By Peter Loftus
The Wall Street Journal
Originally posted September 30, 2014
Drug and medical-device companies paid at least $3.5 billion to U.S. physicians and teaching hospitals during the final five months of last year, according to the most comprehensive accounting so far of the financial ties that some critics say have compromised medical care.
The figures come from a new federal government transparency initiative. The 2010 Affordable Care Act included a provision dubbed the Sunshine Act, which requires manufacturers of drugs and medical devices to disclose the payments they make to physicians and teaching hospitals each year for services such as consulting or research. The Centers for Medicare and Medicaid Services compiled the records into a database posted online Tuesday, though the agency said that about 40% of the payment information won't identify the recipients because of data problems.
The entire article is here.
Friday, October 10, 2014
When Medicine Is Futile
By Barron Lerner
The New York Times
Originally published September 18, 2014
Here is an excerpt:
The medical futility movement, which argued that doctors should be able to withhold interventions that they believed would merely prolong the dying process, did not experience great success. Physicians declaring things to be “futile” sounded too much like the old system of medical paternalism, in which doctors had made life-and-death decisions for patients by themselves. It was this mind-set that bioethics, appropriately, had sought to correct. Patients (or their families) were supposed to be in charge.
The problem was that the new system did not account for one thing: Patients often demanded interventions that had little or no chance of succeeding. And physicians, with ethicists and lawyers looking over their shoulders, and, at times, with substantial money to be made, provided them.
Thursday, October 9, 2014
Reification and compassion in medicine: A tale of two systems
By Anna Smajdor
Clinical Ethics
December 2013 vol. 8 no. 4 111-118
Abstract
In this paper, I will explore ideas advanced by Bradshaw, Pence and others who have written on compassion in healthcare. I will attempt to see how and whether their assumptions about compassion can be justified, and explore the role compassion should play in a modern healthcare system. I will justify scepticism at the idea of attempting to incentivise compassion through metrics. The Francis Report raises important questions concerning the nature of a healthcare system that harms rather than helps patients. If something is failing in modern healthcare, those in charge should naturally seek to remedy it. I will investigate whether this is due to the disappearance of compassion, and if so, what is it that is emerging to fill its place. I will consider whether we need to rehabilitate or enforce compassion in the system, or to acknowledge that our modern healthcare systems are incompatible with compassion and how we can make the best of what remains.
The entire article is here.
Here is an excerpt:
Compassion is neither necessary nor sufficient for the provision of good healthcare
The following assumptions are commonly made about compassion in healthcare:
1. Compassion is intrinsically, rather than instrumentally valuable
2. Compassion is incommensurable
3. Compassion is a necessary attribute for healthcare professionals
In this paper, I do not question the first two assumptions, though it seems plausible that they
could be challenged. Rather, I want to suggest that if we accept the first two assumptions, the
third cannot follow as a matter of course.
Clinical Ethics
December 2013 vol. 8 no. 4 111-118
Abstract
In this paper, I will explore ideas advanced by Bradshaw, Pence and others who have written on compassion in healthcare. I will attempt to see how and whether their assumptions about compassion can be justified, and explore the role compassion should play in a modern healthcare system. I will justify scepticism at the idea of attempting to incentivise compassion through metrics. The Francis Report raises important questions concerning the nature of a healthcare system that harms rather than helps patients. If something is failing in modern healthcare, those in charge should naturally seek to remedy it. I will investigate whether this is due to the disappearance of compassion, and if so, what is it that is emerging to fill its place. I will consider whether we need to rehabilitate or enforce compassion in the system, or to acknowledge that our modern healthcare systems are incompatible with compassion and how we can make the best of what remains.
The entire article is here.
Here is an excerpt:
Compassion is neither necessary nor sufficient for the provision of good healthcare
The following assumptions are commonly made about compassion in healthcare:
1. Compassion is intrinsically, rather than instrumentally valuable
2. Compassion is incommensurable
3. Compassion is a necessary attribute for healthcare professionals
In this paper, I do not question the first two assumptions, though it seems plausible that they
could be challenged. Rather, I want to suggest that if we accept the first two assumptions, the
third cannot follow as a matter of course.
Panel Urges Overhauling Health Care at End of Life
By Pam Belluck
The New York Times
Originally posted on September 17, 2014
The country’s system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel concluded in a report released on Wednesday.
The 21-member nonpartisan committee, appointed by the Institute of Medicine, the independent research arm of the National Academy of Sciences, called for sweeping change.
“The bottom line is the health care system is poorly designed to meet the needs of patients near the end of life,” said David M. Walker, a Republican and a former United States comptroller general, who was a chairman of the panel. “The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly.”
The entire article is here.
The New York Times
Originally posted on September 17, 2014
The country’s system for handling end-of-life care is largely broken and should be overhauled at almost every level, a national panel concluded in a report released on Wednesday.
The 21-member nonpartisan committee, appointed by the Institute of Medicine, the independent research arm of the National Academy of Sciences, called for sweeping change.
“The bottom line is the health care system is poorly designed to meet the needs of patients near the end of life,” said David M. Walker, a Republican and a former United States comptroller general, who was a chairman of the panel. “The current system is geared towards doing more, more, more, and that system by definition is not necessarily consistent with what patients want, and is also more costly.”
The entire article is here.
Wednesday, October 8, 2014
Could Deep-Brain Stimulation Fortify Soldiers’ Minds?
By S. Matthew Liao
Scientific American Blog
Originally posted September 4, 2014
Here is an excerpt:
Brain implants that reduce or eliminate our sense of morality are morally undesirable and are not really enhancements as such. Efforts should therefore be made to ensure that the kind of brain implants we develop do not have these unwanted side effects. In the short term, the brain implants we develop may well be imperfect in just such a way. If so, this would be a good reason to ban such devices in the short term. The interesting theoretical issue is what happens when we have perfected the technology and have brain implants that would enable a soldier to kill at the right time, for the right reasons, and in a proportionate manner? Would we still have ethical problems with soldiers using such a technology
The entire blog post is here.
Scientific American Blog
Originally posted September 4, 2014
Here is an excerpt:
Brain implants that reduce or eliminate our sense of morality are morally undesirable and are not really enhancements as such. Efforts should therefore be made to ensure that the kind of brain implants we develop do not have these unwanted side effects. In the short term, the brain implants we develop may well be imperfect in just such a way. If so, this would be a good reason to ban such devices in the short term. The interesting theoretical issue is what happens when we have perfected the technology and have brain implants that would enable a soldier to kill at the right time, for the right reasons, and in a proportionate manner? Would we still have ethical problems with soldiers using such a technology
The entire blog post is here.
The ‘perfect family’ has created an ethical and moral vacuum
By Zoe Krupka
The Conversation
Originally published September 11, 2014
Here is an excerpt:
Arndt and Hymowitz, like many psychologists, opinionators and policy-makers, have distilled complex family studies research into a series of simplistic, unscientific and punitive ethical shortcuts to the question of how to live well in a family. It’s both a gross misuse of the evidence base and a stunted template for ethical decision-making. Squeezed into a tabloid headline, the message reads: Face Facts: If you’re a parent and you’re not married, your family is dysfunctional and your kids are suffering.
The ideal of the perfect family lurks not so quietly underneath these simple summaries of complex interpersonal and social life. It creates a kind of ethical vacuum where the question of competing factors and conflicting interests becomes invisible. In order to maintain an ideal of perfection, family studies research can be used as a kind of blunt instrument, forcing individuals to bear the brunt of more complex social forces alone.
The entire article is here.
The Conversation
Originally published September 11, 2014
Here is an excerpt:
Arndt and Hymowitz, like many psychologists, opinionators and policy-makers, have distilled complex family studies research into a series of simplistic, unscientific and punitive ethical shortcuts to the question of how to live well in a family. It’s both a gross misuse of the evidence base and a stunted template for ethical decision-making. Squeezed into a tabloid headline, the message reads: Face Facts: If you’re a parent and you’re not married, your family is dysfunctional and your kids are suffering.
The ideal of the perfect family lurks not so quietly underneath these simple summaries of complex interpersonal and social life. It creates a kind of ethical vacuum where the question of competing factors and conflicting interests becomes invisible. In order to maintain an ideal of perfection, family studies research can be used as a kind of blunt instrument, forcing individuals to bear the brunt of more complex social forces alone.
The entire article is here.
Tuesday, October 7, 2014
Ethical trap: robot paralysed by choice of who to save
By Aviva Rutkin
The New Scientist
Originally published September 14, 2014
Here is an excerpt:
In an experiment, Winfield and his colleagues programmed a robot to prevent other automatons – acting as proxies for humans – from falling into a hole. This is a simplified version of Isaac Asimov's fictional First Law of Robotics – a robot must not allow a human being to come to harm.
At first, the robot was successful in its task. As a human proxy moved towards the hole, the robot rushed in to push it out of the path of danger. But when the team added a second human proxy rolling toward the hole at the same time, the robot was forced to choose. Sometimes, it managed to save one human while letting the other perish; a few times it even managed to save both. But in 14 out of 33 trials, the robot wasted so much time fretting over its decision that both humans fell into the hole. The work was presented on 2 September at the Towards Autonomous Robotic Systems meeting in Birmingham, UK.
The entire article, with video, is here.
The New Scientist
Originally published September 14, 2014
Here is an excerpt:
In an experiment, Winfield and his colleagues programmed a robot to prevent other automatons – acting as proxies for humans – from falling into a hole. This is a simplified version of Isaac Asimov's fictional First Law of Robotics – a robot must not allow a human being to come to harm.
At first, the robot was successful in its task. As a human proxy moved towards the hole, the robot rushed in to push it out of the path of danger. But when the team added a second human proxy rolling toward the hole at the same time, the robot was forced to choose. Sometimes, it managed to save one human while letting the other perish; a few times it even managed to save both. But in 14 out of 33 trials, the robot wasted so much time fretting over its decision that both humans fell into the hole. The work was presented on 2 September at the Towards Autonomous Robotic Systems meeting in Birmingham, UK.
The entire article, with video, is here.
Morality in everyday life
By Wilhelm Hofmann, Daniel C. Wisneski, Mark J. Brandt, and Linda J. Skitka
Science 12 September 2014: Vol. 345 no. 6202 pp. 1340-1343
DOI: 10.1126/science.1251560
Abstract
The science of morality has drawn heavily on well-controlled but artificial laboratory settings. To study everyday morality, we repeatedly assessed moral or immoral acts and experiences in a large (N = 1252) sample using ecological momentary assessment. Moral experiences were surprisingly frequent and manifold. Liberals and conservatives emphasized somewhat different moral dimensions. Religious and nonreligious participants did not differ in the likelihood or quality of committed moral and immoral acts. Being the target of moral or immoral deeds had the strongest impact on happiness, whereas committing moral or immoral deeds had the strongest impact on sense of purpose. Analyses of daily dynamics revealed evidence for both moral contagion and moral licensing. In sum, morality science may benefit from a closer look at the antecedents, dynamics, and consequences of everyday moral experience.
Editor's Summary
Moral homeostasis in real life vs. the lab
Individuals who witnessed a moral deed are more likely than nonwitnesses to perform a moral deed themselves and are also more likely to allow themselves to act immorally. Hofmann et al. asked smartphone users to report their encounters with morality (see the Perspective by Graham). Most moral judgment experiments are lab-based and don't allow for conclusions based on what people experience in their daily lives. This field experiment revealed that people experience moral events frequently in daily life. A respondent's ideology influenced the kind of event reported and the frequency, which is consistent with moral foundations theory.
The author's email is here to obtain a copy of the article.
Science 12 September 2014: Vol. 345 no. 6202 pp. 1340-1343
DOI: 10.1126/science.1251560
Abstract
The science of morality has drawn heavily on well-controlled but artificial laboratory settings. To study everyday morality, we repeatedly assessed moral or immoral acts and experiences in a large (N = 1252) sample using ecological momentary assessment. Moral experiences were surprisingly frequent and manifold. Liberals and conservatives emphasized somewhat different moral dimensions. Religious and nonreligious participants did not differ in the likelihood or quality of committed moral and immoral acts. Being the target of moral or immoral deeds had the strongest impact on happiness, whereas committing moral or immoral deeds had the strongest impact on sense of purpose. Analyses of daily dynamics revealed evidence for both moral contagion and moral licensing. In sum, morality science may benefit from a closer look at the antecedents, dynamics, and consequences of everyday moral experience.
Editor's Summary
Moral homeostasis in real life vs. the lab
Individuals who witnessed a moral deed are more likely than nonwitnesses to perform a moral deed themselves and are also more likely to allow themselves to act immorally. Hofmann et al. asked smartphone users to report their encounters with morality (see the Perspective by Graham). Most moral judgment experiments are lab-based and don't allow for conclusions based on what people experience in their daily lives. This field experiment revealed that people experience moral events frequently in daily life. A respondent's ideology influenced the kind of event reported and the frequency, which is consistent with moral foundations theory.
The author's email is here to obtain a copy of the article.
Monday, October 6, 2014
On Aiming for Moral Mediocrity
By Eric Schwitzgebel
The Splintered Mind Blog
Originally published October 2, 2014
People seem to calibrate toward moral mediocrity. If we see, or are told, that many people violate a norm, that seems to increase the rate at which we ourselves violate the norm (e.g., Cialdini et al 2006; Keizer et al. 2011 [though see here]). Commit a good deed or think of yourself in a good light, and shortly thereafter you might be more likely to commit a bad deed, or less likely to commit another good deed, than you otherwise would have been ("moral self-licensing"; though see here). Susan Wolf tells us that people do not, and should not, aim to be moral saints. But maybe she understates the case: Not only do people not want to be saints, they don't even want to be particularly good.
The entire blog post is here.
The Splintered Mind Blog
Originally published October 2, 2014
People seem to calibrate toward moral mediocrity. If we see, or are told, that many people violate a norm, that seems to increase the rate at which we ourselves violate the norm (e.g., Cialdini et al 2006; Keizer et al. 2011 [though see here]). Commit a good deed or think of yourself in a good light, and shortly thereafter you might be more likely to commit a bad deed, or less likely to commit another good deed, than you otherwise would have been ("moral self-licensing"; though see here). Susan Wolf tells us that people do not, and should not, aim to be moral saints. But maybe she understates the case: Not only do people not want to be saints, they don't even want to be particularly good.
The entire blog post is here.
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