Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

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/pdf/acc-aha-2005-guideline-update-for-the-diagnosis-and-4hik65ngbe.pdf

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

In 1974 an article appeared in Science magazine with the dry-sounding title “Judgment Under Uncertainty: Heuristics and Biases” by a pair of psychologists who were not well known outside their discipline of decision theory. In it Amos Tversky and Daniel Kahneman introduced the world to Prospect Theory, which mapped out how humans actually behave when faced with decisions about gains and losses, in contrast to how economists assumed that people behave. Prospect Theory turned Economics on its head by demonstrating through a series of ingenious experiments that people are much more concerned with losses than they are with gains, and that framing a choice from one perspective or the other will result in decisions that are exactly the opposite of each other, even if the outcomes are monetarily the same. Prospect Theory led cognitive psychology in a new direction that began to uncover other human biases in thinking that are probably not learned but are part of our brain’s wiring.

Thinking fast and slow.

ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure).

Mariell Jessup, MD, FACC, FAHA, Chair [*][1]

William T. Abraham, MD, FACC, FAHA[†][2]

Donald E. Casey, MD, MPH, MBA[‡][3]

Arthur M. Feldman, MD, PhD, FACC, FAHA[§][4]

Gary S. Francis, MD, FACC, FAHA[§][4]

Theodore G. Ganiats, MD[∥][5]

Marvin A. Konstam, MD, FACC[¶][6]

Donna M.

/pdf/2009-focused-update-incorporated-into-the-acc-aha-2005-3z9lhvyqwq.pdf

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation

Informed consent and provider-patient relationships in rehabilitation medicine.

There are multiple risk factors for complications following elective total joint replacement (TJR) surgery. Certain risk factors, including operating time, implant choice, component positioning, and intraoperative difficulties (e.g., fracture, nerve and vascular damage), are related to the surgeon’s experience and decision-making and are not patient dependent1,2. However, many risk factors for complications after TJR are patient dependent. Bacterial colonization, diabetes control, body mass index (BMI), smoking status, fall risk, narcotic and/or alcohol dependence, physical conditioning, neurocognitive disorders, nutritional status, cardiovascular status, nongenetic thromboembolic risk, and anemia all represent potentially modifiable factors that increase the risk of complication with TJR1-8.

Orthopaedic surgeons routinely perform TJR on patients who have one or more of the above-mentioned risk factors. However, this is elective surgery, and some of these risk factors are modifiable prior to surgery. As a result, ethical questions arise. Should patients address these risk factors prior to undergoing TJR, and to what extent should the physician, payer, and health-care institution require the patient to do so? Furthermore, should payers and health-care institutions require that surgeons and patients attempt to modify risk factors prior to these interventions that improve quality of life? If modification of risk is in the best interest of both the patient and the health-care delivery system, the criteria of sufficient patient participation that should be required and what should be done for patients unable to accomplish sufficient risk modification remain unclear. Additionally, who pays for risk factor modification and just how surgeons and patients can be incentivized to maximize the health status of the patient prior to surgery remain unclear. For example, heavy smokers and patients with uncontrolled diabetes have good reasons to improve their health status before surgery. However, is there a moral obligation to ensure that the patient …

The Ethics of Patient Risk Modification Prior to Elective Joint Replacement Surgery.

In 2006, the National Conference of Commissioners on Uniform State Laws rewrote the Uniform Anatomical Gift Act. To overcome the problem of family members prohibiting organ donation from their deceased loved ones even when a donor card existed, the commissioners modified the act to prevent end-of-life care from precluding organ donation. An unintended consequence of the new wording creates the potential for end-of-life care that prioritizes care of the potential donor organs over care and comfort of the dying person. The commissioners have now revised the act, but the original version has already been legislated in many states, with others poised to follow. To protect dying patients' wishes about their end-of-life care, states that have legislated or are considering the original act must replace it with the revised version. A long-term and important ethical precept must stand: Care of dying patients takes precedence over organs. Another laudable goal must be promoted as well: Organ donation is an important part of end-of-life care.

Caring for organs or for patients? Ethical concerns about the Uniform Anatomical Gift Act (2006).

It is a “given” in discussions of genetic engineering that no sensible person can be in favour of eugenics. The main reason for this presumption is that so much horror, misery, and mayhem have been carried out in the name of eugenics in the 20th century that no person with any moral sense could think otherwise.1–3 In fact, the abysmal history of murder and sterilisation undertaken in the name of race hygiene and the “improvement” of the human species again and again in this century is so overpowering that the risk of reoccurrence, sliding down what has proved time and time again to be an extremely slick, slippery slope, does seem enough to bring all ethical argument in favour of eugenics to an end. 

However, before dismissing any favourable stance towards eugenics it is important to distinguish what has happened in the past under the banner of eugenics and what might happen in the future. It is important to distinguish between genetic changes undertaken with respect to improving a group or population and genetic change that takes a single individual as its focus.

#### Summary points

The horrible abuses committed in the name of eugenics through coercive policies imposed by governments have obscured the fact that eugenic goals can be the subject of choice as well as coercion

In the rush to map the human genome and reap the benefits of new genetic knowledge it has become commonplace to argue that eugenic goals will play no part in how new genetic knowledge is used

The moral case against voluntary choices to advance eugenic goals by individuals or couples has not been persuasively made

Given the power and authority granted to parents to seek to improve or better their children by environmental interventions, at least some forms of genetic selection or …

/pdf/what-is-immoral-about-eugenics-psowelsjk3.pdf

What is immoral about eugenics

INTRODUCTION: We sought to evaluate the caliber of education mainstream media provides the public about brain death. METHODS: We reviewed articles published prior to July 31, 2015 on the most shared/heavily trafficked mainstream media websites of 2014 using the names of patients from two highly publicized brain death cases, "Jahi McMath" and "Marlise Munoz." RESULTS: We reviewed 208 unique articles. The subject was referred to as being "alive" or on "life support" in 72% (149) of the articles, 97% (144) of which also described the subject as being brain dead. A definition of brain death was provided in 4% (9) of the articles. Only 7% (14) of the articles noted that organ support should be discontinued after brain death declaration unless a family has agreed to organ donation. Reference was made to well-known cases of patients in persistent vegetative states in 16% (34) of articles and 47% (16) of these implied both patients were in the same clinical state. CONCLUSIONS: Mainstream media provides poor education to the public on brain death. Because public understanding of brain death impacts organ and tissue donation, it is important for physicians, organ procurement organizations, and transplant coordinators to improve public education on this topic. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved. Language: en

Arthur L. Caplan

Papers

Informed consent and provider-patient relationships in rehabilitation medicine.

The Ethics of Patient Risk Modification Prior to Elective Joint Replacement Surgery.

Caring for organs or for patients? Ethical concerns about the Uniform Anatomical Gift Act (2006).

What is immoral about eugenics

Public education and misinformation on brain death in mainstream media.