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Topic: Clinical Ethics
September 4, 2014 | Posted By Luke Gelinas, PhD

There has been a good bit of debate lately in bioethics circles over the concept and proper definition of death.   The disagreement is between those who think that the cessation of brain activity or ‘brain-death’ is sufficient for death, on the one hand, and those who think that brain-dead patients whose circulatory systems continue to function are still alive, on the other.  Consider, for example, the recent tragic case of Jahi McMath.  McMath suffered complications from a surgery to correct sleep apnea which resulted in cardiac arrest and her being placed on a ventilator.  Shortly after physicians at Oakland Children’s Hospital pronounced her brain-dead and so legally dead.  Her family, however, disagreed, and appealed to the courts for Jahi to be maintained via mechanical ventilation and PEG tube.

Although Jahi’s family disagrees with the claim that she is brain-dead (insisting that she is merely ‘brain-damaged’), suppose the Oakland physicians are correct in their diagnosis of brain death.  Nonetheless, even after the pronouncement of brain-death Jahi’s body continued to exhibit the sort of homeodynamic equilibrium—at least for the time being, and with assistance from mechanical ventilation and other life-sustaining interventions—characteristic of living organisms.  It was warm to the touch; her heart continued to pump blood through her veins; and so on.  Indeed the bodies of brain dead patients have in some cases remained functional for weeks and even months, performing such surprising feats as undergoing puberty and even gestating fetuses. This has led certain physicians and philosophers to question whether brain death is really sufficient for death.  Patients who are truly dead, after all, could not be warm to the touch or gestate fetuses.  Could they?  

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

August 11, 2014 | Posted By Wayne Shelton, PhD

In my last blog I asked the question, “What is ethics doing?” where I contrasted the armchair, academic ethics that I knew as a graduate student with the clinical ethics cases in which I am now involved in clinical ethics consultations. I alluded to the famous paper by Stephen Toulmin (1922-2009), “How medicine saved the life of ethics” by providing ethics with many practical value laden problems to address. The very process of becoming involved with applied ethics and ethical problems of practicing physicians in the healthcare system was itself as, or perhaps more, transformational for ethics than it was for medicine. Even though medicine needed a serious study of its value-laden issues, which has evolved into bioethics and clinical ethics, the very activity of doing applied ethics has evolved into a better defined field of inquiry with a clearer purpose. But what about the armchair, academic pursuits of philosophical ethics of old? Is there anything left for it to do? This is the question I will attempt to answer in this blog.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

July 22, 2014 | Posted By Wayne Shelton, PhD

I recall being a PhD candidate in philosophy in the 1970’s, I often pondered the subject matter of my graduate courses in ethics. I would ask myself, what does any of this have to do with ethics? What are we doing?

As our courses went from Kant to Mill to G.E. Moore to the Emotivists and others, I couldn’t help but have a sense of unreality about the content of what I was learning.

How can we use reason to find a basis for knowing right action? What are the ways we can define right action based on a normative moral theory?

What is the meaning of good? Right? And obligation? Can these terms be defined within a theoretical, substantive moral framework or are they just expressions of feelings and emotions without any cognitive content? If they are more than the latter, what do they mean?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

June 26, 2014 | Posted By Michael Brannigan, PhD

Ethics here, ethics there, ethics nearly everywhere. Welcome to the world of hyphenated ethics: business-ethics, medical, environmental, media, sports, advertising, legal, even military-ethics. With ethics commissions, committees, councils, consultants, certificates, etc., ethics is big business. Just about anyone can claim to be an "ethicist," a term I decried years ago.

Who are these "ethicists"? What qualifies to be one? In my field, health care ethics, the stakes are high. Recommendations regarding right, wrong, and in-between can be matters of life and death. While ethicists disclaim moral expertise, their views carry weight in bureaucratic institutions. We expect them to be competent in the demanding task of moral analysis, with in-depth experience and interpersonal skills.

But are they?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

June 19, 2014 | Posted By Zubin Master, PhD

By sharing a recent experience in which I delivered a lecture and case at a responsible conduct of research (RCR) workshop for biomedical science trainees, I will comment on why I believe that pedagogy on the RCR, specifically for biomedical scientists, needs two essential ingredients: delivering knowledge/information and providing case-based learning. The art is to determine how much of each element is needed and how to most effectively deliver information on an RCR topic and ensure trainees get the most from the ethical analysis of cases.

Ethics Workshop: Responsible Research Conduct & Misconduct in Stem Cell Research

As part of Canada’s Stem Cell Network at http://www.stemcellnetwork.ca, I had the unique opportunity to organize and present an Ethics Workshop as part of the Network’s annual Till & McCulloch Meetings in October 2013. The workshop was a lecture followed by an interactive ethical case using “The Lab: Avoiding Research Misconduct” video hosted by the Office of Research Integrity (ORI) athttps://ori.hhs.gov/thelab. The 50 to 60 workshop attendees were primarily master’s, doctoral, and post-doctoral trainees, and almost all were biomedical researchers working with stem cells. Most attendees had never heard of RCR. Thus, the goals of the workshop were modest and involved introducing attendees to the following: RCR, research misconduct (fabrication, falsification, and plagiarism), the RCR link to scientific retractions, issues of authorship and publication ethics, and Canada’s RCR framework.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

June 12, 2014 | Posted By Wayne Shelton, PhD

For over a decade the faculty of the Alden March Bioethics Institute has been designing and developing simulated cases for our graduate students who wish to learn the core skills of clinical ethics consultation. The model that we use is called “mock consultations”, which provides students the opportunity to perform an ethics consultation on a simulated case from the beginning when the request is made, to data collection, interviewing key players in the case, and on to case analysis the final recommendation.

In the process of developing simulated cases we have made every effort to make them as real to life as possible. All of the cases we use are from ethics consultation cases that have been deidentified and made into anonymous teaching cases. We have benefitted immensely from working closely with Albany Medical College’s (AMC) Patient Safety Clinical Competence Center (PSCCC). Those involved in medical education will recognize the importance of simulated cases using standardized patients (SP) and the role they play in training new doctors to communicate effectively with patients and families.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website. 

May 29, 2014 | Posted By Marleen Eijkholt, PhD

Imagine you or your partner want to take your placenta home after birth. You feel that the placenta is part of your (partner’s) body and you should be allowed to take it home.  Maybe to eat it: ‘I ate my wife's placenta raw in a smoothie and cooked in a taco’ (Guardian 30 April 2014) or to bury it for cultural reasons, as protection of the soul and the newborn (LA times 31 December 2013). In Oregon you are legally allowed to take it home. In some hospitals elsewhere, you are not. Imagine that due to circumstances, you end up in a hospital that prohibits you from obtaining the placenta. What’s next?

Requests to take placentas home after birth are increasing. Human placentophagy is on the rise. Kim Kardashian spoke about it in her soap series not too long ago.  Newspapers are full of stories about placentas, their use and ability, and significant amounts of websites discuss the pros and cons of bringing placentas home. Different sources report on the alleged benefits of eating your placenta and other reasons to take it home. The public exposure to this ‘appetite’, its context and the rise in requests, raise concerns about prohibitive practices. Prohibitive policies are likely to come under increased scrutiny. My question in this context: What about eating placentas, what about policies prohibiting this?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

April 29, 2014 | Posted By Marleen Eijkholt, PhD

Earlier this month, the New York Times (NYT) reported on individuals in a minimally conscious state (MCS). Although the article headed: ‘PET Scans offer clues on Vegetative States’, its contents addressed the technologies around MCS: a ‘newly’ diagnosed state of consciousness. The paper commented that PET scans would be more beneficial than functional Magnetic Resonance Imaging (functional M.R.I.) in diagnosing this state. Around the same time, the NYT published a paper that headed: ‘Cost of treatment may influence doctors’. This paper quoted a doc saying: “There should be forces in society who should be concerned about the budget, about how many M.R.I.s we do, but they shouldn’t be functioning simultaneously as doctors,”

In this blog post I want to focus on the cost and price of consciousness. I do not only want to focus on the economic costs, but also on costs in a more holistic sense, including the psychological and emotional costs. In the end, I want to ask you: how much is consciousness worth to you?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.bvg

March 3, 2014 | Posted By Marleen Eijkholt, PhD

If someone asked me: What is my philosophy of clinical ethics? I would initially be dumbstruck for an answer. In response, I would probably try to define an answer from my background in bioethics and philosophy. I would pick frameworks in philosophy that represent my approach. For example, I would be inclined to refer to pragmatism and casuistry, as frameworks that determine my clinical ethics approach. My last blogpost about Marlise Munoz, the brain dead woman in Texas is a good example of this. My philosophy as a clinical ethicist is based on the facts of the case, a subsequent calculation of rights and wrongs. The outcome of this sum guides my ethics advice about what is practically possible, conform short-handed pragmatism. In responding to a case, I start with the specifics of a case and formulate answers that may be acceptable by multiple stakeholders, instead of relying on general theoretical outcomes, as a short-handed casuist. Finally, I reason along the lines of several relevant principles, such as autonomy, beneficence, non-maleficence, justice and dignity, and seek to apply these principles to the specifics of a case.

However, given that the background of clinical ethicists lies over a broad spectrum, I doubt that this answer would be satisfactory.  If I hadn’t had a background in bioethics, what would I have answered to this question? Does the fact that I am an ethicist in the clinic mean that I have to frame my answers along philosophical and ethical theories? Would a social worker, an accountant or an attorney equally have a philosophy in their work? Asking myself this latter question, I think that those professions do have a professional philosophy, but that they would be less likely to phrase it in philosophical language. Instead, probably they would describe their philosophy in more layman’s terms and would narrate about their approach in the different cases they see. So how do I approach my cases as a clinical ethicist?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

February 20, 2014 | Posted By Wayne Shelton, PhD

Over the past few decades, clinical ethics consultations have become an important component in providing quality care in cases where there are value conflicts that must be resolved before viable goals of healthcare can be accomplished. With the development of this service and its acceptance as a necessary part of patient care, questions arise as to how and when will clinical ethics consultation be recognized as a specialized professional service comparable to medicine, nursing, social work and pastoral care? For physicians, nurses, social workers, and chaplains there are well-established pathways for practitioners to take in each of these areas in order to be recognized as fully qualified professionals. There is no such pathway to date for those individuals who provide clinical ethics consultations. For those of us who have been involved in this area it is interesting to reflect upon the vast improvements made in providing clinical ethics consultations and whether the field is ready for professionalization.

I recall my early years of training in medical ethics as a graduate student in philosophy at the University of Tennessee. As part of the requirements for the PhD in philosophy with a concentration in medical ethics, students had to spend 3 months at the Health Science Center in Memphis where we participated in intensive internship in medical ethics. At that time I was fortunate to have one of the early pioneers in medical ethics as a mentor, Professor David Thomasma, who was beginning to do clinical ethics consultations. During the 1970’s philosophers and others in fields pertaining to ethics were being invited to enter the medical setting to help physicians and nurses grapple with some of the ethical dilemmas that were becoming more evident with the increasing use of dialysis machines and mechanical life supports. There seemed to be an assumption, perhaps naïve in retrospect, that philosophers like professor Thomasma and others had some special understanding of ethical issues that would shed light on the emerging medical ethical dilemmas and therefore would be in a position to give helpful advice.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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