Literature Review

A moral code: Ethical dilemmas in medicine — three physicians face crossroads in patient care MedPage Today; podcast by Genevieve Friedman, Perspectives Editor; 10/25/24 We are back for another episode of our medical podcast, which we hope isn't really a podcast about medicine, but a podcast about life, death, dilemma, the challenges, and sometimes the joys of medicine. ... Now, medicine is complicated because a lot of times there aren't hard and fast rules ... One treatment isn't always right or wrong for someone. One surgery isn't always successful or unsuccessful, and one diagnosis isn't always correct. Decisions aren't black and white, they're varying shades of gray. So we come up with principles to help handle this -- codes if you will. But even those get a bit marred by complexity at times. As you'll hear in this episode of Anamnesis with the theme of "A Moral Code: Ethical Dilemmas in Medicine," one of our biggest codes is "do no harm." But what is harm? Who decides what harm is, what happens if we disagree?

How physicians can navigate ethical conflicts when caring for patients Physician's Weekly; 10/14/24 ... According to the president of The Physicians Foundation, Gary Price, MD, ethics in medical care are particularly complicated regarding end-of-life choices. While decades ago, a patient’s primary care provider (PCP) would have been involved in that patient’s hospitalized care and their end-of-life decisions within the hospital, the fragmented nature of today’s healthcare system has all but eliminated PCPs from involvement in hospitalized patient care. As such, patients often make end-of-life decisions based on the guidance of doctors with whom they have no pre-existing relationship. Other factors that blur ethical lines in healthcare, adds Dr. Price, are the new state of healthcare ownership and financing. Dr. Price mentions, for instance, conflicts of interest due to the US’s biggest employer of physicians, Optum, being a subsidiary of the same company that owns UnitedHealthcare. This situation allows for an insurer who controls reimbursement and who could, as the physician’s employer, influence decisions made regarding patient care. Sadly, this influence largely comes from financial concern instead of concern for the patient’s best health outcomes. 

Texas families take on Houston-based solar company in arbitration case CBS News Texas; by Andrea Lucia, Lexi Salazar, and Mike Lozano; 9/24/24 In February, the CBS News Texas I-Team revealed a pattern of complaints against Sunnova Energy, accusing it of preying on the sick and elderly by getting them to sign long-term payment plans for solar panels they can't afford. ... Joshua resident Cynthia Hampton was featured in the I-Team's February report about Sunnova. Hampton believed her late father, who was receiving in-home hospice care, was tricked into signing a contract with Sunnova, leaving his children to settle the debt after his death. ... Mark Alexander believes the company's practices violate the Deceptive Trade Practices Act and that the company has committed breach of warranty and fraud. ... In an emailed statement to the I-Team, Sunnova wrote in part: "Nothing is more important to us as a company than customer service. ... 

AI shouldn't decide who dies. It's neither human nor humane Fox News; by John Paul Kolcun and Anthony Digiorgio; 9/20/24 [Opinion] As we write this, PubMed ... indexes 4,018 publications with the keyword "ChatGPT." Indeed, researchers have been using AI and large-language models (LLMs) for everything from reading pathology slides to answering patient messages. However, a recent paper in the Journal of the American Medical Association suggests that AI can act as a surrogate in end-of-life discussions. This goes too far. The authors of the paper propose creating an AI "chatbot" to speak for an otherwise incapacitated patient. To quote, "Combining individual-level behavioral data—inputs such as social media posts, church attendance, donations, travel records, and historical health care decisions—AI could learn what is important to patients and predict what they might choose in a specific circumstance." Then, the AI could express in conversant language what that patient "would have wanted," to inform end-of-life decisions. We are both neurosurgeons who routinely have these end-of-life conversations with patients’ families, as we care for those with traumatic brain injuries, strokes and brain tumors. These gut-wrenching experiences are a common, challenging and rewarding part of our job. Our experience teaches us how to connect and bond with families as we guide them through a life-changing ordeal. In some cases, we shed tears together as they navigate their emotional journey and determine what their loved one would tell us to do if they could speak. 

Hiring manager fired for refusing to post 'ghost jobs' is now sharing how to recognize them Upworthy; by Jacalyn Wetzel; 9/18/24 There doesn't seem to be a shortage in job openings but there does seem to be an abundance of people looking for work for months without finding gainful employment. According to Ceros Whaley, a former hiring manager at an unnamed company, the problem is that unsuspecting hopeful employees are unknowingly applying for "ghost jobs." Whaley shares that part of his job as a hiring manager was to create "ghost jobs," which are simply fake job listings. He explains that these job listings were not created to find more qualified people to fill positions but to "encourage" current employees to improve their performance. Whaley says that he got into a little bit of a kerfuffle with his higher manager over the company continuing the ghost job ruse. By the time the man reached his tolerance level for posting fake jobs, he had already posted over 300 ghost jobs on sites like Indeed, Monster and other hiring sites. But Whaley shares that he found his morals and just couldn't continue the practice. ... [The] frustrated former employee … did a follow up video sharing how to spot ghost jobs and how to avoid them while you're job hunting. [Click on the title’s link to view.] 

Leaving your legacy via death bots? Ethicist shares concernsMedscape; by Arthur L. Caplan, PhD; 8/21/24I heard recently about a fascinating, important development in artificial intelligence (AI)... It has entered into a space where I think patients may raise questions about whether they should use it or seek opinions from doctors and nurses, particularly those involved with seriously ill people. That space is grieving, and what might be called "death bots..." This would allow not only spouses but grandchildren and people in future generations to have some way to interact with an ancestor who's gone. It may allow people to feel comfort when they miss a loved one, to hear their voice, and not just in a prerecorded way but creatively interacting with them. On the other hand, there are clearly many ethical issues about creating an artificial version of yourself. One obvious issue is how accurate this AI version of you will be if the death bot can create information that sounds like you, but really isn't what you would have said, despite the effort to glean it from recordings and past information about you. Is it all right if people wander from the truth in trying to interact with someone who's died?Publisher's note: The article includes several thoughtful ethical questions regarding this use of AI via "death bots".

Vatican’s changing line on end-of-life illustrates that hard cases make bad law Crux, Rome, Italy; by John L. Allen Jr.; 8/11/24 Hard cases, as the famous legal maxim holds, make bad law. The Vatican served up a reminder of the point this week with a new “little end-of-life lexicon,” which not-so-subtly amends an earlier Vatican ruling on the issue of withdrawing artificial nutrition and hydration from chronically ill patients 17 years ago. ... Today, with 17 additional years of both clinical and pastoral experience, it’s perhaps easier to accept that things aren’t always so black-and-white, and that there’s room for differing judgments in concrete cases. ...

Youngstown hospice nurses help alert feds on alleged insurance fraud; company pays settlementMahoning Matters; by Erina Anwar; 7/26/24 ... The U.S. Department of Justice announced on July 17 that federal prosecutors had settled with Gentiva, formerly known as Kindred at Home, after more than 20 whistleblowers — including two hospice nurses from Youngstown, Ohio — alerted the government for alleged fraud. The [Youngstown] nurses, Jason Medved and Anthony Donnadio, will receive a portion of the payout for reporting the fraud at a Youngstown hospice via a lawsuit they filed in 2023 under the federal False Claims Act (FCA). “As registered nurses, Jason and Anthony owed a duty to their hospice patients first and foremost,” Janel Quinn, a principal of The Employment Law Group said. “They were advocates for ethical medicine, even when it wasn’t easy. This settlement is a fitting recognition of their professionalism and their bravery.”

Cedar Rapids nursing home worker needlessly exposed to infectious disease, judge rules The Gazette; by Clark Kauffman, Iowa Capital Dispatch; 7/16/24 A social worker for an Iowa nursing home was justified in quitting after the facility failed to inform her and others of residents who had serious, contagious diseases, according to a judge’s ruling. State records indicate Mary Lovejoy Castaneda was employed by the nursing home chain Care Initiatives as a full-time social worker at Cedar Rapids’ Heritage Specialty Care from March through May of this year. She resigned after citing “stress and anxiety” related to the job, which entailed working with hospice patients. ... [Additionally,] when Care Initiatives hired Castaneda the company assured her it would refrain from assigning her hospice patients, only to later begin doing so. Editor's Note: Yes, lack of information about patients with "serious, contagious diseases" with the need to wear PPE is a significant offense. However, the social worker employee requesting [refusing?] to serve hospice patitents within a nursing home facility raises significant ethical concerns about care for patients and their families. The staff/patient ratio for social workers in a nursing facilities requires extensive, broad coverage. Click on the title's link to continue reading.

Should all healthcare workers take the Hippocratic Oath? Becker's Hospital Review; Madeline Ashley; 5/29/24 As private equity expands across the healthcare industry and proper patient care is brought into question, Don Berwick, MD, a Harvard Medical School health policy lecturer in Boston and former CMS administrator during the Obama administration, called for an extended Hippocratic Oath for all who work in healthcare. During an April 3 senate hearing in Boston, titled, "When Health Care Becomes Wealth Care: How Corporate Greed Puts Patient Care and Health Workers at Risk," Dr. Berwick spoke passionately about how patient needs have been put on the backburner, but should be the No. 1 priority in healthcare.

Nurse charged with stealing pills while taking care of hospice patient Fox56; by Emily Cherkauskas; 5/22/24Pennsylvania State Police say a registered nurse stole hundreds of prescription pills while taking care of a hospice patient. According to Pennsylvania State Police, on Feb. 12, troopers were contacted by the director of operations at the Amedisys Home Health / Hospice Care. Troopers were told that Registered Nurse Ashley Laura Miller, 36, of Mohrsville, had become a suspect in the theft and diversion of Oxycodone and Ativan prescriptions. ... [Upon] the passing of the patient, an additional nurse noted that 200 Oxycodone and 30 Ativan pills were missing from the narcotics count. ... On Wednesday, May 22, Miller was arraigned with bail set at $5000.

Keys to addressing ethical, moral distress in pediatric hospice Hospice News; by Holly Vossel; 5/6/24 Hospices may be under-prepared to navigate the complexities in end-of-life decisions among terminally ill children, as the ethical and moral considerations related to patient autonomy are vastly different for pediatric populations compared to adults. Ethical principles of autonomy vary in pediatric populations due to a number of factors, including a child’s age, developmental stage, cognitive capacity and their spiritual background and beliefs, according to Christy Torkildson, director at the Children’s Hospice and Palliative Care Coalition of California. 

MultiPlan, insurance giants sued over out-of-network rates Modern Healthcare; by Nona Tepper; 4/29/24 A rural health system sued technology company MultiPlan and eight of the country's largest insurance companies over alleged schemes to strongarm providers into accepting low out-of-network rates. At issue in the proposed class-action suit are MultiPlan's repricing tools, which allegedly rely on insurers' data to deflate their out-of-network reimbursement payments.