the Ranks: Vulnerable Subjects, Coercible Collaboration, and the Hepatitis E Vaccine Trial in Nepal. Perspectives in Biology and Medicine 49(1):35–51

35.    Jump up^ GSK fined over vaccine trials; 14 babies reported dead Buenos Aires Herald 1 Aug 2012.

36.    Jump up^ Kirk, S. A., Gomory, T., & Cohen, D. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. Transaction Publishers. pp. 218–219.

37.    Jump up^ Elliott, Carl (September–October 2010). "The deadly corruption of clinical trials. One patient's tragic, and telling, story". Mother Jones. Retrieved 4 August 2017.

39.    Jump up^ "Markingson letter". U of M Board of Regents. November 29, 2010. Retrieved 4 August 2017.

40.    Jump up^ Hagan, Kate (14 August 2010). "Doctors tread ethical minefield, 21 years on". The Age. Retrieved 4 August 2017.

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Full Article

This entry was posted in Health Care and tagged . Posted by Maurice Bernstein, M.D.. Bookmark the permalink.

12/14/2017

Palliative Care vs Just Busine$$

Here is a true story of a decision made by the patient and his opthalmologist to allow a terminally ill patient who is expected to die soon and who has cataracts in both eyes to have cataract surgery to be able to see his family before he dies. Th...

Full Article

This entry was posted in Health Care and tagged . Posted by Maurice Bernstein, M.D.. Bookmark the permalink.

12/14/2017

Palliative Care vs Just Busine$$

Here is a true story of a decision made by the patient and his opthalmologist to allow a terminally ill patient who is expected to die soon and who has cataracts in both eyes to have cataract surgery to be able to see his family before he dies. Th...

Full Article

This entry was posted in Health Care and tagged . Posted by Maurice Bernstein, M.D.. Bookmark the permalink.

11/12/2017

Medical Advance Directive: An Emphatic "NO!" to Dementia




Norman Cantor, a lawyer and Professor of Law at Rutgers University School of Law wrote a thoughtful article about the medical Advance Directive in the Harvard Law School "Bill of Health" blog


and explaining why he is revising his own medical Advance Directive to instruct his physicians and caretakers to allow him to die if he had developed a dementia "upon reaching a degree of permanent mental dysfunction that I deem to be intolerably demeaning.  For me, this means mental deterioration to a point when I can no longer read and understand written material such as a newspaper or financial records such as a checkbook"


Read his entire presentation at the Harvard Law blog link above and then return to present your views on adding profound mental deterioration to the list of physical illnesses which are irreversible and can be highly distressful to the patient and his family's lives and which he does not want to experience or have his family experience further and if he should face a treatable but serious life threatening condition, he should be allowed to die.


Hopefully, all of my blog readers have their own medical Advance Directive written to designate  a  surrogate to attend to their wishes for treatment of a potentially fatal illness when it occurs. If not, as your physician moderator of this bioethics blog, I would strongly recommend it be created and available for your physicians later to read and observe your directive.


  With Professor Cantor's permission, his Revised Advance Directive is reproduced below. ..Maurice..                                                       
My Revised Advance Directive

     I have witnessed the ravages that Alzheimer's disease and similar progressive dementias produce.  I wish to be allowed to die upon reaching a degree of permanent mental dysfunction that I deem to be intolerably demeaning.  For me, this means mental deterioration to a point when I can no longer read and understand written material such as a newspaper or financial records such as a checkbook.       

     This wish to hasten my post-competence demise is not based on prospective suffering or distress, but rather on my personal vision of intolerable indignity and degradation associated with cognitive dysfunction.  For me, it is critical to shape the post-mortem recollections of my loved ones and to preserve the lifetime image as a vital, critically thinking individual that I have strived to cultivate.  In addition, it is important to me to avoid being an emotional, physical, or financial burden on my family and friends, even if they would willingly assume such burdens. 

    I fully understand that my determination to avoid prolonged, progressive debilitation could prompt my demise even though I might appear content in my debilitated condition.  I am exercising my prerogatives of self-determination and bodily integrity to shape my lifetime narrative, including my dying process, in accord with my strong aversions to mental dysfunction and to dependence on others. 

     My determination not to prolong my life at the described point of debilitation includes rejection of any and all life-sustaining means.  This includes simplistic medical interventions such as antibiotics, blood transfusions, and antiarrythmics, as well as more complex interventions like CPR, mechanical ventilation, dialysis, and artificial nutrition and hydration.  Indeed, if my dementia or any other affliction has produced inability or unwillingness to feed myself – for example, because of swallowing difficulties, or other eating disorders, or just indifference to eating -- I instruct that my caregivers refrain from hand feeding unless I appear receptive to eating and drinking (show signs of enjoyment or positive anticipation).  If I am indifferent or resistant to hand feeding, I do not want to be cajoled, harassed, or in any way impelled to eat or drink.   

     The only limitation on my advance rejection of life-sustaining medical intervention is adherence to humane treatment.  That is, I have no desire to subject my future incompetent persona to a torturous or agonizing dying process.  I presume that palliative steps -- including medication for pain, anxiety, or agitation -- will be taken to ease my dying process. 


     The question may arise as to whether I have had a change of mind and revoked my advance directive.  My wish is that no revocation be found unless I do so while still capable of a considered choice, including appreciation of all the major elements involved.  I urge my decision-making agents to avoid the temptation of manipulating my future, incompetent persona to contradict or alter my advance instructions.  And I direct that my original instructions be honored absent an aware, considered change of mind (as opposed to uncomprehending expressions by my demented persona). 


Graphic: Through Google Images. "5th Dementia"PAINTING BY JEFF BOWERING Saatchi Art

Full Article

This entry was posted in Health Care and tagged . Posted by Maurice Bernstein, M.D.. Bookmark the permalink.

11/12/2017

Medical Advance Directive: An Emphatic "NO!" to Dementia




Norman Cantor, a lawyer and Professor of Law at Rutgers University School of Law wrote a thoughtful article about the medical Advance Directive in the Harvard Law School "Bill of Health" blog


and explaining why he is revising his own medical Advance Directive to instruct his physicians and caretakers to allow him to die if he had developed a dementia "upon reaching a degree of permanent mental dysfunction that I deem to be intolerably demeaning.  For me, this means mental deterioration to a point when I can no longer read and understand written material such as a newspaper or financial records such as a checkbook"


Read his entire presentation at the Harvard Law blog link above and then return to present your views on adding profound mental deterioration to the list of physical illnesses which are irreversible and can be highly distressful to the patient and his family's lives and which he does not want to experience or have his family experience further and if he should face a treatable but serious life threatening condition, he should be allowed to die.


Hopefully, all of my blog readers have their own medical Advance Directive written to designate  a  surrogate to attend to their wishes for treatment of a potentially fatal illness when it occurs. If not, as your physician moderator of this bioethics blog, I would strongly recommend it be created and available for your physicians later to read and observe your directive.


  With Professor Cantor's permission, his Revised Advance Directive is reproduced below. ..Maurice..                                                       
My Revised Advance Directive

     I have witnessed the ravages that Alzheimer's disease and similar progressive dementias produce.  I wish to be allowed to die upon reaching a degree of permanent mental dysfunction that I deem to be intolerably demeaning.  For me, this means mental deterioration to a point when I can no longer read and understand written material such as a newspaper or financial records such as a checkbook.       

     This wish to hasten my post-competence demise is not based on prospective suffering or distress, but rather on my personal vision of intolerable indignity and degradation associated with cognitive dysfunction.  For me, it is critical to shape the post-mortem recollections of my loved ones and to preserve the lifetime image as a vital, critically thinking individual that I have strived to cultivate.  In addition, it is important to me to avoid being an emotional, physical, or financial burden on my family and friends, even if they would willingly assume such burdens. 

    I fully understand that my determination to avoid prolonged, progressive debilitation could prompt my demise even though I might appear content in my debilitated condition.  I am exercising my prerogatives of self-determination and bodily integrity to shape my lifetime narrative, including my dying process, in accord with my strong aversions to mental dysfunction and to dependence on others. 

     My determination not to prolong my life at the described point of debilitation includes rejection of any and all life-sustaining means.  This includes simplistic medical interventions such as antibiotics, blood transfusions, and antiarrythmics, as well as more complex interventions like CPR, mechanical ventilation, dialysis, and artificial nutrition and hydration.  Indeed, if my dementia or any other affliction has produced inability or unwillingness to feed myself – for example, because of swallowing difficulties, or other eating disorders, or just indifference to eating -- I instruct that my caregivers refrain from hand feeding unless I appear receptive to eating and drinking (show signs of enjoyment or positive anticipation).  If I am indifferent or resistant to hand feeding, I do not want to be cajoled, harassed, or in any way impelled to eat or drink.   

     The only limitation on my advance rejection of life-sustaining medical intervention is adherence to humane treatment.  That is, I have no desire to subject my future incompetent persona to a torturous or agonizing dying process.  I presume that palliative steps -- including medication for pain, anxiety, or agitation -- will be taken to ease my dying process. 


     The question may arise as to whether I have had a change of mind and revoked my advance directive.  My wish is that no revocation be found unless I do so while still capable of a considered choice, including appreciation of all the major elements involved.  I urge my decision-making agents to avoid the temptation of manipulating my future, incompetent persona to contradict or alter my advance instructions.  And I direct that my original instructions be honored absent an aware, considered change of mind (as opposed to uncomprehending expressions by my demented persona). 


Graphic: Through Google Images. "5th Dementia"PAINTING BY JEFF BOWERING Saatchi Art

Full Article

This entry was posted in Health Care and tagged . Posted by Maurice Bernstein, M.D.. Bookmark the permalink.