Tag: doctors

Bioethics Blogs

Legal Briefing: New Penalties for Ignoring Advance Directives and Do-Not-Resuscitate Orders

I now have nearly thirty “Legal Briefing” articles in the Journal of Clinical Ethics.  The latest one is “New Penalties for Ignoring Advance Directives and Do-Not-Resuscitate Orders.”  Here is the abstract:


Patients in the United States have been subject to an ever-growing “avalanche” of unwanted medical treatment. This is economically, ethically, and legally wrong. As one advocacy campaign puts it: “Patients should receive the medical treatments they want. Nothing less. Nothing more.” First, unwanted medical treatment constitutes waste (and often fraud or abuse) of scarce healthcare resources. Second, it is a serious violation of patients’ autonomy and self-determination. Third, but for a few rare exceptions, administering unwanted medical treatment contravenes settled legal rules and principles. 


This “Legal Briefing” describes a central and growing role for the law. Specifically, courts and agencies have increasingly imposed penalties on healthcare providers who deliberately or negligently disregard advance directives and DNR (do-not-resuscitate) orders. I group these legal developments into the following five categories:


1.   Five Types of Unwanted Medical Treatment
2.   State and Federal Duties to Follow Advance Directives
3.   Doctors Hospital of Augusta v. Alicea
4.   Other Lawsuits for Ignoring Advance Directives
5.   Administrative Penalties for Ignoring Advance Directives.

Source: bioethics.net, a blog maintained by the editorial staff of The American Journal of Bioethics.

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

Conscientious Objection Accommodation in Healthcare – Clashing Perspectives

by Brian D. Earp / (@briandavidearp)

On behalf of the Journal of Medical Ethics, I would like to draw your attention to the current issue, now available online, which is almost entirely dedicated to the vexing question of conscientious objection in healthcare. When, if ever, should a healthcare provider’s personal conviction about the wrongness of some intervention (be it abortion, euthanasia, or whatever) be accommodated?

In a paper that has already attracted much attention, Ricardo Smalling and Udo Schuklenk argue that medical professionals have no moral claim to conscientious objection accommodation in liberal democracies.

In part, they base their argument on their judgment that “the typical conscientious objector does not object to unreasonable, controversial professional services—involving torture, for instance—but to the provision of professional services that are both uncontroversially legal and that patients are entitled to receive” (emphasis added).

It seems clear that a lot hinges on what is meant by “unreasonable” there–and on who should get to decide what falls under that label. One answer to this question might be, “society should get to decide, through the enactment of laws, which ideally express the view of the majority of people as to what is reasonable or unreasonable in medical and other contexts.”

“Therefore,” this answer continues, “if a doctor thinks that some legally allowed service X is immoral, then she should rally her fellow citizens to lobby their representatives to change the relevant law; but she should not be excused from providing the service, if by law the patient is entitled to receive it.”

“And if she really doesn’t want to do X,” the answer concludes, “she can always leave the profession and take up some other line of work.”

This is a rough summary of what Smalling and Schuklenk do in fact say.

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

H3Africa: Fostering Collaboration

Caption: Pioneers in building Africa’s genomic research capacity; front, Charlotte Osafo (l) and Yemi Raji; back, David Burke (l) and Tom Glover.
Credit: University of Michigan, Ann Arbor

About a year ago, Tom Glover began sifting through a stack of applications from prospective students hoping to be admitted into the Master’s Degree Program in Human Genetics at the University of Michigan, Ann Arbor. Glover, the program’s director, got about halfway through the stack when he noticed applications from two physicians in West Africa: Charlotte Osafo from Ghana, and Yemi Raji from Nigeria. Both were kidney specialists in their 40s, and neither had formal training in genomics or molecular biology, which are normally requirements for entry into the program.

Glover’s first instinct was to disregard the applications. But he noticed the doctors were affiliated with the Human Heredity and Health in Africa (H3Africa) Initiative, which is co-supported by the Wellcome Trust and the National Institutes of Health Common Fund, and aims in part to build the expertise to carry out genomics research across the continent of Africa. (I am proud to have had a personal hand in the initial steps that led to the founding of H3Africa.) Glover held onto the two applications and, after much internal discussion, Osafo and Raji were admitted to the Master’s Program. But there were important stipulations: they had to arrive early to undergo “boot camp” in genomics and molecular biology and also extend their coursework over an extra term.

Both agreed and were soon put through the paces of performing basic lab techniques, hearing about the latest in DNA sequencing, learning the basics of designing genomic studies, and immersing themselves in their courses.

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

Texas Considers Letting Doctors Lie to Patients

by Craig Klugman, Ph.D.

The Texas Senate just passed a new bill (SB 25) that would shield doctors from a lawsuit if a baby is born with a disability even if the doctor knew of the concern and chose not to tell the parents. Opponents of the bill say that it permits doctors to lie to their patients if the doctor believes that knowledge might lead the woman to choose an abortion. The Houston Chronicle reports the bill’s aim is to “chip away at abortion rights.”

The Texas law does not go as far as a 2015 Arizona law that mandated physicians lie to patients by telling them that an abortion can be reversed. The new Texas bill would “allow” doctors to lie to patients and shield them from lawsuit unless the patient could prove gross negligence. The burden is on the patient to prove that the doctor should not have lied.

One of the first rules of professionalism that I teach in undergraduate and medical school bioethics courses is that in general, you never lie to the patient. Telling the truth is a bedrock concept necessary to respect patient autonomy. In order to make decisions, patients need to have knowledge of their condition and their treatment options (risks, benefits, and alternatives).

There are a few circumstances in which lying to patients is ethically acceptable: If the physician has strong reasons to believe that information would push the patient to do harm to him/herself or others, or if the family has requested that a patient not be told information because of cultural practices and the patient has agreed that she/he does not want to know the news.

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

M[Emory] Enhancement and its Implications

By Shweta Sahu
Imagine a situation in which you suffer from severe anterograde amnesia, a form of short term memory loss, and can’t recall information presented to you even 7 seconds before– let alone being able to remember the one thing you went to Target to buy, but forgot. Such is the case of Clive Wearing, a man known for his lack of short term memory. His wife notes, “you ask him a question and he’ll give you an answer but while he’s giving me the answer, he’s already forgotten the question. That’s how short it is.” He himself notes “the brain has been totally inactive—day and night the same—no thoughts at all.” Though this is one of the most severe cases of amnesia observed, it underscores how crucial memory is not only to every day functioning, but also for one’s sense of self. Autobiographical memories and the ability to recall these emotional and important events are an integral component of one’s identity. These events, in turn, get tied into personal narratives that our personalities are built on. In the case of Mr. Wearing, he is stuck in this personality because of the damage to his hippocampus and closely related brain regions, an area of the brain necessary for transferring information from short term to long term memory. As a result, he reports that he feels like he is dead and is constantly waking up into a new reality.
Video courtesy of YouTube

Realizing how significant memory is one thing, but the ability to recover or enhance memory is another.

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

Doctors Consider Ethics Of Costly Heart Surgery For People Addicted To Opioids

Cardiologists, surgeons and infectious disease doctors can fix the infection, but not the underlying problem of addiction. And when patients who are still addicted to opioids leave the hospital, many keep injecting drugs, often causing repeat infections that are more costly and more challenging to cure

Source: Bioethics Bulletin by the Berman Institute of Bioethics.

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

The Future of Bioethics: Organ Transplantation, Genetic Testing, and Euthanasia

By Ana Lita

When you think of bioethics, some of the first hot-button topics you may consider are organ transplantation, fertility and genetic engineering, and end-of-life-care. The Global Bioethics Initiative serves as a platform to address many bioethical questions and engages in public debates to develop resolutions to present and emerging issues.

Dr. Ana Lita, founder of the Global Bioethics Initiative, discusses the various areas GBI addresses and highlights the organization’s contributors in their prospective fields. She acknowledges the valuable contribution of the current president of GBI, Dr. Bruce Gelb, in the field of organ transplantation. She also addresses the original co-founder of GBI, Dr. Charles Debrovner, and his lifelong passion in the field of fertility and genetic engineering. Lastly, Dr. Lita offers a brief insight into the future of Bioethics in these uncertain times.

ORGAN MARKETS AND THE ETHICS OF TRANSPLANTATION 

Recent developments in immunosuppressive drugs and improved surgical techniques have now made it much easier to successfully transplant organs from one human body to another. Unfortunately, these developments have led to the rise of black-markets in human organs. This underground market is where people who need kidneys to survive or to improve the quality of their lives, for example, purchasing such organs from impoverished persons in the developing world. In January 2017, scientists announced that they successfully created the first human-pig hybrid and a pig embryo with some human characteristics. Given the increasing need for transplant organs, should such markets be regulated and legalized?  Could the success of therapeutic cloning eliminate the need to consider this option?

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

Moving Toward Answers in ME/CFS

Thinkstock/Katarzyna Bialasiewicz

Imagine going to work or school every day, working out at the gym, spending time with family and friends—basically, living your life in a full and vigorous way. Then one day, you wake up, feeling sick. A bad cold maybe, or perhaps the flu. A few days pass, and you think it should be over—but it’s not, you still feel achy and exhausted. Now imagine that you never get better— plagued by unrelenting fatigue not relieved by sleep. Any exertion just makes you worse. You are forced to leave your job or school and are unable to participate in any of your favorite activities; some days you can’t even get out of bed. The worst part is that your doctors don’t know what is wrong and nothing seems to help.

Unfortunately, this is not fiction, but reality for at least a million Americans—who suffer from a condition that carries the unwieldy name of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), a perplexing disease that biomedical research desperately needs to unravel [1]. Very little is currently known about what causes ME/CFS or its biological basis [2]. Among the many possibilities that need to be explored are problems in cellular metabolism and changes in the immune system.

A number of studies suggest that abnormalities in cellular metabolism, a complex biological process that the body uses to create energy [3][4][5], may underlie ME/CFS. A recent study of metabolite pathways in blood samples from people with ME/CFS reported a signature suggestive of a hypometabolic condition, similar to a phenomenon biologists have studied in other organisms and refer to by the term “dauer” (a hibernation-like state) [5].

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

Intersectionality and the Dangers of White Empathy when Treating Black Patients

by Keisha Ray, Ph.D.

(Originally presented at the 7th International Health Humanities Consortium meeting in Houston, Texas)

I’ve had many odd, seemingly racially motivated experiences with racially uneducated and racially insensitive doctors and nurses. From being told by one of my white physicians that I sound white when I speak, to another physician calling me “sista girl” for what seemed like 100 times during our brief 15-minute interaction, or another physician who in disbelief kept asking me “Are you sure you’ve never been pregnant? It’s very rare for a black woman your age to not have had any pregnancies. Maybe you think I mean births, when I mean pregnancies?” At the time, I was only 25 years old. Although these stories made for good laughs between my friends and I, there is one experience that I have had with the medical profession that was less comical because my doctor’s attitudes about race could have had serious effects on my health.

When I was a senior in college I discovered I had hypertension. I went to see a doctor at a family medicine facility and was prescribed a common hypertension drug. While meeting with the doctor in her office, she was very reassuring and told me not to worry that this drug has been known to work very well for black people.

But this drug did not work for me at all. Consistently my blood pressure readings were 140/120 (what is considered “normal” varies but typically 120/80 is the standard). So after taking the drug for a month as instructed, I went back to see my doctor.

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

When stem cell treatments go wrong, they really go wrong

Three elderly women in Florida have been blinded by an unproven treatment, as a reminder of how dangerous stem cell therapies can be. The New England Journal of Medicine reports that the women signed up for a purported clinical trial in 2015 – for which they had to pay US$5,000. Within a week, they experienced a variety of complications, including vision loss, detached retinas and haemorrhage. Before the surgery, the vision in their eyes ranged from 20/30 to 20/200. They are now blind.

The article is a “call to awareness for patients, physicians and regulatory agencies of the risks of this kind of minimally regulated, patient-funded research,” said Jeffrey Goldberg, of Stanford University School of Medicine and a co-author.

“There’s a lot of hope for stem cells, and these types of clinics appeal to patients desperate for care who hope that stem cells are going to be the answer, but in this case these women participated in a clinical enterprise that was off-the-charts dangerous,” said Thomas Albini, another co-author.

At the clinic, U.S. Stem Cell Inc, fat cells from the patients’ abdomens were processed to obtain stem cells which were injected into their eyes. Patients reported that the entire process took less than an hour. The patients had both eyes treated at once — even though most doctors would opt for a conservative approach to observe how the first eye responds.

“There is a lot of very well-founded evidence for the positive potential of stem therapy for many human diseases, but there’s no excuse for not designing a trial properly and basing it on preclinical research,” Goldberg 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.