Hot Topics: Health Care

Blog Posts (988)

July 29, 2014

New Educational Module on Informed Consent in Safeguarding Children

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has just posted to Bioethics.gov a new educational module on informed consent in the context of pediatric medical countermeasure research. The module integrates material from the Bioethics Commission’s March 2013 report Safeguarding Children: Pediatric Medical Countermeasure Research. The aim of this module is to […]
July 29, 2014

New Educational Module on Informed Consent in Safeguarding Children

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has just posted to Bioethics.gov a new educational module on informed consent in the context of pediatric medical countermeasure research. The module integrates material from the Bioethics Commission’s March 2013 report Safeguarding Children: Pediatric Medical Countermeasure Research. The aim of this module is to […]
July 28, 2014

EVERYTHING COMES FROM THE STREETS: Chicano Low Riders and Bioethics.

Last fall at the San Francisco Latino Film Festival there was a preview of the spectacular documentary, Everything Comes from the Streets. This film is an example of excellent programming on the part of that festival. This year the SF Latino Film Festival runs from September 12 - 22, 2014.

Everything Comes from the Streets is a documentary directed by Alberto Lopez Pulido and co-produced by Mr. Pulido, Kelly Whalen and Rigo Reyes.  It is a story about the significance of Low Riders in Chicano culture. A beautifully shot film, it carefully handles the struggle for identity and civil rights, particularly in the Chicano community. My interest in Low Rider Culture was re-ignited when it was used in the San Francisco based film La Mission (Bratt, 2009), which was the first film blogged on this website.

A Low Rider is both a car and the person who drives it. Low Riders, the cars, are rigged by the expertise of community developed mechanical physicists, operating under the cloak of local driveways and garages. Materials for the work historically come from salvage yards, not only deriving from cars, but the hydraulics of discarded airplanes. The rigging results in the rear of the car riding lower to the ground than the original factory specifications.  This aesthetic preference is also the restructuring that makes the car float, slowly down the roads, cruising on parade. This film illustrates why these vehicles need to be on parade. They are extraordinary pieces of artwork, expressing creative, cultural and engineering pride. There is more to this particular cultural icon than the cars themselves. 

Everything Comes from the Streets traces Low Riders from their roots in East Los Angeles and Espanola, New Mexico. The visual home of the film is San Diego County.  After the first Low Riders hit the streets in the 1950's, organizations began to spring up in support of them; the cars, the people who drove and their admirers.  These social "Car Clubs" developed structures that were also able to support community based social change. Additionally, the Low Rider movement had a specific contribution to Chicana feminism. By the 1970s, women, as well as men, were frequently involved in the same mechanics, redesign of their own vehicles for display, expression of creativity, pride, and organized community responsibilities. 

In the late 1970's, Chicano pride became a threat to the USA status quo. The film illustrated this reality in the San Diego area.  There, city ordinances were selectively enforced to prohibit Low Riders from Cruising and gathering audiences. This abuse of law violated the constitutional right of the Chicano community to peacefully assemble.  Collateral congestion and random legal offenses were inaccurately attributed to organized Car Club cruising. Low Rider Culture was misrepresented as synonymous with gang culture, particularly in the 1979 film, Boulevard Nights.  This representation fueled an even more skewed perception of Low Riders.

Disruption of under-resourced ethnic communities of color, under the guise of "urban renewal," was the norm in the 1960's and 1970's. Being organized, Car Clubs were logically part of community leadership that struggled, and still do struggle, against attempts to dilute Chicano identity and deny the community a geographic venue. With surprising good humor, Everything Comes from the Streets speaks to resisting oppression based on race and class. 

Why should Bioethicist care about Everything Comes from the Streets? The empirical Two Tiered Assessment of Shared Decisional Capacity reviews, Disclosure andBarriers to Disclosure during the process of informed consent, in medicine and clinical research. Clinicians should be aware of common barriers to shared decisional capacity. Examples of those barriers are: physical states including pain; psychological distress like grief, post-traumatic stress syndrome, depression/anxiety; educational differences (language and literacy) and patients’ perception of institutional chauvinisms. Institutional chauvinisms include the major "-isms."  Examples are ageism, sexism, genderism, classism, colonialism, professionalism and racism.  People tend to shut down communication and understanding when they recognize chauvinisms are being applied to them, with or without intention. 

Barriers to shared decisional capacity are barriers to good clinical medical ethical care of patients -- That's why Everything Comes from the Streets is important to Bioethicists. Once barriers are identified, clinicians can work to counter the negative effects.  In the case of institutional chauvinisms, clinicians demonstrating a commitment to learn about a person's family, spiritual needs, struggles and icons of culture, (FaSSI), may help to remove barriers to shared decisional capacity.   Born from the Chicano community, the film Everything Comes from the Streets is about family, spirit, struggle and cultural icons and can help improve goals of more ethical medical care.  
references:

Everything Comes from the Street directed by Alberto Lopez Pulido (2014) http://everythingcomesfromthestreets.vhx.tv/watch (USA) 56min  

LA MISSION. 35 mm. Directed by Peter Bratt. USA. Screen Media Ventures. 2010 (117 min)

September Williams'  Bioethics Screen Reflections: LA MISSION : Prototype for the Peace Genre http://www.bioethicsscreenreflections.com/2010/05/la-mission-prototype-for-peace-genre.html?spref=tw

Regarding Shared Decisional Capacity, FaSSI and institutional chauvanisms see online: Williams, September.  Pain Disparity: Assessment and Traditional Medicine in THE AMERICAN ACADEMY OF PAIN MEDICINE Textbook on Patient Management. 2012 Deer, T.R.; Leong, M.S.; Buvanendran, A.; Gordin, V.; Kim, P.S.; Panchal, S.J.; Ray, A.L. (Eds.) Springer SBN 978-1-4614-1559-6

July 28, 2014

The End of End-of-Life Law

Check out this new article by UVA professor Lois Shepherd "The End of End-of-Life Law."

As the title suggests, Shepherd's article argues that questions about medical care at the end of life should be approached like other important questions about medical care—with consideration to patients’ wishes, values, interests, and relationships, and without special laws, special burdens of proof, or unique requirements for documentation. She contends that reducing legal distinctions between end-of-life decisions and other health care decisions can bring efficacious changes to both sorts of decision making processes.

The heart of the article is a "blueprint for reform" through the following eight general principles that should guide the law relating to all health care decisions, including those we now think of as end-of-life decisions.

  • Principle 1: Respect and Care for the Patient Require Balancing Rather Than Rigidly Prioritizing Among Patient Instructions, Wishes, Values, and Interests
  • Principle 2: All Patients Should Have a Surrogate Decision Maker, and the Same Standards of Decision Making Should Apply to All Surrogate Decision Makers
  • Principle 3: Requirements for Advance Documentation by Patients Should Be Minimal
  • Principle 4: Binding Pre-Commitments Should Be Allowed Only Sparingly and for Compelling Reasons; They Should Not Be Required or Encouraged
  • Principle 5: Rushed Decisions That People Do Not or Should Not Want to “Live Like That” Should Be Avoided
  • Principle 6: Communication About Health Care Decisions Should Be Encouraged but Not Scripted by Law
  • Principle 7: Appropriate Safeguards to Protect Patients with Diminished Capacity Are Needed
  • Principle 8: Relief of Pain and Suffering Should Always Be Permitted and Considered an Important Goal of Care


July 27, 2014

New NINR Video Focuses on Preparing for the End of Life

A new video, co-produced by the National Institute of Nursing Research seeks to help people by answering one of life’s most sensitive questions: how can a person best prepare for the end of life? 



Developed to highlight content from NINR’s recently released End of Life module, the video stresses the importance of learning about end of life care options, which focus on comfort and quality of life.

NINR Director Dr. Patricia A. Grady, the featured speaker in the video, explains “A person can best prepare for the end of life by becoming informed. So many of us have questions about death and dying but hesitate to ask them. Our module provides comprehensive information about the many issues that can arise at the end, from the physical, emotional, and mental symptoms associated with dying to more practical concerns, such as where to find end-of-life care.”   

July 26, 2014

Following in the Errant Footsteps of the VA

The recent revelation of the crisis—and failure–of caregiving in the VA health system raises grave concerns for American health care in general and should motivate physician leaders to re-evaluate their approach to ethical health care. Until recently, the VA health system was a recognized leader in health care quality, patient safety and ethics, outperforming most American hospitals in these areas. It had also established an... // Read More »
July 25, 2014

Even after Tracey Decision, Unilateral & Covert DNR Orders Continue

Last month, the UK Court of Appeal confirmed that while clinicians do not need family consent to write a DNR order, they must at least consult with families before writing a DNR order on an incapacitated patient.   But a court decision does not c...
July 24, 2014

The upcoming debate over “CIRM 2”–CORRECTION

(I made an error about a past video involving the late actor Christopher Reeve in my post yetsterday. I strongly implied, at least, that such a video was used in the 2004 campaign for passage of California Prop. 71.  That would not be correct.  The video in question, easily found on YouTube, was aired [it indicates there] by Nuveen Investments during the 2000 Super Bowl.... // Read More »
July 24, 2014

Presidential Bioethics Commission 101

The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was formed by Congress and charged with identifying fundamental principles for research involving human volunteers. It completed its work and was ended in 1979. That commission is recognized as the first contemporary U.S. bioethics commission and since its formation, bioethics has […]
July 24, 2014

The Facebook Emotions Study

Over at my Business Ethics Blog, I just posted my thoughts on the recent controversy over the Facebook / Cornell study. I look at the question not of the ethics of the Cornell researchers, but of Facebook as a corporation I basically argue that: a) the risks involved were trivial; b) the commercial context matters, […]

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Published Articles (16)

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

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

Vaccine Mandates Are Justifiable Because We Are All in This Together John D. Lantos and Mary Anne Jackson

American Journal of Bioethics: Volume 13 Issue 8 - Aug 2013

Treating Patients as Persons: A Capabilities Approach to Support Delivery of Person-Centered Care Vikki A. Entwistle & Ian S. Watt

American Journal of Bioethics: Volume 13 Issue 8 - Aug 2013

Justice Between Age Groups: An Objection to the Prudential Lifespan Approach Nancy S. Jecker

American Journal of Bioethics: Volume 13 Issue 8 - Aug 2013

Global Aging and the Allocation of Health Care Across the Life Span Norman Daniels

AJOB Primary Research: Volume 4 Issue 2 - Apr 2013

Using the Best Interests Standard to Generate Actual Duties Loretta M. Kopelman

News (1968)

July 22, 2014 3:23 pm

Pregnancy doesn’t drive women doctors out of surgical training

A new study disputes a common stereotype that women who become pregnant during surgical training often drop out of those training programs.

June 18, 2014 2:52 pm

Stroke 'selfie' helps save Canadian woman's life

“The sensation is happening again,” Stacey Yepes tells the camera. “It’s all tingling on left side.”

June 16, 2014 4:37 pm

U.S. health care system ranks last among 11 industrialized nations

Even though it’s the most expensive, the United States’ health care system ranks last among 11 industrialized nations in a new study that examines factors such as quality, efficiency and access to care

May 5, 2014 6:44 pm

Deaths fell after Massachusetts healthcare overhaul: study

When Massachusetts blazed the trail of healthcare reform in 2006 by expanding coverage for the poor and requiring all residents to have health insurance, it may have done more than serve as a model for nationwide reform: it also seemed to save lives, according to a study released on Monday.

May 1, 2014 1:03 pm

Panel Says No to Medicare Coverage for Lung Cancer Screening

After a day’s deliberation, an advisory panel voted last night against recommending national Medicare coverage for annual screening for lung cancer with low-dose computed tomography (CT) in high-risk individuals.

April 25, 2014 1:53 pm

Higher Education Associated With Better Recovery From Traumatic Brain Injury

Better-educated people appear to be significantly more likely to recover from a moderate to severe traumatic brain injury (TBI), suggesting that a brain’s “cognitive reserve” may play a role in helping people get back to their previous lives, new Johns Hopkins research shows.

April 23, 2014 1:46 pm

Would you share your DNA info to advance medicine?

The provocative question of how “big data” will affect medicine and patient privacy is getting a lot of attention at the National Institutes of Health.

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.

March 25, 2014 2:53 pm

Marijuana pills and sprays ease MS symptoms

There is no cure for the condition, and therapies have proven difficult, as many have serious side effects. But now, relief may come in the form of a medical marijuana pill.

March 5, 2014 3:04 pm

Planned Parenthood, Tucson gynecologist, fighting tighter regulations on abortion drugs

Planned Parenthood and a Tucson gynecologist are asking a federal judge to block new rules that will sharply restrict ability to perform abortions using drugs instead of surgery.

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