UK Study: Knowing Physician Religion Won't Help

George Flanagan, DMin, MA

Program Associate

Center for Practical Bioethics

New data won’t rescue us from hasty generalizations. Diversity is inherent among adherents of any world religion. Christianity, e.g., expresses these differences through denominationalism.

(What kind of Christian are you? I’m a Presbyterian. What kind of Presbyterian? Ad nauseum.)

Recent political and geopolitical experiences remind us that adherents of a religion are not ethically uniform. Even if they were uniform, the layperson not equipped to interpret an approach to end-of-life care simply by use of a religious name.

No religious name can simplistically summarize the complex worldview of individual adherents or their level of adherence to the religion’s teachings. It’s much like calling yourself a Republican: it doesn’t say it all.

In the UK study, paternalistic decision making based on the physician’s values rather than the patient’s is the issue. But knowing the name of the physician’s religion won’t help much. Few of us know enough about our own religion, let alone someone else’s, to draw conclusions about our doctor’s care for us when we’re dying.

We don’t need a noun. We need a conversation.

Links:

UK study: Nonreligious doctors hasten death more, Associated Press, August 26

Should doctors come clean? Religion makes a difference to end-of-life decisions, Practical Ethics, August 26

Religion and Medicine: Compatible?, Farr Curlin, MD and John Lantos, MD, The Bioethics Channel podcast, 14 minutes 35 seconds

Stem Cells: The Ethics Debate Begins Anew

Glenn McGee, PhD
August 26, 2010

16 minutes 20 seconds

A US judge blocks rules on embryonic stem cell research, and the ethical merry-go-round begins anew on this controversial issue.

Glenn McGee lends some perspective in this edition of the Bioethics Channel. Dr. McGee is the John B. Francis Chair in Bioethics and editor in chief of the American Journal of Bioethics.

Link to podcast here.

Caplan: America's Sick Deserve Better

Many have called it legislating from the bench. Others have called it sending us back to the stone age.

But as Arthur Caplan puts it in this week's MSNBC column Judge Royce Lamberth's ruling preventing the use of federal funding for embryonic stem cell research hasn't just hobbled stem cell research--it has killed the hopes for recovery of tens of thousands if not millions of Americans.

To read more about Caplan's view of this landmark court decision, click here.

-- Summer Johnson, PhD

The Story of Nancy Cruzan

At the Epicenter: Cruzan and PSDA 20 Years Later
November 12 and 13, 2010

Westin Crown Center
1 Pershing Road
Kansas City, MO

On December 6, 1989, Bill Colby walked to the podium of the Supreme Court of the United States to plead the case of his client, Nancy Cruzan. The next year, our country had a new constitutional right embodied within the Patient Self Determination Act of 1990.

That was 20 years ago. The court decision and the law will be noted during a conference entitled “At the Epicenter: Cruzan and PSDA 20 Years Later.” It’s an opportunity to convene leading voices in law, medicine, theology and ethics to reflect on these events and explore a controversial and difficult topic rooted in these two landmark events, artificial nutrition and hydration.

For more information about the Cruzan case, the conference and to register, click on the links below.

Links:

Overview
Program
Audio Podcast, A Conversation with Bill Colby, William Colby, JD, General Counsel – Truman Medical Center, September 30, 2009

Diverse Ethics of Translational Research

Neema Sofaer

August 23, 2010

12 minutes 41 seconds

Concerns are growing over the ethics of translational research. But not all such research is morally problematic. That’s according to Neema Sofaer and Nir Eyal in the August 2010 issue of the American Journal of Bioethics.

Neema Sofaer is a Wellcome Trust Research Fellow at the Centre of Medical Law and Ethics at King’s College London. Nir Eyal is Assistant Professor in Global Health and Social Medicine at Harvard Medical School.

Link to podcast here.

Palliative Care Study Deserves Fanfare

John Carney
Vice President for Aging and End of Life

Center for Practical Bioethics

The title of the study is certainly innocuous, “Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer.” But the results are profound. It’s the endorsement, the confirmation, even vindication that palliative care professionals have been waiting for – for a long, long time.

This week’s New England Journal of Medicine (August 19, 2010) featured the news, along with high profile coverage in both the Wall Street Journal and the New York Times. Not bad press for a study of 150 or so patients with lung cancer.

So why the fanfare? Three reasons:

First, the study passed muster with the medical establishment. It was a randomized study – the holy grail required to get the scientific community’s attention, and laying claim that the results weren’t subject to chance.

Two, the “study also showed that early outpatient palliative care for patients with advanced cancer can alter the use of health care services, including care at the end of life. Other studies of outpatient palliative care have failed either to investigate these outcomes or to show an effect on the use of resources”.

And three – drumroll, please: Patients lived longer when they received palliative care as part of their course of treatment. From the get go, they got palliative care - and they did better, died later and died better.

So, we can now join the rest of the world and begin to face the proven fact that it’s better to take care of the whole person instead of just throwing an arsenal of munitions at a disease, hoping for the best.

Who’d have thunk that science could actually come to our aid in actually proving that the science of medicine and the art of care could actually have been one and the same all along?

And that Americans who believe that “more is better” in healthcare aren’t wrong after all, at least when the “more” relates to things that matter to the patient’s quality of life.

I like this study, not only because it’s scientifically rigorous, but it makes sense, saves money and helps us see how we can help very sick people live longer.

Game Changer: Early Palliative Care for Lung Cancer Patients Improves Quality of Life AND Median Survival

Lyle Fettig, MD
Pallimed
August 19, 2010

The implications of this study, a randomized control trial of early palliative care in patients with stage IV non-small cell lung cancer published in the New England Journal of Medicine, will not be fully revealed for a while, but are likely to be important and long-lasting.

The primary outcomes of the study stand on their own as important--it's yet more evidence that palliative care interventions improve quality of life and reduce psychological morbidity.

For more click here.

The Politics of Palliative Care

Kathleen M. Foley, MD
Flanigan Lecture – August 3, 2010

Kansas City, MO

Death panel discussions in 2009 high jacked real issues around palliative care. Workforce capacity of palliative care limits access, as do some hospice benefits on concurrent active therapies. And prescription drug abuse impacts end of life pain management.

Those are some of the political challenges around palliative care in the US, according to Kathleen Foley, MD, attending neurologist in the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center in New York City. Dr. Foley spoke to these issues during the Flanigan Lecture August 3, 2010 in Kansas City, MO.

In 2009 the Center for Practical Bioethics established a chair in palliative care named after Dr. Foley.

Links:

Audio Podcast: The Politics of Palliative Care

Video: The Politics of Palliative Care

PowerPoint: The Politics of Palliative Care, Kathleen Foley, MD

Powerpoint: Palliative Care: A Standard for Cancer Care

Ethics of Deactivating Implantable Devices

Glenn McGee, PhD

John B. Francis Chair in Bioethics

Editor in Chief – American Journal of Bioethics

It’s the classic question posed by advancing medical technology – does an implantable device extend living or prolong dying at the end of life? And who decides?

That’s the question for Glenn McGee in this edition of the Bioethics Channel.

Link to podcast: Ethics of Deactivating Implantable Devices, 17 minutes 56 seconds

Do We Harm Our Children By Naming Them "Pop"?

Summer Johnson, PhD
Bioethics.net

According to the University of Oxford Practical Ethics Blog, a Swedish couple has decided to keep the sex of their toddler a secret as to avoid the pressures placed upon children from having to grow up as one gender or another.

Frankly, this sounds like more of a publicity stunt to me than anything else. But it raises important questions about how we think about raising our children as well. Could we ever be truly neutral in what we expose our children to--and would we really want to be?

For more click here.

At the Epicenter: Cruzan and PSDA 20 Years later

November 12 and 13, 2010

Westin Crown Center

1 Pershing Road

Kansas City, MO

Dedicated to the family of Nancy Cruzan and to Father Richard McCormick

The Patient Self-Determination Act (PSDA) marks its 20th anniversary in 2010. It followed the Cruzan decision and codifies patients’ rights to choose or refuse treatment and to name someone to speak for them when they are no longer able to speak for themselves.

This milestone provides an opportunity to convene leading voices in law, medicine, theology and ethics. Participants will reflect on these events and explore a controversial and difficult topic rooted in these two landmark events, artificial nutrition and hydration.

For more and to register click on the links below.

Links:

• Overview


• Program

Pallimed: A Hospice & Palliative Medicine Blog: Donating Eggs from an Anoxic Brain Injury Patient?

Pallimed: A Hospice & Palliative Medicine Blog: Donating Eggs from an Anoxic Brain Injury Patient?

Glad to share this post from our friends at Pallimed.

L2

Hospice Care in Prison

Carol McAdoo

End of life in prison. Hospice is needed there, just like anywhere else. That's according to Carol McAdoo of the National Hospice and Palliative Care Organization.

Lorell LaBoube talks about it with Carol in this edition of the Bioethics Channel.

Link to podcast here.

Making Health Reform Simple

Rosemary Flanigan
August 9, 2010

Just because I'm retired doesn't mean I don't yearn to tell you all the goodies I read and talk about--and the latest is a Harvard Business Review article, April, 2010, in which Richard M.J. Bohmer gives some ideas on "Fixing Health Care on the Front Lines."

He makes re-design sound simple, and I know it isn't, but it ought to be simpler for some of our systems that aren't as complex as others: Think "optimizing patient care" instead of maximizing utilization of beds, tests, procedure rooms, etc.

That means using well-developed evidence on the effectiveness of treatments, especially those "normal" to the institution; for the more complicated cases, develop a hospital-within-a-hospital approach where specialties work together and keep careful records.

Of course, all of this presupposes administrators focused on the re-design who can rally the forces to share information and work toward standardizing "normal" care.

If anyone reads this article, I wish you would give me your "take." Remember my woeful dearth of information about the interior workings of hospitals.

Your Death Venture Will Begin Shortly

Holly Yang, MD

San Diego Hospice and The Institute for Palliative Medicine

Happy to pass along a along a blog posting from Pallimed. In this post Holly Yang, MD provides an overview of the Quality of Death report by the Economist Intelligence Unit, which ranks end-of-life care across 40 countries.
She states in part:

While not perfect (the report stated that U.S. patients have to give up curative therapy to get palliative care), it is an interesting read. There are some illustrative examples of the many things that go into providing good end-of-life care (or don’t) in different countries, which help to paint a picture of the global situation out there for those who have only entertained the WHO Public Health Strategy for Palliative Care in theory.

Reflections on the Flanigan Lecture

Terry Rosell, DMin, PhD
Rosemary Flanigan Chair

August 5, 2010

Today I am writing reflections on a stimulating 16th annual Flanigan Lecture August 3 in Kansas City, followed by a breakfast meeting with mostly oncology folk the next morning. There were well over 200 at the lecture and about 80 for breakfast. Excellent.

Our retiring Distinguished Fellow, Dr Rosemary Flanigan, was acknowledged with standing ovations for 18 years of service at the Center for Practical Bioethics. Accolades all around. Words can't say how much she will be missed... and how grateful we are to you, Rosemary.

Our lecturer was neuro-oncologist Dr Kathy Foley from Sloan Kettering. She lived up to her reputation as palliative care pioneer and virtual icon of that hugely successful movement.

Dr Foley documented with citations elements of p.c. success. And ongoing challenges. No synopsis here, but look for audio and video podcasts of her lecture to be posted for free download at www.practicalbioethics.org by August 12.

I had questions afterward for Dr Foley about medical and ethical challenges of palliative and hospice care for persons whose terminal illness includes significant psychiatric involvement, perhaps even as primary diagnosis with voluntary stopping of eating and drinking (VSED). She didn't have answers, only an immediate clinical anecdote that makes the point on which we could both agree: this is a yet mostly unresolved dilemma for palliative and hospice medicine.

I'm guessing that some of you have relevant anecdotes on this theme, as well. Do you? Or as Rosemary would write: Help!!!

Rosemary’s final request of me last Wednesday, while stepping on the elevator to leave us, was that I post something today about the Flanigan Lecture.

I've done my duty. Gladly.

Top Ten Podcasts: July 2010

July was another active month with The Bioethics Channel, the Center’s weekly 15 minute (or so) podcast – the best month ever with 3,376 downloads.

Here are the top ten podcasts for July 2010.

Ethical Rules and Rules of Policy, Benjamin Sachs

FDA REMS: A Pain Policy Balancing Act, Myra Christopher

Mental Health & the End of Life, Brian Carpenter, PhD

Introducing AJOB Primary Research, Summer Johnson

Sister Rosemary Retires, Rosemary Flanigan and Myra Christopher

Presidential Bioethics, Barbara Atkinson MD and Summer Johnson

Elderburbia: Aging with a Sense of Place, Phil Stafford

The Intersection of Neuroscience and National Security, Jonathan Marks

Organ Donations and Presumed Consent, Terry Rosell

Ethics and Public Health, Summer Johnson

Case Based Palliative Care

Christian Sinclair, MD
Karin Porter-Williamson, MD

August 3, 2010

A new educational tool for palliative care is now available through Humana Press.

It's called Palliative Care: A Case Based Guide, and Bioethics Channel host Lorell LaBoube talks about with Dr. Christian Sinclair of Kansas City Hospice and Dr. Karin Porter Williamson of the University of Kansas Hospital.

Link: Podcast, Case Based Palliative Care

The Transformation Project

The Transformation Project: A New Initiative to Improve Advanced Illness Care

Center for Practical Bioethics and former AARP CEO launch effort to help patients, families and caregivers and to change the care system

Living with advanced illness in America is painful, isolating and costly. Most people spend their last days alone in hospitals and nursing homes, often in pain, despite the availability of effective pain management.

It doesn't have to be that way. Now is the time to get it right.

That is why “The Transformation Project: A New Initiative to Improve Advanced Illness Care” is creating a national consortium of leading organizations and individuals to work collaboratively on this issue. The goal is to produce a system that provides quality care consistent with the patient’s goals and values.

For more click on:

News Release
About the Transformation Project