Where the World Finds Bioethics Fri, 24 Jun 2016 12:00:53 +0000 en-US hourly 1 Christ Disputing with the Doctors Fri, 24 Jun 2016 10:00:00 +0000 0 Santa Claus Revives Dead Children Thu, 23 Jun 2016 10:00:00 +0000 0 Balancing the benefits and harms of advances in medical technology Wed, 22 Jun 2016 13:02:07 +0000 Read More »]]> 0 Public Education and Misinformation on Brain Death in Mainstream Media Wed, 22 Jun 2016 08:30:00 +0000 0 Five Active Brain Death Cases in US Courts Tue, 21 Jun 2016 22:37:00 +0000 0 Time to Heal Tue, 21 Jun 2016 15:23:37 +0000 ]]> 0 Its not just mental health studies: Doctors rarely ask adolescent patients about their sexual orientation & LGBT youth are afraid of bias Tue, 21 Jun 2016 13:48:18 +0000 Continue reading ]]> 0 Cross-Cultural Perspectives on Brain Death Tue, 21 Jun 2016 09:00:00 +0000 Several weeks ago, Harvard Bioethics produced a recorded seminar on "Cross-Cultural Perspectives on Brain Death." 

The panelists were Qing Yang, MD, PhD (Department of Anesthesia, Massachusetts General Hospital) and Robert D. Truog, MD (Director, Center for Bioethics and Professor of Medical Ethics, Anaesthesiology & Pediatrics at Harvard Medical School; Senior Associate in Critical Care Medicine at Children’s Hospital Boston).

Even in the US, some controversy persists over the conceptual defensibility of brain death. Around the world, the philosophical defensibility of brain death is even more debatable. Watch as Dr. Qing Yang presents data regarding the adoption of brain death in China. She discusses cultural differences between Chinese and US medical professionals and patients that inform policy and law when it comes to brain death. Dr. Bob Truog, a prominent brain death critic, replies.

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Organ Harvesting in China Tue, 21 Jun 2016 04:00:29 +0000 Read More »]]> 0 The Politics of Fetal Pain: Why This Is Not A Legislative Issue Mon, 20 Jun 2016 17:41:36 +0000

I read with interest the recent blog by my colleagues Paul Burcher and Claire Horner entitled “The Politics of Fetal Pain”. In their blog they discuss the recent fetal pain bill passed in Utah, which “requires the use of general anesthesia on women seeking abortions at 20 weeks gestation or later.” At stake is the concern that fetuses may be capable of experiencing pain by 20 weeks, which has prompted 12 states to restrict or prohibit abortions from that point on, instead of 24 weeks, which is the current standard.

Burcher and Horner remind us that the issue of fetal pain has been a source of contention for some time, which has led to “several states restricting or prohibiting abortions 20 weeks or later on the basis of potential fetal pain.” The authors are very much aware of the possibility that anti-abortion advocates may be using this issue as a convenient means by which to place additional limits on abortion rights of women. Which is to say, anti-abortion advocates supporting these restrictions on women’s reproductive rights may be using the fetal pain issue as a means to restrict abortion rights. Even if they do have a bias in creating this law, Burcher and Horner still believe that the law itself is justified.

Though I would share a concern about the possibility of fetal pain, if I had reason to believe there were evidence to support it, I disagree that the appropriate next move ethically is to join forces with a legislative agenda of politicians whose interests go far beyond the issue of fetal pain. My worry is that such legislative actions in fact usurp the professional role of physicians as medical experts of scientific data to set appropriate standards for medical care.

I accept that the possibility of fetal pain at 20 weeks is a theoretical possibility. But to the extent I find such a claim plausible I would do so by placing my confidence in scientific evidence, which to date is questionable. The paper from which Burcher and Horner take their evidence about fetal pain comes from an author who makes it clear in his writing that he believes abortion is an act of unjust killing. This is not an unreasonable moral position nor does it mean that he is not accurate in his assessment of the medical and scientific evidence regarding fetal pain. But it does raise concerns about his ability to assess and write about data of fetal pain without bias. Is he following the evidence or is he interpreting the evidence to support his preexisting moral views? The answer is we just don’t know, in the same way we don’t know if the Utah state legislature is really concerned about the possibility of fetal pain beginning at 20 weeks or is their real goal to place additional restrictions on abortions?

I want to make it clear that people, including bioethicists, legislators, and the public at large, have every right to advocate, based on their understanding of the evidence, to ensure that fetuses do not suffer during abortions from 20 weeks and beyond. My only point is that such advocacy should not be expressed in laws that impose standards of care on how physicians practice medicine. Such advocates may retort, but why should I think that the medical profession or the scientific community is unbiased? Could it be the case that these professional bodies are abdicating their professional, moral obligations to reduce the possibility of human suffering? Of course that is a theoretical possibility. But in an era where the role of science is grossly misunderstood and under attack by many advocacy groups, those of us in bioethics must champion the standards of scientific research and judgment by medical professionals to produce evidence that is unbiased and reflects the best available understanding of important empirical questions, such as, can fetuses feel pain? This is not an ethical question, i.e. it has nothing to do with whether or not fetuses have moral standing as human beings—rather the question is purely a matter of getting the facts as clear as possible in determining at what point in the development of a human fetus is there a physiological basis for experiencing pain. This is exclusively the scientific issue about which scientific and medical experts must decide based on the best available evidence.

So where should we look for such an understanding of the data on fetal pain? The answer is we should rely on the experts on such matters as reflected in the opinion from the American Congress of Obstetricians and Gynecologists (ACOG), which concluded “fetal perception of pain is unlikely before the third trimester. Although ultrasound monitoring can show intrauterine fetal movement, no studies since 2005 demonstrate fetal recognition of pain.”

I hasten to make it clear that it is always possible current scientific opinions will need to be revised based on new data. There are many examples that bear out this point. But we should realize just how procedurally disruptive and even iconoclastic it is to impose standards legislatively onto medicine because, in effect, we don’t trust or have faith in the integrity of medical experts to be fair or unbiased themselves. For doing so indicts the institution within our democratic system whose defined role and responsibility is to be the arbiters of empirical disputes. The process, i.e. the scientific method they use is by definition one that has the least chance of bias. And without robust confidence in the scientific enterprise and the knowledge that is generated, bioethics loses its footing to make moral assessments and judgments. Thus I agree with the view of ACOG:

“Sound health policy is best based on scientific fact and evidence-based medicine. The best health care is provided free of governmental interference in the patient-physician relationship. Personal decision making by women and their doctors should not be replaced by political ideology.”

Committing ourselves to make decisions based on scientific evidence, both in individual cases and at the policy level, requires us to always stipulate that our knowledge today may not be getting things exactly right. Advocates for the possibility of fetal pain, and I may be one of them, should not be quiet. They have every right and perhaps an obligation to express their concerns. But to conclude that ACOG refuses to accept the possibility of fetal pain because of politics—the fear of having to possibly create new standards about which they may fear a backlash from prochoice advocates or that they really do not believe a fetus has full moral standing—is to lose trust and confidence in an essential democratic institution, and indeed risks becoming cynical and riding roughshod over the role of professional medical expertise.

Thus, I conclude the Utah bill was not an appropriate action for the legislature to take, even if there is eventually scientific evidence that supports their concerns. I understand that there are some medical concerns about which a state legislature may appropriately pass laws—assisted suicide or narcotics—if there is a clear and compelling public interest. But I submit, since there is no clear and compelling evidence, the issue of fetal pain is not one of them.

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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Competition at Work! Mon, 20 Jun 2016 13:42:43 +0000 Recently, pharmaceutical companies have been pricing many of their products at astounding values. A couple years ago, in fact, an amazing new hepatitis C drug came to market priced at about $90,000 per patient. But since that time, several other … Continue reading

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Medical Devices after Cremation Mon, 20 Jun 2016 09:00:00 +0000 0 Peter Low – Limits of Medicine Mon, 20 Jun 2016 08:07:00 +0000 0 Where Do We Come From? What Are We? Where Are We Going? [EOL in Art 206] Sun, 19 Jun 2016 09:30:00 +0000 Gauguin considered this 1897 work to be his masterpiece and the summation of his ideas. The painting should be read from right to left, beginning with the sleeping infant. 

Gauguin describes the various figures as pondering the questions of human existence given in the title; the blue idol represents “the Beyond.” The old woman at the far left, “close to death,” accepts her fate with resignation.

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28th Annual MacLean Fellows Conference on Clinical Medical Ethics Sat, 18 Jun 2016 09:00:00 +0000 0 Brain Death – Two False Assumptions Sat, 18 Jun 2016 08:38:00 +0000 0 Best intentions, worst outcomes: Ethical and legal challenges for international research involving sex workers Fri, 17 Jun 2016 16:00:52 +0000 Continue reading ]]> 0 Resource-based Thresholds for Futility in Neonatal Intensive Care Fri, 17 Jun 2016 06:45:00 +0000 I am off, this morning, to see Dominic Wilkinson present "Resource-based Thresholds for Futility in Neonatal Intensive Care."  Here is his abstract:

In neonatal intensive care, disputes sometimes arise between families and clinicians over potentially beneficial life-prolonging treatment for a newborn infant. Parents strongly desire the treatment, yet health professionals judge that it would be futile. While professional guidelines support the concept of ‘medical futility’, there is no guidance on how to determine whether or when treatment would be futile. 

In this paper, we explore the application of cost-effectiveness thresholds (CET), used elsewhere in public health systems, to the determination of resource-based futility in newborn intensive care. We outline briefly the concept of futility, and of cost-effectiveness assessment. We then draw on CET to explore sequentially a series of clinical questions. When is a patient’s chance of survival too low to provide expensive life-support? How long is too long to provide intensive life-prolonging medical treatment? What level of quality of life is too low for life- saving surgery to be provided? 

This paper represents the first attempt to evaluate distributive justice based determination of futility in intensive care. It builds on careful analysis of existing empirical evidence as well as ethical argument. We identify and address major counterarguments to the use of cost-effectiveness in deriving futility thresholds for intensive care. 

Conclusions: our analysis identifies key normative questions for resource-based treatment limitation decisions as well as key empirical data necessary to inform such decisions.

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Pediatric Clinical Ethics Summer Internship (Minneapolis) Fri, 17 Jun 2016 06:39:00 +0000 0 Wesley J. Smith on Thaddeus Pope Fri, 17 Jun 2016 06:02:00 +0000 Wesley J. Smith makes this observation about me:  "I disagree fundamentally with Thaddeus Mason Pope about everything, but respect his candor—he doesn’t sugarcoat the hemlock—and deeply appreciate the work he does in archiving various court cases involving bioethics around the world."

"Everything" might be too strong and broad.  But I appreciate the sentiment.  But my most favorite recent comment about me remains Ann Neumann's.  

"Thaddeus Mason Pope is an animated, towering man with a bald head and enigmatic facial features as unforgettable as his name. . . . Pope also runs the Medical Futility Blog, a site with work-a-day formatting and outdated fonts that is nonetheless an indispensable clearing house for news and updates on end of life legislation, litigation and initiatives. Which is why I follow what he writes and blogs religiously."

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Dear Professional Organizations…It’s Not Me, It’s You Thu, 16 Jun 2016 20:57:56 +0000 by Craig Klugman, Ph.D.

Dear Professional Organizations,

Being an active member of my profession is important for both my personal mission and my professional career. I enjoy coming to your meetings and finding myself among those who speak my scholarly language. At such gatherings I learn about new ideas, network with current, former and potentially new collaborators, and sometimes (when looking) find out about new opportunities for jobs, funding, and publishing. And yes, my university expects me to attend these events in order to share my work, to network, and to help with increasing the visibility and reputation of the institution.…

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Burnout and self-care for bioethicists Thu, 16 Jun 2016 16:50:33 +0000 by Keisha Ray, Ph.D.

Like many bioethicists, I often have to research disturbing parts of American culture for various writing projects. Topics like rape, gun violence, sexism, and medical racism are often times the subjects of my scholarly articles and blogs. Many times, I have to research how these topics play out in our everyday lives, forcing me to research popular and heart-breaking news stories such as the Orlando night club shooting or the recent Stanford rape case. Because of technology, social media, and the always handy cell phone, my research often requires me to read or watch the testimonies of witnesses to heinous crimes, crime scene photos, and/or videos of murders.…

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Obamacare Reduced Racial Disparities in Healthcare Insurance Thu, 16 Jun 2016 13:06:15 +0000 Research led by Stacey McMorrow (a former student of mine) shows that Obamacare was especially helpful in enabling black and Hispanic people obtain healthcare insurance: Disparities in insurance rates among either groups are declining:      

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End of Life Law in Australia – New Website Resource to Help You Understand Law at End of Life Thu, 16 Jun 2016 09:00:00 +0000 0 Gender Indiscrimination Thu, 16 Jun 2016 02:00:15 +0000 Read More »]]> 0 Medical Futility Blog Exceeds 125,000 Monthly Pageviews Wed, 15 Jun 2016 20:19:00 +0000 0 Doctor Punished for Bringing Dead Back to Life (Asclepius) Wed, 15 Jun 2016 08:48:00 +0000 0 Reducing Tobacco Use Through Withdrawal Policies: When Should We Ban the Use of a Harmful Product? Tue, 14 Jun 2016 21:15:04 +0000 Kayhan Parsi, JD, PhD

In the first-year clinical skills course at our medical school, we offer a session on tobacco cessation. In this part of our course, we emphasize to our medical students the significant costs tobacco use incurs. The costs to health are now well documented. The financial costs are substantial as well. We teach our students that they can have a positive impact upon their patients’ health by utilizing motivational interviewing techniques and applying the 5 A’s of change (ask, advise, assess, assist, arrange).…

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Sacred and Profane: Balancing the sanctity of the human body with the mechanics of cadaver dissection Tue, 14 Jun 2016 15:10:17 +0000 ]]> 0 Need More Evidence the U.S. Healthcare Market Is Screwed Up? Tue, 14 Jun 2016 13:42:53 +0000 In a healthy consumer market, people compare the price and quality of goods inside whether it’s worth paying extra money to get the best possible products. In healthcare, it’s often almost impossible to figure out what things cost. And when … Continue reading

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Patient Rights in the ICU Tue, 14 Jun 2016 09:00:00 +0000 0 APHA Ethics Section Interview with Dr. Celia B. Fisher on Conversion Therapy Report Mon, 13 Jun 2016 15:13:36 +0000 Continue reading ]]> 0 Parents May Refuse Life Saving Therapy for Child Mon, 13 Jun 2016 10:00:00 +0000 0 Drafting Healthcare Decisions Laws (a Poem) Mon, 13 Jun 2016 10:00:00 +0000 This poem was recited by Phillip Carroll in the closing remarks of his 1987 Presidential Address to the Uniform Law Commission.  The ULC had met in August 1985 to draft the Uniform Rights of the Terminally Ill Act.

  • We came to California, we’re here at Newport Beach,
  • We’re lawyers from the 50 states, uniformity we preach.
  • 96 times we’ve met like this, injustice we outmode,
  • A sample of our efforts – the Uniform Commercial Code.
  • Our tasks are seldom easy, in fact at times it’s all uphill,
  • Remember Minneapolis and the Rights of the Terminally Ill!
  • We said there was a right to die and we could write the tickets,
  • The locals said that we could try, but first get through our pickets.
  • You know I thought I would die from all that agitation,
  • But soon I found that I lacked was nutrition and hydration.
  • We’ll kick this off this morning and our spirits will uplift,
  • We will think things anatomical and how to make a gift.
  • Yes, once again we face the knotty issue of franchise,
  • We’ll do it and we’ll show the world the art of compromise.

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Husband and Wife Both Patients in ICU Mon, 13 Jun 2016 10:00:00 +0000 0 Brain Death in the Courts: Another Injunction Prohibiting Hospital from Conducting Apnea Test Sun, 12 Jun 2016 07:02:00 +0000 0 The Gift: a Parable for Our Time Sat, 11 Jun 2016 14:26:50 +0000 Read More »]]> 0 Surgical Critical Care Innovator Joseph Civetta Sat, 11 Jun 2016 10:00:00 +0000 Here is an impressive recent obituary of surgical critical care innovator Joseph Civetta.

It notes his definition:  “Futility is defined as the gap between what a doctor can achieve and a patient can accept

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Human Life Alliance – Minnesota Annual Gala Sat, 11 Jun 2016 09:30:00 +0000 0 Court Allows Hospital to Perform Apnea (Brain Death) Test over Family Objections Sat, 11 Jun 2016 07:41:00 +0000 0 Small Minds Fri, 10 Jun 2016 15:53:52 +0000

I have recently read an opinion piece published in the Chronicle of Higher Education by John Kaag and David O’Hara entitled Big Brains, Small Minds. In this article Kaag and O’Hara boldly assert that “We are on the verge of becoming the best trained, and least educated, society since the Romans”. In the ensuing explanation we learn that education is science is what he refers to as “trained” while education in the humanities is what he refers to as “educated”. Apparently I have been trained and he has been educated. What a crock. Because I have been trained and not educated it is probably important to clarify that I mean crock not in the sense of an earthenware jar but rather in the sense of something which is complete nonsense.

Kaag and O’Hara appear to believe that one of the primary roles of the humanities is to critique science. That is fine; everybody should critique science, it is much too important to not be evaluated in the context of all types of human knowledge and understanding. It is also fine that they suggest that humanities should not be judged by the metrics of hard science. Of note, however, is I have never heard anyone suggest that humanities should be judged by the metrics of hard science. But I think it is probably important to note, however, that if it is the job of humanities to critique science perhaps those doing the critiquing should also know some science. It should also be kept in mind that scientists are pretty good at critiquing the sciences and, in fact, we usually spend quite a bit of time and energy critiquing each other. Just for the record, Kaag and O’Hara write that Plato teaches us that part of the liberal arts enduring mission is to critique the objectives of science. Science was rather different in the time of Plato. Perhaps he should have a more recent reference. He should also remember that at the time of Plato there was really no distinct boundary between science and philosophy. The authors cite the story of Herodicus as told by Socrates as an example of a disordered mind having “been trained in the STEM fields of his time”.  Really! This took place in the fifth century BC. Again, I think we may well need a newer reference. Parenthetically Herodicus showed great insight in advocating the value of exercise in preserving health.

The job of a professional scientist is to learn what has previously been unknown. They must be able to understand and appreciate the state of knowledge in their field, identify the boundaries of knowledge, and formulate hypotheses that if proven produce new knowledge. For a scientist to be successful they assume the burden of proving or disproving that hypothesis. They must have the communications skills to present their ideas in an adequately compelling manner to be awarded resources to engage these scientific pursuits. They must communicate their findings to the world. None of these are endeavors of the small mind.

The authors of this essay state “If you’re interested in learning about justice, you don’t go to the chemistry laboratory. You go to philosophy class and travel to Plato’s Republic. Perhaps so but I am unconvinced. If the justice one seeks has to do with environmental preservation, species extinction, and biomedical innovation perhaps this is positively contributed to by those who have had their minds expanded by an education which includes science.


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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Testing, testing: Prenatal genetic screening Fri, 10 Jun 2016 13:01:21 +0000 Read More »]]> 0 Medical Futility Blog 2016-06-10 05:00:00 Fri, 10 Jun 2016 09:00:00 +0000 In the new video “Cure,” Benjamin Scheuer conveys the dread that brands cancer patients, whether or not their type of disease is treatable.  

The video is eloquently reviewed by the New York Times.

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Mitochondrial replacement boosterism Fri, 10 Jun 2016 03:57:47 +0000 Read More »]]> 0 National Academies on Gene-Drives Fri, 10 Jun 2016 01:57:00 +0000 0 Resources for Physicians & Patients – California End of Life Options Act Thu, 09 Jun 2016 20:53:00 +0000 0 Landing the Role of a Lifetime Thu, 09 Jun 2016 14:11:52 +0000 ]]> 0 What Would Aristotle Say About the Ethics of Publicly Subsidized Puberty-Blockers? Thu, 09 Jun 2016 13:24:07 +0000 Continue reading ]]> 0 Death & Dying MOOC Thu, 09 Jun 2016 13:14:00 +0000 0 Historic Drop in U.S. Uninsured Rate Thu, 09 Jun 2016 13:00:19 +0000 0