The Point - August 2014
In this edition:
- The ethics behind the Ebola treatment serum
- Recognizing and relating to a patient’s emotions
- News agency blows nosey headline
Excerpted from "Ebola outbreak prompts ethical questions," BioEdge. August 9, 2014 — The worst-ever Ebola outbreak has prompted bioethical discussion on two fronts. The viral disease has killed about 1,000 people in West Africa, mostly in Guinea, Sierra Leone and Liberia. A few cases have been diagnosed in Nigeria. The chances of dying in this outbreak are about 50 percent. Newspapers in Western countries like the U.S., the UK and Australia are highlighting the possibility of their own epidemics.
The first issue, as bioethicist Arthur Caplan points out, is that developed countries only worry about exotic diseases like Ebola when it threatens them: “The harsh ethical truth is the Ebola epidemic happened because few people in the wealthy nations of the world cared enough to do anything about it. We do need headlines about Ebola ... A public health policy that ends at our borders is not fair, just or even smart.”
The second is equitable distribution of a vaccine. There is no approved vaccine at the moment. A small American company, Mapp Biopharmaceutical, has been testing a vaccine called ZMapp on animals. But no one knows whether it is safe or effective on humans. Only a handful of doses at the moment and scaling up production to thousands of doses would take months. However, two white American medical missionaries, Kent Brantly and Nancy Writebol, who contracted the disease in Africa have been given two precious doses of ZMapp and seem to be improving. Why were they chosen instead of Africans? Apparently it is regarded as good practice to treat "first responders" first because of a social responsibility to help those who help others.
The WHO has convoked a gathering to discuss the ethics of providing an untested vaccine. “We are in an unusual situation in this outbreak,” says Dr Marie-Paule Kieny, of the WHO. "We need to ask the medical ethicists to give us guidance on what the responsible thing to do is.”
CMDA CEO David Stevens, MD, MA (Ethics): “I’ve debated Art Caplan on TV and radio on a wide range of bioethical issues. As I do with his comments in this article, we have agreed on some points and disagreed on others.
“He is absolutely correct when he says, ‘A public health policy that ends at our borders is not fair, just or smart.’ The danger in a country where people worship financial, physical and emotional security is that our claim of ‘compassion’ is merely a slushy sentimentality, a loose veneer barely covering our selfishness. At the first hint that a health crisis killing more than a thousand people could affect us, that thin veneer is quickly ripped to shreds. We’ve already seen that. Ann Coulter publically claimed Dr. Kent Brantley was “idiotic” for going to Liberia and that the U.S. should focus on its own problems. Others, including a few Christian leaders, decried bringing Dr. Kent Brantley and Nancy Writebol back to the U.S. for treatment.
“On the other hand, Dr. Caplan’s comment on providing untested treatment to Ebola sufferers puts us in an artificial binary trap of ‘treatment’ or ‘public health.’ It is obvious that the good public health practice is what is needed to contain and ultimately stop the epidemic. But that begs the question about whether an unproven experimental drug should be used to treat seriously ill Ebola victims. With Ebola’s mortality rate, no other alternatives and a deteriorating condition, I would have taken the drug just as Kent Brantley did. He showed marked improvement in hours. It is not good to take an untried drug, but it is the lesser of two evils when you are about to die and an unproven drug has showed promise in animal trials. What’s more, to prohibit its export to other countries if their medical experts desire to use it is paternalistic.
“Many called Kent and Nancy ‘heroes’ for their self-sacrifice for the good of others. “Greater love has no one than this: to lay down one’s life...”(John 15:13, NIV 2011). We should admire their faithfulness to deny themselves, take up their cross and follow Jesus by doing exactly what He would do, but I think Kent and Nancy would not want to be thought of as heroes. They consider what they did as ‘normal Christian behavior.’ So should we.
“For more than two milleniums, Christians have laid down their lives for others. If we seek security, we will never find it. If we give up our security to follow Christ, that is when we find real security in Him. Then true compassion wells up from our souls.”
Excerpted from “Should Your Doctor Cry With You?,” U.S. News & World Report. July 2, 2014 — Doctors deal with intensely emotional situations every day, in the face of which they are taught to remain objective. But there’s a growing recognition in clinics and medical schools that empathy and emotional intelligence have a prominent place in medicine, too.
If doctors really want to connect with their patients, says Peter Ubel, a physician and behavioral scientist at Duke University, they should model themselves after Starbucks’ employees. Baristas are trained to handle angry customers using the “latte” method of communication, which stands for: listen; acknowledge the problem; take action to solve it; thank them for bringing it to your attention; explain what you’ve done to fix the problem.
Instead, doctors often dismiss a patient’s negative emotions, Ubel continues. Studies have shown that when cancer patients expressed feelings such as ‘I’m in pain’ or ‘I’m scared,’ their doctors – mostly experienced oncologists – said nothing or changed the subject. But simple acknowledgment of the patient’s feelings – with something like "Oh, I can understand why this must be scary for you" – can open up an emotional channel that improves the relationship as well as, potentially, clinical outcomes.
At the same time, the distance that doctors are taught to maintain from patients is important to uphold. “You don’t want your doctor blubbering around the hospital,” Barron Lerner, an internist and professor of medicine at New York University School of Medicine, says. “There’s a professionalism associated with being able to deal with profoundly emotional situations in a dispassionate manner.”
Founder, Executive Director and Psychiatrist at Lighthouse Network Karl Benzio, MD: “The Hippocratic Oath is profound in its message as it is a spiritual covenant to hold as the utmost priority the best for the patient and not the best for the healthcare professional or any other third party. ‘The best’ for the patient pertains to the ultimate spiritual and psychological benefits, as Hippocrates said he would not perform an abortion or euthanasia, which would prioritize the physical over the psychological and spiritual.
“Physicians have expertise and healing to impart to patients, but unless a bridge exists to reach patients, healing will be delayed, compromised or not delivered at all. The bridge is relationship, not only doctor-to-patient but also human-to-human. The first step in building this bridge requires communicating understanding, sensitivity, respect, dignity and honor. This is why healthcare professionals ask probing questions, and our demeanor while patients respond allows them to invite us into their pain. Our responses of sympathy and empathy show we are listening and feeling the hurt, fear or uncertainty that can deeply harm them.
Excerpted from “Woman Grows A Nose On Her Spine After Stem Cell Experiment,” Popular Science. July 18, 2014 — Eight years ago, doctors took nasal tissue samples and grafted them onto the spines of 20 quadriplegics. The idea was that stem cells within the nasal tissue might turn into neurons that could help repair the damaged spinal cord, and the experiment actually worked a few of the patients, who regained a little bit of sensation. But it didn’t go well for one woman in particular, who not only didn’t experience any abatement in her paralysis, but recently started feeling pain at the site of the implant. When doctors took a closer look, they realized she was growing the beginnings of a nose on her spine, New Scientist reports.
This is hardly the first case of adverse side effects from a stem cell transplant. The New Scientist article points to several cases where people developed tumors after participating in clinical trials—including one 50-year-old man who, after receiving an experimental treatment for Parkinson’s disease, developed a brain tumor with hairs and cartilage embedded within it.
The nasal tissue experiment took place at a mainstream hospital in Portugal, and there are thousands of legitimate stem cell trials taking place all over the world, but so far only a few stem cell therapies have been approved by the FDA. Stem cells have the potential to treat everything from baldness and diabetes to cardiovascular disease and Parkinson’s. But stem cells, some of which can differentiate into almost any cell in the body, also have the potential to cause harm.
CMDA Member and Senior Fellow for Family Research Council David Prentice, PhD: “It sounds funny—a woman grows a nose on her back or, as another reporter put it, on her spine. Coupled with the buzz term ‘stem cell,’ it ensures notice for the news outlet and reporter. But it’s neither funny nor true.
“The real story: a patient who received her own stem cells in an attempt to treat spinal cord injury had an adverse reaction eight years after treatment. While the cell mixture used didn’t produce tumors as has been seen with embryonic stem cells or fetal stem cells, some ectopic tissue differentiation occurred that pressed on her spinal cord, causing pain. Sadly, the surgeons who removed her partially-differentiated growth published their findings and went to the news media, rather than showing concern for other patients and contacting the doctors who did the spinal cord clinical trial. The older version of this approved clinical trial, which this patient received, has been the only treatment for chronic, complete spinal cord injury resulting in significant functional improvement, with a very low (less than 1 percent) incidence of complications, with more than 140 patients having received the treatment.
“The news of this one adverse event highlights the power of stem cells even years after transplant, the experimental nature of clinical trials and the risk inherent in such trials. Clinicians should be cognizant of all of these factors. Even approved clinical trials using ethically-sourced stem cells must be monitored carefully. The wise healthcare professional keeps concern for the patient first at all times.”