THE SOUL OF BIOETHICS
(Nov. 11, 2011)
Edited by H.R. Moody
- Prostate Screening Debate
- Rationing Redux
- What is Christian Bioethics?
- Alzheimer's: The Great Unlearning
- Cutting Costs: Promise & Pitfall
- Caring Conversations
- Web Sites to See
- Books of Interest
- Coming Events
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PROSTATE SCREENING DEBATE
Remember the film "Jaws II"-- with the ominous phrase "Just
when you thought it was safe to go back into the water?" Well,
remember the big mammography debate of two years ago, when the
U.S. Preventive Services Task Force recommended against mammography
screening for women below a certain age? This time the Task
Force has weighed in again, and it's the men, not the women,
who are engaged. The Task Force has cast doubt on prostate
screening, and related medical interventions.
Is this an ethical dilemma? I'm afraid it is. (Full
Disclosure: I'm 66 years old and have an annual prostate blood
test myself. Am I misguided?)
On the Task Force's own assumptions, they waited two years
before releasing their recommendations, thus permitting thousands
of men to suffer needless medical interventions. Of course,
many clinicians and advocates take the opposite view. They argue
that it is irresponsible for the Task Force to recommend against
screening that might save lives.
One thing is clear: these issues will not go away soon.
With population aging and ever-greater innovations in screening
technologies (e.g., for Alzheimer's) the dilemmas will be
unavoidable. Equally, necessary will be better public communication
about risks and choices for medical screening.
For a good overview of the bioethics issues involved here,
see THE ETHICS OF SCREENING IN HEALTH CARE AND MEDICINE:
Serving Society or Serving the Patient? by Miklas Juth Page and
Christian Munthe (Springer, 2011).
On the prostate screening debate read: "The PSA Debate: Competing Interests" at:
See also "Panel’s Advice on Prostate Test Sets Up Battle" at:
Listen to the podcast "To Screen or Not to Screen?
Ethical Controversies in Mammography Screening" available at:
It seems inevitable that the prostate perplexity will
end up inflaming the debate over age-based rationing. Cost
is undoubtedly an issue. Researchers at the Center for Medical
Integrity have documented the scale of the problem raised by
routine screening of older people. In five years before 2008
Medicare spent nearly $ 2 billion on common cancer screening for
patients older than age-limits recommended by the U.S. Preventive
Services Task Force. For example, 80% of Medicare claims for
cervical cancer screening were for women over 65, despite
recommendation against it. Doctors repeatedly ignore recommendations
when it comes to cancer screening, and, as a result, Medicare is
for billions of dollars in services that may be unnecessary, and,
as in the case of prostate cancer, lead to patient suffering.
Physicians disregard guidelines for many reasons: fear of
malpractice suits, demand by patients, financial incentives, and
sheer ignorance. Yet whenever Medicare tries to rein in spending,
"the great R word comes out," says Gail Wilensky, former director of
the Medicare program, referring to health care rationing.
For more on this issue see "Medicare Wastes Billions of Dollars
on Unnecessary Cancer Screening for Elderly" at:
WHAT IS CHRISTIAN BIOETHICS?
For some answers, consider the following books:
CHRISTIANITY & BIOETHICS: Confronting Clinical Issues,
by Mark W. Foreman (Wipf and Stock, 2011).
THIS MORTAL FLESH: Incarnation and Bioethics, by Brent Waters
BIOETHICS AND THE CHRISTIAN LIFE: A Guide to Making Difficult
Decisions, by David VanDrunen (Crossway, 2009).
BIOETHICS: A Primer for Christians, by Gilbert Meilaender
THEOLOGICAL BIOETHICS: Participation, Justice, and Change,
by Lisa Cahill (Georgetown Univ. Press, 2005).
ALZHEIMER'S: The Great Unlearning
"I call Alzheimer's the great unlearning, because it is
clearly an unraveling of mind, language, and former knowledge.
But in my experience, there is a center, or centers, of apprehension
and experience (such as humor, intuition, and emotion) clearly
intact much longer than mind and language. The nature of Alzheimer's
decline suggests to me both the reality of the radical impermanence
of life (as suggested in the many constantly shifting states and
stages of the disease) and the reality of some deeper knowing/knower.
Therefore, it supports the ethical mandate to honor that deep and
abiding part, or ground, of the person, despite the eroding of the
most basic characteristic of humanness: the self-reflective consciousness. I wonder if what we see in Alzheimer's disease
is a kind of return to our origins -- an Edenic pre-self-conscious,
pre-dualistic state, prior to separation and shame."
From Gisela Webb, "Intimations of the Great Unlearning:
Interreligious Spirituality and the Demise of Consciousness
which is Alzheimer's" at:
CUTTING COSTS; Promise and Pitfall
Can advance directives curb costs at the end of life? Some
research suggests that the answer is "yes." For details see:
What about palliative care? A 2008 study found that even a
single consultation for palliative care could reduce cost of a
hospital stay by $1,700. When a patient died before leaving the
hospital, savings could reach $5,000 for palliative care provision.
But such savings can pose a problem. Dr. Rick Levene, a palliative
care specialist from West Palm Beach, Florida, notes that cost savings
can provoke resistance from patients, families and doctors. Some will
see palliative care as backdoor way to ration healthcare or improve
the hospitals profit margin. There is also the problem
traditionally known as a "medical futility:"
"There are some physicians, some patients and families that can't
give up, and the 'H' word [hospice] has created some negative
connotations with them," Levene says.
For more on this story, see "The Promise and Pitfalls of
Palliative Care" at:
Caring Conversations is a consumer education initiative that
helps individuals and their families share meaningful conversation
while making practical preparations for end-of-life decisions. Each
copy of Caring Conversations includes a healthcare directive document
and a durable power of attorney for healthcare decisions. For a
free download of this tool, visit:
WEB SITES TO SEE
RAM DASS. For Ram Dass's talk on "End of Life Preparations" at
the Legacy of Wisdom conference, visit:
CAREGIVING. For a case study of "The Careless Caregiver" visit:
PROLONGEVITY: YES AND NO. Is longer life a goal in itself?
Gilbert Meilaender offer some reflections on the subject at:
BOOKS OF INTEREST
OXFORD TEXTBOOK OF PALLIATIVE MEDICINE, edited by Terry Altilio
and Shirley Otis-Green (Oxford Univ. Press, 2011). Details at:
OBSERVING BIOETHICS, by Renee Fox and Judith Swazey (Oxford
University Press, 2008).
D.N. Weisstub and colleagues edited a series of books in the
series on International Library of Ethics, Law, and the New
Medicine, which have now been released by Springer Publishers:
AGING: Culture, Health, and Social Change; AGING: Aging: Caring
for our Elders; and AGING: Decisions at the End of Life (All
from Springer, 2010).
MENTAL HEALTH: "Faith, Family and Mental Health Conference"
(Nov. 18, 2011, Atlanta, Georgia). Sponsored by FaithWorks.
For details, visit:
This electronic newsletter, edited by Harry (Rick)
Moody, is published by HealthCare Chaplaincy and
co-sponsored by the Office of Academic Affairs at AARP.
The opinions stated are those of Mr. Moody and may not necessarily
reflect those of HealthCare Chaplaincy or AARP.
HealthCare Chaplaincy is an international leader in the research, education and practice of spiritual care and palliative care, which relieves suffering and improves one’s quality of life. We provide professional chaplaincy services—arguably the most cost-effective resource to increase patient satisfaction— in numerous hospitals in metro New York. During the past 50 years, our professional chaplains have helped more than 5 million patients, loved ones and hospital staff find meaning and comfort regardless of religion or beliefs. We are developing a National Center for Palliative Care Innovation, including a large enhanced assisted living residence. To learn more visit www.healthcarechaplaincy.org
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