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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Doctors Who Torture: Why No Punishment?
Extra-Marital Sex: Sex by the Demented in Nursing Homes
On August 8 2011, I started a thread here titled "Extra-Marital Sex: Spouse of the Demented Marital Partner"
and I got some interesting visitor responses. Today, I would like to switch the topic around a bit to consider extra-marital sex, not by the competent spouse but by the demented spouse living in a nursing home with a sex partner who is also demented. Is this ethical? Is it even legal? Should this activity be prevented by the nursing home? Can the demented still have the capacity to make a decision regarding whether they should engage in sex with another nursing home resident? If one or both are married to a spouse living outside the nursing facility, is it marital infidelity and should be prevented?
To learn a bit more on this subject, the issue was presented yesterday on NPR "All Things Considered". The audio and text is available at NPR .
Bryan Gruley, reporter-at-large for Bloomberg News, talks with Melissa Block about his two-part feature story on sex and nursing home patients with dementia. One key question is whether those with dementia are truly able to consent. How nursing homes deal with this, or not, is increasingly becoming an issue as baby boomers enter nursing homes.
Is such apparently consensual sexual activity between the demented an ethical issue? Is it a legal issue? So, if you were operating a nursing home, what would be your responsibilities in this matter? Would you stop it or allow it to continue, considering it would be humane and even therapeutic? ..Maurice.
Graphic: From Google Images.
Here are the links to the two Bloomberg News articles by Bryan Gruley
Article One Boomer Sex With Dementia Foreshadowed in Nursing Home
Article Two Sex in Geriatrics Sets Hebrew Home Apart in Elderly Care
Are Clinical Ethicists Looking in Wrong Directions?
Clinical ethicists are those who perform ethics consultations
regarding patient care and who also may teach and write about a host of issues
that pertain to that care. These
ethicists are often physicians but also may be philosophers, social workers,
ministers, lawyers, nurses and other occupations but whatever their primary
professions, doing ethics they tend to follow some consensus often developed
amongst themselves to explain and define what is happening and what is ethical.
Issues that are considered are often as basic
and as important in clinical ethics decision-making such as "what is
life" and "what is death" which are, for example, related to
terminating life support and organ procurement. It may be that those ethicists who originate
concepts which others will consider to follow develop explanations and
decisions based on theory and limited, perhaps isolated experiences, rather
than in the direction of the common everyday experience of the meaning and
consequences of life and death. Are
clinical ethicists actually looking for and presenting answers to society in
the wrong direction? Do you think what
you read and hear from ethicists really represent the life which you are
I thought an excellent presentation of this topic was that written to a bioethics listserv today by Steven Miles MD, who is a professor of medicine and bioethics at the University of Minnesota and has written to this blog in the past. I have reproduced, with his permission, his writing. ..Maurice
Personally, I think clinical ethics has accepted a paradigm
of priestly rationalism that is alien to the experienced phenomenon of life. When
my father dies, it is not a biological event, it is a personal one. It is a
social one--the Procrustean constructions of clinical ethics simply do not fit
the dimensions of that experience.
Our rationalism and pursuit of objectivity estranges us from
life. This estrangement is compounded by the fact that most bioethicists write
from the most extreme technological enclave of medicine--tertiary care
treatment centers. In this environment and from this experience, life becomes flattened--two
dimensional in the words of Jacques Ellul. And we would export those expensive
and scarce technological redefinitions of diagnosis and treatment to the
broader community despite the fact that they can not be widely implemented, are
unaffordable, and would be inherently unjustly available or applied.
There is a further problem--call it the Godel (or What is the
square root of -1?) problem. Bioethics' hubristic and extreme embrace of
mastery by rationalism must generate endless cascades of new paradoxes which in
turn spur more extreme rationalism and defy resolution. As we attempt to rationally subjugate the ever expanding tiers of
paradoxes created by our hyperrefined
art--we become both more estranged from lived and experienced phenomenon and we must necessarily declare
that those who are closest to the phenomenon lack the expertise to understand
or address it. In this sense, we expropriate lived-life from those living it.
The resolution to this problem in bioethics is not clear and
certainly not easy. Certainly we need a phenomenological ethics--one which puts
the experience of persons and social units like families at the forefront, one which
constrains machines and machine-logic to the ebbs and flows of quotidian
hope this clarifies matters or at least shows how muddled I have become.
Graphic: From Google Images
"As a Patient: I Am My Own Doctor. Trust Me"
Could there be the possibility that medicine and the medical
system including the schools that teach medicine and the organizations and
governmental agencies which set standards all have become paternalistic toward
the patient as a person and toward the patient's diagnostic workup and
treatments? Could it also be that the
patient is currently struggling to become more autonomous in terms of their
individual various self interests but also
self-diagnosis and self-therapy but is being hindered by regulations and laws
or established standards limiting these opportunities? Shouldn't the patient
have more clout in setting standards which are more in the patient's own best
interest, but from their own point of view and not that of some politician or
regulator? These are questions that
could be considered in view of the current public discussion and debate about
the role of governments in medical care and payment for medical services. Further. current discussions, for example,
deal with the restrictions to ready availability to those in need of
anti-cancer drugs , restrictions of drug availability by denying "over
the counter"purchase without a physician's prescription or how life-saving
organ transplants are allocated. In addition, there are a number of states in
the United States which set regulations
potentially limiting the activities of practitioners of alternative
medical treatments and thus limiting access by the patient.
One could argue that in these days of accessibility of
medical information on the internet and other forums, both in terms of
symptoms, diagnosis and approaches to therapy, that individual patients, for a
host of medical conditions, reasonably could and should, saving time and money,
be able to diagnose themselves (having diagnostic testing available on their
request) and be able to treat themselves and not depend on obtaining a
physician's office visit, wait and then ask the doctor for a prescription. That means that all medication could be
obtained from a pharmacy without a physician's
prescription. That argument could also
include that the patient should have the freedom to access any and all alternative medicine practitioners with the use of their
full armamentarium of offered
therapeutic tools, unhindered by bureaucratic laws or regulations. One could argue: let the patient be fully
responsible for themselves as they should be and be fully able to use the
services of a licensed physician or surgeon as part of the patient's own selection from a host of other
opportunities for diagnosis and treatment. One could argue that there are
limits to the excuse of protecting the patient from themselves or from those
who they consult. And in the final
analysis, it should be the patient who sets the course for their own diagnosis
and treatment and for that course all patients should have freedom to obtain
and use whatever tools are available.
Would you make the, perhaps Libertarian argument I presented above or do you think
that the status with regard to a patient's medical care is just fine now with
adequate autonomy presented to the patient?
Let me read your opinion.
Patient Modesty: Volume 56
I am sure that everyone can spot the "chaperon" for the patient in this classic photograph of
the operating room used at Johns Hopkins Hospital from 1892 to 1927. And I am sure that everyone can find the
"gawkers" who are present in
the photograph. But do you really think
that some patient chaperon, if one was actually present, in this operating room
would have any clout? Regardless of the validity of our assumptions, I think
that this photograph is pertinent to the many years of discussions on this blog
In my opinion, the photograph suggests the challenges that
face the patient particularly within a hospital or particularly a teaching
hospital today if the patient expects his or her modesty issues to be strictly
attended. What do you think? ..Maurice.
Photograph from U.C.L.A. library website obtained through Google Images.
NOTICE: AS OF
TODAY AUGUST 26, 2013 "PATIENT MODESTY: VOLUME 56" WILL BE
CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME 57.
Moses' Basket: Not the Right Basket for Professional Support
This is an apparently supportive advice delivered to one who is in some
emotional or physical distress. And though one may find this advice displayed
on numerous church boards for the public's humorous consideration, it "Have
hope, don’t give up – remember Moses was once a basket case, too" provides an example, in my opinion, of how
clinical advice if given from a physician to a patient should not be expressed. I believe the patient deserves such communication
of advice be based upon facts which are presented with clarity and free of
ambiguity and, in fact, free of humor. To me, humor can degrade any empathy by
the physician that is appropriate to be
transmitted to a patient in distress. I think it says to the patient, what you
are experiencing is, to me, partly a joke.
In contrast, the example, I selected, while attempting to convey some
sort of a supportive message for those who read it and need it, there is a
derogatory but also that humorous tone, along with the use of non-factual
ambiguity in order to make the point of the message. The facts which are missing are that
"basket case" as defined by Merriam-Webster in its original World War
I expression represented "a person who has all four limbs amputated"
or it's more modern use "a person who is mentally incapacitated or worn
out (as from nervous tension); also : one that is not
functioning well or is in a run-down condition." Obviously, this does not
apply to Moses, in the biblical description of his relationship to a
Trust is an essential part of
the doctor-patient relationship, trusting the doctor's decisions and intentions
is critical for the acceptance by the patient of the doctor's advice. While
there are some patients who, on questioning, may not want all the facts of
their condition displayed to them in one sitting and a few actually desiring
others to know but not themselves, I doubt that any want the doctor to finally
tell untruths, misleading information or add humor related to the patient's
emotional and physical distress. Now I
suspect that some of my visitors here may disagree with my commentary and may
find some value to the patient for the doctor to present the advice in the form
found written on those church displays.
If so, I would like to read your view.
Graphic: Photograph taken by me today at a neighborhood church and modified with Picasa3.