Showing posts with label medical ethics. Show all posts
Showing posts with label medical ethics. Show all posts

Tuesday, August 19, 2025

Let’s Not Erase the History of Medical Ethics; The Hastings Center for Bioethics, August 18, 2025

Barron H. Lerner , The Hastings Center for Bioethics; Let’s Not Erase the History of Medical Ethics

"I must admit that when contributing a chapter to a new book on the history of medical ethics, I was uncomfortable with what some of my coauthors believed was the only ethical way to write history: to serve social justice. That is, history not only needed to portray past injustices to vulnerable groups but also to aim toward ameliorating the modern versions of these wrongs.  

But with the news that the Trump administration is planning to delete historical information that “disparages” Americans from National Park Service exhibits and the Smithsonian museums, I am rethinking my position. If there is one thing that characterizes good history, it is transparency. Even if one objects to the intense focus on acknowledging diversity, equity, and inclusion over the past several years, erasing what you may not agree with is not the answer. Our book, Do Less Harm: Ethical Questions for Health Historians, shows the virtue and importance of telling stories that conventional history has often left out.

That the book had a social justice angle was not surprising. The two coeditors, historians of medicine Courtney Thompson and Kylie Smith, as well as many of the other contributors, have for years been doing scholarship exploring the pervasiveness of racism, sexism, and ableism in the history of medicine. The Black Lives Matter movement, which accelerated after the murder of George Floyd in June 2020, led medical centers across the country to reexamine their own racist behaviors when it came to patients, research subjects, and even their own students and employees. Conversations about these and related topics energized those of us who were writing chapters.

Still, I remained uncertain that good history of medicine had to focus on these topics or, for that matter, on connecting these past abuses to similar events potentially occurring within medicine today. After all, wasn’t there a place for good history that wasn’t so overtly political—for example, telling the stories and ethical conundrums associated with famous medical figures, the discovery of specific diseases, the introduction of novel treatments, and the details of cutting-edge experiments?  

But the increasing threats by the current administration to National Park Service and Smithsonian exhibitions are causing alarms throughout the world of history. In an executive order issued in March, President Trump said he seeks to challenge “narratives that portray American and Western values as inherently harmful and oppressive.” And in a recent letter to leaders at the Smithsonian, he stated that the institution should “celebrate American exceptionalism” and “remove divisive or partisan narratives.” To effect these changes, Trump has asked employees of the various sites to identify material they believe may be objectionable—and possibly removed or rewritten. What are some of the revisions being advocated?

One exhibit in Trump’s crosshairs, on the brutality of slavery, is housed at Independence National Historical Park in Philadelphia. A topic within that exhibit discusses how the 1793 Fugitive Slave Act required states to return enslaved individuals who had escaped. Similarly, concerns have been raised about an exhibit at Louisiana’s Cane River Creole National Park that describes the public whipping of escaped slaves and gives the names of the enslavers who carried out the beatings. If Trump has his way, these exhibits may be removed.

Potential changes do not only apply to issues of racism. For example, officials at Great Smoky Mountains National Park in Tennessee and North Carolina have called into question a plaque about the dangers that power plants and cars cause to plants and animals. At North Carolina’s Cape Hatteras National Seashore, an employee has raised concerns about a sign noting the danger of rising seas to wild horses.

The most worrisome thing about the potential removal of this information is its whitewashing of history. Even if one disagrees with specific claims, the best way to refute them is to provide counterarguments, not to “disappear” the contradictory statements. What’s the point of history if the parts of it that you don’t like can just be removed?

These threats to historical knowledge led me to reread many of my colleagues’ contributions to Do Less Harm. In his chapter “Centering the Margins,” historian Antoine Johnson describes much of the history of medicine as the “three D’s”: doctors, drugs, and diseases. While these topics are clearly important, focusing on them highlights the discoveries and innovations largely made by white male doctors. But who gets to say that this information is what should constitute the history of medicine? Aren’t the experiences of women and minorities, whether patients or health professionals, equally part of that history? By looking at the history of medicine through a lens of social justice, the potentially invisible stories come to light. One told by historian Ayah Nuriddin, in her chapter “Silences and Violences,” is that of National Negro Health Week, a grassroots initiative in the early 20th century that merged public health and racial justice efforts. This type of story is missing from traditional histories of medicine because, for too long, no one went looking for them.

Another largely absent topic in medical history is the treatment of psychiatric illness among Black patients. When Kylie Smith researched it, she found that psychiatrists caring for these individuals often created false dichotomies about emotional and psychological issues between Black and white patients. Such beliefs, she writes, “created and justified systems that segregated Black patients from white ones, alienated them from their families, and forced them to perform hard labor under the guise of therapy.” Perhaps this conclusion might be the sort that the Trump administration would rather not hear in its emphasis on the “grandeur of the American landscape.” But, again, excluding certain arguments from your accounts because you disagree with them prevents good history—finding facts, crafting arguments and revisiting previous scholarship—from happening.

Sometimes invisibility is right in front of our eyes. Several chapters in the book focus on museums that house medical specimens, usually “abnormal” body parts obtained decades or centuries ago for display to medical audiences as well as the general public. It took a social justice approach to history to start asking questions about these exhibits. Who were the people, so dehumanized in these displays, whose limbs and brains we now see? Is there any chance they gave consent to show their body parts? What are the ethical duties of museums that house medical specimens? Surely medical history should not only be concerned with these specimens, but also the lives of the individuals who have been partially preserved.

Finally, the most invisible group of all in medicine might be disabled people, who constitute roughly a quarter of the population. Even though such individuals are frequently under medical care, medicine has been interested in them only as examples of diseases or conditions. But who were and are these people? It is often hard to know. As historian Katrina Jirik writes in her chapter, “Disability, Archives and Museums,” “the voices of disabled people are missing from the archival record, muted, silenced by the voices of prominent actors.” Yet once you go looking for them, they are a rich part of medical history.

So, do I now think that all history must pursue social justice? I’m still not sure, but to the degree that it forces us to confront our complicated past, and to do so by finding previously unavailable information, it is a very important tool. The alternative—a sanitized version of history told with cherry-picked sources—isn’t really history at all.

Barron H. Lerner, professor of medicine and population health at the New York University Grossman School of Medicine, is the author of “The Good Doctor: A Father, A Son, and the Evolution of Medical Ethics.” He is a Hastings Center fellow. X: @barronlerner"

Monday, June 16, 2025

‘Extremely disturbing and unethical’: new rules allow VA doctors to refuse to treat Democrats, unmarried veterans; The Guardian, June 16, 2025

 , The Guardian; ‘Extremely disturbing and unethical’: new rules allow VA doctors to refuse to treat Democrats, unmarried veterans


[Kip Currier: As The Guardian article's aptly references, these new V.A. treatment rules are "extremely disturbing and unethical". 

The right to exercise one's religious beliefs is a fundamental constitutional right. However, one has to marvel at the dearth of basic decency of a healthcare provider who refuses to treat someone based on their gender, or whether they're married or an LGBTQ+ person.

Is it too much to expect someone who enters the healthcare professions to be able to commit to helping any veteran who needs care, no matter what that healthcare provider's religious beliefs are or are not?

The answer is and should be an emphatic NO.]


[Excerpt]

"Doctors at Department of Veterans Affairs (VA) hospitals nationwide could refuse to treat unmarried veterans and Democrats under new hospital guidelines imposed following an executive order by Donald Trump.

The new rules, obtained by the Guardian, also apply to psychologists, dentists and a host of other occupations. They have already gone into effect in at least some VA medical centers.

Medical staff are still required to treat veterans regardless of race, color, religion and sex, and all veterans remain entitled to treatment. But individual workers are now free to decline to care for patients based on personal characteristics not explicitly prohibited by federal law.

Language requiring healthcare professionals to care for veterans regardless of their politics and marital status has been explicitly eliminated...

In interviews, veterans said the impact of the new policy would probably fall hardest on female veterans, LGBTQ+ veterans and those who live in rural areas where there are fewer doctors overall."

Sunday, October 27, 2024

Declaration of Helsinki turns 60 – how this foundational document of medical ethics has stood the test of time; The Conversation, October 24, 2024

Consultant Neonatologist and Professor of Ethics, University of Oxford , The Conversation; Declaration of Helsinki turns 60 – how this foundational document of medical ethics has stood the test of time

"If you’re not familiar with the declaration – adopted by the World Medical Association on October 19 1964 – here is an explainer on this highly influential document: how it emerged, how it evolved and where it may be heading.

What is the declaration of Helsinki?

The World Medical Association was set up in the late 1940s in response to atrocities committed in the name of medical research during the second world war. It was focused on promoting and safeguarding medical ethics and human rights. 

Agreed at a meeting in Finland in 1964, the first version of the declaration included principles that have become the cornerstone of global research ethics. These include the importance of carefully assessing the risks and benefits of research projects, and seeking informed consent from those taking part in research."

Thursday, August 29, 2024

The Nuremberg Code isn’t just for prosecuting Nazis − its principles have shaped medical ethics to this day; The Conversation, August 29, 2024

 Director of the Center for Health Law, Ethics & Human Rights, Boston University, The Conversation; The Nuremberg Code isn’t just for prosecuting Nazis − its principles have shaped medical ethics to this day

"I remain a strong supporter of the Nuremberg Code and believe that following its precepts is both an ethical and a legal obligation of physician researchers. Yet the public can’t expect Nuremberg to protect it against all types of scientific research or weapons development. 

Soon after the U.S. dropped atomic bombs over Hiroshima and Nagasaki – two years before the Nuremberg trials began – it became evident that our species was capable of destroying ourselves. 

Nuclear weapons are only one example. Most recently, international debate has focused on new potential pandemics, but also on “gain-of-function” research, which sometimes adds lethality to an existing bacteria or virus to make it more dangerous. The goal is not to harm humans but rather to try to develop a protective countermeasure. The danger, of course, is that a super harmful agent “escapes” from the laboratory before such a countermeasure can be developed.

I agree with the critics who argue that at least some gain-of-function research is so dangerous to our species that it should be outlawed altogether. Innovations in artificial intelligence and climate engineering could also pose lethal dangers to all humans, not just some humans. Our next question is who gets to decide whether species-endangering research should be done, and on what basis?"

Wednesday, August 21, 2024

Leaving Your Legacy Via Death Bots? Ethicist Shares Concerns; Medscape, August 21, 2024

Arthur L. Caplan, PhD, Medscape ; Leaving Your Legacy Via Death Bots? Ethicist Shares Concerns

"On the other hand, there are clearly many ethical issues about creating an artificial version of yourself. One obvious issue is how accurate this AI version of you will be if the death bot can create information that sounds like you, but really isn't what you would have said, despite the effort to glean it from recordings and past information about you. Is it all right if people wander from the truth in trying to interact with someone who's died? 

There are other ways to leave memories behind. You certainly can record messages so that you can control the content. Many people video themselves and so on. There are obviously people who would say that they have a diary or have written information they can leave behind. 

Is there a place in terms of accuracy for a kind of artificial version of ourselves to go on forever? Another interesting issue is who controls that. Can you add to it after your death? Can information be shared about you with third parties who don't sign up for the service? Maybe the police take an interest in how you died. You can imagine many scenarios where questions might come up about wanting to access these data that the artificial agent is providing. 

Some people might say that it's just not the way to grieve.Maybe the best way to grieve is to accept death and not try to interact with a constructed version of yourself once you've passed. That isn't really accepting death. It's a form, perhaps, of denial of death, and maybe that isn't going to be good for the mental health of survivors who really have not come to terms with the fact that someone has passed on."

Thursday, March 16, 2023

Medical Residents Are in an Uproar Over the 'Ethics' of The Last of Us Finale; Time, March 15, 2023

LAURA ZORNOSA, Time ; Medical Residents Are in an Uproar Over the 'Ethics' of The Last of Us Finale

[Spoilers in linked article]

"“What TLOU story wants you to do is a great deal of suspension of disbelief for quite a lot of your medical/ethical knowledge,” they continued. “This is simply because it wasn’t written for people like us who have a great deal of this knowledge.”"

Sunday, January 30, 2022

Two New York nurses charged with forging Covid vaccine cards to earn more than $1.5 million; CNBC, January 29, 2022


Jessica Bursztynsky, CNBC ; Two New York nurses charged with forging Covid vaccine cards to earn more than $1.5 million

"Two nurses on New York’s Long Island are being charged with forging Covid-19 vaccination cards and entering the fake jabs in the state’s database, a scam that allegedly raked in more than $1.5 million."

Monday, January 24, 2022

Friday, December 31, 2021

The top 10 most-read medical ethics articles in 2021; American Medical Association (AMA), December 29, 2021

 

Kevin B. O'Reilly ,  American Medical Association (AMA); The top 10 most-read medical ethics articles in 2021


"Each month, the AMA Journal of Ethics® (@JournalofEthics) gathers insights from physicians and other experts to explore issues in medical ethics that are highly relevant to doctors in practice and the future physicians now in medical schools, as well as the other health professionals who constitute the health care team.

Below, find the 10 most popular AMA Journal of Ethics articles published this year."

Friday, May 28, 2021

Privacy laws need updating after Google deal with HCA Healthcare, medical ethics professor says; CNBC, May 26, 2021

Emily DeCiccio, CNBC; Privacy laws need updating after Google deal with HCA Healthcare, medical ethics professor says

"Privacy laws in the U.S. need to be updated, especially after Google struck a deal with a major hospital chain, medical ethics expert Arthur Kaplan said Wednesday.

“Now we’ve got electronic medical records, huge volumes of data, and this is like asking a navigation system from a World War I airplane to navigate us up to the space shuttle,” Kaplan, a professor at New York University’s Grossman School of Medicine, told “The News with Shepard Smith.” “We’ve got to update our privacy protection and our informed consent requirements.”

On Wednesday, Google’s cloud unit and hospital chain HCA Healthcare announced a deal that — according to The Wall Street Journal — gives Google access to patient records. The tech giant said it will use that to make algorithms to monitor patients and help doctors make better decisions."

Monday, April 13, 2020

Pandemic serves up new questions of medical right and wrong; American Medical Association, April 13, 2020

Timothy M. Smith, American Medical Association; Pandemic serves up new questions of medical right and wrong


"The COVID-19 pandemic is posing unfamiliar challenges for front-line physicians while also casting new light on longstanding health equity issues. An episode of the “AMA COVID-19 Update” explores several underlying ethical questions. Among these: How much risk is too much for physicians? Which patients should get priority access to scarce resources? And how do socioeconomic factors affect quality of care in an emergency?

In a conversation with the AMA’s chief experience officer, Todd Unger, three experts from the AMA delved into relevant ethical guidance.

The AMA and the Centers for Disease Control and Prevention are closely monitoring the COVID-19 global pandemic. Learn more at the  AMA COVID-19 resource center. Also check out pandemic resources available from the AMA Code of Medical EthicsJAMA Network™, AMA Journal of Ethics®, and consult the  AMA’s physician guide to COVID-19."

Monday, April 8, 2019

Circumcision, patient trackers and torture: my job in medical ethics; The Guardian, April 8, 2019

Julian Sheather, The Guardian; Circumcision, patient trackers and torture: my job in medical ethics

"Monday

Modern healthcare is full of ethical problems. Some are intensely practical, such as whether we can withdraw a feeding tube from a patient in a vegetative state who could go on living for many years, or whether a GP should give a police officer access to patient records following a local rape. 

Others are more speculative and future-oriented: will robots become carers, and would that be a bad thing? And then there are the political questions, like whether the Home Office should have access to patient records. My job is to advise the British Medical Association on how we navigate these issues and make sure the theory works in practice for patients and healthcare professionals."

Tuesday, February 12, 2019

Rethinking Medical Ethics; Forbes, February 11, 2019

, Forbes; Rethinking Medical Ethics

"Even so, the technology raises some knotty ethical questions. What happens when an AI system makes the wrong decision—and who is responsible if it does? How can clinicians verify, or even understand, what comes out of an AI “black box”? How do they make sure AI systems avoid bias and protect patient privacy?

In June 2018, the American Medical Association (AMA) issued its first guidelines for how to develop, use and regulate AI. (Notably, the association refers to AI as “augmented intelligence,” reflecting its belief that AI will enhance, not replace, the work of physicians.) Among its recommendations, the AMA says, AI tools should be designed to identify and address bias and avoid creating or exacerbating disparities in the treatment of vulnerable populations. Tools, it adds, should be transparent and protect patient privacy.

None of those recommendations will be easy to satisfy. Here is how medical practitioners, researchers, and medical ethicists are approaching some of the most pressing ethical challenges."

Thursday, November 1, 2018

Medicine and ethics: Will we learn to take research scandals seriously?; Star Tribune, October 29, 2018

Carl Elliott, Star Tribune; Medicine and ethics: Will we learn to take research scandals seriously?

"“The Experiments” is a cautionary tale of how the refusal of institutional leaders to look honestly at ethical problems can lead to the deaths of unsuspecting patients. And while the jury is still out as to whether the Karolinska Institute will reform itself, at least the Swedish public and concerned politicians are trying to hold the institution accountable. 

That is more than we can claim for Minnesota. As they say in the rehabilitation units: The first step to recovery is admitting you have a problem."

Thursday, February 5, 2015

A Failed Trial in Africa Raises Questions About How to Test H.I.V. Drugs; New York Times, 2/4/15

Donald G. McNeil Jr., New York Times; A Failed Trial in Africa Raises Questions About How to Test H.I.V. Drugs:
"The surprising failure of a large clinical trial of H.I.V.-prevention methods in Africa — and the elaborate deceptions employed by the women in it — have opened an ethical debate about how to run such studies in poor countries and have already changed the design of some that are now underway."

Tuesday, November 5, 2013

Medical Ethics Have Been Violated at Detention Sites, a New Report Says; New York Times, 11/4/13

Denise Grady and Benedict Carey, New York Times; Medical Ethics Have Been Violated at Detention Sites, a New Report Says: "A group of experts in medicine, law and ethics has issued a blistering report that accuses the United States government of directing doctors, nurses and psychologists, among others, to ignore their professional codes of ethics and participate in the abuse of detainees in Afghanistan, Iraq and Guantánamo Bay, Cuba. The report was published Monday by the Institute on Medicine as a Profession, an ethics group based at Columbia University’s College of Physicians and Surgeons, and the Open Society Foundations, a pro-democracy network founded by the billionaire George Soros. The authors were part of a 19-member task force that based its findings on a two-year review of public information. The sources included documents released by the government, news reports, and books and articles from professional journals."

Thursday, December 30, 2010

'Conditioned on' kidney donation, sisters' prison release prompts ethics debate; Washington Post, 12/30/10

Krissah Thompson, Washington Post; 'Conditioned on' kidney donation, sisters' prison release prompts ethics debate:

"Mississippi Gov. Haley Barbour's decision to commute the prison sentences of two sisters drew wide attention in part because their cause has been embraced by civil rights activists. But an unusual aspect of the arrangement is also drawing scrutiny: Barbour said his action was "conditioned on" one sister donating a kidney to the other."