medical ethics
palmd | April 8, 2009The Times is reporting that health care workers actively assisted in the torture of CIA detainees overseas. This, as you might imagine, sickens me.
Many of us have seen movies or read spy novels where a doctor stands by as someone is tortured, monitoring their condition and telling the interrogator when they need to back off. It turns out this really happens.
I don't have that much to say about this that isn't obvious, i.e., it's never acceptable for health care workers (HCWs) to participate in activities designed to cause their patients intentional discomfort or injury. That's a no-…
palmd | March 24, 2009The current insanity at JAMA has been well reported elsewhere (also see these links: here, here, here, and here). I'll give you a thumbnail sketch. A professor from a small university wrote to JAMA (the Journal of the American Medical Association) to let them know that an author of an antidepressant study appeared to have an undisclosed conflict of interest (COI). When he didn't hear back from JAMA he wrote to a more prestigious journal, the British Journal of Medicine (BMJ) who published his letter. This caused the editors at JAMA to completely lose their shit, threatening the letter…
palmd | March 21, 2009Janet and I have another bloggingheads discussion up. We talk about ethics, alternative medicine, and her prostate. Go and watch.
palmd | March 18, 2009A frequent commenter on the conscience issue has raised a lot of questions on an recent post. He seems somewhat frustrated that I don't understand his point. What I think he doesn't realize is that I do understand his point all too well---he is just wrong. Here is an example:
You also still haven't cleared up that little inconsistency regarding the matter of whether or not there is a professional obligation to provide elective services. Or is it just physicians, but not pharmacists or other healthcare professionals, who have rights of conscience?
OK, I'll clarify it for you. It's not that…
palmd | March 13, 2009I hate this topic. I really do. But Abel started it this time. Over at Terra Sig, the good pharmacologist brought up the issue of pharmacists behaving badly. I've dealt with the ethical implications of conscience clauses ad nauseum but Abel's discussion raised some important points.
A brief recap: a patient with a valid prescription for morphine was denied her medication by a pharmacist. The reason given was "that [the patient] should find some alternative pain relief", presumably one that does not involve opioid analgesics. I won't bother with my usual rant about the responsibility…
denialism | March 9, 2009I have just finished taking my last major exam of medical school - Step 2 of the boards (including Step 2 Clinical Skills, or CS, which costs 1200 bucks, requires you to travel to one of a few cities in the country hosting it, and is sealed by a EULA that forbids me from talking about what the test was like), and am winding down my medschool career in the next few weeks. It's about 2 weeks from Match Day (the 19th), when I'll find out for sure where I will spend the next 5 or so years of my life. I'll be sure to have a post up a little after noon that day when I find out what the answer is…
palmd | March 4, 2009OK, the title is inaccurate. Kirby is not bound by the same code of ethics as researchers and doctors, so perhaps he's not unethical. But his latest rant in HuffPo encourages unethical behavior. Honestly, I'm getting tired of writing about this guy, but he just keeps bringing the stupid, and something about that just calls out for a response.
So what's so horrible about his latest hunk of drivel? Well, first he starts with a blatant misinterpretation of the truth:
It is not accurate for members of the media to report that the link between vaccines and autism has been "disproven."…
palmd | February 23, 2009A while back I wrote about a naturopathic "physician" who was specifically preying on the Latino community. This is troubling for a number of reasons, some of which I mentioned. In my zeal to rant about the quackery, I may have not delved deeply enough into some of the other important issues.
For example, Hispanics have rates of diabetes and stroke well above the white Anglo population. These are conditions for which we have very effective science-based treatment. Proper treatment of high blood pressure in diabetics reduces the rate of heart attack and stroke by 35-50%. Proper foot care,…
ddobbs | February 10, 2009Marcia Angell makes it plain:
The fact that drug companies pay prescribers to be "educated" underscores the true nature of the transaction. Students generally pay teachers, not the reverse. The real intent is to influence prescribing habits, through selection of the information provided and through the warm feelings induced by bribery. Prescribers join in the pretence that drug companies provide education because it is lucrative to do so. Even free samples are meant to hook doctors and patients on the newest, most expensive drugs, when older drugs -- or no drug at all -- might be better for…
palmd | February 5, 2009Reproductive ethics is a field I'm not all that familiar with, but it's been a big deal lately, so I've been thinking about it a bit. The American Society for Reproductive Medicine has a few broadsheets on ethics, which are actually rather helpful. Reproductive medicine is a great field for looking at ethical problems. Let's examine two of them to learn something about the ethics of the field (and of course, about ourselves as well):
Parental factors, that is, facts about the parents, may be important in reproductive medicine. When doctors become part of the reproductive process, someone…
palmd | January 26, 2009Morning report is a daily conference for medical residents. It is done differently at different institutions, but normally a case is presented, often by the post-call team, and discussed by the senior residents and an attending physician. Today's case will be the first in an occasional series. --PalMD
Case:
Mrs. M is an 89 year old woman who resides in a nursing home who was admitted with confusion and lethargy. She has a past medical history significant for stroke, coronary artery disease, depression in the distant past, and no history of dementia. She has lost significant weight over…
palmd | January 25, 2009Sometimes I feel like I'm pounding my head against a wall. I've been wondering why the issue of so-called conscience clauses just won't die, why otherwise intelligent people can't just agree with me just don't get it.
Quick review: some health care professionals wish to be able to deny patients certain types of care, and want to be protected by law for imposing their own morals on others, in violation of basic medical ethics and human dignity (as you can see, I don't have a strong opinion about this one).
Ethical behavior is difficult. It requires empathy---but in a very particular sense…
palmd | January 21, 2009I'm one of those wacky idealists for whom January 20th was a great day. But with those high hopes, I have some fairly high expectations of our new president, one of the first of which is to repeal the Church Amendment, an HHS directive allowing health care providers to abandon proper ethics without consequence.
I've done quite a bit of blogviating about so-called conscience clauses, the rules that would allow health care providers to deny patients care not because it is outside the standard of care but because it bothers the personal beliefs of the provider. In case my previous writings…
palmd | January 21, 2009Nearly a year ago, a young girl was killed by her parents. She was dying of diabetic ketoacidosis, and her parents provided only prayer. They weren't living on some compound under the thrall of some cult leader. They weren't living in a third-world country far from modern medical care. They were living in the middle of Wisconsin, and had access to any care they might need, but while their child suffered, the parents did the equivalent of nothing. This type of situation has been done to death, but since the parents are about to go on trial, let's review the responsibilities of the state…
palmd | January 20, 2009Make no little plans; they have no power to stir men's blood.
---Daniel Burnham
The last eight years have seen subtle and not-so subtle predations on the practice of medicine. Will the new administration be able to promote the kind of change we need? Let's review some of the challenges facing the Obama administration.
Ethical apocalypse
Bush's evisceration of the Constitution of the United States has affected health care professionals. For example, the military has likely always used psychologists to assist with interrogations, but the last eight years has seen a huge increase in the…
palmd | January 16, 2009Remember those pesky conscience laws the Bush administration is trying to ram into our collective orifaces on their way out the door? No?
Let me remind you.
You see, the theocrats who are on their way out on Tuesday want to step up enforcement of the so-called Church Amendment, which protect health care providers (defined broadly) from the consequences of their own malpractice. With Church in place, your doctor (if she receives federal funds) can refuse to tell you about or prescribe birth control (as one example). Of course, she can do that anyway, but the Church Amendments protect her…
palmd | January 14, 2009In case you missed it, we're plugging the "diavlog" that Janet and I recorded the other night. I could talk medical ethics all day, and we spent an hour doing just that. Thankfully (for you) the thing is indexed, and you can skip around. Still, if you have the patience, try to catch the whole thing.
sb admin | January 11, 2009Ok, really, it's bloggingheads.tv. Dr. Free Ride from Adventures in Ethics and Science invited me for a chat about ethics, which you can view, well, right now. Next time, I'll remember to keep the camera a bit further away.
sb admin | November 10, 2008We've talked quite a bit about ethics in this space, especially medical ethics and "blog ethics". Today, though, we will specifically examine the nature of medical ethics as they apply to so-called alternative medicine.
First, and perhaps most important, I am not an ethicist. I do not have the depth of reading, the knowledge of terminology, or the specific education to lead a formal discussion on ethics. What I am is a practicing internist, who must make ethical decisions on a daily basis. Most of these decisions are of necessity made "from the heart", but it is not infrequent that I must…
sb admin | November 5, 2008The best ethical questions are real ones. Sure, it's fun to play the lifeboat game, but when you're dealing with flesh and blood human beings on a daily basis, games aren't all that helpful. So here's a non-life-and-death question: if a patient comes to see you and smells of alcohol, can you add an alcohol level to their blood work without specifically informing them?
Ethical discussions are best held as, well, discussions, so I'll lay out some ethical principles and let you discuss before I weigh in further.
First, any patient who comes to see a doctor signs a "general consent for…