Friday, May 29, 2009

Center Warns of Unintended Consequences of Proposed FDA Pain Policy

May 29, 2009

The Center for Practical Bioethics is concerned, like many others, about the dramatic increase in the misuse of prescription drugs. At the same time, the Center is asking the Food and Drug Administration for a balanced approach in developing strategies to curb misuse of opioid painkillers.

That’s according to a statement delivered by John Carney, vice president for aging and end of life at the Center for Practical Bioethics, during an FDA public hearing to consider a Risk Evaluation and Mitigation Strategy (REMS) for the use of opioids.

The FDA's Center for Drug Evaluation and Research conducted the two day public hearing in Gaithersburg, Maryland, on May 27 and 28 to gather input on what factors to consider in drafting the strategy.


News Release, May 29

Seeking a Balanced Pain Policy, Center video, 7 minutes 38 seconds

New Policy Brief aims for Balance in Pain Investigations, Center podcast, The Bioethics Channel featuring Bill Colby, 14 minutes 15 seconds

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Tuesday, May 26, 2009

Teaching Bioethics from Virtue to Kant

Rosemary Flanigan
May 26, 2009

Even though this week will be short, it will be a good one.

How can I tell? Because Terry Rosell is starting a new session with 2nd year medical students who are beginning their bioethics M.A. And he has asked John Lantos, John Carney and me to help him out this week.

John L is addressing “Bioethics and Babies” with the class even as I type; tomorrow John C will address “Aging in Community,” and on Thursday I get to do “Doing Ethics and Avoiding Common Fallacies,” (mixing a little logic in with their Beauchamp and Childress readings on Moral Theories and Method and Moral Justification).

At times like this, I wish I could remember everything I had learned in class—and hope that the students do! But, of course, I don’t and they won’t. But to get them at the beginning, to make them aware of how they think about issues—and how others may think differently—is to share a treasured moment with them.

And we shall close with an analysis of the Baby K case (an anencephalic baby whose mother insisted on ventilator support until the baby died). I want them to see that a utilitarian perspective isn’t the only one possible, and that a Kantian perspective can find us caught up in conflicting obligations—but how does one encourage the development of a virtue ethic without sermonizing!!

No ethical theory guarantees us that we shall be “right,” but arguing civilly with one another might just lead to the development of virtue.

And then a dose of fallacies! I hope all three of us leave some lasting impressions.

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Friday, May 22, 2009

Colleen Hauser is a criminal

John Lantos, MD
May 22, 2009

Parents have rights to raise their children as they see fit. They can decide which church or school the children go to, what prayers they learn, what they wear, what books they read or movies they see.

But their rights are not absolute.

They do not have the right to deny their children life-saving medical treatment. Instead, they have the obligation to keep their child alive. If they do not fulfill that obligation, the state can take protective custody of their children and authorize medical treatment. If the children die, the parents can and should be criminally prosecuted.

When cases involving parental treatment refusals come to court, it should only be to establish the facts. Courts confirm the diagnosis, affirm that effective treatment is available and that non-treatment will cause imminent harm, and step in to protect the child.

Given the uncontroversial nature of these claims, and the widespread societal consensus supporting them, it is surprising that cases of parental medical neglect are newsworthy and even controversial. They should be no more controversial than other illegal acts.

There should not be discussion or debate about the morality or legality of such acts, any more than there should discussion about the morality of murder, rape, or bank robbery. There should only be discussion of how to apprehend the criminals.

Colleen Hauser is a criminal. If her son Daniel dies as a result of her reckless negligence, she should be charged with manslaughter.

Children have a right to life independent of their parents’ religious beliefs. Parents are free to make martyrs of themselves for the sake of their own deeply held beliefs. They are not free to make martyrs of their children.


Parental rights, ethics and the Hauser case, Minnesota Public Radio, May 22
Faith, medicine at odds in chemo refusal, USA Today, May 21
Parents' Rights, Judges' Rules, Newsweek, May 19

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Thursday, May 21, 2009

Hiding Diagnosis from Patient

Rosemary Flanigan
May 21, 2009

I am musing over family's instructions to caregivers, "Don't tell. . . ." and I thought back to the 50's when my dad and I took my grandmother to a physician to check a canker sore (?) that wouldn't quit.

The physician examined her, closed the door between the examining room and the waiting area where we were sitting and told us it was cancer. To the best of my knowledge, for the following six months neither of us spoke the "cancer" word to her.

I shall spend the first few eons in heaven apologizing to her for that!!!

I wondered how professional providers could hide a diagnosis from their patients. Do they justify it by compassion or sensitivity? How can the patient consent to treatment if he/she doesn't know what the treatment is for?

HELP! I know the practice is still going on. How is it justified??


Tuesday, May 19, 2009

You Got It and Can't Get Over It -- Chronic Disease and Aging

Vice President - Aging and End of Life
Center for Practical Bioethics

Wednesday, June 3
5:30 pm Reception
6 pm Lecture

Kauffman Foundation
4801 Rockhill Road
Kansas City, MO 64110
The overwhelming majority of Americans will die of complications from a chronic disease. But most will also live with little acknowledgement or awareness of the toll that inattention to the disease process plays as time progresses. Instead, we await the “crash”; the episode that sends chills, demanding we face the inevitable.
How does a consumer become a self-advocate and prepare for a time and place that we’d prefer never occur? Who is to judge when frail patients can no longer reliably judge for themselves?

This lecture is part of Connecting the Dots, the Center’s 25th Anniversary Lecture Series. It is free but registration is requested. Click here to register online.

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Monday, May 18, 2009

Annual Dinner 2009 Podcasts

Could not attend the Center’s Annual Dinner on May 7? No problem.

Practical Bioethics is happy to offer audio from the Annual Dinner and the Bioethics Symposium for your listening pleasure.

Click here for the Robert L. Biblo Lecture, Remove Hot Button Issues from Public Discourse, delivered by John C. Danforth on May 7, 2009.

And click here for the menu of presentations at the Bioethics Symposium.

Let us know what you think!

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Thursday, May 14, 2009

Suspected Elder Abuse -- What should be reported?

Rosemary Flanigan
May 14, 2009

I am giving a short program to hospice/nursing home personnel tomorrow and I am using a case that centers around suspected elder abuse by a family member.

Yes, yes, I know one is bound by law to report it. But how “suspicious” must the circumstances be? In my case there are no bruises but there are rumors of periodic food deprivation.


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Tuesday, May 12, 2009

Defusing Culture Wars -- Senator Danforth

Remarks by Senator John Danforth at the 25th Anniversary event of the Center for Practical Bioethics on May 7 continue to prompt comment. Here's link to blog commentary by Bill Tammeus, who writes the Faith Matters blog for the Kansas City Star.

You will also find link to text of Danforth's remarks.


Cooling hot-button issues, Bill Tammeus, Faith Matters Blog, Kansas City Star, May 12, 2009

Text: Address by John C. Danforth, May 7, 2009 (pdf document)

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Monday, May 11, 2009

Celebrating 25 Years of Practical Bioethics

Rosemary Flanigan
May 11, 2009

We had a gala week last week celebrating our 25th anniversary of the Center for Practical Bioethics.Former Senator Jack Danforth gave the talk (he had involved Myra Christopher in the discussion leading up to the Patient Self-Determination Act of 1990) and I shall comment on that when I have read his talk.

But the next morning we heard from four participants of the meeting of directors of ethics programs that was being held in KC, and we had a good crowd for that, too. Eric Kodish from the Cleveland Clinic gave the arguments pro and con about using babies in research that does not directly benefit them. (It was an excellent “doing of ethics” with the arguments clearly made.)

David Magnus from Stanford talked about the ethical issues related to organ donation after cardiac arrest. He set up the problems well: when is dead “dead”??? How resolve conflicts between physicians and institutions?? What if measures to preserve the organs do not benefit the patient? He did an excellent job “placing” the argument.

Alan Meisel from the University of Pittsburg asked if physician-aid-in-dying is inevitable? in error? or both? And pointed out the incremental advances being made by those supporters of the movement. He said we have to do a better job of distinguishing active from passive euthanasia—and I was surprised because I think neither is helpful in this discussion. He had some excellent arguments against the movement.

Finally, Glenn McGee with the American Journal of Bioethics talked on autism (he has an autistic son) and how the media attention on the subject has radically altered parents’ relationships to their autistic children. (You can tell I couldn’t hear him very well—maybe one of our staff or attendees will do a better job here.)

So after all that heady stuff, we’re back to normal in mid-May.


Balancing Faith and Politics, John C. Danforth, The Bioethics Channel, May 8, 8 minutes 39 seconds

Lecture, John C. Danforth, May 7 (pdf document)

Health Care Rationing with Universal Coverage and in Time of Pandemics, Up to Date, KCUR Radio, May 8

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Friday, May 8, 2009

Clarifying Texas Advance Directives Statute

Kendra J. Belfi, MD, CMD, FACP
Private practice of internal medicine and geriatrics
Fort Worth, Texas

May 8, 2009

Elizabeth Graham of Texas Right to Life was quoted recently in a story about the Texas Advance Directive Statute. (

I was particularly concerned about what she said about doctors writing unilateral DNR orders without consulting patients.

In my experience as an ethics consultant at a hospital in Fort Worth-the main problem is that doctors write unilateral full code orders on everyone without asking patient or family their wishes.

In our institution, in order for the doctor to write a DNR order without patient input the patient needs to be unable to express his wishes and there needs to be no available surrogate--AND there must be two physicians signing, one whom must be a member of the ethics committee.

I also think Ms. Graham’s statement about euthanasia is very misleading.

There is neither physician assisted suicide nor euthanasia legalized in the state of Texas. Before the dispute resolution process is even invoked, there has generally been a long hospitalization, multiple attempts to resolve things outside the process and then a series of meetings before the 10 day clock even begins to run.

The San Diego Bioethics consortium has recently drafted a model hospital policy on non-beneficial treatment and conflict resolutions which I believe has some very good definitions. They point out that parties may disagree on the best course of action in the care of a patient. Steps must be taken to resolve the dispute if the treatment team believes that 1) continuing treatment is non-beneficial or 2) The burden of suffering and intrusiveness of treatment significantly outweighs any potential benefit or 3) treatment is contrary to generally accepted medical standards but the patient or surrogate continue to request the disputed treatment.

I wholeheartedly agree with their statement that "A health care provider or institution is not obligated to comply with health care instruction(s) or decisions(s) that requires non-beneficial treatment or treatment contrary to generally accepted health care standards. "

This is a long-standing ethical principle in American medicine and I believe that physicians need to be courageous enough to stand up to families that are requesting treatment that is neither appropriate nor medically beneficial to patients.

The political compromise that was reached when the Texas Advance Directive act was passed was that patients had a virtually total right to refuse treatment but did not have a corresponding right to demand inappropriate treatment. The example I use for lay audiences is that you cannot demand a liver transplant if you do not meet the criteria for liver transplantation.

People seem to understand that scenario--but often do not understand that there are many other scenarios in which patients/surrogates are demanding inappropriate care.

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Monday, May 4, 2009

Building a Bioethics Center

Mary Beth Blake and Hans Uffelmann
May 4, 2009

It began as a vision a quarter century ago. With medical technology accelerating rapidly, a healthcare attorney, a physician and a philosopher envisioned a place to consider the ethical implications of using this technology.

In this edition of The Bioethics Channel, Mary Beth Blake and Hans Uffelmann describe how the Center for Practical Bioethics evolved into what it is 25 years later.

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