Swastika Anomaly and Ethical Justice

From Los Angeles Times


SWASTIKA?: The buildings, constructed in the 1960s, are on the Coronado amphibious base and serve as a barracks for Seabees. From the ground, or even adjoining buildings, the configuration cannot be seen. Nor are there any civilian or military landing patterns that provide such a view. But Google Earth shows the shape clearly. (Google Earth)

CORONADO, Calif., -- The U.S. Navy has decided to spend as much as $600,000 for landscaping and architectural modifications to obscure the fact that one its building complexes looks like a swastika from the air.


Someone explain to me, would justice be better served by spending $600,000 to ensure that the injured soldiers from Iraq and Afghanistan have their medical records transferred promptly from the military to the veterans administration than to spend that money on some ridiculous anomaly? As a member of the Jewish community I see no harm in the Google eye appearance of the buildings which may have been built in such a configuration to meet a functional need. I just wanted to make my feelings known. ..Maurice.

How Much Is Two Months of Life Worth?: Expensive Cancer Drugs

Although only after we face the decision in some personal way (ourselves or a family member), it is very hard to answer the question "How much is two months of life worth?" And yet patients with cancer, those who have failed other cancer drugs, are having to make such decisions, if they can. Other considerations on the same issue are why the pharmaceutical companies must charge astronomical prices for these drugs which only give to most patients only very limited benefit? Also, who should be paying for these drugs? Should they be available to the illegal immigrants who appear in emergency rooms very sick with cancer? To help us think further and answer some of these questions, I found a very worth while blog, In The Pipeline, written by a pharmaceutical researcher, covering this very topic and followed up by a bunch of very cogent visitor commentaries by people who seem to know in ins and outs of pharmaceutical companies and research. Take a look at the posting there and then return and give me your comments. Do you think you can answer the question "How much is two months of life worth?" ..Maurice.

More on Death With Dignity: Whose Death? What Dignity?

Your child says to you “Mommy! Look! A dead bug! Can I step on it and watch its insides squish out?” What would you say in response? “Don’t do it.. it’s messy!” Or would there be something you would say that would be more educational and perhaps more philosophical? Would it be “All animal creatures are precious and demand respect both alive and dead?” But your observant child might respond “But Mommy, why are you always swatting live flies in the kitchen?” or “why don’t we bury the ants that you kill with the spray?” The issue I want to see discussed on this thread is how should we, how do we educate our children regarding the role of animal creatures in our life and how should we behave in presence of these animal creatures, either dead or alive. Are there some animal creatures that just don’t deserve respect, dead or alive, and no respect or dignity need be given to them dead or alive and should this be the message we send to our children? And does this response send any broader ethical message to our children? ..Maurice.

ADDENDUM: Photograph of a dead bug was taken by me during a walk in Towsley Canyon, Santa Clarita, CA on 9-26-2007. No, I didn't step on it!

The Pope and Directed Food and Fluid Administration vs “Fundamental Human Dignity”

For those who are unaware, there came a response about a week ago from the Vatican to the concerns of the Catholic Bishops in the United States regarding Pope Benedict XVI”s statement earlier related to the administration of food and fluid to a patient who is permanently unconscious in a so-called “permanent vegetative state”. The following response was prepared by the Congregation for the Doctrine of Faith and approved by the Pope.



CONGREGATION FOR THE DOCTRINE OF THE FAITH
RESPONSES TO CERTAIN QUESTIONSOF THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPSCONCERNING ARTIFICIAL NUTRITION AND HYDRATION

First question: Is the administration of food and water (whether by natural or artificial means) to a patient in a “vegetative state” morally obligatory except when they cannot be assimilated by the patient’s body or cannot be administered to the patient without causing significant physical discomfort?

Response: Yes. The administration of food and water even by artificial means is, in principle, an ordinary and proportionate means of preserving life. It is therefore obligatory to the extent to which, and for as long as, it is shown to accomplish its proper finality, which is the hydration and nourishment of the patient. In this way suffering and death by starvation and dehydration are prevented.

Second question: When nutrition and hydration are being supplied by artificial means to a patient in a “permanent vegetative state”, may they be discontinued when competent physicians judge with moral certainty that the patient will never recover consciousness?

Response: No. A patient in a “permanent vegetative state” is a person with fundamental human dignity and must, therefore, receive ordinary and proportionate care which includes, in principle, the administration of water and food even by artificial means.

The Supreme Pontiff Benedict XVI, at the Audience granted to the undersigned Cardinal Prefect of the Congregation for the Doctrine of the Faith, approved these Responses, adopted in the Ordinary Session of the Congregation, and ordered their publication.


Rome, from the Offices of the Congregation for the Doctrine of the Faith, August 1, 2007.
William Cardinal LevadaPrefect
Angelo Amato, S.D.B.Titular Archbishop of SilaSecretary


This means that the Pope has directed that physicians and healthcare providers must provide all patients who are permanently unconscious, not expected to ever recover consciousness, food and fluid by natural (impossible in an unconscious patient) or artificial by intravenous or tube method against medical judgement and against the request of the patient or surrogate who has officially made a statement to the contrary. refusing at some point further food or fluid. This directive presumably would be followed by every Catholic hospital in the world and would, of course, apply to all patients whether Catholic or not. What do you think about this directive and whether, in some cases, by denying a patient’s autonomous decision about their own healthcare actually represents ignoring and not supporting a “fundamental human dignity.”? The other concern is whether the directive will be applied to all patients who refuse food and fluid, even those who are conscious. ..Maurice.

Do You Have a Bioethics Question? If So, Ask Me

Since I started this blog in July 2004, this is currently my 479th posting. A great number of different topics have been covered in these past 3 years. It is interesting and rewarding to discover that despite the popularity of certain topics such as patient modesty, circumcision of male infants and "I hate doctors", there is still daily visitation to a host of other topics going all the way back to the earlier days of this blog And that is what I would say is understandable and appropriate considering the extent of the discipline of bioethics in our modern world.

What I wanted to pose with this posting was the offer my visitors an opportunity to ask me questions about ethical issues in medicine or biology that I haven't really covered in the past threads. Make this a thread consisting as a potpurri of everything you would like to know and perhaps I have an idea of an answer or will try to look it up. However, everyone should realize that bioethics answers are really individual views or consensus opinions. There are no rigorous scientific studies but opinions based on previous declared ethics principles, previous cases, the law and even personal opinion. But give it a try. ..Maurice.

A Fetal Abnormality is Discovered: Anything Wrong With Full Disclosure?

I received an e-mail from a lady in Canada who wrote: “Dear Dr. Bernstein,My name is Renate Lindeman, mother of two beautiful daughters, who happen to have Down syndrome.When I was pregnant with my oldest daughter who is 3,5 years old I was offered screening because of my maternal age of 35. I was naive and declined, thinking 'I am having a baby, I feel good, why screen?'It never occured to me that selective screening and termination happened, at least not on this scale.The past 3,5 years have certainly been a journey of awareness, often a painful one.Recently, I started a petition to call upon the Canadian government to create a 'prenatal diagnosed condition awareness act' http://www.gopetition.com/online/13481.html What can I say, any suggestions, comments or support would be very much appreciated. Renate Lindeman”

Here is my support , Renate.

In the link Renate noted above, she explains the current situation in Canada and elsewhere regarding the need for prenatal diagnosed condition awareness laws.


In Canada each year around 400,000 women will become pregnant and all these women will be offered some sort of screening or testing for an anomaly. As a result thens of thousands of women will be told their unborn baby may have a certain diagnosed condition. Technological advances in fetal screening are presenting parents -and doctors- with enormous ethical, psychological and social dilemmas. Vulnerable, and with limited or biased information as guidance, more than 90% of prospective parents in Canada choose termination if their baby is diagnosed prenatal with Down syndrome. They may never know there is a world of resources, hope and support out there. In spite of tireless efforts from support groups their information pamphlets rarely reach prospective parents at the time they need it most.The United States recently re-introduced the Prenatal Diagnosed Condition Awareness Act, which ensures prospective parents are supplied with balanced information about the diagnosed condition and educational programs for health care providers are established. The U.K. is making great strides in establishing public awareness campaigns about diagnosed conditions. In Canada an expansion of screening programs is not accompanied by an appropriate expansion of awareness and educational programs.The Nova Scotia Down Syndrome Society believes that non-directive and balanced information about all options should be at the heart of prenatal screening.The Nova Scotia Down Syndrome Society joined by the Candian Down Syndrome Society (www.cdss.ca), believe there is an urgent need for an Prenatal Diagnosed Conditions Awareness Act and that the provinces and territories participate or enact equivalent legislation within their jurisdictions. This Act would ensure provinces and territories responsible for health care set aside appropriate resources for the establishment of educational and awareness campaigns that will enhance knowledge about diagnosed conditions and allow organizations to create and distribute balanced and accurate information to women and prospective parents.By creating a law that manages the above, Canada will ensure that all differences are valued equally.


Similar legislation in the United States has been attempted over the past several years but has not gone anywhere. Currently pending in the House of Representative is H.R. 3112: Prenatally Diagnosed Condition Awareness Act of 2007.
The purpose is to amend the Public Health Service Act to increase the provision of scientifically sound information and support services to patients receiving a positive test diagnosis for Down syndrome or other prenatally diagnosed conditions. Introduced July 19 2007, the Bill has been sent to the House Energy and Commerce Committee.

I challenge my visitors to look at the current House Bill and come back and discuss the pros and cons of such legislation. The issue is that once a pre-natal diagnosis of fetal disorder is diagnosed, shouldn’t the parents be informed of the consequences of the diagnosis and given all the possible decisions which could be considered? Is there anything wrong with full disclosure? ..Maurice.

Disclosing Domestic Violence: Role of Privacy and Modesty

Screening for medical and psycho-social problems should be a primary function in physician history-taking beyond asking about the symptoms for which the patient has come for consultation and treatment. Screening is a pro-active way of discovering conditions in the patient’s life which may lead to disorder and symptoms in the future. Screening often involves asking patients about whether they smoke, drink alcohol or take illicit drugs. Hopefully, with the feedback from the physician, the patients will understand the reason for screening and will be forthcoming in their answers. However, screening may involve issues which are felt by some patients to be “too personal” to disclose to anyone. Screening about sexual history and practices, as an example, is being discussed on another thread.

An important screening topic which physicians should inquire is history of domestic violence. This also is complicated by the patient’s concern about the privacy issues and consequences of providing the physician with such information if their abusive spouse finds that the patient “talked.”
An interesting article about this subject is present in Postgraduate Medicine Online
titled “Screening for domestic violence
Identifying, assisting, and empowering adult victims of abuse” by
Katherine J. Little, MD in the August 2000 issue.
Barriers to disclosure are noted both on the part of the patient and that of the physician. Excerpts from the article:

Patients also face barriers to disclosing violent relationships. The perpetrator may have threatened to beat the victim more severely if she discloses information, or he might have implied that their children would be taken away. If the victim reported abuse in the past, she may have been blamed for the situation or the abuse may have escalated. Perpetrators may not allow victims who disclose information to participate in appropriate medical follow-up care. In some cases, a victim's cultural background may have taught her that she must accept her situation and that she should not question or discuss the subservient role into which she has been forced by the perpetrator.
...
Physicians face many barriers when trying to provide the kind of patient care that they themselves would expect to receive. Lack of time--to establish rapport with a patient, to hear in detail about all of her problems, and to ask a multitude of questions for further diagnostic elucidation--is a commonly cited reason for not routinely screening for domestic violence in primary care practice. Physicians do not want to open a Pandora's box of complicated social and psychological issues that could not possibly be evaluated in an allotted 30 minutes or less. Also, for some physicians, such a discussion may trigger memories of their own violent relationships; in such cases, the well-recognized survival technique of distancing oneself from a patient's pain may be ineffective.

I wonder if my visitors might discuss here how they would consider their being screened for domestic violence by their physician, perhaps as part of a routine history and physical. Would it be easier to disclose information about abuse if the questions were asked not face-to-face but in the form of a written or computer driven questionnaire? Is there a kind of modesty involved in this screening, modesty not to reveal ones private marital life? ..Maurice.

Hypocrisy: Do You See It in the Practice of Medicine?

Hypocrisy is a word in the news these days. Currently it is being used in the context of the alleged behavior of U.S. Senator Craig as contrasted with his prior pronouncements and governmental activities. The word is defined in various ways but essentially can be understood as insincerity by virtue of pretending to have qualities or beliefs that one does not really have. My interest in using this word on this blog is to discover if hypocrisy is absent or is present, perhaps flagrantly present within medical practice and the various components that make up medical care from the pharmaceutical companies, insurance companies and HMOs,to the various medical societies including the American Medical Association, to the hospitals and down to the individual physicians, nurses and technicians involved in the care of patients. Do my visitors feel that at any level of health care, there are qualities or beliefs that are expressed to patients but by actions are really not present and not considered when dealing with society, patient groups and individual patients? If present, in what ways do you see it expressed? What do you think? ..Maurice.