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Blog Posts (111)

January 11, 2017

Flatulence and Elections

Approximately once a month I open my schedule and see that my first task of the day is to write a post for the Alden March Bioethics Blog, Bioethics Today. The first part of this task is to determine what to write about. Sometimes that is the most difficult part of the job. I try to give myself fairly wide discretion in choice of topics but this is a bioethics blog so I do try to be conscientious about finding some relationship between the topic of the blog and bioethics. Sometimes that is hard. Recently while perusing the venerable Washington Post I came upon an article that I felt I had to write a blog about.

It also happened that today was the day that my calendar told me it was time to write a blog. So here goes.

It was reported today that there was a fire in the operating room April 15 during a surgical procedure. An unidentified woman was undergoing a surgical procedure on the cervix with a laser. To make a long story short, the woman passed gas, the laser ignited the flatulence and the surgical draping caught fire.

I was attracted to this article because I used to be a young boy (this was a very long time ago) and all young boys believe that everything about farts is funny and entertaining. It was even more entertaining when the flatulence was ignited. Alas when I first saw the article I thought it would be funny but it was not. The woman was seriously burned.  This no longer seemed like a good topic for a blog and I left it incompletely written and unpublished.

While this happened months ago it is current again. At least in my thinking it has become current. The reason for this is that sometimes things that start out seeming funny or absurd become serious issues. I admit that only months ago I thought that the fact that a certain individual was running for president was both funny and absurd. Now he has been elected and it seems neither funny nor absurd. It seems very serious indeed.

So now in my mind the presidential election process evokes thoughts of a woman who was seriously burned in a fire ignited by her own flatulence. I hope the nation and the world are not seriously burned by this election but I fear they will be.

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.

 

 

January 9, 2017

Crossing the Line: When Doctors’ Beliefs Endanger Patients’ Autonomy and Health

by Craig M. Klugman, Ph.D.

In 2016 the Illinois legislature passed and Governor Bruce Rauner signed into law Public Act 099-690 (SB 1564), an amendment to the Health Care Right of Conscience Act.…

January 4, 2017

Last Days of the ACA

by Craig M. Klugman, Ph.D.

Politicians are notorious for making campaign promises and then not carrying them out. With the beginning of the 115th Congress, the GOP has doubled-down on its promise to repeal the Affordable Care Act (aka “Obamacare”).…

January 2, 2017

The Year in Bioethics That Was - 2016

by Craig Klugman, Ph.D.

Happy New Year. As has become a tradition at the bioethics.net blogs, the ending of one year and beginning of another is a time for reflection, for reviewing the year that has passed and planning for the year to come.…

December 13, 2016

Imminent Threats To Healthcare and Medical Professionalism: We Must Remain Vigilant

In a previous blog I expressed concerns about the possible direction of politics in our country and the risks it poses to the larger procedural, democratic framework, which I take to be essential to the work of contemporary bioethics. Now that the election is over and a new administration is taking shape, I have many grave concerns about the fundamentally new policy directions our nation will be taking. None concern me more than how the planned changes in our healthcare system in the United States and, if they happen, how our most vulnerable patients will be affected. This is because a top agenda for them on day one will be to repeal the Affordable Care Act (ACA), which has provided healthcare coverage for about 21 million more people since its inception in 2009.

The ACA was an imperfect healthcare plan from the start. But after decades of false starts to reform a system that does not have a close second in terms of excessive costs and inefficiencies among industrialized nations, especially in relation to outcomes, in 2009 it was the best option our country had at that time. In spite of some problems in its implementation, due largely to lack of cooperation and critics setting up obstacles, the ACA has become entrenched into our healthcare system. If it is repealed, there will be widespread suffering and chaos. Just recently the nations’ hospital industry “…warned President-elect Donald Trump and congressional leaders on Tuesday that repealing the Affordable Care Act could cost hospitals $165 billion by the middle of the next decade and trigger “an unprecedented public health crisis.”

 The eagerness of the new administration to gut the ACA was affirmed by the appointment of Tom Price, Representative from Georgia who has been a ferocious and over the top critic of this law from its inception. A prominent orthopedic surgeon prior to running for Congress, Dr. Price seems to advocate for a system that is extricated from government as much as possible and placed in the hands of the private insurance companies. His plan, which provides for individual fixed tax credits and health savings accounts and allows insurance companies to cross state lines, may be helpful for many Americans who are relatively well off and have healthcare to start with. But for most of the sickest patient in lower income brackets, these market-based ideas will do nothing to help them and in fact make them worse off. But real world, harmful consequences are the concerns of an ideologue: All that matters is having in place a policy that accords with an ideal vision of how the world should work.

There is no practical way that a purely market based approached to providing access to healthcare to Americans will accomplish the goals of healthcare that the majority of Americans have, which is to provide some type of basic, quality healthcare to all citizens, at an affordable cost. Price’s approach will leave millions of American citizens, many already with serious health problems without access to health except via the emergency rooms. The predictable consequences will be astronomically increasing costs because healthcare will retreat to its pre-ACA days of inefficiency by focusing more on rescuing patients from acute conditions than preventing them from occurring in the first place; and physicians caring for patients with insurance will be doing more and more procedures for which they will be handsomely paid, without improving quality for patients. Which makes it all the sadder to see the American Medical Association (AMA), as it has done at prior critical historical junctures as it did in standing against the passage of Medicare and Medicaid in 1965, endorsing Price’s nomination.

Though Price’s nomination may be bad for patients, it likely represents good news for physicians in terms of their incomes from reimbursement rates. Which is the reason why the AMA supports him and why, in my judgment, it is an abdication of professional, ethical good judgment and responsibility. Their support violates the basic tenant of professionalism as stated in the American College of Physicians (ACP) Ethics Manual that require its members “…to teach and expand, by a code of ethics and a duty of service that put patient care above self-interest, and by the privilege of self-regulation granted by society. Physicians must individually and collectively fulfill the duties of the profession.”

I am heartened by practicing physicians and physicians-in-training who speak out and refuse to be a part of the AMA and its support of Price’s appointment to be Secretary of HHS.  Most notably a petition has gained over 5,000 physicians’ signatures that make it clear “The AMA Does Not Speak For Us”.  As they state in the petition:

 

“We are practicing physicians who deliver healthcare in hospitals and clinics, in cities and rural towns; we are specialists and generalists, and we care for the poor and the rich, the young and the elderly. We see firsthand the difficulties that Americans face daily in accessing affordable, quality healthcare. We believe that in issuing this statement of support for Dr. Price, the AMA has reneged on a fundamental pledge that we as physicians have taken?—?to protect and advance care for our patients.”

 

Medical professionalism always exists in relationship to the prevailing economic and political order in society. Because economic and political winds can shift, so can medical professionalism that at times can put it at risk of losing its moral compass. We do not know yet just how strong the head winds will be. But medical professionals and all citizens who care about the future of just and quality healthcare should be especially vigilant in the coming days and remain prepared to show resistance when necessary.

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.

November 17, 2016

Conflictor-In-Chief: President Trump’s Many Conflicts of Interest

by Craig Klugman, Ph.D.

Every year, my university requires me to file a conflict-of-interest (COI) statement. I had to ask the COI committee for permission in order to use the ethics textbook that I edited for my classes (since I do not receive any residuals on it, there’s no conflict, but had I received money for each sale, I would have).…

November 11, 2016

Ethics & Society Newsfeed: November 11, 2016

President-Elect Trump and Ethics Trump and Pence on science, in their own words Donald Trump and Mike Pence’s career and campaign track record of false claims about science, rejection of research conclusions and dangerous rhetoric on misconceptions such as vaccines and autism … Continue reading
November 9, 2016

Bioethics faces a rocky but navigable road

by Arthur Caplan, Ph.D.

Academic bioethics has never been popular with Republicans.  Libertarians dislike academic bioethics because it seems too elitist and anti-free market. …

November 9, 2016

President Trump & A Republican Congress: What Might It Mean?

by Craig Klugman, Ph.D.

In a 2000 episode of The Simpsons, a flash forward shows Lisa being elected the first heterosexual female U.S.…

October 31, 2016

Bioethics.net: The Presidential Election Edition

by Craig Klugman, Ph.D.

Every four years the United States chooses a new chief executive. Although encoded in the Constitution, the idea that a person with such power would willingly surrender it and walk away to allow another to lead is remarkable.…

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Published Articles (19)

American Journal of Bioethics: Volume 15 Issue 6 - Jun 2015

U.S. Complicity and Japan's Wartime Medical Atrocities: Time for a Response Katrien Devolder

American Journal of Bioethics: Volume 15 Issue 2 - Feb 2015

Ritual Male Infant Circumcision and Human Rights Allan J. Jacobs & Kavita Shah Arora

American Journal of Bioethics: Volume 11 Issue 12 - Dec 2011

Personalities, Politics, and Bioethics

American Journal of Bioethics: Volume 11 Issue 12 - Dec 2011

Dead Man Walking?Politics, Sr. Helen Prejean, and the Vocation of the Bioethicist

American Journal of Bioethics: Volume 11 Issue 12 - Dec 2011

The Political Satirist as Public Intellectual: The Case of Jon Stewart

American Journal of Bioethics: Volume 11 Issue 12 - Dec 2011

William B. Hurlbut: Building a Bridge Over Troubled Stem Cell Waters

American Journal of Bioethics: Volume 11 Issue 12 - Dec 2011

Toward a ?Magenta? Public Bioethics Discourse?Bart Stupak and Health Care Reform

American Journal of Bioethics: Volume 11 Issue 12 - Dec 2011

Reason Giving: When Public Leaders Ignore Evidence

American Journal of Bioethics: Volume 11 Issue 12 - Dec 2011

Sense and Nonsense in the Conservative Critique of Obamacare Stephen Wear

American Journal of Bioethics: Volume 8 Issue 12 - Dec 2008

Review of Ezekiel J. Emanuel. Healthcare Guaranteed: a Simple, Secure Solution for America.

News (451)

January 5, 2017 9:00 am

After Backlash, Including From Trump, House GOP Drops Weakening Of Ethics Office (NPR)

House Republicans have reversed themselves and restored the current rules of the Office of Congressional Ethics

December 22, 2016 9:00 am

Trump team targets changes to key metric that calculates social cost of carbon (Science)

Last week a provocative leaked memo hinted at another likely element of the incoming administration’s plan for weakening climate regulations: tweaking an obscure but increasingly utilized economic measure that tallies the costs and benefits of controlling carbon pollution.

December 21, 2016 9:00 am

Update: Surprise! Innovation bill clears House, heads to president (Science)

“This bill maximizes the nation’s investment in basic research, and helps boost U.S. competitiveness, creates jobs and spurs new business and industries”

December 14, 2016 9:00 am

Endgame in Aleppo, the most decisive battle yet in Syria’s war (Washington Post)

Aleppo would go down in history as one of the great failures of the international community to halt human rights abuses.

December 1, 2016 9:00 am

Congress poised to pass sweeping biomedical innovation bill (Science)

$4.8 billion over the next decade for a set of research initiatives, including brain and cancer research and efforts to develop so-called precision medicine treatments

November 21, 2016 9:00 am

With Trump, Gingrich and GOP calling the shots, NASA may go back to the moon (Washington Post)

The new administration will insert a mission to the lunar surface, probably international in character, as a step on the way to Mars

November 17, 2016 9:00 am

CRISPR gene-editing tested in a person for the first time (Nature)

A Chinese group has become the first to inject a person with cells that contain genes edited using the revolutionary CRISPR–Cas9 technique.

November 4, 2016 8:00 am

Beyond Trump vs Clinton: A scientist’s guide to the US election (Nature)

The presidential race between Hillary Clinton and Donald Trump is dominating the discussion about the upcoming US election, but it’s not the only contest to watch on 8 November. Choices that voters make will influence other levels of government — and some of these decisions will steer the course of science and science policy.

October 6, 2016 8:00 am

Doctors' Political Views Affect How They Treat Patients (The Atlantic)

How bad is that thrice-weekly pot habit? How dangerous is it to keep a gun in your home? A new study by Eitan D. Hersh and Matthew N. Goldenberg of Yale University suggests doctors’ responses to those and other hot-button issues could be colored by their political views.

September 20, 2016 8:00 am

Voters barely worry about their own health. Do they really care about the president’s? (Washington Post)

The first of three planned presidential debates will take place at Hofstra University in Hempstead, N.Y., on Sept. 26. Maybe it’s good the debate is slated for a gym. If Hillary Clinton and Donald Trump are really serious about proving their physical vigor and stamina, they can do laps in the arena while they answer questions.

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