Bioethics.net » Health Care http://www.bioethics.net Where the World Finds Bioethics Fri, 17 Apr 2015 19:34:37 +0000 en-US hourly 1 http://wordpress.org/?v=4.0.1 Current Trends in End-of-Life Medical Treatment (MP3) http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/moNkqUfvNSY/current-trends-in-end-of-life-medical.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/moNkqUfvNSY/current-trends-in-end-of-life-medical.html#comments Fri, 17 Apr 2015 03:25:00 +0000 http://www.bioethics.net/?guid=81776b1f57479a24a04bab7554770bcf http://medicalfutility.blogspot.com/feeds/6218317159839860502/comments/default 0 Current Trends in End-of-Life Medical Treatment (MP3) http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/moNkqUfvNSY/current-trends-in-end-of-life-medical.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/moNkqUfvNSY/current-trends-in-end-of-life-medical.html#comments Fri, 17 Apr 2015 03:25:00 +0000 http://www.bioethics.net/?guid=81776b1f57479a24a04bab7554770bcf http://medicalfutility.blogspot.com/feeds/6218317159839860502/comments/default 0 Patients without Surrogates – Twitter Chat http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/8dlj-PI4j8A/patients-without-surrogates-twitter-chat.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/8dlj-PI4j8A/patients-without-surrogates-twitter-chat.html#comments Fri, 17 Apr 2015 03:13:00 +0000 http://www.bioethics.net/?guid=25b57fcf090ef3ea819433aff874a7d0 http://medicalfutility.blogspot.com/feeds/327946056603407328/comments/default 0 A Drive-By Shot at the Concept of “Liberal Neutrality” http://feedproxy.google.com/~r/bioethics-at-tiu/~3/JgkTSdPARS8/ http://feedproxy.google.com/~r/bioethics-at-tiu/~3/JgkTSdPARS8/#comments Fri, 17 Apr 2015 02:34:53 +0000 http://blogs.tiu.edu/bioethics/?p=5898 Read More »]]> http://blogs.tiu.edu/bioethics/2015/04/16/a-drive-by-shot-at-the-concept-of-liberal-neutrality/feed/ 0 Watch Out for Snack Food http://www.peterubel.com/uncategorized/watch-snack-food/ http://www.peterubel.com/uncategorized/watch-snack-food/#comments Thu, 16 Apr 2015 12:45:47 +0000 http://www.peterubel.com/?p=7410 People are correctly paying a great deal of attention to just how many calories it is possible to consume at American restaurants these days. The New York Times, in fact, recently showed just how many calories people typically consume at … Continue reading

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Gonzales vs. Oregon http://www.amc.edu/BioethicsBlog/post.cfm/gonzales-vs-oregon http://www.amc.edu/BioethicsBlog/post.cfm/gonzales-vs-oregon#comments Thu, 16 Apr 2015 11:04:03 +0000 http://www.bioethics.net/?guid=8ccc34502f9825bf2b0a6ab9c09dd894 http://www.bioethics.net/2015/04/gonzales-vs-oregon/feed/ 0 Bioethics Commission Recommends Creating Guidance About Use of Neural Modifiers to Augment or Enhance Neural Function http://blog.bioethics.gov/2015/04/15/bioethics-commission-recommends-creating-guidance-about-use-of-neural-modifiers-to-augment-or-enhance-neural-function/ http://blog.bioethics.gov/2015/04/15/bioethics-commission-recommends-creating-guidance-about-use-of-neural-modifiers-to-augment-or-enhance-neural-function/#comments Wed, 15 Apr 2015 15:50:44 +0000 http://blog.bioethics.gov/?p=1610 http://blog.bioethics.gov/2015/04/15/bioethics-commission-recommends-creating-guidance-about-use-of-neural-modifiers-to-augment-or-enhance-neural-function/feed/ 0 Sex, Consent, and Dementia http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=7378&blogid=140 http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=7378&blogid=140#comments Wed, 15 Apr 2015 14:54:00 +0000 http://www.bioethics.net/?guid=2b229be570595b8b72f5b8e606aa3d02 Bonnie Steinbock]]> http://www.bioethics.net/2015/04/sex-consent-and-dementia/feed/ 0 National Healthcare Decisions Day http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/2fu2lQOIQB0/national-healthcare-decisions-day.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/2fu2lQOIQB0/national-healthcare-decisions-day.html#comments Wed, 15 Apr 2015 09:00:00 +0000 http://www.bioethics.net/?guid=1aeb4123d934994a782fe6411f225bf6 http://medicalfutility.blogspot.com/feeds/4932845918758352882/comments/default 0 VSED Podcast on TWIHL http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/jVhDvZz8pbw/vsed-podcast-on-twihl.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/jVhDvZz8pbw/vsed-podcast-on-twihl.html#comments Tue, 14 Apr 2015 22:53:00 +0000 http://www.bioethics.net/?guid=dcca7d29fc2987f31d4983d3e4f9ac9b http://medicalfutility.blogspot.com/feeds/2204816561121272067/comments/default 0 Is there a “Right to Try” Experimental Drugs? http://researchethicsblog.com/2015/04/14/is-there-a-right-to-try-experimental-drugs/ http://researchethicsblog.com/2015/04/14/is-there-a-right-to-try-experimental-drugs/#comments Tue, 14 Apr 2015 21:50:24 +0000 http://researchethicsblog.com/?p=627 ]]> http://researchethicsblog.com/2015/04/14/is-there-a-right-to-try-experimental-drugs/feed/ 0 LIVING WILLS, GREYHOUNDS AND GOALPOSTS http://practicalbioethics.blogspot.com/2015/04/living-wills-greyhounds-and-goalposts.html http://practicalbioethics.blogspot.com/2015/04/living-wills-greyhounds-and-goalposts.html#comments Tue, 14 Apr 2015 20:14:00 +0000 http://www.bioethics.net/?guid=8ab97f93f0f9361fdb2e2e82e2e1048d National Healthcare Decisions Day – April 16, 2015
By John G. Carney, MEd, President and CEO
Center for Practical Bioethics


For years, I’ve been curious to know whether people fail to complete living wills and avoid naming a healthcare agent out of procrastination or a false sense of confidence that they have plenty of time to do it later.

Reality is, if you don’t do it when you don’t have to, it’s not likely to go well when you do. Naming someone during a time of crisis to speak on your behalf can be downright cruel, especially when you’ve not shared much about the things that are really important to you.

Share What’s Important

What are those things? Well, they aren’t scary or monumental. They include things like how important laughing, talking, sharing and “just being” are to you. Don’t get all tied up in feeding tubes. Instead think about what sharing a meal means to you. Is it a means to an end or an end in itself?

I once shared a house with an older-than-me bachelor and swore when he ate at home he never cooked anything that didn’t come in a box and could go in a microwave. I, on the other hand, started just about every meal sautéing fresh onions and garlic in olive oil. Food had entirely different meanings to us, and that became starkly evident to me when we talked about his dad’s early onset Alzheimer’s and how differently he approached the question of feeding tubes when the difficult question arose in his family.

So stop worrying about a tube in every orifice! Instead think about the sharing what you want more than anything – even at the end. Don’t obsess about completing a living will (aka healthcare directive) to the point that it paralyzes you from acting. Instead, take the time to share with someone who loves and cares for you what’s important to you as you think about life in general and especially its final stages. Focus on the positive - the most fulfilling aspects of your life. This isn’t a “bucket list” of items to do, but rather a sharing of values and convictions. What do relationships, solitude, faith, nature, self-expression and art, work, music and family mean to you?

Then, when that’s all done, ask that person to be your agent. And then promise that person that you’ll do it again in a year or two down the road – or whenever you have a major event in your life – from the birth of a child to the diagnosis of a serious illness. Life happens and, while our wishes and dreams may alter, you’ll be comforted by the fact that values – real bedrock beliefs about life and love – pretty much stay the same. But don’t assume even those close to you know all that.

Recognize Greyhounds and Goalposts

Over the years I’ve learned about two very important syndromes that all of us deal with differently. One is called the “Greyhound Syndrome.” It’s the phenomenon that sometimes we experience a great freedom of anonymity sitting next to a perfect stranger (on a bus traveling cross country) and share our deepest thoughts more freely than we do with those we’ve shared a lifetime with. Hospice volunteers can regale you with stories they’ve heard, never to share again, by a dying patient. These are not necessarily dark secrets of our past so much as unvoiced hidden treasures. Some are worth sharing before we die; others are worth taking to the grave. Think about which is which.

The other syndrome is what’s called “Moving Goal Posts.” This phenomenon deals with how some future state or health condition may appear unacceptable at one point in our lives and much more acceptable at another. That’s why checking boxes and lists on living will forms doesn’t work for people in states of relative good health. But stories, treasured thoughts, values and convictions work at every level.

Have a Caring Conversation Today

So take a leap and share your stories with someone you love. And, this April 16, on National Healthcare Decisions Day, have a caring conversation. Name an agent. Start talking about what matters most and don’t make it a somber depressing discussion. Think about it as a gift to those you love that will lead to peace of mind – for you and them. Because it likely will – far more likely than leaving it to chance. Close to 85% of us will have to rely on someone else to make our final wishes known. 

If you need help getting started, we’ve got a little booklet that will help you do just that. Download a free Caring Conversations workbook or order a printed version from the Center for Practical Bioethics’ website.

Seize the moment and turn what you thought was morbid and ghoulish into the marvelous and glorious. You may just discover something about a loved one that will serve you both in the moment and for a lifetime.
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The Anchoring Heuristic Courtesy of Dilbert http://www.peterubel.com/behavioral_economics/anchoring-heuristic-courtesy-dilbert/ http://www.peterubel.com/behavioral_economics/anchoring-heuristic-courtesy-dilbert/#comments Tue, 14 Apr 2015 12:55:13 +0000 http://www.peterubel.com/?p=7407 Heuristics is jargon used by decision psychologists and behavioral economists to refer to cognitive shortcuts we humans take to make judgments and decisions. One of the first heuristics identified as such by Danny Kahneman and Amos Tversky was the anchoring … Continue reading

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Let’s do a Better Job Educating Everyone http://www.amc.edu/BioethicsBlog/post.cfm/let-s-do-a-better-job-educating-everyone http://www.amc.edu/BioethicsBlog/post.cfm/let-s-do-a-better-job-educating-everyone#comments Tue, 14 Apr 2015 11:04:00 +0000 http://www.bioethics.net/?guid=af253b4832d86221ab3ad56e925fbf52 http://www.bioethics.net/2015/04/lets-do-a-better-job-educating-everyone/feed/ 0 A Not-So-Open Discussion http://feedproxy.google.com/~r/bioethics-at-tiu/~3/qYls6ND9r-U/ http://feedproxy.google.com/~r/bioethics-at-tiu/~3/qYls6ND9r-U/#comments Tue, 14 Apr 2015 01:36:07 +0000 http://blogs.tiu.edu/bioethics/?p=5882 Read More »]]> http://blogs.tiu.edu/bioethics/2015/04/13/a-not-so-open-discussion/feed/ 0 (anti)Discrimination Starts in the Womb http://feedproxy.google.com/~r/bioethics-at-tiu/~3/lgK74CNZfGk/ http://feedproxy.google.com/~r/bioethics-at-tiu/~3/lgK74CNZfGk/#comments Mon, 13 Apr 2015 23:22:23 +0000 http://blogs.tiu.edu/bioethics/?p=5880 Read More »]]> http://blogs.tiu.edu/bioethics/2015/04/13/antidiscrimination-starts-in-the-womb/feed/ 0 Residual Dried Blood and New Born Screening in Minnesota https://thebioethicsprogram.wordpress.com/2015/04/13/residual-dried-blood-and-new-born-screening-in-minnesota/ https://thebioethicsprogram.wordpress.com/2015/04/13/residual-dried-blood-and-new-born-screening-in-minnesota/#comments Mon, 13 Apr 2015 16:24:21 +0000 http://thebioethicsprogram.wordpress.com/?p=537 ]]> https://thebioethicsprogram.wordpress.com/2015/04/13/residual-dried-blood-and-new-born-screening-in-minnesota/feed/ 0 Gratitude for Rev. Gardner C. Taylor http://practicalbioethics.blogspot.com/2015/04/gratitude-for-rev-gardner-c-taylor.html http://practicalbioethics.blogspot.com/2015/04/gratitude-for-rev-gardner-c-taylor.html#comments Mon, 13 Apr 2015 14:56:00 +0000 http://www.bioethics.net/?guid=cc010f0f86d43263f249bb779545d0ce Remembered by Dr. Robert Lee Hill, Senior Minister
Community Christian Church, Kansas City, Missouri
When a comprehensive American religious history of the 20th century is finally compiled, the magisterial preaching eloquence of the Rev. Dr. Gardner C. Taylor will be remembered with astonishment and abiding, awe-struck admiration. Dr. Taylor died on Sunday, April 5. He was 96.

For more than 70 years, Dr. Taylor held forth among African American Baptists and a panoramic array of religious adherents throughout the United States and around the world as an orator with few if any peers.

MLK’s Favorite Preacher

As the pastor of the Concord Baptist Church of Christ in Brooklyn, New York, for 42 years, and afterwards in retirement, Dr. Taylor engaged the issues of his community, the nation and the world with passion, insight and effectiveness. He artfully combined the necessary durative dynamic of transcendence with the equally necessary punctiliar character of incarnation.

With Martin Luther King, Jr., who called Dr. Taylor his “favorite” preacher, he helped found The Progressive National Baptist Church in order for congregations to better address and overcome the ravages of racism and segregation in the U.S. Working from the North, he led the Concord church and many other congregations to raise funds for Dr. King’s efforts in the South.

Dr. Taylor also served on the New York City Board of Education and was always involved in issues that arose in the “public square” of Brooklyn and greater New York. In his later years, Dr. Taylor worried that many religious leaders and their congregations had lost their “prophetic edge” and might fall into the trap of merely mirroring a consumeristic culture.’’

Compassion Sabbath in Kansas City

Whenever he spoke and wherever he travelled, Dr. Taylor dealt with ethical issues and matters of public significance, including when he came to Kansas City.

The Center for Practical Bioethics will remain abidingly thankful for Dr. Taylor’s presence in Kansas City in 1999 at the launching of “Compassion Sabbath,” which engaged more than 80,000 faith community leaders and members in hundreds of congregations in an interfaith initiative to increase the quality of care for those facing the end of life. At a breakfast gathering at Union Station, he spoke compellingly of the need for honesty and compassion in relation to the experience of debilitation and pain at the end of life.

During the time of a sabbatical journey in 2010, I was privileged to share a long interview/conversation with Dr. Taylor in his home in Raleigh, North Carolina. In retirement, Dr. Taylor echoed in his meditations what he put forth as a preacher, pastor, and activist for the betterment of humanity. Well into his 90's, Dr. Taylor spoke plainly and with swift clarity about the process of aging. When asked about what he prayed for, he said his personal prayers were "to get out without too much pain." And he added, with a chuckle, "And I'm ready to get out, I'm ready to go."

People in the pew, the academy of homileticians, and awe-struck fellow clergy regarded Dr. Taylor as a singular personality whose like only comes around once every century or so. We would agree and only add that we’re so glad that he came to Kansas City to share his extraordinary voice for the intertwining for what is “good” and what is “right.”

Note: The Kansas City Star published an article about Dr. Gardner on April 11, 2015, describing his pulpit as “the most prestigious in black Christendom.”]]>
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How Do Scientists’ Beliefs Differ from Those of Laypeople? http://www.peterubel.com/uncategorized/scientists-beliefs-differ-laypeople/ http://www.peterubel.com/uncategorized/scientists-beliefs-differ-laypeople/#comments Mon, 13 Apr 2015 12:51:03 +0000 http://www.peterubel.com/?p=7403 Do you think it is safe to eat genetically modified foods? I do, because I believe that most foods we eat have been genetically modified. Cows wouldn’t be cows if humans hadn’t changed them genetically, through breeding practices. That also … Continue reading

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Should a University President Resign over Research Ethics? http://researchethicsblog.com/2015/04/12/should-a-university-president-resign-over-research-ethics/ http://researchethicsblog.com/2015/04/12/should-a-university-president-resign-over-research-ethics/#comments Sun, 12 Apr 2015 15:35:12 +0000 http://researchethicsblog.com/?p=623 ]]> http://researchethicsblog.com/2015/04/12/should-a-university-president-resign-over-research-ethics/feed/ 0 What’s the Matter with Indiana? https://thebioethicsprogram.wordpress.com/2015/04/12/whats-the-matter-with-indiana/ https://thebioethicsprogram.wordpress.com/2015/04/12/whats-the-matter-with-indiana/#comments Sun, 12 Apr 2015 14:26:39 +0000 http://thebioethicsprogram.wordpress.com/?p=534 ]]> https://thebioethicsprogram.wordpress.com/2015/04/12/whats-the-matter-with-indiana/feed/ 0 Limits of Default Surrogate Laws, Importance of Advance Directives http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/iFjdM7xyP10/limits-of-default-surrogate-laws.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/iFjdM7xyP10/limits-of-default-surrogate-laws.html#comments Sun, 12 Apr 2015 08:00:00 +0000 http://www.bioethics.net/?guid=5278850227cbe5c31d6516613af036c2 http://medicalfutility.blogspot.com/feeds/4869879776031008778/comments/default 0 Ethics of Research on Complementary & Alternative Medicine http://researchethicsblog.com/2015/04/11/ethics-of-research-on-complementary-alternative-medicine/ http://researchethicsblog.com/2015/04/11/ethics-of-research-on-complementary-alternative-medicine/#comments Sat, 11 Apr 2015 16:24:48 +0000 http://researchethicsblog.com/?p=620 ]]> http://researchethicsblog.com/2015/04/11/ethics-of-research-on-complementary-alternative-medicine/feed/ 0 Abortion and Children’s Books http://feedproxy.google.com/~r/bioethics-at-tiu/~3/UgqNew4suqY/ http://feedproxy.google.com/~r/bioethics-at-tiu/~3/UgqNew4suqY/#comments Sat, 11 Apr 2015 14:00:11 +0000 http://blogs.tiu.edu/bioethics/?p=5876 Read More »]]> http://blogs.tiu.edu/bioethics/2015/04/11/abortion-and-childrens-books/feed/ 0 Is International Consensus on Brain Death Achievable? http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/YtVSI-U9rlw/is-international-consensus-on-brain.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/YtVSI-U9rlw/is-international-consensus-on-brain.html#comments Sat, 11 Apr 2015 09:00:00 +0000 http://www.bioethics.net/?guid=acc5776555536a48b12d7673f8848800 Commenting on a new study in NEUROLOGY that shows a wide diversity of brain death practice, James Bernat asks "is international consensus on brain death achievable?"

Bernat observes: "Worldwide concurrence on death determination criteria can enhance public confidence in physicians’ ability to determine death by eliminating the possibility that patients declared dead in one jurisdiction would be considered alive in another. International harmonization also is a constructive step toward improving global systems of organ transplantation."

But, Bernat notes, "formidable medical and societal barriers must be overcome before such consensus becomes possible." 

In addition to other sources of variation results, Bernat notes "disagreement over the conceptual question of whether brain dead patients are truly dead or only “legally dead.” Surveys continue to show both widespread misunderstanding of the brain death concept and its rejection as equivalent to biological death by some health care professionals."

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“Computers Helping Computers Help People Help Computers” http://feedproxy.google.com/~r/bioethics-at-tiu/~3/5SEV4r57qOI/ http://feedproxy.google.com/~r/bioethics-at-tiu/~3/5SEV4r57qOI/#comments Fri, 10 Apr 2015 18:36:43 +0000 http://blogs.tiu.edu/bioethics/?p=5872 Read More »]]> http://blogs.tiu.edu/bioethics/2015/04/10/computers-helping-computers-help-people-help-computers/feed/ 0 Neither Doctors nor Laypersons Understand Brain Death http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/TdzgRClm9S8/neither-doctors-nor-laypersons.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/TdzgRClm9S8/neither-doctors-nor-laypersons.html#comments Fri, 10 Apr 2015 17:33:00 +0000 http://www.bioethics.net/?guid=a9c45df423971dea31cf4eb3cc629d43 http://medicalfutility.blogspot.com/feeds/3519811805312588542/comments/default 0 Ethics in the Age of Ebola http://www.bioethics.net/2015/04/ethics-in-the-age-of-ebola/ http://www.bioethics.net/2015/04/ethics-in-the-age-of-ebola/#comments Fri, 10 Apr 2015 16:30:32 +0000 http://www.bioethics.net/?p=54690
by Joseph J. Fins, M.D.
It now seems a lifetime ago. The first case of Ebola had come to the Western hemisphere and taken the life of Thomas Eric Duncan at a Dallas, Texas hospital. His death, and other cases in the “developed” world, led to a predictable media deluge, a good bit of hysteria, and predictable political posturing. As the November election approached, fear and ideology took hold, with calls for quarantine and allegations of discrimination coming from predictable precincts.
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Toronto Police Criminally Charge Nurse for Stopping Life Support without Consent http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/_nP6kKRrzJM/toronto-police-criminally-charge-nurse.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/_nP6kKRrzJM/toronto-police-criminally-charge-nurse.html#comments Fri, 10 Apr 2015 13:11:00 +0000 http://www.bioethics.net/?guid=9101ed3980b435e9a976c08d88d41c96 Deanna LeblancToronto police have arrested Joanna Flynn (50), a former nurse at Georgian Bay General Hospital for allegedly cutting off a patient’s life support without authorization.  

She is charged with manslaughter and with criminal negligence causing death. The victim, Deanna Leblanc (39), died at the hospital on March 2, 2014.  

The hospital CEO observed "A criminal charge involving someone at our hospital is a highly distressing occurrence and will create a good deal of anxiety for our community." (Toronto Star)  Mark Handelman said he has never seen a Canadian health care practitioner criminally charged for ending life support.

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Ideological Struggles Old and New in America: The Inappropriate Use of Coercive State Authority http://www.amc.edu/BioethicsBlog/post.cfm/ideological-struggles-old-and-new-in-america-the-inappropriate-use-of-coercive-state-authority http://www.amc.edu/BioethicsBlog/post.cfm/ideological-struggles-old-and-new-in-america-the-inappropriate-use-of-coercive-state-authority#comments Fri, 10 Apr 2015 02:04:18 +0000 http://www.bioethics.net/?guid=be672bfec2df66d6556a2465e6b3410a http://www.bioethics.net/2015/04/ideological-struggles-old-and-new-in-america-the-inappropriate-use-of-coercive-state-authority/feed/ 0 Bioethics Commission Makes Recommendation on Equitable Access to Safe and Effective Neural Modifiers http://blog.bioethics.gov/2015/04/09/bioethics-commission-makes-recommendation-on-equitable-access-to-safe-and-effective-neural-modifiers/ http://blog.bioethics.gov/2015/04/09/bioethics-commission-makes-recommendation-on-equitable-access-to-safe-and-effective-neural-modifiers/#comments Thu, 09 Apr 2015 15:52:24 +0000 http://blog.bioethics.gov/?p=1608 http://blog.bioethics.gov/2015/04/09/bioethics-commission-makes-recommendation-on-equitable-access-to-safe-and-effective-neural-modifiers/feed/ 0 Incentive to Stop Smoking? http://www.peterubel.com/behavioral_economics/incentive-stop-smoking/ http://www.peterubel.com/behavioral_economics/incentive-stop-smoking/#comments Thu, 09 Apr 2015 13:16:21 +0000 http://www.peterubel.com/?p=7397 In the United States, the FDA tried to mandate that cigarette companies put nasty images of the harms of smoking onto cigarette packages, images that would take up at least half of the carton. It looks like that effort has … Continue reading

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Do Your Little Bit of Good: National Pain Strategy Comment Period Ends May 20 http://practicalbioethics.blogspot.com/2015/04/do-your-little-bit-of-good-national.html http://practicalbioethics.blogspot.com/2015/04/do-your-little-bit-of-good-national.html#comments Thu, 09 Apr 2015 10:23:00 +0000 http://www.bioethics.net/?guid=371c7345e4755876c0538287e8fe41bb Do Your Little Bit of Good:
National Pain Strategy Comment Period Ends May 20
2.2 Create a comprehensive population health-level strategy for pain….
(Complete before the end of 2012)


In June 2011, those of us who served on the Institute of Medicine’s committee that published Relieving Pain in America sent our report to Congress. It included sixteen recommendations to improve care for at least 100 million Americans who live with chronic pain. It provided what we referred to as a blueprint to “transform the way pain is perceived, judged and treated.”

Our first recommendation (2.1) was to “improve the collection and reporting of data on pain.” We had all been dismayed to learn how little reliable data we actually had to draw from in our process. The second recommendation (2.2) was to “create a comprehensive population health-level strategy for pain prevention, treatment, management, and research. Our “blueprint” was fundamentally a timeline which sequenced our recommendations. We ranked the population health-strategy as our first priority and asked that it be completed within 18 months, i.e., by the end of 2012.

It has been my privilege to serve on the National Pain Strategy Oversight Committee, which was charged by the Department of Health and Human Services (HHS) with developing the plan called for by the IOM. Unfortunately, that charge was not issued until the end of 2012 and the process took much longer than we had anticipated. The committee’s work was completed last summer and then it entered the vetting process. The good news, however, is that last week the National Pain Strategy Report was posted in the Federal Register. Until May 20, 2015, recommendations and comments from the public are possible.

We wish to strongly encourage all of those interested in efforts to improve chronic pain care to review this document and share your thoughts about it. You can do so by going to -
https://www.federalregister.gov/articles/2015/04/02/2015-07626/draft-national-pain-strategy

The report is only 43 pages and is organized in six sections: 1) Population Research, 
2) Prevention and Care, 3) Disparities, 4) Service Delivery and Reimbursement, 5) Professional Education and Training, 6) Public Education and Communication.

Each section contains a statement of “the problem” and then provides objectives and strategies for remedying that problem. From my perspective, some of the Report’s most important objectives are to:
• Foster the collection of more and better data for all populations, including developing metrics for measuring progress. (Good solutions always start with good facts.)
• Determine and analyze the benefit and cost of current prevention and treatment approaches and create incentives for using those treatments with high benefit-to-cost ratios. (Get the biggest bang for the buck.)
• Develop standardized and comprehensive pain assessments and outcome measures intended to increase functionality. (Move beyond 1-10 pain scales.)
• Acknowledge and address biases in pain care. (Biases that are implicit, conscious or unconscious.)
• Demonstrate the benefit of inter-disciplinary, multi-modal care, including behavioral health, for chronic pain. (Pain is a complex issue that requires complex solutions.)
• Align reimbursement with care models that produce optimal patient outcomes. (Both public and private payers are critical to reform.)

Perhaps, most important of all, however, is to improve health literacy, communication and education about pain among patients, healthcare providers, policy makers and the public. 

More than 80 pain and policy experts from across the country volunteered their time to develop this report. Many others in federal agencies have also been involved, and all agreed to the following vision:
If the objectives of the National Pain Strategy are achieved,
the nation would see a decrease in the prevalence across the
continuum of pain, from acute, to chronic, to high-impact
chronic pain, and across the life span from pediatric through
geriatric populations, to end of life, which would reduce the
burden of pain for individuals, families and society as a whole.
Americans experiencing pain – across the broad continuum —
would have timely access to  a care system that meets their
bio-psychosocial needs and takes into account  individual
preferences, risks, and social contexts.  In other words they
would receive patient-centered care.


Further Americans in general would recognize chronic pain  
as a complex disease and a threat to public health and a just
and productive society. 


All those involved in developing the report are committed to getting it right, and to do so, it is critical that people living with chronic pain, their families and those who care for them (especially primary care providers) provide input and feedback. To paraphrase Bishop Desmond Tutu, “Do your little bit of good…. It is those things put together that change the world.”


https://www.federalregister.gov/articles/2015/04/02/2015-07626/draft-national-pain-strategy


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Lawsuit for Unilateral Withdrawal – King v. Summa Health http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/87G0qVGBSrY/lawsuit-for-unilateral-withdrawal-king.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/87G0qVGBSrY/lawsuit-for-unilateral-withdrawal-king.html#comments Thu, 09 Apr 2015 08:00:00 +0000 http://www.bioethics.net/?guid=2bef249cafbefb6aa427e0bf3032fbda http://medicalfutility.blogspot.com/feeds/7529462568151783613/comments/default 0 Texas Futility Law – House Committee Hearing Today http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/cyUB-JuElss/texas-futility-law-house-committee.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/cyUB-JuElss/texas-futility-law-house-committee.html#comments Wed, 08 Apr 2015 12:42:00 +0000 http://www.bioethics.net/?guid=266a538bf5e1d8a32e383992b20e0a1f http://medicalfutility.blogspot.com/feeds/7573156385701036845/comments/default 0 Would Better Risk Communication Reduce Fear of Flying? http://www.peterubel.com/uncategorized/better-risk-communication-reduce-fear-flying/ http://www.peterubel.com/uncategorized/better-risk-communication-reduce-fear-flying/#comments Wed, 08 Apr 2015 12:35:14 +0000 http://www.peterubel.com/?p=7393 With so much recent news about airplane disasters, it’s easy to become frightened about flying. I wonder if a risk graphic like the following will do much to help? As reported on recently in The Economist, the risk graphic comes … Continue reading

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Religious freedom revisited http://feedproxy.google.com/~r/bioethics-at-tiu/~3/KMFa_h2UMnU/ http://feedproxy.google.com/~r/bioethics-at-tiu/~3/KMFa_h2UMnU/#comments Wed, 08 Apr 2015 12:00:14 +0000 http://blogs.tiu.edu/bioethics/?p=5868 Read More »]]> http://blogs.tiu.edu/bioethics/2015/04/08/religious-freedom-revisited/feed/ 0 Has the Pendulum Swung too Far in Favor of Patient Autonomy? http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/WapnXtJfe5A/has-pendulum-swung-too-far-in-favor-of.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/WapnXtJfe5A/has-pendulum-swung-too-far-in-favor-of.html#comments Wed, 08 Apr 2015 08:30:00 +0000 http://www.bioethics.net/?guid=1f9f911329c74019a2ca47c7cf442226 "Institutional Culture and Policies’ Influence on Do Not Resuscitate Decision-Making at the End of Life," online first in JAMA Internal Medicine looks at the difference between (a) hospitals which have policies or a culture that prioritizes patient autonomy with regard to DNAR orders and (b) hospitals where doctors’ recommendations on what might be in patients’ best interests medically hold more sway.

Elizabeth Dzeng and colleagues argue that UK hospitals currently differ from the more consumer-oriented approach of their US counterparts and doctors' recommendations still hold sway over DNAR decisions. However, they are moving more towards the US model as the recent case of Janet Tracey at Addenbrookes hospital in Cambridge shows. Tracey’s family successfully sued the hospital over a DNR order that was implemented without the family's permission.


The authors interviewed 58 doctors and trainees at three academic medical centers in the US and one in the UK. Trainee doctors at hospitals with emphasized patient autonomy often felt compelled to offer the choice of resuscitation in a neutral way in all situations regardless of whether they believed it would be clinically appropriate. 


In contrast, trainees at hospitals where policies and culture prioritized best interest-focused approaches felt more comfortable recommending against resuscitation in situations where survival was unlikely. They felt confident, for instance, to discourage the ineffective use of CPR and found it ethically suspect to offer CPR in futile situations such as for frail elderly patients with incurable metastatic cancer where doing CPR may result in broken ribs and electric shocks as well as depriving them of a dignified death.


Unlike trainees, experienced doctors at all hospitals were willing to make recommendations against resuscitation if they believed it would be futile. 


The authors conclude: "Institutional cultures and policies might influence how physician trainees develop their professional attitudes toward autonomy and their willingness to make recommendations regarding the decision to implement a DNR order. A singular focus on autonomy might inadvertently undermine patient care by depriving patients and surrogates of the professional guidance needed to make critical end of life decisions."  (HT: University of Cambridge)


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When Helpful Nudges Aren’t Helpful http://www.peterubel.com/uncategorized/helpful-nudges-arent-helpful/ http://www.peterubel.com/uncategorized/helpful-nudges-arent-helpful/#comments Tue, 07 Apr 2015 14:23:21 +0000 http://www.peterubel.com/?p=7390 Gerald Ashley (twitter handle @Gerald_Ashley) recently tweeted a photo of what was SUPPOSED to be a helpful nudge, reducing the odds that people would bump into each other going up and down the stairs. Can you see what might not … Continue reading

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Texas Advance Directives Act: Must a Death Panel Be a Star Chamber? http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/OfpuuJpSSDc/texas-advance-directives-act-must-death.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/OfpuuJpSSDc/texas-advance-directives-act-must-death.html#comments Tue, 07 Apr 2015 08:30:00 +0000 http://www.bioethics.net/?guid=8f76a668c47fe27f009d4c4082fc3219 http://medicalfutility.blogspot.com/feeds/1805988542947820533/comments/default 0 American Pharmacists Association Votes to Discourage Pharmacists from Participating in Executions http://www.amc.edu/BioethicsBlog/post.cfm/american-pharmacists-association-votes-to-discourage-pharmacists-from-participating-in-executions http://www.amc.edu/BioethicsBlog/post.cfm/american-pharmacists-association-votes-to-discourage-pharmacists-from-participating-in-executions#comments Tue, 07 Apr 2015 01:04:32 +0000 http://www.bioethics.net/?guid=757648828674dc38dbdf3d9e99c8b997 http://www.bioethics.net/2015/04/american-pharmacists-association-votes-to-discourage-pharmacists-from-participating-in-executions/feed/ 0 A Prayer http://feedproxy.google.com/~r/bioethics-at-tiu/~3/FCy39Hmdn2g/ http://feedproxy.google.com/~r/bioethics-at-tiu/~3/FCy39Hmdn2g/#comments Mon, 06 Apr 2015 23:01:30 +0000 http://blogs.tiu.edu/bioethics/?p=5862 Read More »]]> http://blogs.tiu.edu/bioethics/2015/04/06/a-prayer/feed/ 0 Johns Hopkins University Sued for $1bn Over Guatemalan Study http://researchethicsblog.com/2015/04/06/johns-hopkins-university-sued-for-1bn-over-guatemalan-study/ http://researchethicsblog.com/2015/04/06/johns-hopkins-university-sued-for-1bn-over-guatemalan-study/#comments Mon, 06 Apr 2015 14:36:05 +0000 http://researchethicsblog.com/?p=616 ]]> http://researchethicsblog.com/2015/04/06/johns-hopkins-university-sued-for-1bn-over-guatemalan-study/feed/ 0 Health Insurance Is About Financial Security Too http://www.peterubel.com/health_policy/health-insurance-financial-security/ http://www.peterubel.com/health_policy/health-insurance-financial-security/#comments Mon, 06 Apr 2015 13:03:00 +0000 http://www.peterubel.com/?p=7387 People like me, trained to be physicians, have pushed hard to promote health insurance in the United States because we believe, with some evidence to back up our claims, that good health insurance promotes better health. When people don’t have … Continue reading

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Non-beneficial Treatment Policy University Hospitals – Case Medical Center (video) http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Td_5xAKVlq8/non-beneficial-treatment-policy.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Td_5xAKVlq8/non-beneficial-treatment-policy.html#comments Mon, 06 Apr 2015 08:00:00 +0000 http://www.bioethics.net/?guid=bd901dd6312e66e68a8956f95c766eb9 http://medicalfutility.blogspot.com/feeds/6847713983230139282/comments/default 0 Medical Futility – Like Ordering Osso Buco at a Vegan Restaurant http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Q1mdfsFDq24/medical-futility-like-ordering-osso.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/Q1mdfsFDq24/medical-futility-like-ordering-osso.html#comments Sun, 05 Apr 2015 08:00:00 +0000 http://www.bioethics.net/?guid=23c41840650254dbd438172e23498cf3 http://medicalfutility.blogspot.com/feeds/8224696550837958205/comments/default 0 More Safeguards Often Mean Less Access http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/GY9_YDhhrvY/more-safeguards-often-mean-less-access.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/GY9_YDhhrvY/more-safeguards-often-mean-less-access.html#comments Sat, 04 Apr 2015 13:16:00 +0000 http://www.bioethics.net/?guid=c1c722b56384194ae58b42bb7228a7f2 http://medicalfutility.blogspot.com/feeds/424348966670876819/comments/default 0 Brain Death: Legal Obligations and the Courts http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/N8RS93M8w74/brain-death-legal-obligations-and-courts.html http://feedproxy.google.com/~r/MedicalFutilityBlog/~3/N8RS93M8w74/brain-death-legal-obligations-and-courts.html#comments Fri, 03 Apr 2015 20:15:00 +0000 http://www.bioethics.net/?guid=817f210c33fa2993bb5e68e4fbf5b1d2 http://medicalfutility.blogspot.com/feeds/3268654439236458656/comments/default 0 Suing for Justice? More on the U.S. STD Studies in Guatemala http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=7365&blogid=140 http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=7365&blogid=140#comments Fri, 03 Apr 2015 14:54:00 +0000 http://www.bioethics.net/?guid=421ede11ee01f47d291064bcdb5507ca http://www.bioethics.net/2015/04/suing-for-justice-more-on-the-u-s-std-studies-in-guatemala/feed/ 0 The Best Way To Get Cancer http://www.peterubel.com/uncategorized/best-way-get-cancer/ http://www.peterubel.com/uncategorized/best-way-get-cancer/#comments Fri, 03 Apr 2015 13:19:40 +0000 http://www.peterubel.com/?p=7382 What would you like first: the good news or the bad news? Let me start with the bad. Life expectancy among patients in the U.S. with thyroid cancer lags behind that in Korea. In fact, the vast majority of patients … Continue reading

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