Hot Topics: Health Care

Blog Posts (5508)

October 12, 2018

Ending Medical Self-Regulation: Does Less Physician Control Improve Patient Safety and Protect Patient Rights?

Here is video from a webinar that I did at Michigan State University Center for Ethics and Humanities in the Life Sciences on Wednesday. The title is "Ending Medical Self-Regulation: Does Less Physician Control Improve Patient Safety and Protect ...
October 11, 2018

Patient Dignity (Formerly: Patient Modesty): Volume 92

"Modesty is Not About Hiding Your Body. It's About Revealing Your Dignity"What I wrote in Volume 91 detailing  this expression:In other words "hiding your body" is a component of "dignity", a concept that is worthy of reminding those in the medica...
October 11, 2018

Shared Decision Making & Advance Care Planning: Using Decision Aids to Improve Patient Safety

Thank you ACP Michigan for inviting me to speak with passionate advance care planning professionals about "Shared Decision Making & Advance Care Planning: Using Decision Aids to Improve Patient Safety."
October 10, 2018

What I Practice: Democratic Medicine

When people ask me what kind of medicine I practice, I most often say family medicine. Now, however, I am also apt to say I practice “democratic medicine.” What is democratic medicine? Less a style than a way of being, it embodies five principles born of democratic values related to history, duty, community, citizenship, and… Read more

The post What I Practice: Democratic Medicine appeared first on The Hastings Center.

October 10, 2018

“OFF THE PAGE” — A READING FROM THE BELLEVUE LITERARY REVIEW

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October 10, 2018

A Response to Alumni Disappointed in Stritch’s Support for DACA

By Sunny Nakae In May the Stritch alumni magazine published a cover feature article about our first cohort of DACA recipients admitted to the Loyola University Chicago Stritch School of Medicine and their impending graduation.  We received both positive and negative correspondence about this feature.  What follows is a compilation of complaints I received from […]
October 10, 2018

A Response to Alumni Disappointed in Stritch’s Support for DACA

By Sunny Nakae In May the Stritch alumni magazine published a cover feature article about our first cohort of DACA recipients admitted to the Loyola University Chicago Stritch School of Medicine and their impending graduation.  We received both positive and negative correspondence about this feature.  What follows is a compilation of complaints I received from […]
October 9, 2018

Federal Appellate Court Allows Lawsuit for Unilateral DNR

The U.S. Court of Appeals for the 11th Circuit has affirmed the partial denial of a prison warden's motion to dismiss a lawsuit brought by an inmate's family after the warden unilaterally entered a do not resuscitate order and directed removal from artificial life support.

Marquette F. Cummings, Jr. was an inmate at St. Clair Correctional Facility in Springville, Alabama. He was seriously stabbed in the eye and was airlifted  to University of Alabama at Birmingham Hospital.

His family filed a federal lawsuit based on the following conduct at the hospital. Dr. Sherry Melton, a medical supervisor at UAB Hospital, changed Cummings's code status to Do Not Resuscitate without authorization from Gaines or any other family member and without notifying Gaines and Cummings's family of the decision.

Plaintiffs allege that Dr. Melton relied upon statements from the St. Clair warden to change Cummings's code status to DNR even though Gaines and several other family members were at the hospital. Plaintiffs further allege that “Warden Davenport authorized UAB medical personnel to stop giving Cummings medication and to disconnect the life support machine.” Plaintiffs allege that contrary to Gaines's wishes, and “[b]ased on [the] directive from Warden Davenport, Cummings was taken off of life support....” Cummings passed away just hours after UAB medical personnel removed his life support.

Finding that the warden lacked any authority under Alabama law to make those treatment decisions, the court found the warden was not entitled to qualified immunity, and denied the warden's motion to dismiss the Estate's § 1983 claim based on Warden Davenport's alleged deliberate indifference to Cummings's serious medical need in violation of the Eighth Amendment.



October 9, 2018

Federal Appellate Court Allows Lawsuit for Unilateral DNR

The U.S. Court of Appeals for the 11th Circuit has affirmed the partial denial of a prison warden's motion to dismiss a lawsuit brought by an inmate's family after the warden unilaterally entered a do not resuscitate order and directed removal from artificial life support.

Marquette F. Cummings, Jr. was an inmate at St. Clair Correctional Facility in Springville, Alabama. He was seriously stabbed in the eye and was airlifted  to University of Alabama at Birmingham Hospital.

His family filed a federal lawsuit based on the following conduct at the hospital. Dr. Sherry Melton, a medical supervisor at UAB Hospital, changed Cummings's code status to Do Not Resuscitate without authorization from Gaines or any other family member and without notifying Gaines and Cummings's family of the decision.

Plaintiffs allege that Dr. Melton relied upon statements from the St. Clair warden to change Cummings's code status to DNR even though Gaines and several other family members were at the hospital. Plaintiffs further allege that “Warden Davenport authorized UAB medical personnel to stop giving Cummings medication and to disconnect the life support machine.” Plaintiffs allege that contrary to Gaines's wishes, and “[b]ased on [the] directive from Warden Davenport, Cummings was taken off of life support....” Cummings passed away just hours after UAB medical personnel removed his life support.

Finding that the warden lacked any authority under Alabama law to make those treatment decisions, the court found the warden was not entitled to qualified immunity, and denied the warden's motion to dismiss the Estate's § 1983 claim based on Warden Davenport's alleged deliberate indifference to Cummings's serious medical need in violation of the Eighth Amendment.



October 9, 2018

Film Series: Watching Big Fish Next to My Mother in the Hospital

Now, this is an interesting coincidence, as I was watching “Big Fish” on Amazon Video whilst visiting my mother during her last week in this world.  I was summoned to Portland by my physician brother who told me that my mother was dying.  She had been ill and we expected her to pass a year ago, but she rallied and was discharged from hospice.  But now, she was having another heart attack and we had decided that with her progressive dementia and renal failure, she would not undergo dialysis.  We had this discussion with her before the first heart attack and she had agreed with the plan.  She was lucid enough to understand the consequences of this decision.  As she became progressively more demented, we confirmed with another discussion.  She felt that her life was complete and she was ready to go.  My father had passed away 6 years ago, and most of their friends had died.  She had suffered increasing dementia, complete deafness and renal failure.  She was struggling to maintain her dignity with loss of control of her life and basic bodily functions.  The heart failure was going to be the last straw.

I watched the movie whilst she was sleeping and was actually surprised that there was not much discussion about this kind of stuff in this movie. This is a story about a young man who is coming to terms with the tales that his father told him when he was young.  The son thought that the stories were just that, stories, and he did not respect his father  as he perceived them as lies.  Towards the end of the movie, he finally comes to terms with his father’s identity through these stories, which were at least partially true and perhaps a little exaggerated.  His father then dies and becomes the “Big Fish” that haunts the waters of the local river.  Was it symbolic that the fish got away?

So was this intentional, leaving out the elephant in the room.  It was implied through the whole movie that the father was dying.  He did not talk about his feelings, his love, legacy and his wishes for the living.  They certainly did not talk about invasive therapy and life support.  Maybe, if they did, no one will watch the movie.  At any rate, it seems like such a different death than the one I was witnessing.  We discussed all these things as a family with my mother.  She also had lived an amazing life, surviving the Japanese occupation in China, the communist takeover, decades in the Middle East and watching her children vanish into the West, another “Big Fish” story, but this one did not get away.


* Written by Jane Lombard, MD, MBA a board member with the Center for Practical Bioethics. 

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Bioethics Film Series

From reproduction to end of life, bioethical issues affect all of us. What better and more fun way to think about them than film? 

The Center for Practical Bioethics is thrilled to partner with the Tivoli Cinema in Kansas City to present the Bioethics Film Series featuring three iconic films. 

Following screenings at 7:00 pm, Center staff will lead discussion of each film’s major themes. Tickets may be purchased from the Tivoli in advance or at the door (Adults $9, Students $7)


Big Fish
Thursday, October 11, 2018
7:00pm


Tivoli Cinemas 

4050 Pennsylvania 

Kansas City, MO 64111


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Published Articles (86)

AJOB Neuroscience: Volume 18 Issue 3 - Sep 2018

Telling the Truth About Pain: Informed Consent and the Role of Expectation in Pain Intensity Nada Gligorov

AJOB Neuroscience: Volume 18 Issue 3 - Sep 2018

Punishing Intentions and Neurointerventions David Birks & Alena Buyx

American Journal of Bioethics: Volume 18 Issue 9 - Sep 2018

The Ethics of Smart Pills and Self-Acting Devices: Autonomy, Truth-Telling, and Trust at the Dawn of Digital Medicine Craig M. Klugman, Laura B. Dunn, Jack Schwartz & I. Glenn Cohen

American Journal of Bioethics: Volume 18 Issue 8 - Aug 2018

When Parents Refuse: Resolving Entrenched Disagreements Between Parents and Clinicians in Situations of Uncertainty and Complexity Janine Penfield Winters

American Journal of Bioethics: Volume 18 Issue 8 - Aug 2018

The Harm Principle Cannot Replace the Best Interest Standard: Problems With Using the Harm Principle for Medical Decision Making for Children Johan Christiaan Bester

American Journal of Bioethics: Volume 18 Issue 8 - Aug 2018

Are Organ Donors Really Dead: The Near-Irrelevance of Autoresuscitation Robert M. Veatch

AJOB Primary Research: Volume 9 Issue 2 - Jun 2018

Cross-cultural perspectives on decision making regarding noninvasive prenatal testing: A comparative study of Lebanon and Quebec Hazar Haidar, Meredith Vanstone, Anne-Marie Laberge, Gilles Bibeau, Labib Ghulmiyyah & Vardit Ravitsky

AJOB Primary Research: Volume 9 Issue 2 - Jun 2018

How acceptable is paternalism? A survey-based study of clinician and nonclinician opinions on paternalistic decision making Kunal Bailoor, Thomas Valley, Chithra Perumalswami, Andrew G. Shuman, Raymond DeVries & Darin B. Zahuranec

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

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

AJOB Neuroscience: Volume 9 Issue 1 - Mar 2018

Disorders of Consciousness, Agency, and Health Care Decision Making: Lessons From a Developmental Model Megan S. Wright, Claudia Kraft, Michael R. Ulrich & Joseph J. Fins

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News (2112)

October 12, 2018 9:00 am

The approach to predictive medicine that is taking genomics research by storm (Nature)

Polygenic risk scores represent a giant leap for gene-based diagnostic tests. Here’s why they’re still so controversial.
October 3, 2018 9:00 am

How Stratification Unites Ethical Issues in Precision Health (AMA Journal of Ethics)

The contributors to this issue address many of the ethical issues that arise in the context of precision health. Although none addresses the idea of stratification directly, the concept of stratification links their contributions together, since stratification is the basis of all precision health efforts. Stratification has only rarely been explored as a concept with ethical fallout and is often downplayed in favor of the label “precision.” Therefore, this editorial lays out how the ethical issues explored by our contributors and in precision health more broadly are united and organized by the concept of stratification.

October 2, 2018 3:47 pm

AAMC Statement on Proposed Changes to Public Charge Rule (AAMC)

The AAMC issued a statement on the Department of Homeland Security’s proposed changes to how and whether immigrants can be classified as a public charge. “The AAMC and the nation’s medical schools and teaching hospitals are opposed to any policy that discourages people from pursuing medical care to which they are legally entitled. The proposed new rule would create a system where individuals are penalized for using health programs for which they legally qualify and could cause them to forgo crucial medical care, bringing with it all the health consequences that could follow. Teaching hospitals treat a disproportionate share of Medicaid patients, and we know from firsthand experience that access to care is key to ensuring that the nation’s patients have the stability and continuity of care that leads to better health outcomes,” said AAMC President and CEO Darrell G. Kirch, MD.
September 25, 2018 9:00 am

Veterans Struggling After Sexual Assault Increasingly Turn To Service Dogs (NPR)

Service dog providers are seeing an influx of applications from veterans like Michel who have experienced sexual trauma while in the military. But the U.S. Department of Veterans Affairs, which provides veterinary benefits for service dogs assigned to people with physical disabilities, does not currently recognize psychiatric service dogs as a proven therapy for mental illness.

September 20, 2018 6:00 am

Are We Being Misled About Precision Medicine? (The New York Times)

Doctors and hospitals love to talk about the cancer patients they’ve saved, and reporters love to write about them. But deaths still vastly outnumber the rare successes.

September 14, 2018 2:00 am

Drug executive: It's a 'moral requirement' to charge patients the highest price (Los Angeles Times)

In his interview with the Financial Times published Tuesday, Mulye defended Martin Shkreli, the former drug company CEO who became the face of the industry’s profiteering in 2015 when he jacked up the price of a generic anti-parasitic drug needed by HIV patients by more than 5,000%. “I agree with Martin Shkreli that when he raised the price of his drug he was within his rights because he had to reward his shareholders,” Mulye told the FT. (Shkreli is currently serving a prison term on fraud charges unrelated to the price hike.)

September 12, 2018 9:00 am

Hospitals are fed up with drug companies, so they’re starting their own (The Washington Post)

A group of major American hospitals, battered by price spikes on old drugs and long-lasting shortages of critical medicines, has launched a mission-driven, not-for-profit generic drug company, Civica Rx, to take some control over the drug supply.

September 10, 2018 9:00 am

At $1,650 per month, the first digital pill will soon roll out to certain Medicaid patients with mental illness (STAT)

The first digital pill will carry a price tag of $1,650 per month and soon be rolled out commercially to the first patients: people with mental illness covered by Medicaid, likely in regions including Florida and Virginia.

September 6, 2018 1:34 am

Insulin's High Cost Leads To Lethal Rationing (NPR)

Diabetic ketoacidosis is a terrible way to die. It’s what happens when you don’t have enough insulin. Your blood sugar gets so high that your blood becomes highly acidic, your cells dehydrate, and your body stops functioning. Diabetic ketoacidosis is how Nicole Smith-Holt lost her son. Three days before his payday. Because he couldn’t afford his insulin.

August 30, 2018 9:00 am

Open Medical Records Can Spur Frank Talk Between Doctors And Patients (NPR)

Theoretically, American patients have been able to see what doctors write about them for years. The Health Information Portability and Accountability Act, a 1996 law known as HIPAA, protects a patient’s right to see and get a copy of personal health records. In practice, though, formal records requests can take weeks to process and few patients take advantage of the option.A growing movement is using technology to try to change that. What started as an academic experiment has now become the norm at an increasing number of health care systems across the country: When doctors sign their notes, a copy is automatically visible to patients online.

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