Practical Bioethics

GOP Candidates on Advance Directives

2012-01-27T10:06:00.000-08:00

This from the GeriPal Blog yesterday.

L2

Are you encouraged that the candidates have at least some healthy respect for Advance Directives and the right not to have CPR performed upon them? Are you dismayed by some of the statements about judicial review for end of life decisions?

I for one am hopeful as the language used in this debate is very different than the language used during the debates about health care reform (in particular the provision to pay for advance care planning consultations).

Link to blog here.

IOM Report and NEJM

2012-01-19T08:59:00.000-08:00

Alleviating Suffering 101 — Pain Relief in the United States

Philip A. Pizzo, M.D., and Noreen M. Clark, Ph.D.
New England Journal of Medicine
January 19, 2012

The magnitude of pain in the United States is astounding. More than 116 million Americans have pain that persists for weeks to years. The total financial costs of this epidemic are $560 billion to $635 billion per year, according to Relieving Pain in America, 1 the recent report of an Institute of Medicine (IOM) committee that we cochaired.

Links:

Alleviating Suffering 101 — Pain Relief in the United States, New England Journal of Medicine, January 19, 2012

Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, Institute of Medicine

What’s Next? The IOM Report on Pain, Myra Christopher, The Bioethics Channel

Part II: Undocumented Organ Donor

2012-01-18T08:30:00.000-08:00

Here are some responses to yesterday’s post on this subject.

L2

Response 1: I cannot think of any compelling moral reason not to use the living donors for this person regardless of their alien status as long as no one is burdened against their will. This is to say if the insurance is willing to pay for the donors as well as the recipient (including follow-up for complications) and if the donors are giving fully informed consent then what would be the argument against doing so. It is a gift and alien status really is of no consequence if the burdens are accepted.

The policy of the Organ Procurement and Transplant Network (OPTN) 6.2 clearly states that a resident alien cannot not be discriminated against for transplantation if they fulfill all of the other requirements for transplantation. I can understand recipient not getting the transplant (though I may not agree with it) but cannot see how being a donor would disqualify.

Response 2: Seems to me that, if one eliminates the reimbursement issue, what you are left with is this question: Are people without the "proper" paperwork somehow of lesser status as human beings, and thus entitled to a lesser standard of care?

I hope the answer to that is obvious.

Response 3: The other side of the coin is not whether the “donee” is entitled to the same standard of care. It is whether the “donors” of organs are in the same vulnerable position as prisoners, and therefore not ethically allowed to donate organs.

The donors are in the unique situation of assuming significant risks with no benefits from the procedure and therefore should be entitled to greater protection from coercion.

Undocumented and Organ Donor?

2012-01-17T09:04:00.000-08:00

Consultation for ethics response pertains to a case in which a resident alien (documented) with end-stage renal failure, recently listed with UNOS for a deceased donor kidney transplant, presents to the kidney transplant program two or three potential living donors who are undocumented immigrants.

Question put to Ethics is: Ought the transplant program evaluate and accept undocumented persons as living donors of a kidney?
Note: This transplant program, and others asked, typically have not transplanted (recipient) undocumented persons. Public insurance apparently is not available without legal immigration status; although for a documented person/patient recipient of an organ, public insurance (or private, if they have it) is apt to pay medical expenses both for recipient and donor.

Are there nonetheless compelling moral grounds for not using as living donors persons without papers--or for doing so?

MLK and the Center for Practical Bioethics

2012-01-16T11:53:00.000-08:00

In March 1965, Rosemary Flanigan was among a group of Catholic nuns who traveled to Selma, Alabama to advocate for civil rights. The trip came shortly after "Bloody Sunday" on March 7, 1965, when 600 civil rights marchers were attacked by state and local police with billy clubs and tear gas.

Sister Rosemary shared her experience and her thoughts during an event sponsored by the Center for Practical Bioethics on January 19, 2009. The next day, the first African American in US history was sworn in as President of the United States.

Sisters of Selma – Bearing Witness to Change
Sister Rosemary Flanigan
Father Norman Rotert

A Sister of Selma Celebrates Martin Luther King’s Birthday
Sister Rosemary Flanigan
3 minutes 02 seconds

A Priest Reflects on Dr. Martin Luther King
Norman Rotert
3 minutes 13 seconds

Hospice in American Prisons January 30

2012-01-11T15:03:00.000-08:00

Nationally, about 3,300 men and women die in American prisons each year. A decade ago, most died alone and in pain. Today, thanks to the creative leadership of a few prison wardens and superintendents, there are seventy five active hospice programs in this country.

They believe the provision of hospice care for dying inmates transforms lives: the life of the dying inmate and the life of the inmate caregiver.

Find out how during a special program January 30th at 5 pm at the Community Christian Church in Kansas City, MO.

Serving Life, a documentary about the hospice program at Angolo Penitentiary in Louisiana, will be shown followed by discussion and review of a traveling photo exhibit about the program.

For more information and to register click here.

Part II: Does parsimonious equal ethical?

2012-01-10T14:53:00.000-08:00

It might be that the American College of Physicians would be wiser to not use what amounts to a technical term better understood by an audience they're mostly not addressing in this document.

Read in context, I think it should not be difficult for most readers to get the meaning intended. The full quotation from this article is as follows:

"Physicians have a responsibility to practice effective and efficient health care, and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available."

Seems pretty clear to me.

Given the number of very expensive, situationally ineffective, even risky or harmful, and oftentimes unnecessary-but-for-"defensive medicine" scans and interventions that are ordered so long as someone (Medicare/Medicaid/Tri-Care/insurance) will pay . . . I'm having a hard time getting too worried about ACP finally using the "p" word with physicians.

It appears to me, rather, that it is Gottlieb who gets it wrong here, if quoted accurately: "I mean, that really implies that care should be withheld." Does it? Or is he constructing a straw man?

Even if we correct his misuse of the term "care" (surely he means to say "treatment"), the only real implication I see is that of encouraging a wiser, more equitable use of healthcare resources.

While we might not want to put that responsibility fully on the shoulders of clinicians--the rest of us as patients and parents/families, politicians and other policy makers, have as much or greater responsibility to choose and use wisely--physicians too need to get on board so that fewer trains to nowhere good never leave the station.

Tarris Rosell, PhD, DMin
Rosemary Flanigan Chair
Center for Practical Bioethics

Does parsimonious equal ethical?

2012-01-06T07:49:00.000-08:00

The American College of Physicians recently released an updated ethics manual calling for physicians to practice "parsimonious" care.

That prompted a practical discussion of what this means among the list serv discussion group at the Center for Practical Bioethics. Here’s a sampling, edited for length:

I was not uncomfortable with the ACP use of the term parsimony or parsimonious practice. I am used (to) the term as it is often referred to as "Occam's Razor" or lex parsimoniae and as applied to medical practice I see it as referring to avoiding expensive and not so useful testing or testing for the sake of testing and perhaps even, shudder the thought, reducing ineffective medical treatment.

Traditionally and at least within the context of philosophy, the terms has always referred to the use of an economy of assumptions, a minimalist approach to thought and practice, and, of course if used in particular fields, the terms will usually assume a more narrow and more focused meaning. It is certainly not a neologism but a definition that may have a more specifically focused connotation. Many logicians refer to this practice as using "precise definition.

Parsimonious does not mean ethical. It is a shame that the statement does not simply say “medical care congruent with professional standards and the patient’s goals and values.”

Wow. My Webster’s dictionary has as one of the definitions of parsimonious….”frugal to the point of stinginess.” Also parsimony has as one definition….”economy in the use of means to and end.” Hmmm, how do we define “end”?

What do you think? More commentary later.

L2

Deadly Spin at KC Public Library

2011-12-29T10:02:00.000-08:00

Wednesday, January 11, 2012
6:30pm
Central Library

Wendell Potter, a former VP of CIGNA, argues that health insurers make promises they have no intention of keeping, flout regulations designed to protect consumers, and skew political debate with multibillion-dollar PR campaigns to mislead the press and public.

In Deadly Spin, Potter takes readers behind the scenes to show how a huge chunk of health care spending bankrolls a propaganda campaign focused on protecting one thing: profits.

For more information and to register click here.

Wesley Smith on William Hurlbut

2011-12-21T07:34:00.000-08:00

The December 2011 edition of The American Journal of Bioethics features a special “trending” section on personalities and politics in bioethics.

Wesley Smith, Senior Fellow at the Discovery Institute’s Center on Human Exceptionalism and a special consultant for the Center for Bioethics and Culture, chose to write about William Hurlbut in an article entitled “Building a Bridge over Troubled Stem Cell Waters.” Lorell LaBoube visited with Smith about the article in this edition of The Bioethics Channel.

Link to podcast here.

Plain Speaking at the End of Life

2011-12-19T07:26:00.000-08:00

Paula Span
New York Times
December 14, 2011

I don’t switch to comfort care. I discontinue any treatments that don’t contribute to comfort. Because if this is the day you’re switching to comfort, what kind of care are you switching from? A patient’s symptoms, like pain or shortness of breath — weren’t those important yesterday?

Link to article here.

A Transition at the Center for Practical Bioethics

2011-12-14T07:29:00.000-08:00

Myra Christopher
John Carney

A time for change at the Center for Practical Bioethics, as the founding executive steps into a new role, and a former Center executive returns as the new president and CEO of the Center.

Lorell LaBoube talks about the transition with Myra Christopher, the Kathleen M. Foley Chair for Pain and Palliative Care, and John Carney, president and CEO of the Center for Practical Bioethics.

Link to podcast here.

Lifesaving Treatment or Wasting Resources?

2011-12-13T07:34:00.000-08:00

As I read this I asked myself where and how do we find the line between life saving treatment and wasting resources – and how we ethically get there.

Thoughts?

L2

When Care Is Worth It, Even if End Is Death
Peter B. Bach, M.D.
New York Times
December 12, 2011

I am not saying that every health care dollar is well spent. But five carefully done studies have now shown that hospitals that spend more on caring for sick patients have better outcomes than those that spend less.

The more nuanced reality is that some aggressive treatment delivers value and is appropriate, even though some patients who receive such care die; other treatment is too aggressive and should be curtailed no matter what the short-term outcome.

The Ethics of Presumed Consent

2011-12-06T07:35:00.000-08:00

“Opt out is not the magic bullet. It will not be the magic answer we have been looking for,” said Dorry L. Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine and leader of the study published online in the journal Transplantation.

“With opt out, the perception becomes, ‘We will take your organs unless you take the time to fill out a form.’ That’s a dangerous perception to have. We only want to use donated organs from people who intended to donate.”

Links:

**Presumed consent no answer to solving organ shortage in U.S., The JHU Gazette, Johns Hopkins Medicine, December 5, 2011

**Podcast: The Ethics of First Person Consent, Terry Rosell, DMin, PhD and Rob Linderer, Midwest Transplant Network

Christopher set for national podcast on relieving pain

2011-12-05T09:00:00.000-08:00

National Fibromyalgia & Chronic Pain Association Podcast to discuss "Relieving Pain in America"

Friday, December 9, 2011
12 pm ET/11 am CST

Myra Christopher is the Director of the Pain Action Alliance Initiative: A National Strategy (PAAINS) and the holder of the Kathleen Foley Chair on Pain and Palliative Care at the Center for Practical Bioethics.

Christopher will be discussing her role as a member of the Pain Study Committee at the Institutes of Medicine focused on the under-treatment of pain which produced the IOM report, “Relieving Pain In American: A Blueprint for Transformation in Prevention, Care, Education and Research.” The historic report was submitted to Congress this past June.

For more information click here.

An All Too Typical Case Study

2011-12-02T09:39:00.000-08:00

A typical case – older gentleman, no advance directive, uninsured, suddenly without consciousness and the family doesn’t know what to do. Conflict between family and doctors and hospital results.

What do you think?

L2

Don't Pull The Plug! A Family's Battle With The Hospital
Carolyn Rosenblatt
Forbes
December 1, 2011

What little brain activity was left in the lower brain would probably diminish soon and the dispute would end. However, they did not deserve to be lied to by hospital personnel in the meantime. This was crisis management, filled with the family’s pain and the hospital’s financial dilemma communicated as pressure to end the problem by forcing the family to let go.

New Development for Seniors

2011-12-01T11:03:00.000-08:00

Stephanie Liebergen
NBC Action News KSHB-TV
November 30, 2011

Rockhill Greens will be built on a 13-acre plot of land connected to the Brookside Campus of Research Medical Center.

The two groups are working together to build an environmentally friendly development that promotes a healthy lifestyle.

Links:

New development for seniors coming to Brookside, NBC Action News KSHB-TV
November 30, 2011

Podcast: Developing Independent Senior Living, Kelley Hrabe and Jeremy Whitt, The Bioethics Channel

http://www.kc4aic.org/

Reminder: Disaster Ethics Symposium and Forum December 7

2011-11-30T13:21:00.000-08:00

The Perfect Storm: Disaster Ethics Symposium and Public Forum

Wednesday, December 7, 2011

Kansas City Public Library – Plaza Branch
Truman Forum Auditorium
4801 Main Street
Kansas City, Missouri 64112

The Center for Practical Bioethics is hosting a symposium and forum on the ethics of disasters on December 7 at the Kansas City Public Library-Plaza Branch. The symposium features presentations by medical professionals who were on the scene during the Hyatt Hotel disaster in Kansas City, Hurricane Katrina in New Orleans, and the tornado that ripped through Joplin, Missouri in May 2011.

Continuing education credits are available for the symposium.

At 5 pm that evening, a public forum is scheduled with Anna Pou, MD, who spent nearly a week in Memorial Hospital in New Orleans after Hurricane Katrina hit in 2005. A responder panel will follow Dr. Pou’s remarks. Registration for the public forum is $15.

· Symposium: 8 am to 4 pm
· Public Forum featuring Dr. Anna Pou and responder panel: 5 pm (New Time!)
· Online Registration

Questions? Contact Cindy Leyland at cleyland@practicalbioethics.org or call 816-979-1357.

Publish Opinions of Hospital Ethics Committees?

2011-11-29T07:30:00.000-08:00

Our friend Thaddeus Pope prompted a wide ranging discussion on our end with the suggestion that hospital ethics committees publish their opinions.

Following are the thoughts of Tarris Rosell, PhD, the Rosemary Flanigan Chair at the Center for Practical Bioethics.

L2

Hmm. I can see Thad Pope's point. And there are any number of interesting case consultations on which collegial input might be welcomed.

It is easier to think of publishing (online, listserve, journal) a case that is several years past rather than one current or recent, due to fear of violating privacy even with de-identified data. Feedback on the latter sort (current or recent) likely would be of more value for its freshness and immediate critique, affirmation or accountability.

Yet, I wonder what our HIPAA people and Risk Manager would say about Professor Pope's
suggestion...

By the way, I think there are not a majority of ethics committees that function in a way as to have potentially publishable "committee opinions." Many of our hospitals have consultation services or subcommittees, or else a solo clinical ethics consultant.

The chart notes or emailed responses that are drafted in response to a consultation request typically would not rise to the level of written "opinion" that an attorney like Pope might have in mind. On the other hand, we do write recommendations in the chart oftentimes, and those could well be challenged by peer review--if submitted for such.

Tarris Rosell, PhD, DMin
Rosemary Flanigan Chair
Center for Practical Bioethics

Schedule Change - Disaster Ethics Public Forum

2011-11-22T15:43:00.000-08:00

The public forum featuring Anna Pou, MD, scheduled for December 7 at 6 pm, has been changed to 5 pm. A responder panel will focus on Kansas City’s ethical response to a disaster following Dr. Pou’s remarks.

Dr. Pou will speak about the days following Hurricane Katrina when she and two nurses at Memorial Medical Center were arrested and charged with second-degree murder of patients. A grand jury refused to indict any of the three and the case never went to trial.

Local media reports indicated the situation “ignited a furious debate in New Orleans and elsewhere about whether sharp ethical boundaries can be drawn around decisions on patient comfort made in a crisis.’

The Perfect Storm – Disaster Ethics Symposium & Public Forum will begin with the symposium at 8 am at the Plaza Branch of the Kansas City Public Library. The symposium features presentations by medical professionals who were on the scene during the Hyatt Hotel disaster in Kansas City, Hurricane Katrina in New Orleans, and the tornado that ripped through Joplin, Missouri in May 2011.

Continuing education credits are available for the symposium.

Links:

· Overview
· Symposium: 8 am to 4 pm
· Public Forum featuring Dr. Anna Pou: 5 pm
· Online Registration

Defining Decisional Incapacity

2011-11-16T11:10:00.000-08:00

Tarris Rosell, DMin, PhD
Rosemary Flanigan Chair
Center for Practical Bioethics

We recently received a request to define limited/partial/diminished decisional capacity and found that such a definition is not as easy as one might think.

There are many definitions available of what it means to have and to assess capacity. The definitional problem is that limited/partial/diminished (and transient) all fall on a spectrum between full and no capacity, and is context/decision specific.

One resource can be found at www.apa.org/pi/aging/.../capacity-psychologist-handbook.pdf. Otherwise I suggest these definitions:

Full decisional capacity means that an individual has sufficient . . .

· knowledge with understanding (of relevant information, including risks and benefits)
· voluntariness without coercion,
· decisionality (ability to choose between options)
· communicability (ability to communicate choices made)

So as to be able to make all types of life decisions for oneself.

Limited, partial, or diminished capacity means that an individual has insufficient knowledge, voluntariness, decisionality, and/or communicability so as not to be able to make some types of life decisions for oneself.

Capacity or incapacity is always in relation to the type of decision to be made. Decisions involving higher risk and/or lower benefit require more sufficiency of knowledge with understanding and voluntariness without coercion. Decisions involving lower risk and/or higher benefit require less sufficiency of knowledge with understanding and voluntariness without coercion.

Decisionally incapacitant means that an individual has insufficient knowledge, voluntariness, decisionality, and/or communicability so as not to be able to make any type of life decision for oneself.

What do you think?

Resuscitate the Slow Code?

2011-11-14T09:43:00.000-08:00

John Lantos, MD

Slow codes, defined as half-hearted efforts to resuscitate patients, have been called deceptive, dishonest, unethical and deplorable. But is it time to reconsider that point of view? Can slow codes be appropriate, and ethically defensible?

Dr. John Lantos thinks so and he expresses that point of view in the November 2011 edition of The American Journal of Bioethics. And he talks about it with host Lorell LaBoube of The Bioethics Channel.
Link to podcast here.

Carney appointed President/CEO at Center for

2011-11-09T09:59:00.000-08:00

The Center for Practical Bioethics has announced John G. Carney will assume leadership of the Center by January 1, 2012. He replaces the Center’s founding executive, Myra Christopher, as president and chief executive officer.

Carney is a well-known advocate for patients, families and caregivers dealing with chronic and progressive disease. Christopher will continue with the Center as the Kathleen M. Foley Chair for Pain and Palliative Care.

For more click here.

Top 10 - Lectures in Bioethics October 2011

2011-11-03T07:23:00.000-07:00

Systems Reform and Innovation, Robert St. Peter, MD
Religion. Healthcare. Do the Twain Meet?, Rosemary Flanigan
The Role of Conscience in Medical Decisions, Daniel Sulmasy,MD
I'm dying STAT! Call my -- lawyer?, Bill Colby, JD
Health care reform needed but comes hard, Steven Schroeder, MD
Chronic Disease and Aging, John Carney
A Physician's Reflections on Bioethics, Robert Potter, MD
Bioethics and the Underserved: Culture, Values and Justice, Richard Payne, MD
Pain is HARD: The Complexity of Pain Treatment and Management, Rollin “Mac” Gallagher, MD
Eugenics, Race and Bioethics, Glenn McGee, PhD

Top 10 - The Bioethics Channel October 2011

2011-11-02T07:38:00.000-07:00

Here are links to Top 10 editions of The Bioethics Channel for October 2011.

If you have any ideas for topics and guests please let me know at llaboube@practicalbioethics.org.
Thanks for listening!
Lorell LaBoube
Director of Communications
Center for Practical Bioethics

Top 10 - The Bioethics Channel October 2011
Ethically Dubious: Prisoners and Organ Donations, Art Caplan, PhD
Nurses Treating Pain, Pamela Bennett and Ann Schreier
The State of Altered Consciousness, Joseph Fins, MD
Advance Directives and Medicare Spending, Myra Christopher
Pain and Public Health, Daniel Goldberg, PhD
Avoiding Unwanted Hospitalizations, Sandy Silva
Integrative Pain Treatment, Heather Tick, MD
The Ethics of Donating Eggs, Glenn McGee, PhD
Ashley X Revisited, Norman Fost, MD and John Lantos, MD
Religion and Medicine: Compatible?, Farr Curlin, MD and John Lantos, MD

Disaster Ethics Symposium Dec 7 in Kansas City

2011-11-01T07:51:00.000-07:00

Terri Edens, RN, is an emergency room nurse at St. John’s Regional Medical Center in Joplin, MO. On May 22, 2011, she was on duty when a devastating tornado shredded much of the southwest Missouri community.

Edens looks forward to the completion of the hospital’s temporary facility.

“It will be very nice to have more space and solid walls again,” Edens says, “but mainly we look forward to continuing to do the job we love which is serving our community.”

Hear Terri Edens and a host of other medical professionals describe their disaster experiences during The Perfect Storm: Disaster Ethics Symposium and Public Forum on Wednesday, December 7, 2011 in Kansas City.

The symposium features presentations by individuals who were on the scene during the Hyatt Hotel disaster in Kansas City, Hurricane Katrina in New Orleans, and the tornado that ripped through Joplin, Missouri in May 2011.

At 6 pm that evening, a public forum is scheduled with Anna Pou, MD, who spent nearly a week in Memorial Hospital in New Orleans after Hurricane Katrina hit in 2005. Registration for the public forum is $15.

Continuing education credits are available for the symposium.

Links:
Symposium - 8 am to 4 pm
Public Forum featuring Dr. Anna Pou: 6 pm
Online Registration
PDF Flier

Avoiding Unwanted Hospitalizations

2011-10-31T07:58:00.000-07:00

A new study suggests frail elderly patients in nursing homes who document what medical treatment they want have fewer unwanted trips to the hospital.

Sandy Silva, JD, a program associate at the Center for Practical Bioethics, talks about the study in this edition of The Bioethics Channel.

Links:

Podcast: Avoiding Unwanted Hospitalizations, Sandy Silva, JD, The Bioethics Channel, October 28. 12 minutes 09 seconds

Informed Patient: Advance Directives Cut Unwanted Hospitalizations, Wall Street Journal, October 24

Transportable Physician Orders for Patient Preferences, an initiative of the Center for Practical Bioethics

National Strategy for Chronic Pain

2011-10-28T09:27:00.000-07:00

The biggest misconception about chronic pain, according to Summer Johnson McGee, PhD, is that it's a symptom of another condition and not a disease in its own right.

"There's this notion that pain is to be endured, perhaps even valorized," she says. "I find that unacceptable, given today's medical advances. From a moral perspective, we have a responsibility to ameliorate chronic pain, even if we can't completely eradicate it."

Link: Bioethics expert calls for a national strategy to address chronic pain, KUMC News,
October 25, 2011

Knotty Question Part 2

2011-10-27T08:59:00.000-07:00

Here is my first best thought: From a systems theory perspective, the good doctor has just been triangulated.

A tells B about C, rather than
A enabling C to tell B, or
B just telling C on her own steam, or
A telling B about his own anxiety pertaining to C.

Triangling happens all the time, and triangulation (where B gets choked) often. It's always an awkward and uncomfortable position to be in, and sometimes dangerous.

So prevention would have been good--seeing it coming and heading it off at the moment when the husband calls and begins talking about his wife. Unless she's on the phone with him, or next to him, or he says, "It's okay to tell her I told you."

If he didn't say that, then the physician might call back and get permission. If not granted, one might inform that handling that information con-fidere (with faith or care) would mean discussing important info and source of such with the patient/wife regardless.

Or, as you suggest, one might simply ask pointed questions of the patient from a position of undisclosed knowledge, and be enabled to get to the heart of things more quickly without seeming to violate anyone's confidentiality.

Thinking ethics in addition to systems theory: The rules of confidentiality are meant to protect privacy. If the physician has indeed been triangulated on grounds of confidentiality (with the husband-caller), whose privacy is potentially being violated here? Or whose counts for most?

The caller has some privacy rights, yes, but the call he initiated was meant to disclose private information of the patient-wife; and her interests now may well weigh more heavily than his.

I would think that the most important ethics issue in this scenario would not be potential violation of confidentiality but (mis?)prescribing on grounds of not violating confidences despite having obtained information that matters.

Analogy is that of having obtained knowledge of a pending disaster while illegally eavesdropping, and then deciding not to sound a warning since the data was obtained unethically.

True?

--Tarris Rosell, Rosemary Flanigan Chair

A Knotty Question re Private Information

2011-10-26T14:16:00.000-07:00

Years ago, when Dr. Robert Potter and I were colleagues at the Center for Practical Bioethics, he was engaged in getting doctors' office staffs to "do ethics," and so when I ran across some "office ethics" cases, I decided to use them for my November ethics brown bag.
BUT I NEED HELP!!

So I am back with you asking for your prudent and wise advice.

"Two hours before a doctor is to see a patient, her husband calls to relate private information that he fears the patient will not share with the physician. Should the physician disclose this conversation to the patient? What is the risk if she discovers at a later time that a confidential conversation occurred?"

I know we don't have a clue about the nature of the "private information," but if the patient does NOT tell it to the doctor and if the information is relevant to her condition, then should I weigh consequences of revealing/not revealing--and march into the fray as autilitarian?

Or might it be better to keep the informant's remarks private and instead ask questions that hopefully will lead the patient to reveal the information? And if she doesn't, then to prescribe on the basis of what she has told the doctor.

I think this is knotty!!!! And I would love some real-life insight. THANKS.

--Rosemary Flanigan

End of Life Decisions: Family Consent Law Proposed

2011-10-26T07:51:00.000-07:00

End-of-life decisions can be wrenching for families. In the early 2000s, the case of Terri Schiavo riveted the nation, as her family battled over whether to remove her feeding tube or keep her on life support.

Now, 44 states have so-called "family consent laws," which help determine which family member should make health care decisions. Missouri is one of six states with no such law, putting families and doctors in legal limbo. But, as KBIA's Jacob Fenston reports, a bill headed for the Missouri legislature could change that.

Links:

KBIA Report: End-of-Life Decisons: Family Consent Law Proposed

Podcast, The Surrogacy Saga, John Carney, The Bioethics Channel

Pain and Public Health

2011-10-24T12:18:00.000-07:00

Daniel Goldberg, JD, PhD

Viewing pain as a disease symptom - rather than a disease itself - has contributed to the neglect of this condition in the world of public health.

Daniel Goldberg of East Carolina University explains in this edition of The Bioethics Channel.

Link to podcast here.

Continuing Education Credits Available

2011-10-20T12:27:00.001-07:00

Need continuing education credits before the end of the year?

Such credits are available for physicians and other medical professionals by attending “The Perfect Storm: Disaster Ethics Symposium and Public Forum” in Kansas City on December 7.

The two events examine the ethical issues faced by medical professionals who were on the scene during the Hyatt Hotel disaster in Kansas City, Hurricane Katrina in New Orleans, and the tornado that ripped through Joplin, Missouri in May 2011.

Dr. Anna Pou, who faced second degree murder charges following Hurricane Katrina, is one panelist during the symposium and will be the featured speaker at the public forum.

Continuing medical education credits are available for physicians; other credits are available through a Certificate of Attendance.

The Perfect Storm: Disaster Ethics Symposium and Public Forum
Wednesday, December 7, 2011

Symposium: 8 am to 4 pm
Public Forum: 6 pm
Online Registration

For more information and to register click here.

States try more aggressive Rx opioid controls

2011-10-19T08:07:00.000-07:00

The strictest regulation of opioid prescribing is in Washington state. In July, rules affecting osteopathic physicians and nonphysician prescribers took effect. The rules, which cover allopathic physicians starting in January 2012, include detailed instructions on how to evaluate and care for patients with chronic noncancer pain.

Also required are written treatment plans known as "patient contracts" that call for mandatory, periodic urine screenings.

Links:

**Article, States try more aggressive Rx opioid controls, American Medical News, October 17

**Podcast: Pain Contracts: Great Good or Great Harm?, Scott Fishman, MD, The Bioethics Channel

The Coalition to Transform Advanced Care

2011-10-18T07:07:00.000-07:00

Powerhouse of organizations coming together to transform advanced care in the US.

Here’s link to news release.

Ethically Dubious: Prisoners and Organ Donations

2011-10-17T14:45:00.000-07:00

Art Caplan, PhD

The use of prisoners as sources of organs - an ethically dubious practice. That's the title of an article in the October 2011 issue of The American Journal of Bioethics.

Art Caplan of the Center for Bioethics at the University of Pennsylvania is the author, and he talks about it in this edition of The Bioethics Channel.

Link: The American Journal of Bioethics, October 2011

The PSA Debate: Competing Interests

2011-10-14T12:12:00.000-07:00

I have a personal and professional interest in how this debate plays out.

My Dad died with prostate cancer, not from it. He was 78 when he passed away in 1994. Sixteen years later, my brother died from prostate cancer. He was 52 when he passed away in 2010. Since Dad died I’ve had both the PSA blood test and digital exam on an annual basis. Am I wasting time and money?

Professionally, the Center for Practical Bioethics paid significant attention to the mammography debate sparked by this same panel two years ago. I’ve asked my friend and colleague, Terry Rosell, if similar attention might be paid to this debate.

It’s only ethical, isn’t it?

L2

Links:

Panel’s Advice on Prostate Test Sets Up Battle
Gardiner Harris
New York Times
October 7, 2011

Their hope is to copy the success of women’s groups that successfully persuaded much of the country two years ago that it was a mistake for the same panel, the United States Preventive Services Task Force, to recommend against routine mammograms for women in their 40s.

Lecture: To Screen or Not to Screen? Ethical Controversies in Mammography Screening, March 24, 2010

The Perfect Storm: Disaster Ethics Symposium and Public Forum

2011-10-12T09:27:00.000-07:00

Wednesday, December 7, 2011

· Symposium: 8 am to 4 pm
· Public Forum: 6 pm

The Center for Practical Bioethics is hosting a symposium and forum on the ethics of disasters on December 7 at the Kansas City Public Library-Plaza Branch.

The symposium features presentations by medical professionals who were on the scene during the Hyatt Hotel disaster in Kansas City, Hurricane Katrina in New Orleans, and the tornado that ripped through Joplin, Missouri in May 2011.

Continuing education credits are available for the symposium.

For more information and to register click here.

Ethics of Selling Eggs for Stem Cell Research

2011-10-07T13:42:00.000-07:00

Some ethicists have argued that paying women for their eggs might create an exploitative trade. But in this case, it may be the reason why the researchers were able to collect enough healthy eggs (they used 270 in all) to get their historic result.

Glenn McGee, PhD, the Center’s John B. Francis Chair in Bioethics, talks about the ethics of selling eggs for stem cell research in this edition of The Bioethics Channel.

Link: Stem cell research used cloning technique, paid women for eggs, Los Angeles Times
October 6, 2011

Advance Directives and End of Life Costs

2011-10-05T07:46:00.000-07:00

Meryl Lin McKean
WDAF-TV 4
October 4, 2011

A living will or advance directive makes your wishes known about the health care you do or do not want at the end of life. Myra Christopher of the Center for Practical Bioethics points to new research that finds having one makes a difference in several ways including the cost of care.

Links: Living Wills & Advance Directives Helpful at End of Life, WDAF-TV 4, October 4

Regional Variation in the Association Between Advance Directives and End-of-Life Medicare Expenditures, Journal of the American Medical Association, October 5

September Top 10: The Bioethics Channel

2011-10-04T08:58:00.000-07:00

Resuscitating the Dead Donor Rule, David Magnus
Nurses Treating Pain, Pamela Bennett & Ann Schreier
Defining Chronic Pain Ethics, Myra Christopher & Summer McGee
End of Life and Public Health, Lynda Anderson
The Moral Culpability of Guatemala, Summer McGee, PhD
End of Life Status and POLST, Charles Sabatino
The Story of the American Chronic Pain Association, Penney Cowan
Legal and Ethical? Healthcare Information Exchanges, Jeff Ellis, JD & Glenn McGee, PhD
Terri Schiavo -- Five Years Later, Glenn McGee, PhD
Bioethics and the Kenya Peace Initiative, Terry Rosell, PhD

Integrative Pain Treatment

2011-10-03T10:18:00.000-07:00

More and more people in pain and the medical professionals who treat them are turning to integrative medicine to treat pain. Dr. Heather Tick explains in this edition of The Bioethics Channel.

Links:

Is Your Chronic Pain A Disease?, Dr. Oz
Balance, Uniformity and Fairness, Effective Strategies for Law Enforcement for Investigating and Prosecuting the Diversion of Prescription Pain Medications while Protecting Appropriate Medical Practice
Video: Seeking a Balanced Pain Policy, You Tube

Medical Ethics in the Doctor's Office

2011-09-30T08:11:00.000-07:00

Like this item from the Kevin MD blog.

L2

We physicians face ethical dilemmas every day in the mundane world of our medical practices. They won’t appear in your newspapers or pop up on your smart phones, but they are real and they are important.

Here is a sampling from the everyday ethical smorgasbord that your doctor faces. How would you act under the following scenarios?

Link to blog here.

The Perfect Storm: Disaster Ethics Symposium and Public Forum

2011-09-29T08:31:00.000-07:00

Wednesday, December 7, 2011
Symposium: 8 am to 4 pm
Public Forum: 6 pm

Kansas City Public Library
Plaza Branch
Truman Forum Auditorium
4801 Main Street
Kansas City, Missouri 64112

The Center for Practical Bioethics is hosting a symposium and forum on the ethics of disasters on December 7 at the Kansas City Public Library-Plaza Branch. The symposium features presentations by medical professionals who were on the scene during the Hyatt Hotel disaster in Kansas City, Hurricane Katrina in New Orleans, and the tornado that ripped through Joplin, Missouri in May 2011.

Continuing education credits are available for the symposium.

At 6 pm that evening, a public forum is scheduled with Anna Pou, MD, who spent nearly a week in Memorial Hospital in New Orleans after Hurricane Katrina hit in 2005. Registration for the public forum is $15.

For more information and to register click here.

The Center for Practical Bioethics is sponsoring this program in partnership with the Missouri Humanities Council and with support from the National Endowment for the Humanities, along with support from:

Missouri Hospital Association
Kansas Hospital Association
Kansas City Metropolitan Healthcare Association
Saint Luke's Health System
Department of History and Philosophy of Medicine, University of Kansas Medical Center and Kansas University Endowment Association
Sirridge Office of Medical Humanities and Bioethics/University of Missouri-Kansas City School of Medicine
Children's Mercy Hospitals and Clinics

Transparency in Organ Donations

2011-09-28T07:40:00.000-07:00

Supporters of the new rules argue that the guidelines will ensure that a patient's wish to donate his organs will be respected. Critics, however, state that the proposed changes run the risk of dehumanizing patients into mere sources for materials.

Links:

Catholic ethicist calls for transparency in organ donor controversy, Marianne Medlin
Catholic News Agency, September 24, 2011
Changes in controversial organ donation method stir fears, Washington Post, September 20
Resuscitating the Dead Donor Rule, David Magnus, The Bioethics Channel

Nurses Treating Pain

2011-09-27T07:18:00.000-07:00

Pamela Bennett
Ann Schreier

Nurses play an important role in pain management. Two nurses -- Ann Schreier of the American Society for Pain Management Nursing and Pamela Bennett of Purdue Pharma -- talk about it in this edition of The Bioethics Channel.

Educational Links: Disparities in Pain Management
**Article: Unequal Access to Pain Treatment, State Initiatives in End of Life Care
**Podcast: Chronic Pain and Health Disparities, September Williams, MD, The Bioethics Channel

End of Life and Public Health

2011-09-26T08:48:00.000-07:00

Lynda Anderson
An online course sponsored by the Centers for Disease Control is designed to equip professionals at public health departments and aging services networks with the tools to discuss advance care planning with their clients.

Lynda Anderson of the CDC explains in this edition of The Bioethics Channel.

Link to podcast here.

No Pill for Chronic Pain

2011-09-21T07:24:00.000-07:00

Bob Twillman, PhD

American Academy of Pain Management

If there was one thing I could do to relieve pain in America, it would be to have everyone understand that no pill, no shot, no surgery will relieve the vast majority of chronic pain.

Chronic pain is relieved only when there is a joint effort, on many fronts, of the person with pain, his or her healthcare providers, and those in his or her social milieu, to address ALL of the aspects of pain. This means focusing not only on the biological components of pain, but also on its behavioral, cognitive, emotional, social, and spiritual aspects.

By attending to all of these components of the pain experience, it may be possible for people with chronic pain to return to wellness, even if their pain does not completely go away. That is to say, they may be well emotionally, spiritually, cognitively, behaviorally, and socially even if they continue to experience some pain.

That state of overall wellness should be the goal for which we strive in treating chronic pain.

Note: September is Pain Awareness Month. For information on activities conducted by the Center for Practical Bioethics click here.

The Moral Culpability of Guatemala

2011-09-20T09:12:00.000-07:00

Summer McGee, PhD

The Presidential Commission for the Study of Bioethical Issues holds US doctors and researchers morally culpable for experiments involving hundreds of people from 1946 to 1948. Lorell LaBoube visits with Summer McGee about this report in this edition of The Bioethics Channel.

Link to podcast here.

Corporate Responsibility for Clinical Misadventures

2011-09-19T09:50:00.000-07:00

Kenneth Kipnis

Where is the boundary between marketing and medical education? And at what point does a corporation become responsible?

Those are the questions posed by Kenneth Kipnis in the September 2011 issue of The American Journal of Bioethics. Host Lorell LaBoube discusses the article with Professor Kipnis in this edition of The Bioethics Channel.

Link to podcast here.

Wisconsin - Missouri 2005?

2011-09-16T13:01:00.000-07:00

Here's a case of deja vu all over again. Language, arguments in Wisconsin virtually the same as debate in Missouri in 2005.

For more click here.

Research at risk
Editorial
Milwaukee Journal Sentinel
Sept. 12, 2011

Identical bills introduced by Republicans in the state Assembly and Senate would make it a crime for researchers in Wisconsin to use cells derived from fetal tissue.

A ban would put an end to research in labs at the University of Wisconsin-Madison and the Medical College of Wisconsin and would almost certainly lead to an exodus of both scientists and the companies that are putting their research to work.

Bioethicists will pay for proof of Bachman HPV claim

2011-09-15T09:06:00.000-07:00

Scott Hensley
Shots – NPR Health Blog
September 15, 2011

Dr. Steven Miles, a bioethicist at the University of Minnesota, has ponied up $1,000 if the mother Bachmann talked about can produce medical proof that her daughter suffered mental retardation from the HPV vaccine, the Star Tribune reports.

"These types of messages in this climate have the capacity to do enormous public health harm," Miles told the paper. "It's an extremely serious claim and it deserves to be analyzed."

For more click here.

If there's one thing I would do to relieve pain in America ...

2011-09-14T09:38:00.000-07:00

Daniel S. Goldberg, JD, PhD

East Carolina University

I would do everything in my power to convince both providers and pain sufferers to rid themselves of the idea that one must be able to see and objectify pain in order for it to be legitimized and treated properly.

The capacity to correlate discrete, material pathologies with illness complaints is a phenomenon that is literally constitutive of Western allopathic medicine, from the early 19th century to the present. As the quintessential subjective experience, pain defies objectification, and the vast majority of chronic pain experiences are literally defined by the absence of a material lesion that can be so correlated.

Yet such clinical sight is simply not necessary either to validate the experiences of those who live with pain, or to use the various safe and effective remedies that exist to ameliorate such pain.

I also believe that this emphasis on objectification and visibility plays a role in the terrible prevalence and intensity of chronic pain stigma and inequities in diagnosing and treating pain, but laying out the argument is a subject for future posts . . .

Ultimately, the need to objectify and see pain, which has been documented among pain sufferers and caregivers as well as health care providers, is in my view a primary culprit in the devastating and inequitable undertreatment of pain.

Even though such a need is literally baked into the foundations of American medicine and science, we should reject it.

Link: Ethics and the Chronic Pain Stigma in Geriatric Populations, Daniel Goldberg, The Bioethics Channel

Lectures in Bioethics: August 2011

2011-09-12T14:56:00.000-07:00

Here are the Top 10 Lectures in Bioethics for August 2011.

L2

Bioethics and the Underserved: Culture, Values and Justice, Richard Payne, MD
The Role of Conscience in Medical Decisions, Daniel Sulmasy, MD
Systems Reform and Innovation, Robert St. Peter, MD
I'm dying STAT! Call my -- lawyer? Bill Colby, JD
Chronic Disease and Aging, John Carney
A Physician's Reflections on Bioethics, Robert Potter, MD
Religion. Healthcare. Do the Twain Meet?, Rosemary Flanigan
Health care reform needed but comes hard, Steven Schroeder, MD
The Ethics of Living Forever, Glenn McGee, PhD
The Politics of Palliative Care, Kathleen Foley, MD

Webinar: The IOM Report - Relieving Pain in America

2011-09-12T11:18:00.000-07:00

A webinar sponsored by the Center for Practical Bioethics

Thursday, October 6, 2011
10 AM Central

Registration:
Member Rate: $15
Nonmember Rate: $25

On June 30 the Institute of Medicine released a landmark report on pain, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Since then, individuals and organizations devoted to advancing quality pain treatment for all Americans have been investigating ways to carry through on the IOM report’s recommendations.

Myra Christopher, president and CEO of the Center for Practical Bioethics and holder of the Kathleen M. Foley Chair for Pain and Palliative Care, served on the IOM committee that developed this report. In this webinar, Christopher presents an overview of the report.

Registration:

$15 if you are a member of the Center for Practical Bioethics. Click here to register.

$25 for nonmembers. Click here to register.

Linking information will be sent your way following your registration.

If you have a question about your membership status, please email Lorell LaBoube at llaboube@practicalbioethics.org.

Introducing: A New Online Course on Advance Care Planning

2011-09-09T13:39:00.000-07:00

A new on-line course is now available from the Centers for Disease Control Healthy Aging Program.

Entitled Advance Care Planning: An Introduction for Public Health and Aging Services Professionals, the course was developed by CDC in partnership with Myra Christopher, President and CEO of the Center for Practical Bioethics, and the Directors of Health Promotion and Education.

The goal of the course is to equip professionals in the public health and aging services networks with the information and resources needed to assist their clients in better understanding issues related to advance care planning.

For more information click here.

Defining Chronic Pain Ethics

2011-09-07T14:32:00.000-07:00

September is Pain Awareness Month

There is a nationwide consensus developing around the ethical issues involved in the diagnosis and treatment of chronic pain. That’s according to an article in the September 2011 issue of Pain Medicine entitled “Defining Chronic Pain Ethics.”

Two of the authors of the article talk about it in this edition of The Bioethics Channel. For more information on September as Pain Awareness Month click here.

Educational Links:

Publication: Medical Professionalism and Responsibility in Pain Management, Practical Bioethics

Podcast: The Ethics of Untreated Pain, Richard Payne, MD

The Bioethics Channel: Top 10 August 2011

2011-09-07T08:09:00.000-07:00

A wide range of topics covered in the August Top 10 for The Bioethics Channel - from the ethics of healthcare information exchanges and rationing medical care to nursing and medical ethics and the dead donor rule.

If you have any ideas on topics or speakers please contact me at:
practicalbioethics@gmail.com.

Legal and Ethical? Healthcare Information Exchanges, Jeff Ellis, JD and Glenn McGee, PhD

End of Life Status and POLST, Charles Sabatino, JD

Bridging the Divide: Nursing and Medical Ethics, Nelda Godfrey, RN and Noreen Thompson, RN

A Progress Report on Palliative Care, Carol Buller, RN, Christian Sinclair, MD, and Karin Porter Williamson, MD

The Standardized Patient, Walter Winch

Spirituality, Race and End of Life Care, Richard Payne, MD and Tarris Rosell, PhD

Rationing Just Medical Care, Lawrence Schneiderman, MD

The Elderly and Public Transportation, Tom Gerend

Resuscitating the Dead Donor Rule, David Magnus

Bioethics: Ripe for Transformation, Richard Payne, MD

Resuscitating the Dead Donor Rule

2011-09-06T09:09:00.000-07:00

"Can the Dead Donor Rule be Resuscitated?" That's the title of an editorial in the August 2011 issue of The American Journal of Bioethics.

Editorial co-author David Magnus of the Stanford University Center for Biomedical Ethics addresses the question in this edition of The Bioethics Channel.

Link to podcast here.

End of Life Status and POLST

2011-08-29T10:53:00.000-07:00

Charles Sabatino

Now I Am the One Making the Decision.

That's the title of the 7th Annual Policy Summit sponsored by the Missouri End of Life Coalition on September 29, 2011.

Charles Sabatino, JD, the director of the Commission on Law and Aging at the American Bar Association, is one of the speakers at this event, and he joins Lorell LaBoube on The Bioethics Channel.

Link to podcast here.

AJOB: Immediate Impact

2011-08-26T08:59:00.000-07:00

The American Journal of Bioethics has been ranked as the highest impact journal in medical ethics and health policy in 2010 for the fifth consecutive year, with an impact factor more than double that of any other bioethics publication across the last year.

“The American Journal of Bioethics has changed all our notions about what kind of impact bioethics can have on public discourse about health,” says Glenn McGee, PhD, the publications’ founder and editor in chief and the John B. Francis Chair at the Center for Practical Bioethics, where AJOB offices are housed.

For the complete news release click here.

The Elderly and Public Transportation

2011-08-23T07:22:00.000-07:00

By 2015 more than 15.5 million Americans are expected to live in communities where public transportation is poor or nonexistent.

What does that mean and what should we do about it?
This edition of the Bioethics Channel addresses those questions with Tom Gerend, assistant director of transportation at the Mid America Regional Council in Kansas City, MO.

Link to podcast here.

Legal and Ethical? Healthcare Information Exchanges

2011-08-22T09:20:00.000-07:00

Jeff Ellis, JD
Glenn McGee, PhD

What do you know about your healthcare information? And how would your understanding change as healthcare reform calls for health information exchanges?

Those are the questions for this edition of The Bioethics Channel. Host Lorell LaBoube talks about the issues with Jeff Ellis, JD of Spencer Fane Britt and Brown in Kansas City, and Glenn McGee, PhD, the John B. Francis Chair at the Center for Practical Bioethics.

Link to podcast here.

Refuse Food. Get Evicted?

2011-08-19T07:39:00.000-07:00

Mikaela Conley
ABC News
August 18, 2011

Marshall Kapp, director of the Florida State University Center for Innovative Collaboration in Medicine and Law, said there were several issues the facility likely considered after it learned of the couple's plan to refuse food and water.

Link: Elderly Couple Refuse Food, Water to Die; Get Evicted from Facility

The Standardized Patient

2011-08-17T08:19:00.000-07:00

More and more medical institutions are using standardized patients to train future doctors on patient interactions. In this edition of The Bioethics Channel, host Lorell LaBoube visits with an actor who portrays a standardized patient.

Links:

-- These Troupers Take Dramatic Turns at the Hospital, Wall Street Journal, August 16
-- Podcast: The Standardized Patient, The Bioethics Channel, August 12

The Ethics of Smoking

2011-08-16T07:51:00.000-07:00

A Kansas City doctor suggested to me years ago that the way to save medical costs was to have more smokers. They would simply die before accessing Medicare and Social Security.

Provocative? Yes, but it’s almost amusing how we treat tobacco companies and their consumers. We make it as difficult as possible to promote and use a legal product, then happily accept the taxes generated by sales of said product.

Right or wrong?

Link: Smoking is cost-effective, says report, BBC News

Medical Ethicists as Secular Priests

2011-08-15T07:54:00.000-07:00

This from the August 14 post on Health Care Organizational Ethics.

L2

I feel squeamish when I'm introduced as an "ethicist." Since questions about what's the right thing to do come up every day of our lives, we're all "ethicists." Sometimes I make that point. But when I feel the situation requires a "secular priest" I bite my tongue and accept the label.

But there's a serious risk in following that path - we might come to believe the attribution ourself!

For more click here.

Surrogacy Scandal Raises Question about Regulation

2011-08-12T08:57:00.000-07:00

Julie Watson
Associated Press
August 11, 2011

Versions of this article were also published online on ABC News and in the Atlanta Journal Constitution, Boston Globe, Detroit News, Forbes, Kansas City Star, Los Angeles Times, Oakland Tribune, San Francisco Examiner, and Seattle Times

"Surrogacy is hard to regulate and hard to do responsibly if there are market pressures, and if there are exploitative and predatory legal practices," said Glenn McGee, PhD, John B. Francis Chair at the Center for Practical Bioethics. "There is so much potential for abuse here."

At the same time, he said surrogacy has enriched the lives of countless people yearning to raise a child of their own, and he worries cases like this could stymie efforts to properly regulate it.

Link to story here.

Gender Tests: Seeking the Next Ballerina

2011-08-11T07:29:00.000-07:00

Eric Burke
FOX 4 News Kansas City
August 10, 2011

New research says a blood test that determines a fetus' sex is incredibly accurate. In some cases, it can be close to perfect. Glenn McGee, PhD, the John B. Francis Chair at the Center for Practical Bioethics, worries it may raise issues that some parents are not ready to handle.

Link to report here.

Bioethics and the Underserved: Culture, Values and Justice

2011-08-08T15:18:00.000-07:00

There is much in contemporary health care that is ripe for transformation, including bioethics.

In this 2011 Flanigan Lecture in Kansas City, MO, Dr. Richard Payne of Duke University submits that standard bioethics codified in traditional ethical principles needs to be challenged as too limiting for analyzing and responding to the issues of inadequate health care.

Link to audio here.

Link to Powerpoint here.

From the Archives: Do No Harm

2011-08-05T08:04:00.000-07:00

This case study was published in the summer 1996 edition of Bioethics Forum. For a full archive of this publication click here.

To the medical director as physician, the accomplishment represents the true greatness of modern medicine, but to the physician as a medical director, the advancement poses an increasingly frequent conundrum.

The medication costs $400,000 a year and treating this one patient will severely compromise the bottom-line of this small and growing for-profit managed care company.
Money that had originally been budgeted for implementation of a high risk pregnancy outreach program will no longer be available.

Click here for the full case study and let us know what you think by clicking on "Comments."

Blackwood Open Scores in 2011

2011-08-04T14:03:00.000-07:00

$10,000 contribution 15% increase from 2010 event

It was a happy day July 29 at the Center as Joe Landes came carrying a check representing a contribution to Center from the 2011 Blackwood Open. Landes chaired the event for the second year in honor of his friend Jim Blackwood, who died in June 2010.

Myra Christopher, Center president and CEO, accepted the check for $10,000 as Center staff and the Blackwood family looked on. Donna Blackwood, Jim’s wife, has worked and volunteered at the Center for much of its 27 years of existence. Two of the Blackwood daughter’s, Natalie Wetzel and Eden Thorne, attended the check presentation.

For more information about the Blackwood Open visit http://www.blackwoodopen.com/.

A Progress Report on Palliative Care

2011-08-04T07:23:00.000-07:00

Karin Porter Williamson, MD
Christian Sinclair, MD
Carol Buller, RN

A progress report on palliative care provided by a trio of medical professionals in the trenches of the Midwest. That's the subject host Lorell LaBoube takes on in this edition of The Bioethics Channel.

Guests include Carol Buller, a geriatric nurse practitioner at Shawnee Mission, Kansas Geriatric Center; Dr. Christian Sinclair, associate medical director at Kansas City, Hospice, and Dr. Karin Porter Williamson, associate professor and medical director for palliative care services at the University of Kansas Hospital.

Link to podcast here.

Bridging the Divide: Nursing and Medical Ethics

2011-08-03T08:30:00.000-07:00

Nurses face any number of ethical issues at the bedside. Is there a difference between nursing and medical ethics? And how should nurses best address those differences?

In this edition of The Bioethics Channel Lorell LaBoube talks about it with Nelda Godfrey, RN, associate dean for undergraduate programs at the University of Kansas School of Nursing, and Noreen Thompson, RN, clinical nurse specialist at the University of Kansas Hospital.

Link to podcast here.

Top 10 July: Lectures in Bioethics

2011-08-02T12:09:00.000-07:00

Update on Public Health
Regina Benjamin, MD

Systems Reform and Innovation
Robert St. Peter, MD

Pain is REAL: The Meaning of Pain and Suffering
Melanie Thernstrom

A Physician’s Reflections on Bioethics
Robert Potter, MD

The Role of Conscience in Medical Decisions
Daniel Sulmasy, OFM, MD, PhD

Religion. Healthcare. Do the Twain Meet?
Sister Rosemary Flanigan

Healthcare Reform Needed but Comes Hard
Steven Schroeder, MD

I’m dying, STAT! Call my…lawyer?
William Colby, JD

You Got It and Can’t Get Over It: Chronic Disease and Aging
John Carney

Eugenics, Race and Bioethics
Glenn McGee, PhD

July Top 10: The Bioethics Channel Podcast

2011-08-01T12:47:00.000-07:00

Here is the Top 10 list for The Bioethics Channel in July 2011.

L2

Rationing Just Medical Care
Lawrence Schneiderman, MD

Bioethics: Ripe for Transformation
Richard Payne, MD

What’s Next? The IOM Report on Pain
Myra Christopher

Why do people still suffer at the end of life?
Myra Christopher

The Ethics of Translational Research
Lauren Aaronson, PhD, John Lantos, MD, and Glenn McGee, PhD

Bridging the Divide: Nursing and Medical Ethics
Nelda Godfrey, RN and Noreen Thompson, RN

Palliative Sedation: Not a Panacea
Alexander Kon, MD
A Progress Report on Palliative Care
Karin Porter Williamson, MD; Christian Sinclair, MD; and Carol Buller, RN
The Legacy of Dr. Jack Kevorkian
Myra Christopher
The Race Between Ethics and Science
Glenn McGee, PhD

The Continuing Debate on Stem Cell Research

2011-07-29T09:11:00.000-07:00

Judge Rejects Stem-Cell Suit
Mark H. Anderson and Maya Jackson-Randall
Wall Street Journal
July 27, 2011

The appeals court also determined that the National Institutes of Health had reasonably concluded government funding for embryonic-stem-cell research isn't prohibited by a 1996 law that bars the use of federal money for research in which an embryo is destroyed.

Link: Podcast, Stem Cells: The Ethics Debate Begins Anew, Glenn McGee, PhD, August 27, 2010

Reforming Human Subject Research

2011-07-28T07:51:00.000-07:00

Reforming the Regulations Governing Research with Human Subjects

Ezekiel J. Emanuel, M.D., Ph.D., and Jerry Menikoff, M.D., J.D.
New England Journal of Medicine
July 25, 2011

Since 1991, there has been almost no change to the Common Rule. Yet research with humans has substantially increased in volume, with more international and multisite studies, more health-services research, and more research with biospecimens.

Links:

Protecting Research Subjects with Diminished Capacity – Balancing Research Needs with Ethical Concerns, Center policy brief, Summer 2006

Assessing Social Issues of Research, Summer McGee, The Bioethics Channel, May 19, 2011

Center in the News

2011-07-27T14:33:00.000-07:00

To deal with aging population, we need more effective planning
Sandra Silva
Kansas City Star
July 27, 2011

We must acknowledge that the unprecedented increase of older adults in our region will insist we address areas such as caregiving, health/technology, housing, mobility/transportation, social/civic engagement and work force development from a perspective that includes and serves all those who work, live and participate in commerce.

Dr. Richard Payne on Bioethics
Up to Date
KCUR Radio
July 26, 2011

Steve Kraske talks with Dr. Richard Payne of Duke University about how cultural narratives and diverse perspectives might need to be a more significant part of ethical decision-making. We'll explore the key bioethical issues facing minority communities, low-income patients and others who have not always had full access to the health care system.

Was it futile?

2011-07-26T12:27:00.000-07:00

Jim deMaine, MD
Blog: End of Life – thoughts from an MD
July 24, 2011

After three weeks in the ICU, Mary's heart stopped and the nurses, much against their wishes, had to perform fruitless CPR. Mary thus died in a traumatic way, ribs broken from chest compressions, suffering the kind of technological imperative that's sarcastically referred to by the staff as "medical last rites."

For more and to comment click here.

Rationing Just Medical Care

2011-07-20T15:38:00.000-07:00

Lawrence J. Schneiderman, MD
The American Journal of Bioethics
July 2011

U.S. politicians and policymakers have been preoccupied with how to pay for health care. Hardly any thought has been given to what should be paid for—as though health care is a commodity that needs no examination—or what health outcomes should receive priority in a just society

In the July 2011 edition of The American Journal of Bioethics Dr. Lawrence Schneiderman presents a rationing proposal, consistent with U.S. culture and traditions, that deals not with “health care,” the terminology used in the current debate, but with the more modest and limited topic of “medical care.”

Links:

· Table of Contents, The American Journal of Bioethics, July 2011
· Podcast, The Bioethics Channel, July 22

Giving Chronic Pain a Medical Platform of Its Own

2011-07-20T09:23:00.001-07:00

Tara Parker Pope
New York Times
July 18, 2011

“Most people with chronic pain are still being treated as if pain is a symptom of an underlying problem,” said Melanie Thernstrom, a chronic pain sufferer from Vancouver, Wash., who wrote “The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering” and was a patient representative on the committee.

“If the doctor can’t figure out what the underlying problem is,” she went on, “then the pain is not treated, it’s dismissed and the patient falls down the rabbit hole.”

Links:

Pain is REAL: The Meaning of Pain and Suffering, Melanie Thernstrom, presentation during bioethics symposium April 26, 2011

What's Next? The IOM Report on Pain, Myra Christopher, The Bioethics Channel

Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, Institute of Medicine

Bioethics: Ripe for Transformation

2011-07-18T09:42:00.000-07:00

Richard Payne, MD
Standard bioethics is ripe for transformation. Richard Payne, MD of the Duke Institute on Care at the End of Life explains why in this edition of the Bioethics Channel.

Dr. Payne will talk about this issue during the Flanigan Lecture July 26, 2011 in Kansas City, MO. For more information and to register click here.

Links:
Bioethics: Ripe for Transformation, Richard Payne, MD, Bioethics Channel
Flanigan Lecture information and registration

Preparing Today for Tomorrow's Aging America

2011-07-15T08:06:00.000-07:00

Associated Press
July 11, 2011

America’s cities are beginning to grapple with a fact of life: People are getting old, fast, and they’re doing it in communities designed for the sprightly. To envision how this silver tsunami will challenge a youth-oriented society, just consider that seniors soon will outnumber schoolchildren in hip, fast-paced New York City.

Links:

AGING AMERICA: Communities take creative steps to prepare for silver tsunami of baby boomers, Associated Press, July 11, 2011

Developing Independent Senior Living, Kelley Hrabe and Jeremy Whitt, The Bioethics Channel

Surrogates and DNR Decisions

2011-07-14T12:34:00.000-07:00

Laura Landro of the Wall Street Journal reports on a study conducted by researchers at Indiana University and the Regenstrief Institute. Published in the July issue of the Journal of the American Geriatrics Society, it found that when a surrogate had to evaluate whether or not to sign a DNR, the decision process took significantly longer than when patients decided for themselves.

Links:

Delays are Frequent When Surrogates Make DNR Decisions, Laura Landro, Wall Street Journal
July 11, 2011

Case Study: Alice’s Frail Mother, Rosemary Flanigan

Case Study: The Ethics of Empacho

2011-07-12T10:44:00.000-07:00

Your clinic is located in a largely Hispanic area of the community. You have often treated children whose illnesses have been called “empacho” by their parents.

What is the ethical dilemma you see in this case?

Read here and share your comments.

The Ethics of Translational Research

2011-07-11T11:00:00.001-07:00

Lauren Aaronson, PhD
John Lantos, MD
Glenn McGee, PhD

It’s called Frontiers: The Heartland Institute for Clinical and Translational Research. Based at the University of Kansas Medical Center its aim is to transform laboratory discoveries into treatments and cures.

We’ll talk about Frontiers – and the ethical component of the program – in this edition of the Bioethics Channel.

Link to podcast here.

RSVP Today for Flanigan Lecture

2011-07-07T09:34:00.000-07:00

Bioethics and the Underserved: Culture, Values and Justice
Richard Payne, MD
Director – Duke Institute on Care at the End of Life
Tuesday, July 26
Reception: 6 pm
Lecture: 7 pm
St. Joseph Medical Center
Alex George Auditorium
1000 Carondelet
Kansas City MO
For more information about this free lecture and to register click here.

June 2011 Top 10 Bioethics Channel

2011-07-05T08:45:00.000-07:00

Here are the June 2011 Top 10 Bioethics Channel programs by download.

The State of Global Bioethics, Glenn McGee
Working with a Chronic Disease, Sandy Silva
The Legacy of Dr. Jack Kevorkian, Myra Christopher
The Ethics of Research for Pregnant and Fetal Patients, Laurence McCullough
Palliative Sedation: Not a Panacea, Alexander Kon, MD
The Race Between Ethics and Science, Glenn McGee
Honor and Respect in Healthcare, Rabbi Richard Address
Religion and Medicine: Compatible?, John Lantos, MD and Farr Curlin, MD
Assessing Social Issues of Research, Summer McGee
Religion. Healthcare Policy. Do the Twain Meet?, Rosemary Flanigan

Media Coverage IOM Report

2011-06-30T09:13:00.000-07:00

Major report urges changes in chronic pain treatment
Alan Bavley
Kansas City Star
June 30, 2011

“It is morally unconscionable. We have 116 million people struggling every day with chronic pain. It is a moral duty of people in health care to address this issue,” said Myra Christopher, president of the Kansas City-based Center for Practical Bioethics and a member of the 19-person panel that wrote the report.

Chronic Pain Leaves Millions Hurting Each Year
Meryl Lin McKean
WDAF-TV 4
June 29, 2011

A new report on finds that almost half of all Americans suffer from chronic pain, and it means hundreds of billions of dollars in lost productivity each year. But the report does propose some ideas that could mean some real relief for pain sufferers.

What's Next? The IOM Report on Pain

2011-06-29T08:50:00.000-07:00

Myra Christopher
June 29, 2011

At least 116 million US adults suffer from chronic pain. That's more than the number affected by heart disease, diabetes and cancer - combined. The annual economic cost - $560 to $635 billlion.

That's according to a new report released by the Institute of Medicine, Relieving Pain in America-A Blueprint for Transforming Prevention, Care, Education and Research.

Myra Christopher served on the IOM committee releasing the report, and describes how various groups plan to act on IOM recommendations in this edition of the Bioethics Channel.

Links:
Podcast with Myra Christopher
IOM link to press release and report brief

IOM Report on Pain this Wednesday

2011-06-28T14:27:00.000-07:00

The Institute of Medicine (IOM) Wednesday releases a landmark report on pain called Relieving Pain in America – A Blueprint for Transforming Prevention, Care, Education and Research.

The report will be released to the public tomorrow, Wednesday, June 29, 2011, at 11 am ET during a live event in Washington D.C. To register for a live webcast of the release event click here. The webcast link and report will also be posted on www.iom.edu/relievingpain.
In addition to the webcast, the IOM will tweet the event live using the hash tag #relievingpain.
Myra Christopher, president and CEO of the Center for Practical Bioethics, who served on the IOM’s Committee on Advancing Pain Research, Care, and Education, believes changes in the way we assess, treat and manage pain in the US are morally imperative and must happen quickly.

As part of the Pain Action Initiative: A National Strategy (PAINS), Myra and the Center recently held regional stakeholder meetings about pain in communities across the country. A common theme of those meetings – solutions lie in systemic changes, and previous ways of addressing the problem won’t work anymore.
PAINS convened several organizations to report the Center’s findings and to discuss the possibility of working together to implement recommendations made in the IOM report.
Determined not to allow the IOM report to sit on the shelf, the group plans to meet again in August to analyze where common efforts can be coordinated and enhanced, to identify areas where there is currently little activity, and to consider opportunities for collaboration.
As a group of organizations, many of whom have toiled in these fields for many years, a concise set of actions will be developed to address each IOM recommendation while encouraging individual organizational activities and collective strategies.
For more information on the PAINS initiative click here.

Working with a Chronic Disease

2011-06-24T09:24:00.000-07:00

Sandy Silva
June 24, 2011

We're living longer, we're working longer, so how do we strike a balance between the needs of the person with the chronic disease and the needs of the workplace?

Sandy Silva, director of the KC4 Aging in Community Initiative at the Center for Practical Bioethics, suggests some answers in this edition of The Bioethics Channel.

Link to podcast: Working with a Chronic Disease

Caring for Those in a Vegetative State

2011-06-23T08:09:00.000-07:00

Ann Alexander
BBC News
June 21, 2011

Expert clinicians have highlighted a number of concerns about the care of vegetative state patients and their families. They believe some are being misdiagnosed as a result of inconsistencies in assessment across the country. There is also evidence families are not routinely being told of all the options open to them.

Links:

The heartache of caring for 'vegetative state' patients, Ann Alexander, BBC News, June 21, 2011

Podcast: Ethics of Disorders of Consciousness, Joseph Fins, MD and Art Caplan, PhD, The Bioethics Channel

Examining New Knowledge and Controversies about Serious Disorders of Consciousness, State Initiatives in End of Life Care

Save the Date! Flanigan Lecture July 26

2011-06-20T07:55:00.000-07:00

Flanigan Lecture July 26 featuring Dr. Richard Payne

Dr. Payne is the Director of the Duke Institute on Care at the End of Life.

The lecture is entitled “Bioethics and the Underserved: Culture, Values and Justice.” It’s scheduled for 7 pm at St. Joseph Medical Center in Kansas City, MO.

This lecture is free but registration is requested by clicking here.

Captain America: The Next Great Research Ethics Movie?

2011-06-17T07:38:00.000-07:00

Summer McGee
June 17, 2011

Could this movie inspire serious debate about post-war research ethics, relativism, and more? Is Captain America the bioethics movie of 2011? Between X-Men and Captain America, it would seem to be one interesting summer for bioethics at the movies.

For more click here.

NEW! Bioethics Forum Archive Online

2011-06-15T12:20:00.000-07:00

From 1985 through 2005, the Bioethics Forum served as the primary publication of the Center for Practical Bioethics.

All the articles published during those 20 years are available, from the first edition of Midwest Medical Ethics and a focus on organ donations, to the final edition of the Bioethics Forum on caregiving.

Encountering "socialized medicine" enroute to Africa

2011-06-10T08:52:00.000-07:00

Terry Rosell
June 10, 2011

Enroute to East Africa, the Lofgren Rosell family has stopped in Firenze (Florence), Italy for a few days. Daughter Hannah spent the past semester here studying art, so we are able to see where she has been and some of what she experienced. Like pasta and pizza and gelato.

And Italian hospitality.

While hiking in a coastal area yesterday, beautiful Cinque Terre, our son Nehemiah slipped and injured his foot. It is bruised, swollen and painful—perhaps a sprain but possibly a small fracture. He has plans to backpack Europe for three months upon return here from Africa, including several weeks at Thich Nhat Hanh’s Plum Village (a monastery) in France. Non-ambulatory status is not good for such plans, or those of our family for this month’s travel either. So today Miah and I rode a couple buses (convenient and inexpensive public transportation) from our hostel campground on the south side of Firenze Centrale, and easily found Careggi Hospital on the north side.

Arriving about 4:00 p.m. or so, we are here still, at 6:00 p.m. on Friday, June 3. We will wait several hours, probably, to see a physician. While disappointing relative to sight-seeing lost opportunity, this is appropriate triage for a “non-critico” condition since there are others waiting also who are more needy or were here first.

Actually, Nehemiah was seen immediately by a nurse in the Emergency Department, and then was kindly directed to Centro Traumatologico Ortopedico (First Aid) by a registration clerk. We were accompanied to this building by a physician from whom we asked further directions a bit later, and who then proceeded to sit down and enter Nehemiah’s personal data into the CTO registration computer, making sure we were well taken care of before continuing on his way. He and I had a brief bioethics discussion while walking over here, slowly on account of Miah’s injury. I noted that this doctor exhibited significant virtues, including an admirable “bedside manner.” Indeed, we have received only graciousness and compassion from everyone here thus far, and an apology for the long wait.

Earlier today Ruth asked someone what all this would cost. The answer received is familiar to those who have traveled outside the United States and required urgent care. Those queried here smiled and said, “Free, of course! Healthcare is for everyone in Italy.” Even American tourists.

We learn in CTO that we will encounter some charges anyway, for X-rays, crutches (from a Farmacia), an Ace bandage, and a small doctor’s fee on account of being in the next to lowest priority code of triage. But for the most part, universal healthcare means that those who are injured or ill get seen by a doctor as a matter of course, a human right. If any worse than a minor hiking injury, your neighbors will take care of you completely. When it’s their turn to need help, we all take care of them. How could one argue that this sort of “socialized medicine” is inferior to the American way of healthcare commodification? I am disinclined to do so.

All communication has been accomplished with accommodation to our language handicap, not having learned to speak Italian while in Italy. We are grateful, and a bit embarrassed, by the hospitality of those who cater patiently to our own ignorance. My better educated son gets by, somewhat, speaking Spanish. But his daddy is still pretty much mono-lingual.

And gratefully waiting.

Terry

P.S. Nehemiah was seen by a doctor, after a few hours wait. X-rays were normal. No fracture, just a bad sprain. Total cost to us for ER and urgent care visit, radiology, elastic bandage, nursing and physicians, English and kindness = 46 Euros ($67). Grazie.

The State of Global Bioethics

2011-06-09T14:37:00.000-07:00

Glenn McGee, PhD
June 3, 2011

Glenn McGee, PhD, the John B. Francis Chair at the Center for Practical Bioethics, recently attended and presented at the International Bioethics Conference of the United Nations and UNESCO.

Dr. McGee talks about his trip to Singapore and what happens next in this edition of The Bioethics Channel.

Link: The State of Global Bioethics, Glenn McGee, PhD, The Bioethics Channel, June 3, 2011

Science of Compassion Conference Aug 10-12

2011-06-07T13:28:00.000-07:00

Join the National Institute of Nursing Research and partners for an interdisciplinary examination of end-of-life and palliative care research, practice, and policy.
“The Science of Compassion: Future Directions in End-of-Life and Palliative Care” Summit will take place August 10-12 at the Hyatt Regency Bethesda in Bethesda, MD. Attendance is free. Register today at www.ninr.nih.gov/scienceofcompassion.