Tag Archives: Bioethics

Waiting for medical records “after discharge” is of no help for decision making Autonomy

Medical records: Waiting for medical records “after discharge” is of no help.  Reviewing medical records  in the hospital allows the patient and/or a surrogate decision maker to obtain the greatest amount of information possible over the cross section of medical specialties providing care.  It provides a clear picture of the condition of the patient with respect to cognition, pain and prognosis. Review of reports of CT scans, x-rays, and MRI’s can bring a clear picture of improvement and deterioration in the patient’s condition. All of this will ensure that consent is based upon complete information and make it easier for…

Can late stage abortions be murder ? Reproductive Technololoy

Dr. Nicola Riley is being held without bail in Utah following her arrest on December 28. 2011. She worked for Dr. Steven Brigham in New Jersey, who owns abortion clinics.   Both of them have been charged with the crime of murder for performing late-term abortions in Maryland. Their apparent modus operandi was to “start” abortions in New Jersey and complete them in Maryland where abortion laws are less stringent. Maryland has a Fetal Homicide Law that permits murder charges to be brought against people who “intend to cause the death of a viable fetus, yet specifically excludes physicians carrying out…

Patient Access to Cancer Care and Proposed Medicare Budget Cuts – Press Release Bioethics

July 27, 2011 ASCO Urges Policymakers to Protect Patient Access to Cancer Care from Debt Ceiling Negotiation Package The American Society of Clinical Oncology (ASCO ) is deeply concerned about the proposed $3 billion in cuts to Medicare reimbursement as part of a debt ceiling negotiation package. If the cuts are put into place, patient access to cancer care will be threatened as previous cuts to Medicare have already caused oncology practices to close, consolidate and turn away Medicare patients. ASCO is closely monitoring the situation, and advocating on behalf of oncology practices and patients. This week, ASCO placed print…

Withdrawing Life Sustaining Treatment – End of Life Care: the Doctor-Patient Relationship A Refusal to Communicate Clinical Bioethics

The New England Journal of Medicine recently published an article entitled: “ The Palliative Care Information Act in Real Life,” (NEJM 364;No.20 May 2011), regarding a New York statute that requires a physician to have discussions of end of life treatment options with the patient when the patient is “terminally ill.” Alan Astrow MD and Beth Popp, MD, the authors of the article, are troubled by the phrase terminal illness. They argue that the definition in the statute is vague and an improper interference with the physician-patient relationship. The fact that they find the phrase, “terminal illness” troublesome, is troublesome. The…

Withdrawing Life Sustaining Treatment – Betancourt v Trinitas – Appellate Court Decision Bioethics Conflicts

The New Jersey Superior Court–Appellate Division dismissed the appeal in Betancourt v Trinitas finding the appeal moot. The court stressed it’s concern over the  “sparse record” presented at the time of  the original hearing in the trial court as well as on appeal and found that the evidence was not “conclusive in several areas necessary to fully adjudicate the substantial issues raised.” This is sometimes referred to as insufficiency of evidence. If the person or entity bringing the case does not provide sufficient evidence the court will dismiss the claim. In this case Tinitas Hospital’s request to withdraw the ventilator….

Withdrawing Life Sustaining Treatment – Betancourt v Trinitas – Life, Not Policy Withdrawal/Withholding of Care

Ruben Betancourt, 72 years old, was unconscious following the dislodging of a ventilator breathing tube after surgery at Trinitas Medical Center, which resulted in anoxic encephalopathy. He was readmitted to Trinitas in July 2008 with a diagnosis of renal failure. He received dialysis treatments, remained on a ventilator, and feeding tube. The physicians at Trinitas diagnosed Mr. Betancourt as being in a persistent vegetative state and told the family of their intention to stop dialysis and allow him to die. The Superior Court in New Jersey held a two day hearing and thereafter enjoined the hospital from withdrawing life support without the consent…

Red Flag Rules and the Practice of Medicine Abandonment

Red Flags Rules require financial institutions and businesses that give credit to consumers to establish some sort of program or procedure to identify customers who may be involved in identity theft. Since most medical providers provide medical services and allow the patient to pay their bill at a later time, and in concert with insurance benefits, the FTC intends to treat medical practice as a “creditor” and thus come within the scope of Red Flag rules. “Creditor” is defined by this law as any business or organization that defers payments for goods or services.”     On May 21, 2010…

Funding for physician discussion of end-of life decisions Clinical Bioethics

Each patient deserves more than a brief discussion about end of life decision-making. In  “A Piece of My Mind” section of this month’s JAMA (volume 303, No.13, April 7, 2010) Paul Kettl M.D. argues for monetary compensation to be provided to physicians for end of life discussion and planning. He fails to make clear, however, that the decision rests with the patient, not what is best for the family. Physicians must be careful not to wear too many hats and should turn to skilled clinical bioethicists and if necessary the Hospital Ethics Committee for review and recommendations. This will protect…

Publically Managed Care found to be Superior to Private Managed Care Clinical Bioethics

Boston University School of Public Health researchers reported that older, male patients receiving care from the Veterans Health Administration (VHA) health care systems had better health outcomes than those in privately managed care plans that are part of the government-run Medicare Advantage program using private contracted managed care.    Two surveys were done on 107,300 men, ages 65 and older, between 1999 and 2003.   VHA care was found to be more effective that the privately contracted Medicare Advantage program. This was true for the average elderly male patient cared for in the VHA as well as for vulnerable sub-populations."…