Curious Bioethics: December 7, 2024
Public response to CEO shooting, failure of self-regulation in medicine, being trans in America, medical/dental integration ethics
In today’s curated collection, you’ll find:
🗞️Bioethics News: United CEO shooting and public response, charlatan oncologist
📚Recommended Reading: on being Trans in Trump’s America
🦉Educational Opportunities: Medical/dental integration with Nanette Elster
Happy Sunday, My Curious Readers!
I’ve been on a combo of ethics call and transplant call for the last two weeks, and it’s been a doozy. The work remains interesting, even if I’ve been exhausted.
Saturday was my first day off, and I very much enjoyed putting my work phone on Do Not Disturb.
Saturday was an altogether lazy day in the best way. I filled my creativity cup by attending Writing Medicine with my genius pal,
. I sharpened knives - an under appreciated relaxing past time (though my favorite time to sharpen is when I can work from home and attend a zoom meeting with my camera off). At the end of the day, I made a delicious cake from Dessert Person - perhaps the best dessert cook book of all time (it has a chart showing difficulty on one axis and how much time it takes to make on another and this is the decision aid I always need).
What are you doing to fill your cup during these days when the sun sets so dang early?
🗞️ Bioethics in the News
UnitedHealthcare CEO’s shooting opens a door for many to vent frustrations over insurance
Brian Thompson was murdered on a midtown Manhattan street early on Wednesday when a gunman shot him and then rode away on a bicycle.
In a true testament to Americans’ unbridled hatred of our abysmal insurance industry, the killing of UnitedHealthcare’s CEO garnered emotions from ambivalence to mockery.
According to police, the bullet casing had the phrase “delay” and “deny” written on it with a Sharpie marker - presumably alluding to the methods routinely used by insurers to deny claims. Jay Feinman’s 2010 book Delay, Deny, Defend criticizes the insurance industry.
If you’re dealing with claim denials, you have a right to know the grounds of the denial. You can use ProPublica’s guide explaining how to submit a claim file request to get that information. They also have resources for healthcare providers.
“Eat What You Kill”
Hailed as a savior upon his arrival in Helena, Montana, Dr. Thomas C. Weiner became a favorite of patients and his hospital’s highest earner. As the myth surrounding the high-profile oncologist grew, so did the trail of patient harm and suspicious deaths.
Thomas Weiner was a beloved oncologist, treating an outsized number of patients in his practice. He ensured he remained the only oncologist in the hospital system. He also made himself the primary care physician for his oncology patients, in addition to being their cancer physician. Not only did this enrich Weiner, but it also minimized the amount of insight any colleagues might have into his harmful practices. He kept illegible and minimal records, and prescripted narcotics by hand, bypassing safety checks. This all made it possible for an oncologist to do the unthinkable - to treat patients without cancer diagnoses with powerful chemotherapy drugs, including experimental treatments. Other patients suffered delayed diagnoses of actual cancer. Countless patients were prescribed high doses of opioids for nonsensical reasons.
Medicine relies heavily on self-regulation. In a deferential environment, it can take a while for other clinicians to see red flags. It takes moral courage and psychological safety to escalate those concerns. Weiner seems to have had a cult-like following in the hospital and orchestrated votes of no confidence against administrators who questioned his practices and pay. Numerous clinicians made their concerns known, and an administrator acted to get more evidence; it took years of investigation to get Weiner out of the hospital.
📚 Recommended Reading
Waking Up Trans in Trump’s America
by Gabrielle Bellot
“And yet, when you take away these myths about binaries, being trans becomes far less unusual. Many people are born intersex, unable to fit neatly into one sex or gender category at birth. There are many other medical conditions in which people’s chromosomal or corporal makeup deviates sharply from this male/female binary. These are not deviations from biology; these are biology, are the more nuanced story of humanity. Nature is not neat and tidy; it prefers spectrums to binaries. And to me, this is beautiful.”
Read the full essay on LitHub.
🦉Educational Opportunities
The Ethical Imperative for Medical/Dental Integration
Speaker: Nanette Elster, JD, MPH
Nanette Elster is a national expert in dental ethics - and one of my professors when I was in my masters in bioethics and health policy program. This should be a very informative talk for anyone interested in the wild past of how the bones in our mouth came to be managed by a totally different profession than the rest of our bodies.1
Learning Objectives:
Understand the history of medical/dental integration.
Identify current challenges to medical/dental integration.
Examine ethical underpinning of both medicine and dentistry for better coordination.
Presented by Colorado University and the National Collaborative on Humanities & Ethics in Dentistry
Date: Thursday, December 12, 2024
Time: 12:00 - 1:00 PM (MT)
Location: Virtual (Register for the Zoom link)
That’s it!
As always, thanks for being curious!
Hit reply and let me know what ethics issues you are most curious about this week—I’d love to hear from you!
See you next week!
Be Well & Be Curious,
Alyssa
Also, our feet being cared for by a different profession, Podiatry.