Tag: physicians

Bioethics Blogs

How to make Nazi doctors

Most people who go into medicine have as at least part of their motivation the desire to help other people. I’m sure this was as true in 1930’s Germany as anywhere else. So how did a cadre of Nazi doctors come not only to commit crimes against humanity, but also to defend the moral correctness of their conduct when placed on trial for those crimes? The answer is complex, but one way was through the teaching of medical ethics.

An article in the April 18th Annals of Internal Medicine tells a cautionary tale for teachers and learners of bioethics. Entitled “Lectures on Inhumanity: Teaching Medical Ethics in German Medical Schools Under Nazism,” the article details how the Nazi party developed a curriculum for teaching ethics in medical schools that “was intended to explicitly create a ‘new type of physician’ . . . trained to internalize and then implement the Nazi biomedical vision . . . shifting the focus of ethical concern and medical care away from the individual patient and toward the general welfare of society or the people.” The curriculum included lectures in racial hygiene, the science of heredity, population policy, military medicine, and the history of medicine. Only long-standing members of the Nazi party were appointed lecturers. The lecturer at Berlin University, Rudolf Ramm, wrote the ethics textbook used in the curriculum, which emphasized physician paternalism in practicing their moral obligation to rid society of certain groups, and asserted that every (Aryan) person in Germany had a moral duty to stay healthy.

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 Blogs

Next Up: A Proposal for Values-Based Law Reform on Unilateral Withholding and Withdrawal of Potentially Life-Sustaining Treatment

Jocelyn Downie

The latest issue (54:3) of the Alberta Law Review is a special issue on health law.  


I plan to read several of the articles and already read this one:  “Next Up: A Proposal for Values-Based Law Reform on Unilateral Withholding and Withdrawal of Potentially Life-Sustaining Treatment.”


The unilateral withholding and withdrawal of potentially life-sustaining treatment presents a complex issue of law and public policy.  Jocelyn Downie, Lindy Willmott, and Ben White examine the current state of this practice and conclude that it is occurring, being challenged in the courts, and is treated differently in different jurisdictions. 


Downie, Willmott & White review the current state of the law in the United Kingdom, Australia, New Zealand, the United States, and Canada. The authors use Canada as a case study to outline a process for pursuing law reform. The authors propose a model for law and policy reform in this area that is both informed and shaped by the fundamental values of Canadian society.


Ultimately, the authors argue that physicians should NOT have unilateral authority to limit life-sustaining treatment.  Nicely, their vocabulary maps that in the 2015 ATS multi-society statement.  


I have had the pleasure of working with Downie, Willmott and White before and look forward to seeing them later this year in Halifax at the Second International Conference On End Of Life Law, Ethics, Policy, And Practice.

Source: bioethics.net, a blog maintained by the editorial staff of The American Journal 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

Clinical Research Ethics Question of the Month: April 2017

This month’s question places you in the FDA commissioner’s seat:

You are the Commissioner of the FDA. A friend has informed you of the following situation: Over 1,000 people with severe, refractive emphysema have banded together to test a drug that is approved for asthma but not emphysema. Participants “drew straws” to determine which of them would ask their physicians for a prescription. While the FDA has no authority over the practice of medicine, it does have authority over clinical studies that create generalizable knowledge.

The post Clinical Research Ethics Question of the Month: April 2017 appeared first on Ampersand.

Source: Ampersand, the blog of PRIM&R.

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

Blinded by the Promise of Stem Cell Treatments

Alan F. Cruess cautions against the use of unproven stem cell ‘treatments.’

__________________________________________

Recently, many of you may have read about three patients who are blind after receiving stem cell ‘treatments.’  The patients were ‘treated’ at a Florida clinic for age-related macular degeneration. This common eye condition is the leading cause of vision loss among people over the age of 50. The clinic harvested stem cells from the patients using liposuction and then injected these stem cells into their eyes. Again, these three patients, are now all blind as a result of this unproven ‘treatment.’

There are two types of age-related macular degeneration: ‘wet’ and ‘dry.’ In recent years, treatment of wet macular degeneration has been transformed by new drugs which can be very effective if they are applied early. Meanwhile, treatment of the more common dry macular degeneration remains elusive. As such, patients with dry macular degeneration may be desperate to prevent and reverse blindness and willing to try emerging regenerative therapies.

Some experimental stem cells treatments to prevent blindness are promising, and they are being studied worldwide in laboratories and highly regulated clinical trial settings. In these settings, the safety and efficacy of experimental treatments can be closely monitored. Yet, the safety and efficacy should be called into question when these so-called ‘treatments’ are marketed outside of the research context. This was the case at the Florida clinic.

Before subjecting oneself or a loved one to any new ‘treatment’ with stem cells patients should be informed about the risks and potential benefits of the proposed treatment.

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

United States commits to improve both physicians training and quality in palliative care

A system to prepare physicians to address this type of medical need that showed a significant improvement in the quality of life expected in patients with serious illnesses.

In 1998 in the United States, only 15% of hospitals with 50 beds or more had an official palliative care programme. By 2013, this percentage had risen to 67%, and today, 90% of hospitals with more than 300 beds now have this type of care. However, it appears that widespread training of physicians to address this type of medical need has not yet been realised.

Palliative care physicians training

For this reason, the United States wish to implement a system to prepare physicians, the Palliative Care and Hospice Education and Training Act, to improve both training and quality in palliative care. A budget of 49.1 US million dollars has been allocated to this end, which does not seem high for the improvement in the quality of life expected in patients with serious illnesses (See HERE).

Furthermore, a recent systematic review (See HERE) that evaluated the effects of palliative care on patients and caregivers using data from 12,731 patients (mean age 67 years) and 2,479 caregivers showed a significant improvement in patient quality of life in the 1 to 3 months after care began. However, no association was found between palliative care and survival.

The authors concluded that this meta-analysis shows a significant association between patient quality of life, although results were more inconsistent with respect to the caregivers, and no significant association was found between palliative care and patient survival.

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

Texas ‘Wrongful Birth’ Legislation

On March 21st, the Texas Senate passed SB 25, which eliminates “wrongful birth” as a cause of action for malpractice suits.  The text of the bill states, “A cause of action may not arise, and damages may not be awarded, on behalf of any person, based on the claim that but for the act or omission of another, a person would not have been permitted to have been born alive but would have been aborted. […]  This section may not be construed to eliminate any duty of a physician or other health care practitioner under any other applicable law.”

The bill’s supporters contend that the legislation “reverses a decades-old injustice and bad public policy that devalues babies, both unborn and born, who have a disability,” and removes pressure that physicians may feel to recommend abortions in order to preempt lawsuits.

However, opponents of the bill argue that it gives physicians the clearance to lie to patients about fetal health to prevent them from having an abortion. One activist argues that the legislation provides physicians the “opportunity to impose the religious beliefs on pregnant women by withholding information about the condition of their fetus and depriving them of making an informed decision about continuing with their pregnancy.”  The text of the bill, however, clearly precludes such a scenario.

In overturning wrongful birth precedent, this bill recognizes and defends the dignity of individuals with disabilities from the morally backwards concept of “wrongful birth.”

Source: bioethics.net, a blog maintained by the editorial staff of The American Journal 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

America’s Healthcare Price Problem

Want to know why we continue to spend so much more on healthcare than other countries? We have a price problem, one that experts predict will play a huge role in future healthcare spending:

If we want to reign in healthcare spending, we must go after high prices. That means taking on physicians, hospitals, pharma companies, device manufacturers…Any politicians ready to do that?

The post America’s Healthcare Price Problem appeared first on PeterUbel.com.

Source: bioethics.net, a blog maintained by the editorial staff of The American Journal 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

Hospice Fraud and Euthanasia

FisherBroyles summarizes recent federal prosecutions of healthcare fraud. There were 60 in 2015.  They break these cases into four types:

  1. Kickbacks paid to physicians and other healthcare providers for hospice referrals
  2. Recruiting hospice patients who are not medically eligible for hospice care
  3. Classifying patients as requiring a higher level of care than medically necessary
  4. Providing more treatment than medically necessary

Perhaps the most disturbing cases are those in which patients were recruited who were not even terminally ill.  For example, at the end of February, indictments were handed down against owners and clinicians at Novus and Optim in Texas.  


Among numerous other types of fraud, to justify the higher payments for continuous care, nurses gave high doses of drugs such as morphine, regardless of whether patients needed it.  In some instances, these excessive dosages resulted in death. (US Attorney, Northern District of Texas)

Source: bioethics.net, a blog maintained by the editorial staff of The American Journal 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.