Monday, November 30, 2009

Glenn McGee named as John B. Francis Chair in Bioethics

Glenn McGee, PhD, will assume the John B. Francis Chair in Bioethics on January 1, 2010. He follows John D. Lantos, MD. The chair was established in 2005 through a $3 million endowment from the Francis Family Foundation to the Center for Practical Bioethics.

The Francis Chair was designed for an individual with national stature in bioethics, a proven track record in teaching and research and proven leadership qualities in fostering excellence in collaboration. In addition to his research, Dr. McGee will engage in public outreach, and consult with policymakers on medical ethics issues.

“Dr. McGee brings enormous expertise, experience and energy to his new role as the John B. Francis Chair in Bioethics,” says Myra Christopher, president and CEO of the Center. Dr. McGee is known for a pragmatic approach to bioethics, making him a perfect fit for the Center for Practical Bioethics.”


Francis Chair Announcement

Bio brief, Glenn McGee, PhD

Podcast, Introducing: the new John B. Francis Chair in Bioethics, The Bioethics Channel, 11 minutes 39 seconds

Labels: ,

Monday, November 23, 2009

Who's willing to listen to the dying patient?

John Carney
November 23, 2009

In watching Dr. Ira Byock on Sunday night (11/22/09) on 60 Minutes, I felt the sting of CBS interviewer, Steve Kroft’s remark – “so this really is about death panels”, a reference to limiting invasive treatment for those in the throes of dying. Ira, a good friend, a veteran palliative care doc, gifted author, and someone who’s dedicated his medical practice to those living with advanced disease, responded admirably.

But I doubt he made any new friends.

If I have my wits about me whenever a well intentioned advocate asks me that kind of question, I ask permission to ask a few in return. If we can agree that all of us will die someday, can we also agree that some ways of dying are preferable to others (e.g., being pain free, surrounded by loved ones, in your own home)? And if we can agree there are, wouldn’t you want your doctor to tell you when that time is approaching so you can receive the kind of care that helps rather than hinders your goals of care?

While death remains an anathema; most of us can also do a pretty good job of describing, at least theoretically, what kinds of things we’d prefer as dying patients. Healthcare professionals who have knowledge and insights about advanced disease should also have the courage to ask me questions that I’m too scared to ask myself.

Facing reality is sometimes a good thing when it comes to life and death. I’d rather answer their questions than wonder why no one asked when they suspected otherwise.

Dying people deserve the best we have to offer. Forcing them to undergo treatment to recover from a condition they won’t recover from may be easier for us, but it is not better for them.

Perhaps those of us accused of supporting death panels need to turn the question around, posing for our accusers as ridiculous a corollary – why do you support the torture of dying patients? I’m not at all convinced that it enhances the dialogue, but maybe it will startle us into realizing that the real purpose of this discussion is not about who’s got the more worthy cause, but who’s willing to listen to the dying patient.

Link: The Cost of Dying, 60 Minutes, CBS News, November 22, 2009

Labels: ,

End of Life Care in the News

The State of Aging and End of Life
KMBZ Radio
November 21, 2009

53 minutes 51 seconds

The task of making our medical wishes known during a serious illness or at the end of life is much more complicated now that it’s part of a political debate. John Carney, Vice President of Aging and End of Life at the Center for Practical Bioethics, explains in this edition of Health Talk on KMBZ Radio, Kansas City.

The Cost of Dying
60 Minutes
CBS News
November 22, 2009

Last year, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients' lives. And it has been estimated that 20 to 30 percent of these medical expenditures may have had no meaningful impact.

You might think this would be an obvious thing for Congress and the president to address as they try to reform health care. But what used to be a bipartisan issue has become a politically explosive one.

Labels: , , ,

Friday, November 20, 2009

What's MORAL about mammogram policy?

Rosemary Flanigan
November 20, 2009

There’s value and worth under discussion here—and that value and worth are justified by a utilitarian calculus: balancing harms over benefits. But there is no objective “harm” or “benefit” in utilitarianism. When it comes to mammograms, women in their 40’s might well determine “worth” and “value” differently.

To increase our awareness of how much of our lives are shot through with moral considerations—and how much we should be open to questioning the justification for those judgments or policies or habits that stream along with us—is a hallmark of ethical reflection.

I think of the bundles of institutional “habits” or policies that make up a healthcare organization. We assume that 98% of them can be justified—and we’d never get any work done if we were reviewing them all the time.

But that “ethical component” is integral to the “character” of the entire institution.

Labels: , , ,

Wednesday, November 18, 2009

The Cultural Politics of Disease

Keith Wailoo is the Director of the Center for Race and Ethnicity at Rutgers University and author of acclaimed books examining the cultural politics of disease in America.

In this edition of The Bioethics Channel, Dr. Wailoo explains the different cultural and clinical responses to diseases like Tay-Sachs and sickle cell anemia.

Link: Podcast, The Cultural Politics of Disease, 10 minutes 24 seconds


Tuesday, November 17, 2009

Give Me ObamaCare and Give Me Your So-Called "Death Panels." It's Surely Better Than What We Have Now.

A debate between Dr. Summer Johnson, dubbed a "progressive bioethicist" by the conservative Mercatornet, and Nancy Valko, RN of Missouri Nurses for Life, summarizes why the health care reform problem has been so difficult to resolve.

To read Dr. Johnson's post, click here.


Thursday, November 12, 2009

Raising Problems Before Offering Solutions

Rosemary Flanigan
November 12, 2009

At the risk of being thought insane—or hopelessly naïve—I propose to you the following scenario: What if, PRE-healthcare reform activities in Congress, there had been a “softening up” series of discussions across the nation, through all sorts of media, to raise the problems BEFORE we started offering “solutions”?

That is the program I think we could do in Kansas City around the issues involved in pandemic preparedness. Missouri-wide, from a consortium of 4-5 ethics centers, a draft document has been prepared based on four fundamental ethical values: fairness, respect, solidarity, limiting harm.

If we were to get people to think about fairness (allocating healthcare resources fairly with a special concern for the most vulnerable), respect (each person must know that they will always be cared for and will be treated with dignity), in solidarity (each individual must consider the needs of others, not just family and loved ones but also to the community), and limiting harm (acknowledging that healthcare professionals will do as much good as possible while limiting harm resulting from the scarcity of resources), then we might have some reasonable discourse.

I know no better way to encourage such thinking than with small groups of people wrestling with broad moral values. THEN, begin to get specific.

ANY EXPERIENCE with this sort of thing in your part of the world????


End of Life Debate Continues

Even though the House passed health reform legislation specifies counseling wouldn't force patients to limit efforts to keep them alive, and even with the support of the American Medical Association, AARP and others, suspicion has lingered.


Few Americans make end-of-life wishes known, Associated Press, November 11, 2009

End of Life Scare II, podcast, John CarneyVP for Aging and End of LifeCenter for Practical Bioethics, August 28, 2009 13 minutes 45 seconds

The End of Life Scare, podcast, Myra Christopher, President/CEO, Center for Practical Bioethics
August 3, 2009 14 minutes 44 seconds

Labels: ,

Wednesday, November 11, 2009

What should count in rating doctors?

Rosemary Flanigan
November 11, 2009

The Center’s 25th anniversary is being celebrated with lectures by the program staff and last night was Dr. Gary Pettett, a fellow at the Center and a neonatologist at Children’s Mercy, who talked on “Professionalism—What has Trust (not Truth) Got to do With It?”

It was a delightful evening because Gary had us in the audience write down the 3 most valuable traits we wanted to find in our physician. Then he talked about four different kinds of physician-patient relationships and how there is no “one size fits all” but different encounters between the two call forth different relationships between them (paternalistic, interpretive, deliberative, etc.)

Then he asked us for our “most valuable traits” and dutifully recorded them. Following that, he listed what physicians might expect in a quality physician: advising yearly checkups for prostate, mammograms, daily dose of aspirin, cautions against smoking and weight gain, etc.

QUESTION: which set of traits is easier to rate, evaluate? But is this what ought to count?

A friend of mine introduced policy governance to her hospital board (board members are in charge of ends, not means) and she reminded me how often she remembered advice given to her: Don’t choose ends that are easy to rate just because they are easy. Choose proper ends and work over evaluation criteria to try to rate their achievement.

Every professional deserves the experience that Gary offered us last night. Lorell will tell you when you can hear it on one of our podcasts.


Labels: ,

Thursday, November 5, 2009

Medical Professionalism: What's trust -- not truth -- got to do with it?

Gary Pettett, MD
October 30, 2009

The physician patient relationship is changing … as is the concept of medical professionalism. Is it time to redefine what we mean by medical professionalism?

And how will that affect your relationship with your doctor?

Doctor Gary Pettett, a neonatologist and a Fellow at the Center for Practical Bioethics explains in this edition of the Bioethics Channel.

Link: Podcast, 18 minutes 28 seconds

Labels: ,

Tuesday, November 3, 2009

Pallimed: A Hospice & Palliative Medicine Blog: Advance Care Planning Provision Still Alive in Reform

Pallimed: A Hospice & Palliative Medicine Blog: Advance Care Planning Provision Still Alive in Reform

Our friend Dr. Christian Sinclair shares and comments on end of life provisions in House version of healthcare reform.