My first encounter with informed medical consent came as a young law student. I was assigned to assist a lawyer in the defense of an older man who had refused treatment for leukemia. His daughter objected, and asked the court to appoint her to be his conservator so she could compel him to undergo treatment. When the father spoke to my supervisor, his position became clear. His atypical choice was informed by his cultural background and personal character. An immigrant from Eastern Europe, he was adamantly against yielding control of his life to his daughter. He had tried the medicines, and found they sapped his strength and made him weak. He would rather go on strong for as long as possible and remain his own master.
Among the most controversial of medical issues is the resuscitation of newborns that are unlikely to survive. The Born-Alive Infants Protection Act (BAIPA), enacted in 2002, and the enforcement guidelines later issued by the United State’s Department of Health and Human Services (DHS) outlined clinical procedures to be used in the resuscitation and care of infants born between 20 and 24 weeks gestation. (A normal, full-term pregnancy is 37 to 42 weeks of gestation.) This act has gained remarkably limited attention, and many neonatologists are not familiar with the act or DHS guidelines concerning its enforcement. A recent study published in Pediatrics suggested that most neonatologists surveyed did not agree with the legislation, but that it did have the power to change medical practice if it was enforced.
With the intensifying call for transparency in corporate America, several pharmaceutical companies have announced plans to jump on the proverbial bandwagon early. In anticipation of the passage of the Physician Payments Sunshine Act in the U.S. Senate, Eli Lilly and Merck have announced plans to establish online registries of payments made to physicians. Additionally, Glaxo Smith Kline, Pfizer, and AstraZeneca will disclose charitable giving and change the way they financially support educational programs.
You can’t have skeletons in the closet if you want to be the Commander in Chief of the U.S. Armed Forces. As Election Day draws near, I imagine that both McCain and Obama are exhausted; both have been run through the ringer. After all, they must endure non-stop campaigning schedules, high pressure debates, and the constant scrutiny of the press. Along with this, every aspect of their lives are being examined under the most powerful of microscopes. From tax records to religious affiliations to personal friendships, both men are left bare, no secrets uncovered.
- The Broken Mirror
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