At the Center
Capturing the lively discussions, presentations, and other events that make up the daily activities of the Markkula Center for Applied Ethics at Santa Clara University.
The following postings have been filtered by category Bioethics
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Thursday, Mar. 15, 2012 3:00 PM
Santa Clara University students are invited to apply for 2012-2013 health care ethics internships, sponsored by the Markkula Center for Applied Ethics. The internship is a year-long program that brings undergrads into local hospitals and hospices to learn first-hand about the ethical issues arising in medical care. Students shadow doctors, nurses, chaplains, and others who work in patient care. In addition to learning more about medical ethics, they have an opportunity to see what it would be like to work in the health care field. Applications are due April 13
Tuesday, Feb. 7, 2012 11:14 AM
The impact of health care reform on hospitals was the focus of a presentation by Center Executive Director Kirk O. Hanson to the 2012 Premier Governance Education Conference held Jan. 30 - Feb. 1 in Miami Beach.
Hanson focused on the ethical implications of reform for hospitals as business organizations. Among the considerations he addressed were:
- Clear organizational ethics goals – ethical behavior toward all stakeholders; honest reporting; control unethical behavior
- Concern for Conflicts of Interest
- Greater responsibility for competence and integrity of staff and partners
- Adequate policies and procedures to manage incentives to violate
- Concern for understanding and adherence to ethical norms throughout organization
Friday, Dec. 16, 2011 3:17 PM
Periodically, visitors to our Web site send us fascinating questions. While we can't respond to each one, this question from a nurse raised an issue we think may of general interest. The answer is by bioethicist Margaret R. McLean, the Center's associate director.
Q: Where can I find information about a physician's refusal to honor a patient's repeated request for hospice? The request was repeatedly denied until she changed doctors. We are looking for ways to change this and advocate for others who are being refused.
A: Your question intrigued me, partly because anecdotal evidence would indicate that the situation you describe is far from rare. However, I have no clear answer. I brought your case to two colleagues—one an elder law attorney and the other a hospice chaplain. They both found it an interesting question for which they, too, had no answer.
Whereas one would hope that a physician would follow the directions given by his/her patient, this is not always the case, as you know. There are legitimate reasons for physician's refusal, e.g., what the patient is requesting is not medically indicated; what the patient is requesting may be medically indicated but the physician (or other health care professional) refuses for reasons of conscience.
In such cases, once it is established that an impasse has been reached, the physician should make every effort to transfer care to another physician who is willing to comply with the patient's wishes. In the acute care setting, communication between physician and patient could be facilitated by the Ethics Committee, which could provide the opportunity for value identification and conversation about goals of care. In the case that you present, the burden fell on the patient to change doctors. I believe that the right outcome was achieved, but the burden was misplaced.
Here's where your desire to advocate on behalf of patients facing similar circumstances becomes vitally important to good patient care. It certainly helps to have someone—or, better yet, more than one—on the care team advocate for the patient's best interest, in this case, a transfer to hospice care. If this is in an acute care setting, then I would involve the Ethics Committee as well.
I have seen cases in which there has been a long-term relationship between the physician and patient, and the physician has a hard time "letting go." I have also seen cases in which a particular physician will never refer to hospice, a very unfortunate state of affairs. In such cases, ethics asks us to follow the patient's best interest and articulated goals of care, and facilitate a transfer of care to a physician who will comply with the patient's wishes and complete the hospice referral.
Wednesday, Nov. 23, 2011 9:13 AM
In 2002, a Wisconsin pharmacist declined to fill a prescription for birth control pills because, as a Catholic, he said to do so would violate his religous beliefs. He also refused to refer or transfer the prescription.
That incident forms the basis of a case study by Center Bioethics Director Margaret McLean, exploring the rights and responsibilities of medical professionals who do not wish to be involved in lawful and standard treatments that violate their personal consciences.
She delivered the case at a recent conference, The Spark of Conscience Inflames Debate, which examined conscientious refusals in health care.
Friday, Nov. 18, 2011 5:08 PM
Students in the class "Social and Ethical Dimensions of Biotechnology" will present their quarter's research in the form of a poster session Dec. 1.
The class is an interdisciplinary consideration of contemporary biotechnology and its ethical implications. Topics include human cloning, stem cell research, human genome project, genetic testing, gene therapy, genetically modified organisms, personalized medicine, clinical trials, and public policy. Instructors are Center Associate Director Margaret R. McLean and Associate Professor of Biology Leilani Miller.
Tuesday, Nov. 1, 2011 5:00 PM
May a pharmacist refuse to fill a prescription to which the pharmacist has a moral objection? Such cases of conscience have become more common in the health care setting and raise fundamental questions about the obligations of health care workers and the rights of patients.
The Spark of Conscience Inflames Debate is a daylong conference Thursday, Nov. 3, featuring top experts in this area from the United States and Canada. The conference, sponsored by the Ethics Center, the Ignatian Center for Jesuit Education, and the SCU Philosophy Department, will be held in the Wiegand Room of the Arts and Science Building at SCU, 8:45 a.m. - 5:15 p.m. The event is free.
Tuesday, Jun. 28, 2011 12:33 PM
Sarah Ludwig has been appointed as the 2011-2012 Honzel Fellow in Health Care Ethics. Ludwig, a senior chemistry major and public health science minor, hopes to become a physician. She participated in the Center's Health Care Ethics Internship, which allows students to shadow health care providers at local hospitals and observe ethical issues as they arise in day-to-day medical care. As the Honzel Fellow, she will mentor next year's interns.
The Honzel Fellowship is made possible by a gift from the Honzel Family Foundation, which also provides major support to the broader Center focus on health care ethics and biotechnology.
Wednesday, May. 4, 2011 3:55 PM
"Imagine a village ravaged by pneumonia and far from the nearest clinic. A couple in the village has lost one child to the disease when they are approached by a pharmaceutical company representative asking them to enroll their newborn in a trial for a new pneumonia vaccine"
SCU student Brenda Everling considers the challenges such a couple might confront in understanding key elements of the trial, such as the use of placebos in this Evolving Vaccine Trials: Adaptive Informed Consent in the Global Context, which she presented at the 2011 National Undergraduate Bioethics Conference at Duke University.
Friday, Apr. 29, 2011 2:03 PM
A new case in the Center's ongoing Culturally Competent Care project examines an unproductive encounter between a Latino family and a therapist. Pablo, a 15-year-old, is already enmeshed in the juvenile justice system when he is referred to a therapist for poor concentration, irritability, and oppositional conduct. Pablo's relationship with his mother is one area of misunderstanding. Reflection on the case is offered by SCU Psychology Professor Thomas Plante.
Tuesday, Apr. 19, 2011 11:31 AM
From an ethical point of view, can the cost of a treatment figure into medical decision making? Does this put a dollar figure on the value of human life? Center Bioethics Director Margaret R. McLean leads a discussion with the Center's Emerging Issues group about whether, as individuals or as a society, we can take into account the financial burdens of medical care when we decide decide to accept or forego treatment.