Bioethics Discussion Blog

REMINDER: I AM POSTING A NEW TOPIC ABOUT ONCE A WEEK OR PERHAPS TWICE A WEEK. HOWEVER, IF YOU DON'T FIND A NEW TOPIC POSTED, THERE ARE AS OF MARCH 2013 OVER 900 TOPIC THREADS TO WHICH YOU CAN READ AND WRITE COMMENTS. I WILL BE AWARE OF EACH COMMENTARY AND MAY COME BACK WITH A REPLY.

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Tuesday, April 10, 2018

Patient Modesty: Volume 86



The above graphic for this Volume really shows distinctly a major discussion point which has continued on our blog thread, literally for years: the requirement for the patient undergoing surgery with general anesthesia to have his underwear removed, in this case for his arthroscopic knee surgery. The story is told by an onion farmer in his blog "Mucking It Up in Muckville"

I hope my visitors here go to the above link and first read the patient's story.  Then, come back and  continue, reading the experience and view of an anethesiologist-ethicist Dr. Alyssa Burgart.  I have been given her permission to reproduce her presentation here but besides writing your Comments to my blog thread, you should go re-read the text and write your comments directly on her own blog "Medicine, Ethics and More" and therefore to her own readers.  I am pleased to be able to get Dr. Burgart's experience and knowledge in both her areas of experience.
Her blog address: http://www.alyssaburgart.com/blog/2018/04/11/underwear-for-surgery/ and here is what she wrote:



Why was I asked to take off my underwear for surgery?







It can feel weird to be asked to take off your knickers… Underwear makes us feel proper, protected, clothed. Even though I get that those are concerns, there are several reasons why you may be asked to remove underwear:
Number One and Number Two
Under general anesthesia, patients sometimes pee and/or poop. It’s not pretty, it’s not always easy to know when this will happen, and we usually ask patients to use the restroom before surgery by means of prevention. If a surgery will be very short, the risk is lower. It is completely irrelevant which body part being operated on when the whole body is anesthetized and unfortunately, this can be a messy situation. The nice, clean skivvies the patient wore to the hospital are going to be peeled off and put in a biohazard bag. Patients do not necessarily bring extra underwear with them and don’t have any to wear home. Removing the garments before surgery means the patient can put those clean undies on when they wake up. We usually still have patients lie on an absorbent towel/pad, just in case. Undies or no, the nurses in the OR are going to make sure the skin is cleaned before the patient wakes up.
Time
If a surgery is long, a Foley catheter is typically placed to drain, collect, and measure urine. Placing the catheter requires sterile prep of the genital area and underwear are going to be in the way. They won’t fit properly and can apply unwanted pressure to the catheter once placed. This can even cause a pressure injury to the skin.
Spic and Span
Some people (not you, I’m sure) wear undies that are not very clean. It’s a gross over-generalization to apply that concern to everyone, but for practical reasons, it can be easier to just have everyone take them off.  If you’re having a belly surgery, your skin will usually need to be cleaned as low as your pubic bone. Knee surgery? To clean the whole knee, it has to be lifted up and the prep drips down the thigh. Those undies can get saturated with cleaning solution. They might get stained with the dye in the soap, which is rude on our part. They may not dry very quickly– and this can increase the risk of a fire during surgery (yeah – we have to worry about your pants on fire!). Realistically, the only procedures that underwear don’t get in the way are those on the chest and above.
While You Were Sleeping, We Got Back Pain
Is it more awkward to ask a patient to take off their panties or, if they absolutely have to come off, to take them off when they’re under anesthesia? Personally, I think it’s weird to wait until someone is anesthetized to take off their tighty whities. Then the patient wakes up having lost their underoos. If they need to come off for any number of reasons, I prefer the patient does it themselves. I think it’s weird to take them off in the operating room. Plus, it can take multiple people to get them off and we genuinely risk workplace injuries (back pain anyone?) to do so.
That’s nice, but maybe you still don’t want to ditch your briefs.
There may be hospital staff that get their panties in a bunch about your underpants. If you’re an adult, no one can MAKE YOU take off your clothes. If you refuse to do it, you can take your chances that your underwear will be on your body and be clean. But they may need to come off emergently (or because they interfere with the procedure you showed up to get) and that may mean they get cut off. There is dignity in controlling the removal of your own clothes, as I would personally find it more of an affront to emerge from anesthesia with clothing inexplicably missing. But that’s me. Maybe you don’t mind. There are perfectly uncomfortable mesh underwear that hospitals are likely to have on hand – meant to hold absorbent pads for post-partum or menstruating patients, or who have other reasons to need them. (To the above points, those will be promptly cut off if they are in the way, or of the patient urinates.)
When teens and adults are concerned about removing their underpants, I ask them why and offer to explain the reasons why it is called for in their particular case. Generally, I think the whole underwear things gets patients bend out of shape when they don’t feel they are being heard. Coming in for surgery is stressful, and maybe taking your tighty whities off based on the demands of a pre-op nurse is the last straw. When it comes down to it, patients are usually certain that they are just being asked to do something ridiculous, with not reasoning behind it. Secondly, they are concerned that their body will not be respected while they’re anesthetized and that it will be exposed for no good reason. By staff taking the question seriously, a dialog can form where the patient hears that they are respected, and staff have a chance to explain that this isn’t a thoughtless, nonsensical request to diminish inherent human dignity.
We have better things to do all day than play power mind games with our patients. I can’t speak for every operating room out there, but I have yet to be in an OR where patients were left exposed for no good reason. First and foremost, we respect patients’ dignity and modesty. We have lots of sheets and blankets and use them to cover whatever we can. On a practical matter, it’s really important to keep patients warm, and leaving them uncovered is super counter productive.
On the surface, most of these reasons might seem like they are solely for the benefit of the healthcare people involved, but I think they are rooted in an effort to prevent patient inconvenience from dirty, damaged, wet, stained undies and loss of dignity from being given a biohazard bag full of soiled unmentionables, and to ensure that, above all, the patient gets safe care. If you disagree and refuse to take em off, staff should listen to your concerns to find an acceptable solution.


Tuesday, March 06, 2018

Patient Modesty: Volume 85


I think this Volume's graphic really defines the basis for the ongoing modesty discussions which continues to focus on the behavior of some females in the healthcare profession with regard to their male patients but also importantly seemingly often the inability of male patients to express their distress or, in fact, change the system to male demands for the system to attend to their modesty as the system offers to female patients. The men seeming just have to stand for this inequality. Isn't this "the Problem"? ..Maurice.

Graphic: From Google Images and modified by me with ArtRage.

Beginning TODAY  April 10 2018, no further Comments will be posted on Volume 85 but the
discussion can continue on Volume 86.  



Monday, February 05, 2018

President Trump:Diagnosis and, if Necessary Therapy: Doing it Ethically









An excellent article written by physician-ethicist  Joseph J. Fins in Harvard Medical  School Bioethics Journal  and it is my reading that he suggests when it comes to the psychiatric fitness of Donald Trump to be the United States President, it should not be a psychiatric diagnosis (such as "sociopathy")  from afar but should be the education of the public in a clinical non-partisan fashion  by the psychiatrists of the symptoms of disease and it will be the public and their government to prescribe and carry out the appropriate treatment. 


In Dr. Fin's words:


In the context of the president’s personality, it is not an outright diagnosis that is needed per se but a public appreciation of what sociopathy is that can help inform a response. Medical diagnosis demands a high evidentiary standard. In the public sphere, mere knowledge of what sociopathy entails may enable the requisite scientific literacy for the citizenry to decide if observed behaviors fit a discernable pattern of psychiatric diagnosis that has a bearing on an ability to govern. This knowledge is especially important in sociopathy, which by its nature can obscure and seduce the observer. Human nature is drawn to sociopathy and vulnerable to its charm. Public awareness of sociopathy’s existence and nature is thus vital to deliberative democracy. This knowledge becomes a component of basic scientific literacy for deliberative democracy. Having said this, this knowledge need not require understanding at the level of clinical nosology. It may constitute essential knowledge like the germ theory of disease: even if they can not diagnostically distinguish an errant gastroenteritis caused by E. Coli or Salmonella, the public knows enough to engage in personal hygiene and perhaps avoid potato salads simmering in the sun at a summer picnic. Public knowledge about sociopathy has a similar utility: it can help guide behaviors and inform responses by our political leaders and journalists in the Fourth Estate as they do their work. 



So read the entire but brief article  and return with your idea of the role, if any, for the psychiatrists in relation to the American public with regard to President Trump.  Remember, this thread is not about presidential policies but about how to make a psychiatric diagnosis and who should be supervising any treatment.  ..Maurice.

GRAPHIC: From Google Images

Sunday, February 04, 2018

Patient Modesty: Volume 84





Currently on a bioethics listserv to which I read and contribute there is a discussion about policies within the healthcare system which attempt to protect the participants of the medical institution from demands of patients with regard to race and ethnic background.  One response by a physician was that his hospital institution had a policy to
"employ people on the basis of their skills and competence and without regard to gender, skin color, religion, etc. and when patients or families make discriminatory requests they must be evaluated in light of this commitment.  Some seemingly discriminatory requests may be accommodated if there are good reasons to believe they have good psychological or medical validity and if doing so can be accomplished without compromising patient care pr staff safety (e.g., a teenage girl requesting a female physician for a pelvic exam).  In our experience, the overwhelming majority of these incidents occur with nursing staff and allied health personnel (like phlebotomists or ECG techs). Most never percolate up the chain so that senior folks hear about them and they are usually handled locally by juggling staff assignments."

I responded with : It ain't just a "teenage  girl requesting " a gender selection of a physician or more often that of nursing and allied staff (including scribes!) performing or presence when genitals are being exposed.  And in my 13 year ongoing Bioethics Discussion Blog thread on "Patient Modesty" it is mainly men who are demanding but very often not receiving their gender "discrimination" requests and are left either avoiding necessary medical care or leaving "care" emotionally upset.  Although my blog thread is titled "modesty" there  has  been "no...none" racial or country origin demands ever mentioned or exampled. 

Well, another listserv participant followed up with: "Maurice, maybe that is because discriminatory requests based on race or national origin are not necessarily associated with the heading of 'modesty' ?"  

And so to start off this new Volume,  yes, the title of this thread is "modesty" but is it true as the participant wrote it is inappropriate for me to infer that beyond this issue the writers here are free from racial or ethnic bias or any of the other issues of social inequality because of this thread's directed subject matter?  Or are gender issues lengthily covered here may be or are  related to other medical treatment concerns which could be described as attached to other aspects of social equality or inequality such as race and ethnic origin which also bothers my visitors? Repeating: Is the medical profession not offering all that it should be offering to patient desires to those writing here in terms of social quality, beyond poor attention to modesty.  ..Maurice.

Graphic: From Google Images and modified by me with ArtRage 3.  

THERE WILL BE NO FURTHER POSTING OF COMMENTS ON VOLUME 84.
THE POSTING OF COMMENTS WILL RESUME ON VOLUME 85.



Saturday, January 20, 2018

Difficult Patient vs Difficult Doctor

One cannot ignore the potential for conflictive behavior as a potential in medical patient-physician relationships (and indeed associated with other individuals in the medical system interacting with patients and patients interacting with them.) This behavior can be disruptive to attain important professional relationships and effective diagnosis and treatment. 

The following is a brief analysis of the dynamics associated with such behavior and hopefully toward resolution as researched and written by a first year medical student.  The obvious goal, hopefully, is resolution of potential conflicts to promote a therapeutically effective doctor-patient relationship.  My visitors' views on this issue are welcome.  ...Maurice.

                   DIFFICULT PATIENT VS DIFFICULT DOCTOR
                                                           
                                           Surabhi Reddy
                                   First Year Medical Student

A doctor’s worst nightmare? A patient that is impatient, inattentive, rude, and demanding. A patient’s worst nightmare? A doctor that is impatient, inattentive, rude, and demanding. A so-called “difficult patient” or “difficult doctor” represent two sides of the same coin, with similar behavioral and communicative factors causing conflict. Occasionally, the difficult relationship may culminate in a
messy outburst – as recently seen in a violent altercation between a Gainesville doctor and patient.1  The duality of the patient-physician relationship allows us to examine (from both perspectives) what underlying actions and issues initiate the conflict – and eventually focus on mediation and resolution. Addressing the “difficult” nature of these parties is a vital first step towards creating positive patient-physician relationships and health outcomes.

You may hear the phrase “difficult patient” offhandedly thrown around in a physician’s lounge – a blanket term like “problem child” or “one of those” that draws universal understanding but little clarity on the specifics of the interaction. Physicians characterize 15-20% of all patients as “difficult.”2,3 Such encounters point to a strong association between the “difficult” characterization and patient mental disorder – namely, depression, panic disorder, and anxiety.2,3 Doctors note these patients are either 1) not interested in a medical opinion whatsoever, or 2) have repetitive, non-specific complaints. However, it was also noted that difficult patients are hard to describe and characterize as a group.4 Mental health does not preclude a difficult interaction. In a series of interviews, physicians described “difficult” as conversational issues such as patients being “violent, demanding, aggressive, rude and [seeking] secondary gain.”5 Physicians describe their primary motivations as the desire to solve medical problems and help others – and anything that stymies this process sadly draws the label “difficult.”

The onus is not completely on the patient, however. One study points out that the difficulty may stem from the doctor’s work style, belief system, and/or cultural barriers.5 The more experienced a family medicine physician is, the less likely he/she is to characterize a patient as “difficult” – suggesting that there is a burden on the doctor to develop the interpersonal skills to handle the interaction. Collectively, physicians that report high frustration with patients are those that are younger, work longer hours, and have symptoms of depression, anxiety, and stress.6 While physicians often characterize patients as difficult, patients are less likely to describe their physician as so. In most studies, patients are evaluated for their “satisfaction,” which includes many aspects of their medical care, including perceived expectations, the underlying medical condition, and other members of the healthcare team. This may also reflect the power dynamic between patient and physician. Patient complaints may be dismissed, once again, as the patient being “difficult” - leaving the physician immune to criticism.

The difficult patient-physician relationship involves both behavioral (mental disorders, stress) and communicative (rude and aggressive language) factors from both parties. Ultimately, cooperative relationships stem from respect, empathy, and patience. As one physician stated in his interview, “First of all, what I have learned with the years is being empathetic toward [patients].” Taking the time to understand another’s perspective can go a long way in making the difficult into easy.5



Sources
1.       Bever, Lindsey. (2017). A doctor shouted at a sick mother to 'get the hell out.' Now he's under criminal investigation. Washington Post.
2.       Hahn, S. R., Kroenke, K., Spitzer, R. L., Brody, D., Williams, J. B., Linzer, M., & Verloin deGruy, F. (1996). The difficult patient. Journal of general internal medicine, 11(1), 1-8.
3.       Jackson, J. L., & Kroenke, K. (1999). Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Archives of Internal Medicine, 159(10), 1069-1075.
4.       Koekkoek, B., van Meijel, B., & Hutschemaekers, G. (2006). " Difficult patients" in mental health care: a review. Psychiatric Services, 57(6), 795-802.
5.       Steinmetz, D., & Tabenkin, H. (2001). The ‘difficult patient' as perceived by family physicians. Family practice, 18(5), 495-500.

6.       Krebs, E. E., Garrett, J. M., & Konrad, T. R. (2006). The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data. BMC health services research, 6(1), 128. 


 GRAPHIC: From Google Images.

Monday, December 25, 2017

Patient Modesty: Volume 83


And the discussion about inequality in certain aspects of medical attention and behavior by the medical system toward male patients continues..
For those arriving here prior to reviewing Volume 82, you may want to go to Volume 82 to refresh yourself on the ongoing conversations. Graphic: From Google Images ("Public Domain Review")  and my modification using ArtRage Studio Pro.


AS OF FEBRUARY 4 2018 NO FURTHER COMMENTS WILL BE PUBLISHED ON THIS VOLUME.  PLEASE WRITE YOUR COMMENTS NOW ON VOLUME 84.

Saturday, December 23, 2017

The 1000th Thread!


This is the 1000th presentation to my bioethics blog since starting on Google Blogspot.com in 2004.
There has been many topics covered. Though comments by the visitors has always been encouraged and, since as a "discussion blog", comments leading to discussions I have felt was the definitive function here. Virtually none of the thread topics have gone unread and most have had some commentary, some with mainly particularly strong and emphatic opinions http://bioethicsdiscussion.blogspot.com/2013/01/should-pathologists-be-physicians.html, some with extensive up to 12 years long continued discussion http://bioethicsdiscussion.blogspot.com/2017/10/patient-modesty-volume-82.html, still there have been some with no visitor response http://bioethicsdiscussion.blogspot.com/2005/01/public-good-vs-money-in-pockets-or.html. It is interesting to understand why such differences have occurred.
Though most of the topics were bioethics as related to the subject of medical care, an occasional topic was related to plants http://bioethicsdiscussion.blogspot.com/2014/06/can-tree-experience-hurt-if-it-can-do.html and animals  http://bioethicsdiscussion.blogspot.com/2012/04/spending-lot-of-money-on-your-sick-dog.html.
Nevertheless, it is the multitude of issues regarding human medical ethics which has dominated this blog.  In  my opinion, a great listing and summarization of those issues was and is being presented by Wikipedia https://en.wikipedia.org/wiki/List_of_medical_ethics_cases and is reproduced below (courtesy of published permission for reproduction by Wikimedia).
I want, in this 1000th thread posting, to thank all those who have participated to, by their comments and input made this blog more interesting and dynamic than if my thoughts were simply just a "list". It is the "back and forth" of  discussion which makes a commentary written by one person something dynamic and much more useful and of value.   Best wishes to all and a happy upcoming New Year.  ..Maurice.  Graphic: Use of Picasa 3

List of medical ethics cases
From Wikipedia, the free encyclopedia
Some cases have been remarkable for starting broad discussion and for setting precedent in medical ethics.
Contents
  [hide] 
·         1Research
·         7References
Research[edit]
Research
case
country
location
year
summary
1880s
Psychosurgery (also called neurosurgery for mental disorder) has a long history. During the 1960s and 1970s, it became the subject of increasing public concern and debate, culminating in the US with congressional hearings. Particularly controversial was the work of Harvard neurosurgeon Vernon Markand psychiatrist Frank Ervin, who wrote a book entitled Violence and the Brain in 1970.[1] The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in 1977 endorsed the continued limited use of psychosurgical procedures.[1][2]Since then, a few facilities in some countries have continued to use psychosurgery on small numbers of patients. In the US and other Western countries, the number of operations has further declined over the past 30 years, a period during which there have been no major advances in ablative psychosurgery.[3]
United States
1920s
Controversial psychiatrist Henry Cotton at Trenton State Hospital in New Jersey became convinced that insanity was fundamentally a toxic disorder and he surgically removed body parts to try to improve mental health.[4]
United States
Iowa
1939
The Monster Study is the name given to a stuttering experiment performed on orphan children in Davenport, Iowa in 1939. It was conducted by Wendell Johnson at the University of Iowa. The research began with the selection of 22 subjects from a veterans' orphanage in Iowa. None were told the intent of the research, and they believed that they were to receive speech therapy. The study was trying to induce stuttering in healthy children. The experiment became national news in the San Jose Mercury News in 2001, and a book was written. On 17 August 2007, six of the orphan children were awarded $925,000 by the State of Iowa for lifelong psychological and emotional scars caused by six months of torment during the Iowa University experiment. Although none of the children became stutterers, some became self-conscious and reluctant to speak.[5] A spokesman for the University of Iowa called the experiment "regrettable".
Medical Experimentation on Black Americans[6]
United States
Various
Occurred over many decades
There has been a long history of medical experimentation on African Americans. From the era of slavery, when atrocities were committed on black women by J. Marion Sims, to the present day, Black Americans have been unwitting subjects of medical experimentation.[7][8] Author Harriet Washington argues that "diverse forms of racial discrimination have shaped both the relationship between white physicians and black patients and the attitude of the latter towards modern medicine in general".[9]
In the 1960s, Ionia State Hospital, located in Ionia, Michigan, was one of America's largest and most notorious state psychiatric hospitalsin the era before deinstitutionalization. Doctors at this hospital diagnosed African Americanswith schizophrenia because of their civil rightsideas. See The Protest Psychosis.
Plutonium injections
United States
1945-1947
Eighteen people were injected with plutoniumby Manhattan Project doctors. None of the patients was told what was going on, and the doctors did not ask for their consent. See Eileen Welsome's book The Plutonium Files.[10]
United States
1946
German medical doctors went on criminal trial for Nazi human experimentation. See The Years of Extermination.
U.S./
Guatemala
1946-48
The syphilis experiments in Guatemala were United States human experiments conducted in Guatemala from 1946 to 1948. The experiments were led by physician John Charles Cutler. They were done during the administration of American President Harry S. Truman and Guatemalan President Juan José Arévalo.[11]
Doctors infected soldiers, prostitutes, prisoners, and mental patients with syphilisand other sexually transmitted diseaseswithout the informed consent of the subjects, and treated most subjects with antibiotics. This resulted in at least 83 deaths.[12] In October 2010, the US formally apologized to Guatemala for conducting these experiments.
United States
New York State
1950s
More than 1200 homeless men from Lower Manhattan were convinced with promises of food and shelter to have their prostates biopsied by a Dr. Perry Hudson. They were not informed of possible side effects, i.e., rectal tearing and impotence. The homeless were targeted for these biopsies because the biopsies were painful and untested, and less vulnerable populations would not volunteer.
Radioactive iodine experiments
United States
1950s
The U.S. Atomic Energy Commission has a history of involvement in experiments involving radioactive iodine. In a 1949 operation called the "Green Run," the AEC released iodine-131and xenon-133 to the atmosphere, which contaminated a 500,000-acre (2,000 km2) area containing three small towns near the Hanford site in Washington.[13] In 1953, the AEC ran several studies on the health effects of radioactive iodine in newborns and pregnant women at the University of Iowa. Also in 1953, the AEC sponsored a study to discover if radioactive iodine affected premature babies differently from full-term babies.[14] In another AEC study, researchers at the University of Nebraska College of Medicine fed iodine-131 to 28 healthy infants through a gastric tube to test the concentration of iodine in the infants' thyroid glands.[14]
United States
1951
A product derived from a cancer patient's specimen, HeLa is the cornerstone of an industry. Cancerous tissue was taken from her without her consent.
United States
Philadelphia
1951-1974
Clinical non-therapeutic medical experiments on prison inmates was conducted at Holmesburg Prison in Philadelphia from 1951 to 1974 under the direction of dermatologistAlbert Kligman.[15]
Canada
1957–1964
The Allan Memorial Institute is known for its role in the Project MKULTRA run by the CIA. The Agency's initiative to develop drug-induced "mind control" techniques was implemented in the institute by its then-Director Donald Ewen Cameron.
UK mental institutions
UK
1960s
In the 1960s, there was abuse and inhumane treatment of psychiatric patients who were hidden away in institutions in the UK. Barbara Robb documented her difficult personal experience of being treated at Ely Hospital. She wrote the book Sans Everything and she used this to launch a campaign to improve or close long stay facilities. Shortly after, a long stay hospital for the mentally handicapped in Cardiff was exposed by a nurse writing to the News of the World. This exposure prompted an official inquiry, which was highly critical of conditions, staff morale, and management. At the same time Michael Ignatieff and Peter Townsend both published books which exposed the poor quality of institutional care.[16]
United States
1961
The Milgram experiment on obedience to authority figures was a series of notable social psychology experiments conducted by Yale University psychologist Stanley Milgram, which measured the willingness of study participants to obey an authority figure who instructed them to perform acts that conflicted with their personal conscience.[17] The detailed findings are discussed in his 1974 book, Obedience to Authority: An Experimental View.[18] The experiments were controversial, and considered by some scientists to be unethical and physically or psychologically abusive. Psychologist Diana Baumrind considered the experiment "harmful because it may cause permanent psychological damage and cause people to be less trusting in the future." [19]
1962-1979
Controversial Australian psychiatrist Harry Bailey treated mental patients via deep sleep therapy and other methods at a Sydney mental hospital. He has been linked with the deaths of 85 patients.[20] He committed suicide before he could be punished.
Soviet Union, Romania,
Hungary,
Czechoslovakia, Yugoslavia and China
1960s to 1980s
Psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience.[21]:6 In the period from the 1960s to 1986, abuse of psychiatry for political purposes was reported to be systematic in the Soviet Union and other Eastern European countries.[22]:66 Political abuse of psychiatry also takes place in the People's Republic of China.[23] Psychiatric diagnoses such as the diagnosis of "sluggish schizophrenia" in political dissidents in the USSR were used for political purposes.[24]:77
United States
1971
The Stanford prison experiment was a study of the psychological effects of becoming a prisoner or prison guard. The experiment was conducted in August 1971 by a team of researchers led by psychology professor Philip Zimbardo.[25] Participants took on the roles of prisoners and guards in a mock prison situated in the basement of the Stanford psychology building. Some of the prisoners were subjected to psychological torture. Many of the prisoners passively accepted psychological abuse, and Zimbardo himself permitted the abuse to continue. Two of the prisoners quit the experiment early and the entire experiment was abruptly stopped after only six days. Certain portions of the experiment were filmed and excerpts of footage are publicly available.
United States
1970s
Human radiation experiments were directed by the United States Atomic Energy Commissionand the Manhattan Project. In Nashville, pregnant women were given radioactive mixtures. In Cincinnati, some 200 patients were irradiated over a period of 15 years. In Chicago, 102 people received injections of strontium and cesium solutions. In Massachusetts, 74 schoolboys were fed oatmeal that contained radioactive substances. In all of these cases, the subjects did not know what was going on and did not give informed consent.[10] The government covered up most of these radiation mishaps until 1993, when President Bill Clinton ordered a change of policy. The resulting investigation was undertaken by the Advisory Committee on Human Radiation Experiments. See The Plutonium Files.
United States
1972
A 40-year experiment conducted by the U.S. Public Health Service withheld standard medical advice and treatment from a poor minority population with an easily treatable disease. The experiment targeted black male farmers who were told they needed to be treated for 'bad blood',[26] some of whom had previously encountered syphilis. Others were intentionally given syphilis during the course of the experiment. In addition to many fatalities, some children were born with congenital syphilis due to the study.
United States
1976
Researchers commercialized a patient's discarded body parts. The man did not authorize the use of his bodily tissues or fluids, and researchers did not obtain informed consent. He did not want his donation to generate commercial profit for private entities.
1980s
Eugene Ellsworth Landy was an American psychologist and psychotherapist best known for his unconventional 24-hour therapy as well as ethical violations concerning his treatment of Beach Boys co-founder Brian Wilson in the 1980s. In 2015, Landy's relationship with Wilson was dramatized in the biographical filmLove & Mercy.
United States
1987
A school had been infecting disabled children in experiments for years.
Canada, United States
12 psychiatric centers
1994–2001
SmithKlineBeecham, known since 2000 as GlaxoSmithKline, conducted a clinical trial from 1994 to 1997 in 12 pychiatric centers in North America to study the efficacy of paroxetine(Paxil, Seroxat), an anti-depressant, on teenagers. The trial data suggested that the drug was not efficacious and that the paroxetine group were more likely to think about suicide. The paper that wrote up the study was published in 2001, osensibly authored by a group of academics, but actually ghostwritten by the drug company. The article downplayed the negative findings and concluded that paroxetine helped with teenage depression. The company used this paper to promote paroxetine for teenagers. The ensuing controversy led to several lawsuits, including from the parents of teenagers who killed themselves while taking the drug, and intensified the debate about medical ghostwriting and conflict of interest in clinical trials. In 2012 the US Justice Department fined GlaxoSmithKline $3 billion for several violations, including withholding data on paroxetine, unlawfully promoting it for adolescents, and preparing a misleading article about study 329. New Scientist wrote in 2015: "You may never have heard of it, but Study 329 changed medicine."[27]
Death associated with psychotropic drugs
United States
1998
In 1998, 60-year-old Donald Schell went to see his doctor complaining of difficulty sleeping. He was diagnosed with an anxiety state and placed on Paxil, an SSRI anti-depressant. Within 48 hours of being put on Paxil Schell killed his wife, daughter, infant granddaughter, and himself. Tim Tobin, Schell’s son-in-law, took legal action against SmithKline (now GlaxoSmithKline). The Tobin case was heard in Wyoming from May 21 to June 6, 2001. The jury returned a guilty verdict against SmithKline and awarded Tobin $6.4 million.[28][29][30][31]This was the first guilty verdict returned against a pharmaceutical company regarding adverse behavioral effects of a psychotropic drug.[28]
United States
2002
Courtney is a former pharmacist who owned and operated Research Medical Tower Pharmacy in Missouri.[32] In 2002, he was convicted of pharmaceutical fraud and sentenced to federal prison.[32]
United States
2003
Patients donated tissue samples, which researchers subsequently used in a plan to generate profit.
GlaxoSmithKlinehuman experiments
Various
2004–2012
In 2004 GlaxoSmithKline (GSK) sponsored at least four medical trials using Hispanic and black children at New York's Incarnation Children's Center. Normally trials on children require parental consent but, as the infants were in care, New York's authorities held that role. Experiments were designed to test the “safety and tolerance” of AIDS medications, some of which have potentially dangerous side effects.[33]
In 2006, GSK and the US Army were criticized for Hepatitis E vaccine experiments conducted in 2003 on 2,000 soldiers of the Royal Nepalese Army. It was said that using soldiers as volunteers is unethical because they "could easily be coerced into taking part."[34]
In January 2012, GSK and two scientists who led the trials were fined approximately $240,000 in Argentina for "experimenting with human beings" and "falsifying parental authorization" during vaccine trials on 15,000 children under the age of one. Babies were recruited from poor families that visited public hospitals for medical treatment. Fourteen babies allegedly died as a result of the trials.[35]
Death from prescription drugs
United States
2006
Rebecca Riley, the daughter of Michael and Carolyn Riley of Massachusetts, was found dead in her home at age four, her lungs filled with fluid, after prolonged exposure to various medications. The medical examiner's office determined the girl died from "intoxication due to the combined effects" of prescription drugs. Police reports state she was taking 750 milligrams a day of Depakote, 200 milligrams a day of Seroquel, and .35 milligrams a day of Clonidine. Rebecca had been taking the drugs since the age of two for bipolar disorder and ADHD, diagnosed by child psychiatrist Kayoko Kifuji of the Tufts-New England Medical Center.[36]
University of MinnesotaResearch Participant Dan Markingson
United States
Minnesota
2004
University of Minnesota research participant Dan Markingson committed suicide in May 2004 while enrolled in an industry-sponsored pharmaceutical trial comparing three FDA-approved atypical antipsychotics: Seroquel (quetiapine)Zyprexa (olanzapine), and Risperdal (risperidone). Writing on the circumstances surrounding Markingson's death in the study, which was designed and funded by Seroquel manufacturer AstraZeneca, University of Minnesota Professor of Bioethics Carl Elliott noted that Markingson was enrolled in the study against the wishes of his mother, Mary Weiss, and that he was forced to choose between enrolling in the study or being involuntarily committed to a state mental institution.[37] Further investigation revealed financial ties to AstraZeneca by Markingson's psychiatrist, Dr. Stephen C. Olson, oversights and biases in AstraZeneca's trial design, and the inadequacy of university Institutional Review Board (IRB)protections for research subjects.[38] Although a 2005 FDA investigation appeared to clear the university, greater awareness of the case stemming from Elliott's 2010 article in the magazine Mother Jones resulted in a group of university faculty members sending a public letter to the Board of Regents urging an external investigation into Markingson's death.[39]
Termination of mechanical ventilation and life support[edit]
case
country
location
year
summary
United States
2008
A hospital wished to withhold treatment from someone whom it judges to have no chance of living.
United States
2008
The parents of a brain-dead boy wanted to keep him on life support.
United States
2007
Prison officials question whether to force-feed inmates who are on hunger strike.
United Kingdom
2017
After losing a UK Supreme Court case, the parents of Gard, 10 months, petitioned the EU Court in France, and lost the final appeal. They wanted the hospital to allow them to travel to the U.S. for an experimental therapy that may have provided some temporary benefit but likely would not have improved his neurological condition, due to a mitochondrial DNA depletion disease (the treatment is nucleoside bypass therapy). At the least, they wanted for the hospital to continue to provide advanced life support palliative care for their son—respiration, nutrition, hydration—or to send him home on life support to eventually die, but those requests were also denied and support will be turned off.
United States
2005
The hospital removes life support from an unconscious immigrant from Eritrea against her family's wishes. The family are in a foreign country and unable to travel.
2010
A man seems to be in a persistent vegetative state, and after 23 years a communication test is conducted.
United States
Texas
2004
An infant is removed from life support against his mother's wishes.
United States
1992
The mother of an anencephalic baby wishes to keep the child on life support perpetually.
United States
2004
Parents wish to keep a child on life support.
United States
2005
A family wishes to keep life support for a man in a persistent vegetative state.
United States
1984
A boy dies at age 12 after living a lifetime with highly unusual medical care in a sterile environment.
United States
2013
A teenaged woman is declared brain-dead and her family wishes to maintain her body on mechanical ventilation perpetually.
Withholding life-prolonging medical treatment[edit]
Withholding life-prolonging treatment
case
country
location
year
summary
United States
1983
The parents of a child born with horrible birth defects request the right to refuse treatment and keep the child off life support.
Australia
1989
Parents and doctors agreed to withhold life-prolonging measures of severely disabled newborn baby, including surgeries and medication, while Right to Life activists claimed the baby was murdered.[40]
Informed consent to medical treatment[edit]
Informed consent to medical treatment
case
country
location
year
summary
Germany
2011
Informed consent and involuntary sex reassignment in the case of an adult intersex woman.
England
1985
The right of minors to request contraception from their doctor without parental consent.
Person wishes for assisted suicide[edit]
Assisted suicide
case
country
location
year
summary
2007
A couple request the legal right to commit suicide together, although only the husband was ill.
United States
1973
A man who suffered severe burns requests the right to die.
Italy
2007
A man in pain requests a legal right to die.
Canada
1991
A woman requests a right to assisted suicide.
Spain
1998
For 29 years a man requests his right to assisted suicide.
India
2011
A court case debates the right to die for a woman in a persistent vegetative state for 37 years.
Italy
2006
A patient requests a legal right to die.
Person wishes for euthanasia for another[edit]
Euthanasia of another
case
country
location
year
summary
United States
2008
A parent is charged with critically harming his child who is on life support. If the child dies, the parent may be charged with murder. At question was whether parents should be legally allowed to make medical decisions for children they have allegedly abused.
England
1993
Bland was the first patient in English legal history to be allowed to die by the courts through the withdrawal of life-prolonging treatment.
United States
2002
A mother euthanizes her adult sons to relieve their suffering from Huntington's disease.
United States
1990
The parents of a woman in a persistent vegetative state request the right to remove her life support equipment.
1992
Parents receive permission to remove the life support from a woman in a persistent vegetative state for 17 years.
United States
2009
A sister is charged with euthanizing her brother after he has medical problems.
United States
Michigan
1994
A medical doctor advocates for assisted suicide and the right to die.
Canada
1993
A man euthanizes his child who has lived for years in pain.
United States
New Jersey
1976
A 21-year-old girl is in a persistent vegetative state. Her parents wish to remove her from artificial respiration.
United States
2005
A woman is in a persistent vegetative state. Her husband wishes to remove her life support. Her parents wish her to remain on life support.
United States
2013
A woman is declared brain-dead by her physician. Her husband and family wish to remove life support. The hospital persists in keeping her on life support because it claims it cannot legally withdraw life support from a pregnant patient.
References[edit]
1.      Jump up to:a b Mashour, G.A.; Walker, E.E.; Martuza, R.L. (2005). "Psychosurgery: past, present and future". Brain Research Reviews. 48 (3): 409–18. doi:10.1016/j.brainresrev.2004.09.002PMID 15914249.
2.      Jump up^ Casey, B.P. (Mar 2015). "The surgical elimination of violence? Conflicting attitudes towards technology and science during the psychosurgery controversy of the 1970s". Science in Context. 28 (1): 99–129. doi:10.1017/S0269889714000349PMID 25832572.
3.      Jump up^ Sachdev, P.; Chen, X. (2009). "Neurosurgical treatment of mood disorders: traditional psychosurgery and the advent of deep brain stimulation". Current Opinion in Psychiatry. 22 (1): 25–31. doi:10.1097/YCO.0b013e32831c8475PMID 19122531.
5.      Jump up^ Huge payout in US stuttering case - BBC News
8.      Jump up^ Nelson, Alondra (7 January 2007). "Unequal Treatment. Medical Apartheid"The Washington Post.
12.    Jump up^ "Guatemalans 'died' in 1940s US syphilis study"BBC News. 29 August 2011. Retrieved 29 August 2011.
13.    Jump up^ Goliszek, Andrew (2003). In The Name of Science. New York: St. Martin's Press. pp. 130–131. ISBN 978-0-312-30356-3.
14.    Jump up to:a b Goliszek, Andrew (2003). In The Name of Science. New York: St. Martin's Press. pp. 132–134. ISBN 978-0-312-30356-3.
15.    Jump up^ Richardson, Theresa (2001). "Acres of skin: human experiments at Holmesburg Prison. A true story of abuse and exploitation in the name of medical science". Canadian Journal of History. 36 (1): 184–186.
17.    Jump up^ Milgram, Stanley (1963). "Behavioral Study of Obedience". Journal of Abnormal and Social Psychology. 67 (4): 371–78. doi:10.1037/h0040525PMID 14049516. as PDF. Archived 2011-06-11 at the Wayback Machine.
18.    Jump up^ Milgram, Stanley (1974). Obedience to Authority; An Experimental View. Harpercollins. ISBN 0-06-131983-X.
19.    Jump up^ Baumrind, Diana (1964). "Some Thoughts on Ethics of Research: After Reading Milgram's "Behavioral Study of Obedience". American Psychologist. 19: 421–423. doi:10.1037/h0040128.
20.    Jump up^ Kaplan, Robert (2009). Medical Murder: Disturbing Cases of Doctors Who Kill. Allen & Unwin. ISBN 1741765773.
21.    Jump up^ Semple, David; Smyth, Roger; Burns, Jonathan (2005). Oxford handbook of psychiatry. Oxford: Oxford University Press. p. 6. ISBN 0-19-852783-7.
23.    Jump up^ van Voren, Robert (January 2010). "Political Abuse of Psychiatry—An Historical Overview"Schizophrenia Bulletin36 (1): 33–35. doi:10.1093/schbul/sbp119PMC 2800147Freely accessiblePMID 19892821.
24.    Jump up^ Katona, Cornelius; Robertson, Mary (2005). Psychiatry at a glance. Wiley-Blackwell. p. 77. ISBN 1-4051-2404-0.
26.    Jump up^ "Tuskegee Study - Timeline". NCHHSTP. CDC. June 25, 2008. Retrieved December 4, 2008
27.    Jump up^ "New look at antidepressant suicide risks from infamous trial"New Scientist, 16 September 2015.
28.    Jump up to:a b Anne Thompson (July 9, 2001). "Paxil Maker Held Liable in Murder/Suicide". Lawyers Weekly USA.
31.    Jump up^ Philip J. Hilts (June 8, 2001). "Jury Awards $6.4 Million in Killings Tied to Drug". The New York Times.
32.    Jump up to:a b Draper, Robert (June 8, 2003). "The Toxic Pharmacist"New York Times. Retrieved 2010-08-31.
33.    Jump up^ UK firm tried HIV drug on orphans The Observer, Sunday 4 April 2004
34.    Jump up^ Andrews, J.R. 2006. Research in the Ranks: Vulnerable Subjects, Coercible Collaboration, and the Hepatitis E Vaccine Trial in Nepal. Perspectives in Biology and Medicine 49(1):35–51
35.    Jump up^ GSK fined over vaccine trials; 14 babies reported dead Buenos Aires Herald 1 Aug 2012.
36.    Jump up^ Kirk, S. A., Gomory, T., & Cohen, D. (2013). Mad Science: Psychiatric Coercion, Diagnosis, and Drugs. Transaction Publishers. pp. 218–219.
37.    Jump up^ Elliott, Carl (September–October 2010). "The deadly corruption of clinical trials. One patient's tragic, and telling, story". Mother Jones. Retrieved 4 August 2017.
39.    Jump up^ "Markingson letter". U of M Board of Regents. November 29, 2010. Retrieved 4 August 2017.
40.    Jump up^ Hagan, Kate (14 August 2010). "Doctors tread ethical minefield, 21 years on". The Age. Retrieved 4 August 2017.
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