Controversial U.K. Policy Withholding Surgery from Smokers and Obese Patients

The United Kingdom’s county of Hertfordshire has expanded a controversial health care policy that withholds surgery from patients who are obese or who smoke. The policy was originally implemented in 2011 and, at the time, only applied to hip and knee operations. In 2012, it was expanded to include other non-urgent routine surgeries. Under the policy, patients were banned from having surgery for a specific period of time as an effort to urge them to improve their health by losing weight or quitting smoking in order to become eligible for surgery. However, the most recent expansion of the policy is labeled as an “indefinite” ban on all routine surgeries until the patient’s health is improved.

Proponents assert that the expanded policy will help patients improve their health while also alleviating the county’s health care budget and reducing length of hospital stays. Opponents, however, argue that the policy is unethical.  One professor of psychology, Robert West, has expressed that “[r]ationing treatment on the basis of unhealthy behaviors betrays an extraordinary naivety about what drives those behaviors.” Although reducing obesity and smoking prior to any surgery is beneficial to a patient’s recovery, it remains unclear whether withholding surgery altogether is actually successful in improving overall health.

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Ethical Dilemmas Presented by the Legal Euthanization of the Mentally Ill

Cornelia Geerts, a fifty-nine year old woman who struggled with mental illness in Belgium, asked her psychiatrist to help her end her own life. In 2014, about one year after her initial request, a physician administered a lethal dose of drugs that killed her. Euthanasia is currently legal in only five countries: Canada, Colombia, Luxembourg, the Netherlands, and Belgium, where Ms. Geerts’ death occurred. Euthanasia is not legal anywhere in the U.S., but six states and Washington D.C. have legalized physician assisted suicide, which allows physicians to prescribe lethal drugs to terminally ill patients for patients to administer themselves. Belgium and Luxembourg permit euthanasia of people suffering from terminal illnesses as well as people suffering from mental illnesses, who may not be at the end of life.

The number of patients euthanized because of psychological suffering makes up a small percentage of euthanization cases in Belgium—of the approximate 2,000 euthanasia deaths that occur per year, only about 40 involve those who were suffering from mental illness. Though these cases are few, they highlight the bioethical dilemmas that physicians and lawmakers face in dealing with mental health issues and an individual’s right to make his or her own healthcare decisions. Advocates argue that individuals suffering from mental illness should be afforded the same rights as those who suffer from a physical illness. Yet, others believe that it is nearly impossible to know when a mentally ill individual decides to end his or her own life with sound mental capacity and not as a result of their underlying mental health disorder. Opponents believe that society has a responsibility to help those suffering from mental illness and to find help through means other than euthanasia.

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Sweden Dismisses Investigation of Stem Cell Scientist

Swedish authorities have dismissed claims against Dr. Paolo Macchiarini, an Italian stem cell scientist, who had been under investigation for voluntary manslaughter in connection with the death of three of his patients following windpipe transplants that were made partly from the patients’ own stem cells. The procedure is considered experimental by many researchers and experts. Yet, many scientists and physicians believe it could revolutionize medicine, particularly in regards to organ renewal and growth of new organs in laboratory settings.

The Swedish authorities argued that the use of “artificial” windpipes is negligent and medically unjust. However, there is very little consensus from medical experts regarding treatment and standard protocols that should be implemented with stem cell research. In addition, the Swedish authorities could not establish a direct connection between Dr. Macchiarini’s actions and the deaths of his patients. Without sufficient causation or standard of care protocols, the claims against Dr. Macchiarini were dismissed.

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Catholic Health Services Provider Faces Lawsuit for Denying Transgender Surgery

Seventeen year old Paxton Enstad, a transgender male, sought chest-reconstruction surgery as part of his gender dysphoria treatment.  When his parents, Cheryl and Mark Enstad, sought to obtain pre-authorization for the surgery, PeaceHealth St. Joseph Medical Center, a Catholic organization, denied the services without offering a rationale as to why it was denied.

The Enstads filed suit in U.S. District Court, claiming that PeaceHealth’s refusal to cover the services violates the Affordable Care Act (“ACA”) and the State of Washington’s anti-discrimination laws.  Specifically, they claim that the refusal to authorize the surgery enforces gender stereotypes and amounts to gender discrimination.

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Read Complaint Here.

 

 

 

Bioprinting Technology May Ease Donor Organ Deficit

Each year, about 120,000 Americans need organ transplants, yet the demand for donor organs far outweighs the supply. The solution: Bioprinting. A 3-D printer is used to dispense different cells, creating layers of cells that form tissue. So far, artificial organs are successfully functioning in animals. Mice, for instance, were able to conceive and give birth by means of prosthetic ovaries.

However, as this new industry emerges, so does the opportunity to capitalize on it. A company in China estimates that the market in America for artificial livers is approximately $3 billion annually. With that sort of potential for profits, larger companies have taken an interest in the future of bioprinting. Well-known companies are making significant progress printing skin for burns and ulcers. A company in Pennsylvania has developed a method to print skin directly onto the patient by spraying stem cells onto the area in need of new skin. Such interest by major companies is advancing this new technology.

From The Economist, “Printed human body parts could soon be available for transplant”

Excerpt from article:

But a lack of suitable donors, particularly as cars get safer and first-aid becomes more effective, means the supply of such organs is limited. Many people therefore die waiting for a transplant. That has led researchers to study the question of how to build organs from scratch.

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The New Trump Presidency Brings Uncertainty to the Health Care Industry

As one of his first items of business after taking the Oval Office, President Trump signed an executive order “instructing federal agencies to grant relief to constituents affected by the Affordable Care Act.”  In an already unstable market, this order leaves many questions unanswered, not only for states and other lawmakers, but also for consumers, medical professionals, and insurance companies. Senate Republicans insist that they are working with the Trump Administration to ensure “an orderly process.” However, without a replacement plan in place, many stakeholders are concerned that several insurance companies will leave the state health insurance exchanges by 2018, and Trump’s executive order will result in anything but an “orderly” transition away from Obamacare.

From The Washington Post, “With executive order, Trump tosses a ‘bomb’ into fragile health insurance markets”

Excerpt from article:

The political signal of the order, which Trump signed just hours after being sworn into office, was clear: Even before the Republican-led Congress acts to repeal the 2010 law, the new administration will move swiftly to unwind as many elements as it can on its own — elements that have changed how 20 million Americans get health coverage and what benefits insurers must offer some of their customers.

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Successful Implantation of Ovary Frozen Prior to Puberty Gives Hope to Young Women Struggling with Fertility

For women who struggle with fertility as a result of damage to reproductive organs by radiation treatment for cancer and other health conditions, a breakthrough procedure in the United Kingdom may offer hope and a new alternative. Moaza Al Matrooshi became the first woman in the world to give birth to a child conceived from an ovary that was frozen before she entered puberty. Before undergoing chemotherapy for a blood disorder at the age of nine, Moaza decided to have her ovaries removed and frozen. Years later, at the age of twenty-four, she was able to give birth to a healthy baby after relying on in vitro fertilization to restore her fertility using the frozen ovaries. Moaza believes her pregnancy and childbirth are a true miracle.

From The Telegraph, “Woman Gives Birth to Baby Using Ovary Frozen in Her Childhood in ‘World First’

Excerpt from article:

“This is a huge step forward. We know that ovarian tissue transplantation works for older women, but we’ve never known if we could take tissue from a child, freeze it and make it work again.”

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Relocating to Afford Medical Treatment

A recent CNN.com article follows two stories about families forced to relocate because of the lack of care their disabled children receive under Florida’s Medicaid program. Families and patients’ rights organizations have brought multiple cases against the state for poor management of the program. The spokesman for Florida’s Agency for Health Care Administration stated that the problems occurred prior to the state’s transition to a managed care system; under the new system the problems have been resolved. However, parents are not willing to take that risk and are moving to states where providers will not refuse to see them due to delayed insurance payments and where life-saving medicines are easily accessible for their disabled children.

From Cnn.com, “Health care refugees: Family flees Florida to save daughter’s life”

Excerpt from article:

Like nearly half of all children in Florida, Abby has Medicaid, the state-run health insurance. Her parents say that instead of being helpful, Florida Medicaid refused to pay for lifesaving medicines and took so long to pay some of her health care providers that at times, they refused to treat her.

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How Long is Too Long? Medical Interns Soon to Be Working Much Longer Hours

The current rules state that medical interns cannot work longer than 16 consecutive hours. This rule is in place to prevent accidents and mistakes as a result of fatigue. Recently, The Accreditation Council for Graduate Medical Education has proposed a change that would allow interns to work almost twice as long, for 28 hours without a break. The Council argues that this change would help expose interns to real-life practice. However, opponents of the rule argue that allowing these long hours is a severe risk to patients.

From npr.org, “Medical Interns Could Work Long Without A Break Under New Rule”

Excerpt from article:

“For years, medical interns have been limited to working no more than 16 hours without a break to minimize the chances they would make mistakes while fatigued. But that restriction could soon be eased.”

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The Link Between C-Sections and Obesity

This article reports on a study showing that the method of childbirth might affect that child’s weight well into adulthood. Babies who were delivered by caesarean have a 15% higher risk of being obese than babies who were delivered vaginally. The article suggests causative links, but the study did not prove that a caesarean section is a cause of obesity.

From TheGuardian.com, “Babies born by caesarean more likely to be obese as adults, study suggests”

Excerpt from article:

“Birth by caesarean was linked to a 15% higher risk of obesity in children compared with vaginal birth.”

 To read full article: Babies born by caesarean more likely to be obese as adults, study suggests