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Love on the Hospital Walls

December 17, 2015

Michael Sekeres, MD, “I have made it a habit to scan the walls of my patients’ rooms, to gain some insight into their lives outside of the surreal experience of their lengthy hospital stay.”

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Does a more humane hospital make a safer hospital? That’s a question Johns Hopkins is grappling with — and Dr. Peter Pronovost believes the answer is yes. Berman Institute faculty and staff are among the Project Emerge collaborators seeking to improve the intensive care experience

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The ‘Right to Die’ and the Regulation of Medicine

October 29, 2015

(Video) Prof. Tom Beauchamp, PhD, of the Kennedy Institute of Ethics at Georgetown University, discusses the legislative history and ethics of the right to die and physician assistance in the United States

In Hospitals, A Little Bit of Rudeness Can Be A Very Big Deal

August 21, 2015

When someone makes a nasty quip, cuts us off in traffic, ignores our suggestions or takes credit for our work, we get mad, sad and even angry. Rudeness, even just little, can really hurt

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The Death Treatment

June 17, 2015

When should people with a non-terminal illness be helped to die?

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Respect in the ICU

June 8, 2015

Beginning in 2012, Gail Geller, a professor in the School of Medicine with a history of addressing ethical questions, and several ethicists at the Berman Institute of Bioethics began examining issues of respect and dignity in ICUs. Their research was part of Project Emerge, an ongoing study by the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine

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Respect in the ICU

Monday, June 8th, 2015

Modern intensive care units are loaded with technology, and ICU clinicians frequently are pressed for time. So it can be common for physicians to take the quickest path of least resistance in dealing with ICU patients. For instance, they might look first not at the patient but at the readout on a machine, or they might speak to family and other people in the room as if the patient—who may be harder to engage because of sedation or impairment—were not present and an important part of the conversation.

Beginning in 2012, Gail Geller, a professor in the School of Medicine with a history of addressing ethical questions, and several ethicists at the Berman Institute of Bioethics began examining issues of respect and dignity in ICUs. For example, is not doing enough to include patients in conversations about their care disrespectful? And, in light of studies that show improved outcomes when patients are involved in their own care, might that disrespect do actual harm?

Their research was part of Project Emerge, an ongoing study by the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, which has been examining preventable harm in the ICU. Forms of preventable harm include delirium from sedation, ICU-acquired weakness due to inactivity, complications that can arise from being on a ventilator, and loss of respect and dignity. The bioethicists became involved in the study, Geller says, because “bioethics includes clinical or medical ethics, and respect and dignity—and respect is one of the major virtues in clinical practice. It is centrally a moral virtue. If we don’t treat other people with respect, there’s reinforcement of hierarchy, which leads to injustice. Respect for persons is a big part of medical ethics.”

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Johns Hopkins Magazine

California Dying

June 2, 2015

Gerald Dworkin: I am finishing the six months a year that I live in California. While here I have been working on the campaign, led by an organization called Compassion and Choices, to get a bill passed by the California legislature–SB128. This is a bill to allow medically-assisted dying in the state of California

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California Dying

Tuesday, June 2nd, 2015

It is modeled on the measure passed by referendum in Oregon in 1994 by 51% of the voters. A legal injunction halted implementation of that law until 1997 when the Ninth Circuit lifted the injunction. In 1992 Californians rejected a referendum legalising assisted-dying, and the legislature has rejected similar bills four times.

Some form of medically assisted-dying is now legal in Oregon, Washington, Montana, Vermont , and one county of New Mexico. This latter reminds me of Woody Allen’s view on the existence of God. He exists everywhere except in certain parts of New Jersey.

The methods of legalization differed from state to state. Oregon was by referendum. Montana was a Supreme Court ruling. Vermont was by statute. Washington’s ballot initiative passed by 58% of the voters.

My own interest in these issues has been long-standing. In 1998 I wrote, together with two other philosophers, a book called Euthanasia and Physician-Assisted Suicide. Two of us argued for its moral and legal permissibility; one against. I should note that the use of the term “Physician-assisted suicide” is now politically incorrect, for tactical reasons. I understand that the popular prejudice against suicide makes it more difficult to rally support for the bills I favor. And even some potential users of such measures object to their death-certificate reading “suicide.” But to list the cause of death, as many such bills do, as the underlying disease process seems to me simply a lie. What caused the person diagnosed with terminal cancer to die now, rather than somewhat later, is the secobarbital the patient took. But learning to keep silent about such terminological matters was only one of many lessons I had to learn.

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3 Quarks Daily

The Last Day of Her Life

May 18, 2015

When Sandy Bem found out she had Alzheimer’s, she resolved that before the disease stole her mind, she would kill herself. The question was, when?

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The Last Day of Her Life

Monday, May 18th, 2015

Sandy Bem, a Cornell psychology professor one month shy of her 65th birthday, was alone in her bedroom one night in May 2009, watching an HBO documentary called “The Alzheimer’s Project.” For two years, she had been experiencing what she called “cognitive oddities”: forgetting the names of things or confusing words that sounded similar. She once complained about a “blizzard” on her foot, when she meant a blister; she brought home a bag of plums and, standing in her kitchen, pulled one out and said to a friend: “Is this a plum? I can’t quite seem to fully know.”

Sandy was a small woman, just 4-foot-9 and 94 pounds, with an androgynous-pixie look: cropped hair, glasses and a wardrobe that skewed toward jeans and comfortable sweaters she knit herself in the 1990s. As she watched the documentary, her pulse thrumming in her ears, a woman on screen took a memory test. Sandy decided to take it along with her. Listen to three words, the examiner said, write a sentence of your choice and then try to remember the three words. Sandy heard the three words: “apple,” “table,” “penny.” She wrote a brief sentence: “I was born in Pittsburgh.” She said aloud the words she could remember: “apple,” “penny” . . . . The simplest of memory tests, and she had failed.

The next month, Sandy’s husband, Daryl, from whom she had been amicably separated for 15 years, drove her from Ithaca to the University of Rochester Medical Center for cognitive testing by a neuropsychologist named Mark Mapstone. Mapstone showed Sandy a line drawing and asked her to copy it, and then to draw it from memory 10 minutes later. He read her a list of words and had her recall as many as she could. He gave her two numbers and two letters and asked her to rearrange them in a particular order: low letter, high letter, low number, high number. Thank goodness that last one wasn’t timed, she thought to herself, as she focused all her mental energy on the task. She felt as gleeful as a kid who had earned a gold star when Mapstone said, “Yes, that’s right.”

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NY Times Magazine

Love on the Hospital Walls

Love on the Hospital Walls

Putting Care Back in the ICU

Putting Care Back in the ICU

The ‘Right to Die’ and the Regulation of Medicine

In Hospitals, A Little Bit of Rudeness Can Be A Very Big Deal

In Hospitals, A Little Bit of Rudeness Can Be A Very Big Deal

The Death Treatment

The Death Treatment

Respect in the ICU

Respect in the ICU

California Dying

California Dying

The Last Day of Her Life

The Last Day of Her Life

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