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02/18/2012 - 5:03am

Existence is the most fundamental thing which is taken for granted. When we actually think about it, we all find it pretty mysterious, but I wonder if you realize just how mysterious it really is. Here’s a few things to consider.

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02/17/2012 - 8:53pm
Dr. J. reads Dr. Nick Bostrom’s allegory of the struggle to stop aging, published in the Journal of Medical Ethics. (First broadcast in December of 2004)
02/17/2012 - 6:36pm

I finally got a look at the issue of MD Advisor [5(1) Winter 2012) in which my article "Responding to Requests for Non-Beneficial Treatment" appears.  

02/17/2012 - 5:35pm

Yesterday, I happened to read a New York Times story that was published exactly 40 years ago this week:  "The Right to Choose Death."  Remarkable is that, despite the birth and growth of bioethics, very little has changed.  The article notes:  "One of the most potent fears of the aging . . . is that they may be subjected to a lingering and painful death or that their bodies may go on living after their minds and spirits have ceased . . . ."  This is still true today.  

02/17/2012 - 3:48pm

I have written on this blog and in several articles about my admiration for the 2010 Andalusia statute, "Personal Rights and Guarantees to Die in Dignity."  Now there is a great way for others to learn from this model, a new book:  Ethics and Death with Dignity. History of a Law (Ética y Muerte Digna. Historia de una Ley).  The book is written in both Spanish and English.  Here is the table of contents:

02. Challenges ...

02/17/2012 - 2:15pm

Just because a person with advanced dementia CAN swallow doesn't mean s/he WANTS to swallow -- especially if skilled personnel are putting thickened puree at the back of his/her tongue so s/he swallows by REFLEX... especially if such "feeding" (not "eating") only prolongs the process of dying and increases the risk of more pain and suffering.

Psychiatrist Dr. Stanley A Terman, PhD, MD, is the founder and Medical Director of the non-profit organization, Caring Advocates.  In the following video (an edited version of a live presentation at the San Francisco Bay Area End-of-Life Care Network on February 1, 2012) Dr. Terman planned to spend more time brain storming ways to educate the general public that there now exists an easy way to complete Advance Care Planning that can effectively reduce suffering....

02/17/2012 - 11:39am

CALL FOR PAPERS AND PRESENTERSHONORING PATIENTS’ TREATMENT CHOICES AT THE END OF LIFE:    NEW TOOLS, NEW CHALLENGES, NEW LIMITS

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02/17/2012 - 8:54am

Unless you've been living under a rock for the past few weeks, you’re now well aware of the other health care mandate. The Affordable Care Act requires insurers to cover “preventative health services” without charging a copayment, co-insurance, or a deductible, and the Obama administration has interpreted this requirement to include the full range of contraceptive methods approved by FDA, as well as sterilization procedures.

 From the start, the interpretive rule had an exemption for certain religious employers, including churches. But it did not exempt the insurance provided to employees of Catholic hospitals, colleges, and charities. Supporters have applauded the administration as scoring a major victory for women's health. But the Catholic Bishops and many Republicans don't see it that way. For them, failure to adopt a broader exemption was nothing short of an attack on religious liberty.

Last Friday, President Obama "tweaked" the rule in a solution that seemed quite reasonable. Women will still get free contraceptives, while charities and hospitals with religious objections can avoid the complicity of having to provide the coverage, pay for it, or refer employees to it. And insurers won too. The onus will now be on them to reach out to the employees of objecting employers, but pills are a lot cheaper than pregnancies (not to mention more covered dependents). As with any good compromise, of course, no one is happy and the debate continues.

No doubt about it, conscience is a tricky issue, one I have tackled elsewhere. Ultimately, freedom of conscience is something we should strive to protect, and President Obama is normatively right, and not just politically expedient, to seek a resolution that will accommodate all parties. Whether or not you agree with the administration's latest proposal, however, there's a better solution, although one that's admittedly much more than a "tweak." We need to decouple health insurance from employment.

The current system is the result of a sort of historical accident that we just have not been able to shake, rather than some reasoned health policy judgment that insurance and employment ought to be linked. When wage and price controls were imposed during World War II, employers needed some new way to attract the best and brightest, so they turned to benefits such as offering housing subsidies and health insurance. At the same time, the IRS agreed to exclude the value of these benefits from taxable income, while counting it as a business expense for the employer, such that both employers and employees saw tax perks in this approach. When the wage and price controls were removed after the war, the IRS rule was not -- and the insurance system stuck.

As a result, today we have a system where people (and their families) lose coverage when they change or lose jobs unless they are willing and able to pay high COBRA fees or purchase their own insurance. We have a system where workers’ wages have been depressed as employers shift funds to keep up with insurance premiums, which are rising to keep up with inflating health care costs. And we have a system where religious employers, be they charities and hospitals or businesses without any sort of religious mission, will sometimes fundamentally conflict with their employees over the scope of insurance coverage, necessitating a difficult balance between respecting conscience and preserving access to health care services that people want and often need. With problems like these, among several others, the employer-based health insurance system needs a much stronger justification than simple inertia. 

Affordable health care is essential to human flourishing, and people ought to have access no matter who their employer is or even whether they work. Ultimately, health insurance should not be treated as a "benefit" – a term that suggests that it is somehow a bonus or an extra. It should be considered a right, provided to all by the government. Would there still be debates over coverage, for both financial and moral reasons? Absolutely, just as we see now in the context of Medicaid and Medicare. But the issues of complicity there are the same as for any tax-paying citizen whose contributions are used for government programs they may disagree with, from the death penalty to various military engagements. That is the price we pay for membership in a society.

The Affordable Care Act went as far as it could politically in reforming a broken system (perhaps even too far, according to some legal interpretations), and it made some critical improvements. However, cementing the employer in the health care relationship was a fundamental failure. Let’s make use of the controversy over contraceptive coverage to demonstrate one more reason why the status quo of employer-based health insurance just does not make sense.

Holly Fernandez Lynch is an Academic Fellow at Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics.

02/17/2012 - 3:00am
Marshall Brain - Automation & Unemployment
02/17/2012 - 2:16am

Zombies are a strange source of ethical inspiration, but as I mentioned to io9′s Lauren Davis, if academic ethicists get to spend all day talking about trolleys, I see no reason we can’t banter about the ethics of the undead.

Lauren posed the following query: When is it ok to kill a zombie? Should zombies be killed on sight, or quarantined as sick humans? As an answer, she has an excellent post up that has a some other cool responses to the questions and is worth a full read....