"Health" & "Health Care"

What defines health?  We've started this discussion in class.  How ought it to be refined?

After you've discussed that, start an exploration about what a "health care" system ought to cover.  Is health care like buying a car?  Or more like a collective community responsibility to its members, like education or having police, fire, emergency workers?  What kind of a right is health care?

These are both parts of your first exam question.

Health Care Elsewhere

What did you find most surprising about your assigned country?  About the data collected by the class? 

How does this impact your definition of health?  Of health care?

The Diving Bell & The Butterfly

What was your first reaction to the film?  What did you think when it finished?

Identify some ways that the film relates to class.

Does the film change your mind about anything related to end-of-life decisions, the provision of health care, individual choice, responsibility of health care providers?

Current

*new*  Patenting Genes - U.S. Supreme Court Case
http://www.nytimes.com/2013/04/15/business/as-court-considers-gene-patents-case-may-overlook-relevant-issues.html?nl=todaysheadlines&emc=edit_th_20130415&_r=0

 more on the federal Brain project
http://chronicle.com/article/Obama-Kicks-Off-100-Million/138241/?cid=at&utm_source=at&utm_medium=en

video on dying "Can We Live Forever?"
From Lauren: I saw this video in my psychology of aging class.  Its called can we live forever?  I think it relates quite well to class maybe we can watch it. http://m.video.pbs.org/video/1754457671/

Multiculturalism

TED Talk about female circumcision
http://www.ted.com/talks/kakenya_ntaiya_a_girl_who_demanded_school.html?utm_source=email&source=email&utm_medium=social&utm_campaign=ios-share

Medicine & the Arts

"Love Alone," a new play at the Trinity Rep in Providence, R.I., breaks the mold of the medical melodrama in its portrayal of the consequences of a devastating medical mistake. http://nyti.ms/KiMqPJ

Genetics

*new* 9April13 Elizabeth Blackburn molecular biologist worked on teleomeres, has new medical test
 http://www.nytimes.com/2013/04/09/science/elizabeth-blackburn-molecular-biologist-charts-her-own-course.html?nl=todaysheadlines&emc=edit_th_20130409&_r=0

1April13  Genetics & Cancer (story in al-Jazeera)
http://m.aljazeera.com/story/201332814458981700
 
1April13 Gene Therapy for sight, smell, hearing, etc.
http://www.the-scientist.com/?articles.view/articleNo/34778/title/Sensing-Gene-Therapy/

20Mar13 Genetic Therapy Show Promise for Acute Leukemia
http://www.nytimes.com/2013/03/21/health/altered-t-cell-therapy-shows-promise-for-acute-leukemia.html?_r=0&hp=&adxnnl=1&adxnnlx=1363814668-O+Rsx6N6JC3dOyYLSzE44Q

13Mar13 NOVA's Cracking Your Genetic Code (video we watched in class)
http://video.pbs.org/video/2215641935/

13Mar13 How Well Do You Want to Know Your DNA? | PBS NewsHour

Coincidentally to showing NOVA's "Cracking Your Genetic Code" on 12March, was a story on tonight's NewsHour also about genetics & personal medicine.
http://www.pbs.org/newshour/rundown/2013/03/if-your-genes-revealed-you-were-likely-to-get-a-disease-would-you-want-to-know.html

Hemophilia B is the first well-known disease to appear treatable by gene therapy, a technique with a 20-year record of almost unbroken failure. http://nyti.ms/uI3yx7

Knome’s New Machine to Aid Labs in Genomic Analysis - NYTimes.com
http://www.nytimes.com/2013/02/03/business/knomes-new-machine-to-aid-labs-in-genomic-analysis.html?nl=todaysheadlines&emc=edit_th_20130203

Human Genome Project story
http://www.pbs.org/wgbh/nova/body/cracking-the-code-of-life.html

History

Compensation for Forced Sterilizations
http://www.nytimes.com/2011/12/10/us/redress-weighed-for-forced-sterilizations-in-north-carolina.html?pagewanted=3&_r=1&nl=todaysheadlines&emc=tha23

*new 21Apr13* International Research Ethics (+ Paper 3)

21Apr13  NYTimes: In the Basement of a School Known for Science, a Holocaust Museum
http://nyti.ms/15nHkOR  
The Bronx High School of Science spent more than a dozen years and $1 million on a Holocaust museum and studies center. “Great scientists have to be ethical people,” said the school’s principal.

11Apr13  Feds Fault Preemie Researchers For Ethical Lapses

http://m.npr.org/news/front/176811809

13Mar13 NYTimes: African Trial of H.I.V. Drugs Fails
The failure was not due to the methods — two different pills and a vaginal gel — but to the fact that the women did not use them consistently. 
http://nyti.ms/ZbxRSZ



Discussion questions (from case I scanned and emailed you on Sun 10 March):

1. What are Ellen's responsibilities to Sebena, to Tefera, to her adviser and to the research study?
2. How could the informed consent form or the process of obtaining informed consent be modified to address Ellen's concerns?  Consider issues such as different cultural meanings of disease, the need for background knowledge about science, medicine and research study design, and the length and depth of the information provided?
3. Ellen notices that Sebena appears intimidated through the informed consent process.  Moreover, the research study has provided the funds to build the new medical care facility in this resource-poo area.  Does the evident inequality in power between the researchers and the participants have an ethical impact on the informed consent process?
4. What are the ethical implications of providing a U.S. standard of medical care through a research study in a society that cannot support the cost of such care outside a foreign-sponsored research protocol?
5. What ethical issues are raised in obtaining individual informed consent in a culture where family and/or community consent is also warranted, and, as in this situation, obtained in the form of an agreement between the researchers and the community elders?

Health Care System & Reform

*newly posted* 3Apr13  NYTimes: A Prescription for Frustration
 http://nyti.ms/10pfUTi
In two new books, doctors write about the problems, and details, of American medicine today.

13Mar13  Why Doctors Can't Say 'No'
http://www.salon.com/2011/11/28/why_doctors_cant_say_no/singleton/?mobile.html

 Supreme Court on Affordable Health Care Act
http://www.nytimes.com/interactive/2012/03/27/us/27scotus.html?nl=todaysheadlines&emc=edit_th_20120327

Editorial on HC reform ideashttp://www.nytimes.com/2011/12/14/opinion/advice-from-dr-berwick-a-health-care-visionary.html?nl=todaysheadlines&emc=tha211

 Op-Ed on Women's Health Care at Risk
http://www.nytimes.com/2012/02/29/opinion/womens-health-care-at-risk.html?nl=todaysheadlines&emc=tha211

 Gains in Health System Seen as Lasting by Some
http://www.nytimes.com/2012/05/23/us/gains-in-health-system-seen-as-lasting-by-some.html?_r=1&nl=todaysheadlines&emc=edit_th_20120523

Treating You Better for Less
http://www.nytimes.com/2012/06/03/opinion/sunday/treating-you-better-for-less.html?nl=todaysheadlines&emc=edit_th_20120603

Approaching Illness as a Team at the Cleveland Clinic
http://www.nytimes.com/2012/12/25/opinion/approaching-illness-as-a-team-at-the-cleveland-clinic.html?nl=todaysheadlines&emc=edit_th_20121225


Researchers say Oregon’s lottery system for granting health insurance has made it the best place to study the costs and benefits of the federal health care law.
http://www.nytimes.com/2012/06/23/health/oregon-study-reveals-benefits-and-costs-of-insuring-the-uninsured.html 

posted 27Feb13
* Do smokers and the obese deserve insurance?

January 28, 2013 03:39 PM | MARY ELIZABETH WILLIAMS
View full article at Salon.com

* Health care professionals beyond so much reliance on doctors
http://www.nytimes.com/2012/12/16/opinion/sunday/when-the-doctor-is-not-needed.html?nl=todaysheadlines&emc=edit_th_20121216&_r=0

25Feb13 An article on how to get the incentives right in health care:
http://www.nytimes.com/2013/02/24/business/overcoming-obstacles-to-better-health-care.html?ref=business&_r=0

Case 9 Informed Consent

As a class, analyze this case.  Whoever starts should pick a theoretical perspective (Kant, utilitarianism, Principles of Bioethics, etc.) and analyze, and then everyone else follows suit to either refine the analysis or add in a different theoretical perspective.  At least one person should argue that the nurse should give the information, and at least one other person should argue the opposite.

Research Ethics

 *Newly posted* 13Mar13 NYTimes: In Girl’s Last Hope, Altered Immune Cells Beat Leukemia
Emma Whitehead, 7, has been in full remission for months after scientists used a disabled form of H.I.V. to reprogram her immune system to kill cancer cells.  http://nyti.ms/UvUGQy

*13Mar13*
Signing yourself up for a research study
http://www.the-scientist.com//?articles.view/articleNo/34433/title/Do-It-Yourself-Medicine/

Ethics of self-studies
http://www.the-scientist.com//?articles.view/articleNo/34690/title/Opinion---Unconventional-Standards/

25Feb13   Here's an example from today's NYTimes about stopping a clinical trial early.  The research was on diet and heart disease:  http://www.nytimes.com/2013/02/26/health/mediterranean-diet-can-cut-heart-disease-study-finds.html?ref=global-home

Also this story on a lung transplant for a Jehovah's Witness patient  http://www.nytimes.com/2013/02/25/us/bloodless-lung-transplants-for-jehovahs-witnesses.html?nl=todaysheadlines&emc=edit_th_20130225

This current event perfectly coincides with next week's readings on global research:
http://www.the-scientist.com//?articles.view/articleNo/34325/title/Bad-Blood/

One Billion Rising extra credit

Did you participate in the OBR event on Thursday 14 Feb?  What's your response?

Virtuous Practice & Professional Roles

Class,
What responses do you have to the readings for today (virtuous physicians, role of nurses, cosmetic surgery, talking to patients) taken together?  Are there things that health professionals shouldn't do?  Are roles static or dynamic?  Do they change depending on what kind of doctor and to the needs/wants of the patients.

Case 21 Q#2

We didn't sufficiently discuss this question, p. 716

"When a patient who is in a great deal of pain, weak, and close to death makes a request that seems at odds with a decision he made when he may have been more fully autonomous, which request should guide those caring for him?"

Case 23 / Minors / A Lion in the House

Further comments on cases involving minors?  You might also be interested in a documentary called A Lion in the House filmed at Cincinnati Children's Hospital and Medical Center.  I'll get the video for you if you ask me:  there is a 1 hour version and a 4 hour version.  * * * FYI: this is also pretty hard to watch * * *

http://www.pbs.org/independentlens/lioninthehouse/02_index.htm

http://www.lioninthehouse.com/

http://www.youtube.com/watch?v=c6_EXFbSjbg

Dax's Case

* * * Please don't watch the video casually . . . it is graphic and can be quite disturbing.  At the very least read the descriptions first * * *

Info on the film
https://www.mededportal.org/publication/785
http://litmed.med.nyu.edu/Annotation?action=view&annid=10114
http://en.wikipedia.org/wiki/Dax_Cowart 

Link to the video
http://www.youtube.com/watch?v=IsxaaMbZMtA

Euthanasia

Start with your readings. . . what do Rachels, Callahan, and Brock say about the morality of euthanasia?  What do we mean by euthanasia?  (It might not be what you think).

Ethical Theory

You'll need to know the three main theories (utilitarianism, Kant, virtue ethics) well enough to apply them starting this week and for the rest of the semester.  Watch the Sandel videos, read your text, and ask your questions here.  In class on 15 Jan we'll talk start to walk through the theories, but you'll need to get to work on them yourselves!

Case 4: Dentist & Pt. Autonomy

What say ye?  Be sure to answer the questions at the end of the case and respond to each other.

Case 3 Voluntary Sterilization

Reaction?  Course of action to recommend?  Answer the questions at the end of the case and respond to each other.

Health Care Reform

*new* 12Feb13  Reduction in Health Care costs
http://www.nytimes.com/2013/02/12/us/politics/sharp-slowdown-in-us-health-care-costs.html?nl=todaysheadlines&emc=edit_th_20130212&_r=0

Electronic Medical Records Systems have not reduced costs http://www.nytimes.com/2013/01/11/business/electronic-records-systems-have-not-reduced-health-costs-report-says.html?smid=pl-share

Health Care Elsewhere

More affordable testing for disease in developing countries
http://www.the-scientist.com//?articles.view/articleNo/33761/title/A-Dime-a-Dozen/

Current Events

Relevant film, tv, places, museums, websites?

Expectations?

What are your expectations about class? About discussing ethical problems in the biomedical realm?

Introductions

Who are you?  Why are you in this class?