Ethics Archives - Page 3 of 4

The brave new world of contemporary bioethics

Michel AccadSeptember 5, 2016December 13, 2016Ethics, Philosophymedical ethics8 Comments

A few months ago, I tweeted that today’s ethicists sometimes serve the function that sophists used to fulfill in Ancient Greece: to provide moral cover for the powerful. A “consensus statement” issued last week by a committee of philosophers and bioethicists brings some pertinence to my comment.

These international scholars–all from prestigious Western institutions–had met in June in Geneva, Switzerland to take up the question of conscientious objection in healthcare. Here are the first five points of their ten-point statement, published on the Practical Ethics blog of the University of Oxford philosophy department:Continue reading “The brave new world of contemporary bioethics”

The mother of all medical errors

Michel AccadJuly 14, 2016December 13, 2016Ethics, Healthcare policy, Medical science, Philosophy2 Comments

A study published a couple of months ago in the BMJ made headlines for claiming that medical errors are the third leading cause of death. As expected, the reactions were swift and polarized.

For some, the study confirmed that the self-serving healthcare system is utterly careless about the welfare of patients. For others, the claim was complete hogwash, based on faulty methodology designed to justify further regulatory oversight.

The two positions are not necessarily mutually exclusive.Continue reading “The mother of all medical errors”

The pharma-fed doctor

Michel AccadJune 20, 2016December 13, 2016Ethics, Healthcare economics, Healthcare policy7 Comments

In his recent article “Feed Me, Pharma,” ProPublica’s Charles Ornstein has been calling attention to studies showing that the prescribing decisions of doctors are linked to the amount of money that drug companies can bestow on them, usually in the form of meals, travel expenses, tuition support to attend courses, and so on.

I find nothing surprising about that, and Ornstein need not be so scrupulous when he clarifies that “the researchers did not determine if there was a cause-and-effect relationship between payments and prescribing.” To deny that perks have a causal effect on physician behavior invites improbable considerations.

In fact, the data suggests that doctors are particularly easy to manipulate. One of the researchers interviewed by Ornstein was “surprised that it took so little of a signal and such a low value meal [to influence doctors]” A Chick-fil-A is all that it takes!Continue reading “The pharma-fed doctor”

In defense of the employed physician

Michel AccadJune 9, 2016March 18, 2017Ethics, Healthcare economics, Healthcare policy6 Comments

I wish to make one clarification and one prediction regarding employed physicians.

The clarification is this: There is a common misconception that if healthcare operated under free market conditions, it would primarily be a cottage industry of solo practices and of small physician-owned hospitals. Such operations would not develop the capabilities of large healthcare entities that we commonly associate with central planning.

In reality, however, the opposite would be the case. Continue reading “In defense of the employed physician”

Practicing medicine for the common good

Michel AccadMay 26, 2016October 28, 2017Ethics, Healthcare economics, Healthcare policy4 Comments

In a recent New England of Medicine article titled “Considering the Common Good—The View from Seven Miles Up,” Dr. Martin Shapiro tells a story that serves as a parable for a more general point: Instead of only considering the best interests of individual patients, American physicians should adopt “a more communitarian approach to decision making” and consider “the implications of individual clinical decisions for other patients and society as a whole.”

The parable is as follows: two sick patients are aboard an airplane, each with his own physician. The first one is terminally ill and on his way home; the second one has a grave illness but stands a small chance of surviving. A decision to land midway must be made in flight, and it pits the interests of the one against those of the other.Continue reading “Practicing medicine for the common good”

Taking stock of our existence

Michel AccadJanuary 28, 2016December 13, 2016Ethics, Philosophyempiricism, gawande, physician-assisted suicide6 Comments

My last post was prompted by a reader’s comment where Victor Frankl’s Man’s Search for Meaning and Atul Gawande’s Being Mortal were juxtaposed. Since receiving that message, I have had occasion to notice that others also associate these two books.

For example, both are mentioned positively in this moving article by Dr. Clare Luz about a friend’s suicide, and in these tweets from Dr. Paddy Barrett’s podcast program:

Must Reads: Man’s Search for Meaning by Victor Frankl. Reread, then reread. Just brilliant! https://t.co/131G3KSYqU pic.twitter.com/zIbAtRsmgU

— TheDoctorParadox (@paradox_doctor) January 2, 2016

Must Reads: Being Mortal: Medicine and What Matters in the End by Atul Gawande. Excellent!! https://t.co/ymiDLtqNQH pic.twitter.com/7YHKEr8GSS

— TheDoctorParadox (@paradox_doctor) January 7, 2016

Friends and patients of mine have likewise mentioned these two works to me, expressing praise and testifying to the deep impact the books have had on them.

I suspect that many readers of this blog will at least be familiar with these two books. If not, summaries are here (Frankl) and here (Gawande).

I read the books in succession and found the difference between the two striking. Frankl and Gawande seem to be at polar opposites on the question of life and death. In this post, I will explore this difference, starting with Gawande’s point of departure.Continue reading “Taking stock of our existence”

Good medicine starts with friendship

Michel AccadNovember 20, 2015December 13, 2016Ethics, Medical practice, Philosophydoctor-patient relationship, friendshipLeave a comment

Whenever I have the opportunity to suggest that good medicine is based on friendship, I usually get a nod of approval mixed with a quizzical look. What’s that supposed to mean?!

At a recent meeting of an editorial board on which I serve, the reaction to my suggestion was more forceful and perhaps more honest. The topic of the day concerned patient education, and how hard it can be to move patients to do things like exercise more or eat better. I timidly proposed that, as physicians, we might want to start by being our patients’ friends. The physician sitting next to me immediately objected: “I wouldn’t go that far!”Continue reading “Good medicine starts with friendship”

How to safeguard your career in a treacherous healthcare environment.

Michel AccadNovember 13, 2015September 10, 2021Ethics, Healthcare economics, Medical practice, Medical science, Philosophy7 Comments

[the following post is a slightly edited version of an article kindly commissioned by In-Training, a website run by and for medical students. The advice I give in the article is based on lessons I learned long after finishing medical school, so I hope you will find this piece of interest, even if you are well established in your healthcare profession.]

Dear medical student,

I am honored by the opportunity to offer some advice on how to safeguard your professional career in a treacherous healthcare system.

I will not elaborate on why I think the healthcare system is “treacherous.” I will assume—and even hope—that you have at least some inkling that things are not so rosy in the world of medicine.

I am also not going to give any actual advice. I’m a fan of Socrates, so I believe that it is more constructive to challenge you with pointed questions. The real advice will come to you naturally as you proceed to answer these questions for yourself. I will, however, direct you to some resources to aid you in your reflections.

I have grouped the questions into three categories of knowledge which I am sure are not covered or barely covered in your curriculum: economics, ethics, and philosophy of medicine.

I have found that reflecting on these questions has been essential to give me a sense of control over my career. I hope that you, in turn, will find them intriguing and worth investigating.Continue reading “How to safeguard your career in a treacherous healthcare environment.”

Is assisted suicide “medically necessary?”

Michel AccadNovember 10, 2015December 13, 2016Ethics, Healthcare economicsphysician-assisted suicide2 Comments

André Picard, one of Canada’s foremost healthcare journalists, published an article today in which he analyzes the funding rationale for his country’s healthcare system.

Canada has the most singularly bizarre health-funding model in the world. It is, to use the technical term, bifurcated – meaning there are two distinct categories.

“Medically necessary” care, defined as hospital and physician services, is paid 100 per cent from the public purse. Selling these services privately is, with few exceptions, illegal or subject to punishing penalties…

The rest of health care is, by default, not deemed medically necessary, but still gets varying degrees of public funding. Only about 6 per cent of dental care is paid publicly, as are almost half of prescription drug costs, and about two-thirds of long-term care costs.

Given Canada’s perennial healthcare budget deficits and notorious waiting lines for medical care, Picard adds:

Getting the mix of public and private care right means ensuring everyone has access to essential care in a cost-effective manner, and still allowing patients a modicum of choice, and the ability to supplement their publicly funded care with other services.

At some point, we have to make some clear, coherent decisions to ensure that happens. Doing so begins with asking, and answering, the question: What is really “medically necessary”?

The final question Picard asks couldn’t come at a more opportune time.Continue reading “Is assisted suicide “medically necessary?””

The suicide Robin Williams was denied

Michel AccadNovember 4, 2015December 13, 2016Ethicsphysician-assisted suicideLeave a comment

The autopsy performed after Robin Williams committed suicide showed that the actor had widespread Lewy body disease. His widow Susan just revealed that information and told reporters that depression was only a small part of the myriad of frightening and incomprehensible symptoms that beset him for more than a year before he took his life. As the disease progressed, he suffered from impaired movement, anxiety, paranoid thoughts, and depression.

Last month, Governor Jerry Brown signed into law a bill that allows doctors to prescribe a lethal medication to terminally ill patients who wish to end their lives. In the letter he issued as he signed the bill, he wrote: “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

But apparently, Jerry Brown and those who support the law would deny “that right” to people who, like Robin Williams, suffer from Lewy body disease.Continue reading “The suicide Robin Williams was denied”