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Blog Posts (2778)

February 3, 2016

When Is CPR Futile?

Here in the February 2016 AMDA newspaper CARING FOR THE AGES, is a reasonable and informed analysis of when CPR may or should be refused in the long-term care setting.
February 3, 2016

Bioethics & the Status of Women Filmmakers

There are currently less than 7% of films created by women making it to major film festivals —that is 7%, per year, worldwide. This percentage has remained low and static for 25 years. Film festival screenings constitute theatrical releases. Theatrical releases are required for film and/or television distribution.

Low access to film festivals limit women’s ability to earn livings behind the camera in their industry. The number of screen stories genuinely reflecting women’s experiences is also disproportionately diminished. Omission of the perspective of women in film complicates matters in the purview of bioethics: beneficence, autonomy and justice. 

23 percent of people surveyed consider entertainment television as the top three sources of their health information. That health information is being controlled through a male perspective as shots are usually called by male producers, directors and writers. It is a bioethical tenant that equality does not equal sameness. This was learned when in 1993, the US federal government mandated women and racial minorities be included in drug research. Clinical observation showed women and minorities were being harmed by lack of inclusion as women’s responses to pain and pain medications were significantly different from those of men. These new observations coincided with increasing the critical mass of women and peoples of color in the medical profession. Women in film seems to represent a parallel situation.

Women filmmakers are denied the opportunities to reflect functional abdominal pain, menopause, postpartum depression, caregiver burnout, forced sterilization. We are not seeing these stories; yet women struggle to comprehend their meanings in gyms, carpools and walks on dirt roads to schools around the world.

What is to be done? The 38th Mill Valley Film Festival (MVFF) in October 2015, piloted its “Mind the Gap” programming. This is a conscious efforts to seek and evaluate more films by women. The “Mind the Gap” goal is to change the disproportionately low numbers of films in major festivals, representing women working behind the camera, —directors, writers, cinematographers and producers. However, it is also an attempt to participate in a dialog about the origin of the problem. Mind the Gap includes a commitment to search for those films which do manage to be made by women, despite nearly insurmountable barriers. The hope is to help establish models which can be replicated to improve women filmmakers access to the industry. 

The MVFF is among the oldest and most respected USA film festivals. It is juried through the coveted Audience Awards, bestowed by a historically film savvy 60,000 MVFF patrons. In 2015, some 170 films were screened. Programmers of the MVFF are legendary for their curatorial capacity. Many of the independent, international, documentary, short and feature films seen at this festival are U.S, North American or World Premieres. MVFF’s influence derives from consistently programming and hosting major award winners well before the beginning of the award nomination season.
In the October 2015 MVFF, roughly thirty-three percent of films screened were developed by women behind the camera. That is a better female to male ratio than most top tier film festivals: compare Toronto, Cannes, Berlin, Sundance. However, the California Film Institute, the parent organization sponsoring the MVFF, has even higher aspirations. The CFI-MVFF goal is a fifty-fifty, female to male film director ratio, a far cry from the current international paltry 7% representation of women’s films in festivals. 

Among the 2015 MVFF premieres, with significant women’s content and as it happens also other forms of diversity, which you may not find in the Oscar lineup, were: Under the Same Sun (dir. Mitra Sen), A LIGHT BENEATH THEIR FEET (dir. Valerie Weiss), INTERWOVEN (dir.V.W. Scheich), and THE ASSASSIN (dir.You Hsiao-Hsien.)

Read: 
Smith, S., Pieper, K. et al, Gender & Short Films: Emerging Female Filmmakers and the Barriers Surrounding Their Careers examining short films and directors. http://annenberg.usc.edu/pages/~/media/MDSCI/MDSC%20LUNAFEST%20Report%2010515.ashx, accessed February 1, 2016.

Smith, Stacy L., Choueiti, M. et al. Inequality in 700 Popular Films: Examining Portrayals of Gender, Race,
accessed February 1, 2016

MVFF Mind the Gap http://www.mvff.com/mind-the-gap/ accessed February 1, 2016.


NIH Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research US Public Health Service http://archive.hhs.gov/ohrp/humansubjects/guidance/59fr14508.htm Accessed Feb 1, 2016

Cross Reference: 

http://www.bioethicsscreenreflections.com/2015/10/a-light-beneath-their-feet-bridges.html



http://www.bioethicsscreenreflections.com/2015/10/the-assassin-and-bioethics-death-and.html
February 2, 2016

A Health Insurance Double Whammy

In case you missed it, I am recirculating a picture put together by the Kaiser Family Foundation , which reveals two unsettling facts about health insurance in United States. First, the cost of employer-based health insurance has risen 61% since … Continue reading

The post A Health Insurance Double Whammy appeared first on PeterUbel.com.

February 2, 2016

Founding Father Thomas Paine on Medical Futility and Brain Death

Thomas Paine wrote The American Crisis during the American Revolution,  in 1778.  But he makes an interesting observation about medical futility: "To argue with a man who has renounced the use and authority of reason . . . is like ...
February 1, 2016

Best Email of the Week

I got an unusual email message a little while ago. It was from someone I had never met before, and it wasn’t obvious to me, at first, why this person was contacting me. The email began like this: “I am … Continue reading

The post Best Email of the Week appeared first on PeterUbel.com.

February 1, 2016

TOUGH CASES: Code of Ethics Now Available for Healthcare Ethics Consultants

Tarris Rosell, PhD, DMin    
Consider the following hypothetical case scenarios:

Case #1

Jessica, APN, is a member of the Hospital Ethics Committee and serves also on the HEC’s ethics consultation team. Each week, one of eight volunteer consultants takes first call on the dedicated Ethics pager. Two other team members serve as back up to the on-call ethics consultant. 

One day, a consult request is forwarded to the Ethics pager, which Jessica is carrying. It involves a patient on the Medical ICU where Jessica is also a nurse manager. She knows the patient and family, and is all too aware of their conflicted situation with hospital staff regarding goals of care. Jessica also supervises the nursing staff, which rotates care duties on Patient Joe so as not to get too burned out, given his dementia-related raging and flailing. As Jessica reads the ethics consult order, she feels conflicted about her multiple roles in this challenging situation. She wants to be of assistance for ethics, but isn’t certain that she can do so without confusion about what “hat” she’s wearing up on the unit.

What ought Jessica to do, and how would she know?

Case #2

Jonathan, PhD, is taking first call on the Ethics pager this week. One of three consult requests received involves a very messy situation involving a difficult discharge. The 56 -year old female patient, Helen, is homeless and had come to the emergency department weeks earlier in a police cruiser.

At the point when she becomes medically stable, a dilemma is encountered. How could we safely discharge this patient back to the street where she insists on going “if,” as she says, “you won’t let me stay here?” It’s cold outside, and Helen is barely ambulatory, with some signs of dementia. Follow-up self-care would require daily insulin injections and finger sticks for glucose monitoring. While the patient claims ability to do so, the attending isn’t convinced. 

Ethics is consulted, and Jonathan convenes a multi-disciplinary care meeting, including the patient. Consensus eventually is reached on a discharge plan. Helen agrees to go to a homeless shelter with a clinic. 

However, after leaving the hospital, the cab driver lets her off at a downtown intersection instead, as directed by his rider. It is a blustery and frigid winter day. Helen is wearing the thin autumn coat and sandals she had been wearing upon admission. A newspaper journalist happens to stop at the intersection where Helen stands shivering, and notes her hospital bracelet. He rolls down the window and asks if Helen is okay. She mutters that City Hospital left her off here to die. The journalist calls 911, and then makes a call to the hospital operator asking to speak with someone in Ethics. 

When Jonathan receives this page and phone call, what should he say, or not say, to the journalist, and how would he know?

Code of Ethics 

Ethics consultation, like any other professional practice in healthcare, requires professionalism of the consultant. Ethics consultants can either help or hurt those who request assistance. Sometimes even life and death hang in the balance, especially when it is unclear as to which of those two options would be the worse outcome for a critically ill patient. Always there is confidential information to be handled with care and in compliance with HIPAA rules. 

Ethics professionalism matters.

Until recently, healthcare ethics consultants familiarized themselves with the codes of ethics pertaining to other professions, but had none of their own. Jessica and Jonathan might have discerned successfully what they ought to do about their professional ethics dilemmas in the scenarios described. Now their decisions may also be guided by a code of ethics and responsibilities drafted specifically for healthcare ethics consultants.

The American Society for Bioethics and Humanities has posted A Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants as a downloadable document at http://asbh.org/publications/books. The document lists seven ethical responsibilities for healthcare ethics consultation (HCEC):

1. Be competent.
2. Preserve integrity.
3. Manage conflicts of interest and obligation.
4. Respect privacy and maintain confidentiality.
5. Contribute to the field.
6. Communicate responsibly.
7. Promote just healthcare within HCEC.

Each of these responsibilities is explained in the ASBH document, with illustrative examples provided. 

Applying the Code

In Jessica’s case, she might recuse herself from ethics consultation on grounds of #3, the need to manage conflicts of interest and obligation. One of her back-up consultant colleagues can be called upon to respond instead. 

Jonathan would be guided in his own ethics dilemma by responsibilities #4 and #6 especially, and possibly #7. The probably well-intended journalist may benefit from clarification of the situation with Helen; but any communications with him must be done responsibly, perhaps by a designated hospital spokesperson, and with HIPAA-protected privacy ensured both for the patient and her healthcare providers.

Center for Practical Bioethics personnel contributed to the development and publishing of the ASBH Code of Ethics and Professional Responsibilities for Healthcare Ethics Consultants. It is currently being utilized in hospitals in Kansas City and elsewhere for professional performance improvement toward the goal of excellence in ethics consultation.


Tarris Rosell, PhD, DMin, is the Rosemary Flanigan Chair at the Center for Practical Bioethics. He also serves as Co-Chair of the Hospital Ethics Committee and Director of the Ethics Consultation Team at the University of Kansas Hospital.
February 1, 2016

Boston's Fine Arts Museum Offers Doctors Time for Reflection [EOL in Art 197]

Doctors and nurses at Boston’s Brigham and Women’s Hospital are honing their communication and teamwork skills in an unexpected environment: an art museum.


February 1, 2016

Bioethics and A Recent Trip to Cuba

Two weeks ago, I had the opportunity to travel to Havana, Cuba and speak with people interested in the topic of bioethics. Los Pinos Nuevos, a Protestant denomination with over 400 churches throughout the country, invited my wife and me to participate in discussions on bioethics over three days with up to twenty people involved in the educational activities of the denomination. I have been... // Read More »
January 31, 2016

Jahi McMath - Update on the Malpractice Litigation

On Friday, January 29,  the Alameda County Superior Court held a brief hearing on the medical defendants' demurrers to the McMath family's first amended medical malpractice complaint.   As he indicated in prior rulings on similar motions, Ju...
January 30, 2016

Brand New Futile Care Fellowship Created

"Futile care has finally blossomed into its own branch of medicine."  Check out this clever, funny, and too true post at Gomer Blog.