The Catheter Popped! But Whose to Blame?

The ruling by the United States Supreme Court on February 20, 2008 protects medical device manufacturers from law suits by patients who have been injured by some malfunction of the device if the device has been approved and allowed to be distributed by review of the Food and Drug Administration (FDA). You can read about the decision in the Washington Post of February 21, 2008. In the Fall of this year, the Supreme Court will be deciding whether to protect pharmaceutical companies against lawsuits regarding the FDA approved drugs.


As I understand it, the Court doesn’t want the states or others to interfere with the decision making of the FDA with regard to medical devices. If the FDA finds that the devices are safe and effective and may be used, that is sufficient to deny claims against the manufacturer. If it could be proven that that the manufacturer failed to follow FDA rules or presented false or misleading information to the FDA then the manufacturer could be held liable for injuries to patients.

But if patients have been injured by a device or a drug which the FDA concludes is safe, who is responsible for the consequences? If the FDA is considered by the courts as the final decider of safety and effectiveness, shouldn’t the FDA be held responsible for any inadequate evaluation it has made? Who should be responsible party when there is harm, the manufacturer, the FDA, the physician or the patient? It appears that the current Supreme Court ruling, by protecting the manufacturer and with no recourse against the FDA, it is the patient who must ultimately bear the burden of errors in the system apparently in order not to stifle medical research and development which would be of benefit to the many patients. What do you think about the ruling and who should be responsible? Are the harms simply spontaneous accidents and therefore simply an act of God and nobody should be penalized? ..Maurice.

Is Being A Modest Doctor a Virtue and a Benefit for Their Patients?

What is modesty? Modesty can be defined as reserve or propriety in speech, dress or behavior; lack of pretentiousness, simplicity. If a doctor demonstrated modesty, would that be a virtue? Is that something that patients would want in their doctor?

Would you want the doctor to tell you as a patient “you are mistaken if you think I know everything about your illness and I don’t want to pretend that I do, so I must do a little research first before we talk about treatment”? Is such a response open and frank and comforting to the patient or would the patient feel more comfortable with some comment by the same doctor but which is much less reserved and less intellectually modest such as “I have been trained to decide on illnesses like yours and based on my educated guess, I would begin the following treatment”? Which would be a benefit for the patient?

How about the physician who advertises in the local newspaper or has an ad on television (as some specialists do) and even presenting example patients on TV? Or simply the signage outside the office: should the sign give only the name and specialty of the doctor or should it be more descriptive with noteworthy other degrees, affiliations and rewards written there? Do patients pay attention to this advertising and what is the reaction? Should a doctor advertise to patients his or her positive reputation in the medical community?

What about the appearance of the doctor? Should the clothing and dress be modest or show professional success.. maybe an expensive ring on the finger. For a woman physician, how much and what kind of makeup or hairdo would be appropriate and acceptable by the patient? Would excesses with regard to appearance make a difference to patients?

And finally, should the physician’s own personal issues regarding their own bodily modesty affect how they perform a physical examination or procedure on a patient? And do you think it does? Many questions..any answers? ..Maurice.

The Spurning of Death by the Love of Life

Here are two poems by Ella Wheeler Wilcox (1855-1919) in which the second poem seems to answer the question set by the first. There is much to think about in both poems. Do these poems bring to mind the issues we face in medical ethics about suicide, euthanasia, need for palliative care and the reasons why patients and families may want to continue on with futile treatment? ..Maurice.

DEATH'S PROTEST
Why dost thou shrink from my approach, O Man?
Why dost thou ever flee in fear, and cling
To my false rival, Life? I do but bring
Thee rest and calm. Then wherefore dost thou ban
And curse me? Since the forming of God's plan
I have not hurt or harmed a mortal thing,
I have bestowed sweet balm for every sting,
And peace eternal for earth's stormy span.

The wild mad prayers for comfort sent in vain
To knock at the indifferent heart of Life,
I, Death, have answered. Knowest thou not 'tis he,
My cruel rival, who sends all thy pain
And wears the soul out in unending strife?
Why dost thou hold to him, then, spurning me?

COULEUR DE ROSE
I want more lives in which to love
This world so full of beauty,
I want more days to use the ways
I know of doing duty;
I ask no greater joy than this
(So much I am life's lover),
When I reach age to turn the page
And read the story over.
(O love, stay near!)

O rapturous promise of the Spring!
O June fulfilling after!
If Autumns sigh, when Summers die,
'Tis drowned in Winter's laughter.
O maiden dawns, O wifely noons,
O siren sweet, sweet nights,
I'd want no heaven could earth be given
Again with its delights
(If love stayed near).

There are such glories for the eye,
Such pleasures for the ear,
The senses reel with all they feel
And see and taste and hear;
There are such ways of doing good,
Such ways of being kind,
And bread that's cast on waters fast
Comes home again, I find.
(O love, stay near.)

There are such royal souls to know,
There is so much to learn,
While secrets rest in Nature's breast
And unnamed stars still burn.
God toiled six days to make this earth,
I think the good folks say -
Six lives we need to give full meed
Of praise--one for each day
(If love stay near).

But oh! if love fled far away,
Or veiled his face from me,
One life too much, why then were such
A life as this would be.
With sullen May and blighted June,
Blurred dawn and haggard night,
This dear old world in space were hurled
If love lent not his light.
(O love, stay near!)


Note: The poems by Ella Wilcox Wheeler are from the Gutenberg Project And more of her poems are available on the link as a GNU,General Public License.

“Being Too Ethical”: Is That Real and Is That Ethical?

I have been asked and I have also wondered whether there was such a condition or behavior as “being too ethical”. Being ethical has to do with doing good by deciding and doing the right things and it usually is applied to how actions affect others and not necessarily simply what is right for one’s self-interest. But, the question is can “ethical do gooders” go overboard, by inappropriate ethics conclusions or application of their ethics so that their acts become, themselves, unethical?

For example, President Bush has expressed concern that those in Congress who ethically want to preserve the privacy of the American people and refuse to allow eavesdropping on telephone conversations without a court order are in fact overstepping the ethics of justice and autonomy and allowing terrorists to gain access to harm the American people. On the other hand, some have found that President Bush’s refusal to allow federal funding of embryonic stem cell research based on ethical/moral grounds was also impairing and delaying the anticipated good that could be the result of cures for currently untreatable or poorly treatable disorders.

So, what is your opinion? Is there such a thing as “being too ethical” and is it unethical to be that way? ..Maurice.

Teaching Medical Students What is Torture and When to Disobey Orders

It would seem that based on the formal survey of medical students published the International Journal of Health Services, Volume 37, Number 4, Pages 643–650, 2007, currently medical students are unaware that later as physicians they can be drafted into the Armed Services of the United States if the need arises, many are unaware of the Geneva Convention requirements regarding care of the wounded or about torture and many are divided on what orders represent torture and what orders in the military they ethically would be obliged not to follow.

Amongst other elements of the survey, the students were asked under what circumstances an officer is ethically required to disobey a direct order from a superior:

1) When ordered to threaten a prisoner with injection of a psychoactive drug which will not actually be administered.
2) When ordered to inject a harmless bolus of saline into a prisoner who fears he is receiving a lethal injection.
3) When ordered to inject a lethal drug into a prisoner.

According to the article “over 27 percent of respondents thought that the only scenario in which they were ethically required to disobey was when asked to inject a lethal drug into a prisoner; over 6 percent felt that none of these scenarios required them to disobey and 66.1 percent correctly answered 'all of the above.'"

“...only a small percentage of respondents had received any instruction in
military medical ethics. About 94 percent had received less than 1 hour of
instruction during medical school about the ethical obligations of physicians
serving in the military. Just over 4 percent had received between 1 and 5 hours
of instruction, and 1.5 percent reported receiving more than 5 hours of teaching about these matters."

If you were setting up the curriculum for a medical student’s education, would you include military ethics? What standards of a physician’s behavior which a physician should follow would you expect to be taught? Would you teach about a physician disobeying a military order and, if so, under what circumstances? ..Maurice.

Responsibilities of a Professional: Choice or No Choice

In order to realize his personal responsibilities as both a husband and a father, Dr. Green regretfully had to turn aside his professional obligations leaving his patients without their physician and a pandemic looming on the horizon. A killer flu was en route to Kansas…


The above excerpt is from a brief but telling story by James E. Kelley published in the December 2007 issue of Virtual Mentor about choices and professional duties.

Please read the story and come back and write us your impression of this professional dilemma. How can and how should a physician balance his responsibilities to himself and his family with the responsibilities he has taken on with his patients? Do you think the balance is any different if the physician is a woman? Let us know what you think. ..Maurice.

ADDENDUM 3-29-2008: A recent article [full article may require subscription] in the March 26,2008 issue of the Journal of the American Medical Association titled "Potential Penalties for Health Care Pofessionals Who Refuse to Work During a Pandemic" by Coleman and Reis seems to cover the very issue brought up in this thread but specifically with regard to punishment. Here is a brief extract of the article: "The severe acute respiratory syndrome (SARS) epidemic and the spread of avian influenza have generated renewed interest in health care professionals' (HCPs’) obligations to work during a pandemic. However, most discussions of this issue have occurred on a relatively abstract level of ethical analysis, with less attention to what should actually happen to HCPs who are unwilling to work. Should HCPs who refuse to work be fired from their jobs? Should they lose their licenses? Should they go to jail?"

“Do we run because we are scared or are we scared because we run?"

“Do we run because we are scared or are we scared because we run?"

Do we have moral beliefs because of the behavior we see around us or is the behavior around us the result of the moral beliefs?

I am morally against abortion because I see people killing unborn babies.
I would have an abortion because I believe in the freedom of women to make that decision.

To understand why people think and why people do the way they do, what is the answer to my question: “Do we have moral beliefs because of the behavior we see around us or is the behavior around us is the result of the moral beliefs?” ..Maurice.