Last week we shared a link to a story by Lisa Krieger, science and medicine reporter for the San Jose Mercury News, on the long and protracted death of her father and the high cost of end-of-life care. She spoke with Daniel Callahan, co-founder of the Hastings Institute, about his views on the cost of end-of-life care, and today Dr. Callahan posted an interview he conducted with Ms. Krieger:
While her father had made clear prior to his dementia that he wanted to die a “natural death,” what he got what he got was an unnatural “death by medicine,” as someone once put it. The total cost for the hospital stay alone was $323,000. Again and again Krieger had to make a decision about going on, as one crisis after another surfaced. With each new crisis, the doctors offered hope. There was, they said, “a decent chance we could turn it around.” They could not, and he finally died. But as the days moved along from one crisis after another, Krieger kept asking herself, Was it all worth it? “Should we have quit?” she wrote. And when?
I have come to think that the decisions about stopping life-sustaining treatments may have become harder, not easier, since the 1960s, when the reform movement was gaining momentum. Medicine has become increasingly skilled technologically in keeping the dying alive. Her father, Krieger noted, “thanks to modern medicine . . . lived decades longer than his father.” That same medicine gave him a miserable death. That is a dilemma of modern medicine we have yet to resolve.
I don’t oppose the disclosures of industry payment to physicians, but I’m skeptical that they will have the purifying effect that its proponents promise. Remember, we’re not outlawing corporate payments. A disclosure doesn’t eliminate a potential conflict of interest; it only announces it. Ethical physicians behave ethically because they are wired to do so, not because they disclose payments and gifts.
A thought-provoking Q & A with Allen Buchanan, Professor of Philosophy at Duke University, a consultant to the President’s Council on Bioethics and author of the book, Better Than Human:
It could be that we are on the verge of a great deluge of cognitive enhancement. Or it’s possible that new brain-enhancing drugs and technologies will be nothing compared to how we’ve transformed our minds in the past. If it seems that making ourselves “artificially” smarter is somehow inhuman, it may be that similar activities are actually what made us human.
Let’s look at the nature of the new technology. Last week a team of ethicists from Oxford released a paper on the implications of using Transcranial Direct Current Stimulation TDCS to improve cognition in human beings. Recent years have seen some encouraging, if preliminary, lab results involving TDCS, a deep brain stimulation technique that uses electrodes placed outside the head to direct tiny painless currents across the brain. The currents are thought to increase neuroplasticity, making it easier for neurons to fire and form the connections that enable learning. There are signs that the technology could improve language acumen, math ability, and even memory. The Oxford paper argues that TDCS has now reached a critical stage where its risks must be carefully considered before the research goes further.
Of course, not everyone is convinced that the technology will pan out. Some remain skeptical of TDCS, calling it a fad, the latest in a long series of “neuro-myths” that bubble up when scientists distort or embellish their findings in the name of publicity. But even if brain stimulation fizzles, the questions raised by the Oxford paper are going to be with us for a long time. That’s because TDCS is just one of many promising new technologies that neuroscientists hope will enhance cognition, including smart pills, genetic engineering, and brain-to-computer interfacing. As deep brain stimulation has become the flavor du jour in neuroscience, bioethicists have increasingly given it a starring role in the thought experiments they use to tease out the philosophical dilemmas posed by cognitive enhancement.
Good Morning America reports on a new survey from the Wellcome Trust Sanger Institute to gauge opinions on what to do with genetic information. In this clip, Dr. Bruce Korf, a medical geneticist at the University of Alabama at Birmingham, explores the ethical implications of withholding information obtained through whole genome sequencing of a patient:
We’ve received some questions about our cancellation policy for the Bioethics Bootcamp. Once you’ve registered, you may request a full refund up to 21 days before event, a 50 percent refund up to 7 days before the event, and no refund thereafter.