Latest news with #medicalethics
Forbes
21 minutes ago
- Health
- Forbes
Raiders' Release Of Christian Wilkins May Conflict With Medical Autonomy Provided For In CBA
Photo byOn July 24, the Las Vegas Raiders reportedly released defensive tackle Christian Wilkins, a six-year veteran with whom the Raiders signed a four-year, $110 million contract prior the 2024 season, $82.75 million of which was guaranteed. The Raiders were reportedly unhappy with the progress on Wilkins' recovery from a foot injury suffered last season, including a disagreement with Wilkins about whether additional surgery was needed. The Raiders' position – and the related voiding of Wilkins' contract – potentially runs afoul of player protections in the collective bargaining agreement (CBA) between the NFL and NFLPA, resulting in a grievance filed by the NFLPA. Bioethical Considerations The situation raises serious bioethical concerns. Bioethics refers to the application of ethics – the philosophical discipline pertaining to notions of right and wrong – to the fields of medicine and healthcare. Bioethical analyses are generally conducted through the lens of specific principles, the most commonly-recognized being respect for autonomy, non-maleficence (the duty to avoid harm), beneficence (the duty to do good), and justice. Of most relevance to Wilkins' situation is the concept of autonomy. As described by leading bioethicists Tom Beauchamp and James Childress, '[p]The Raiders' apparent insistence that Wilkins have another surgery despite his preference otherwise appears to run afoul of the principle of autonomy, i.e., the right to control what is done to one's own body. The Raiders' actions could be viewed as self-serving, or at a minimum paternalistic (a question that has arisen with Miami Dolphins quarterback Tua Tagovailoa). Who Decides? The Raiders' position also raises legal issues, as evidenced by the NFLPA's grievance. Specifically, Section 6 of Article 39 of the CBA protects a player's right to receive a second medical opinion from a doctor of his choice and at the team's expense after having been first examined by the team's doctor. That provision also provides that a 'player shall have the right to follow the reasonable medical advice given to him by his second opinion physician with respect to diagnosis of injury, surgical and treatment decisions, and rehabilitation and treatment protocol, but only after consulting with the Club physician and giving due consideration to his recommendations.' This provision is generally understood to provide players with the ultimate right to choose their own course of treatment, consistent with the principle of autonomy. Additionally, if surgery is required, players are permitted to utilize an appropriately qualified surgeon of their choosing. The right of NFL players to control their medical treatment is not an approach shared by all sports leagues. While MLB also permits players to make the final decision about their treatment, the NBA, NHL and MLS CBAs provide the clubs with the right to determine a player's course of treatment. (See here for a report I co-authored in 2017 comparing the health-related policies and practices of the different leagues.) Indeed, this right was a major issue for NHL players in their recent CBA negotiations with the league after a dispute between Jack Eichel and the Buffalo Sabres concerning treatment for a neck and back injury. Whether such a right is now provided for in the recently agreed to CBA has not been publicly revealed and the NHLPA did not immediately respond to a request for comment. The Value Of A Guarantee The NFLPA is also likely taking the position that the Raiders' release of Wilkins violated his contract, including specifically the $35.2 million remaining in guaranteed compensation. Portions of NFL player contracts can be 'guaranteed' in a variety of ways. Under the standard NFL player contract, a player's contract can be terminated if: (1) 'at any time, in the sole judgment of Club, Player's skill or performance has been unsatisfactory as compared with that of other players competing for positions on Club's roster…, [or (2)] during the period any salary cap is legally in effect…, in Club's opinion, Player is anticipated to make less of a contribution to Club's ability to compete on the playing field than another player or players whom Club intends to sign or attempts to sign, or another player or players who is or are already on Club's roster, and for whom Club needs room.' Player contracts frequently provide that they will continue to receive some portion of their pay despite these two termination rights, known as 'skill' and 'cap' guarantees. Additionally, player contracts also frequently guarantee that a player will continue to receive his pay despite having suffered an injury. While the player's contract and CBA generally require a player to be paid their salary for so long as they are physically unable to provide their services because of an on-field injury, the duration of the injury and the required payment are frequently a subject of dispute and resolved through a process known as an Injury Grievance. An injury guarantee avoids this uncertainty and offers the player broader protection against release as a result of an injury. ESPN's report indicates that the Raiders' reason for the release was because Wilkins had failed 'to maintain his physical condition to play.' Wilkins and the NFLPA undoubtedly believe that the real reason for his release stems from Wilkins' on-field injury and that failing to continue paying him will violate injury guarantees in his contract. The dispute will now be resolved before a neutral arbitrator. In the meantime, Wilkins is free to sign with another club. And in the event Wilkins prevails in his grievance, the Raiders will likely claim that any pay Wilkins received from another club should offset any amounts owed by the Raiders. The Raiders did not respond to request for comment and the NFLPA declined to comment about Wilkins' situation.
Associated Press
3 days ago
- Health
- Associated Press
Book Review: 'The Sleep Room' is the harrowing story of psychiatric care in the 1960s
In the 1960s, a hospital in London held a ward full of women who suffered from a range of mental disorders. The women in this 'sleep room' were subjected to various medical procedures, including electroconvulsive therapy, or ECT, and, at times, a lobotomy, without their consent. In 'The Sleep Room: A Sadistic Psychiatrist and the Women Who Survived Him,' Jon Stock tells the harrowing history of the British doctor who subjected them to medical abuse and gives voice to those who survived him. With interwoven firsthand testimony from surviving patients and rigorous research, Stock provides a haunting account of what the psychiatrist did to his patients without their knowledge. Throughout the book Stock also works to hold the medical establishment accountable for the neglect that occurred, but at times can simplify the complexities of psychiatric care during the '60s that most likely led to the abuse endured by many patients. While the switching between patient stories, history and research can create some confusion for the reader, the patient testimonies allows Stock to deliver an emotionally powerful narrative that is equally as disturbing. Written with nuance and tact, the 'The Sleep Room' is a chilling exposé into psychiatric care that will resonate deeply readers and, especially, true crime fans. ___ AP book reviews:
Telegraph
3 days ago
- Health
- Telegraph
Whatever happened to the Hippocratic Oath?
As a young artist, my grandfather took the long journey by ship to Japan in 1908. The trip was his prize for winning a competition. While in Japan, he took up jiu-jitsu, the martial art. It was a condition of his training that he should sign an oath, in his own blood, that he would use the skills he learned for good and not for ill. He was gaining, after all, skills that would enable him to wound or kill. It was required that he would promise to deploy them virtuously and responsibly. It is a similar story with medical ethics. In ancient Greece, as doctors first began to learn methods that could mean the difference between life and death, a code of ethics was developed, known as the Hippocratic Oath. One part of it reads: 'I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them'. It also includes a promise to maintain patient confidentiality and not to poison anybody, even when asked to. Many people assume that trainee doctors still swear the Hippocratic Oath but they don't. Medical schools have their own oaths or declarations. Bristol University, for example, asks its medical students to make a 'promise', the final part of which is: 'I will work for the good of all persons whose health may be placed in my care and for the public wellbeing'. The medical profession is, or at least used to be, a vocation. It was driven in large measure by a desire to do good in the world rather than for the pursuit of financial gain. In the early 20th century, before the creation of the NHS, general practitioners varied their fees according to the means of their patients. It is estimated that one fifth of the population was given treatment for free. Surely today, too, most young people who go into medicine also have at least some sense of vocation and a feeling that their training and skills give them a responsibility to others. But how do they now square these ideas with withdrawing their labour – as they have voted to do – between the 25th and 30th of July? This is not equivalent in any way to industrial action undertaken to delay the collection of bins, or force commuters into the inconvenience of riding a slow rail-replacement bus. Doctors know, better than anyone else, that vast numbers of people are waiting for operations. They know that the delay of an operation or therapy for, say, cancer, means that it is more likely that the patient will die. Cancer, by its nature, grows. If it spreads too far, it becomes impossible to save the patient. By withdrawing their services, doctors know that more patients will have more delays in the treatment of cancer, heart disease and other potentially deadly diseases. Is this what they went into medicine for? To threaten fatal consequences for patients for the sake of a better pay deal? If so, it is a sad transformation of the ideals that doctors once represented. On another issue, the attitude of the British Medical Association to puberty blockers suggests a big change in ideology. The very thorough Cass Review asserted that the evidence base and rationale for early puberty suppression was unclear, and that masculinising/feminising hormone therapy should not be provided for people below the age of 16. The leadership of the BMA is clearly capable of working when it comes to 'critiquing' the Cass Review. It appears to be ideologically opposed to its findings. The Hippocratic priority of doing 'no harm or injustice' appears to have been pushed aside yet again in the service of political expediency. As for assisted dying (in other words, helping to end someone's life) this is, on the face of it, directly contrary to the Hippocratic Oath. If this becomes law, doctors will – or at least one hopes they will – wrestle with their consciences to be as confident as possible that they are 'working for the good of all persons'. But the sad truth is, as a young doctor said to me yesterday, that the philanthropic ideal of medicine is not as strong as it once used to be. Those now entering the field of medicine should not be surprised to see their status in the public eye suitably diminished.
Mail & Guardian
4 days ago
- Health
- Mail & Guardian
Let's talk about death and dying
Medical school prepares our future doctors to save lives. But with death being the endpoint for all of us, shouldn't we be talking about it? Photo: Maria Luísa Queiroz/Unsplash There is an old joke about someone collapsing on an aeroplane mid-flight. The flight attendant shouts out, 'Is there a doctor onboard?' A passenger comes forward but just stands there. 'Why aren't you doing anything? He's dying!' the flight attendant cries. 'I'm a doctor of philosophy,' the passenger says dryly. 'We're all dying.' I can relate. I'm a moral philosopher, and a lot of my professional life has focused on matters relating to death. From the rightness or wrongness of abortion, to the morality of capital punishment or the ethics of using dead bodies for medical research, I've found that death, in the abstract, is an endlessly fascinating subject. But death is no longer just abstract for me. A few years ago, I lost my mother to cancer. I am currently facing a serious health probem of my own. So I've had a lot of time professionally and personally to contemplate death in the not-so-abstract. I teach in the department of medicine at the University of Cape Town, where I talk to my students about respecting patients' choices, avoiding causing harm, helping others and treating all people fairly. Developed by biomedical ethicists Tom Beauchamp and James Childress in the 1970s, these In my classes, we talk about patients' rights, including the right to refuse lifesaving treatment like blood transfusions on religious grounds, or the right to have life-sustaining treatments withdrawn, like saying no to more chemotherapy or other cancer treatments. But we don't talk about what happens after patients exercise these rights, and what it may feel like for the treating clinicians when their patients die from what seem like preventable deaths. Difficult conversations In June I attended the annual In my workshop on using the tools of philosophy to resolve ethical dilemmas, I used an example of a child with terminal cancer to illustrate a point, and during the break, one of the workshop participants, a I wanted to rage and cry at the injustice of the situation, but she seemed calm and at peace. These different reactions suggested to me that there is a critical need to transform the way we relate to death — and we can start by having conversations about it. We can start with our medical students who are focused on their future jobs of 'saving lives'. Of course, I'm not suggesting we shouldn't train our healthcare practitioners to focus on saving lives. But I do think — given that we are all going to die — that we shouldn't avoid the subject as many of us do. We could do so much better to prepare our students ethically, emotionally and practically for one of the critical things they will have to deal with in their professions. If we talk about death with our students, and how it feels to see someone die, perhaps they will be better equipped to help support those who are dying and those who are grieving. Talking about death is challenging. It touches all of us in different ways, whether in our personal experience or professionally. We may have competing views about it, informed by our experience, our religion, our culture. But 'difficult' is not a reason not to have the conversation. Here's the thing: not only do we not talk enough about death with our students, but we also don't talk about dying. I recently read palliative paediatrician Alastair McAlpine's wonderful 'No lecture had prepared me for this. No one had counselled me on how to comfort someone who was dying. Or what to say to someone who was in such pain and distress. I had studied the pharmacological approach to pain management, but not how to deal with loneliness, fear and sadness. Nor how to manage my own feelings around a patient who was slipping away. I didn't know what to do or say. In the face of death, words felt impotent and inadequate.' Patient mortality, professional failure For many philosophers, the task is to analyse and understand death. For me, the task is also to make space for it: in our classrooms, our hospitals, and our hearts. In our classrooms, we need to go beyond asking students what kind of doctors they want to be and ask them to think about what kind of doctors they want to be when their patients are dying. We need to have conversations about how to transition from offering care that cures to care that comforts patients with irreversible conditions such as terminal cancer or end-stage organ failure. When we teach students to be empathetic to their patients' and families' situations, we also need to caution them about becoming overwhelmed and not taking on their patients' suffering as if it were their own. If we don't teach them how to manage their own mental health, we risk them suffering from depression, burnout or compassion fatigue. We need to teach them to learn from experience without being consumed by it. In our clinics and hospitals, we need to challenge the idea that patient mortality equates to professional failure. We can reframe morbidity and mortality meetings, which allow clinicians to review patient care and treatment, as opportunities for learning rather than for shaming. We can encourage our colleagues to view each other — and themselves — as companions who support patients in the full human experience rather than as warriors fighting inevitable biological processes. Chocolates and jokes Upon receiving my recent diagnosis, my first thoughts and words were 'I don't want to die'. I realise now that what I meant was, I don't want to die now. Or soon. But having to consider that I will die at some point has helped me think about how I'd like to live with whatever time I have left — and hopefully it's a lot. It's also helped me talk to others about how I'd like to die and what I'd like after my death. (For example, I don't want the word 'feisty' on my tombstone, however appropriate a description of me it might be.) Talking about death has reduced the anxiety I had about death, and given me some assurance that when the time comes, I can trust others to know that I will have dignity in dying. That if I cannot care for myself, or speak about what I want, they will be able to do so for me, authentically — and hopefully with a dash of dark humour. I'm not religious, so I asked for chocolates and jokes rather than thoughts and prayers. I believe that how we care for ourselves and for others is fundamental to who and what we are. How we live with the dying can say a great deal about who we are, and how we die can say a great deal about how we've lived. Heidi Matisonn is a senior lecturer in bioethics in the EthicsLab at UCT's Neuroscience Institute and department of medicine. This story was produced by the . Sign up for the .
New York Times
6 days ago
- Health
- New York Times
Is It Fair for a Doctor's Mom to Get Faster Emergency-Room Care?
My partner recently took a bad fall on some concrete steps and got a large gash on her head. Fortunately, her son — a prominent cardiologist at a local hospital — was present. He drove past two closer hospitals to reach the one where he is on staff. The E.R. was basically standing room only, but she was ushered into a private room and received immediate attention, as well as staples and other treatments. A scan, too, was provided right away, with a prompt reading from a radiologist. What would probably have been a five-hour ordeal for most took less than 70 minutes. Was this special treatment ethical? One religious leader I asked said yes, arguing that such perks are a legitimate reward for his work. Another said no, insisting that no one should have to wait longer because others receive V.I.P. priority. Thoughts? — Name Withheld From the Ethicist: Here's a classic example of how our special responsibilities to loved ones can come into tension with the more general obligations we owe to others. Ideally, doctors — and indeed all of us — should support triage systems in which patients are cared for strictly according to medical urgency, not personal connections or status. That's simple fairness. Yet, in ways the philosopher Bernard Williams explored, our moral obligations are also shaped by our relationships. If, confronted with two drowning people — one your spouse, one a stranger — you paused to deliberate whether it was defensible to save your spouse, you may, in Williams's famous words, have had 'one thought too many.' Sometimes morality not only permits but requires us to give priority to those dearest to us. In this case, the doctor was making decisions not as a hospital official but as a son. Taking his mother to be his special concern, he understandably pushed for her to be seen quickly. In these circumstances, simply standing by might seem cold, a dereliction of filial duty. Want all of The Times? Subscribe.
