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Blog Posts (3212)

June 28, 2016

Physicians More Willing to Administer Futile Treatment Requests when Based on Religion

The June 2016 issue of the Journal of Pain & Symptom Management includes "U.S. Physicians’ Opinions About Accommodating Religiously   Based Requests  for  Continued  Life-Sustaining Treatment."

The authors report survey results showing that physicians appear to give more deference to requests that are linked in a clear way to religious commitments.

In contrast, physicians give less deference to expectations for a miracle.  While religious claims fall outside physician expertise, hope  for miracles seem more arbitrary and idiosyncratic and counterclaim physician medical authority.

June 27, 2016

Legal Standards for Brain Death under Attack

My new article, "Legal Standards for Brain Death" was just published in the Journal of Bioethical Inquiry, 13(2), 173-178 (2016). A major appellate court decision from  the United States seriously questions the legal sufficiency of prevailin...
June 26, 2016

Pain-Capable Abortion Bans

More than three decades ago, I went to visit a friend who was hospitalized at NIH in Bethesda, Maryland. On the way from the parking lot to her room, I encountered a group of animal rights activists protesting the use of animals in medical research. To this day I vividly remember the chant they repeated again and again: “A cat is a rat is a... // Read More »
June 26, 2016

Parliamentary Committee Recommends Protection for Physicians Withdrawing Futile Treatment

The Parliament of Victoria Legal and Social Issues Committee recently released a 350-page report, "Inquiry into End of Life Choices."  It is heavily focused on palliative care, advance care planning, and assisted dying.   Recommendation 29 c...
June 25, 2016

Support Medical Futility Blog

I am preparing to move this blog to its own new top-level domain.   If you find the content useful, please consider making a small donation.
June 24, 2016

Zeke Emanuel May Not Be Right This Time: Increasing Costs Will Probably Not Slow Antibiotic Resistance

Ezekiel J. (Zeke) Emanuel, MD, PhD, is chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. On May 30, 2016, the Washington Post published an opinion piece by Dr. Emanuel titled “Want to Win $2 Billion? Create the Next Antibiotic.”

In the article, Dr. Emanuel makes two key points: (1) the low cost of antibiotics may be one of the principal factors that have led to doctors over-prescribing these drugs; (2) the low cost of antibiotics with the resulting low rate of return on investment for pharmaceutical companies dis-incentivizes drug manufacturers from allocating more resources for the research and development of new antibiotics to combat evolving “superbugs” (bacteria resistant to current antibiotics). He offers ideas to help solve the problem including: (1) mandating that all hospitals create antibiotic stewardship programs to monitor antibiotic use within institutions; (2) require that all antibiotic prescriptions written be reviewed to assure that the prescribing is warranted according to national guidelines; (3) increasing the charges for antibiotics; and (4) creating a $2 billion prize with additional taxes or surcharges to be awarded to individuals or entities that develop new antibiotics to counter identified microbial threats.

One should be very careful in challenging any suggestions Dr. Emanuel might make – after all he is an internationally recognized health policy and medical ethics expert – but in this case I think he is mistaken about issues and that his ideas may have unintended negative consequences that will make matter worse.

Decades years ago, antibiotics were far more expensive than they are today. Loss of patent protection and generic substitutes have substantially lowered antibiotic costs. But the cost of the antibiotics a few years back had little to do with the development of resistant organisms. One might argue that antibiotics perhaps are far more readily available than is good for man. (One example is farmers using antibiotics to improve their beef cattle and dairy herds.) Antibiotic resistance is as evitable as natural selection; resistance evolves from appropriate and inappropriate use.

Without question, antibiotics are too freely used and are unnecessarily available. The Centers for Disease Control and Prevention has estimated that over half of the outpatient antibiotic prescriptions written are medically unnecessary. Some might suggest that they be available without prescription. If it were safer to use antibiotics without proper provider oversight, certainly they would be marketed as over-the-counter drugs in the US. But with evolving resistance, it is also apparent that antibiotics should be accessible only with better foresight and oversight.

But even if we in the United States were to dramatically curtail antibiotic use by prescribing drugs more appropriately, one should still ask “What about the rest of the world?” The US has 4% of the world’s population. In the US (and more developed countries), we are very concerned about the availability of antibiotics and appropriate use; but most of the world is not. Antibiotics are readily available in Central and South America and Asia and Africa without a prescription. Clearly resistant organisms will continue to evolve in the world whether we decrease the rate of resistance in the US or not. Moreover, the more recent worldwide epidemic health scares have been from viruses – Ebola, Zika, and Chikungunya – for which antibiotics are of no help.

The very best strategy in combating resistant organisms remains prescribing antibiotics appropriately. Successful ideas to help prescribe antibiotics more appropriately have been proposed. Somehow, we need to get providers to practice evidence-based medicine. Of course, we should be doing this in every aspect of providing care, not just in prescribing antibiotics. Our primary ethical obligation as providers is to practice competently. Radical ideas – like increasing the cost of antibiotics, mandating that all hospitals have antibiotic stewardship programs, asking more knowledgeable peers to review every single antibiotic prescription, and taxing Medicare hospitals to create prize money to award successful antibiotic developers – may work; but the formula seems too extreme. If we need peers watching everything that other providers do, is this really the solution that will assure best practice over the long haul?

June 24, 2016

Doctors Can’t Be Trusted to Tell Patients Whether They Should Receive Robotic Surgery

Patients often rely on physicians for information about their treatment alternatives. Unfortunately, that information is not always objective. Consider a man with early stage prostate cancer interested in surgical removal of his tumor, but uncertain whether it is better for … Continue reading

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June 24, 2016

Christ Disputing with the Doctors

This painting (National Gallery of Scotland) from the 1400s depicts "Christ Disputing with the Doctors."  The conflict between religion and medicine is a common theme in many recent brain death and futility conflicts.  
June 23, 2016

Santa Claus Revives Dead Children

I was surprised to see this Gerard David painting at the National Gallery of Scotland.  The 1510 painting from the Netherlands depicts St. Nicholas dressed as a bishop reviving three boys who had been murdered and salted down for meat during a fam...
June 22, 2016

Balancing the benefits and harms of advances in medical technology

Last week I had the opportunity to attend the annual summer conference of the Center for Bioethics and Human Dignity. This year’s conference was titled Transformations in Care, and it was focused on how medical care is changing and the ethical challenges that go along with those changes. As usual, the conference was excellent with thought-provoking speakers and interesting workshops and paper presentations. One of... // Read More »

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Published Articles (22)

American Journal of Bioethics: Volume 16 Issue 1 - Jan 2016

Professional Judgment and Justice: Equal Respect for the Professional Judgment of Critical-Care Physicians David Magnus & Norm Rizk

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

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News (2017)

June 28, 2016 8:31 am

End-Of-Life Care Better For Patients With Cancer, Dementia: Study Finds (Kaiser Health News)

A new study offers surprising findings about end-of-life care — specifically, physicians tend to be more likely to accommodate the advanced-care wishes of patients with cancer or dementia than renal disease, congestive heart failure, pulmonary disease or frailty.

June 9, 2016 7:59 am

White Male Doctors Are Paid Way More Than Blacks and Women (Time)

Far too often, a person’s sex or skin color is connected to how much he or she earns—even in the reputationally well-paying field of medicine, finds a new study published in The BMJ. Men make more than women, and white male doctors typically earn about $60,000 more than black male doctors.

June 2, 2016 9:51 am

We’re spending $107 billion on cancer drugs, but is it worth it? (Washington Post)

A flood of innovative cancer treatments helped fuel an 11.5 percent surge in spending on oncology drugs over the past year — to $107 billion globally, according to a new report. But there’s a crucial question the study can’t quite answer: How much are patients benefiting from this expanding arsenal of high-priced drugs?

June 1, 2016 8:00 am

Why taking morphine, oxycodone can sometimes make pain worse (Science)

There’s an unfortunate irony for people who rely on morphine, oxycodone, and other opioid painkillers: The drug that’s supposed to offer you relief can actually make you more sensitive to pain over time.

May 31, 2016 8:41 am

Infection Raises Specter of Superbugs Resistant to All Antibiotics (New York Times)

American military researchers have identified the first patient in the United States to be infected with bacteria that are resistant to an antibiotic that was the last resort against drug-resistant germs.

May 24, 2016 8:36 am

Just 5% of Terminally-Ill Cancer Patients Fully Understand Prognosis, Study Finds (ABC News)

Just a fraction of terminally-ill cancer patients fully understood their prognosis according to a new small study published today in the Journal of Clinical Oncology.

May 17, 2016 8:29 am

Should Your Doctor Ask If You Own Guns? (Time)

Doctors routinely ask if you smoke, and counsel you to wear your seat belt when you’re in a car. Technically, either behavior isn’t any of their business, but they do fall under the umbrella of preventive care. Now Dr. Garen Wintemute, director of the violence prevention research program at the University of California Davis, and his colleagues want to add firearms to the office visit for similar reasons.

May 13, 2016 8:41 am


Andrew Levy’s parents knew that the rare and deadly cancer in his blood could not be
beaten, so they began to prepare for the worst. Then something mysterious happened.

May 4, 2016 9:44 am

Medical errors may be third leading cause of death in the U.S. (CNN)

You’ve heard those hospital horror stories where the surgeon removes the wrong body part or operates on the wrong patient or accidentally leaves medical equipment in the person they were operating on. Even scarier, perhaps, is a new study in the latest edition of BMJ suggesting most medical errors go unobserved, at least in the official record.

May 3, 2016 10:11 am

For Hospitals, Prestige Leads To Profits (Kaiser Health News)

When it comes to hospitals, which benefit most from high health care prices? It may sound counter-intuitive, but a group of not-for-profit hospitals appear to be among those doing the best business.

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