Monday, October 31, 2011

Avoiding Unwanted Hospitalizations

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.


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


Friday, October 28, 2011

National Strategy for Chronic Pain

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."


Thursday, October 27, 2011

Knotty Question Part 2

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.


--Tarris Rosell, Rosemary Flanigan Chair

Wednesday, October 26, 2011

A Knotty Question re Private Information

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.

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

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.


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

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


Monday, October 24, 2011

Pain and Public Health

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.


Thursday, October 20, 2011

Continuing Education Credits Available

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.


Wednesday, October 19, 2011

States try more aggressive Rx opioid controls

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.


**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


Tuesday, October 18, 2011

The Coalition to Transform Advanced Care

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

Here’s link to news release.


Monday, October 17, 2011

Ethically Dubious: Prisoners and Organ Donations

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


Friday, October 14, 2011

The PSA Debate: Competing Interests

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?



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


Wednesday, October 12, 2011

The Perfect Storm: Disaster Ethics Symposium and Public Forum

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.


Friday, October 7, 2011

Ethics of Selling Eggs for Stem Cell Research

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


Wednesday, October 5, 2011

Advance Directives and End of Life Costs

Meryl Lin McKean
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


Tuesday, October 4, 2011

September Top 10: The Bioethics Channel

Monday, October 3, 2011

Integrative Pain Treatment

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.


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