Bioethics.net » Health Care http://www.bioethics.net Where the World Finds Bioethics Tue, 28 Jun 2016 12:31:45 +0000 en-US hourly 1 End-Of-Life Care Better For Patients With Cancer, Dementia: Study Finds http://www.bioethics.net/news/end-of-life-care-better-for-patients-with-cancer-dementia-study-finds/ http://www.bioethics.net/news/end-of-life-care-better-for-patients-with-cancer-dementia-study-finds/#comments Tue, 28 Jun 2016 12:31:45 +0000 http://www.bioethics.net/?post_type=news&p=59575 http://www.bioethics.net/news/end-of-life-care-better-for-patients-with-cancer-dementia-study-finds/feed/ 0 Physicians More Willing to Administer Futile Treatment Requests when Based on Religion http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/KW1eCxfxyUI/physicians-more-willing-to-administer.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/KW1eCxfxyUI/physicians-more-willing-to-administer.html#comments Tue, 28 Jun 2016 09:30:00 +0000 http://www.bioethics.net/?guid=58717b47647c9a5166d6b297d1c00420 The June 2016 issue of the Journal of Pain & Symptom Management includes "U.S. Physicians’ Opinions About Accommodating Religiously   Based Requests  for  Continued  Life-Sustaining Treatment."

The authors report survey results showing that physicians appear to give more deference to requests that are linked in a clear way to religious commitments.

In contrast, physicians give less deference to expectations for a miracle.  While religious claims fall outside physician expertise, hope  for miracles seem more arbitrary and idiosyncratic and counterclaim physician medical authority.

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Legal Standards for Brain Death under Attack http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Hi7uFe8M-vg/legal-standards-for-brain-death-under.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Hi7uFe8M-vg/legal-standards-for-brain-death-under.html#comments Mon, 27 Jun 2016 09:30:00 +0000 http://www.bioethics.net/?guid=280d1f501dabed39589e7e132f22b6b2 http://medicalfutility.blogspot.com/feeds/4209977154445835027/comments/default 0 Pain-Capable Abortion Bans http://blogs.tiu.edu/bioethics/2016/06/26/pain-capable-abortion-bans/ http://blogs.tiu.edu/bioethics/2016/06/26/pain-capable-abortion-bans/#comments Sun, 26 Jun 2016 12:42:01 +0000 http://blogs.tiu.edu/bioethics/?p=6823 Read More »]]> http://blogs.tiu.edu/bioethics/2016/06/26/pain-capable-abortion-bans/feed/ 0 Parliamentary Committee Recommends Protection for Physicians Withdrawing Futile Treatment http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/CDkB4WurOUA/parliamentary-committee-recommends.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/CDkB4WurOUA/parliamentary-committee-recommends.html#comments Sun, 26 Jun 2016 09:00:00 +0000 http://www.bioethics.net/?guid=33bd33b4c7336eb7ff4907b49428162d http://medicalfutility.blogspot.com/feeds/2657174333777472301/comments/default 0 Support Medical Futility Blog http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/OYT7G_sTAPQ/support-medical-futility-blog.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/OYT7G_sTAPQ/support-medical-futility-blog.html#comments Sat, 25 Jun 2016 10:00:00 +0000 http://www.bioethics.net/?guid=6ca22cd9e80db96e9f6ea6debcc22e71 http://medicalfutility.blogspot.com/feeds/8512935475794870755/comments/default 0 Zeke Emanuel May Not Be Right This Time: Increasing Costs Will Probably Not Slow Antibiotic Resistance http://www.amc.edu/BioethicsBlog/post.cfm/zeke-emanuel-may-not-be-right-this-time-increasing-costs-will-probably-not-slow-antibiotic-resistance http://www.amc.edu/BioethicsBlog/post.cfm/zeke-emanuel-may-not-be-right-this-time-increasing-costs-will-probably-not-slow-antibiotic-resistance#comments Fri, 24 Jun 2016 14:48:31 +0000 http://www.amc.edu/BioethicsBlog/post.cfm/zeke-emanuel-may-not-be-right-this-time-increasing-costs-will-probably-not-slow-antibiotic-resistance

Ezekiel J. (Zeke) Emanuel, MD, PhD, is chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania. On May 30, 2016, the Washington Post published an opinion piece by Dr. Emanuel titled “Want to Win $2 Billion? Create the Next Antibiotic.”

In the article, Dr. Emanuel makes two key points: (1) the low cost of antibiotics may be one of the principal factors that have led to doctors over-prescribing these drugs; (2) the low cost of antibiotics with the resulting low rate of return on investment for pharmaceutical companies dis-incentivizes drug manufacturers from allocating more resources for the research and development of new antibiotics to combat evolving “superbugs” (bacteria resistant to current antibiotics). He offers ideas to help solve the problem including: (1) mandating that all hospitals create antibiotic stewardship programs to monitor antibiotic use within institutions; (2) require that all antibiotic prescriptions written be reviewed to assure that the prescribing is warranted according to national guidelines; (3) increasing the charges for antibiotics; and (4) creating a $2 billion prize with additional taxes or surcharges to be awarded to individuals or entities that develop new antibiotics to counter identified microbial threats.

One should be very careful in challenging any suggestions Dr. Emanuel might make – after all he is an internationally recognized health policy and medical ethics expert – but in this case I think he is mistaken about issues and that his ideas may have unintended negative consequences that will make matter worse.

Decades years ago, antibiotics were far more expensive than they are today. Loss of patent protection and generic substitutes have substantially lowered antibiotic costs. But the cost of the antibiotics a few years back had little to do with the development of resistant organisms. One might argue that antibiotics perhaps are far more readily available than is good for man. (One example is farmers using antibiotics to improve their beef cattle and dairy herds.) Antibiotic resistance is as evitable as natural selection; resistance evolves from appropriate and inappropriate use.

Without question, antibiotics are too freely used and are unnecessarily available. The Centers for Disease Control and Prevention has estimated that over half of the outpatient antibiotic prescriptions written are medically unnecessary. Some might suggest that they be available without prescription. If it were safer to use antibiotics without proper provider oversight, certainly they would be marketed as over-the-counter drugs in the US. But with evolving resistance, it is also apparent that antibiotics should be accessible only with better foresight and oversight.

But even if we in the United States were to dramatically curtail antibiotic use by prescribing drugs more appropriately, one should still ask “What about the rest of the world?” The US has 4% of the world’s population. In the US (and more developed countries), we are very concerned about the availability of antibiotics and appropriate use; but most of the world is not. Antibiotics are readily available in Central and South America and Asia and Africa without a prescription. Clearly resistant organisms will continue to evolve in the world whether we decrease the rate of resistance in the US or not. Moreover, the more recent worldwide epidemic health scares have been from viruses – Ebola, Zika, and Chikungunya – for which antibiotics are of no help.

The very best strategy in combating resistant organisms remains prescribing antibiotics appropriately. Successful ideas to help prescribe antibiotics more appropriately have been proposed. Somehow, we need to get providers to practice evidence-based medicine. Of course, we should be doing this in every aspect of providing care, not just in prescribing antibiotics. Our primary ethical obligation as providers is to practice competently. Radical ideas – like increasing the cost of antibiotics, mandating that all hospitals have antibiotic stewardship programs, asking more knowledgeable peers to review every single antibiotic prescription, and taxing Medicare hospitals to create prize money to award successful antibiotic developers – may work; but the formula seems too extreme. If we need peers watching everything that other providers do, is this really the solution that will assure best practice over the long haul?

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Doctors Can’t Be Trusted to Tell Patients Whether They Should Receive Robotic Surgery http://www.peterubel.com/uncategorized/doctors-cant-trusted-tell-patients-whether-receive-robotic-surgery/ http://www.peterubel.com/uncategorized/doctors-cant-trusted-tell-patients-whether-receive-robotic-surgery/#comments Fri, 24 Jun 2016 14:09:13 +0000 http://www.peterubel.com/?p=8015 Patients often rely on physicians for information about their treatment alternatives. Unfortunately, that information is not always objective. Consider a man with early stage prostate cancer interested in surgical removal of his tumor, but uncertain whether it is better for … Continue reading

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Christ Disputing with the Doctors http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/RTb94ZyeXEk/christ-disputing-with-doctors.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/RTb94ZyeXEk/christ-disputing-with-doctors.html#comments Fri, 24 Jun 2016 10:00:00 +0000 http://www.bioethics.net/?guid=7387b0b1f21390f52e622bd463995994 http://medicalfutility.blogspot.com/feeds/3453001250105066764/comments/default 0 Santa Claus Revives Dead Children http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/6YDcINGtw-s/santa-claus-revives-dead-children.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/6YDcINGtw-s/santa-claus-revives-dead-children.html#comments Thu, 23 Jun 2016 10:00:00 +0000 http://www.bioethics.net/?guid=481fa92c99108347fce9e7cdfc81a3f3 http://medicalfutility.blogspot.com/feeds/3101774063210125480/comments/default 0 Balancing the benefits and harms of advances in medical technology http://blogs.tiu.edu/bioethics/2016/06/22/balancing-the-benefits-and-harms-of-advances-in-medical-technology/ http://blogs.tiu.edu/bioethics/2016/06/22/balancing-the-benefits-and-harms-of-advances-in-medical-technology/#comments Wed, 22 Jun 2016 13:02:07 +0000 http://blogs.tiu.edu/bioethics/?p=6821 Read More »]]> http://blogs.tiu.edu/bioethics/2016/06/22/balancing-the-benefits-and-harms-of-advances-in-medical-technology/feed/ 0 Public Education and Misinformation on Brain Death in Mainstream Media http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Y5wEuQ0CcdA/public-education-and-misinformation-on.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Y5wEuQ0CcdA/public-education-and-misinformation-on.html#comments Wed, 22 Jun 2016 08:30:00 +0000 http://www.bioethics.net/?guid=5d75ba976c5f7072fa552bec54ce48cf http://medicalfutility.blogspot.com/feeds/7117195998601196092/comments/default 0 Five Active Brain Death Cases in US Courts http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/eA0tVgHpQPc/five-active-brain-death-cases-in-us.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/eA0tVgHpQPc/five-active-brain-death-cases-in-us.html#comments Tue, 21 Jun 2016 22:37:00 +0000 http://www.bioethics.net/?guid=60fbc04a9745505c5e509fbef45af8df http://medicalfutility.blogspot.com/feeds/4775179457474407289/comments/default 0 Time to Heal https://reflectivemeded.org/2016/06/21/time-to-heal/ https://reflectivemeded.org/2016/06/21/time-to-heal/#comments Tue, 21 Jun 2016 15:23:37 +0000 http://reflectivemeded.org/?p=251 ]]> https://reflectivemeded.org/2016/06/21/time-to-heal/feed/ 0 Its not just mental health studies: Doctors rarely ask adolescent patients about their sexual orientation & LGBT youth are afraid of bias https://ethicsandsociety.org/2016/06/21/its-not-just-mental-health-studies-doctors-rarely-ask-adolescent-patients-about-their-sexual-orientation-lgbt-youth-are-afraid-of-bias/ https://ethicsandsociety.org/2016/06/21/its-not-just-mental-health-studies-doctors-rarely-ask-adolescent-patients-about-their-sexual-orientation-lgbt-youth-are-afraid-of-bias/#comments Tue, 21 Jun 2016 13:48:18 +0000 http://ethicsandsociety.org/?p=1854 Continue reading ]]> https://ethicsandsociety.org/2016/06/21/its-not-just-mental-health-studies-doctors-rarely-ask-adolescent-patients-about-their-sexual-orientation-lgbt-youth-are-afraid-of-bias/feed/ 0 Cross-Cultural Perspectives on Brain Death http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/SCz3EKYzknA/cross-cultural-perspectives-on-brain.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/SCz3EKYzknA/cross-cultural-perspectives-on-brain.html#comments Tue, 21 Jun 2016 09:00:00 +0000 http://www.bioethics.net/?guid=91b24fef988cb516ed73420f33d0aeaa Several weeks ago, Harvard Bioethics produced a recorded seminar on "Cross-Cultural Perspectives on Brain Death." 

The panelists were Qing Yang, MD, PhD (Department of Anesthesia, Massachusetts General Hospital) and Robert D. Truog, MD (Director, Center for Bioethics and Professor of Medical Ethics, Anaesthesiology & Pediatrics at Harvard Medical School; Senior Associate in Critical Care Medicine at Children’s Hospital Boston).

Even in the US, some controversy persists over the conceptual defensibility of brain death. Around the world, the philosophical defensibility of brain death is even more debatable. Watch as Dr. Qing Yang presents data regarding the adoption of brain death in China. She discusses cultural differences between Chinese and US medical professionals and patients that inform policy and law when it comes to brain death. Dr. Bob Truog, a prominent brain death critic, replies.



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Organ Harvesting in China http://blogs.tiu.edu/bioethics/2016/06/20/organ-harvesting-in-china/ http://blogs.tiu.edu/bioethics/2016/06/20/organ-harvesting-in-china/#comments Tue, 21 Jun 2016 04:00:29 +0000 http://blogs.tiu.edu/bioethics/?p=6811 Read More »]]> http://blogs.tiu.edu/bioethics/2016/06/20/organ-harvesting-in-china/feed/ 0 The Politics of Fetal Pain: Why This Is Not A Legislative Issue http://www.amc.edu/BioethicsBlog/post.cfm/the-politics-of-fetal-pain-why-this-is-not-a-legislative-issue http://www.amc.edu/BioethicsBlog/post.cfm/the-politics-of-fetal-pain-why-this-is-not-a-legislative-issue#comments Mon, 20 Jun 2016 17:41:36 +0000 http://www.amc.edu/BioethicsBlog/post.cfm/the-politics-of-fetal-pain-why-this-is-not-a-legislative-issue

I read with interest the recent blog by my colleagues Paul Burcher and Claire Horner entitled “The Politics of Fetal Pain”. In their blog they discuss the recent fetal pain bill passed in Utah, which “requires the use of general anesthesia on women seeking abortions at 20 weeks gestation or later.” At stake is the concern that fetuses may be capable of experiencing pain by 20 weeks, which has prompted 12 states to restrict or prohibit abortions from that point on, instead of 24 weeks, which is the current standard.

Burcher and Horner remind us that the issue of fetal pain has been a source of contention for some time, which has led to “several states restricting or prohibiting abortions 20 weeks or later on the basis of potential fetal pain.” The authors are very much aware of the possibility that anti-abortion advocates may be using this issue as a convenient means by which to place additional limits on abortion rights of women. Which is to say, anti-abortion advocates supporting these restrictions on women’s reproductive rights may be using the fetal pain issue as a means to restrict abortion rights. Even if they do have a bias in creating this law, Burcher and Horner still believe that the law itself is justified.

Though I would share a concern about the possibility of fetal pain, if I had reason to believe there were evidence to support it, I disagree that the appropriate next move ethically is to join forces with a legislative agenda of politicians whose interests go far beyond the issue of fetal pain. My worry is that such legislative actions in fact usurp the professional role of physicians as medical experts of scientific data to set appropriate standards for medical care.

I accept that the possibility of fetal pain at 20 weeks is a theoretical possibility. But to the extent I find such a claim plausible I would do so by placing my confidence in scientific evidence, which to date is questionable. The paper from which Burcher and Horner take their evidence about fetal pain comes from an author who makes it clear in his writing that he believes abortion is an act of unjust killing. This is not an unreasonable moral position nor does it mean that he is not accurate in his assessment of the medical and scientific evidence regarding fetal pain. But it does raise concerns about his ability to assess and write about data of fetal pain without bias. Is he following the evidence or is he interpreting the evidence to support his preexisting moral views? The answer is we just don’t know, in the same way we don’t know if the Utah state legislature is really concerned about the possibility of fetal pain beginning at 20 weeks or is their real goal to place additional restrictions on abortions?

I want to make it clear that people, including bioethicists, legislators, and the public at large, have every right to advocate, based on their understanding of the evidence, to ensure that fetuses do not suffer during abortions from 20 weeks and beyond. My only point is that such advocacy should not be expressed in laws that impose standards of care on how physicians practice medicine. Such advocates may retort, but why should I think that the medical profession or the scientific community is unbiased? Could it be the case that these professional bodies are abdicating their professional, moral obligations to reduce the possibility of human suffering? Of course that is a theoretical possibility. But in an era where the role of science is grossly misunderstood and under attack by many advocacy groups, those of us in bioethics must champion the standards of scientific research and judgment by medical professionals to produce evidence that is unbiased and reflects the best available understanding of important empirical questions, such as, can fetuses feel pain? This is not an ethical question, i.e. it has nothing to do with whether or not fetuses have moral standing as human beings—rather the question is purely a matter of getting the facts as clear as possible in determining at what point in the development of a human fetus is there a physiological basis for experiencing pain. This is exclusively the scientific issue about which scientific and medical experts must decide based on the best available evidence.

So where should we look for such an understanding of the data on fetal pain? The answer is we should rely on the experts on such matters as reflected in the opinion from the American Congress of Obstetricians and Gynecologists (ACOG), which concluded “fetal perception of pain is unlikely before the third trimester. Although ultrasound monitoring can show intrauterine fetal movement, no studies since 2005 demonstrate fetal recognition of pain.”

I hasten to make it clear that it is always possible current scientific opinions will need to be revised based on new data. There are many examples that bear out this point. But we should realize just how procedurally disruptive and even iconoclastic it is to impose standards legislatively onto medicine because, in effect, we don’t trust or have faith in the integrity of medical experts to be fair or unbiased themselves. For doing so indicts the institution within our democratic system whose defined role and responsibility is to be the arbiters of empirical disputes. The process, i.e. the scientific method they use is by definition one that has the least chance of bias. And without robust confidence in the scientific enterprise and the knowledge that is generated, bioethics loses its footing to make moral assessments and judgments. Thus I agree with the view of ACOG:

“Sound health policy is best based on scientific fact and evidence-based medicine. The best health care is provided free of governmental interference in the patient-physician relationship. Personal decision making by women and their doctors should not be replaced by political ideology.”

Committing ourselves to make decisions based on scientific evidence, both in individual cases and at the policy level, requires us to always stipulate that our knowledge today may not be getting things exactly right. Advocates for the possibility of fetal pain, and I may be one of them, should not be quiet. They have every right and perhaps an obligation to express their concerns. But to conclude that ACOG refuses to accept the possibility of fetal pain because of politics—the fear of having to possibly create new standards about which they may fear a backlash from prochoice advocates or that they really do not believe a fetus has full moral standing—is to lose trust and confidence in an essential democratic institution, and indeed risks becoming cynical and riding roughshod over the role of professional medical expertise.

Thus, I conclude the Utah bill was not an appropriate action for the legislature to take, even if there is eventually scientific evidence that supports their concerns. I understand that there are some medical concerns about which a state legislature may appropriately pass laws—assisted suicide or narcotics—if there is a clear and compelling public interest. But I submit, since there is no clear and compelling evidence, the issue of fetal pain is not one of them.

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 website.

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Competition at Work! http://www.peterubel.com/uncategorized/competition-work/ http://www.peterubel.com/uncategorized/competition-work/#comments Mon, 20 Jun 2016 13:42:43 +0000 http://www.peterubel.com/?p=8011 Recently, pharmaceutical companies have been pricing many of their products at astounding values. A couple years ago, in fact, an amazing new hepatitis C drug came to market priced at about $90,000 per patient. But since that time, several other … Continue reading

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Medical Devices after Cremation http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/LnqyGROyHOw/medical-devices-after-cremation.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/LnqyGROyHOw/medical-devices-after-cremation.html#comments Mon, 20 Jun 2016 09:00:00 +0000 http://www.bioethics.net/?guid=b9dadc4c1bd2ffb114deb3a721227c58 http://medicalfutility.blogspot.com/feeds/6795580081937775272/comments/default 0 Peter Low – Limits of Medicine http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/zFZLmalh0P0/peter-low-limits-of-medicine.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/zFZLmalh0P0/peter-low-limits-of-medicine.html#comments Mon, 20 Jun 2016 08:07:00 +0000 http://www.bioethics.net/?guid=8569d4b8194d377c2d1eac5ea64ff96c http://medicalfutility.blogspot.com/feeds/4852993863593053863/comments/default 0 Where Do We Come From? What Are We? Where Are We Going? [EOL in Art 206] http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Vs8Q9EATsdQ/where-do-we-come-from-what-are-we-where.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Vs8Q9EATsdQ/where-do-we-come-from-what-are-we-where.html#comments Sun, 19 Jun 2016 09:30:00 +0000 http://www.bioethics.net/?guid=dbce6058868ecda2e81b87fbd45b566d Gauguin considered this 1897 work to be his masterpiece and the summation of his ideas. The painting should be read from right to left, beginning with the sleeping infant. 

Gauguin describes the various figures as pondering the questions of human existence given in the title; the blue idol represents “the Beyond.” The old woman at the far left, “close to death,” accepts her fate with resignation.


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28th Annual MacLean Fellows Conference on Clinical Medical Ethics http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/cyOKF3cs32w/28th-annual-maclean-fellows-conference.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/cyOKF3cs32w/28th-annual-maclean-fellows-conference.html#comments Sat, 18 Jun 2016 09:00:00 +0000 http://www.bioethics.net/?guid=bde4282215dc23aa76ef18d3ea21324b http://medicalfutility.blogspot.com/feeds/2143962035642311222/comments/default 0 Brain Death – Two False Assumptions http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/eChub4P2UU4/brain-death-two-false-assumptions.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/eChub4P2UU4/brain-death-two-false-assumptions.html#comments Sat, 18 Jun 2016 08:38:00 +0000 http://www.bioethics.net/?guid=060404fa60bf11a757f1b8afeefab7e2 http://medicalfutility.blogspot.com/feeds/6659635115716985556/comments/default 0 Best intentions, worst outcomes: Ethical and legal challenges for international research involving sex workers https://ethicsandsociety.org/2016/06/17/best-intentions-worst-outcomes-ethical-and-legal-challenges-for-international-research-involving-sex-workers/ https://ethicsandsociety.org/2016/06/17/best-intentions-worst-outcomes-ethical-and-legal-challenges-for-international-research-involving-sex-workers/#comments Fri, 17 Jun 2016 16:00:52 +0000 http://ethicsandsociety.org/?p=1847 Continue reading ]]> https://ethicsandsociety.org/2016/06/17/best-intentions-worst-outcomes-ethical-and-legal-challenges-for-international-research-involving-sex-workers/feed/ 0 Resource-based Thresholds for Futility in Neonatal Intensive Care http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/ShhBkOsRuC8/resource-based-thresholds-for-futility.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/ShhBkOsRuC8/resource-based-thresholds-for-futility.html#comments Fri, 17 Jun 2016 06:45:00 +0000 http://www.bioethics.net/?guid=99e018350330f206b9d476e5fc57bca2 I am off, this morning, to see Dominic Wilkinson present "Resource-based Thresholds for Futility in Neonatal Intensive Care."  Here is his abstract:

In neonatal intensive care, disputes sometimes arise between families and clinicians over potentially beneficial life-prolonging treatment for a newborn infant. Parents strongly desire the treatment, yet health professionals judge that it would be futile. While professional guidelines support the concept of ‘medical futility’, there is no guidance on how to determine whether or when treatment would be futile. 

In this paper, we explore the application of cost-effectiveness thresholds (CET), used elsewhere in public health systems, to the determination of resource-based futility in newborn intensive care. We outline briefly the concept of futility, and of cost-effectiveness assessment. We then draw on CET to explore sequentially a series of clinical questions. When is a patient’s chance of survival too low to provide expensive life-support? How long is too long to provide intensive life-prolonging medical treatment? What level of quality of life is too low for life- saving surgery to be provided? 

This paper represents the first attempt to evaluate distributive justice based determination of futility in intensive care. It builds on careful analysis of existing empirical evidence as well as ethical argument. We identify and address major counterarguments to the use of cost-effectiveness in deriving futility thresholds for intensive care. 

Conclusions: our analysis identifies key normative questions for resource-based treatment limitation decisions as well as key empirical data necessary to inform such decisions.

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Pediatric Clinical Ethics Summer Internship (Minneapolis) http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Y9HTO8J21Ic/pediatric-clinical-ethics-summer.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Y9HTO8J21Ic/pediatric-clinical-ethics-summer.html#comments Fri, 17 Jun 2016 06:39:00 +0000 http://www.bioethics.net/?guid=4e7e5ac380b7e75ca65122fc8ddce9a1 http://medicalfutility.blogspot.com/feeds/6143213942998873608/comments/default 0 Wesley J. Smith on Thaddeus Pope http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/g9gcWDuyMMA/wesley-j-smith-on-thaddeus-pope.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/g9gcWDuyMMA/wesley-j-smith-on-thaddeus-pope.html#comments Fri, 17 Jun 2016 06:02:00 +0000 http://www.bioethics.net/?guid=f161f419ddcafa67a82a38d258a7cfb8 Wesley J. Smith makes this observation about me:  "I disagree fundamentally with Thaddeus Mason Pope about everything, but respect his candor—he doesn’t sugarcoat the hemlock—and deeply appreciate the work he does in archiving various court cases involving bioethics around the world."

"Everything" might be too strong and broad.  But I appreciate the sentiment.  But my most favorite recent comment about me remains Ann Neumann's.  

"Thaddeus Mason Pope is an animated, towering man with a bald head and enigmatic facial features as unforgettable as his name. . . . Pope also runs the Medical Futility Blog, a site with work-a-day formatting and outdated fonts that is nonetheless an indispensable clearing house for news and updates on end of life legislation, litigation and initiatives. Which is why I follow what he writes and blogs religiously."

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Obamacare Reduced Racial Disparities in Healthcare Insurance http://www.peterubel.com/uncategorized/obamacare-reduced-racial-disparities-healthcare-insurance/ http://www.peterubel.com/uncategorized/obamacare-reduced-racial-disparities-healthcare-insurance/#comments Thu, 16 Jun 2016 13:06:15 +0000 http://www.peterubel.com/?p=8007 Research led by Stacey McMorrow (a former student of mine) shows that Obamacare was especially helpful in enabling black and Hispanic people obtain healthcare insurance: Disparities in insurance rates among either groups are declining:      

The post Obamacare Reduced Racial Disparities in Healthcare Insurance appeared first on PeterUbel.com.

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End of Life Law in Australia – New Website Resource to Help You Understand Law at End of Life http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/A9EUZUgIY08/end-of-life-law-in-australia-new.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/A9EUZUgIY08/end-of-life-law-in-australia-new.html#comments Thu, 16 Jun 2016 09:00:00 +0000 http://www.bioethics.net/?guid=c0e11006ba6158f4d2b30a9fcc4f6625 http://medicalfutility.blogspot.com/feeds/8798079445873643909/comments/default 0 Gender Indiscrimination http://blogs.tiu.edu/bioethics/2016/06/15/gender-indiscrimination/ http://blogs.tiu.edu/bioethics/2016/06/15/gender-indiscrimination/#comments Thu, 16 Jun 2016 02:00:15 +0000 http://blogs.tiu.edu/bioethics/?p=6782 Read More »]]> http://blogs.tiu.edu/bioethics/2016/06/15/gender-indiscrimination/feed/ 0 Medical Futility Blog Exceeds 125,000 Monthly Pageviews http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/B66IuJKjmzc/medical-futility-blog-exceeds-125000.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/B66IuJKjmzc/medical-futility-blog-exceeds-125000.html#comments Wed, 15 Jun 2016 20:19:00 +0000 http://www.bioethics.net/?guid=9cfc11c5781db176d394b56930571166 http://medicalfutility.blogspot.com/feeds/4598727603226770080/comments/default 0 Doctor Punished for Bringing Dead Back to Life (Asclepius) http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Q-U45GJwHZg/doctor-punished-for-bringing-dead-back.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Q-U45GJwHZg/doctor-punished-for-bringing-dead-back.html#comments Wed, 15 Jun 2016 08:48:00 +0000 http://www.bioethics.net/?guid=d74e75c7340d32b56045df8ee4266b61 http://medicalfutility.blogspot.com/feeds/8144460990593635772/comments/default 0 Sacred and Profane: Balancing the sanctity of the human body with the mechanics of cadaver dissection https://reflectivemeded.org/2016/06/14/sacred-and-profane-balancing-the-sanctity-of-the-human-body-with-the-mechanics-of-cadaver-dissection/ https://reflectivemeded.org/2016/06/14/sacred-and-profane-balancing-the-sanctity-of-the-human-body-with-the-mechanics-of-cadaver-dissection/#comments Tue, 14 Jun 2016 15:10:17 +0000 http://reflectivemeded.org/?p=247 ]]> https://reflectivemeded.org/2016/06/14/sacred-and-profane-balancing-the-sanctity-of-the-human-body-with-the-mechanics-of-cadaver-dissection/feed/ 0 Need More Evidence the U.S. Healthcare Market Is Screwed Up? http://www.peterubel.com/health_wellbeing/need-evidence-u-s-healthcare-market-screwed/ http://www.peterubel.com/health_wellbeing/need-evidence-u-s-healthcare-market-screwed/#comments Tue, 14 Jun 2016 13:42:53 +0000 http://www.peterubel.com/?p=8001 In a healthy consumer market, people compare the price and quality of goods inside whether it’s worth paying extra money to get the best possible products. In healthcare, it’s often almost impossible to figure out what things cost. And when … Continue reading

The post Need More Evidence the U.S. Healthcare Market Is Screwed Up? appeared first on PeterUbel.com.

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Patient Rights in the ICU http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/BZ2jOdQtkiM/patient-rights-in-icu.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/BZ2jOdQtkiM/patient-rights-in-icu.html#comments Tue, 14 Jun 2016 09:00:00 +0000 http://www.bioethics.net/?guid=b3b56b41928601a61640326252f4b02c http://medicalfutility.blogspot.com/feeds/3611553638881458139/comments/default 0 APHA Ethics Section Interview with Dr. Celia B. Fisher on Conversion Therapy Report https://ethicsandsociety.org/2016/06/13/apha-ethics-section-interview-with-dr-celia-b-fisher-on-conversion-therapy-report/ https://ethicsandsociety.org/2016/06/13/apha-ethics-section-interview-with-dr-celia-b-fisher-on-conversion-therapy-report/#comments Mon, 13 Jun 2016 15:13:36 +0000 http://ethicsandsociety.org/?p=1842 Continue reading ]]> https://ethicsandsociety.org/2016/06/13/apha-ethics-section-interview-with-dr-celia-b-fisher-on-conversion-therapy-report/feed/ 0 Husband and Wife Both Patients in ICU http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/rek0vW9J8oQ/husband-and-wife-both-patients-in-icu.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/rek0vW9J8oQ/husband-and-wife-both-patients-in-icu.html#comments Mon, 13 Jun 2016 10:00:00 +0000 http://www.bioethics.net/?guid=6677959665b19e446c9d0a24c161a338 http://medicalfutility.blogspot.com/feeds/5987655062125855381/comments/default 0 Drafting Healthcare Decisions Laws (a Poem) http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/PMDzdKyO8OY/drafting-healthcare-decisions-laws-poem.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/PMDzdKyO8OY/drafting-healthcare-decisions-laws-poem.html#comments Mon, 13 Jun 2016 10:00:00 +0000 http://www.bioethics.net/?guid=6106800e1a399161d915ce415bcf904b This poem was recited by Phillip Carroll in the closing remarks of his 1987 Presidential Address to the Uniform Law Commission.  The ULC had met in August 1985 to draft the Uniform Rights of the Terminally Ill Act.

  • We came to California, we’re here at Newport Beach,
  • We’re lawyers from the 50 states, uniformity we preach.
  • 96 times we’ve met like this, injustice we outmode,
  • A sample of our efforts – the Uniform Commercial Code.
  • Our tasks are seldom easy, in fact at times it’s all uphill,
  • Remember Minneapolis and the Rights of the Terminally Ill!
  • We said there was a right to die and we could write the tickets,
  • The locals said that we could try, but first get through our pickets.
  • You know I thought I would die from all that agitation,
  • But soon I found that I lacked was nutrition and hydration.
  • We’ll kick this off this morning and our spirits will uplift,
  • We will think things anatomical and how to make a gift.
  • Yes, once again we face the knotty issue of franchise,
  • We’ll do it and we’ll show the world the art of compromise.


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Parents May Refuse Life Saving Therapy for Child http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/LBTG1CIPgLs/parents-may-refuse-life-saving-therapy.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/LBTG1CIPgLs/parents-may-refuse-life-saving-therapy.html#comments Mon, 13 Jun 2016 10:00:00 +0000 http://www.bioethics.net/?guid=54e5521cf64a116b38aa5f6f371e84a6 http://medicalfutility.blogspot.com/feeds/8948101354972450422/comments/default 0 Brain Death in the Courts: Another Injunction Prohibiting Hospital from Conducting Apnea Test http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/503Jx8oUKik/brain-death-in-courts-another.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/503Jx8oUKik/brain-death-in-courts-another.html#comments Sun, 12 Jun 2016 07:02:00 +0000 http://www.bioethics.net/?guid=360a74ca42546f49e9b5f45b4cab6e18 http://medicalfutility.blogspot.com/feeds/4993936493660493709/comments/default 0 The Gift: a Parable for Our Time http://blogs.tiu.edu/bioethics/2016/06/11/the-gift-a-parable-for-our-time/ http://blogs.tiu.edu/bioethics/2016/06/11/the-gift-a-parable-for-our-time/#comments Sat, 11 Jun 2016 14:26:50 +0000 http://blogs.tiu.edu/bioethics/?p=6778 Read More »]]> http://blogs.tiu.edu/bioethics/2016/06/11/the-gift-a-parable-for-our-time/feed/ 0 Surgical Critical Care Innovator Joseph Civetta http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/qa0K9Mx_8SY/surgical-critical-care-innovator-joseph.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/qa0K9Mx_8SY/surgical-critical-care-innovator-joseph.html#comments Sat, 11 Jun 2016 10:00:00 +0000 http://www.bioethics.net/?guid=3d56b686212cf45dd70a70c66dd04fdb Here is an impressive recent obituary of surgical critical care innovator Joseph Civetta.

It notes his definition:  “Futility is defined as the gap between what a doctor can achieve and a patient can accept

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Human Life Alliance – Minnesota Annual Gala http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Mnm9i2dB1xM/human-life-alliance-minnesota-annual.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Mnm9i2dB1xM/human-life-alliance-minnesota-annual.html#comments Sat, 11 Jun 2016 09:30:00 +0000 http://www.bioethics.net/?guid=6f503bc5c02b0474d51390bafeda602c http://medicalfutility.blogspot.com/feeds/406839726488077808/comments/default 0 Court Allows Hospital to Perform Apnea (Brain Death) Test over Family Objections http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/IHmIagpY8HA/court-allows-hospital-to-perform-apnea.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/IHmIagpY8HA/court-allows-hospital-to-perform-apnea.html#comments Sat, 11 Jun 2016 07:41:00 +0000 http://www.bioethics.net/?guid=d152661115b94e7c80ba014121ec646b http://medicalfutility.blogspot.com/feeds/2233982450624402304/comments/default 0 Small Minds http://www.amc.edu/BioethicsBlog/post.cfm/small-minds http://www.amc.edu/BioethicsBlog/post.cfm/small-minds#comments Fri, 10 Jun 2016 15:53:52 +0000 http://www.amc.edu/BioethicsBlog/post.cfm/small-minds

I have recently read an opinion piece published in the Chronicle of Higher Education by John Kaag and David O’Hara entitled Big Brains, Small Minds. In this article Kaag and O’Hara boldly assert that “We are on the verge of becoming the best trained, and least educated, society since the Romans”. In the ensuing explanation we learn that education is science is what he refers to as “trained” while education in the humanities is what he refers to as “educated”. Apparently I have been trained and he has been educated. What a crock. Because I have been trained and not educated it is probably important to clarify that I mean crock not in the sense of an earthenware jar but rather in the sense of something which is complete nonsense.

Kaag and O’Hara appear to believe that one of the primary roles of the humanities is to critique science. That is fine; everybody should critique science, it is much too important to not be evaluated in the context of all types of human knowledge and understanding. It is also fine that they suggest that humanities should not be judged by the metrics of hard science. Of note, however, is I have never heard anyone suggest that humanities should be judged by the metrics of hard science. But I think it is probably important to note, however, that if it is the job of humanities to critique science perhaps those doing the critiquing should also know some science. It should also be kept in mind that scientists are pretty good at critiquing the sciences and, in fact, we usually spend quite a bit of time and energy critiquing each other. Just for the record, Kaag and O’Hara write that Plato teaches us that part of the liberal arts enduring mission is to critique the objectives of science. Science was rather different in the time of Plato. Perhaps he should have a more recent reference. He should also remember that at the time of Plato there was really no distinct boundary between science and philosophy. The authors cite the story of Herodicus as told by Socrates as an example of a disordered mind having “been trained in the STEM fields of his time”.  Really! This took place in the fifth century BC. Again, I think we may well need a newer reference. Parenthetically Herodicus showed great insight in advocating the value of exercise in preserving health.

The job of a professional scientist is to learn what has previously been unknown. They must be able to understand and appreciate the state of knowledge in their field, identify the boundaries of knowledge, and formulate hypotheses that if proven produce new knowledge. For a scientist to be successful they assume the burden of proving or disproving that hypothesis. They must have the communications skills to present their ideas in an adequately compelling manner to be awarded resources to engage these scientific pursuits. They must communicate their findings to the world. None of these are endeavors of the small mind.

The authors of this essay state “If you’re interested in learning about justice, you don’t go to the chemistry laboratory. You go to philosophy class and travel to Plato’s Republic. Perhaps so but I am unconvinced. If the justice one seeks has to do with environmental preservation, species extinction, and biomedical innovation perhaps this is positively contributed to by those who have had their minds expanded by an education which includes science.

 

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 website.

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Testing, testing: Prenatal genetic screening http://blogs.tiu.edu/bioethics/2016/06/10/testing-testing-prenatal-genetic-screening/ http://blogs.tiu.edu/bioethics/2016/06/10/testing-testing-prenatal-genetic-screening/#comments Fri, 10 Jun 2016 13:01:21 +0000 http://blogs.tiu.edu/bioethics/?p=6765 Read More »]]> http://blogs.tiu.edu/bioethics/2016/06/10/testing-testing-prenatal-genetic-screening/feed/ 0 Medical Futility Blog 2016-06-10 05:00:00 http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/chCJnj_NQOk/in-new-video-cure-benjamin-scheuer.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/chCJnj_NQOk/in-new-video-cure-benjamin-scheuer.html#comments Fri, 10 Jun 2016 09:00:00 +0000 http://www.bioethics.net/?guid=caa872a66a5b591b9413edebed9c1d47 In the new video “Cure,” Benjamin Scheuer conveys the dread that brands cancer patients, whether or not their type of disease is treatable.  

The video is eloquently reviewed by the New York Times.



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Mitochondrial replacement boosterism http://blogs.tiu.edu/bioethics/2016/06/09/mitochondrial-replacement-boosterism/ http://blogs.tiu.edu/bioethics/2016/06/09/mitochondrial-replacement-boosterism/#comments Fri, 10 Jun 2016 03:57:47 +0000 http://blogs.tiu.edu/bioethics/?p=6763 Read More »]]> http://blogs.tiu.edu/bioethics/2016/06/09/mitochondrial-replacement-boosterism/feed/ 0 National Academies on Gene-Drives http://feedproxy.google.com/~r/ABlogOnBioethics/~3/q3icJilv19M/national-academies-on-gene-drives.html http://feedproxy.google.com/~r/ABlogOnBioethics/~3/q3icJilv19M/national-academies-on-gene-drives.html#comments Fri, 10 Jun 2016 01:57:00 +0000 http://www.bioethics.net/?guid=beced1c65b658498878e7f290a88d910 http://ablogonbioethics.blogspot.com/feeds/4663769527934801202/comments/default 0