Reality Check on "Frankenfood" Fear

Brody nicely lays out the popular myths and irrational fears of genetically modified foods in this NY Times piece . --Dominic Sisti

No More Selective Abortion in China

In an attempt to right an imbalanced gender ratio, and as part of its aggressive single-child policy, the Chinese government will outlaw selective abortions of female fetuses. But is this a naïve stopgap? As this Reuters article points out, fixing the gender gap is far more complex since the cards remain stacked against Chinese girls once they make it out of the womb. --Dominic Sisti

Blogs as Teaching Tools

Actual case studies and personal narratives are oftentimes the optimal jumping off point in teaching ethical theory, methods, and stimulating discussion. In addition to the standard hardcopy tome, why not use the real-time lived experiences of bloggers? Here are a few blogs to check out, which might serve as discussion starters in your bioethics class:

A Little Pregnant [http://www.alittlepregnant.com/] Description: Madcap misadventures in infertility, pregnancy, and parenthood.

Hospice Blog [http://hospiceblog.blogspot.com/] Description: Fighting for quality hospice care for those that need it.

A Single Woman's Journey To Motherhood [http://kajohn345.blogspot.com/] Description: I am 30 and ready to start my family. I am beginning TTC in January. If that doesn't work (after 6 months to a year), I am heading to adoption. These are my random thoughts and obsessions about TTC, adoption, weight loss, teaching, and working on (actually procrastinating) my Master's. If you stop by, please leave me a short note! I like to know when I have visitors.

Code Blog: Tales of a Nurse [http://www.codeblog.com/]

Death Maiden [http://www.deathmaiden.blogspot.com/] Description: The following postings are all fictionalized. Names and circumstances have all been changed to protect the identity of persons in the stories. Any resemblance to real life people and circumstances is purely coincidence. This blog has been created to explore my personal feelings and professional experiences with death and dying. --Dominic Sisti

Take Two of These and See Me in the Morning (Although I Might Have a Hangover)

An interesting question was addressed in Journal of Medical Ethics by James Peterman, "Is it ethical for physicians to drink while they are on call?" Peterman says no. But others aren't quite the teetotalers. Bill Glasson, the president of the Australian Medical Association: '[I]f you go home and have a glass of wine with your spouse, that's OK.' " [Link] - Dominic Sisti

Gandhi on Euthanasia

The Times of India received this letter concerning a recent series of stories on euthanasia in India. The subject is Mahatma Gandhi's view of euthanasia, and the writer included this interesting quote:

"A calf, having been maimed, lay in agony in the ashram and despite all possible treatment and nursing, the surgeon declared the case to be past help and hope. The animal's suffering was very acute.

"In the circumstances, I felt that humanity demanded that the agony should be ended by ending life itself. The matter was placed before the whole ashram. Finally, in all humility but with the cleanest of convictions I got in my presence a doctor to administer the calf a quietus by means of a poison injection, and the whole thing was over in less than two minutes.

"Would I apply to human beings the principle that I have enunciated in connection with the calf? Would I like it to be applied in my own case? My reply is yes. Just as a surgeon does not commit himsa when he wields his knife on his patient's body for the latter's benefit, similarly one may find it necessary under certain imperative circumstances to go a step further and sever life from the body in the interest of the sufferer".

[thanks Dominic Sisti]

Broken Health Care System --> Charity Care Mess

In an incredibly biased piece, Jonathan Cohn writes about the problems some non-profit hospitals have in fulfilling their charity care obligations. He cites one case in particular and highlights that there are sometimes insurmountable obstacles for patients accessing charity care funds. Yes, it looks pretty bad when a hospital sues a grieving widow for an enormous amount of cash.

But Cohn's account is more cynical than accurate. For every case like the example he describes, there are thousands others that get done right. (Go check out the IRS's database of Form 990.) Non profit hospitals eat millions and millions of dollars of medical bills every year. In combination with shortfalls in reimbursements from medical assistance (Medicaid programs), and astronomical liability insurance premiums, charity care costs are often far more than the tax break non profits enjoy.

There is a distinction between indigent care- services provided to those who don't pay- and charity care- services provided to those who can't pay. Often the two groups are the same, but it takes some finesse in figuring out who's who at patient intake- a process riddled with problems indeed. Sick patients or their families don't want to fill out a stack of forms and disclose they are broke because they fear they will be denied care. No fault of their own, these folks often don't realize providing accurate financial information will make them eligible for charity care.

Really, the lesson here is our health system is broken. Providing medical care for the uninsured or underinsured should not fall to nonprofits only. A basic, universal and just health care system is the only way to fix this mess. - Dominic Sisti

Negative Results in Evidence Based Medicine: Huh?

Tim Christie writes in the Eugene Register-Guard that Evidence Based Medicine (EBM) has taken full root. Once personal experience, medical authority, or anecdotal evidence were the physicians' bases for a medical decision. With the latest data from randomized controled trials and meta-analyses streaming to their palm pilots, EBM is used by clinicians to make treatment decisions. EBM standards are also used by journals to pick publishable papers and by continuing education programs to teach docs.

And lets not forget about a payers interest in paying for interventions that actually work. Really, isn't this just common sense? Dr. Norman Kahn, of the American Academy of Family Physicians: "Physicians yearn to deliver what works," "So when they learn there is evidence for this vs. no evidence for that, they are rapid adopters."

The missing piece in this account is that sometimes, as we've seen lately, "no evidence" really means "suppressed negative results." - Dominic Sisti

Interesting New Data on Ethical Safeguards in Psychiatric Research

In December's American Journal of Psychiatry, data are presented that indicate the key safeguards of ethical research – informed consent, alternative decision makers, institutional review boards, data safety monitoring boards, and confidentiality measures- are recognized by both research subjects and researchers as important measures used to protect subjects' rights and well-being. Does a positive recognition of these safeguards by the stakeholders say anything about the effectiveness of the safeguards themselves? -Dominic Sisti

Living Wills Have "Failed"

Here in the Miami Herarld is an account of a recent paper in the Hastings Center Report, which describes the failure of living wills- paper documents that list medical choices if you become terminal and incapacitated. A more helpful thing to do- although by far not foolproof- is designate a trusted surrogate to make your end-of-life choices. "Another choice that holds less legal weight but perhaps more influence: thoughtful conversations in advance with your regular doctors." -Dominic Sisti

Moving Toward Bioethics in Secondary School

Ethics and Topical Issues Could Replace Traditional Sciences , writes RedNova. "Teenagers will be able to ditch traditional science studies and focus on the ethics of hot topics like cloning and MMR, under GCSE reforms outlined this week." Is this true? Feedback from partner teachers working with Penn's high school bioethics project would indicate that unless the teaching of bioethics somehow replaced the teaching of science, it would be a welcome option. Many teachers tell us they don't have the time and, some say, the training to teach bioethics in a systematic way. Nonetheless teachers fit bioethics in because they are interested, their students are interested & ask the right questions, and because by teaching basic science in a broader context they can point out the relevance of emerging technologies for students, their families, and society. -Dominic Sisti

"Motorcyle Diaries" a Medical Ethics Flick

Unbeknownst to young Ernesto 'Che' Guevara, he was both a political revolutionary and a medical ethicist. The latter led to the former. On his journey, Che noticed the direct relationship between how a society treats its sick and its poor & the ethics (or lack thereof) of said society. What might this relationship tell us about a nation complacent in the face of 45 million uninsured and millions more left without adequate health care? -Dominic Sisti

Last Minute Abortion Language in the Budget

An 11th hour provision was added to a spending bill that is needed to keep federal agencies up and running. Most of the language is a continuation of past years. The new language would give "conscience protection" to physicians who oppose abortion. -Dominic Sisti

Guest Blogger Dominic Sisti

Welcome to Dominic Sisti, our Guest blogger for the next few months. Those of you with interest in bioethics for high school students know him, and we think he's great.

Here's a biosketch: Dominic A. Sisti is a researcher at the University of Pennsylvania Center for Bioethics, an ethicist at Holy Redeemer Health System in Philadelphia, and an adjunct instructor at Villanova University. Dominic received his master's degree from the University of Pennsylvania (Bioethics, 2000) and his Bachelor of Science degree from Villanova University (Biology, 1996). He serves on several ethics committees and is currently working to develop the Center's High School Bioethics Project (PI- Prof. McGee) (see highschoolbioethics.org). Dominic is a co-editor of Health, Disease, and Illness: Concepts in Medicine (with Profs. Caplan & McCartney, Georgetown University Press, June 2004).

Welcome, Dom!