Archive for the ‘Medical Ethics’ Category

It may come as somewhat of a surprise to find out that physicians don’t always think about defibrillator care when considering end of life issues, which can lead to very unpleasant experiences for dying patients. What do I mean? Well, an implantable cardioverter-defibrillator (ICD) is a device which can be inserted into patients who have heart rhythm problems. Its job is to shock the heart into proper rhythm when it goes astray. However, this may not be desired in someone who has made the decision to use hospice care in order to die as peacefully and pain-free as possible. If an ICD is not deactivated, it can go off repeatedly and deliver very unpleasant shocks to the patient. A study published in this month’s Annals of Internal Medicine suggests that most hospices don’t routinely speak to patients about defibrillator decisions, and nearly 60% of hospices had at least one patient shocked within the past year, sometimes multiple times at once. More surprisingly, only one in twenty hospices had a method to identify whether a patient had an implant or not. Defibrillators continue to be implanted at incredible rates (more than 100,000 a year). Therefore, doctors taking care of patients near end of life should be more aware and proactive in speaking to them about what their wishes are regarding deactivation of their ICD. [via AP News]

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A survey recently released by the American Psychiatric Association has found that American workers are hesitant about seeking mental health care for fear of confidentiality issues and possibly losing status at work. Among the 1,129 people surveyed 76% believed their work status would be damaged by seeking treatment for drug addiction, 73% for alcoholism, and 62% for depression, compared with 55% who thought seeking care for diabetes would affect their work status and 54% for heart disease. In total only about 40% of respondents thought their employers were supportive of employees seeking general and mental health care, which sounds counterproductive, especially since research (and logic) shows that people who receive proper health care are healthier and more productive. [HealthDay/Businessweek]

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Senator Vince Illuzzi (R) of Vermont has sponsored a bill that brings back the debate of fetal personhood. The bill was proposed after Patricia Blair, a Vermont citizen, was involved in a motor vehicle accident which took the lives of her unborn, 6-month-old twins. Current Vermont law does not recognize a fetus, even a viable one, killed in an accident as a victim, nor are there additional penalties for killing a fetus. The majority of states have some form of fetal homicide law which recognizes the killing of a fetus as a criminal act punishable to varying degrees under the law. What they may not have are laws that formally recognize fetal personhood, which has implications in the abortion debate. There are current 16 states without a fetal homicide law – Alabama, Alaska, Colorado, Connecticut, Delaware, Hawaii, Kentucky, Maine, Maryland, Montana, New Jersey, Oregon, Texas, Vermont, West Virginia, Wyoming. [via WPTZ]

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In the midst of the U.S. healthcare debate, a minor provision appears to be stirring up some controversy. The provision, inserted by Sen. Orrin G. Hatch (R-Utah) with the support of Democratic Sens. John F. Kerry and the late Edward M. Kennedy (both of Massachusetts, home to the Church of Christ, Scientist), would require insurers to consider covering Christian Science prayer treatments as legitimate medical expenses. The church believes that spiritual healing in the form of prayer treatments is an effective alternative to conventional interventions. However, opponents of the measure are concerned that this could open the door for other groups to seek medical legitimacy for practices that lie outside of science. But, there is precedence for this. Namely, the IRS allows the cost of prayer services to be counted as tax-deductible medical expenses. Is this blurring the line between church and state? Should spiritual health and healing be overlooked as an integral part of physical and mental well-being?  [via LA Times]

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The American Society for Reproductive Medicine (ASRM) has expelled Dr. Michael Kamrava, the physician famous for transferring numerous embryos via in vitro fertilization to Nadya Suleman, who later went on to give birth to octuplets. Dr. Kamrava of the West Coast IVF Clinic in Beverly Hills, California transferred six embryos into Ms. Suleman’s uterus – it’s believed that two of those embryos split into twins, leading to the birth of eight infants. In patient younger than 35 years of age, ASRM guidelines say that only one or two embryos can be transferred to reduce the risk of multiple births. Provider tracking data apparently shows that Dr. Kamrava transferred, on average, 4.1 embryos to patients under 35. [via Medical News Today]

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Poor education predisposes one to poorer health. Study after study has confirmed this link, and now experts are honing in on the reasons for it and what can be done.  “Persons with a higher education tend to have better jobs, and better income, better benefits,” said David R. Williams, a professor at the Harvard School of Public Health and staff director for the Robert Wood Johnson Foundation’s Commission to Build a Healthier America. These “better benefits” not only include more accessible healthcare but can include factors such as the ability to take time away from work to see the doctor. As well, people with higher levels of education tend to have more resources to cope with stress and life, such as access to a health club to exercise during periods of stress. Being more educated also means that a person can better understand the complexities that go along with modern medicine. In fact, a report from May, 2009 found that adults who did not graduate from high school were 2.5 times more likely to be in less than very good health, compared with counterparts who have a college degree. Williams is advocating that health promotion should be taught earlier in schools and that improvement in literacy rates could better the health of people as they become adults. [via Businessweek]

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A new survey of Americans’ perception of organ donation has yielded some interesting results. Among the misconceptions include the notion that there’s a black market in the US in which people can buy and sell organs, or that doctors won’t try as hard to save someone’s life if that person is an organ donor. The number of people in the US needing organ donation has risen to more than 100,00 and, on the average, 18 people die each day while waiting for an organ. However, only 38% of drivers license holders are registered as organ donors.

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A Los Angeles fertility clinic has sparked controversy by offering parents the ability to select the sex, hair color and eye color of babies. However, “designer babies” have actually been here for many years already. The technology, called preimplantation genetic diagnosis (PGD), is currently used during in vitro fertilization to screen embryos for genetic diseases (such as Huntington’s disease, sickle cell anemia, muscular dystrophy) prior to implantation into the mother’s womb. The difference now is that you are selectively choosing an embryo based on physical traits.  The LA Fertility Institute’s first such designer baby is expected to be born next year and will no doubt spark discussions of ethics and morality.

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Researchers across the US are awaiting an imminent lift on the current embryonic stem cell research ban. The Obama administration is expected to overturn the policy set forth by former President George W. Bush later this week. Unlike adult stem cells, embryonic stem cells are derived from eggs that have been artificially fertilized in an in vitro fertilization clinic, and then donated for research purposes with informed consent of the donors. Embryonic stem cells can become any of the 220 types of cells in the body, whereas adult stem cells are more limited. Scientists at the University of California, Irvine have already developed a therapy based on embryonic stem cells which made paralyzed rats walk again. Earlier this month they were given federal approval to be the first embryonic stem cell treatment to be tested in humans.

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News sources are reporting that lawmakers in Papua, one of Indonesia’s poorest provinces, are considering passing a law that would mandate certain “sexually aggressive” HIV-positive people be implanted with microchips so they can be better monitored. This would allow them to be easily prosecuted if they knowingly infect others, a provincial crime that carries a sentence of up to 6 months or a large fine. Prostitution and drug use are believed to be the major cause of HIV infection in Indonesia. In Papua, tribal rituals that encourage partner swapping, along with lack of education about STDs and condom use, are thought to be particular reasons for the high rate of HIV spread. Those who are against the bill say it’s a breach of human rights and support a focus on HIV/AIDS education instead.

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