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by Mark Siegler, MD

Dr. Elisabeth Kübler-Ross graduated from the University of Zurich Medical School, did her residency training at several hospitals in New York City, and then did fellowship training in psychiatry at the University of Colorado. On completing fellowship training, she stayed on as a faculty psychiatrist at the University of Colorado School of Medicine. In 1965, she was recruited to the University of Chicago as an assistant professor of psychiatry. Her first assignment at the University was as Acting Director of the Psychiatric Inpatient Service. One year later, she became Assistant Director of the Psychiatric Consultation and Liaison Service.…

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by Craig Klugman, Ph.D.

The Resident (Season 3; Episode 6): Gambling on patients and dangerous surgeries; New Amsterdam (Season 2; Episode 8): Unrelieved pain; Making promises; Chicago Med (Season 5; Episode 8): Assent/Consent, Medical decision-making by internet vote, not treating family, creating a public health threat

The Resident (Season 3; Episode 6): Gambling on patients and dangerous surgeries

During a high stakes game of poker, Cain wins a chronic spinal patient in a poker game. Cain wants to perform an experimental surgery on the patient to replace four spinal discs with artificial ones. The surgery has never been done in the U.S.…

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During a period of lucidity, a mentally ill individual completed an advance directive declining anti-psychotic medications. However, when the patient was later incapacitated and in state custody, the state facility applied for court permission to ad...

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During a period of lucidity, a mentally ill individual completed an advance directive declining anti-psychotic medications. However, when the patient was later incapacitated and in state custody, the state facility applied for court permission to ad...

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In this talk [AUDIO + SLIDES], Prof. Peter Sandøe (Philosophy, Copenhagen University), argues that, from an ethical viewpoint, gene editing is the best solution to produce hornless cattle. There are, however, regulatory hurdles. (Presented at the workshop ‘Gene Editing and Animal Welfare’, 19 Nov. 2019, Oxford – organised by Adam Shriver, Katrien Devolder, and The […]

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The U.S. District Court for the Eastern District of Michigan has postponed a hearing on the plaintiff's motion for a preliminary injunction. The parties are set to appear before a mediator.   Titus Cromer remains at Royal Oak Beaumont Hospit...

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The topic of childhood vaccination has become increasingly tendentious in recent years.  While ‘vaccine hesitancy’—a term that encompasses a wide range of attitudes, from those who have some misgivings about vaccination to those who refuse all vaccinations for their children—has existed ever since Edward Jenner developed the smallpox vaccine in 1798, many point to a now retracted 1998 paper in The Lancet as the origin of today’s particular brand of vaccine hesitancy.

In the United States, there are three ways by which a child can be exempt from vaccination.  State laws differ with regard to which types of exemptions are recognized.  In five states, the only children who are exempt from vaccine requirements are those with medical exemptions, meaning they must have a medical condition that makes their receipt of a vaccine contraindicated.  The remaining 45 states also authorize religious exemptions, whereby parents can refuse to have their children vaccinated on grounds that vaccination goes against their religious beliefs.  And fifteen of these states further recognize a philosophical exemption, whereby parents can refuse vaccination by appeal to its discordance with their non-religious beliefs.

Recent outbreaks of measles in the U.S. have prompted some states to reconsider their policies on non-medical exemptions. Earlier this year, New York joined Maine, California, Mississippi, and West Virginia in implementing legislation that eliminates religious exemptions for children in childcare centers and classroom-based schools.  Those with an unvaccinated child entering kindergarten had two choices: initiate vaccination for the child (and ensure that the child is up to date by the end of the school year) or remove the child from the school.  Those who select the latter option must then decide whether to home school or move to a different state.

Supporters of the legislation claim that the law will ensure that vaccines’ immense public health benefits are actually realized.  Critics of the law claim that it infringes on personal and parental rights, favoring the interests of the public over the rights of individuals.  And then there are those who fall in the middle—they are supportive of the law’s aims but skeptical of the law’s methods and/or efficacy. 

There is evidence to suggest that skepticism about the law’s efficacy may be warranted.  In a 2018 article in Pediatrics, Delamater et al. study the effects of a 2016 law in California that eliminated all non-religious exemptions to vaccination.   The authors found that an initial decrease in the percentage of unvaccinated kindergarteners in the first year of the law’s effect did not persist into the next year.  They point to phenomena like fraudulent use of medical exemptions, the presence of grandfather clauses, and inconsistent enforcement of the rules as reasons for the law’s limited effects.  They also suggest that the initial decrease in unvaccinated kindergarteners might be explained by something other than the legislation. 

In light of this, what ought researchers and policymakers do?  First, further data collection is key; with the passage of similar legislation in Maine and New York this year, we will have more data to analyze in the next few years to begin to understand the efficacy of these laws.  But it is also worth considering what other policy strategies are available.  Further brainstorming is prudent not only because of the limited efficacy of the current laws but also because some states are unlikely to pass this type of legislation.

What might some of these alternatives look like?  Stay tuned—I’ll discuss one possible strategy in my next blog post.  

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On October 9th, the National Council on Disability (NCD) released a report on the dangers of assisted suicide laws as they relate to persons with disabilities. The report provides a nice background on the history and justification of the Council’s position against assisted suicide as far back as 1997. The present report, available here, provides …

Continue reading "Assisted Suicide and Disability"

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Written by Stephen Rainey Pub bet: I bet you can’t button your coat up. You smell a rat, but go along with it, fastening you coat to see what’s up. I claim a victorious pint of plum porter because you close your coat starting with the top button and moving down. You didn’t button your […]

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The media often sow seeds of confusion, doubt, and mistrust about brain death. There are too many headlines like "Brain dead Woman Kept Alive on Life Support." But now even cardiac death is getting misrepresented. A Fox News story this week reports th...

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