A Muslim in America Practicing Medicine

Rauf Mir, MD

What's it like to be a Muslim practicing medicine in the United States?

Lorell LaBoube talks with Dr. Rauf Mir about that subject in this edition of The Bioethics Channel.

Changing How We Care for the Incurable

Judy Citko & Myra Christopher
San Diego Union Tribune
February 24, 2012

To a certain extent, how we live life and face our inevitable death are determined by a nameless and faceless bureaucracy that we call “the system.” While there are deficiencies and inadequacies at every level, the sum of these broken parts can total disaster for people who live with pain, and those who fear dying in pain.

Link to commentary here.

Death and Dying Attitudes in California

Blog: GeriPal
February 21, 2012

In California not only ethically, but legally pursuant to California assembly bill 2747, effective January 2009, if a physician makes a diagnosis that a patient may have less than one year less to live they are ethically and legally obligated to offer to inform patients of all of their health care treatment options.

Link to blog here.

Legal Immigrant - Illegal Donors. Ethics?

Tarris Rosell, PhD
Rauf Mir, MD
Lindsay Bohonik

A legal immigrant needs a kidney transplant and presents undocumented immigrants as potential living donors. What are the ethics involved in such a case? Host Lorell LaBoube works through the issues in this edition of The Bioethics Channel.

Link to podcast here.

Medical Futility: Wrong Medicine?

Lawrence Schneiderman, MD

In this edition of The Bioethics Channel host Lorell LaBoube visits with the co-author of a new book, Wrong Medicine - Doctors, Patients and Futile Treatment.

Links:

Podcast, The Bioethics Channel

Wrong Medicine: Doctors, Patients, and Futile Treatment, Book Review, Journal of the American Medical Association, February 1, 2012

Webinar: What if the Family Says "No!"?

Ethics of Response to Family Opposition in 'First Person Consent' Organ Donation

Terry Rosell, PhD, DMin
Rosemary Flanigan Chair at the Center for Practical Bioethics

February 22, 2012
11 am Central Time

The Uniform Anatomical Gift Act, as adopted and revised, affirms personal autonomy of those who wish to donate organs or tissue after death. Not even next of kin are permitted to revoke such "first person" authorizations to donate.

Yet the traditional rights of family upon death of a loved one are weighty, especially in regard to deciding what happens to the body.

So what happens, or ought to happen, if the family says, "No!" to donation?

For more information and to register click here.

Link: The Ethics of First Person Consent, Terry Rosell, DMin, PhD and Rob Linderer, Midwest Transplant Network, The Bioethics Channel, May 6, 2011

Thoughts on Final Exit Case

Before too much is made of the Georgia Supreme Court's ruling freeing four Final Exit volunteers from criminal charges for assisting a suicide, let's look at the facts:

1) This was a unanimous 7-0 decision of the court. No small feat these days. The judges made it clear that their ruling was about free speech protected by both the US and Georgia Constitutions.

2) The court stated overtly in its ruling that Georgia legislators could have banned assisted suicide outright in its 1994 law, but didn't - preferring instead to banning only the "advertisement" of assisting in a suicide. That left the question of legality about assisted suicide unaddressed. The court went so far as to say that a total ban on assisted suicide could be considered to be constitutional.

3) The Court ruling further argues that Georgia's law made criminal only the "public" advertising of assisted suicides accompanied by an act to do so - thus the objection by the court to the free speech issues.

4) State lawmakers adopted the law in 1994 to prevent Dr. Kevorkian types from advertising their services, an understandable preventive step, but incomplete, especially in light of other recent state laws that have made physician aid in dying legal.

5) Finally, Dr. Lawrence Egbert and others in Final Exit Network are not Jack Kevorkian types. The group does not advertise their efforts to take the lives of patients, but only assist the patient in taking her own. Though that may seem like splitting hairs to some, when there is no state law on the books that bans assisted suicide, advertising or publicly advocating for a troublesome and morally objectionable activity does not a criminal make.

Rather than alleging claims about judicial activism by its highest court, Georgia legislators simply need to set about the work of adopting legislation to ban assisted suicide all together, if that is what they truly want. That may not be a bad thing to do, but it may be easier said than done.

John G. Carney
President/CEO
Center for Practical Bioethics

Link: Court strikes down Georgia's assisted-suicide law, Ashley Hayes, CNN, February 6, 2012

DNR Orders and Foregoing Treatment

Karin Porter Williamson, MD
John Carney

A study in the Journal of the American Medical Association suggests Do Not Resuscitate Orders may prompt caregivers to forego treatments that patients may have wanted.

Lorell LaBoube, host of The Bioethics Channel, examines the issues with Karin Porter Williamson, MD of the University of Kansas Hospital, and John Carney, President/CEO of the Center for Practical Bioethics.

Responses: Ethics of Placebos

Interesting responses from the question about the ethics of placebos. A brief and more extensive response shared below.

L2

--So, I’ll throw out a question to that question – if the intervention (drug/procedure/whatever) works regardless of the intent, is it really a placebo?


--Historically, people doing ethics have railed against the use of placebos as being deceptive and corrosive to the physician/patient relationship.

I raised all kinds of arguments with my colleagues who served with me on the Institute of Medicine committee to study the state of pain care in the US. In Chapter 3 of our report, Relieving Pain in America, there is a note on the use of placebos. I encourage people to go online and review the entire report.

We note in the report that there is a lot of interesting discussion about the use of placebos. Since its publication last June, there was an article in the New Yorker talking about the beneficial impact of placebos.

My view after reading it is that the point is really about the importance of the therapeutic relationship. If a patient is told that the treatment is a placebo by a physician they trust it still has a positive impact. Also, interestingly, if the medication is topical, it is less beneficial than if it is ingested, which is less beneficial that if it is injected.

The power of relationships and expectations of patients are both significantly important to consider.

Myra J. Christopher
Kathleen M. Foley Chair
Center for Practical Bioethics

Placebos for Patients?

Is it ethical to prescribe a placebo for a patient?
Jim deMaine, MD
Kevin MD
February 2, 2012

Our formulary at that time (a number of years ago) carried a “drug” called Obecalp. As you might have guessed this is Placebo spelled backwards and was doled out now and then but I had never prescribed it. Nancy begged me to try it for her Mom, “It can’t do any harm, why not? I know doctors don’t want to deceive patients, but I’m desperate and so’s Mom!”