Hot Topics: Health Care

Blog Posts (1282)

October 29, 2014

How Medicare Is Punishing Hospitals That Care For Poor People

Such a no-brainer: If patients who receive care at Hospital A are more likely to get readmitted to the hospital 10, 20 or 30 days after discharge than patients in Hospital B, then Hospital A must be doing something wrong. … Continue reading
October 29, 2014

Ebola and Human Nature

With over half of the posts on this blog in the past 2 weeks being about Ebola I was hesitant to write more about it, but I will anyway. In the midst of daily e-mails from the hospital system I work for about mandatory Ebola screening training and containment procedures and questions from the students where I teach it is hard to avoid thinking about... // Read More »
October 29, 2014

Jahi McMath - Prematurely Fostering Mistrust

Jahi McMath was adjudicated as legally dead in December 2013.  Her family has yet to deliver any cogent, definitive evidence that supports changing her diagnosis. Can they?  Will they? If Jahi's family can establish (with independent expert ...
October 28, 2014

If no travel restrictions, then….quarantine?

As the Ebola epidemic rages on, the debate about travel limitations has moved inevitably to the next stage: whether there ought to be a quarantine imposed on healthcare providers and others returning from service in endemic areas. We have been reading two opposing views, one emphasizing, as did Governor Christie of New Jersey, that “the obligation of elected officials is to protect the public health... // Read More »
October 28, 2014

Responding to Ebola: The Question of Quarantine

Karyn L. Boyar
October 28, 2014

More Secret DNR Orders in UK - Barbara Gibson

In the UK, clinicians may write a DNR order without consent, if they deem that to be in the patient's best interest.  But clinicians must still consult with the patient or family.  In other words, they may write a unilateral DNR order.  But they may not write a "secret" DNR order.
 
Yet, as I have recounted on this blog more than a dozen times, this continues to happen.   One of the most recent cases occurred in August 2014 at Ayr Hospital.

In an apology letter to the family, the said: “I wish to offer my sincere apologies again on behalf of all the staff concerned for the distressing events you have described, and wish to reassure you that lessons have been learned and that practice around DNACPR decisions are being reviewed and improved as a matter of urgency across the organization. . . .  It is evident from the review of Mrs Gibson’s medical records, and discussions with staff involved, there were failures in communicating the medical decisions around resuscitation to Mrs Gibson and yourselves.”




October 27, 2014

Bioethics Commission FAQs from ASBH

Last week the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) attended the American Society for Bioethics and Humanities (ASBH) annual meeting, held in San Diego, California October 16-19. Along with leading multiple presentations, the Bioethics Commission was pleased to host a booth in the conference’s exhibition hall. The exhibit featured Commission reports […]
October 27, 2014

Must we all die with forced hand-feeding in Advanced Dementia? Will others honor our Living Will?

A nice video by Stanley Terman reviewing the Margot Bentley case now on appeal in British Columbia.
October 27, 2014

Brittany Maynard Urges Palliative Care Specialist to Stop Misrepresenting Her Case

Brittany Maynard urges palliative care specialist Ira Byock to stop misrepresenting her case prior to his debate with Compassion & Choices President Barbara Coombs Lee on the Diane Rehm Show this week
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In comments that Brittany posted on the website for Rehm’s nationally-syndicated NPR show, she denied claims by Byock and other opponents of death with dignity that Compassion & Choices is using her to advance the aid-in-dying movement. Rehm read part of Brittany’s comments during her show. 

“I am Brittany Maynard and it concerns me that Dr. Ira Byock will speak on my ‘behalf’ at all again. I watched a special on PBS where this same individual spoke about my case as though he knew personal details about me, saying some things that were quite frankly not true.

“For example, he said that a gentle death would be available to me easily through hospice, unfortunately that would be after a great length of time, with lots of suffering (physical and emotional), and loss for my young body. He is right that this is not being accomplished successfully for many terminally ill Americans on a widespread basis across our country. This needs to change too, I agree with him there."

“But perhaps most disturbingly, Byock claimed that Compassion & Choices had somehow taken advantage of me through ‘exploitation’ and that I feel compelled to die now based on public expectations. I DO NOT, this is MY choice, I am not that weak. The day is my choice, I have the right to change my mind at any time, it is my right. I am very confident about this. This is a patient right that is critical to understanding Death with Dignity."

“The claim of exploitation is utterly false considering I had gone through the entire process of moving, physician approval for DWD [death with dignity], and filled my prescription before I EVER even spoke to anyone at Compassion and Choices about volunteering and decided to share my story. I support the organization because I support the cause. I believe this is a healthcare right and CHOICE that should be available to ALL terminally ill Americans."

“I made my decisions based on my wishes, clinical research, choices, discussions with physicians, and logic. I am not depressed or suicidal or on a ‘slippery slope.’ I have been in charge of this choice, gaining control of a terrifying terminal disease through the application of my own humane logic. We as a country have real issues with the way doctors are trained to speak about, educate and embrace realities of death."

“As a terminally ill patient, I find it disrespectful and disturbing when people discuss my personal health with details that are not accurate to push an agenda. My request is that physicians speak only what they directly know to be factually true and have a right to discuss. The best change for all our community, physicians and patients, will come from us pulling together and developing policies to protect the severely ill based on honesty, education, and humane treatment of suffering."

“I wish nothing but peace and healing for whom it is available, and a peaceful passing of comfortable choice for whom it is not.”

October 26, 2014

Authorship in Global Health Research

<p><span style="line-height: 19.0400009155273px;">In a recent paper published in <em><a href="http://www.biomedcentral.com/content/pdf/1472-6939-15-42.pdf">BMC Medical Ethics</a></em></span><span style="line-height: 19.0400009155273px;">, my co-authors and I argued that there are unique issues in authorship in the context of global health research (GHR).</span><span style="line-height: 19.0400009155273px;">Global health places priority on improving and ensuring equity in health worldwide. GHR is often multi/interdisciplinaryand involves large collaborative networks. Our analysis of authorship GHR applies to situations where researchers from high income countries (HICs) partner with those in low and middle-income countries (LMICs). First, let’s start by illustrating an example of a GHR research project. Let’s say that researchers wanted to study the genetics of a tropical disease. They wrote and succeeded in obtaining a U.S. National Institutes of Health funded grant. HIC researchers may bring to the collaboration scientific expertise, access to genomics/proteomic technologies, and may have been the main PI on the grant. LMIC researchers may be from a nation affected with the disease and can also provide scientific expertise, insight into local perceptions and realities, and access to the study population – the latter especially being difficult for HIC researchers given possible issues surrounding trust. Together, the team may gather epidemiological genetic data relevant to international public health interventions and also help address local needs and interests.</span></p> <p><strong style="line-height: 19.0400009155273px; color: #34405b; font-family: Arial, Helvetica, sans-serif; font-size: 12px;">The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our <a style="text-decoration: underline; color: #000099;" href="/Academic/bioethics/index.cfm">website</a>.</strong></p>

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Published Articles (17)

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

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

News (1974)

September 23, 2014 1:55 pm

More patients could wear regular clothing in hospital: study

Although doctors say many patients in hospitals could be wearing their own clothing below the waist, and most want to, a majority still don’t, according to a small Canadian study.

September 15, 2014 5:14 pm

Insurance giants creating massive database of patient records

Two of California’s largest health insurers are partnering to create a massive database of patient medical records.  But the system faces significant technological challenges and privacy concerns.

September 11, 2014 2:54 pm

Health Reform Watch: Study finds fewer deaths after MA health reform

In this edition of Health Reform Watch: Harvard Asst. Professor Ben Sommers explains his widely-quoted study showing a measurable drop in adult deaths in Massachusetts in the wake of the state’s health reform program, the model for the Affordable Care Act.

September 8, 2014 6:47 pm

Top U.S. health adviser wants end to partisan fighting over Obamacare

President Barack Obama’s top health adviser on Monday called for an end to partisan bickering over Obamacare, saying the public and businesses are sending a clear message to Washington that it is time to move on with implementing the law.

August 11, 2014 1:31 pm

Ethical questions emerge over who gets Ebola drug

In a development that raises a host of ethical issues, Spain announced it had obtained a scarce U.S.-made experimental Ebola drug to treat a Spanish missionary priest infected with the killer virus.

July 30, 2014 5:10 pm

Calif. Considers Bilingual Drug Labels

This week California’s Board of Pharmacy will discuss new regulations that would require all pharmacies in California to provide translated labels on prescription drug bottles.

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.

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