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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March 28, 2017 9:00 am
DeBartoli walks with difficulty and falls frequently. He’s losing his ability to breathe on his own. Now the 55-year-old from Tracy, Calif., has pinned his hopes on an experimental drug made by Genentech — and a new “right-to-try” law that allows desperate patients to take medications before they’ve been fully vetted by the Food and Drug Administration. The measure’s newest fan is President Donald Trump, who said the FDA’s caution in granting dying patients access to some medications had “always disturbed” him. But for all its populist appeal, the push for right-to-try laws has raised the ire of ethicists, drug safety experts and a former FDA commissioner.
March 20, 2017 9:00 am
As doctors, our goal is to help you, of course, and to do no harm. But we may actually hurt you, irreversibly. Not that this happens frequently, but it might. How does that sound? Ready to take the plunge? The secret is that informed consent in health care is commonly not-so-well informed. It might be a document we ask you to sign, at the behest of our lawyers, in case we end up in court if a bad outcome happens. Unfortunately, it’s often not really about informing you.
March 16, 2017 9:00 am
Spurred by concerns about the “deny and defend” model — including its cost, lack of transparency and the perpetuation of errors — programs to circumvent litigation by offering prompt disclosure, apology and compensation for mistakes as an alternative to malpractice suits are becoming more popular.
March 14, 2017 9:00 am
Scientists have taken another important step toward creating different types of synthetic life in the laboratory. An international research consortium reports Thursday that it has figured out an efficient method for synthesizing a substantial part of the genetic code of yeast.
February 10, 2017 9:00 am
A pair of Boston University (BU) brain researchers is pushing back against demands by the National Hockey League (NHL) that they release data, brain pathology slides, and interview records of former NHL players and their families. The scientists accumulated the records during their research on chronic traumatic encephalopathy (CTE), a neurodegenerative disease that has been linked to repetitive head trauma.
February 2, 2017 9:00 am
By studying the insects under more-natural conditions, scientists hope to better understand how to eradicate them — and malaria — using an emerging genetic-engineering technology called gene drives. The technique can quickly disseminate genetic modifications in wild populations through an organism’s offspring, prompting some activists to call for it to be shelved. Yet gene drives might not be as effective as activists think. Recent research has identified a major hurdle to using them to eliminate diseases and vanquish invasive pests: evolution.
January 26, 2017 9:00 am
Growing functional human tissues and organs would provide much needed material for regeneration and repair. New technologies are taking us in that direction. In addition to their use in regenerative medicine, stem cells that grow and morph into organ-like structures known as organoids can be used in drug development and toxicology testing. The potential developments and possibilities are numerous and affect not only biomedicine but also areas of ongoing ethical debate.
January 19, 2017 9:00 am
Stem cells: The key to boosting bone healing in diabetes
January 16, 2017 9:00 am
CRISPR may be used to repair a gene that has a deficient product, such as an enzyme or receptor, or alter code that merely suggests of risk. Ideas on how to use it change hourly. The method is here to last. The ethics will only get more fraught.
January 13, 2017 9:00 am
Trials conducted in Guinea, one of the West African countries most affected by an outbreak of Ebola that ended this year, show it offers 100% protection. The vaccine is now being fast-tracked for regulatory approval.
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