My Bioethical Opinion is... (1) Questions

An opportunity to pick the brain of a physician who has long been interested and participated in medical student education and has been involved in hospital clincal ethics committees since the mid 1980's. My responses are simply my own (and does not represent my affiliation) but may represent current ethical consensus however it may have no more worth than the views the reader holds. I am interested in educating the readers on issues in medical education and medical care of which they may not be aware.

Those readers of Knol may recognize me as the moderator of the Bioethics Discussion Blog which is now starting its 5th year. On the blog, I set the topics and await for my visitors to write their comments on the ethical issues described. Since I don't want to bias or direct my visitor's responses, I usually do not regularly express my own views on the topic. I thought it would be worthwhile using the format of Knol to let the readers set the topic and if I find that I have enough experience or knowledge to contribute to the topic, I would try. My experience is that of 50 years of medical practice and over 20 years of teaching first and second year medical students and participating in hospital clinical ethics committees.

I would welcome your questions about the ethics involved in medical education and medical practice.  I will select to answer those questions that I feel I have some knowledge, experience and viewpoint to be of value to the questioner. I have to limit my responses to general issues which arise in the question and not to the specific cases presented to me. Making ethics decisions is based on facts. Some of the facts necessary are not immediately apparent. It is unlikely that any personal specific case presented to me by this Knol will provide sufficient facts for me to suggest a specific decision. (In a hospital ethics committee consultation, it may take an hour of reviewing the history and medical facts to provide the stakeholders with suggestions for ethical decisions.) I may use the topic suggestions by the readers here to put up as new threads on my bioethics blog.

I will number the Knols in sequence with one Knol for each topic. This is #1,  the Question Knol. where the readers can post their questions about bioethics for me. Those questions which I feel I have the capacity (knowledge, understanding and viewpoint) to answer, I will post my answer on seperate Knols for each topic and for responses by the readers including my own responses to what they write. WRITE YOUR ORIGINAL QUESTION TO BE ANSWERED HERE. WRITE ANY COMMENTS PERTINENT TO A SUBJECT ON THE KNOL WHERE THE ANSWER IS PUBLISHED..

.Maurice.

Comments


Anonymous

I have a question...

that is being asked out of heartache. When a doctor requests testing for something...lets say the spine...and the results are back, aren't they obligated to read the whole report and discuss the 'whole' of it with the patient? I ask because my sister went for an MRI on her spine three months ago. The following week her Dr told her she would need surgery to correct her spine...the only other possibility shots of some sort. She opted for the shots...then had an uneasy feeling and canceled. Time went on and she decided it was silly to put off the surgery and contacted the dr who had her pick up her records for the surgeon. She looked over the report from her MRI...THREE MONTHS AFTER IT WAS DONE, mind you...and found a paragraph that mentioned a 12mm by 18mm complex cyst on the stem of her left kidney. She asks if she should be concerned about it and it's as if the dr is seeing it for the first time. So last week she is sent for another MRI with contrast...3 months after the fact...and it's now showing it has spread to her liver. My thoughts are that three months ago it might have been taken care of before it had that time to spread...especially if it's aggressive. Anyway...my question is this. Aren't Doctors ethically supposed to read and report on all the findings on a test taken?

Thank you for your time...God bless

Last edited Sep 12, 2009 9:48 PM
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Tiff1

Using Ethical Theories

A 12 year old Susan began complaining to her mother about having frequent cramps, headaches and backaches as well as being nauseated. The mother began to assumed that her daughther may be experiencing early symptoms of her menstration cycle and decided that she would make an appointment with the family doctor to discuss with her and her daughther about the changes her body is now going through. The doctor gladly met with the mother and daughter and ran a regular checkup on Susan. A few days later the doctor informed the mother that her and her daughter should meet with him right away. The doctor informed the mother and daughter that the symptoms that Susan was having may have not been a sign of menstration but symptoms that Susan was pregnant. The doctor gave the mother and dauther the option of Susan going through with her pregnancy or to terminate the pregnancy as soon as possible. The mother who was very upset and distraught told the doctor that Susan can not have an abortion she is too young. However Susan said " I am not mature enough to have a child".

Based on ethical theories such as (utilitarian, Kantian etc.) which of them would be reasonable to think that Susan holds?
Was the doctor right for telling both susan and her mother at the same time?
Since both parties have two different answers how could he use the MORAL Model to help them come to an agreement?

Last edited Jun 11, 2009 4:23 PM
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Saqib Raza

Ethical Dilemma

Ethical Dilemma
Mrs. Gomez is a 92 year old Mexican American woman who presents to the ED with fatigue, palpitations, and intermittent chest pain. She us a first generation immigrant, speaks English well, lives alone since her husband died. She is accompanied by one of her daughters who lives nearby.
PE identifies atrial fibrillation, elevated pulse rate, elevated BP and abnormal lab values. After stabilization and a MI is R/O a medication review is done. Mrs. Gomez says she has been taking levothyroxine for many years for her low thyroid. She sometimes has problems remembering if she has taken it and so she “just takes another for good measure”. She is not sure how many times a day she actually takes it. “If one pill is good, then three or four are probably better”.
The daughter is horrified and says “that’s it, I work and cannot watch you every minute, you are going to a nursing home where you will be safe”. Mrs.Gomez begins to cry inconsolably and saying “no, no, no, how could you do this to me, your mother?”.
1. What moral principles (autonomy, beneficence, non-maleficence, justice, caring, veracity) are involved for whom?
2. What information might reduce the dilemma?
3. Is there an intervention that would lead to a resolution and be moral for the mother and the daughter?
4. Is culturally appropriate care an issue with this patient situation?

Last edited Mar 7, 2009 8:02 PM
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Anonymous

tests done without patients permission

A 70 year old is undergoing a minor operation, the surgeon discovers that she has one undescended testicle. The surgeon informs her family physician who orders a genetic analysis. The analysis shows she is genetically male. Can the physician order the test with out permission in this case?

Last edited Mar 2, 2009 3:48 PM
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Krishan Maggon

Organ Transplant and shortage of organs

The current shortage of organs for transplant leads to death of several patients on the waiting lists worldwide and has lead to organ trade, medical tourism in various forms. The concept of free organs for transplants is outdated. WHO and UNO should allow organ trade under strict conditions and provide good follow up healthcare and financial incentives to donors?

It can be addressed by invoking "Presumed consent" and paying families
for the medical costs of the brain dead dead patient before harvesting organs.

Hospitals, surgeons and laboratories gain a lot of prestige and money doing organ transplants.

Why a poor person, who wants to make a new start in life,
not able to sell his kidney in the open to the hospital and provided medical care and follow up in case of any problems?

I had set up a new Bioethics knol (unpublished) to debate this issue'



Last edited Feb 9, 2009 9:39 PM
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Christopher Harris

Rewarding deep brain stimulation for human use

What would have to happen for a research/surgical team to be given approval by a university/hospital ethics committee to fit a willing human subject with an iPlant (see http://knol.google.com/k/christopher-harris/iplant/3t1ux01d2xqyk/2 or http://www.iplant.eu)? Do you think such approval would be granted in the US or EU?

For the sake of argument, let's assume that the application for approval is submitted regarding either

1) An attempt to use rewarding deep brain stimulation to motivate physical exercise in a morbidly obese patient. Note that rewarding brain stimulation has long been an effective method for motivating behaviors such as physical exercise in experimental animals (Burgess et al, 1991; Garner et al, 1991), and that deep brain stimulation has already been used, unsuccessfully, in an attempt to reduce hunger in a morbidly obese patient (Hamani et al, 2008).

or

2) The case of one member of the research/surgical team wishing to serve as experimental subject. Note that researchers such as Kevin Warwick have already been granted permission to 'self-implant' on several occasions (Warwick et al, 2005).


References

Burgess et al (1991) Intracranial self-stimulation motivates treadmill running in rats. Journal of Applied Physiology 71(4), p1593-1597

Garner et al (1991) Intracranial self-stimulation motivates weight-lifting exercise in rats. Journal of Applied Physiology 71(4), p1627-1631

Hamani et al (2008) Memory enhancement induced by hypothalamic/fornix deep brain stimulation. Annals of Neurology 63(1), p119-23

Warwick K et al (2003) The application of implant technology for cybernetic systems. Archives of Neurology 60(10), p1369-1373

Last edited Aug 29, 2008 3:32 PM
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Alex Tang MD

Cardiac Death and Organ Harvesting

The normal procedure for organ harvesting is from patients who has been certified brain death. In the United States, the Uniform Determination of Death Act (UDDA) set two criteria for death; (1) sustained irreversible of circulatory and respiratory function, and (2) all function of the brain including the brain stem is considered non-existent.

In recent years, there is a movement to harvest organs when the heart stops but brain function is still present. This is usually in patients that are severely ill and are going to die. This is termed "Non-Heart-Beating" or "Cardiac Death" organ donation. The University of Pittsburgh Medical Centre allocated 2 minutes after the heart stops before organ harvesting can begin. There is some uncertainty about this and the Institute of Medicine (IOM) extended the time to 5 minutes. However there have been documented cases of "autoresuscitation" i.e. the heart restarts after 10 minutes of no heart beats. The University of Zurich allows 10 minutes. This is a scary development because doctors are allowing patients to die so that organ harvesting can take place.

Dr Mark M Boucek reported the first heart transplants in three children after cardiac failure rather than brain death in August 14, 2008 issue of the New England Journal of Medicine. The transplants were done in Denver's Children Hospital in Denver. The time between the heart stops and organ harvesting is...75 seconds.

This is a scary development because the ends has justified the means. While it cannot be denied that there is a need for human organs, these organs must be harvested from patients who are already brain dead, not those allowed to die.

What do you think?

Last edited Aug 29, 2008 9:43 AM
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Twister

Organ Donation and the BMV

Hi,
I recently took my fifteen year into the BMV/DMV to get her permit. As I stood at the counter with her, they asked her if she wanted to be an organ donor. I spoke up and said no. I will express my reasons why later. Then a month later when she went back in to get her actual license, I was not at the counter with her and they asked her again, without my input, and she said yes. So now she is an organ donor against my wishes and she is a minor. Why is the BMV allowed to do this to minors? I bet there are some surprised parents who have lost their teenagers in car crashes, when the organ donor companies show up at the hospital. I have heard that sometimes, they are so pushy that it puts a burden on families at a very hard time. Please let me know your thoughts on this.
Seashel2001@aol.com

Last edited Aug 9, 2008 11:37 PM
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