» Informed Consent Where the World Finds Bioethics Sat, 25 Jun 2016 10:00:22 +0000 en-US hourly 1 BioethicsTV: Paternalism (again) on Chicago Med Fri, 13 May 2016 19:10:19 +0000 by Craig Klugman, Ph.D.

Our favorite television dramas this week were light on bioethics issues with the exception of Chicago Med (season 1; episode 17 “Withdrawal”) that continues to explore bioethical issues. This week the theme was arrogant paternalism—residents and fellows believing that only they know what is in the best interest of the patient.

The first storyline concerns a patient brought into the ED in the throes of alcohol withdrawal. He is a frequent flyer patient and has not had a drink in 2 days.…

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Euthanasia for Reasons of Mental Health Thu, 12 May 2016 21:35:40 +0000 by Craig Klugman, Ph.D.

An article in the (UK) Daily Mail this week focused on a Dutch woman who chose euthanasia “after doctors decided her post-traumatic stress and other conditions were incurable.” Under Dutch euthanasia laws, a physician can end a patient’s life with a lethal injection for mental suffering. Her life was ended last year.

Euthanasia is when a physician delivers the substance that ends a patient’s life. This is distinct from physician/doctor/provider-assisted suicide (often called aid-in-dying) where a physician makes the means to end life available (often through a prescription) but the patient must ingest the life-ending medication.…

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BioethicsTV: Mistaken diagnosis, patient battery, “work-arounds,” and trans-gender patient health Fri, 06 May 2016 19:47:19 +0000 by Craig Klugman, Ph.D.

A look at the ethical and professionals issues raised in medical dramas this week: Chicago Med and Heartbeat.

Chicago Med

This new show is always good for presenting challenges in professionalism and bioethics. This week (season 1; episode 16) is no exception as the fictional hospital finds itself in the middle of a surprise Joint Commission visit (though they often refer to the organization as “jay-koh” it’s previous abbreviation). One of the storyline this week deals with a retired neurologist and her husband with Lewy Body syndrome.…

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“And Death Shall Be No More” Thu, 05 May 2016 15:59:58 +0000 by Craig Klugman, Ph.D.

Two years after John Donne’s death, the Holy Sonnets were published. In Sonnet 10, Donne speaks about the end of death: “Death, thou shalt die.” Although a metaphorical conceit referring to eternal life in heaven, the poem takes on new meaning in the age of regenerative medicine.

Since the 1968 ad hoc Harvard committee on defining death, brain death has been defined as the “irreversible loss of all functions of the brain, including the brainstem.” If a new project is successful that definition may have to be revised or deleted.…

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Ethics of research in usual care settings: Data on point Wed, 27 Apr 2016 17:26:18 +0000 0 Adrift in the gray zone: IRB perspectives on research in the learning health system Wed, 27 Apr 2016 17:24:41 +0000 0 The patient’s perspective on the need for informed consent for minimal risk studies: Development of a survey-based measure Wed, 27 Apr 2016 17:23:51 +0000 0 Patient and physician views about protocolized dialysis treatment in randomized trials and clinical care Wed, 27 Apr 2016 17:22:56 +0000 0 Alternative consent models for comparative effectiveness studies: Views of patients from two institutions Wed, 27 Apr 2016 17:21:34 +0000 0 Patients’ views concerning research on medical practices: Implications for consent Wed, 27 Apr 2016 17:20:02 +0000 0 Letters Telling Women About Breast Density Are Often Too Darn Dense Wed, 27 Apr 2016 12:00:02 +0000 0 BioEthicsTV: A night of consent issues on ChicagoMed Wed, 27 Apr 2016 03:40:58 +0000 by Craig Klugman, Ph.D.

On this week’s episode of ChicagoMed (Season 1; Episode 15) issues of consent was the main focus. The first major storyline concerned a 16-year-old in abdominal pain who enters the ED with her father, a heroin addict. Although in pain and in need of a diagnostic endoscopy, the patient refuses any and all medications: She fears that even one dose will turn her into the addict that her father has been for her entire life. The doctors try the endoscopy without anesthetic or pain medications and they are unable to get through the procedure.…

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Biases and Heuristics in Decision Making and Their Impact on Autonomy Tue, 26 Apr 2016 19:58:20 +0000 0 Clarifying the Rules: No media in patient treatment areas Thu, 21 Apr 2016 21:41:40 +0000 by Craig Klugman, Ph.D.

In January, I wrote about the case of Mark Chanko, a patient run over by a truck whose death was recorded for a real-life medical show and was later viewed on television by his horrified widow who had never been asked for permission for the airing. Now a settlement with federal regulators announced today will forever tighten health privacy recording restrictions in the hospital. In short, to film patients in the hospital, you have to get their consent before recording, not after as has been the procedure for most real-life medical shows.…

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Stinging Doctors: Recording Your Own Surgery Wed, 20 Apr 2016 23:26:33 +0000 by Craig Klugman, Ph.D.

Ethel Easter expressed outraged this week at what her health care team said about her during her surgery in Texas last year. She claims that before her operation she was flagged as a difficult patient and instead of talking to her doctors at that time, she hid a recording device in her hair. Listening to the recording after her operation, she heard the medical staff discussing her as a “handful” and making other disparaging comments.

This case comes after “D.B.” in 2013 accidentally left his cell phone in record mode during a procedure.…

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BIOETHICSTV: Chicago Med 3/29 Wed, 30 Mar 2016 21:45:29 +0000 by Craig Klugman, Ph.D.

BioethicsTV is an occasional feature where we examine bioethical issues raised in televised medical dramas.

Tonight marked the mid-season premiere of Chicago Med, a freshman television show that seems to relish throwing professional and bioethical issues at its audience. This week, viewers saw no fewer than 4 ethical challenges.

1. Blood draws for DUI in the ED. The first story was about a young man who crashes his car into a house. He is brought to the ED and needs immediate surgery for internal bleeding.…

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Doctors, Patients, and Nudging in the Clinical Context—Four Views on Nudging and Informed Consent Thu, 01 Oct 2015 19:58:52 +0000 0 Placebo Effects and Informed Consent Thu, 01 Oct 2015 19:53:33 +0000 0 Broad Consent for Research With Biological Samples: Workshop Conclusions Tue, 01 Sep 2015 19:49:44 +0000 0 Prudentia Populo: Involving the Community in Biobank Governance Tue, 01 Sep 2015 19:43:41 +0000 0 The Stanford Prison Experiment film: An Essential Teaching Tool Tue, 04 Aug 2015 11:00:11 +0000 By Craig Klugman, Ph.D.

In teaching research ethics, there are a few “classic cases” that we offer students as examples of where human subject research went wrong: Tuskegee Study of Untreated Syphilis, the Nazi medical experiments, Willowbrook Hepatitis Experiments, human radiation experiments, and (now) the Guatemala syphilis study, among others. When discussing social science examples, the two studies that are usually taught at Milgram’s obedience studies and Zimbardo’s Stanford Prison Experiment.

As an undergraduate at Stanford, my Psychology 101 teacher was Philip Zimbardo.…

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Investigating Two Claims Against Planned Parenthood: Center of Medical Progress’s Secret Videos Mon, 27 Jul 2015 22:00:39 +0000 by Craig Klugman, Ph.D.

Before you being reading, I have a disclaimer: Growing up, my mother worked for Planned Parenthood. As a nurse, she practiced in their clinics offering well women services, counseling, and contraception. After many years, she went on to direct their clinic’s in vitro fertilization program. I also heard the word “Planned Parenthood” stated with a quick northeastern accent. Said that way, as a child, I thought the place was called “Plant Parenthood” and wondered what plants had to do with women’s health.…

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Welcoming the Concept of Alief to Medical Ethics Mon, 15 Jun 2015 06:33:28 +0000 Welcoming the Concept of Alief to Medical Ethics

 by J.S. Blumenthal-Barby, Ph.D.

Philosopher Tamar Gendler has introduced (circa 2008) a new concept in the philosophical literature that could be of interest to medical ethicists. The concept is that of ‘alief’ and it is meant to contrast with the concept of ‘belief.’ An example Gendler discusses to tease out the difference between the two concepts is the example of a woman who believes African American and Caucasian people to be of equal intelligence, yet in her behavioral responses it seems as if she believes differently (e.g., she is more surprised when an African American student of hers makes an intelligent comment than she is when a Caucasian student does, she more quickly associates intelligence with her Caucasian students, when grading exams she might grade the same quality exam differently if written by an African American student than a Caucasian student, etc.).…

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Research 2.0: Rise of the Citizen-Scientist and the Death of Privacy Thu, 26 Mar 2015 07:34:05 +0000 by Craig Klugman, Ph.D.

On Monday I attended a symposium on inter-professional education. During a session on new technologies in medicine (telemedicine, wearables, and mobile devices) I brought up the question of preserving privacy. The foundation sponsoring the event replied to me, “There is no such thing as privacy. It’s dead.” For someone who works in bioethics, serves on an IRB, and was formerly a journalist, this notion is scary. Perhaps, I have simply been in denial. After all, I use a mobile phone that tracks my position, synchs with the cloud, and provides much convenience.…

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Seeing medical records might ease hospital patients’ confusion Mon, 09 Mar 2015 22:28:29 +0000 0 Of Course 23andMe’s Plan Has Been to Sell Your Genetic Data All Along Tue, 13 Jan 2015 15:29:40 +0000 0 Sophie’s Choice: Can Machines Do Any Better? Wed, 24 Sep 2014 21:34:03 +0000 by Craig Klugman, Ph.D.

In the 1979 novel Sophie’s Choice by William Styron, the reader meets a Holocaust survivor who was forced in the camps to choose which of her two children would die immediately. Making the choice led to a life of alcoholism, depression, and self-destructive behavior. One interpretation of this novel, later made into an Academy Award winning film (1982), is that having choose whether a loved one lives or dies is a spirit-wrenching decision.

And yet, everyday, health care providers and bioethicists ask legally appointed health care power of attorneys and other designated surrogates to decide whether an incapacitated patient has surgery, receives a feeding tube, is resuscitated, or is intubated.…

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Big Data Peeps At Your Medical Records To Find Drug Problems Tue, 02 Sep 2014 23:57:34 +0000 0 California lawmakers pass bill banning inmate sterilizations Wed, 20 Aug 2014 20:21:30 +0000 0 Do OkCupid and Facebook experiment on vulnerable populations? Mon, 04 Aug 2014 18:25:10 +0000 by Keisha Ray, Ph.D.

A few months ago Facebook announced that some Facebook users were a part of a 2012 experiment. In the experiment Facebook altered the number of negative and positive posts and photos that appeared in users’ newsfeed. In a paper documenting the results of the study, authors noted that by changing what users saw in their feed, Facebook was able to alter moods, emotions, and the kind of posts that people posted. The study was meant to be an experiment in online social interactions and emotional connections.…

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AIN’T JUST THE MEAT IT IS ALSO THE MOTION: CONSENT MATTERS! Tue, 29 Jul 2014 17:18:43 +0000 “But look, you found the notice, didn’t you?”

“Yes,” said Arthur. “yes I did. It was on display in the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying ‘Beware of the Leopard.'”

                           –Douglas Adams, The Hitchhiker’s Guide to the Galaxy

Any apologia for Facebook’s recent behavioral study has to address one issue head on: that of informed consent. Informed consent is the bedrock upon which the ethics of all biomedical and behavioral research on humans rests.…

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Enter the Corporate Congress: SCOTUS & FACEBOOK Wed, 02 Jul 2014 03:01:44 +0000 by Craig Klugman, Ph.D.

One of the facts that hiring managers are taught is that you can never ask a potential employee about their religion (among other protected areas) unless the candidate brings it up. But after this week, any job candidate would be wise to ask their potential employer about his/her/its (in the case of corporations) religious beliefs.

Who one works for is increasingly determining not only what health care coverage you have but also what laws you have to follow and what legal protections you have.…

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Community Consultation Should Include Social Media Thu, 19 Jun 2014 06:41:24 +0000 by Nuriel Moghavem

A New York Times article published this week describes a clinical trial in Pittsburgh where incapacitated and rapidly exsanguinating gunshot victims have their blood replaced by cold saline for up to an hour in an effort to preserve neurological function and life. This trial has raised many ethical concerns, one of which is whether the community consultation conducted before and during the trial (which is required by federal guidelines) was adequate enough to inform the community about the opt-out trial and to collect extensive feedback from it.…

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MEDICAL FUTILITY, THEN AND NOW Mon, 16 Jun 2014 17:22:16 +0000 by Barron H. Lerner, M.D., Ph.D.

When an article promoting the idea of medical futility appeared in the Annals of Internal Medicine in 1990, my father was thrilled.  He believed the term was an apt description of the end-stage cases he too often saw as an infectious diseases consultant, in which he was expected to prescribe progressively more complicated antibiotic regimens to severely ill patients with no hope of recovery.

The concept of medical futility has achieved mixed success.  Advocates have promoted it as a way to discourage aggressive treatment of medical conditions that are not reversible. …

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Tragedy in Research History: The Children of Ireland Tue, 10 Jun 2014 19:14:40 +0000 by Craig Klugman, Ph.D.

For many people, the film Philomena was an introduction to a history of Irish babies being taken from their unwed mothers and adopted to “good” Catholic families in other countries. I put “good” in quotes because often what qualified a couple was the ability to pay. In the last week, news has come out of Ireland of a mass grave holding the remains of 796 infants buried in a septic tank on the grounds of a former “mother and baby” home in Galway.…

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Chip and Fish: Inadvertent Spies Sun, 08 Jun 2014 07:46:43 +0000 by Arthur Caplan, Ph.D.

There has been a great deal of fingerpointing, second-guessing and recrimination over the decision by the President to exchange five former Taliban leaders for the American soldier, Bowe Bergdahl.  “You’ve just released five extremely dangerous people, who in my opinion … will rejoin the battlefield,” Senator Marco Rubio, R-Fla., and likely Presidential candidate told Fox News.  Senator John McCain, R-AZ, told ABC news and many other outlets that he would never have supported the swap if he’d known exactly which prisoners would be exchanged given their former high roles in battling the U.S.…

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Revitalizing Informed Consent Law Wed, 04 Jun 2014 21:40:53 +0000 by Thaddeus Mason Post, JD, PhD

In a few days, the Journal of Clinical Ethics will publish my seventeenth “Legal Briefing” column.  Each column reviews recent legal developments involving a particular issue in clinical bioethics.  I have covered topics from organ donation and medical futility, to home birth and conscience clauses.  This one, in 25(2):152-174, is titled “Informed Consent in the Clinical Context.”

I covered this topic in two previous “Legal Briefings”: an overview in 2010 and another in 2013 that was focused on shared decision making and patient decision aids. …

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Artistic Inquiry: Informed Consent on Stage Fri, 16 May 2014 06:00:49 +0000 0 Bioethics Commission Staff Holds Multidisciplinary Educational Materials Webinar Mon, 28 Apr 2014 15:06:57 +0000 0 Would you share your DNA info to advance medicine? Wed, 23 Apr 2014 17:46:06 +0000 0 The Ethics of Advertising for Health Care Services Wed, 19 Mar 2014 19:26:00 +0000 0 The Supreme Court’s terrible—and dangerous—ruling this week on the Fifth Amendment. Fri, 20 Dec 2013 18:58:30 +0000 0 The Use of Deception in Public Health Behavioral Intervention Trials: A Case Study of Three Online Alcohol Trials Tue, 05 Nov 2013 21:09:43 +0000 0 Pennsylvania law gives patients the right to ask doctors about care Fri, 27 Sep 2013 18:22:28 +0000 0 Stop Therapeutic Obstinacy: Penalties for Administering Futile ICU Interventions Wed, 18 Sep 2013 17:36:45 +0000 by Thaddeus Pope JD Ph.D.

Intensive care clinicians and clinical ethicists have long known that the provision of interventions perceived to be “futile” is a major problem in U.S. hospitals.  Medical futility is frequently reported to be a leading reason for ethics consultations.  Last week, a new study in JAMA Internal Medicine further quantified the prevalence and cost of interventions perceived to be “futile.”

In the study, a “futile” intervention was defined as treatment administered in situations satisfying one or more of five conditions:

  1. The burdens grossly outweigh the benefits.
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Patient Informed Consent For The Teaching Hospital “Trainee” Care: Informing Realistic Scenarios Mon, 16 Sep 2013 20:00:48 +0000 by Maurice Bernstein MD

Informed consent is the ethical and legal hallmark for the support of patient decision-making in medicine.  Though the ethics of patient communication of facts without deceit has been part of medical consideration for generations, it wasn’t until the landmark decision Schloendorff v The Society of the New York Hospital in 1914 that informed consent became United States law.  Informed consent has been also been emphasized from the aspect of medical ethics, in recent decades, as decision making has moved from physician paternalism to patient autonomy. …

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UC Davis surgeons resign after bacteria-in-brain dispute Tue, 27 Aug 2013 17:03:26 +0000 0 Electronic Informed Consent: Will it Increase Patient Knowledge on Trials? Wed, 14 Aug 2013 22:32:29 +0000 0 Stop Worrying About Privacy, Start Caring About Identity Tue, 02 Jul 2013 17:41:49 +0000 0 The Ethics of “Gawking ” in Medicine Thu, 20 Jun 2013 16:42:17 +0000 Maurice Bernstein, MD

Gawking, defined in Merriam-Webster dictionary  as “to gape or stare stupidly.” It is the “stupidly” which I think sets the ethics of the behavior.  The “stupidly” can represent more than some ignorance of what is being observed but also a lack of true purpose at the time of the observation for either understanding or even participation.  Gawking is directed primarily for self-interest of the gawker and for no other purpose.  A general example of gawking can be given as motorists stopping briefly at an automobile accident simply to observe the trauma but not with an intent to provide assistance. …

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