Prohibition of Abortion in Rape: Who is Responsible for the Outcome?

Particularly these days, as a Presidential election is nearing, the politics of abortion is now in the forefront though it always has been a political and religious issue. Even, from an ethics point of view, the debate has been engaged as to whether a fetus was a person and what ethical, if not legal, rights was available for the fetus.. The issue of abortion is usually associated with either disease or injury on the part of the mother or in the case of an unwanted, unintended pregnancy.  Another area for consideration of abortion is in the case of rape with an associated pregnancy. Should abortion be an option for the mother if pregnant as a consequence of rape? There are political and religious views which deny such an option for the mother since rape should not lead to the punishment of the fetus for such a criminal act. Yet, one can argue that if the fetus of rape is unwanted by the mother and even by the rest of the family and abortion is not an option, who will be responsible for the continuing of the pregnancy and who will be responsible for the further life of the child when it is born?  Some might consider if the responsibility is put on the mother and family that this is simply an ongoing punishment of the mother and family for a crime they did not commit. If the rapist is not the one to assume the responsibility for the result of the crime, do the politicians and religions and others in society who hold that abortion is not acceptable in such a pregnancy, agree that then they are all responsible for the consequences of their dictum including the ongoing management, care and expense of the product of the rape?  Making political, religious or ethical decisions and failing to be responsible for the consequences should be open to scrutiny. What do you think?  ..Maurice.

Patient Modesty: Volume 50

This graphic modified by me from the graphic in an article in the July 30, 2010 New York Times sets an area of discussion on this Patient Modesty thread which we should settle by some consensus.  Those with such intense physical modesty concerns that would interfere with an efficient medical workup and treatment have been, after reading the responses to this thread, in my mind statistical outliers since I never have experienced such patients in my years of medical practice.  OK..that's one potential outlier. The other is the group of healthcare providers who have shown by their behavior and in many ways sexual and dominating actions creating emotional harm of their assigned patients.  I suspect (and hope) this group of providers are also statistical outliers.  I am not saying that such outliers whether patients or providers should be ignored but I think we must appreciate the majority of patients and providers who continue to attempt to improve health and service and not generalize the behaviors of the outliers to the entire population.  This is the topic that I would like further discussion upon as characterized by this Volume's graphic. ..Maurice.

NOTE: FOR THOSE VISITORS WHO HAVE NOT AS YET READ VOLUME 49 AND WOULD LIKE TO DO SO FOR CONTINUITY  (BUT NOT POST) MAY GO THERE WITH THIS LINK.

ADDENDUM; AS OF SEPTEMBER 10 2012, I HAVE STARTED A PETITION SIGNING DRIVE ON
ONE OF THE FREE PETITION WEBSITES TO ACCUMULATE SIGNATURES TO SEND TO THOSE OF RESPONSIBILITY IN THE MEDICAL SYSTEM REGARDING THE ISSUES AND CONCERNS AS PRESENTED IN THESE 50 VOLUMES OF PATIENT MODESTY. IF YOU WISH TO PARTICIPATE, GO TO THE FOLLOWING THEPETITIONSITE LINK.
http://www.thepetitionsite.com/799/493/745/medical-care-providers-must-attend-to-patient-modesty-issues-and-provider-gender-requests/

Graphic: see above linked source.

NOTICE: AS OF TODAY OCTOBER 14, 2012 "PATIENT MODESTY: VOLUME 50" WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 51 

"No.. Not Yet":Answering the Patient's Request for "Off Label Use" of a Drug

In the United States, physicians can legally write a prescription for a drug to be administered to a patient with a disease not approved by the Food and Drug Administration (FDA) for use, so-called "off label use" if that drug has already been approved for use by the FDA  for some other disease.  Often, patients and their families faced with a serious disease and unresponsive to any beneficial action by the available drugs for that condition may, after learning from the media of "promising results" from preliminary drug studies for that disease insist that their physicians prescribe that drug.  The "promising results" may be more supposition based on elementary animal studies of the patient's disease and not as yet studied in humans with that disease.  Yet, such "results" are readily documented by the media and thus available for the public to consider and desire.

Physicians practice under the ethical obligations of their profession to be beneficent in their actions with the patient and to avoid harm.  Such beneficence would include to attempt to attain a goal of "cure" for the patient's disease.  But what if the "cure", at present, was only theoretical and not documented by valid testing in humans?  To "avoid harm" is another matter of concern since if approval of the drug was carried out in studies or experience with a disease other than that experiencing by the current patient, can the physician be sure that the drug will be equally safe?

The ethical issue is how should a physician respond to a vigorous and understandable request by a patient or family member for the doctor to prescribe a drug as "off label" for a critical illness, not responding to prior drugs, but a drug which has not been approved by the FDA for such use and whose benefit/safety value for that disease has not been proven but only suggested by the media?

Should what is read by the public on a website or newspaper or heard on TV be something to challenge the doctor?  And does the doctor have the time, knowledge and ethical strength to defend any refusal to follow the request and finally say "no.. not yet."  Or at a certain end-point of an illness, the refusal itself is unethical?   ..Maurice.

p.s.- For more on this topic: "The Ethics of Early Evidence---Preparing for a Possible Breakthrough in Alzheimer's Disease" by Lowenthal, Hull and Pearson in the Perspective Section of August 9 2012 issue of the New England Journal of Medicine.

Graphic: My photograph of medicine bottle and modified with ArtRage and Picasa3.

Refusing to Cast a Deaf Ear to the Ethics of Maintaining Deafness within a Deaf Family

You may not be affected by this topic but as one interested in the ethical issues within society, it is important that you don't ignore and cast a deaf ear on an ethics topic that relates to behavioral actions of other cultures attempting to maintain uniformity and comfort.

There is a view in the culture of the Deaf to maintain deafness within the deaf family. The options, which have been proposed in the literature  to accomplish this cultural requirement would be to 1) prior to implantation of a preserved embryo to first determine whether it had the genetic makeup to be deaf and, if so, proceed with implantation and 2) have the mother take a toxin during a normally started pregnancy to cause the fetus to be born deaf.  Of course, there is a third option: for the family to adopt a deaf child into that deaf family.

So without casting that deaf ear to this topic, do my visitors agree that there is nothing unethical in the culture of the Deaf to maintain that culture by acquiring a deaf child?  If the goal of maintaining the culture is ethical, then about the options presented, would my visitors consider them all ethical to meet that goal? If not, which ones and why? I will be interested to read your opinions.   ..Maurice.

Is Current "Teaching" Medical Students Really "Preaching" to Medical Students?

You know, I was thinking, medical school is all about preaching to the students their Commandments toward their future practice of the profession of medicine.  We are saying to them:
1. "Here are Your Tools for practice We have Chosen to be Given to You, Here is Your Medical Education We have Devised, Here are Your Standards of Practice
2.Here are Your Codes of Ethical Practice
3.You will be Monitored by Us to Graduation and by Others beyond for adherence to Continuing your Medical Education 
4. Your Adherence to Standards of Practice and Codes of Ethics
5.You may Select a Specialty of your Choosing and Comfort but Monitoring for Your Adherence will Continue." 

And if that isn't Preaching the gospel of Medicine, I don't know what Is? 

Should we, in medical school education, really be teaching students only about the options available for taking a history, for performing a physical exam, for making a diagnosis, for providing treatment and for the overall practice of medicine including the pros and cons of various behaviors within the responsibilities of a medical doctor rather than be setting a series of medical rules which have been carried down from one medical generation to another without empiric, statistical documentation of the value or harm of each dictum?

What do you think?  ..Maurice.

Graphic: Preaching from Fellowship Room via Google Images.

   

"The Truth, Whole Truth and Nothing But.." Followed by Words of Comfort

Now here is an Essay from the Hastings Center Report July-August 2012 issue which you can read free and in full by clicking on this LINK which I think brings out a modern and perhaps a common behavior by physicians which clearly is of ethical importance and should be considered by all patients.. The Essay, titled "Comfort Care as Denial of Personhood" by William J. Peace starts with the following abstract.  


Comfort care is an ethical good for the patient but should not be used to meet the needs or frustrations of the healthcare providers. Read the Abstract below but then go to the Essay LINK and read the entire Essay. Then return here and present your comments. Do you think that a physician's suggestion for "comfort care" could be premature and actually be an ethical wrong for the patient? ..Maurice.








 ABSTRACT

It is 2 a.m. I am very sick. I am not sure how long I have been hospitalized. The last two or three days have been a blur, a parade of procedures and people. I had a bloody debridement for a severe, large, and grossly infected stage four wound-the first wound I have had since I was paralyzed in 1978. I know the next six months or longer are going to be exceedingly difficult. I will be bedbound for months, dependent upon others for the first time in my adult life. As these thoughts are coursing through my mind, a physician I have never met and the registered nurse on duty appear at my door. As they put on their gowns I am weary but hopeful. Surely there is something that can be done to stop the vomiting. The physician examines me with the nurse's help. Like many other hospitalists that have examined me, he is coldly efficient. At some point, he asks the nurse to get a new medication.
What transpired after the nurse exited the room has haunted me. Paralyzed me with fear. The hospitalist asked me if I understood the gravity of my condition. He grimly told me I would be bedbound for at least six months and most likely a year or more. That there was a good chance the wound would never heal. If this happened, I would never sit in my wheelchair. I would never be able to work again. Not close to done, he told me I was looking at a life of complete and utter dependence. He went on to tell me I was on powerful antibiotics that could cause significant organ damage. He informed me I had the right to forego any medication, including the lifesaving antibiotics. If I chose not to continue with the current therapy, I could be made very comfortable. I would feel no pain or discomfort at all. Although not explicitly stated, the message was loud and clear. I can help you die peacefully.

Which Direction is Ethical? Should We Simply "Count the Cars"?

My question for this thread is who should set ethics? Who should establish "what is ethical and what is not"? Should it always be society as a whole to establish which direction is the right ethical direction with the decision based on observation of which direction the majority of society is moving?  Or is "what is ethical and what is not" really not a matter of statistics but should be decided upon independent criteria and beyond simply observing the direction set by the general public?

If so then should the decision  be based on what philosophers or other "thinkers" have set in the past and then carried on to the present and the future? In other words do ethical actions and behavior really change over the years? Or if they can and do change should what is ethical be based on how current philosophers look at current issues? What should be the role of religions to establish what is moral and what isn't? Are the religions and their members really the ones to define what is or is not ethical? Finally, should we disregard society, philosophers and religions and say that what is "good" and what is "bad" be defined only by those who are directly involved as actors or recipients in any activity or behavior?  Should it be only the participants who set the ethical standards. 

Who do you want to tell you what is ethical and what isn't? ..Maurice.

Graphic: Photograph taken by me today of the 405 Freeway in Southern California

Failure to Use the Anatomic Names for Female Genitals: Ethical Illegitimacy?

I was a bit surprised and perplexed when I found and read an Essay in the current May-June 2012 issue of the Hastings Center Report, one of the major ethics journals.  Sarah Rodriguez and Toby Schonfeld wrote the Essay titled "The Organ That Must-Not-Be-Named: Female Genitals and Generalized References". It is all about the observation that in various public presentations, the vagina is referred to as "it"  or  "the v" or the female genitalia, presumably the vagina, as "down there" and failure to specifically name the vulva,clitoris, mons or the vagina itself.

My concern with the Essay is whether this is really a vital ethical issue and whether TV's hiding the anatomic names from their advertisements of women's products is worth an ethical dialogue as hoped for by the authors in their final paragraph excerpted here: "Our purpose is to encourage not a monologue about the vagina, but rather a dialogue. Part of this discourse involves recognition on the part of women, men, their doctors, and advertising companies that female genitalia, like male genitalia, are multiply constituted, diverse, and, of necessity, named. We must start using words like vagina in order for the words to become normalized and for the speakers of the words to be empowered and respected—something Betty Ford did for “breast” in the 1970s."


I think there are so many more significant ethical issues around us in this world and the way humans are treated that printed space and reading time should be better applied to them. Go to the link above and read the free full Essay and then return and share your opinion regarding my concern.  Oops! Well, I guess we will have started the authors' dialogue.  ..Maurice.


Graphic: Image from Wikipedia modified with Picasa 3.

Doctor Spying on a Patient's Blog

How would you feel, as a patient, if without your knowledge, your doctor found your blog and was monitoring it for additional information about you?  If you would be upset about that, why? If the doctor told you in advance that he or she was going to look but asked your permission, how would you respond? Do you think that your doctor has every right to look at your open blog as any other visitor? Do you think that your privacy is being intruded upon by the doctor looking at or following your postings on your blog? Would it make any difference if you had a mental illness and your doctor was your psychiatrist? 

In the June 2012 issue of the American Medical Association's Virtual Mentor, the topic of psychiatrists monitoring their patients' blogs is brought up with a scenario and followed by a commentary by psychiatrist David H. Brendel, MD, PhD under the title "Monitoring Blogs: A New Dilemma for Psychiatrists". The first paragraph of the commentary follows.  Go to the link above and read the entire article and then return and answer my questions. Your responses will be worth while to this topic since Dr. Brendel can only express his concerns speaking as a psychiatrist but you can provide feedback to us from any patient's point of view. ..Maurice.

Internet technologies in the twenty-first century have provided countless opportunities and potential pitfalls for professional practice in areas as diverse as medicine, law, politics, business, and academia. These technologies have especially serious implications for psychiatry, where emotional complexities, boundary issues, and privacy concerns are of particular concern in the relationship between clinician and patient. In the course of routine clinical practice, psychiatrists nowadays must grapple with questions about whether to exchange e-mails with patients, to participate in social networking sites such as Facebook, and to perform Internet searches in order to learn information about patients. Each of these uses of Internet technologies in psychiatry has received growing attention in the professional literature [1-3]. The case scenario raises the question of whether clinical psychiatrists ought to read and monitor the websites or blogs of some of their patients.

Graphic: From Colocation America. com via Google Images.