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09/18/2017

If We Cut Surgical Pay, Will Surgeons Cut into More People?

Shutterstock Knee replacements are booming. Between 2005 and 2015, the number of knee replacement procedures in the U.S. doubled, to more than one million. Experts think the figure might rise 6-fold more in the next couple decades, because of our … Continue reading

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09/18/2017

New Symposium on VSED

The Seattle Journal for Social Justice has published several articles flowing from  our October 2016 conference on VSED (Voluntarily Stopping Eating and Drinking). The articles are available for free here.

How Helpful is Voluntary Stopping of Eating and Drinking (VSED) to Avoid Dementia?
Dena S. Davis

Three Barriers to VSED by Advance Directive: A Critical Assessment
Paul T. Menzel

A Good Quality of Death
Phyllis Shacter

Alzheimer’s Disease and Written Directives to Withhold Oral Feedings: Clinical Challenges in New York State
Judith K. Schwarz

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

09/17/2017

Prayer and Health

Many readers are aware of several scientific studies in recent years that have sought to quantify the effect of prayer on patients’ health in medical settings. The studies have been variously conceived. Some have researched the effect on patients who know they are being prayer for, others on patients who don’t know they’re being prayed for; some studies involved prayers and patients who know each... // Read More »

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This entry was posted in Health Care and tagged , , , . Posted by Philip Thompson. Bookmark the permalink.

09/16/2017

The unbefriended and their doctors

There is a rapidly growing class of uniquely vulnerable patients showing up on our hospital doorsteps. Referred to as the unbefriended, or more prosaically as the unrepresented, these are patients who have no capacity to make medical decisions themselves, have no advance directives, and have no family or friends or anybody else on the face of the earth to speak for them. It is as... // Read More »

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09/15/2017

Medical Futility Blog Surpasses 3 MILLION Pageviews

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

09/15/2017

Medical Gawking Case Points to Need for Culture Change

by Craig Klugman, Ph.D.

According to a news report in The Washington Post, a number of medical staff at a Pittsburgh hospital have been reprimanded over a gross violation of a patient’s privacy. The patient was under anesthesia and a crowd of staff gathered to watch and take photos of “a patient’s genitals with a foreign object protrusion.” Many photos were shared with others. The “crowd” was significant and consisted of more people than those involved with the patient’s care. According to one person interviewed in the investigation (who took a picture of the patient when requested to do so): “There were so many people it looked like a cheerleader type pyramid.”

I am friends with many health care providers and I have seen them post pictures of unusual surgeries on Facebook, or sent me a text with a picture with a caption like, “can you believe this thing?” I have been told stories of surgeons inviting people to take a look at a patient’s unusual anatomy during a procedure.…

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This entry was posted in Cultural, Featured Posts, Informed Consent, Media, Privacy, professional ethics and tagged , . Posted by Craig Klugman. Bookmark the permalink.

09/15/2017

Mitchell Hamline Health Law Students Facilitate Advance Care Planning

While I am in Nova Scotia, Mitchell Hamline health law students were in Hastings, Minnesota at the Dakota County Judicial Center with the Mobile Law Network. Students and faculty were on hand to help residents draw up health care directives. It's anot...

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09/14/2017

Perceived Ethical Dilemmas from Labels

Ever hear the expression it’s all in your head? In witnessing a pattern of ethics consults, I have been wondering lately how much of ethical dilemmas are truly perceived dilemmas and not really dilemmas at all. We are our own worst enemies in many ways and health care providers are no exceptions to the flaws of humanity. We perceive a conflict and therefore a conflict arises. Then comes the need for an ethics consultant. Perceptions drive much of society, including ethical dilemmas. 

A physician will hear a label, whether it is ‘drug-addict,’ ‘Christian,’ ‘illiterate,’ ‘difficult,’ ‘noncompliant,’ and he/she will assume all the characteristics that go with that label. This will then create a perceived conflict between the provider and patient based on the presumed characteristics. These labels could have attached to the patient years prior to the current admission but yet, they remain in a patient’s record as past medical history. The classic example is ‘wanting everything done’ when it comes to end-of-life care. Many jump to the conclusion based on particular faiths (or even just hearing that the patient is religious) that patients and families want everything done and will not be open to a conversation about comfort care and hospice. They assume based on a label, that may not be true. A perceived conflict has emerged. These assumptions change how the conversation will go, whether the physician realizes it or not, because the physician is preparing for a challenge. A simple question or inquiry by a family or friend about the medical information may then seem like push-back, since that is what the physician is expecting, when in reality it is just a question. 

I joke that it’s part of the ethics magic of just appearing in a room and problems are solved, but yet, there is more to it. Many would argue that it is the comforting and supporting presence just in case something goes wrong in conversations with patients and families. The presence being the ethics consultant. Much of it is facing the perceived dilemma only to realize there is no conflict at all. This is also the role of the ethics consultant, to face the conflict with the provider and to show that nothing’s wrong. There has many family meetings where providers have asked for an ethics consultant for a variety of reasons and it turns out that the providers could handle the conversation without any assistance. Some may say this is a good provider because the physician is recognizing his/her own limits and asking for help. And maybe it is but maybe labeling it as a conflict is not the best approach either. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and a Graduate Certificate in Clinical Ethics. For more information on AMBI's online graduate programs, please visit our website.  

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This entry was posted in Clinical Ethics, Health Care and tagged , , . Posted by Bioethics Today. Bookmark the permalink.

09/14/2017

The Key to Surviving Your Hospital Stay? Get Admitted During Inspection Season

A fascinating study from JAMA Internal Medicine shows that hospital mortality rates decline when hospitals are being inspected by The Joint Commission, a national accrediting agency. Here’s a picture showing the research findings: Which raises the question – is there a … Continue reading

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09/14/2017

Right to Die – Top Legal Developments 2017

The first of two 2018 updates to the legal reference book Right to Die: The Law of End-of-Life Decisionmaking will cover the following new legal developments among others.  

  • The New York Court of Appeals’ rejection of both statutory and constitutional challenges alleging that New York laws criminalizing assisted suicide statutes do not and may not apply to medical aid in dying.
  • A major amendment to the Uniform Determination of Death Act that clarifies both which medical criteria are authoritative for determining death by neurological criteria and that clinicians do not need family consent to administer brain death tests.
  • A statute that requires clinicians to obtain patient or surrogate consent before writing a facility-based DNR order.
  • The passage of a new POLST statute in and the material expansion of another.
  • An innovative statute that requires default surrogates to gather information about an incapacitated patient’s beliefs, values, and preferences before making a health care decision.
  • The passage of another statute directing the creation of an electronic registry for health care directives.
  • The passage of statutes in two more states that direct the formation of quality of care and palliative care task forces and that direct health departments to promote both professional and consumer palliative care education.

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