In New York state last week legislators passed an extraordinary bill that, effectively, indicts the practice of New York doctors. That the bill was thought necessary, and, even more so, that it was opposed by the Medical Society of New York is a sad reflection of medical practice in that part of the world.
In a paper released today in the Journal of Medical Ethics, a large survey of UK doctors found that doctors’ religion influenced their views and practice of end-of-life care. Why does this matter? A number of headlines highlighted that atheist or agnostic doctors were more likely to report having participated in “ethically contentious end-of life actions”: ie taking part in terminal sedation or in actions that they expected or partly intended would hasten the patient’s death. But other headlines emphasised the obvious flip-side: doctors who identified themselves as ‘very religious’ or ‘extremely religious’ were about 35% less likely than non-religious doctors to report having taken this sort of step.
Read More »Should doctors come clean? Religion makes a difference to end-of-life decisions
Is drug addiction a disease? Substance Dependence appears as a diagnosis in the influential Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-IV). There are medical specialists in the field who use a range of different drug and non-drug treatments for patients who are addicted. There are hospitals and clinics where those who are addicted can seek help. But if it is a disease why is it treated as a crime? After all we do not lock people up because they have cancer, or hepatitis, or heart disease.
A powerful BBC documentary, “Between Life and Death”, screened this evening on BBC One. The documentary (which can be viewed online for the next week in the UK) examined the life and death decisions made for critically ill patients with severe brain injury. Neuro-intensive care provides a way to interrupt the process of dying for such patients. But it raises difficult questions for medical staff and for families about the wishes of patients, the wishes of family members, and about uncertainty. Should treatment continue at the risk of the patient surviving in a severely impaired state? Or should patients be allowed to die, with the risk that perhaps if treatment had continued they may have recovered?
by Dominic Wilkinson Quads, Quins, Sexts, Septs, even Octs! High order multiple pregnancies such as the Suleman octuplets in California generate enormous media attention. However, they also raise some unique ethical questions. In the second of a series of seminars on critical care ethics, the neonatal grand round today looked at ethical questions arising from… Read More »Critical Care ethics series – the ethics of maxiple pregnancies
In the news today – scientists have identified a cluster of longevity genes. From the Daily Mail A genetic test which tells whether you will make it to your century has been developed by scientists. The computer program will give individuals their odds of reaching the age of 100 – and tell them whether their… Read More »Will you live to 100? Should we tell people that they have (or lack) the genes for long life?
by Dominic Wilkinson
Television child star Gary Coleman died recently following a severe brain haemorrhage. He was taken to an intensive care unit, but the next day was taken off life support because of the severity of his brain injury.
Decisions like the one made by Gary Coleman’s doctors are common in intensive care. Many deaths follow decisions to stop intensive treatment because it is believed to have no chance of succeeding or because of the burden of illness even if the treatment does work. One question raised about cases like these is about the importance (or risks) of living wills. A separate question (and one that was raised during the critical care grand round earlier today) is about the difference between stopping treatment and failing to start treatment.
Read More »A costly separation between withdrawing and withholding treatment
by Dominic Wilkinson
Today I gave a talk at the John Radcliffe Medical Grand Round on Advance Directives and treatment withdrawal decisions in intensive care – based on a case I was involved in last year.
A middle-aged patient presents with acute respiratory failure, and is intubated and transferred to the intensive care unit. After admission he improves, but it transpires that he has a progressive neurodegenerative disorder and has previously expressed a wish not to have intensive life support measures provided.
by Dominic Wilkinson
"Absolutely!" is the answer of Boston physician Amy Ship writing in the New England Journal of Medicine, and interviewed over at the LA Times blog. She includes questions about seatbelts and phone use while driving in her routine questions for patients
Read More »Is it any of your doctor’s business whether you text and drive?
One issue emerging from the recent media circus over Craig Venter’s apparent creation of a synthetic life form is the potential danger … of ethics commentary itself.
