Pulse
Briefs
Nuremberg Revisited
American bioethics was born out of the Nuremberg trials and needs to return to those roots, according to George Annas, J.D., M.P.H.
The Boston University bioethicist, who delivered the Deinard Memorial Lecture on Law and Medicine at the University of Minnesota in February, noted that the trial of 12 Nazi physicians by the United States produced a set of principles for human experimentation that included voluntary, informed consent of the participant.
The Nazi doctors had conducted experiments on prisoners that ended in death. “These defendants did not kill in hostility. They were trained physicians. They were responsible for murder and unspeakably cruel torture,” Annas told the audience of faculty and students. He added that it took doctors and lawyers working together to convict the Nazi doctors and ultimately establish the Nuremberg code, which provides directives for human experimentation.
Annas pointed out the United States has had a “checkered past” when it comes to living up to those standards. He cited the U.S. military agreeing to not prosecute Japanese physicians who conducted experiments on American and Chinese prisoners if they handed over data that might prove useful, the Tuskegee syphilis experiments, and the plutonium experiments as examples of how “we are not always faithful to our own values.”
Annas also chastised the U.S. bioethics community for being “abjectly silent” on the mistreatment of prisoners at Guantánamo Bay—treatment he says violated Article 5 of the Geneva Convention, which prohibits death, torture, and cruel, inhumane, or degrading treatment of prisoners as punishment. It also forbids them from being subjected to medical or scientific experimentation without their consent.
Annas described how hunger-striking prisoners at Guantánamo were strapped down and force fed through nasogastric tubes. “It wasn’t ordered for medical care, but as torture and intimidation or at least cruel and inhumane treatment,” he said.
Annas concluded by saying that doctors and lawyers need to come together again as they did at Nuremberg to end such acts. “It was doctors and lawyers working together that developed human rights law and basic medical ethics law. It’s what made Nuremberg important to us then, and it’s what makes Nuremberg important to us today.”—Kim Kiser
End-of-Life Wishes
A pilot study of 22 physicians and 71 of their patients with terminal cancer or end-stage congestive heart failure raises questions about what physicians know about their patients’ end-of-life wishes.
Researchers from Penn State University and the University of South Carolina asked physicians and their patients about the patients’ condition, the services they might need, and whether the physician knew of factors that might influence the type of care their patients wished to receive, how their patients wished to deal with pain, and where they would like to die.
Although physicians did a good job of informing patients about available services, only about one-third knew whether religious concerns or financial circumstances were affecting their patients’ choices regarding care.
Even fewer knew how their patients wished to manage their pain or their preferred place of death, with only 14 percent correctly identifying what their patients wanted in each case.
The study appeared in the June 2007 Journal of Palliative Medicine.
Society News
The University of Minnesota’s chapter of the Alpha Omega Alpha (AOA) Medical Honor Society, which recognizes academic achievement and promotes scholarship among medical students, turns 100 this year. To mark the occasion, the chapter is establishing an endowed scholarship to aid worthy medical students.
The society’s decision to focus on scholarships reflects one of the big concerns in medical education today—its high cost. In 1908, when Minnesota became home to the 13th AOA chapter in the nation, the primary concern was the quality of medical schools.
At the time, Hamline Medical School had merged with the University of Minnesota. An editorial in the St. Paul Medical Journal (the precursor to Minnesota Medicine) praised the move, noting that the fundamentals of medical education could only be gained in the “expensive” laboratories of the university and that the university stood for the “highest ideals of medical education.”
Elevating the caliber of medical education and medical students was the impetus for the founding of the first AOA chapter in Chicago in 1902. One of the founders, William Root, even called the society a protest against the “rowdyism, boorishness, immorality, and low educational ideas” of medical students at the time.
Now, of course, all students enter medical school with strong credentials. Even so, says Minnesota AOA faculty counselor James House, M.D., certain students stand out. “Even in the richest milk, there’s a little cream that goes to the top.” Each year, a committee selects about 40 of those students for inclusion in the society on the basis of their board exam scores and ratings on clinical rotations, as well as their volunteer work and research accomplishments.
Members participate in service projects such as organizing medical students to staff the Minnesota Science Museum’s Human Body Gallery and teaching anatomy to middle and high school students to generate interest in medicine as a career.
House says AOA members are so bright and creative that their work enhances the image of all medical students in the community. That’s an outcome the society’s founders would likely approve of today.—Carmen Peota
U to Develop Ethics Website
The University of Minnesota is developing a website and bibliographic database through which ethics scholars will be able to share, rate, and comment on academic papers, articles in the popular press, multimedia files, and archival documents.
The site, called EthicShare, is being developed by the Center for Bioethics, the University of Minnesota Libraries, and the department of computer science and engineering with a $517,000 grant from the Andrew W. Mellon Foundation.
The site is expected to be up by late 2009.
Fair Questions
Last summer, representatives from the University of Minnesota Center for Bioethics asked nearly 1,000 State Fair visitors to answer one of four questions regarding tough issues that blend medicine and ethics.
Here are the questions and how they responded:
Should medicines and surgeries to prevent growth be given to limit the physical size of children with severe, irreversible neurological and cognitive impairments who will depend on others for care the rest of their lives? (n=107)
Yes 44%
No 47%
Unsure 9%
Should doctors receive bonuses if their patients achieve certain quality measures (well-
controlled blood sugar for diabetics, blood pressure, cholesterol, etc.)? (n=410)
Yes 26%
No 73%
Unsure 1%
Should health insurers or the medical community be responsible for caring for patients who return from another country having purchased an organ there? (n=137)
Yes 29%
No 63%
Unsure 8%
Should prospective parents with certain disabilities have the right to use genetic testing on embryos to select those with the same disabilities (dwarfism or deafness, for example) so their children can fully share the culture and lifestyle of the parents? (n=325)
Yes 15%
No 84%
Unsure 1%