Tag: pain

Bioethics Blogs

Kathy Greenlee’s Reflections on Paths to Person-Centered Planning

Challenging Us to See the Whole Person at All Stages of Life

Kathy Greenlee, VP for Aging and Health Policy

The Center for Practical Bioethics hosted the Joan Berkeley symposium on Thursday, April 6. The title for the day was “Paths to Person-Centered Planning.” In planning the event, my objective was to focus on tools and techniques grounded in a disability policy perspective that could benefit healthcare professionals and bioethicists. The day brought articulate and engaged speakers, raised new questions, introduced different language, and ultimately affirmed the strength of a multi-disciplinary approach to supporting people and their families as they face serious illness and end of life. 

Four distinct concepts emerged:
1) the perspective of the person as patient,
2) similarities and differences between shared decision-making and supported decision-making, 
3) the balance between what is “important to” a person and “important for” a person, and
4) the need to see a patient within the context of their family, however defined.

Person-Centered Communication

The panelists who opened the day demonstrated the importance of listening to people and the first speaker stole the show. 
Cathy Enfield, member of Self-Advocates Becoming Empowered (SABE), is an articulate adult woman with a developmental disability. She uses an iPad for communication assistance. She gave a first-person account of having healthcare providers look past her and talk directly to her caregiver. 
To communicate, Cathy needs support. Yet, public policies ranging from transportation to healthcare create barriers and financial disincentives that require her to be accompanied by someone to assist. Cathy’s comments were so compelling one of the medical educators in the audience intends to make them required reading for his first-year medical students.

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 Bioethics View of Executions in Arkansas

by Craig Klugman, Ph.D.

This week the state of Arkansas had planned to execute 8 death-row inmates in 4, back-to-back killings using lethal injection over 10 days. The last execution in Arkansas was 12 years ago, so why the sudden rush? As part of the three-drug cocktail used by this state, their supply of midazolam—an anesthetic—is about to expire. If they do not use the drug by the expiration date, then they can’t use it and the company that makes the drug will not sell it to the state for this purpose.

Arkansas had planned to use a combination of 3 drugs in the execution, midazolam (an anesthetic), vecuronium bromide (a paralytic), potassium chloride (to stop the heart). This cocktail would be used to kill the 8 men.

I say “had planned” because last week, two of the prisoners had judges issue stays on their executions. This move is not unusual as there is often a flurry of court appeals and filings in the time before an execution. What is unusual is that over the weekend, another judge placed a stay on all executions on the request of drug companies and distributors—Pfizer, Fresenius, West-Ward Pharmaceuticals, and McKesson—who do not want their drugs to be used in an execution. McKesson’s concern is that when they learned the reason the state bought the vecuronium bromide, that they refunded the cost and asked for the drug to be returned. Drug manufacturers and distributors have come out against their products being used to kill prisoners. The association is unlikely to be good for sales or brand reputation.

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

Serotonin produced from neurons obtained with iPS and embryonic stem cells

Serotonin is implicated in functions as important as humour, sadness, feelings of aggression, anxiety and sleep disturbances, among others. A deficiency in serotonin release has been related with schizophrenia, depression, bipolar disorder, obsessive-compulsive disorders, chronic pain and eating disorders. All of this supports how important it is for the central nervous system to function well. Now, to facilitate “in-vitro” studies of the neurons that produce this substance, a technique has been developed that enables them to be obtained from human pluripotent cells, both embryonic and human iPS cells (Nature Biotechnology 34; 89-94, 2016). The use of human embryonic stem cells has objective ethical difficulties, but not so human iPS cells, so their use opens up a scientific and ethical avenue for the production this substance from neurons, and to take another step forward in the treatment of conditions linked to serotonin imbalance.

La entrada Serotonin produced from neurons obtained with iPS and embryonic stem cells aparece primero en Bioethics Observatory.

Source: Bioethics Observatory.

This article was originally published by the Bioethics Observatory of the Catholic University of Valencia. Up-to-date news and reports from the Bioethics Observatory at the Catholic University of Valencia (Spain), covering a wide range of bioethical issues including stem cell research, abortion, assisted suicide and much more. General interest and specialised topical articles with ethical implications, based on the latest research findings from some of the world's top medical and scientific 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

The ethnographic case: series conclusion by Emily Yates-Doerr

Editors note: This entry concludes the series “The Ethnographic Case” which ran every other Monday between June 2015 and July 2016. The bookCase, which holds 27 cases, can be accessed here.

One day, early on in the series, we received two submissions. Their similar anatomy was striking. Each featured a medical waiting room. Someone entered the space with a gift for the clinical personnel, the gift was accepted, and something shifted in the resulting care.

In Aaron Ansell’s case, set within gardens of an informal clinic in Piauí, Brazil, the gift was a small satchel of milk. Rima Praspaliauskiene’s was set in a Lithuanian public hospital and the gift was a rich chocolate cake. Aaron, who works and teaches on legal orders, analyzed the exchange as a challenge to hospital norms of equalitarianism. He helped us to see how the give-and-take of milk interrupts the requirements of a deracinated liberal democracy, offering instead the warm sociality of personal affinity. Rima, who focuses on medical care and valuing, used the object of the cake to query the social scientist’s impulse to explain why people do what they do. She shows us how this impulse may rest upon the linearity and equivalence of rational calculation, uncomfortably treating sociality as a commodity.

The juxtaposition of these submissions is emblematic – a case, if you will – of something we have seen throughout this series: the art of ethnographic writing resides in a relation between what is there and what is done with it.

Beginnings

We might trace the origin of the series to a business meeting at the AAAs, when we offered the idea of “the ethnographic case” for a Somatosphere series.

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

20 Years of Death with Dignity in USA

The nation’s first “death with dignity” law turns 20 this year.  Since the six other states have affirmatively legalized medical aid in dying.


A new analysis published in JAMA Oncology is taking a look back at how the law has been utilized in Oregon since it went into effect in 1997. 

  • Total Usage – A total of 1545 prescriptions were written, and 991 patients died by using legally prescribed lethal medication. 
  • Age & Gender – Of the 991 patients, 509 (51.4%) were men and 482 (48.6%) were women. The median age was 71 years (range, 25-102 years). 
  • Increase – The number of prescriptions written increased annually (from 24 in 1998 to 218 in 2015), and the percentage of prescription recipients dying by this method per year averaged 64%. 
  • Diagnoses – Of the 991 patients using lethal self-medication, 762 (77%) recipients had cancer, 79 (8%) had amyotrophic lateral sclerosis, 44 (4.5%) had lung disease, 26 (2.6%) had heart disease, and 9 (0.9%) had HIV. 
  • Mental Health Screening – Of 991 patients, 52 (5.3%) were sent for psychiatric evaluation to assess competence. 
  • Race & Hospice – Most (953; 96.6%) patients were white and 92.2% were in hospice care. 
  • Insurance & Education – Most (118, 92.2%) patients had insurance and 92 (70.8%) had at least some college education. Most (94%) died at home. 
  • Duration – The estimated median time between medication intake and coma was 5 minutes (range, 1-38 minutes); to death it was 25 minutes (range, 1-6240 minutes). 
  • Complications – Thirty-three (3.3%) patients had known complications. 
  • Motivation – The most common reasons cited for desiring PAD were activities of daily living were not enjoyable (89.7%) and losses of autonomy (91.6%) and dignity (78.7%); inadequate pain control contributed in 25.2% of cases.

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

In Pain? Many Doctors Say Opioids Are Not The Answer

Many primary care doctors no longer liberally prescribe opioid painkillers such as oxycodone, fentanyl and hydrocodone for back pain, migraines and other chronic conditions. Instead, they are increasingly turning to alternative medications and non-drug options such as acupuncture and physical therapy

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 Blogs

A Lesson in Humanism to Medical Students Prompted by a Mass Casualty Event

by Sergio Salazar, MD, MBE

The purpose of this editorial is to reveal how one of the most tragic events in our nation’s history helped teach future medical providers the influence that humanistic actions can have on relieving suffering and forward healing.

On June 12, 2016 the largest mass shooting incident in our nation’s history claimed the lives of forty-nine innocent victims at the Pulse night club in Orlando. The Pulse night club was frequented by the Latino LGBTQ community. The shooter was identified as a terrorist with extremist religious beliefs adding intolerance for alternative lifestyles and race to the massive loss of life.    Due to the emotional turmoil experienced by everyone in the community, a session was prepared to provide a platform for discussion and closure for our students. Some students had been directly or indirectly involved in the care of the victims. The majority were like the rest of us, bystanders trying to come to grips with the senseless loss of life.

The longitudinal curricular themes (LCT) at the University Of Central Florida College Of Medicine include Ethics and Humanities. As with other aspects of medicine, learning becomes enhanced when the context of a lesson is presented as a real life scenario. After the mass casualty event known as the “Pulse” event, it was evident to everyone that the student body needed the opportunity to express their feeling regarding this tragedy.  To meet this need, the faculty devoted one of the ethics and humanities LCT sessions to facilitate discussion using an expert panel format.

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

Which is It? “Tissue” or “Baby”?

I’m not a physician. I know next to nothing about biology or embryology. I’m confused. Will those who are trained in medical sciences please help me to understand?

In January 2017, Arkansas governor Asa Hutchinson signed into law Bill 1032 which prohibits a procedure, “dilation and evacuation” (D&E), that is used in a large percentage of abortions after the 14-week mark. Critics complain that making this “safe and common” procedure illegal effectively bans second trimester abortions. Declaring the bill unconstitutional, Rita Skylar, executive director of the ACLU of Arkansas, contends: “It’s an empty gesture that’s going to cost the state tens of thousands of dollars in litigation fees and costs.” Skylar is correct in at least this regard. The new law will be opposed stridently by Arkansas ACLU and various pro-abortion groups and will, more than likely, become hung up in appeals court, as is the “pain capable abortion” bill—banning abortions after 20 weeks—that was passed in 2013.

Ignorant as I am about surgical procedures, I looked up “Dilation and Evacuation (D&E) for Abortion” on WebMD. Admittedly, the procedure itself sounded rather dreadful to a person untrained in medicine and surgery like myself. I found especially intriguing the terminology used to described what is “evacuated” in this procedure. Repeatedly, the article referred to “tissue,” “larger pieces of tissue,” and “uterine contents.”

Granted, I do not know much about embryology either, but I assumed that at 14 weeks the fetus was more than simply “tissue,” even “large pieces of tissue.” Thus, I searched the same website and found a slideshow on “Fetal Development: Month by Month.” In light of the website’s description of D&E, the title of the slideshow was startling: “Your Baby’s Growth: Conception to Birth.” Consistently, the slideshow referred to the developing embryo-fetus as “baby.” Viewing pictures of the “baby” at 12 weeks, 14 weeks, and 16 weeks, I concluded that my original assumption was correct.

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: Aggressive Treatment Chosen for Patients at the End of Life

by Craig Klugman, Ph.D.

This week’s Thursday night medical TV was all about end of life decision-making and delved into the questions of how much aggressive treatment is too much, what happens when physicians lose clinical distance, and who makes decisions for patients.

On Chicago Med (Season 2, Episode 18), a patient with Alzheimer’s is admitted to the ED with a fever and chills. She has pneumonia and has for several days, only being sent to the hospital that day by her long-term care facility. The patient is Dr. Bella Rowen, Halstead’s former mentor and administrator Goodwin’s former colleague (from her nursing days). As the patient is brought in, a nurse says “No advance directive, no family, and the surrogate just passed away, so it’s going to be our call.” Halstead is emotionally invested in his mentor and takes over decision-making for her care. She is frail and does not remember him. When Rowen codes, Halstead pushes CPR even though, as his colleagues tell him, he will break all of her ribs and only cause suffering. He resuscitates and intubates her. We are told that she will never get off the vent. When her kidneys fail, he orders dialysis. Goodwin talks to him and says that such measures will lead Rowen to live the rest of her days on machines, bedridden with sores, and open to infections. Goodwin tells Halstead that the woman he knew was gone and forcing this patient to live would not bring his mentor back.

One of the major ethical issues raised in this case is whether, in fact, Halstead should have been making decisions for the patient.

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

SHEEFs, Sentience, and the 14-Day Rule

March 31, 2017

by Professor Bonnie Steinbock 

Embryo research, made possible by IVF, raised the question of the moral status of human embryos. Are human embryos human subjects, who are entitled to stringent protections? Or are they clumps of cells that can be used in research, so long as the permission of their creators is obtained?

Various commissions (Ethics Advisory Board, 1979; Warnock Commission, 1984; National Institutes of Health, 1994) considered this issue, and all arrived at a similar conclusion. Embryos are neither persons nor mere tissue, but a very early form of human life and, as such, entitled to special respect. Specifically, they all agreed on the 14-day rule, which specifies that experiments with human embryos must not let them develop beyond 14 days.

Fourteen days is when the primitive streak (PS), the precursor of the spine and nervous system, appears. This is important because of the connection between the nervous system and sentience, the ability to experience pain or pleasure. Sentience is regarded as morally relevant because causing pain is, in general, wrong. Kicking a can down the road is perfectly permissible, but it would be very wrong to do the same to a sentient guinea pig. On a sentience criterion, nonsentient beings do not have the moral standing that sentient beings do, and research on nonsentient embryos is morally acceptable.

Some argue that what makes it wrong to kill an embryo has nothing to do with sentience. Rather, the embryo is the earliest stage of a unique human being. If it would be wrong to kill a developed human, it is equally wrong to kill that same human being in its earliest stages.

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.