Media Watch 561

Attached is the current issue of Media Watch (#561).

Of particular interest in this week's issue:


Responding to those who hope for a miracle: Practices for clinical bioethicists

AMERICAN JOURNAL OF BIOETHICS, 2018;18(5):40-51. Significant challenges arise for clinical care teams when a patient or surrogate decision-maker hopes a miracle will occur. This article answers the question, “How should clinical bioethicists respond when a medical decision-maker uses the hope for a miracle to orient her medical decisions?” The authors argue the ethicist must first understand the complexity of the miracle-invocation. They provide a taxonomy of miracle-invocations that assist the ethicist in analyzing the invocator's conceptions of God, community, and self. After the ethicist appreciates how these concepts influence the invocator's worldview, she can begin responding to this hope with specific practices. The authors discuss these practices in detail and offer concrete recommendations for a justified response to the hope for a miracle. 


Palliative care in humanitarian crises: A review of the literature

JOURNAL OF INTERNATIONAL HUMANITARIAN ACTION | Online – 20 April 2018 – The authors presents findings from a review of the literature (2005-2017) on palliative care (PC) in humanitarian crises (e.g., disasters, armed conflicts, epidemics). This review set out to describe PC needs, practices, barriers, and recommendations in humanitarian crisis settings. It contributes to current discussions within the field of humanitarian healthcare aimed at clarifying whether or not and how best to respond to PC needs in humanitarian crises. Analysis of 95 peer-reviewed and gray literature documents reveal a scarcity of data on PC needs and interventions provided in crises, challenges of care provision particularly due to inadequate pain relief resources and guidelines, a lack of consensus on the ethics of providing or limiting PC as part of humanitarian healthcare response, and the importance of contextually appropriate care. These findings suggest more research and open discussion on PC in humanitarian crises are needed. This review contributes to defining PC needs in humanitarian crises, building consensus on humanitarian healthcare organizations’ ethical responsibilities towards individuals and families with PC needs, and developing realistic and context-appropriate policies and guidelines. 


Of special note

Barbara Bush and the problem with “comfort care”

U.S. (Pennsylvania) | The Inquirer (Philadelphia) – 24 April 2018 – Two days before she died, former first lady Barbara Bush announced through a family spokesman that, in light of her failing health, she would not seek additional medical treatment, opting instead for “comfort care.” Scouring Twitter after the announcement, I found that most tweets expressed sorrow, largely because Mrs. Bush was electing comfort care and that meant that she would die imminently. Many other tweets lauded her choice of comfort care, noting how brave she was to stop treating her illness. Both of these sentiments reflect the language problem that doctors and patients have at the end of life. When physicians such as me divide care into “medical treatment” and “comfort care,” we ignore that we should focus on both comfort and medical treatment at the same time. Medicare policy reinforces the divide between medical care and comfort care. For example, patients must forgo curative treatment (such as chemotherapy) if they choose to enroll in hospice. As an oncologist, I see on a daily basis how this language problem makes it harder for doctors to do what’s best for our patients