Where the World Finds Bioethics Fri, 29 May 2015 21:01:29 +0000 en-US hourly 1 “Should I feel badly that I acted unethically?” Fri, 29 May 2015 21:01:29 +0000 Ms. Barnard is a business woman who has opened a medical clinic across the street from an existing facility. She suspects that the Other Clinic is “playing unfairly” by not having a physician on site. Since a physician costs a lot of money to employ, the Other Clinic could be undercutting the competition if this were true as well as violating their state license. Ms. Barnard asks her employee, Roger, to visit Other Clinic posing as a patient and seeing if indeed there was a physician present.…

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Bundling Hospital Pay Without Bungling Patient Care Fri, 29 May 2015 16:51:08 +0000 Paying someone to mow your lawn is a pretty straightforward affair. Ryan the lawn guy will look at the lawn size and maybe the hilliness of your yard and you’ll settle on a price for mowing and trimming it. When … Continue reading

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Sharing the Experience – Honoring Choices Minnesota Fri, 29 May 2015 09:00:00 +0000 0 Scary Hospital Room [EOL in Art 19] Fri, 29 May 2015 08:30:00 +0000 0 ICU StoryWeb – Sharing Stories about ICU Treatment Decisions Thu, 28 May 2015 12:03:00 +0000 0 Shadow of Death [EOL in Art 18] Thu, 28 May 2015 09:00:00 +0000 0 Why not be inclusive rather than exclusive when selecting abstracts for conferences? Thu, 28 May 2015 07:05:38 +0000 0 Roundtable Discussion: Improving Public Dialogue of Bioethics Wed, 27 May 2015 20:18:49 +0000 0 Bioethics Education from Three Viewpoints Wed, 27 May 2015 19:11:17 +0000 0 What Happens When We Penalize Hospitals For Harming Patients? Wed, 27 May 2015 17:51:11 +0000 I recently had surgery to relieve an impingement of my left hip. I suffered a complication of the procedure in the hospital where I received the surgery performed follow-up care to treat the complication. As I lay on the table … Continue reading

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How to Elevate Bioethics Deliberations to a National Level Wed, 27 May 2015 17:32:16 +0000 0 MST3K is the perfect embodiment of postmodernism Wed, 27 May 2015 15:41:15 +0000

The observers become part of the text. Criticism of the text exposes intertextual connections and undermines the intent of the author. Nothing in the text is treated with reverence, the forth wall is constantly broken, and reference to the film as a film while also taking its constructed reality at face value. Two of the observers [...]

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Lessons from Democratic Deliberations Wed, 27 May 2015 15:22:42 +0000 0 Brain Death Conference – Milwaukee Wed, 27 May 2015 14:24:00 +0000 0 The Bioethics Commission Remembers Commission Member John D. Arras Wed, 27 May 2015 13:54:08 +0000 0 Bioethics Commission Meeting 21: Live from Philadelphia Wed, 27 May 2015 13:07:58 +0000 0 Father at Mt. Sinai [EOL in Art 17] Wed, 27 May 2015 08:30:00 +0000 0 New Zealand Case and New York Times Magazine Article Draw Attention to Physician Aid in Dying Tue, 26 May 2015 14:54:00 +0000 0 Cost of Treating Hepatitis C Is Soaring Tue, 26 May 2015 13:13:45 +0000 Here is a fascinating picture from the Wall Street Journal, showing how much Medicare has been spending on hepatitis C treatments lately. You can see that the cost is rising dramatically: Keep in mind, however, that the new and expensive … Continue reading

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End-of-Life Care Is Getting Worse Tue, 26 May 2015 09:30:00 +0000 Joan Teno's new report in The Journal of Palliative Medicine confirms that there are still large gaps between the kind of care that patients and families want and the care they actually receive. 

Teno and her coauthors compared two surveys, one conducted in 2000, and the second carried out between 2011 and 2013. Each of the studies asked individuals about the care received by elderly loved ones at the end of life.  

Despite all the effort put into improving end-of-life care in recent years, there was a marked decline in satisfaction between the first survey and the second. While 56.7% of respondents in 2000 said that the care their loved one received was “excellent,” only 47% could say the same in the 2011-2013 study.

Teno rightly observes: “People are less satisfied with care at the close of life, and I think it’s now urgent for us to start thinking about what interventions we can do to improve care at the end of life.

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Death Carts [EOL in Art 16] Tue, 26 May 2015 09:30:00 +0000 The death cart is an object that was used in acts of corporal penance performed by the Hermanos de la Fraternidad Piadosa de Nuestro Padre Jesús Nazareno. The Brotherhoods were secretive, lay-religious fraternal organizations that served the spiritual needs of Hispanic Roman Catholics in northern New Mexico and southern Colorado in the 19th and early 20th centuries. 

Public processions reenacted the sorrow and suffering of Christ’s final days.  The female Angel of Death, Doña Sebastiana, serves as a reminder of human mortality and the importance of preparing for a good death through prayer and virtuous deeds. 

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Mad Max: Fury Road reminds us why we love the post-apocalypse Mon, 25 May 2015 15:21:22 +0000

When it comes to telling big, epic, awesome, mythopoetic stories, our world is boring. It is boring because it is known. We can google any spot on the planet and get a complete breakdown of that place’s ecology, politics, history, industries, and turn-by-turn directions on how to get there. Not only that, most of [...]

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Louise Vernet on Her Death Bed [EOL in Art 15] Mon, 25 May 2015 09:30:00 +0000 0 Another California Lawsuit for Following the Wrong Surrogate Mon, 25 May 2015 09:30:00 +0000 A few days ago, Bart F. Sullivan filed a lawsuit in Orange County Superior Court (California) against Park Vista at Morningside and Placentia Linda Hospital.  His 92-year-old mother, Clara, died there in May 2014.  Sullivan's legal theories include: abuse of an elder person, negligent wrongful death, medical malpractice, infliction of emotional distress, and fraud.

Most interesting is a claim that the nursing home and hospital lacked a good faith belief in the validity of Clara Sullivan's DNR order.  From the complaint: "Clara Sullivan’s daughter Gail Mitsch had signed a “Do Not Resuscitate” form for Clara . . . a form not only without Plaintiff’s signature (as Plaintiff shared POA for Health care, Exhibit “X” ), but contradicting Clara’s Health Care Directive. . . .  Clara Sullivan on many occasions has expressed her desire for optimal medical treatment."

This sounds a little like the Noval lawsuit in which the hospital proceeded on the basis of the consent of some of the patient's family but without the consent of the duly authorize agent.

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Texas Advance Directives Act – House Debate Today Sun, 24 May 2015 12:34:00 +0000 Today, the Texas House is set to consider legislation to re-evaluate the state’s health commission. The Texas Tribune notes that a number of amendments could set the stage for a fiery debate over the futility provisions in the Texas Advance Directives Act.

Republican lawmakers have filed amendments to Senate Bill 200 that would limit medical professionals’ abilities to override patients' advance directives or their families’ wishes to continue life-sustaining treatment.

The fight over end-of-life care has been a perennial one at the Legislature as lawmakers have struggled to decide whether families or medical professionals should make the final decision to end life-sustaining treatment for a terminally ill patient.

Texas law allows physicians to discontinue treatment they deem unnecessary. But if a physician’s decision to halt treatment is at odds with patients' advance directives — or if their families or surrogates disagree — patients or their families have 10 days to find an alternative medical provider.

They can also appeal the doctor’s decision to a hospital ethics committee.

Some lawmakers want to prohibit physicians from discontinuing care against a family’s wishes, while others want to give patients and their surrogates more discretion but preserve a physician’s ability to make a medical judgment to end treatment.

The pre-filed amendments would give more weight to a family’s wishes over physicians' recommendations.

One pre-filed amendment by Republican state Rep. Bryan Hughes of Mineola would direct the state’s executive health commissioner to develop rules that would prohibit a health care facility or hospital ethics committee from ending life-sustaining treatment based on the “lesser value” the health care facility may place on an elderly, disabled or terminally ill patient versus a young patient who is not disabled or terminally ill.

Hughes said Republicans were pushing the end-of-life measures as amendments to the health agency bill, also known as a Sunset bill, after they were unable to pass them on the House floor.

"Sunset bills have always been vehicles for legislation whether from the left or from the right," Hughes said, adding that the bills were fair game despite the "controversy and concern" surrounding end-of-life issues.

Another amendment by Republican state Rep. James Frank of Wichita Falls would extend from 10 days to 21 days the time families have to find an alternative medical provider to continue life-sustaining treatment their current physician has deemed unnecessary.

Meanwhile, state Rep. Jonathan Stickland, R-Bedford, filed an amendment to prohibit abortions on the basis of fetal abnormalities. In its 20-week abortion ban, the state carved out an exception for abortions in cases of a "severe fetal abnormality," but some conservatives are looking to remove that.

This wouldn’t be the first time a debate over a social issue has come during consideration of a state agency review. An April debate on legislation to reform the Department of State Health Services morphed into a fight over abortion, and the bill was pulled down after a pair of anti-abortion amendments, including one repealing the fetal abnormality exception, were tacked onto the bill over the author’s objections.

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Woman Praying at a Deathbed [EOL in Art 14] Sun, 24 May 2015 09:30:00 +0000 0 European Court of Human Rights Judgment in Vincent Lambert v. France Sun, 24 May 2015 09:00:00 +0000 The European Court of Human Rights will be delivering its Grand Chamber judgment in the case of Lambert and Others v. France (application no. 46043/14) at 11 a.m. on 5 June 2015 in the Human Rights Building, Strasbourg.  A video of the January 2015 hearing is available here.

The ECHR is reviewing the June 2014 judgment by the Conseil d’État (the French Supreme Administrative Court) authorizing the withdrawal of the artificial nutrition and hydration of Vincent Lambert.

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"Commercial Surrogacy": Women’$ Bodie$ as Container$ Sat, 23 May 2015 15:59:00 +0000

The title of this blog thread " 'Commercial Surrogacy': Women's Bodies as Containers" with the plural expressed with dollar signs may be a bit over descriptive but yet it emphasizes a commerce present today which is utilizing local women or bringing foreigners into the United States and elsewhere to directly participate in the pregnancy and delivery another family's genetic child.  The question is whether this is a fair utilization and commercialization of a woman and her body and whether, after delivery and she is no longer a container for the pregnancy, she should be allowed to maintain some relationship to the child and the child's family.

This topic is, I think, very nicely described, in a paper by a PhD student Hannah Giunta on the Michigan State University Bioethics website. The ethical and humanistic point which is stressed by Ms Giunta is "Commercial surrogacy arrangements where prospective parents possibly supply the raw ingredients, sign a contract, and return for pick-up with the intention never to see the surrogate again require women to do fundamentally relational work without relational support or respect. Effectively, couples are saying,'You’re good enough to carry our child but not welcome as part of our family.' It’s this attitude that is unacceptable." 

 What I would like to see discussed here on this blog thread is both the ethical good or bad of this form of commerce but also Ms Giunta's concern that if such use of women and their bodies is socially and legally acceptable whether something more should be offered to these women: acceptance into the newly born child's family as a family member.  ..Maurice.

Graphic: From Google Images modified with ArtRage and Picasa3..


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Victor Hugo on His Deathbed [EOL in Art 13] Sat, 23 May 2015 09:00:00 +0000 0 Jahi McMath – Status in May 2015 Sat, 23 May 2015 09:00:00 +0000 0 Absence of POLST Leads to Criminal Charges Sat, 23 May 2015 02:32:00 +0000 0 The Question Isn’t Whether We Are Overdiagnosing Cancer, But How Much Fri, 22 May 2015 14:19:25 +0000 Medical experts now agree that as a result of aggressive screening programs, we have an epidemic of cancer overdiagnosis in the United States. With mammograms finding tiny cancers and PSA tests discovering unpalpable prostate cancers, we are now unearthing some … Continue reading

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Dying without Dignity – Investigations by the Parliamentary and Health Service Ombudsman into Complaints about End of Life Care Fri, 22 May 2015 11:47:00 +0000 The UK Parliamentary and Health Service Ombudsman has just published an alarming report on the end of life care, “Dying Without Dignity.”  It is a painful and sad read.

The report identifies six key themes, all illustrated with case studies
  1. Not recognising that people are dying, and not responding to their needs – if the needs of those who are close to death are not recognised, their care cannot be planned or co‐ordinated, which means more crises and distress for the person and their family and carers.
  2. Poor symptom control – people have watched their loved ones dying in pain or in an agitated state because their symptoms have been ineffectively or poorly managed.
  3. Poor communication – poor communication is an important element in our complaints on end of life care. It is clear that healthcare professionals do not always have the open and honest conversations with family members and carers that are necessary for them to understand the severity of the situation, and the subsequent choices they will have to make.
  4. Inadequate out‐of‐hours services – people who are dying and their carers suffer because of the difficulties in getting palliative care outside normal working hours.
  5. Poor care planning – a failure to plan adequately often leads to the lack of co‐ordinated care, for example, GPs and hospitals can fail to liaise.
  6. Delays in diagnosis and referrals for treatment – this can mean that people are denied the chance to plan for the end of their life and for their final wishes to be met.

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Marcel Proust on His Deathbed [EOL in Art 12] Fri, 22 May 2015 09:30:00 +0000 0 Conscience and Proper Medical Treatment Fri, 22 May 2015 00:21:00 +0000 0 Don’t Be Afraid to Team Up with Your Doctor about Healthcare Costs Thu, 21 May 2015 12:24:06 +0000 Here is a fine story in the Los Angeles Times written by Lisa Zamosky about the importance of talking with your doctor about your out of pocket medical costs. Despite high medical costs topping Americans’ list of financial concerns, many … Continue reading

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Terminally Ill Patients Visit the Museum [EOL in Art 11] Thu, 21 May 2015 09:30:00 +0000 0 Aid in Dying: An Important Possibility at the End of Life Thu, 21 May 2015 09:00:00 +0000 0 Dare to Fail Wed, 20 May 2015 22:10:37 +0000 by Craig M. Klugman


  1. The fact of becoming exhausted or running short, giving way under trial, breaking down in health, declining in strength or activity, etc.
  2. The act of failing to effect one’s purpose; want of success; an instance of this. (Oxford English Dictionary 2015, entry 67663)

There is not enough failure in our modern world. I am not talking about the kind of failure that comes from not trying or being neglectful, but rather the failure that comes from working hard to achieve a goal and not making the mark.…

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These Americans Are Rich – Should We Celebrate? Wed, 20 May 2015 20:55:29 +0000 American manufacturing has declined precipitously in the past few decades. Companies that were once the source of fabulous wealth for Americans – the U.S. Steel profits that enriched the Carnegie family, the Ford Motor F -1.29% Company profits that enriched … Continue reading

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Grief and Mourning at Death [EOL in Art 10] Wed, 20 May 2015 09:00:00 +0000 0 Physicians Should Not Act Like Judges (video) Wed, 20 May 2015 08:30:00 +0000 0 New Educational Module from the Bioethics Commission on Informed Consent in Neuroscience Now Available Tue, 19 May 2015 15:55:08 +0000 0 Aruna Shanbaug Dies after 42 Years in PVS Tue, 19 May 2015 15:37:00 +0000 Aruna Shanbaug has died in Mumbai after spending 42 years in a vegetative state.

Shanbaug suffered brain damage from a sexual assault and strangling in 1973 by a cleaner at the hospital where she worked. She remained in a vegetative state in Mumbai’s King Edward Memorial Hospital until her death this week.  (Wall Street Journal)

In 2011, the Supreme Court considered Shanbaug’s case after her biographer and friend, Pinki Virani, filed a petition asking judges to order the hospital to stop feeding her and “allow her to die peacefully.”  But, as I wrote at the time, the court denied Virani's petition.

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Monet and Camille [EOL in Art 9] Tue, 19 May 2015 09:00:00 +0000 Monet lived to 86.  But his wife Camille Doncieux died at just 32.

“Camille Monet sur son lit de mort,” or “Camille on Her Deathbed” (1879) is one of Monet’s most powerful paintings of his wife.

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Monet and Camille [EOL in Art 9] Tue, 19 May 2015 09:00:00 +0000 Monet lived to 86.  But his wife Camille Doncieux died at just 32.

“Camille Monet sur son lit de mort,” or “Camille on Her Deathbed” (1879) is one of Monet’s most powerful paintings of his wife.

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Should someone who does not want biological children be diagnosed as infertile? Tue, 19 May 2015 08:05:43 +0000 0 Whispering of Death [EOL in Art 8] Mon, 18 May 2015 09:00:00 +0000 Arnold Böcklin painted this self-portrait in 1872.  Since there seems to be only one string left on the violin, it seems that death is whispering, "I'm coming for you soon."

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Texas House Votes to Narrow Futility Law Mon, 18 May 2015 08:00:00 +0000 0 History of Cardiac Arrest and Its Effect on Contemporary Medicine (video) Sun, 17 May 2015 09:30:00 +0000 0