Hot Topics: Health Care

Blog Posts (4708)

November 16, 2017

Love This Picture

I had the great pleasure of talking about out-of-pocket healthcare costs at Periodic Tables: Durham’s Science Café, a speaker series run by The Program for Science and Society at Duke University. The crowd was absolutely awesome, and much larger than … Continue reading

The post Love This Picture appeared first on PeterUbel.com.

November 15, 2017

Obesity Nation!

Here is a picture, courtesy of the Financial Times, showing obesity rates among OECD nations. Only 5% of people living in Korea and Japan qualify as obese. Yet obesity rates are drastically higher in the United States; if someone’s in … Continue reading

The post Obesity Nation! appeared first on PeterUbel.com.

November 15, 2017

Communicating about cancer: a need for a closer look at Patient Empowerment

This post is written in response to Ubel, Scherr and Fagerlin’s target article, “Empowerment Failure: How Shortcomings in Physician Communication Unwittingly Undermine Patient Autonomy” published in the November 2017 issue of The American Journal of Bioethics.

November 14, 2017

Legal History of Medical Aid in Dying (video)

Here is a video of my presentation of the University of New Mexico Law School, "Legal History of Medical Aid in Dying." Other talks at UNM on MAID and on the role of state constitutions are here.   
November 14, 2017

Fordham University Ethics & Society Master’s Student Working to Eradicate Poverty

On October 17th, 2017, Omar Lebron, a graduate student of Fordham University’s Master of Arts in Ethics and Society program, moderated the event “Answering the Call of October 17 to end poverty: A path toward peaceful and inclusive societies” at the United Nations in New York to commemorate the 25th anniversary of the International Day for … More Fordham University Ethics & Society Master’s Student Working to Eradicate Poverty
November 14, 2017

Re-structuring the patient-provider communication process to empower patients

This post is written in response to Ubel, Scherr and Fagerlin’s target article, “Empowerment Failure: How Shortcomings in Physician Communication Unwittingly Undermine Patient Autonomy” published in the November 2017 issue of The American Journal of Bioethics.

November 14, 2017

9th International Shared Decision Making Conference (videos)

Videos of the plenary sessions from the 9th International Shared Decision Making Conference in Lyon are now available here.  
November 13, 2017

Isaiah Haastrup - a "Charlie Gard" Legal Battle

As might have been expected, commentators are now using "Charlie Gard" as an adjective to describe medical futility conflicts between parents and clinicians. One of the latest such cases involves 8-month-old Isaiah Haastrup. Isaiah was both in Februar...
November 12, 2017

Medical Advance Directive: An Emphatic "NO!" to Dementia




Norman Cantor, a lawyer and Professor of Law at Rutgers University School of Law wrote a thoughtful article about the medical Advance Directive in the Harvard Law School "Bill of Health" blog


and explaining why he is revising his own medical Advance Directive to instruct his physicians and caretakers to allow him to die if he had developed a dementia "upon reaching a degree of permanent mental dysfunction that I deem to be intolerably demeaning.  For me, this means mental deterioration to a point when I can no longer read and understand written material such as a newspaper or financial records such as a checkbook"


Read his entire presentation at the Harvard Law blog link above and then return to present your views on adding profound mental deterioration to the list of physical illnesses which are irreversible and can be highly distressful to the patient and his family's lives and which he does not want to experience or have his family experience further and if he should face a treatable but serious life threatening condition, he should be allowed to die.


Hopefully, all of my blog readers have their own medical Advance Directive written to designate  a  surrogate to attend to their wishes for treatment of a potentially fatal illness when it occurs. If not, as your physician moderator of this bioethics blog, I would strongly recommend it be created and available for your physicians later to read and observe your directive.


  With Professor Cantor's permission, his Revised Advance Directive is reproduced below. ..Maurice..                                                       
My Revised Advance Directive

     I have witnessed the ravages that Alzheimer's disease and similar progressive dementias produce.  I wish to be allowed to die upon reaching a degree of permanent mental dysfunction that I deem to be intolerably demeaning.  For me, this means mental deterioration to a point when I can no longer read and understand written material such as a newspaper or financial records such as a checkbook.       

     This wish to hasten my post-competence demise is not based on prospective suffering or distress, but rather on my personal vision of intolerable indignity and degradation associated with cognitive dysfunction.  For me, it is critical to shape the post-mortem recollections of my loved ones and to preserve the lifetime image as a vital, critically thinking individual that I have strived to cultivate.  In addition, it is important to me to avoid being an emotional, physical, or financial burden on my family and friends, even if they would willingly assume such burdens. 

    I fully understand that my determination to avoid prolonged, progressive debilitation could prompt my demise even though I might appear content in my debilitated condition.  I am exercising my prerogatives of self-determination and bodily integrity to shape my lifetime narrative, including my dying process, in accord with my strong aversions to mental dysfunction and to dependence on others. 

     My determination not to prolong my life at the described point of debilitation includes rejection of any and all life-sustaining means.  This includes simplistic medical interventions such as antibiotics, blood transfusions, and antiarrythmics, as well as more complex interventions like CPR, mechanical ventilation, dialysis, and artificial nutrition and hydration.  Indeed, if my dementia or any other affliction has produced inability or unwillingness to feed myself – for example, because of swallowing difficulties, or other eating disorders, or just indifference to eating -- I instruct that my caregivers refrain from hand feeding unless I appear receptive to eating and drinking (show signs of enjoyment or positive anticipation).  If I am indifferent or resistant to hand feeding, I do not want to be cajoled, harassed, or in any way impelled to eat or drink.   

     The only limitation on my advance rejection of life-sustaining medical intervention is adherence to humane treatment.  That is, I have no desire to subject my future incompetent persona to a torturous or agonizing dying process.  I presume that palliative steps -- including medication for pain, anxiety, or agitation -- will be taken to ease my dying process. 


     The question may arise as to whether I have had a change of mind and revoked my advance directive.  My wish is that no revocation be found unless I do so while still capable of a considered choice, including appreciation of all the major elements involved.  I urge my decision-making agents to avoid the temptation of manipulating my future, incompetent persona to contradict or alter my advance instructions.  And I direct that my original instructions be honored absent an aware, considered change of mind (as opposed to uncomprehending expressions by my demented persona). 


Graphic: Through Google Images. "5th Dementia"PAINTING BY JEFF BOWERING Saatchi Art
November 12, 2017

2017 Publications by Thaddeus Mason Pope

As the end of the year approaches, I take stock of what I published this year.   Hopefully, a few more pieces will come out over the next few weeks. But even without those, I count:  3 law review articles 2 book updates 1 book ...

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Published Articles (64)

American Journal of Bioethics: Volume 17 Issue 11 - Nov 2017

Empowerment Failure: How Shortcomings in Physician Communication Unwittingly Undermine Patient Autonomy Peter A. Ubel, Karen A. Scherr & Angela Fagerlin

American Journal of Bioethics: Volume 17 Issue 11 - Nov 2017

Reasons to Amplify the Role of Parental Permission in Pediatric Treatment Mark Christopher Navin & Jason Adam Wasserman

American Journal of Bioethics: Volume 17 Issue 11 - Nov 2017

To Whom Do Children Belong? John Lantos

AJOB Neuroscience: Volume 8 Issue 3 - Oct 2017

Cogitas Ergo Es? Metaphysical Humility in Disorders of Consciousness Douglas C. McAdams, W. Kevin Conley II & G. Kevin Donovan

AJOB Neuroscience: Volume 8 Issue 3 - Oct 2017

The Problems With Fixating on Consciousness in Disorders of Consciousness David Fischer & Robert D. Truog

AJOB Neuroscience: Volume 8 Issue 3 - Oct 2017

Differences That Make a Difference in Disorders of Consciousness Joseph J. Fins & Nicholas D. Schiff

American Journal of Bioethics: Volume 17 Issue 10 - Oct 2017

Saving Life, Limb, and Eyesight: Assessing the Medical Rules of Eligibility During Armed Conflict Michael L. Gross

AJOB Primary Research: Volume 8 Issue 3 - Sep 2017

Membership recruitment and training in health care ethics committees: Results from a national pilot survey Anya E. R. Prince, R. Jean Cadigan, Warren Whipple & Arlene M. Davis

American Journal of Bioethics: Volume 17 Issue 8 - Aug 2017

Saving or Creating: Which Are We Doing When We Resuscitate Extremely Preterm Infants? Travis N. Rieder

American Journal of Bioethics: Volume 17 Issue 8 - Aug 2017

What We Do When We Resuscitate Extremely Preterm Infants Jeremy R. Garrett, Brian S. Carter & John D. Lantos

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News (2082)

November 7, 2017 9:00 am

How Should Organizations Promote Equitable Distribution of Benefits from Technological Innovation in Health Care? (AMA Journal of Ethics)

Technological innovations typically benefit those who have good access to and an understanding of the underlying technologies. As such, technology-centered health care innovations are likely to preferentially benefit users of privileged socioeconomic backgrounds. Which policies and strategies should health care organizations adopt to promote equitable distribution of the benefits from technological innovations?

October 12, 2017 9:00 am

Birth control: Trump expands opt-out for workplace insurance (Washington Post)

President Donald Trump is allowing more employers to opt out of providing no-cost birth control to women by claiming religious or moral objections, issuing new rules Friday that take another step in rolling back the Obama health care law.

September 21, 2017 9:00 am

As Federal Government Cuts Obamacare Ads, Private Insurer Steps Up (NPR)

Open enrollment for Affordable Care Act insurance doesn’t start for another six weeks. But the quirky insurance startup Oscar Health is launching an ad campaign Monday aimed at getting young people to enroll.

September 5, 2017 9:00 am

F.D.A. Approves First Gene-Altering Leukemia Treatment, Costing $475,000 (The New York Times)

The Food and Drug Administration on Wednesday approved the first-ever treatment that genetically alters a patient’s own cells to fight cancer, a milestone that is expected to transform treatment in the coming years.

July 5, 2017 10:00 am

For Parents of U.K. Infant, Trump’s Tweet Is Latest Twist in an Agonizing Journey (The New York Times)

The long journey for Connie Yates and Chris Gard, whose infant son, Charlie, cannot breathe or move on his own, appeared to have come to an end last week. The courts had ruled that the baby’s rare genetic condition was incurable and that the only humane option was to take him off life support. The couple announced that they were getting ready “to say the final goodbye.” Then Pope Francis and President Trump weighed in, offering statements of support and thrusting a global spotlight onto a heart-rending case that has become a cause célèbre in Britain.

June 20, 2017 10:58 am

Trump ‘simply does not care’ about HIV/AIDS, say 6 experts who just quit his advisory council (Washington Post)

The first hints of an uncertain future for the Presidential Advisory Council on HIV/AIDS came last year, when Donald Trump’s presidential campaign refused to meet with advocates for people living with HIV, said Scott Schoettes, a member of the council since 2014. That unease was magnified on Inauguration Day in January, when an official White House website for the Office of National AIDS Policy vanished, Schoettes said. Last week, he and five others announced they were quitting the Presidential Advisory Council on HIV/AIDS, also known as PACHA.

June 6, 2017 9:00 am

Superantibiotic is 25,000 times more potent than its predecessor (Science)

The world’s last line of defense against disease-causing bacteria just got a new warrior: vancomycin 3.0. Its predecessor—vancomycin 1.0—has been used since 1958 to combat dangerous infections like methicillin-resistant Staphylococcus aureus. But as the rise of resistant bacteria has blunted its effectiveness, scientists have engineered more potent versions of the drug—vancomycin 2.0. Now, version 3.0 has a unique three-pronged approach to killing bacteria that could give doctors a powerful new weapon against drug-resistant bacteria and help researchers engineer more durable antibiotics.

June 5, 2017 9:00 am

Unsafe delivery of measles vaccine kills 15 children in South Sudan (CNN)

In a remote village in South Sudan, 15 children died from severe toxicity caused by contaminated measles vaccines, government health investigators said Thursday. The National Adverse Events Following Immunization Committee, supported by the World Health Organization, and UNICEF vaccine safety experts examined the cases and those of 32 other children who suffered fever, vomiting and diarrhea.

May 1, 2017 9:00 am

Human vaccine data release jump-starts biotech’s bid for RNA drugs (Science)

The executive team at Moderna raised a cheer today after publishing their first early snapshot of human efficacy data that demonstrate their messenger RNA tech works — at least on the first try. The biotech tested their H10N8 flu vaccine on a small group of 31 subjects, looking at their response in two different measures. All demonstrated a sufficient immune response to fight off the virus in the first measure, and all but 3 in the second, for a total of 23 who received the vaccine.  None of the 8 subjects who received a placebo responded.

April 10, 2017 9:00 am

First medical diagnosis often incomplete or outright wrong, study finds (The San Diego Union-Tribune)

When your doctor gives a diagnosis of a complicated disease, it often pays to get an independent second look, according to a study from Mayo Clinic published Tuesday.

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