Chicago Med (Season 3; Episode 4)
Confidentiality: A husband comes into the ER with his wife who is experiencing Braxton Hicks contractions. He does not look well so Dr. Halstead gives him an examination. Tests results are inconclusive for Zika virus. The patient says he was in Buffalo, NY and has not traveled anywhere known to have the virus. When Halstead says that he is going to have to test the wife for the virus because of its potential negative effects on the fetus, the husband informs Halstead that he was in Aruba with a “lady friend” and he’s not about to lose his marriage: “Did they teach you about patient confidentiality in medical school because they certainly did in law school.…
When inevitably faced with issues of mortality, many of us – whether patient, family or clinician – will suffer needlessly for a variety of reasons, some cultural, some clinical, some a matter of access.
End Well’s objective is to address these issues as a multidisciplinary community, bringing together design, technology, health, policy and activist imagination and expertise. We seek to create a platform that will transform thought into human-centered action as we reimagine the end of life experience in ways that are universally available and serve the needs of the individual.
by Craig Klugman, Ph.D.
As you may be aware, the U.S. House and U.S. Senate are in conference over a major tax bill. Each chamber of Congress passed different versions of a 2017 tax reform bill. The next step is for representatives from each chamber to negotiate the differences and then to present a reconciled bill for final votes. The GOP has an ambitious timeline of completing reconciliation by the Christmas holiday meaning that the bills are being rushed and not receiving careful discussion and debate. What is important for the world of bioethics with these bills is that they contain significant changes to the health care landscape and even a few easter eggs that will effect bioethics practice.…
Meanwhile, in the U.S. Court of Appeals for the Fifth Circuit another case raising similar issues has now been fully briefed. (Emily-Jean Aguocha-Ohakweh v. Harris County Hospital Dist.)
Aphaeus Ohakweh was admitted to Ben Taub Hospital on March 4, 2015, in need of treatment for AML – acute myeloid leukemia – a potentially fatal cancer that interferes with the production of normal red blood cells.
On March 6, 2015, while being intubated, Mr. Ohakweh’s oxygen levels dropped significantly. Though an emergency tracheostomy was performed, he sustained anoxic brain damage. Mr. Ohakweh’s condition made it impossible to treat his AML with chemotherapy. He lapsed into a persistent vegetative state and remained hospitalized at Ben Taub until his death due to AML on September 7, 2015.
As the result of Mr. Ohakweh’s persistent vegetative state, his treating physicians recommended that no further measures be undertaken to resuscitate Mr. Ohakweh in the event that his condition declined further. Though informed of this recommendation, Mr. Ohakweh’s family representatives refused to authorize this level of care.
After weeks of continued supportive care with no improvement to Mr. Ohakweh’s condition, the Harris Health System convened an Ethics Committee in July 2015 pursuant to Texas Health & Safety Code section 166.046.
On July 24, 2015, the Ethics Committee met with the patient’s family representatives and the treating physicians. After considering the facts, the Committee recommended that no heroic resuscitation efforts be implemented for Mr. Ohakweh, due to his persistent vegetative state and the very high likelihood that Mr. Ohakweh’s condition would in no event improve.
The family representatives were advised of the right to transfer Alphaeus Ohakweh to other facilities, and also of their right to appeal the Ethics Committee decision to the Texas probate court within ten (10) days.
After the family declined to transfer Mr. Ohakweh or to agree to the proposed level of care, the Ethics Committee voted to authorize the treating physicians not to institute further dialysis or CPR.
The family representatives were advised of the Ethics Committee’s determination, which became effective August 20, 2015. They received the notification of this determination from the Ethics Committee but filed no appeal with the probate court.
|Richard Payne, MD|
Recently, a new study reported that defective genes in an embryo were edited and repaired through a revolutionary technique known as CRISPR-Cas9. The procedure was used to eliminate hypertrophic cardiomyopathy – a devastating heart disease and the most common cause of death in otherwise healthy young athletes. Use of this technology is under intense scrutiny by scientists and ethicists to understand its risks and benefits. Moral, ethical and practical concerns are particularly strong as applied to genetic engineering of sperm and egg cells, because such “germline” editing not only affects the individual embryo, but also future generations.
So, does germline gene editing “cross the line?” There are strong arguments in support of the wise use of CRISPR-Cas9 technologies in medicine. Obvious examples relate to eliminating types of cancer, cardiovascular and neurological diseases by selective editing genes of embryos with identifiable mutations that cause these disorders. The study reporting correction of the cardiomyopathy mutation specifically targeted the abnormal gene, indicating that the technology is becoming more precise and safer in a remarkably short period of time. This is why the National Academy of Sciences, Engineering and Medicine and the FDA have ethics guidelines permitting research on germline editing and engineering. The ethical principles behind these safeguards include the notion that genomic editing technologies will be used by appropriately trained scientists in transparent processes to promote well-being for all humans.
However, there are concerns we should not ignore. Germline editing requires monitoring of future generations of the embryo’s offspring, which raises a host of practical, legal and regulatory issues currently unaddressed. Furthermore, use of gene editing to enhance human characteristics such as physical appearance and cognitive performance is less ethically justifiable and subject to potential abuse. Despite these concerns, many prominent scientists warn that halting research and potential medical applications for fear of unknown risks and unaddressed ethical questions is also risky, and poses problems by not addressing current moral concerns—such as application of these technologies to reduce the number of abortions and loss of embryos.
The late theologian-ethicists Paul Ramsey and Alan Verhey raised the possibility that “playing God” may not always be negative, with one qualification. They wrote that humans should only “play God, the way God plays God.” By that they meant that it is morally appropriate for humans to research and explore the natural world and to wisely use wonders such as CRISPR-Cas9 because God made humans in his image and made us stewards of creation. We humans “can play God the way God plays God,” they argue, if we intend and promote human flourishing through our scientific and medical discoveries and technologies, and if we make these advances available to all humankind by seriously attending to social justice and fairness. This is truly wise counsel and worthy of application as we inevitably push forward on our revolutionary genomic journey. It also may be much more challenging than the science.
Richard Payne, MD, is the John B. Francis Chair at the Center for Practical Bioethics, Kansas City, MO, and the Esther Colliflower Professor of Medicine and Divinity (Emeritus) at Duke University.