March 7th, 2011 by Elaine Schattner, M.D. in Health Policy, Opinion
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[Recently] a short article in the New York Times, New Kidney Transplant Policy Would Favor Younger Patients, [drew] my attention to a very basic problem in medical ethics: Rationing.
According to the Washington Post coverage, the proposal comes from the United Network for Organ Sharing, a Richmond-based private non-profit group the federal government contracts for allocation of donated organs. From the Times piece:
Under the proposal, patients and kidneys would each be graded, and the healthiest and youngest 20 percent of patients and kidneys would be segregated into a separate pool so that the best kidneys would be given to patients with the longest life expectancies.
This all follows [the recent] front-page business story on the monetary value of life.
I have to admit, I’m glad to see these stories in the media. Any reasoned discussion of policy and reform requires frank talk on healthcare resources which, even in the best of economic times, are limited.
*This blog post was originally published at Medical Lessons*
February 25th, 2011 by DrRich in News, Opinion
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A minor firestorm has erupted regarding those doctors in Wisconsin this week who were handing out fake “sick excuses” to demonstrating teachers, Fox news producers, Andrew Breitbart, and, apparently, anyone else who had some use for one.
Indeed, there has been more outrage about this episode than DrRich would have thought. Conservative commentators, of course, were predictably apoplectic about the sight of these callow youths, preening in their white coats, abusing and debasing the sacred trust which has been granted to them by virtue of their profession. There’s nothing surprising about that. But even most of the more mainstream commentators expressed at least a slight bit of discomfort about the actions these doctors were taking, even if they were doing it for a very good and noble cause.
Only a very few seemed to endorse their actions completely, explaining that these doctors are engaging in classic civil disobedience, and that, by standing on street corners in their white coats repeatedly committing felonies with the cameras whirring, their behavior is every bit as deserving of our approbation as the actions we admire so much of Thoreau or Gandhi. DrRich is open to this explanation.
Civil disobedience, of course, is to a) openly and non-violently disobey a certain law that you consider unjust, b) to admit to the operative authority, upon apprehension, that you intentionally broke the law specifically because you consider it unjust, and finally c) to passively accept whatever punishment the authority hands out to you. These doctors have executed step “a” flawlessly, and DrRich waits with interest to see whether they will successfully complete steps “b” and “c.” Read more »
*This blog post was originally published at The Covert Rationing Blog*
February 11th, 2011 by Michael Kirsch, M.D. in Health Policy, Opinion
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I have previously posted on the ethics of paying for organ donation. I find this notion to be ethically troubling, but I believe the issue deserves fair debate. In general, my belief is that a personal anecdote should not drive policy in medical ethics. There are many individual vignettes that are poignant and heartbreaking that tempt us to relax our ethical boundaries.
For example, permitting us to harvest organs from folks who are “not quite dead,” would save lives, but society’s rights outweigh this benefit, in my view. For similar reasons, I resist efforts to relax the definition of death in order to increase the reservoir of available organs. If death is redefined as a result of a search for truth, then the process is ethically permissible. Participants in these discussions would include medical professionals, theologians, ethicists, legal experts and ordinary people.
If a result of this process would be that there would be more organs available for transplantation, then I would be supportive. The distinction is that increasing organ supply would not be the primary objective. In other words, I reject the approach of, “Hey, we need more organs to save lives. Let’s roll back the definition of death to get there.”
Recently, two sisters who were serving life sentences in Mississippi for a crime related to armed robbery were released by Governor Haley Barbour. They were not pardoned, but their sentences were indefinitely suspended. A condition of their release was that one woman must agree to donate a kidney to her sister.
The women have always maintained their innocence, and supporters have argued that the verdict was wrong or disproportionate to the crime. I am not knowledgeable on the facts and offer no view on the whether the verdict and sentence were just. Read more »
*This blog post was originally published at MD Whistleblower*
February 10th, 2011 by Elaine Schattner, M.D. in Better Health Network, Opinion
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[Recently] I came upon a Jan 24 op-ed, “A Fighting Spirit Won’t Change Your Life” by Richard Sloan, Ph.D., of Columbia University’s psychiatry department. Somehow I’d missed this worthwhile piece on the sometimes-trendy notion of mind-over-matter in healing and medicine.
Sloan opens with aftermath of the Tucson shootings:
…Representative Giffords’s husband describes her as a “fighter,” and no doubt she is one. Whether her recovery has anything to do with a fighting spirit, however, is another matter entirely.
He jumps quickly through a history of the mind cure movement in America: From Phineas Quimby’s concept of illness as a product of mistaken beliefs — to William James and “New Thought” ideas — to Norman Vincent Peale’s 1952 “Power of Positive Thinking” — to more current takes on the matter. These ideas, while popular, are not reality-based.
In his words:
But there’s no evidence to back up the idea that an upbeat attitude can prevent any illness or help someone recover from one more readily. On the contrary, a recently completed study* of nearly 60,000 people in Finland and Sweden who were followed for almost 30 years found no significant association between personality traits and the likelihood of developing or surviving cancer. Cancer doesn’t care if we’re good or bad, virtuous or vicious, compassionate or inconsiderate. Neither does heart disease or AIDS or any other illness or injury.
*Am. J. Epidemiol. (2010) 172 (4): 377–385.
The New York Times printed several letters in response, most of which point to pseudo-evidence on the matter. All the more reason to bolster public education in the U.S. — people won’t be persuaded by charismatic, wishful thinking about healthcare.
It happens I’m a fan of Joan Didion’s. I was so taken by the “Year of Magical Thinking,” in fact, that I read it twice. Irrational responses — and hope — are normal human responses to illness, disappointment, and personal loss. But they’re not science. It’s important to keep it straight.
*This blog post was originally published at Medical Lessons*
February 9th, 2011 by GruntDoc in Better Health Network, News
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From an AP article in the Dallas-Fort Worth Star-Telegram:
AUSTIN — Texas medical regulators on Friday placed on probation a West Texas doctor involved in the unsuccessful prosecution of two nurses who complained anonymously that the physician was unethical and risking patients’ health.
The Texas Medical Board technically suspended Dr. Rolando G. Arafiles Jr. but allowed him to continue to practice medicine while on probation for four years if he completes additional training.
The board also said Arafiles must be monitored by another physician and submit patient medical and billing records for review. The monitor will report his or her findings to the board.
In the mediated order signed in Austin, the board concluded that Arafiles failed to treat emergency room patients properly, did not apply hormone therapy to a female patient appropriately and failed to document patient diagnoses and treatment plans.
The board also found that Arafiles improperly tried to intimidate two nurses who reported him to the medical board for unethical behavior.
Ugh.
*This blog post was originally published at GruntDoc*
