Hot Topics: Health Care

Blog Posts (3493)

October 20, 2016

Board of the Network selects the Chairperson and Co-Chairpersons

On 16 October 2016, Board members composed of country focal points and the secretariat met in Cairo and discussed the structure and function of the BiNWIAR. They reviewed activities of the network carried out since 2011, discussed the way to … Continue reading
October 19, 2016

The Oxford Handbook of Ethics at the End of Life

I just received my hard copy of The Oxford Handbook of Ethics at the End of Life.  I am delighted to be a part (see chapter five on futility) of this fantastic anthology.  Here is the complete table of contents.

Stuart J. Youngner and Robert M. Arnold

Legal Issues in Death and Dying: How Rights and Autonomy Have Shaped Clinical Practice
Alan Meisel

“So What Do You Want Us to Do?”: Patients’ Rights, Unintended Consequences, and the Surrogate’s Role
Mark P. Aulisio

Death at the Beginning: The Neonatal Intensive Care Unit
Renee D. Boss

Dying Children and the Kindness of Strangers
John D. Lantos

Medical Futility and Potentially Inappropriate Treatment
Douglas B. White and Thaddeus M. Pope

Conscientious Objection
Mark R. Wicclair

Continuous Sedation at the End of Life
Sigrid Sterckx and Kasper Raus

The Ethics of Medically Assisted Nutrition and Hydration at the End of Life: Separating the Wheat from the Chaff
Daniel P. Sulmasy

Disorders of Consciousness and Neuro-Palliative Care: Toward an Expanded Scope of Practice for the Field
Joseph J. Fins and Maria G. Master

Ethical Issues in Prognosis and Prognostication
Alexander K. Smith and Paul Glare

The Smell of Chlorine: Coming to Terms with Death
Stuart J. Youngner

Talking and Working with Dying Patients: True Grief and Loss
Lisa Humphrey

The Nature of Suffering
Eric J. Cassell

On Our Difficulties Speaking to and About the Dying
David Barnard

The Cost of Dying Among the Elderly in the United States: Ethical Issues
Susannah L. Rose and Janelle Highland

Death, Dying, and the Disabled
Anita Silvers and Leslie P. Francis

The Effect of Social Media on End-of-Life Decision Making
Jessica Berg

Cultural Factors
Megan Crowley-Matoka

Ethnicity as a Factor
Kimberly S. Johnson and Ramona L. Rhodes

Reframing Care in End-of-Life Care Helpful Themes from a Catholic-Christian Understanding of Death
Michael McCarthy and Mark Kuczewski

Physician-Assisted Death in the Netherlands
Gerrit Kimsma

The Case Against Physician-Assisted Suicide and Euthanasia
Ira Byock

Goodbye, Thomas: The Case for Physician-Assisted Dying
Margaret P. Battin

Depression and the Desire to Die Near the End of Life
Nathan Fairman and Scott A. Irwin

Hospice and Palliative Care: Developments, Differences, and Challenges
David Clark

Potential Perils to the Promise of Specialty Palliative Care
Robert M. Arnold

Marketing Palliative Care
Bridget Tracy and Rolfe Sean Morrison

October 19, 2016

Copay Assistance Controversy Continues

My article with Peter Bach of Memorial Sloan Kettering continues to generate debate. The two of us argues that copay assistance programs from pharmaceutical companies help specific patients in the short run, but make it easier for drug companies to … Continue reading

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October 18, 2016

Ideals and Inadequacies: Living the Physician’s Vocation

By Amy Blair I was not sure I wanted to be a physician when I stood in front of the dark blue US mail box on the street corner of my college campus, one hand on the door handle and the other on my neatly typed applications, hesitant to let them go. I wanted an […]
October 18, 2016

Fordham Study Addresses Health Care of Bisexual Adolescent Girls

For bisexual female adolescents,  proper sexual healthcare is difficult to obtain due to healthcare providers’ judgmental attitudes and assumptions of patient heterosexuality, and lack of opportunities for HIV and sexually transmitted infections (STI) testing. Additionally, youth openness with healthcare providers is restricted due … Continue reading
October 18, 2016

Margot Bentley - VSED Denied

In our 200+ participant conference on VSED, this weekend, we had 10 sessions with around 40 presenters.  But we had only one standing ovation: for Katherine Hammond's compelling presentation on her mother, Margot Bentley.  

The photo below attests to Margot Bentley’s vegetative condition. In the advance directive she signed when she was healthy, Margot asked that she not be fed or nourished if she developed an incurable condition. The document is neither recognized by the courts nor the nursing home.

The case is back in the news, because a care provider breached confidentiality to comment during the last round of media coverage.  

October 18, 2016

“Introducing New Guide to Democratic Deliberation for Public Health Ethics Professionals”

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has released a set of new educational materials focused on democratic deliberation in public health ethics. This set of training materials builds on the content of the Bioethics Commission’s report, Bioethics for Every Generation: Deliberation and Education in Health, Science, and Technology.
October 17, 2016

Ethically Sound Episode 6: New Directions

The Presidential Commission for the Study of Bioethical Issues bioethics_twitter-v3-08(Bioethics Commission) has released the sixth episode, "New Directions", in its new podcast series Ethically Sound. This podcast series is dedicated to bringing the Bioethics Commission’s body of work to a broad audience. The Bioethics Commission, established in 2009 by President Bara ck Obama, has produced 10 reports, each of which focuses on key ethical considerations surrounding a particular topic. Today’s episode is based on the Bioethics Commission’s first report, New Directions: The Ethics of Synthetic Biology and Emerging Technologies.
October 17, 2016

DNR without Consent in British Columbia - Zaixing Wang

A new case in British Columbia is reminiscent of
the many Ontario cases brought by Joy Wawrzyniak on behalf of her father Douglas DeGuerre.

Clinicians refused to resuscitate Zaixing Wang, because a doctor had written a DNR order on his medical chart.  His daughter never consented to the order and never even understood that one would be written.

But the attending physician told two review panels that he had explained his treatment plan to the family, including putting a DNR order on Wang’s chart in the event of “acute cardiopulmonary deterioration,” given his “poor pulmonary reserve.”

In the recently completed reviews, both the College of Physicians and Surgeons and Vancouver Coastal Health Authority’s Patient Care Quality Office accepted Lau’s statement that he had that conversation with the family.

This case may illustrated the challenge with obtaining only "assent" rather than consent when writing a DNR order on the basis of medical futility.  The family may not understand that clinicians will automatically implement the announced plan.

October 15, 2016

VSED - Hastening Death by Stopping Eating & Drinking

Today, we completed a two-day conference on VSED in Seattle. Compared to aid-in-dying, VSED has been the Cinderella of end-of-life research, largely neglected. This >200 participant conference is the first anywhere specifically focused on the...

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Published Articles (33)

American Journal of Bioethics: Volume 16 Issue 11 - Nov 2016

Diagnosis by Documentary: Professional Responsibilities in Informal Encounters Alistair Wardrope & Markus Reuber

American Journal of Bioethics: Volume 16 Issue 11 - Nov 2016

The Ethics of Organ Donor Registration Policies: Nudges and Respect for Autonomy Douglas MacKay & Alexandra Robinson

American Journal of Bioethics: Volume 16 Issue 11 - Nov 2016

Autonomy by Default Cass R. Sunstein

American Journal of Bioethics: Volume 16 Issue 10 - Oct 2016

War Metaphors in Health Care: What Are They Good For? Kayhan Parsi

American Journal of Bioethics: Volume 16 Issue 9 - Sep 2016

The Importance of Fostering Ownership During Medical Training Alex Dubov, Liana Fraenkel & Elizabeth Seng

American Journal of Bioethics: Volume 16 Issue 9 - Sep 2016

Owning Medical Professionalism Jon C. Tilburt & Richard R. Sharp

AJOB Primary Research: Volume 7 Issue 3 - Jul 2016

Religious identity and workplace discrimination: A national survey of American Muslim physicians Aasim I. Padela, Huda Adam, Maha Ahmad, Zahra Hosseinian & Farr Curlin

AJOB Primary Research: Volume 7 Issue 3 - Jul 2016

Improving third-year medical students' competency in clinical moral reasoning: Two interventions Paul J. Cummins, Katherine J. Mendis, Robert Fallar, Amanda Favia, Lily Frank, Carolyn Plunkett, Nada Gligorov & Rosamond Rhodes

AJOB Primary Research: Volume 7 Issue 3 - Jul 2016

Experimental evidence showing that physician guidance promotes perceptions of physician empathy Daniel Russell Hans, Priyanka Dubé & Jason Adam Wasserman

American Journal of Bioethics: Volume 16 Issue 8 - Aug 2016

The Curious Case of the De-ICD: Negotiating the Dynamics of Autonomy and Paternalism in Complex Clinical Relationships Daryl Pullman & Kathleen Hodgkinson

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News (2047)

October 19, 2016 8:00 am

The drug industry’s answer to opioid addiction: More pills (Washington Post)

Cancer patients taking high doses of opioid painkillers are often afflicted by a new discomfort: constipation. Researcher Jonathan Moss thought he could help, but no drug company was interested in his ideas for relieving suffering among the dying.

October 18, 2016 8:00 am

DNA’s new ‘miracle’: How adoptees are using online registries to find their blood relatives (Washington Post)

Last year, Bob Nore, a Vietnam War veteran in Huntsville, Ala., was working on a family tree and wanted to trace his ancestors’ history and origins. So he sent a vial of saliva and $89 to a DNA registry for analysis.

October 17, 2016 8:00 am

Comparison of Physician and Computer Diagnostic Accuracy (JAMA)

The Institute of Medicine recently highlighted that physician diagnostic error is common and information technology may be part of the solution.1 Given advancements in computer science, computers may be able to independently make accurate clinical diagnoses.2 While studies have compared computer vs physician performance for reading electrocardiograms,3 the diagnostic accuracy of computers vs physicians remains unknown. To fill this gap in knowledge, we compared the diagnostic accuracy of physicians with computer algorithms called symptom checkers.

October 14, 2016 4:47 pm

Doctors Significantly Better Than Google, According To New Research (Huffington Post)

Doctors are much better than symptom-checker programs at reaching a correct diagnosis, though the humans are not perfect and might benefit from using algorithms to supplement their skills, a small study suggests.

October 13, 2016 8:00 am

Major Investor Sues Theranos (WSJ)

One of Theranos Inc.’s biggest financial backers has sued the embattled startup and its founder for allegedly lying to attract its nearly $100 million investment, according to a fund document and people familiar with the matter.

October 12, 2016 8:00 am

Excuse Me, Why Are You Wearing Those Surgical Scrubs Outside The Hospital? (WBUR)

I work in Boston’s Longwood Medical Area, one of the densest concentrations of hospitals in the country, and I often have this reaction when I’m out on the street among my work neighbors: “Dude. Ew.”

October 7, 2016 8:00 am

This 8-year-old is free of cancer — for now — after a ‘breakthrough’ treatment (Washington Post)

By the time 8-year-old Ava Christianson got to the National Institutes of Health this summer, she had lost several grueling rounds to leukemia and was bracing for the next one.

October 5, 2016 8:00 am

How We Got Here: Treating Addiction In 28 Days (NPR)

Louis Casanova is playing cards with a friend on the back deck of a recovery house in Philadelphia’s northern suburbs.

October 3, 2016 8:00 am

Furor Over Drug Prices Puts Patient Advocacy Groups in Bind (NY Times)

Public anger over the cost of drugs has burned hot for a year, coursing through social media, popping up on the presidential campaign, and erupting in a series of congressional hearings, including one last week over the rising price of the allergy treatment EpiPen.

September 29, 2016 8:00 am

Depression, daily stressors and inflammatory responses to high-fat meals: when stress overrides healthier food choices (Nature)

Depression, stress and diet can all alter inflammation. This double-blind, randomized crossover study addressed the impact of daily stressors and a history of major depressive disorder (MDD) on inflammatory responses to high-fat meals. During two separate 9.5 h admissions, 58 healthy women (38 breast cancer survivors and 20 demographically similar controls), mean age 53.1 years, received either a high saturated fat meal or a high oleic sunflower oil meal. The Daily Inventory of Stressful Events assessed prior day stressors and the Structured Clinical Interview for DSM-IV evaluated MDD. As expected, for a woman with no prior day stressors, C-reactive protein (CRP), serum amyloid A (SAA), intercellular adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) were higher following the saturated fat meal than the high oleic sunflower oil meal after controlling for pre-meal measures, age, trunk fat and physical activity. But if a woman had prior day stressors, these meal-related differences disappeared—because the stressors heightened CRP, SAA, sICAM-1 and sVCAM-1 responses to the sunflower oil meal, making it look more like the responses to the saturated fat meal. In addition, women with an MDD history had higher post-meal blood pressure responses than those without a similar history. These data show how recent stressors and an MDD history can reverberate through metabolic alterations, promoting inflammatory and atherogenic responses.

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