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Blog Posts (2581)

November 22, 2015

Drifting - a Graphic Novel about PVS [EOL in Art 183]

Bill Doan's “Drifting” is being considered as more than a play. He is working with Penn State Press to do an adaptation of this as a graphic novel.

Doan's sister has suffered a traumatic brain injury and is in a permanent vegetative state.   Doan struggles with the question of what's to be done when medical technology saves a life that maybe shouldn't have been saved.  

November 22, 2015

Who Decides When We Die? Lessons from the Life of Jahi Mcmath

Early next month is the 7th International Symposium on Brain Death.  One of the submitted abstracts is of special interest.
November 21, 2015

A View from the Other Side: Roboticized Care

After years of disillusionment with regard to the bureaucratization of medicine and dissatisfaction with my increasing inability to care for patients appropriately (issues I wrote about frequently on this site), I retreated, retiring from the practice of medicine in 2014. Having lived a healthy life-style, I hoped to avoid contact with the system, an intention made more possible by the recent trend towards elimination of... // Read More »
November 21, 2015

2016 Health Law Professors Conference

If you are interested in presenting at the 2016 Health Law Professors Conference, please submit a proposal here. If you haven't submitted a proposal yet there is still time. The deadline has been extended to December 15th. The 39th Annual Health La...
November 21, 2015

Drifting - a Play about PVS [EOL in Art 182]

Bill Doan’s play “Drifting” follows the relationship of a brother and sister, who is in a vegetative state after a traumatic brain injury. 

The play travels from the sister’s hospital room to inside the minds of each character. The play confronts the ethical challenges surrounding prolonging the sister’s life and the difficult decision the brother and the family have to make.

November 20, 2015

How To Die Like a Victorian [EOL in Art 181]

Interesting talk at the Florence Nightingale Museum.  The Victorian preoccupation with death and dying might seem morbid to modern eyes. But have we now gone too far in the opposite direction?  

In 21st century Britain, death tends to be hidden from public view. Today, medical professionals and undertakers take on many of the duties which in the past would have been carried out by the deceased’s relatives, such as washing and ‘laying out’ the body. Unlike the Victorians, today we experience a lack of familiarity with the dead which has led to the discussion of death becoming almost taboo and a subsequent rise in so called ‘death anxiety.'

In this talk, Holly Carter-Chappell will examine 19th-century memorial traditions and show how they are more relevant to modern day practices than we might think.

November 19, 2015

A Precious Gift: Conversation Ahead of the Crisis

Linda Doolin Ward and Sandra Doolin Aust
Our mother lived through the experience of our grandmother dying from complications of Alzheimer’s Disease. When she received her own Alzheimer’s diagnosis, she sat down with us and had the “talk.” She knew the course of this disease and the decisions we would face as it progressed: increasing need for assistance with daily activities, appropriate precautions to keep her safe, treatment options that she wanted to avoid including feeding tubes and ventilators that she knew from experience would not be helpful. She was very clear about what she did and did not want. Over the next eight years, we were guided by her clear and early direction, even as she lost the ability to speak in the last two years of her life. It was heartbreaking to lose her, especially in this cruel way, but she had given us a precious gift—confidence that we were doing what she would want us to do.  

Medicare on Board

We are heartened, finally, that policymakers are recognizing the value of this gift and the need to make it easier for patients, families and clinicians to have “the talk,” also known as “advance care planning.” 

In September 2014, the National Academy of Medicine (formerly the IOM) released its report, Dying in America. As the NAM website states, “no care decisions are more profound than those made near the end of life” and we have a “responsibility to ensure that end-of-life care is compassionate, affordable, sustainable, and of the best quality possible.”  

Starting in January 2016, the Centers for Medicare and Medicaid (CMS) will activate two payment codes for advance care planning services provided to Medicare beneficiaries by “qualified health professionals.” In paying for these services, CMS takes an important step in enabling seniors and other Medicare beneficiaries to make important decisions that give them control over the type of care they receive and when they receive it. 

As 2,200 people in our region turn 65 each month, the National Academy of Medicine report and Medicare’s new reimbursement policy are both important and timely. Diverse as we are, all of us will share the experience of dying. In our society, we try to push this fact of life away, and we would rather talk about almost anything else. Attention from the NAM gives us a reason to talk about it. We are honored in Kansas City that Dr. Christian Sinclair was on the NAM committee and Myra Christopher of the Center for Practical Bioethics was a reviewer.  

The Center Can Help

From our personal experience both in our respective roles at the Center for Practical Bioethics and Shepherd’s Center Central, as well as our role as daughters, we suggest that “having the conversation” ahead of the health crisis may be the most important conversation you and your family will ever have. All of us need to name someone to speak for us when we cannot speak for ourselves. Data show that 85% of us will die without the ability to make our own decisions for any number of reasons. 

The Center for Practical Bioethics has developed several tools available at, as well as a program called Caring Conversations® in the Workplace, to provide a process to help with this difficult “talk.” Anyone can download the Caring Conversations® workbook at no cost and employees from the companies and organizations who currently participate have the chance, with the help of a Center staff member, to understand the difference that initiating this talk can have in families. It requires us to be brave. And it’s worth it.  

It literally can be the difference between not having Thanksgiving together anymore because the family fought over what Mom would have wanted, and “Mom’s death brought us even closer together as a family because she made sure we all knew her wishes, and she would have been proud of how we came together to honor her.” It is never easy, but at the Center for Practical Bioethics, it’s called “the greatest peace of mind possible.”

Linda Doolin Ward is the Executive Vice President and Chief Operating Officer of the Center for Practical Bioethics, Kansas City, Mo. Sandra Doolin Aust is the Director of Coming of Age Kansas City, Shepherd’s Center of KC Central, Kansas City, Mo. Both sisters reside in Kansas City, Mo.
November 19, 2015

UK Courts Remind Clinicians - No Unilateral DNAR without Consultation

Carl Winspear
In 2014, the UK Court of Appeals handed down its judgment in Tracey v. Cambridge University Hospitals NHS Foundation Trust, clarifying that clinicians must consult with the patient before writing a DNAR order.  

A study earlier this year showed that most UK clinicians had never  heard of the case.  And practice regarding DNAR orders had not changed.

This month, a new case confirmed the holding in Tracey and extended it to require consultation with the family when the patient lacks capacity.

At 3:00 am on January 3, 2011, clinicians wrote a DNAR order for incapacitated Carl Winspear without consulting his mother or family.  The physician "did not want to inflict on Carl as treatment that was distressing, painful, undignified, and futile because it had no chance of success."  When his mother learned about it, she had the DNAR order withdrawn at 12:30 pm the same day.

While Carl never coded during the 9 hours the DNAR order was in effect, the High Court held that the clinicians violated Carl's rights under the European Convention on Human Rights.  "Ms. Winspear as carer does not have a veto over the treatment plan but she is entitled to be consulted . . . ."

"I accept the claimant’s case that the core principle of prior consultation before a DNACPR decision is put into place on the case file applies in cases both of capacity and absence of capacity. The fact that there was no cardiac arrest before the notice was cancelled is not decisive, as its existence is itself an interference with private life; it is an important decision about medical treatment of a potentially life saving nature."

"If . . . it is both practicable and appropriate to consult then in the absence of some other compelling reason against consultation, the decision to file the DNACPR notice on the patient’s medical records would be procedurally flawed."

"The discharge of this procedural obligation is not a matter of challenging a clinical judgment as to the appropriate treatment for a patient. The formation of such a judgment is a necessary first step in the decision making process before a DNACPR notice is placed on file but not generally a sufficient one."

November 18, 2015

Taking Science Seriously in the Debate on Death and Organ Transplantation

Michael Nair-Collins has just published "Taking Science Seriously in the Debate on Death and Organ Transplantation" in the Nov.-Dec. Hastings Center Report.

The effort to develop international guidelines for determination of death purports to start with an objective understanding of the biology of death. So far, however, it is showing once again how moral and metaphysical claims about death often masquerade as scientific facts.

The concept of death and its relationship to organ transplantation continue to be sources of debate and confusion among academics, clinicians, and the public. Recently, an international group of scholars and clinicians, in collaboration with the World Health Organization, met in the first phase of an effort to develop international guidelines for determination of death. The goal of this first phase was to focus on the biology of death and the dying process while bracketing legal, ethical, cultural, and religious perspectives. The next phase of the project will include a broader group of stakeholders in the development of clinical practice guidelines and will use expert consensus on biomedical criteria for death from the first phase as scientific input into normative deliberation about appropriate policies and practices.

Surely, science alone cannot resolve the normative and philosophical questions intertwined in debates about moral status, legal and moral rights, the ethics of killing, and personhood and the nature of the self; however, scientific input is necessary for informed moral deliberation. An objective and unbiased investigation of the biology of death is independent of, and should be undertaken prior to, an analysis of the normative questions engendered by debate about determination of death. This strategy is explicitly endorsed by the International Guidelines for Determination of Death and reflects the prevailing view of these issues in the mainstream medical literature. 

However, this mainstream literature, exemplified by the IGDD group’s recent report, does not exhibit any of the characteristics usually associated with a scientifically rigorous investigation, such as making empirically testable and falsifiable claims, a commitment to evidence and logic over authoritative assertion, or a willingness to revise hypotheses and theories in light of new evidence. 

Indeed, the core claims and methodologies of the mainstream medical literature on death, both of which are represented by the IGDD report, are not merely scientifically unjustified; they are not science at all. This situation creates a problem for the integrity of science and the academy, and it unjustly obscures and prevents legitimate democratic and moral deliberation about issues that, at bottom, are normative, not scientific.

November 17, 2015

Member Discussion of the Intersection of Deliberation and Education

This is the last session of the Bioethics Commission’s twenty-third meeting. During this session, Members discussed what to recommend at the intersection of deliberation and education. In previous meetings, the Bioethics Commission has heard from experts in education that using deliberation as an educational tool builds the skills that will help students become informed and […]

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Published Articles (21)

American Journal of Bioethics: Volume 15 Issue 10 - Oct 2015

Do Patients Want to Participate in Decisions About Their Own Medical Care? John D. Lantos

American Journal of Bioethics: Volume 15 Issue 4 - Apr 2015

Ideology and Microbiology: Ebola, Science, and Deliberative Democracy Joseph J. Fins

American Journal of Bioethics: Volume 15 Issue 2 - Feb 2015

Collectivizing Rescue Obligations in Bioethics Jeremy R. Garrett

American Journal of Bioethics: Volume 15 Issue 2 - Feb 2015

Rethinking the Rescue Paradigm Kayhan Parsi

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 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 6 - Jun 2014

Patient and Citizen Participation in Health: The Need for Improved Ethical Support Laura Williamson

American Journal of Bioethics: Volume 14 Issue 2 - Feb 2014

Ethical Review of Health Systems Research in Low- and Middle-Income Countries: A Conceptual Exploration Adnan A. Hyder, Abbas Rattani, Carleigh Krubiner, Abdulgafoor M. Bachani & Nhan T. Tran

American Journal of Bioethics: Volume 14 Issue 2 - Feb 2014

Connecting Health Systems Research Ethics to a Broader Health Equity Agenda Bridget Pratt

American Journal of Bioethics: Volume 13 Issue 9 - Sep 2013

An Ethical Analysis of Mandatory Influenza Vaccination of Health Care Personnel: Implementing Fairly and Balancing Benefits and Burdens Armand H. Matheny Antommaria

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News (1996)

October 28, 2015 6:19 pm

Personal Care Products With Parabens May Be Dangerous, Even At Low Levels; What To Look For On Labels

Every morning after waking up, when a person showers and shampoos their hair, lotions their body, dons sunscreen, or moisturizes their face, they expose themselves to dozens of controversial, possibly harmful chemicals. Called parabens, a team of researchers from the University of California Berkeley recently discovered these chemicals may be more dangerous at low doses than previously thought.

October 22, 2015 1:33 pm

Even doctors and nurses don’t always have healthy lifestyles

Even doctors and nurses don’t always follow the healthy lifestyle choices they recommend for patients to reduce the risk of medical problems like obesity, heart disease and diabetes, a U.S. study suggests.

October 14, 2015 5:42 pm

Michigan Catholic hospital failed to help woman with brain tumor: complaint

The American Civil Liberties Union on Wednesday accused a Catholic hospital in Michigan of failing to provide appropriate care by refusing on religious grounds to allow a pregnant woman with a brain tumor to be sterilized.

October 12, 2015 3:52 pm

Exclusive - Transatlantic divide: how U.S. pays three times more for drugs

U.S. prices for the world’s 20 top-selling medicines are, on average, three times higher than in Britain, according to an analysis carried out for Reuters.

October 8, 2015 2:23 pm

Perceived discrimination linked to smoking and poor diet

Feeling like the target of discrimination may increase a person’s odds of harmful behaviors like smoking, eating fatty foods and getting less sleep, a study of African-Americans suggests.

October 7, 2015 2:15 pm

Medical students and physicians share their writings on “becoming a real doctor”

The dilemma of being a medical student on clinical rounds who wants to help patients but can’t was captured by third-year student Raymond Deng in his essay “Performing Grief,” at a recent reading held by Stanford’s Medicine and the Muse Program and Pegasus Physician Writers group.
October 2, 2015 3:22 pm

Venom experts say global snake bite death tolls 'grossly underestimated'

Venom specialists said on Wednesday disease and disability caused by snake bites is far higher than official global health estimates suggest and antivenom stocks are running dangerously low.

September 23, 2015 6:32 pm

Clinton plan to cut health costs includes tax credits, more sick visits

Democratic presidential candidate Hillary Clinton unveiled a plan on Wednesday to lower out-of-pocket health costs, including expanded coverage of sick visits to the doctor and tax credits for those with substantial medical bills.

August 25, 2015 2:05 pm

Women, minorities still underrepresented in medical specialties

Too few women and minorities are entering certain medical specialties in the U.S., researchers say.

May 14, 2015 3:39 pm

U.S. says insurers must cover FDA-approved birth control methods

The U.S. government said health insurers must cover all FDA-approved methods of birth control without co-pays or charges to the patient, as it issued a paper on Monday looking to clarify coverage guidelines under the Affordable Care Act.

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