Tag: autonomy

Blog Posts (45)

January 8, 2016

OB Potpourri

This month’s issue of the medical journal Obstetrics & Gynecology (O&G) has a review of the four best ethics articles that appeared in their journal in the last year. Here are my comments (in italics) on their review (in quotes). Article title: “Clinical, Ethical, and Legal Considerations in Pregnant Women With Opioid Abuse.” O&G‘s bottom line: “Opioid abuse is a chronic medical illness, not a... // Read More »
October 22, 2015

Truth Telling In Medicine: Problems Old and New

<p style="font-size: 11.2px; line-height: 19.04px;">The issue of truth telling in medicine was a lively concern in the early days of modern medical ethics during the 1970’s. A new moral awareness had emerge that provided a clear moral rejection of the paternalistic approach taken in the physician-patient relationship that prioritized the traditional values of beneficence and non-maleficence over truth telling. Of course the key development that fueled this new moral perspective as well as the growing passion for medical ethics was the newfound sense that arose beginning in the 1960’s that patients with capacity have a fundamental right both to refuse unwanted treatment and give voluntary informed consent to treatments they were considering. It became obvious to students of medical ethics that if patients are to be able to exercise their right to give voluntary informed consent they must receive a full and accurate disclosure of the relevant information necessary for them to make a decision.</p> <p style="font-size: 11.2px; line-height: 19.04px;">Up to the early 1960’s, patients coming into the health care system very well may not have had an opportunity to give voluntary informed consent. Giving patients this opportunity just wasn’t part of the medical culture. In the early 1960’s it was common for oncologists to not disclose a diagnosis of cancer; by the late 1970’s there was almost universal agreement that full disclosure was the expectation. The full moral force of the principle of respect for patient autonomy happened relatively quickly, especially after the Belmont Report of 1978, which articulated the basic principles of medical ethics (though non-maleficence was subsumed under beneficence). There is no question that the physician-patient relationship has been evolving ever since with new levels of expectations and involvement of patients and their surrogates. There is now universal agreement that physicians are expected to be truthful to patients and accurately disclose their medical condition, including diagnosis and prognosis. Without this first basic step of truth telling in disclosing the medical facts to the patient about their condition, patients cannot exercise their right to express their preferences and wishes about medical treatment and care goals, and specially give voluntary informed consent to medical interventions to treat their condition.</p> <p><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;"><strong>The Alden March Bioethics Institute offers a Master of Science in Bioethics, a</strong> </span><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.04px;">Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
June 8, 2015

Actions vs. Words: What counts most in understanding patient preferences?

<p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Clinicians striving to help patients achieve healthcare goals often encounter the perplexing dichotomy of the patient’s stated goals and preferences and actions to the contrary. Some of these challenges can be overcome with education and close follow up to help reinforce adherence to medical recommendations, but other times, these barriers are more enigmatic.</span></p> <p class="MsoNormal" style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;"><span style="font-size: 11.1999998092651px; line-height: 19.0400009155273px;">Take for example, a patient who requires hemodialysis to sustain life. She sometimes shows up for her outpatient dialysis, but more often does not show up and is admitted to the hospital for emergent dialysis several months in a row. In consultation with her providers she is adamant that she does not want to die, and knows that she needs the dialysis to remain alive. She is discharged, and the pattern continues. Liberal scheduling with the outpatient service, transportation, reminders are all offered. Psychological tests and support are provided, and yet, her action pattern of not adhering to the treatment plan continues. Again, she is advised it is acceptable to halt and she will be offered palliative care. She refuses, and says she wants to live and will sit for dialysis. What is her genuine preference? Should we honor these statements, or accept her actions as the more authentic expression of her wishes? Though this hypothetical example is quite familiar to renal care providers, the dynamic spans many scenarios leaving many practitioners with a dilemma about the practical limits of honoring verbalized wishes that are not supported by congruent actions.</span></p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 19.0400009155273px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="color: #000099; text-decoration: underline;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
March 27, 2015

How to Get A Head in Life

Note: The Bioethics Program blog will be moving to its new home on April 1, 2015. Be sure to change your bookmarks to http://bioethics.uniongraduatecollege.edu/blog/ by Bonnie Steinbock, Bioethics Program Faculty An Italian scientist, Sergio Canavero, claims that he is two years away from performing the world’s first human head transplant, in which the head of one person would […]
March 23, 2015

Will Ariadne Lead Us Through the Maze of End-of-Life Healthcare?

Note: The Bioethics Program blog will be moving to its new home on April 1, 2015. Be sure to change your bookmarks to http://bioethics.uniongraduatecollege.edu/blog/   by Richard Koo, Bioethics Program Alum (MSBioethics 2011) and Adjunct Faculty About four years ago, Susan D. Block, M.D. posted a blog on Harvard Business Review’s website as part of a series of […]
March 6, 2015

Understanding the Latino Patient with Cancer

by Beatriz Lorena Hurtado, Bioethics Program Alumna (MSBioethics 2014) As a Latina working in healthcare I have always felt the responsibility to provide education about my culture, and to clarify cultural differences and misconceptions. It is always surprising to witness how eliminating misconceptions eventually translates into an increase in patient satisfaction, and less apprehension about […]
February 25, 2015

The Man Who Mistook His Life For A Hat

by Jacob Dahlke, Bioethics Program Alum (MSBioethics 2012) Our society tends to put on pedestals the celebrities among us, particular upon their deaths. For author Oliver Sacks, it is no different except that he is not yet dead. He did, however, recently announce in the New York Times that metastasized tumors were found in his body. […]
February 24, 2015

Speaking about dignity

Several years ago, while on the verge of delivering the baby of a seventeen year old, I was taken aback by the number of friends that she had asked to accompany her at the event…an event formerly considered far more private than one in which fifteen or so friends might attend (it was a large delivery room). And speaking of private, the wording and location... // Read More »
February 19, 2015

The Carter v. Canada Conundrum: Next Steps for Implementing Physician Aid-in-Dying in Canada

by Sally Bean and Maxwell Smith (Bioethics Program Alum, 2010) We applaud the February 6, 2015 Supreme Court of Canada’s (SCC) unanimous ruling in Carter v. Canada (Attorney General), 2015 SCC 5. The Court found the criminal prohibition of assisted death to be in violation of section 7 of the Canadian Charter of Rights and Freedoms, which […]
February 16, 2015

The Importance of History for Bioethics: It is What it Was

by Barry Shuster, Bioethics Program Alum (2013) At a holiday social gathering last year, I sat with a former colleague, a physician, who inquired about my progress in bioethics. While he finds bioethics interesting and occasionally useful, he broached the familiar refrain: “It’s all relative”. “We say this is ‘right’ or ‘wrong’ based on someone’s […]

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Published Articles (16)

AJOB Neuroscience: Volume 4 Issue 4 - Sep 2013

Autonomy in Neuroethics: Political and Not Metaphysical Veljko Dubljević

American Journal of Bioethics: Volume 10 Issue 12 - Dec 2010

The Encompassing Ethics of Bariatric Surgery

American Journal of Bioethics: Volume 10 Issue 12 - Dec 2010

Stuck in the Middle: The Many Moral Challenges With Bariatric Surgery

American Journal of Bioethics: Volume 10 Issue 9 - Sep 2010

Deidentification and Its Discontents: Response to the Open Peer Commentaries

American Journal of Bioethics: Volume 10 Issue 10 - Oct 2010

Invited Commentary: ?Rethinking Research Ethics,? Again: Casuistry, Phronesis, and the Continuing Challenges of Human Research

American Journal of Bioethics: Volume 10 Issue 7 - Jul 2010

Review of The Ethics of Consent, eds. Franklin G. Miller and Alan Wertheimer

American Journal of Bioethics: Volume 10 Issue 3 - Mar 2010

The Secret of Caring for Mr. Golubchuk

American Journal of Bioethics: Volume 10 Issue 3 - Mar 2010

The Case of Samuel Golubchuk and the Right to Live

American Journal of Bioethics: Volume 9 Issue 12 - Dec 2009

Response to Open Peer Commentaries on ?A Duty to Deceive: Placebos in Clinical Practice?

American Journal of Bioethics: Volume 9 Issue 12 - Dec 2009

A Duty to Deceive: Placebos in Clinical Practice

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