University at Buffalo

Center for Clinical Ethics and Humanities in Health Care

Bioethics Bulletin

Editor: Tim Madigan
August 1995
Volume Two, Number Eight

The Center for Clinical Ethics and Humanities in Health Care

Co-Directors: Gerald Logue, MD and Stephen Wear, PhD
Secretary: Lisa Bolton Address:
The Center for Clinical Ethics and Humanities in Health Care
VAMC
3495 Bailey Avenue
Buffalo, New York 14215

Telephone: 862-3412
FAX: 862-4748

E-mail sent to Lisa Bolten LBolton@ubmedc.buffalo.edu.
Please note that the Center address has been changed, along with its phone and fax numbers: this signals the recent move of the Center to a new suite of offices at the VAMC.

Center Library

The Center is starting a research library, and would appreciate donations of books, articles and journals pertaining to biomedical ethics. These will all be made available for visitors to the Center. Our thanks to Betty Zavon, RN for her recent contribution to this collection.

Newsletter Distribution

The Center newsletter can be delivered to you via e-mail or fax. If you would like to receive the newsletter over the Internet, please forward your request to Jack Freer JFreer@ubmedb.buffalo.edu. If you would like to receive it by fax, call Lisa Bolten at the telephone number above and tell her your fax number. We encourage the use of e-mail and fax distribution rather than paper for the newsletter.

Upcoming Center Meetings

Community Affairs Committee Grand Rounds

The Community Affairs Committee sponsors an ongoing series of bioethics grand rounds at area hospitals on a monthly basis. All Center members are encouraged to attend.
"Medical Futility." Friday, September 22, 8:00 - 9:00 AM. VA Medical Center, 3495 Bailey Avenue. 11th Floor - Room 1109C. AMA/PA and RN continuing education credit will be secured. Presenters: John Banas, MD; Benjamin Phillips, RN; Sally Schimmel, RN; Stephen Wear, PhD; Eric Ten Brock, MD. The issue of medically futile treatment has occasioned much discussion during the past decade, in the ethics and clinical literature, as well as in health care institutions. It is especially controversial in its claim that health care providers should be able to withdraw medical treatment that they deem to be without benefit even though the patient and/or patient's family is demanding that it be given. Whether such a claim amounts to a last, and particularly egregious, example of medical paternalism, or is a valid reaction to irrational desires by medical consumers, is part of the issue. Equally important is whether such a policy can be administered with equality and justice, and without abuse. The Buffalo VAMC has had a futility policy in place for over a year. Beyond presenting this policy (which has both "qualitative" and "quantitative" aspects), members of its ethics committee will briefly present (1) a few typical cases that the policy was intended to deal with; (2) a sense of the considerations that effected the evolution of the policy into its final form (i.e. a "procedural" policy which avoids providing specific definitions of futility); (3) the experience at the VAMC with various patients who were subsequently claimed to be futile under the policy; (4) a comment by a non-VAMC ethics committee member regarding the relevance of all this to other Western New York health care institutions. Time for audience questions and participation will be provided. For further information, call Benjamin Phillips at 834-4270.

Center Reading Group

The Center will be establishing a reading group, the purpose of which is to discuss in-progress publications and encourage new publications. The first work to be discussed is Steven Wear's book Informed Consent: Patient Autonomy and Physician Beneficence Within Clinical Medicine. The book, published by Kluwer Academic Publishers in 1993, will be going into its second edition, and Wear is interested in receiving comments and suggestions. If you would like to participate in the reading group, please contact Tim Madigan at 877-9428, or by e- mail: timmadigan@aol.com.

Upcoming Lectures

"Staying Calm During the Storm." Friday, August 18, 9:00 AM - 10:00 AM. Presenter: Linda Koch, CSW. HIV Psycho-Social Grand Rounds - Sponsored by the Immunodeficiency Services and Life Transitions Center, an affiliate of Hospice of Buffalo, Inc. Held at Erie Community Medical Center, Smith Auditorium (3rd floor). For further information, contact Lori Berds at 898-4119.

Bioethics Workshop, at Medina Memorial Hospital, 200 Ohio Street, Medina, New York. Thursday, September 7. Presenters: Drs. Jane Greenlaw and Jeffrey Spike, University of Rochester. Topics include: withdrawing treatment; nutrition and hydration; medical decisions for minors; decisions by surrogate. For further information, contact Margo Kargbo at 798-2000.

Society for Bioethics Consultation Ninth Annual Meeting. September 14-17, Stouffer Hotel, Cleveland, Ohio. For information, write to Society for Bioethics Consultation, Clinical Ethics Program, Dept. of Medicine, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, Ohio 44106-6033. Or contact the SBC President, Stuart Youngner, MD, at 216- 844-3429; e-mail: sxy2@po.cwru.edu. This meeting is strongly recommended by Center members who have attended in the past.

The Family Living With AIDS - An Example of Disenfranchised Grief. Friday, September 22, 9:00 AM - 10:00. Presenter: Karen Briggs, RN. HIV Psycho-Social Grand Rounds. Sponsored by the Immunodeficiency Services and Life Transitions Center, an affiliate of Hospice of Buffalo, Inc. Held at Erie County Medical Center, Smith Auditorium (3rd floor). This program has been approved for 1.0 hour of AMA/PRA Category 1 credit. For further information, contact Lori Berds at 898-4119.

Ethics, Medicine and Health Care: An Appraisal of the Thought of H. Tristram Engelhardt, Jr. Friday, September 29 and Saturday, September 30. Youngstown State University, Youngstown, Ohio. The conference is convened in recognition of the publication of the second edition of H. Tristram Engelhardt, Jr.'s The Foundations of Bioethics. It includes four plenary addresses, a panel presentation, and a comprehensive response by Engelhardt. It also includes constructive and critical papers on Engelhardt's bioethics, philosophy, theology, political and social theory, philosophical anthropology, and theories of medicine and health care. The conference fee is $75.00. The Banquet fee is $25.00. The combined fee for other meals (dinner on Friday, and breakfast and lunch on Saturday) is $30.00. To register, send a check or money order payable to Youngstown State University, Continuing Education Registration, Office of University Outreach, Youngstown, Ohio 44555- 3358. For further information, call Brendan Minogue at 1-216-742-1464. Center members Stephen Wear, Tim Madigan and Wade Robison will be giving presentations. If you would like to share a ride to the conference, please contact Tim Madigan at 877-9428, timmadigan@aol.com.

Tools for Clinical Precepting: A Novel Approach Using "Standardized Students." Monday, October 2, 1:30 PM - 4:30 PM. Presenter: LuAnn Wilkerson, EdD, UCLA School of Medicine. Sponsored by the School of Medicine and Biomedical Sciences, University at Buffalo through the Primary Care Resource Center's Teaching Effectiveness Program. To be held at the University at Buffalo South Campus, Lippschutz Room, CFS Addition, 3435 Main Street, Buffalo. $10.00 registration fee is required. Contact Diane Schwartz DSchwart@ubmedc.buffalo.edu at the Primary Care Resource Center for further information, 829-3176.

Society for Health and Human Values. Annual Meeting: October 12-15, San Diego, CA. Theme: "Values of Health Care: Diverse Perspectives." For information, contact the SHHV National Office, 6728 Old McLean Drive, McLean, VA 22101, phone: 703-556-9222, fax: 703-556-8729, e-mail: shhv@aol.com.

Fall 1996 Sesquicentennial Conference

A symposium on Ethics and Values in Medicine and the Biomedical Sciences will be held in conjunction with the UB School of Medicine and Biological Science's sesquicentennial, November 14-16, 1996. The keynote speaker of the symposium will be H. Tristram Engelhardt, Jr., whose work is also being honored at a conference this September 29-30 at Youngstown State University (see above for information). Engelhardt holds an MD with honors from Tulane University School of Medicine and a PhD from the University of Texas at Austin, where he completed his undergraduate work. In 1969 he was a Fulbright Graduate Fellow at Bonn University, and in 1988 he was Fellow at the Institute for Advanced Study in Berlin, Germany. Currently, Dr. Engelhardt is Professor in the Department of Medicine, and Obstetrics and Gynecology, Baylor College of Medicine. In addition, he is Professor in the Department of Philosophy, Rice University and Adjunct Research Fellow, Institute of Religion, Houston, Texas. Dr. Engelhardt has recently written Bioethics and Secular Humanism: The Search for a Common Morality. He is editor of the Journal of Medicine and Philosophy, co-editor of Christian Bioethics, and co-editor of the Philosophy and Medicine book series with over forty volumes in print. He is also co-editor of the book series Clinical Medical Ethics and editor of the series Philosophical Studies in Contemporary Culture. His The Foundations of Bioethics was first published in 1986, and was one of the early sustained theoretical representations of the burgeoning field of bioethics. The second edition has just been published. Engelhardt has authored over two hundred articles and chapters in books, in addition to numerous book reviews and other publications.

Call for Papers

American Association for the History of Medicine, 1996 Annual Meeting. May 9-12, at the Hyatt Hotel, Buffalo. The Chair of the Program is James T. H. Connor, Hannah Institute for the History of Medicine, 14 Prince Arthur Avenue, Suite 101, Toronto, Ontario, CANADA M5R 1A9. Any person interested in presenting a paper at this meeting is invited to submit an abstract (one original and six copies) to Dr. Connor. Any subject in the history of medicine is suitable for presentation, but the paper must represent original work not already published or in press. Submissions on comparative aspects of the history of medicine (by period, region, country, or by culture) are especially welcome. Presentations are limited to twenty minutes. Because the Bulletin of the History of Medicine is the official journal of the AAHM, the Association encourages speakers to make their manuscripts available for consideration by the Bulletin upon request. Abstracts must be typed, single-spaced on one sheet of paper, and must not exceed 300-350 words in length. Abstracts should embody not merely a statement of a research question, but findings and conclusions sufficient to allow assessment by the committee. The following biographical information is also required: Name, title (occupation), preferred mailing address, work and home telephone numbers, and fax numbers, e-mail address, present institutional affiliation and academic degrees. Abstracts must be received by October 15, 1995. Please note that abstracts submitted by e-mail or fax will not be accepted. As in the past, the 1996 program will include lunch-time roundtable workshops and may include poster sessions. Those wishing to submit abstracts for these sessions should follow the instructions given above.

Members Corner

Jack Freer and UB medical student Vamil Divan are recipients of a John A. Hartford/American Federation for Aging Research award in conjunction with the AFAR visiting scholar program for medical students. The award is designed to raise the visibility of geriatrics in the home institution. The funds will be used to support an educational program on Geriatric Ethics during the 1995-1996 academic year.

Joseph Kelly, PhD, JD, Associate Professor of Business at Buffalo State College has been asked by the United Nations Development Program, Regional Project on HIV & Development, to write a chapter on "HIV and Insurance Law" as part of a source book "intended primarily for use by law teachers, law students, legal practitioners, human rights activists and HIV/AIDS national program administrators in the Asia and Pacific region." The book is expected to be in publication by the end of 1995.

Comments and Suggestion

Your comments and suggestions regarding this newsletter are encouraged. Please send them to the Center address, or by e-mail to the newsletter editor, Tim Madigan - timmadigan@aol.com. We also need information on upcoming events that would be of interest to Center members. The deadline for the next newsletter is August 15th.