Dear Friends,
As a subscriber to a HealthCare Chaplaincy publication, we are pleased to send you the “Soul of Bioethics" newsletter, which we now publish periodically. It is edited by Harry (Rick) Moody, Ph.D., director of academic affairs for AARP in Washington, DC.
Contents
- Prostate Screening Debate
- Rationing Redux
- What is Christian Bioethics?
- Alzheimer's: The Great Unlearning
- Cutting Costs: Promise & Pitfall
- Caring Conversations
- Web Sites to See
- Books of Interest
- Coming Events
PROSTATE SCREENING DEBATE
Remember the film "Jaws II"-- with the ominous phrase "Just when you thought it was safe to go back into the water?" Well, remember the big mammography debate of two years ago, when the U.S. Preventive Services Task Force recommended against mammography screening for women below a certain age? This time the Task Force has weighed in again, and it's the men, not the women, who are engaged. The Task Force has cast doubt on prostate screening, and related medical interventions.
Is this an ethical dilemma? I'm afraid it is. (Full Disclosure: I'm 66 years old and have an annual prostate blood test myself. Am I misguided?)
On the Task Force's own assumptions, they waited two years before releasing their recommendations, thus permitting thousands of men to suffer needless medical interventions. Of course, many clinicians and advocates take the opposite view. They argue that it is irresponsible for the Task Force to recommend against screening that might save lives.
One thing is clear: these issues will not go away soon. With population aging and ever-greater innovations in screening technologies (e.g., for Alzheimer's) the dilemmas will be unavoidable. Equally, necessary will be better public communication about risks and choices for medical screening.
For a good overview of the bioethics issues involved here, see THE ETHICS OF SCREENING IN HEALTH CARE AND MEDICINE: Serving Society or Serving the Patient? by Miklas Juth Page and Christian Munthe (Springer, 2011).
On the prostate screening debate read: "The PSA Debate: Competing Interests" at:
http://practicalbioethics.blogspot.com/2011/10/psa-debate-competing-interests.html?utm_
source=feedburner&utm_medium=email&utm_campaign=Feed%3A+PracticalBioethics+
%28Center+for+Practical+Bioethics+Blog%29&utm_content=Yahoo%21+Mail
See also "Panel’s Advice on Prostate Test Sets Up Battle" at: http://www.nytimes.com/2011/10/08/health/policy/08prostate.html?_r=2&ref=research
Listen to the podcast "To Screen or Not to Screen? Ethical Controversies in Mammography Screening" available at: http://practicalbioethics.org/ethics-education/symposia
RATIONING REDUX?
It seems inevitable that the prostate perplexity will end up inflaming the debate over age-based rationing. Cost is undoubtedly an issue. Researchers at the Center for Medical Integrity have documented the scale of the problem raised by routine screening of older people. In five years before 2008 Medicare spent nearly $ 2 billion on common cancer screening for patients older than age-limits recommended by the U.S. Preventive Services Task Force. For example, 80% of Medicare claims for cervical cancer screening were for women over 65, despite recommendation against it. Doctors repeatedly ignore recommendations when it comes to cancer screening, and, as a result, Medicare is for billions of dollars in services that may be unnecessary, and, as in the case of prostate cancer, lead to patient suffering.
Physicians disregard guidelines for many reasons: fear of malpractice suits, demand by patients, financial incentives, and sheer ignorance. Yet whenever Medicare tries to rein in spending, "the great R word comes out," says Gail Wilensky, former director of the Medicare program, referring to health care rationing.
For more on this issue see "Medicare Wastes Billions of Dollars on Unnecessary Cancer Screening for Elderly" at: http://www.iwatchnews.org/2011/10/07/6898/forty-percent-medicare-spending-common-cancer-screenings-unnecessary-probe-suggests
WHAT IS CHRISTIAN BIOETHICS?
For some answers, consider the following books:
CHRISTIANITY & BIOETHICS: Confronting Clinical Issues, by Mark W. Foreman (Wipf and Stock, 2011).
THIS MORTAL FLESH: Incarnation and Bioethics, by Brent Waters (Brazos, 2009).
BIOETHICS AND THE CHRISTIAN LIFE: A Guide to Making Difficult Decisions, by David VanDrunen (Crossway, 2009).
BIOETHICS: A Primer for Christians, by Gilbert Meilaender (Eerdman’s, 2005).
THEOLOGICAL BIOETHICS: Participation, Justice, and Change, by Lisa Cahill (Georgetown Univ. Press, 2005).
ALZHEIMER'S: The Great Unlearning
"I call Alzheimer's the great unlearning, because it is clearly an unraveling of mind, language, and former knowledge. But in my experience, there is a center, or centers, of apprehension and experience (such as humor, intuition, and emotion) clearly intact much longer than mind and language. The nature of Alzheimer's decline suggests to me both the reality of the radical impermanence of life (as suggested in the many constantly shifting states and stages of the disease) and the reality of some deeper knowing/knower. Therefore, it supports the ethical mandate to honor that deep and abiding part, or ground, of the person, despite the eroding of the most basic characteristic of humanness: the self-reflective consciousness. I wonder if what we see in Alzheimer's disease is a kind of return to our origins -- an Edenic pre-self-conscious, pre-dualistic state, prior to separation and shame."
From Gisela Webb, "Intimations of the Great Unlearning: Interreligious Spirituality and the Demise of Consciousness which is Alzheimer's" at: http://www.crosscurrents.org/webb.htm
CUTTING COSTS; Promise and Pitfall
Can advance directives curb costs at the end of life? Some research suggests that the answer is "yes." For details see: http://health.usnews.com/health-news/managing-your-healthcare/healthcare/articles/2011/10/04/advance-directives-might-curb-cost-of-end-of-life-care
What about palliative care? A 2008 study found that even a single consultation for palliative care could reduce cost of a hospital stay by $1,700. When a patient died before leaving the hospital, savings could reach $5,000 for palliative care provision.
But such savings can pose a problem. Dr. Rick Levene, a palliative care specialist from West Palm Beach, Florida, notes that cost savings can provoke resistance from patients, families and doctors. Some will see palliative care as backdoor way to ration healthcare or improve the hospitals profit margin. There is also the problem traditionally known as a "medical futility:"
"There are some physicians, some patients and families that can't give up, and the 'H' word [hospice] has created some negative connotations with them," Levene says.
For more on this story, see "The Promise and Pitfalls of Palliative Care" at: http://www.latimes.com/health/la-he-palliative-care-side-20111024,0,6155818.story
CARING CONVERSATIONS
Caring Conversations is a consumer education initiative that helps individuals and their families share meaningful conversation while making practical preparations for end-of-life decisions. Each copy of Caring Conversations includes a healthcare directive document and a durable power of attorney for healthcare decisions. For a free download of this tool, visit: http://practicalbioethics.org/about/model-and-methodology/making-your-wishes-known-for-end-of-life-care/
WEB SITES TO SEE
RAM DASS. For Ram Dass's talk on "End of Life Preparations" at the Legacy of Wisdom conference, visit: http://www.youtube.com/watch?v=eJIW79vBRSA
CAREGIVING. For a case study of "The Careless Caregiver" visit: http://practicalbioethics.org/wp-content/uploads/2011/06/Case_study_19_1_2.pdf
PROLONGEVITY: YES AND NO. Is longer life a goal in itself? Gilbert Meilaender offer some reflections on the subject at: http://www.firstthings.com/article/2011/03/thinking-about-aging
BOOKS OF INTEREST
OXFORD TEXTBOOK OF PALLIATIVE MEDICINE, edited by Terry Altilio and Shirley Otis-Green (Oxford Univ. Press, 2011). Details at: http://www.us.oup.com/us/catalog/general/subject/Medicine/PalliativeMedicine/?view=usa&ci=9780199693146
OBSERVING BIOETHICS, by Renee Fox and Judith Swazey (Oxford University Press, 2008).
D.N. Weisstub and colleagues edited a series of books in the series on International Library of Ethics, Law, and the New Medicine, which have now been released by Springer Publishers:
AGING: Culture, Health, and Social Change; AGING: Aging: Caring for our Elders; and AGING: Decisions at the End of Life (All from Springer, 2010).
COMING EVENT
MENTAL HEALTH: "Faith, Family and Mental Health Conference" (Nov. 18, 2011, Atlanta, Georgia). Sponsored by FaithWorks. For details, visit: http://www.faithworksga.com/docs/FaithworksConf2010.pdf
This electronic newsletter, edited by Harry (Rick) Moody, is published by HealthCare Chaplaincy and co-sponsored by the Office of Academic Affairs at AARP.
The opinions stated are those of Mr. Moody and may not necessarily reflect those of HealthCare Chaplaincy or AARP.
To submit items of interest, contact H.R. Moody at soulofbioethics@yahoo.com
(c) Copyright 2011; all rights reserved.
