REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.
TO FIND A TOPIC OF INTEREST TO YOU ON THIS BLOG, SIMPLY TYPE IN THE NAME OR WORDS RELATED TO THE TOPIC IN THE FIELD IN THE LEFT HAND SIDE AT TOP OF THE PAGE AND THEN CLICK ON “SEARCH BLOG”. WITH WELL OVER 900 TOPICS, MOST ABOUT GENERAL OR SPECIFIC ETHICAL ISSUES BUT NOT NECESSARILY RELATED TO ANY SPECIFIC DATE OR EVENT, YOU SHOULD BE ABLE TO FIND WHAT YOU WANT. IF YOU DON’T PLEASE WRITE TO ME ON THE FEEDBACK THREAD OR BY E-MAIL DoktorMo@aol.com
IMPORTANT REQUEST TO ALL WHO COMMENT ON THIS BLOG: ALL COMMENTERS WHO WISH TO SIGN ON AS ANONYMOUS NEVERTHELESS PLEASE SIGN OFF AT THE END OF YOUR COMMENTS WITH A CONSISTENT PSEUDONYM NAME OR SOME INITIALS TO HELP MAINTAIN CONTINUITY AND NOT REQUIRE RESPONDERS TO LOOK UP THE DATE AND TIME OF THE POSTING TO DEFINE WHICH ANONYMOUS SAID WHAT. Thanks. ..Maurice
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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.
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.