Tag: continuing education

Bioethics Blogs

Fee-for-service: an ethical conflict

Andrew Mitchell suggests that innovative institutional changes are needed to sustain universal healthcare in Canada.

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When Canadian provinces instituted universal healthcare, doctors were reluctant to become salaried employees, so a system of fee-for-service was developed. This payment model creates incentives for physicians to focus on quantity instead of quality of care and turns patients into bits of piecework. Indeed, most of us have experienced the whirlwind consultation with a doctor eager to get to the next patient.

Fees for specialist services are greater than those for family doctors. This encourages physicians-in-training to specialize and reduces the supply of family doctors. On average, doctors in Canada earn over $250,000 annually. Specialists often make twice this amount. Some specialists earn more than a million dollars a year. These kinds of salaries encourage individuals to enter medicine for reasons of high income and status, rather than a true desire to serve those who are sick.

Healthcare services are expensive and so they are rationed by provincial governments that restrict both the numbers of doctors and specialists, and the availability of operating rooms and diagnostic equipment. In this way, governments create an artificial, administered market for healthcare characterized by a scarcity of healthcare providers and high costs. This rationing often results in wait times for treatment, with some patients waiting for more than a year in pain and distress.

Physician associations have bargained with provincial governments and received benefits for doctors that usually would be considered employee benefits. In British Columbia, for example, the benefits include a disability plan and continuing education benefits.

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

Health Law Classes Online J Term 2017

Legal Compliance Essentials for Drug, Device, and Biotech Companies

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January 2-13, 2017
Online
2 J.D. credits
Approved for 15 on-demand standard CLE credits (event code: 227898)
Approved for 15 Regulatory Affairs Certification (RAC) Credits.
The Compliance Certification Board (CCB)® has approved this event for up to 10.8 CCB CEUs. Continuing Education Units are awarded based on individual attendance records. Granting of prior approval in no way constitutes endorsement by CCB of this program content or of the program sponsor

Faculty

Dr. Seth Whitelaw, J.D., Founder, Whitelaw Compliance Group, LLCSenior Fellow and Adjunct Professor, Life Sciences Compliance
Description

ccb-logo

The U.S. health care system is composed of three primary parts: providers, payers, and finally manufacturers (drug, device, and biotech companies). It is a complex, complicated, and challenging system of laws, regulations, cases, guidance and, in some cases, folklore. This course is designed for the current and future attorney or compliance professional supporting drug, device, and biotech companies. Students will gain a practical understanding of the laws, regulations, cases, and guidance they will encounter in daily practice. Also, upon completion, all participants will understand how to design and operate an effective company compliance program.

Textbook

O’Reilly, et. al, Food and Drug Administration, 4th ed. (can be accessed online via Westlaw)
Holland & Knight, Corporate Compliance Answer Book 2017, Practicing Law Institute

From Addiction to Zika: Current Issues in Public Health Law

Jill Krueger, J.D.
January 2-13, 2017
Online
2 J.D. credits
Faculty

Description

This course explores public health law through the lens of current issues in population health.

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

BioethicsTV: The Night Shift Needs More Sleep

by Craig Klugman, Ph.D.

Summer is a slow time for television and especially for the medical drama. One show that has been filling this warm weather slot is The Night Shift, a fairly uninteresting and poorly done drama. Frankly, I only started watching it because of its setting in a fictitious hospital in my former home of San Antonio. However, this week’s episode (Season 3, Episode 5: Get Busy Livin’) raised several ethical issues and resolved them poorly.

First, a patient is in the final stages of cancer. She has accepted her death and even has plans for one final vacation, but she runs into a physician who is not willing to let her go. The patient has agreed to a DNR and is firm in her decision that she’s done enough to fight her disease. She watched her mother die of breast cancer just a few years and does not want that kind of suffering. The physician actually colludes with a pharmaceutical rep who lies about the patient’s recent medical record in order to qualify for an experimental clinical trial. Perhaps this physician was absent on the day that clinical trials were taught in medical school, but in most trials there is no guarantee that the patient will be helped by the new drug. Some trials exist just to determine the side effects or whether there is any help. And what the physician also clearly did not know is that being in a randomized clinical trial does not mean the patient will receive the experimental agent—the patient could end up with placebo (which in some cases is better since placebo has fewer side effects).

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

Enhancing learning and teaching about mental health in higher education by Hanna Kienzler

An interview with Jill Anderson about the Mental Health in Higher Education project

mhhe can be found at www.mhhehub.ning.com and, on twitter, @mhhehub.

The UK-based project Mental Health in Higher Education (mhhe) sets out to increase networking and sharing innovative approaches to learning and teaching about mental health and distress across the disciplines in higher education. An important feature of this project is that it advocates for the involvement of service users and carers in mental health education, teaching and training. I had the great opportunity to interview the coordinator of mhhe, Jill Anderson (department of Educational Research at Lancaster University) about the project and new pedagogical approaches that it has engendered.

HK: What motivated the development, in the UK, of the Mental Health in Higher Education (mhhe) project?

JA: That’s an interesting question. It means thinking back a decade or so. . . . Creation of the project predated my appointment as development worker. There were, I think, two drivers.

First, there was an awareness that if people experiencing mental health difficulties are to receive the services they need, delivered in ways that work for them, then professionals need to work together across the disciplines in health and social care.  That kind of collaboration doesn’t come easy. It has to be learned, through interprofessional education initiatives aimed at beginning practitioners. And – here’s the rationale for the project – if those, in turn, are to be effective then there is a need for educators in a higher education context to learn together too.

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

Guest Post: KILLER ROBOTS AND THE ETHICS OF WAR IN THE 21th CENTURY

Written by Darlei Dall’Agnol[1]

I attended, recently, the course Drones, Robots and the Ethics of Armed Conflict in the 21st Century, at the Department for Continuing Education, Oxford University, which is, by the way, offering a wide range of interesting courses for 2015-6 (https://www.conted.ox.ac.uk/). Philosopher Alexander Leveringhaus, a Research Fellow at the Oxford Institute for Ethics, Law and Armed Conflict, spoke on “What, if anything, is wrong with Killer Robots?” and ex-military Wil Wilson, a former RAF Regiment Officer, who is now working as a consultant in Defence and Intelligence, was announced to talk on “Why should autonomous military machines act ethically?” changed his title, which I will comment on soon. The atmosphere of the course was very friendly and the discussions illuminating. In this post, I will simply reconstruct the main ideas presented by the main speakers and leave my impression in the end on this important issue. 

In his presentation “What, if anything, is wrong with Killer Robots?,” (for those interested, a forthcoming paper), Alexander Leveringhaus started by trying to define a robot as an artificial device, embodied artificial intelligence, that can sense its environment and purposefully act on or in that environment. Despite the fact that this may not be a clear-cut definition, most military robots, for example, The Dragonrunner Robot, The Alpha Dog, The Predator Drone (MQ-1), Taranis, Iron Dome, Sentry Robot etc. fit this definition. He then argued that the main objection against using autonomous weapons in an armed conflict is not that there is an accountability gap between programming and operating these tools and what they will effectively do, but instead the real issue is whether the imposition of such risk can be justified.

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

…So That We Know How to Live

by Craig Klugman, Ph.D.

This Spring Quarter I had the honor of creating and teaching a new course at my university: HLTH 341 Death & Dying. Most readers of this blog in bioethics probably work in the medical school environment. When I taught in a medical school we provided lessons and experiences in giving bad news and hospice. We may have even taught briefly on the diagnostic tools to diagnose death. In one session put on by the Palliative Care program (thanks Sandra), students met with survivors and learned about death from the family perspective and how palliative care informed that experience.

I now teach in an undergraduate (baccalaureate) program. My students are 18 to 24 years of age. Few of them have worked with patients. Few have experienced the death of a loved one. Most are searching for a personal and professional identity—figuring out who they want to be in the world. This is not a professional program where people are trained for specific jobs, but a liberal arts curriculum where we teach people to be independent thinkers and good citizens of the world.

Most undergraduate schools and universities have a course with a similar title. Sometimes the course is taught through Anthropology & Sociology and examines how people around the world hold beliefs and rituals around the end of life. Sometimes it is a Psychology course that examines human responses to death, mourning, and grief. And other times it may be a course in Philosophy or Religious Studies that looks at various belief systems, historic practices, and sacred texts that discuss the good death and what comes next.

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

Strengthening Hospital Ethics Committees

The first hospital ethics committees in the nation were established in the 1970s, and the primary catalyst for their growth was the 1976 Karen Quinlan case. As the case was argued, the judge, who had read an article about ethics committees in the Baylor Law Review, remarked that cases like this belong before ethics committees rather than courts.

In 1992, the Joint Commission – then the Joint Commission for the Accreditation of Healthcare Organizations – mandated that hospitals establish a clinical ethics “mechanism.” For more than two decades, this guidance has allowed hospitals to craft widely varied responses. A facility may or may not have a standing ethics committee. The committee may or may not meet regularly. Its members may or may not have training in thinking through issues ethically.

The three primary functions of ethics committees, as identified by the American Hospital Association in 1986, are to:
• Educate themselves to “do ethics”
• Develop and review hospital policies
• Consult on complex cases arising in the hospital

Center for Practical Bioethics’ Efforts

In 1986, in response to numerous ethics committee members seeking opportunities to learn from each other, the Center for Practical Bioethics, which counseled both sides of the Cruzan case, convened the Kansas City Regional Hospital Ethics Committee Consortium, This is the oldest continuously operating Consortium of its kind in the nation.


In a project entitled “Organizational Ethics: Beyond Compliance,” Center staff traveled to cities across the country to present new standards for patients’ rights and organizational ethics, after collaborating with the Joint Commission in 1993 to promulgate them.

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

Medicare’s Proposed Rule Is Just the First Step

As Jane Jankowski, DPS, LMSW discussed in her last AMBI blog posted on June 16, 2015, the proposed rule to reimburse providers for conversations with patients about advance care planning takes a positive step toward educating patients on end-of-life medical considerations by incentivizing doctors to take the time to address these issues in the clinical setting.  Assuming that such reimbursements depend only on raising the topic of advance care planning with patients and not on the content of a patient’s choices (such as whether or not a patient chooses to forego treatment), encouraging health care providers to discuss health care decision making in advance with patients can go a long way to support patient autonomy and provide helpful guidance to surrogate decision-makers when a patient lacks capacity.  Doctors often cite lack of time as a reason why they do not address advance directives in the clinical setting, but this rule would compensate doctors for their time, allowing them more flexibility in allocating time to address these issues.  However, the proposed rule does nothing to ensure that the providers having these conversations are equipped with the proper tools and training to do so.

Advance directives, although they address the provision of medical treatments, are legal documents that can be complex and far-reaching, and therefore are not necessarily self-explanatory to patients or providers.  Many states offer a statutory form advance directive as an example, but all too often these forms may be merely printed by a provider and given to patients to sign without sufficient explanation.  These forms vary in their scope, but some sample living wills, such as forms from West Virginia and South Carolina, are little more than a declaration that no life-sustaining treatments should be provided.

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

A Step Toward a Cultural Transformation in the Way Pain is Perceived, Judged and Treated

The following blog post is the executive summary of the June 29-30, 2015, PAINS Collaborators Meeting in Washington, DC, held in response to Department of Health and Human Services’ publication of the National Pain Strategy Report. 

BACKGROUND

In anticipation of publication of the National Pain Strategy (NPS) Report, in June 2015 the Pain Action Alliance to Implement a National Strategy (PAINS), a coalition of national leaders and organizations committed to advancing the sixteen recommendations made in the Institutes of Medicine’s report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research, convened a Collaborators Conference in Washington, DC. The purpose of the meeting was to discern opportunities and challenges to implementation of the report, to build enthusiasm for it and promote collaboration among attendees in order to move the NPS Report from a vision to a reality. More than 100 prominent leaders from professional societies, academic institutions, federal agencies, patient advocacy groups, and policy organizations met to review the NPS Report and discuss each of its six sections.

In April 2015, the NPS Report underwent preliminary review by multiple federal agencies and was then posted in the Federal Register for public commentary. In opening remarks, Walter Koroshetz, Director of the National Institute of Neurological Disorders and Stroke (NINDS), told attendees that more than 770 responses were received and the plan is expected to be released in the late summer/early fall. Expectations for it are high. The report’s vision states, “If the objectives of the National Pain Strategy are achieved, the nation would see a decrease in prevalence across the continuum of pain, from acute, to chronic, to high-impact chronic pain, and across the life span from pediatric through geriatric populations, to end of life, which would reduce the burden of pain for individuals, families, and society as a whole.

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

Opportunities for Advancement: Promoting Employee Engagement in Animal Care and Use Programs

By Angela Craig, DVM, lab animal veterinarian and institutional animal care and use committee (IACUC) member at the University of Minnesota

Each of us has a unique path that brought us to our career in laboratory animal care and use. I started my career in laboratory animal medicine twenty years ago as a member of the husbandry staff. I enjoyed the close connection I made with the animals under my care, and I understood that they depended on me for their basic needs. I further realized how the scientific discoveries unfolding were dependent on physically and psychologically healthy animals. When you feel deeply invested in the work you do, it is natural to think about the ways you can improve your knowledge, skills, and experience for the benefit of the animals and the research program. You think about how the work you enjoy might develop into a lifelong career. For me, the connection I felt to the animals in my care led me to become a laboratory animal veterinarian.

Opportunity for advancement is frequently cited as a key factor affecting employee job satisfaction. Advancement may include the development of new skills, greater responsibility, and/or promotion. Within an animal care and use program, there are many options for growth, but staff members are not always aware of how to get on the right track. They also may not realize the various directions they can go with their interests. In addition to careers oriented toward husbandry and veterinary care, there are also the paths of laboratory animal resource management, and animal program administration and compliance.

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.