Tag: breast cancer

Bioethics Blogs

BioethicsTV: Aggressive Treatment Chosen for Patients at the End of Life

by Craig Klugman, Ph.D.

This week’s Thursday night medical TV was all about end of life decision-making and delved into the questions of how much aggressive treatment is too much, what happens when physicians lose clinical distance, and who makes decisions for patients.

On Chicago Med (Season 2, Episode 18), a patient with Alzheimer’s is admitted to the ED with a fever and chills. She has pneumonia and has for several days, only being sent to the hospital that day by her long-term care facility. The patient is Dr. Bella Rowen, Halstead’s former mentor and administrator Goodwin’s former colleague (from her nursing days). As the patient is brought in, a nurse says “No advance directive, no family, and the surrogate just passed away, so it’s going to be our call.” Halstead is emotionally invested in his mentor and takes over decision-making for her care. She is frail and does not remember him. When Rowen codes, Halstead pushes CPR even though, as his colleagues tell him, he will break all of her ribs and only cause suffering. He resuscitates and intubates her. We are told that she will never get off the vent. When her kidneys fail, he orders dialysis. Goodwin talks to him and says that such measures will lead Rowen to live the rest of her days on machines, bedridden with sores, and open to infections. Goodwin tells Halstead that the woman he knew was gone and forcing this patient to live would not bring his mentor back.

One of the major ethical issues raised in this case is whether, in fact, Halstead should have been making decisions for the patient.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Breast Intentions Are Fraught With Disappointment

Breast cancer is one of the leading causes of cancer death among American women, second only to lung cancer. Nearly 250,000 new cases are detected each year in the United States, and over 40,000 women die annually from the disease. Breast cancer is a public health crisis, and one that deserves a strong, concerted and well-reasoned response. The problem, however, is that current public health messages about breast cancer screening and treatment are disjointed at best and dangerous at worst.

— Delivered by Feed43 service

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Reports Of Medical Breakthroughs Often Don’t Prove Out

When you pick up a newspaper and read a story about the latest results on breast cancer, autism, depression or other ailments, what are the odds that finding will stand the test of time? The answer, according to a study in the journal PLOS One is: flip a coin

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Law Ignored, Patients at Risk

February 17, 2017

(STAT News) – Stanford University, Memorial Sloan Kettering Cancer Center, and other prestigious medical research institutions have flagrantly violated a federal law requiring public reporting of study results, depriving patients and doctors of complete data to gauge the safety and benefits of treatments, a STAT investigation has found. The violations have left gaping holes in a federal database used by millions of patients, their relatives, and medical professionals, often to compare the effectiveness and side effects of treatments for deadly diseases such as advanced breast cancer.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Dozens Of New Cancer Drugs Do Little To Improve Survival, Frustrating Patients

Marlene McCarthy’s breast cancer has grown relentlessly over the past seven years, spreading painfully through her bones and making it impossible to walk without a cane. Although the 73-year-old knows there’s no cure for her disease, she wants researchers to do better

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Many High-Risk Patients with Breast Cancer Aren’t Getting Genetic Testing. Here’s Why.

February 7, 2017

(The Washington Post) – Doctors often fail to recommend genetic testing for breast-cancer patients, even those who are at high risk for mutations linked to ovarian and other cancers, according to a study published Tuesday. Researchers said the findings, which appear online in the Journal of the American Medical Association, are troubling because genetic tests can help guide women’s choice of treatments for existing disease, as well as point to ways to reduce the risk of future cancer. Women who have a dangerous mutation might choose to have more stringent screening or opt to have surgery before a cancer develops, they said.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals – January 2017 by Anna Zogas

Welcome to a new year of Somatosphere’s In the Journals section! Here are some of the articles available in January 2017. Enjoy!

Medical Anthropology

Chronic Subjunctivity, or, How Physicians Use Diabetes and Insomnia to Manage Futures in the United States
Matthew Wolf-Meyer & Celina Callahan-Kapoor

Prognostication has become central to medical practice, offering clinicians and patients views of particular futures enabled by biomedical expertise and technologies. Drawing on research on diabetes care and sleep medicine in the United States, in this article we suggest that subjectivity is increasingly modeled on medical understandings of chronic illness. These chronic conceptions of the self and society instill in individuals an anxiety about future health outcomes that, in turn, motivate practices oriented at self-care to avoid negative health outcomes and particular medical futures. At its most extreme, these anxieties of self-care trouble conceptions of self and social belonging, particularly in the future tense, leading patients and clinicians to consider intergenerational and public health based on the threats that individual patients pose for others.

Decoding the Type 2 Diabetes Epidemic in Rural India (open access)
Matthew Little, Sally Humphries, Kirit Patel & Cate Dewey

Type 2 diabetes mellitus is an escalating public health problem in India, associated with genetic susceptibility, dietary shift, and rapid lifestyle changes. Historically a disease of the urban elite, quantitative studies have recently confirmed rising prevalence rates among marginalized populations in rural India. To analyze the role of cultural and sociopolitical factors in diabetes onset and management, we employed in-depth interviews and focus groups within a rural community of Tamil Nadu.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Special Issue! Between Biopolitical Governance and Care: Rethinking Health, Self, and Social Welfare in East Asia by Anna Zogas

The first issue of Medical Anthropology in 2017 is a special issue, “Between Biopolitical Governance and Care: Rethinking Health, Self, and Social Welfare in East Asia.” Enjoy!

Between Biopolitical Governance and Care: Rethinking Health, Selfhood, and Social Welfare in East Asia (open access)
Amy Borovoy & Li Zhang

(There is a video abstract, too.)

In East Asia, health has historically been entwined with notions of morality and broader social ideals. But can the state and other institutions legitimate their involvement in everyday life habits that contribute to poor health outcomes? For example, food consumption, smoking, or cancer—issues that can be conceived as a matter of
‘individual choice’ and personal responsibility. In this issue, we explore the fine lines between exercises of social power that are repressive and controlling, and those that are productive, caring, or supportive. We examine intersections of individual desires and self-work with statism and the public good—for instance, drug addiction care and the use of psychological counseling in China, understanding cancer and stress in South Korea, and the containment of harmful behavior in Japan.

The Rise of Therapeutic Governing in Postsocialist China
Li Zhang

In this article, I explore how and why psychological intervention, often in the name of guanai (care), has gradually become a critical tool of managing the population and governing society in postsocialist China. Psychological counselors and experts are becoming a new form of authority, an indispensable part of creating and managing knowable, stable, and governable subjects for the military, the police, schools, and enterprises. ‘Therapeutic governing’ refers to the adoption of the therapeutic ethos, techniques, and care to improve the management of the work force and to help individuals cope with life in a rapidly changing society.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Chronic Pain and the Opioid Epidemic: Wicked Issues Have No Simple Solutions

Written By Myra Christopher
My mom was a steel magnolia (i.e., southern and perfectly charming), but she had a steel rod up her back. After her first surgery for stomach cancer at age 53, she refused pain medication because she said that she “could take it.” She was young and strong and committed to “beating cancer.” After nearly two years of chemotherapy, radiation and two more surgeries, the cancer won. Eventually, I watched her beg nurses to give her “a shot” minutes before another was scheduled and be told they were sorry but she would have to wait. I could tell by the expressions on their faces they truly were sorry.

Calls of Desperation

When the Center for Practical Bioethics began more than 30 years ago, I frequently had calls and letters from other family members telling me that an elderly loved one was dying in terrible pain and that the care team refused to give pain medication more often than scheduled or to increase the dose because they were told their loved one might become addicted and/or because a higher dose of morphine might affect the patient’s respiration and hasten death.
·      ICU nurses regularly reported calling physicians and pleading for orders to increase pain medication only to be told, “Absolutely no and do not call again!”
·      Physicians told me about patients who refused medication and suffered unnecessarily because they believed their pain was punishment from God and that their pain was “redemptive.”
·      A case I will never forget involved a father who coaxed his son dying of bone cancer to “be a man” and refuse the pain meds his doctor had prescribed.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.