Tag: double effect

Bioethics Blogs

Elective or life-saving? Catholic hospitals and the ban on tubal ligation

Tags: Doctor-Patient Relationships, Ethics and Morality, Health Care Policy, Patient Care, Religion, Reproductive Medicine, Women’s Reproductive Rights

A Catholic hospital came under fire recently for stating that it would not permit doctors to perform a tubal ligation during a c-section scheduled for October.  According to news reports (including an article written by the patient herself), the pregnant patient has a brain tumor, and her doctor have advised her that another pregnancy could be life-threatening.  Her doctor has recommended that she have a tubal ligation at the time of her c-section.  While my knowledge about this hospital, this case, and the participants is limited to what has been reported in the media, it raises an interesting question: in our pluralistic society, where conscientious objection is respected while maintaining a patient’s right to a certain standard of care, is it ethical to allow a religiously-affiliated health care institution to refuse to provide certain treatments it finds morally objectionable?

As background, the Catholic Church has historically been outspoken on bioethical issues and has a strong and robust bioethical teaching.  Catholic hospitals are governed by the Ethical and Religious Directives for Catholic Health Care Services (ERDs), a document promulgated by the United States Conference of Catholic Bishops (USCCB) that clearly articulates the bioethical policies that must be followed in a health care institution based on the Church’s moral teachings.  It explains the Church’s teaching against direct sterilization as a method of birth control based on the principle of double effect.  “Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.

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

Part I: THE IMITATION GAME meets HOW I CAME TO HATE MATH/Comment j’ai détesté les Maths, Moral Relativism vs Beneficence and Justice: Moral Injury, War and Computer Science

THE IMITATION GAME 
Alan Turing was a Cambridge trained mathematician, wonderfully portrayed by Benedict Cumberbatch (Sherlock) in the WWII bio-historical thriller, THE IMITATION GAME. The film directed by Morten Tyldum and written by Graham Moore was screened at the 36th annual Mill Valley Film Festival 2014. It is an adaptation of a book by Andrew Hodges, Alan Turing: The Enigma 
While a fellow at the MacLean Center for Clinical Medical Ethics in 1990, it was this writer’s profound good luck to meet and spend time with the late Dr. Stephen Toulman, a British born physicist, mathematician, philosopher and communications expert. Also Cambridge educated, Stephen knew Alan Touring and his work. Dr. Toulman shared his 1984 New York Review of Books article ‘The Fall of Genius,’ a critique of the Hodges book, with a digestible explanation of the way that mathematicians minds work. 
Moral relativism is used in arguments about defense of safety and security in times of war. War being defined as “a state of armed conflict between different nations or states or different groups within a nation or state”. In the loosie-goosie world of the noncombatant, war is often used as a metaphor. Dr. Toulman wanted to be sure of what we spoke. Most importantly he looked at the arguments which drive scientific exploration during war and their consequences. 
The plot of THE IMITATION GAME supplies a protagonist who is focused on the work of his mind, to the exclusion of most social contact nearly on the Asperger’s Syndrome spectrum. During this period, that work is construction of a machine ultimately able to decode Nazi strategic plans for attacks on allied forces during WWII.

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

Text Messaging: A Cure for Common Nonadherence?

by Craig Klugman, Ph.D.

According to research studies on medication usage, nearly 22% of all e-prescriptions and 28% of new prescriptions are not filled. For heart medications among people who have experienced a heart attach, one-half to two-thirds (depending on the medication) of patients were nonadherent to a prescription regimen. Patient adherence to medication is related to the disease, side effects, how long they are treated (there is a drop off after 6-months of treatment), complexity and the regimen, severity of disease, and cost of the medication.

Nonadherence can increase the cost of treating patients. Estimates on that cost vary but range from $100 to $290 billion each year and $7,800 per patient. Patients with chronic diseases who do not adhere to a prescribed medical regiment have higher death rates, more hospitalizations, more emergency department visits, and more physician visits.

A new study out of the U.K. found that one way to reduce nonadherence is through text messages. In a trial of 303 patients prescribed drugs to lower medication or lipid-levels, half were sent daily text messages either every day (or alternate days) for two weeks following by weekly texts for 22 additional weeks. In a self report, patients were asked about whether they took their medication, whether the text was an important reminder, and if they did not take their medication, whey they did not do so. Patient medication levels were measured after 6 months. In the control group, about 25% of patients were nonadherent (defined as taking less than 80% of medication) compared to 9% in the experimental group.

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

An All-Too-Brief Review of Being Mortal

Being Mortal, which is subtitled “Medicine and What Matters in the End,” is about aging and frailty, decline and death, and dealing with those as well as possible.  It’s not really a book about medical ethics or even about medicine as much as about our latter days.  It’s full of stories about the loss of independence, assisted living, nursing homes, intensive care at the end of life, hospice, and finally having “difficult conversations” and “letting go” (those are two of the chapter titles). 

The point of these stories is to plead for better, whole-person-driven palliative care throughout the practice of medicine.

I found it deeply about human dignity and autonomy, in the best sense of that word.  As the author, Atul Gawande, M.D., puts it in his epilogue, “We’ve been wrong about what our job is in medicine.  We think our job is to ensure health and survival.  But really it is larger than that.  It is to enable well-being.  And well-being is about the reasons one wishes to be alive.”

For me, the book’s key graph is on page 128:

“The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant.  The problem is that they have had almost no view at all.  Medicine’s focus is narrow.  Medical professionals concentrate on repair of health, not sustenance of the soul.  Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days.

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

Assisted Suicide: A Better Alternative

The new DPP Alison Saunders has clarified the Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide issued by the previous DPP, Keir Starmer, in 2010. This has led to claims by right to life groups that assisted suicide will be available in the UK. This is, I argue, false. Assisted suicide remains a crime. I argue a better alternative under current law is Voluntary Palliated Starvation. This could render unconscious patients who embark on suicide by starvation and dehydration, such as the recent tragic case of Mrs Jean Davies. This could be lawful under current law and acceptable to doctors who do not wish to kill, but wish to relieve suffering.

On October 16, the Director of Public Prosecutions clarified the CPS Policy on cases of encouraging or assisting suicide:

“In considering the section which indicates the likelihood of prosecution of health care professionals, the DPP has made it clear that this refers to those with a specific and professional duty of care to the person in question.

The relevant paragraph offers guidance on cases where the suspect is “acting in his or her capacity as a medical doctor, nurse, other healthcare professional, a professional carer [whether for payment or not], or as a person in authority, such as a prison officer, and the victim was in his or her care”.

During earlier proceedings in the Court of Appeal, the then Lord Chief Justice interpreted this guidance to mean that if a person operating in one of the prescribed professions had cared for a victim to the extent that they were in a position of authority, and may have been able to use that authority to exercise undue influence over the victim, then this may be considered as a factor tending in favour of prosecution.

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

“Example isn’t another way to teach, it is the only way to teach” *

Over this autumn school term, members of our Education Advisory Group are sharing thoughts and ideas based on their own experience of how bioethics and debate can be useful in education contexts. This post is written by Andy Greenfield, Programme Leader in Developmental Genetics at the Medical Research Council Harwell, STEM Ambassador and Member of the Nuffield Council on Bioethics.

* Quote from Albert Einstein

Over recent years, in my capacity as a STEM ambassador, I have had the opportunity to visit some secondary schools to discuss biology and ethics with pupils in the age range of 14-18 years. Sometimes this combination of science and ethics has been an explicit request on the part of the school – such as when I was asked to contribute to a discussion on science and religion. On other occasions I have been asked to discuss some aspect of my own scientific research – such as the genetic control of embryonic development – but I have incorporated an element of bioethics because it seems to me that young people find the combination stimulating: it reminds them that what scientists do involves making choices, sometimes difficult ones. I believe that both science and ethics can become more interesting to the uninitiated when combined.

Some topics that I have addressed include old favourites, such as the manipulation of the human germ line to combat disease or the use of animals in scientific research. The Council’s own reports on mitochondria and animal research have been enormously helpful in framing subsequent discussions. However, I usually resort to a warm-up routine consisting of the now famous trolley-problems**.

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.