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Archive for the ‘Medical Ethics’ Category

Several recent news items worth mentioning:
Eletronic Physicians Orders for End-of-Life Treatment
States are creating electronic databases that will store physicians’ orders regarding the type of care patients want at the end of their lives. The goal is to make such orders more readily available to emergency workers, as paper based orders (including advance directives) are frequently misplaced. Such orders are called POLST, or physician orders for life-sustaining treatment. Also, such orders will be honored by other physicians in other health care institutions and therefore, no need to interpret wishes in an advance directives, which can differ between different physicians. Read this article here>

Alzheimer’s Tests: Who Controls the Information?  Doctors or Patients? Recent tests (such as MRI and spinal taps and APOE tests) that can predict with some accuracy the likelihood of developing Alzheimer’s are becoming more widespread and raises the question of whether doctors should order such tests and tell patients the results, the concern being that there is no treatment yet for Alzheimer’s. But many patients are saying they want to know. Are physicians being too paternalistic?
Read the article here

Proper Rationing of Transplants??  Recently Arizona decided not to cover the costs of transplants under its Medicaid program, the reason being that the data shows that most people die even with the transplants. But are the data accurate? Read the article here.

Spinal Fusin Surgery and Medicaid Fraud?   Recent data from the Medicaid database show that several medical centers have performed an extraordinary amount of spinal fusion surgeries and the concern is that their surgeons are receiving large payments from the device companies that manufacture the hardware used in such surgeries. Do such surgeons have a conflict of interest? Read the article here.

Enjoy the readings and enjoy the holidays!!

Henry Silverman

Investigators have found that patients with terminal lung cancer began receiving palliative care immediately at the time of diagnosis  were happier, more mobile,  in less pain as the end-of-life and ALSO:  lived nearly three months longer than those who did not receive palliative care.

The study was published in The New England Journal of Medicine and contrasts with the rhetoric about ‘death panels’ that surfaced during the debate on the Obama  Administration’s health care bill, thus casting doubt on the decision to strike end-of-life provisions from the health care overhaul passed last year.

In the three-year study performed at the Massachusetts General Hospital, 151 patients with advanced lung cancer were randomly assigned to get either oncology treatment alone or oncology treatment with palliative care — pain relief and other measures intended to improve a patient’s quality of life. They were followed until the end of 2009, by which time about 70 percent were dead.  Those getting palliative care from the start reported less depression and happier lives as measured on scales for pain, nausea, mobility, worry and other problems. Moreover, even though substantially fewer of them opted for aggressive chemotherapy as their illnesses worsened and many more chose to forgo cardiopulmonary resuscitation,  they  lived almost three months longer than the group getting standard care, who lived a median of nine months.

Palliative care is traditionally seen as an intervention only for those in their last weeks of life.  But, contrary to this opinion, the institution of palliative care makes sense from the beginning of an illness.