How much is too much and who decides?

When I see an article like this I'm reminded of a question we ask often at the Center for Practical Bioethics -- how much is too much, and who decides?

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Authors of an article in the New England Journal of Medicine argue doctors should aggressively tackle cancer to the best of their ability using the best treatments available, but after all realistic options are exhausted, they should encourage patients to set realistic goals for their future.

Links:

End-of-Life chemotherapy costs billions, Tracy Sears, WTVR -- Richmond, VA, May 27, 2011

Bending the Cost Curve in Cancer Care, New England Journal of Medicine, May 26, 2011

Feeding Tube Risks for Dementia Patients

Nearly 90% of patients with advanced dementia have problems feeding themselves, lose weight or choke on food.

But feeding tubes may not be the right response to the problem. Observational studies have found that feeding tubes do not prolong life, reduce aspiration pneumonia risk or improve quality of life for these patients.

Kevin O'Reilly reports in this article in American Medical News.

ACP Done Right - On TV No Less!

From our friend Thaddeus Pope on the Medical Futility blog -- TV program shows the ideal when it comes to advance care planning.

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Blog: Medical Futility
May 24, 2011

It’s probably not a terribly accurate portrayal of what happens in U.S. hospitals. But it is good to see television portraying: (a) the limits of medicine, (b) the use of advance directives, and (c) the proper implementation of advance directives.

For more click here.

An ER Case of Applied Ethics

Thought this an interesting post, both the case presented by the ER doc and the comments. What do you think?

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Blog: Movin’ Meat
May 23, 2011

It's the right of a patient to refuse treatment they don't want. I don't take it personally, but it can be a bit frustrating when you have to watch someone make a really bad decision.

But it does bring up an interesting and tricky issue: when is a patient NOT allowed to refuse care?

Blog post here.

Assessing Social Implications of Research

Summer McGee, PhD
American Journal of Bioethics
May 19, 2011

The May 2011 edition of the American Journal of Bioethics focuses on social issues in research. Why does social context matter for ethical research design? If institutional review boards can't assess the social implications of research, then who will and must?

The host of the Bioethics Channel, Lorell LaBoube, visits with Summer McGee, PhD about these issues. Dr. McGee is the executive editor of the American Journal of Bioethics.

Link to podcast here.

Will Your Child be Baller or Putter? Good Thing There's a Genetic Test for That

Summer McGee, PhD
May 19, 2011

Comments from our colleague Summer McGee on DNA tests for sports genes. She says in part:

"I agree with Lainie Friedman Ross, and others, who have said that this trend is very disturbing. Not only is this kind of genetic determinism most likely to be flawed in every way, it is just another way of "helicopter parents" trying to map out their children's entire lives."

For more click here.

Questions about iPS Cells

Art Caplan says making research decisions based on pronouncements by those with huge ethical or ideological stakes in the game—in the case of iPSCs, those opposed to the destruction or manipulation of human embryos—makes for very poor science policy.

Links:

Cash or a Prayer Book, Arthur Caplan, Science Progress, May 16th, 2011

Are iPS Cells the Ethical Holy Grail?, Glenn McGee, PhD, John B. Francis Chair in Bioethics, The Bioethics Channel

Honor and Respect in Healthcare

Rabbi Richard Address

We are in the midst of a longevity revolution and that’s presenting challenges for us all.

Rabbi Richard Address is the director of the Department of Jewish Family Concerns for the Union for Reform Judaism based in New York City. He was in Kansas City recently for presentations on honor and respect in healthcare. Lorell LaBoube visited with him about those issues on this edition of the Bioethics Channel.

Link to podcast here.

Mixed Views on Industry Funded CME

The authors of a new study published in the Archives of Internal Medicine administered a survey to HIV clinicians, including doctors, nurses, and physician assistants, who took CME courses in 2009 delivered by the International AIDS Society, a nonprofit medical organization.

Of the 770 respondents, 88% said they believed that commercial support of CME introduces a greater risk of bias. However, only 15% supported eliminating industry support.

Link: Docs Say Industry-Funded CME Biased but Vital

The Ethics of First Person Consent

Terry Rosell, DMin, PhD
Rob Linderer

May 6, 2011

There are more people who need organs than there are organs available. That puts pressure on all sides of the organ donation equation – patients, families and medical professionals.

Joining host Lorell LaBoube on the Bioethics Channel to talk about one approach to this challenge are Terry Rosell, DMin, PhD, Rosemary Flanigan Chair at the Center for Practical Bioethics, and Rob Linderer, president and CEO of the Midwest Transplant Network.

Link: Podcast

Lectures in Bioethics Top 10

Here are the top ten Lectures in Bioethics by download for the month of April 2011.

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The Politics of Palliative Care, Kathleen Foley, MD
25th Anniversary: KC Ethics Committee Consortium
The Role of Conscience in Medical Decisions, Daniel Sulmasy, MD, PhD
Eugenics, Race and Bioethics, Glenn McGee, PhD
The Ethics of Living Forever, Glenn McGee, PhD
Eugenics, arranged marriages, gene therapy , Chris Austin, MD
Religion. Healthcare. Do the Twain Meet?, Rosemary Flanigan, PhD
Bending the Cost Curve -- Responder Panel
I'm dying STAT! Call my -- lawyer?, William Colby, JD
The World According to Autism, Glenn McGee, PhD

Top 10 - The Bioethics Channel April 2011

Here are the Top 10 podcasts for the Bioethics Channel in April 2011. If you have a topic or guest you would like to include in the program, please let me know at llaboube@practicalbioethics.org.

Thanks!

Lorell LaBoube

Director of Communications

Center for Practical Bioethics

Top 10 The Bioethics Channel
April 2011
From a Neuroscience of Pain to a Neuroethics of Care, James Giordano, PhD
Ethical HIV Testing, Teresa Celada, PhD

Myths of Healthcare Costs, Dave Kingsley, PhD
Have You Had the Talk?, Health Talk, KMBZ 980 AM/98.1 FM Radio
Religion and Medicine: Compatible?, Farr Curlin, MD and John Lantos, MD
Collision of Religion and Pain Treatment, Richard Randolph, PhD
A Universal Design Home, Krissy Garrett
Pain Contracts: Great Good or Great Harm?, Scott Fishman, MD
Ethical Stalemates in Clinical Research, Peter Ubel, MD
The State of Altered Consciousness, Joseph Fins, MD

Another court ruling on stem cell research

The issue of federal financing of stem cell research is a contentious one — pitting scientists who say that stem cells will lead to medical advances against opponents who say it is immoral to destroy human embryos to obtain stem cells.

Links:

Appeals court lifts ban on human stem cell funding, Washington Post, April 29, 2011

Stem Cells: The Ethics Debate Begins Anew , Glenn McGee, PhD