Tag: patient care

Bioethics Blogs

Happy Labor Day

As we enjoy the unofficial end of summer on this Labor Day, it’s good to remember those who do their difficult jobs well with little fanfare and in some cases, with some risk involved. One recent example is the case of Alex Wubbles, a Utah nurse who was arrested in July for simply following the basics of patient care when she stopped a police officer from taking blood from an unconscious patient without any warrant or consent.

If you have seen the troubling body-cam video of the incident, you can see the nurse calmly explain to the officer why she could not allow him to draw blood from the patient. During the confrontation, she spoke to her supervisor on the phone, who was able to confirm the correctness of her actions. Even this did not stop the officer from dramatically taking her into custody.

Clearly, this was an extraordinary occasion. However, we mustn’t miss an important point: Alex Wubbles put her patient’s rights first. By demonstrating patient-centered care, she valued the patient as a human being. This is medical care (and, by extension, bioethics) at its best. Even in the best of times, being a patient in the hospital can be a wearying and disorienting experience—all of the professionals coming in and out of the room, the strange sounding terminology, accompanied by the uneasy feeling that no one is listening to you. In the midst of it all, it is important to remember that the rights of the most vulnerable are as important as those of the most powerful.

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

In the Journals – July 2017 by Danya Glabau

American Quarterly

Regina Kunzel

Among the central themes of the eclectic field of mad studies is a critique of psychiatric authority. Activists and academics, from a range of positions and perspectives, have questioned psychiatry’s normalizing impulses and have privileged mad-identified knowledges over expert ones. One of the most successful assaults on psychiatric authority was launched by gay activists in the 1960s and early 1970s, resulting in the removal of homosexuality from the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973. But if that event marked an inspirational victory against psychiatric power, it was also, as Robert McRuer notes, “a distancing from disability.”1Revisiting this history through analytic lenses offered by disability and mad studies defamiliarizes familiar historical narratives and unsettles the critique of psychiatric authority, especially when countered by claims to health.

 

Conflicts over the value, meaning, and efficacy of vaccination as a preventive practice suggest that vaccination resistance stages disagreement within modern biological citizenship. This paper explores how immunity circulates in both vaccination controversy and biopolitical philosophies. Two positions—one characterized by somatic individualism, flexible bodies, reflexive approaches to knowledge, and the idea of the immune system as “the essential relation the body has with its vulnerability,” and another characterized by the immunitary paradigm, biosecurity, trust in expert systems, and vaccination—emerge. Understanding that oppositional relation can reframe public understanding of vaccine skepticism and public health responses to it.

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

How Much Should Your Boss and the U.S. Department of Labor Know About Your Opioid Prescription History?

As the
price of health care and uncertainty about health insurance coverage increases,
employers are taking more of an interest in their employees’ health. Indeed,
this is not a new trend as the United States health insurance system has been
employment-based since its creation. However, this trend may seem more
justifiable when the federal government also takes an interest in employees’
health.  From a public health
perspective, monitoring a society’s health is very important but it must be
balanced against the individual’s privacy interest as well as the harms and
benefits of that monitoring. There is also the issue of who/what is the most
appropriate entity to be doing the monitoring.

On June
27, 2017,
the
United States Department of Labor announced
it
will officially be
monitoring
use of opioid prescriptions by workers
under the
Federal Employees’ Compensation Act, which is the law surrounding the worker’s
compensation system.  The announcement
expressed a safety concern based on overdoses and addiction of opioids in the
midst of our current opioid crisis.

When an
employee files a worker’s compensation claim,
the
employer must be notified
and the employer
has access to the health records included in that claim
.
The employer’s access to health records is limited to whatever is included in
the claim and is justified based on the premise that the employer has an
interest in the worker’s compensation claim. However, this new monitoring
system means that an employer will now have access to its employees’ opioid
prescription history, as this is information the U.S. Department of Labor will
be monitoring as part of the worker’s compensation process.

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

How Much Should Your Boss and the U.S. Department of Labor Know About Your Opioid Prescription History?

As the
price of health care and uncertainty about health insurance coverage increases,
employers are taking more of an interest in their employees’ health. Indeed,
this is not a new trend as the United States health insurance system has been
employment-based since its creation. However, this trend may seem more
justifiable when the federal government also takes an interest in employees’
health.  From a public health
perspective, monitoring a society’s health is very important but it must be
balanced against the individual’s privacy interest as well as the harms and
benefits of that monitoring. There is also the issue of who/what is the most
appropriate entity to be doing the monitoring.

On June
27, 2017,
the
United States Department of Labor announced
it
will officially be
monitoring
use of opioid prescriptions by workers
under the
Federal Employees’ Compensation Act, which is the law surrounding the worker’s
compensation system.  The announcement
expressed a safety concern based on overdoses and addiction of opioids in the
midst of our current opioid crisis.

When an
employee files a worker’s compensation claim,
the
employer must be notified
and the employer
has access to the health records included in that claim
.
The employer’s access to health records is limited to whatever is included in
the claim and is justified based on the premise that the employer has an
interest in the worker’s compensation claim. However, this new monitoring
system means that an employer will now have access to its employees’ opioid
prescription history, as this is information the U.S. Department of Labor will
be monitoring as part of the worker’s compensation process.

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

End-of-Life Healthcare Sessions at ASBH 2017

The 2017 ASBH
conference
 in October 2017 includes over 400 workshops, panels, and
papers in bioethics and the health humanities.  Here are ones that pertain
to end-of-life issues.


THURSDAY, OCTOBER 19


THU 1:30 pm:  End-of-Life Care and Decision-Making in the ICU – Limited
English Proficiency as a Predictor of Disparities (Amelia Barwise)


Importance: Navigating choices in predominantly English-speaking care settings
can present practical and ethical challenges for patients with limited English
proficiency (LEP). Decision-making in the ICU is especially difficult and may
be associated with disparities in health care utilization and outcomes in critical
care. 


Objective: To determine if code status, advance directives, decisions to limit
life support, and end-of-life decision-making were different for ICU patients
with LEP compared to English-proficient patients. 


Methods: Retrospective cohort study of adult ICU patients from
5/31/2011-6/1/2014. 779 (2.8%) of our cohort of 27,523 had LEP. 


Results: When adjusted for severity of illness, age, sex, education, and
insurance status, patients with LEP were less likely to change their code
status from full code to do not resuscitate (DNR) during ICU admission (OR,
0.62; 95% CI, 0.46-0.82; p


Conclusion: Patients with LEP had significant differences and disparities in
end-of-life decision-making. Interventions to facilitate informed
decision-making for those with LEP is a crucial component of care for this
group.


THU 1:30 pm:  “But She’ll Die if You Don’t!”: Understanding and
Communicating Risks at the End of Life (Janet Malek)


Clinicians sometimes decline to offer interventions even if their refusal will
result in an earlier death for their patients. For example, a nephrologist may
decide against initiating hemodialysis despite a patient’s rising creatinine
levels if death is expected within weeks even with dialysis.

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

PCORI Announces New Initiative to Support Shared Decision Making

The Patient-Centered Outcomes Research Institute (PCORI) today announced a new initiative designed to help patients work with their clinicians to choose the healthcare options best suited to their needs.


PCORI’s Board of Governors today authorized up to $6.5 million in initial funding to support efforts to promote wider use of shared decision making strategies. Shared decision making is the process by which clinicians and patients consider available effective treatment options and the comparative evidence for risks and benefits of each, and then work together to choose which might work best for the patients. 


This process is important because even when adequate evidence is available to support the effectiveness of two or more options, individual patients often have unique priorities and preferences that lead them to make different choices.


PCORI has always been committed to promoting shared decision making as a path to improving patient care and outcomes. The institute has made a significant investment in research related to shared decision making strategies and interventions to help patients, caregivers and clinicians work together to consider healthcare options. 


This new initiative is an extension of that effort, focusing on putting into practice tested strategies that incorporate the latest evidence.
“PCORI recognizes that for many clinical situations, patients and clinicians need to work together to consider all available treatment options, informed by the patients’ preferences,” said PCORI Executive Director Joe Selby, MD, MPH. “For a variety of reasons, shared decision making isn’t as widely used in practice as it should be. Figuring out how to address the barriers limiting its use and move these strategies into practice is important to us.”

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

Participants’ Testimonials: GBI Summer School a Smashing Success, (June 19-30), 2017

The GBI Summer School proved to be even better than anticipated or described. As a newcomer to the discipline, I had expected the course to provide a broad overview of topics and speakers. Indeed, while broad, the degree of expertise and timely subject material provided an excellent and comprehensive survey of the discipline in global and local settings. Moreover, the students provided another dimension of diversity, both in nationalities and areas of expertise. The speakers made their presentation materials readily available, answered questions, and were willing to address topics of interest offline. I would strongly recommend the course to both novices and subject matter experts alike. The course especially demonstrated the need, relevance, and desirability for global bioethics to be better incorporated into public policy formulation.

Geoffrey Pack, Prevention and Protection Officer, Office of Homeland and Security, City of San Diego, M.A.L.D., Fletcher School of Law and Diplomacy, Tufts University in Cooperation with Harvard University

The GBI Summer School, in the heart of NYC’s Pace University Campus, is a fantastic opportunity! International scholars and professionals from all over the world attended the program, contributing their experiences and engaging with bioethics experts. The City of New York – with the nearby Pace University Campus, Brooklyn Bridge, City Hall, and 9/11 Memorial – provided the perfect setting to discuss the global ethical challenges in technology and medicine. Discussions ranged from law and politics to culture and psychology, encompassing the ethical dilemmas that define the 21st century. I have immensely enjoyed not just the internationally known faculty but also hearing from the learners who come from all over the world representing diverse fields.

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

Health Affairs Briefing: Advanced Illness And End-Of-Life Care

Few areas of health
care are as personal, or as fraught, as care for people with serious
illnesses who are approaching death. At a point in their lives when their
needs are often as much social and spiritual as they are medical, people
are confronted with a fragmented, rescue-driven health care

system that produces
miraculous results but also disastrous failures.


As the nation’s population of individuals over the age of 65 is expected to
reach 84 million by 2050, addressing these challenges becomes increasingly
important, requiring coordination across multiple sectors and levels of
government. Innovations are needed to produce improvements in care
delivery; better communication between clinicians, patients and families; greater
uptake of advance care planning tools; and payment systems and policies
that support patient needs and preferences. 


The July 2017 issue of Health Affairs, “Advanced Illness and End-of-Life Care”
includes a comprehensive look at these issue and others. In addition, HA
is hosting a forum at the National Press Club on
Tuesday, July 11.


Topics covered will include:

  • Care At The End Of Life
  • Financing & Spending
  • Quality Of Care &
    Patient Preferences
  • Hospice & Palliative
    Care

The program will
feature the following presenters:

  • Melissa Aldridge, Associate
    Professor, Department of Geriatrics and Palliative Medicine, IcahnSchool
    of Medicine at Mount Sinai, on Epidemiology And Patterns Of Care At The
    End Of Life:Rising Complexity, Shifts In Care Patterns And Sites of Death
  • Rachelle E. Bernacki,
    Director of Quality Initiatives, Psychosocial Oncology and PalliativeCare,
    Dana Farber Cancer Institute; Assistant Professor, Harvard Medical School;
    and Associate Director, Serious Illness Care Program, Ariadne Labs, on A
    Systematic Intervention To Improve Serious Illness Communication In
    Primary Care
  • Julie Bynum, Associate
    Professor Geisel School of Medicine, Dartmouth, on High-Cost Dual Eligible
    Service Use Demonstrates Need For Supportive And Palliative Models Of Care
  • Janet Corrigan, Chief
    Program Officer for Patient Care, Executive Vice President, Gordon and
    Betty Moore Foundation
  • Katherine Courtright,
    Instructor of Medicine, Division of Pulmonary, Allergy, and Critical Care
    Medicine University of Pennsylvania Health System on Approximately One In
    Three US Adults Completes Any Type Of Advance Directive For End-Of-Life
    Care
  • Robrecht De Schreye,
    Researcher, End of Life Care, University of Brussels, on Applying
  • Quality Indicators From
    Linked Databases To Evaluate End-Of-Life Care For Cancer Patients In
    Belgium
  • Rachel Dolin, Fellow, David
    A.

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

Confronting Medicine in the Holocaust & Beyond

By Hedy S. Wald

Galilee, Israel, May 7-11, 2017. I was privileged to be at the Second International Scholars Workshop on “Medicine in the Holocaust and Beyond.” Why so meaningful?  Why so needed? 140 purposeful, passionate scholars from 17 countries delved into the past history of medicine at its worst in order to inform the future.  From 1933-1945, presumed healers within mainstream medicine (sworn to uphold the Hippocratic Oath) turned into killers (1).  Yes, medical ethics in Nazi-era medical school curricula existed, yet included “unequal worth of human beings, authoritative role of the physician, and priority of public health over individual-patient care”(2).  In Western Galilee College, (Akko), Bar-Ilan University Faculty of Health Sciences (Safed), and Galilee Medical Center and Ghetto Fighters’ Museum, (both in Nahariya), historians, physicians, nurses, medical and university educators, medical students, ethicists and more gathered to grapple with this history and consider how learning about medicine in the Holocaust can support healthy professional identity formation with a moral compass for navigating the future of medical practice with issues such as prejudice, assisted reproduction and suicide, resource allocation, obtaining valid informed consent, and challenges of genomics and technology expansion (3)…

The conference, in essence, served as a lens for the here and now, reinforcing my contention (and others’) that history of medicine in the Holocaust curricula including confronting the Nazi physicians’ and scientific establishment’s euthanasia of “lives unworthy of life,” forced sterilizations, horrific experimentation on their victims, and medicalized genocide (leading to the destruction of a third of the European Jewish population and many others) is a “moral imperative” in healthcare professions education (1,4).

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

UpToDate – Legal Aspects in Palliative and End of Life Care in the United States

I am delighted to contribute to UpToDate, starting with “Legal Aspects in Palliative and End of Life Care in the United States.”


UpToDate is an evidence-based clinical decision support resource which clinicians trust to make the right point-of-care decisions. More than 6,500 world-renowned authors, editors, and peer reviewers use a rigorous editorial process to synthesize the most recent medical information into trusted, evidence-based recommendations that are proven to improve patient care and quality. 


Over 1.3 million clinicians in 187 countries and nearly 90% of major academic medical centers in the United States rely on UpToDate to provide the best care. More than 80 research studies confirm widespread usage of UpToDate and the association of its use with improved patient care and hospital performance — including reduced length of stay, fewer adverse complications, and lower mortality.


UpToDate is a product of Wolters Kluwer Health.  I co-author a related publication for Wolters Kluwer Law and Business: the 1500-page reference Right to Die: The Law of End-of-Life Decisionmaking.

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.