Medical Ethics Discussions

A do not resuscitate order is a legal document. Deborah Ann Moore Black, RN, watched families override it about fifteen percent of the time, the moment the patient could no longer speak for themselves.   This is not a paperwork problem. It is a chain-of-custody problem in how we honor a person's wishes when they lose the ability to defend them.   Moore-Black spent thirty-three years in critical care. She watched the same sequence repeat: a competent patient states clearly that they want no machines and no heroics, then slips into a coma, and control passes to a family that cannot bring itself to let go. The document is binding right up until the people in the room decide it isn't.   For anyone who builds systems meant to protect people's stated wishes, in health care, in estate planning, in any field where a person delegates a decision they cannot later supervise, three lessons sit inside her experience.   First, a signed document is not a control. It is an artifact. A control is the named, willing person who enforces the document when the original decision-maker goes silent. If you have one without the other, you have a wish, not a safeguard.   Second, the failure point is predictable and it is emotional, not legal. The override does not come from bad actors. It comes from loving people under maximum stress who were never prepared for the moment. A system that ignores the emotional load at the point of failure will keep failing in the same place.   Third, the person you delegate to needs more than trust. They need the resolve to hold a hard line in a room full of grief. Moore-Black's real takeaway was not "sign the form." It was "choose someone who will honor it when you cannot speak, and make sure they are willing to."   Search "The Podcast by KevinMD" wherever you listen to podcasts.   What is one decision in your organization that currently relies on a document, where the real safeguard should be a named and prepared person?   #EndOfLife #HealthcareLeadership #PalliativeCare #ThePodcastbyKevinMD

The National Institute of Standards and Technology (NIST) team have spent over 12 months exploring how the key ethical research principles for biomedical and behavioral research with human subjects in the United States can be integrated into AI research. One being that by obtaining informed consent from research participants and designing studies to minimize risks they can ensure transparency and protect individuals' data. Additionally, selecting subjects fairly and avoiding inappropriate exclusion can help address biases in AI datasets. It is important to note that the authors of this document emphasize thoughtfulness rather than advocating for more government regulation. By adopting these ethical principles voluntarily, companies can demonstrate their commitment to responsible AI development and usage. You can read this fascinating report here: https://lnkd.in/d7-t5e8d

Safe and efficacious medicines are a matter of public trust. Food safety and drug safety are two pillars of public health. While much attention is rightly given to the quality of medicines, affordability and ethical pricing are equally important. A medicine that is priced unfairly is, for many patients, effectively out of reach. Maharashtra FDA is strengthening its focus across the pharmaceutical ecosystem, from manufacturing standards and quality assurance to prescription compliance, prevention of antimicrobial resistance, and, where warranted, examination of instances of excessive pricing in coordination with the appropriate statutory authorities. Our objective is to foster a culture where compliance becomes the norm, ethical business practices are rewarded, and every stakeholder understands that public health must always come before commercial interests. The pharmaceutical industry has been a cornerstone of India’s growth and global reputation. Maintaining that reputation requires unwavering adherence to quality, transparency, ethical practices and the rule of law. Ultimately, good governance is measured not by the number of inspections conducted, but by the confidence citizens have that the medicines they purchase are safe, effective, fairly priced, and available without compromise. #PublicHealth #DrugSafety #Pharmaceuticals #Healthcare #GoodGovernance #Leadership

With the cancellation of $700M+ in vaccine contracts, are we ready for the next influenza pandemic? In our new BMJ Global Health study, my colleagues Govind Persad, Johan Dellgren, and I identify four critical fallacies that undermined fair allocation of scarce medical resources during COVID-19 and mpox outbreaks – mistakes we can’t afford to repeat: ❌ Physician-Patient Fallacy: Optimizing treatment for individual patients while ignoring population impact. ❌ Certainty Fallacy: Basing all decisions on a level of certainty that limits the development and approval of beneficial treatments. ❌ Sameness Fallacy: Focusing only on saving the most lives, treating all deaths identically. ❌ Ethics-Only/Ethics-Free Fallacies: Making decisions purely on ethical ideals OR purely on politics. Moving forward, we must consider how allocation affects everyone, recognize that uncertainty is inevitable in a pandemic, prioritize preventing deaths that cause greater life-years lost, and balance ethical principles with practical constraints from the outset. The stakes are too high to repeat past mistakes. We need allocation frameworks that are ethically sound, evidence-informed, and implementable before the next pandemic hits. Read our full analysis, linked in the comments below. #PandemicPreparedness #PublicHealth #H5N1 #HealthPolicy #MedicalEthics

A directory that helps Black patients find Black doctors is being sued for I saw this through Janice Gassam Asare’s thread and immediately stopped scrolling. Because as a Black female physician, I need people to understand something: Black patients don’t seek out Black doctors because they hate white doctors. They seek us out because culture matters in medicine And pretending it doesn’t can literally harm patients. I see retinoids prescribed aggressively on melanated skin — without understanding how differently pigment responds to irritation and inflammation. I see ketoconazole shampoo prescribed for “dandruff” — without warning a Black patient how drying it is for tightly coiled hair. I see diabetes education delivered with zero understanding of cultural food norms. You cannot counsel someone about managing their A1C at the cookout if you don’t know what happens at the cookout. That’s not racism. That’s reality. And then there’s trust. My patients sit down and say: “You know what it be like when…” And yes. I DO know what it be like when. That changes everything. Patients open up differently when they feel seen. When they don’t have to translate their culture. When they believe someone will actually hear them. Let’s also stop pretending preference in medicine is unusual. When a man has erectile dysfunction, he often prefers a male doctor. When a woman needs a Pap smear, she often prefers a female physician. When a survivor of sexual assault walks into an ER, she may need a woman in that room. Nobody files a lawsuit over that. Nobody calls it segregation. But when Black patients say they want a Black doctor? Suddenly there’s outrage. And let’s not pretend medical bias is ancient history. Studies still show some trainees falsely believe Black patients have thicker skin and feel less pain. That is modern medicine. Meanwhile, hospitals are rolling back bias training and DEI initiatives at record speed. So while people debate whether directories like this should even exist — maybe we should ask why patients feel they need them in the first place. Because this lawsuit doesn’t make Black patients feel safer. It makes many of us feel less safe. My answer? Build a nationwide directory of Black doctors. A modern medical Green Book. Because being sick while Black in America is still dangerous. And until that changes — representation in medicine is not a preference. It’s a prescription. And let’s talk about Dr. Travis Morrell and the organization @donoharm for a second. A Colorado physician. Suing over a directory. Not over malpractice. Not over access to care. Not over the physician shortage killing rural communities. A directory. Sir — with respect — if your concern is discrimination in medicine, I have a list of actual problems that need your energy.👏🏾OK? It mental health month. Work on that And honestly? If this is how you feel about Black patients seeking Black doctors — We don’t want you as a doctor! Ever!

Your AI can be 100% compliant and still be unsafe. This has happened more than a few times in recent months, and it’s worth surfacing: AI launch meetings treating compliance as the finish line… when it should be the starting point. On paper, the project looked perfect. 🔸 Documentation? Complete. 🔸 Legal sign-offs? Secured. 🔸 Regulatory boxes? All ticked! But here’s the problem, the compliance review never asked: 🔸 How were training datasets sourced and validated? 🔸 Could patients understand how the AI reached its conclusions? 🔸 Who’s accountable when the AI gets it wrong? Here's the thing, Compliance checks boxes, Responsible AI earns trust. 🔹 Compliance is like passing a driving test 🔹 Responsibility is how you drive when no one’s watching 🔹 Compliance protects you from penalties 🔹 Responsibility protects people. With AI tools moving from pilot to frontline faster than policies can catch up, the gap between compliant and responsible is where harm happens. A compliant AI might flag a patient as low-risk, but without transparency, the clinician can’t see it missed a crucial symptom. One missed symptom → delayed care → worse outcomes → mistrust that can last years. Responsible AI starts with three pillars: 🔹 Ethical frameworks: Ground decisions in fairness, accountability, and beneficence, not just legal allowances. 🔹 Transparency: Let clinicians, patients, and regulators see how the AI works, its limits, and its data sources. 🔹 Oversight: Ensure a human is always answerable for AI actions, with mechanisms to detect and correct harm quickly. The real test of AI in healthcare isn’t whether it passes an audit, it’s whether it can earn and sustain trust. If you’re leading AI in healthcare today, this is the question your patients would want you to answer - which are you building? 💡This post is part of 'Rethinking Digital Health Innovation' (RDHI), empowering professionals to transform digital health beyond IT and AI myths. 💡The ongoing series and additional resources are available at www•enabler•xyz 💡Repost if this message resonates with you!

The poorest 20% of people in the UK are three times more likely to develop chronic illness before 50. We’re building a world where the quality of your healthcare and how long you live is being shaped by your income. The top 20%, those who hold 43% of all wealth are gaining access to longevity clinics, private AI diagnostics, and the best preventative care on the planet. That gap isn’t just uncomfortable. It’s unethical. AI, precision medicine, and HealthTech were meant to democratise healthcare, but right now, they risk creating a two-tier system: one for those who can pay to live longer, and one for those who can’t afford to stay well. So I’m asking a different question: 💥 If we can build AI that predicts disease, why can’t we build systems that deliver care fairly? In this week’s Well Purposed newsletter, I explore: ✍ Why health inequality is deepening in an age of innovation ✍How we can redesign systems to reward prevention, not privilege ✍Practical ways founders and investors can embed equity into growth Because healthcare isn’t innovation until it’s accessible, and progress isn’t progress if it’s only for the privileged few. 💭 I’d love to know - what does equitable healthcare look like to you?

I’ll never forget during an appointment when a patient’s brother turned to him and said in anger and disgust: 🗣️ “You shouldn’t be depressed. You’re in the United States. Our family back home are the ones who should be feeling depressed.” That statement carried weight, not just for my patient, but for so many first generation professionals and children of immigrants who hear variations of it every day. 🌍 In our cultures, depression, anxiety, ADHD, OCD, or bipolar disorder are often met with silence, shame, or comparisons. The message is clear: you are not allowed to struggle because others had it harder. But here is the truth ⬇️ 💔 Pain does not check your passport 🙅🏾♂️ Suffering in silence does not honor the sacrifices our families made 💪🏾 Getting help is not weakness, it is courage As a first generation Nigerian American psychiatrist, I have seen how family pride, fear of labels, and stigma can stop people from reaching out. That is why culturally competent care matters. ✨ Seeking therapy ✨ Considering medication management ✨ Talking with a professional None of these are betrayals of your culture, they are acts of courage that can break generational cycles. If this resonates with you, let it be a reminder: 🌟 Your story matters 🌟 Your struggles are valid 🌟 Healing is possible #MentalHealth #Psychiatry #Culture #FirstGeneration #Immigrant #Therapy #FairfaxVA #AlexandriaVA. #WashingtonDC

The medical profession is vital to society, yet it grapples with significant accountability challenges. Due to the complexity of medical knowledge, diagnoses can vary, and doctors' collective decisions often go unquestioned. In surgical settings, factors such as the surgeon’s mood or implicit biases may influence outcomes, often disadvantaging economically weaker patients compared to wealthier ones. Adding to these concerns, pursuing financial gain can sometimes lead to unethical practices, such as falsifying diagnoses to justify unnecessary procedures. Moreover, governmental authorities often have limited oversight of private hospitals, stepping in only when complaints reach alarming levels. Despite these systemic flaws, it’s essential to recognize the ethical doctors who prioritize patient welfare and strive to provide equitable care, countering these challenges. To address these issues, healthcare systems can focus on: >>Transparent Protocols: Standardized practices to reduce subjectivity and abuse. >>Patient Advocacy: Independent mediators to address disparities and ethical breaches. >>Outcome Reviews: Regular audits to ensure fairness and detect inconsistencies. >>Ethics Training: Continuous sensitization to equity and empathy. >>Stronger Oversight: Enhanced regulatory mechanisms for private hospitals, including surprise inspections and stringent compliance checks. >>Tech Integration: AI tools for unbiased diagnostics and decision validation. By combining systemic reforms with the integrity of ethical practitioners, we can move toward a healthcare system that values fairness, accountability, and compassion for all, ensuring that no patient is left behind. #medicine #doctors #equality #diversity #inclusion #fairness #humanvalue

A reminder of why healthcare is a calling, not just a career. A 3-year-old boy, Kartik, fell from a terrace and was impaled by a metal rod that pierced his shoulder and head. While a private facility allegedly quoted ₹15 lakh for treatment, Dr. Ankur Bajaj stepped in, performed a complex 6-hour surgery, and saved the child—reportedly for just ₹25,000. Key takeaways: * Compassion and skill can change outcomes in the toughest moments. * Access and affordability matter as much as advanced medical capability. * Ethical leadership in healthcare inspires trust and saves lives. Let’s celebrate professionals who put patients first and push for systems where no critical care decision hinges on cost. Gratitude to every medical professional who shows up with courage, empathy, and excellence—day after day. Stories like this remind us what responsible, patient-centric care looks like in practice. If you work in healthcare, what policies or practices have you seen that improve affordability without compromising quality? Let’s share ideas that can scale. #HealthcareHeroes #PatientFirst #MedicalEthics #AffordableCare #TraumaCare #Surgery #PublicHealth #HealthcareLeadership #ImpactStories #DoTheRightThing