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Exploring Lifelong Bioethics Education

Bioethics Commission member Col. Nelson Michael was recently interviewed by BioEdge, a bioethics news site, about the Commission’s capstone report Bioethics for Every Generation: Deliberation and Education in Health, Science and Technology. Col. Michael discussed lifelong bioethics education, which the Commission supports in its report.

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Jahi McMath Family Argues "Statistically Improbable Likelihood" Malpractice Action Will Resolve Issue of Her Life

Chris Dolan, McMath attorney in federal case 
This week, the Jahi McMath family filed a new brief in its federal lawsuit against the State of California.  The purpose of this brief is to apprise the U.S. District Court of developments in the state medical malpractice lawsuit.

In a nutshell, the state courts have repeatedly ruled that the McMath family may present evidence that Jahi is now alive.  They are not barred by 2013 court rulings that Jahi is dead.  But despite winning at the trial and appellate levels in state court, in this week's federal brief, the family argues that "the issue of whether Jahi McMath is alive or not will not necessarily be resolved in the malpractice action."

This is true.  After all, Jahi's life/death status is  relevant only to the issue of money damages.  And the issue of damages will be addressed only if the elements of duty, breach and causation are first proven.  (On the other hand, the court has been asked to bifurcate the trial such that damages could be tried first.)

In short, the McMath family further argues that the federal lawsuit is still necessary, because the state lawsuit is unlikely to resolve the life/death issue.  Why?  Because plaintiffs lose most medical malpractice cases.  And they take a very long time to litigate in any case (maybe 5 years).  

"There is, at best, a possibility that Jahi’s status as live or dead will ever be decided in the state court action. Even if a jury or judge ever reach this issue, an appeal could drag on for years."

"Jahi and her mother should not have to pin their hopes of reunion with their family during Jahi’s lifetime on the statistically improbable likelihood that the state court malpractice  action will resolve the issue of her life.

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


New AMA Code of Medical Ethics

We now have a completely revised and updated AMA Code of Medical Ethics.

In introducing the revision, the AMA notes that the "Code, over the years, became more fragmented and unwieldy. Opinions on individual topics were difficult to find; lacked a common narrative structure . . . ."  Therefore, "in the revision, when 2 or more existing opinions provided substantially similar guidance on closely related topics, key content was consolidated into a single, more comprehensive  opinion."

For example, 2.035 (Futile Care) and 2.037 (Medical Futility in End-of-Life Care) were combined and revised into 5.5 (Medically Ineffective Interventions.)

I do not see any substantive change in AMA guidance on this issue.  But Wesley Smith rightly notes that even vocabulary choice signals some judgments.  The term "ineffective" sounds objective and scientific.  But the situations anticipated in 5.5 are almost always value-laden.  The AMA might have aligned the vocabulary here to that recommended, last summer, by five other medical societies.     

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Medical Education Research and IRB Review

By Emily Anderson Medical school curricula now emphasize evidence-based medicine.  We also need to prioritize evidence-based educational strategies.  There are some great educational innovations happening at our medical school, but too few publications highlighting these.  Conducting research on medical education faces many barriers, not least of all, lack of funding.  Publication in any peer-reviewed academic […]

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Rape as a public health issue

Some people may be surprised that I am discussing rape on a bioethics blog because they do not think that sexual violence is a bioethics issue. However, rape is a public health matter that raises serious ethical concerns, especially regarding justice and equality. The goal of public health is to protect and improve the lives of the public. Rape harms many people especially women: 1 out of 6 women and 1 out of 33 men in the United States will experience a rape or attempted rape (Esposito 2006).

The act of rape can cause various immediate health concerns such as general body trauma (e.g. bruises, lacerations, broken bones, etc.), STI exposure, and unintentional pregnancy. Rape also has long-term health consequences for survivors both psychologically and physiologically. Rape survivors frequently experience depression, anxiety, PTSD, and negative sexuality issues. Furthermore, sexual violence has been connected to health problems for survivors across almost all body systems (e.g. gastrointestinal, cardiopulmonary, etc.) (Wasco 2003).

Rape is not only harmful to its victims, but rape culture has a toxic effect on women as a group. Rape culture perpetuates an oppressive patriarchal system in which women are sexually objectified and devalued. Furthermore, rape culture leads women to live in constant fear about their physical safety because they are worried that they will be victims of sexual assault. Feelings of objectification and devaluation as well as anxiety regarding one’s safety are clearly not good for women’s health.

Despite the deleterious effects rape has on its victims, women as a group, public health, and society at large, as we have seen with the Brock Turner case, as well as other cases, unfortunately our legal system frequently does not treat rape as a serious crime. In a recent publication, “Rape as a Hate Crime: An Analysis of New York Law,” I argue that the punishment for rape should carry more serious consequences. Specifically, I claim that in most cases rape should be considered a hate crime since the rapist chooses the victim based on gender, gender identity, and/or sexual orientation. Recognizing rape as a hate crime would not only qualify it for sentencing enhancements, but it would also acknowledge that rape reinforces the patriarchal and heteronormative hegemony.






Esposito, N. (2006). Women with a history of sexual assault. Health care visits can be reminders of a sexual assault. Am J Nurs, 106(3), 69-71, 73.


Wasco, S. M. (2003). Conceptualizing the harm done by rape: applications of trauma theory to experiences of sexual assault. Trauma Violence Abuse, 4(4), 309-322.

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Bioethics really is For Every Generation: Vice Chair publishes editorial on K-12 Education

James Wagner, Vice Chair of the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission), recently published a commentary in Education Week. In this piece on the Bioethics Commission’s tenth report, Bioethics for Every Generation

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New Appellate Court Case on Medical Futility – In re A

Lady Justice King Last week, the UK Court of Appeal decided another medical futility case in favor of treating clinicians. 2-year old A was badly injured in a traffic accident in November 2015.  He is completely unresponsive and makes no r...

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What Behavioral Economics Get Wrong About Improving Healthcare

It is notoriously difficult to change physician behavior. When it’s discovered that primary care physicians are, say, prescribing too few cholesterol pills or too many antibiotics, it will not be easy to change those behaviors. Physicians are strong-willed people, with … Continue reading

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Jahi McMath – New Video Interview with Mom

Jahi McMath's mother, Naila Winkfield, talks about the case at last week's National Right to Life Conference.

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


When Doctors and Parents Disagree Ethics, Paediatrics and the Zone of Parental Discretion

A new book explores ethical decision­making when clinicians and parents disagree about medical  treatment for a child.  

When Doctors and Parents Disagree Ethics, Paediatrics and the Zone of Parental Discretion develops and explores a concept called the zone of parental discretion: an ethical tool that aims to balance children’s wellbeing and parents’ rights to make medical decisions for their children. 

Written by experienced clinical ethicists and paediatric clinicians, this book offers ethical analysis and practical guidance based on real­life clinical cases. It aims to assist doctors, nurses, allied health professionals and clinical ethics staff to deal with these ethically challenging situations.

In paediatrics, clinicians and parents sometimes disagree about the appropriate medical treatment for a child. Parents can prefer an option that differs from the clinician’s recommendation. When should the parents’ decision about their child’s medical treatment be overridden?

Part I – An ethical tool: the zone of parental discretion

1.  The zone of parental discretion

2.  Within the ZPD: focusing on harm and children’s interests

Part II – Roles of doctors and parents in decision­making

3. So, do we really need doctors anyway? Information, expertise and the changing dynamic between doctors and families

4. Who should decide for critically ill neonates and how? The grey zone in neonatal treatment decisions

5. Parental rights: who has them and what are their limits?

Part III – Clinicians encountering parental refusals

6. The rehabilitation context: the ZPD and ongoing care questions 

7. When a parental refusal of treatment is only distantly or unpredictably life ­threatening to the child

8. Parental discretion and medical tests for children

Part IV – Clinicians encountering parental requests for treatment

9. Parents seeking treatment that health professionals consider burdensome 

10. Children with profound cognitive impairment: growth attenuation and the ZPD 

Part V – Clinicians encountering parental requests for interventions on healthy children

11. The ethics of performing elective appearance­altering procedures to alleviate or prevent psychosocial harms to the child: the case of paediatric otoplasty

12. Genetic carrier testing in children 

13. Parent ­led request for female genital cosmetic surgery in an adolescent 

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