You are currently browsing the tag archive for the ‘bioethics’ tag.

I recently had the opportunity to listen to a rather provocative podcast at All in the Mind about cognitive enhancing drugs.  Specifically they discuss Modafinil, a drug used to treat Narcolepsy, a disease in which sleep comes suddenly and often, to help them with excessive daytime sleepiness.  I was startled to learn that many in the neuroscience community are using this drug, openly, and sharing it with others in order to work longer hours, get more done, focus more, and think more.  This blew we away.  Read the rest of this entry »

Advertisements

  It turns out that trust is chemical, at least according to modern neuroscience and research into oxytocin.  Oxytocin is a hormone produced by the neuron part of the pituitary gland that has long been known to strengthen uterine contractions in childbirth and to start milk production in breast feeding.   More recently, scientists have started to understand its role in brain and behavior with key role in trust. Read the rest of this entry »

Choosing on a medical specialty involves learning your own answers to a series of questions?

-Do I enjoy patient interaction or not?

If no, consider Pathology or Radiology

-Do I like surgery and procedures more, or medicine and clinical reasoning, or both?

note- Anesthesia is a procedure and OR specialty, sort of surgery-lite.

Both- Ophthalmology, Orthopedic Surgery (well peds ortho anyway), ENT, Ob-Gyn, and Emergency medicine for procedures

-Do I prefer general, broad knowledge or limiting to one area or system, Primary care or specialist?

This is often a question of knowing a little about a lot, or a lot about a little.  However, It also involves whether you prefer relatively healthy patients or relatively sick.

-Do I do I prefer to see kids, adults, or both? (remember you can do almost anything for kids that you can for adults.)

The last question was easy for me.  From my point of view, pediatric care is superior to adult medicine in so many ways. Read the rest of this entry »

Becoming the parent of a child with a genetic disease is a harrowing experience. This is likely more true today than it has ever been. We are hardwired to want the best for our children. Discovering they have a life altering condition pulls the rug right out from under parents. Discovering that the very genetic blueprint they passed on to the child is the problem makes this “act of God” personal. Suddenly, it is your fault.

Read the rest of this entry »

We live in an age where our understanding of life is far beyond what our forefathers could have dreamed. We have cracked the genetic code. We have to capability to splice and dice. We have an entirely new field, bioengineering dedicated to the proposition that we can literally, “engineer life” to suit our needs. The breakthroughs we have made are astonishing. We have sequenced the entire genome of mankind. We have the power to modify species at will.

In a sense we have been at this for a very long time. We have domesticated the dog and the cat. The grains that we rely on to feed mankind are all a product of manipulation of one seed with another, keeping the ones that grow the “best” crop. Rice, wheat, corn are all essentially artificial and manmade in a sense. I find it a little ironic those that will look at genetically altered agricultural produce with fear and disdain when by definition, agricultural products are manmade. Whether we select genetic traits in a lab or in the field, the fact is we alter them. Read the rest of this entry »

MS NBC has a beautiful little story about a relatively new phenomenon, perinatal hospice and the experience of having a child with a fatal prenatal diagnosis given before birth. (hat tip to PalliMed). Scientists have now unlocked the entire human genome, madly dashing to figure out what the function of each piece is. As a result our ability to test for genetic disease has exploded for an entire host of conditions. Unfortunately, diagnosing is a lot different than treating or curing. Knowing what is coming most often does not include being able to treat it or improving outcomes.

In many ways this is a throwback to the medicine of past centuries. Back then, doctors didn’t have a lot of effective treatments, so they made house calls, they learned to comfort patients, and be of whatever assistance they could. Childbirth was vastly different then as well. Infant mortality was much higher. Names weren’t picked out until you knew the child was okay. Attachment and hope were much more cautious.

My chosen specialty is often like this, though less often than you might think. There is an old joke about neurologists being admirers of disease rather than treaters. This is becoming less true everyday, but like most stereotypes, maybe had a small kernel of truth at its base, now distorted and stretched by the generalization. The sad truth is, any pediatric subspecialty is going to have more than its fair share of heartache and incurable conditions. And so, my heart went out to this family. I can relate. We doctors have to learn to deal with grief too. We love to bottle it up and this has led more than one physician on the fast track to burnout.

It makes me wonder what the impetus is for developing these gene tests. Too often in Obstetrics, it feels like the entire point of prenatal testing is to abort the pregnancy should it be deemed “defective”. I know this isn’t always the case. Being given time to adjust, grieve and mourn a very real loss can be helpful to so many families in this situation. Often, the worst part for families dealing with childhood illness is not having a diagnosis. Even if you can’t treat it, there is real relief in giving it a name and description of what to expect. It is not my wish to stand in judgement of any parent who has faced such a very difficult situation. Certainly facing the choice of “terminating” vs palliative care is heartbreaking either way. I have to say I was absolutely floored by the video interview of this family and the courage they took in loving, embracing, and caring for their child with Edward’s syndrome for the duration of its very brief life.

It would have been so easy not to get attached. It would have been simple not to mourn. It is the default protection response of many. It is a form of denial, the first stage of grief. I think it stops the grieving process dead in its tracks, and can make a family sick. You never get the chance to try to make peace with the tragedy.

I think this story is a beautiful example of what can be gained by not giving in to this impulse. In short, families are allowed to grieve, to cherish a memory and their short time with the baby. Then they can heal. Sometimes we need to allow pain to wash over and immerse us in order to move on and be healed. We need to grieve, and grieve fully.

The number of families that choose to carry a pregnancy with a terminal diagnosis to term is unknown, but definitely a small minority. They face family and friends who are often baffled by their decision not to terminate. One small British study showed that the number of families who choose this options reached 40% when perinatal hospice is offered. This tells me there are many who would like to see, spend time with, and know their infant and be able to tell them good bye. They just need a little help and support in doing so. What a wonderful cause.

Anyone who is interested in learning more, supporting, or referring a friend to perinatal hospice can find information at Http://www.perinatalhospice.org

  The human body is a wonderful and marvelous gift.  As wonderful as it is for us as individuals, it can also be a wonderful gift for the good of mankind.  I posted a recent link about a special group of individuals.   Every medical student, along with many other training medical professionals has the opportunity, in order to learn the art of medicine, to open up the empty shell left behind by these people in mortality and study it firsthand, orienting themselves to the structures that they will later learn the marvelous functions of.  They donate their bodies to science, where we can learn from them prior to their returning to the dust and apply that knowledge to the healing of others.  Read the rest of this entry »

Medicine has long had the intuitive goal of preserving life.  It is what medicine is for.  We are historically not the type of people to give up on life.  In our society demographically, lifespans are at an all time high, up from age 40 in 1900 to 79 for women and 74 for men.  Eradication of many childhood diseases through immunization, better care during childbirth, which historically killed one in four women lifetime, and better sanitation have all played a role. 

But medicine and infant mortaility are what have influenced the numbers most.  Read the rest of this entry »

RSS Nuggets from all over

  • An error has occurred; the feed is probably down. Try again later.

Archives

Advertisements