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05/14/2015

Raging Against the Dying of the Light

by Craig Klugman, Ph.D.

When do we die? The legal and medical answer is we are dead when we either (a) have experienced total loss of all brain function or (b) cessation of cardiopulmonary activity. The biological answer is that we are dead when as an organism we have lost our ability for integrated function—that is enough parts have ceased to function that the organism cannot be put back together again. That moment we call “death” is in a real way, quite arbitrary. It takes much longer for our tissues and cells to die once the integrity is lost.

I am in the second half of the academic quarter, teaching a course on Death & Dying.…

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This entry was posted in End of Life Care, Featured Posts and tagged , , . Posted by Craig Klugman. Bookmark the permalink.

05/14/2015

Why Do We Over Treat Patients in the U.S.?

<p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">As a clinical ethics consultant and bioethics professor for many years, it still amazes me that one of the most common problematic features of our healthcare system is the tendency to over treat patients to the point of causing harm and wasting financial resources. The question is, why?</span></p> <p style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">The question, why do physicians generally over treat patients in the U.S., must be approached in light of the fact that we spend more per capita and more overall, about 16% of GDP, on healthcare and get far worse outcomes than do countries like Canada and Western European countries who spend far less of their GDP on healthcare. But to be fair, before we blame physicians entirely for making poor judgments about treatment options, it is important to keep in mind that the U.S. is big, diverse nation with complex social and economic issues where creating efficient systems of healthcare is both practically and politically challenging. Also the U.S. spends more on medical research than most other countries, which still benefits patients everywhere. But what is most uniquely American is an economic system designed by politicians first and foremost for creating wealth for investors and that provides, generally speaking, efficient markets for consumer goods and services. But, whatever the virtues of American capitalism in creating efficient markets, it does not hold true for healthcare.</span></p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.0400009155273px; 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="color: #000099; text-decoration: underline;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; line-height: 19.0400009155273px; font-size: 12px;"> </span><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 11.1999998092651px; line-height: 19.0400009155273px;"> </span></p>

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This entry was posted in Health Care and tagged , , , , . Posted by Hayley Dittus-Doria. Bookmark the permalink.

05/13/2015

Bioethics Commission recommends establishing clear requirements for identifying legally authorized representatives for research participation

On March 26 the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) released the second volume of its two-volume report on neuroscience and ethics, Gray Matters: Topics at the Intersection of Neuroscience, Ethics, and Society (Gray Matters, Vol. 2). In Gray Matters, Vol. 2, the Bioethics Commission recognized the challenging tension between the […]

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

05/13/2015

ETHICS OF THE POLITICS OF PAIN

Picking Up the Gauntlet

On May 1, the Center for Practical Bioethics hosted an ethics symposium, something they do every spring. What made this event special enough that it moved me to write about it was the topic, Healing What Hurts: The Politics of Pain.

I’m a bit of an oddball in the pain world. I am not a healthcare professional, nor am I person with chronic pain. I am not an academician or researcher; I don’t work in industry. I am someone who came in the ‘side door’ to the pain world providing services like strategic planning, meeting coordination, and program/project management to organizations like the Center. I can’t truthfully say that helping to change the way pain is perceived, judged and treated is a personal passion of mine. But it has become something I believe in and care about, a testament to the incredible people at the Center with whom I have the privilege of working, and my exposure to the thinking and work of individuals like those who presented last week.

At the symposium, I felt like I was witnessing the creation of a beautiful tapestry, with each speaker picking up the thread of those who came before and continuing to weave the threads together until the complicated (and troubling) reality of the polarizing space in which pain currently resides was achingly clear. Some threads:
  • Historian and author Dr. Keith Wailoo’s spellbinding historical dissection of the poles our policymakers and courts have swung between in answering the questions, “Whose pain matters and who deserves care?” While historians feel more comfortable looking back instead of ahead, Dr. Wailoo did offer some insight into my question of how to have success this time around in making sure that reimbursement model changes follow our ability to demonstrate that comprehensive multi-modal pain care holds down costs and improves outcomes.
  • Dr. Kathy M. Foley (I view her as the Grand Dame of this continent’s pain movement) exposing the harsh realities of care being forced to focus on what’s reimbursable vs. what’s best for the person with pain.
  • Dr. Bob Twillman laying bare the damage caused when overly simplistic policy and action around harm reduction focuses solely on cutting down on the supply of prescription narcotics, without looking at the demand side and asking, “In which patients should we use opioids, at what doses, for how long, with which adjunctive treatments, and with what precautions?”
  • Dr. Richard Payne sharing some pretty mind-blowing emerging science about how the social determinants of health most closely associated with underserved populations actually affects one’s biology. Melissa Robinson from the Black Health Care Coalition made it real for the impoverished in Kansas City.
  • And, pain pioneer Dr. Lynn Webster, pain advocate Janice Lynn Shuster, and public policy expert Katie Horton reminding us all that the lives of people in pain matter and their stories must be heard.
Having worked in this arena for over a decade, I will own that the fight to make things better for people with pain feels akin to running a marathon in five feet of mud – it’s a slow slog even on good days. The assembled audience sensed there may still be some dark days ahead before the pendulum swings back towards reason and progress. But the conviction that things will get better and that we must continue the fight was evident in abundance.

Who else but the Center could and would provide the kind of thought provoking and engaging delve into the ethics of the politics of pain? There may be others, but the Center picked up the gauntlet and ran with it. And for that, they have my love, admiration and respect. [In the spirit of full disclosure, I currently do some consulting work for the Center on the PAINS Project.]

Written By Ann J. Corley, MS

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This entry was posted in Health Care and tagged . Posted by Practical Bioethics. Bookmark the permalink.

05/13/2015

Showing Doctors How to Lower Healthcare Costs

There are lots of things we need to do to get healthcare costs under control in the United States. Critical to most of our efforts, however, is to get physicians to practice cost-conscious care. Here is a nice story on … Continue reading

The post Showing Doctors How to Lower Healthcare Costs appeared first on PeterUbel.com.

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05/13/2015

Overtreatment in 1848 [EOL in Art 3]

Edward Lamson Henry portrays his ailing fiancee, Kate White of Philadelphia, who died around the time of the painting.  The flowers, fruit, and cakes, and sunlight make this look like something other than a deathbed scene. But look at all that me...

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

05/13/2015

POLST – An Authoritative Summary

The latest issue of BIFOCAL, the journal of the ABA Commission on Law and Aging includes a lucid four-page summary of POLST.   It is written by four of the top experts on POLST:  Amy Vandenbroucke, Susan Nelson, Patricia A. Bomba, and Alvin ...

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

05/12/2015

New Education Materials from the Bioethics Commission on Research Design Now Available

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has posted to Bioethics.gov a new series of educational modules on research design. The materials on research design increase the breadth of topics covered by the Bioethics Commission’s educational resources. Previous topics include privacy, community engagement, compensation for research-related injury, informed consent, and vulnerable […]

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

05/12/2015

What Do Cancer Centers Think Patients Are Looking For?

If you were a cancer center trying to get patients to come to receive care at your facility, what message would you send them? In other words, what would you as a cancer center director think people would value in … Continue reading

The post What Do Cancer Centers Think Patients Are Looking For? appeared first on PeterUbel.com.

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05/12/2015

Respice Finem [EOL in Art 2]

Respice Finem means consider the end.  Here is Saint Jerome in his study surrounded by objects symbolizing transience and death (Joos van Cleve, 1521).  Note the skulls, the snuffed out candle, and other symbols. This predates the genre of m...

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