hospitals

More Ethics Emanations From The World Of Medicine: The Charles Cullen Story

/ Jack Marshall / 2 Comments

Having spent a fair amount of time yesterday and today in a hospital, I was reminded of this post that had been stalled on the runway…

In November of last year, Netflix began running “The Good Nurse,” a disturbing movie based on the real story of Charles Cullen, a serial killer-nurse (played by Eddie Redmayne in the film), who murdered between 45 and over 400 patients at a series of hospitals and medical facilities in New jersey and Pennsylvania over a 16-year period. The film concentrates on the colleague who finally brought him down, Amy Loughren, a fellow nurse and freind (played by Jessica Chastain) who alerted the police after she became suspicious of Cullen’s links to patient deaths as well as his irregular computer accessing of medications.

The real horror of the film and the facts is that so many of the administrators of  the hospitals where Cullen committed his murders either strongly suspected that he was killing patients, were certain he was, or resorted to contrived ignorance to avoid discovering what was right in front of their staff’s eyes. At least 16 hospitals fired Cullen on various other grounds and gave him sufficiently ambiguous recommendations to allow him to find new employment where he could kill again. Law enforcement authorities were also alerted by hospital staff more than once, and let Cullen slip through their fingers. Continue reading →

Wuhan Virus Ethics Train Wreck Update, Part 2: Hospital Masking

/ Jack Marshall / 9 Comments

I actually witnessed this exchange three days ago, as part of my four-day Alexandria, VA hospital adventure:

Woman: Put on a mask! This is a hospital!

Man: Why should I? You’re not wearing one!

Woman: I am!

Man: You’re wearing it under your nose!

Woman: I’m still wearing it! Put one on, or I’m reporting you!

Man. Go ahead!

Whereupon the woman turned to the elderly volunteer manning the desk at the entrance. He wasn’t wearing a mask.

Are the idiotic pandemic masks the official symbol and attire of The Great Stupid? I think so. My experience at the INOVA hospital convinced me. At the Emergency Room entrance. a large sign mandated masks. A security guard ordered me to put one on (but not my wife, who was being checked in). The masks being handed out were those cheap paper things that are either completely useless or mostly useless, depending on who you talk to. During the four days of hospital visits, I didn’t see a single N95 mask on the faces of staff, patients or visitors.

Around the busy ER waiting area, there were unmasked people, masked people, and people wearing masks under their noses or chins. When my wife was being checked in, nobody appeared to care about the masks at all. The nurse processing us wore no mask. I didn’t; my wife didn’t. The attendants who took her to the temporary room did. Later on, all of the nurses and techs were masked, but some doctors were not. Nobody ever asked me or my wife to put one on. In the nearby rooms, the typical scene was an unmasked patient and a mixed crowd of masked and unmasked family members, shoulder to shoulder.

Later, when my wife was moved to a regular hospital room, the signs even disappeared. The Patients Entrance and Visitors entrance had cheap masks available, but there were no apparent requirements. Sometimes the receptionists were masked, sometimes not. Sometimes one was and the other wasn’t. I walked in maskless (let’s see…) eight times, and nobody said a word.

What’s going on here?

Madness, as Major Clipton said. Virtue signaling. Confusion. Mixed messages. Chaos. Fear. Stupidity.

Science!

ER Ethics

/ Jack Marshall / 10 Comments

I’m running back and forth to the Alexandria hospital’s Emergency Room today (don’t ask why). It’s been at least 6 months since the last unpleasant visit, and something new has been added in the check-in area. It is a large sign warning that “aggressive, threatening or inappropriate conduct or language” will not be tolerated, and may result in refusals to offer treatment.

It was immediately evident why the hospital felt such a threat was necessary. The place was a disaster. It was obviously understaffed, and the staff members that were there were rude, distracted, slow and harried. I watched a 90-year old woman stand at the check-in window as the woman behind it left without explanation abandoning the potential patient who was literally whimpering as the minutes ticked by. “At least there’s no emergency,” I said to the angry lady. She was not amused.

As with so many other places in which professional, timely service is expected and once, before the pandemic gave them an excuse to go with skeleton staffing, was delivered, the ER was lowering its standards and telling people that they could like it or lump it, but they had better not complain or express frustration.

And life in the USA gets just a little bit shittier.

Pandemic Ethics Overflow, Including The Funniest Story So Far [Updated]

/ Jack Marshall / 12 Comments

1. The funniest pandemic-related story comes out of Australia, and it goes in the “Scientific incompetence” files. Or maybe the “Sure, we should always trust the judgment of scientists” file. From The Guardian:

An Australian astrophysicist has been admitted to hospital after getting four magnets stuck up his nose in an attempt to invent a device that stops people touching their faces during the coronavirus outbreak.

Dr Daniel Reardon, a research fellow at a Melbourne university, was building a necklace that sounds an alarm on facial contact, when the mishap occurred on Thursday night.

The 27 year-old astrophysicist, who studies pulsars and gravitational waves, said he was trying to liven up the boredom of self-isolation with the four powerful neodymium magnets….“I had a part that detects magnetic fields. I thought that if I built a circuit that could detect the magnetic field, and we wore magnets on our wrists, then it could set off an alarm if you brought it too close to your face…

So he made millions of people around the world slap their foreheads in amazement.

2. About those idiots who drank the fish tank cleaner: The emerging facts, after so many headlines blamed the husband’s death on the President’s misinformation, show this was more fake news. The Arizona woman who said that she and her 68-year-old husband ingested a substance used to clean fish tanks after hearing President Donald Trump enthuse about the potential value of chloroquine (but not fish tank ccleaner constaining the chemical)  as a cure for the Wuhan Virus is a Democrats, opposes Trump, and has given thousands of dollars to Democratic groups and candidates over the last two years. In late February, she gave to a Democratic PAC, the 314 Action Fund, that is part of the  “pro-science resistance.”It has even used the death of her husband to attack the White House.

Now the surviving fish tank-cleaner gourmet admits that she and her husband were both Democrats, not Trump supporters. But she  told NBC News that she took the fish tank cleaner to follow Trump’s advice.  “We saw Trump on TV—every channel—and all of his buddies and that this was safe,” she said last week. “Trump kept saying it was basically pretty much a cure.” Naturally, nobody checked her story: it was too good an opportunity to get Trump.

Now the women admits that she heard about the potential benefits of chloroquine, an antimalarial drug, in news reports, and decided at the “spur of the moment” to try  it “We weren’t big supporters of [Trump], but we did see that they were using it in China and stuff,” Wanda told the Free Beacon. “And we just made a horrible, tragic mistake,” she said. “It was stupid, and it was horrible, and we should have never done it. But it’s done and now I’ve lost my husband….We didn’t think it would kill us. We thought if anything it would help us ‘cus that’s what we’ve been hearing on the news.”

But at least she was able to spin the story so the  the news media would falsely say that the President was responsible for them drinking fish tank cleaner, so it wasn’t a total loss. Continue reading →

Monday Ethics Musings, 10/7/2019: Questions, Questions…

/ Jack Marshall / 19 Comments

Thinking…

Wait, where are my clothes???

1. When will Mrs. Q make her debut as a regular contributor to Ethics Alarms? I’m working out the details. She’s ready, I’m behind, we’ll get it done. Very excited.

2. If everything is going to be done online, is it reasonable to expect those companies who force us to interact that way to be competent? Case Study: The Boston Globe just offered me a 6 month digital subscription for a buck. But an old password connected to my email address prevented me from entering the new one necessary to accept the deal. All links went to current subscription or subscribing at the regular price. It took 40 minutes of online chats with robots and a human being (who disconnected me one) to fix the problem, which was in how the Globe set up the offer acceptance page. I ended up using a password made up by “Sherry” because I couldn’t reset my password myself. This kind of thing happens all the time. I wouldn’t have a clue how to set up a website response system, but if that was my job, I would be obligated to do better than this.

3. What good are movie critics whose opinions and tastes aren’t shared by their readers? My view: not much. The job of a critic is to let readers know if readers would appreciate the movie or not. A critic who can’t or won’t do that, and most don’t, is useless. I was thinking about this when I encountered this article in The Guardian listing the films for which audience ratings and critical ratings diverged the most.

Much of the disparity today is caused by critics who allow their ideological biases to dominate their judgment: yes, bias makes them stupid. Another problem, harder to over-come, is that the judgment of people who see hundreds of movies a year and who are often steeped in the art of film-making often has no relevance to the movie average audience member at all. Yet another is the unavoidable fact that few critics are equally qualified to review all genres. Horror movies are especially frequent victims of this problem.

Incidentally, yesterday I watched a new horror movie, “A.M.I.” that exploited the inherent creepiness of online personal assistants like Siri and Alexa. It was pretty bad, but the final scene was so ridiculous (and predictable) that it almost justified the film. Almost. Continue reading →

Sunday Ethics Warm-Up, 10/6/2019: Fan Ethics, Hospital Ethics, Vandalism Ethics, And Diplomatic Immunity

/ Jack Marshall / 27 Comments

Well, I woke up…

…and as my father was fond of saying, that should be enough. Of course, he adopted that philosophy during combat in World War II…

1. I have been asked, “With your beloved Red Sox out of the post-season, are you paying attention to the play-offs?” The answer is, “Oh, sure.” I’m not like Yankee fans, what my dad called “summer soldiers.” In fact, the post-season is a more enjoyable, less anxious, purer experience for a fan when his or her team is absent. I can just enjoy the beauty, suspense and constant surprises of baseball without being distracted by my emotions, conflicts of interest, and bias. Post-season baseball is the best of the game; when I am trying to introduce baseball to neophytes, this is the best time to do it. Yes, the dumbed-down broadcasting by the networks is annoying, but it’s always been that way. And yes, I still have some rooting biases: most of my friends  are Washington Nationals fans, do a piece of me is supporting them. I like underdogs, so the Twins, Rays, and every National League team but the Dodgers have my sympathies. The Yankees have had such a courageous, astounding season, winning over a hundred games despite having more significant injuries than any MLB team in history, that I even find myself rooting for them, because if any team deserves a championship, the 2019 New York Yankees do.

2. First, do no harm. Second, don’t be an asshole...This is incredible. Employees at a St. Mary’s Regional Medical Center in Lewiston, Maine  created a “wall of shame” where they displayed confidential medical records of disabled patients in 2016, the state Human Rights Commission has found.

The records posted on the wall concerned sexual activity, photos and descriptions of  body parts and bodily functions of patients. St. Mary’s told CNN that it is “fully committed to ensuring this doesn’t happen again.”

Gee, that’s comforting. How did this happen in the first place?

The Shame Wall was revealed as part of a harassment complaint. MyKayla McCann, an employee who had been treated at the hospital, said that the existence of the “wall of shame” constituted an “abusive environment” where hospital staff displayed open hostility to those with disabilities.

“Coworkers constructed a workplace display ridiculing patients with disabilities. [McCann] encountered the display every day as part of her regular environment, making harassment pervasive,” the investigation said. “The information posted on Shame Wall was intended to demean and humiliate and included supposed ‘jokes’ about the hospital’s physically and mentally disabled patients.”

One employee was fired and another was given a warning in response to the incident. It took the hospital  four months after McCann’s complaint to take the Shame Wall down, according to the report. How caring. How efficient.

Continue reading →

The Bioethical Dilemma Of The Mother’s DNR Revisited, And More Fetal Rights Ethics Confusion [UPDATED]

/ Jack Marshall / 14 Comments

In Part 2 of the New York Times editorial board’s examination of the ethical and legal complexities of conflicting laws protecting the right to kill a fetus, the rights a fetus does have, and the mother’s rights, the question is posed:

Katherin Shuffield was five months pregnant when she was shot in 2008. She survived, but she lost the twins she was carrying. The gunman, Brian Kendrick, was charged with murdering them. Bei Bei Shuai was eight months pregnant and depressed when she tried to kill herself in 2010. She was rushed to the hospital and survived, but her baby died a few days later. Ms. Shuai was charged with murder.

Both cases are tragedies. But are Ms. Shuai and the man who shot Ms. Shuffield really both murderers?

It is an ethical question, a legal one and a logical one. Unfortunately, and typical of the entire series, the Times cannot play straight, or begin with basic principles. No, the questions is asked with an assumption in hand: the right to abortion must trump everything, even logic and justice The editors go on:

“Ms. Shuai is one of several hundred pregnant women who have faced criminal charges since 1973 for acts seen as endangering their pregnancies, according to National Advocates for Pregnant Women, which has completed the only peer-reviewed study of arrests and forced interventions on pregnant women in the United States. In many cases, the laws under which these women were charged were ostensibly written to protect them. Ms. Shuai, for instance, was charged under a law that was stiffened after the attack on Ms. Shuffield.

These criminal statutes are results of a tried-and-true playbook, part of a strategic campaign to establish fetal rights, reverse Roe v. Wade and recriminalize abortion. The sequence begins with anti-abortion groups seizing upon a tragic case in which a woman loses her pregnancy because of someone else’s actions. Public outcry then helps to strengthen a state feticide law that recognizes such lost pregnancies as murder or manslaughter. It’s a backdoor way of legally defining when life begins.”

In other words, the Times relies on ideology to duck an ethics conflict that points in a direction that radical abortion advocates don’t like, and thus refuse to acknowledge, because they don’t have a good answer for it. Here’s my answer: Yes, they are both murderers. If a mother who is gestating a child that she and her husband intend to have, and the child is killed by the act of a third party, a human being has been murdered, and charges are just. In the Sheffield case, her twins were within the protection of abortion limitations, though I would hold that this doesn’t matter, if they were both going to be delivered. If you don’t call this a murder, then a manic could perform an involuntary abortion on a 9 month’s  pregnant women, ripping her fetus out of her with murderous intent, and still face no murder charges as long as the mother recovered. Were it not that all obstacles to abortion must fall, even logical ones, no woman, no human being would call such an act anything but murder. Once any rights are assigned to the unborn at all, however, such logic is impolitic. Continue reading →

The Ethics Incompleteness Theory, The Bigot Doctor,”The Hader Gotcha,” And The Apology Scale

/ Jack Marshall / 25 Comments

Yes, she actually has both arms. She’s also photogenic: the Democrats should nominate her for Congress.

I christened the Hader Gotcha last year after several athletes were forced to apologize for youthful social media comments that suggested a bigoted or insensitive state of mind. The ethics Alarms position on people looking through old social media posts to embarrass public figures and force them to grovel apologies to which ever group their comments offended was summarized in this post in the moderate, calm manner for which I am justly praised:

As I have written here before, searching for lingering social media idiocy that an athlete authored before he could drink or vote is despicable conduct, as is anyone making an issue of  what the deep Twitter dives expose. First, what a baseball player said or thought—they are often not the same thing—in the past has nothing to do with his job, which is playing baseball and not making social policy, and second, nothing anybody says or even does before their brain has matured should be held against them in adulthood, unless it is criminal, and even then the law urges us to be forgiving. I know that a lot of social justice warriors think that any racist, sexist or homophobic comments made post birth should be treated a crimes, but they are anti-democratic nuts, and hostile to free thought and speech, so to hell with them.

That post was largely ignored, because too many readers here still fail to grasp that ethics issues arising in baseball often, indeed usually, have broader wisdom to convey. Since I wrote it, the employment of the Hader Gotcha has been expanded outside the realm of sports, most notably the recent example of Kevin Hart, the popular comic who was attacked the very day he was designated as the host of the upcoming Oscars. Hart was forced to withdraw because a Hader Gotcah exposed old anti-gay tweets. This time, however, I agreed that the tweets mandated his withdrawal, writing, Continue reading →

Comment Of The Day: “Proposition: An Illegal Immigrant Is Entitled To Receive A Life-Saving Organ Transplant That Otherwise Would Go To A U.S. Citizen In Similar Need”

/ Jack Marshall / 20 Comments

I am backed up on Comments of the Day again, especially embarrassing after I announced that I would be posting one a day if possible. Getting one of the comments in the queue last night required trying to use my netbook while watching the Westminster Dog Show with my old Jack Russell feeling insecure and cuddling in my lap. The Update will be late today.

The post about the Oregon hospital being bullied by the local ACLU into placing an illegal immigrant on its transplant list simultaneously raised medical ethics issues and illegal immigration ethics issues, so I am grateful that Zoltar Speaks! resuscitates the topic with his comment. I am particularly greateful for his raising the question, “Is the perception of an action what makes the action ethical, or is it the motives behind the action that makes the action ethical, or does it take both?”

My answer, which I think I have made clear over 80,000 posts, is that it is what an action does or can reasonably be expected to do, within the intention and goal of the actor, that makes conduct ethical or not. Unanticipated and unanticipatable results don’t count, and neither does pollution by non-ethical and unethical motives mixed in with the ethical motives, unless they warp the conduct and the decision to engage in it.

There are exceptions, of course.

Here is Zoltar Speaks’ Comment of the Day on the post, Proposition: An Illegal Immigrant Is Entitled To Receive A Life-Saving Organ Transplant That Otherwise Would Go To A U.S. Citizen In Similar Need:

On one hand there is the Hippocratic Oath that directly implies that medical need trumps things like legal status, so in that regard the policy change is a direct reflection of the core of the Hippocratic Oath and it can be said that they changed their policy to reflect the ethical core of the Hippocratic Oath and present that argument to the public and their actions on the surface can be regarded as ethical. (Yes it’s a run-on sentence)

On the other hand there is the fact that illegal immigrants are literally taking advantage of a near “border-less” country and existing systems in place across the United States that ignore their legal status will allow them to do whatever they want regardless of the fact that they are in the United States illegally and some existing systems in place that actually help them do anything they want because they’re illegal immigrants. The United States has been, and still is, enabling illegal immigrants and this policy change is another system changed that enables illegal immigration.

This leads me directly to a topic that we’ve talked about on Ethics Alarms in the past: is the perception of an action what makes the action ethical, or is it the motives behind the action that makes the action ethical, or does it take both? If I remember correctly, I think the general consensus was that it’s the perception of the action that makes it ethical.

The perception of this action is two fold; first ethically complying with the intent of the Hippocratic Oath and second it’s another policy change enabling illegal immigration. Continue reading →

Comment Of The Day: “Proposition: An Illegal Immigrant Is Entitled To Receive A Life-Saving Organ Transplant That Otherwise Would Go To A U.S. Citizen In Similar Need”

/ Jack Marshall / 5 Comments

“Hello, is this the Oregon hospital? Yes, I live in Mexico, and I need a liver right away. When can I schedule a time to come to the US and get a transplant? That sounds perfect! See you soon!”

The post about an Oregon hospital being publicly shamed into accepting an illegal immigrant for a potential liver transplant attracted the varies and thoughtful response here I hoped for. I have an unusual gut reaction to it, for me at least: I am sure that my position that the hospital is wrong (and that the ACLU is very wrong to bully the hospital into changing its policy) is ethically correct, but I feel badly about it anyway.

Here is what I told myself to make me feel better: Would anyone argue that the same woman would have any right or claim to an organ transplant from an Oregon clinic if she lived in Mexico?  Would the ACLU dare argue that she had a right to be placed on a waiting list? Would even an Oregon hospital think twice before rejecting such a request? Would the ACLU be able to create a public outcry against her rejection? Let’s see: No, no, no, and “you’ve got to be kidding.”

Yet logically and ethically, I see that alternate universe version of Silvia Lesama-Santos being more deserving of a transplant, and receiving a lifesaving organ that a citizen in similar need would receive otherwise, than the actual Silvia. The actual Silvia, unlike my theoretical one, broke our laws. The actual Silvia has already benefited unjustly from doing so. My compassion for the theoretical Silvia is not reduced by my objection to her conduct and disrespect for our immigration laws; given the choice between whether to give a liver to her or the real Silvia, I would choose her, and it wouldn’t be a hard choice. She is more deserving than the real Silvia, unless one reasons that breaking out laws and continuing to avoid accountability for doing so over 30 years is a positive accomplishment. And yet the alternate Silvia has no right to a liver at all.

There. I feel better now.

Here is JutGory’s Comment of the Day on the post,,Proposition: An Illegal Immigrant Is Entitled To Receive A Life-Saving Organ Transplant That Otherwise Would Go To A U.S. Citizen In Similar Need: Continue reading →