Blog Posts (74)
July 26, 2015
I was invited to write a review of the book, Being Mortal, by Atul Gawande recently. While not a Christian book, it addresses end of life issues of interest to all involved with bioethics. This is the second half of the review, the first of which can be found here. Nearly half of Gawande’s book reflects on final things, on letting go of life in... // Read More »
July 23, 2015
From time to time, conservative positions on bioethical issues—e.g., opposition to physician-assisted suicide—are met with a charge that religious “dogma” is asserting itself, sometimes successfully, against the dictates of reason. This charge merits response, although I find it pretty weak. I personally find it necessary to resist the temptation to be nothing more than a haughty moralist in responding. Perhaps I am not alone in... // Read More »
July 13, 2015
In a previous blog response about physician-assisted suicide (PAS), Mark McQuain asked, “Why involve physicians at all?” That question gets too little attention. There are some easily discernible (and perhaps expressed) reasons why physicians are chosen to be the agents of assisting suicide. First, they have access to pain- or consciousness-relieving pharmacologic measures that also have the (in this case) desirable effect of stopping breathing... // Read More »
July 9, 2015
California Senate Bill 128, the “End of Life Options Act,” has stalled in the state Legislature, and appears to have no prospects for passage this year. The bill, which is modeled on Oregon’s physician-assisted suicide (PAS) law, had passed the state Senate 23-15, largely on party lines. (There are 26 Democrats and 14 Republicans in the state Senate; all Republicans had opposed the bill and... // Read More »
July 5, 2015
I was invited to write a review of the book Being Mortal by Atul Gawande recently. While not a Christian book, it addresses end of life issues of interest to all involved with bioethics. This is part one of two. Evidence of humankind’s tendency to avoid the inevitable surrounds us in our culture. Burgeoning numbers of technological and surgical enhancements, from Botox to Nano therapy,... // Read More »
June 22, 2015
Two responses to my June 8th post provide useful points of departure for further discussion about physician-assisted suicide (PAS). The first respondent argued that the Hippocratic Oath states that physicians should not give a “poison,” as opposed to stating that they should not give a “deadly drug.” The respondent’s claim was that inherent in the term “poison” was malintent, which would make the causation of... // Read More »
June 12, 2015
The American Thoracic Society has issued new guidelines regarding requests for treatments that clinicians believe should not be implemented. Key recommendations: Be proactive in communicating treatment plans and involving specialists in ethics and palliative care, in an attempt to “avoid intractable conflicts.” Limit the use of the word “futile” to interventions “that simply cannot accomplish the intended physiologic goal.” These should not be provided. Use... // Read More »
June 8, 2015
A May 26th post in the Bioethics Forum of The Hastings Center asks “Are we reaching a tipping point in the debate over physician aid in dying?” The author cited the case of a Cornell psychologist who opted to commit suicide with physician assistance before Alzheimer’s caused her to lose “all quality of life” and “meaning.” Cases such as these are compelling, because aging, infirmity,... // Read More »
June 4, 2015
California Senate bill SB 128, the “End of Life Options Act,” passed the state Senate today by a 23-14 vote. The overall makeup of that body is 26 Democrats, 14 Republicans. I have not yet seen the vote posted to determine whether it passed on a strict party line, or how my (Republican) state Senator voted. The organization LifeNews.com has a good discussion, which includes... // Read More »
April 25, 2015
This week I had the privilege of job shadowing in the clinical ethics department at a hospital here in Illinois. In clinical ethics, it is impossible to know exactly what your days will look like in advance, since your schedule depends on the varying needs of others in your workplace. There may be several days in a row where no requests for consults come in,... // Read More »
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October 23, 2012 6:01 pm
[I]n South Australia last week, a bill has been proposed to clarify the legal status of advance directives. One very small part of that bill involves a modification to an older palliative care act. The modification corrects an ambiguity in wording in the earlier act. The ambiguity is subtle. However, that choice of words has had major consequences for seriously ill children and adults in South Australia and for health practitioners. It is a salutary reminder of how hard it is to enact good laws in the area of end of life, and how easily such laws can make things worse rather than better.
September 21, 2012 8:12 pm
EDINA, Minn. — Just down the hallway, in Room 356, Curtis Kelly’s body lay covered to the chest by a white blanket, his torso rising and falling with the help of a ventilator. A neurologist at Fairview Southdale Hospital had declared him brain-dead nearly six hours earlier. Mr. Kelly’s far-flung family — a son, three siblings, a sister-in-law, his girlfriend and the daughter of a former girlfriend — had gathered in a narrow conference room in the intensive care unit so that John P. LeMay could ask permission to recover his tissue and organs.
August 14, 2012 7:47 pm
Healthcare providers should have rapid access to legal remedies for end-of-life disputes involving children whose parents resist withdrawal of aggressive therapy on the basis of religious beliefs, authors of a review concluded. Over a 3-year period, 17 of 203 cases could not be resolved after lengthy discussions with parents. Subsequently, most of the cases were resolved, but five remained undecided, each because of the parents’ belief in a miracle for their children, according to an article published online in the Journal of Medical Ethics.
August 14, 2012 7:45 pm
Arthur Caplan, the head of the division of medical ethics at NYU Langone Medical Center, recalls a case of a man who had beaten his six-month-old child to death. It was a horror the mother simply could not accept. A deeply religious woman, she pushed the doctors to do more, telling them that God would intervene and allow her daughter to make a miraculous recovery. For several hours there was a tense standoff between caregivers and parent.
August 7, 2012 9:35 pm
Living or dying is not at issue. The question this family confronts is how the patient will die: a little sooner, with adequate morphine, surrounded by loved ones in the hospice unit, or a little later, in a never dark or quiet patch of the I.C.U., ribs broken by failed, if well-intentioned, CPR. Add to this the following: The patient and family are black. And while race should not be relevant at this moment, research tells us otherwise.
July 27, 2012 5:57 pm
Are doctors more likely to refuse revival in the event of cardiac arrest? In the Hopkins study, 90 percent of doctors said they’d rather die by cardiac arrest than be resuscitated. Only a quarter of the public feels the same way. Do doctors know something we don’t about the miracles of CPR? In one Japanese study of 95,000 CPR cases, just eight percent of patients survived for longer than a month after being revived.
July 26, 2012 4:25 pm
Another challenge for the U.S. with respect to overall health care costs is our cultural approach to end of life care. Medicare now estimates that 27 percent of its budget goes for care provided in the last year of life, and a big chunk of that is spent in the last few weeks of a person’s life. The Lien Foundation did a study on end of life care in 40 developed countries. While the U.S. ranked high on the availability and quality of end-of-life care, its cost of care was one of the highest.
July 11, 2012 6:41 pm
“Countries differ greatly in demography, culture and organization of medical care,” Lo, who is also director of the medical ethics program at the University of California, San Francisco, wrote in a comment accompanying the study. More in- depth information is needed to better understand how patients and physicians reach their decisions, he said.
July 10, 2012 4:23 pm
There are calls for a Queensland doctor to be stripped of his right to practice medicine and investigated over allegations he prematurely ended the lives of patients under his care. Former Queensland Medical Board investigator Jo Barber says the doctor’s actions are so dangerous he could have been charged with manslaughter or murder. Ms Barber says there are a number of deaths linked to the doctor, who, after fronting the state’s medical board, was allowed to continue practising as long as he was not working in intensive care.
July 9, 2012 9:12 pm
Protecting the health and wellbeing of the population directly or indirectly involved with death and dying is a huge public health challenge. Currently, high quality end of life care is not yet available in most parts of the world, and in those countries where it is available it is not accessible or not initiated timely for all in need, independent of their disease, age, gender, socioeconomic, or ethnic background. Largely as a result of that, a large majority receives overly aggressive treatment until death or shortly before death, has undertreated psychological and physical symptoms at the end of life, and is not able to die in a place or manner that accords with their personal preferences.
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