Where the World Finds Bioethics Fri, 29 Apr 2016 12:00:27 +0000 en-US hourly 1 BioethicsTV: Boundaries are Black and White on Grey’s Fri, 29 Apr 2016 05:13:38 +0000 by Craig Klugman, Ph.D.

Reaching back to its roots, Grey’s Anatomy in its 12th season has been investigating more professional and ethical challenges in medicine. The April 28th episode (Season12: Episode 21) focused on questions of boundaries of why physicians should not treat their loved ones.

The first story was about a resident dating a former patient. Since the key term is former such a move may not be a pragmatic choice, but it does not violate professional boundaries (unless the physician is a psychiatrist in which case the APA says it may never be okay to date a former patient).…

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A Bit More about the Minimal Genome Fri, 29 Apr 2016 04:48:15 +0000 Read More »]]> 0 Expanding The Moral Community: Why is it so hard? Thu, 28 Apr 2016 17:30:53 +0000

Much of American history can be described as the struggle to expand the moral community in which an increasing number of human beings are seen as having basic rights under the constitution. We forget sometimes that though the inclusion of all people was perhaps implied in our early documents, as in “We hold these truths to be self-evident, that all men are created equal…” from the Declaration of Independence, it has taken historical time and struggle to come closer to realizing that ideal. This struggle has been the quest for recognition of more and more individuals not assumed initially to have the right to vote and exercise control over their lives, which included African Americans, women, minorities, and more recently the LGBT community. The growing recognition of more and more individuals as being full fledged citizens has been a slow, often painful, birthing process of freedom, in the sense of unleashing human potential and possibilities, within the democratic process.


The recent uproar over the Anti-LGBT law passed in North Carolina is a reminder of how difficult it is for many states and communities to accept and accommodate historically marginalized people into the mainstream of society. This law was a quick reaction by the right wing North Carolina legislature and governor to an ordinance passed in Charlotte, similar to what other cities around the country are doing, allowing transgender people to use restrooms according to their gender identity. Perhaps this law also should be seen as a reaction to the Supreme Court ruling in 2015 legalizing same-sex marriage, which has been propelling society toward greater openness and acceptance of LGBT life styles, integrating them into the mainstream. Many who favor the Anti-LGBT law claim that individuals born as male, but are now identifying as female, could pose a risk to women and girls in public bathrooms, though there seems to be no substantial evidence whatsoever of such a risk. My sense is that the individuals who support this law in fact are using risk as a smokescreen in attempting to preserve what they perceive as waning values and norms in society: In the name of conservatism they hang on to an exclusionary vision of society that no longer fits the conditions of expanding freedom and opportunity.


So what some see as waning values and norms, others see as moral progress toward more robust democratic ideals and values. This inherent, historical struggle of opposing social and political forces has resulted with unexpected rapidity in the social and legal acceptance of gays and lesbians in the past 20 years in the United States. Most young people today especially those living in metropolitan areas, like Charlotte, where cultural diversity is a daily reality, readily accept that people naturally have different sexual orientations and gender identities, which people should be free to express in their lives. This liberal openness to diversity likely stems from the fact that they live in the midst of, and have normal interactions and friendships with, people of diverse sexual orientations and gender identities, which prompts them to look upon them as neighbors and as normal people. On the other hand, my guess is that many of the advocates of the Anti-LGBT Bill in North Carolina have little or no contact (of which they are aware) and no or limited relationships with LGBT individuals. Also, part of the resistance to greater inclusion of the LGBT community could be stem from the anxiety of having to recognize one’s own uncomfortable feelings and inclinations about sexuality and gender.


An additional factor to explain the reluctance of many self-identified conservatives to accept alternative sexual and gender orientations may be related to religion. Particularly, in the “bible belt” regions, regardless of whether or not they are followed by church leaders and members, clear notions of basic moral norms of right and wrong are assumed. Sadly, religious morality has been historically integrated with and used to justify a range of regional cultural values and norms—even heinous ones such as the use of Christianity to justify the institution of slavery. But in fairness even many Christians outside the bible belt follow Catholic natural law theory based on certain features about human nature from which basic norms are predicated about what is “normal” as well as “right” and “wrong” in a content rich, objective sense. In short, the point is if one believes that members of the LGBT community are engaging in a personal life style that is assumed to be inherently immoral, a barrier to inclusion is created.


So we in America today are in the midst of a culture war between conservative communities in rural and smaller towns on the one side espousing religious assumptions about human nature (which affects how they perceive risks) and liberals celebrated diversity in more progressive, metropolitan areas on the other. Advocates on either side of this divide bring to bear ideas and theories in an effort to convince others of their position. However, my sense is that articulating arguments to defend the root moral assumptions of either side is unlikely to change the minds of individuals on the other side. The result seems to be communities of individuals living in parallel universes with alternate moral vocabularies who “talk at” each other. Though I am for a liberal, moral vocabulary to account for moral progress within the democratic process, the real change that many of us liberals seek really is at the emotional, and even spiritual, level relating to how human beings are able to show empathy and respect for their fellow human beings in their communities.


We know human identity is based largely on social identity within a particular group or groups related to broad social categories such as religion, race, ethnicity, social class, etc. and to more specific ones such as professions, sports teams, political parties, etc. One of the inherent features of social identity is that individuals have a sense of self-identity by virtue of their group affiliations, which is also defined in terms of groups with which they are not affiliated and to which they stand in opposition. When group identities become rigid, to the point of engendering animus toward other groups, barriers are created which can marginalize the rights of individuals in those groups. But through exposure to, and openness to personal relationships with, individuals outside one’s own group, group identity becomes more flexible and open to change—this is an inner change of heart and disposition toward others.


Perhaps many of those who self-identify as conservatives in North Carolina who favor the Anti-LGBT law, and who also are predominantly Christian, should remember the ministry of the central character of their faith tradition. The thrust of Jesus’ ministry as defined by scholars like John Dominic Crossan is one of radical inclusion and hospitality. Jesus spent his time interacting with, eating with, and drinking wine with those on the margins of society who were outcasts and viewed as unclean and dangerous according the prevailing hygiene laws. His message to these people was that they too can be included in the moral community and be loved like all others. This is a robust message of compassion and love.


Ultimately, struggle for expanding inclusion can only succeed when opponents of bills like the Anti-LGBT Bill are able to show members of the LGBT community the kind of compassion and love Jesus showed to those on the margins of society in his day. The struggle of inclusion really is the struggle to expand what one thinks of as the moral community, or more simply, the neighborhood.




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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More Coverage of Our Research on Out-Of-Pocket Cost Conversations Thu, 28 Apr 2016 14:52:06 +0000 Here is a nice summary of our research, published by an excellent reporter at The American Journal of Managed Care: A new qualitative study of clinical meetings between physicians and patients pointed out certain behavioral concerns that stand in the … Continue reading

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This Is How Prince’s Death Begins Conversation About Addiction Thu, 28 Apr 2016 14:46:00 +0000 Myra Christopher
Lynn Webster, author of the blog below, is a member of Pain Action Alliance to Implement a National Strategy (PAINS) Steering Committee. He is also one of the most authoritative and committed experts in the United States working on both pain and addition. PAINS has been benefitted tremendously from his involvement in our efforts to “transform the way pain is perceived, judged and treated.” 
Over the last couple of years, PAINS has come to understand the importance of embracing the need for dramatic change in the way two diseases – chronic pain and substance abuse disorders, especially opioid addiction -- are addressed, and that by advocates focused on both working together, we are far more likely to improve the health and well-being of all Americans.  
Although relationship the between these two public issues is not yet clearly understood, there is without question a correlation between the two. Unfortunately, these two patient populations have often been pitted against one another by the media and fear-mongers for personal or political advantage. PAINS has attempted to reach out to those focused on opioid addiction and to neutralize some of the ill-will between those focused on pain and those focused on addiction.  
These efforts are  gaining some traction with people of goodwill – no matter their primary locus of concern; PAINS is committed to this work because we are confident that there are shared values and common ground upon which we can collaborate.
We are grateful to Dr. Webster for allowing us to post a blog he wrote shortly after the sudden death of one of America’s great artists, Prince. We believe it  makes a compelling case for what PAINS is trying to do. 

The Conversation Is About Compassion and Addiction

Lynn Webster, MD
When I published my recent blog, Prince and Why We Need More Compassion About Addiction, I began by saying that we didn’t yet know why Prince died. The facts weren’t in, and I didn’t want to draw conclusions until I had more information.
I still don’t have all the facts about the circumstances surrounding Prince’s death. I wasn’t Prince’s physician during his lifetime, and I had no opportunity to look at his medical records either before, or after, his death.
All I know about Prince’s death is what you know. Some entertainment media outlets (TMZVariety, and more) initially reported that Prince was treated with naloxone, which is the antidote for opioids including heroin, in the days before his death. An autopsy (in which I had no participation) was conducted on Prince’s remains, and according to CNN, it could be weeks before we know why the beloved musical icon is no longer with us.
Several of my colleagues and friends posted a link to my blog on their social networks, and they told me they were surprised to see that some of their supporters had reacted swiftly and furiously. For example, Jan Favero Chambers, President/Founder of the National Fibromyalgia & Chronic Pain Association, was gracious enough to post a link to my blog on her Facebook page.
Among the negative comments she shared with me was this one:
“Jumping the gun a bit. We don’t know the cause of death. Respect his memory, by not posting this.”
If you look at the comments below my original blog, you’ll find someone raised an objection there, too:
“Why are you using Prince to draw people into this article? Do you know his medical history? Have the autopsy results come back? Please school me on your knowledge,” reads the comment.

Empathize, Don’t Blame, People in Pain or With Addiction

As I said in my response to that comment, part of my life’s work is to teach people to empathize with, and not blame, people in pain or with addiction. The untimely death of a beloved musical icon provides an opportunity to test our ability to demonstrate compassion. That is why I blogged about it.
I blogged about the death of Prince not because I jumped to conclusions about how he died. As I wrote then, I didn’t know any more about the cause, or causes, of his death than anyone else who hadn’t treated him or viewed his medical records.
But what I did know is that we, as members of society, had experienced a communal loss. While that’s tragic and sad, it provides us with one benefit: an opportunity to compassionately discuss the difficult topic of addiction and related issues.
Since TMZ, Variety, and other entertainment media had linked Prince’s death with naloxone, which is the antidote for opioids including heroin, I believed (and I still believe) that it was a good time to discuss addiction.

Addiction Is a Disease, Not a Character Flaw

Addiction is a disease, and yet it frequently elicits anger and judgment rather sympathy and support. This is true for everyone, famous or not, with addiction.
I don’t know whether Prince was one of the people with addiction. But what I do know is that, as an addiction specialist, I treated thousands of people with addiction over the years. My professional background qualifies me to make the observation that it’s wrong to deny compassion to the people in various stages of the disease of addiction.
When we blame people with addictions for the choices that led to their addictions, we overlook the fact that addiction is a complex problem. Because there are so many factors involved in addiction, it’s inaccurate and unfair to point a finger at an individual and say, “This disease is your fault.”
It is true that we all own some agency for our decisions, but once the disease of addiction is firmly rooted, the power to choose is stolen by the brain.
My concern was that, if the medical evidence supported the conclusion that Prince died of addiction, the outpouring of devotion that his memory had inspired would turn to rage against him. That, in my opinion, would be a shame, because the people we care about — whether they are family members, friends, colleagues, or celebrities whom we’re unlikely to meet in person — are as worthy of our love in their sickness as they are when they enjoy their full health.
To me, the death of Prince represents an opportunity to begin a discussion about why we negatively judge anyone who is sick. It provides us all with an opportunity to open up our hearts and listen to people in pain and with addiction.
And, most of all, it gives us a chance to feel compassion toward all people, sick or healthy, famous or anonymous, rich or destitute, gifted performer or shy wallflower, and friend or stranger. We’re all members of the same tribe, the human race, and we’re all entitled to love and understanding during every stage of our lives — whether we make good choices or bad choices, and whether we enjoy the happiness of success and health or the difficulties of sickness and even death.
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Cross-Cultural Perspectives on Brain Death (video) Thu, 28 Apr 2016 09:00:00 +0000 0 The Paradigm of the Paradox: Women, Pregnant Women, and the Unequal Burdens of the Zika Virus Pandemic Wed, 27 Apr 2016 22:18:04 +0000 by Lisa H. Harris, Neil S. Silverman, and Mary Faith Marshall

The inequalities of outcome are, by and large, biological reflections of social fault lines (Paul Farmer)

Three paradoxes characterize the Zika virus pandemic and clinical and policy responses to it:

  1. Zika virus has been shown to cause severe developmental anomalies in the fetuses of infected women. As a result, both women and men in endemic areas are asked to avoid or delay pregnancy. However, access to effective contraception and safe pregnancy termination is either not available (especially for those living below the poverty line) or a crime for many women in Zika-endemic regions.
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Israel Stinson – Video Purporting to Disprove Brain Death Wed, 27 Apr 2016 21:44:00 +0000 0 Bioquark Questions Irreversibility of Brain Death Wed, 27 Apr 2016 08:30:00 +0000 0 BioEthicsTV: A night of consent issues on ChicagoMed Wed, 27 Apr 2016 03:40:58 +0000 by Craig Klugman, Ph.D.

On this week’s episode of ChicagoMed (Season 1; Episode 15) issues of consent was the main focus. The first major storyline concerned a 16-year-old in abdominal pain who enters the ED with her father, a heroin addict. Although in pain and in need of a diagnostic endoscopy, the patient refuses any and all medications: She fears that even one dose will turn her into the addict that her father has been for her entire life. The doctors try the endoscopy without anesthetic or pain medications and they are unable to get through the procedure.…

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Five Current Brain Death Cases in California Tue, 26 Apr 2016 18:55:00 +0000 0 Legal history ignored by opponents of medically assisted death Tue, 26 Apr 2016 18:00:59 +0000 by Stuart Chambers, Ph.D.

In a recent article in the National Review, author and lawyer Wesley Smith takes issue with what he describes as an unprincipled attack against Not Dead Yet (NDY), an American disability rights organization. From a legal and medical standpoint, both NDY and Smith support the withholding and withdrawing of medical treatment but remain steadfast in their opposition to legalizing assisted suicide and euthanasia.

As with NDY, Smith vigorously defends this stance based on the omission/commission moral distinction.…

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Transnational Reproduction: Race, Kinship and Commercial Surrogacy in India Tue, 26 Apr 2016 17:40:33 +0000 Continue reading ]]> 0 Online Summer JD Health Law Classes – HIPAA Privacy, Medical Marijuana, Compliance Institute Tue, 26 Apr 2016 17:14:00 +0000 0 Genetic Prime Patterns Tue, 26 Apr 2016 16:21:36 +0000 Read More »]]> 0 Physicians Can’t Stop Overtreating Diabetes And Hypertension Tue, 26 Apr 2016 16:18:41 +0000 Aggressive control of blood pressure has saved millions of lives, and has prevented millions of people from experiencing heart attacks, strokes and kidney failure, among other things. Admittedly, controlling blood pressure is not the sexy part of medical care, but … Continue reading

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Norwegian Air Force Brings ECMO to Remote Hospital Tue, 26 Apr 2016 09:00:00 +0000 0 A brief thought on rising suicide rates Tue, 26 Apr 2016 01:42:36 +0000 Read More »]]> 0 The Invitation Mon, 25 Apr 2016 19:19:08 +0000 ]]> 0 Watch Out for Those Deductibles! Mon, 25 Apr 2016 15:18:03 +0000 Lots of folks in the U.S. are finding themselves with health insurance coverage that requires them to pay lots of money, in their deductible, before insurance kicks in. Here is a nice piece in Cancer Today Magazine on the topic: … Continue reading

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What’s Behind Gender Panic in the Restroom? Mon, 25 Apr 2016 14:54:00 +0000 Timothy F. Murphy]]> 0 VSED : Bridge to MAID Mon, 25 Apr 2016 09:30:00 +0000 0 Now a Third California Brain Death Dispute – Alan Sanchez Sun, 24 Apr 2016 12:40:00 +0000 LA County-USC Medical Center says 17-year-old Alan Sanchez is brain dead. But his family wants to fight on.

“We’re fighting for his life right now,” said his sister, Laura Sanchez-Alvarado.  They said he needs another operation. Doctors are refusing to perform the operation because they said Sanchez is brain dead, days after being involved in a car accident.  

The family is working the phones and hoping a judge will step in.  (CBS News)  There is a GoFundMe site.

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Israel Stinson Brain Death Dispute Continues Sun, 24 Apr 2016 09:00:00 +0000
Israel Stinson was declared dead by clinicians at Kaiser Permanente Roseville Medical Center.  But his parents, Jonee Fonseca and Nate Stinson, do not accept that diagnosis. 

They explained in a recent interview:  “Because of our faith we will wait for our son to wake up . . . It’s just something telling us, ‘Don’t give up.’” 

“And we won’t give up. God won’t give up. . . .  We’re hoping with God that something gives. Anything’s possible.”

Life Legal Defense Foundation (LLDF), got a one-week extension on a temporary restraining order mandating Kaiser to continue "treatment" to keep Israel’s condition stable, while the family seeks a second opinion.

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Surgeon Recommends DNAR to Cover Up Error Sat, 23 Apr 2016 09:00:00 +0000 An alarming $10 million lawsuit was just filed against the chief of vascular surgery at INOVA Fairfax Hospita.  Yeatts v. Mukherjee, No. 2016-05070.  

The complaint alleges that surgeon Dr. Dipankar Mukherjee operated on the wrong leg of his patient, Reginald M. Manning.  Further, the suit alleges that when Mukherjee realized he had operated on the wrong leg, he ended the surgery and added false entries in the records to cover it up."  

Mukherjee then counseled the family to agree to a DNAR plan as a “pretense to cover up the fact that he intentionally performed a wrong-leg sur­gery."

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Dr. Celia B. Fisher Examines Whether IRBs Hinder HIV Research with LGBT Youth Fri, 22 Apr 2016 15:04:01 +0000 Continue reading ]]> 0 Questions About Using “Mosaic” Embryos in IVF Fri, 22 Apr 2016 14:54:00 +0000 0 More Coverage of Our Out-Of-Pocket Expenses Research Fri, 22 Apr 2016 13:26:50 +0000 My colleagues and I have been doing lots of research lately on how physicians and patients discuss out-of-pocket expenses during clinic encounters. One of our recent publications has been getting lots of attention, with this being the latest example. I … Continue reading

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Simon’s Law – Requiring Parental Consent for DNAR Orders Fri, 22 Apr 2016 12:44:00 +0000 Both Kansas and Missouri are considering enacting Simon's Law.  This legislation would prohibit clinicians from placing DNAR orders on critically ill children without their parent's knowledge or consent.

KNOWLEDGE:  Prohibiting secrecy and covertness is a solidly defensible goal.  As a series of recent high profile UK court decisions explain, clinicians should not write DNAR orders without family knowledge.  

CONSENT:  But the Simon's Law legislation also requires clinicians to obtain parental consent.  I have called this sort of requirement a "red light" law.  And I have been critical of this approach.

But the father of the child for whom the law is named wrote a powerful newspaper letter.  Scott Crosier questions whether "medical professionals and institutions . . . are all-knowing and a better decision-maker than a parent or loved one. . . .  Do they really believe their medical acumen is so superior to a family’s love?"

CPR is not physiologically futile for a baby with Trisomy 18 or for other critically ill babies.  Therefore, the appropriateness of CPR is not a medical or scientific judgment.  It is a heavily value-laden judgment about whether CPR is worthwhile. 

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Public Attitudes about Gene Editing Fri, 22 Apr 2016 03:30:51 +0000 Read More »]]> 0 Clarifying the Rules: No media in patient treatment areas Thu, 21 Apr 2016 21:41:40 +0000 by Craig Klugman, Ph.D.

In January, I wrote about the case of Mark Chanko, a patient run over by a truck whose death was recorded for a real-life medical show and was later viewed on television by his horrified widow who had never been asked for permission for the airing. Now a settlement with federal regulators announced today will forever tighten health privacy recording restrictions in the hospital. In short, to film patients in the hospital, you have to get their consent before recording, not after as has been the procedure for most real-life medical shows.…

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Is It Rational for Breast Cancer Patients to Have Bilateral Mastectomies? Thu, 21 Apr 2016 20:18:25 +0000 Warning: I am not writing about Angelina Jolie. I am not asking whether women like Jolie, with a strong family histories of breast cancer and known genetic mutations, should consider having bilateral mastectomies. Women like Jolie face extremely high lifetime … Continue reading

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Sometimes It Snows In April Thu, 21 Apr 2016 18:14:00 +0000 0 New Reasons for Outrage Over Persistence of Healthcare Disparities: Ignorance and Neglect Thu, 21 Apr 2016 15:25:00 +0000 Richard Payne, MD
Race and socio-economic status are regrettably important factors in determining life expectancy. There has been a persistent gap in mortality between whites and blacks for many decades, with one study showing that blacks suffer approximately 800,000 “excessive deaths” over a 10-year period relative to whites. More recently, studies have demonstrated that the wealthiest Americans live more than 8 years longer than less wealthy Americans and, tragically, color is still a marker for poverty in our country.

Although various studies indicate that lower socio-economic status is the most powerful determinant of health, there have been a plethora of studies over the past two decades showing that there are disparities in access and outcomes of care between whites and communities of color, especially black and brown. Tellingly, these disparities even occur in the Medicare system, where there is a presumption of equal access. 

In 2002, The Institute of Medicine issued a report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” ( The report described basic factors that support the persistence of racially-based healthcare disparities: differences in patient preferences, unfair and inequitable operations of the healthcare system, and frank racism and discrimination.

Black and White Pain

Now, a recent spate of articles adds THREE more factors responsible for persistence of healthcare disparities: ignorance, neglect, and lack of conviction to change the status quo. Earlier this month the National Academy of Sciences published the results of a University of Virginia study in which 222 white medical students and residents were asked to rate on a scale of zero to 10 pain levels they would associate with two mock pain cases – for both a white and black patient. It was not surprising that the students rated pain lower for black patients than whites and chose less aggressive treatment options for people of color, because disparities in pain assessment and treatment have been reported for decades. The students were simply reflecting this unfortunate reality. 

More disturbing were the reasons underlying the students’ choices. For example, 8% and 14% of first- and second-year medical students, respectively, endorsed the belief that “blacks’ nerve endings are less sensitive than whites’” and 29% of first-year and 17% of second-year medical students endorsed the belief that “black people’s blood coagulates more quickly than whites’.” On average, about 50% of participants reported that at least one of the false belief items as probably or definitely true.  

These and other responses reflect frankly racist myths and misconceptions and conform to stereotypes that many of us had hoped were long ago vanquished. Of great importance, the study also found that “racial bias in pain perception is associated with racial bias in pain treatment recommendations.” 

Explaining the Bias

Myra Christopher
This level of biological ignorance among medical personnel is, as the authors of the study said, “highly surprising.” We would add that it is unacceptable and outrageous. But how does one explain this level of ignorance in otherwise highly intelligent and educated medical students? One can only assume that these data would be similar in other medical schools, although this needs further study. One can speculate that some of this ignorance is related to implicit racially-based biases (which by definition operate at a subconscious level) that all persons exhibit, even doctors. 

There are likely many reasons other than poor medical school pedagogy for this ignorance. According to 2013-2016 American Association of Medical College Statistics, only 7.8% of applicants to U.S. medical schools are African-Americans (compared to 48% whites and 19.3% Asian). Although we do not have data on the racial demographics of the University of Virginia medical school class, one can only wonder if racial and socio-economic factors among the respondents in the study were such that they had little exposure to blacks. This would not be surprising. Many commentators have reported that one of the reasons for persistence of the racial divide in the U.S. is that we are, as the award-winning author David Shipler described in the title of his book, A Country of Strangers. The relatively affluent and privileged applicants that apply to medical school and eventually become doctors likely grow up with little exposure to African-Americans.

Bioethics Response?

It is important to see how we in the bioethics community respond to the University of Virginia and similar studies. Recently, a spate of articles criticizing the relative lack of commentary and activity related to the negative effects of racism in medicine have appeared in the bioethics literature. The April issue of the American Journal of Bioethics focused on this problem. Pointing to a paucity of articles and analysis of the impact of racism on the persistence of health disparities, and the failure of bioethicists to address this issues over time, John Hoberman claims in a recent Hastings Report article that the field of bioethics has a “race problem” and that the “ moral imagination in bioethics has largely failed African-Americans.” The neglect of targeting the obvious injustice of persistence of racially-based health disparities by the sharp analytical and philosophical minds in bioethics is an outrage and must be remedied.

All of us who analyze or deliver healthcare or who create policy to regulate and administer it are obligated to respond to injustice. Not to do so is an outrage. Thomas Jefferson once said: “Do you want to know who you are? Don’t ask. Act! Action will delineate and define you.” These are wise words indeed. Put another way, the persistence of inaction will condemn us as moral failures.

Richard Payne, MD, holds the John B. Francis Chair at the Center for Practical Bioethics and the Esther Colliflower Professor of Medicine and Divinity at Duke Divinity School, Duke University.

Myra Christopher
holds the Kathleen B. Foley Chair in Pain and Palliative Care at the Center for Practical Bioethics.

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Stinging Doctors: Recording Your Own Surgery Wed, 20 Apr 2016 23:26:33 +0000 by Craig Klugman, Ph.D.

Ethel Easter expressed outraged this week at what her health care team said about her during her surgery in Texas last year. She claims that before her operation she was flagged as a difficult patient and instead of talking to her doctors at that time, she hid a recording device in her hair. Listening to the recording after her operation, she heard the medical staff discussing her as a “handful” and making other disparaging comments.

This case comes after “D.B.” in 2013 accidentally left his cell phone in record mode during a procedure.…

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Thoughts on Shared Decision Making Wed, 20 Apr 2016 17:03:27 +0000 I recently gave a talk about shared decision making at the annual conference for the National Comprehensive Cancer Network. Here is a nice write-up of that talk. For those of you silly enough not to travel to Florida to hear … Continue reading

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Who should we listen to? Wed, 20 Apr 2016 15:53:41 +0000 Read More »]]> 0 Canada Backpedals on Medical Aid in Dying Wed, 20 Apr 2016 14:54:00 +0000 Juliet Guichon]]> 0 Moral Stress in Mental Health Practice and Research Wed, 20 Apr 2016 13:32:19 +0000 Continue reading ]]> 0 Overtreating Physician Fined & Barred from Treating Terminally Ill Patients Wed, 20 Apr 2016 12:48:00 +0000 0 Extremis – Film on Hospital End-of-Life Cases Wed, 20 Apr 2016 03:07:00 +0000 Following its premiere at the Tribeca Film Festival this week, "Extremis" is headed to Netflix in September

Extremis was shot at the ICU at Highland Hospital, a public care facility in Oakland, California, and tells the stories of ordinary people from a range of backgrounds and beliefs, all grappling with profound questions around human mortality.

Director Dan Krauss explained:  “I strive to explore weighty ethical and moral questions though my films. . . .  Doctors today can sustain life in ways once thought impossible, ushering in new and extremely complex questions about what it means for critically ill people to be kept alive. I hope audiences will take courage from the incredible dignity and compassion that the film’s subjects displayed amidst the most challenging circumstances.”

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Awareness Creation in Healthcare Should be a Priority in the Developing World Mon, 18 Apr 2016 20:01:47 +0000 ]]> 0 Using the Bioethics Commission’s Meeting to Educate About Democratic Deliberation Mon, 18 Apr 2016 18:15:53 +0000 0 The Bills People Struggle to Pay Mon, 18 Apr 2016 16:49:36 +0000 I post pretty regularly on out-of-pocket medical expenses, a topic I’ve been conducting research on, and one that will fit centrally into the new book I’m writing. Most often when people think about paying for medical care, they think about … Continue reading

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California End of Life Options Act Task Force (Video) Mon, 18 Apr 2016 13:44:00 +0000 0 Can Teaching Ethics be “Safe”? Mon, 18 Apr 2016 03:19:32 +0000 Read More »]]> 0 Brain Death Rejected: Expanding Legal Duties to Accommodate Religious Objections Mon, 18 Apr 2016 00:14:00 +0000 0 National Healthcare Decisions Day in Roseville, Minnesota Sat, 16 Apr 2016 22:20:00 +0000 0 National Healthcare Decisions Day Sat, 16 Apr 2016 08:30:00 +0000 0 Pharmaceutical Transparency Bills: Targeting Disclosures Purposefully Fri, 15 Apr 2016 14:54:00 +0000 0