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12/14/2017

Be the Light – A Chanukah (and Medical Education) Reflection

By Hedy Wald It’s a festive time of year.  And medical educators so busy, busy trying to tie up loose ends on never-ending projects.  It is good to hear of plans for fun times with family and friends and looking forward to that sense of renewal in the new year… I sent a Happy Chanukah […]

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12/14/2017

Hemisphere-wide Conference on Improving Care for Dying Patients

Join me at "Dying in the Americas 2018," a conference devoted to re-imagining the future of dying with the objective of a peaceful death for everyone.  The conference is March 21 to 25, 2018 in the peaceful setting of the Hilton Lake Las Veg...

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This entry was posted in Health Care and tagged . Posted by Thaddeus Mason Pope, JD, PhD. 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...

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

12/13/2017

Unbefriended and Unrepresented: Better Medical Decision Making for Incapacitated Patients without Healthcare Surrogates

Join me at UCLA on January 17, 2018 for "Unbefriended and Unrepresented: Better Medical Decision Making for Incapacitated Patients without Healthcare Surrogates." I have collected some resources here.

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This entry was posted in Health Care and tagged . Posted by Thaddeus Mason Pope, JD, PhD. Bookmark the permalink.

12/13/2017

BioethicsTV (12/11-13): Confidentiality, Cost, Religious Objection

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.…

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12/13/2017

Christmas and the personhood of the unborn

One of the most interesting details of the account of Jesus’ birth in the gospels is what happened when Mary visited her cousin Elizabeth. Luke tells us in the first chapter of his gospel that Elizabeth and her husband Zechariah were infertile and beyond their childbearing years. The angel Gabriel appeared to Zechariah and told him that he and his wife were going to have... // Read More »

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12/13/2017

End Well Symposium – Design for the End of Life Experience

Based on a thorough review at Pallimed, consider attending "End Well Symposium - Design for the End of Life Experience" on December 6, 2018 in San Francisco.

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.



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This entry was posted in Health Care and tagged . Posted by Thaddeus Mason Pope, JD, PhD. Bookmark the permalink.

12/12/2017

Tax Acts of 2017: Big Changes to Health Care and Education May Be Coming

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.…

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12/12/2017

Second Constitutional Challenge to Texas Advance Directives Act

Chris Dunn's constitutional challenge to the Texas Advance Directives Act is on appeal to the Texas First District Court of Appeals.  An opening brief has not yet been filed.

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.

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This entry was posted in Health Care and tagged . Posted by Thaddeus Mason Pope, JD, PhD. Bookmark the permalink.

12/11/2017

Ethics, Morality and Genomic Science: Can We Play God the Way God Plays God?

Richard Payne, MD
The wisdom of humans tinkering with nature has been challenged throughout the ages based on a common storyline: humans unwisely tamper with nature with disastrous consequences for the creator when we cross a line previously reserved for the deity. Three decades ago, in the early days of gene engineering, scientists raised ethical and moral concerns about “playing God.” They weren’t opposed to interrupting the natural order to cross breed animals and plants or to cure or treat disease. Rather, they warned against exercising the power of science and technology without sufficient regard for its consequences, admonishing not to cross boundaries that manipulated nature in ways traditionally thought only an omniscient and benevolent God could or should do. 

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.

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