Albany Medical Center
 Search
Home / Caring / Educating / Find a Doctor / News / Give Now / Careers / About / Calendar / Directions / Contact
Topic: Communication
May 12, 2014 | Posted By Wayne Shelton, PhD

Recently, the Governor of Tennessee signed into law a bill, SB 1391, which criminalizes a woman who has had a baby with drug-related complications.  As a result babies born with addictions due to drug use by the mother during pregnancy will be grounds for the mother being charged with aggravated assault, which could result in sentence of up to 15 years in prison for the mother. The concerns of the state legislators who promoted and passed this bill were over a condition in newborns called neonatal abstinence syndrome (NAS).  This condition results from exposure to addictive drugs while in the mother’s womb. In 2013 the Tennessee state Health Department reported 921 babies born with NAS and 278 cases so far in the past four months. The stated goal of the law was to reduce the number of babies born with this condition. But is criminalizing drug use during pregnancy, in this first of its kind state law, the most effective way of accomplishing this goal?

It is important to note that the bill was passed against the strong objections of women’s rights groups as well as health care and addiction specialty groups. First of all these experts agree that cause more harm to babies as pregnant women will be afraid to seek medical care.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

March 13, 2014 | Posted By Wayne Shelton, PhD

Efforts to educate the public are based on the assumption that human beings can be persuaded by good reasons and evidence in formulating their responses to important questions about public health. But are things this straightforward? Are humans really this rational in how they make their decisions? 

Think of any social problem that is predicated on how people understand and use information to make good decisions for themselves, especially decisions that have significant social costs. For example, consider the question: does having a gun in one’s home make one more or less safe? A recent piece from the New York Times is typical of the clear evidence presented from social science research to show that guns in the home “were fired far more often in accidents, criminal assaults, homicides or suicide attempts than in self-defense. For every instance in which a gun in the home was shot in self-defense, there were seven criminal assaults or homicides, four accidental shootings, and 11 attempted or successful suicides.” Moreover, there is a strong risk factor of having a gun in the home for female homicides and intimidation of women. These data do not prevent gun rights advocates from passionately arguing against any limitations place on guns including assault rifles. In fact some pro-gun advocates falsely claim that any limitation of assault weapons would in fact make women less safe as though that the typical woman would not have the full ability to protect herself. It appears many people view the evidence through the lens of their preexisting set of assumptions, which makes them ignore the scientific evidence or to see it as biased; thus, they continue to believe that having guns in their homes make them safer.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.
December 5, 2013 | Posted By Marleen Eijkholt, PhD

Early November 2013: TB, a 32 year old deer hunter from Indiana, falls 16 feet from a tree while on a hunting trip and crushes his spinal cord. He injures his C3,4 and 5 vertebrae, but does not suffer any brain damage. TB’s prognosis includes paralysis from the shoulders down and potentially life-long dependence on a ventilator. His family asks the physicians if they can get him out of sedation and remove his ventilator, so that he can decide about how to proceed with his treatment. Once awake, TB hears his prognosis and asks to stop treatment. He dies one day after incurring his injury.

Several factors seem to have sparked the headlines and stir controversy, and I would like to focus on one of these. I question whether TB’s decision was and could be informed. Using this case, I propose that TB’s decision was perhaps a shot in the dark. I raise some of the pressing questions about informed consent in the clinical ethics context. I ask how we should ensure informed decision making, what we should do to enlighten patient’s perspectives and what we should do if patients refuse information that we consider material in the decision making process? 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

May 9, 2013 | Posted By Wayne Shelton, PhD

In the fall of 1970 Philip Tumulty, a Johns Hopkins’ internist, gave a lecture to the 3rd year medical school class at Johns Hopkins. His lecture was published in the same year in the New England Journal of Medicine under the title of “What is a clinician, and what does he do?” (Tumulty PA. What is a clinician and what does he do? N Engl J Med. 1970 Jul 2;283(1):20-4.) In this classic piece, this eminent physician of his era claimed that the primary role of the clinician is to “manage a sick person with the purpose of alleviating the total effect of his illness”. 

This paper, probably better than any other paper I have ever read gets to the essence of what a patient needs from an expert clinical caregiver; it lays out eloquently and robustly the characteristics of a good clinician and what is involved in excellent clinical care of patients. As Tumulty says, it is not a diseased body organ that shows up for physical diagnosis and treatment; rather, it is an anxious, fearful, wondering person concerned about her personal life, including her family, work, friends as well as her hopes and dreams. This means the clinician must be a thoughtful and systematic fact finder, a careful listener, a keen analyst of the facts and a prudent planner regarding which tests and treatment options make the most sense for this particular patient. Moreover, Tumulty rightly assumes that these skills should be embodied in the clinician as natural traits that the clinician genuinely enjoys performing. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

November 23, 2012 | Posted By Jane Jankowski, LMSW, MS

Giving bad news is a difficult thing to do. Receiving bad news is hard, too, but is perhaps a close second to hearing a complicated, vague version of the same set of facts. In healthcare, the failure to disclose pertinent facts in clear, uncomplicated language and verify the information is understood is harmful to the recipient of this information, but also to the provider, who must often untangle the resulting misunderstandings later on.  Families and patients who find they are asking "Why didn’t someone tell me?" may be on the receiving end of an attempt to give bad news.

I tend to think of these vague communication moments as 'dodges.' Rather than stating "I believe your Aunt Lila’s condition will not improve and we need to talk about what kind of care she would want" is instead a listing of diagnoses, medications, lab values, and a review of body systems, surgical options, and statistical probabilities. This type of encounter shifts the focus from the overall prognosis to the details, which though factual, obscure the big picture of a patient who is not expected to recover. Avoiding a frank disclosure of the fact that a patient is doing poorly doesn’t help the patient, and does not help anyone make informed decisions. But it serves a purpose in the moment. Sidestepping the straightforward presentation of bad news may avert or postpone the experience of delivering upsetting news and witnessing the emotional suffering of others who hear it. I get it. It is stressful and distressing to be the source of often devastating news. Yet, we must keep in mind that the news itself is the source of the upset, and the bearer of the news need not feel morally culpably for the facts. The old adage applies, 'it’s not what you say, it is how you say it.' We owe it to medical providers to give them adequate practice and training in delivering bad news as well as opportunities to observe experienced practitioners talk with patients and families when critical conversations are held.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

SEARCH BIOETHICS TODAY
SUBSCRIBE TO BIOETHICS TODAY
ABOUT BIOETHICS TODAY
BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
TOPICS