Tag: delivery of health care

Bioethics News

Leading bioethics editors attack conscientious objection

The debate over conscientious objection is continuing, with the editors of two major bioethics journals calling for strict limits on “objection at the bedside”.

In a paper released in Bioethics this week, Julian Savulescu, the editor of the Journal of Medical Ethics, and Udo Schuklenk, the co-editor of Bioethics, argue that doctors have “no right to refuse access to assistance in dying, contraception or abortion”. 

Savulescu and Schuklenk believe that disagreements about the provision of healthcare should be carried out in policy forums, and not in a clinical context.

“Individual values ought not to govern delivery of health care at the bedside. Doctors can campaign for policy or legal reform. They can also provide advice with reasons, based on their values. But they have no claim to special moral status that would permit them to deny patients medical care that these patients are entitled to.”

Savulescu and Schuklenk respond at length to a paper published by Christopher Cowley of University College Dublin defending conscientious objection in healthcare.

The authors extol the virtues of restrictions on conscientious objection in Scandinavian countries. A test case of new conscientious objection laws in Norway is currently underway, involving a Polish GP working in the country who refused to provide abortifacients to patients. 

This article is published by Xavier Symons and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation.

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

How Telemedicine Is Transforming Health Care

June 28, 2016

(The Wall Street Journal) – After years of big promises, telemedicine is finally living up to its potential. Driven by faster internet connections, ubiquitous smartphones and changing insurance standards, more health providers are turning to electronic communications to do their jobs—and it’s upending the delivery of health care. Doctors are linking up with patients by phone, email and webcam. They’re also consulting with each other electronically—sometimes to make split-second decisions on heart attacks and strokes. Patients, meanwhile, are using new devices to relay their blood pressure, heart rate and other vital signs to their doctors so they can manage chronic conditions at home.

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

Stinging Doctors: Recording Your Own Surgery

by Craig Klugman, Ph.D.

Ethel Easter expressed outraged this week at what her health care team said about her during her surgery in Texas last year. She claims that before her operation she was flagged as a difficult patient and instead of talking to her doctors at that time, she hid a recording device in her hair. Listening to the recording after her operation, she heard the medical staff discussing her as a “handful” and making other disparaging comments.

This case comes after “D.B.” in 2013 accidentally left his cell phone in record mode during a procedure. The insulting comments made while he was sedated led to a $500,000 payment for medical malpractice and defamation.

While pundits and social media expressed outrage at what the medical staff said during these patients’ surgeries, where is the outrage over a patient running a sting operation on her health care providers? DB’s recording was an oversight: He forgot to turn off the machine while recording his post-operative instructions. But Easter purposely hid a device for recording. This is a form of lying by omission because she did not inform anyone, and a violation of the sanctity of the patient-provider relationship. Trust is the cornerstone of this relationship, which was violated by her clandestine activity. What trust is possible if patients are going to be secretly recording? Besides the ethical issues this raises, there are legal ones as well: In eleven states it is illegal to record a conversation unless both parties are aware and have given consent.

As a bioethicist and clinical ethicist for 15 years, I have heard my share of “gallows humor” about patients.

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

Research ethics during medical disruption

A couple years ago, I experienced first-hand the effects of political turmoil on research. My university was conducting epidemiological research involving sex workers in Antananarivo, Madagascar. Special clinics were being piloted for this stigmatized, hard-to-reach and vulnerable population. Then the political crisis of 2009 hit. Everything ground to a halt, including much of the activity in the hospitals where the research was taking place. The sudden upheaval in the routines of everyday life caused much confusion and disarray: what now?

A new publication in the Journal of Medical Ethics by House et. al. is therefore very welcome, because it covers some neglected ground. In the rare case that bioethicists discuss ethical challenges within politically unstable contexts, they tend to concentrate on the reliable delivery of health care. Instead, this article focuses on the conduct of health research when social life gets gnarly, and more specifically when medical services are disrupted, based on the authors’ experiences in Kenya. The authors make a useful three-way distinction between the ethics of not starting research, stopping it once it has started, and keeping on going in the face of communal strife.

The authors argue that the ethics of not starting research, and continuing it once it has started, are different. If the political upheaval is so disruptive that ethical standards of research cannot be upheld, research should wait. But an ongoing study may involve serious commitments and expectations, a relationship of trust between researchers and communities, and research participants may benefit from research-related interventions. Stopping an ongoing study requires deliberation with the local community and a careful collaborative weighing of options and trade-offs.

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

Equality and the Clinical Trial Dating Agency

The first advert for the sale of a clinical trial place offers, for $2 million, the chance to participate as a patient in a trial investigating the Farmington virus (FARV) and its potential efficacy in treating certain forms of brain tumours. Meanwhile, Alexander Masters has written convincingly about his idea for a clinical trial dating agency: matching wealthy but sick donors with scientists who have an idea for a cure but no money for a trial (shorter version also available). In Masters’ idea as in the real life case, the proposal is that the wealthy donor will pay not just for himself or herself, but enough for the trial to go ahead with a full complement of those who could not otherwise afford it, recruited on the same basis as any trial.

Predictably, ethical concerns have been raised, perhaps the main one being equality: “In the UK, the principles in participating in clinical trials include open and equal access for those who chose to participate” (Kate Law, director of clinical and population research at Cancer Research UK, quoted in The Telegraph ).

Yet there are many more clinical trial ideas with potential to become effective treatments, and many more patients desperate for a Hail Mary pass, than there are funds to cover their costs. The alternative to this method of funding is not a clinical trial funded by the government, or by pharmaceutical companies, or by charities, but no clinical trial at all. Diseases that are rare are particularly vulnerable.

Moreover, the wealthy have always been able to access newer and better forms of healthcare than others.

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

Responding to Ebola: Selected Commentaries on Key Ethical Questions

The Ebola outbreak in West Africa is the largest and deadliest on record, and the crisis is evolving rapidly. More than 2,200 people have been infected in Sierra Leone, Liberia, Guinea, and Nigeria, and more than half have died. The response to the epidemic has raised ethical questions about the fair allocation of scarce resources, the appropriate use of unproven medicines, obligations to health care workers who volunteer for dangerous assignments, and international obligations to invest in adequate public health infrastructures.

Two excellent commentaries this week by Hastings Center Fellows explore these questions, analyze structural problems that are contributing to the present crisis, and offer recommendations for public health planning.

Nancy Kass, writing in Annals of Internal Medicine, addresses three questions: Was it ethical to airlift two infected American health care workers to the United States for treatment? Was it ethical to give them a “highly experimental” drug? And if it was ethical to give them this treatment, should Africans infected with Ebola receive it too?

Kass argues that the airlift was ethical. While mindful of the duty not to abandon patients, she points out that few health care workers would ever volunteer to care for Ebola patients in West Africa, and “traveling to help patients with an illness both highly contagious and usually fatal is what ethics calls “supererogatory”–above and beyond usual norms of good ethical conduct.” (In a recent interview Joanne Liu, president of Doctors Without Borders, said that recruiting health care workers for West Africa is more difficult than for war zones.)

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.