2013 Readings

"How Doctors Help Us to Die" with Marcia Angell, MD (Cowan Memorial Lecturer)

Throughout the U. S. it has been legal for over 20 years for patients (or their surrogates) to have physicians withdraw life-sustaining treatment, including food and hydration, to bring about death..  It is also legal for physicians to prescribe opiates at doses that will hasten death as long as they can make the case that it is necessary to relieve suffering.  And it is legal for physicians to sedate dying patients to unconsciousness and then allow them to die of dehydration.  Yet, in only three states is it legal for a physician to write a prescription for medication that will bring about the death of terminally ill patients, and then, only in tightly restricted circumstances.  What are the ethical distinctions between these methods of hastening death?  And on what basis are they drawn?  Please prepare for this discussion by reading Dr.Marcia Angell’s  10-12-12 New York Review of Books article,  “May Doctors Help You to Die?” 

"Can We Talk about the Nuremberg Code?" with Alice Dreger, PhD (David Green Memorial Lecturer)

Why do we keep seeing the same basic ethical mistakes over and over again in clinical research, particularly failure of informed consent? Might the use of unstudied medical interventions in general medical practice constitute a major ethical problem? What might prevent good people from doing bad things? And how are all these questions ultimately related? Our conversation will center on these questions, launching from a new essay Dr. Dreger has drafted for our discussion, “Can We Talk about the Nuremberg Code?” This essay explores our relationships with the myths and realities of the history of human subjects research and Nazi atrocities, in part by using her own family’s history in Poland. Ultimately the essay argues for a valuing of clinical humility of a type that bridges scientific and moral humility, a clinical humility that recognizes the potential for individual failure and for resistance to institutionalized evils.

"Is One Minute Enough? Patient Education Approaches to Prenatal Testing"

Despite technological advancements in prenatal testing for fetal abnormalities, significant challenges remain for effectively informing couples about their risk and options. Prenatal diagnosis for aneuploidy and neural tube defects has been widely available for decades and this clinical service has been the focus of extensive ethical debate and the source of substantial legal liability for clinicians.  Nevertheless, research demonstrates that pregnant couples are poorly informed about their risks and options.  It is widely recognized that current standards for patient education in this domain are ineffective. it is unknown how pregnant couples are informed about prenatal testing and the current education approaches.

A pilot study was conducted funded by the University of Utah College of Nursing Research Committee. The purpose of this research was 1) to describe the specific content and amount of time typically spent by prenatal care providers in Salt Lake City in delivering prenatal testing education during early pregnancy; and 2) to identify gaps in prenatal education specific to prenatal testing. Results showed that prenatal testing was not discussed with patients approximately 50% of the time. When discussed, the most common approach was to provide a brochure and to encourage the patient to think about testing. In general, only 50% of the clinical visits discussed prenatal testing and of those, less than one minute was spent during the prenatal encounter on prenatal testing options and the content of this discussion primarily focused on how to schedule the screening.  

Please join us to learn more about this study, the ethical questions it raises, and to share your thoughts and ideas about approaches to improving patient education about prenatal testing.  What type of information do think is important to give expecting parents to make an informed decision?  How would you assess if someone made an informed decision? (There is no background reading for this Evening Ethics session.)

"American Eugenics--from Long Island to Auschwitz and Its Modern Shadow" with  Edwin Black

A special Evening Ethics talk on Wednesday September 25th at 4:00–5:30pm in the Eccles Institute of Human Genetics auditorium will feature Edwin Black's talk,  American Eugenics--from Long Island to Auschwitz and Its Modern Shadow.  A book signing will follow. Edwin Black is a New York Times bestselling international investigative author of more than 80 award-winning editions in 14 languages in 65 countries. He focuses on genocide and hate, corporate criminality and corruption, governmental misconduct, academic fraud, philanthropic abuse, oil addiction, alternative energy and historical investigation. He is author of the best seller, War Against the Weak: Eugenics and America's Campaign to Create a Master Race. For more information on Edwin Black please see: http://www.edwinblack.com

"Medical Errors and Malpractice, On Stage" 

This Evening Ethics Discussion is sure to spark discussion about how medical mistakes reverberate emotionally for families and for physicians and providers. 

This session is in anticipation of the new play, Love Alone, by Deborah Salem Smith, which opens its regional premiere at the University of Utah Department of Theatre on November 14th and runs through November 24th in Studio 115. 

Love Alone has been brought to the University of Utah through the latest of several collaborative efforts between the Division of Medical Ethics and Humanities and the University of Utah Theatre Department. The play originally premiered in conjunction with Brown University Medical School, and Ms. Smith has taken the play, in whole or in part, to other medical schools, as well. 

In Love Alone, “after a routine medical procedure goes tragically wrong, a lawsuit ensues and the lives of both the patient’s family and the doctor charged with her care are transformed. Love Alone compels us to reflect on how we treat those we love in times of crisis and how we maintain control of our lives when we lose people we love.” 

At this Evening Ethics, the Utah cast will perform short scenes from Love Alone from 5:30pm-6:00pm, after which discussion will follow. Because the actors will perform during the first half hour, there will be no background reading, but we do ask that people arrive promptly at 5:30 so as to see the cast perform. We are honored to have around the discussion table, the playwright, Deborah Salem Smith, the director, Andra Harbold, and the Head of Theater studies at the University of Utah, Sydney Cheek- O’Donnell, as well as the two medical advisors who worked with the Utah cast, Lauren Florence, MD, and Jim McGauley, MD. Gretchen Case, PhD, will facilitate discussion. 

The New York Times calls Love Alone a, “lucid, deeply nuanced and fearless work.” The Boston Globe calls it “…first rate…a gleaming gem.” For more information about the play and to buy tickets, see http://www.theatre.utah.edu/event/love-alone/

This program is approved for 1-½ hours of CME credit.

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