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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"P in a Pod":(Physician Owned Distributorship): Physicians as Investors and Distributors in the Gadget Placed in Your Spine
If you have chronic back pain and
your doctor refers you to an orthopedic surgeon who tells you that he or she
can relieve the pain by inserting an appliance in your spine, there is a worry
that the surgeon may be offering the surgery mainly for the surgeon's financial
interest in that very appliance.
A POD is a
Physician Owned Distributorship. Under this business model, a doctor is an
investor in, and distributor of, the devices or hardware he may put into his
patients. Multiple doctors can have a financial interest in one POD.
business arrangement legal?
In and of
itself the arrangement is legal, but the Department of Health and Human
Services’ Office of Inspector General has concluded that PODs are “inherently
suspect under the anti-kickback statute.” It issued fraud alerts about PODs in
2006 and in 2013.
find out if my surgeon is involved in a POD?
your physician is under no legal obligation to disclose that information. The
Sunshine Act, a provision of the Affordable Care Act, does require that each year,
certain medical device makers and distributors disclose to the Centers for
Medicare and Medicaid Services ownership or investment interests held by
physicians or their immediate family members. The law requires the Centers to
post online the first batch of information it received by September.
‘Sunshine Act’ require my doctor to inform me that he is involved in a POD?
No. You will
have to ask on your own, or search that Centers for Medicare and Medicaid
Services website when it is published. The Centers say the site “will be
organized and designed to increase access to and knowledge about these
relationships and to provide information to enable consumers to make informed
Yes, there are laws preventing
physicians from referring their patients to facilities in which they own and
invest for laboratory services or procedures. The Federal regulations called
Stark (after Pete Stark, congressman who was its primary sponsor) can be
summarized as follows: A physician may not make a referral to an entity for the
provision of a designated health service (“DHS”) for which Medicare payment may
be made (and the entity may not present a claim for services provided as a
result of such a referral) if the physician or an immediate family member has a
financial relationship with the entity unless either the referral or the
financial relationship is “excepted” from the statute’s coverage. To read more about Stark regulations, here is
the link to a paper by Homchick and Looney which explains its current status.
Please read the excellent KPCC article about this unsettled and unsettling issue and then return back here and
write what you would you think about Physician Owned Distributorship and its
implications regarding providing the least expensive but the best in medical
care. Balancing the right of private
investment by any person versus the need for unbiased decision-making and care
by your physician, how do you size up POD, ethically, legally and if you were
the patient with that back pain and were told "I have just the operation
that can fix it"? ..Maurice.
Graphic: From Google Images and modified by me with ArtRage and Picasa3.
Can a Tree Experience Hurt?: If It Can, Do Ethics and Law Apply?
I was visiting a well known botanic garden in Southern
California today, taking pictures of all the beautiful flowers when I saw this
tree shown above in the pictures I took.
Honestly, what I saw, a tree apparently being pulled by straps out of
its normal posture, pained me as I projected myself as if I were that tree. Of course, I am not that tree but then this
got me thinking about the bioethics of what had been done to the tree. (First of all, I want to admit that I have no
idea how long the straps were in place or for what future duration and what the
gardeners were intending to accomplish with the straps since I haven't talked
to the garden management. Finally, I am not sure that trees experience
Bioethics is not just about the ethics of humans and
animals, healthy or with disease but it is also about ethics dealing with the
plant kingdom. A current example of ethical concern is genetically modifying
plants, including those we eat. And the question that came to me was whether
what was done to the tree was unethical, that is, failing to meet the ethical
standard for the principles of beneficence (to do good) and non-malificence (avoiding
causing harm). But, though what I saw "hurt" me, the questions were
whether the tree, a living creature of the plant kingdom was, in its own way,
appreciating some "hurt" and with some ethical significance. Was the
tree recognizing discomfort? Was the purpose of the straps to benefit the tree
(which might be considered ethical) or to re-position the tree for its
appearance to the benefit of the viewing public? The latter might be considered unethical if
the tree experienced "hurt".
To try to answer my concerns, as I often do, I go to
Wikipedia to get a bit of help. I found
the article on Plant Rights which I have, as is permitted, reproduced
below. I would be most interested in the
viewpoints of my visitors and perhaps they have found additional information
regarding the science answering the question as to whether trees can "feel" or "express
distress" to physical discomfort. If they can, should they have themselves
certain "rights" both legally and ethically? The question is either
fascinating or just "dumb". Tell me what you think...Maurice.
From Wikipedia, the
On the question of whether animal rights
can be extended to plants, philosopher Tom Regan argues that animals
acquire rights due to being aware, what he calls
"subjects-of-a-life". He argues that this does not apply to plants,
and that even if plants did have rights, abstaining from eating meat would
still be moral due to the use of plants to rear animals.According
to philosopher Michael Marder, the
idea that plants should have rights derives from "plant
subjectivity", which is distinct from human personhood. Philosopher Paul Taylor holds that all life has inherent worth and argues for respect
for plants, but does not assign them rights. Christopher D. Stone, the
son of investigative journalist I. F. Stone,
proposed in a 1972 paper titled "Should Trees Have Standing?" that if
corporations are assigned rights, so should natural objects such as trees.
Whilst not appealing directly to "rights",
Matthew Hall has argued that plants should be included within the realm of
human moral consideration. His "Plants as Persons: A Philosophical
Botany" discusses the moral background of plants in western philosophy and
contrasts this with other traditions, including indigenous cultures, which
recognise plants as persons—active, intelligent beings that are appropriate
recipients of respect and care. Hall backs up his call for
the ethical consideration of plants with arguments based on plant
neurobiology, which says that plants are autonomous, perceptive
organisms capable of complex, adaptive behaviours, including the recognition of
In the study of plant physiology,
plants are understood to have mechanisms by which they recognize environmental
changes. This definition of plant perception differs from the notion
that plants are capable of feeling emotions, an idea also called plant perception. The latter concept, along with plant
intelligence, can be traced to 1848, when Gustav Theodor Fechner, a German experimental psychologist, suggested that plants are
capable of emotions, and that
one could promote healthy growth with talk, attention, and affection. The Swiss Federal Ethics
Committee on Non-Human Biotechnology analyzed scientific data on plants, and
concluded in 2009 that plants are entitled to a certain amount of
"dignity", but "dignity of plants is not an absolute
Inanimate objects are sometimes
parties in litigation. A ship has a legal personality, a fiction found useful
for maritime purposes... So it should be as respects valleys, alpine meadows,
rivers, lakes, estuaries, beaches, ridges, groves of trees, swampland, or
even air that feels the destructive pressures of modern technology and modern
life...The voice of the inanimate object, therefore, should not be stilled.
Samuel Butler's Erewhon contains a chapter,
"The Views of an Erewhonian Philosopher Concerning the Rights of
Constitution contains a provision
requiring "account to be taken of the dignity of creation when handling
animals, plants and other organisms", and the Swiss government has conducted ethical
studies pertaining to how the dignity of plants is to be protected.The
single-issue Party for Plants entered candidates in the 2010 parliamentary
election in the Netherlands. Such concerns have been
criticized as evidence that modern culture is "causing us to lose the
ability to think critically and distinguish serious from frivolous ethical
In 2012 a river in New Zealand was legally
declared a person with standing (via guardians) to bring legal actions to
protect its interests.
Stone, Christopher D. (2010). Should Trees Have
Standing? Law, Morality, and the Environment (Third ed.). Oxford
University Press. ISBN 0-19-973607-3.
Stone, Christopher D. (1972). "Should Trees Have
Standing--Toward Legal Rights for Natural Objects". Southern
California Law Review 45: 450–87.
Hall, Matthew (2011). Plants as Persons: A
Philosophical Botany. SUNY Press.ISBN 1-4384-3428-6.
Michael Heidelberger Nature from within: Gustav
Theodor Fechner and his psychophysical worldview 2004, p. 54
Graphics: Photographs taken by me June 12 2014
Patient Modesty: Volume 66
The inattention to patient physical modesty in the medical system is just one part of a whole system-wide issue of inattention to the patient. A good example of such inattention in another area is that of the behavior of the medical system to a physical injury is told by a physician who was injured and describes her experience in a hospital emergency room and later on the wards. While this physician's story is not strictly about medical staff ignoring her modesty, I think it does show major causes for inattention in many areas of medical practice: putting more emphasis to attend to making a diagnosis or just be seen as "doing something" for the patient but, because of workload, available time,need to rush ahead, follow protocol and move on, that attention to the patient as a unique individual with their individual needs and requests is simply ignored. I think that unless the medical system expands its population of available healthcare providers and these providers are trained to think about the patient as an individual person as themselves, the sad experiences described over the years on this blog thread and the "hurt" (not simply the trauma) that this doctor felt as a patient will just continue onward. ..Maurice.
ADDENDUM: I changed the graphic today for this Volume in order to emphasize what should be the
theme for the Patient Modesty thread: PATIENT CENTERED CARE.
Graphic: From Policy and Medicine
NOTICE: AS OF TODAY JULY 14 2014 "PATIENT MODESTY: VOLUME 66
WILL BE CLOSED FOR FURTHER COMMENTS. YOU CAN CONTINUE POSTING COMMENTS ON VOLUME67
"This is Mine!": Property and Ethical Rights of Your Body by Yourself and Others
Jean-Jacques Rousseau, Discourse on Inequality,
1754 wrote "The first man who,
having fenced in a piece of land, said 'This is mine,' and found people naïve
enough to believe him, that man was the true founder of civil society." Of course, property rights has continued
through the ages and their defense has let to law suits as well as wars. The question in recent years as applied to
the human body is how property rights are applied to the body or tissues or
cells or the genetic DNA of the cells themselves. I found a very interesting discussion of this
issue titled "Whose Body Is It Anyway?
Human Cells and the Strange Effects of Property & Intellectual
Property Law" written by Robin Feldman, Professor of Law and Director, Law
& Bioscience Project, UC Hastings College of the Law and which can be
accessed through this link.
She begins her analysis with the following:
"There are many
aspects of our lives over which we can exercise what can be called ownership, control, or dominion.
However one conceptualizes ownership, it is
clear that people can hold such rights in many things, ranging from more
concrete items, such as automobiles,
jewelry, or a plot of land, to more abstract concepts such as our labor, our writings, our innovations, and
even our commercial image.
Whatever else I might own in this world, however, it would
seem intuitively obvious that I own the cells of my body. Where else could the
notion ofownership begin, other than with the components of the tangible corpus
that all would recognize as 'me'?
The law, however, does not view the issue so neatly and clearly.
Through the rambling pathways of property and intellectual property law, we are
fast approaching the point at which just about anyone can have property rights
in your cells, except you. In addition, with some alteration, anyone can have
intellectual property rights in innovations related to the information
contained therein, but you do not.
I should be clear at the outset that I am talking about
property and intellectual
property rights to cells when they are no longer in your
body. The sanctity of control over one’s body remains reasonably intact, as
long as the cells are attached to you. When cells are no longer attached,
however, the legal landscape shifts, and the resulting tableau has a strong
effect on the choices one can make with those cells that do remain in the body.
As so often happens in law, we have reached this point, not
by design, but by the piecemeal development of disparate notions. Various doctrinal
strands have emerged in isolation of each other, each appearing to solve a
particular problem in its own domain. When gathered together, however, the
doctrines form a strange and disconcerting picture."
As one can see from her discussion, the answer to my question has
been legally muddled over the years. My question to my visitors here is
how do you look at the property rights of your own bodies? Should you have
potential control of any cells or tissues removed from your body both when you
are alive and even after death? If the
cells or tissues are used by others which end up in financial gain, should you
or your beneficiary also have access to
that gain? How far should your exclaiming "This is Mine" apply? ..Maurice.
Graphic: Photograph taken by me June 7 2014 and modified
The Ethics of Delay: A Good or a Bad?
The following article I wrote for Bioethics.net
reproduced here with permission.