Tag: public hospitals

Bioethics Blogs

Why Doctors Treat the Dying, Even When They Know It’s Futile

If a patient is dying, and you know treatment won’t help, do you still treat anyway?


Professor Lindy Willmott, from the Australian Centre for Health Law Research, set out to discover why most doctors still do. She reported research results at the Australian and New Zealand College of Anaesthetists (ANZCA) conference this week.


Willmott carried out a survey of 96 doctors and medical staff in Queensland public hospitals to help understand why unnecessary treatment was happening.


Here are a few of the responses:


“Doctors felt it difficult to not offer something because it made them feel as if they weren’t doing their job.” 


“The default is to keep treating.” 


“You do a procedure because it can be done, even if it doesn’t change the outcome.” 


“Doctors who are under time pressure might find that [continuing treatment] is the path of least resistance.”

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

Why Doctors Treat the Dying, Even When They Know It’s Futile

If a patient is dying, and you know treatment won’t help, do you still treat anyway?


Professor Lindy Willmott, from the Australian Centre for Health Law Research, set out to discover why most doctors still do. She reported research results at the Australian and New Zealand College of Anaesthetists (ANZCA) conference this week.


Willmott carried out a survey of 96 doctors and medical staff in Queensland public hospitals to help understand why unnecessary treatment was happening.


Here are a few of the responses:


“Doctors felt it difficult to not offer something because it made them feel as if they weren’t doing their job.” 


“The default is to keep treating.” 


“You do a procedure because it can be done, even if it doesn’t change the outcome.” 


“Doctors who are under time pressure might find that [continuing treatment] is the path of least resistance.”

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

Costa Rica’s resistance to legal IVF crumbles

Ronald Reyes/The Tico Times    

A girl named Maria José has become the first IVF baby to be born in the Central American nation of Costa Rica. Her parents, Jenny Garbanzo y José Barana, had been lobbying for the right to access IVF in Costa Rica since 2007. However, under a ruling by the Supreme Court in 2000, IVF was banned because it resulted in the destruction of embryos. It took substantial international pressure to force the government to give in.

The first IVF procedures were carried out in middle of last year at two certified private clinics.

The Inter-American Court of Human Rights (IACHR) has also ordered the government to make IVF available at public hospitals. Construction of a public fertility clinic is scheduled to begin in August next to the National Women’s Hospital, near the Costa Rican capital of San José. The government is also funding overseas training of IVF specialists from Costa Rica for the clinic. The first procedures in public hospitals will begin in 2018. 

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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

Kenya’s Public Doctors to End 100-Day Strike That Saw Deaths

March 14, 2017

(ABC News) – Thousands of doctors at Kenya’s public hospitals have agreed to end a 100-day strike that saw people dying from lack of care, an official with the doctors’ union said Tuesday. The strike was blamed for dozens of deaths, as the majority of Kenyans cannot afford private health care. The government and union officials signed a deal to address pay and other issues in dispute, said Dr. Ouma Oluga, the secretary-general of the Kenya Medical Practitioners, Pharmacists and Dentists Union.

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 ‘P’ Word: Hospital Ethics Committees and Palestinian National Identity by Guy Shalev

Anthropologists like to tell their stories of ‘entering the field,’ whether they are left alone on a tropical beach as their dinghy sails away (Malinowski 1922) or run away from the police into a local’s courtyard (Geertz 1973). These stories are often told to show us, their readers, the distance anthropologists must travel from their own worlds into those of their research subjects. If stories traditionally fall within the thriller or adventure genres, my own is rather more Kafkaesque. And much like the stories from The Trial and The Castle, it is more about the system in which my interlocutors and I live than our own personal stories.

It took me more than six months to get my research with Palestinian physicians approved in two large Israeli hospitals. In a third hospital my access was denied. My ‘entry story’ is thus about my repeated attempts to obtain the approval of three Helsinki Committees (HCs, Israeli hospitals’ research ethics committees) to conduct ethnographic research with Palestinian physicians in Israeli public hospitals. While my research was eventually approved in two of these institutions, correspondence with HC representatives, as well as evidence of their informal moves with institutions’ management, reflect their perceptions of the risk my study posed.

I had already passed the University of North Carolina’s meticulous ethical approval process, and so the very different response of Israeli committees left me bewildered. Had the UNC’s committee overlooked important risks? In fact, the discrepancies between these committees calls into question the very idea of a universal ethical code of research conduct, as the 1964 Declaration of Helsinki aimed to establish.

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

“European” health care not a “fix” for Canada

Colleen M. Flood and Bryan Thomas discuss the current legal challenge before the BC Supreme Court about whether public medicare violates the Charter by forcing patients onto long wait lists.

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The plaintiffs in the hearings that have begun at the BC Supreme Court – led by Dr. Brian Day of Cambie Surgery Centre (a private clinic in Vancouver) – want the court to overturn three laws: the law that stops the sale of private health insurance for medically necessary care; the law against dual practice that prohibits physicians from working in both the public system and the private sector; and the law against extra-billing so that physicians can charge whatever they wish for the care they provide, whether in public hospitals or in private clinics.

Those involved in the Cambie legal challenge argue that many western “European” health care systems have ‘two-tier’ health systems that are the envy of the world. If only Canada would allow greater private payment, they say, the invisible hand of the market would lead us to join their ranks.

Unfortunately, it’s not that simple.

For a start “Europe” is not one model of health care financing, but a variety of significantly different models.  Proponents of Canada adopting a “European” model never tell us if it’s the French, Irish, English, Dutch, German, or Italian model we are meant to be following. Moreover, while Canada is somewhat unique in its approach to enacting laws that restrict private payment, these other countries limit private payment by other means.

In England, for example, instead of fee-for-service, specialists working in the public system are salaried and contractually bound to a full-time forty-hour work schedule.

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

Musings on the Materiality of Health Care by Cristina A. Pop

Nightstand in a psychiatry hospital from Alba-Iulia, Romania. The picture was taken by Odeta Catana in November 2014, as part of a project initiated by the Center for Legal Resources. Reproduced with permission.

In October of 2014, Romanian mass-media featured the local story of a few dozen citizens—most of them Orthodox nuns—refusing their newly issued state health insurance cards, on the grounds that the term card imprinted on the card would spell, when read backwards, drac—the Romanian word for “devil.” It seemed that the nuns, along with a few Orthodox priests and monks and other laymen, rejected the cards because they saw in them instruments of population control imbued with malefic powers. In their view, anyone who would accept the biometric chip-enabled health insurance card would bear the “mark of the beast,” as prophesied in the Christian Book of Revelation. “The beast” would be the computerized data system of global surveillance, whose ultimate aim is to strip humans of their God-bestowed freedom.

Upon reading this news, I was not necessarily astonished by the fact that a narrow demographic group would express such apocalyptically articulated anxieties when facing the biopolitical regimes of health care provision. In Romania, as elsewhere, fundamentalist Orthodox websites disavow various biomedical procedures—like vaccination—on similar grounds, by equating them with receiving “the mark” and by evoking the millennialist opening of the seals that precede the coming of the Antichrist. What did surprise me was the backwards reading of the word card as drac. Why would someone read anything backwards? And how does one get the idea of reading in reverse in the first place?

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

If You Get Sick at the Olympics, Don’t Expect a Private Hospital Room

August 3, 2016

(STAT News) – When the Olympics kick off Friday, ailing athletes will go to a sparkling new clinic built just for the games. Sick tourists, meanwhile, will be sent to a public hospital whose cramped communal quarters may come as a surprise. Municipal Hospital Souza Aguiar, housed in a gloomy 1960s building in downtown Rio de Janeiro, is one of five public hospitals officially designated to accept Olympic tourists. Spectators who attend the opening and closing ceremonies — as well as other sports in the Maracanã Olympic Zone, including soccer, track and field, and archery — will be directed to Souza Aguiar.

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

Nurse ignites debate over euthanasia in Portugal

The head of Portugal’s national nurses’ association has blown the whistle on covert euthanasia in public hospitals. Ana Rita Cavaco told a radio program that she personally had heard doctors discussing the topic.

She declared on the Catholic station Rádio Renascença, that euthanasia “is sometimes practiced in the health service hospitals, with doctors suggesting this solution for some patients”.

“I have personally witnessed such situations – I don’t need to look for further other examples. I have seen cases where doctors have suggested administering insulin to induce an insulin coma. I am not going to shock anybody as everyone who works in the health service knows these things happen out of sight and sound, so let’s talk about it openly.”

She gave no details, but the mere suggestion was enough for Portugal’s national medical association to demand that she be prosecuted for alleging that doctors were participating in an illegal activity. The association declared that Portuguese should have complete confidence in doctors.

These statements can not be passed over in silence with the swiftness with which they were uttered. They are libellous and undermine the dignity of doctors and nurses, so it must be proven or clearly and formally denied”.

The Health Ministry has ordered an urgent inquiry into the allegations.

The controversy comes at a sensitive time in Portugal as Parliament will probably debate euthanasia later this year, after a high-profile petition secured enough signatures to bring the matter before the legislature. 

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This article is published by and BioEdge under a Creative Commons licence.

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

Pharmaceutical Prosthesis and White Racial Rescue in the Prescription Opioid “Epidemic” by Helena Hansen

Introduction

A U.S. public discourse of addiction as a disabling psychiatric condition (as opposed to a moral flaw or social deviancy) was codified into Social Security policy in 1972, following its emergence in post-war clinical science and popular media (Conrad & Schneider, 1980; Duster, 1970). In recent years, this discourse has taken divergent forms in policy and media debates surrounding black and brown urban heroin users on one hand, and white suburban and rural prescription opioid users on the other. In both populations, efforts to decriminalize addiction led treatment advocates to rebrand it a disabling “chronic brain disease.” Whites, however, are imagined as in need of rescue within the gentle discipline of private medical offices, while brown and black heroin users are seen as in need of public discipline within federally-regulated methadone programs and/or the criminal justice system. Whether white, black, or brown, the U.S. social imaginary associates urban heroin use with violence and welfare dependency, inspiring public fear.

To quell the potential public dangers associated with heroin users, U.S. policies support what I am calling “pharmaceutical containment,” with adherence to multiple, sedating psychotropic medications a requirement to qualify for Social Security benefits. For white prescription opioid users, federal and state legislatures, pharmaceutical manufacturers, and community physicians have conjointly developed a new apparatus of private office opioid maintenance designed to rescue youth from “wasting their whiteness,” in line with a trope of white drug use as a tragedy of wasted potential as documented by analyses of popular media (Daniels, 2012). This apparatus of private clinical care endows them with “pharmaceutical citizenship” through which they have access to psychotropics that “bring the patient back into (middle-class consumer) society” (Ecks, 2005).

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.