The truth of the matter

This update of a case came to my attention while perusing the recent journals in dealing with organ transplantation. It is commentary on the journalistic reporting the case of California vs. Roozrokh. It is found in The Hastings Center Report At Law section "Jesting Pilate"-of July-August 2008, p14-15 (www.thehastingscenter.org) by Carl E. Schneider (He is the Chauncey Stillman Professor of Law Professor and Professor of Internal Medicine at the University of Michigan as well as a member of the President's Council on Bioethics) - This case involves a new transplant surgeon who was accused in the New York Times of murder: "Surgeon Accused of Speeding a Death to Get Organs." (http://www.nytimes.co/2008/02/27transplant?_r=1&oref=slogin). The case is one dealing with Donation after Cardiac death (DCD) and has significant warnings and possible chilling implications. The author's point however has to do with what is presented to the public and what is true. In his own investigation of the case he found that there had been a preliminary hearing, a ruling, and a judicial opinion. The surgeon had not been charged with murder but with three felonies, only one of which will be permitted to go to trial: "dependent Adult Abuse...by willfully causing the patient to be placed in a situation in which his health was endangered by the prescription of excessive amounts of morphine and Ativan, and/or by introduction of Betadine into the stomach."(1). This count is much less serious than that of homicide and the prosecutor would only have to show that the surgeon was criminally negligent.

The patient had adrenoleukodystrophy, which damages the nervous and muscular systems. This is a genetic condition. He had been admitted in a coma and his mother gave consent to withdraw life support and made him an organ donor. He was not brain dead. The transplant surgeon in question was not involved in any of these decisions. But the surgeon had apparently never before been involved with DCD cases, nor had any of the hospital staff, nor had the transplant coordinator, the chief of transplant surgery at the institution had never been involved with one, and there was no written of national DCD policy. There was much confusion in the evidence gathering regarding the frequency and dosing of narcotics. There was a preliminary hearing and not a trial where facts are found in discovery and put in evidence.

The author's point is that journalistic reporting of the law is often poor and inaccurate, few journalists have legal training. The law itself is fragmented and difficult to cover. Finally the point is made that most legal events take a long time to sort out. The questions this poses are many as are the lessons- is this murder or a series of mistakes and inexperienced personnel? Is the rush to journalistic judgment appropriate or is it sensationalism to sell newsprint? For ethicists this brings up such issues as ethical oversight of reporting practices, criticism of the editors who do nt insist on fact checking, another instance of self policing that does not work. The bigger question of which is DCD appropriate at all and, if so, where is the national policy that should be followed? It would seem that Donation after Cardiac Death entails lively and active bioethical input.

Women are so sensitive

A 51 year old "board certified" orthopedic surgeon in New Jersey is offended that a woman who went in for back surgery and discovered a temporary rose tatoo at her pantyline, on the side of her body opposite her back, has brought suit against him because, according to the surgeon's lawyer, her suit " suggests something he did was intended to be prurient, and nothing could be further from the truth," Rather, "It was intended just to make the patient feel better." Apparently, this was something the surgeon did frequently to "lift spirits" and no one had ever complained.
http://www.abajournal.com/news/new_jersey_woman_sues_surgeon_over_temporary_rose_tattoo/

Art Caplan was called in. While of course what he said is exactly right, "You cannot do something like this even as a joke,'' it is horrifying that in 2008 it was necessary to get a comment from a professional ethicist to say this is wrong. Also, although I know to some of you a 51 one year old can be excused because "times were different" when he was raised I am only five years younger than he is and believe me this is not so.

[Editor's note: for non-lawyers, this doctor could be held liable for battery, for unauthorized touching (i.e., beyond the original informed consent, with no implied consent because it wasn't medically necessary). Given that the patient was under anesthesia, and the location of the tattoo, he could also be held liable for intentional infliction of emotional distress, which could warrant punitive damages.]

Could Coral Reefs Really Be In Danger?

By: Jenny Walters

A recent featured report on National Public Radio (NPR) entitled Study: Global Coral Crisis Is In Full Bloom, by John Nielsen dealt with the increasing loss of coral reefs around the world.

According to Nielsen, “coral reefs around the world are in bad shape these days.”[1] A recently published paper by Kent Carpenter, a reef expert at Virginia’s Old Dominion University, reported, “as much as a third of the world’s coral species may now be headed toward extinction, thanks to problems ranging from destructive fishing boats to ocean waters warmed by global climate change.”

Carpenter went on to state “problems faced by these important ecosystems may be worse than a lot of experts think they are…A third of the world’s coral species are now declining toward extinction, partly owing to increased outbreaks of coral diseases…This is a whole ecosystem that we could potentially be losing.”1

Carpenter’s paper was prepared with the aid of the coral researchers affiliated with the International Union for Conservation of Nature, a nonprofit conservation group whose scientific work is widely thought to be definitive.1 The coral researchers put together the “‘red list’ that concludes that a third of the world’s coral species may be declining toward extinction.” The researchers also found some evidence of “a link between coral-killing diseases and warming ocean waters.”

Carpenter warns if emission of global warming gases is not reduced soon; even bigger problems will emerge.1 Currently, ocean waters are more acidic as they soak up carbon dioxide, the main global warming gas. Although there is some evidence that coral reefs can adapt to warming waters, such as reefs in some parts of the far Pacific are now thriving in the warming waters, there is no proof they can cope with the more acidic oceans.

Carpenter concluded by saying, “Obviously the overarching problem that has to be solved is the [buildup of man-made] carbon dioxide in the atmosphere.”1

To help solve the problem, wounded reefs such as the Great Barrier Reef have been put off limits to commercial fishermen.1 According to Philip Munday, a reef expert at Australia’s James Cook University reported, following the restriction of commercial fishermen, a large number of big fish have filled the area over a few years. Munday went on to state: “That gives us enormous hope that these populations…can rebound in they’re given the chance to do so. However, these programs won’t protect coral reef problems causes buy global warming, but they might help buy the reefs a little extra time.”

This article shed light on the overwhelming effects that global warming has on our planet. Global warming affects every aspect of our planet. It is everyone’s responsibility to help fight the effects of global warming.

[1] Nielson J. Study: global coral crisis is in full bloom. July 2008. Available at: http://www.npr.org/templates/story/story.php?storyId=92432491. Accessed on July 13, 2008.