» Clinical Ethics Where the World Finds Bioethics Sat, 25 Jun 2016 10:00:22 +0000 en-US hourly 1 Moral Hazard in Pediatrics Tue, 14 Jun 2016 17:13:32 +0000 0 Why America Needs Bioethics Right Now Fri, 27 May 2016 19:23:01 +0000 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. This blog has also paid attention to some of the orphan issues of bioethics: public health, social justice, health disparities, climate change and medicine in war, torture and guns.…

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BioEthicsTV: A night of consent issues on ChicagoMed Wed, 27 Apr 2016 03:40:58 +0000 by Craig Klugman, Ph.D.

On this week’s episode of ChicagoMed (Season 1; Episode 15) issues of consent was the main focus. The first major storyline concerned a 16-year-old in abdominal pain who enters the ED with her father, a heroin addict. Although in pain and in need of a diagnostic endoscopy, the patient refuses any and all medications: She fears that even one dose will turn her into the addict that her father has been for her entire life. The doctors try the endoscopy without anesthetic or pain medications and they are unable to get through the procedure.…

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Clarifying the Rules: No media in patient treatment areas Thu, 21 Apr 2016 21:41:40 +0000 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. Now a settlement with federal regulators announced today will forever tighten health privacy recording restrictions in the hospital. In short, to film patients in the hospital, you have to get their consent before recording, not after as has been the procedure for most real-life medical shows.…

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Stinging Doctors: Recording Your Own Surgery Wed, 20 Apr 2016 23:26:33 +0000 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. She claims that before her operation she was flagged as a difficult patient and instead of talking to her doctors at that time, she hid a recording device in her hair. Listening to the recording after her operation, she heard the medical staff discussing her as a “handful” and making other disparaging comments.

This case comes after “D.B.” in 2013 accidentally left his cell phone in record mode during a procedure.…

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The Unbearable Whiteness of Bioethics: Exhorting Bioethicists to Address Racism Mon, 21 Mar 2016 16:42:50 +0000 by Kayhan Parsi, Ph.D.

To be ignorant of what occurred before you were born is to remain always a child.” (Cicero)

Fight the Power” (Public Enemy)

Recently, our medical school hosted Dr. Linda Rae Murray to give a talk on structural racism and medicine. A former president of the American Public Health Association, Dr. Murray gave a powerful presentation on the history of racism in the United States and its lingering impact upon health disparities. In one of her more provocative slides, she graphically conveyed the long history of racism toward African Americans in the United States (before and after the founding of the republic).…

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Meditations on the Flood Fri, 18 Mar 2016 16:47:03 +0000 When I first moved to Albany several months ago in pursuit of the exciting and glamorous life of a clinical ethics fellow, I brought with me only a handful of my earthly possessions; if the Fates have their way with me, I will likely leave with even less.

During this past month, in the late-night hours one night I awoke from my slumber to discover that while I had slept the majority of my basement apartment had been transformed into a bog. Yes, I was experiencing wintery real-life application of the law of thermal expansion as it applies to dihydrogen monoxide (i.e., a water pipe burst). After an emergency call to my landlord, I proceeded with my own separation of sheep from goats: what could be saved and salvaged was transported to the little dry land remaining in my now water-logged kingdom, while those items clearly destined to doom and decay were left languishing amidst the advancing liquid army. Few of my books survived, but among them was one I thought quite fitting to the circumstances: Marcus Aurelius’ Meditations.

Essential reading for any good Stoic (and, to my mind, useful if not essential reading for all human beings), Meditations, and the ancient words of wisdom it contains, helped me to navigate through and reflect upon my experience of the flood and its corresponding aftermath. Some choice morsels include:

Casting aside other things, hold to the precious few; and besides bear in mind that every man lives only the present, which is an indivisible point, and that all the rest of his life is either past or is uncertain. Brief is man’s life and small the nook of earth where he lives… (Book III, Number 10)

But among the things readiest to hand to which you should turn, let there be these two: One is that things do not touch the soul, for they are external and remain immovable; so our perturbations come only from our inner opinions. The other is that all the things you see around you change immediately and will no longer be; and constantly bear in mind how many of these changes you have already witnessed. The universe is transformation: life is opinion. (Book IV, Number 3)

Everything is only for a day, both that which remembers and that which is remembered. (Book IV, Number 35)

“I am unhappy, because this has happened to me.” Not so: say, “I am happy, though this has happened to me, because I continue free from pain, neither crushed by the present nor fearing the future.” For such a thing as this might have happened to every man; but every man would not have continued free from pain on such an occasion. Why then is that rather a misfortune than this a good fortune? (Book IV, Number 49)

One of the main life lessons Marcus Aurelius (and indeed all stoics) reiterates time and again is that the essential nature of our human existence is flux and fleetingness. Another is that our ability to respond to this flux and fleetingness, and how we choose to respond, constitute a great human power and our capacity for nobility. Our ability to bear the small things – minor losses of time, possessions, or our sense of control – help to prepare us for the inevitable big things with which we will one day be faced. The major losses.

I sometimes think that one of the most valuable things we can do as clinical ethicists is to help people – patients, families, physicians, etc. – with these particular life lessons. For many, the hospital experience is the epitome of flux, the reason for hospitalization a reminder of life’s fleetingness. Whatever the official reason for requesting an ethics consultation, minor and major losses are always there, whether in the present situation or looming on the horizon. We are consulted, I believe, in large part to help people bear these losses. 

And this becomes another part of my meditation: that this experience, and indeed each of my experiences, has the potential to become a tool for me to help others. The patient’s flood or the family’s flood may not be the same as my own flood, but in reflecting on how I could bear my flood, hopefully I can help guide or companion others as they bear theirs.

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.
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‘Difficult’ patients may tend to get worse care, studies find Wed, 16 Mar 2016 17:33:05 +0000 0 A Shot of Hope: Efforts to Address the Opioid Addiction Crisis Thu, 10 Mar 2016 20:33:09 +0000

According to the American Society of Addiction Medicine, drug overdose is the leading cause of accidental death in the US with close to 50,000 deadly overdoses in 2015 alone.  Opioid addiction accounted for nearly 20,000 of these and heroin alone was a factor in just over 10,500 deaths. The magnitude of opioid abuse related hospitalizations, sales of prescription pain killers and deaths have increase exponentially between 1999 and 2008 according to ASAM. Increased access to Narcan (naloxone) to reverse life threatening effects of opioid for first responders has now expanded to making Narcan available to the general public as well. In some areas, Narcan can be purchased without a prescription by family members and friends who expect they may need to quickly rescue a loved one. While I support this program because it can and will likely save lives, it does not address the need for effective rehabilitation of persons who suffer the all-consuming and devastating effects of opioid addiction. Regulations which will allow persons with opioid addictions to be detained involuntarily in health care setting are also being discussed, but pose some dilemmas as well.

Massachusetts Governor Charlie Baker has taken a strong stand to help limit access to the powerful pain medication by placing statutory limits on the quantity of opioid pain medication that can be prescribed to a patient to a 72 hour supply the first time opioids are prescribed to them – with exceptions.  Physicians have had a mixed response according the October 2015 Boston Globe article. Some cite that placing prescribing restrictions on prescribing pain killers is an invasion of the state into the doctor-patient relationship and dismisses the clinical judgment of physicians to discern a given patient’s need for pain relieving medications. Others indicate that this is a public health matter and deserves statutory supports as have other issues that post a risk to the wellbeing of the population at large. Who is helped and who is harmed by restricting opioid prescriptions and providing naloxone without a prescription to the public? It seems these are just the tip of the iceberg in terms of a robust program for addressing the opioid addiction crisis in the US. Prevention will be more complicated than limiting the supply that flows from a physicians prescription pad and rescue will ultimately require more than easily access to Narcan.


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.

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Clinical Ethics Consultation As Practical Philosophy Fri, 04 Mar 2016 14:22:40 +0000

As a philosopher who works in a large health science center where the scientific method and perspective reign supreme, it is common to hear comments about the abstract and ideal nature of philosophy. As though those who think about human problems from a philosophical perspective do so from an abstract, insular perspective with little or no practical impact. Though I hear such dismissive comments about philosophy less often than I used to, say 20 or more years ago, I sense there is still a commonly held view that those who think from a philosophical perspective as not well oriented to practical affairs. And with some justification do people have this view of philosophy.


As I have written in previous blogs, philosophy has long and even proud part of its tradition for being, well, useless. If we assume that the basis of philosophical truth and wisdom lay in some ultimate, objective form that only those who think in certain ways can grasp, then knowledge becomes privileged to the philosophical few as an end it itself. This type of Platonic philosophical truth quickly divides the here and now inferior world from the more exclusive understandings of reality. Because of this basic influence of Platonic philosophy, much of the history of philosophy in the Western tradition has been focused on the search for a rational, objective basis of truth, value, and reality. Not surprisingly, the goal has not been reached. But the quest continued through most of last century and philosophical got its more or less justified reputation for being an insulated, esoteric, and detached form of intellectual activity. Put bluntly, philosophers, with a few exceptions, rarely got their hands dirty in the real world of practical activity.


The role of philosophy vis-à-vis practical life began to change with the advent of applied ethics in the 1970’s. In the field of bioethics and clinical ethics, after a few decades of many philosophers actually working closely with practitioners, learning their language and the nature of their concerns about value laden dilemmas that arise in the experience of carrying out their responsibilities to patients and to society, philosophers I think are less useless. In fact I am pretty sure we are helpful, at least at times. Most of the time I interact with physicians and nurses about clinical cases in the hospital, or even with basic scientists about issues related to scientific integrity, I feel pretty sure we usually have constructive conversations and there is a sense of mutual respect as I attempt to make a recommendation that might help manage problematic situations. As someone nearing retirement (nothing definite) I am part of the first generation of bioethicists or as I prefer to think of myself, clinical ethics consultants, who were first trained as philosophers and then went on to become deeply involved in the practical and complex world of medicine and scientific research.


As I think about my work during the past 25 years and the nature of the problems that I now think about in my work experience, I am becoming more convinced that I am getting in touch with philosophy in a way I did not expect as a gradate student: as a natural human, practical activity meant to make a difference for the better. To be honest, I have always been attracted to a less influential lineage of philosophers, who believed philosophy is grounded in the most human concerns. Philosophy from this view, beginning in pre-Socratic philosophy, was very much like a medical art—in the same way medicine sought to treat bodily ills, philosophy sought to treat illnesses of the soul. Epicurus (341–270 BC) for example, famously said, “empty is that philosopher’s argument by which no human suffering is therapeutically treated.” Schools of philosophy sought to understand the world and human beings for the purpose of living a better life and relieving the soul of its natural tendency to be disturbed in a myriad of ways. Thus, philosophers who followed the teachings of Epicureanism, Stoicism, Skepticism, as well as Aristotelianism, were trained individuals who could be helpful in this regard—who could coach their students and prepare them for a life that brought out the most important characteristics necessary for well being, which always included prominently the emotions. In all of these philosophies, there is a keen focus on how the emotions could be regulated by correct or constructive belief, which leads to desired action and habit formation, and a change of internal disposition. The central focus for these schools of philosophy was eudaimonia, which generally means for those who study ethics, those actions that lead to a state of well-being or ataraxia (undisturbed soul or inner tranquility). The task of being a philosopher from this perspective is to learn those methods and approaches that would lead those being served or taught to such ends.


Perhaps the closest iteration of such a philosophy in recent times is American Pragmatism, particularly the works of William James and John Dewey, which unlike the pre-Socratics, particularly Dewey, is colored profoundly by the modern scientific method. Truth becomes a matter of what works based in experimental methods and that can bring about desire ends for better human living. Dewey’s hope was that philosophy would become part of the fabric of democratic life and be used to make a positive practical difference in society. His hope did not happen during his lifetime, but with the rise of applied ethics, this philosophical perspective of philosophy being connected the practical world, much like the ancient pre-Socratics, is now able to take a new contemporary shape in bioethics.


In spite of the obvious constraints of working in a contemporary hospital where patients have well articulated ethical and legal rights and physicians have clear professional obligations and responsibilities, many of the encounters I have as an ethics consultant involve individuals facing many of the same challenges that motivated ancient philosophers to develop remedies for treating their distressed emotions. When a family member of a dying patient is facing the loss of a loved one and the obligation to make excruciatingly difficult decisions about when to discontinue life supportive treatments, there is a deep emotional disturbance. Individuals in these situations are stressing, grieving, and often confused. The beliefs they have relative to the decisions they must make can have an enormous impact on their emotional state. For example if someone falsely believes that their making a decision to follow their loved one’s wishes and to withdraw ventilatory support for a dying patient was tantamount to them being personally responsible for the patient’s demise, the feelings of guilt and indecisiveness can be overwhelming.


In talking to individuals in these situations, much my goal is to help ease their emotional suffering if possible, or as Epicurus would say, is to offer words that provide therapy for the soul. There is nothing necessarily deeply philosophical to grasp. I start by seeing where the individual is. Why he or she is so distressed. What is the source of the disturbed emotions? Then a dialogue can occur to examine the beliefs he or she has that is connects to those emotions. As the ethics consultant, my role is facilitate, lead the dialogue, and allow the individual to critically examine his or her belief and to come to new understandings. Following someone’s stated wishes, for example, can be construed as a way of showing respect for your loved one; permitting the physicians to disconnect artificial life supports is not the cause of the patient’s death; it is rather the removal of burdens that are only prolong his terminal illness. A new narrative can often emerge. A new understanding that sheds light on one’s former beliefs and that brings some relief to suffering.


In a very different historical context than ancient philosophy, one of high technology and democratic life, applied ethicists have similar functions and practice with similar methods as practical philosophers of the past. The next time you hear someone disparaging philosophy as irrelevant or impractical, don’t believe them.


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.

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Finding the Right Tools for Assessing Quality of Clinical Ethics Consultation Thu, 03 Mar 2016 05:19:36 +0000 by David Magnus, Ph.D.

This issue of the American Journal of Bioethics contains two extremely important Target Articles in the history of clinical ethics consultation. The first presents the eagerly awaited results of the ASBH attestation pilot, while the second provides a detailed account of the development and application of the VA National Center for Ethics Consultation quality assessment tool that aims to evaluate the quality of an ethics consultation by analysis of documentation.

Together, these articles mark an important step in the development of standards and tools for those of us engaged in clinical ethics consultation.…

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A Pilot Evaluation of Portfolios for Quality Attestation of Clinical Ethics Consultants Tue, 01 Mar 2016 23:24:43 +0000 0 Ethics Consultation Quality Assessment Tool: A Novel Method for Assessing the Quality of Ethics Case Consultations Based on Written Records Tue, 01 Mar 2016 23:21:55 +0000 0 Finding the Right Tools for Assessing Quality of Clinical Ethics Consultation Tue, 01 Mar 2016 23:13:38 +0000 0 Code Black Ends the Season on Bioethics Tue, 01 Mar 2016 19:27:47 +0000 BioethicsTV is an occasional feature where we examine bioethical issues raised in televised medical dramas.

by Craig Klugman, Ph.D.

The season finale of Code Black (season 1; episode 18 – February 24, 2016) presented a plethora of ethical challenges for the hard working doctors and nurses of Angels Memorial Hospital’s emergency department. The conceit for this show is that this is the busiest emergency room in the country, entering “code black” on over 300 days a year. The show defines a code black as overwhelmed, understaffed, overcrowded.…

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When the Patient is One of Our Own Fri, 19 Feb 2016 06:33:09 +0000 by Craig Klugman, Ph.D.

A physician walks into the break room, looking forward to a few minutes of downtime with a cup of stale coffee and some space to breathe. The minute he opens the door he knows something is wrong as the floor is covered in blood. A nurse has fallen over, smacked her head on a table and lays unconscious, bleeding on the ground.

“If it was a patient, I would know exactly what to do,” said one of her colleagues.…

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Does Bioethics Tell Us What to Do? Mon, 15 Feb 2016 16:45:43 +0000 by J.S. Blumenthal-Barby, Ph.D.

 Applied ethicists—including bioethicists—are in the business of making normative claims. Unlike, say, claims in meta-ethics, these are meant to guide action. Yet, when one examines the literature and discourse in applied ethics, there are three common barriers to these claims being action-guiding. First, they often lack precision and accuracy when examined under the lens of deontic logic. Second, even when accurately articulated in deontic language, they often fall into the category of claims about “permissibility,” a category that yields low utility with respect to action guidance.…

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Pain Relief is an Ethical Issue Fri, 12 Feb 2016 16:52:53 +0000 When patients lack capacity, physicians look to family and friends to step in and provide consent for treatment on behalf of the patient.  These surrogates, whether they were appointed by the patient as their health care agent or become health care surrogates by default under state law based on their relationship to the patient, have the right to receive information related to the care and treatment of the patient and have the corresponding responsibility to make health care decisions for the patient based on either the patient’s previously expressed wishes or her best interests.  What they don’t have, however, is the right to control and direct every minute aspect of the patient’s care in the hospital.  It would take several blog posts to discuss the conflicts that occur between surrogates and health care providers because of this (such as DNR orders, barriers to discharge, and demands for certain medications, to name a few), but perhaps the most concerning example of surrogate over-reach is the issue of inadequate pain management.

The use of pain medication can be difficult for both patients and providers, especially with the rate of opioid abuse in this country.  Patients and their families are often afraid of the possibility of addiction, while physicians are reticent to prescribe narcotics for fear of misuse.  Whether or not a patient is a “drug-seeker” is a common question that arises when physicians are deciding what to prescribe.  However, in the context of terminal illnesses – particularly at the very end of the illness – the shift in focus from curative to palliative care highlights the need for sufficient pain control in the face of nearly intractable pain.  It is in this context that denial of pain medication, or poor pain management, is most clearly an ethical issue.

I have often heard complaints from health care providers about how surrogates have refused to consent to pain medications, or insist that physicians give lower doses than medically appropriate.  When I ask how the provider responded to such requests, all too often the answer is, “I followed their direction.”  We are so used to turning to surrogates for consent for every treatment and procedure, but is it really within the surrogate’s authority to consent to or refuse pain medication?   Assuming there is no advance directive from the patient opposing adequate pain medication, do surrogates have the right to refuse it?  More importantly, is it ethical for physicians to withhold adequate pain medication at the direction of a surrogate despite obvious signs of pain in the patient?

While respect for autonomy is a bedrock principle in our society, and we would certainly honor the informed refusal of pain medication by a patient with capacity, this respect for autonomy does not mean we necessarily honor the directives of the patient’s surrogate to the same extent as we would the patient herself when it comes to pain control.  Without explicit direction from the patient, certain basic assumptions are made about what the patient would want: namely, relief of pain and suffering.  While questions of withdrawal of life-sustaining treatment or palliative surgery may properly be left to the surrogate, the provision of pain medication is assumed as part of basic care for the patient in accordance with the principle of nonmaleficence.  We have an obligation to do no harm to patients, and to the extent possible, to relieve suffering.  While the side effects of opioids should certainly be considered and discussed with the patient’s family, particularly as it may affect the patient’s awareness or respiration, if other palliative approaches are not sufficient to address the patient’s pain, these side effects should not preclude the use of pain medication.  Interventions aimed at pain relief should be given in the overall best interests of the patient, considering the risks and benefits.  Especially at the end of life, providing comfort to the patient should be of utmost importance, even if the surrogate objects.  When pain relief is an ethical issue, it is not an issue for the surrogate alone to decide.

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.


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A Letter to Dick Wolf & Chicago Med Wed, 03 Feb 2016 08:37:59 +0000 by Craig Klugman, Ph.D.

When I was a graduate student in my clinical bioethics masters program I was rotating through a pediatric subspecialty, following a physician. The first half of the day was great. The doctor introduced me to patients, explained what was going on with them, explained his plans and his hopes for each patient. About two-thirds through one particular day he asked me for my stethoscope. I thought “Uh-oh, He doesn’t understand.” When I responded that I did not have one, he said “What kind of medical student are you.” I shrugged my shoulders.…

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The Sky is Falling: How Much Do We Owe A Patient? Tue, 26 Jan 2016 21:13:42 +0000 by Craig Klugman, Ph.D.

Imagine if a patient went sky diving without a parachute and survived. You fixed up her body and explained to her the dangers of her activities. You refer her to a program that offers free parachutes and trains people on how to use them. Upon discharge, she does the same thing again and ends up back in your hospital? Do you perform the same surgeris again? What if she does this 3 times? Four times? Is there a point at which we “give up” on patients when they consistently return for the same problem from the same cause after ignoring all advice?…

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Can Health Care Providers Love Their Patients? Mon, 18 Jan 2016 13:00:12 +0000 by J.S. Blumenthal-Barby

Ms. Clara [name changed] is one of our patient partners on a PCORI funded project. PCORI is unique in that they aim to include patients and other stakeholders in all stages of research—from conceptualization of projects and their aims to the dissemination of results. We’ve been working closely with Ms. Clara and other patient partners for almost two years now. A few months ago, when visiting Ms. Clara in the hospital, her eyes became teary and she exclaimed, “I love you guys.…

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Professional Judgment and Justice: Equal Respect for the Professional Judgment of Critical-Care Physicians Wed, 13 Jan 2016 20:43:57 +0000 by David Magnus, PhD and Norm Rizk, MD

This issue’s target article by Kirby (2016) raises an incredibly important and challenging set of issues: Whether, when, and how should limits be placed on patient access to intensive medical care? What are limits of shared decision making? Is bedside rationing ever appropriate? Kirby’s move away from bedside rationing to a mesolevel approach is novel and interesting. However, as some of the commentaries note, the question of whether there are limits to what will be offered to patients and their families often has to be made at the bedside.…

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Balancing Legitimate Critical-Care Interests: Setting Defensible Care Limits Through Policy Development Fri, 01 Jan 2016 23:37:03 +0000 0 Professional Judgment and Justice: Equal Respect for the Professional Judgment of Critical-Care Physicians Fri, 01 Jan 2016 23:33:21 +0000 0 Professional Judgment and Justice: Equal Respect for the Professional Judgment of Critical-Care Physicians Fri, 01 Jan 2016 21:40:54 +0000 0 More than half of U.S. doctors experience burnout Tue, 08 Dec 2015 19:54:44 +0000 0 When medical knowledge is at a crossroads, how research can take patient preferences into account Wed, 02 Dec 2015 23:31:04 +0000 0 Is There An Ethics Consultant In The House? Striving For Verisimilitude In Chicago Med Thu, 19 Nov 2015 16:44:23 +0000 by Kayhan Parsi, JD, PhD and Nanette Elster, JD, MPH

The new NBC medical drama Chicago Med premiered this week. A spin off of other established NBC dramas (Chicago Fire and Chicago PD), Chicago Med focuses on the working lives of health care professionals in a busy emergency department in the city of Chicago. Sound familiar? It should, because that was the premise of the hugely successful NBC series ER that premiered over 20 years ago in 1994 and launched the careers of several successful actors.…

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The Theranos mess: A timeline Tue, 10 Nov 2015 21:48:33 +0000 0 A group of middle-aged whites in the U.S. is dying at a startling rate Tue, 03 Nov 2015 17:12:06 +0000 0 Can a 5-year-old refuse treatment: The Case of Julianna Snow Wed, 28 Oct 2015 23:39:09 +0000 by Craig Klugman, Ph.D.

Julianna Snow is a 5-year-old who suffers from Charcot-Marie-Tooth disease, a neurodegenerative illness. This is the most common of all inherited neurological disorders (about 1 in 2,500 people have it). The disease usually is noticed in adolescence or early adulthood. For Julianna, the disease affects not only movement but swallowing and breathing. She is subjected to NT suctioning every few hours to remove the mucus that accumulates. Her decline was rapid and severe. Michelle and Steve Snow have written extensive blogs about their experiences and conversations.…

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Heaven over hospital: Dying girl, age 5, makes a choice Tue, 27 Oct 2015 22:11:09 +0000 0 Clash in the name of Care Mon, 26 Oct 2015 23:24:40 +0000 0 Deeply Superficial Fri, 09 Oct 2015 11:10:24 +0000 0 Doctors, Patients, and Nudging in the Clinical Context—Four Views on Nudging and Informed Consent Thu, 01 Oct 2015 19:58:52 +0000 0 Do Patients Want to Participate in Decisions About Their Own Medical Care? Thu, 01 Oct 2015 19:48:15 +0000 0 Black patients fare better than whites when both get same healthcare, study finds Thu, 24 Sep 2015 17:02:49 +0000 0 Poverty may increase odds of repeat hospitalizations Wed, 16 Sep 2015 20:01:04 +0000 0 Rise in crowdfunding lets patients seek help for medical treatment Tue, 15 Sep 2015 19:54:29 +0000 0 Stethoscope meets smartphone and the heart knows it’s right Wed, 02 Sep 2015 18:50:04 +0000 0 Patient Perspectives on the Learning Health System: The Importance of Trust and Shared Decision Making Tue, 01 Sep 2015 19:47:14 +0000 0 The Changing Definition of What Is ‘Brain Dead’ Mon, 31 Aug 2015 18:48:05 +0000 0 “One Shoe Can Change Your Life”* Mon, 24 Aug 2015 11:00:55 +0000 by Jeanie Sauerland, BS, BSN, RN

I hate shopping for shoes – always have. Footwear was not the reason I chose nursing – but it sure made it nice, to be able to wear comfortable walking shoes without looking like you wore orthopedic shoes made for someone 90 years old. The world of white caps and starched uniforms disappeared long before I became a nurse. Even so, the shoes are still designed more for function than fashion: These are meant to be work shoes.…

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In graphic detail, medical journal describes ‘heavy overtones’ of sexual assault in operating room Tue, 18 Aug 2015 18:02:29 +0000 0 A doctor discovers an important question patients should be asked Mon, 17 Aug 2015 18:06:39 +0000 0 Physician writers share a “global perspective on healing” Wed, 15 Jul 2015 21:21:49 +0000 0 Clinical Ethics Consultant Professionalization: A Response to Dr. Shelton Tue, 07 Jul 2015 07:07:37 +0000 0 Does Clinical Ethics Consultation Lend Itself to Professionalization? Thu, 18 Jun 2015 02:06:02 +0000 0 Actions vs. Words: What counts most in understanding patient preferences? Tue, 09 Jun 2015 01:06:41 +0000 0 U.S. Complicity and Japan’s Wartime Medical Atrocities: Time for a Response Mon, 01 Jun 2015 17:29:42 +0000 0