Hot Topics: Clinical Ethics

Blog Posts (80)

June 13, 2018

Over-Screening, Rigid Protocols, and Changing Guidelines: A Personal Journey Through the Looking-Glass

by Craig Klugman

A new JAMAarticle reports on a US Preventive Services Task Force recommendation against routine ECG in patients without symptoms of heart disease: “For asymptomatic adults at low risk of CVD events (individuals with a 10-year CVD event risk less than 10%), it is very unlikelythat the information from resting or exercise ECG (beyond that obtained with conventional CVD risk factors) will result in a change in the patient’s risk category….

June 4, 2018

Outsider/Insider

This post also appears as an editorial in the June 2018 issue of The American Journal of Bioethics.

by Albert R.

April 26, 2018

War Against Science 3.0: The EPA, Doublespeak, and Obfuscation

by Craig Klugman, Ph.D.

Transparency is a good thing. In ethics courses, we teach that doctors should be transparent to their patients, being truthful and disclosing information.…

April 24, 2018

BioethicsTV (April 16-20): #TheResident, #ChicagoMed, #GreysAnatomy

by Craig Klugman, Ph.D.

The Resident (Season 1; Episode 10): Self-doctoring; nonmaleficence; the problem with hospitals…; Chicago Med (Season 3; Episode 16): Compassionate lying; choosing gender; medical error; Grey’s Anatomy (Season 14; Episode 20): #METOO

The Resident (Season 1; Episode 10): Self-doctoring; nonmaleficence; the problem with hospitals…

After Conrad has a run-in with a skateboard while jogging, he hobbles into the hospital with a sprained ankle.…

February 13, 2018

Want more efficient and cheaper medicine? Just outsource the doctor

by Craig Klugman, Ph.D.

A new medical school opening this fall in the University of Illinois system will focus on the tech revolution.…

February 9, 2018

BioethicsTV (January 29-February 9): #TheResident, #TheGoodDoctor, #ChicagoMed

by Craig Klugman, Ph.D.

The Resident (Season 1; Episode 3): The Cost of a Life The episode opens with residents and nurses attending a required meeting on billing by a “billing consultant”.…

January 26, 2018

A Reflection on Two-Physician Consent

In a recent series of clinical ethics consultations, some physicians expressed concerns over the possible unilateral nation of using two-physician consent for medical decisions for patients without capacity. This concern comes many physicians for a wide range of treatment decisions, a concern of acting without express consent.

Like many states, New York State Family Health Care Decisions Act authorizes two physicians to make medical decisions in the event that no one can be identified to act on behalf of a patient without capacity. It is a safety mechanism to ensure that even those who do not have anyone in their lives will have someone to make medical decisions on their behalf. Some states may use a different mechanism, such as an ethics committee or a surrogate decision-making committee, but the underlying goal is the same. The “unbefriend” patients are arguably one of the most vulnerable population of patients. They lack an advocate, someone to voice their preferences or to consider their best interests. At least in New York, it then becomes the moral responsibility of physicians to decide what is in the best interest of the patient.

For those who distrust the medical profession in general, mechanisms like two-physician consent may seem like a scary option, but then who else should be making these decisions? It is scary to think that maybe one day we will be alone with no family and friends but it is an unfortunate reality. Physicians have years of medical training that can guide a determination in the patient’s best interest. In addition, physicians have taken an oath to uphold a patient’s best interest and practice the standard of care. Physicians are ethically obligated to provide care that benefits and prevents harm to the patient. People who chose to practice medicine tend to have an inherent goodness as they are joining a profession that helps people. These individuals are committed to ensuring a patient’s best interest.

Yes, depending on the gravity of the medical decision and the potential impact it may have on the patient’s quality of life, making medical decisions is a burden. What is also important to note about the New York’s mechanism is it always two physician consent, one physician does not make the decision in isolation. Though there are concerns that the concurring physician will not disagree with his/her colleague.

I empathize with the physicians who express concern in making these decisions but I also think some of these physicians are too focused on the hypothetical legal consequences. This authority to make such decisions is codified in a law and is ethically supported by ancient notions of beneficence.  Maybe we have become too comfortable with the notion of autonomy and without an expression of autonomy, we become uncomfortable. We are forgetting the rest of medical ethics. This is why we have a best interest’s standard in healthcare decision-making and established standards of care.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and a Graduate Certificate in Clinical Ethics. For more information on AMBI's online graduate programs, please visit our website.

January 23, 2018

BioethicsTV (January 21-22, 2018): The Resident-Our Most Unethical Hospital System

The Resident (Season 1; Episode 1): The Most Unethical Hospital Ever

This new Fox show begins with newly minted MD Devon Pravesh’s first day at a fictional Atlanta hospital.…

January 11, 2018

Managing Expectations: Delivering the Worst News in the Best Way?

This post also appears in the January 2018 issue of the American Journal of Bioethics

by Alyssa M. Burgart & David Magnus

In this issue, Weiss and Fiester’s (2018) “From ‘Longshot’ to ‘Fantasy’: Obligations to Patients and Families When Last-Ditch Medical Efforts Fail” calls attention to the weight of clinician word choice when discussing interventions in the pediatric population.…

January 2, 2018

A Bioethicist by Any Name

by Craig Klugman, Ph.D.

A few months ago, I was attending a conference where the keynote speaker introduced herself as a bioethicist.…

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Published Articles (93)

American Journal of Bioethics: Volume 18 Issue 1 - Jun 2018

Were the “Pioneer” Clinical Ethics Consultants “Outsiders”? For Them, Was “Critical Distance” That Critical? Bruce D. White, Wayne N. Shelton & Cassandra J. Rivais

American Journal of Bioethics: Volume 18 Issue 1 - Jun 2018

Outsider/Insider Albert R. Jonsen

American Journal of Bioethics: Volume 18 Issue 5 - May 2018

What's in a Name? The Ethical Importance of Respecting a Patient's “Unexplained” Medical Concerns Kayhan Parsi & Nanette Elster

AJOB Primary Research: Volume 8 Issue 1 - Mar 2018

“God is the giver and taker of life”: Muslim beliefs and attitudes regarding assisted suicide and euthanasia Chaïma Ahaddour, Stef Van den Branden & Bert Broeckaert

American Journal of Bioethics: Volume 18 Issue 3 - Mar 2018

The Default Position: Optimizing Pediatric Participation in Medical Decision Making Aleksandra E. Olszewski & Sara F. Goldkind

American Journal of Bioethics: Volume 18 Issue 3 - Mar 2018

Pediatric Participation in Medical Decision Making: Optimized or Personalized? Maya Sabatello, Annie Janvier, Eduard Verhagen, Wynne Morrison & John Lantos

American Journal of Bioethics: Volume 18 Issue 2 - Feb 2018

Resolving Ethical Dilemmas in a Tertiary Care Veterinary Specialty Hospital: Adaptation of the Human Clinical Consultation Committee Model Philip M. Rosoff, Jeannine Moga, Bruce Keene, Christopher Adin, Callie Fogle, Rachel Ruderman, Heather Hopkinso & Charity Weyhrauch

American Journal of Bioethics: Volume 17 Issue 11 - Nov 2017

To Whom Do Children Belong? John Lantos

AJOB Primary Research: Volume 8 Issue 3 - Sep 2017

Main outcomes of an RCT to pilot test reporting and feedback to foster research integrity climates in the VA Brian C. Martinson , David C. Mohr, Martin P. Charns, David Nelson, Emily Hagel-Campbell, Ann Bangerter, Hanna E. Bloomfield, Richard Owen & Carol R. Thrush

AJOB Primary Research: Volume 8 Issue 3 - Sep 2017

Consent for organ donation after circulatory death at U.S. transplant centers George E. Hardart, Matthew K. Labriola, Kenneth Prager & Marilyn C. Morris

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News (214)

May 28, 2018 12:54 pm

Did witnesses fail USC women in care of 'predator' gynecologist? (CNN)

As lawsuits mount against the University of Southern California and a former gynecologist who worked at the school, so do the outrage and demand for answers. Mixed into the conversation is this: If nurses or medical assistants serving as chaperones witnessed Dr. George Tyndall inappropriately touching and treating students, as some have claimed, what’s the point of chaperones?

May 24, 2018 9:00 am

How tech can turn doctors into clerical workers (Washington Post)

In America today, the patient in the hospital bed is just the icon, a place holder for the real patient who is not in the bed but in the computer. That virtual entity gets all our attention.

May 22, 2018 9:00 am

Experimental drugs poised for use in Ebola outbreak (Nature)

International health organizations are in discussions with the Democratic Republic of Congo about how and whether to deploy treatments in addition to a vaccine.

May 4, 2018 9:00 am

Up to 270 women may have died after England breast cancer screening failures (CNN)

As many as 270 women in England may have died because they were not called for a final breast cancer screening, the British government disclosed on Wednesday. UK Health Secretary Jeremy Hunt announced an independent inquiry into the failings, attributed to a computer algorithm error. An estimated 450,000 women failed to get a letter inviting them to their final screening, he said.

April 20, 2018 9:00 am

We’re Bad at Evaluating Risk. How Doctors Can Help. (The New York Times)

My patient and I were locked in a game of decision-making hot potato. “What would you do, Doc?” he said. We’d been discussing whether he should get screened for prostate cancer. Such questions trouble most doctors. We often lob the choice back to patients, or “on the one hand, on the other hand” so much that they start sympathizing with Harry Truman, who reportedly joked he wished for one-handed advisers.

April 6, 2018 9:00 am

To treat some diseases, researchers are putting immune cells on a diet (Science)

Once triggered into action, an immune cell overhauls its metabolism, making changes that could be exploited for treatment.

March 23, 2018 9:00 am

Mississippi bans abortions at 15 weeks, earliest in the nation (CNN)

With a swipe of a pen Monday, Mississippi Gov. Phil Bryant signed into law a bill that prevents women from getting abortions after 15 weeks of pregnancy. His state, effective immediately, now holds the distinction of having the earliest abortion ban in the nation.

March 15, 2018 9:00 am

FDA authorizes, with special controls, direct-to-consumer test that reports three mutations in the BRCA breast cancer genes (FDA)

Test only reports 3 out of more than 1,000 known BRCA mutations and negative result doesn’t rule out increased cancer risk

March 12, 2018 9:00 am

Fast genome tests are diagnosing some of the sickest babies in time to save them (MIT Technology Review)

Genetic diseases are the leading cause of death for infants in North America, affecting an estimated 4 percent of newborns. So while the work at Rady is still in the research stage, costing the hospital about $6,000 per baby, the hope is that it could lead to a standard medical test with the potential to save thousands of lives.

March 9, 2018 9:00 am

Why Crisis Pregnancy Centers Are Legal but Unethical (AMA Journal of Ethics)

Although crisis pregnancy centers enjoy First Amendment rights protections, their propagation of misinformation should be regarded as an ethical violation that undermines women’s health.

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