by Craig Klugman, Ph.D.
Ebola burst onto the scene in 1976 when a thirty-old man arrived at the Yambuku Mission Hospital in Zaire complaining of severe diarrhea. He left the hospital two days afterwards and was never found again. In the days and weeks that followed, people who were patients or care providers at this facility when he was there all died after experiencing dehydration, fever, vomiting, diarrhea, and bleeding everywhere. The death rate was staggering, as over 80% of affected patients did not recover.
Since then, the CDC reports there have been 34 distinct outbreaks of the five strains of Ebola.…
by J.S. Blumenthal-Barby, Ph.D.
In a recent article in Ethics, “Beyond Point-and-Shoot Morality: Why Cognitive (Neuro)Science Matters for Ethics,” Josh Greene argues that empirical research in moral judgment has significant relevance for normative ethics in that it (1) exposes the inner workings of our moral judgments, revealing that we should have less confidence in some of our judgments and the ethical theories that are based on them, and (2) informs us of where we tend to rely on intuition or automatic processing (which is often heavily emotive), but ought to rely more manual, controlled processing (such as consequentialist reasoning).…
Tomorrow, the Supreme Court of Canada hears arguments on whether terminally ill Canadians have right to a doctor-assisted death.
Twenty-one ago, the court upheld the law that criminalizes physician and in dying. But, as many of the more t…
A New Jersey Senate Concurrent Resolution urges CMS to provide reimbursement to physicians for advance care planning consultations with Medicare participants. A related bill (S.2435) would provide Medicaid coverage. Here is the text of the resolution:
WHEREAS, Advance care planning is the practice of making explicit written instructions to caregivers, family and friends on measures for delivering health care and for preserving that adult’s dignity in the event that the adult is unable, because of incapacity, to make those instructions known when needed at a later time; and
WHEREAS, Advance care planning provides support for patients and their families making difficult life decisions; and
WHEREAS, Advance care planning ensures that the patient’s informed end-of-life health care choices are known, documented, and respected; and
WHEREAS, Advance care planning provides competent adults with a legal tool to designate a health care agent and express preferences about health care options to go into effect only after the adult loses the ability to make or communicate health care decisions, including deeply personal decisions about end-of-life care; and
WHEREAS, Advance care planning includes the use of advance health care directives, health care powers of attorney, and medical orders for life-sustaining treatment that can be administered effectively within the health care system; and
WHEREAS, Studies funded by the Agency for Healthcare Research and Quality have shown that individuals who talked with their families or physicians about their preferences for care had less fear and anxiety, felt that they had more ability to influence and direct their medical care, believed that their physicians had a better understanding of their wishes, and indicated a greater understanding and comfort level than they had before the discussion; and
WHEREAS, New Jersey has helped promote and facilitate advanced care planning in this State with the enactment of the “New Jersey Advance Directives for Health Care Act,” P.L.1991, c.201 (C.26:2H-53 et seq.) and the “Physician Orders for Life-Sustaining Treatment Act,” P.L.2011, c.145 (C.26:2H-129 et seq.); and
WHEREAS, An increasing number of private health insurance plans reimburse physicians for advance care planning discussions held with patients, but the federal Medicare program and most state Medicaid programs do not; and
WHEREAS, The Specialty Society Relative Value Scale Update Committee, a body of the American Medical Association that advises the federal Centers for Medicare & Medicaid Services on Medicare physician reimbursement, has recently recommended that Medicare begin to cover advance care planning discussions; now, therefore,
BE IT RESOLVED by the Senate of the State of New Jersey (the General Assembly concurring): This Legislature respectfully urges the Centers for Medicare & Medicaid Services to provide reimbursement to physicians for advance care planning consultations with Medicare participants.
The story of Brittany Maynard, a 29-year old newlywed who has been given the diagnosis of terminal glioblastoma, an especially aggressive brain tumor, has gone viral over the past week. Many know the story already, but it centers on her decision to end her life by taking an oral medication prescribed by her physician, who will be sitting at her bedside with her husband and… // Read More »
The Hamline Health Law Institute and Compassion & Choices are pleased to host:
Barbara Mancini: Innocent of Assisted Suicide
5:30 p.m. Reception
6:00 p.m. to 7:00 p.m. Presentation
Thursday, November 13, 2014
Kay Fredericks Room, Klas Center, Haml…
by Patricia Mayer, MD, Bioethics Program Alumna (2009) All I can think of when reading the case of Indian sprinter Dutee Chand is Harrison Bergeron, protagonist of a 1961 short story by author Kurt Vonnegut. For those of you who don’t know who Dutee Chand is, she is a Indian sprinter who was banned from […]
In the October 2014 edition of Medical Ethics Advisor, Timothy Quill notes that when treatments might possibly help a little and they have some very small potential utility, patients can typically get access to these.
This may change down the road. &n…
<p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">As I have been saying in recent blogs, most of what we do in clinical ethics, but also in most areas of bioethics, is procedural ethics. That is when we are faced with an ethical dilemma, our approach, whether consciously or unconsciously is usually to try to reach a reasonable compromise or consensus among the key participants that are in conflict consistent with well-established values and principles. This tendency reflects an obvious reality about the nature of contemporary ethics that we often ignore: in the current Western moral setting, our only viable methodology for resolving value laden disputes, whether at the micro level in clinical ethics or macro level in healthcare policy, is to attempt to craft an agreement or consensus among those with a say. Whether we are dealing with patients and families at odds with their physician on how to define the goals of care in the hospital setting or trying to build a consensus of opinion among voters in the political arena, we assume there are no final, authoritative moral answers that avail themselves to us. Whether we like it or not, we humans must figure out ethical dilemmas for ourselves and learn to get along.</span></p>
<p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">Yet the idea of procedural ethics remains very worrisome for many people, including such bioethicists and Tristram Engelhardt, Jr. He believes that procedural ethics, such much of what we do in clinical ethics, is not really ethics in because it is based on convention and legalistic type standards. For him ethics worthy of the name must flow from a content-rich, canonical moral tradition that provides moral authority to our everyday ethical and moral judgments. The prototype ethical tradition was the medieval Christian Natural Law perspective grounded in Aristotelian philosophy. Aristotle assumed the inherent order and intelligibility of the cosmos, which also permeated his understanding of ethics. Humans, like all natural things, had a natural function, which was to be rational. But rational did not mean to that ethics was about finding intellectual or theoretical basis for right action according to rational rules in order to know and perform one’s duty—this was Kant’s (1724-1804) ethics during the 18</span><sup style="line-height: 19.0400009155273px;">th</sup><span style="line-height: 19.0400009155273px;"> century following the rise of modern science. For Aristotle, the question was, how can one live and embody the good life; so rationality in this sense meant internal harmony between emotions and decision-making that resulted in well-established habits or states of character. This means finding in all of one’s activities the balance between excess and deficiency, or what he called the “mean”. Over time, forming the right habits according to the mean in all areas of life lead to excellence and happiness or what he called the good life. This was the natural fulfillment of the human function in practical terms consistent with the ancient Aristotelian.</span></p>
<p class="MsoNormal" style="line-height: 19.0400009155273px;"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">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="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a></strong></p>