Robert E. Cranston, MD, MA (Ethics), Author at Christian Medical & Dental Associations® (CMDA)

Private Equity in Healthcare

While many people, including healthcare professionals, think that much of medical ethics is highly arbitrary and relativistic, with the single prevailing rule being patient autonomy, there are nonetheless some widely accepted principles within medical ethics. Principlism, which is based on four guides made famous by Beauchamp and Childress, includes patient autonomy, beneficence, non-maleficence and justice. Unfortunately, for many people, these are the only ethical considerations needed to make informed decisions regarding right and wrong regarding patient care. Several other considerations are needed to decide complex issues rightly.

Redemptive Treatment of Healing Professionals

Some systems have treated healthcare professionals with clinical skill loss in an almost punitive manner. Aside from careless incompetence, abandonment of patients or grossly unprofessional behavior, this is inappropriate, damaging to the professionals and harmful to society.

Identifying Healthcare Professionals Who May No Longer Be Able to Care for Patients

As Christian healthcare professionals, God has granted us the high privilege and responsibility of serving others through healthcare. Part of this responsibility is that of maintaining clinical knowledge and skill in order to provide high quality care to our patients. If we lose some of our skills due to trauma, physical or mental illness, or due to normal aging, this may not always be optimally possible.

The Incredible Impact of a Humble Man of Faith

In a previous blog, I recommended John Stonestreet, president of the Colson Center, and BreakPoint, his daily blog. The Colson Center has several formats for outreach including the Colson Fellow program, weekly podcasts, daily email briefings and Wilberforce Weekend. The Colson Center takes on many of the most pressing issues of the day and thoughtfully discusses ways in which we as Christians can engage our culture. As I said in that earlier blog, if you stop reading this right now and explore the Colson Center options, I will have succeeded in pointing you to a good path for improving your Christian walk.

Let Us Be Healers

n the process of these elections—national, state, county, city—people who used to treat others civilly have forgotten how to do so. Politics has torn families apart, severed relationships and caused some people to say and do things that can never be unsaid or undone. In their efforts to obtain elected office, politicians and their support teams in both parties perpetrated rumors, lies and innuendo regarding opposition candidates. Some of these actions have destroyed reputations. Social media has helped to perpetrate the spread of misinformation.

My Continued Education in American Racism

In my most recent blog, I wrote of some of my personal efforts to educate myself about racism in America, as well as improve my service for Christ to His world. While I do not ascribe to the tenets of critical theory, and I believe America has made significant progress in combatting its racist tendencies, I affirm the work of Dr. Omari Hodge and the new R2ED Committee he is leading for CMDA. I think it is important and necessary for our moral growth as a nation and our spiritual growth as Christians that we examine these issues and act appropriately.

Brief Reflections on My Recent Education in American Racism

CMDA’s Board of Trustees recently created the R2ED Team, which is a taskforce focused on racism and reconciliation, equality and diversity. As followers of Christ, we want to see persons of all colors and ethnicities blessed by the gospel of Christ and involved in the work and ministry of CMDA as much as possible.

Was Jesus a Proponent of Critical Theory?

With recent discussions about allocation of scarce resources with the COVID-19 pandemic, concern has been raised about ensuring justice across all ethnic and political lines in caring for our patients. If allocation is determined based on anticipated quality life years based on treatment, then an inherent bias is baked in against the elderly. If likelihood of good outcome is a major criterion, then patients with higher levels of pre-existing disease will lose out. An example of this would be that among certain ethnic/racial populations there is at baseline a higher proportion of people with underlying heart, lung, metabolic or environmental disease. The African American population, in general, has a lower life expectancy, based on these factors, so if one weighs the allocation models to provide support for healthier patients, they will disadvantage people of color in distribution of ventilators, ICU beds and hospital admissions. Similar claims are made regarding people from other minority groups based on religion, gender, socio-economic class, educational attainment, etc.

Heroes, Wistfulness, Roles and Faithfulness

The viral attack hit especially in the major metropolitan epicenters, and many doctors, nurses, respiratory therapists and other healthcare professionals stayed at work in the trenches, came out of retirement or traveled long distances to volunteer their services to aid those in distress.

COVID-19 Ramblings and Reflections

The world is caught up in the COVID-19 pandemic. This virus has changed our lives, and it will continue to change the lives of people all over the world for years to come. Schools, churches, businesses, restaurants, sporting events and entire countries are closed or are placed under lockdown. Shelter-in-place, an old term, unknown to most, is now widely used, and it affects, by some estimates, more than half the country. At any hour of the day or night, one can find the most up-to-date tallies for morbidity and mortality in the U.S. and around the world. This led me to three observations.

Physician-Assisted Suicide and Euthanasia

On October 27, 1997, Oregon became the first state to legalize physician-assisted suicide. Many Americans were shocked and dismayed at this development. Over time, more and more people have accepted physician-assisted suicide, and it continues to gain momentum.

Ethics of Immigration

Yesterday I attended a seminar at our hospital entitled “Immigration Ethics.” I was hoping to be enlightened on this complicated topic. Unfortunately, the only messages I got were that immigrants are people, too, and we should be humane in dealing with them. I heartily agree with these two points, but the issue is complex and entails a number of points on which many people cannot agree. One major question in discussing this is whether we are referring to legally documented or undocumented immigrants. Most of us are grateful for the legal, highly skilled immigrant engineers, scientists and physicians who make our lives better in many ways.

God Uses Flawed People

If you ever want the entire world to know about the skeletons in your closet, run for political office. In the last year or so, we have heard countless accusations thrown at almost all of the potential presidential candidates, judicial nominees and current senators and representatives. A few of these may even be true! We may never know. Nonetheless, our country continues to function reasonably well under the guidance of these allegedly flawed leaders.

Abuse in Scientific Research

Scientists are often viewed as highly ethical, curious seekers of truth. In many cases, this is true. Unfortunately, in pursuit of “truth” some researchers cross important ethical lines, possibly rationalizing their crimes, in a utilitarian manner, as a means to better healthcare for the greater populace.

Trust in Patient Relationships

Any third year medical student knows that the basic principles of medical ethics are autonomy, beneficence, non-maleficence and justice. At least, that is, according to Beauchamp and Childress’s Principles of Medical Ethics, first published in 1985. For many people these are the only specific guidelines we should employ in sorting through clinical ethics conundrums. In western medicine, Autonomy (with a capital A) seems to be the primary, major consideration. The customer is always right.

Mandatory Re-Testing?

Driver’s license renewal age standards vary from state to state. In Arizona, drivers over the age of 65 have a shorter license renewal cycle. In Hawaii, the renewal cycle drops from every eight years to every two years for persons over 72. In Illinois, the renewal cycle drops from four years to two after the age of 81, and then it drops to a yearly renewal cycle after 87 years.

Civility

A few years ago, at the height of the embryonic stem cell research controversy and public debate, I was asked to be one of four presenters for a Friday medical school forum discussing this topic. There were three other presenters: a semi-retired professor whose area of work was in rehabilitation and advocating for accommodations for persons with disabilities, a social science professor and Dr. X, an MD/PhD whose main area of study was stem cell research. I was the lone conservative.

Nonconsensual Intimate Physical Examinations: Time to Stop

Recently, a law professor I was breakfasting with asked an interesting question, “Is it ethical to perform pelvic exams on patients who are under anesthesia without their permission?” My immediate response was a quick, “No!” and then, “That is something that was done in the distant past, but the question was settled long ago. Without permission, this would be battery, essentially rape.”

Predictions

In medicine, patients and families want to know diagnoses, therapies, risks, benefits and side effects of proposed treatment options. At times the thing they most want to know is what is likely to happen to themselves or their loved ones based on possible interventions. This, however, may be the most difficult answer to give people.

How We Got Where We Are: Same-Sex Reproduction

In the realm of sexual reproduction, the idea of in vitro fertilization, a technological (and for many an ethical) impossibility years ago, is now commonplace. And, as foreseen in the futuristic movie Gattaca, it may someday become the standard method of reproduction.

Rights of Conscience, Moral Complicity and Free Speech

The title of the article might lead a reader to believe the authors support a physician’s right of conscience, but they do just the opposite. They strongly assert the will of the patient over the conscience of the physician. They write, “Making the patient paramount means offering and providing accepted medical interventions in accordance with patients’ reasoned decision,” and “Health care professionals who are unwilling to accept these limits [putting aside their own conscience to support patient autonomy] have two choices: select an area of medicine, such as radiology that will not put them in situations that conflict with their personal morality, or if there is no such areas, leave the profession.” While this quote would seem to apply to a broad variety of issues, in the context of the article the authors are referring to abortion.

The “Five Solas,” Then and Now

October 31, 1517 is often identified as the birthdate of the Protestant Reformation. On this date Martin Luther purportedly nailed his “95 Theses” to the cathedral door in Wittenberg, Germany. Actually, as Eric Metaxas tells us in Martin Luther: The Man Who Rediscovered God and Changed the World…

Keeping the Main Thing the Main Thing

The top 10 causes of death in the U.S., after heart disease and cancer, are Chronic Obstructive Pulmonary Disease (COPD), accidents, stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, chronic renal disease and suicide. Some of these conditions are not preventable, so a more pertinent question is, what are the addressable risk factors for morbidity and premature death in general? And how do we focus on them with our patients?

The Three-Parent Child

Imagine the heartache of learning that your new baby will die slowly and painfully before the age of seven, or much sooner, with the same disabling, degenerative disease that killed your last two children. Now, imagine all of this could be prevented by a newly developed technique that a world-renowned physician is willing to perform on your eggs to ensure your child’s good health. Does this sound too good to be true? Dr. Robert Cranston explains the ethical issues surrounding this new procedure.

IVF and Aging Parents

On April 19, 2016, Mohinder Singh Gill, age 79, and his wife Dajinder Kaur, 72, gave birth to their first child. Kaur, long past menopause, and Gill conceived their child with the help of Dr. Anurag Bishnoi’s IVF Clinic, reportedly employing their own egg and sperm.