Surgical Bioethics: Is It Different?

By Wydell L. Williams, Jr.

Recently I was asked to give a talk on ethics to my surgical colleagues.  The Nevada Chapter of the American College of Surgeons has regular meetings and there are usually one or two speakers giving talks that are relevant to surgeons and their practice.  The speakers are usually academic surgeons or residents talking about their research or someone from the national level discussing policies that will affect our practices.  I was excited to be offered this opportunity because I felt that it was an acknowledgement of my recent degree in bioethics and would allow me to share with my surgical colleagues the concepts I learned.  Suddenly I realized that I was going talk to surgeons who sometimes view themselves as being compassionate, self-sacrificing, methodical, and confident but also can be dominant, brash, impersonal, egocentric, difficult and demanding.  So, I needed to find a topic that would appeal to the diverse surgical specialties and personalities that would be present.  I decided to look at the principles of bioethics and consider how they apply to surgery and do they apply differently from other specialties…
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Confronting Medicine in the Holocaust & Beyond

By Hedy S. Wald

Galilee, Israel, May 7-11, 2017. I was privileged to be at the Second International Scholars Workshop on “Medicine in the Holocaust and Beyond.” Why so meaningful?  Why so needed? 140 purposeful, passionate scholars from 17 countries delved into the past history of medicine at its worst in order to inform the future.  From 1933-1945, presumed healers within mainstream medicine (sworn to uphold the Hippocratic Oath) turned into killers (1).  Yes, medical ethics in Nazi-era medical school curricula existed, yet included “unequal worth of human beings, authoritative role of the physician, and priority of public health over individual-patient care”(2).  In Western Galilee College, (Akko), Bar-Ilan University Faculty of Health Sciences (Safed), and Galilee Medical Center and Ghetto Fighters’ Museum, (both in Nahariya), historians, physicians, nurses, medical and university educators, medical students, ethicists and more gathered to grapple with this history and consider how learning about medicine in the Holocaust can support healthy professional identity formation with a moral compass for navigating the future of medical practice with issues such as prejudice, assisted reproduction and suicide, resource allocation, obtaining valid informed consent, and challenges of genomics and technology expansion (3)…
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How Do You Deal With Death All the Time?

By Shannon Tapia

My husband the Anesthesiologist came home one evening solemn, affected, not himself.  His patient died in the recovery room.  It was sudden, unexpected for my husband, and despite the team’s swift efforts and perfectly executed code, the patient died anyway.  It’s relevant to note that his patient was an almost 90 year old man with significant Congestive Heart Failure, probably Chronic Kidney Disease, and complete occlusion of one of his carotids who sustained hip fracture and thus required the surgery to pin his hip for both healing but also comfort.  This is the ultimate Catch 22 in medicine (or at least in Geriatrics).  Someone who really should not be having Anesthesia or surgery due to their life-threatening chronic medical conditions has an accident and now requires a surgery to make their remaining life bearable.  My husband and the surgeon delivered the bad news together, and as the patient’s wife understandably fell apart, my husband cried in front of patients (family) for the first time, ever.  As we processed this together, he asked me, the Geriatrician, “How do you deal with death all the time?”

I won’t pretend to have all the answers.  However, I don’t think my husband or any doctor is alone in needing help or any tips at coping with death. So here are some ways this mother, family physician now Geriatrician copes with death, an ever-present part of Geriatric medicine…
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Caregiving: Can It Be An Attribute of Our Healthcare System?

By David C. Leach

An old joke begins by asking that you imagine a man drowning 100 feet offshore while a conservative and a liberal are observing.  The conservative throws him a 50 foot rope and says: “swim the extra distance, it’s good for you.”  The liberal, on the other hand, throws him a 100 foot line and then promptly drops his end of the line in order to go and do another good deed.

While offering insight into our politics the story also illuminates some of our habits around caregiving in our current healthcare system and the policies supporting that system.  Certainly individual stories of near heroic caring can be found, but the system itself is designed around processes and structures that seem to diminish the importance of the caring relationships at the heart of our work.  Caregivers frequently depend on work arounds.  What would it take to develop a system that respects, rewards, or at least enables genuine caregiving?

Caregiving, of course, is an attribute of humans, not systems.  To care for another requires a voluntary opening of the heart to compassion; it requires noticing and acknowledging the uniqueness of the other and a willingness to enter into their context.  Keenan defines mercy as the willingness to enter into the chaos of the other.  (1) The biblical story of the Good Samaritan (Luke, 10:33) illuminates an interesting attribute of caregiving that may indicate why humans can care and systems cannot; the clue is in the voice of the verbs used.  The story is well known: a traveler has been assaulted and robbed. Two others pass by without helping while the third, a Samaritan, “was moved by compassion” and stopped to help.  I believe that the passive voice of the verb is not an accident.  The first step in caring is to allow oneself to be moved by compassion.  “Be compassionate” doesn’t fit naturally on a to do list; the initial step is not a “doing” but an emergent openness when one has been moved.  Subsequently there may be many action steps, but it starts by being moved by something greater than the caregiver…
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Growing Up with Doctors: A Mother’s Reflection on Physicians, Healthcare Teams, and a Lifetime with Spina Bifida

By Marsha Miller

Almost ten years ago, I wrote a story about my experience navigating the healthcare system as a young woman with a myelomeningocele baby.  It was a story about “forgiveness” because my baby was two-months old before his back was closed, his brain shunted, and his prolapsed rectum repaired. It was a system failure.  Now, I would like to talk about how different medical encounters can be when a person with a disability is an adult rather than a pediatric patient…
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“I Never Considered That.” Medical Student Professionalism Peer- Evaluations and the Self-Identity of a Future Physician.

By Anna Lama

I recently presented a workshop on the assessment of professionalism at the Southern Group on Educational Affairs (SGEA) conference.  I planned to discuss the elements of assessment: developing a framework to define professionalism, discussing successful assessment practices and reviewing the various tools available to assess professionalism.1  Much to my surprise, the discussion quickly moved into deeper inquiry on student participation, perceptions, and self-identity through the use of peer evaluations on professionalism…
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Medical Students Can Handle the Truth; Their Mentors Should be More Open About It

By Shannon Tapia

Medical School is rough.  Fortunately there is a recent movement to make medical education more humane.  The movement to bring humanity, ethics, and love back into the molding of our future physicians is crucial. Personally, I felt my medical school was on the forefront of this push.  Perhaps it was because we had Jesuit priests for attendings and the hospital’s motto of “We also treat the human spirit” filtered into the treatment of students.  Whether it was something about myself or my medical school, I was fortunate to never experience the depression, competitive urges, burnout and isolation that is so prevalent during American medical school years…
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