Tuesday, September 29, 2009

Center Events -- October and November

Healthcare Reform 2009: Truth, Justice and the American Way

The Center’s series of four public forums examining issues around healthcare reform begin next Tuesday, October 6. Each forum is free and open to the public from 7 pm to 8:30 pm at Community Christian Church, 4601 Main Street, Kansas City, MO.

Next Tuesday’s session is entitled Good Ethics Start with Good Facts. The evening will feature presentations by John Carney of the Center for Practical Bioethics, Teresa Brooks of Polsinelli Shughart and Max Skidmore, PhD of the University of Missouri-Kansas City, Department of Political Science.

To register for the October 6 forum and the remaining sessions on October 13, 20 and 26 click here. You may also contact Donna Blackwood at (816)979-1352 or dblackwood@practicalbioethics.org.


Program schedule, content and speakers
Pdf flier outlining forums

I'm dying, STAT! Call my ... lawyer?

Reflections on the Cruzan argument at the US Supreme Court 20 years later

William Colby, JD, General Counsel, Truman Medical Center

October 14, 2009
5:30 pm Reception, 6 - 7 pm Lecture and Discussion

Kauffman Foundation, 4801 Rockhill Road, Kansas City, MO 64110

This lecture is part of the 2009 Connecting the Dots Series to honor the Center's 25th Anniversary. To register for this free event, click here.

Genetics, Jewish Diseases and Personalized Medicine

November 2 and 3, 2009

Kansas City Public Library, 14 W 10th Street, Kansas City, MO 64105

This two day conference will feature panelists from around the world to discuss the ethical implications of new discoveries in genetics. The focus will be on diseases that are more prevalent in Jewish populations, but we will draw lessons that are relevant for everyone.

For more information and to register for this free event, click here.

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Monday, September 28, 2009

Getting an "A" in Pain Policy

Robert Twillman, PhD
13 minutes 25 seconds

Kansas gets an “A” … Missouri a “C” for state policies addressing pain. What does that mean for physicians and patients when it comes to treating pain?

Dr. Robert Twillman explains in this edition of The Bioethics Channel. He is a Clinical Associate Professor of Psychiatry and Behavioral Sciences at the University of Kansas School of Medicine.


Getting an "A" in Pain Policy podcast

Archive: The Bioethics Channel

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Friday, September 25, 2009

Assessing Quality of Ethics Case Consults

Rosemary Flanigan
September 25, 2009

I feel so fortunate to have you conscientious discussion-groupers when I have a vexing question—and I am vexed by the first article in the recent Cambridge Quarterly.

George Agich is the guest editor for the issue on "Consultation: Time for Assessment and Evaluation." My query is about assessing the quality of our case consults.

I have been helping to drive our ethics committee at Carondelet Health for 19 years and the only specific “quality assessment” we have conducted is through the self-assessment tool prepared by the Consortium.

On Case consultation, there are 11 questions:

Who may ask for a consult?
Questions about the screening process
What happens to a case that is “screened out”?
How is the consult addressed (individual? a few members? the whole?)
Response time
Required consents
Who else is involved?
How documented
How reported and to whom?
Written procedures?
Have we reviewed Core Competencies?

But how ought we to assess the quality of the consult? Do any of you have a specific time to do it? A tool to use?

It’s as if I’ve neglected something very important.


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Tuesday, September 22, 2009

The Distinction Between Morality and Ethics

Rosemary Flanigan
September 22, 2009

The distinction between morality and ethics is not at all clear in some of our minds, and the distinction between clinical practice and ethics/morality is likewise foggy. I am much more prone to see almost every conscious activity (except for tying my shoes) to have a moral component—and wherever there is morality, there can be ethical reflection—whether or not there is conflict.

Terry Rosell asked, “But what if the patient/family objected to the cardiologist’s request for a consult?” and the author said, “In many ways, the notion that any one individual involved in a patient’s situation may be given the ability to deny another to seek assistance to address that other’s own ethical concerns flies in the face of now 30-plus years of recognition that clinical ethical matters are not the sole domain of any one group.”

And he goes on to say that whether or not consent must be sought prior to the initiation of a clinical ethical situation is clearly answered NO, it is still possible that consent might be needed subsequently.

It’s very possible that I’m getting “loose as a goose” conscience-wise, but I think of countless “consults” taking place in hospital hallways, nooks, and crannies across the nation—concerning patients, families, and fellow professionals.

What is the “right and good thing to do” is at stake here, so I argue that we’re doing ethics. And preserving privacy to the extent that we can suffices for me. I don’t want practitioners to be mute because of their scrupulous sense of propriety.

How LOOSE is my GOOSE????

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Monday, September 21, 2009

What happens to Jesus if I donate my heart?

A narration of religious influences on organ donations

Rosemary Flanigan Chair at the Center for Practical Bioethics

September 23, 2009
5 pm Reception6 - 7 pm Lecture and Discussion

Kauffman Foundation
4801 Rockhill Road
Kansas City, MO 64110

This lecture is part of the 2009 Connecting the Dots Series to honor the Center's 25th Anniversary. For more information and to register for this free event, click here.

For a preview of the program, click here for a 12 minute 31 second podcast with Dr. Rosell.

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Friday, September 18, 2009

Humor in Healthcare a Serious Business

Humor in Healthcare a Serious Business

Hob Osterlund, RN11 minutes 54 seconds

The Center for Practical Bioethics honored nurses, social workers, chaplains and allied health professionals with Frontline Action Awards during activities September 8 in Kansas City.
Hob Osterlund, RN, palliative care nurse and nationally known humorist, presented her unique approach to health care before an audience of more than 200 people.

In this edition of The Bioethics Channel, Hob explains how her comic character, Ivy Push, RN, reflects the absurdities that take place all too often in healthcare.


Celebrating with Frontliners, Hob Osterlund, RN, Lectures in Bioethics, September 8, 2009 34 minutes 39 seconds

Humor in Healthcare a Serious Business, Hob Osterlund, RN, You Tube, September 8, 2009 6 minutes 14 seconds


Ethics Consultation: what is at stake and for whom?

Rosemary Flanigan
September 18, 2009

The recent issue of Cambridge Quarterly for Healthcare Ethics arrived at home and the entire issue is devoted to reviewing and assessing ethics consultation. One of the articles asks, “Is Consent Necessary for Ethics Consultation?” and it shows that consults may be called for participants other than the patient.

Thus one must ask what is at stake and for whom.

An example given is the cardiologist who is the attending physician for an elderly gentleman for whom he has provided care for over a decade. All along, the patient has insisted that he not end up debilitated and in a nursing home, but here it is, the fifth hospitalization in the past 18 months and the old gentleman is on mechanical ventilation, is in acute renal failure, has a variety of infections and a prolonged altered mental status.

The cardiologist has talked to the family and they have agreed that life support be withdrawn and their father allowed to die. It was at this point that the cardiologist requested an ethics consultation—not for the purpose of reviewing the case or checking the hospital’s DNR policies/terminal weans but whether or not this the “right” time to stop.

If this were your ethics committee, would you invite the family into the consult?

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Monday, September 14, 2009

Medical Futility Blog -- by Thaddeus Pope: Pauline Chen on Rationing and 'American Values'

Medical Futility Blog -- by Thaddeus Pope: Pauline Chen on Rationing and 'American Values'

Are there ... should there ... be limits to patient autonomy? Especially when it comes to medical professionals saying "no?" Our friends Pauline Chen and Thaddeus Pope weigh in.

Friday, September 11, 2009

Organ allocation and doing justice

Rosemary Flanigan
September 11, 2009

A student is writing an ethics paper on whether or not criminals are eligible for transplants—so let us give her some help. I would suggest that she read the policy and procedures of the transplant network which is in place.

Judging justly, I would deem there would be few—if any—discriminations mentioned—not age, certainly not social worth. I would imagine that the procedures were focused on physical condition and time spent on the waiting list. If she wants to argue scarcity of organs, then how will she argue allocation—and do justice?

I would think the heart of her argument would be found in the materials of the transplant network. Am I wrong???

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Wednesday, September 9, 2009

Ethics of Selling Eggs for Stem Cell Research

David Albertini, PhD
Kansas University Medical Center

Nancy Howell, PhD
St. Paul School of Theology

18 minutes 4 seconds

The state of New York has decided to pay women for donating eggs for stem cell research. What are the scientific implications of such a move? What are the ethical considerations?

David Albertini of the University of Kansas Medical Center and Nancy Howell of the Saint Paul School of Theology in Kansas City discuss the issue in this edition of The Bioethics Channel.


Ethics of Selling Eggs for Stem Cell Research, The Bioethics Channel, September 4, 2009

What happens to extra embryos after IVF?, CNN, September 1, 2009

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Friday, September 4, 2009

For the patient's good. Complex?

Rosemary Flanigan
September 4, 2009

I sometimes think our ethics committee at Carondelet Health must be one of the most knowledgeable groups in the area—sometimes our self-education takes almost the whole meeting!—but I wish that simultaneously with learning so much, we could be DOING equally much (and maybe we are and I’m just not aware of it).

Back in 1988 the Pellegrino/Thomasma twosome wrote For the Patient’s Good. The Restoration of Beneficence in Health Care, and we are going to discuss the different meaning of the “good” of the patient:

-- The ultimate good (that which constitutes the patient’s ultimate standard for his/her life’s choices, that which has the highest meaning for him/her

--Biomedical good (that which can be achieved by medical interventions

-- The patient’s perception of his/her own good at the particular time and circumstances of the clinical decision and how one prefers to advance one’s own life plan

-- The good of the patient as a human person capable of reasoned choices

The physician is bound to advance each of these four senses of good to the extent possible.

So let’s say the patient dying of cancer who had consistently refused resuscitation now during his/her last hours begs to be put on a respirator because of difficulty in breathing. Here is the place that people might fear their living wills or advance care plans will work against them.

But the physician may order the respirator—in order to make the patient comfortable—without negating the patient’s life plan entirely.

BUT, what if the patient is unable to speak and there is conflict between physician and proxy? Call in the ethics committee!!!! (hopefully, a well-educated one!)

The “patient’s good” is a highly complex concept!!! COMMENTS????

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Wednesday, September 2, 2009

The Chaplain's Role in Advance Directives

A good chaplain friend from Nebraska has sought our help and I intend to provide some from my perspective.

He asked in part, “Is it right to initiate an end of life planning discussion with a person whether or not the person has indicated a desire to talk of such matters?”

Now, I’ve never been a chaplain, nor have I been lying as a patient in a hospital bed in recent history. But my admiration for what it means to be a chaplain in a healthcare institution leads me to opine that chaplains could ask almost anything and I would treat the question respectfully—maybe not answer it, but I would presume his/her right to ask it.

So let’s talk specifically about advance directives. In the admissions process, the patient has been asked if he/she has one. Whether the answer is yes or no, the chaplain not only has the privilege but the obligation to follow up on the patient’s answer.

Patients from 18-88 (and beyond) need to have this discussion, and who better than an unhurried chaplain. So I argue that beneficience obliges the chaplain to open the discussion, thus contributing to the patient’s welfare.


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