Blog.
01/23/2015
Patient Modesty: Volume 71
I would like to start out this Volume 71 with a basic question to help define what is understood as physical modesty and how it applies to this issue as experienced by patients within the medical system. Is modesty of an individual only related to how ...
01/23/2015
The Power of Free
The Atlantic recently reproduced a figure showing just how much people like things when they are free. Specifically, they looked at health interventions and show that people are more likely to take up these interventions, or products, when they don’t … Continue reading →
by Craig M. Klugman
The United States has passed a milestone, the first year of the Affordable Care Act’s insurance mandate. This is the requirement that all U.S. residents have health insurance whether through an employer, an organization, or via the insurance marketplaces. Opponents of the ACA (also known as “Obamacare”) feared that this act would destroy the country by decimating the economy, creating a federal government takeover of healthcare, forcing employers to drop coverage, workers quitting who no longer need their employer-based health insurance, and companies cutting workers to stay below minimum thresholds.
The results of the first year are positive.…
<p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">Although life-saving, cancer treatments (e.g. radiation, chemotherapy, and surgery) can also lead to infertility in both women and men. Established reproductive technologies for women and men like gamete freezing and embryo freezing allow cancer patients to preserve their fertility in case they want to become biological parents in the future. </span></p>
<p style="line-height: 19.0400009155273px;">Unfortunately, patients are frequently not adequately informed and sometimes not informed at all about fertility preservation. Some oncologists don’t consider fertility preservation to be an important issue, as they are more focused on saving the patients’ lives and see fertility preservation as a secondary consideration. Research has shown that even when oncologists refer their patients for fertility preservation they often do so based on social factors (they are more likely to refer wealthy, white, heterosexual, married patients) rather than purely on medical indications. Even when health care providers discuss fertility preservation with patients, many patients say that once they heard the word “cancer” as a diagnosis, they didn’t absorb much else from their initial conversation with their provider. </p>
<p style="line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong><span style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;"> </span></p>
01/23/2015
Death Test: Criteria for Screening and Triaging to Appropriate ALternative Care (CRISTAL)
Australian critical care physician Ken Hillman and health services researcher Magnolia Cardona-Morrell have just published a new checklist in BMJ Supportive and Palliative Care: "Development of a Tool for Defining and Identifying the Dying Patient in Hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)."The goal is to develop an evidence-based screening tool to identify elderly patients at the end of life and quantify the risk of death in hospital or soon after discharge. The Telegraph calls it a "death test."
This should minimize prognostic uncertainty and avoid potentially harmful and futile treatments. After all, an unambiguous checklist may assist clinicians in reducing uncertainty patients who are likely to die within the next 3 months and help initiate transparent conversations with families and patients about end-of-life care.
Today California Senate Bill SB 128 was introduced. It is described in the press as being comparable to Oregon’s law. Its status can be followed here. Apparently (I am betraying my weak knowledge of the civics of my home state here) it is first referred to the California Senate Rules Committee for committee assignment. I have just downloaded the text and have not studied... // Read More »
In case you didn't know, a woman's breast milk is a commercially but also a nutritionally valuable commodity at least as an example supported by Medolac Labs and Mother's Milk Cooperative. This milk is said to be needed by hospitalized pre-term infants whose mothers are not yet lactating. I read about it in an article in the Michigan State University Bioethics website on lactation and the laws and actions which have been taken including commodification of the woman's milk.
A scholarly article on the subject of the sale of mother's milk was written in the Winter 2009 issue of the Nevada Law Journal
The sale of organs for transplant is not approved in the United States, only donation. The question arises as to whether it is ethical to have lactating women provide their breast milk for sale. Is breast milk analogous to a solid organ?
Can or should the same arguments regarding the value, availability and ethics of "selling" apply to both breast milk and kidney? (You can read more on the issue of the selling of solid organs for transplant in my blog thread "Organ Donation: Who, How, Why and also What are the Ethics (5))"
How about comparing selling the mother's milk to the legal commodification of eggs and sperm or blood elements?
A physician ethicist has reassured me on this topic:
"Maurice, ...
There are American markets for buying and selling human body parts, including blood, plasma, platelets, breast milk, hair, sperm, and unfertilized eggs. The National Organ Transplant Act bans compensation for organs, including livers, kidneys, and bone marrow. Flynn v. Holder adds the acquisition of hematopoietic stem cells from circulating blood to the list of acceptable activities.
An ethical analysis suggests that the key characteristics of these acceptable market-based donations of human body products are:
– The donated stuff can with time be regenerated.
– The injury to the donor is minimal and commensurate with the sale price.
– The risks to the donor of more serious morbidity and mortality are minimal."
And then, of course, there is the long history of "wet nursing" when other women took on the task of nursing a child if the mother was unable to do so.
To my visitors: Do you find any arguments against the selling of the milk obtained from a lactating mother and, if you do, what are they? ..Maurice.
Graphic: Migrant Mother, Dorothea Lange, Library of Congress / Public Domain / Wikimedia Commons
01/22/2015
Should North Carolina Expand Medicaid?
My home state of North Carolina is one of a number of states that refused to expand Medicaid, even though the Affordable Care Act stipulates that the federal government will cover the majority of expenses associated with such expansion. Here … Continue reading →
01/22/2015
A Better Death: End of Life Care: Doctors, Machines and Technology Can Keep Us Alive, but Why?
The Vancouver Sun has just published the first of a significant 3-part series on "A Better Death": "End of Life Care: Doctors, Machines and Technology Can Keep Us Alive, but Why?"
01/21/2015
Infertility, ethics, and fairy tales
This weekend my wife and I went to see the movie version of the musical Into the Woods. The music was done beautifully and the characters were casted and acted well, but I left disturbed by the ethics presented in the story. For those who have not yet seen the musical I will attempt to comment on it without spoiling it for you. The plot... // Read More »
AJOB
Target Articles:
Transferring Morality to Human–Nonhuman Chimeras
Ethical Review of Health Systems Research in Low- and Middle-Income Countries: A Conceptual Exploration
Correspondence:
Changing the Discourse on Health Systems Research: Response to Open Peer Commentaries on “Ethical Review of Health Systems Research in Low- and Middle-Income Countries: A Conceptual Exploration”