Bioethics on TV: What is being portrayed?

(Image credit: ABC/Eric McCandless)

It is likely no surprise to regular viewers of the television medical dramas “Grey’s Anatomy” and “House, M.D.” that bioethical issues and the conflict they create are frequent components of the storylines. These programs aim to entertain, and the drama inherent in contentious bioethical issues seems a natural fit. Furthermore, these programs aim for realism, frequently employing physicians as consultants to check their medical facts. This combination of realism and frequency raises concern that these medical dramas have the potential to affect viewers’ beliefs and perceptions of bioethics. In fact, previous studies have demonstrated this phenomenon in other areas, including organ transplantation and obesity.

With that background, I, along with Dr. Ruth Faden and Dr. Jeremy Sugarman at the Johns Hopkins Berman Institute of Bioethics, aimed to systematically describe the bioethical and professionalism content of one season each of the widely watched medical dramas. While we would have liked to include “E.R.,” it wasn’t available on DVD for the same time frame. In addition, “Nip/Tuck” and “Scrubs” were excluded because of their dissimilarity to the shows analyzed. Our goal was simply to document the bioethical and professionalism content of these two programs as a starting point for a discussion about their possible impact on the perceptions and beliefs of the general public, as well as their utility as a tool in the education of medical and nursing students.

Perhaps unsurprisingly, we found that both “Grey’s Anatomy” and “House, M.D.” are rife with depictions of bioethical issues and egregious deviations from the norms of professionalism. We identified 179 depictions of bioethical issues, which we separated into 11 categories, of which the top three were consent, ethically questionable departures from standard practice, and death and dying. We also identified a total of 396 deviations from normal professional interactions, classifying those into categories of “respect,” “sexual misconduct,” “integrity and responsibility,” and “caring and compassion.” Most of the professionalism incidents were negative, which is less striking when one considers the fact that these programs are more akin to soap operas than documentaries. Importantly, we did not try to evaluate the possible impact, whether positive, negative, or neither, on viewers of these programs. Rather, we hope that our study will provide the groundwork for other studies assessing exactly that.

I’d personally like to encourage any interested readers to take a look at the full text of our article, “Bioethics and professionalism in popular television medical dramas,” which is available in the April issue of the Journal of Medical Ethics. In addition, more information about the wide variety of ethical issues investigated by the Johns Hopkins Berman Institute of Bioethics can be found at our website, http://www.bioethicsinstitute.org. Finally, more information about media and health can be found at the Kaiser Family Foundation website.

Thanks for letting us share our work with the thoughtful readers of the Women’s Bioethics Blog!

-Matt Czarny

Ethics on the chopping block

[Cross posted from the Research Ethics blog] Two related stories came to my attention this week. Reading the first one, I was worried. But when I came across the second story, I thought, this needs to be talked about! In two places, both affected by the now globally worrisome economy, strict budget cuts are being made. And the first thing on the chopping block? Ethics.

The University of Tenneessee is considering closing down The Department of Human Values and Ethics in the College of Medicine along with a number of other science and medicine programs. Here's the story from the AAPR Bulletin Today: Possible University of Tennessee job cuts will draw protest.

Across the globe in New Zealand, the government will sign off on disbanding the country's Bioethics Council on Monday. The Bioethics Council was created in 2002 in response to public concern that the government was making decisions — in an ad hoc and unadvised manner — on complex and controversial biotech and genetic issues without considering the unique ethical, cultural and spiritual demographics of the country. Here is the story, from the Radio New Zealand newsfeed: Bioethics Council to be Disbanded

So what does this have to do with research ethics and ethics review boards? Well, plenty.

We should be concerned that the first cuts insitutions and governments want to make are on what they apparently consider to be highly expendable programs, like ethics. Seems to me that in perilous times, we just might need ethics a little more.

Ethics review boards, in either academic or medical settings, should be doing more than reviewing protocols, providing approvals and monitoring ongoing research in a silo somewhere, unconcerned that these kinds of cuts, as they don't name "research ethics" explicitly, have nothing to do with them. While reviewing research takes up a tremendous amount of time and energy, as I well know chairing an ethics review board myself, there is a certain amount of advocacy, outreach and education that an ethics review board must be committed to doing, on an ongoing and iterative basis.

So a few words on each of the three things I've identified here that ethics review boards should be committed to doing:

Advocacy for what? For strong ethics programs that are ideologically and financially supported by the administrators of the institution, situated logically within broader programs that have a commitment to research ethics; for fair, transparent and ethical processes in any context; and for fair treatment of not only participants — yes, that is our mandate — but also novice and experienced researchers, ethics review board members and others involved in research processes without whom researchers couldn't do their work. In these two cases, I would hope that those involved in research ethics at the University of Tennessee and from across NZ would speak out against the discontinuation of these broader ethics programs.

Outreach? Yes, outreach. Ethics review board members can do a great deal of outreach in their own departments and schools by articulating and clarifying what it is an ethics review board does, the kinds of principles upon which we base our deliberations and decisions, the challenges as well as the kinds of rewards that this work affords those who are dedicated to it and the kinds of broader values that ethics review boards, at their best, should be committed to upholding — things like autonomy of persons, voluntariness, maintaining dignity and integrity of persons and facilitating ethically sound research.

Outreach also implies making strong connections between ethics review boards, bioethicists and clinical ethicists, educators and other persons and programs within and between institutions.

Finally, education. As ethics review board members and those who are committed to research ethics in perhaps other ways, it's important, perhaps imperative, that we educate people not only about "what it is we do" but also why it's important to have people, who are concerned with ethics, hanging around. Bioethicists, clinical ethicists, research ethicists, those concerned with environmental ethics, business ethics...the list goes on. Usually most institutions don't think a great deal about these kinds of programs — and the associated dedicated people — until something goes wrong and suddenly, the institution turns to the same programs and people for help, advice and guidance. Seems that UT and NZ might not have anywhere to turn soon.

posted by Nancy Walton, Ph.D. at 6:10 PM

Health Literacy – A Cry for Universal Health Care

Health care is now a business that rivals the industrial complex. Its major consumers are victims of lopsided capitalist principles that exploit weaknesses within our educational systems – mainly literacy. If literacy is at an all-time low in this country, health literacy must be virtually non-existent. But what does this mean? And more importantly, why should anyone care? These questions are made complicated by arguments that weave a moral blanket of hypocrisy which does not provide comfort – let alone security - to those most impacted by a poor health infrastructure. That is, too often we blame the sick for having sickness and the uneducated for not knowing when the real cause of either or both is mis-education combined with quests for power and, ultimately, control.

Literacy is not merely the act of reading and comprehending fragments of generic knowledge. It is a tool for understanding the constellation of knowledge that shapes our views of the world and defines our positions in it. Understanding who we are in terms of how our bodies work optimally is essential to securing a competitive advantage – particularly in a free-market economy. However, large swatches of the US population are disproportionately denied basic health needs such as potable water, adequate shelter, and access to basic health care - they do not have insurance or they have inadequate insurance which is poorly defined and, therefore, subject to intricate loopholes. The health literature is replete with epidemiologic data illustrating the link between access to basic health needs and illness while the health economic literature highlights the impact of sickness to the work force and societal growth. So wouldn’t it make sense to promote and support a healthy society if for no other reason than the well-being of our economy and securing a prosperous future? It does to me.

However, in order for this to happen we need to eliminate the barriers to access which includes class-based health insurance and, more importantly, advance a comprehensive education about the relationship of personal health to societal development. Yet, too often, we exert power by enacting laws on the basis of a sense of moral superiority; and we use oppressive means to control basic needs. This is best exemplified by the gross amounts of narcotics and pharmaceuticals that act to subdue harmless physiologic impulses and abolish the most basic human right – the right to health (as defined by the World Health Organization). Or, perhaps it is the intention of the powers-that-be to keep certain people ignorant and weak from poor health. What better way to control people than to continuously exploit their vulnerabilities while making them dependant on small acts of welfare disguised as generosity?