Thursday, June 30, 2011

Media Coverage IOM Report

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
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.


Wednesday, June 29, 2011

What's Next? The IOM Report on Pain

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.

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


Tuesday, June 28, 2011

IOM Report on Pain this Wednesday

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
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.


Friday, June 24, 2011

Working with a Chronic Disease

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.


Thursday, June 23, 2011

Caring for Those in a Vegetative State

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.


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


Monday, June 20, 2011

Save the Date! Flanigan Lecture July 26

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.

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Friday, June 17, 2011

Captain America: The Next Great Research Ethics Movie?

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.


Wednesday, June 15, 2011

NEW! Bioethics Forum Archive Online

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.


Friday, June 10, 2011

Encountering "socialized medicine" enroute to Africa

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.


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.


Thursday, June 9, 2011

The State of Global Bioethics

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


Tuesday, June 7, 2011

Science of Compassion Conference Aug 10-12

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


End of Life Discussion - Check

I know there are a lot of good reasons for this law, but I can’t help but sympathize with the docs on this one.

During my years with the Metropolitan Medical Society in Kansas City I saw law after law passed, combined with regulation after regulation from health plans and multiple measures to protect doctors from medical malpractice. Eventually, we’ve achieved what we have now in far too many cases – a doctor simply going down a checklist, making sure he or she has complied with said laws, regulations and lawsuit avoidance.

In my mind the question is this – do we want end of life discussions reduced to an item on a checklist?

Eager to hear your thoughts.

Link: Law on End-of-Life Care Rankles Doctors, Jane E. Brody, New York Times, June 6, 2011


Monday, June 6, 2011

Take Two - A Statue for "Dr. Death?"

A range of responses, as expected, around question of whether or not we should erect a statue to Dr. Jack Kevorkian. That and more media coverage can be found on links below.

I doubt he would want a statue. His legacy, at best, may lie in the gratitude of the survivors of the 130 patients he assisted and the boost to palliative care as a better alternative to fear of suffering at the end.

-- Annette Prince

He too easily avoided the deeper philosophical question, "Who is my suffering neighbor and what is my responsibility to him/her?" in my thinking. Living with pain must be a hideous experience but there must be something besides killing the patient to deal with it. I'll pray for him--but I'll not be sending in money for a statue!!!

-- Rosemary Flanigan

Dr. Kevorkian was an unjustly maligned and punished man who performed a great humanitarian service.

-- D.J. Moss

Dr. Kevorkian’s Victims, Ross Douthat, New York Times, June 5, 2011

‘Dr. Death’ Jack Kevorkian dies at age 83, Sindya N. Bhanoo, Washington Post, June 5, 2011


Friday, June 3, 2011

A Statue Honoring Dr. Death?

A few years back I hosted a radio program with Myra Christopher on end of life issues and the subject of Dr. Jack Kevorkian came up. A caller to the program, obviously an older gentleman, said firmly, "We should erect a statue of Dr. Kevorkian in front of every hospital in the country."

Certainly, Dr. Kevorkian had his supporters and detractors. And it can be said that he had an impact on the public debate around physician assisted suicide and the end of life.

What do you think? What is the legacy of Dr. Jack Kevorkian?

Link: Jack Kevorkian, crusader for right to assisted suicide, dies aged 83 at Michigan hospital, Associated Press, June 3


Thursday, June 2, 2011

May's Top 10 Bioethics Channel

Top 10 podcasts by number of downloads for the month of May 2011.


The Ethics of First Person Consent, Terry Rosell and Rob Linderer

Honor and Respect in Healthcare, Rabbi Richard Address

Assessing Social Issues of Research, Summer McGee

The End of Life Scare, Myra Christopher

Matching Physicians with Patients in Need, Jill Watson, Metropolitan Medical Society of Greater Kansas City and Dr. Tyler Brundige

Terri Schiavo Lives On, John Carney

Religion and Medicine: Compatible?, Drs. Farr Curlin and John Lantos

Healthcare Reform: Deja Vu All Over Again?, John Lantos, MD

Ashley X Revisited, Drs. Norman Fost and John Lantos

Celebrating with Frontliners, Karren King Crouch, Helen Emmott, Jane Rues and Dianne Shumaker


Wednesday, June 1, 2011

Ethics of Refusing Informed Consent II

This is a followup to a blog post from last week.


In this case, there were a variety of compelling reasons to over-ride the patient's refusal of care. First, this was a very serious, irrevocable decision. It was life-or-death, decide now, no takebacks. You can always withdraw care later, but you can't re-animate the dead if you change your mind. And, um, you can't change your mind if you're dead. The context argued for full treatment.

For more click here.