There are some strange things going on in Phoenix Arizona between St. Josephs Hospital and Bishop Thomas Olmstead. The scenario began in November 2009 when the pregnancy of a woman with malignant pulmonary hypertension was terminated to save her life. At that time the Bishop responded by excommunicating a member of the ethics committee which had authorized the procedure. Fast forward to November 22, 2010 when Bishop Olmstead sent a letter (read it here) to the President of Catholic Healthcare West, St. Joseph’s parent corporation threatening to strip St. Joseph’s of their Catholic identity unless they concurred with several conditions that include acknowledgement that they were wrong and he is right.  Click on the picture of St. Joseph's below to see coverage.

Read the letter-the hubris is palpable. Now the Bishop has followed through on his threat and St. Joseph’s has stated it could not ethically and legally comply with the Bishop’s demands. Essentially the Bishop has behaved as a bully and taken the position that you either play my way or I will take my ball and go home. Now he has taken the ball. Fortunately St. Joseph’s, the largest teaching hospital in Arizona and a significant provider of care for the poor and indigent seems poised to continue without the Bishop.

If you have taken a course in the philosophy of science or have thought about the essential characteristics of science you know that the scientific method is the foundation of how we distinguish scientific knowledge from mere opinion. Fundamental to scientific method is the assumption that the results of a valid study must be replicable. That is, according to the scientific method, the results of a research study that are statistically significant, i.e. not likely to be a random outcome, should be replicable in future studies using the same procedure. It is just assumed that similar results will be replicated if the study is repeated. Maybe this is why most studies with significant results are not replicated. Quite interestingly, many statistically significant results are now being shown actually to be more difficult to replicate, so claims an article called "The Truth Wears Off: Is there something wrong with the scientific method?" by Jonah Lehrer, in the December 13, 2010 issue of The New Yorker. In this article Lehrer discussed the phenomenon referred to as the “decline effect’ which purports to show from a wide range of studies that some of “our facts are losing their truth”. Perhaps this is an interesting article worth thinking about more?

An article posted last week on cnn.com is entitled “Activist group claims to send AIDS-tainted razors to animal researcher”. Click the picture below to be taken to the article.

(photo from www.cnn.com)

I appreciate that CNN reported this news but the article left a question lingering in my mind. I will grant that it has not been verified that the razorblades were tainted with HIV. However, nobody seems to be questioning that this UCLA researcher working in the important area of methamphetamine addiction did receive the razorblades at his home and that they were accompanied by a death threat. CNN goes on to tell that "Since 2006, other anonymous activists claimed responsibility for at least 11 acts of sabotage, vandalism, criminal damage and firebombing against UCLA faculty or property, either on or off campus, university officials said. In March 2009, activists seeking to stop the use of animals in research claimed to set fire to Jentsch's vehicle parked overnight outside his home."

Other similar events have delayed, disrupted, or stopped research throughout the world and placed numerous researchers at risk. The groups claiming responsibility freely admit their intent to punish researchers and deter others from conducting research out of fear. So the question lingering in my mind is why these people are referred to as "activists" It sounds to me like a pretty good description of terrorists.

When it comes to medical care, Americans want the best. The collective opinion of thought leaders in the field – often published by national groups as consensus expert guidelines and recommendations by seasoned, well-schooled, respected, and thus authoritative physician peers – is one the gold standards of professional practice. But, sometimes the experts, the respected authorities, get it wrong. And, the argument may be made that, as a consequence of the wrong advice – regardless of how well intentioned and widely regarded, patients may have been harmed. And when harmed, patients want someone held responsible for the perceived damages.

One example of this phenomenon has appeared in the news recently. The Los Angeles Times reported on November 24 that the “Nevada Supreme Court Upholds $58M Judgment Against Wyeth Over Hormone Drugs."  See the report here [accessed December 1, 2010].

Estrogen replacement (HRT) for menopause symptoms was recognized therapy – it was standard of care treatment – in the late 20th Century.

Student Jacob M. Appel, M.D. (http://www.jacobmappel.com/) called the Winter Term Bioethics and Law class’ attention to this recent ABC News feature found here [accessed December 6, 2010].

Dan Crews is 27 years old. He has been a quadriplegic since age 3, as the result of a car accident. He cannot breathe without the aid of a ventilator, but he can speak and eat with assistance. He asked to be removed from the life-sustaining breathing machine, but the Wisconsin hospital refused because the psychiatrist service is of the opinion that he is depressed and thus incapable of making the decision to remove the ventilator.

From the story it appears that he has been asking to be removed from the ventilator since May 2009! The patient is reported to have said that “[h]e doubts the hospital will reverse its decision – ever.”From the story it appears that he has been asking to be removed from the ventilator since May 2009! The patient is reported to have said that “[h]e doubts the hospital will reverse its decision – ever.”

Recently National Public Television aired a Frontline documentary on “Facing Death” filmed in a medical intensive care unit at Mt. Sinai hospital in NYC.

The program focused on several patients who were in the last weeks of their lives and who were making (or their surrogates) medical decisions. Several things struck me, even after acknowledging   that editing hundreds of hours of filming into one hour is not likely to portray the whole story. It is not my intention to criticize the caring and competent physicians whose daily work touches so many of their patients’ lives in a positive manner.

One patient had been in the hospital for months, hoped to go home (and did briefly before being readmitted) and insisted on getting more treatment in spite of the fact that no one in the family or health care team thought there would be any benefit. Our modern focus on “patient autonomy” led the team to give the impression that the patient’s choices would trump, regardless of cost or likelihood of improvement. I couldn’t help but think that the patient simply wanted to live (preferably in his pre-illness state) yet  by offering him options that had virtually no curative or remissive power, he got the message that he could simply choose life over death. We knew that he did not want to die but we also knew that he was actively dying.   Continually providing him with empty choices felt wrong. Perhaps his denial of impending death helped him cope with the inevitable and if so, no problem. But, I have to question the prudence of allowing a dying patient in some degree of denial to be the sole or primary decision maker for his care. We want to do what you want John, even if we can’t deliver it.

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