Blog Posts (66)
January 25, 2017
by David Magnus and Danton Char
The woods decay, the woods decay and fall,
The vapours weep their burthen to the ground,
Man comes and tills the field and lies beneath,
And after many a summer dies the swan.…
December 1, 2016
by Alyssa M. Burgart & Katherine E. Kruse
As physician ethicists, we often receive consultations where there is no clear ethical question, but rather, discomfort around value judgments.…
October 12, 2016
Two recent presentations at the
2016 Annual Meeting of the American Society for Bioethics and Humanities in Washington,
DC – offered within just a couple of hours of each other – had a similar theme
but approached the issue from different angles. The first presentation was a
case review by David Kappel, MD, a surgeon at the University of West Virginia,
and Valerie Satkoske, MSW, PhD, a bioethics professor at the University of West
Virginia Center for Bioethics and Health Law. The case involved a 75-year-old-man
admitted for surgery. Unfortunately, following the surgery, he was delirious.
The delirium continued for several days. He had to be restrained and fed with a
nasogastric tube. The situation was very upsetting to his family; they were
completely taken aback by this complication. The delirium was so unexpected and
surprising that the family wondered whether or not the patient would have
agreed to the surgery if he had fully understood that the extended delirium
might result. The title of this presentation was: “You Should Have Told Me!
Struggling to Meet the Spirit of Informed Consent.” As one can imagine, the
presenters asked if information about the possibility of an extended delirium
should have be included as a part of the informed consent process. The delirium
was not part of the patient’s and family’s expectations. Of course, even with a
more extensive, informed consent process, the family still may have not been
fully prepared to deal with the complication anyway. Perhaps the answer turns
more on the likelihood of the complication arising in this patient’s case given
the particulars and context? Some complications are more probable than others
given the circumstances?
presentation, titled “I Never Promised You a Rose Garden: On the Necessity of
Not Meeting Expectations Regarding Clinical Ethics Consultation,” was given by
Virginia L. Bartlett, PhD, and Stuart G. Finder, PhD, of Cedars-Sinai Medical
Center. This presentation too dealt with expectations: the expectations those
who ask for a clinical ethics consultation might have of clinical ethics
consultants. The presenters suggested that the expectations might range from
“ethics policeman” to “ethics superhero.” The presentation ended with the
relatively unsatisfactory mechanisms available to evaluate the effectiveness or
helpfulness of clinical ethics consultation services interventions. From the
presentation, it was clear that clinical ethics consultants should be prepared
for not meeting expectations of those who request assistance.
both presentations highlight how important it is for clinicians – whether
physicians or surgeons directly caring for patients or clinical ethics
consultants offering advice or recommendations to colleagues or patients or
families – to understand stakeholder expectations as well as they can. With
doctors and nurses it may be a bit easier: mostly likely the patient wants to
be restored to health or a baseline with the least discomfort and minimal
aggravation. With clinical ethics consultation services, the expectations are
often not this clear. Moreover, with both clinical medicine and clinical ethics
consultation service interventions, there are complications and unintended
consequences. One cannot always fully anticipate which way a case may turn, or
which word or phrase at a particular moment may result in a worse situation
rather than a better situation.
For good or
ill, there is no informed consent equivalent for clinical ethics consultation
services when stakeholders ask for a consultation. The various stakeholders –
when they request a clinical ethics consultation – may or may not know exactly
what they are asking for anyway. But, most likely, what they are asking for is
help with a very troublesome or thorny issue that has ethical implications or dimensions.
In this respect, clinical ethics consultants perhaps should worry less about
meeting expectations than other clinicians, since the goals of clinical ethics
consultation services often times are much less clear – at least when the
consultation is requested – than restoring the patient’s health or previous
baseline with the least discomfort and minimal aggravation. However, may always
be better for the clinical ethics consultant to ask, “How do you think we can
help?” and try to set or reset expectations as well as one can at the beginning
of the process.
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.
September 12, 2016
The October 2016 Annual Meeting of the American
Society for Bioethics and Humanities (ASBH) announced its theme for the
Washington, D.C., convocation several months ago: “After over half a century of
work, and as ASBH celebrates its coming-of-age, we have chosen to focus on
‘critical distance’ and our ‘insider-outsider’ status at our 18th annual meeting.”
Some may be relatively unfamiliar with these notions of “critical distance” and
the early 1970s, when medical center and medical school thought leaders began
hiring “humanists” to teach, round with teams, and attend morning reports and
noon conferences, it was unclear what – if any - specific outcomes might
result. However, the center executives and deans wanted to try something to
help inject human values and humanistic thought into the educational process to
offset the very strong influences of advancing technologies, specialization,
and materialism, and to assure the outraged public in the face of recently
revealed research scandals.
“humanists” were theologians, religious studies scholars, and philosophers. In
just a few years, the philosophers were predominating in this growing field of applied
ethics educators and scholars. In explaining this transition, Art Caplan wrote:
“It proved very difficult to do bioethics in public in anything approximating a
religious voice. ... [I]t quickly became clear that to command the attention of
scientists and physicians, as well as policy-makers, a more secular voice was
required. Philosophy, emerging out of decades of mainly futile wrangling about
meta-ethical issues, was more than happy to oblige ... .” Caplan AL. The birth and
evolution of bioethics. In Ravitsky V, Fiester A, Caplan AL. The Penn Center
Guide to Bioethics. New York: Springer Publishing Co., 2009, p. 5.
philosophers who taught applied ethics or their philosophy colleagues in the
academy challenged medical ethics in the classroom and at the bedside. The
academic philosophers were concerned that the medical school philosophers might
be losing their bearings. This difference of opinion was stated by Harvard
philosophy professor F.M. Kamm in 1988: “[P]hilosophers should try to bring
‘real-life’ problems (and those that have them) up to the abstractions
of philosophy, rather than just bring philosophy down to the level of the
problems. [Emphasis in original.]” Kamm FM. Ethics, applied ethics, and
applying applied ethics. In Rosenthal DM, Shehadi F, eds. Applied Ethics and
Ethical Theory. Salt Lake City: University of Utah Press, 1988, p. 170. To be even clearer, she continued: “[C]reative
solutions to practical problems come only after a period of detaching ourselves
from them to consider more fundamental concepts. ... [E]mphasizing the
discovery of solutions to problems conflicts with a detached interest that goes
wherever an illuminating, but not obviously or immediately useful, aspect of a
questions leads one.” Ibid, p. 170-171. “If philosophers who do applied ethics
do not maintain such attitudes, in common with academic philosophers, they run
the risk of being bad philosophers and becoming merely the bearers of
simplified, falsely reassuring news from the theorists.” Ibid, p. 171.
back, it must have been a phenomenal trial for several medical school philosophers
to attempt to satisfy the academic philosophers while taking a new path. For
the academics the question must have been how does one comment upon the matters
at hand without learning so much about related topics and processes or becoming
deeply enmeshed in the milieu that one is no longer an “outsider” but an “
insider” without critical distance? This turf battle must have been particularly
worrisome for some distinguished philosophers who gained national and
international reputations as academic philosophers and who then moved to medical
school and clinical settings. Of course, a good many philosophers and
theologians thought doctors were too close to the problem (that is, lacked critical distance) to be
part of any solution. (And quite naturally, some of the doctors thought the theologians
and philosophers lacked a sufficient clinical knowledge base to fully
understand the contexts in which they were involved.) History has shown that
many of the medical school philosophers transitioned and cared little about
what the academic philosophers said anyway.
early and middle 1980s, other professionals joined the philosophers and
theologians in broadening the bioethics or clinical ethics base and voice:
physicians, nurses, social workers, chaplains and pastoral care workers, and
lawyers, just to name a few. For health care professionals, chaplains, and
lawyers, this notion of “critical distance” as not an overriding factor. If
these bioethicists gave any thought to “detachment,” they probably interpreted
it as “objectivity.” Objectivity
calls to mind: “impartiality,” “lack of bias,” “fairmindedness,” “neutrality,”
“open-mindedness,” “fairness,” and “justice.”
clinical ethics consultants move toward professionalization, the outsider-insider
issue has lost its relevance. Few may even understand the context of the
initial problem now. Clinical ethics consultants exist in great part to improve
patient care and the patient care experience; they are undoubtedly insiders. And,
whether one thinks in terms of critical distance or not, objectivity in
providing service to others remains critically important.
August 12, 2016
By: J.S. Blumenthal-Barby
In his book, Self-Deception Unmasked, philosopher Ale Mele writes about two types of self-deception. There is the straight-forward kind, where a person falsely believes—in the face of strong evidence to the contrary—things that she would like to be true.…
July 13, 2016
by John D. Lantos, MD
Pullman and Hodgkinson present a case that, it seems, should have been an easy one. A competent adult makes a simple request to discontinue a medical therapy.…
May 27, 2016
by Craig Klugman, Ph.D.
From the title, you probably assumed I’m going to talk about the fast changing pace of medical technology, whether we should be working on human embryos, claims that scientists will be able to do head transplants within 2 years, or even whether the Olympics should be postponed because of Zika.…
April 26, 2016
by Craig Klugman, Ph.D.
On this week’s episode of ChicagoMed (Season 1; Episode 15) issues of consent was the main focus.…
April 21, 2016
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.…
April 20, 2016
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.…
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May 19, 2017 9:00 am
For 40 years starting in 1932, medical workers in the segregated South withheld treatment for unsuspecting men infected with a sexually transmitted disease simply so doctors could track the ravages of the horrid illness and dissect their bodies afterward. Finally exposed in 1972 , the study ended and the men sued, resulting in a $9 million settlement. Twenty years ago this May, President Bill Clinton apologized for the U.S. government. It seemed to mark the end of this ugly episode, once and for all. Except it didn’t.
May 12, 2017 9:00 am
Last month, the US National Academies of Sciences, Engineering, and Medicine published a report called Fostering Integrity in Research. Later this month, the 5th World Conference on Research Integrity will be held in Amsterdam. Over the years, universities have followed some funders’ mandates to improve the prevention and investigation of misconduct. Many discussions have been held about unreliable research. None of these initiatives pays sufficient attention to a specific issue: the research health of research groups and the people who lead them. This includes technical robustness of lab practices, assurance of ethical integrity and the psychological health and well-being of group members.
May 10, 2017 9:00 am
Mobile phones are helping to take conventional laboratory-based science into the field, the classroom and the clinic.
May 2, 2017 9:00 am
A research misconduct investigation of a prominent stem cell lab by the Harvard University–affiliated Brigham and Women’s Hospital (BWH) in Boston has led to a massive settlement with the U.S. government over allegations of fraudulently obtained federal grants. As Retraction Watch reports, BWH and its parent health care system have agreed to pay $10 million to resolve allegations that former BWH cardiac stem cell scientist Piero Anversa and former lab members Annarosa Leri and Jan Kajstura relied on manipulated and fabricated data in grant applications submitted to the U.S. National Institutes of Health (NIH).
April 24, 2017 9:00 am
Scientists face tough decisions when the latest gene-editing findings don’t match up with the results of other techniques.
April 21, 2017 9:00 am
Blood from younger humans may have similar rejuvenating effects on older animals as blood from young mice.
April 14, 2017 9:00 am
On 28 March, a Japanese man in his 60s became the first person to receive cells derived from induced pluripotent stem (iPS) cells donated by another person. The surgery is expected to set the path for more applications of iPS-cell technology, which offers the versatility of embryonic stem cells without their ethical taint. Banks of iPS cells from diverse donors could make stem-cell transplants more convenient to perform, while slashing costs.
April 12, 2017 6:00 am
Do the anatomical differences between men and women—sex organs, facial hair, and the like—extend to our brains? The question has been as difficult to answer as it has been controversial. Now, the largest brain-imaging study of its kind indeed finds some sex-specific patterns, but overall more similarities than differences. The work raises new questions about how brain differences between the sexes may influence intelligence and behavior.
April 10, 2017 9:00 am
When your doctor gives a diagnosis of a complicated disease, it often pays to get an independent second look, according to a study from Mayo Clinic published Tuesday.
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