Hot Topics: Clinical Ethics

Blog Posts (25)

June 25, 2014

Challenge Business of Ethics

<p>Ethics here, ethics there, ethics nearly everywhere. Welcome to the world of hyphenated ethics: business-ethics, medical, environmental, media, sports, advertising, legal, even military-ethics. With ethics commissions, committees, councils, consultants, certificates, etc., ethics is big business. Just about anyone can claim to be an "<a href="http://tinyurl.com/ncekfl9">ethicist</a>," a term I decried years ago.</p> <p>Who are these "ethicists"? What qualifies to be one? In my field, health care ethics, the stakes are high. Recommendations regarding right, wrong, and in-between can be matters of life and death. While ethicists disclaim moral expertise, their views carry weight in bureaucratic institutions. We expect them to be competent in the demanding task of moral analysis, with in-depth experience and interpersonal skills.</p> <p>But are they?</p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">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="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
June 18, 2014

Relevance of Case-Based Studies in Workshops on RCR for Diverse Audiences (Part I)

<p class="MsoNoSpacing">By sharing a recent experience in which I delivered a lecture and case at a responsible conduct of research (RCR) workshop for biomedical science trainees, I will comment on why I believe that pedagogy on the RCR, specifically for biomedical scientists, needs two essential ingredients: delivering knowledge/information and providing case-based learning. The art is to determine how much of each element is needed and how to most effectively deliver information on an RCR topic and ensure trainees get the most from the ethical analysis of cases.</p> <p class="MsoNoSpacing"><strong>Ethics Workshop: Responsible Research Conduct &amp; Misconduct in Stem Cell Research</strong></p> <p class="MsoNoSpacing">As part of Canada’s Stem Cell Network at <a href="http://www.stemcellnetwork.ca/">http://www.stemcellnetwork.ca</a>, I had the unique opportunity to organize and present an Ethics Workshop as part of the Network’s annual Till &amp; McCulloch Meetings in October 2013. The workshop was a lecture followed by an interactive ethical case using “The Lab: Avoiding Research Misconduct” video hosted by the Office of Research Integrity (ORI) at<a href="https://ori.hhs.gov/thelab">https://ori.hhs.gov/thelab</a>. The 50 to 60 workshop attendees were primarily master’s, doctoral, and post-doctoral trainees, and almost all were biomedical researchers working with stem cells. Most attendees had never heard of RCR. Thus, the goals of the workshop were modest and involved introducing attendees to the following: RCR, research misconduct (fabrication, falsification, and plagiarism), the RCR link to scientific retractions, issues of authorship and publication ethics, and Canada’s RCR framework.</p> <p class="MsoNoSpacing"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">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="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>
June 11, 2014

Teaching Graduate Students the ASBH Core Skills of Communication and Interpersonal Skills Through Mock Consultations

<p>For over a decade the faculty of the Alden March Bioethics Institute has been designing and developing simulated cases for our graduate students who wish to learn the core skills of clinical ethics consultation. The model that we use is called “mock consultations”, which provides students the opportunity to perform an ethics consultation on a simulated case from the beginning when the request is made, to data collection, interviewing key players in the case, and on to case analysis the final recommendation.</p> <p class="MsoNormal">In the process of developing simulated cases we have made every effort to make them as real to life as possible. All of the cases we use are from ethics consultation cases that have been deidentified and made into anonymous teaching cases. We have benefitted immensely from working closely with Albany Medical College’s (AMC) Patient Safety Clinical Competence Center (PSCCC). Those involved in medical education will recognize the importance of simulated cases using standardized patients (SP) and the role they play in training new doctors to communicate effectively with patients and families.</p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">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><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20.399999618530273px;"> </span></p>
June 10, 2014

Tragedy in Research History: The Children of Ireland

by Craig Klugman, Ph.D.

For many people, the film Philomena was an introduction to a history of Irish babies being taken from their unwed mothers and adopted to “good” Catholic families in other countries.…

June 2, 2014

The Ethics of Delay: A Good or a Bad?

by Maurice Bernstein, M.D.

Delay, something late or postponed, can be looked upon as either ethically good or ethically bad.…

May 28, 2014

Placentas: Food for Thought.

<p class="MsoNormal"><span style="font-family: Calibri, sans-serif; color: #536c71;"><span style="font-size: 15px; line-height: normal;">Imagine you or your partner want to take your placenta home after birth. You feel that the placenta is part of your (partner’s) body and you should be allowed to take it home.  Maybe to eat it: <a href="http://www.theguardian.com/lifeandstyle/2014/apr/30/i-ate-wifes-placenta-smoothie-taco-afterbirth">‘I ate my wife's placenta raw in a smoothie and cooked in a taco’</a> (Guardian 30 April 2014) or to bury it for cultural reasons, as protection of the <a href="http://articles.latimes.com/2013/dec/31/nation/la-na-oregon-placenta-20140101">soul and the newborn</a> (LA times 31 December 2013). In <a href="http://articles.latimes.com/2013/dec/31/nation/la-na-oregon-placenta-20140101">Oregon </a>you are legally allowed to take it home. In some hospitals elsewhere, you are <a href="http://www.parents.com/pregnancy/my-body/pregnancy-health/take-placenta-home/">not</a>. Imagine that due to circumstances, you end up in a hospital that prohibits you from obtaining the placenta. What’s next?</span></span></p> <p class="MsoNormal"><span style="font-family: Calibri, sans-serif; color: #536c71;"><span style="font-size: 15px; line-height: normal;">Requests to take placentas home after birth are increasing. Human <a href="http://en.wikipedia.org/wiki/Human_placentophagy">placentophagy </a>is on the rise. Kim Kardashian spoke about it in her soap series not too long ago.  Newspapers are full of stories about placentas, <a href="http://www.nytimes.com/2014/05/22/health/study-sees-bigger-role-for-placenta-in-newborns-health.html?ref=health&amp;_r=2">their use and ability</a>, and significant amounts of websites discuss the pros and cons of bringing placentas home. Different sources report on the alleged benefits of eating your placenta and <a href="http://www.sciencebasedmedicine.org/eating-placentas-cannibalism-recycling-or-health-food/">other reasons</a> to take it home. The public exposure to this ‘appetite’, its context and the rise in requests, raise concerns about prohibitive practices. Prohibitive policies are likely to come under increased scrutiny. My question in this context: What about eating placentas, what about policies prohibiting this?</span></span></p> <p class="MsoNormal"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">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="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.</strong></p>
April 29, 2014

The Price of Consciousness

<p>Earlier this month, the New York Times (NYT) reported on individuals in a minimally conscious state (MCS). Although the article headed: ‘<a href="http://www.nytimes.com/2014/04/16/health/pet-scans-found-to-clarify-vegetative-state.html">PET Scans offer clues on Vegetative States</a>’, its contents addressed the technologies around MCS: a ‘<a href="https://www.neurology.org/content/58/3/349.full">newly</a>’ diagnosed state of consciousness. The paper commented that PET scans would be more beneficial than functional Magnetic Resonance Imaging (functional M.R.I.) in diagnosing this state. Around the same time, the NYT published a paper that headed: ‘<a href="http://www.nytimes.com/2014/04/18/business/treatment-cost-could-influence-doctors-advice.html">Cost of treatment may influence doctors</a>’. This paper quoted a doc saying: “There should be forces in society who should be concerned about the budget, about how many M.R.I.s we do, but they shouldn’t be functioning simultaneously as doctors,”</p> <p>In this blog post I want to focus on the cost and price of consciousness. I do not only want to focus on the economic costs, but also on costs in a more holistic sense, including the psychological and emotional costs. In the end, I want to ask you: how much is consciousness worth to you?</p> <p><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">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="text-decoration: underline; color: #000099;" href="http://www.amc.edu/Academic/bioethics/index.cfm">website</a>.bvg</strong></p>
March 2, 2014

Is there a philosophy of clinical ethics? What does a clinical ethicist do?

<p class="MsoNormal">If someone asked me: What is my philosophy of clinical ethics? I would initially be dumbstruck for an answer. In response, I would probably try to define an answer from my background in bioethics and philosophy. I would pick frameworks in philosophy that represent my approach. For example, I would be inclined to refer to pragmatism and casuistry, as frameworks that determine my clinical ethics approach. <a href="/BioethicsBlog/post.cfm/a-brain-dead-woman-and-her-fetus-calculating-rights-and-wrongs">My last blogpost</a> about Marlise Munoz, the brain dead woman in Texas is a good example of this. My philosophy as a clinical ethicist is based on the facts of the case, a subsequent calculation of rights and wrongs. The outcome of this sum guides my ethics advice about what is practically possible, conform short-handed <a href="http://plato.stanford.edu/entries/pragmatism/">pragmatism</a>. In responding to a case, I start with the specifics of a case and formulate answers that may be acceptable by multiple stakeholders, instead of relying on general theoretical outcomes, as a short-handed <a href="http://plato.stanford.edu/entries/theory-bioethics/#StrParCas">casuist</a>. Finally, I reason along the lines of several relevant principles, such as autonomy, beneficence, non-maleficence, justice and dignity, and seek to apply these principles to the specifics of a case.</p> <p class="MsoNormal">However, given that the background of clinical ethicists lies over a broad spectrum, I doubt that this answer would be satisfactory.  If I hadn’t had a background in bioethics, what would I have answered to this question? Does the fact that I am an ethicist in the clinic mean that I have to frame my answers along philosophical and ethical theories? Would a social worker, an accountant or an attorney equally have a philosophy in their work? Asking myself this latter question, I think that those professions do have a professional philosophy, but that they would be less likely to phrase it in philosophical language. Instead, probably they would describe their philosophy in more layman’s terms and would narrate about their approach in the different cases they see. So how do I approach my cases as a clinical ethicist?</p> <p class="MsoNormal"><strong style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20px;">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>
February 12, 2014

Take Two Aspirin and Let Me Tell You What I Think About the Affordable Care Act

by Kayhan Parsi, JD, PhD

I recently saw a subspecialist for a medical procedure.  I had never met this physician before so as he sat down to review what was going on in the monitor in front of him, the first thing he asked me was what I did for a living. …

September 16, 2013

Patient Informed Consent For The Teaching Hospital "Trainee" Care: Informing Realistic Scenarios

by Maurice Bernstein MD

Informed consent is the ethical and legal hallmark for the support of patient decision-making in medicine.  Though the ethics of patient communication of facts without deceit has been part of medical consideration for generations, it wasn’t until the landmark decision Schloendorff v The Society of the New York Hospital in 1914 that informed consent became United States law. …

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Published Articles (27)

American Journal of Bioethics: Volume 14 Issue 7 - Jul 2014

The Principle of Equivalence Reconsidered: Assessing the Relevance of the Principle of Equivalence in Prison Medicine Fabrice Jotterand & Tenzin Wangmo

American Journal of Bioethics: Volume 14 Issue 7 - Jul 2014

Observations on the Nature and Extent of Injustice in the American Prison System Ben A. Rich

American Journal of Bioethics: Volume 14 Issue 6 - Jun 2014

Exploring Accountability of Clinical Ethics Consultants: Practice and Training Implications Kathryn L. Weise & Barbara J. Daly

American Journal of Bioethics: Volume 14 Issue 6 - Jun 2014

Health Intuitions Inform Patient-Centered Care Aanand D. Naik & Laurence B. McCullough

American Journal of Bioethics: Volume 14 Issue 3 - Mar 2014

The Ethics of Advertising for Health Care Services Yael Schenker, Robert M. Arnold & Alex John London

American Journal of Bioethics: Volume 14 Issue 1 - Jan 2014

Structuring a Written Examination to Assess ASBH Health Care Ethics Consultation Core Knowledge Competencies Bruce D. White, Jane B. Jankowski & Wayne N. Shelton

American Journal of Bioethics: Volume 14 Issue 1 - Jan 2014

Developing a Certifying Examination for Health Care Ethics Consultants: Bioethicists Need Help Ellen Fox

American Journal of Bioethics: Volume 13 Issue 12 - Dec 2013

Quality Improvement Ethics: Lessons From the SUPPORT Study Benjamin S. Wilfond

American Journal of Bioethics: Volume 13 Issue 12 - Dec 2013

Informed Consent and Standard of Care: What Must Be Disclosed Ruth Macklin & Lois Shepherd

American Journal of Bioethics: Volume 13 Issue 12 - Dec 2013

What Should Be Disclosed to Research Participants? David Wendler

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News (89)

July 10, 2014 3:59 pm

Do doctors understand test results?

Are doctors confused by statistics? A new book by one prominent statistician says they are – and that this makes it hard for patients to make informed decisions about treatment.

July 9, 2014 2:11 pm

San Francisco passes law allowing forced treatment of mentally ill

San Francisco lawmakers approved a law late on Tuesday allowing the forced treatment of mentally ill patients under certain conditions, drawing swift criticism from patient advocacy groups who say the measure tramples civil rights.

June 23, 2014 1:55 pm

Critical Care Challenge: Dying with Dignity in the Intensive Care Unit

After a long ICU stay because of septic shock and multiple complications, a frail 77-year-old man had a fall and suffered an acute subdural hematoma and hemorrhagic contusion. Twelve days after evacuation of the subdural hematoma, he remains in a coma and is still receiving mechanical ventilation. How should decisions be made about further treatment?

May 19, 2014 2:46 pm

‘Right to Try’ laws spur debate over dying patients’ access to experimental drugs

Colorado, Missouri and Louisiana are poised to become the first states in the nation to give terminally ill patients the right to try experimental drugs without the blessing of the Food and Drug Administration, setting the stage for what could be a lengthy battle over who should decide whether a drug is too risky to try.

May 19, 2014 2:45 pm

How to Succeed in Translational Science

An advisory group today offered the National Institutes of Health (NIH) some suggestions for how to frame metrics for evaluating its vast $475 million consortium of translational research centers—such as the need to define what it takes to be a translational scientist. But it’s leaving the details of those metrics to NIH staff.

April 23, 2014 1:40 pm

UC OKs paying surgeon $10 million in whistleblower-retaliation case

The settlement ends a case brought by the ex-head of UCLA’s orthopedic surgery department, who says the medical school allowed doctors to take industry payments that may have compromised patient care.


April 22, 2014 12:51 pm

Cloning advance using stem cells from human adult reopens ethical questions

Scientists have grown stem cells from adults using cloning techniques for the first time — bringing them closer to developing patient-specific lines of cells that can be used to treat a whole host of ailments, from heart disease to blindness.

April 17, 2014 5:37 pm

Free samples of prescription drugs are costly to patients, study says

Free samples of prescription drugs may seem like a great deal for patients. But even when doctors think they’re doing patients a favor by handing out the freebies, the real beneficiaries are the drug manufacturers, according to new research in the journal JAMA Dermatology.

April 16, 2014 2:04 pm

Is a patient ‘vegetative?’ The crucial answer may be quite wrong.

It seems as if barely a year goes by without a painful, public and often politicized controversy over whether or not someone is in a “vegetative state,” beyond consciousness and some say the need for life support. The most famous case was that of Terri Schiavo in 1990.

April 2, 2014 2:14 pm

PatientsLikeMe Launches “Data for Good” Campaign to Encourage Health Data Sharing to Advance Medicine

Today, PatientsLikeMe kicks off a new campaign promoting the value of sharing health information to advance research.

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