Tag: private hospitals

Bioethics Blogs

Texas Advance Directives Act – Broad Alliance Files Amicus Brief Defending TADA Constitutionality

Kelly v Methodist Hospital challenges the constitutionality of the Texas Advance Directives Act. The case is getting ready for trial in Harris County District Court.


At the end of July, a broad alliance submitted a 28-page amicus brief on behalf of the defendant. The amici include:

  • TEXAS ALLIANCE FOR LIFE
  • TEXAS CATHOLIC CONFERENCE OF BISHOPS
  • TEXAS BAPTIST CHRISTIAN LIFE COMMISSION
  • TEXANS FOR LIFE COALITION
  • COALITION OF TEXANS WITH DISABILITIES
  • TEXAS ALLIANCE FOR PATIENT ACCESS
  • TEXAS MEDICAL ASSOCIATION
  • TEXAS OSTEOPATHIC MEDICAL ASSOCIATION
  • TEXAS HOSPITAL ASSOCIATION
  • LEADINGAGE TEXAS

I will make just two observations about the brief.


1.  The amici argue that there is no state action, because clinician and hospital use of TADA is completely voluntary. They may but need not use TADA. On the other hand, the amici concede that similar process based approaches in other states “had little practical effect” because of the threat of liability. Consequently, they concede that TADA’s provision of safe harbor immunity really did change clinician and hospital behavior. Texas clinicians and hospitals would not withdraw life-sustaining treatment without consent BUT FOR the immunity conferred by TADA.


2.  Since the 1970s, numerous appellate courts (e.g. Quinlan) have held that all sorts of medical treatment issues can and should be handled by hospital committees. But these judicial opinions are very clear that conflicts and disputes should still go to court. Since TADA authorizes hospital review committees to adjudicate life and death disputes, these committees are exercising a judicial function. That is state action sufficient to make constitutional requirements apply to private hospitals like Methodist Houston.

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 bit of a compromise’: Coming to terms with an emergency caesarean section by Terena Koster

During the midwife-hosted antenatal class Cath attended in a private hospital in Cape Town, South Africa, where she would eventually give birth, pregnant women were encouraged to name the kind of birth they wanted. They were presented with three options: “natural all the way with no medication”, “natural but open to medication”, or “elective caesarean”. The ‘choice’ women were expected to make featured as an important point of concern in their antenatal care and in their preparations for birth.

Hannah, a participant in the class, recalls a particularly striking moment when the midwife went around the room and pointed at each of the participants and asked, “Who is your gynae”. She went on to predict diverse birth outcomes, irrespective of participants’ stated intentions to birth vaginally. For Hannah this was an “eye opening” experience. A first time mother, she was now invited into a highly politicised birthing environment. Hannah had been uncertain about what kind of birth she wanted, but at 8 months pregnant she had decided on a ‘natural’ birth as opposed to a ‘caesarean’, with the caveat that in the event that an emergency caesarean section was a likely outcome, she would proactively opt for an elective caesarean.

At 39 weeks and near the end of her pregnancy, she found herself sitting opposite her obstetrician who told her there was “a real threat of the umbilical cord wrapping around [the baby’s] neck as she … drop[s] down,” adding that because the baby was “so big” there was “a high likelihood of [Hannah] tearing”. For the first time, the obstetrician instructed her to make a birthing decision: to continue trying for a vaginal birth or to opt for an elective caesarean section.

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

UK report on prenatal testing calls for ban on sex disclosure

A new report by the UK’s Nuffield Council on Bioethics, “Non-invasive prenatal testing: ethical issues”, has probably pleased no one by trying to steer a course between banning abortions for sex-selection and allowing abortions for the most common kind of foetal abnormalities.

NIPT is a major breakthrough. It uses a blood sample taken from the pregnant woman and can be done from 9 or 10 weeks of pregnancy. It analyses DNA from the placenta that circulates in the woman’s blood to estimate the chance that the fetus has Down’s, Edwards’ or Patau’s syndromes, as well as single-gene disorders like cystic fibrosis and achondroplasia. It can also determine its sex.

The test is currently available in the UK through private hospitals and clinics, and in some NHS (ie, public) hospitals. Last year, the UK Government announced that from 2018, the NHS will offer NIPT to pregnant women who have been found through initial screening to have at least a 1 in 150 likelihood of having a fetus with Down’s, Patau’s or Edwards’ syndromes.

The report says that NIPT should lead to fewer false results and fewer diagnostic tests, which carry a small risk of miscarriage. In the case of Down syndrome fetuses, 200 more would be identified (with 90% or more being aborted) and 17 fewer miscarriages of healthy foetuses because of invasive tests.

In addition, the Nuffield Council calls for a moratorium on the use of NIPT in sequencing the whole genome of fetuses; it wants a ban on its use in finding out the sex of the fetus because that would lead to sex-selective abortion.

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

Beyond Miracles: How Traditional Chinese Medicine Establishes Professional Legitimacy in Post-colonial Macau by Loretta I.T. Lou

[Editor’s Note: An earlier version of this article appeared in Imponderabilia: The International Student Anthropology Journal (2014). This piece is updated with new data and photos collected between 2015 and 2016.]

In Search of Reclusive Doctors (xunzhao yin shi yishu) was the first Chinese TV documentary about medical miracles “made” by doctors of traditional Chinese medicine (TCM). When it was first broadcasted in 2001, it evoked great public interest in the Pearl River Delta region. In exalting the Chinese doctors’ miraculous power to save people on their deathbeds, the documentary paradoxically placed great emphasis on the scientific validity of TCM and folk medicine. In line with this, Mei Zhan’s ethnographic study of TCM doctors in Shanghai and San Francisco also found that the legitimacy of traditional Chinese medicine is built upon its ability to treat difficult cases (Zhan 2001:454). She argues that TCM doctors have used “miracle-making” to “craft a niche for traditional Chinese medicine within a biomedicine-centered health care system. The everyday practice and discourse of traditional Chinese medicine has come to be a site for the ‘production of the extraordinary’” (Ibid).

In an environment where TCM is in fierce competition with biomedicine, it is understandable that some TCM practitioners feel they have to establish their legitimacy through miracle-making. However, my research in Macau suggests a different story. A former colony of Portugal (1557-1999), Macau was returned to the People’s Republic of China in 1999 and is now a Special Administrative Region (SAR) of the PRC. Although Macau had the first Western-style hospital in Asia, it was not until 1984 when the Macau-Portuguese government finally reformed its health care system and established a public health network composed of a government hospital and a dozens of community health centers.

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

1000 Risks and Birth-and-Death in Cape Town by Kathleen McDougall

“I was willing to die,” Terri told me, “I just didn’t want to have another caesarian.” She referred to her vaginal birth after three c-sections (a VBA3C), which took place at home, since no Cape Town hospital would allow her what is termed a trial of labour – an attempt at vaginal birth – for fear of uterine rupture. It is widely agreed that the risks for planned VBACs are far less than that of planned repeat c-sections (RCOG 2015; Curtin et al 2013). Yet, all the obstetricians that Terri consulted in this pregnancy and the last two (in both the public and private healthcare sectors) preferred planned c-section risks to the risk of uterine rupture. One doctor told her that waiting for spontaneous onset labour was like running blindfolded across a busy freeway. Terri came to disagree profoundly with the doctor’s risk assessment. Now, most medical caregivers agree that the risks are far higher for VBACs taking place at home, not because there is a greater risk of uterine rupture at home, but because in that extremely rare case it may take too long to reach an operating theater. However, Terri could not find a hospital that was willing to support her attempt at a VBA3C. In addition, at a previous attempt at a VBAC in a private hospital, Terri was only allowed to labour for seven hours before being told she must have a repeat c-section. This time, with her husband’s wholehearted support, she prepared carefully for home birth, where she would have more control.

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

India’s Organ Deficiency: How Struggle for Second Chance at Life Gets Extremely Difficult

May 16, 2016

(The Economic Times) – While statistics show donations are not nearly enough to meet the requirements, the issue is not just about getting more people to donate organs. The country needs to gear up its infrastructure to address shortages and also prevent wastage of organs that do get donated, said transplant specialists as well as government and non-government organisations. Cost is prohibitive in private hospitals and government hospitals often don’t have the facilities or trained manpower.

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

Remedies for South Korea: Stopping MERS Before it Starts August 11, 2015 Although the respon…

August 11, 2015

by Seunghye Chai, Bioethics Program Student

On May 20, 2014, an outbreak of Middle East Respiratory Syndrome (MERS) was reported in South Korea. The outbreak was the largest to date outside the Middle East. South Korea’s governmental response was harshly criticized due to passive intervention and lack of a timely response. These criticisms arose because MERS is not a new disease. According to a report from the South Korean Ministry of Health and Welfare, “there have been a total of 1154 patients with MERS confirmed in 24 countries, including Saudi Arabia, 471 of which have died, after the first report of [MERS] breakout [in Saudi Arabia] in September 2012. Most of those patients were from Saudi Arabia and the United Arab Emirates, and the others mainly involved cases of the infection while traveling in Saudi Arabia.”

Keiji Fukuda, a World Health Organization official, identified several factors contributing to the extent of the outbreak when he visited South Korea:

●   South Korean doctors’ unfamiliarity with MERS;

●   The country’s “overcrowded” emergency rooms;

●   The practice of “doctor shopping” for care at many different clinics; and

●   The fact that hospital rooms tend to be bustling with visitors.

It’s no surprise that nearly all of the country’s confirmed MERS patients were infected while seeking care or visiting patients at hospitals. There were several clinicians who were infected as well.

Many of the factors Fukuda identified will be difficult to change because they are cultural or beyond the control of public health officials.

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

WHO alarmed by C-section rise

There is no evidence that a Caesarean section rate of more than 10% saves the lives of mothers or babies, says the World Health Organization. In a new statement it recommends that C-sections be performed based only on the needs of the patient, rather than focusing on target rates.

Caesarean section is one of the most common surgeries in the world, with rates continuing to rise, particularly in high- and middle-income countries. In the US, about one in three women gives birth via C-section. In Brazil more than half of all births are C-section, with rates rising to 80% in private hospitals.

However, WHO says that there is no evidence showing the benefits of caesarean delivery for women or infants who do not require the procedure. As with any surgery, C-ections are associated with short and long term risk which can extend many years beyond the current delivery and affect the health of the woman, her child, and future pregnancies. These risks are higher in women with limited access to comprehensive obstetric care.

Since 1985, the international healthcare community has considered the “ideal rate” for caesarean sections to be between 10% and 15%. New studies reveal that when caesarean section rates rise towards 10%, the number of maternal and newborn deaths decreases. But beyond that mortality rates do not improve.

“These conclusions highlight the value of caesarean section in saving the lives of mothers and newborns,” says WHO’s Marleen Temmerman. “They also illustrate how important it is to ensure a caesarean section is provided to the women in need – and to not just focus on achieving any specific rate.”

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

Medical Profession Losing Its Aura of Sanctity with the Rising Cases of Malpractice and Negligence

(Business Insider) – Even the best private hospitals are prone to medical negligence so the percentage of error in government run hospitals is much higher. Often cases are not reported, for either the patient is unaware of the medical malpractice and or does not have resources to fight the system. Studies have shown that compared to USA, India has almost double the number of cases of medical malpractice.

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

CRISIS ETHICS: Hope for the best, prepare for the worst

by Craig Klugman, Ph.D.

An Ebola epidemic rages through Western Africa. Civil unrest and terrorist turmoil rocks Syria/Iraq, Libya, Israel/Gaza, and Ferguson, Missouri. A 6.1 earthquake damages Napa and shakes the entire San Francisco Bay Area. All of these events are examples of crisis—a catastrophic disaster (natural or human-made) that disrupts the regular operating of a region.

In terms of health, a crisis is a “state of being that indicates a substantial change in health care operations and the level of care than can be delivered in a public health emergency, justified by specific circumstances” (IOM, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response 2012). In other words, these are situations that strain the ability of the health care system to provide needed treatment to all patients. An epidemic of a deadly disease, civil unrest (whether because of invasion, terrorism, or uprising), and natural disasters are all situations where the regular infrastructure collapses and the ability to provide a regular standard of care is compromised threatening high rates of morbidity and mortality as well as a shortage of supplies and personnel.

In 2013, the Institute of Medicine released its third report on crisis preparedness and management: “Crisis Standards of Care: A Toolkit for Indicators and Triggers” is a framework for states and cities to develop plans for dealing with mass casualty situations. The IOM program requests conversations between and among state and local governments, EMS programs, hospitals, care systems, and the public for planning in the event of crisis.

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.