Abstract Medical futility is commonly understood as treatment that would not provide for any meaningful benefit for the patient. While the medical facts will help to determine what is medically appropriate, it is often difficult for patients, families, surrogate decision-makers and healthcare providers to navigate these difficult situations. Often communication breaks down between those involved or reaches an impasse. This paper presents a set of practical strategies for dealing with cases of perceived medical futility at a major cancer center. Content (...) Type Journal Article Pages 1-8 DOI 10.1007/s10730-011-9168-3 Authors Colleen M. Gallagher, Section for Integrated Ethics in Cancer Care, Unit 1430, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX 77230-1402, USA Ryan F. Holmes, St. Louis University, St. Louis, MO, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

At the 2022 Clinical Ethics Unconference, the authors perceived a significant lack of racial and ethnic diversity, which was consistent with their experiences in other clinical ethics settings. As a result, they convened a working group to address the pervasive lack of diversity present in the field of clinical ethics and to propose strategies to increase the representation of people from racial and ethnic minority populations. This article identifies the harms associated with the lack of diversity in the healthcare setting (...) and translates these to the field of clinical ethics. The article then proposes a framework that may be used to help diversify the field of clinical ethics. Specifically, the authors identify existing barriers to appropriate diversity, actionable steps to increase diversity, and tools the field can utilize to systematically assess its progress with respect to achieving diversity. (shrink)

The American Journal of Bioethics, Volume 12, Issue 10, Page 47-49, October 2012.

The biopsychosocial model is characterized by the systematic consideration of biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery. This model opposes the biomedical model, which is the foundation of most current clinical practice. In the biomedical model, quest for evidence based medicine, the patient is reduced to molecules, genes, organelles, systems, diseases, etc. This reduction has brought great advances in medicine, but it lacks a holistic view of the person. To solve (...) the problem, we propose an early team based approach where the primary care physician leads a group of people that can help her/him address the psychosocial issues while she/he attends to the biomedical issues. This article addresses one case where the clinical ethicist facilitating a team based biopsychosocial model for the care of a patient worked as a bridge between the primary team, the critical care team, and the psychosocial team to advance the argument that good communication among the groups can lead to a true biopsychosocial model where the collaboration of the social worker, psychologist, chaplain, ethicist and the different medical teams can improve the overall patient experience. (shrink)

This case study details a request from a patient family member who calls our service without an articulated ethical dilemma. The issue that arose involved the conflict between continuing further medical interventions versus transitioning to supportive or palliative care and transferring the patient home. Beyond the resolution of the ethical dilemma, this narrative illustrates an approach to ethics consultation that seeks practical resolution of ethical dilemmas in alignment with patient goals and values. Importantly, the family’s suffering is addressed through a (...) relationship driven, humanistic approach that incorporates elements of compassion, empathy and dialog. (shrink)

La nueva enfermedad del coronavirus de 2019 (Covid-19), producida por el coronavirus del Síndrome Respiratorio Agudo Severo 2 (SARS-CoV-2), es una pandemia que está creando una creciente crisis sanitaria mundial, dada su novedad, su alcance y sus inicialmente limitadas opciones de tratamiento eficaz. En efecto, se sabe poco acerca de las intervenciones no farmacéuticas óptimas para evitar la morbilidad y mortalidad causadas por él, y también se conoce poco sobre la rentabilidad y aspectos éticos de dichas intervenciones. Por lo tanto, (...) éste es el primer análisis ético y de rentabilidad de las medidas de contención del Covid-19 que se conoce (así como de las medidas de cuarentena de la población para cualquier pandemia en particular), con el fin de ayudar a los sistemas de salud y a los gobiernos a garantizar la atención clínica más rentable que pueda proporcionarse equitativamente al mayor número posible de pacientes, durante esta pandemia y en las futuras crisis mundiales que sean similares. Este análisis utilizó la metodología adoptada por los Centros para el Control y la Prevención de Enfermedades (CDC), cifras comúnmente aceptadas como entradas, y los supuestos mínimos tanto extremos como del mundo real para proporcionar los resultados más sólidos y confiables posibles. El análisis de costos indicó que en los escenarios extremos, o en el mejor de los casos para las medidas de contención del Covid-19 durante la cuarentena de la población, hay una relación de costo-efectividad de $154.86 millones de dólares gastados por cada muerte evitada, y un costo neto de $1.92 billones a nivel mundial. En el mundo real, esta intervención tiene una proporción de 2,520 millones de dólares gastados por cada muerte evitada y un costo neto de 1,99 billones de dólares. La ética del contrato social personalista, tal y como se articula en el popular sistema ético de derechos y deberes de las Naciones Unidas, pone de manifiesto la especial preocupación por el hecho de que estos confinamientos pueden derivar en injusticias poco éticas perpetuadas por los Estados, de manera que socavan las vidas y las libertades individuales, al tiempo que afectan de manera des- proporcionada a las comunidades de menores ingresos, especialmente a las minorías raciales. Este estudio sugiere, por tanto, que la práctica prevalente de la cuarentena entre la población, en comparación con las precauciones de tipo estándar y las intervenciones más específicas, puede proporcionar un beneficio neto inadecuado por su costo financiero y ético. En un momento de escasez mundial, que pone a prueba la capacidad de los sistemas sanitarios para detectar y atender adecuadamente a los pacientes con Covid-19, especialmente en los países en desarrollo y en las comunidades desatendidas, este estudio respalda que se dediquen menos recursos a intervenciones con una relación costo- beneficio poco clara, y más recursos a intervenciones más asequibles, éticas y equitativas, con mayores pruebas de sus beneficios netos para salvar vidas. (shrink)

In 2006, a WHO survey found evidence of a substantial increase in patient-led litigation against health authorities and funders over access to medicines around the world. New Zealanders have seldom litigated denials of access to health care. Part of the explanation lies in the fact that New Zealand has a legislated patients' "bill of rights", with enforcement through a complaints mechanism. Although the separate regime does not afford patients substantive legal protection in respect of complaints about lack of access to (...) care, this form of alternative, low-level resolution of health care disputes does condition disgruntled patients not to turn to the courts for legal redress in relation to their rights. But given the increasing need for prioritization arising from serious concern about the sustainability of the public health system, as well as a trend towards greater explicitness when it occurs, increased disappointment on behalf of patients and the public when care is denied or limited seems inevitable. This may well translate into increased patient-led litigation against health boards and funders. Part 1 provides an overview of the New Zealand health system, with a focus on the points at which resource allocation decisions are made, the identity of the decision-maker, and the methods by which priority-setting occurs. Part 1.1 describes inequalities between population groups in New Zealand, both in health outcomes and in access to health care. Part 2 describes the legal framework surrounding the health and disability sector, and discusses the lack of legislated rights to health and the limited right of access to health care in legislation, despite the existence of a legally enforceable Code of Health and Disability Services Consumers' Rights. (shrink)

In their article “Racial Justice Requires Ending the War on Drugs,” Earp, Lewis, and Hart argue for the end of our War on Drugs in order to alleviate our reliance on mass incarceration, harm...

This purpose of this qualitative study was to gather detailed information about student perceptions of self-plagiarism and the perceived effectiveness of a brief self-plagiarism video tutorial. Semi-structured interviews were conducted and health sciences doctoral students were queried regarding their knowledge and perceptions of self- plagiarism. The population for this study was new doctoral students, as well as students who had committed self-plagiarism during the semester. Overall, participants reported a specific self-plagiarism intervention was more helpful in preventing self- plagiarism than a (...) traditional plagiarism intervention and that the intervention should be included in initial program orientation. Overwhelmingly, students did not believe self- plagiarism was a serious academic offense and think they own their intellectual property and unpublished works. (shrink)

It is easy to call for public engagement (or dialogue) around difficult, morally fraught policy topics such as synthetic biology, but it is quite another thing to make sure that the deliberation is meaningful, as Kaebnick, Gusmano, and Murray aptly insist it should be. The surveys, focus groups, and public dialogues that have been held about synthetic biology to date show a very low level of public knowledge about it. Focus group findings also suggest that the in­herent uncertainty and complexity (...) surrounding synthetic biology give rise to greater ambivalence moving forward. The Science and Technology Innovation Program at the Woodrow Wilson International Center for Scholars and Hart Research Associates presented respondents with a “balanced description” of synthetic biology in nation­wide phone surveys and eight sessions of focus groups and found that, after respondents received information, the percentage saying that the risks outweighed the ben­efits consistently increased.In my view, the Hart research suggests three very im­portant conclusions about how best to structure public deliberation. First, information about uncertainty may not inform the public in any meaningful way. Second, the purpose of assessing public opinion and conduct­ing public deliberation is crucially important. Third, as Kaebnick, Gusmano, and Murray point out, the type and framing of the information given and the timing of the discussion matters a great deal for shaping the content. (shrink)

Cognitive control constrains retrieval processing and so restricts what comes to mind as input to the attribution system. We review evidence that older adults, patients with Alzheimer's disease, and people with traumatic brain injury exert less cognitive control during retrieval, and so are susceptible to memory misattributions in the form of dramatic levels of false remembering.

Volume 20, Issue 7, July 2020, Page 185-187.

Access to care has become a key and contentious issue in the Canadian health care system. In this article, I explore the role of Canadian courts in determining rights to access public health insurance, beginning with a brief overview of the Canadian system and its distinguishing features, and then moving to discuss challenges to governmental limits on publicly-funded Medicare using the Canadian Charter of Rights and Freedoms. I argue that the Canadian courts are not, as is often charged, proactive in (...) this area. I question whether the deference exhibited by courts to governmental limits on Medicare is justified given concerns about the fairness of the principles and processes followed by decision-makers. In sharp relief to the judiciary’s conservative approach to applications for better or timely access to publicly-funded Medicare is the recent Supreme Court of Canada’s decision in Chaoulli v. Quebec which upheld a right to buy private health insurance for “medically necessary” hospital and physician services. (shrink)

Access to care has become a key and contentious issue in the Canadian health care system. In this article, I explore the role of Canadian courts in determining rights to access public health insurance, beginning with a brief overview of the Canadian system and its distinguishing features, and then moving to discuss challenges to governmental limits on publicly-funded Medicare using the Canadian Charter of Rights and Freedoms. I argue that the Canadian courts are not, as is often charged, proactive in (...) this area. I question whether the deference exhibited by courts to governmental limits on Medicare is justified given concerns about the fairness of the principles and processes followed by decision-makers. In sharp relief to the judiciary’s conservative approach to applications for better or timely access to publicly-funded Medicare is the recent Supreme Court of Canada’s decision in Chaoulli v. Quebec which upheld a right to buy private health insurance for “medically necessary” hospital and physician services. (shrink)

As the patient drew her last breaths, with her daughter at her bedside, and the curtain closed across the room, my resident, whom I will call Emma, talked me through what was happening. She explained that the patient's only hope for survival had been surgery, yet surgery would surely have killed her. Emma talked about the different ways different families approach withdrawing the level of care provided in the intensive care unit, allowing a loved one's death. She talked about how (...) hard it is to leave behind everything that happens in this job when she goes home. An intern arrived to make the declaration of death, and Emma encouraged me to go back into the patient's room for this. I placed my stethoscope on the patient's still chest, confirming what we already knew to be true. Death was palpable in that room, and my response was visceral. I did my best to leave the ICU calmly and then ran down five flights of stairs to the hospital chapel and sobbed. When I returned, Emma could see that I was shaken. “It's human,” she told me. In the afternoon, I felt the deep tiredness that I always feel after really crying. In that haze of emotion, I wasn't sure quite how to respond when Emma's next activity for us was to find a patient who needed an arterial blood gas. (shrink)

Participatory deliberation, whereby diverse experts and publics collectively engage in decision‐making, can ensure a more informed and just decision by centering historically marginalized perspectives and engaging a spectrum of value systems. Broad and diverse participation is crucial for the equitable distribution of risks and benefits resulting from complex and uncertain decisions such as environmental gene editing. From an ethical position that gives intrinsic value to the nonhuman and recognizes the interconnectedness of species across generations, we argue that deliberation over environmental (...) gene editing must include the voice of nature and the voice of future generations. Inclusion of these key participant groups can encourage reflection on the human relationship with nature and help safeguard intergenerational equity of decisions reached. By drawing from the legal rights of nature movement, the Boardman River Dams Project, and methods for representative participation, we offer strategies for inclusion of nonhuman nature and future generations in deliberative processes about environmental gene editing and other crucial decisions about our shared environments. (shrink)

This work discusses an empirical study of reasoning as it occurs in conversations. Reasoning in this context has features not usually accounted for in standard methods for describing argumentation (e.g., Toulmin, (1964), Toulmin, Rieke, and Janik (1984)). For example, insufficient attention has been paid to challenges which can be used to shift the ground of an argument and to the development of multiple conversational grounds. Moreover, even though the value of cooperative efforts in building arguments is widely recognized, more needs (...) to be said about analyzing co-constructed arguments. This empirical work was primarily descriptive and concerned with how people construct arguments in conversations, but one goal of the study was to lay groundwork for comparing the quality of reasoning in conversations which differ with respect to whether the arguments they contain are primarily the contributions of individuals or are genuinely co-constructed arguments. (shrink)

Empathy can be viewed as an intervening variable to explain complex webs of causation between multiple factors and the resulting responses. The mediating role of emotion, implicit in the concept of an intervening variable, can be at the basis of the flexibility of empathic responses. Knowledge of the underlying neurophysiological mechanisms is needed for empathy to be considered as a biologically functional intervening variable.

Women use power in more prosocial ways than men and they also engage in more emotional labor. However, these two constructs have not been previously connected. We propose that gendered emotional labor practices and pressures result in gender differences in the prosocial use of power. We integrate the literature on emotional labor with research on the psychology of power to articulate three routes through which this happens. First, women may be more adept than men at the intrapersonal and interpersonal processes (...) entailed in emotional labor practices—a skill that they can apply at all hierarchical levels. Second, given women’s stronger internal motivation to perform emotional labor, they construe power in a more interdependent manner than men, which promotes a more prosocial use of power. As a result, female powerholders tend to behave in more prosocial ways. Third, when they have power, women encounter stronger external motivation to engage in emotional labor, which effectively constrains powerful women’s behaviors in a way that fosters a more prosocial use of power. We discuss how, by promoting prosocial behavior among powerholders, emotional labor can be beneficial for subordinates and organizations, while simultaneously creating costs for individual powerholders, which may reduce women’s likelihood of actually attaining and retaining power by making high-power roles less appealing, guiding women toward less prestigious and more precarious leadership roles, draining powerful women’s time and resources without equitable rewards, and making it difficult for women to legitimize their power in the eyes of subordinates. Thus, emotional labor practices can help explain the underrepresentation of women in top leadership positions. (shrink)

Behavioural variant frontotemporal dementia (bvFTD) is a subtype of frontotemporal dementia characterized by changes in personality, social behaviour, and cognition. Although neural abnormalities cause bvFTD patients to struggle with inhibiting problematic behaviour, they are generally considered fully autonomous individuals. Subsequently, bvFTD patients demonstrate understanding of right and wrong but are unable to act in accordance with moral norms. To investigate the ethical, legal, and social issues associated with bvFTD, we conducted a scoping review of academic literature with inclusion & exclusion (...) criteria and codes derived from our prior work. Among our final sample of fifty-six articles, four mentioned bvFTD patient-offenders as unfit to stand trial by insanity, and sixteen mentioned the use of dementia evidence in a court of law to better understand the autonomy of bvFTD patients. Additional emergent issues that were discovered include: training police officers to handle situations involving bvFTD patients and educating healthcare providers on how to help caregivers navigate bvFTD. The current literature highlights the inadequacy of traditional applications of medico-legal categories such as autonomy, capacity and competence, in informing cognitive capacity assessments in clinical and legal settings and deserves consideration by neuroethicists. (shrink)

There is currently an evidentiary gap in the scholarship concerning medical tourism's impact on low- and middle-income destination countries (LMICs). This article reviews relevant evidence that exists and concludes that there are signs of correlation between medical tourism and the expansion of private, technology- intensive health care in LMICs, which has largely remained out of reach for the majority of the local patients. In light of this health care inequity between local residents and medical tourists in LMICs, we argue that (...) the presumption should not be in favor of medical tourism and that governments have a legitimate interest in seeking to regulate this industry to ensure that the net effects for their citizens is positive. Moreover, sending countries, particularly those in the developed world, have the responsibility to adopt public policies to diminish demand on the part of their citizens for medical tourism and to work with LMICs to ensure that the growth of medical tourism does not occur at the expense of the poorest of the poor. (shrink)

Travelling internationally to acquire medical treatments otherwise unavailable or inaccessible in one’s home country is not a novel concept. Conventionally, such medical travel largely entailed patients from developed countries or wealthy patients from the developing world seeking care in Western facilities like the Mayo Clinic in the U.S. and myriad private clinics along Harley Street in London, England. What is different about the topical phenomenon known as “medical tourism” is the growing trend of health services export in the opposite direction. (...) The number of patients travelling from the developed world to low- and middle-income countries for treatments has ballooned in recent years, primarily driven by difficulties with accessing affordable care at home. According to a liberal estimate by the Deloitte Center for Health Solutions, the number of Americans travelling abroad for care rose from 750,000 in 2007 to 1.6 million in 2012. On the flip side, Thailand reportedly treated a total of 1.3 million foreign nationals in 2007, which represented a 16% leap from 2001. (shrink)