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12/01/2016

Is This Enough Competition for You?

Some people look at the figure below, and say that too few insurance companies have too much of the market for Medicare Advantage (a program that allows Medicare recipients to get private coverage). But I look at it and think … Continue reading

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12/01/2016

BioethicsTV (November 2016): Informed consent, HIV organ transplants, Forgiveness, Assisted Suicide, Treating Prisoners, Undue Influence in Consent, and Failure to Vaccinate

by Craig Klugman, Ph.D.

Grey’s Anatomy (Season 13, Episode 9). A building collapses when a landlord has failed to make necessary repairs a year after an earthquake. The landlord mistakes a resident for a priest and confesses that his neglect was the cause of the tragedy that has led to much morbidity and mortality. The resident wonders if he has to preserve confidentiality like a priest or if information told to a doctor is different. A fellow resident tells him that since it’s not medically related, he has no obligation to maintain this particular confidence. Later, after surgerty the landlord tells the resident that he knows there was never a priest, but he simply needs someone to forgive him.…

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11/30/2016

Another Obamacare Failure: It Wasn’t a Job Killer!

According to many conservative pundits, Obamacare is a job killer. Five days before Obama signed the law, in fact, speaker John Boehner declared that the president was pushing “his job killing government takeover of healthcare that will hurt small businesses.” Years after … Continue reading

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11/30/2016

Handing over the Control in Breast Reconstruction Surgery


A company named AirXpanders is in the process of developing a medical device that will give women a
sense of control over breast reconstruction surgery.  The name of the product is AeroForm and it is currently under review by the FDA.  It is approved in Europe and sold in Australia. AeroForm is currently in clinical trials.

Using an implant is the current standard of care for breast reconstruction.
  In order for an implant to achieve its designed purpose, space must be made in the breast tissue.  Before AeroForm, this space was achieved through multiple visits to the doctor’s office using a saline injection. It was a painful process for some women and could take months. AeroForm is a wireless, needle-free tissue expansion device.  A device is surgically inserted into the breast that will deliver small amounts of CO2 gas to expand the tissue as the saline used to do. The release of the gas is controlled through an internal valve signaled by a wireless dose controller operated by the patient. The patient can release the gas at her/his own rate to make it less painful and can be done at home.  It also can speed up the process from months to weeks. The device is more expensive than saline injections but it reduces the numbers of physician’s visits, so cost is comparable. 

The process of restoring something so intimate may be embarrassing as well as medicalizing part of one’s identity.
  This device may be a way to restore lost confidence for breast cancer survivors.  Losing one’s breast can be damaging to one’s identity. We as a society equate breasts with feminine identity. Without breasts, according to society, a woman becomes less desirable or less feminine. A primary goal of reconstructive surgery is to restore the bodily image of what is socially accepted, but also what the patient wants personally. Positive body image is an important part of self-identity and confidence and positive body image connects to what is socially accepted. Although this device is arguably reinforcing the social norm that women need to have breasts, this device is ultimately restoring confidence and identity. Allowing women to have a role in this medical process allows for restoring some of that lost privacy and identity in an already emotional experience. This restored control can also have a psychological effect on the patient during recovery. In a sense, this device is following the trend of our society to favor patient autonomy and increasing patient involvement in healthcare.

But when is patient control too much? Physicians may still remain cautious with devices such as these because it is moving treatment away from the known, controlled setting of the physician’s office to the patient’s home. This is the balance between respecting patient autonomy and beneficence. The downside of using this device at home is if there are any issues during the gas release, a physician will not be there immediately. Some may argue that care outside a physician’s office is not beneficial but there are also a lot of benefits to self-administration of care like this case. This device is only a small part of the entire reconstructive process. But society should still keep in the back of its mind that physicians still have a very relevant role to play in health care decisions, no matter the location of treatment. 

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11/30/2016

James L. Bernat – Brain Death: Consensus and Controversies

Here is a superb overview video on the medical and philosophical aspects of brain death.  

James L. Bernat, professor of Neurosicence at Dartmouth, delivered this lecture in Barcelona at the Víctor Grífols i Lucas Foundation on November 15, 2016.




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

11/29/2016

LA LA LAND and BIOETHICS: Aspiration, Casuistry and Musical Mimetics

La La Land Opening Night Mill Valley Film Festival 2016
Mark Fiskin(CFI/MVFF), Damien Chazelle (director), 
Justin Hurwitz (composer), Emma Stone (actor) 
The opening and closing films of the 39th Mill Valley Film Festival were both romances, different from one another as night and day. The starting film was about elusive love. Written and directed by Damien Chazelle, LA LA LAND is a romantic musical whose comedic elements facilitate the dramatic. It feels like a cross between Preston Sturges' Sullivan’s Travels and Singing in the Rain. LA LA LAND’s enduring impression is a sensibility for people defined by creative aspirations.

The title, LA LA LAND, is a double entendre. The more concrete allusion calls up the musical note ‘La,’ as in the Rogers and Hammerstein’s Sound of Music, “La is just to follow so.” What marks the feature as a high concept film is the other meaning— the rarely attainable, though ubiquitous, high hopes for creative success in the unreal Los Angeles — while moving into the developmental stage of adult intimacy.

Ryan Gosling and Emma Stone act (and dance) in subtle ways. Their performances are beyond being the coat hangers for music, choreography, and the exquisite mostly on location scenery. Complexity of the main characters is clarified by the arrival of the co-star, John Legend, at the mid-point of the film. He draws the arrow telling Gosling’s character, a musician, that there is only one path to follow. That way pushes him away from his lover, Stone, a writer.


The opening scene of La La Land is set squarely in one of the plagues of Los Angeles life. The setting, time, and characters shout that you are entering a cross cultural zone, where fantasy is allowed. Replete with classic musical film homages, Justin Hurwitz’s score shares the passion of Leonard Bernstein’s West Side Story, rather than the showmanship of an Arthur Freed musical. We quickly learn the rival gangs are the tensions between the creative aspirations in the heads of each star, fighting for attention and love.


Hurwitz’s uses the advantage of Jazz, Blues and Rock & Roll, having been racially integrated after the glory days of the classic 1940s and 50s musicals, to broaden the range of emotions. The love theme of La La Land represents the magical inner voice of the protagonist’s relationship. When you hear this film’s music forty years from now, be forewarned, if it made you cry this year, it will then. 
How does a Romantic Musical help Bioethics?


LA LA LAND shows tension between the ‘competing goods’ of the noble aspirations of intimacy and creativity. The film is a captivating metaphor, showing a version of goal attainment reached through an unexpected narrative path. Other creative intents are not unlike those of a surgeon in training, or a doctoral student dreaming to cure global warming, in conflict with raising their families. The shared challenge is not aiming for competence but greatness.


Casuistry can exist beyond ‘the word.’ When visuals are added to written narratives additional neuropsychological features join ‘the case’ presented. Even a single photograph is a visual narrative. Music, as in LA LA Land, is interpreted even more subjectively than visual cues. “Research into the bodily basis of musical meaning has focused on conceptual metaphor and image theory but the processes whereby embodied experience becomes relevant to music conceptualization remains largely unexplained.” 


We do not know exactly why the blues is cathartic, for some and not others though we know it is so. Related are examples where sound, say of a bottle of soap falling, has been known to result in smelling soap for some people sans attendant visual stimulus. It is clear that the sound of music has a narrative language specific to its own form. 


The core of the “musical mimetic hypothesis” suggests we understand sounds in comparison to sounds we have made ourselves, and this process of comparison involves tacit imitation, or mimetic participation, which in turn draws on the prior embodied experience of sound production.  That is second hearing draws a reaction to the first hearing of the primary sound and stimulates a similar feeling and physical response. Each note delves into the influence that note has had in one’s life. If this is true, clearly the Casuistic case for LA LA LAND is maximized by the music itself.


LA LA LAND is a choreography of the mind, expressed by over a hundred dancers, actors and musicians along with nearly as many crew. It takes a lot of nerve and talent to wield  such a team. Luckily for the audience composer Hurwitz choreographer Mandy Moore (Silver Lining's Playbook), cinematographer Linus Sandgren (American Hustle), and writer-director Damien Chazelle are chutzpah endowed. LA LA LAND is a film to watch and hear. It opens in theaters December 16, 2016.

Casuistry uses cases or narratives to illustrate ethical conflicts and their resolutions. Despite the potential abuse of Casuistry, Medicine and Law are both fields where cases are applied to ethical decision making. Religious books, literature, drama and film can also be used in Casuistic analysis of moral dilemmas. At its core, Casuistry requires solving a second unrelated case by using the logic of the original narrative — so stories need not be medical or science based to argue Bioethics. 






Albert Jonsen and Stephen Toulmin, The Abuse of Casuistry: A History of Moral Reasoning, Berkeley, U California Press (1990)

Underriner IV, Charles Francis THE SOUND-POETRY OF THE INSTABILITY OF REALITY: MIMESIS AND THE REALITY EFFECT IN MUSIC, LITERATURE, AND VISUAL ARTdigital.library.unt.edu/ark:/67531/.../UNDERRINER-DISSERTATION-2016.p Accessed  October 31, 2016

Cox, Arnie, The mimetic Hypothesis and Embodied Musical Meaning, Musicae Scientiae Fall 2001 5: 195-212,http://msx.sagepub.com/content/5/2/195.abstract  Accessed November 3, 2016

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This entry was posted in Health Care and tagged . Posted by September Williams, MD. Bookmark the permalink.

11/29/2016

Our Devices, Our Selves: How to Avoid Practicing Distracted Doctoring

By Laura Vearrier Americans check their phones an average of 46 times per day, (Eadicicco 2015) and they do so no matter what they are doing, including while driving, while at church, during sex, or out to dinner. (Rodriguez 2013) Are healthcare providers any different?  In a survey of medical students, 46 % reported texting, […]

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11/29/2016

Texas Right to Life Seeks Repeal of Texas Advance Directive Act in 2017

Texas Right to Life has announced its legislative priorities for the 85th Texas legislative session that begins on January 10, 2017. Not surprisingly, this agenda includes a repeal of the dispute resolution provisions in the Texas Advance Directi...

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

11/29/2016

Texas Right to Life Seeks Repeal of Texas Advance Directive Act in 2017

Texas Right to Life has announced its legislative priorities for the 85th Texas legislative session that begins on January 10, 2017. Not surprisingly, this agenda includes a repeal of the dispute resolution provisions in the Texas Advance Directi...

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

11/28/2016

Fordham RETI Fellow Discusses Addiction with U.S. Surgeon General on NPR

Earlier this month, the United States Surgeon General issued a report declaring substance use disorders, like addiction, the “most pressing public health crises of our time.” The report called the country to action to both help those struggling with the chronic illness of addiction and change how addiction in the U.S. is perceived as a “criminal justice problem” rather than … More Fordham RETI Fellow Discusses Addiction with U.S. Surgeon General on NPR

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