Up@dawn 2.0

Tuesday, January 31, 2017

Alternative Quiz #4

1. George Bernard Shaw described the medical relationship in his play, The Doctors's Dilemma, as a "conspiracy against the larity'. What does this mean? (p.80)

2. (T/F) Deciding what is in the best interest of the patient is ALWAYS straightforward? (p. 81)

3. What are the three key features of valid consent? (p.83)

4.  (T/F) No matter what, a doctor or health care professional is not allowed to disclose patient information. (p.87)

5. What is the medical terminology for the termination of pregnancy? (p. 88)

6. What is "in vitro" fertilization?  (p.92)

7. What is a designer baby? (p.96)

8. What does SCNT stand for? (p. 99)

9. What are cadavers and why are they relevant? (p. 109)

10. Name one of the books Campbell recomended for further reading and resources for this chapter.

DQ:

1. How do you feel about the concept behind designer babies?



A Clip from House for Discussion

House as a series is pretty great at showcasing all kinds of moral and ethical dilemmas that can come up in the medical field, and one that I think should be mentioned here is when one of the doctors in the show (Chase) has a patient who happens to be a dictator of an African country. This dictator has been charged with crimes against humanity, and is a pretty stereotypical evil character. While this man is in the hospital, Chase has an opportunity to murder him and make it appear like an accident. The ethical question here is: Do you kill the dictator? Or do you let him live so he can "fly back to his country and murder thousands of people?" (quote from the show).

This raises a few interesting questions. One of them is not restricted to the medical field, and it can be stated as "If you know someone is going to kill numerous innocent people, and the only way you can stop this person is by killing them, should you do it?" The other one, which is specifically medically related, "Do doctors have an obligation to treat their patients to the best of their ability, even if they believe their patient is despicable human (in their opinion)?"

Alternative Quiz Questions: Ch. 4 Clinical Ethics


1. Campbell states that the "first consideration of a health professional must always be the best interests and welfare of the patient -". Why is this seemingly obvious statement even stressed? (80)

2. What is the overall result of long-term care of severely mentally or physically compromised patients who cannot care for themselves and make their own treatment decisions? (86)

3. What is considered the strongest reason for stressing the importance of confidentiality? (87)

4. An individual who HIV positive refuses to inform a sexual partner of their diagnosis. This is an example of a breach to what principle? (88)

5. What are some of the numerous conceptual difficulties mentioned by Campbell under the mentality that the entity created at conception is a person due to genetic uniqueness? (89)

6. Name at least one of the ethical concerns raised by the possibilities of creating a child mentioned by Campbell. (93- 94)

7. What is the relation between the term "natural" and the term "person" and how does this perhaps  contradict the teachings of the catholic church? (94-95)

8. What is the therapeutic potential of of Somatic Cell Nuclear Transfer? (99)

9. What are the two concerns related to ethical issues revolving around individuals with mental illness? (101)

10. After accepting death as a _______________, and not merely as a __________________, the question of whether to withhold or withdraw treatment immediately arises. (105)

Optional Alternate Quiz for Chapter 4




1.      In the play by George Bernard Shaw, the medical relationship is seen as a ‘conspiracy against the laity’. What does he mean by this?(80)


2.      What are the 3 key  features of valid consent?(83)


3.      What is ‘tort’? How can a health care professional be guilty of it?(85)


4.      Which court case resulted in the general principle that confidentiality could be breached if there was a clear threat to an individual?(87-88)


5.      The Roman Catholic Church led some groups to describe abortion as… (89)


6.      The ___________ view is one that sees the fetus as the beginnings of a nascent human life, but still far short of individual human existence as a person. As it develops it has increasing significance. (90)


7.      What is a weak justification for wanting to get an abortion? (91)


8.      Through assisted reproduction, theoretically how many parents could a baby have? (93)


9.      What are considered the ‘building blocks’ of all organic tissues in regenerative medicine?(99)


10.  What is a traditional approach in delivering a ‘bad prognosis’? (103)

Sunday, January 29, 2017

Should a person with mental disabilities be denied an organ transplant?

The New England Journal of Medicine recently reported that U.S. Congress legislators made a petition to the Department of Health and Human services regarding whether a person with disabilities should receive an organ transplant or even be put on the list. With over a hundred thousand people on the waiting list for an organ, it’s safe to say the supply is limited. Some healthcare providers are afraid to give a person with intellectual/mental disabilities an organ because of the fear it may be “wasted.” The theory is that the person receiving the organ may not have the mental capacity to take care of themselves post-op and, thus, the organ may be rejected. If that is the case, someone who could have taken better care died while on the waiting list. However, research has shown that children with intellectual disabilities have the same odds of having a successful transplant as the children without disabilities. This study did not include adults, however, and children do have parents, guardians, or caregivers to ensure the best quality of care. Still, healthcare providers are wary to give children the transplant if they have a disability. One story became viral of a three-year-old girl named Amelia Rivera when she was denied a kidney transplant. The reasoning? She suffered from Wolf-Hirschhorn syndrome that causes severe intellectual impairment. The internet created a campaign with over fifty thousand people supporting her and she received the transplant. Other man in his twenties was denied a heart transplant because he was diagnosed with autism. Medical professionals are now calling for a review board that can make the decision if the case is debatable. Personally, I think they should not be excluded on the waiting list or denied an organ transplant.


Source: http://www.philly.com/philly/health/topics/HealthDay719036_20170125_Should_a_Mental_Disability_Keep_Patients_Off_Organ_Transplant_Lists_.html

Friday, January 27, 2017

Quizzes Jan31 & Feb 2

Quiz Jan 31, BB 4 - Clinical Ethics

1. (T/F) Dignity, respect, and confidentiality are among the aspects of the clinical relationship which emphasize the importance of trust. 

2. What (according to most recognized oaths and conventions) must always be the deciding factor guiding professional decisions? 

3. The idea that the doctor always knows best is called what? 

4. Is a diagnosis of mental illness grounds for establishing a patient's lack of capacity to render competent consent to treatment? 

5. What general principle allows breach of confidentiality? 

6. What term expresses the central ethical concern about "designer babies"? What poet implicitly expressed it?

7. Why have organizations like the WHO opposed any form of organ trading?

8. Besides the Kantian objection, what other major ethical issue currently affects regenerative medicine?

9. What does palliative medicine help recover?

10. What would most of us consider an unwelcome consequence of not retaining the acts/omissions distinction with respect to our response to famine (for example)?

DQ


  • How do you generally go about establishing trust in a new relationship? Do such general considerations apply equally to the clinical relationship? How does "professionalism" relate to trust?
  • Considering the "demented professor" (81) and other instances of patients whose expressed "best interests" may conflict with a clinician's therapeutic impulses: how important is the patient's present happiness, in influencing your clinical evaluation?
  • What's wrong, if in fact the doctor does possess more accurate information and more relevant experience, with treating the patient after the analogy of parent and child?
  • What would Dr. House do about patients who make (in his opinion) foolish decisions regarding their care? Would you hire him to work in your hospital?
  • Under what circumstances would you NOT violate confidentiality and inform a patient's partner that they were HIV positive?
  • What concept is more relevant in evaluating the ethical status of abortion: viability, humanity, personhood, maternal rights, or... ?
  • What do you think of Thomson's violinist analogy (91-2)?
  • Can a baby really have five parents (as opposed to five co-progenitors)? How do you define parenthood?
  • Should surrogacy, organ trafficking, and transplant tourism be regulated? How, and by whom? 
  • Do you think our society has a healthy attitude towards mental illness? Is it possible to declare a politically and ideologically neutral standard of sanity?
  • How would you counsel patients who insist they no longer value their "quality of life" and refuse potentially effective treatment and medication?  
  • Can the medical profession ever fully embrace the concept of ars moriendi, the art of dying?
  • Can you imagine ever facilitating a suicide, professionaly or personally?
  • Is there anything wrong with displaying cadavers in a museum exhibit (as in "Bodies: The Exhibition")? What guidelines should be followed?

==
Also of interest:

Drug Shortages Forcing Hard Decisions on Rationing Treatments...In a survey of cancer doctors conducted in 2012 and 2013, 83 percent of respondents who regularly prescribed cancer drugs reported having been unable to provide the preferred chemotherapy agent at least once during the previous six months. More than a third of them said they had to delay treatment “and make difficult choices about which patients to exclude,” according to a letter published in The New England Journal of Medicine.

The threat of future shortages in children’s treatments is serious enough that Dr. Peter Adamson, who leads the Children’s Oncology Group, the largest international group of children’s cancer researchers, assigned his organization to set priorities. “We’ve been forced into what we think is a highly unethical corner,” he said in an interview...
==
Scientists create a part-human, part-pig embryo — raising the possibility of interspecies organ transplants
http://wapo.st/2k85Wt3

http://www.nytimes.com/2017/01/26/science/chimera-stemcells-organs.html?smprod=nytcore-iphone&smid=nytcore-iphone-share
Human stem cells could be implanted in an early pig embryo, making a chimera with human organs suitable for transplant.

http://www.nytimes.com/2017/01/26/opinion/mr-trumps-gag-rule-will-harm-global-health.html?smprod=nytcore-iphone&smid=nytcore-iphone-share
The president has greatly expanded a policy restricting federal aid to health organizations abroad that talk to women about abortion.

==
Quiz Feb 2, BB 5 - Research.  Happy Groundhog Day! (It still casts a shadow...)

Today in Bioethics we'll talk "research." Things like clinical trials and research involving animals and their rights, and genetics, and epidemiology. We'll look at the funding gap between what we need to cure and where our research dollars are actually going, and at the moral imperative of genuine and informed consent. We'll look at disturbing instances of fraudulent and dishonest research. And we'll consider Peter Singer's claims about "speciesism."


The future of research is a daunting source of apprehension and speculation. Michael Sandel and Bill McKibben have aired serious concerns about genetic and other "enhancement" research as potentially catastrophic for our capacity to achieve or even recognize "meaningful" lives. Enhanced may not mean improved.

1. Name one of the basic requirements agreed upon by all codes devised to protect individuals from malicious research.

2. What decree states that consent must be gained in all experimentation with human beings?

3. Name one of four areas of research discussed in the book.

4. Which famous contemporary philosopher coined the term speciesism?

5. Name one of four R's used in international legislation pertaining to animal rights in research?

6. Dilemmas in epidemiological research illiustrate what general point?

7. What did Hwang Woo-suk do?

8. What is the term for altering the numbers in a calculation to make the hypothesis more convincing, with no justification form the research findings for such members?

9. What categories of human enhancement does Campbell enumerate, and what does he identify as its "extreme end"?

10. What is the "10/90 Gap"?

DQ:

  • Can there really ever be "fully informed" voluntary consent, given the many unknown variables and unpredicted consequences involved in most research?
  • Discuss: "Trials of pharmaceuticals may be driven as much by commercial considerations as by the likelihood of real therapeutic gain." 122
  • What concerns do you have about the use of animals in medical research? Is speciesism one of them? 10 medical breakthroughs due to animal testing... PETA... Touring an animal research facility
  • What limits, if any, would you like to see imposed on genetic research and the uses to which it may be put?
  • Were ethical improprieties committed in the case of Henrietta Lacks, whose cells (HELA cells) were harvested without her consent? (Rebecca Skloot... BBC...CBS...)
  • If "dreams of perfect health by the better-off will determine the research agenda" in the future, resulting in soaring health care costs and greater health "enhancement" opportunities for the wealthy, what should be done to insure adequate attention to "the health problems of most of the world's population"? 129
  • Should we be worried about a "Prozac revolution" and a "brave new world" of somatically-induced apathetic bliss? 130
  • Would you give special priority to any of Campbell's five enhancement categories (130)? Is "Transcendence"-style enhancement beyond the realm of reasonable concern (given the considerable monied interest of people like Larry Page)? 
  • Comment: "Why would we want such a 'posthuman' future? Are our lives better if we become physically stronger or more agile, or have an increased intelligence, or live for centuries?" 131
  • Is the outsourcing of clinical drug trials to developing countries ethically defensible? 132
  • How would you propose making research priorities "aligned to the needs of the majority"? 133
  • Is it likely that biobanks and other communitarian initiatives will in the future "prioritize health research according to need rather than profit," particularly in the U.S.? Would you support such a reprioritizing? How?
  • Have you seen Sicko? Care to share a review? Or of Michael Moore's latest doc'y?
==
Also of note:

To enhance our SuperBowl experience-
The New York Times (@nytimes)
N.F.L. Great Ken Stabler Had Brain Disease C.T.E. nyti.ms/1R1vYYw
==
It's the birthday of the first woman to graduate from medical school, Elizabeth Blackwell, born on this day in Bristol, England, in 1821. She wanted to become a doctor because she knew that many women would rather discuss their health problems with another woman. She read medical texts and studied with doctors, but she was rejected by all the big medical schools. Finally the Geneva Medical College (which became Hobart College) in upstate New York accepted her. The faculty wasn't sure what to do with such a qualified candidate, and so they turned the decision over to the students. The male students voted unanimously to accept her. Her classmates and even professors considered many medical subjects too delicate for a woman, and didn't think she should be allowed to attend lectures on the reproductive system. But she graduated, became a doctor, and opened the New York Infirmary for Women and Children. WA Feb3
==
IACUC - Institutional Animal Care and Use Committee

The Institutional Animal Care and Use Committee (IACUC) is a regulatory body comprising MTSU faculty who are appointed by the University's President through the recommendations from the Institution's Faculty Senate. The IACUC is responsible for reviewing the activities that involve the use of animals to enforce humane & ethical practices to be adopted by the University employees. MTSU adopts the following minimum requirement for the Committee's constitution thereby complying with the requirements of both USDA and PHS...
==
Neil Gorsuch wrote the book on assisted suicide. Here’s what he said.

Not since 2006 has the Supreme Court taken up a case involving “death with dignity” legislation — the handful of state laws that allow people to end their lives with the help of a physician. That year, the court handed a victory to death with dignity advocates, ruling that the attorney general could not bar doctors in Oregon — the first state to pass such a law — from giving terminally ill patients drugs to facilitate suicide.

It was only the third time the court had heard a case challenging such statutes, and the six-member majority tread lightly, recognizing the sensitivity of the issue.

“Americans are engaged in an earnest and profound debate,” the majority wrote, quoting from a previous opinion, “about the morality, legality, and practicality of physician-assisted suicide.”

That debate is far from resolved today — and it’s one Neil Gorsuch, President Trump’s nominee to the high court, will surely be eager to weigh in on, should he win confirmation.

Gorsuch, a 49-year-old federal appeals court judge from Colorado, was tapped by Trump on Tuesday to replace Justice Antonin Scalia, who died last year after three decades on the Supreme Court. Aside from his bona fides as a lawyer and a jurist — which may all but guarantee a favorable vote in the Senate — Gorsuch has cultivated something of an expertise in assisted suicide and euthanasia in his legal career.

[Trump picks Colo. appeals court judge Neil Gorsuch for Supreme Court]

In 2006, the year he was nominated to the federal bench, he released a heavily researched book on the subject titled “The Future of Assisted Suicide and Euthanasia.” The front cover looks almost like a Tom Clancy novel, with purple all-caps block text set against a black background. But the book itself is a deep, highly cerebral overview of the ethical and legal debate surrounding the practices... (continues)
==



Thursday, January 26, 2017

Website: Bioethics.

http://www.bioethics.com/
This website is a good one to us here in Bioethics. It has a numerous number of topics about bioethics' topics. 

Culture and Religion on Bioethics.

The field of bioethics continues to struggle with the problem of cultural diversity, cultural relativism and ethical relativism: can universal principles guide ethical decision making, regardless of the culture in which those decisions take place? Or should bioethical principles be derived from the moral traditions of local cultures? These questions are inevitable when diverse cultures and moral traditions share a common world, but they are barely considered and poorly addressed when Western bioethics travels abroad. We all agree with the influence of culture and religion on ethics. Each culture has such a unique form of society. Indeed, each culture has its unique ethical principles. We challenge the premises of moral universal-ism, showing how this approach imports and imposes moral notions of Western society and leads to harm in non-western cultures. Therefore, we cannot use universal principles guide ethical decision making regardless of the culture in which those decisions take place. As what Campbell asked "Should we suppose that each of us is trapped in our own culture and belief system, so that there is no possibility of a shared human morality? This case is called ethical relativism. I think this is one of the main theory that relates to the bioethics. Even if there are some serious problems with it. I also agree with Campbell about cultural influences seems better to talk about, but not to accept that they are so utterly determinative of it that there is no point in seeking universal human values. Last point I would like to share with you is about "moral absolutism". Moral Absolutism is the ethical belief that there are absolute standards against which moral questions can be judged, and that certain actions are right or wrong, regardless of the context of the act. I think moral absolutism doesn't even exist. 

M.Ghaly

Midterm choice

I'm  interested in the Case against Perfection as a choice for the midterm project . . . If anyone else is interested in this too, please let me know. :)

Stem Cell Research and Ethical Theories

This will probably overshoot 250 words, but I just wanted to run the stem cell debate past some of the ethical theories we talked about in chapter 2.

Utilitarian Consequentialism

The expectation of stem cell research is that the use of such research will rapidly expand our knowledge and production of certain types of intelligence regarding human tissues and organs. It's not hard to see how this research could be incredibly beneficial to humanity and reduce a large amount of pain and suffering; therefore, I would say that the utilitarian would be on board with stem cell research.



Kantian Deontology

This one is a pretty slippery slope. Kant wants us to treat ever person as an end, not a means to an end; however, when we're talking about embryonic stem cells, the discussion becomes: when does one obtain "personhood." Depending on your opinion (which Kant would want you to be very honest about), it may be a hard pass- Kant would never want you to destroy a life for the potential benefit of another.

Virtue Ethics

Far and away the most enigmatic ethical theory, in my opinion, virtue ethics would have us ask "how should I be?" The implications of this are numerous and seem to naturally mingle with the same issues that Kantian Deontology brought forth. What is more conducive to building moral character- to strive to advance medical science? Would it necessitate the sacrifice of innocent lives and, if so, would it be worth it? I'm not approaching this for an answer. The vague nature of (my understanding of) virtue ethics lends itself to a cycle of perpetual reflection more so than the other theories we've covered, and for that, it may be my favorite.

Word count: 287

Alternative Quiz Questions: Ch. 3 Perspectives

1. A 2009 report published by the WHO showed that the biological and behavioral advantages of women in higher-income countries are outweighed by what? (49)

2.What are some common stereotypes of masculinity and femininity in regards to the way people handle moral issues? (52)

3. How does the philosophical idea of dualism view the mind in relation to the body? (52)

4.What are the subtle differences between ‘caring for’ and ‘caring about’ people? (56)

5. What is the philosophical paradox that Campbell uses to address the issue with ethical relativism? (57)

6. (T/F) Globalization of trade and the rapid spread of mass communication has had a significantly negative effect on Asian cultures and has been detrimental to their economies. (58)

7. Both of the dharmic traditions Campbell discusses see spiritual development and liberation rather than simply moral development, which results in what sort of behavior towards the world? (68)

8.  Which of the five religions discussed does Campbell consider to be the most “complex and diverse”? (72)

9. Arguably the most characteristic feature of Islamic bioethics is that it is ___________. (76)

10. How do the ideals of Islam view God’s will in terms of the Socratic question, “Is something good because God wills it, or does God will it because it is good?” (77)

Wednesday, January 25, 2017

Quiz Jan26

NOTE: a version of this quiz posted earlier has been modified, as of 2:55 pm Wednesday.

1. Chapter 3 begins by asking if our bioethical perspective ("vision") is skewed by _____... (a) cultural assumptions, (b) gender bias, (c) religious faith, (d) all of the above

2. What's the leading global cause of death among women of reproductive age?

3. (T/F) The "feminist critique" says bioethics has been dominated by culturally masculine thinking.

4. What ethical perspective did Nel Noddings (supported by Carol Gilligan's research) describe as the "feminine approach"?

5. What's a furor therapeuticus?

6. Does Campbell consider the outlawing of female genital mutilation culturally insensitive?

7. What's allegedly distinctive about "Asian bioethics"?

8. What western ethical preconception is "somewhat alien" in the eastern dharmic traditions?

9. What gives Buddhists and Hindus a "whole new perspective" on bioethical issues?

10. What does Campbell identify as a "tension in the Christian perspectives" on bioethics?

DQs:

  • How do you think your own attitudes and assumptions about gender, religion, etc. influence your Bioethical perspective?
  • What do Plato's Euthyphro and the Biblical story of Abraham & Isaac suggest to you about the place of religion in addressing biotethical issues? (61-2)
  • What is Buddhism's bioethical relevance? (69)
  • How should medical professionals treat and care for children whose parents object to medical intervention on religious grounds?
  • Is it best for caregivers to try and limit their personal knowledge of patients' particular perspectives, beliefs, identities (religious, political, cultural etc.) so as to avoid conscious or unconscious bias in treatment, or does this unduly sacrifice the humane dimension of medical practice?
  • Post your DQs

Bioethics today is about the ways our vision of issues and outcomes may be occluded, blurred, or otherwise compromised by our respective points of view or perspectives. Of course this is not unique to bioethics, all human comprehension is subject to bias by the attenuation of culture, gender, religion, ideology, experience, the absence of experience, greed, egoism, and on our list could go. It is in our nature to see what we've seen, to see what we want to see, to see through a glass darkly. Without corrected vision the people perish.

Our native tendency to frame experience incorrectly, conformable to our own pre-vision and hence occlusive of other ways of seeing and clinically intervening, is a constant challenge to the fair-minded ethicist. Bioethical philosophers across the perspectival spectrum presume to prescribe corrective frames, but inattention to the varieties of sight is a constant hazard. Here's a link to a good little essay on the subject, from esteemed bioethicist Arthur Caplan: "When Religion Trumps Medicine."

We should play with this metaphor. As a lifetime wearer of framed corrective lenses, I can attest to the temporary excitement of a new prescription, or even just a stylish new frame to house the old set of lenses. The trick is always to find frames that hold up through every season of wear, that don't grow tiresome, and that justify the expense of change. (My wife returned from Costco one day reporting that the same frames she'd found at the Eye Doc's were $100s cheaper there.) Sometimes new lenses in the old frame suffice, sometimes you just need a new look.

So, some of the perspectives we'll try to focus and reframe today: attitudes and assumptions around HIV/AIDS, especially as occluded by miseducation; violence as a public health issue; "feminist critiques" of contingently-drawn, historically-conditioned categories of masculinity and femininity, locked into patriarchal institutions and practices that discriminate against women; misogyny; marginalization; advocacy; embodiment; empowerment; relational autonomy; metaphysical dualism; care; furor therapeuticus; female genital mutilation; "Asian bioethics"; Plato's Euthyphro; Abraham & Isaac; Buddhism; and more.

How do you get that "new look"? I always like to suggest trying the John Rawls Original Position/Veil of Ignorance frames. Some of us can wear them.

One more indulgence, before discussion: the snarly TV doc Gregory House was suggested by a student last semester as a good example of how some practitioners seem driven less by the patient's best care than by their own egoism. But, getting the diagnosis and treatment right regardless of motive and ego still seems the most important thing. Doesn't it? Maybe you can find & share links to other YouTube moments illustrative of good and bad medical-ethical practice.

Also of interest:
HHS nominee skirts questions about impact of Drumpf’s executive order on ACA

President Drumpf’s choice for health secretary declined Tuesday to promise that no Americans would be worse off under Drumpf’s executive order to ease provisions of the Affordable Care Act — and distanced himself from the president’s claim to have an almost-
finished plan to replace the law.

At a testy Senate confirmation hearing on his nomination to lead the Department of Health and Human Services, Rep. Tom Price (R-Ga.) sought to play down the influence he would have on reshaping the health-care system along conservative lines, while attempting to deflect accusations from Democrats about his ethics.

He repeatedly flashed his long-standing distaste for federal insurance standards and other government strategies to guide medical care. And although he embraced certain policies popular within the GOP, such as special insurance pools for patients with preexisting medical conditions, he steered clear of other ideas he has supported, including the transformation of Medicaid from an entitlement program for lower-income people to a set of block grants to states.

By the time the hearing ended after four hours, the Senate Finance Committee’s partisan divisions appeared as bitter as they had at the beginning, with the Republicans aligned solidly behind the nominee despite sharp Democratic attacks on his investment and legislative practices.

Chairman Orrin G. Hatch (R-Utah) praised Price as a singularly qualified nominee and took broad swipes at Senate Democrats, saying they were tearing at the fabric of the chamber as an institution with their attempts to undercut Drumpf’s Cabinet ­choices.

The committee’s ranking Democrat, Sen. Ron Wyden (Ore.), countered that Price, if confirmed, would “take America back to the dark days when health care was for the healthy and the wealthy.” Focusing on the private investments in health-care companies that could have benefited from bills Price sponsored, Wyden said that “it is hard to see this as anything but a conflict of interest and an abuse of position.”

[Who is Tom Price?]

A fresh allegation Tuesday was that Price underreported to the committee and the Office of Government Ethics the value of shares he holds in an Australian company, Innate Immunotherapeutics. Price, who purchased some of that stock through a discounted, private offering, attributed the under­reporting to “a clerical error” and a misunderstanding of the question.

“The reality is that everything that I did was ethical, above­board, legal and transparent,” Price said — a message Republicans sought to reinforce throughout the hearing.


Democrats targeted most of their questioning on the direction that Price, if confirmed, would try to take the health-care system. Price demurred repeatedly.

For instance, he sidestepped a series of questions about the effects of the sweeping order Drumpf issued just hours after his ­swearing-in that directed agencies to lift or soften federal rules implementing aspects of the ACA. Price declined to commit that no one would be harmed, that no one would lose insurance coverage or that the regulations would be rewritten only after a plan exists to replace the 2010 health-care law.

He similarly deflected a question about whether the new administration would try to stop enforcement of the ACA’s individual insurance requirement prior to a replacement plan.

See how your coverage could be impacted by four prominent plans proposed by RepublicansVIEW GRAPHIC

“I commit to working with you,” Price finally told Wyden after reiterating that his goal is to ensure all Americans have an opportunity for access to health insurance. The ACA’s goal is universal coverage.

“We didn’t get an answer,” Wyden retorted.

Price also skirted questions by Sen. Sherrod Brown (D-Ohio) about Drumpf’s statements the weekend before his inauguration that the health-care plan he was completing would provide “insurance for everybody.”

Brown asked: “President Drumpf said he’s working with you on a replacement plan for the ACA, which is nearly finished and will be revealed after your confirmation. Is that true?”

Price replied: “It’s true that he said that, yes.”

The packed hearing room broke into laughter.

Brown persisted: “Did the president lie about this, that he’s not working with you?”

The nominee gave an oblique answer, saying, “I’ve had conversations with the president about health care.”

[HHS nominee’s mix of investments, donations, legislations keeps raising questions]

Tuesday’s hearing was the more significant of two appearances Price has made in the past week on Capitol Hill because the Finance Committee has jurisdiction to vote on his nomination. A date has not been set.

Democrats’ numerous attacks on Price in the past week prompted Sen. Johnny Isakson (R-Ga.), who officially introduced Price to his Finance Committee colleagues, to say, “I feel like I’ve been asked to be a character witness in a felony trial in the sentencing phase of a conviction.” WaPo
==
Faith-Based Decisions: Parents Who Refuse Appropriate Care for Their Children
Adam Lovell*, an active 2 ½ -year-old boy, was healthy until the day his parents took him to the local emergency department for vomiting and a suspected case of acute gastroenteritis. To the physicians, Adam appeared lethargic and was responsive only to painful stimulus. A blood culture was obtained, and other laboratory tests were performed. The blood culture later grew a meningococcus. Within hours "purple splotches" appeared on his face, legs, and trunk. Adam was diagnosed with meningococcemia and was started on appropriate antibiotics and steroids administered intravenously. Adam was intubated to stabilize his airway and transported to the County Memorial Hospital. On arrival, his perfusion was poor and blood pressure low. The tips of all his digits were dark blue; purpura (purple splotches) were present over most of his trunk, feet, and hands in a "stocking-glove" distribution. Intravenous fluid boluses and vasoactive drug infusions were administered. Adam's parents consented to multiple blood component therapy to treat a coagulopathy. Adam was also treated for respiratory failure related to meningococcal sepsis with both conventional and high frequency mechanical ventilation for the first 11 days of hospitalization.

At 10 days, Adam had well demarcated patches of dry, devitalized tissue (dry gangrene) on both of his feet, his left hand, and the fingers of his right hand. An eschar was present on the posterior surface of his right thigh. Ulcerated areas of skin were present in the perineal region. Consulting surgeons talked to his parents about the risks, benefits, and alternatives of amputation and debridement of portions of both of Adam's feet, his left hand, and the fingers of his right hand. The Lovells consented to the debridement and surgical treatment and signed the consent form. Shortly thereafter the family's minister came to the hospital and prayed with Adam's parents for God to restore life to the devitalized tissues. Soon afterward, the Lovells rescinded consent to surgical treatment and communicated that they wished to allow time to elapse so that God could heal Adam's dead and injured tissues. When the physician and the surgeon told Adam's parents that infection and sepsis would be inevitable without treatment, they agreed verbally that, in the event of sepsis, amputation should be performed.

Over the ensuing 2 ½ weeks, physicians met with the Lovells and vigorously attempted to persuade them to proceed with Adam's amputation and debridement of dead tissues. Mr. and Mrs. Lovell remained adamant that an expectant approach be maintained. During this time neither sepsis nor wet gangrene, which would have offered absolute indication for surgical intervention, occurred. Despite the best efforts of the family and staff, many hours elapsed where Adam remained quiet and alone in his bed. He would cry and appeared to be sad. At times he cried out "hand" while gazing at his outstretched and mummified hands. During visits, the Lovells read the Bible to Adam and assured him that God would direct his hands and feet to re-grow. The Lovells asserted to the staff that Jesus had arisen from the dead and shown himself to believers, and that God would revitalize Adam's dead tissues. Both family-associated and hospital-based clergy were regularly present to expand opportunities for mutual understanding of religious and medical issues. Adam's parents were repeatedly confronted with the ever-present and increasingly imminent reality that Adam needed amputations to prevent new onset of sepsis and to avoid possible death from sepsis.

After almost a month in the pediatric intensive care unit, Adam began to experience fevers and his white blood cell counts increased; both signs were indicative of developing infection. Therapy with topical and systemic antibiotics was continued and modified. His parents were informed of the changes and of the increasing need to consent to surgical therapy. In an effort to reinforce the inescapable need for surgical therapy, the physicians consulted with a burn surgeon at a neighboring institution by telemedicine. The surgeon confirmed that amputation was unavoidable. These communications were shared with the Lovells, who nevertheless, were not dissuaded from insisting upon further observation. Despite considerable effort to understand and support the parents by their own family members, by the medical staff, by social service, by psychology and by clergy (hospital and family), a clear impasse had been reached. The Division of Social Services (DSS) was engaged to evaluate the case for a possible claim of medical neglect against Adam's parents. With the possibility of the child's custody being assumed by DSS, the parents signed consent for amputation and debridement. The mother signed consent because "only death would take my baby from me." The family requested that a "hands-on" surgical evaluation be performed at another medical facility. This request was granted. Expedited transfer was made, surgical intervention was deemed necessary by the receiving surgeon and amputation and debridement followed within 2 days.
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Letting them die: parents refuse medical help for children in the name of Christ
The Followers of Christ is a religious sect that preaches faith healing in states such as Idaho, which offers a faith-based shield for felony crimes – despite alarming child mortality rates among these groups
Mariah Walton’s voice is quiet – her lungs have been wrecked by her illness, and her respirator doesn’t help. But her tone is resolute.

“Yes, I would like to see my parents prosecuted.”

Why?

“They deserve it.” She pauses. “And it might stop others.”

Mariah is 20 but she’s frail and permanently disabled. She has pulmonary hypertension and when she’s not bedridden, she has to carry an oxygen tank that allows her to breathe. At times, she has had screws in her bones to anchor her breathing device. She may soon have no option for a cure except a heart and lung transplant – an extremely risky procedure.

All this could have been prevented in her infancy by closing a small congenital hole in her heart. It could even have been successfully treated in later years, before irreversible damage was done. But Mariah’s parents were fundamentalist Mormons who went off the grid in northern Idaho in the 1990s and refused to take their children to doctors, believing that illnesses could be healed through faith and the power of prayer.

As she grew sicker and sicker, Mariah’s parents would pray over her and use alternative medicine. Until she finally left home two years ago, she did not have a social security number or a birth certificate.

Had they been in neighboring Oregon, her parents could have been booked for medical neglect. In Mariah’s case, as in scores of others of instances of preventible death among children in Idaho since the 1970s, laws exempt dogmatic faith healers from prosecution, and she and her sister recently took part in a panel discussion with lawmakers at the state capitol about the issue. Idaho is one of only six states that offer a faith-based shield for felony crimes such as manslaughter.

Some of those enjoying legal protection are fringe Mormon families like Mariah’s, many of whom live in the state’s north. But a large number of children have died in southern Idaho, near Boise, in families belonging to a reclusive, Pentecostal faith-healing sect called the Followers of Christ... (continues)