Authors

A doctor holding a paper that reads "stay at home"

Ethical Duties of Health Care Providers and the Public in the Time of COVID-19

Paul C. McLean Leave a comment

By Jonathan M. Marron, Louise P. King, and Paul C. McLean

In medical ethics, we often speak of duties, such as the duty one has to patients, to society, to our families, to ourselves. In fact, deontology is a moral theory often cited in medical ethics based primarily on the consideration and application of such duties.

But we typically speak of duties under “normal” circumstances, and normal certainly does not describe the current COVID-19 pandemic. It is unclear whether and how our typical conceptualization of duties – the duty of clinicians, of health care institutions, and of the public – apply under these unprecedented conditions. These questions are being considered in our hospitals, living rooms, the lay press, and on social media.

What follows is an edited version of a Twitter dialogue between surgeon Louise P. King and pediatric oncologist Jonathan Marron, both faculty members at the Harvard Medical School Center for Bioethics. Drs. King and Marron were responding to a tweet by Paul McLean, social media editor at the Center for Bioethics, on his personal account.

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basketball on court

The Long-Term Harm of Favoritism in COVID-19 Testing

Paul C. McLean Leave a comment

By Jonathan M. Marron and Paul C. McLean

One of us is a sports fan, childhood cancer doctor, and bioethicist. The other is a former sportswriter drawn to medical ethics since the cure of his only child. If sports and ethics have something in common, it’s the value of a level playing field. Fairness matters. There’s a coin toss: heads or tails. Fairness, not favoritism.

We view the doctor-patient relationship through slightly different lenses, but it’s precious either way. It’s a relationship — above all else — built on trust. And that relationship, a cornerstone of healthcare, is suddenly like an already vulnerable person facing an uncertain prognosis. If the doctor-patient relationship is to survive the novel coronavirus (COVID-19) pandemic, it will require a unified team, trust, and a level playing field, regardless of how much money or influence you have.

What does sports have to do with this?

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Graphic of DNA

Science and ethics experts still reeling from #CRISPRbabies fallout

Paul C. McLean 2 Comments

Watching David Baltimore open the #GeneEdit Summit last week brought back a memory of the last time I saw the Nobel laureate in such a role. The 2015 #GeneEditSummit concluded with a Q&A about the summit’s statement — which many considered was a moratorium on gene editing of embryos.

An audience member, with a sense of the promise of the science but concern for buy-in from a distrustful public, asked whether the statement might be translated into clearer language for those hard-pressed to understand CRISPR even with the acronym spelled out for them. To which Baltimore replied: “You mean it isn’t?”

That exchange convinced me that even gene editors need an editor. Especially gene editors. Indeed, if He Jiankui read that 2015 moratorium before he altered his own future in unintended ways, he did not see it as a red light.

In a tweet, director Francis Collins (@NIHdirector) clarified that the National Institutes of Health considers the light red: “The work of Dr. He Jiankui presented at #GeneEditSummit is profoundly disturbing & tramples on ethical norms. We need to develop binding international consensus on limits for this research. #NIH does not support the use of gene-editing in human embryos.”

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organ transplant

The NRA versus Medical Professionals: Only One is Interested in Saving Lives

Paul C. McLean Leave a comment

Advocating for patients is in a physician’s job description. Sometimes we forget that, and need a reminder. The National Rifle Association, a little itchy with its Twitter finger, needed a reminder.

Gun-related injuries and death are a clear public health problem, inspiring a set of guidelines by the American College of Physicians published recently in Annals of Internal Medicine.

To which @NRA had this to say: “Someone should tell self-important anti-gun doctors to stay in their lane.” Read More

group of nurses walking in hospital hallway

Burnout and Moral Distress in Nurses: Can Staffing Numbers Increase Patient Safety?

Paul C. McLean 3 Comments

I know Nurse X only by her failures the night a young woman with asthma died gasping for breath just steps from the emergency entrance of Somerville Hospital. The preventable nature of the woman’s death, and the discovery of that hard truth by her husband, are described thoroughly and compellingly in Sunday’s Boston Globe magazine.

This death was the result of medical error, estimated to be the third leading cause of death behind heart disease and cancer.

But the blurry image of Nurse X, standing in the ER doorway and failing to see the dying woman in the shadows steps away, is for me a snapshot of burnout. I’ll carry it with me to the voting booth on Tuesday when I stare at Question 1, the ballot measure in Massachusetts that could determine and lock into place nurse-to-patient staffing levels. Read More

american flag at half staff

Running healthcare, research and public trust up the flag pole

Paul C. McLean 1 Comment

While I was aghast earlier this week that the White House struggled over whether to fly the flag at half-mast or full for the death of John McCain, and relieved that it was still the American flag, I distracted myself from the drama in Washington with other news:

Item: In Europe, there were 5,000 cases of the measles in all of 2016, 24,000 in 2017, and already 41,000 halfway through 2018, including 37 deaths, according to the World Health Organization. Globally, measles remains a leading cause of death among young children even though a safe and cost-effective vaccine is available.

Item: In the bizarre case of a convicted murdered claiming his victim wouldn’t have died had he stayed on life support, the Georgia Supreme Court rejected that argument because the patient “was basically brain dead.” [PDF]

Item: Twenty-five years later, gene therapy finally got a common-sense definition: “the intentional, expected permanent, and specific alteration of the DNA sequence of the cellular genome, for a clinical purpose.”

Bioethicists, policymakers, and clinicians tend not to lump brain death, gene therapy and the anti-vaccine movement together. And why should they? Though fate management is central to each, they are perplexing enough to the public (i.e. me) when considered separately.

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Can a national conscience be gene edited?

Paul C. McLean Leave a comment

Gene editing is at once promising and perilous. Or, as John Oliver said in a recent episode of his news show, it is ”either going to kill all disease or kill every last one of us.”

The Nuffield Council on Bioethics is not as amusing as John Oliver, and unlike the summer film “Rampage,” its new gene editing report features neither The Rock nor a genetically modified, 30-foot wolf.

But if you want to understand what we may actually be getting ourselves into, England’s de facto national bioethics commission has produced a useful roadmap for educating the public and addressing concerns. It may the summer read you’ve been looking for.

And if there’s a gene splicer for envy, I’m ready to be CRISPR’d.

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doctor and patient talk

The non-capture capture of “patient voice.” Isn’t it ironic?

Paul C. McLean Leave a comment

Register here for this weeks’s event, “Putting Patients at the Center of Research: Opportunities and Challenges for Ethical and Regulatory Oversight”

In a previous life I was a headline writer, so I have to give props for the title of this Friday’s Petrie-Flom panel: “Patients and Conflict of Interest: How Can We Keep the Patient’s Voice from Being ‘Captured’?

That is, how do you avoid “capturing” the patient voice when “capturing” the patient voice is the whole point of Patient Centered Outcomes Research? And yet this is a central challenge to bringing expertise unique to the receiving end of medicine and research into all levels of the process.

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