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>
Lesley Stahl of CBS recently did a story for 60 Minutes on the high price of cancer drugs. Physicians at Memorial Sloan Kettering and M.D. Anderson have been seeking to remedy the “financial toxicity” of cancer drugs, something which has been mentioned in this bioethics blog as well. In Stahl’s story, Dr. Peter Bach of Sloan Kettering relates how a simple op-ed in the New… // Read More »
Konni Burton is running for the Texas State Senate as a Tea Party candidate. She recently took a position on the end-of-life medical disputes.
Burton sent a campaign mailer that stated: “As State Senator, Konni will fight to protect the elderly and disabled patients from doctors who want to administer life-ending procedures.” (Star Telegram) This is an attack on Texas Health & Safety Code 166.046, the so-called Texas “medical futility law.”
A letter from the Texas Medical Association Political Action Committee attacks Burton for her opposition to the 1999 law.
- “Do you know one single doctor who proposes to do such a thing? In my house, we would call that murder.”
- “By this statement alone, Burton proves she is totally out of touch with the reality of medical care.”
- “Burton has demonstrated repeatedly that she is an enemy of the physicians of Texas.”
Lucas Moore was born prematurely at 23 weeks weighing 520 grams, just 0.7 of an ounce over the hospital’s 500 gram cut-off point for intervention. (Telegraph)
With severe health problems – including a bleed on the brain and a hole in his heart – Lucas’s chances seemed dire, and doctors warned there was a high chance of him suffering disabilities as a result.
But Lucas defied predictions and has now celebrated his first birthday. The Daily Mail suggests that the case will fuel the debate over guidelines governing whether hospitals try to save the lives of extremely premature babies.
Joseph J. Fins
<p><span style="line-height: 19.0400009155273px;">When the Affordable Care Act, commonly referred to as Obamacare was under consideration there was an unrelenting partisan attack against both the proposed legislation and the president who proposed it. We were told that millions would lose insurance coverage, that the cost of medical care would skyrocket, and that government bureaucrats would be interfering with the health care relationship between us and our physicians. We were told that death panels would be making decisions to end the life of the elderly and infirm. We were told all sorts of things that were so ridiculous that I cannot recall them. The fact is we were told lies. Interestingly and importantly none of these things have occurred. The Affordable Care Act was designed to increase the extent of medical insurance coverage and the corresponding access to health care permitted by insurance coverage. The Affordable Care Act was also designed to slow the growth of health care costs. While it is true that there were initial technical glitches in its rollout, now a year after people could begin to enroll, and still only months after the initiation of most of its provisions it is clearly apparent that it is doing just what it was designed and implemented to do. Yes, the Affordable Care Act, Obamacare, is a success.</span></p>
<p><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; 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="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a></strong></p>
Just published: The Law and Ethics of Dementia, edited by: Charles Foster, Jonathan Herring, Israel Doron
Dementia is a topic of enormous human, medical, economic, legal and ethical importance. Its importance grows as more of us live
longer. The legal and ethical problems it raises are complex, intertwined and under-discussed. This book brings together contributions from clinicians, lawyers and ethicists – all of them world leaders in the field of dementia – and is a comprehensive, scholarly yet accessible library of all the main (and many of the fringe) perspectives.
It begins with the medical facts: what is dementia? Who gets it? What are the current and future therapeutic and palliative options? What are the main challenges for medical and nursing care? The story is then taken up by the ethicists, who grapple with questions such as: is it legitimate to lie to dementia patients if that is a kind thing to do? Who is the person whose memory, preferences and personality have all been transformed by their disease? Should any constraints be placed on the sexual activity of patients? Are GPS tracking devices an unpardonable interference with the patient’s freedom? These issues, and many more, are then examined through legal lenses. The book closes with accounts from dementia sufferers and their carers. It is the first and only book of its kind, and the authoritative text.
The book is divided into five main sections:
- Medical Fundamentals
- Ethical Perspectives
- Legal Perspectives
- Social Aspects
- Patient & Carer Perspectives
Twelve of the 44 chapters are in the legal section:
23. A Legal Overview Mary Donnelly
24. Assessing Capacity Lesley King and Hugh Series
25. Best Interests and Dementia Jonathan Herring
26. Proxy Decision-Making: A Legal Perspective Winsor C Schmidt
27. Being and Being Lost: Personal Identity and Dementia Jesse Wall
28. Dementia, Autonomy and Guardianship for the Old Margaret Isabel Hall
29. Restriction of Liberty Michael Schindler and Yael Waksman
30. Research on Patients with Dementia Phil Bielby
31. Dementia and Carers: Relationality and Informal Carers’ Experiences Rosie Harding
32. End-of-Life Care Ofra G Golan
33. Health Care Resource Allocation Issues in Dementia Keith Syrett
34. The Use of New Technologies in the Managementof Dementia Patients Karen Eltis