Category Archives: Clinical Bioethics

Withdrawing Life Sustaining Treatment – Early Withdrawal of Life Sustaining Treatment in Severe Traumatic Brain Injuries, by Bernard W. Freedman JD, MPH Standard

CDC Statistics Traumatic Brain Injuries On August 29, 2011 the Canadian Medical Association published the findings of a multicenter cohort study evaluating the withdrawal of life-sustaining treatment for patients who had suffered a traumatic brain injury. This study is of particular interest because by the nature of the injury  patients cannot make decisions for themselves and generally such decisions in patients in end-of-life care have a variety of comorbidities which make an evaluation of the efficacy of the decisions to withdraw life sustaining care difficult. 720 patients were evaluated from six different major medical centers. Of the 720, 228 patients…

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

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…

Rationing “scarce medical resources” and lying to the patient – do these go hand in hand? Standard

Rationing “scarce medical resources” and lying to the patient – do these go hand in hand? 7 comments Claudia Ruiz M.D • I don’t think so, I’m from Mexico, and I have worked plenty with the mayan communities, they really don’t have any acces to medicines o medical attention. We did our best to get them what they need, but sometimes it is impossible. Anyways, I never lie to my patients, they deserve to know the truth always. Maybe it is a different situation in the United States and the HMOs, but in principle, I don’t think it is ethical…

Rationing Medical Care Part II Standard

Efforts to encourage (or compel) physicians to lie to their patients were faced years ago when “gag clauses” were inserted into contracts between HMO’s and contracted physicians. The gag clause established a contractual obligation on the part of the physician to withhold information regarding treatment modalities that were not within the HMO protocol of allowable categories of care.  Contractually, it is common to exclude specific types or categories of care – “We will pay for this, we won’t pay for that.” Every contract of insurance has exclusions. Gag clauses, however, go further. They contractually bar physicians from fulfilling their fiduciary duties…

Clinical Bioethics – Rationing – the Ethics of Lying to the Patient – Part I Standard

Rationing : Withholding Medical Care by Lying to the Patient Rationing of medical care and “triage” are different. Triage prioritizes the use of limited medical resources when resources are insufficient for immediate treatment.  Rationing is the withholding of available care for political/economic reasons. With respect to rationing, therefore, it must be decided whether or not the patient is going to be told the truth. The requirement of informed consent cannot cease to exist because of political/economic policy. Nevertheless the degree of informed consent may vary with the degree and type of risk. Informed consent for a blood pressure medication may…

Bad Ad Program for Misleading Drug Ads Standard

  The U.S. Food and Drug Administration has created a program to help recognize misleading prescription drug promotion and provide an easy way to report concerns. The program will engage health care providers at medical conventions and partner medical societies to distribute educational materials. Phases 2 and 3 will expand the FDA’s to update educational materials developed for Phase 1. The FDA’s traditional monitors prescription drug promotion presentations created by drug companies themselves. Health care professionals are encouraged to report a potential violation in drug promotion by sending an email to badad@fda.gov or calling 877-RX-DDMAC. Reports can be submitted anonymously….

Mandated Insurance Coverage for Phase I and II Clinical Trials Standard

At present the Missouri State Senate is considering new legislation (SB 365), which means to provide health insurance coverage for Phase I and Phase II clinical trials for cancer treatment. The law in the state of Missouri presently limits mandated insurance coverage to Phase III and Phase IV clinical trials. Aside from the fact that this bill makes no sense whatsoever, it highlights the ignorance of what Phase I or Phase II trials are intended to accomplish. SB 365 seeks to force insurers, non profit health services plans, or health maintenance organizations to treat Phase I and II trials as if…

Funding for physician discussion of end-of life decisions Standard

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…

Targeting Breast Cancer Patints Standard

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius sent a letter to WellPoint urging them to immediately end their practice of dropping health insurance coverage for women with breast cancer, after Reuters reported that the company “has specifically targeted women with breast cancer for aggressive investigation with the intent to cancel their policies.” —–

Use of Feeding Tubes in Patients with Advanced Dementia is Higher in For-Profit Facilities Standard

 Dementia is now a leading cause of death in the United States A study was published this week in JAMA (Journal of the American Medical Association) regarding nursing home patients with advanced dementia and who have feeding tubes inserted. The results showed that the frequency of feeding tubes is  greater in for-profit hospitals versus government or state owned hospitals.  "A higher rate of feeding tube insertions also was independently associated with for-profit ownership vs hospitals owned by state or local government… White residents had the lowest likelihood of feeding tube insertion, while black residents experienced nearly a 2-fold increase in…