Tag: patients

Bioethics Blogs

A Surprising Way Health Insurance Might Save Your Life

Rep. Raul Labrador (R-ID) speaks with members of the media at Trump Tower December 12, 2016 in New York. / AFP / KENA BETANCUR (Photo credit should read KENA BETANCUR/AFP/Getty Images)

Back in May, an angry constituent asked Congressmen Raul Labrador why he voted for the Republican House Healthcare Bill, that the constituent claimed would cause people to die for lack of Medicaid funding. The Freedom Caucus member shot back with a now infamous retort: “Nobody dies because they don’t have access to healthcare.” Amidst backlash over what he now describes as an inelegant statement, Labrador tried to clarify his remarks: “I was trying to explain that all hospitals are required by law to treat patients in need of emergency care regardless of their ability to pay, and that the Republican plan does not change that.”

But Labrador forgot to mention that, although hospitals are required to treat emergently ill patients regardless of ability to pay, they are also allowed to bill those patients for that care. That means people without insurance often find themselves either avoiding emergency rooms altogether, or driving long distances to hospitals known for being more forgiving of medical debt. Labrador overlooked the life-threatening risks that financially strapped people take to keep out of medical debt.

Insurance sometimes saves lives by enabling people to get emergency care close to home, without fear of financial insolvency.

This travel-and-die phenomenon is not what most insurance enthusiasts think about when they say insurance improves health. Instead, they talk about how insurance makes people more likely to receive the primary care that prevents life threatening illnesses – mammograms and colonoscopies; blood pressure pills and flu shots.

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

Calling Nurse A ‘Hero,’ Utah Hospital Bars Police From Patient-Care Areas

September 5, 2017

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“Law enforcement who come to the hospital for any reason involving patients will be required to check in to the front desk of the hospital,” said chief nursing officer Margaret Pearce of the University of Utah Hospital. “There, a hospital house supervisor will meet the officers to work through each request.”

Hospital officials say they created the policy one day after the July incident in which nurse Alex Wubbels refused to allow a police investigator identified as Jeff Payne to get a blood sample from a patient who was injured in a deadly collision with another driver. Wubbels was following the hospital’s policy (and a recent Supreme Court decision) that requires either a warrant, the patient’s consent, or the patient being under arrest for such a sample to be obtained legally.

Last year, the Supreme Court ruled that the Fourth Amendment bars blood tests from being obtained without a warrant in drunk-driving cases.

… Read More

Image: By UofUHealthCare at English Wikipedia, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=56696604

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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 Neuroethics Blog Series on Black Mirror: White Bear

By Kristie Garza
Image courtesy of  Wikimedia Commons.

Humans in the 21st century have an intimate relationship with technology. Much of our lives are spent being informed and entertained by screens. Technological advancements in science and medicine have helped and healed in ways we previously couldn’t dream of. But what unanticipated consequences of the rapid expansion into new technological territory? This question is continually being explored in the British sci-fi TV series Black Mirror, which provides a glimpse into the not-so-distant future and warns us to be mindful of how we treat our technology and how it can affect us in return. This piece is part of a series of posts that discuss ethical issues surrounding neuro-technologies featured in the show and will compare how similar technologies are impacting us in the real world. 



*SPOILER ALERT* – The following contains plot spoilers for the Netflix television series Black Mirror. 

Plot Summary


“White Bear” begins with Victoria, the episode’s main character, awakening in an unfamiliar room in front of a TV displaying an unfamiliar symbol. She has no memory of who she is or how she wound up in the room.
Afraid, Victoria begins to explore her outside surroundings, where she finds “onlookers,” individuals in a trance-like state, filming her with their phones. A masked man then appears and begins chasing Victoria. While fleeing, she meets Jem, a fellow individual not under the trance. Jem explains to Victoria that the onlookers were put in their trance due to the strange symbol on the screens and that the masked man is a “hunter,” part of an evil people not affected by the strange symbol.

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

‘Being a burden’: a illegitimate ground for assisted dying

The issue of the legality in England and Wales of physician-assisted suicide has recently been revisited by the Court of Appeal. Judgment is awaited. The judgment of the Court of Appeal, granting permission for judicial review, is here.

The basic issue before the Court of Appeal was the same as that in Nicklinson v Ministry of Justice and R (Purdy) v DPP: does the right to determine how one lives ones private life (protected by Article 8 of the European Convention on Human Rights)  confer a right to have an assisted death?

Many factors have been said to be relevant to decisions about assisted dying. They include are intractable pain (rather a weak criterion, given modern palliative methods), hopeless prognosis – likely to result in death in a short time, and simple autonomy (‘It’s my right to determine where, when, and in what circumstances I end my life, and that’s an end of the matter’). One factor, commonly in the minds of patients asking for help in ending their lives, but rarely mentioned by advocates of assisted dying, is that the patient feels that she is a burden to her family and carers.

A recent systematic review of the literature concluded that 19-65% of terminally ill patients felt that they were a burden to others.  The 2016 Report relating to the Oregon Death with Dignity Act  concluded that 48.9% of patients whose lives were ended under the Act cited seeking an assisted death cited ‘being a burden’ as one of their concerns.

Concern about being a burden should not be a criterion to which any law relating to assisted dying should be permitted to have regard.

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

FDA recall of pacemaker raises questions about cybersecurity

by Karola Kreitmair, PhD

The FDA has issued a recall of 465,000 pacemakers on the grounds that they are vulnerable to hacking. It was discovered that unauthorized users could remotely access the implanted cardiac device and modify its programming, thereby delivering inappropriate shocks or rapidly draining the battery. In effect, a nefarious actor could hack into the very thing tasked with sustaining someone’s life and turn it into the device that kills them.

Now, luckily, patients with affected pacemakers do not need to have the device removed, an in-office software update suffices, and there have been no reports, so far, of anyone being harmed. But it does provide a poignant reminder that allowing cyber-vulnerable technology into our lives and into our bodies comes with serious risks and drawbacks. Beyond pacemakers, individuals rely on an array of wearable devices to monitor and control their health, such as wearable EMG devices to monitor seizures, or wearable patches to deliver personalized medication transdermally. A much broader group of people uses personal technology to enhance their wellbeing through devices such as fitness trackers, sleep trackers, or mental health apps. Moreover, with the internet of things (IoT), technologies are now more interconnected than ever, with cyber pathways opening up between smart household appliances and personal medical devices, via the central role of the smartphone. This makes us vulnerable not only to hackers interfering with the programming of devices, with the possibility of deadly consequences, but also to the massive theft of highly sensitive data.

We should enter into the personalized health and wellness technology era with eyes wide open.

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

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 – August 2017 by Livia Garofalo

Here is the article round-up for August, put together in collaboration with Ann Marie Thornburg.  There is a special issue section of Social Science and Medicine out this month on Austerity, Health, and Wellbeing (abstracts below). Also of note is a recent ‘Takes a Stand’ statement on the End of AIDS published in Global Public Health by Nora Kenworthy, Richard Parker, and Matthew Thomann. You can take advantage of the article being temporarily free access and on early view here. Enjoy!

 

Cultural Anthropology (Open Access)

Tangles of Care: Killing Goats to Save Tortoises on the Galápagos Islands

Paolo Bocci

If calls to care for other species multiply in a time of global and local environmental crisis, this article demonstrates that caring practices are not always as benevolent or irenic as imagined. To save endemic tortoises from the menace of extinction, Proyecto Isabela killed more than two hundred thousand goats on the Galápagos Islands in the largest mammal eradication campaign in the world. While anthropologists have looked at human engagements with unwanted species as habitual and even pleasurable, I discuss an exceptional intervention that was ethically inflected toward saving an endemic species, yet also controversial and distressing. Exploring eradication’s biological, ecological, and political implications and discussing opposing practices of care for goats among residents, I move past the recognition that humans live in a multispecies world and point to the contentious nature of living with nonhuman others. I go on to argue that realizing competing forms of care may help conservation measures—and, indeed, life in the Anthropocene—to move beyond the logic of success and failure toward an open-ended commitment to the more-than-human.

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

An ‘Army Of People’ Helps Houston Cancer Patients Get Treatment

September 1, 2017

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As rains pounded Houston on Sunday, Dr. Karen Lu took to Twitter and conveyed both alarm and reassurance: “Roads around @MDAndersonNews impassable. Our on-site ride out team is caring for patients and we are all safe.

Lu is a professor of gynecologic oncology and interim chief medical officer at the University of Texas MD Anderson Cancer Center, a top cancer hospital and research center. Earlier that morning, the hospital had sent a high-water vehicle — a box truck — to Lu’s neighborhood, and she walked eight blocks through flooded streets to meet it.

The storm forced the hospital to close to outpatients. Surgeries, chemotherapy and radiation treatment and other appointments were put on hold for the 13,000 people MD Anderson sees each week.

Inside the hospital, doctors, nurses, technicians and facilities and food service staff were keeping things running for more than 500 inpatients and their families.

Lu spoke to Morning Edition host Mary Louise Kelly as the hospital was shifting into recovery mode Thursday.

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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

Abortion pills at home: the new sinister face of the global abortion business

Dutch website “Women on web” is offering to deliver abortion drugs based on mifepristone (RU-486) and misoprostol for use at home, through a simple request on their website (there are lots of sites like this, after which they ask for “a donation of at least 90, 80 or 70 euro”. The website literally states that “a medical abortion can be done safely at home as long as you have good information and have access to emergency medical care in the rare case that there are complications”. Both drugs legally require a medical prescription, so their sale on the internet is illegal.

Abortion pills at home

A woman who feels tempted to make an “abortion” request on this site should know that the side effects of RU-486 are common and objective (see HERE), particularly vaginal bleeding, abdominal pain, nausea, vomiting and fatigue [2]. In some cases, the intensity of the vaginal bleeding requires a blood transfusion  [3], [4]. A total of 607 adverse events were reported between September 2000 and September 2004 : 237 hemorrhages, which included 1 fatal, 42 life-threatening, 168 serious, and 68 requiring blood transfusions; 66 infections, which included 7 cases of septic shock, 3 of which were fatal while 4 were life-threatening; 513 patients required a subsequent secondary surgical intervention, 235 urgent and 278 non-urgent. The need to have a surgical abortion after failure of the chemical abortion can be considered a side effect, and occurs in between 1% and 10% of cases. This second surgical intervention can increase the risk of permanent sterility http://journals.sagepub.com/doi/pdf/10.1345/aph.1G481a.

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 FDA Approves a Landmark Cancer Drug

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The Food and Drug Administration on Wednesday approved a new therapy to treat leukemia in kids and young adults—a decision whose importance is as much symbolic as it is practical.

Kymriah, from the Swiss pharmaceutical company Novartis, is a cancer therapy that represents several things at once: a game-changing way to treat cancer through genetic engineering, a novel paradigm for the biotech business, and the latest turn in the debate over just how astronomically expensive a life-saving therapy can be.

Kymriah is strikingly effective for young patients with acute lymphoblastic leukemia, or ALL, but it is far more involved than taking a pill or getting an infusion. It requires inserting a human-designed gene into a patient’s own T cells so they recognize and ferociously attack cancer cells. Researchers began modifying T cells for patients in the 1990s—and now the technology called CAR T-cell therapy is finally ready for prime time in treating cancer.

Of several dozen ALL patients in a clinical trial for Kymriah, 83 percent were cancer-free after three months. It is a lifeline for patients in which traditional treatments like chemotherapy and bone-marrow transplants had failed. When the FDA’s advisory committee initially voted in favor of approving Kymriah, one member called it “the most exciting thing I’ve seen in my lifetime” for childhood leukemia. Novartis is hardly the only company interested in CAR T. Kymriah is the first approved therapy, but several clinical trials—mostly notably Kite Pharma’s for lymphoma—are right behind it.

(To clear up any possible confusion about terminology: The FDA and others have chosen to call CAR T-cell therapy a form of gene therapy—and thus deemed it the first gene therapy to be approved in the United States.

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.