Tag: nursing

Bioethics Blogs

Interview with Arthur Caplan

by Kaitlynd Hiller and Rachel F. Bloom

It is a difficult task to succinctly describe the professional accomplishments of Arthur Caplan, PhD. For the uninitiated, Dr. Caplan is perhaps the most prominent voice in the conversation between bioethicists and the general public, as well as being a prolific writer and academic. He is currently the Drs. William F. and Virginia Connolly Mitty Professor of Bioethics at NYU Langone Medical Center and NYU School of Medicine, having founded the Division of Bioethics there in 2012. Additionally, he co-founded the NYU Sports and Society Program, where he currently serves as Dean, and heads the ethics program for NYU’s Global Institute for Public Health. Prior to joining NYU, he created the Center for Bioethics and Department of Medical Ethics at the University of Pennsylvania Perelman School of Medicine, serving as the Sidney D. Caplan Professor of Bioethics. Dr. Caplan is a Hastings Center fellow, also holding fellowships at The New York Academy of Medicine, the College of Physicians of Philadelphia, the American Association for the Advancement of Science, and the American College of Legal Medicine. He received the lifetime achievement award of the American Society of Bioethics and Humanities in 2016.

Dr. Caplan’s experience is not at all limited to the academic realm: he has served on numerous advisory counsels at the national and international level, and is an ethics advisor for organizations tackling issues from synthetic biology to world health to compassionate care. Dr. Caplan has been awarded the McGovern Medal of the American Medical Writers Association, the Franklin Award from the City of Philadelphia, the Patricia Price Browne Prize in Biomedical Ethics, the Public Service Award from the National Science Foundation, and the Rare Impact Award from the National Organization for Rare Disorders; he also holds seven honorary degrees.

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

Nudges in the ICU: When and How Should Intensivists Guide Surrogates’ Decisions?

Coming up next week at the ATS International Conference in Washington, DC: “Nudges in the ICU: When and How Should Intensivists Guide Surrogates’ Decisions?”


This 2-hour session will address the use of behavioral economics and “nudges” in the ICU to guide surrogate decision-making. In particular, it will explore methods for effectively deploying nudges—tools for clinicians to use in the ICU—and an ethical framework within which to do so that adequately balances autonomy and paternal beneficence.


At the conclusion of this session, the participant will be able to:

  • Discuss principles of behavioral economics (a.k.a. decision psychology) that physicians might employ to ethically and effectively guide end-of-life decision making in the ICU
  • Clarify misconceptions about the meaning and importance of patient autonomy and informed assent among ICU patients lacking decisional capacity
  • Discuss special considerations when deploying behavioral economics with pediatric patients and their parent surrogates

Behavioral Economics, Choice Architecture, and Nudges in the ICU
G.L. Anesi, MD, MBE, Philadelphia, PA


Intensivists’ Use of Informed Assent When Patients Lack Capacity
J.R. Curtis, MD, MPH, Seattle, WA


Default to DNR?
R.D. Stapleton, MD, PhD, Burlington, VT


Integrated ICU Team Communications and the Nursing Perspective
D.K. Costa, PhD, RN, Ann Arbor, MI


The (Ambiguous) Role of Autonomy in Surrogate
Decision-Making
D.B. White, MD, Pittsburgh, PA


Helping Parents with Decisions
M.F. Haward, MD, Bronx, NY

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

Nudges in the ICU: When and How Should Intensivists Guide Surrogates’ Decisions?

Coming up next week at the ATS International Conference in Washington, DC: “Nudges in the ICU: When and How Should Intensivists Guide Surrogates’ Decisions?”


This 2-hour session will address the use of behavioral economics and “nudges” in the ICU to guide surrogate decision-making. In particular, it will explore methods for effectively deploying nudges—tools for clinicians to use in the ICU—and an ethical framework within which to do so that adequately balances autonomy and paternal beneficence.


At the conclusion of this session, the participant will be able to:

  • Discuss principles of behavioral economics (a.k.a. decision psychology) that physicians might employ to ethically and effectively guide end-of-life decision making in the ICU
  • Clarify misconceptions about the meaning and importance of patient autonomy and informed assent among ICU patients lacking decisional capacity
  • Discuss special considerations when deploying behavioral economics with pediatric patients and their parent surrogates

Behavioral Economics, Choice Architecture, and Nudges in the ICU
G.L. Anesi, MD, MBE, Philadelphia, PA


Intensivists’ Use of Informed Assent When Patients Lack Capacity
J.R. Curtis, MD, MPH, Seattle, WA


Default to DNR?
R.D. Stapleton, MD, PhD, Burlington, VT


Integrated ICU Team Communications and the Nursing Perspective
D.K. Costa, PhD, RN, Ann Arbor, MI


The (Ambiguous) Role of Autonomy in Surrogate
Decision-Making
D.B. White, MD, Pittsburgh, PA


Helping Parents with Decisions
M.F. Haward, MD, Bronx, NY

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

New Gene Tests Pose a Threat to Insurers

An estimated 5.5 million people in the United States have Alzheimer’s disease, and these patients constitute half of all nursing home residents. Yet very few people in the United States have been tested for the ApoE4 gene

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

Ethics, sexuality, and dementia in long-term care

Alisa Grigorovich and Pia Kontos suggest that long-term care residents with dementia can benefit from leisure and social activities that are supportive of sexual expression and the formation of intimate and romantic relationships.

__________________________________________

Recently, media stories on dementia have focused on the sexualities of persons living with dementia in residential long-term care settings, such as nursing homes. This media attention has been predominantly negative, consisting of descriptions of sexual violence, and apocalyptic warnings of the legal, ethical, and moral dangers of allowing persons with dementia to express their sexuality.

Often the primary criterion used to determine whether sexual encounters between residents with dementia are involuntary is the cognitive ability of the female resident. Frequently, she is characterized as globally incapable of agreeing to sexual activity because of cognitive impairment.

Consider, for example, the now infamous case of Henry Rayhons. He was accused (and ultimately acquitted) of sexually assaulting his wife who had dementia. As well, there is the lawsuit filed in a case involving two residents with dementia who had intercourse while living in Windmill Manor. While such stories highlight the importance of protecting vulnerable persons from sexual abuse, they ignore the need to also ensure that persons with dementia have opportunities to pursue intimate and romantic relationships.

Sexual expression is a universal human need that transcends age and disability. It has many positive health and wellness benefits, including the opportunity to experience pleasure, decreased pain sensitivity, and increased relaxation. However, older persons living in nursing homes often experience reduced sexual freedom.

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

Unbefriended and Unrepresented: Better Medical Decision Making for Incapacitated Patients Without Healthcare Surrogates

How should we make medical decisions for incapacitated patients who have no available legally-authorized surrogate decision maker? Because these patients lack decision making capacity, they cannot authorize treatment themselves. Because they lack a surrogate, nobody else can authorize treatment either. Clinicians and researchers have referred to these individuals as “adult orphans” or as “unbefriended,” “isolated,” or “unrepresented” patients. Clinicians and researchers have also described them as “unimaginably helpless,” “highly vulnerable,” and as the “most vulnerable,” because “no one cares deeply if they live or die.”

The persistent challenges involved in obtaining consent for medical treatment on behalf of these individuals is an immense problem in ethics and patients’ rights. Some commentators describe caring for the unbefriended as “one of the most difficult problems in medical decision making.” Others call it the “single greatest category of problems” encountered in bioethics consultations.

Appropriately, this problem is getting more attention. Major policy reports from both legal and medical associations have focused on decision making for the unbefriended. Perhaps most notably, the elite mainstream media has repeatedly covered the problem of the unbefriended in the United States. Decision-making for the unbefriended has also been the primary topic of recent day-long or multi-day conferences, both themed, subject-specific conferences, and individual sessions at several national and regional professional association meetings.

Finally, the problem of the unbefriended has received increasing attention not only in the meeting halls of conferences, but also in the pages of academic literature. New articles have been printed in law journals, medical journals, nursing journals, long-term care journals, and bioethics journals.

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

Unbefriended and Unrepresented: Better Medical Decision Making for Incapacitated Patients Without Healthcare Surrogates

How should we make medical decisions for incapacitated patients who have no available legally-authorized surrogate decision maker? Because these patients lack decision making capacity, they cannot authorize treatment themselves. Because they lack a surrogate, nobody else can authorize treatment either. Clinicians and researchers have referred to these individuals as “adult orphans” or as “unbefriended,” “isolated,” or “unrepresented” patients. Clinicians and researchers have also described them as “unimaginably helpless,” “highly vulnerable,” and as the “most vulnerable,” because “no one cares deeply if they live or die.”

The persistent challenges involved in obtaining consent for medical treatment on behalf of these individuals is an immense problem in ethics and patients’ rights. Some commentators describe caring for the unbefriended as “one of the most difficult problems in medical decision making.” Others call it the “single greatest category of problems” encountered in bioethics consultations.

Appropriately, this problem is getting more attention. Major policy reports from both legal and medical associations have focused on decision making for the unbefriended. Perhaps most notably, the elite mainstream media has repeatedly covered the problem of the unbefriended in the United States. Decision-making for the unbefriended has also been the primary topic of recent day-long or multi-day conferences, both themed, subject-specific conferences, and individual sessions at several national and regional professional association meetings.

Finally, the problem of the unbefriended has received increasing attention not only in the meeting halls of conferences, but also in the pages of academic literature. New articles have been printed in law journals, medical journals, nursing journals, long-term care journals, and bioethics journals.

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

Bending the Odds: Pedagogy and Dialogue in Large Lecture Courses by Sandra Hyde

As academics in large public research universities, I am always amazed that when we speak of an ideal pedagogy, we speak about our small intimate seminars where we have the time and resources to experiment with 25 students or less. In my 13 years of teaching, I look forward to those settings when I get to teach one small undergraduate seminar a year. Over the years, I have also tried to make my large lecture hall shrink by trying to utilize different techniques to foster student based learning and most important, to create more interactive group problem solving and reduce the teacher as lord model of education. While this often works in small seminars, those wonderful nuggets of intimate interactive learning, I find it a challenge to accomplish this when I am in large lecture halls (over 200 students) with limited to graduate student teaching support.

In a large Introduction to Medical Anthropology course (what is called Anthropology 227 at McGill), I have worked over the years to integrate more student-interactive learning. I often compare teaching this course to managing a large ocean-liner with staff of different standing and students who are extremely eclectic as they are drawn from across campus from multiple faculties. For example, students in engineering and medicine will take the course as their one social science requirement and for others they find introduction to medical anthropology intriguing. Students in the humanities are also looking to take their one social science course. There are also medical practitioners and their allied health colleagues often nursing students returning to university to complete their BS.

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

Remarks on Retirement: A Career in Medicine & Bioethics

by Steven Miles, MD

The following remarks were delivered on April 27, 2017 upon Steven Miles’ retirement

Bioethics is not scholastic theorizing. It must venture outside the walls of Academic Health Centers to speak on behalf of marginalized and silenced people including those without access to affordable health care, prisoners and enemies, nursing home residents and refugees. Bioethics is about our ethos—how we live.

No one who reveres Universities ever really leaves. I set out as an itinerant emeritus carrying a backpack stuffed with University’ values and tools.…

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

America’s Other Drug Problem

Every year nursing homes nationwide flush, burn or throw out tons of valuable prescription drugs. Iowa collects them and gives them to needy patients for free. Most other states don’t

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.