Bioethics Discussion Blog: May 2006





Tuesday, May 30, 2006

Trusting vs Trustworthiness of Physicians and Medical Profession

There has been concern in the medical community for some time that African-Americans and other minorities distrust the medical profession. This concern has raised questions as to whether this distrust and the documented history of past research abuse such as in the Tuskegee Syphilis Study is also reflected in lesser numbers of African-Americans or other minorities willing to participate in health research clinical trials thus impairing the universal validity of the trial results. If true, another consequence might be possibly denying the direct benefits of the trials or the trial results to those racial and ethnic groups.

A literature search by David Wendler and others was published in the Open Access internet medical journal PloS Medicine, February 2006 titled “Are Racial and Ethnic Minorities Less Willing to Participate in Health Research?” Their conclusion was:

“We found very small differences in the willingness of minorities, most of whom were African-Americans and Hispanics in the US, to participate in health research compared to non-Hispanic whites. These findings, based on the research enrollment decisions of over 70,000 individuals, the vast majority from the US, suggest that racial and ethnic minorities in the US are as willing as non-Hispanic whites to participate in health research. Hence, efforts to increase minority participation in health research should focus on ensuring access to health research for all groups, rather than changing minority attitudes.

In the May 2006 issue of the same PloS Medicine, Matthew K. Wynia and Vanessa Northington Gamble respond suggesting that unwarranted conclusions were made by Wendler and others in their paper. Though Wynia and Northington disagree with the analysis and conclusion that "racial and ethnic minorities in the US are as willing as non-Hispanic whites to participate in health research",they add:

“Despite these scientific weaknesses, Wendler et al. are right to conclude that it is inappropriate to focus on changing African Americans' attitudes of mistrust, but not because those attitudes don't exist. Many minorities don't feel welcome and respected within the health-care system. Those who do come in have already crossed a threshold of trust, at least with their individual doctor. Those who don't come in, of course, will never have the opportunity to be asked to enroll in a clinical trial. Instead, the reason it would be inappropriate to focus on changing patient attitudes is because these attitudes of mistrust are based on a history of untrustworthy behavior by the health professions, which must be acknowledged and rectified. In other words, the medical profession should not focus on making minorities be more trusting; we should focus on ensuring that we are becoming trustworthy.”

I would be interested to know the general attitude of those visitors to my blog who are other than “non-Hispanic whites” regarding trust in physicians and the medical profession. ..Maurice.

Sunday, May 28, 2006

Religion in Politics, Government and Science: Is there a Role?

In recent years we have all watched, in the United States, how science, politics/government and religion have interacted. Examples include the federal limitations on stem cell research and human cloning, issues involving abortion and perhaps even in the Terri Schiavo termination of life support case.

Writing in the current May 25, 2006 issue of the New England Journal of Medicine under the title “Evolution in the Classroom and Courtroom”, George J. Annas reminds us of another example of this interaction.

The First Amendment to the U.S. Constitution provides in the “Establishment Clause” that “Congress shall make no law respecting an establishment of religion, or prohibiting the free expression thereof.” It has been the First Amendment declaration that prevented outlawing education about evolution and prevented later attempts to insert Creationism and more recently Intelligent Design into the science classrooms.

Dr. Annas states that polls suggest that in the U.S. 50% of the adults believe that God created humans in their present form within the past 10,000 years.
Therefore he predicts that there will be a new wave “that will feature yet another strategy to promote creationism by questioning evolution.” This strategy will employ a “teach the controversy” approach by teaching what the promoters want in classes on current affairs, politics and religion but not in science classes.

Finally Dr. Annas writes “The quest to banish religion from politics and government is ultimately, as the Jesuit priest Robert Drinan notes, ‘hopelessly unrealistic, because religions are by their nature intended to create cultures, even civilizations.’ Religion and government are not inherently incompatible, and they necessarily have formal and informal relationships with each other. Nor are science and religion inherently incompatible. Nevertheless, religion is not science and should not be taught in science class. In the United States, the highest power that prevents this is the First Amendment.”

What do you think about the role of religion in politics, government and science? ..Maurice.

Saturday, May 27, 2006

Memorial Day Should Include Ethical Contemplation About War

In Flanders Fields
By: Lieutenant Colonel John McCrae, MD (1872-1918)
Canadian Army

IN FLANDERS FIELDS the poppies blow

Between the crosses row on row,

That mark our place; and in the sky

The larks, still bravely singing, fly

Scarce heard amid the guns below.

We are the Dead. Short days ago

We lived, felt dawn, saw sunset glow,

Loved and were loved, and now we lie

In Flanders fields.

Take up our quarrel with the foe:

To you from failing hands we throw

The torch; be yours to hold it high.

If ye break faith with us who die

We shall not sleep, though poppies grow

In Flanders fields.

When we look back at those who have died in war and those who are carrying on, we must still wonder about the merit of the war that was being fought and the true moral responsibilities of those who continued the fight. We must also remember that there are not only Flanders fields for the soldiers but also burial grounds of the non-combatant civilians who also died because of the war. The moral and ethical issues of war have had added complexity particularly in the recent century by the wars which include issues of preemptions and also lack of signs of identification between combatants and the innocent civilians. Yes, Memorial Day is a day to think about those servicemen and women who have fallen in our battles but it is a day also to contemplate the ethics of war: what ethical principles will support the resultant loss of all the lives that lie in their own Flanders fields throughout the world. ..Maurice.

Tuesday, May 23, 2006

Teaching Being an Ethical Doctor: The Physician Role Model and Humility

There is a need for a good role model for medical students and residents as they learn the skills and burdens of medical practice. I think that the most effective role model would be a physician mentor. But that physician mentor needs to have qualities beyond the teaching of diagnoses or medical and surgical techniques. In addition the role model must also be an example of the best in professionalism with the understanding of ethics but also the simultaneous practicing of ethical behavior that becomes obvious to all those he or she mentors. Unfortunately, as I have mentioned in previous posts, there is a “hidden curriculum” in the later years of medical education that, as being practiced by poor role models, is morally destructive. This must change.

One of the important qualities a physician model should demonstrate to the students and residents is that of personal humility. Humility, the ability to give up some of one's self-importance and assertiveness and show them that there is merit in the practice of medicine to listen to the advice and concerns of others. This means not only listening to and considering, even accepting, the advice and concerns of colleagues in one's own discipline but also the concerns, advice and point of view of those from other disciplines and from the patient and finally also from those students and residents who look up to the model. It is hard for some doctors to shy away from expressing their self-importance.

- Philip James Baley wrote: “Lowliness is the base of every virtue,
And he who goes the lowest builds the safest.”

Physicians, by themselves, are not always right in what they know, what they say and what they do. They need the feedback of others. Without behaving with humility, all the other virtues a physician might express
may give way and lead to misjudgments, medical error and absence of trust by colleagues and patients. In conclusion, I would tell students: “Physician, Be Humble”...Maurice

Sunday, May 21, 2006

Should Patient Autonomy End and Something Else Begin in End-of-Life Decision-Making?

There is discussion in the ethics community about whether patient autonomy (the right for patients to make their own medical decisions) should apply to end-of-life decisions or decisions when the patient has no capacity to make personal medical decisions; This issue is discussed in an article “The End of Autonomy” by Robert A. Burt in the Hastings Center Special Report November-December 2005 “Improving End of Life Care: Why Has It Been So Difficult?”

Prior to the Karen Quinlan Supreme Court decision in 1976 end-of-life medical decisions were essentially made by physicians and paternalistically suggested to patients or their families. Since then there has been an ethical,legal and social consensus that patients themselves have a right and should make their own decisions regarding all medical issues but particularly including those decisions which influence the course when end-of-life is nearing. However, repeated studies and surveys suggest that most patients don’t create advance directives telling the healthcare workers what they, autonomously, want to be done if they are critically ill and the chance for recovery is poor or the results of therapy will be a quality of life that the patient will not want to tolerate. There often is confusion about what the patient would have wanted and disagreement between family members and between family and doctors. Yet decisions have to be made and if not by the patient or paternalistically by the physician then what alternatives are there for end-of-life decision-making?

Robert Burt,in his article, suggests 3 additional possibilities:

1) No one should be authorized to engage in conduct that directly, purposefully, and unambiguously inflicts death, whether on another person or oneself.

2) Decisions that indirectly lead to death should be acted upon only after a consensus is reached among many people. No single individual should be socially authorized to exercise exclusive control over decisions that might lead to death, whether that individual is the dying person, the attending physician or a family member acting as a healthcare proxy.

3) As much as possible, end-of-life care should not depend on explicit decisions made at the bedside of a specific, dying person but rather should be implicitly dictated by system-wide decisions about available resources, personnel, and institutional settings—that is, by setting up definite pathways that implicitly guide and even control caretaking decisions in individual cases.

Should we do away with patient autonomy in end-of-life decision-making and return to physician paternalistic decisions, avoid any action that inflicts death, have the decision made not by the patient or any one person but by a consensus by many people or, finally, a system-wide decision applied to all patients and based not on the patient’s personal interest but on economics,strategy and logistics of the system itself? Or do you have another idea? ..Maurice.

Saturday, May 20, 2006

“A Wasted Illness” And The Request To Jump From The Train

“Inside every patient, there’s a poet trying to get out. My ideal doctor would ‘read’ my poetry, my literature.”-Anatole Broyard

So I read the poem of Thomas Masterson Hardy (2 June 1840 - 11 January 1928) a novelist and poet, generally regarded as one of the greatest figures in English literature. The poem titled “A Wasted Illness” awakened in me a new issue regarding what goes on in the patient's mind after we, as physicians, treat and cure them of serious illnesses or provide them with what we call a remission. I really never thought about this particular patient concern but, you know, I wouldn’t doubt that it really exists. Here is how Hardy puts it:

Thomas Hardy - A Wasted Illness

Through vaults of pain,
Enribbed and wrought with groins of ghastliness,
I passed, and garish spectres moved my brain
To dire distress.

And hammerings,
And quakes, and shoots, and stifling hotness, blent
With webby waxing things and waning things
As on I went.

"Where lies the end
To this foul way?" I asked with weakening breath.
Thereon ahead I saw a door extend -
The door to death.

It loomed more clear:
"At last!" I cried. "The all-delivering door!"
And then, I knew not how, it grew less near
Than theretofore.

And back slid I
Along the galleries by which I came,
And tediously the day returned, and sky,
And life--the same.

And all was well:
Old circumstance resumed its former show,
And on my head the dews of comfort fell
As ere my woe.

I roam anew,
Scarce conscious of my late distress . . . And yet
Those backward steps through pain I cannot view
Without regret.

For that dire train
Of waxing shapes and waning, passed before,
And those grim aisles, must be traversed again
To reach that door.

Do you think that there are patients who have made that train ride with the burden of suffering and recover (for example, a cancer remission) and then are faced with the possibility of that ride again finally “to reach that door”, look to physician-assisted suicide as an escape to jump from that moving train? Just a thought...Maurice.

Thursday, May 18, 2006

The Meticulous Doctor: An Ideal Doctor?

From the “THE BOSCOMBE VALLEY MYSTERY” in the classic "The Adventures of Sherlock Holmes" by Arthur Conan Doyle, Sherlock Holmes. after inspecting the grounds of where a murder had taken place responds to his friend and colleague Dr. Watson’s questions:

…"And the murderer?"

"Is a tall man, left-handed, limps with the right leg, wears
thick-soled shooting-boots and a gray cloak, smokes Indian
cigars, uses a cigar-holder, and carries a blunt pen-knife in his

By an examination of the
ground I gained the trifling details which I gave to that
imbecile Lestrade, as to the personality of the criminal."

"But how did you gain them?"

"You know my method. It is founded upon the observation of

"His height I know that you might roughly judge from the length
of his stride. His boots, too, might be told from their traces."

"Yes, they were peculiar boots."

"But his lameness?"

"The impression of his right foot was always less distinct than
his left. He put less weight upon it. Why? Because he limped--he
was lame."

"But his left-handedness."

"You were yourself struck by the nature of the injury as recorded
by the surgeon at the inquest. The blow was struck from
immediately behind, and yet was upon the left side. Now, how can
that be unless it were by a left-handed man? He had stood behind
that tree during the interview between the father and son. He had
even smoked there. I found the ash of a cigar, which my special
knowledge of tobacco ashes enables me to pronounce as an Indian
cigar. I have, as you know, devoted some attention to this, and
written a little monograph on the ashes of 140 different
varieties of pipe, cigar, and cigarette tobacco. Having found the
ash, I then looked round and discovered the stump among the moss
where he had tossed it. It was an Indian cigar, of the variety
which are rolled in Rotterdam."

"And the cigar-holder?"

"I could see that the end had not been in his mouth. Therefore he
used a holder. The tip had been cut off, not bitten off, but the
cut was not a clean one, so I deduced a blunt pen-knife."

Is this example of meticulous inspection and interpretation what you would be satisfied from your personal physician or is there something else or more that you would expect?

On the blog posting from July 2004 about “Growing Ideal Doctors”, I had started the discussion of ideal doctors. I would like to continue the discussion by presenting my visitor comments to the question from the now inactive “Bioethics Discussion Pages” on that very subject. The oldest comments start at the bottom of the post. ..Maurice.

What Makes an Ideal Doctor?

Many of the topics throughout these pages represent issues of medical care and how physicians ought to provide care to the sick. It is important that the public have a voice in these issues. Beyond these issues, it would be also valuable to hear what the public considers are the characteristics which make up an ideal physician. What is it about a doctor which would make you feel the most comfortable and give you the greatest confidence with regard to you or your family's care?

Here are the questions:
What do you think are characteristics which make an ideal doctor? What are those which would cause you to reject a physician?

Date: Fri, May 9, 2003 12:22 PM From: To:

The "ideal" doctor is someone who validates my pain, listens to my problem and treats me with professional courtesy. I, in turn, want to be the ideal patient. Who asks questions, follows medical advice and says "thank you." I have found that doctors are not what they used to be; it used to be about the patient, now it's about them and making money.
Date: Tue, Apr 1, 2003 4:07 PM From: To:

As a nurse and nursing student, I have seen what I would say are "ideal" physicians and some you look at and wonder why they are even in the profession. What I consider to be a good characteristic of an ideal doctor is a doctor who treats patients and all in the health profession as human beings. In the profession, everyone is there to work as a team. Sometimes doctors do not view the care of the patient in this matter. I know that the profession is becoming stressful due to the shortage, but we must be there for our patients and one another.
Date: Mon, Mar 3, 2003 9:24 AM From: To:

Since I have been a student at a large medical center, I have had the opportunity to interact with many different kinds of doctors from a wide range of specialties. In my opinion, there are several qualities that make up the ideal doctor. First and most important of all, I think that doctors need to be excellent listeners. I'm sure it is very overwhelming to them sometimes because they must listen to patients, family members and all members of the health care team. But, if they can truly listen to what everyone has to say, they can provide even better care because they understand all aspects of the patient. Another quality of the ideal doctor is to be an expert at their field of study. If they don't know something, then who is going to know? I'm not saying that they need to know every tiny detail because that would be impossible, but the ideal doctor should be able to admit when they don't know something, and be able to be resourceful enough to find the right answer for their patient. I think in today's world, many patients have some knowledge of health care and actually do research on what conditions they might have. The ideal doctor can realize this and counsel with the patient so they can discuss all available treatment options. I also believe that the ideal doctor has the qualities of empathy and compassion. Just by having those two qualities, I think that patients sense this and feel more bonded and trusting to their physician.

Doctors have a very important and life changing position, and I feel that the ideal doctor would not abuse this power. The ideal doctor is understanding, competent, and conducts himself after thinking about things ethically. Overall, I am glad to have been able to think about this subject, and I hope that everyone will decide for themselves what makes their "ideal doctor!"
Date: Mon, Oct 28, 2002 3:19 AM From: To:

[ Moderator's Note: This visitor writes views on a number of ethical issues but concludes regarding the ideal doctor]

I am answering more than this one question but I think that a lot of them are intertwined. Although we do not live in the time of the ancient Egyptians and I do not believe that we need our organs for the next life I do believe that we should all have the choice to donate or not. In death as in life we should be able to make decisions about our own bodies and those decisions should be respected in the same way that someone's request to not be resuscitated should be respected and the same as a patients choices for their care should also be respected. No-one has the right to decide for someone else if they are still capable and even when they're not I find it hard to let people make choices for others. I believe that a terminal patient should be able to refuse treatment, I believe people should be able to refuse treatment on religious grounds. I do not believe that parents should be able to refuse life saving treatments for their children. Such children should be given the chance to grow and live and make their own decisions. I do not believe in 'social worth'. It disgusts me that a lot of healthcare is available according to a persons financial situation. This leads me to what makes the perfect doctor. I knew a doctor once who bulk billed all his patients through Medicare including ticking the bulk billing box when sending patients for x-rays and bloods so that they can save on gap fees. He also provided his home number, pager number and mobile phone number to his patients. They were all actually printed on his card. He treated the patient but he also treated the family and the marriage. He always made sure he new the full story and was never in too much of a hurry. I have never seen him make a decision lightly. I have also never seen him dismiss a patients fears or beliefs. He was one of those doctors who would lend an ear as often as he would treat a complaint. That is the perfect doctor. I only wish we still lived there. Thankyou, K.Hill, Brisbane, QLD. Australia

Date: Sun, Oct 20, 2002 9:21 PM From: To:

My experience with a local physician one time was a perfect example of what I would not want in a doctor. I found this man to be rude, inconsiderate and quickly hurrying through a visit that I was really worried at the time. I actually was having an allergic reaction to medication and I feel he never believed me. During a doctor visit after this incident a week later, I preceded to tell him that I did not appreciate the way he treated me. He made me feel like I was imagining symptoms and he could understand why I was feeling so bad. I looked perfectly normal on the outside. I found myself telling this physician how rude he was and continued telling him that I felt he never heard a word of what I had said to him when since he had met me. So, the ideal doctor would be someone who takes the time for their patient to listen and be concerned when someone is scared. The doctor entered into the field to help people and he should never forget that thought process. He should have respect for all his clients and always bring himself down to the patient's level as a person.

Shelly Williams, OUSN
Date: Tue, Oct 8, 2002 5:04 AM From: To:

I believe that it's quite simple. Since no one is more directly affected by the doctor's actions than the patient, doctors should serve their patients first and foremost, respecting their wishes. Treatment without consent is assault. Few things are worse than doctors who preserve life at the cost of comfort and wellbeing. The last thing a patient needs is a doctor who cares more about being 'morally correct' than about what the patient wants.

Sincerely, Winston
Date: Mon, Jan 7, 2002 5:49 PM From: To:

I know the answer to this one, having learned it the hard way. The ideal doctor is an expert in medicine who presents options for health to the patient and lets the patient decide the path they will take together. His ego is small, his purpose is to offer counsel. He has enough faith in his patient to allow her to make her own decisions and he supports her cause and her choices.

When I finally found this doctor, my decade-long battle with life-threatening disease was won. Although I will never again be of complete health, I am once again a contributing member of my family and of society in general.

Date: Wed, Dec 26, 2001 8:09 AM From: To:

An ideal physician is an altruist. He/she must never put personal gain before the welfare of the patient. He/she must also be able to feel empathy for every patient that is encountered and must never look on patients as second to the physician. The physician must never ever have any notions of prejudice towards patients, let it be by race, colour or any other attribute of patients. He/she must also have an unbreakeble will to help others to get as well as possible.
Date: Tue, Oct 2, 2001 8:55 PM From: To:

Speaking as someone who has been injured in a doctors care and will be affected for the rest of my life, which will be from this point on riddled with interventions. There are a few things I will forever look for and walk if they are not present. 1)honesty 2)they must truly and sincerely want to help. 3)I must feel that I or my Family is more than a $ to them. What it comes down to is trust. And now if I can, I will reach as many people with my story and they will reevaluate their doctors, causing a change for the better in the level of care we receive. Who am I to say this and bring about this change? I will say Someone who will do it!
Date: Thu, Apr 12, 2001 9:31 PM From: To:

I am a nurse who has recently discovered an ideal doctor. The one in particular I am referring about is a pediatrician. We live in a small communty where the hospital has not had a good name for a long time. Most people travel to surrounding cities to doctor there. This doctor who I have recently employed is amazing. I has morals. I mean like patient first. NOT money. He is not afraid to speak the truth. Other doctors around here are in a click. THey are mad at my doctor because he transfers patient if they complain about the staff or if he feels they are not equipped to take care of a particular case. Trust me. Its bad on the floor, I worked it before. They (the other doctors do and will compromise their patients health and well being just so the hospital won't get upset. He goes to his patients sports games and stuff if they ask him. He is truely a unique and caring man. He also is a very teaching and nice doctor to work for. He has taught me so much, more than any nursing school could ever teach me. That is an ideal doctor. From Davida

Date: Mon, Apr 2, 2001 10:51 AM From: To:

Thanks for your website. This is a hot topic for me because of a recent broken leg. What the best doctors give me: Sufficient Time

Human Respect

Medical Expertise

Honest Communication

SUFFICIENT TIME: I can get an appointment when I need it. Even if the doctor feels time pressure, I should not be penalized by his overly-full schedule. He should not impose his time pressure on me unduly. I donÕt want to waste his time, but I need him to give me enough to address my concerns and questions. HUMAN RESPECT: I donÕt want another parent figure; I need a partner in health care and treatment and in making the most of my quality of life (QOL). The best doctor helps me understand whatÕs happening to me and what it means to QOL. After all, weÕre talking about MY body. ItÕs not just an arm or leg, itÕs ME, and my future ability to enjoy life and function normally. ItÕs IMPORTANT to me, I need to feel itÕs important to my doc too. I am smart and educated. I want to know and am capable of understanding, and acting on, what's happening to my body and what I can do to affect it. The best doctor respects my time too; if the doctor always runs late; he should review the officeÕs scheduling practices and change them, even if it means increasing billing rates. Another part of respect (and time) is understanding that I only call him when IÕm seriously worried, not just for chit-chat. The best doctors know that, and even if my concern is about something Òto be expectedÓ, he tells me that factually. The best docs have handouts so I can re-read them and make an informed decision about if/when to call the doc, when something happens. MEDICAL EXPERTISE: As in all other areas of my life (financial planner, lawyer), I need to consult my doctor as an expert in an area where I do not have the requried knowledge to do it for myself; I need and expect thoroughly professional, balanced, complete, and dispassionate responses, for a price to be sure, but I'm willing to pay that price for expert advice and detailed information that I can use to drive life-altering decisions. NOTE: I'd be happy to pay for extra time and additional treatment options, even if the insurance company wouldn't -- I just want to know more and be able to participate fully in all aspects of my recovery. Things move so fast today that no one person (or doc) can expect to know everything. I expect my doctor to say when he doesnÕt know something, and to tell me if I or he should learn more about it. After a life altering experience (heart attack, stroke, chronic diagnonsis, trauma), IÕm totally obsessed with my medical situation and healing; after all, I may be at home all day, sitting on my butt with nothing else to do. I'm afraid, I hurt, and when something asociated with my condition feels or looks different, this generates lots of worry & questions. IÕve never had this before, so I have no clue about whatÕs normal and whatÕs not. In the entire world, only this doc knows the details of my injury and treatment because he put me back together. No one other than the doc has any info that I can trust, unless he points me to another resource. HONEST COMMUNICATION: HippocratesÕ directive: ÒFirst, do no harmÓ extends beyond the obligation to provide appropriate medical treatment. It extends to communication responsibility Ð clear, honest, complete, detailed. If asked Òif you were in this situation, what would you do?Ó the patient is trying to access expertise that they donÕt have, and to answer questions they donÕt even know they need to ask. An honest answer shoud be given to the question, along with an explanation and perhaps exploration of WHY. The doc speaks a foreign language (medical jargon); what is routine to the doc is often new to me. I need to doc to speak english, not medicalese. The other side of communication is listening. Docs need to listen to the intent beyond the questions and not get caught in the technicalities of the content/wording. I need my doc to walk in my moccasins for a bit. Docs have personalities, and so do patients. The best docs know that, and adjust communication accordingly.
Date: Tue, Mar 13, 2001 11:44 AM From: To:

What do you think are characteristics which make an ideal doctor? What are those which would cause you to reject a physician?: A good Doctor sees me as a human being.
Date: Mon, Jan 29, 2001 10:56 AM From: To:

I'm a premed student who had the best role model in Dr. Jose, an OB/GYN I used to volunteer for. The first thing that's apparent about Dr. Jose is his intelligence. He knew so much about the female body. But even more special about his knowledge was his astuteness regarding the female patient. He understood they had special needs and special pains, and although he'd never actually experiences such personal pains as cramps or delivery, he had so much understanding. I often wondered from where his amazing source of empathy and compassion stems from. He was also very professional. Integrity and ethics was what he always stressed to me. "It's the foundation of practicing good medicine, " he used to say. I aspire to one day have such qualities as competence, human understanding, and strong medical ethics.
Date: Tue, Mar 21, 2000 10:37 PM From: To:

Classically, an ideal doctor (by Hippocratic standards, at any rate), would be one who adhered to the tenets of the Hippocratic Oath: not abusing the power of the position or taking advantage of his patients, not administering abortions or assisting in euthanasia, maintaining utmost confidientality with regards to his patient. Though certain terms and phrases lend themselves to varied interpretations, the overall message and description of how a doctor should conduct himself and his practice are very easy to follow: honor, integrity, and the best interests of the patient. In today's medical world, however, things are not quite so simple, and the Hippocratic Oath of the classical world is not so easy to follow. Some of the provisions of the Oath, such as not abusing the position of a doctor's power, or breaching patient confidientality are still quite valid points, and are standards to measure our own doctors against. However, varied political, religious and moral stances all but render the lines prohibiting abortions and euthanasia useless, though they do serve to set a standard of appreciation and value of human life, and this is a necessity in physicians. To close: an ideal doctor in today's world would be one who set the needs of the patient foremost in his practice and preserved the spirit of the Hippocratic Oath, that is the respect for human life (whether is to respect life by seeing something as euthansaia as a peaceful end to pain, or to respect life by refusing to end it, no matter how desperate it may be) and the perserving the rights of the patient. An ideal doctor would be one who could adapt the Hippocratic Oath to today's world, whether it be applying the basic spirit of the Oath in interpretaion to his practice, or applying it literally.

Michael Stafford,University of South Carolina

Date: Sun, Mar 12, 2000 9:04 PM From: To:

The classical ideal doctor is very simple to describe. One was to be as knowledgeable as that time permitted, always work for the preservation of life, and keep the knowledge esoteric in nature, for a little bit of knowledge can be a harmful thing. The Hippocratic Oath lays all these points forward for one to swear by. It is a clear cut template that all doctors should abide by, the covenant identifies acceptable practices and the ethical code, which is prone to ambiguous interpretation, yet with a common theme of serving the patients best interest. All these characteristics apply to todayÕs ideal doctor, along with a few extras. TodayÕs doctor must be somewhat of a more complex character. The esoteric knowledge has been replaced somewhat by schools and universities that offer teaching to anyone capable. Also, the term ÒdoctorÓ holds so much esteem that it is often difficult to communicate with one. If a patient is too intimidated by a doctor to divulge all the information, no matter how skilled the doctor is, their efforts will fall short. The ideal doctor is one that is capable of performing the task at hand, as well as one who is able to be looked on as a peer.

Brantley D. Busbee

Date: Sun, Mar 12, 2000 8:01 PM From: To:

There are many characteristics of what I would assume the ideal doctor to be found in the Hippocratic Oath, although I may not agree with it in entirety. I feel that a doctor should be very caring and truly love helping people. This love of his profession should come from his desire to help those in need. A doctor should be unselfish and do everything in his power to aid a patient in recovery. I disagree with the Hippocratic Oath in the statement that surgery should not be performed because many times this is the best means by which a person may be aided. One of the most important qualities of the ideal doctor is trustworthiness. This is also included in the Hippocratic Oath. A patient should always feel confident in the fact that his doctor will keep his health issues as well as his personal issues private. He should also trust that his doctor will do everything he can to work in his best interest.
Date: Sun, Mar 12, 2000 6:51 PM From: To:

In the ideal doctor, I see several necessary characteristics that he or she must possess or somehow obtain. First and foremost, the ideal physician must have an unwavering desire to help those in need. Medicine is, in many areas of society today, a very distinguished and financially rewarding profession. Yet, an ideal physician should not be concerned with making excessive amounts of money. In the Hippocratic Oath, the physician is described as one who performs services "without fee and covenant." Another key characteristic I see in the ideal doctor is a vast knowledge of the "art" of medicine, as it is described in the Oath, especially the particular field in which he or she specializes. Finally, the ideal physician, I believe, must be willing to apply this knowledge through research, to find better methods for patient treatment. I see research and the technological advancements that result from it as being as instrumental in medicine as the actual treatment.

-Jon Taylor, University of South Carolina

Date: Sun, Mar 12, 2000 5:43 PM From: To:

The phrase "ideal doctor" incorporates many different duties, responsibilities, and meanings. Concern for the patient and the health of mankind in general is a foremost issue. However, the most often expressed trait that doctors need to possess is compassion. They need true, genuine interest in each individual case they work on, making sure that the patient's needs are met. Knowledge of medical and technological expertise are the roots of practical assistance, but direct patient contact is very important as well. It is very easy to think of the "ideal doctor" and picture Robin Williams as Patch Adams- where the ultimate concern is patient contact and patient happiness. In an ideal world, that would be sufficient. However in today's world of HMO's and raving insurance companies, its next to impossible to receive personalized care for any length of time. Consequently, is it fair to judge today's doctor's who are plagued by the restraints of insurance companies in order to protect the financial well-being of their patients? That is in itself another topic.

Dating back to the 4th and 5th centuries B.C., we can see the values written in the Hippocratic Corpus. Within these writings is evident a respect for life, similar to Pythagoras. Ideally, a doctor places his deep knowledges for healing above personal desires, etc. and handles patient matters with utmost concern. The Hippocratic Oath, which many regard as the ultimate in doctor ethics, advocates chastity, patient secrecy, and utmost concern for the patient. As times have changed though, more concern has arisen over that spelled out dictation of what a good doctor is. Is it possible to make specific declarations of what an ideal doctor consists of? "Ideally," a doctor thinks of each patient as important as the others, and treats them all with the fullest extent of her knowledge in hopes to relieve whatever pains them.
Date: Sun, Mar 12, 2000 4:22 PM From: To:

In my opinion, the ideal doctor is one who embodies the traits of the Hippocratic Oath. The Oath, often sworn to by graduating medical students, was written with the intent of producing doctors who would inspire trust from their patients and work for the good of humanity. The ideal physician is firmly devoted to his trade. He should have all of the knowledge and skills necessary to be a physician, but he must also care about the patients, and not just the money. I believe that being a doctor is more than just a job, but also a devotion to the betterment of human life.

I do not, however believe that we should follow the Oath verbatim. The Hippocratic Corpus was written in the fifth and fourth centuries B.C. The writers of the Oath could not have forseen the advances that medicine has made and the issues that a physician must tackle today. For instance, doctors today need not practice chastity; very few remain unmarried or do not date, I would think. Also, the Oath prohibits surgery ("I will not cut, even for the stone..."). We would not have such medical success without the new and innovative types of surgery that save lives every day. Furthermore, abortion and physician-assisted suicide are prohibited in the oath, and these are serious topics for discussion in society. It is obvious that the Oath can not effectively be followed exactly.

However, the first promise in the ethical code of the Oath is the basis for modern ethics; the physician swears to help the sick to the best of his or her ability and to abstain from harming. The last promise is the promise of confidentiality, which is vital for doctor-patient trust. The Hippocratic Oath taken word for word is certainly long outdated. A physician need not follow it strictly to be a good one, but he should work to help (not harm) and do all that he can to treat patients and preserve their trust.

Ken Byrd, Student at the University of South Carolina
Date: Sun, Mar 12, 2000 7:58 AM From: To:

The ideal physician should be primarily concerned with the health of his patients. This is evidenced in documents as early as the Oath of Hippocrates in the Greco-Roman era. In the Oath's ethical code, the physician swears to use his power to help the sick to the best of his ability and judgement. In order to treat patients in this way, a doctor must possess significant medical expertise and be competent in his practice. He must also be equipped with the latest technological knowledge and be able to use it with great accuracy and precision. The Hippocratic Corpus embodies another work, The Canon, regarding the characteristics desirable for a medical student. A portion reads, "Want of skill is a poor thing to prize and treasure...It makes [a man] prone to cowardice and recklessness." The canon also requires the ideal aspiring physician to possess a natural disposition for the practice and knowledge of medicine. This would require compassion, good listening skills, empathy, adaptibility, and sound decision making under pressure and time constraints.

The Hippocratic Oath also addresses issues concerning bedside manner and respect for the patient. Upon taking the Oath, a physician promises to do no harm or injury with intention. The physician also swears not to abuse his power and position when in private situations with his patients. The issue of the right to privacy is also mentioned in the Oath. The practitioner upholding the Hippocratic Oath says what he sees and hears professionally will be kept secret.

The ideal physician should be primarily concerned with improving the human condition. To accomplish this goal, he must put aside religious views which may come into conflict with the patients' treatments. The Canon reads, "Science and opinion are two different things; science is the father of knowledge but opinion breeds ignorance." This has transcended many years of scrutiny and is certainly controversial today. The World Medical Association administers this pledge upon admission into the medical profession. "I will not not permit consideration of religion, nationality, race, party politics or social standing to intervene between my duty and my patient."

The Canon states that there are many doctors in name but few in fact. I agree with this statement completely. I hope that I can be the physician described above, and I plan to practice medicine by the philosophy that the hand that holds is as essential as the hand that heals.
Date: Mon, Dec 20, 1999 7:20 AM From: To:

I became quite excited when I saw this question on the bulletin board.I just wrote my Master's thesis in this area. However, I would like to caution everyone who wishes to reply to your question. I think it is an incomplete question. In the patient-physician dyad, physicians are not the only party who has an active role in the relationship. If someone asks what kind of person a physician ought to be, the answer, if there is one, only addresses half of the clinical encounter. A physician may possess medical expertise, technological precision, and compassion, but these qualities or attributes by themselves do not constitute an ideal relationship between a patient and physician. Responsibilities do fall more heavily on the physician; they are in a practice that professes to heal. However, the patient should not be only a passive recipient of care. The medical literature rarely addressses what kind of person a a patient ought to be. I would not focus so much on that subject. What intrigues me is the relationship as a whole, would would an ideal encounter with a patient and a physician look like? We can submit any formula for ameliorating the clinical performance of a physician, however, the patient needs to be an active part of this performance too. "The Ideal Physician" image is the ancient residue of "The Hippocratic Oath". We need to address both constituents of the clinical relationship.

Melinda Rosenberg
Date: Wed, Dec 1, 1999 10:54 PM From: To:

An ideal doctor is one who listens to the patient, the family, the nurse, the CNAs and then makes his decisions. An ideal doctor is not concentrating on being an angel to an internet start-up company.
Date: Thu, Jun 3, 1999 12:13 PM From: Tall To:

Perhaps there is no simple definition of the ideal doctor. Approaching the bedside, physicians and other providers establish links on a variety of levels. The physician-scientist churns through differential diagnoses the moment he/she walks through the door, taking in the sum of subtle and not so subtle clues. As well, good clinicians learn to establish human links quickly. The best clinicians I've known in my career recognize the reflection of all life in each patient. As such, patients often easily lend to such persons intimate details of their illness. These clues, and others, enable the "technically prepared" clinician to soar beyond simple clinical competence to an ew level as "healer" rather than technician. As healer and patient take this journey together, they dance an intimate, human waltz which opens new doors to consciousness for both. Such interactions are sometimes brief and sometimes quite long. In either case, both learn more about the nature of suffering. In so doing, each is doctor and each is patient.
Date: Tue, Apr 20, 1999 8:27 PM From: To:

a good doctor is one that gives kids lollipops and has ear know...the ones that make you feel good about yourself even when you're feeling bad. all because he knows how to feel good about himself and being able to respect ALL of his patients.

Date: Tue, Dec 8, 1998 7:23 PM From: To:

I came across a link I had not visited before: What is an Ideal Doctor?

I noticed that many of the responses focused on competence and caring. Personally, I believe most of us who choose this profession do so because we care about improving the human condition (maybe the aloofness patients see in their doctors is just a defense mechanism -- it's difficult to always be human when there are people who die and suffer needlessly). And I doubt that most doctors could practice without some modicum of medical mastery. However, as I think back to the many posts I have read on the bioethics page, I've come to the conclusion that being a caring doctor is not enough.

Four years from now when I become a doctor (how's that for confidence, huh? hahaha!), I will be faced with new technologies, dilemmas, decisions. Yet the caring healer as the paradigm to follow opens up a medical Pandora's box full of questions which cannot be neatly answered. What does it mean to care for a patient? Sometimes what will apply to one patient will not necessarily be best for another. So, for me, after exploring this site, I believe the ideal physician is one who is **adaptable**.

The art of medicine is changing at a much faster rate that ever before in its history. What awaits us we cannot prophesy its exact nature. The ideal physician will be someone, who has empathy, who is competent, and who, despite posessing a strong code of ethics, has the courage to accept a different code which may be incongruous to their own. It's a tall order: to be human and masterful and wise like Solomon!


Raechelle C. Yballe, Case Western Reserve University, Cleveland, Ohio
Date: Fri, Mar 27, 1998 11:07 PM To:

I work daily with doctors. I find most of them to be competent and genuinely concerned about the well-being of those they treat. What I find lacking among many physicians, however, is the capacity to be human toward their patients.

This usually is through no fault of their own. Doctors are trained early in their careers to discount their emotions when treating patients. Physicians are taught to cure rather than care. The most powerful tool available to physicians today, however, is the ability to express what is in their hearts for their patients.

How many physicians today truly greet patients as they would a beloved friend? How many physicians today use the art of listening for its capacity to heal rather than as a tool for simply gathering information? How many physicians today would gently stroke the hair of a seriously ill, adult, same-sex patient--and admit it to their peers?

Yes, I want a doctor who is smart. Yes, I want a doctor who keeps abreast of the latest medical technology and therapies. And, yes, I want a doctor who can cure me if at all possible. But what I want most of all is a doctor who has the genius to provide me his humanity.

Sincerely, D. Dredla
Date: Sat, Feb 21, 1998 3:30 PM From: To:

A good doctor is someone who knows how to heal themselves, physically, mentally,and spiritually. The only possible way to achieve this is to get to the core of who one is. This is not something that is learned in the confinements of the classroom. This is an adventure into the very existance of a the human life force in which we have spawned from. This is a journey that leads us to the universal truth that lyes within all of us. It is almost as if the layers of society have to be striped from us in order to expose the truth that lyes beneath. A good doctor is someone who has stripped themselves of all of societies layers and discovered the truth. Once the universal truth has been reached,I believe a special talent unique to that individual will be felt. If that talent happens to be to heal, then so be it a healer.
Date: Tue, Jan 20, 1998 7:22 AM From: To:

Basically, three qualities are most important to me. I want my physician to be:

1) competent, 2) caring, 3) communicative

Still, Ii would agree with the previous poster who said that the balance of characteristics or skills depends on the physician's specialty.

Date: Tue, Dec 16, 1997 7:31 PM From: To:

The question is so general that one can answer it in only the most generalized of terms. We seem to ask questions in terms of the kindly old family G.P. when, in fact, there is great differentiation in the practice of medicine. So, in the most general of ways, my priority is that my physician be competent, i.e., very competent, and I would reject the incompetent. Beyond this, I would opt for interpersonal qualities, morality, etc. But this mixture might vary somewhat depending on the situation/specialty. Competence might be somewhat more important to me if my physician was my neurosurgeon as opposed to my G.P. Generally, however, I think that we are mistaken in talking about "the doctor" and we might be advised to speak about "doctors."

Monday, May 15, 2006

Hospital Patient Safety:"Ask me if I have washed my hands."

There is no doubt that patient safety in the hospital environment is a challenge that has to be met but apparently is only doing so… slowly. The hospital is not always a safe place since a patient there may get a serious infection that he or she didn’t have on admission. They may accidentally get the wrong pill or injection medication and become very sick or die. They may be mistaken for another patient and get a procedure or test that was ordered but not for them. The limb or kidney which was normal may be removed in error while the diseased organ left in place. In the past but less likely now, within the operating room, the wrong gas had been administered by the anesthesiologists in error causing the death of the patient.

The burden of medical mistakes have been placed on the individual physician. This has led to physicians afraid to report minor mistakes that fortunately did not lead to patient injury. Since most of the medical mistakes in hospitals appear to be system errors, acknowledging and acting on these minor mistakes, if they were only reported and evaluated, might have prevented a future major medical injury. System errors in air transportation are carefully investigated and remedied, why can’t hospital errors be treated likewise?

In the Sounding Board section (page 2063) of the current May 11 2006 issue of the New England Journal of Medicine is a commentary by ethicist George Annas telling us, physicians and the hospital organizations where we practice, that based on estimates among experts in the patient safety field that little has changed to improve patient safety in hospital care since the 1999 Institute of Medicine's report "To Err is Human". The report had noted that for attempts toward improvement of patient safety "safety must be an explicit organizational goal that is demonstrated by clear organizational leadership...". Annas says this hasn't happened and he feels that the best motivating method for accomplishing attention of hospitals to patient safety, thus improving quality of care, would be through legal actions "that are focused on patient safety systems in hospitals, rather than the actions of individual physicians." He continues "Physicians cannot change a hospital's safety policy by themselves. But by working with patients (and their lawyers) to establish a patient'! s right to safety, and by proposing and supporting patient-safety initiatives, physicians can help pressure hospitals to change their operating systems to provide a safer environment for the benefit of all patients." Thus, he feels that subjecting hospital organizations who fail to investigate, change policies and then end up with errors to legal suits will improve their motivation to make hospitals safer. Further, Annas is concerned that organizations that supervise the behavior of hospital activity are also not attacking the safety problem correctly. As an example, he points to the Joint Commission for Accreditation of Health Organizations (JCAHO) recent patient-safety initiative. The JCAHO idea was to encourage physicians to wear a button that reads "Ask me if I have washed my hands." Annas states "This is an example of putting the responsibility for patient safety on the patients themselves. The fact the commission sees patient self-defense actions as an important safety strategy is a symptom of the problem, not a solution."

There are some that feel that patient safety should be an active concern for many entities including hospitals, physicians and even self-defense actions by patients themselves. What do you think? Would more law suits of hospitals help? Should patients, if possible, pay more attention and be more inquisitive and be more responsible regarding how they are being treated? Finally, do you think patients have a "right" to be safe in a hospital? ..Maurice.

Friday, May 12, 2006

Genitalia and Rectal Exams:Learning the Right Words and Right Technique

In past blog postings, I have explained how medical students are given standardized patients, actors, to interview and examine, thus allowing them to make mistakes or meet patient challenges without being embarrassed or hurting a patient. In a posting in November of last year, I discussed real patients who are trained to teach medical students about their illnesses. Today, as a segue from the last discussion of patient modesty in examinations, I would like to introduce my visitors to a common activity now in medical schools where medical students practice pelvic, male genitalia, rectal and breast examinations… on their teachers! With attention, calmness and understanding along with their other teaching skills, these uncommon and altruistic “patients” guide medical students through the process of these examinations from the beginning with the development of the initial informing the patient of what is to be done, the use of the “right” words, the behavior of the doctor during the exam and the technique of the exam itself and the final discussion with the patient. Since these folks are in real time experiencing the comfort or discomfort of the exam and can feel where the student’s finger is located they can update the student moment to moment as to what the student is doing right or wrong. Hopefully, by the time the student examines the first real patient, of course with the patient’s informed permission, there will be less apprehension by the student and the examination will be more comfortable for the patient.

A very descriptive article about this topic titled “Intimate Subjects” can be found in the Stanford Medicine Summer 1999. The article starts out as follows: AT A RECENT MONDAY NIGHT TEACHING SESSION, THIRD-YEAR STUDENT REBECCA LEIBOWITZ WAS A STUDY IN COMPOSURE AS SHE SAT, FINGER POISED, READY TO BEGIN HER FIRST RECTAL EXAM. Her subject, Barry Forgione, had already demonstrated the four possible positions for the exam, and now waited patiently, knees-to-chest, to talk her through the procedure. "That wasn't so bad," Leibowitz said when the ordeal was over. "The anticipation was a lot worse."

Forgione and others regularly lay aside their inhibitions and submit their bodies to repeated explorations by hesitant student fingers to coach the novices through these most intimate of examinations. Known as patient educators, these trained specialists teach medical students how to conduct pelvic and breast exams for men and women.

The reason why I write about how we go about teaching medical students to become doctors is that there is much detail in medical education which is unknown to the public, even those watching ER or other medical TV programs. It is important for the public to be aware of the techniques and goals and then they can size up the results as they experience physician behavior to themselves as patients. When behaviors are noted that cause patients concern, it is important to reflect that concern back to the medical school teachers. Maybe our teaching techniques need to expanded or modified. I am trying to promote that feedback though this blog. ..Maurice.

Thursday, May 11, 2006

Patient Modesty: A More Significant Issue?

Although I shouldn't really be surprised, I am surprised about the relatively large number of comments I received regarding my posting in August 2005 titled Naked.
The posting deals with an article written in the New England Journal of Medicine titled "Naked" by a surgeon in which he describes the inconsistent or better absent guidelines in U.S. medical practice culture regarding how to perform a physical examination in keeping with patient modesty. If the slant of the comments is an indication of general patient feeling, it would seem that there are a lot of unhappy, worried and embarassed patients out there who feel that in many ways physicians and others involved in medical management such as nurses or medical technicians are either unaware or uncaring about their patient's modesty or there are a number of physicians who appear as upright physicians on the outside but sexual perverts on the inside. If these comments to the issue are a reliable reflection of what is the view of U.S. society and not just those who took the time to write to my blog, then I think those who attend to the undressed patient need some enlightenment about what their patients may be concerned about. I want to believe that the physicians and others are simply doing their job, are under pressure of time and may think there are more important issues to be concerned about the patient than their transient modesty problem.

Nevertheless, as state medical board experience will show, there are "bad apple" unprofessional doctors in the profession and they should be dealt with and possibly removed from practice.

My suggestion is that if a patient finds modesty a personal issue at the time of the exam or proceedure, the patient should speak up about their concerns at that time and expect some explanation or response. On my posting, the visitors also raised the issue about those patients who,in surgery, while under anesthesia were "immodestly" exposed. In that case, although, unlike the view of my visitors I think such an occurance is very rare. If some inappropriate and unnecessary exposure of a patient was seen by others, those in attendance should express their concerns to the surgeon or superiors.

As with the complaints by some of the public about physicians asking inappropriate questions in history taking, the concern of the public with regard to modesty may represent a previously considered trivial matter in medical practice that now should be looked at as a more significant issue and therefore more intensively considered by those who teach and practice medicine. ..Maurice.

ADDENDUM: The photographs of bronzes were taken by me 7-5-07 at Huntington Library and Botanic Gardens, San Marino, CA. Left: Male-Unknown French 1780s Right:Female-Unknown Italian Late 17th-Early 18th century. The photograph of the plaster statue of a woman was taken by me on 9-25-07 outside the Boddy House, Descanso Gardens,Flintridge, CA.


Monday, May 08, 2006

The Effect of Prolonging Life on the Requests for Euthanasia

Today’s post is short but it extends the recent discussion on the prolongation of life by technology. A visitor to my now inactive Bioethics Discussion Pages wrote me the following interesting question:
“How will Euthanasia be affected if medicine and
technology makes everyone live longer?”

I wrote him back the following:
… medical and technological prolongation of life does not necessarily mean a life meeting the quality standards set by the individual and doesn't assure a happy life or a life free of suffering.. or does it?
So, therefore, if life is too long or too burdensome, there might be some persons who would desire a "good death" to end that prolonged life.

Does everyone agree with my response? ..Maurice.

Saturday, May 06, 2006

U of P Center for Bioethics Symposium: Legacy of Terri Schiavo

Much has already been written and voiced and shown on TV about the Terri Schiavo case. And there continues to be more discussion about Terri's experience and comparisons of other cases with her history. There is much to be learned about her and her family's experience. But also to consider from various points of view what was done right and what was done wrong and how such consideration might impact on future actions regarding advance directives and discontinuing life-support including the role of the judiciary and politicians. Each side have set up ongoing organizations to continue a Terri Schiavo legacy.

The University of Pennsylvania Center for Bioethics celebrated it's 10th anniversary by producing a symposium on April 30 and May 1 titled "The Legacy of the Terri Schiavo Case: Why is it so hard to die in America?" The entire program is available as archived webcast of the event and presented for RealPlayer viewing at the Center for Bioethics website.

Speaking is Michael Schiavo but also the session has a number of ethicists and others discussing the important topics as noted in the Program noted below (taken from the Center of Bioethics website).

The on-demand streaming video webcast is of high quality and watching it makes you feel like you were in the symposium audience. I recommend my visitors taking a look. I would be interested to know what you thought of the symposium in terms of telling the whole story and discussing what to take away as future considerations from the Terri Schiavo experience. ..Maurice.

Sunday, April 30
Welcome Remarks
Speaker: Jeanette Lerman, Chair, External Advisory Board to the University of Pennsylvania Center for Bioethics

3:15-5:00pm Personal Experiences with Death and Dying
Moderator: Michael Smerconish, J.D., WPHT Radio, Philadelphia Daily News
Lead Speaker: Michael Schiavo, R.N.
Panel Members: Julia Duane Quinlan, Karen Ann Quinlan Hospice
Mary J. Labyak, M.S.S.W, L.C.S.W.*, The Hospice of the Florida Suncoast

David Casarett, M.D., University of Pennsylvania

Rabbi Gerald I. Wolpe, University of Pennsylvania

Monday, May 1
8:30-8:45am Welcome Remarks
Speaker: Arthur H. Rubenstein, M.B.B.Ch., Executive Vice President, University of Pennsylvania for the Health System; Dean, School of Medicine, University of Pennsylvania

8:45-10:15am Who Should Decide: Surrogates / Families?
Moderator: Jennifer M. Kapo, M.D., University of Pennsylvania
Lead Speaker: Jay Wolfson, Dr.P.H., J.D., University of South Florida
Panel Members: Adrienne Asch, Ph.D., M.S., Yeshiva University
Janet F. Haas, M.D., Chair of the Corporation, William Penn Foundation

Jason Karlawish, M.D., University of Pennsylvania

10:30-12:00pm Who Should Decide: Courts / Legislators?
Moderator: Arthur L. Caplan, Ph.D., University of Pennsylvania
Lead Speaker: Hon. George W. Greer, J.D., Florida Circuit Judge

Panel Members: Hon. Leonard B. Sokolove, J.D., Retired Judge of the Common Pleas Court of Bucks County; of counsel with Eastburn & Gray, PC
Nora Dowd Eisenhower, J.D., Secretary of Aging, Commonwealth of Pennsylvania

12:15-12:30pm Welcome Remarks
Speaker: Amy Gutmann, Ph.D., President, University of Pennsylvania

12:30-1:30pm The Role of the Media: Lunch Talk
Speaker: Robert Bazell, Chief Science and Health Correspondent, NBC News

1:30-3:00pm How Should American Society Cope with Death? Religious Perspectives
Moderator: Paul Root Wolpe, Ph.D., University of Pennsylvania
Panel Members: Kenneth Kraft, Ph.D., Lehigh University
Abdulaziz A. Sachedina, Ph.D., University of Virginia

Rev. Dr. William J. Shaw, President, National Baptist Convention, USA, Inc.

Kevin O'Rourke, O.P., J.C.D., S.T.M, Neiswanger Institute for Bioethics and Health Policy Stritch School of Medicine, Loyola University of Chicago

3:15-4:45pm How Should American Society Cope with Death? Socio/Political Perspectives
Moderator: Charles L. Bosk, Ph.D., University of Pennsylvania
Panel Members: Myra Bluebond-Langner, Ph.D., Rutgers University - Camden
Ronald Cranford, M.D.*, University of Minnesota

Carol Levine, United Hospital Fund

Elizabeth M. Armstrong, Ph.D., Princeton University

4:45-5:00pm Closing Remarks
Speaker: Arthur L. Caplan, Ph.D., University of Pennsylvania

*Note: Mary J. Labyak and Ronald Cranford were unable to participate in the symposium.

Friday, May 05, 2006

How Old is Too Old To Become a Mother?

From today’s Times Online comes word of another elderly woman soon to give birth.

Yes, we have thought it all through, says IVF mother, 63
By Will Pavia

BRITAIN’S oldest expectant mother answered her critics yesterday, saying that her IVF-induced pregnancy, though “potentially controversial”, had been planned responsibly.

Patricia Rashbrook, a consultant child psychiatrist, will be 63 when she gives birth. She is seven months pregnant after treatment by an Italian embryologist. Doctors and anti abortion groups have accused her of selfishness and expressed fear for the child’s long-term welfare, growing up with two parents already over 60.

In 1997, a similar event occurred in the United States. On my now inactive Bioethics Discussion Pages, I presented the issue of a woman age 63 becoming pregnant and delivered after obtaining invitro fertilization. I posed the question of whether this was an ethically “right” thing to do. I certainly got a large number of very interesting responses from my visitors over the years. I have posted them here with the oldest comments at the bottom of this post. I welcome any comments from my current blog visitors. ..Maurice

On April 23 1997, it was announced that a woman, who had no children and was married to a 60 year old husband, had successfully undergone a delivery of a 6 pound 4 ounce baby girl after an in vitro fertilization and frozen embryo transfer. Though the assisted reproduction program where the transfer and followup was done had set age 55 as the maximum age for the procedure, it appeared that the woman represented herself as 10 years younger than her real age. After she became pregnant did she admit she was 63 years old. She is now possibly the oldest woman documented to have delivered a child. There have been many issues of public concern which has developed since the announcement. From the point of view of these Bioethics pages, the question arises as to whether it was "right" for the woman along with her husband to have initiated and brought to fruition a pregnancy and to become the parents of the child.
Here is the question:
What are the ethical implications of becoming a 63 year old mother? Is it right?

Date: Fri, Jan 23, 2004 10:38 AM From: To:
There have been so many responses to this that I feel foolish to add yet another, but I could not get this off of my mind until I replied to it. I am a single mother of two children, 3 and 5. I work part time and am a full time nursing student. I love my children. They have made me a better person and given meaning to my life. But let's face it, in our youth (I do still consider 25 as youthful) we do not have the patience, life experience, and sometimes financial stability that we may have at a later time in our lives. I try to have as much time for my children as possible, but I have to put food on the table and college is important so that in the forseable future I can give my children food, clothing, shelter without a daily struggle but this does come at a price. At 65 this child is being raised in a household that has 2 loving parents, they are probably financialy stable if they could afford the procedure, and they are most likely retired or close to retirement giving them time to raise their child in a loving stable home. Even if they are only alive till their child is 20 they have probably spent more quality time with their child then most of us who will be alive when our children are 50. She was physically able to carry the child to term and deliver. Some 20-30 year olds are unable to do this and have several miscarriages before they reach success, should they not try to have children. How about people who have had cancer. After remission should they not try to conceive? The cancer may come back and kill them before the child is out of diapers? Our bigger problem is people who mistreat their children, who use abortion as birth control, the babies left in trash cans. Let's all appreciate parents who are trying to do their best and try to help those who are not.
Michelle Blackwelder 04

Date: Wed, Apr 9, 2003 10:38 AM From: To:
I feel that this is unethical due to mainly the age of the woman and her husband. She is 63 years of age and her husband is 60 years of age. How old will this child be when they die? Eventhough the life span has greatly increased, this child will eventually be left without parents at a young age. Who will take care of the child? How will the death of his parents affect him and his quality of life. I just don't think that this child will have the opportunity to be a child and enjoy the things that children of younger parents enjoy, such as playing baseball, football, basketball, cheerleading, beauty pagents, and a whole lot more.
Some people elude to the fact of Sarah and Abraham being blessed with a son in their nineties when justifying this pregnancy, but I do not think that they are at all similar. For one, Issac was a miracle from God. He planted the seed into Sarah's womb, God did not need any help from man or technology, this to me is a true miracle. The later is man playing god, and trying to change a manipulate his plan for each of our lives, but with this manipulation comes a great deal of consequences that are not weighed. Yes, it may seem great that this woman was able to produce a child at the age of 63, but what about the what happens after the child is born, and the aging process continues with the parents.
But this is America, and we are a great nation with the right to choose as we please. I do not agree with it, but I do agree that the right should be given to those that choose to do this procedure.

Date: Mon, Mar 3, 2003 9:41 AM From: To:
I feel that if a woman no matter what age can provide a child with the love and resources needed to care for them, why can't she have a child. I myself feel that I would not have a baby at that age because I would want to make sure that I am able to enjoy them and their life. I would be interested to know how it came about that a woman of her age who most likely had gone through menopause was able to conceive?

Date: Sun, Feb 16, 2003 5:56 PM From: To:
Personally I believe that this woman is extremely lucky. The only thing that she wanted was to have a baby. I myself am in my mid twenties and can't even have children, even though it is the only thing that I ever wanted in my life. this woman might have a 63 year old body but here heart is that of a young spirited woman. In my opinion that little baby is the luckiest baby in the world.

Date: Tue, Jan 28, 2003 12:40 PM From: To:
Hi I am a 45 year old woman never married or had any children. I guess reason for even reading this article is that I had to do a paper for shool and I found the responses facinating. I think that in a way it was unethical in bringing up the child at such an old age and that they may not be there to see the child grow up, get married but who are we to say anything because we all do not know how much time we have left on this earth. Also Sarah in the bible had a baby at the age of 90. I think that is the record of the oldest woman having a baby. I think that if she did conceive it is her right and there that we have the right to say about it. What if it was You? This is a gray area question that you have to do what is in your own belief system and what you believe is right.

Date: Fri, Nov 22, 2002 8:33 AM From: To:
I am also amazed -as one person put it -at the selfish, arrogant, ignorant and immature responses to this question. Life should be as valued as our Father in Heaven values it. We are His Work / His Glory. Have faith in Him. I don't question His miracles. These people talk about the mother as if she were not also a miracle of God. In each of us there is a Divine Purpose. Would those people think differently about this child being born if this is the child that discovers the cure for aids? for cancer? develops a way to get rid of nuclear waste? or maybe simply being in the right place at the right time to save a child from crossing the street in front of a vehicle. How would they think of the mother then? We are promised nothing in this life except His enduring love and guidance - whether our days are many or few. We each make our choices, thanks to His gift of free agency, and we must accept the consequences of those decisions. I wish only the choicest of God's blessings for this family. (Ethical? It is a baby - not a scientific experiment.)
Debrah L. Hardee, Surfside Beach, SC U.S.A.

Date: Sun, Aug 18, 2002 1:13 PM From: FOUR To:
Its not against any ethics for a man to help produce a child at an older age, so why stress a woman who wants to conceive and have a baby at ages 55 or older. A man can keep making as many babies as he wants as long as he still gets a good erection. You don't hear the media jumping all over us now do you? ?subject= 63 year old mom:13 PM

Date: Sat, Aug 10, 2002 12:50 PM From: To:
I don't think the clinic or anybody else has a right to say if a person can or cannot have a child. The mother should not have had to lie about her age. If the law says a woman has the right over her body to terminate a pregnancy, how can they then say she has no right over her body to begin one? If doctors are allowed to assist in terminating pregnancy, then why not be morally correct in assisting the startup? The love of a good parents is the best start in life any child could have, come what may.

Date: Mon, Jun 24, 2002 2:24 PM From: To:
I think it was unethical for the couple to bring a child into the world at their ages. I believe as I do because of the six ethical principles and one of the principles is that of fidelity-faithful. The couple violated this principle when they choose to lie about their ages. The institution has age limits set for particular reasons. Reasons for concern of the unborn child and for concern of the mother. I, myself being a mother in my mid twenties have a hard enough time keeping up the high energy level of my three year old. I could not imagine trying to do it in my sixties. I would be concerned of health risks relating to that age and health problems of my spouse. I hope they have a lot of support near by!

Date: Mon, Jun 17, 2002 7:05 PM From: To:
It is not our place to judge as mankind. We are not God, only shaped in the likeness of him. I do believe though that if God intended for this particular woman to conceive and give birth to a child, she would have gotten pregnant without the assistance of modern technology. I believe that anything is possible with the help of the Lord, but to "play God" is not the correct way to go about planned childbirth, and parenting. At the ages of 60 and 63 it will take God to help them through all of those crying spells, wet and soiled diapers, and of the mental strain of rearing today's generation of children. I wish this blessed couple the best of luck.

Date: Sun, Apr 28, 2002 10:59 AM From: To:
hi, my name is Ashley and I'm 15 yrs. old. I just want to congratulate you on your 6 lb. 4 oz. baby. I feel that if you are healthy enough to have a baby then so be it. you should be very grateful because there are many women out there that can't conceive and don't have the money for in vitro. bye!!!
--I'm sure your baby is beautiful.

Date: Fri, Dec 28, 2001 5:09 PM From: To:
I am a 65 year old Grandmother trying to raise a 13 yr old help financially or any other way.....and I can't imagine a 63 year old woman wanting to become a Mother again. I do not feel that God would have chosen a woman at this age to become a mother.God made a woman at a certain age where she could not become pregnant. And I do not think its fair on a child. I think it is selfcentered as for any woman at age 63 to bring a child into this world...I do not feel they are thinking of the child,but rather their own selfish wants. Its difficult to raise a child again at that age and its difficult on the child having a mother that age.....I don't believe that the people who say this is just wonderful, have really thought this out much less experienced raising a child again at that age. No I do not feel this is right.

Date: Tue, Nov 6, 2001 11:31 AM From: To:
Just wanted to say I think it is wonderful that you are willing to help older women become mothers..because it is a blessing in life...and any women at any age can be a good mother and also a better mother. That child will be more mature at age 18 and will be a better provider for themselves and their family. Would like to see more of them.... Cheers for the over 50's new mothers.......

Date: Fri, Oct 5, 2001 8:33 PM From: To:
I am 41 yrs. old and I have had 7 children of my own. they are all grown and gone now. I am now in a marriage with a man that don't have any children. He would make such a wonderful father, but, I can't have anymore! I would love very much to have a baby with him, but unfortunately I can't find a Dr. here in Mich. let alone the money. I feel that any woman in her later years wanting a child should be able to have one. They are Gods gift, God gave women the gift of creating life. And know one should ever criticize a woman for having one. As long as a woman is healthy and can carry a pregnancy that so be it.

Date: Mon, Sep 17, 2001 11:39 AM From: To:
hi i am doing a project on women having babies later in life and i logged on to you're web site !
I feel that it is ethical for a women of 63 to have a child. Obviously it is what they both wanted and i feel that it is a nice thing that thier wishes have come true i wish them all the best and plus i don't feel it is up to us to judge any one else that chooses to have a baby late in life !!!
well thanx 4 listening Fallon 16yrs, bye

Date: Sun, Jul 1, 2001 1:50 PM From: To:
I think that the 63 year-old woman really wanted a child and I believe that if God allowed it to happen than it was a right choice. Although I would not promote older women to take on the risk of a bearing a child, I think that in special cases it works out to be the best decision. Perhaps this woman had never experiences the wonder and excitement of being a mother. How can we take that right away from her just because of her age? I believe that as long as she was educated about the risks and dangers to both her and her baby, than it is still her decision. I am glad to see that the pregnancy and birth of her child was a success!
Amber Pearson- OKC, OK

Date: Wed, Jun 27, 2001 7:34 PM From: To:
I believe the mother had the right of privacy in choosing to get pregnant. She has the right to do whatever she chooses in her personal life as long as she does not violate the rights of others. One has to question though, whether she violated the rights of the child by bringing her into the world at a greater disadvantage from other children her age. She likely faces years of ridicule and torment at the hands of her peers...violation enough!

Date: Mon, Jun 25, 2001 7:16 PM From: To:
Who are we to judge these women and make decisions for them? Who's to say that I might not be one in my older years trying to do the same thing? It seems to me that this child is going to have more love than she ever wanted due to her parents wanting her so badly as compared to the person who is still in shock trying to figure out how she became pregnant.

Date: Sun, Apr 8, 2001 12:59 PM From: To:
As long as God permits her body to have a child in a natural way it is ethical. If God wanted to permit humans from giving birth at a curtain age He would end our right to give the miracle of birth in his own way, by not allowing her body to conceive such a child. A child is a miracle sent from God himself! Don't ever doubt him! I am a 21 year old from MN.

Date: Thu, Mar 15, 2001 8:27 PM From: To:
I believe that if this woman wanted a child bad enough to lie to the doctor in order to have one, surely she weighed out all of the pros and cons of her decision before doing so. I'm sure she was aware of the risks to both her and the child, yet she decided to procede. I realize that she is an elderly woman, but as long as she provides for this child both mentally and physically, I think she has just as much right to have a child as someone in their twentys. I do think that since she is a much older person, she should make plans for her child's future in the event of her death. This woman was clearly desperate to have a child of her own. Who are we to judge a mother's love? If God didn't want this to happen, it would not have. I say "Way to go!" I wish her all the happiness in the world.

Date: Mon, Feb 12, 2001 3:28 AM From: To:
We are two 18years-old students and we have parents of 40yr and granparents of 70yr/65yr. We are glad, happy, proud and so on we have known our own grandparents but we have grown up with OUR PARENTS!!!! We think and it's sure that that poor baby WILL NEVER KNOW his grandparents and first of all, his parents if they die soon!! In this case people shouldn't take care of the wishes of the mother (SHE HAD TIME TO HAVE ONE CHILD WHEN SHE WAS "YOUNGER") but we should focus on the future of the little child.

Date: Mon, Feb 12, 2001 3:13 AM From: To:
we think that having a baby at the age of 63 is a personal choice and nobody can judge this woman! there could be some genetic and psychological problems but what matters is that the mom loves her child!!!

Date: Mon, Jan 29, 2001 3:15 AM From: To:
we think becoming mother at 63 years old is not ethical because you are too old to have a baby,there is a big difference between a baby and his mother.

Date: Sun, Jan 28, 2001 11:54 AM From: To:
We think that when a woman gives birth to a child at the age of 63 she is not the example of mother a child sees when he or she goes to school every day, she'd rather look like the grandmother, making the child get embarassed. It is also a medical risk: the more a woman is old, the more the chances of having a sick child become bigger. So in our opinion it is not so right to have a child when the mother is so aged. Noemi & Stefania

Date: Sun, Jan 21, 2001 11:09 AM From: To:
i find it morally and ethically wrong for a older woman such as herself trying to take on the responsibility of raising a child. with the ever changing world and the pressures that face our teens today, an elderly couple most likely cannot keep up with the requirements for raising a child. the main focus and point of concern should be with the quality of life this elderly couple can provide for the child. he/she sould not have to suffer and face the world alone at such a young age.

Date: Mon, Dec 11, 2000 2:29 PM From: To:
Many people have argued in favor of the woman's decision, citing young parents who have exhibited poor child-rearing skills or grandparents who have done an admirable job in raising their children's kids. Yes, young people can be miserable parents and older people may be wonderful parents, but I think the focus has to be on the experience of the child. People, regardless of their age, need to think seriously about the quality of life they are able to provide for children. All too often, people are lured by the wrong motives for having kids -- It's the right thing to do, kids are so adorable, I'll have someone to love me now, and a hundred other invalid reasons. My gut feeling is that a 63 year old woman, no matter how wonderful and healthy she may be now, may not be as well-equipped as someone half her age to deal with the ever-changing physical and emotional demands of raising a child throughout the upcoming years. But before I pass judgment, I would like to ask her if she's considered all the issues particular to her case, most of all, how she plans to provide for her daughter if she dies while her daughter is still dependent upon her. If I could hear her answers, I might discover she is no better or worse than any parent of any age.

Date: Mon, Nov 13, 2000 5:57 PM From: To:
I think the most important issue in this situation is the child, not the mother. We need to focus on the circumstances that this child is facing. How much time is this child going to spend with her parents? Is she going to bond and feel close enough to them to share moments that are crucial in the growing up process? I believe that there may be many situations in the future that these parents won't be able to handle. Unfortunately, it's the child who will be hurt in the end. I'm trying to stay away from "bad-mouthing" the parents because I believe that everyone should have the opportunity to have and love a child, but may be this should have been planned out a little better.

Date: Thu, Nov 2, 2000 8:46 AM From: To:
In response to your ethical question:
The article featuring a discussion about a woman who, at the age of 63, lied to her doctor and told him she was ten years younger so she would be eligible to receive an in-vetro fertilization and frozen embryo transfer. On April 23, 1997 she gave birth to a 6 pound 4 ounce baby girl. The topic is whether it was "right" for this woman and her 60-year old husband to be the parents of a child.
I have known some 62-year-old grandparents who became the adoptive parents of their daughters children. The children were age 2 and 5. The daughter, lost in her world of selfishness and immaturity, abandoned her children. Grandma picked up the pieces, legally adopted the children, and struggled to maintain a happy, healthy home for them. This situation was not on the news, no one thought to discuss or argue their decision. No one really cared. And it is a situation that is all too common in our society today. Grandparents raising children and doing it well.
So I question why there are so many negative responses because the woman in question gave birth to a wanted baby. If it is a question of the woman dying before her baby was raised to maturity, then I say that none of us are in control of our death. Young mother die too.
What I want to know is the baby loved? Is she nourished and nurtured? Is she picked up when she cries? Is she rocked to sleep? Are the parents providing stimulation, education, and stability for the baby? These to me are the issues to focus on. If the parents are doing these things, and more, for the baby girl, then we as a nation full of abused, neglected children, should bring our hands together and give thanks.

Date: Thu, Oct 5, 2000 4:14 PM From: To:
First of all whom are we to judge this woman for wanting a child just because she is 63 years old?? The majority of people would not even blink an eye if the father was 63 -- so what is the big deal?? You always hear of a lot of older dads. Also as far as the possibility of the mother having medical problems while the child is young -- that can happen to parents of any age. We had a family member die when he was only 32 -- and another mom to die at age 28 when her twins were 1 yr. old. -- and what about the ethical issues of these teen kids that have babies that they don't want or just "flush down the toilet!" God has a plan for us and apparently this baby was certainly in his plans. I congratulate this 63-year old mom for wanting to become a mother despite her age -- I certainly believe that this woman will be a wonderful mother. Her child has a lot to be thankful for -- a mom that truly wanted her.

Date: Tue, Oct 3, 2000 11:12 AM From: To:
Personally I think that it is totally radically amazing how a 63 year old women can have a child. I think it was wrong for her to lie about her age, so what if she is 63 she has got to be in great shape to beable to have a child at that age! I praise her, My mom had me at 46 years old. I am now 17 years old, does that make my mom a descrase to women cause she wasn't suppose to be able to have another child, and here I am, almost 18 years old ! it's a total marical! I wish I could be able to tell my future children that their grandmother had me when she was 63, it would be a great history past family thing to pass on in the future.

Date: Tue, Sep 12, 2000 4:23 PM From: To:

Date: Sun, Jul 2, 2000 10:57 PM From: To:
i think it is disgusting and decieving. her body went through menopause for a reason! i feel so sorry for the child. it will be about 16 or something when its parents are too old and feeble to care for it. this woman is a disgrace to all womankind! she should be punished for lying. i know what i would have done if it were me in her shoes i would have adopted. and if she were fertile earlier on in her life she should have had a kid then and if she werent fertile she should have doe this test tube thing earlier. shes disgusting.

Date: Tue, Apr 11, 2000 8:11 AM From: To:
I would just like to point out that men have become fathers at all ages so, if science allowes it, why should we as a society withhold that same right to a woman. Yes there are problems to do with age but the fathers at 65 or older have had to cope with them so why does everyone think that th e 63 year old woman will not?

Date: Wed, Mar 22, 2000 6:29 PM From: To:
Dear Dr. Mo-
My name is Diane Hoffman. I have been absolutely facinated by the questions and responses at your site. It must be the best on the web. When I got to this one, I absolutely had to respond. I cannot believe some of the arrogant, selfish, responses regarding this issue.
In the first place, yes 63 is old, but not THAT old. If this woman was able to shave away 10 years and fool the doctors long enough to undergo fertilization, and she wanted a baby so badly that she was willing to risk her health for it, then I say "You go girl."
How dare these people assume that someone at 73 is incompetant and unable to raise a child. There are many women at least that old raising their grandchildren because their own children are struggling trying to survive, are too selfish to take care of a child that will disrupt their standard of living, or have lost their own children due to whatever circumstances. The list goes on and on. There is absolutely nothing that says this woman will be a dottering old fool unable to take care of this child she has brought into the world. Many of the geriatric set are far more capable and have the time and money to raise a child than their younger counterparts. I am also sure this woman has made adequate arrangements in the event that her death happens before the child is old enough to be on its own.
I may not be 63, but I am a single mom with a 9 year old and a 27 year old. At 46 I am continually mistaken for someone 10 to 15 years my junior. Having a late life baby was not my choice, but I would not change a thing. My daughter and my older son are the driving force that keeps me young and motivated. It was a lot easier when I was younger, but I expect to be alive and kicking for a long time yet. I feel this woman had every right to have a child. God bless her and I wish her all the best.

Date: Wed, Mar 1, 2000 2:14 PM From: To:
Dear Dr. Mo-
My name is Bridget McLain and I am a student at Deuel High School. I have just posted a filamentality Web Quest about ethical childbearing age limits. I believe that the process of doctors reversing menopause and impregnating women through in vitro fertilization is wrong. There are so many women today of childbearing age and condition that would love to have children. In any case like this, we must look at the best interests of the child involved. When a child is born with a sixty-three year old mother, you can most likely count on him/her not being able to share some very important times with his/her mother. There are also many risks older women take when getting pregnant, especially with chromosomal abnormalities. Although there could be some special situations, I believe that it is unethical for women to reverse menopause and artificially become prgnant to bear children at a later age. Thank you for your time. You should reply to the address; if you have any questions.
Bridget McLain

Date: Fri, Oct 8, 1999 7:28 PM From:
Well, I think it was wrong for her to lie about her age, especially since there was an age cutoff mark. She must have had her reasons. I know by personal experience that having a baby can really wear you out. I hope and pray that she has the stamina that it requires or the financial resources for a nanny. I wish her luck because she can't change her mind now.

Date: Sun, Jul 25, 1999 11:15 AM From: To:
I feel that there would be nothing unethical in becoming pregnent at 63 if there was higher risk of having a child with birth defects. Unfortunately children that are born to older mothers do have a greater risk of having disorders (1 out of 9 children born to mothers over 45 have Down Syndrome). In this case apparently the eggs were taken from her at the earlier age and kept frozen until she was prepared to have children. So technically the baby did not develop from a 63 year-old egg. I do not know what the risks were of having children with birth defects under these circumstances but if the risks are great then the practice should not be allowed. The aspring mother should consider adoption instead.

Date: Wed, Mar 24, 1999 5:43 PM From: To:
Hello, the chance of this woman being a great mother or should I say an experienced grandmother is possible. However, this particular woman had many, many, many years to have a child. Either these people will raise this child to be dependent on itself for making ethical desicions or this child will be spoiled rotten. The future for this child will be promising for who knows how long its parents will be around therefore the parents money could afford to award this human with a promising education. Lets think about the teen years where high school activites and friendships play an important role in ones life. They better have a full time taxi cab driver, this woman will be 76 years old when the child is 13 and discovering it own life and needs guidance and support with its decisions for its well being.Good luck, I cant see a 76 years old mother and father tolerating " Spice Girls "? Have fun.

Date: Wed, Mar 3, 1999 2:57 PM From: To:
I am amazed to see so many people with disagreement for this subject. It is clear to me that most if not all of these people have never had to deal with infertility, and for their sakes I hope they never do. As to the question of this woman being too old to be a mother, and that she may die very soon, i had my daughter at the age of 25years, and could get hit by a bus tomorrow, so does that mean I shouldn't have kids either? As for her lying about her age, try to put yourselves in her shoes, and see if you would have acted differently. Leave the woman alone to get on with her business :))
Tracey Rowe, Therapeutics,, ICQ: 26877644

Date: Thu, Nov 5, 1998 11:05 AM From: To:
I read the discussions on this page and I have an opinion which is not really represented here. I do agree that an older woman will have more wisdom and stability with which to raise a child. And also that she will probably die before her child will benefit much from this wisdom about life. I believe that most of the fertility treatments available today are a bad idea. If people are either infertile, or past the age of fertility, they should not be artificially enabled to bear children. This, to me, has nothing to do with what God would want (being quite agnostic), but more of what nature itself dictates. Looking at the big picture, do we really need to indulge ourselves so exessively and create more people for the overpopulated world? -- and this arguement even has some validity when you are not talking about involving unnatural, complex, and expensive hormones, drugs, needles, in vitro fertilization, and/or other fertility "solutions." There are plenty of kids (already born and naturally, at that) who need to be adopted if she is looking for a child to care for. If not, then she is only looking to be in Guinness and is obviously not very mature at her advanced age anyway.
*Sarah M. student - University of Michigan

Date: Fri, Sep 18, 1998 2:57 PM From: To: that is something you don't hear about everyday! Although I am not really sure if I think that such a scientific development is unethical, I don't think that I really believe in the intelligence of the act. There are so many issues to be considered when discussing an elderly mom. Personally, I think that it is unfair to the child. Just like those children born to adolescents, girls who got pregnant before they were mature enough to handle the responsibility, a child with an extravagently older mother is at a bit of a disadvantage. While, granted, a mother and child should not be too close in age, a generation gap that actually spans over at least two generations does not allow the mother and child to relate to each other well enough for a healthy relationship. Its hard enough trying to get the other family memeber to understand with normal age gaps. There is also the issue of the mother's untimely death early in the child's life. Although death is an inevitability, I am of the opinion that an elderly mother is possibly forcing the child to have to deal with the grief of death too early in life. It is difficult to deal with the death of a loved one, harder still if the deceased is a family memeber. But nothing in the world can replace a mother's love, and to have to lose that love too early in life is not an event that a child should have to deal with if it is otherwise avoidable.

[Ed. Note: I am not sure whether all three messages below are from the same student or three students.] Date: Fri, May 15, 1998 8:44 AM From: sheilac@kalama.doe.Hawaii.Edu To:
I don't think this is wrong but i do think it's gross. At long as they think about her dying befor the child hits puberty. And not if she has to take drugs. ...
I don't feel that it was right for a 63 year old women to give birth. She should have thought about the unborn child and the consequences that may have occured. Plus she had to take fertility drugs so she could get pregnant. The baby and herself could have been put in danger. ...
Well I think its wrong for a old woman as old as 63 years of age should have a child because by the time the child grows older he probably wont even see his or her mother due to her death.

Date: Wed, Mar 18, 1998 12:42 PM From: To:
I feel that it was wrong for the grandmother, excuse me, mother to lie about her age to recieve tha treatment. Because she could have risked her life to make a life. What if complications were to occur during delivery. Today many complications began when labor begins. This old women could have had a heart attack and put her life as well as the childs life in danger. Also, when this child becomes of age to wanting a role model, she can't look to her mom as one. Because she will most likely be sitting in a rocking chair still recovering from giving birth. This child will also be looking for grandparents, uncles, aunts, just some type of family member. To bad they may already be dead.

Date: Sun, Nov 23, 1997 10:15 AM From: To:
I think that if God had intended for 63 year old women to have babies, that he would have made it possible for women of that age to do so. There are many complications involved with having a child at that age. When the child is entering high school, the mother will be close to 80 years old. Young children need mothers who will care for them, not the other way around. Although I do feel that people have the right to have children of their own, they should have their children at an age when they are able to care for their children. The child might also feel out of place having parents much older than the parents of their friends. The mother should have taken into consideration the stress she would be putting her child through before having it.

Date: Thu, Nov 20, 1997 6:23 PM From: To:
I do not believe that it is fair to the child to have a mother that old. My own mother was 48 when she delivered me, and I constantly received ridicule from the children at school because my mom looked like she should be my grandma. People need to think about the ramifications that this can have on the child.

Date: Sun, Nov 9, 1997 4:27 PM From: To:
I personally think that it is a person's decision whether or not they want a child and at what age they want to have it. I know people that are teenagers that have parents that are over 50 and 60 years old, and some of them have younger brothers or sisters. Obviously their parents wanted their to grow, at what age they decide to do this is up to them. BUT, I do also believe that if a couple who is over 50 and 60 years old, wants to have a child, then let them do it naturally, without invitro fertilization. If they are too old to bear a child at that age, then they should see that as a sign from God that they missed their chance.

Date: Fri, Nov 7, 1997 5:50 PM From: To:
I believe that it is quite absurd to even consider whether having a child at 63 yrs of age is ethical or not. In today's society where people typically live to see 100, it is quite alright for a mom to have a child that late, though there are many risks involved in this late pregrancy. After all, millions of American parents have used their own parents as baby sitters and we all seem to grow and develope to be fine. A 63yr old mother is much more preferable and better at raising a child than a 12yr old.
-Sinjin, Berkeley, CA

Date: Sat, Oct 25, 1997 8:09 PM From: To:
I don't believe we can ever say that a person does not have the right to have a child (or at what age), in order to enforce that view unethical measures would have to taken. However, I do not believe that what this woman did was ethical. In the first place let us not forget that the woman lied about her age to go through the procedure. But with that aside, I still think she gave little thought to the needs of a child. A child needs more than wisdom and love, he needs a parent physically able to deal with his demands. The child may turn out just fine, but the risk is increased with the age of the parents. It is well and good to know the child is wanted and loved but I think the age of this couple puts an unnecessary burden on the child. The child will have to deal with the thought of his parents dying much earlier than the average child does, not to mention that he may be faced with having to take care of his aging parents. This is a situation a 20 or 30 yr old is better equipped to deal with, not a 10 yr old. Children are faced with many disadvantages in the world, but to have no parents is the greatest of all. As I said before, the woman had a right to do what she did, but that does not make her choice a moral one.

Date: Fri, Sep 26, 1997 5:13 PM From: To:
I think it is her right to have the child. I do wonder about the child. She would be about 80 years old when the child graduates high school. Can you imagine the child in grade school and her 67 to 73 year old mother discussing the child's progress with the teacher? It seems to me that the child will be subjected to a lot of stressful situations because of the mother's age.
Jamie Thomas, OU College of Nursing

Date: Sat, Jul 26, 1997 7:32 AM From: (William H. Reading, MD) To:
It seems rather to me that this could be assumed to be ethical unless proven otherwise. See my comments regarding life in the response to Gov. Lamm's statement. Is it ethical to force Chinese mothers to abort? Would it be ethical to single out one type of individual and say that this individual should not be allowed to give birth when others are? How would you decide who has the intrinsic right to give birth? The issues regarding a 63 year old mother seem to be about the same as an HIV positive mother given current treatment options.

Date: Wed, Jul 16, 1997 7:39 AM From: To:
If the parents are in good health there is no reason not to allow this. Certainly there are more considerations to becoming a parent at 65 but why are we so concerned? Older parents have the advantage of maturity, and hopefully wisdom. They are quite likely to be more financially secure, and today still stand at least a somewhat reasonable chance of outliving there child. And then again what business is it of ours to dictate what is right and or wrong to would be parents at this age? We will not even adequately address the issue of teen pregnancies, and that is an issue which we KNOW has drastic societal costs. Yes there are potential problems, but if you think about them they are mostly emotional ones of acceptance of an idea with which we are unfamiliar. This couple with forethought conceived and bore a child. How many Grandparents have had one forced upon them? Either because of their own children's inability to cope with the consequences of their actions, or as is far less often the case by the circumstances of a tragedy which left the parents of the child or children dead or permanently incapacitated. I have not addressed many issues that I have heard raised about this occurance as they are ,to me at least, non-issues.
To Dr Bernstein thank you for this forum it is much appeciated
Chuck Masters RN