Up@dawn 2.0

Tuesday, January 16, 2018

Bioethics humor-tests, pills, insurance...

Image result for bioethics cartoons new yorker

Image result for bioethics cartoons new yorker

Image result for bioethics cartoons new yorker
Image result for bioethics cartoons new yorker

Image result for bioethics cartoons new yorker
Image result for bioethics cartoons new yorker
Image result for bioethics cartoons new yorker
Image result for bioethics cartoons new yorker

Image result for bioethics cartoons new yorker


We begin with an invitation: tell us who you are, and why you're here. We'll introduce ourselves in class and online (hit "comments" below). I'll start.

I'm the prof for this course, PHIL 3345, Bioethics. I hold degrees from the University of Missouri and Vanderbilt, and I'm here because the ethics of life and death is at the very heart of what philosophy, defined as the love of (and quest for) wisdom, is about. I'm still here in middle Tennessee, after relocating for Grad School, because I met my wife here and decided to stay.

I also teach courses on Atheism, Environmental Ethics, and Happiness, among others.

Enough about me.

Who are you? Why are you here? (Bear in mind, as you reply, that this is an open site. There's nothing preventing the world from reading what we post here, except of course the world's own distraction.)

Monday, January 8, 2018

"This was not the good death we were promised"

When my father was dying of pancreatic cancer last summer, I often curled up with him in the adjustable hospital bed set up in his bedroom. As we watched episodes of “The Great British Baking Show,” I’d think about all the things I couldn’t promise him.

I couldn’t promise that the book he’d been working on would ever be published. I couldn’t promise he would get to see his childhood friends from England one more time. I couldn’t even promise he’d find out who won the baking show that season.

But what I could promise — or I thought I could — was that he would not be in pain at the end of his life.

That’s because after hearing for years about the unnecessary medicalization of most hospital deaths, I had called an in-home hospice agency to usher him “off this mortal coil,” as my literary father still liked to say at 83.

When a doctor said my father had about six months to live, I invited a hospice representative to my parents’ kitchen table. She went over their Medicare-funded services, including weekly check-ins from a nurse and 24/7 emergency oversight by a doctor. Most comfortingly, she told us if a final “crisis” came, such as severe pain or agitation, a registered nurse would stay in his room around the clock to treat him. (continues)
Resolutions of a Cancer Doctor

My mom was given a diagnosis of lung cancer this past year. And whether I liked it or not, almost midway through my career, it put me squarely in the position of being re-educated about cancer from the other end of the biopsy needle. It also gave me the opportunity to approach my patients with a new resolve in the coming year.

My mother lives in Rhode Island, and I live in Ohio. It took weeks for her to get her diagnosis, and I quickly found, as family members of my own patients have told me countless times, how difficult it is to coordinate the care of your loved one from a distance. Fortunately, my mom’s cancer was caught at an early stage, and I convinced her to come to Cleveland for surgery at the hospital where I work. She was discharged from the hospital following removal of the mass to my house, where she spent the entire month of May recovering.

For anyone who has never played the role of assisted living facility for a septuagenarian who has undergone a major medical intervention, it isn’t easy, either for the patient or her host. Our expectations for participation in physical and respiratory therapy diverged wildly. I had been raised in an era in which regular exercise was approached with near religious conviction. She came of age at a time when people joked about exercise: “Can’t you pay somebody to do that for you?” And it turns out that mothers do not want to be told what to do by their sons.

Even when they have medical degrees. And specialize in cancer. And are taller than she is.

And sons don’t like to see their mothers sick with cancer. Not surprisingly, it is nearly impossible to separate that emotional reaction from calm, clearheaded guidance to your own mother... (continues)
‘Forget About the Stigma’: Male Nurses Explain Why Nursing Is a Job of the Future for Men

For Doctors, Age May Be More Than a Number

Medical Research? Congress Cheers. Medical Care? Congress Brawls

Saturday, January 6, 2018

"How to Counter the Circus of Pseudoscience"

Maybe one day, once I have decades of experience as a doctor and further training in my area of specialization, I will be able to speak about health matters with the tone of authority of the average naturopath.

That was the thought that crossed my mind recently while I waded through the online world of alternative-health practitioners, wellness bloggers, whole-food chefs and Gwyneth Paltrow.

I did not seek it out at first; it came to me through a social-media algorithm. Facebook offered up a video advertisement from a “female hormonal health specialist” with her own “practice.” Not an endocrinologist but a naturopath. She lectured with confidence on thyroid testing, though much of what she said was wrong. And down the internet rabbit hole I went.

One traditional view of the medical profession is that doctors are commanding and authoritarian, even arrogant. Though some individuals fit that description, in fact, the profession is built on doubt.

Most doctors, especially the good ones, are acutely aware of the limits of their knowledge. I have learned from those much more experienced and qualified than me that humility is something to be cultivated over time, not lost.

Our field is built around trying to prove ourselves wrong. In hospitals we hold morbidity and mortality meetings trying to show where we have failed, what we need to change, how we can do better. Our hospital work is audited to identify where we fell short of our ideals. Through scientific research we try to disprove the effectiveness of treatments. Our failings are exposed from the inside.

The nature of evidence-based health care is that practices change as new evidence emerges.

That is also the case for other health professionals whose practice is based on science, like qualified dietitians, physiotherapists, occupational therapists and psychologists. Guidelines are revised, advice is reversed — on blood pressure, diet, hormone replacement, opioid prescribing. This can be immensely frustrating for patients, even though it is what we must do to provide the best possible treatment...

(Lisa Pryor, continues)

Wednesday, January 3, 2018

"My Father’s Body, at Rest and in Motion"

His systems were failing. The challenge was

to understand what had sustained them for so long.

The call came at three in the morning. My mother, in New Delhi, was in tears. My father, she said, had fallen again, and he was speaking nonsense. She turned the handset toward him. He was muttering a slow, meaningless string of words in an unrecognizable high-pitched nasal tone. He kept repeating his nickname, Shibu, and the name of his childhood village, Dehergoti. He sounded as if he were reading his own last rites.

“Take him to the hospital,” I urged her, from New York. “I’ll catch the next flight home.”

“No, no, just wait,” my mother said. “He might get better on his own.” In her day, buying an international ticket on short notice was an unforgivable act of extravagance, reserved for transcontinental gangsters and film stars. No one that she knew had arrived “early” for a parent’s death. The frugality of her generation had congealed into frank superstition: if I caught a flight now, I might dare the disaster into being...

(Siddhartha Mukherjee, continues)
This Cat Sensed Death. What if Computers Could, Too?

Friday, December 29, 2017

"Want to be happy? Think like an old person"

Nearly three years ago, I started following the lives of six New Yorkers over the age of 85, one of the fastest-growing age groups in America. The series of articles began the way most stories about older people do, with the fears and hardships of aging: a fall in the kitchen, an aching leg that did not get better, days segueing into nights without human contact. They had lived through — and some were still challenged by — money problems, medical problems, the narrowing of life’s movements.

But as the series went along, a different story emerged. When the elders described their lives, they focused not on their declining abilities but on things that they could still do and that they found rewarding. As Ms. Wong said, “I try not to think about bad things. It’s not good for old people to complain.”

Here was another perspective on getting old. It was also a lesson for those who are not there yet.

Older people report higher levels of contentment or well-being than teenagers and young adults. The six elders put faces on this statistic. If they were not always gleeful, they were resilient and not paralyzed by the challenges that came their way. All had known loss and survived. None went to a job he did not like, coveted stuff she could not afford, brooded over a slight on the subway or lost sleep over events in the distant future. They set realistic goals. Only one said he was afraid to die... (continues)

Tuesday, December 19, 2017

Life 3.0: Being Human in the Age of Artificial Intelligence

Max Tegmark is a physicist who understands and respects the value of philosophy:
"...to wisely decide what to do about AI development, we humans need to confront not only traditional computational challenges, but also some of the most obdurate questions in philosophy. To program a self-driving car, we need to solve the trolley problem of whom to hit in an accident. To program a friendly AI, we need to capture the meaning of life."

Saturday, December 16, 2017

An Oath for New Physicians


Written by the University of Minnesota Medical School class of 2017 during their orientation in August 2013, and administered at their graduation on May 5, 2017:

In the presence of our families, colleagues, and communities, we take this oath in recognition of the honor and privilege of becoming a physician.

We arrive at the threshold of our chosen profession pledging to preserve our humility, integrity, and all the values which brought us to the practice of medicine. We will engage in honest self-reflection, striving for excellence but acknowledging our limitations, and caring for ourselves as we care for others.

We will collaborate with our colleagues, patients, and communities to improve the practice of medicine. We will discover, innovate, learn, and teach as responsible stewards of medical knowledge.

We will seek to heal the whole person rather than merely treat disease, committing to a partnership with our patients that empowers them and demonstrates empathy and respect. We will cure sometimes, treat often, and comfort always.

We will not betray the trust of our patients, who give us the privilege to stand by them in their most vulnerable moments. We will respect diversity in all forms and advocate for the needs of our patients in the context of their lived experiences. We will fight for health equity and social justice on behalf of our patients, our communities, and our world.

Let this Commencement day symbolize the acknowledgement of our own humanity, our dedication to the art and science of medicine, and our responsibility to serve.

This oath was mentioned in the On Being episode “Atul Gawande — What Matters in the End.”

Listen here...