by Craig Klugman, Ph.D.
In the 1983 comedic film, The Man with Two Brains,” Steve Martin’s character falls in love with a female brain preserved in a jar. The brain can communicate with Martin and they fall in love. Similarly, in the world of the soon-to-be-retired cartoon “Futurama,” most celebrities and politicians are kept as heads in a jar after death, where they can speak, eat, and even run the country.
On July 1, President Obama requested that the Presidential Commission for the Study of Bioethical Issues “identify a set of core ethical standards—both to guide neuroscience research and to address some of the ethical dilemmas that may be raised by the application of neuroscience research findings.” This request is part of his BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies) that was announced April 2.…
How Future Doctors Think
Flanigan Lecture Explores How Medical Students Make Sense of Their World
If you want something more, the research conducted by Felicia Cohn, Ph.D., who presented the 19th Annual Rosemary Flanigan Lecture on July 30, 2013, underscores the importance of knowing how your doctor thinks and helping him or her to understand your story.
Patterns in Their Stories
When Dr. Cohn taught medical ethics at the University of California-Irvine School of Medicine, she noticed patterns in the stories medical students shared concerning conflicts they encountered between their personal values and professional obligations and what they did about them. Her colleague at UCI, Humanities Director Johanna Shapiro, wondered if there might be a way to analyze and identify themes from these stories as told in 299 papers Dr. Cohn had collected.
“The themes of the students’ narratives really did fall quite neatly into six categories,” said Dr. Cohn.
• Restitution (38%) - Appealed to a moral norm or ethical principle.
• Compromise (16%) – Conceded core values.
• Journey (16%) – Grew through experience.
• Witnessing (13%) – Felt empathy but stood by and watched.
• Resistance (9%) – Rejected professional ethics in favor of personal views
• No Problem (2%) – Never experienced any conflict.
“I thought the papers would tell a lot more stories about witnessing and compromise, which were the type of stories that the students mostly shared in class,” said Dr. Cohn. “But it turned out that restitution – appeal to principle – was the most common story they told. And more often than not the principle the students appealed to was autonomy. In other words, it’s okay for me to do this because it’s what the patient said he wants.”
Autonomy or Guidance?
Dr. Cohn explained that this emphasis on autonomy in modern medical culture has important implications for both healthcare professionals and their patients.
“If physicians really think what a patient is doing is wrong but feel that respecting autonomy takes precedence, they’re going to be spending a lot of time doing things that they think are wrong. Then they’re miserable and we go and ask them to be nice to patients. I can’t help but think that’s where a lot of the dissatisfaction and even burnout from healthcare professionals comes from.”
Conversely, for the patient who wants more than options from their physician – who wants their physician to consider how their illness and treatment will integrate into their life and make honest recommendations based on that – then the doctor who tells a restitution story probably isn’t the doctor for them.
Learn more at http://www.PracticalBioethics.org
by Craig Klugman, Ph.D.
Way back in 2009 when the Affordable Care Act (ACA) was being debated across the country, one of the more controversial elements was a section (HE 3200, Section 1233) that would provide physician reimbursement for conversations about end-of-life advance care planning. Quickly, Sarah Palin branded such a move as a “death panel” via Facebook that made discussions of end-of-life care reimbursement a taboo topic and a political third-rail. Ms. Palin stated that these conversations were about rationing care at the expense of the “sick, the elderly, and the disabled.”
Now, 6 months before the ACA was supposed to be fully enacted (some provisions of which are delayed by 1 year including the employer mandate requirement and most recently the section that limits out-of-pocket costs for patients), two senators have proposed Medicare coverage for end-of-life conversations.…
by Craig Klugman, Ph.D.
How much is your privacy worth? Would you be willing to give up your rights to medical privacy for $50? The company CVS Caremark is betting that you would. Earlier this year, CVS began counting pharmaceutical purchases toward its rewards program. For every 10 prescriptions filled, a customer can receive $5 worth of credits to be used at CVS up to a maximum of $50 per year. Such programs are not new; Walgreens and Rite-Aid also offer rewards for prescription purposes. According to David Lazarus at the LA Times, the difference is that CVS requires customers to give up their HIPAA privacy rights to participate.…
Jennifer Chevinsky, B.S.
Conversation around the ethics of medical student treatment – or mistreatment – has changed greatly over the past 50 years. From hazing to ‘pimping’ – overnights to business hours – ‘see one, do one, teach one’ to facilitated and guided learning. Literature continues to discuss the moral erosion of students as they progress through medical school and go on to further training. The hierarchical structures and the domains of influence (especially relating to grading policies) have been illuminated. What are ways that you, the healthcare professional, can best and most ethically incorporate medical students into clinical practice?
Starting on my third-year medical school rotations, I have been given an amazing and humbling opportunity to interview patients, perform physical examinations, and participate on a medical team. …