Bioethics.net http://www.bioethics.net Where the World Finds Bioethics Mon, 23 May 2016 18:50:45 +0000 en-US hourly 1 http://wordpress.org/?v=4.2.2 The Politics of Fetal Pain http://www.amc.edu/BioethicsBlog/post.cfm/the-politics-of-fetal-pain http://www.amc.edu/BioethicsBlog/post.cfm/the-politics-of-fetal-pain#comments Mon, 23 May 2016 18:50:45 +0000 http://www.amc.edu/BioethicsBlog/post.cfm/the-politics-of-fetal-pain

Earlier this year, Utah passed a fetal pain bill that requires the use of general anesthesia on women seeking abortions at 20 weeks gestation or later.  This bill, which relies on a controversial claim that fetuses may feel pain as early as 20 weeks, has been heavily criticized as an attempt to abrogate abortion rights rather than serving a legitimate protective purpose. 

The issue of fetal pain has long been a source of contention in the scientific community, and the dispute has led to several states restricting or prohibiting abortions 20 weeks or later on the basis of potential fetal pain.  While many argue that this law is just one of many across the country aimed not at protecting health, but at restricting or eliminating abortion rights, this law, in fact, seems to be justified in its goal of minimizing the possible experience of suffering by the fetus. 

While studies have not proven that a fetus can feel pain prior to the third trimester, reasonable doubt about the possibility of fetal experience of pain exists.  As E. Christian Brugger argues in his article entitled “The Problem of Fetal Pain and Abortion: Toward an Ethical Consensus for Appropriate Behavior,” there is no moral certitude that fetuses do not feel pain after 20 weeks, and “a preponderance of evidence supports the conclusion that fetal-pain experience beginning in the second trimester of pregnancy is a real possibility.”  Brugger makes the argument, drawing from several researchers of fetal neuroanatomy that all the neural structures for both pain perception and consciousness are in place by 18-20 weeks.  Furthermore, he argues that those who deny fetal consciousness until much later in pregnancy may be relying on outdated assumptions which place the seat of consciousness in the cerebral cortex, despite growing evidence that the upper brainstem and subcortical tissues may actually play a greater role.

If it is reasonable to believe that the fetal experience of pain is possible after 20 weeks, it seems equally reasonable to consider requiring anesthetic or analgesia for such fetuses to prevent unnecessary suffering.  Despite statements from ACOG and others supporting the assertion that fetal pain is not likely before the third trimester, even the possibility that the fetus may experience significant pain and distress supports the notion that, in the face of uncertainty, we should err on the side of preventing such pain.

Opponents of such requirements argue that anesthesia can pose significant and disproportionate risks to the woman with no corresponding benefit, and that the use of anesthesia will increase the cost of abortion significantly, potentially limiting access to the procedure for many women for financial reasons.  While mandating anesthesia or analgesia is not without risks, these risks are not disproportionate if the benefit is eliminating possible pain experienced by the fetus. 

Whether or not the primary purpose of this law is to curtail abortion rights, its effect is, in fact humane; that is, it is an attempt, in light of scientific and moral uncertainty, to prevent unnecessary fetal pain if, in fact, the fetus can and does experience it.  This compassionate approach seems eminently reasonable, and should be supported.

 

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 website.

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Brain Cancer Awareness Month http://blogs.tiu.edu/bioethics/2016/05/23/brain-cancer-awareness-month/ http://blogs.tiu.edu/bioethics/2016/05/23/brain-cancer-awareness-month/#comments Mon, 23 May 2016 10:00:59 +0000 http://blogs.tiu.edu/bioethics/?p=6721 Read More »]]> http://blogs.tiu.edu/bioethics/2016/05/23/brain-cancer-awareness-month/feed/ 0 Making End-of-Life Care More Scientific http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/H9XnmjU6hro/making-end-of-life-care-more-scientific.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/H9XnmjU6hro/making-end-of-life-care-more-scientific.html#comments Mon, 23 May 2016 10:00:00 +0000 http://www.bioethics.net/?guid=eeb96169df05042d8ba8febb29f1a641 http://medicalfutility.blogspot.com/feeds/3560066296162073370/comments/default 0 British Court of Protection Decides Another Medical Futility Case http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/re7RwdaMxf4/british-court-of-protection-decides.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/re7RwdaMxf4/british-court-of-protection-decides.html#comments Sun, 22 May 2016 09:30:00 +0000 http://www.bioethics.net/?guid=5dc170902ecae8bc501c52254ebb8784 http://medicalfutility.blogspot.com/feeds/17687138485713832/comments/default 0 Ninth Circuit Cautious about Brain Death Stay http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Y7RO9IwSDqE/ninth-circuit-cautious-about-brain.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Y7RO9IwSDqE/ninth-circuit-cautious-about-brain.html#comments Sat, 21 May 2016 13:30:00 +0000 http://www.bioethics.net/?guid=b8e86241722c0816c72adb046eea191e http://medicalfutility.blogspot.com/feeds/7373917103973240031/comments/default 0 4% to 5% of Patients Are Incapacitated and Unrepresented http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/b_BVy5bcChc/4-to-5-of-patients-are-incapacitated.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/b_BVy5bcChc/4-to-5-of-patients-are-incapacitated.html#comments Sat, 21 May 2016 10:00:00 +0000 http://www.bioethics.net/?guid=ac84bf00e0979376852563018b753c7e http://medicalfutility.blogspot.com/feeds/2736070501811344322/comments/default 0 Roundup Ready® Humans http://blogs.tiu.edu/bioethics/2016/05/20/roundup-ready-humans/ http://blogs.tiu.edu/bioethics/2016/05/20/roundup-ready-humans/#comments Fri, 20 May 2016 20:26:27 +0000 http://blogs.tiu.edu/bioethics/?p=6705 Read More »]]> http://blogs.tiu.edu/bioethics/2016/05/20/roundup-ready-humans/feed/ 0 New Case – Lawson v. VCU Medical Center http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/jUikJ16JfK8/new-case-lawson-v-vcu-medical-center.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/jUikJ16JfK8/new-case-lawson-v-vcu-medical-center.html#comments Fri, 20 May 2016 12:28:00 +0000 http://www.bioethics.net/?guid=2028f0835d6a4d61c6762af39fbde394 http://medicalfutility.blogspot.com/feeds/5160695268423051202/comments/default 0 Fonseca v. Kaiser – Briefing on Stay from Ninth Circuit http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/sMzwgYqpaGA/fonseca-v-kaiser-briefing-on-stay-from.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/sMzwgYqpaGA/fonseca-v-kaiser-briefing-on-stay-from.html#comments Fri, 20 May 2016 10:00:00 +0000 http://www.bioethics.net/?guid=bf3820cd9e732ba012576829a327a209 http://medicalfutility.blogspot.com/feeds/2229882906263169785/comments/default 0 BioethicsTV: Week of May 20 – Assisted suicide, public health crisis management, and making promises http://www.bioethics.net/2016/05/bioethicstv-week-of-may-20-assisted-suicide-public-health-crisis-management-and-making-promises/ http://www.bioethics.net/2016/05/bioethicstv-week-of-may-20-assisted-suicide-public-health-crisis-management-and-making-promises/#comments Fri, 20 May 2016 06:55:00 +0000 http://www.bioethics.net/?p=59202 Chicago Med
In its first season finale (episode 18), Dr. Downey arrives in the emergency department in distress—he is bleeding from his liver as a side effect from his cancer treatment. When he does not awake from the anesthesia, Dr. Rhodes, his protégé, suspects a stroke during surgery. A CT scan shows that Downey did not have a stroke, but rather has a large, inoperable brain tumor—his cancer has metastasized. We are told that his future prognosis is grim and that he is in unrelievable pain.…

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Fabricating Man http://blogs.tiu.edu/bioethics/2016/05/19/fabricating-man/ http://blogs.tiu.edu/bioethics/2016/05/19/fabricating-man/#comments Fri, 20 May 2016 04:48:52 +0000 http://blogs.tiu.edu/bioethics/?p=6703 Read More »]]> http://blogs.tiu.edu/bioethics/2016/05/19/fabricating-man/feed/ 0 In Memoriam: Vivian Weil, PhD (1929-2016) http://www.bioethics.net/2016/05/in-memoriam-vivian-weil-phd-1929-2016/ http://www.bioethics.net/2016/05/in-memoriam-vivian-weil-phd-1929-2016/#comments Thu, 19 May 2016 14:38:09 +0000 http://www.bioethics.net/?p=59198 by John Douard, JD, PhD

I just found out that an old friend of mine, Vivian Weil, died earlier this month. This is very sad news for me personally, but also for the philosophical community because Vivian was one of the most important philosophers in the world, especially for those who believe philosophy can and should have an impact on the way we live our lives. Vivian and Nancy Cartwright were the first two students to receive a PhD from the University of Illinois at Chicago (then called Chicago Circle) from the philosophy department, which then and now was one of the best philosophy departments in the country.…

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Peer Comparison Can Reduce Antibiotic Prescribing http://www.peterubel.com/uncategorized/peer-comparison-can-reduce-antibiotic-prescribing/ http://www.peterubel.com/uncategorized/peer-comparison-can-reduce-antibiotic-prescribing/#comments Thu, 19 May 2016 13:04:42 +0000 http://www.peterubel.com/?p=7977 Very interesting article in the Lancet recently, from the nudge unit in the United Kingdom. They give physicians feedback on how much they prescribed antibiotics compared to their peers, and found that such feedback reduced antibiotic prescriptions. I hope to … Continue reading

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New Georgia Case – Parents Will Not Consent to DNR for Dinah Whited http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/QqZZk1Z0w2M/new-georgia-case-parents-will-not.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/QqZZk1Z0w2M/new-georgia-case-parents-will-not.html#comments Thu, 19 May 2016 11:33:00 +0000 http://www.bioethics.net/?guid=5038100ca0eefda369ff4b190eb21d7d http://medicalfutility.blogspot.com/feeds/6681805486670236804/comments/default 0 Democratic Deliberation in Bioethics for Every Generation http://blog.bioethics.gov/2016/05/19/democratic-deliberation-in-bioethics-for-every-generation/ http://blog.bioethics.gov/2016/05/19/democratic-deliberation-in-bioethics-for-every-generation/#comments Thu, 19 May 2016 10:00:06 +0000 http://blog.bioethics.gov/?p=1852 http://blog.bioethics.gov/2016/05/19/democratic-deliberation-in-bioethics-for-every-generation/feed/ 0 Fonseca v. Kaiser – Brain Death Dispute Now at U.S. Court of Appeals http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/jPAP0fPGNCw/fonseca-v-kaiser-brain-death-dispute.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/jPAP0fPGNCw/fonseca-v-kaiser-brain-death-dispute.html#comments Wed, 18 May 2016 14:50:00 +0000 http://www.bioethics.net/?guid=6334e62868fa88dcccd082a177bbbb45 http://medicalfutility.blogspot.com/feeds/2016677098034474404/comments/default 0 Sexual Harassment in the Medical Profession http://www.peterubel.com/uncategorized/sexual-harassment-medical-profession/ http://www.peterubel.com/uncategorized/sexual-harassment-medical-profession/#comments Wed, 18 May 2016 14:09:41 +0000 http://www.peterubel.com/?p=7972 Here is a report from a study I collaborated on, led by the amazing Reshma Jagsi, a physician at the University of Michigan. It reveals just how common it is for female academic physicians to report experiencing sexual harassment in … Continue reading

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What Does "Futility" Mean? An Empirical Study of Physician Perceptions http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/ooxdb7Iw93I/what-does-futility-mean-empirical-study.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/ooxdb7Iw93I/what-does-futility-mean-empirical-study.html#comments Wed, 18 May 2016 09:30:00 +0000 http://www.bioethics.net/?guid=45dc3816c26deb82eb8feeb34ef88624 http://medicalfutility.blogspot.com/feeds/7122094114881415909/comments/default 0 Here’s Why Insulin Is So Expensive, And How To Reduce Its Price http://www.peterubel.com/uncategorized/heres-insulin-expensive-reduce-price/ http://www.peterubel.com/uncategorized/heres-insulin-expensive-reduce-price/#comments Tue, 17 May 2016 14:38:15 +0000 http://www.peterubel.com/?p=7975 She drew the life-saving medication into the syringe, just 10cc of colorless fluid for the everyday low price of, gulp, several hundred dollars. Was that a new chemotherapy, specially designed for her tumor? Was it a “specialty drug,” to treat … Continue reading

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A Selfish Request for Honest Conversations http://practicalbioethics.blogspot.com/2016/05/a-selfish-request-for-honest.html http://practicalbioethics.blogspot.com/2016/05/a-selfish-request-for-honest.html#comments Tue, 17 May 2016 14:15:00 +0000 http://www.bioethics.net/?guid=d853e38954588960f86d1cd464b6e916 Rev. Shanna Steitz 
On Monday of this last week, I had to fill out a medical advance directive for my husband, Ryan. He was in the hospital at North Kansas City, and they needed a document on file. We have documents at home, but the form was easiest because it was in front of us and immediate. I had to smile when I read the form and saw the small print at the bottom: “This document is provided as a service by the Center for Practical Bioethics.“ I smiled because I was headed to the Center’s annual dinner the very next night.  


If you aren’t familiar with the Center, it is a nonprofit, free-standing and independent organization nationally recognized for its work in practicalbioethics. For more than 30 years, the Center has helped patients and their families, healthcare professionals, policymakers, and corporate leaders grapple with difficult issues in healthcare and research involving patients. I am so proud that several members of our congregation are involved with this important organization:  Myra Christopher is the former President and CEO and still on the staff, Dr. Sandra Stites serves on the Board of Directors, and Rev. George Flanagan is a Center Fellow and formerly on the staff. I saw several other members and friends of our congregation in attendance.  


When I got home from the dinner, my 12-year old son Jacob was up waiting for me. He wanted to know about the evening. We discussed the Center and what our friends there did. It was an interesting conversation...one we’ve had many times before, but it was especially unique given that his dad was spending a third night in the hospital. Ryan wasn’t dying, but Jake knows his parents’ wishes if we should. He has for years. I say this not to use our family as an example, but to remind you that it is my prayer that we will continue to be a congregation where we can be our most real selves. Where we can be truly authentic and have honest conversations. And where we can help one another to do and be that - Authentic. Real.


It is important that you have these honest conversations with your family members about what is important to you.  They can be hard talks, I know.  But it’s important for you and your family and it’s also important to me.  Because if you don’t have those exchanges now...I end up in the middle of those discussions with families later - during stress and crisis moments.  So, this is a selfish request (wink, smile).  It’s easier on me later if you do it now.  The Center has great resources to help begin those talks, and obviously we at Community have people who can help.


This is a first conversation for us around this... you and me.  I look forward to more of them.


May it be so. May it be so for us.


-- Rev. Shanna


P.S. My Ryan is fine. As I finish this on Friday, we are hopeful to go home tomorrow! 




Blog Editor’s Note



Rev. Shanna Steitz is the senior minister at Community Christian Church in Kansas City, Missouri. We welcome her contribution to our blog, which was originally published in the church’s May 8, 2016, newsletter under the title, “What I really want to say…”

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What’s Laremy Tunsil Got To Do With It? Professionalism, Social Media, and Medical Education https://reflectivemeded.org/2016/05/17/whats-laremy-tunsil-got-to-do-with-it-professionalism-social-media-and-medical-education/ https://reflectivemeded.org/2016/05/17/whats-laremy-tunsil-got-to-do-with-it-professionalism-social-media-and-medical-education/#comments Tue, 17 May 2016 13:47:38 +0000 http://reflectivemeded.org/?p=204 ]]> https://reflectivemeded.org/2016/05/17/whats-laremy-tunsil-got-to-do-with-it-professionalism-social-media-and-medical-education/feed/ 0 Juniper French – 23 Weeks and 6 Days http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/8o-P7_xYrmk/juniper-french-23-weeks-and-6-days.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/8o-P7_xYrmk/juniper-french-23-weeks-and-6-days.html#comments Tue, 17 May 2016 10:00:00 +0000 http://www.bioethics.net/?guid=3264840bfe6099dd0a211a18285007f7 http://medicalfutility.blogspot.com/feeds/5105629546980431871/comments/default 0 Taking a ride down the slippery slope http://www.amc.edu/BioethicsBlog/post.cfm/taking-a-ride-down-the-slippery-slope http://www.amc.edu/BioethicsBlog/post.cfm/taking-a-ride-down-the-slippery-slope#comments Mon, 16 May 2016 15:09:18 +0000 http://www.amc.edu/BioethicsBlog/post.cfm/taking-a-ride-down-the-slippery-slope

Did you know: we can now make sperm from embryonic stem cells (in mice).  Not only can we create this sperm, but we can use it to successfully fertilize an egg and develop into a fully grown mouse.  And what is the role of bioethics in this scientific discovery, according to the article?  A brief mention of theoretical ethical issues relegated to the end of the news article that no one reads far enough to see, anyway.

 

Scientific advancements in reproduction have occurred at an unbelievable rate.  We not only have the ability to create sperm, but we can also create an embryo using three genetic donors, choose or reject embryos based on their genetic traits, such as sex, and correct genetic defects by essentially cutting and pasting healthy DNA sequences over defective ones.  Conversely, using such technology, we also have the potential to clone human beings, choose or reject embryos based on traits such as hair color or athletic ability, and irreversibly alter a germ cell line, potentially leading to unknown negative effects in later generations.

 

While breakthroughs in reproductive technologies have the potential to address issues as important and varied as male infertility, uterine factor infertility, mitochondrial disease, genetic defects and disease, and even artificial gestation, one wonders whether anyone is stopping to ask: to what end?  How will we use this technology?  What are the short- and long-term effects?  How might this technology be misused?  And, my personal favorite, when will we start to regulate how and when we tinker with biology at a genetic level?

 

Despite the promise of treatment or eradication of genetic diseases using this technology, there is still a persistent and very realistic fear that this technology will be misused.  Even worse, the misuse may become so common as to be considered acceptable, particularly in our profit-driven fertility industry.  Will the desire to prevent Huntington’s disease also lead to the desire to enhance intelligence?  Can we really resist the urge to create so-called designer babies, and should we accept that while some may win the genetic lottery, others will be able to afford to stack the deck?

 

Bioethicists are sometimes viewed as obstructionists on the path of progress, unnecessarily blocking scientists from discovering all that can be accomplished through science and medicine. (For an excellent rebuttal, read here).  But the very purpose of the vast and diverse field of bioethics is to identify and acknowledge the normative implications of scientific advances and engage in a dialogue that directly addresses the “should” in a world of “could.”  Hence, the age-old question that is often asked but rarely answered: just because we can do it, does it mean we should?

 

In the world of reproductive technologies and germline manipulation, perhaps the answer, sometimes, is no.

 

 

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 website.

 

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Bioethics Commission Recommends Deliberation and Education to Facilitate Civic Engagement with Pressing Bioethical Concerns http://blog.bioethics.gov/2016/05/16/bioethics-commission-recommends-deliberation-and-education-to-facilitate-civic-engagement-with-pressing-bioethical-concerns/ http://blog.bioethics.gov/2016/05/16/bioethics-commission-recommends-deliberation-and-education-to-facilitate-civic-engagement-with-pressing-bioethical-concerns/#comments Mon, 16 May 2016 14:29:31 +0000 http://blog.bioethics.gov/?p=1847 http://blog.bioethics.gov/2016/05/16/bioethics-commission-recommends-deliberation-and-education-to-facilitate-civic-engagement-with-pressing-bioethical-concerns/feed/ 0 Voluntarily Stopping Eating and Drinking: Exploring an End of Life Option for Suffering Patients http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/ZpYnA3DsW6g/voluntarily-stopping-eating-and.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/ZpYnA3DsW6g/voluntarily-stopping-eating-and.html#comments Mon, 16 May 2016 09:30:00 +0000 http://www.bioethics.net/?guid=bbb73fd6fd481db0c8fe794d511c3eec http://medicalfutility.blogspot.com/feeds/3952732638180277533/comments/default 0 US District Court Rejects Attack on Brain Death http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/bYS79Fqf-nk/us-district-court-rejects-attack-on.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/bYS79Fqf-nk/us-district-court-rejects-attack-on.html#comments Sun, 15 May 2016 12:16:00 +0000 http://www.bioethics.net/?guid=43593c04bab3b1638dd5033b9739afd8 http://medicalfutility.blogspot.com/feeds/5517744910194027695/comments/default 0 Honoring Choices Minnesota Conference http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/w_g18oHaiRU/honoring-choices-minnesota-conference.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/w_g18oHaiRU/honoring-choices-minnesota-conference.html#comments Sun, 15 May 2016 10:00:00 +0000 http://www.bioethics.net/?guid=06f11fc3e8309ea0241afc4802b96dc2 http://medicalfutility.blogspot.com/feeds/1397125085893254623/comments/default 0 New York Bill Would Punish Clinicians Who Disregard Patient Directives http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Eab_qcysPF0/new-york-bill-would-punish-clinicians.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Eab_qcysPF0/new-york-bill-would-punish-clinicians.html#comments Sat, 14 May 2016 09:30:00 +0000 http://www.bioethics.net/?guid=d2b57dbb850744e932d1e1c2d566a5ea http://medicalfutility.blogspot.com/feeds/9062198010475991722/comments/default 0 BioethicsTV: Paternalism (again) on Chicago Med http://www.bioethics.net/2016/05/bioethicstv-paternalism-again-on-chicago-med/ http://www.bioethics.net/2016/05/bioethicstv-paternalism-again-on-chicago-med/#comments Fri, 13 May 2016 19:10:19 +0000 http://www.bioethics.net/?p=59144 by Craig Klugman, Ph.D.

Our favorite television dramas this week were light on bioethics issues with the exception of Chicago Med (season 1; episode 17 “Withdrawal”) that continues to explore bioethical issues. This week the theme was arrogant paternalism—residents and fellows believing that only they know what is in the best interest of the patient.

The first storyline concerns a patient brought into the ED in the throes of alcohol withdrawal. He is a frequent flyer patient and has not had a drink in 2 days.…

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Reframing Conscientious Care: Q&A with Mara Buchbinder http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=7882&blogid=140 http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=7882&blogid=140#comments Fri, 13 May 2016 14:54:00 +0000 http://www.bioethics.net/?guid=28a58846732bf633a9cea02a32212e8c http://www.bioethics.net/2016/05/reframing-conscientious-care-qa-with-mara-buchbinder/feed/ 0 Does Florida Require Surrogate Consent for a DNAR Order? http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/PzGUx8PS8Dw/does-florida-require-surrogate-consent.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/PzGUx8PS8Dw/does-florida-require-surrogate-consent.html#comments Fri, 13 May 2016 09:30:00 +0000 http://www.bioethics.net/?guid=dc31ab7865893e9225cb7a0e3cfe3a1e http://medicalfutility.blogspot.com/feeds/4080188700949817693/comments/default 0 Doctors Push the PAS Envelope http://blogs.tiu.edu/bioethics/2016/05/12/doctors-push-the-pas-envelope/ http://blogs.tiu.edu/bioethics/2016/05/12/doctors-push-the-pas-envelope/#comments Fri, 13 May 2016 03:59:39 +0000 http://blogs.tiu.edu/bioethics/?p=6701 Read More »]]> http://blogs.tiu.edu/bioethics/2016/05/12/doctors-push-the-pas-envelope/feed/ 0 Euthanasia for Reasons of Mental Health http://www.bioethics.net/2016/05/euthanasia-for-reasons-of-mental-health/ http://www.bioethics.net/2016/05/euthanasia-for-reasons-of-mental-health/#comments Thu, 12 May 2016 21:35:40 +0000 http://www.bioethics.net/?p=59126 by Craig Klugman, Ph.D.

An article in the (UK) Daily Mail this week focused on a Dutch woman who chose euthanasia “after doctors decided her post-traumatic stress and other conditions were incurable.” Under Dutch euthanasia laws, a physician can end a patient’s life with a lethal injection for mental suffering. Her life was ended last year.

Euthanasia is when a physician delivers the substance that ends a patient’s life. This is distinct from physician/doctor/provider-assisted suicide (often called aid-in-dying) where a physician makes the means to end life available (often through a prescription) but the patient must ingest the life-ending medication.…

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Career Paths in Public Health Law and Health Law http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Co0BwNE-TkU/career-paths-in-public-health-law-and.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Co0BwNE-TkU/career-paths-in-public-health-law-and.html#comments Thu, 12 May 2016 19:10:00 +0000 http://www.bioethics.net/?guid=17d6b98457e3c38c56c3183f556574d4 http://medicalfutility.blogspot.com/feeds/6850661652680428312/comments/default 0 See Mom, I CAN Teach! http://www.peterubel.com/uncategorized/see-mom-can-teach/ http://www.peterubel.com/uncategorized/see-mom-can-teach/#comments Thu, 12 May 2016 13:40:17 +0000 http://www.peterubel.com/?p=7968 I got a really nice email the other day, from one of the provosts at my university. Here is the highlight: “During the 2015 fall semester, in the categories of Quality of Course and/or Intellectual Stimulation, your course evaluations were … Continue reading

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Why Science Denial is Immoral https://ethicsandsociety.org/2016/05/12/why-science-denial-is-immoral/ https://ethicsandsociety.org/2016/05/12/why-science-denial-is-immoral/#comments Thu, 12 May 2016 13:15:18 +0000 http://ethicsandsociety.org/?p=1823 Continue reading ]]> https://ethicsandsociety.org/2016/05/12/why-science-denial-is-immoral/feed/ 0 New Bioethics Commission Report Lays Out Roadmap for Tackling Tough Ethical Questions http://blog.bioethics.gov/2016/05/12/new-bioethics-commission-report-lays-out-roadmap-for-tackling-tough-ethical-questions/ http://blog.bioethics.gov/2016/05/12/new-bioethics-commission-report-lays-out-roadmap-for-tackling-tough-ethical-questions/#comments Thu, 12 May 2016 12:01:20 +0000 http://blog.bioethics.gov/?p=1838 http://blog.bioethics.gov/2016/05/12/new-bioethics-commission-report-lays-out-roadmap-for-tackling-tough-ethical-questions/feed/ 0 Advance Care Planning (ACP) Redesign: Transforming Person-Centered Care http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/kUf1MagHWvo/advance-care-planning-acp-redesign.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/kUf1MagHWvo/advance-care-planning-acp-redesign.html#comments Thu, 12 May 2016 09:30:00 +0000 http://www.bioethics.net/?guid=84e7ededc990fd01ba63994c0456ec95 This September in Milwaukee, join the first Respecting Choices® National Share the Experience Conference.

Plenary speakers will share their varied expertise in leading ACP implementation and research strategies. Workshop and concurrent sessions will demonstrate the quality of abstract submissions from individuals and groups dedicated to sharing ACP success stories, challenges, and creative solutions. You will have the opportunity to learn from the experiences of coalitions and organizations across the USA, parts of Europe, and Canada.

An extensive brochure is already available.  You will leave this conference with new ideas for how well-designed ACP programs are instrumental in creating a healthcare culture of  person-centered care; care that honors an individuals’ goals and values for their current as well as future healthcare plan.

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Advance Care Planning (ACP) Redesign: Transforming Person-Centered Care http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/kUf1MagHWvo/advance-care-planning-acp-redesign.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/kUf1MagHWvo/advance-care-planning-acp-redesign.html#comments Thu, 12 May 2016 09:30:00 +0000 http://www.bioethics.net/?guid=84e7ededc990fd01ba63994c0456ec95 This September in Milwaukee, join the first Respecting Choices® National Share the Experience Conference.

Plenary speakers will share their varied expertise in leading ACP implementation and research strategies. Workshop and concurrent sessions will demonstrate the quality of abstract submissions from individuals and groups dedicated to sharing ACP success stories, challenges, and creative solutions. You will have the opportunity to learn from the experiences of coalitions and organizations across the USA, parts of Europe, and Canada.

An extensive brochure is already available.  You will leave this conference with new ideas for how well-designed ACP programs are instrumental in creating a healthcare culture of  person-centered care; care that honors an individuals’ goals and values for their current as well as future healthcare plan.

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Call For Papers – Innovations in Life Sciences and Stakeholder and Agency Responses http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Es_FjFrXyhE/call-for-papers-innovations-in-life.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Es_FjFrXyhE/call-for-papers-innovations-in-life.html#comments Thu, 12 May 2016 00:58:00 +0000 http://www.bioethics.net/?guid=c20dbbbe3b403eb005d0fd8a5c228937 http://medicalfutility.blogspot.com/feeds/6220104248075189108/comments/default 0 CONCUSSION: Bioethics, Foot Ball and Post Traumatic Lies. http://www.bioethicsscreenreflections.com/2016/05/concussion-bioethic-foot-ball-and-post.html http://www.bioethicsscreenreflections.com/2016/05/concussion-bioethic-foot-ball-and-post.html#comments Wed, 11 May 2016 17:20:00 +0000 http://www.bioethics.net/?guid=b45036102972b7539314751205f56bc0
Concussion is a documentary biography about medical science’s triumph over a social and corporate conspiracy to suppress evidence of a serious preventable disease. Forensic pathologist, Bennett Omalu, MD, discovered a pathognomonic sign confirming chronic traumatic encephalopathy (CTE). He happened to find it in a cluster of professional football players during autopsies. Concussion was written and directed by Peter Landesman, who managed a riveting story pace, despite most of the visuals occurring in the inglorious world of microscopes and morgues —done to death on television. 

Will Smith’s Dr. Omalu in the lead role is a flawless interpretation of African born Omalu. The supporting cast includes Alec Baldwin, Gugu Mbatha-Raw, Luke Wilson, Albert Brooks, Adewale Akinnuoye-Agbaje and others. Ridley Scott is the principle producer. This is a heavy hitter production. Though several Black film awards recognized the work, few others have. Perhaps this is because the lead character is a Black man who is not blowing up anything, except the gladiator culture we like to call Football.

Concussion is a gentle story where a brilliant man driven by unflappable moral instinct does the right thing. Others join him, many kicking and screaming, eventually recognizing the effects of repetitive concussions in football and so elsewhere. The fact that this bold faced David and Goliath story, taking on the industry of Football, has had such a poor reception is a shocking, though not a surprising, eyebrow raising event. As the old word play goes, “Denial is more than a river in Africa.” 

Traumatic Brain Injuries from bomb blast during war, car crashes, playing football and other sports, share similar features.(See Going the Distance on this blog.) Exploring Concussion makes viewers understand the randomness of traumatic brain injury (TBI) especially with all those shots of players on the film colliding, pulled from game stock footage. It is similar to watching car accidents from a helicopter.

The effects of CTE develop progressively over a long latent period, often 1-1.5 decades into a football career. TBI goes to dementia more often than not if, a person lives long enough. Dementia is certainly the insidious boogyman many adults in the wealthiest nations most fear. 
If syphilis was considered the great masquerader during the first half of the twentieth century, and AIDS that of the latter half, TBI is vying for the role in this millennium. 

The emergency room is often where patients with traumatic injuries are first seen. How fast was the vehicle moving? What did it hit? These are among the first questions asked by ER clinicians. They are quickly estimating the amount of G-Force the person has been subjected to upon encountering an immovable object, like another car, or another players football helmet. 

When patients leave the ER, they often are relieved by the proclamation that a “brain scan” showed no bleeding. They do not understand the comment does not mean brain injury is absent. It only means one kind of brain injury has not been seen, bleeding. Bleeding is an acute brain injury which is treatable if recognized. CTE so far is not treatable, only preventable. 

When the injured ER patient is they told to come back if they vomit, have unequal pupils, and to have someone around to do “neuro checks,” they do not understand, these are signs of  brain swelling from edema or bleeding. The complications of repetitive, or single concussions do not usually manifest immediately and tend to be very subtle initially. People need to be told watch for those signs down the line and seek clinical assistance even if distant for the incident of injury. 

G-Forces of 50G or greater against a head causes a concussion. The outcome of that concussion only becomes clear overtime. Football players routinely suffer greater than 90G hits repetitively. The luke warm public response to the film Concussion reflects the reality that this “message film” convey’s at least one notion so terrifying that most parents and football fans, do not want to hear. The most poignant scene of the film is the final one, when you see it, you will understand why. 



Recent science and trauma protocols suggest neurological logical rest following brain injury improves late outcomes. Rest is a more appropriate instruction than, ”you are fine.” In bioethics, beneficence or doing good with the knowledge of science, out ranks both autonomy 

References

See:
Concussion directed by Peter Landesman (2015) Star Capital
Village Roadshow Pictures,Scott Free Productions,The Shuman Company
Cara Films, The Cantillon, Company Star Capital (USA)122 min.


Read:


 "Concussion by Jeanne Marie Laskas | PenguinRandomHouse.com". PenguinRandomhouse.com. Retrieved 2016-01-11.

The Concussion foundation http://concussionfoundation.org/

Boston University Brain Research Bank http://www.bu.edu/cte/our-research/brain-bank/

Center for Disease Control Brain Injury Recovery http://www.cdc.gov/traumaticbraininjury/recovery.html
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Should You Want a Robot to Do Your Surgery? http://www.peterubel.com/uncategorized/want-robot-surgery/ http://www.peterubel.com/uncategorized/want-robot-surgery/#comments Wed, 11 May 2016 16:19:23 +0000 http://www.peterubel.com/?p=7965 Karen Scherr, an MD PhD student working with me, just published a paper showing that physicians don’t always give patients objective advice about the pros and cons of robotic surgery. Here is a news story on her work: Duke University research … Continue reading

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Clinical Trial to Rregenerate Brains of Dead People http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/QGNchp3GvC4/clinical-trial-to-rregenerate-brains-of.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/QGNchp3GvC4/clinical-trial-to-rregenerate-brains-of.html#comments Wed, 11 May 2016 09:30:00 +0000 http://www.bioethics.net/?guid=779246529bb50bfa353545e4248dd03b http://medicalfutility.blogspot.com/feeds/6607557587422171961/comments/default 0 What is a Doctor and What is a Nurse? As Patients, We Have the Answer http://reflectivemeded.org/2016/05/10/what-is-a-doctor-and-what-is-a-nurse-as-patients-we-have-the-answer/ http://reflectivemeded.org/2016/05/10/what-is-a-doctor-and-what-is-a-nurse-as-patients-we-have-the-answer/#comments Tue, 10 May 2016 14:25:37 +0000 http://reflectivemeded.org/?p=195 ]]> http://reflectivemeded.org/2016/05/10/what-is-a-doctor-and-what-is-a-nurse-as-patients-we-have-the-answer/feed/ 0 The Majority of Doctors in the Majority of Specialties – Are Experiencing Burnout http://www.peterubel.com/uncategorized/majority-doctors-majority-specialties-experiencing-burnout/ http://www.peterubel.com/uncategorized/majority-doctors-majority-specialties-experiencing-burnout/#comments Tue, 10 May 2016 13:58:19 +0000 http://www.peterubel.com/?p=7962 And the problem is getting worse with time!

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Bioethics Essay Contest (cash prizes) http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/KITNr2sLBwo/bioethics-essay-contest-cash-prizes.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/KITNr2sLBwo/bioethics-essay-contest-cash-prizes.html#comments Tue, 10 May 2016 10:00:00 +0000 http://www.bioethics.net/?guid=3d7240a8e4971438110eba63b90c4355 http://medicalfutility.blogspot.com/feeds/9025973692021273891/comments/default 0 Bad Moms, Blameless Dads: Examining How the Media Portrays Age-Related Preconception Harm http://www.amc.edu/BioethicsBlog/post.cfm/bad-moms-blameless-dads-examining-how-the-media-portrays-age-related-preconception-harm http://www.amc.edu/BioethicsBlog/post.cfm/bad-moms-blameless-dads-examining-how-the-media-portrays-age-related-preconception-harm#comments Mon, 09 May 2016 16:23:44 +0000 http://www.amc.edu/BioethicsBlog/post.cfm/bad-moms-blameless-dads-examining-how-the-media-portrays-age-related-preconception-harm

As I discussed in a previous blog, the blame for fetal harm is generally directed at women. Some of my colleagues and I, including AMBI faculty member Zubin Master, were interested in examining how fetal harm, and more specifically age-related preconception harm, is portrayed in the media. Our findings were published earlier this year in the American Journal of Bioethics Empirical Bioethics.

Given the significant social change that many people today are delaying childbearing in comparison to previous generations, it is relevant to examine the media portrayal of older parental age and risk to future offspring. Furthermore, there is clear evidence that older parental age carries certain risks to offspring: older age in women and men leads to an increased risk of having children with autism and Down syndrome and older paternal age has also been linked to higher rates of children with schizophrenia. Many people get most of their scientific news from the media, so it is important to examine the accuracy and biases of the information.

Our results indicate that reproduction is still largely seen as the domain of women, rather than of couples or of men. We rarely found articles discussing reproduction as it relates to both women and men as the majority of articles were maternally focused. Even among the articles that were paternally focused, they almost always discussed maternal harm as well. However, the reverse – maternally focused articles containing discussions of paternal harm – were almost nonexistent. This pattern suggests that men alone are never seen as solely responsible for fetal harms, but rather that this responsibility is always shared with women.

Responsibility and blame typically go hand-in-hand and not surprisingly articles were four times more likely to blame women for fetal harms than men. The infrequency of paternal blame suggests that authors either do not recognize men’s contribution to harm due to ignorance or denial, or do not want to hold men responsible for harm. Even when men’s contribution to harm was acknowledged, the authors were more likely to absolve men from responsibility for harm by presenting reassuring information, such as the overall risk of fetal harm is quite low, in conjunction with factual information stating that older paternal age can increase risks to future children. The same sort of reassurance was not seen for women.

Although reproductive blame and responsibility is still typically assigned to women, newspapers are increasingly discussing the relationship between paternal age and preconception harm: no articles discussed this relationship in the 1970s or 1980s, 20% discussed it in the 1990s, and nearly 40% discussed it between 2000 and 2012. The increase in articles on paternal harm in the 2000s may be due to the increase in scientific data showing the connection between paternal age and harm, the growing body of social science literature on male reproduction, the rising medicalization of men’s sexuality and reproduction, as well as changes in social norms that make discussions of paternal role and responsibility in reproduction more commonplace.

However, despite the fact that newspapers are actually acknowledging and discussing paternal age and preconception harm, the primary focus of newspaper articles regarding preconception harm remains concentrated on women and articles are more likely to blame women than men for any harm. In short, our analysis of age-related preconception harm reflects the broader gendered social patterns regarding reproduction that tend to minimize, and even ignore, men’s role in and responsibility for reproduction.

 

 

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 website.

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Aspen Health Strategy Group Seeks YOUR Idea for Improving End-of-Life Care http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/pb2SQE2K0Mw/aspen-health-strategy-group-seeks-your.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/pb2SQE2K0Mw/aspen-health-strategy-group-seeks-your.html#comments Mon, 09 May 2016 10:00:00 +0000 http://www.bioethics.net/?guid=13f795f8c307a3a356c675da0215225c Former DHHS secretaries Kathleen Sebelius and Tommy Thompson are co-chairs of the newly formed Aspen Health Strategy Group (AHSG). The Aspen Health Strategy Group comprises 24 senior leaders across influential sectors such as health, business, media, technology, tasked with providing recommendations on important and complex health issues to promote improvements in policy and practice.

Submit Your Big Idea Big on End-of-Life Care

Each year AHSG will tackle one issue for a year-long, in depth study. The first topic is how to improve end of life care. Do you have ideas to address this issue? Submit them to Aspen by May 20.  

What Is a Big Idea

A useful big idea will be specific about what should happen and who should do it. It will provide a rationale for the action and describe what would happen if it were implemented. Source documents, background research and cost estimates are optional, but they will help make your case.

They should be "big" – as in meaningful and bold – and "ideas" as in reflecting thought and not just an exhortation that someone do something they should be doing already. Ideas will be judged on creativity, feasibility and the completeness of details around rationale and potential consequences

Why End-of-Life Care

No topic is more personal than end-of-life care, an issue that impacts all of us. Care toward the end of life reflects the best and worst of American healthcare: amazing medical advances delivered by dedicated clinicians, but reflecting the fragmentation of the health system, its high costs, and its resistance to incorporating patient preferences.

How do we honor the oft-stated desire to “die with dignity?” How do hospitals and other healthcare settings prepare to make sure people’s wishes are honored and their medical, social, and spiritual needs are met? How do we help people have effective conversations about this highly sensitive, and sometimes politicized, topic? What is the role of public policy in improving end-of-life care? 

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Medical errors and more medical errors http://blogs.tiu.edu/bioethics/2016/05/08/medical-errors-and-more-medical-errors/ http://blogs.tiu.edu/bioethics/2016/05/08/medical-errors-and-more-medical-errors/#comments Mon, 09 May 2016 02:04:19 +0000 http://blogs.tiu.edu/bioethics/?p=6696 Read More »]]> http://blogs.tiu.edu/bioethics/2016/05/08/medical-errors-and-more-medical-errors/feed/ 0 Medical errors and more medical errors http://blogs.tiu.edu/bioethics/2016/05/08/medical-errors-and-more-medical-errors/ http://blogs.tiu.edu/bioethics/2016/05/08/medical-errors-and-more-medical-errors/#comments Mon, 09 May 2016 02:04:19 +0000 http://blogs.tiu.edu/bioethics/?p=6696 Read More »]]> http://blogs.tiu.edu/bioethics/2016/05/08/medical-errors-and-more-medical-errors/feed/ 0