Blog RSS Blog.

Author Archive: Maurice Bernstein

About Maurice Bernstein

06/06/2013

The Disabled: Ethical and Practical Issues Yet to be Resolved: What Can You Find Out and Tell Us About Them?

I have developed a number of threads on this blog presenting and discussing issues that deal with the disabled person such as the following:"Thinking and Writing about the Disabled:Courageous or Burdened" "Eugenics,“Feeblemindedness” and the “Dro...

Full Article

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

06/06/2013

The Disabled: Ethical and Practical Issues Yet to be Resolved: What Can You Find Out and Tell Us About Them?











I have developed a number of threads on this blog presenting and discussing issues that deal with the disabled person such as the following:










Many of the issues presented in these threads over the past number of years are still not  settled and some, of recent interest have not even been discussed here as yet..

Some of the issues still undecided by ethicists but also by the public are listed below.  I have not performed a library or Google search regarding the current facts regarding the status and full arguments for or against these issues to present here on my blog.


I thought it might be interesting to have my readers do the research on one or more of these topics and write a comment here about the arguments and status of the debate as researched.  On the other hand, based on their experience or current knowledge, some visitors might like to just write about their own opinions regarding any of these issues.


I hope my visitors don't think that I am just lazy making this request. I'm not. I just want to see, through this experiment how others discover and present the facts regarding these issues which are very important both to the disabled person, that person's family and to the society in general.  So go and Google the topic, learn and return and tell us what you know. ..Maurice.



The use of bionic eyes


The use of cochlear implants


Prosthetics for everyday use or competitive sports


“Normalizing” surgery for individuals with Down Syndrome


Limb lengthening surgeries (e.g., for individuals with achondroplasia)


The use of growth hormones


The use of “neuroenhancement” drugs (e.g., to improve focus, memory, or other cognitive functioning)


Laws that influence decision making on behalf of disabled children (e.g., the Swedish law requiring parents to consult with member of the Deaf community prior to agreeing to cochlear implant surgery for their child)


Growth attenuation procedures


Familial or community pressure to modify or refuse modifications of one’s body



Graphic:  Classic "the disabled" signage from Google Images









Full Article

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

05/28/2013

"Good People Doing Bad Things for Good Reasons": Revision

The following original article which I wrote and was published today at the bioethics.net website is reproduced here with permission.  ..Maurice05/28/2013GOOD PEOPLE DOING BAD THINGS FOR GOOD REASONSMaurice Bernstein, MDWhat is ethical o...

Full Article

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

05/28/2013

"Good People Doing Bad Things for Good Reasons": Revision




The following original article which I wrote and was published today at the bioethics.net website is reproduced here with permission.  ..Maurice

Maurice Bernstein, MD
What is ethical or not is often in the eye of the beholder. That is why often the ethics of decisions or acts that we deal with in medicine is established through the process of consensus. And I don’t necessarily mean consensus by only scholars, lawyers or ethicists or even physicians. I think in ethical consensus the many voices of society should be included. I think that an understanding of reason for the divergent views that may occur in ethical analysis can be expressed by what Marcia Angell, former editor-in-chief of the New England Journal of Medicine has said in the past. Perhaps you have already have heard it.“Ethical violations are usually not a case of bad people doing bad things for no good reason, it is usually the case of good people doing bad things for good reasons.” If it were bad people, bad things and bad reasons, there would be no ethical conflicts. The question is whether the acts of those good people carried out for those good reasons best meet the principles of ethics for that particular issue.
Many times in clinical ethics, we find that all of the stakeholders of an issue have meritorious reasons to base their suggested actions. There also may be a meeting of an ethical principle for each action so that there is no strictly unethical violation. The problem arises when one action is inconsistent with another action and we have to decide which act and its ethics trumps another. But trumping may mean that some stakeholders may lose. Therefore, those of us who perform the responsibilities of the hospital ethics committee must remember that we are dealing with good people who have good reasons and perhaps their intended actions are not even that bad except in light of the context of the issue.
Three members of a hospital ethics committee met with 4 family members and two physicians of the patient to come to a decision about the patient’s further management. The patient, a 67- year-old diabetic male who had been a heavy smoker for most of his life, three weeks earlier had suffered a massive stroke which left him unconscious and unresponsive but able to breathe.  Supplemental oxygen by nasal catheter had to be replaced by continuous ventilator breathing support within the Intensive Care Unit when after a week bilateral pneumonia developed and adequate spontaneous breathing ceased.  His course was further complicated by signs of progressive renal failure and gastro-intestinal bleeding of unknown cause, which was significant enough to require repeated blood transfusions to maintain a minimally satisfactory blood count. The patient’s mental state remained unchanged.
The attending physician and neurologist presented to the family and the ethics committee a conclusion to terminate energetic treatment because the patient’s condition was progressively worsening despite intensive medical management, the patient would be unable to tolerate exploratory surgery for the bleeding and the neurologic prognosis was that significant recovery was unlikely. The ethics committee reminded the meeting that the repeated blood use was utilizing a particularly scarce resource.  The son and two daughters agreed with the physicians’ conclusion but the wife who was the legal surrogate stated that she was told by the nursing staff, confirmed by the physician, that the patient had begun triggering the ventilator and that she felt that this was a good sign and that her husband would have wanted treatments to continue.
One of the tools the ethics committee has in this case is compromise. Sometimes compromise mitigates the conflict if even only temporarily. Though it may be only a band-aid in making an ethical solution, it often permits time to get the parties together on a final decision. If, as an example, the issue is end-of-life decision-making and family members are in conflict as to whether enough time on treatment has elapsed to be assured that the patient will not recover, a compromise can be often reached.
In the case presented, at the suggestion of the ethics committee members, the family and physicians agreed to seven more days of current management and then meeting again to re-evaluate the situation and if there was no improvement to then agreed to provide solely comfort care rather than the current attempts to cure.  While the ethics committee agreed with the physicians’ initial conclusions along with that of the children, the committee recognized that the wife, as the surrogate, had some basis for her initial rejection and that compromise with the wife was appropriate.
Those of us “doing ethics” should always temper our dogmatic views, if we carry them, to realize that generally we are dealing with good people and their good reasons. And the “bad” things they may want to do is often just “relatively bad.”.

Full Article

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

05/28/2013

Good People Doing Bad Things for Good Reasons

Maurice Bernstein, MD

What is ethical or not is often in the eye of the beholder. That is why often the ethics of decisions or acts that we deal with in medicine is established through the process of consensus. And I don’t necessarily mean consensus by only scholars, lawyers or ethicists or even physicians. I think in ethical consensus the many voices of society should be included. I think that an understanding of reason for the divergent views that may occur in ethical analysis can be expressed by what Marcia Angell, former editor-in-chief of the New England Journal of Medicine has said in the past.…

Full Article

This entry was posted in End of Life Care, Featured Posts, Philosophy & Ethics and tagged . Posted by Maurice Bernstein. Bookmark the permalink.

05/26/2013

Patient Modesty: Volume 55

As we move on to Volume 55 of this thread on Patient Modesty there appears to be more discussion about ways to educate physicians, nurses and other healthcare providers regarding the personal feelings and concerns and particularly related to physical m...

Full Article

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

05/26/2013

Patient Modesty: Volume 55

As we move on to Volume 55 of this thread on Patient Modesty there appears to be more discussion about ways to educate physicians, nurses and other healthcare providers regarding the personal feelings and concerns and particularly related to physical m...

Full Article

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

05/26/2013

Smelling the Unethical: Can You? Should You?

The question arises as to how the average person can "smell" (suspect without documentation) that some act or behavior of an individual or individuals is unethical. An often used expression is: "It smells fishy to me." Is everything which determines wh...

Full Article

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

05/26/2013

Smelling the Unethical: Can You? Should You?

The question arises as to how the average person can "smell" (suspect without documentation) that some act or behavior of an individual or individuals is unethical. An often used expression is: "It smells fishy to me." Is everything which determines wh...

Full Article

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

05/25/2013

Patient to Physician Confidentiality: Under All Circumstances?








Within the May 10 2013 issue of the New York Times comes the following concern from a physician:

I am a physician. Years ago, I saw a young patient with headaches, who disclosed — reluctantly — that he had committed a serious crime and that somebody else took the fall for it. I believe he was telling me the truth (his headaches soon resolved after the confession). Before his admission, I assured him that whatever he told me would not leave the room. Later, without giving specifics, I consulted our hospital lawyer, who told me that we were under no obligation to report the incident, because the patient wasn’t in danger of hurting himself or others. But the future of an innocent man hinges on two people’s consciences, my patient’s and my own. I feel like a coward, hiding behind the Hippocratic oath, doing nothing. NAME WITHHELD

Well, if you were going to give advice to this physician..what would you say? If the doctor had initially given the patient assurance of confidentiality, should that promise be kept under any circumstance that arose in further communication? What is your opinion? ..Maurice.

Graphic: From Google Images

Full Article

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