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Viewing by month: March 2013
March 28, 2013 | Posted By Paul Burcher, MD, PhD

Two articles in the New York Times raise a disturbing question regarding the ethics of cancer treatment in this country.  The first on ovarian cancer treatment noted that despite significantly better survival data with intraperitoneal chemotherapy (IP) over intravenous chemotherapy (IV) for ovarian cancer, most oncologists were still using IV chemotherapy. The reason given is that IP chemotherapy is more difficult to give, and more labor intensive, but is not reimbursed at a higher rate.  That is, physicians are routinely withholding the more effective treatment for economic reasons.  Another recent article describes how oncologists tend to choose more expensive chemotherapy even when it is not more effective because they are paid a percentage of the drug’s cost. 

It is an often-repeated truism that physician behavior will follow economic incentives perfectly—if you wish to reduce physician procedures capitate patient care, if you wish to increase patient procedures, pay physicians on a fee-for-service basis.  While this has been empirically demonstrated, it is a bit hard to accept that this adage remains true even when physicians seems to be crossing the line into unethical behavior in order to follow the almighty dollar.  The IP chemotherapy issue is most troubling because it represents physicians giving care they know to be inferior because the better treatment costs more to deliver, and this reduces their own income.

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.

March 25, 2013 | Posted By Marleen Eijkhjolt, PhD

This blog post solicits for your opinion, so please stick with me. 

There are two prominent sad realities in my clinical ethics fellowship. The first is that many cases deal with end-of-life issues. The second is that there are many ‘lonely’ patients, who often die in the hospital ‘alone’. The two issues combined tend to raise some unfortunate but fascinating clinical PELSI (Policy, Ethics, Legal and Social Issues). One such issue is: Who should make medical decisions at a patient’s end-of-life when this patient lacks capacity and there is no surrogate? 

In the State of New York, we have the Family Health Care Decisions Act (FHCDA) that governs many of these issues, including end-of-life decisions in absence of a surrogate. (I will explain the legislative scheme below) However, this legislation does not solve all problems, as the written word leaves leeway for different interpretations and practices. One of these problems is related to decisions to withhold or withdraw life-sustaining treatment, and can be phrased as: Who should be the second, independent concurring physician in such decisions, in cases where the patient lacks capacity and there is no surrogate?

Let me explain. 

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.

March 21, 2013 | Posted By Zubin Master, PhD

Last month I wrote a blog arguing that bioethicists should pay closer attention to the responsible conduct of bioethics research. Just to recap, the responsible conduct of research (RCR), also known as research integrity, has to a large extent focused on the natural and applied sciences and very little attention has been devoted to interdisciplinary areas of research i.e., bioethics. RCR can be described as a set of norms and practices that aim to ensure integrity in the conduct of research and focus on various aspects including fabrication, falsification and plagiarism, authorship and publication ethics, peer review, good mentoring, data management, and other areas. There has been little research on research integrity done as it relates to bioethics and I pointed to a few studies on authorship and publication ethics that have been published. This month, I would like to raise a question I have been thinking about for some time and an area of research integrity in bioethics I wish to write about in the not too distant future. The question I would like to address is what is conceptual bioethics research? Perhaps a better way to phrase this question might be to ask, what is good conceptual bioethics research or even what might not be considered conceptual bioethics research?

It is really difficult to find anything on the term “conceptual research” and coming from a biomedical science background, I had never heard of this form of research until I transitioned into bioethics. Somewhat equivalent terms are theoretical research, or thought experiments. All research involves the systematic study to develop and increase knowledge. This could mean confirming previous results, challenging theories, and testing the validity of theories, practices or instruments. In a paper co-authored with Dr. David Resnik, we defined research as “a systematic investigation that attempts to advance human knowledge or wisdom. Though research is often associated with scientific inquiry, we do not limit the concept in this way. Research may include scientific studies as well as other scholarly activities, such as philosophical or legal analysis, literature interpretation, theological reflection, historiography, journalism, etc.”

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.

March 18, 2013 | Posted By John Kaplan, PhD

Recently the University of Pennsylvania Health System in Philadelphia announced that it would no longer hire tobacco smokers. This seemed like a smart move for several reasons. There are some pretty obvious benefits for the institution including reductions in employee health care costs, reduced rates of absenteeism due to sick days, fewer employee breaks, and the more minor advantages such as fewer people smelling of smoke. There are similarly benefits to individuals who can be convinced not to smoke by such policies. A longer healthier life spared of the expense and inconvenience of procuring these dangerous and addicting instruments should be reward enough. Thus firms which ban hiring of smokers help advance the cause of providing the twenty some percent of adults who still smoke a reason to quit. Moreover health care organizations seem to be the natural groups to take the lead in instigating this sort of social progress.

This is not a new trend. Turner Broadcasting System banned the hiring of smokers in the 1980s and has maintained this policy since. Similar bans on hiring smokers have been implemented by the Cleveland Clinic, Baylor University’s Hospital and the Geisinger Clinic. It all seems to make so much sense. Nevertheless there has been a reaction. Smokers are not a protected class under federal law. Federal law permits a company to discriminate against smokers. However no less than twenty-nine states , including here in New York State, have laws outlawing bans on the hiring of those who smoke. A list is provided here. This is a testimony to the power of the tobacco lobby.

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.

March 14, 2013 | Posted By Wayne Shelton, PhD

A story last week from Bakersfield, California received an enormous amount of attention and seemed to capture the public’s imagination. The story was in both the print and electronic media as though a great injustice has been unearthed.  People were outraged that no action was taken to provide cardiopulmonary resuscitation (CPR) on an 87 year-old woman who had arrested in an independent living facility where she was a resident. The story was the rage on Facebook and other social media—people weighing in with their concerns, which again was mostly outrage and disbelief that something like this could have happened. Now that we are a week or so out from when this event happened, I thought it might be worth thinking about what happened in this story and see what lessons we can learn.

The story begins when Lorraine Bayless, the 87 year-old resident of Glendale Gardens, a Bakersfield independent living facility, collapsed and someone, presumably an employee, called 911. Apparently the employee called to report this emergency and was expecting the paramedics to respond quickly. The dispatch operator, realizing the importance of a quick response, admonished the caller to begin CPR herself, before the paramedics arrived. The caller, who identified herself as a nurse, told the dispatcher that she was not permitted by the facility to provide CPR for patients. Glendale Gardens is an independent living facility that says by law they are "not licensed to provide medical care to any of its residents." So in the cool light of calm reflection, did something wrong take place?

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.

March 12, 2013 | Posted By Jane Jankowski, LMSW, MS

Thomas Gray first coined the phrase “ignorance is bliss,” in his Ode on a Distant Prospect of Eaton College, but is that truly the case when it comes to the millions of people who are diagnosed with some form of dementia related cognitive impairment? According the a recent article in the Wall Street Journal, early dementia testing may offer many benefits to patients and families who will face long term care needs as the disease progresses.  The article notes that early screening is only one step in a continuum of care and planning. Once a diagnosis is made, do the benefits of knowledge outweigh the burdens for the patient?

When it comes to care planning, the benefits of early detection of a progressive dementia likely do outweigh the burdens, for both patient and family. Depending on the patient’s awareness of the cognitive changes, the individual may be able to indicate wishes for treatment and complete advance directives. Family members can discuss residential options and consider how supervision and support will be provided before they face a crisis. Though many strains may be minimized with early planning, it may be difficult to interpret the patient’s genuine preferences at later stages, and just how much weight should later wishes be given? 

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.

March 7, 2013 | Posted By Lisa Campo-Engelstein, PhD

One of the reasons pharmaceutical companies give for not pursuing male contraceptive research and development is that there is no market for it. However, recent empirical studies have shown that men are concerned about pregnancy prevention and are interested in using male contraceptives. For example, a survey of 9,000 men in 9 nine countries in 2005 revealed that 55% of men were willing to use male hormonal contraceptives, while only 21% were unwilling. Another study showed one third of men would use male contraception as their main form of contraception. Further evidence that there is indeed a market for male contraceptives is the fact that men are already responsible for contraception, as approximately 27% of heterosexual couples in western nations use a male-dependent form of contraception (condoms or vasectomy).

Despite this empirical evidence, however, there remains a strong cultural belief that men won’t use contraception because they don’t value the end of preventing pregnancy as much as women do. This cultural trope is usually presented as fact without much or any empirical backing in the lay literature and even in the academic literature. One explanation for this phenomenon is that reproductive prowess is an important component of masculinity. It’s true that fatherhood, especially biological fatherhood, is important to many men. However, the desire to be a father should not be conflated with a lack of reproductive responsibility or with the biological determinism to “spread one’s seed” and have as many children as possible mentality. 

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.

March 4, 2013 | Posted By Bruce D. White, DO, JD

Consider the following recent news articles. In one sentence, the alleged facts are that a hospital supervisor reassigned a 25-year-veteran neonatal intensive care unit nurse to “[honor] a father's request to not let black nurses treat his infant son.”

Patients and patients’ legally authorized representatives have rights in the provider-patient relationship. A number of states have codified some of these rights in statutes and regulations in ways that look like a “patient’s bill of rights.” Typical within these declarations are statements that give patients many broad choices with respect to care. Some may see this is an extension of a patient’s autonomous choices in healthcare delivery generally.

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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