By Eli Valley in The Nation (Behind a wall).
Beware the DNR order February 17, 2014
This post is for those of us involved in caring for ourselves or others. (If you don’t give a sh*t about anyone, don’t read on.) It comes from a blog post by a highly credentialed physician and professor of medicine.
“DNR” is supposedly just about employing CPR. Even that was somewhat surprising, but facts about how it’s used can be very upsetting:
And it’s not just in the midst of a disaster that physicians mistake “DNR” for “Do Not Treat.” Study after study has shown that physicians say they would not administer a whole variety of treatments to patients who are DNR. One representative study of 241 physicians found that they were far less likely to agree to transfer a patient to the intensive care unit or even to perform simple tests such as drawing blood.
Most recently, physicians and nurses caring for pediatric patients also told interviewers that in practice, DNR means far more than just do not perform CPR. In this survey of 107 pediatricians and 159 pediatric nurses in a hospital setting, 67% believed a DNR order only applies to what to do after a cardiac arrest—but 33% said it implied other limitations. And 52% said that once a DNR order is in place, a whole host of diagnostic and therapeutic interventions should be withdrawn, over and beyond CPR, and a small but disturbing minority, 6%, said that a DNR order means that comfort measures only are to be provided.
Note: comment 1 below draws our attention to the possibility of state variations on a DNR order. In addition, some DNR forms are part of a living will, where you specify more about what is wanted. So it is worth checking out what is available. The focus of this post is to say ‘DNR’ may not be understood as you want it to be.
I’m reminded here of the Wiittgensteinian point that you won’t find an interpretation that won’t itself need an interpretation. That’s why at some point we need community practices.
General anaesthesia (GA) for older people June 16, 2013
I had no idea about any specific link between dementia and GA. In fact, given the announcement’s date, few people could have known about it until recently. But it seems to me the sort of thing one should know about, either as potential victim or as someone close to a potential victim. ‘Elderly’ starts at 65.
June 1, 2013 — Exposure to general anaesthesia increases the risk of dementia in the elderly by 35%, says new research presented at Euroanaesthesia, the annual congress of the European Society of Anaesthesiology (ESA). The research is by Dr Francois Sztark, INSERM and University of Bordeaux, France, and colleagues.
Postoperative cognitive dysfunction, or POCD, could be associated with dementia several years later. POCD is a common complication in elderly patients after major surgery. It has been proposed that there is an association between POCD and the development of dementia due to a common pathological mechanism through the amyloid β peptide. Several experimental studies suggest that some anaesthetics could promote inflammation of neural tissues leading to POCD and/or Alzheimer’s disease (AD) precursors including β-amyloid plaques and neurofibrillary tangles. But it remains uncertain whether POCD can be a precursor of dementia.
In this new study, the researchers analysed the risk of dementia associated with anaesthesia within a prospective population-based cohort of elderly patients (aged 65 years and over). The team used data from the Three-City study, designed to assess the risk of dementia and cognitive decline due to vascular risk factors. Between 1999 and 2001, the 3C study included 9294 community-dwelling French people aged 65 years and over in three French cities (Bordeaux, Dijon and Montpellier)…The data were adjusted to take account of potential confounders such as socioeconomic status and comorbidities.
The mean age of participants was 75 years and 62% were women. . After adjustment, participants with at least one GA over the follow-up had a 35% increased risk of developing a dementia compared with participants without anaesthesia.
Dr Sztark concludes: “These results are in favour of an increased risk for dementia several years after general anaesthesia. Recognition of POCD is essential in the perioperative management of elderly patients. A long-term follow-up of these patients should be planned.”
Constructing the Myth of the Crack Baby May 21, 2013
Ta Nehisi Coates has a short blurb about about the crack baby ‘epidemic’ in the early 1980s in the US. You can also watch a ten minute video / short documentary about it here.
Coates mentions the influence of racism in how women were being prosecuted for being pregnant while addicted to cocaine. In fact, there’s a whole confluence of racism, classism, misogyny, and ableism that feed into the crack baby hysteria:
–the racism and classism that goes into poor WoC being more easily seen as irresponsible mothers who were recklessly endangering their unborn children
–the general misogyny that a woman’s health (like helping her with her addiction) is not nearly as important as the health of the her unborn child (so she should be prosecuted for potentially harming it.)
–the ableism that influence our standards of health. Part of the hysteria was that babies would be born with physical and cognitive disabilities, which not only lead us to think of them as not being fully human, but we were then also concerned about all the extra money they disabled kids would cost us. Because you know, the *tragedy* here is not that there are a bunch of women addicted to a dangerous drug, but that people’s taxes will go up from from all these costly, disabled babies.
Eek, it’s like a messed-up game of “spot how the -ism influences our moral concerns.”
Catholic Hospital Argues Fetuses Are Not Persons January 26, 2013
A wrongful death lawsuit has been filed against St. Thomas More Hospital in Colorado. Lori Stodghill, who was pregnant with twins, died from a heart-attack shortly after she had been admitted. Her husband filed a suit in which his lawyers argue that a cesarean-section could have saved the twins, and so ought to have been performed.
Catholic organizations have for decades fought to change federal and state laws that fail to protect “unborn persons,” and Catholic Health’s lawyers in this case had the chance to set precedent bolstering anti-abortion legal arguments. Instead, they are arguing state law protects doctors from liability concerning unborn fetuses on grounds that those fetuses are not persons with legal rights.
You can read more here.
a cautionary word about weight loss and pills January 24, 2013
A few weeks ago I did a poll on whether one would want the side effects of a pill that causes weight loss. And in another post I mentioned falling. Oddly enough, the two were connected.
According to web lore, one of the generics of Wellbutrin has not been certified by the CDC or whatever as the same as the brand. And the uncertified one can cause really unpleasant side effects in a very, very small part of the population, anonymous people on the web maintain. Now, we are not talking a fall or two; I think I actually fell 7 times in about a week, mostly outdoors, and was prevented from falling 3 or so other times. This is actually very dangerous and I was worried.
Since no doctor or pill book seemed to know what might be going on, I decided to follow the web advice and switched back to the very expensive brand name. And I stopped falling.
Dizziness is listed as a possible side effect of Wellbutrin, but that is not what was happening. It felt as though some signal was not getting through, and in particular the ones that have one shift one’s center of balance when one’s carrying something, going up a step and so on. In fact, I think there might be some subtle counter-example to claims about knowledge without observation. That is, I suspect I could briefly access the signals consciously. But that’s not the point here!
And thanks to ChrisTS, who suggested that I try to find out what was happening! Her comment helped focus my attentions.
The “Perfect Woman” December 30, 2012
Oh, how the times change. Unsurprisingly, the perception of what the “perfect woman” looks like — and what a healthy weight is — has changed a lot since 1912 (though, I cannot figure out why Cornell was doing anything of this sort in the first place).
Cornell University’s medical examiner, Dr. Esther Parker, selected Scheel from a pool of 400 Cornell women. The New York Times described her as “a light-haired, blue-eyed girl whose very presence bespeaks perfect health,” and The Star, a Wilmington, Del. paper, reported that Scheel was 171 pounds, 5 ft. 7 in. tall and had similar proportions to the famous Greek statue, Venus de Milo.
The full story is over at Huffington Post.
Women still missing in (US) Medicine’s higher ranks September 28, 2012
An article in the NY Times raises some interesting issues that women in philosophy might want to think about. First of all, tenure is less prevalent in medical schools. According to a Science blog:
The percentage of new faculty hired on the tenure track at U.S. academic medical centers and medical schools has been falling steadily for almost a quarter of a century, according to a report out this month from the Association of American Medical Colleges. Only a quarter of new clinical faculty hired in 2009 were on the tenure track, as opposed to 46 percent in 1984.
One figure has been virtually unchanged: The number of men in tenure track positions exceeded that of tenure-track women by eight percentage points in 1984 and in 2009. “Future research could assess the personal significance of tenure to women, as tenured positions may become more scarce for this subgroup of faculty,” the report’s authors write.
Nonetheless, women have dismal career prospects, if the figures of actual job distributions are predictors. And some of the reasons are familiar; the difference between men’s and women’s lives may have an impact independent of tenure. On the other hand, I do not remember seeing the sense of inclusion and confidence raised very much in philosophy discussions. There may be good reasons for this; linking poor career advancement to women’s self-confidence can easily turn into blaming the victim. From the NY Times:
This phenomenon is well documented. While women make up about half of all medical students and a third of academic faculty, they are nearly absent in the upper ranks. A recent review in The Journal of General Internal Medicine showed that only 4 percent of full professors are women. Only 12 percent of department chiefs are women. In the survey, men and women were engaged in their work to a similar degree, and both groups had comparable aspirations for leadership roles.
But over all, women did not feel the same sense of inclusion in the medical world as men did. They were not confident about their ability to be promoted, despite their interest in advancement. These findings do not come as a surprise to most women in medicine.
Is it that the medical world remains biased against women, despite the increasing number of women in the ranks? Or is it, as some have postulated, that the culture of the workplace — built around the needs of men for generations — simply remains that way? Despite trends toward more equitable distribution of family responsibilities and more child care services, women still shoulder more of the family burden. For most people, peak career-building years overlap with peak family-building years.
Still, there may be something to the lack of self-confidence and to the inability of some to imagine their getting to the top. So the idea of “possible selves” might be worth exploring. And, as you will see, finally implicit bias is given a place of importance:
There is also the idea of “possible selves.” If you see lots of women who are doctors, a teenager can imagine that for herself as a possible life. But if you never see any women leading a department, it’s much harder for a junior faculty member to envision that job as a possibility.
No one I’ve spoken to feels there is much deliberate bias in medicine these days. But the lingering unconscious bias involving the various waves of newcomers — women, members of racial and ethnic minorities, gays and lesbians — resonates for many.
ND lawsuit an affront to gender equity September 3, 2012
More on the students’ opposition to Notre Dame’s lawsuit:
If the University can provide access to medications that treat erectile dysfunction without question, because it trusts that men will use it wisely, why not treat women likewise when it comes to contraceptives? The University’s policies do not treat men and women as equally capable and trustworthy moral agents, and the University is going to court to defend that disparity.
While it is not clear to us that compliance with the mandate would violate Catholic conscience, it is clear that gender inequity is wrong both legally and morally. ‘Dignitatis Humanae,’ the Vatican’s 1965 declaration of religious freedom, says: “[G]overnment is to see to it that equality of citizens before the law, which is itself an element of the common good, is never violated, whether openly or covertly, for religious reasons. Nor is there to be discrimination among citizens.”
Truly living out the University’s mission and Catholic identity requires creating more equitable University policies and a more family-friendly environment.
We seek a frank, open discussion about why complying with the mandate is contrary to its conscience, and why filing a lawsuit against the federal government is a suitable means of furthering the university’s moral mission.
Father’s age a factor in autism and schizophrenia August 22, 2012
The report seems to me to have political dimensions that can pull us in very different directions. On the one hand, it still seems to me amazing to see any questioning of the idea that it is only women who face a ticking reproductive clock. On the other hand, you know that the chances are very high that there is a lot of ablest thought that the research is going to inspire, and may well have been inspired by.
Let me add in that as a parent, the thought that one’s child might not be able to earn a living is utterly terrifying. Perhaps especially in the US, the fate of at least fairly markedly neuro-atypical adults can be very awful indeed.
Having said that, let me ask that if anyone has information on what people with markedly neuro-atypical children can do to plan a safe future for the child after they have died. Supposing, that is, that they don’t want to be academics. (JOKE!)