» Health Care Where the World Finds Bioethics Sun, 30 Aug 2015 09:30:00 +0000 en-US hourly 1 Kevorkian "Coma" [EOL in Art 111] Sun, 30 Aug 2015 09:30:00 +0000 0 New Futility Case: Siner v. Kindred Hospital Indianapolis Sun, 30 Aug 2015 08:30:00 +0000 The Court of Appeals of Indiana issued a decision that allows a family to proceed with its medical malpractice action alleging that a hospital's unilateral DNR order caused the patient's death. 

"October 26, 2007, eighty-six-year old Geraldine Siner became a patient at Kindred Hospital. Geraldine suffered from advanced dementia caused by Alzheimer’s disease and as a result could no longer care for herself. Geraldine’s son, John Siner, was designated as her health care representative and had power of attorney."

"Upon Geraldine’s admission to Kindred, and several times thereafter, John informed . . . Geraldine’s attending physician, that Geraldine was to be a ‘full code’ patient. On November 16, 2007, Kindred’s Ethics Committee decided to make Geraldine a No Code/Do Not Resuscitate (“DNR”) patient, meaning that Kindred staff would not attempt to resuscitate her in the event that she went into respiratory or cardiac arrest (otherwise known as “coding”)."

"The Ethics Committee did not receive approval from John or any other family member to change Geraldine’s status in this manner. Geraldine’s health continued to decline over the following two weeks and Kindred declined to keep Geraldine on ‘full code’ status despite her family’s protests."

Expert Testimony
Plaintiff's expert Timothy Pohlman opined both that the hospital was negligent and that this negligence caused Siner's death.

"Kindred’s Ethics Committee recommended over-riding the wishes of the family and instructions of the patient’s medical representative for full treatment, and instituted Do Not Resuscitate (DNR) order, which ruled out such alternative treatments."

"Gerri Siner was also suffering from over-whelming infection, and septic shock at the time of intake. There is no documentation produced for me that indicate SCCM Surviving Sepsis Guidelines, . . . were followed . . . . These guidelines were not followed apparently because the patient was under a DNR order."

"Full damages and suffering that more likely than not resulted from re-prioritization of treatment modalities for Gerri Siner based on her existing ‘DNR’ order that was left in place without full agreement and consent of her Surrogate decision makers . . . ."

Appellate Ruling
The trial court granted summary judgment n favor of Kindred Hospital, finding the family had failed to introduce any evidence on causation.  The appellate court reversed, because Pohlman's testimony does create a disputed fact as to causation

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“Our Family Secrets” Exposed — The Ethics of Whistleblowing Sat, 29 Aug 2015 14:00:34 +0000 Read More »]]> 0 Kevorkian "Very Still Life" [EOL in Art 110] Sat, 29 Aug 2015 10:00:00 +0000 0 Supreme Court of Nevada Asked to Determine Brain Death Standards Sat, 29 Aug 2015 09:00:00 +0000 0 Minnesota Board of Medical Practice at Hamline Fri, 28 Aug 2015 23:34:00 +0000 0 Are Arguments about GMO Safety Really About Something Else? Fri, 28 Aug 2015 14:54:00 +0000 0 Free: Boxed Set! Fri, 28 Aug 2015 13:17:24 +0000 Back in June, I published a series of essays about efforts to fly people around the country to give them better access to life-saving organ transplants. For your convenience, I have pulled the three essays together into one PDF. As … Continue reading

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Marketing Trumps Science, or How the Pink Pill Does Not Even the Score Fri, 28 Aug 2015 10:08:05 +0000 0 The Changing Definition of What Is ‘Brain Dead’ Fri, 28 Aug 2015 09:30:00 +0000 Healthline News has just posted a nice new review of the debate over brain death.  It is not 100% accurate.  But it is a lucid, comprehensive, lay presentation of the issues.  

I love this quote from the distinguished critical care specialist and ethicist John Luce: " The brain dead people are not as dead as we once thought they were, in the overall biological sense."

The article also notes that Calixto Machado is working on a paper, to be published before the end of the year, which will propose a new category of consciousness to describe Jahi McMath’s as-yet-unseen circumstances.

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Medicine Holding Back Death [EOL in Art 109] Fri, 28 Aug 2015 09:00:00 +0000 0 Abortion: “Loopholes” and Attitudes Fri, 28 Aug 2015 00:21:20 +0000 Read More »]]> 0 Is ICU Treatment Inappropriate? Clinicians Now Have Guidelines Thu, 27 Aug 2015 22:35:00 +0000 0 Insured But Not Covered Thu, 27 Aug 2015 14:06:35 +0000 Under the Affordable Care Act, the percent of Americans who lack any health insurance has declined significantly. Put another way – more Americans have health insurance than ever. But having insurance coverage is different than being well covered by insurance. Sometimes a … Continue reading

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Child’s Garden for the ICU [EOL in Art 108] Thu, 27 Aug 2015 10:00:00 +0000 0 The Sale of Fetal Tissue Wed, 26 Aug 2015 15:04:00 +0000


Virtually everyone is familiar with Mitch Albom’s book, Tuesdays With Morrie. Myra Christopher (Foley Chair at the Center and former Center CEO) and Rosemary Flanigan (Retired Center Program Staff) have decided to regularly contribute to the Center for Practical Bioethics’ blog and call it “Tuesdays with Rosemary and Myra” (even though it won’t necessarily be published on a Tuesday). Read more about Rosemary and Myra at the bottom of this post.

The Sale of Fetal Tissue

M:  Rosemary, you know all the hub-bub about the video of the executive from Planned Parenthood being caught on tape talking about the sale of fetal tissue to two people posing as employees of a company looking to procure fetal tissue for research purposes. It’s been all over the Internet…

R:  I do know about it. It’s gone viral!

M:  It certainly has, and it has provided fodder for those hoping to be nominated by one of the parties for the 2016 presidential election. The video has been proven to be an example of “hit and run” journalism, but that doesn’t negate the ethical question that underpins it, i.e., “Is it acceptable to sell fetal tissue?” And that’s what I want to talk about.

R:  And I want to ask is there any difference in fetal tissue and other human tissue, all of which gets “sold.”


R:  Of course, there is something special about fetal tissue, but does that mean that it can’t be used for research. It’s not the same kind of tissue that comes off your elbow…

M:  Why not? What makes it different?

R:  It is because of the potentiality involved in what it can or could become, but let’s don’t have an argument about that right now. Even though it will certainly come up in our argument later, I’m still going to say that fetal tissue can be used for research purposes.

M:  Okay, but your first claim reminds me of one that Don Marquis, a philosopher at Kansas University, made in an argument against abortion years ago in an article he wrote for the Center. He said the difference between tissue from your elbow and a fetus is that the elbow has a past, i.e., we know something about the arm it hinged, but has no future, whereas a fetus has a future but no past that could reveal anything about its history or values. Is that your argument?

R:  No! It’s not just about tissue’s history; I am trying to skirt intrinsic worth. So, don’t you push me into talking about that, Myra Christopher. I hate objective whatevers!

M:  Whatevers? Sorry, Rosemary, but I want to push you just a little. Most all of us will say that human life is sacred/special, and what I want to talk about may align with your “potentiality” comment, but it may not; I don’t know. But I want to talk to you about the difference between human tissue and a human “being.”

R: I would find it morally reprehensible to use fetal tissue for insignificant research purposes.

M: You‘re still avoiding my issue, but OK….  Insignificant research like what?

R:  I’m trying to get circumstances involved here so that they cast a moral evaluation on their use in one instance and their not being used in another. For example, I would not object to fetal stem cells being used to find cures for cystic fibrosis or sickle cell disease, but I would find it morally reprehensible to use fetal tissue to find a better face cream and make old women look younger.

M:  I agree. I think it is repulsive. It reminds me of the former chair of the President’s Bioethics Commission Leon Kass’s determination based on what he called the “yuck factor”, i.e., if it is just plain old gross, it may be just plain old wrong.

R:  I’ve thought this for a long time, and there is something to be said that should lead us to reflect on why we feel the “yuck”, and maybe in some instances it should cause something to be tagged “unethical”, but in other instances it may simply be a societal “no-no”.

M: I think the point you are getting to is important – not just in this discussion, but in many arguments claimed to be “ethical arguments”. There are important distinctions that should be made between ethics, social norms, etiquette, and the aesthetic.

Last night, I was thinking about us possibly blogging about this topic today, and I remembered being at a women’s rights rally once and a person claiming to be absolutely opposed to abortion was walking around trying to force people to look at an aborted fetus she had in a box. It struck me as the epitomy of irony that a person crusading for the sanctity of life would objectify a fetus for political purposes. 

R:  Poor soul! She was very confused. 

M:  Rosemary, when I was thinking about this last night, I thought about the many, many times I have heard you ask (when teaching ethics committee members), “Is it wrong to torture little children?”

R:  “Needlessly, needlessly torturing little children!” Is what I asked? The point behind that was that, most often, general rules need to have adverbs to make them valid and true.

M:  I agree and add that speaking in “absolute” terms almost always forces you into a corner. But I want to go back to the distinction I need to make between human “tissue” and human “beings” Because it is critical to my position.

For me, “being” implies “personhood” and by that I mean an independent individual whether 1 day old or 100 years old. I would argue that it applies only to fetuses that are sustainable independent of the mother.

R:  You’re not placing the same meaning on potentiality that I am. So, you and I will have a different argument because we differ in the meaning of the potentiality involved in the fetus. That is so simple to me. You want to say that the point of differentiation is when it (the fetus) can live on its own. I say that is not the point; we have to respect it until it gets there; so I am going to call for more heavy arguments for the use of fetal tissue than you would before it is sustainable.

What I'm saying is that justification for use of fetal tissue ought to be weightier the closer the fetus comes to live birth before being aborted. I'm trying to show that potentiality develops and thus the arguments must take that development into account.

M:  I think that’s true. However, I think at a certain point in the development of the fetus our lines cross, and we find ourselves at the same place. However, I want to say that I agree wholeheartedly that fetal tissue, no matter the gestational age of the fetus from which it comes, should always be treated with respect. 

I am reminded of a situation years ago, probably 20 years ago, when a faith-based hospital reached out to the Center for help in deciding what to do with fetal tissue that was not suitable for research. Fertility specialists in their institution were burning such tissue in trash cans in their clinic. That is one extreme. Another was a time when the Center was contacted by a hospital because a group was demanding that the hospital “bury” fetuses with a proper ceremony – no matter its gestational stage.

R:  Why do you call burning tissue in a trash can an extreme?

M:  Good question, because I wouldn’t find it objectionable to burn it in the hospital’s incinerator.  I think the “aesthetics” of the situation were objectionable to me. The whole idea that it was “trash” bothered me and others in the hospital. 

R:  I see it’s not the “burning”; it’s the “trash” that bothers you. So much of these arguments depend on the way we use language and define specific terms.

M: Back to the Planned Parenthood fiasco; I think we agree and disagree about components of this situation. Although we get there along different paths, we agree that when used for significant research that could potentially help people living with disease and injury AND when conducted in done in a way that is respectful of the “donation”, the use of fetal tissue in research can be justified.

However, there are other important factors as well, including “tone”, context, and intent when in discussion about ethically sensitive issues.

About Rosemary and Myra

For several years before her retirement, Rosemary facilitated an online discussion group, primarily for ethics committee members, which had a faithful following. We hope some who participated and others will read our blog posts and respond with their thoughts on whatever subject we are writing about. We would also be grateful if you would provide suggestions for future blog topics. With your help, the two of us are moving into the 21st century, but for Pete’s sake, don’t expect us to tweet!

We have decided to write a regular blog for several reasons. First, there has never been a greater need for ethical reflection than there is today. We both agree about that, but we are very different people, and often disagree on issues. We hope it will be helpful for us to model respectful disagreement. In addition, we just finished writing a history of the Center which took us three years, and we enjoyed doing that so much that we need an excuse to continue writing together on a weekly basis. So, we don’t mind bothering you with our ideas.

I call myself a “philosophical Christian agnostic” and Rosemary is a member of the Sisters of St. Joseph of Carondolet. Rosemary taught high school English and philosophy at Rockhurst University. She is a stickler for the “King’s English” and proper grammar. I grew up in Texas and just like to talk. We are both old; I turned 68 in July; Rosemary is older. We both have had training and education in ethics, but Rosemary has a PhD. We have both worked in bioethics for many years, and we both LOVE to argue. As Rosemary says, “Doing ethics is all about argument.” But ethics is not about mean-spirited disrespectful exchanges that are so prevalent today in a “red-state/blue-state culture.” Through blogging, we hope that our agreements and disagreements will demonstrate that we can argue respectfully and still love and care about one another.]]> 0
Banning Abortion for Down Syndrome: Legal or Ethical Justification? Wed, 26 Aug 2015 14:54:00 +0000 Bonnie Steinbock]]> 0 Original Art in the ICU Waiting Room [EOL in Art 107] Wed, 26 Aug 2015 09:30:00 +0000 0 Women, minorities still underrepresented in medical specialties Tue, 25 Aug 2015 18:05:26 +0000 0 How Much Sugar Is in Your Beverage? Tue, 25 Aug 2015 13:20:09 +0000 Here’s a display from an elementary school science fair, cleverly showing how much sugar various beverages contain:

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Original Art in the ICU [EOL in Art 106] Tue, 25 Aug 2015 09:00:00 +0000 0 Canadian Medical Protective Association – End-of-Life Panel Tue, 25 Aug 2015 08:00:00 +0000 The Canadian Medical Protective Association works to protect the professional integrity of physicians and promote safe medical care in Canada.  Its annual meeting starts tomorrow in Halifax.  

The meeting includes a session on "End-of-Life Care: Medical Legal Issues." 


  • Mr. André Picard, Health reporter and columnist, The Globe and Mail


  • Dr. Douglas Grant, Registrar, College of Physicians and Surgeons of Nova Scotia
  • Dr. James Downar, Palliative care physician and intensivist, University Health Network
  • Mr. Eric van Wijlick, Senior policy advisor, Royal Dutch Medical Association
  • Mr. Domenic Crolla, Gowling Lafleur Henderson, CMPA General Counsel

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Reproducibility Project or Research Police? Tue, 25 Aug 2015 04:08:24 +0000 0 Seeing the Horror Tue, 25 Aug 2015 01:31:39 +0000 Read More »]]> 0 The "Dark Side" of Medical Education? Mon, 24 Aug 2015 16:32:00 +0000

It is rare that a medical journal would publish an essay by a physician anonymously which describes the "dark side of medicine" and perhaps including the "dark side" of medical education.  The article is in the August 18 2015 issue of the Annals of Internal Medicine 
and in an editorial  in the same issue, the following:

We hope that medical educators and others will use this essay as a jumping-off point for discussions that explore the reasons why physicians sometimes behave badly and brainstorm strategies for handling these ugly situations in real time. By shining a light on this dark side of the profession, we emphasize to physicians young and old that this behavior is unacceptable—we should not only refrain from personally acting in such a manner but also call out our colleagues who do. We all need the strength to act like the anesthesiologist in this story and call our colleagues “assholes” when that label is appropriate. We owe it to ourselves, to our profession, and especially to our patients. 

So this "dark side" can be said to also involves those of us in involved medical education such as myself.. Perhaps  medical educators are inadequately inspecting and controlling the content of the "hidden curriculum" being presented to medical students  and  not facilitating advice and support for those students and doctors who witness "dark behavior" to "speak up"  to the perpetrators but also to superiors in administration. 

By the way, if you want more, read the article in Better Health
an immediate response to the Annals essay.   ..Maurice.

Graphic: From Google Images and modified by me with ArtRage and Picasa3.

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View from the Head End [EOL in Art 105] Mon, 24 Aug 2015 09:00:00 +0000 0 Do Not Leave Definition of Death Just to Doctors Mon, 24 Aug 2015 08:30:00 +0000 0 Ohio bill would forbid abortion of Down Syndrome pregnancies Mon, 24 Aug 2015 02:22:08 +0000 ]]> 0 Futility Dispute – Mary Jane Pierce v. B.C. Women’s Hospital Sun, 23 Aug 2015 10:00:00 +0000 0 Prescription for Medical Students: A Day at the Art Museum? [EOL in Art 104] Sun, 23 Aug 2015 10:00:00 +0000 0 600 Days of Death – Jahi McMath Sun, 23 Aug 2015 08:30:00 +0000 DocBastard posts some good thoughts on brain death and the Jahi McMath case by Cory Franklin, a retired ICU physician from Cook County Hospital in Chicago.  Franklin had a shorter version of his remarks in the San Francisco Chronicle.

"Any time you have a diagnosis with an outlier, it’s a good idea to review your original assumptions. In this case our assumptions about what brain death actually is."

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Stop Futile Treatment – Be Surgeons, Not Sissies Sat, 22 Aug 2015 09:00:00 +0000 At a recent panel discussion on geriatric medicine at Westmead Hospital (in Sydney) several leading specialists agreed doctors should be “surgeons not sissies” and objectively evaluate the prospects of successful treatment.

One surgeon, Henry Pleass, remarked:  “I work quite closely with physicians in renal transplantation and I’m amazed sometimes these people are still being dialysed. . . .  I think: ‘Why on earth are they doing that?’ because they are dialysing a corpse, so to speak."

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Music Thanatology [EOL in Art 103] Sat, 22 Aug 2015 08:00:00 +0000 0 Man Experiencing First Real Moment of Peace in Years Resuscitated Fri, 21 Aug 2015 16:36:00 +0000 The Onion is so funny, because it is so true.

"Interrupting the only moment of genuine peace the man had known in several decades, a team of paramedics reportedly resuscitated area resident Alan Taborsky this morning following an apparent cardiac arrest."

"Reports indicated that just as Taborsky had reached a state of complete relaxation in which he felt unburdened by his life’s troubles for the first time in recent memory, medical technicians wrenched him back into consciousness with a pair of defibrillator pads."

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Humane Endeavor Fri, 21 Aug 2015 16:25:23 +0000 0 Is the Government Trying to Make Us Fat? Fri, 21 Aug 2015 12:53:07 +0000 The FDA has proposed new labels on grocery store food products, that adjust serving sizes to more accurately capture what Americans eat. Research I conducted with Steven Dallas and Peggy Liu suggests these labels could be a problem. Here is … Continue reading

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Some Reflections On Summer Vacation Reading Fri, 21 Aug 2015 09:08:03 +0000 0 Better to Burn Out than to Fade Away [EOL in Art 102] Fri, 21 Aug 2015 08:30:00 +0000 0 LaVecchia Brain Death Dispute Continues in NJ Fri, 21 Aug 2015 02:36:00 +0000 The New Jersey Record continues coverage of the Michael LaVecchia brain death dispute.

The family says that he was wrongly pronounced dead by St. Joseph’s Regional Medical Center.  They moved him to Robert Wood Johnson University Hospital.

The newspaper story includes a family-produced video showing relatives bending Michael’s bruised index toe on his left foot, which prompted a movement they believed to be a flinch.  His mother says: “He’s feeling something . . . to feel pain has to register in your brain somehow.”

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More about Doctor-Assisted Suicide—in California and Elsewhere Fri, 21 Aug 2015 01:21:49 +0000 Read More »]]> 0 Bioethics Deliberation and Education in Privacy and Progress Thu, 20 Aug 2015 18:36:15 +0000 0 Girlfriend in a Coma [EOL in Art 101] Thu, 20 Aug 2015 08:30:00 +0000 0 Minnesota Case Illustrates Importance of POLST Thu, 20 Aug 2015 02:58:00 +0000 0 More Brain Death Disputes – Michael Lavecchia III Wed, 19 Aug 2015 12:59:00 +0000 0 NIH Budget Increase on One Hand, Fewer Outputs on Another Wed, 19 Aug 2015 10:08:02 +0000 0 Aden Hailu – Another Brain Death Lawsuit Wed, 19 Aug 2015 08:30:00 +0000 0 Don’t Fear the Reaper [EOL in Art 100] Wed, 19 Aug 2015 08:30:00 +0000 0 Health Care Reform in Minnesota: Mission Advanced But Not Accomplished Tue, 18 Aug 2015 22:23:00 +0000 The Hamline Law Review has just published its Symposium Issue: Health Care Reform in Minnesota: Mission Advanced But Not Accomplished, Volume 38, Issue 2 (2015).  This is the printed product from the Hamline Health Law Institute's October 2014 conference.

Thaddeus M. Pope

Deborah Farringer

Autumn AmadouBlegen

Mary Pareja

Daryll Dykes

Lawrence Massa and Matthew Anderson

James Teufel and Shannon Mace

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Sleepless in the Hospital Tue, 18 Aug 2015 13:59:51 +0000   A while back, I wrote a piece on the problems caused when hospitals don’t coordinate care in a way that promotes patient sleep. Now Shefali Luthra, a reporter at Kaiser Health News, has written a great piece, delving deeper into this … Continue reading

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The Knife and Gun Club: Scenes from an Emergency Room [EOL in Art 99] Tue, 18 Aug 2015 09:30:00 +0000 0