» Health Care Where the World Finds Bioethics Fri, 30 Jan 2015 21:16:19 +0000 en-US hourly 1 Obama thinks “precision medicine” will make us healthier. Experts are skeptical. Fri, 30 Jan 2015 19:50:47 +0000 0 Obama to Request Research Funding for Treatments Tailored to Patients’ DNA Thu, 29 Jan 2015 19:55:42 +0000 0 Wall Street Journal readers weigh in on PAS Thu, 29 Jan 2015 12:34:35 +0000 Read More »]]> 0 V-Ticket to Ride Thu, 29 Jan 2015 11:51:44 +0000 ]]> 0 Oklahoma Medical Treatment Laws Information Act – The Disclosures Thu, 29 Jan 2015 09:30:00 +0000 0 End of life conversations Wed, 28 Jan 2015 16:04:51 +0000 Read More »]]> 0 Texas Advance Directives Act – 2015 Legislative Session Wed, 28 Jan 2015 09:00:00 +0000 The 2015 legislative session (the 84th) in Texas has just begun and some are getting ready to again tackle the Advance Directives Act.

TADA was last amended in 2003.  Multiple bills were advanced in 2007, 2009, 2011, and 2013.  But none were enacted.  Get ready for round five.    

In the January 2015 issue of TEXAS MEDICINE:  "In anticipation of another round of debates over end-of-life care, TMA's workgroup dedicated to the issue will work to protect physicians' ability to do what's best for patients in their final days."

Defending TADA is part of the Texas Medical Association's strategic roadmap for state advocacy initiatives, Healthy Vision 2020 (2d ed.).

"Legislation has been introduced over the past four legislative sessions that would instead require indefinite treatment with no provision for the physician exercising ethics or moral judgment. TMA has opposed these proposals because they would prolong unnecessary — and often painful or even torturous — care that cannot prevent but can only prolong death. They would also require physicians, nurses, and other health care professionals to provide medically inappropriate care, even if that care violates medical ethics or the standard of care. They also would set a dangerous precedent for the legislature to mandate the provision of physician services and treatments that may be medically inappropriate, outside the standard of care, or unethical."

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Academic Medicine: In need of an examination? Wed, 28 Jan 2015 00:55:10 +0000 Read More »]]> 0 Have a Miscarriage and Go to Jail? Potential Consequences of Personhood Amendments Tue, 27 Jan 2015 14:54:00 +0000 Bertha Alvarez Manninen]]> 0 The Hepatitis C Epidemic in One Picture Tue, 27 Jan 2015 14:05:10 +0000 Continue reading ]]> 0 Medical Benefit Is ALWAYS Patient Determined Tue, 27 Jan 2015 09:00:00 +0000 0 Paying for Journal Peer Review Tue, 27 Jan 2015 07:01:35 +0000 0 Golden years? Researcher explores longevity research and the companies banking on its success Mon, 26 Jan 2015 19:49:13 +0000 0 Great Writing through Analogy Mon, 26 Jan 2015 13:53:03 +0000 Continue reading ]]> 0 New Mexico Court of Appeals to Hear Aid in Dying Case Mon, 26 Jan 2015 09:00:00 +0000 In January 2014, a New Mexico trial court  ruled that patients have a fundamental right to aid in dying under the state constitution.

This afternoon, the New Mexico Court of Appeals will hear oral arguments in the case, captioned as

KARI BRANDENBURG, in her official capacity as District Attorney for Bernalillo County, New Mexico, and GARY KING, in his official capacity as Attorney General of the State of New Mexico, Defendants-Appellants

A number of amici are also involved:
  • Attorneys for Disability Rights
  • ALS Association NM Chapter
  • NM Psychological Association
  • American Medical Women’s Association
  • American Medical Students Association
  • NM Public Health Association

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5th International Conference on Advance Care Planning and End-of-Life Care (ACPEL) Sat, 24 Jan 2015 09:00:00 +0000 0 Patient Modesty: Volume 71 Fri, 23 Jan 2015 18:45:00 +0000 0 The Power of Free Fri, 23 Jan 2015 15:00:21 +0000 Continue reading ]]> 0 The Need for Patient Navigators for Fertility Preservation Fri, 23 Jan 2015 12:01:05 +0000 0 Death Test: Criteria for Screening and Triaging to Appropriate ALternative Care (CRISTAL) Fri, 23 Jan 2015 09:30:00 +0000 Australian critical care physician Ken Hillman and health services researcher Magnolia Cardona-Morrell have just published a new checklist in BMJ Supportive and Palliative Care:  "Development of a Tool for Defining and Identifying the Dying Patient in Hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL)."

The goal is to develop an evidence-based screening tool to identify elderly patients at the end of life and quantify the risk of death in hospital or soon after discharge.  The Telegraph calls it a "death test."

This should minimize prognostic uncertainty and avoid potentially harmful and futile treatments.  After all, an unambiguous checklist may assist clinicians in reducing uncertainty patients who are likely to die within the next 3 months and help initiate transparent conversations with families and patients about end-of-life care. 

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The “End of Life Option Act” Introduced in the California Senate Fri, 23 Jan 2015 05:04:59 +0000 Read More »]]> 0 WOMAN’S BREAST MILK: SHOULD IT BE UP FOR SALE? Thu, 22 Jan 2015 22:52:00 +0000

In case you didn't know, a woman's breast milk is a commercially but also a nutritionally valuable commodity at least as an example supported by Medolac Labs and Mother's Milk Cooperative.  This milk is said to be needed by hospitalized pre-term infants whose mothers are not yet lactating.  I read about it in an article in the  Michigan State University Bioethics website  on lactation and  the laws and actions which have been taken including commodification of the woman's milk.

A scholarly article on the subject of the sale of mother's milk was written in the Winter 2009 issue of the Nevada Law Journal 

The sale of organs for transplant is not approved in the United States, only donation.  The question arises as to whether it is ethical to have lactating women provide their breast milk for sale. Is breast milk analogous to a solid organ?

Can or should the same arguments regarding the value, availability and ethics of "selling" apply to both breast milk and kidney?   (You can read more on the issue of the selling of solid organs for transplant in my blog thread "Organ Donation: Who, How, Why and also What are the Ethics (5))"

How about comparing selling the mother's milk to the legal commodification of eggs and sperm or blood elements?

A physician ethicist has reassured me on this topic:

"Maurice, ...

There are American markets for buying and selling human body parts, including blood, plasma, platelets, breast milk, hair, sperm, and unfertilized eggs. The National Organ Transplant Act bans compensation for organs, including livers, kidneys, and bone marrow. Flynn v. Holder adds the acquisition of hematopoietic stem cells from circulating blood to the list of acceptable activities.

An ethical analysis suggests that the key characteristics of these acceptable market-based donations of human body products are:

– The donated stuff can with time be regenerated.

– The injury to the donor is minimal and commensurate with the sale price.

– The risks to the donor of more serious morbidity and mortality are minimal."

And then, of course, there is the long history of "wet nursing" when other women took on the task of nursing a child if the mother was unable to do so.

To my visitors: Do you find any arguments against the selling of the milk obtained from a  lactating mother and, if you do, what are they?  ..Maurice.

Graphic: Migrant Mother, Dorothea Lange, Library of Congress / Public Domain / Wikimedia Commons

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Should North Carolina Expand Medicaid? Thu, 22 Jan 2015 13:55:13 +0000 Continue reading ]]> 0 A Better Death: End of Life Care: Doctors, Machines and Technology Can Keep Us Alive, but Why? Thu, 22 Jan 2015 13:08:00 +0000 0 Infertility, ethics, and fairy tales Wed, 21 Jan 2015 15:46:11 +0000 Read More »]]> 0 Managing Conscientious Objections in Intensive Care Medicine Wed, 21 Jan 2015 14:47:00 +0000 I was delighted to be a part of this ad hoc subcommittee of this American Thoracic Society Ethics and Conflict of Interest Committee that developed An Official Policy Statement: "Managing Conscientious Objections in Intensive Care Medicine."  It was just published in the American Journal of Respiratory and Critical Care Medicine 191(2): 219–227.

"Intensive care unit (ICU) clinicians sometimes have a conscientious objection (CO) to providing or disclosing information about a legal, professionally accepted, and otherwise available medical service. There is little guidance about how to manage COs in ICUs."

"The policy recommendations are based on the dual goals of protecting patients’ access to medical services and protecting the moral integrity of clinicians. Conceptually, accommodating COs should be considered a “shield” to protect individual clinicians’ moral integrity rather than as a “sword” to impose clinicians’ judgments on patients."

"The committee recommends that: 

  1. COs in ICUs be managed through institutional mechanisms
  2. Institutions accommodate COs,  provided doing so will not impede a patient’s or surrogate’s timely access to medical services or information or create excessive hardships for other clinicians or the institution
  3. A clinician’s CO to providing potentially inappropriate or futile medical services should not be considered sufficient justification to forgo the treatment against the objections of the patient or surrogate
  4. Institutions promote open moral dialogue and foster a culture that respects diverse values in the critical care setting."

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What Causes Couch Potatoes To Eat So Many Potato Chips? Wed, 21 Jan 2015 14:13:23 +0000 Continue reading ]]> 0 Fight threatens thousands of Californians’ health coverage Wed, 21 Jan 2015 00:16:01 +0000 0 The Bioethics Commission’s Meeting 20 Milestone Tue, 20 Jan 2015 17:18:15 +0000 0 VSED & Complexities of Choosing an End Game for Dementia Tue, 20 Jan 2015 09:30:00 +0000 On the front page of today's Science section of the New York Times, Paula Span has an important story, " Complexities of Choosing an End Game for Dementia."

Can you specify in advance of severe dementia, "triggering conditions" to ensure that nobody tries to keep you alive by spoon feeding or offering liquids?

Can people who develop dementia use VSED (“voluntarily stopping eating and drinking”) to end their lives by including such instructions in an advance directive?

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Involvement of ICU Families in Decisions: Fine-tuning the Partnership Mon, 19 Jan 2015 18:28:00 +0000 0 The Beginning of the End of Economism? One View Mon, 19 Jan 2015 17:18:00 +0000 0 Why Buying A Car Is So Unlike Buying Healthcare Mon, 19 Jan 2015 05:01:16 +0000 0 "Being Mortal" – Atul Gawande on FRONTLINE Sat, 17 Jan 2015 18:05:00 +0000 0 Can Safety, Freedom And Rationing Co-Exist For The Elderly? Sat, 17 Jan 2015 16:08:28 +0000 ]]> 0 How Effective Are Mammograms? Fri, 16 Jan 2015 13:42:42 +0000 Continue reading ]]> 0 The Case of Cassandra C: Finding Clarity and Responsibility as a Mom and a Bioethicist Fri, 16 Jan 2015 12:38:10 +0000 ]]> 0 In for Life: Procreative Liberty for Incarcerated Persons Serving Prison Sentences Fri, 16 Jan 2015 10:01:19 +0000 0 Virginia to Strengthen Futile Care Law Fri, 16 Jan 2015 10:00:00 +0000 This week, Virginia introduced a new bill (S.B. 2153) that would strengthen and clarify that state's long-standing futile care law.


Current law provides that "Nothing in this article shall be construed to require a physician to prescribe or render health care to a patient that the physician determines to be medically or ethically inappropriate. . . .  If the conflict remains unresolved, the physician shall make a reasonable effort to transfer the patient to another physician who is willing to comply with the request . . . .  The physician shall provide . . . a reasonable time of not less than fourteen 14 days to effect such 27 transfer. During this period, the physician shall continue to provide any life-sustaining care . . . ." 

The bill would add the following language.  "If, at the end of the 14-day period, the physician has been unable to transfer the patient to another physician who is willing to comply with the request of the patient, the terms of the advance directive, the decision of the agent or person authorized to make decisions pursuant to § 54.1-2986, or the Durable Do Not Resuscitate Order despite reasonable efforts, the physician may cease to provide care that he has determined to be medically or ethically inappropriate."

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Physician-assisted suicide, torture, and Hippocrates: He may be old, but (let’s hope) he ain’t dead yet Fri, 16 Jan 2015 06:01:41 +0000 Read More »]]> 0 Australian Medical Association Calls for Cuts to ‘Futile Care’ to Make Medicare Sustainable Fri, 16 Jan 2015 05:42:00 +0000 Australian Medical Association President Patricia Montanaro said that needed healthcare savings could be found by cutting out “futile care” - where people were given ­expensive (and often risky) treatments with no hope of lengthening life or improving quality of life.

"We’re continuing to push treatments that may not be what – if you could explain them to the patient and had other options for them – what they would choose."

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The Era of Mega-Hospitals Has Arrived Thu, 15 Jan 2015 15:31:36 +0000 Continue reading ]]> 0 Don’t Categorically Refuse CPR to Ebola Patients Thu, 15 Jan 2015 14:54:00 +0000 Paul J. Edelson ]]> 0 Debating Physician-Assisted Death (i.e.,Physician-Assisted Suicide) Thu, 15 Jan 2015 14:12:09 +0000 Read More »]]> 0 (Golden) Global Change and LGBT Rights Thu, 15 Jan 2015 12:05:35 +0000 ]]> 0 Consequentialism and surrogacy Thu, 15 Jan 2015 02:42:15 +0000 Read More »]]> 0 Futility Conflicts Turn Violent Wed, 14 Jan 2015 18:46:00 +0000 0 How Behavioral Economics Could Have Prevented The Harvard Meltdown Over Healthcare Costs Wed, 14 Jan 2015 15:47:14 +0000 Continue reading ]]> 0 Worrying about patient satisfaction only harms the patient Wed, 14 Jan 2015 11:00:52 +0000 by Craig Klugman, Ph.D.

Anyone who has been in a hospital in the last 9 years has encountered a patient satisfaction survey. This national survey provides rankings of hospitals based on how satisfied patients are with their experience. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) “is a survey instrument and data collection methodology for measuring patients perceptions for their hospital experience.” For anyone who works in a hospital, the results of this survey can mean raises, firings, and changes of position.…

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Of Course 23andMe’s Plan Has Been to Sell Your Genetic Data All Along Tue, 13 Jan 2015 15:29:40 +0000 0