Most reasonable people acknowledge that Karl Helge Hampus Hellekant has committed a grave moral offense: the 33-year-old Swede, also known as Karl Svensson, was convicted of killing trade unionist Björn Söderberg in 1999 at the behest of the Swedish neo-Nazi movement. What is not so clear is whether Hellekant, who is currently free on parole, should be permitted to become a physician. The former extremist was admitted to the medical school at Stockholm’s Karolinska Institute in 2007, but later expelled—following considerable (...) public debate—after school officials discovered that he was temporarily unable to verify his academic records. Sweden’s most prestigious medical school, Uppsala, subsequently confirmed these records and matricatulated him in 2008. (shrink)

When physicians search the web for personal information about their patients, others have argued that this undermines patients’ trust, and the physician-patient relationship in general. We add that this practice also places other relationships at risk, and could jeopardize a physician’s career. Yet there are also reports of web searches that have unambiguously helped in the care of patients, suggesting circumstances in which a routine search of the web could be beneficial. We advance the notion that, just as nonverbal cues (...) and unsolicited information can be useful in clinical decision making, so too can online information from patients. As electronic records grow more voluminous and span more types of data, searching these resources will become a clinical skill, to be used judiciously and with care—just as evaluating the literature is, today. But to proscribe web searches of patients’ information altogether is as nonsensical as disregarding findings from physical exams—instead, what’s needed are guidelines for when to look and how to evaluate what’s uncovered, online. (shrink)

Approximately one in three American adults has executed a living will or healthcare declaration stating personal preferences regarding medical treatment in the event that he or she becomes terminally ill and unable to communicate. This figure stands in striking contrast to the 90% of Americans who, when asked, express specific wishes regarding their choice of care under such circumstances. Congress attempted to increase the number of Americans with advance directives when it passed the Patient Self Determination Act in 1990, billed (...) at the time as the “Miranda Warning” of medicine, which requires hospitals and nursing homes receiving federal funds both to inform patients of their right to refuse life-sustaining care and to record all written directive in patients’ charts. (shrink)

The level of impairment shown by the 1.3 million residents of nursing homes in the United States varies significantly, and this raises considerable challenges for how to address the sexual and romantic interests and needs of these diverse individuals. Unfortunately, bright-line rules and a onesize- fits-all approach are often taken when addressing these challenges. This article proposes a novel taxonomy for classifying the potential sexual and romantic relationships of cognitively impaired nursing home residents that includes relationships between unmarried residents, relationships (...) between residents and their own spouses, and adulterous relationships. We explore the ethical and logistical challenges distinctive to each category of relationship. (shrink)