Hot Topics: Clinical Ethics

Blog Posts (31)

November 18, 2014

Elderspeak: Words Can Hurt

by Craig Klugman, Ph.D.

During the season premiere of the HBO comedy, Getting On, I noticed the excessive use of toddler-speak toward patients portrayed as being elderly.…

November 11, 2014

Making a Case for Case Studies

<p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">In Peter D. Kramer’s New York Times piece published in the ‘Couch’ section on October 18, 2014 (</span><a style="line-height: 19.0400009155273px;" href="http://opinionator.blogs.nytimes.com/2014/10/18/why-doctors-need-stories/">Why Doctors Need Stories</a><span style="line-height: 19.0400009155273px;">) he affirms the experience of learners, educators, and researchers in his arguments that a case vignette can provide a kind of instruction that cannot be duplicated by data collection alone. While we do still need evidence based material to assure safety and efficacy of treatments, the case study offers contextual material that makes the evidence come to life.</span></p> <p class="MsoNormal" style="line-height: 19.0400009155273px;">As a Clinical Ethicist each clinical encounter is rich with substantive information that is part of an individual or family story intersecting with the healthcare setting. When invited to provide input, support, or recommendations in any given case, the most informative elements of any case are the story of the patient. What was before, what is now, and what the future may require is different for each patient, and I am often awed by the ‘before.’ The contextual landscape of each story is often where we come to understand the psychosocial factors that weigh heavily in how a patient, family, or community interacts with the healthcare community. Hard data is not as useful as hearing the story that belongs to the patient.</p> <p class="MsoNormal" style="line-height: 19.0400009155273px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">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>
October 3, 2014

The Scylla and Charybdis of Medical Ethics: Not Enough Medicine, Not Enough Ethics

<p class="MsoNormal" style="line-height: 19.0400009155273px;"><span style="line-height: 22.3999996185303px;">I was at a conference last week in medical ethics, and I was surprised by, or perhaps appalled at, the attitude displayed by many of the philosophers regarding the importance of medical knowledge in medical ethical decision making. Several of them proudly announced a total ignorance of the medical issue they were speaking on, and also showed no interest in what I would call “real world” implications of their conclusions.</span><span style="line-height: 22.3999996185303px;">  </span><span style="line-height: 22.3999996185303px;">Although I have a PhD in philosophy, I am not a philosopher in the sense that I am capable of, or interested in, spinning arguments from “thin air” with no grounding in medical facts, and no implications for real medical practice.</span><span style="line-height: 22.3999996185303px;">  </span><span style="line-height: 22.3999996185303px;">Medical ethics must begin in real life issues and problems, and end with equally real and meaningful conclusions that can be applied, and sometimes even empirically tested.</span><span style="line-height: 22.3999996185303px;"> </span></p> <p class="MsoNormal" style="line-height: 22.3999996185303px;"><span style="line-height: 22.3999996185303px;">This is not to say that philosophers cannot make good, or even great, medical/clinical ethicists. But they need to begin with a healthy respect for the way in which the “facts on the ground” inform the ethical decision-making.  A brief example illustrates my point.  In Hilde Lindemann Nelson’s famous </span><a style="line-height: 22.3999996185303px;" href="http://link.springer.com/article/10.1023/A:1008844116526?LI=true">article</a><span style="line-height: 22.3999996185303px;"> explaining narrative ethics, she discusses the case of Carlos and Consuela. Carlos is an HIV positive gang member wounded in gang violence, who is recovering from his injuries in a hospital.  He is now ready for discharge, but needs dressing changes at home.  He wants his sister Consuela to do the dressing changes, but he insists that she not be told about his HIV status.  While Dr. Lindemann Nelson uses this case to make several excellent points about the limitations of principle based ethics, one aspect of the question, crucial to any ethical reasoning on the case, is obviously the transmissibility of HIV infection through dressing changes.  This “fact” is an essential aspect that underpins any ethical judgment regarding the case.  The conflict between patient confidentiality and duty of nonmaleficence (toward Consuela) pivots in part on the fact that HIV is not readily contagious, and simple universal precautions should make the risk to Consuela essentially nil.</span></p> <p class="MsoNormal" style="line-height: 22.3999996185303px;"><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">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>
September 3, 2014

A Distinction for the Debate over Brain-Death

<p style="line-height: 19.0400009155273px;"><span style="line-height: 19.0400009155273px;">There has been a good bit of debate lately in bioethics circles over the concept and proper definition of death.   The disagreement is between those who think that the cessation of brain activity or ‘brain-death’ is sufficient for death, on the one hand, and those who think that brain-dead patients whose circulatory systems continue to function are still alive, on the other.  Consider, for example, the recent tragic case of Jahi McMath.  McMath suffered complications from a surgery to correct sleep apnea which resulted in cardiac arrest and her being placed on a ventilator.  Shortly after physicians at Oakland Children’s Hospital pronounced her brain-dead and so legally dead.  Her family, however, disagreed, and appealed to the courts for Jahi to be maintained via mechanical ventilation and PEG tube.</span></p> <p style="line-height: 19.0400009155273px;">Although Jahi’s family disagrees with the claim that she is brain-dead (insisting that she is merely ‘brain-damaged’), suppose the Oakland physicians are correct in their diagnosis of brain death.  Nonetheless, even after the pronouncement of brain-death Jahi’s body continued to exhibit the sort of homeodynamic equilibrium—at least for the time being, and with assistance from mechanical ventilation and other life-sustaining interventions—characteristic of living organisms.  It was warm to the touch; her heart continued to pump blood through her veins; and so on.  Indeed the bodies of brain dead patients have in some cases remained functional for weeks and even months, performing such surprising feats as undergoing puberty and even gestating fetuses. This has led certain physicians and philosophers to question whether brain death is really sufficient for death.  Patients who are truly dead, after all, could not be warm to the touch or gestate fetuses.  Could they?  </p> <p style="line-height: 19.0400009155273px;"><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><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20.3999996185303px;"> </span></p>
August 11, 2014

What Is Philosophical Ethics Doing?

<p>In my last blog I asked the question, “What is ethics doing?” where I contrasted the armchair, academic ethics that I knew as a graduate student with the clinical ethics cases in which I am now involved in clinical ethics consultations. I alluded to the famous paper by Stephen Toulmin (1922-2009), “How medicine saved the life of ethics” by providing ethics with many practical value laden problems to address. The very process of becoming involved with applied ethics and ethical problems of practicing physicians in the healthcare system was itself as, or perhaps more, transformational for ethics than it was for medicine. Even though medicine needed a serious study of its value-laden issues, which has evolved into bioethics and clinical ethics, the very activity of doing applied ethics has evolved into a better defined field of inquiry with a clearer purpose. But what about the armchair, academic pursuits of philosophical ethics of old? Is there anything left for it to do? This is the question I will attempt to answer in this blog.</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>.</strong><span style="color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px; line-height: 20.399999618530273px;"> </span></p>
July 22, 2014

What Is Ethics Doing?

<p class="MsoNormal" style="text-align: left;">I recall being a PhD candidate in philosophy in the 1970’s, I often pondered the subject matter of my graduate courses in ethics. I would ask myself, what does any of this have to do with ethics? What are we doing?</p> <p class="MsoNormal" style="text-align: left;">As our courses went from Kant to Mill to G.E. Moore to the Emotivists and others, I couldn’t help but have a sense of unreality about the content of what I was learning.</p> <p class="MsoNormal" style="text-align: left;">How can we use reason to find a basis for knowing right action? What are the ways we can define right action based on a normative moral theory?</p> <p class="MsoNormal" style="text-align: left;">What is the meaning of good? Right? And obligation? Can these terms be defined within a theoretical, substantive moral framework or are they just expressions of feelings and emotions without any cognitive content? If they are more than the latter, what do they mean?</p> <p class="MsoNormal" style="text-align: left;"><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>
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.…

View More Blog Entries

Published Articles (31)

American Journal of Bioethics: Volume 11 Issue 11 - Nov 2011

Should the “Slow Code” Be Resuscitated? John D. Lantos & William L. Meadow

American Journal of Bioethics: Volume 14 Issue 9 - Sep 2014

Addressing Dual Agency: Getting Specific About the Expectations of Professionalism Jon C. Tilburt

American Journal of Bioethics: Volume 14 Issue 8 - Aug 2014

Changing the Conversation About Brain Death Robert D. Truog & Franklin G. Miller

American Journal of Bioethics: Volume 14 Issue 8 - Aug 2014

Whither Brain Death? James L. Bernat

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

View More Articles

News (92)

October 7, 2014 2:16 pm

'Decision fatigue' may lead docs to prescribe unnecessary antibiotics

As the day wears on and doctors get tired, they’re about 25 percent more likely than early in their shifts to prescribe antibiotics to patients who don’t need them, according to a new study.

September 30, 2014 2:27 pm

Videos explain concepts of clinical research

When a doctor asks a patient if he or she would like to be randomized into an arm of a standard-of-care treatment study, does the patient really understand the question?

August 11, 2014 1:31 pm

Ethical questions emerge over who gets Ebola drug

In a development that raises a host of ethical issues, Spain announced it had obtained a scarce U.S.-made experimental Ebola drug to treat a Spanish missionary priest infected with the killer virus.

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.

View More News Items