Monday, September 29, 2014

Failures of end of life healthcare redux

It's not news that end of life care is broken.  A recap from current discussions; Zeke Emmanuel (yes the brother of Rahm, formerly seen around the White House and presently holding offices in Chicago), and others.

Every now and then, it is instructive to see what physicians choose for themselves, in end of life health care.  See, and their obvious rejection of continued treatment in situations where the benefits are hard to identify, other than keeping the body alive.
----------from the article-------
A chart of doctor responses from the Precursors Study:
Preferences of physician-participants for treatment given a scenario of irreversible brain injury without terminal illness. Percentage of physicians shown on the vertical axis. For cardiopulmonary resuscitation (CPR), surgery, and invasive diagnostic testing, no choice for a trial of treatment was given. Data from the Johns Hopkins Precursors Study, 1998. Courtesy of Joseph Gallo, "Life-Sustaining Treatments: What Do Physicians Want and Do They Express Their Wishes to Others?"

Thursday, September 25, 2014

Back to basics

This blog is about medical ethics, I understand that.  But sometimes it's useful to stand back and examine the assumptions of what constitutes "ethics" and "moral behavior."  Most of us would, I believe, consider moral and ethical decisions the domain of people rather than machines, but as computers and software that run on them become ever more powerful, some developments are worth keeping an eye on: autonomous machines that are expected to make moral / ethical decisions. 

$7.5 million is a drop in the very large bucket that could make such a scenario possible, yet the very existence of the bucket should wake us up and think about, and sort out in our heads, what is "right" and "moral" and "ethical."

There have been many and complex arguments taking positions at extremes such as "of course computers will be sentient (and soon!)" to "machines can never achieve awareness that humans do," and every slice in between.

If you have already thought about what you mean by these words, excellent. If not, now's a good time to wrap one's head around this nontrivial topic.  Can an autonomous robot make moral decisions?    Public policy on it depends on thoughtful input.