As a subscriber to a HealthCare Chaplaincy publication, we are pleased to send you the “Soul of Bioethics” newsletter, which we publish periodically. It is edited by Harry (Rick) Moody, Ph.D., director of academic affairs for AARP in Washington, DC and co-sponsored by the Office of Academic Affairs at AARP.
– Affordable Care Act: What about Aging?
– Ethics and Aging: The Critical Turn
– Dept. of Conflict of Interest
– Ethics of Waste Avoidance
– Will Stem Cells Cure Aging?
– Suffering from Life?
– Fast-Breaking Stories
– Web Sites to See
– Books of Interest
AFFORDABLE CARE ACT: What about Aging?
The Affordable Care Act has been subject to continuing political debate. The recent Supreme Court decision upholding the law has some tangible implications for health and aging policy which deserve attention:
– Medicare beneficiaries will continue to receive prescription drug savings through discounts
– The Part D prescription drug coverage gap (the ‘doughnut hole’) will continue to be phased out
– Health promotion is enhanced because annual wellness visits for beneficiaries will continue to be provided under Medicare. Beneficiaries will pay less for preventive services, such as mammograms, pap smears, bone mass measurements, depression screening, diabetes screening, and screening for HIV and obesity
– More than 3 million uninsured Americans between age 50 and 64 will be covered under Medicaid
– The Medicare Trust Fund’s solvency has been extended for 8 more years
The impact of these measures has been documented. By starting to close the doughnut hole, 5.3 million people on Medicare Part D have already saved $3.7 billion since the law was enacted. In the first five months of 2012, 745,000 people on Medicare saved $485 million on prescription drugs in the doughnut hole coverage gap for an average of $651 in savings per person this year. More than 32 million Americans in Medicare used free preventive services in 2011 and 2.2 million people with traditional Medicare benefited from the new Annual Wellness Visit in 2011.
Many provisions of the Affordable Care Act have not been well understood by older adults. Continuing debate should include attention to these elements of the law.
For more details on these developments, visit: http://www.aarp.org/healthlawguide
ETHICS AND AGING: The Critical Turn
How often do we hear that honoring autonomy should be the foundation of ethical respect for elders. But accomplishing that may require a “critical turn” in our thinking about ethics:
“To honor autonomy… calls for a focus on the external conditions that support or impede its exercise… Part of the responsibility of professionals working with elders is to start with awareness about the autonomy-constraining features of these contexts and to then work with persons to reveal their values and desires… Narrative, based on a communicative or dialogic approach, is the way most of us make important decisions and reflect upon our lives. We urge its further practice to work with older people.”
From ETHICS, AGING AND SOCIETY: The Critical Turn, by Martha Holstein, Jennifer Parks and Mark Waymack (Springer, 2011).
For more about this book, visit: http://www.springerpub.com/product/9780826116345
DEPT. OF CONFLICT OF INTEREST
We in bioethics focus a lot of attention on ethical dilemmas and quandaries of all sorts. But what about the blatant corruption that is gradually creeping into our healthcare System? For a glimpse of a specific conflict-of-interest problem, see:
“Insurers Pay Big Markups as Doctors Dispense Drugs” at: http://www.nytimes.com/2012/07/12/business/some-physicians-making-millions-selling-drugs.html?emc=eta1
ETHICS OF WASTE AVOIDANCE
Medical ethicist Howard Brody offers an important argument about why the debate over healthcare “rationing” has been so confusing and destructive of public dialogue. In his article “From an Ethics of Rationing to an Ethics of Waste Avoidance” he offers the following case study:
“A case study for the shift in ethical focus is the treatment of advanced, metastatic breast cancer with high-dose chemotherapy followed by autologous bone marrow transplantation. This treatment was initially thought to offer perhaps a 10% chance of a significant extension of life for patients who would otherwise be fated to die very soon. Insurers’ refusal to pay the high costs of this last-chance treatment did much to torpedo public trust in managed care during the 1990s. Data now suggest that the actual chance of meaningful benefit from this treatment is zero and that the only effect of the treatment was to make patients’ remaining months of life miserable. In this case, the ethical debate over rationing was misplaced.”
For full text of the article, visit: http://www.nejm.org/doi/full/10.1056/NEJMp120336 5
For more about the related “Choosing Wisely” Campaign, see: http://www.ama-assn.org/amednews/2012/04/16/bisa0416.htm
WILL STEM CELLS CURE AGING?
Maybe some day, but not quite yet. Perhaps I’m overly sensitive about this subject because I’ve had two close friends who died of cancer after being taking human growth hormone (against my advice).
What about stem cells, that new frontier of regenerative medicine? Well, research is one thing, but use of stem cells for clinical treatment as appropriately been called “21st century snake oil.” An expose of this entire field was done by “60 Minutes” at: http://www.cbsnews.com/8301-18560_162-57354695/stem-cell-fraud-a-60-minutes-investigation/
The International Society for Stem Cell Research (ISSCR) offers guidance on the credibility of claims for so-called stem cell treatments, including claims for so-called “anti-aging” interventions.
For more details, see the “Closer Look at Stem Cells” website at: http://www.closerlookatstemcells.org//AM/Template.cfm?Section=Home1
FOREVER YOUNG: A Cultural History of Longevity from Antiquity to the Present, by Lucian Boia (Reaktion Books, 2004).
A HISTORY OF IDEAS ABOUT THE PROLONGATION OF LIFE, by Gerald Gruman, MD PhD (Springer, 2003).
SUFFERING FROM LIFE?
Some in the Netherlands now want to extend that nation’s legalized euthanasia policy in a new way: people over age 70 would be eligible for voluntary euthanasia even if they’re not suffering from an illness. They need only be “suffering from life,” a category that seems pretty broad, indeed. This proposal is controversial, but it raises new questions about the meaning of old age.
For more on this issue, visit: https://achaplainsjourney.wordpress.com/2012/05/08/can-a-person-suffer-from-life/
HUMAN VALUES IN AGING
The “Human Values in Aging” e-newsletter publishes items on positive aging, including spirituality, autobiography, lifelong learning, and late-life creativity. For a sample copy or free subscription, send a message to email@example.com.
The following stories will be of interest:
“Hospitals Letting Patients Die to Save Money” at:
“Doctor Accused of Ending Patients’ Lives Prematurely” at:
“Legal Euthanasia Didn’t Raise Death Rate, Researchers Say” at:
“Patients Reluctant to Disagree with Doctor’s Advice” at:
(Thanks to “This Week in Bioethics” at Bioethics.net for these citations.)
WEB SITES TO SEE
CHOOSING WISELY has an appealing slogan: Doctors Want To Do The Right Thing. To find out more about this initiative, visit: http://healthaffairs.org/blog/2012/06/06/choosing-wisely-doctors-want-to-do-the-right-thing/
CARE PLANNING. “Advance Care Planning Decisions is a series of narrative videos designed to educate patients and their families about options for medical care. Available at: http://www.acpdecisions.org/videos/
DISABILITY. “Many people assume disability is a fate worse than death,” writes William J. Peace, in an article in the current Hastings Center Report. For commentary on disability and end-of-life choices, visit:
BOOKS OF INTEREST
RETHINKING INFORMED CONSENT IN BIOETHICS, by Neil C. Manson and Onora O’Neill (Cambridge Univ. Press, 2007).
TRANSFORMING PALLIATIVE CARE IN NURSING HOMES: The Social Work Role, edited by Mercedes Bern-Klug (Columbia Univ. Press, 2012).
MAKING HEALTH CARE WHOLE: Integrating Spirituality into Health Care, by Christina Puchalski, M.D. and Betty Puchalski (Templeton Press, 2010).
This electronic newsletter, edited by Harry (Rick) Moody, is published by HealthCare Chaplaincy and co-sponsored by the Office of Academic Affairs at AARP.
The opinions stated are those of Mr. Moody and may not necessarily reflect those of HealthCare Chaplaincy or AARP.
To submit items of interest, contact H.R. Moody at firstname.lastname@example.org.
(c) Copyright 2012; all rights reserved.