Virtual Mentor February 2010

Some goodies from this issue. What is informed consent for experimental procedures? Do patients really understand the risk? How will surgical procedures progress if there are no patients? What about the harm during the learning curve?

(For best results, view as HTML or request text version from virtualmentor@ama-assn.org)

Virtual Mentor. February 2010, Volume 12, Number 2: 67-142. Full Issue PDF

February 2010 Contents

Ethics and Innovation in Surgery

From the Editor

Responsible Progress in Surgical Innovation: A Balancing Act
Catherine Frenkel
Full Text | PDF
Virtual Mentor. 2010; 12:69-72.

Educating for Professionalism

Clinical Cases

New Devices and Truly Informed Consent
Commentary by Charles Rosen
Full Text | PDF
Virtual Mentor. 2010; 12:73-76.

Prophylactic Bariatric Surgery
Commentary by Robert E. Brolin, Bruce Schirmer, and Angelique M. Reitsma
Full Text | PDF
Virtual Mentor. 2010; 12:77-86.

Technical Skill and Informed Consent
Commentary by Robert M. Sade
Full Text | PDF
Virtual Mentor. 2010; 12:87-90.

Questionable Marketing to Doctors (2)

In response to my post on Questionable Marketing to Doctors, especially to Merck publishing a 'fake journal', I received this email in response.

Dear Dr. Tang:

Thank you for your recent e-mail letter to Merck. Merck has always been committed to the highest standards of scientific integrity, patient safety and ethics. Our voluntary withdrawal of VIOXX in September 2004 is a good example of that commitment.

Since the voluntary withdrawal there have been significant misstatements of fact in the press and elsewhere about VIOXX and it appears some of these misperceptions have found their way into your letter. The facts concerning the Australasian Journal of Bone and Joint Medicine Journal are disclosed in our company statement which is attached and posted on Merck.com (http://www.merck.com/newsroom/vioxx/pdf/statement_20090430.pdf).

The pdf file is a Merck Company statement dated 30 April 2009 which started with

Merck Responds to Questions about the
Australasian Journal of Bone and Joint Medicine Journal

Questions about a 2001 Circulation Article also Addressed

WHITEHOUSE STATION, N.J., April 30, 2009 – Merck & Co., Inc. today provided the following statement regarding questions stemming from the courtroom testimony of professor George Jelinek in Australia.

The Australasian Journal of Bone and Joint Medicine to which professor Jelinek referred was published by the medical publishing company Elsevier. Merck Sharp & Dohme Australia understood that Elsevier envisaged the complimentary publication would draw on the vast resources of Elsevier, publishers of many leading peer-reviewed journals including Lancet, Bone, Joint Bone Spine and others, to deliver novel and timely full-text articles and abstracts to physicians.

read the rest of the statement (http://www.merck.com/newsroom/vioxx/pdf/statement_20090430.pdf).and decide for yourself.

Questionable Marketing to Doctors (2)

In response to my post on Questionable Marketing to Doctors, especially to Merck publishing a 'fake journal', I received this email in response.

Dear Dr. Tang:

Thank you for your recent e-mail letter to Merck. Merck has always been committed to the highest standards of scientific integrity, patient safety and ethics. Our voluntary withdrawal of VIOXX in September 2004 is a good example of that commitment.

Since the voluntary withdrawal there have been significant misstatements of fact in the press and elsewhere about VIOXX and it appears some of these misperceptions have found their way into your letter. The facts concerning the Australasian Journal of Bone and Joint Medicine Journal are disclosed in our company statement which is attached and posted on Merck.com (http://www.merck.com/newsroom/vioxx/pdf/statement_20090430.pdf).

The pdf file is a Merck Company statement dated 30 April 2009 which started with

Merck Responds to Questions about the
Australasian Journal of Bone and Joint Medicine Journal

Questions about a 2001 Circulation Article also Addressed

WHITEHOUSE STATION, N.J., April 30, 2009 – Merck & Co., Inc. today provided the following statement regarding questions stemming from the courtroom testimony of professor George Jelinek in Australia.

The Australasian Journal of Bone and Joint Medicine to which professor Jelinek referred was published by the medical publishing company Elsevier. Merck Sharp & Dohme Australia understood that Elsevier envisaged the complimentary publication would draw on the vast resources of Elsevier, publishers of many leading peer-reviewed journals including Lancet, Bone, Joint Bone Spine and others, to deliver novel and timely full-text articles and abstracts to physicians.

read the rest of the statement (http://www.merck.com/newsroom/vioxx/pdf/statement_20090430.pdf).and decide for yourself.

Questionable Marketing to Doctors

It is a sad day for me to learn of this action of the pharmaceutical giant Merck. Of all the pharmaceutical companies I have dealt with, I have always respected Merck for their integrity and responsibility. Over the years, as I watch the merging and buying over of various other pharmaceutic companies, I have noticed a declining standards of ethics and morality especially in their marketing departments. Over the last couple of years I noticed a declining standard in Merck. This report from The Scientist reveals the extent of the rot.

Merck published fake journal

Posted by Bob Grant

[Entry posted at 30th April 2009 04:27 PM GMT] in The Scientist.com website

Merck paid an undisclosed sum to Elsevier to produce several volumes of a publication that had the look of a peer-reviewed medical journal, but contained only reprinted or summarized articles--most of which presented data favorable to Merck products--that appeared to act solely as marketing tools with no disclosure of company sponsorship. Image: flicker/meviola "I've seen no shortage of creativity emanating from the marketing departments of drug companies," Peter Lurie, deputy director of the public health research group at the consumer advocacy nonprofit Public Citizen, said, after reviewing two issues of the publication obtained by The Scientist. "But even for someone as jaded as me, this is a new wrinkle." The Australasian Journal of Bone and Joint Medicine, which was published by Exerpta Medica, a division of scientific publishing juggernaut Elsevier, is not indexed in the MEDLINE database, and has no website (not even a defunct one). The Scientist obtained two issues of the journal: Volume 2, Issues 1 and 2, both dated 2003. The issues contained little in the way of advertisements apart from ads for Fosamax, a Merck drug for osteoporosis, and Vioxx. (Click here and here to view PDFs of the two issues.) read more

Dr Summer Johnson writing in blog.bioethics.net comments

What's wrong with this is so obvious it doesn't have to be argued for. What's sad is that I'm sure many a primary care physician was given literature from Merck that said, "As published in Australasian Journal of Bone and Joint Medicine, Fosamax outperforms all other medications...." Said doctor, or even the average researcher wouldn't know that the journal is bogus. In fact, knowing that the journal is published by Elsevier gives it credibility! Read more

This is one of the danger of pharmaceutical companies becoming bigger and bigger. Somehow the growth is not proportional to the growth of ethics in these companies and not consistent with the sense of morality of their original founders.


.

Questionable Marketing to Doctors

It is a sad day for me to learn of this action of the pharmaceutical giant Merck. Of all the pharmaceutical companies I have dealt with, I have always respected Merck for their integrity and responsibility. Over the years, as I watch the merging and buying over of various other pharmaceutic companies, I have noticed a declining standards of ethics and morality especially in their marketing departments. Over the last couple of years I noticed a declining standard in Merck. This report from The Scientist reveals the extent of the rot.

Merck published fake journal

Posted by Bob Grant

[Entry posted at 30th April 2009 04:27 PM GMT] in The Scientist.com website

Merck paid an undisclosed sum to Elsevier to produce several volumes of a publication that had the look of a peer-reviewed medical journal, but contained only reprinted or summarized articles--most of which presented data favorable to Merck products--that appeared to act solely as marketing tools with no disclosure of company sponsorship. Image: flicker/meviola "I've seen no shortage of creativity emanating from the marketing departments of drug companies," Peter Lurie, deputy director of the public health research group at the consumer advocacy nonprofit Public Citizen, said, after reviewing two issues of the publication obtained by The Scientist. "But even for someone as jaded as me, this is a new wrinkle." The Australasian Journal of Bone and Joint Medicine, which was published by Exerpta Medica, a division of scientific publishing juggernaut Elsevier, is not indexed in the MEDLINE database, and has no website (not even a defunct one). The Scientist obtained two issues of the journal: Volume 2, Issues 1 and 2, both dated 2003. The issues contained little in the way of advertisements apart from ads for Fosamax, a Merck drug for osteoporosis, and Vioxx. (Click here and here to view PDFs of the two issues.) read more

Dr Summer Johnson writing in blog.bioethics.net comments

What's wrong with this is so obvious it doesn't have to be argued for. What's sad is that I'm sure many a primary care physician was given literature from Merck that said, "As published in Australasian Journal of Bone and Joint Medicine, Fosamax outperforms all other medications...." Said doctor, or even the average researcher wouldn't know that the journal is bogus. In fact, knowing that the journal is published by Elsevier gives it credibility! Read more

This is one of the danger of pharmaceutical companies becoming bigger and bigger. Somehow the growth is not proportional to the growth of ethics in these companies and not consistent with the sense of morality of their original founders.


.

What will you do? (10)

It is the year 2020. Darren and Kylie are a young couple married for two years. Darren works for a large insurance company in Sydney, Australia and Kylie is a kindergarten teacher. They attend an independent evangelical community church,where they lead a Bible study and fellowship group. Kylie and Darren have decided it is time to start a family, so they visit their local Reproductive Clinic for the preliminary tests, which routinely include genetic testing. At their interview with the doctor, she tells them that if any genetically transmitted disease is found in either of them, pre-implantation genetic diagnosis (PGD) will enable them to make sure they do not pass the disease on to their children. This technique involves producing a number of embryos in the laboratory using their own sperm and eggs. The embryos are then tested to identify whether or not they carry the disease gene and only disease-free ones are implanted.

The doctor also mentions that if they wish, they can select either male or female embryos for implantation. In addition (since they have private health insurance) they could use gene modification on their selected embryo to enhance qualities such as intelligence or athletic ability. ‘For instance’ she says, ‘I couldn’t help noticing both of you are on the short side and a bit overweight. Why not help your children avoid these challenges?’

Darren and Kylie go home with lots of thoughts and questions, as well as some worries about what they might be doing. The next evening Kylie raises the topic of sex selection and genetic enhancement at her book club group. Most are very enthusiastic and encourage them to ‘do the best for your children.’ But they are still confused and doubtful whether this is the sort of thing Christians should do. They visit their pastor, but when they explain the situation, he admits it is not an issue he knows anything about and he has no idea where they can get any material from a Christian perspective. ‘Why doesn’t the church have any resources about this?’ they ask.

What issues does this story raise?

What will you do?
.

What will you do? (10)

It is the year 2020. Darren and Kylie are a young couple married for two years. Darren works for a large insurance company in Sydney, Australia and Kylie is a kindergarten teacher. They attend an independent evangelical community church,where they lead a Bible study and fellowship group. Kylie and Darren have decided it is time to start a family, so they visit their local Reproductive Clinic for the preliminary tests, which routinely include genetic testing. At their interview with the doctor, she tells them that if any genetically transmitted disease is found in either of them, pre-implantation genetic diagnosis (PGD) will enable them to make sure they do not pass the disease on to their children. This technique involves producing a number of embryos in the laboratory using their own sperm and eggs. The embryos are then tested to identify whether or not they carry the disease gene and only disease-free ones are implanted.

The doctor also mentions that if they wish, they can select either male or female embryos for implantation. In addition (since they have private health insurance) they could use gene modification on their selected embryo to enhance qualities such as intelligence or athletic ability. ‘For instance’ she says, ‘I couldn’t help noticing both of you are on the short side and a bit overweight. Why not help your children avoid these challenges?’

Darren and Kylie go home with lots of thoughts and questions, as well as some worries about what they might be doing. The next evening Kylie raises the topic of sex selection and genetic enhancement at her book club group. Most are very enthusiastic and encourage them to ‘do the best for your children.’ But they are still confused and doubtful whether this is the sort of thing Christians should do. They visit their pastor, but when they explain the situation, he admits it is not an issue he knows anything about and he has no idea where they can get any material from a Christian perspective. ‘Why doesn’t the church have any resources about this?’ they ask.

What issues does this story raise?

What will you do?
.

What will you do? (9)

Mary and Theng Huat have been undergoing treatment for infertility for over a year. Recently, they went through a round of in vitro fertilization (IVF). Mary’s fertility doctor retrieved 12 eggs and fertilised them with Theng Huat’s sperm, which resulted in ten embryos. Three were transferred to Mary’s uterus: the other seven were frozen in the clinic for later use. None of the first three embryos implanted resulted in a pregnancy, but on the second cycle of treatment Mary became pregnant with twins. A year or so after the birth of a healthy girl and boy, Mary’s gynaecologist sent a letter asking whether or not she and her husband had decided what they wanted to do with their four frozen embryos.The letter indicated that if they no longer wanted them stored, they should call Mr Tan at the clinic.

‘What do you think?’ Mary asks Theng Huat after opening the letter. They haven’t made up their minds whether they want any more children, but they are also unsure about what happens to the embryos if they say they don’t want them. So Mary calls Mr Tan and asks him about this. ‘If you remember, we discussed this when you signed the consent form for the treatment’ he replies. ‘Of course, you can simply have us throw the frozen embryos away, if you no longer need them, but it would be much more sensible for you to donate them for embryonic stem cell research.’ ‘What’s that?’ Mary asks. Mr Tan explains, ‘It is research that uses embryos to develop new medical treatments. We think this research holds tremendous promise for treating conditions like diabetes, heart disease, Alzheimer’s and Parkinson’s.’

That evening Mary discusses donation with her husband over dinner. Theng Huat observes that his father has already benefited from experimental stem cell treatment for his heart disease, so donating their embryos for further stem cell research would probably be a good idea. ‘I would agree with you’ says Mary ‘but I seem to recall they used your father’s own cells to develop the treatment for his heart condition. We would be letting them use embryos instead. Is that really the same thing?’

What issues does this story raise?

What will you do?

.

What will you do? (9)

Mary and Theng Huat have been undergoing treatment for infertility for over a year. Recently, they went through a round of in vitro fertilization (IVF). Mary’s fertility doctor retrieved 12 eggs and fertilised them with Theng Huat’s sperm, which resulted in ten embryos. Three were transferred to Mary’s uterus: the other seven were frozen in the clinic for later use. None of the first three embryos implanted resulted in a pregnancy, but on the second cycle of treatment Mary became pregnant with twins. A year or so after the birth of a healthy girl and boy, Mary’s gynaecologist sent a letter asking whether or not she and her husband had decided what they wanted to do with their four frozen embryos.The letter indicated that if they no longer wanted them stored, they should call Mr Tan at the clinic.

‘What do you think?’ Mary asks Theng Huat after opening the letter. They haven’t made up their minds whether they want any more children, but they are also unsure about what happens to the embryos if they say they don’t want them. So Mary calls Mr Tan and asks him about this. ‘If you remember, we discussed this when you signed the consent form for the treatment’ he replies. ‘Of course, you can simply have us throw the frozen embryos away, if you no longer need them, but it would be much more sensible for you to donate them for embryonic stem cell research.’ ‘What’s that?’ Mary asks. Mr Tan explains, ‘It is research that uses embryos to develop new medical treatments. We think this research holds tremendous promise for treating conditions like diabetes, heart disease, Alzheimer’s and Parkinson’s.’

That evening Mary discusses donation with her husband over dinner. Theng Huat observes that his father has already benefited from experimental stem cell treatment for his heart disease, so donating their embryos for further stem cell research would probably be a good idea. ‘I would agree with you’ says Mary ‘but I seem to recall they used your father’s own cells to develop the treatment for his heart condition. We would be letting them use embryos instead. Is that really the same thing?’

What issues does this story raise?

What will you do?

.

What will you do?(8)

Evening is falling when Suzanne finds William. The doctor has just told her she is not pregnant and, indeed, could not become pregnant. Something is wrong with her body. She has been told her womb is fine, but she has no eggs that could live. A tear is in her eye as she says to William having children is natural. It is what all couples should do. It is what God wanted when he said ‘Be fruitful and multiply.’ William says ‘I love you no matter what. We’ll see what options there are.’

After three weeks, at the recommendation of their family doctor, William and Suzanne visit a specialist at a city clinic. The specialist offers several options. ‘You can, of course, go home and accept this is nature’s way. Or you could adopt. Though this would not be your child genetically, no doubt you would grow to love the baby. Or we could try an assisted reproductive technique. We’d take eggs from a donor and fertilize them with William’s sperm. At that stage you could choose the sex of your child too, if you want. We would then pick the best few embryos and insert them into Suzanne. The ones that grow best will be kept in the womb.’

On the ride home, the couple decide they should go ahead. Suzanne says ‘At least our baby will have part of our genes and I will be able to feel him grow in me. That way he is part of both of us.’ ‘Let’s pray about it, but I think this is a good idea’, William responds ‘and if you want, we can talk it over with the pastor.’ ‘No, not yet, let’s keep this to ourselves, at least for now’ she replies.

After eight months, though still not pregnant, the couple have an argument about who should know what. William says ‘Sweetheart, this is simply how some people have children nowadays. Of course we can tell your parents and mine...and, of course, we will tell the baby when he – and the doctor said he could select the sperm so our child should be male – when he is old enough.’ Suzanne replies ‘There is no way we are going to tell anyone about this. It is between us and the doctor.’

It is two years later, driving home from the specialist having been told once again that the procedure has failed, that William asks Suzanne if this is not God telling them the whole thing is wrong. They have spent a lot of money and have even been told by the doctor that he could allow them only one more try. Once again Suzanne is crying. ‘Should we adopt? There are babies in our country and throughout the world who need parents. We could love a baby, I know.’ They drive home in silence.

What issues does this story raise?

What will you do?

.

What will you do?(8)

Evening is falling when Suzanne finds William. The doctor has just told her she is not pregnant and, indeed, could not become pregnant. Something is wrong with her body. She has been told her womb is fine, but she has no eggs that could live. A tear is in her eye as she says to William having children is natural. It is what all couples should do. It is what God wanted when he said ‘Be fruitful and multiply.’ William says ‘I love you no matter what. We’ll see what options there are.’

After three weeks, at the recommendation of their family doctor, William and Suzanne visit a specialist at a city clinic. The specialist offers several options. ‘You can, of course, go home and accept this is nature’s way. Or you could adopt. Though this would not be your child genetically, no doubt you would grow to love the baby. Or we could try an assisted reproductive technique. We’d take eggs from a donor and fertilize them with William’s sperm. At that stage you could choose the sex of your child too, if you want. We would then pick the best few embryos and insert them into Suzanne. The ones that grow best will be kept in the womb.’

On the ride home, the couple decide they should go ahead. Suzanne says ‘At least our baby will have part of our genes and I will be able to feel him grow in me. That way he is part of both of us.’ ‘Let’s pray about it, but I think this is a good idea’, William responds ‘and if you want, we can talk it over with the pastor.’ ‘No, not yet, let’s keep this to ourselves, at least for now’ she replies.

After eight months, though still not pregnant, the couple have an argument about who should know what. William says ‘Sweetheart, this is simply how some people have children nowadays. Of course we can tell your parents and mine...and, of course, we will tell the baby when he – and the doctor said he could select the sperm so our child should be male – when he is old enough.’ Suzanne replies ‘There is no way we are going to tell anyone about this. It is between us and the doctor.’

It is two years later, driving home from the specialist having been told once again that the procedure has failed, that William asks Suzanne if this is not God telling them the whole thing is wrong. They have spent a lot of money and have even been told by the doctor that he could allow them only one more try. Once again Suzanne is crying. ‘Should we adopt? There are babies in our country and throughout the world who need parents. We could love a baby, I know.’ They drive home in silence.

What issues does this story raise?

What will you do?

.

What will you do? (7)

Katia is a 17 year old Russian student who lives with her divorced mother. Her mother has to work two jobs to pay for ballet lessons for Katia, who has won many competitions and dreams of becoming an international star. One of her fellow dancers is Ivan and through spending time with him, they have grown closer, to the point where they have begun to sleep together. They have talked about getting married one day, but both have many goals to achieve before then.

Just a few months before the national competitions, Katia misses her menstrual period. At first she thinks this might be due to stress or her strenuous training regime, but after another month, she starts to panic, and visits her doctor. She is stunned to learn she is pregnant and rings up Ivan in tears. He is also shocked and asks her what she is going to do about it. He says ‘Neither of us is ready for a baby now. Why don’t you visit one of those clinics?’

Katia doesn’t know what to do. She is too ashamed to tell her mother, so she makes an appointment at a pregnancy counselling service. Here she is told by a very kind nurse she should not worry and that a simple procedure will solve her problem for her. So, even though she is upset about what she is doing, she makes an appointment for a termination of pregnancy and this is performed the following week.

Ten years later, Katia has moved to the USA to pursue her ballet career and has started to attend a church. There she meets Todd, a committed Christian who is active in the pro-life movement. He strongly believes that abortion under any circumstances is wrong. They begin dating and things progress rapidly. Todd thanks God for sending him this wonderful woman as a friend and potential wife. He thinks about Katia constantly and daydreams about their future together as missionaries in Russia.

When Todd asks Katia to marry him, she begins to cry. ‘Oh, Todd’ she sobs, ‘I love you so much. But there’s something I have to tell you.’ When she tells him about her abortion, Todd feels as if his whole world has fallen apart. How could he ever forgive her? Why has God allowed him to fall in love with a woman who has killed her own baby?

Over time and with counselling from their pastor, Todd is able to forgive Katia and they get married the next year. They are thrilled when two years later Katia discovers she is pregnant. But, on antenatal testing, the foetus is discovered to have Down syndrome. Their doctor encourages them to consider aborting.

What issues does this story raise?

What will you do?

.

What will you do? (7)

Katia is a 17 year old Russian student who lives with her divorced mother. Her mother has to work two jobs to pay for ballet lessons for Katia, who has won many competitions and dreams of becoming an international star. One of her fellow dancers is Ivan and through spending time with him, they have grown closer, to the point where they have begun to sleep together. They have talked about getting married one day, but both have many goals to achieve before then.

Just a few months before the national competitions, Katia misses her menstrual period. At first she thinks this might be due to stress or her strenuous training regime, but after another month, she starts to panic, and visits her doctor. She is stunned to learn she is pregnant and rings up Ivan in tears. He is also shocked and asks her what she is going to do about it. He says ‘Neither of us is ready for a baby now. Why don’t you visit one of those clinics?’

Katia doesn’t know what to do. She is too ashamed to tell her mother, so she makes an appointment at a pregnancy counselling service. Here she is told by a very kind nurse she should not worry and that a simple procedure will solve her problem for her. So, even though she is upset about what she is doing, she makes an appointment for a termination of pregnancy and this is performed the following week.

Ten years later, Katia has moved to the USA to pursue her ballet career and has started to attend a church. There she meets Todd, a committed Christian who is active in the pro-life movement. He strongly believes that abortion under any circumstances is wrong. They begin dating and things progress rapidly. Todd thanks God for sending him this wonderful woman as a friend and potential wife. He thinks about Katia constantly and daydreams about their future together as missionaries in Russia.

When Todd asks Katia to marry him, she begins to cry. ‘Oh, Todd’ she sobs, ‘I love you so much. But there’s something I have to tell you.’ When she tells him about her abortion, Todd feels as if his whole world has fallen apart. How could he ever forgive her? Why has God allowed him to fall in love with a woman who has killed her own baby?

Over time and with counselling from their pastor, Todd is able to forgive Katia and they get married the next year. They are thrilled when two years later Katia discovers she is pregnant. But, on antenatal testing, the foetus is discovered to have Down syndrome. Their doctor encourages them to consider aborting.

What issues does this story raise?

What will you do?

.

What will you do? (6)

Mrs Milowicz is a 60 year old widow who had a severe stroke eight months ago, which left her bed bound and unable to swallow. She has gone into a nursing (caring) home, but her only daughter, Anna, is not satisfied with the conditions there. It is understaffed and those who are there seem poorly trained. Anna visits her mother every day, carrying out many of the nursing tasks herself, but this is difficult for her as she lives on the other side of town, with her husband who is unemployed and two children who are at school. She relies on the bus service and the trip to the nursing home takes up to two hours.

Mrs Milowicz has now been sent to the hospital, because her nasogastric feeding tube (a tube inserted through the nose which goes into the stomach) has come out, and the staff are unable to replace it. Anna arrives with her, and explains the situation in the nursing home. She also tells the doctor that her mother has progressively deteriorated over the months and no longer communicates.
The doctor notes the daughter’s good care for her mother, since there are no bed sores. But Anna admits she is finding the daily visits very tiring and she is upset because her mother doesn’t even talk to her any more. ‘It’s such a strain, doctor’ she says, ‘I don’t know how much longer I can keep doing it. I’ve had to give up my job, and we can’t keep up with the bills.’

The doctor tells her that putting the feeding tube back would not benefit her mother who is in the process of dying. The doctor also tells her ‘I see the love you have for your mother, but it looks like it is now time for God to take care of her.’ ‘Do you mean we will just let her starve to death?’ Anna asks. Then after a moment’s reflection she adds: ‘Isn’t there anything else you could do to make it easier?’

What issues does this story raise?

What will you do?

.

What will you do? (6)

Mrs Milowicz is a 60 year old widow who had a severe stroke eight months ago, which left her bed bound and unable to swallow. She has gone into a nursing (caring) home, but her only daughter, Anna, is not satisfied with the conditions there. It is understaffed and those who are there seem poorly trained. Anna visits her mother every day, carrying out many of the nursing tasks herself, but this is difficult for her as she lives on the other side of town, with her husband who is unemployed and two children who are at school. She relies on the bus service and the trip to the nursing home takes up to two hours.

Mrs Milowicz has now been sent to the hospital, because her nasogastric feeding tube (a tube inserted through the nose which goes into the stomach) has come out, and the staff are unable to replace it. Anna arrives with her, and explains the situation in the nursing home. She also tells the doctor that her mother has progressively deteriorated over the months and no longer communicates.
The doctor notes the daughter’s good care for her mother, since there are no bed sores. But Anna admits she is finding the daily visits very tiring and she is upset because her mother doesn’t even talk to her any more. ‘It’s such a strain, doctor’ she says, ‘I don’t know how much longer I can keep doing it. I’ve had to give up my job, and we can’t keep up with the bills.’

The doctor tells her that putting the feeding tube back would not benefit her mother who is in the process of dying. The doctor also tells her ‘I see the love you have for your mother, but it looks like it is now time for God to take care of her.’ ‘Do you mean we will just let her starve to death?’ Anna asks. Then after a moment’s reflection she adds: ‘Isn’t there anything else you could do to make it easier?’

What issues does this story raise?

What will you do?

.

What will you do? (5)

An urban congregation in sub-Saharan Africa has very positive experiences with Mercy Ships and other short-term medical outreach programmes. They approach a mission agency staffed by Europeans, Americans and local health professionals. It is funded by Korean Christians and they plan to establish a permanent clinic. The local congregation argue this is one of their most powerful evangelistic tools.

‘The government provides only the bare minimum when it comes to health care’ says one of the elders. ‘If someone is very sick, they may get treatment at a public hospital for a reduced fee, but often there is no opportunity to access medical services. It’s not so bad here as in rural areas, but even here in the city there are not enough facilities. So people with “connections” get served in the hospital sooner, even before people who may be very sick and have waited a long time, but don’t know the “right” people.’ He goes on: ‘Western and Asian churches who are economically strong but don’t help their poorer brothers and sisters, never mind those who might be evangelised, are really no different than the rest of the world. Christians who have much have a duty to help believers who have little.’

Another influential church leader takes a different view. She claims the local congregation should instead put their efforts into expanding local services. ‘Health care is a right and the government should provide it. When the church steps in all it does is supply a quick fix, like putting a plaster or band aid on a gaping wound. Both the local people and the mission agencies should try to get the laws changed to provide adequate national healthcare services.’

What issues does this story raise?
What will you do?

.

What will you do? (5)

An urban congregation in sub-Saharan Africa has very positive experiences with Mercy Ships and other short-term medical outreach programmes. They approach a mission agency staffed by Europeans, Americans and local health professionals. It is funded by Korean Christians and they plan to establish a permanent clinic. The local congregation argue this is one of their most powerful evangelistic tools.

‘The government provides only the bare minimum when it comes to health care’ says one of the elders. ‘If someone is very sick, they may get treatment at a public hospital for a reduced fee, but often there is no opportunity to access medical services. It’s not so bad here as in rural areas, but even here in the city there are not enough facilities. So people with “connections” get served in the hospital sooner, even before people who may be very sick and have waited a long time, but don’t know the “right” people.’ He goes on: ‘Western and Asian churches who are economically strong but don’t help their poorer brothers and sisters, never mind those who might be evangelised, are really no different than the rest of the world. Christians who have much have a duty to help believers who have little.’

Another influential church leader takes a different view. She claims the local congregation should instead put their efforts into expanding local services. ‘Health care is a right and the government should provide it. When the church steps in all it does is supply a quick fix, like putting a plaster or band aid on a gaping wound. Both the local people and the mission agencies should try to get the laws changed to provide adequate national healthcare services.’

What issues does this story raise?
What will you do?

.

What Will You Do (4)

Uncle Joe is a member of your church for the last 20 years. He has chronic kidney failure and has been on dialysis for the last 6 years. This means that he has to go to the dialysis centre three times a week, hook himself to a machine which clean out the toxins in his blood for at least 4 hours each session. He is on the kidney transplant list in a local government hospital but the chances of his being chosen is slim.

He wants to go to China for a kidney transplant. He has come into contact with a person who promise that he will be able to buy a kidney for Uncle Joe. You are Uncle Joe's best friend. What will you tell him?

What Will You Do (4)

Uncle Joe is a member of your church for the last 20 years. He has chronic kidney failure and has been on dialysis for the last 6 years. This means that he has to go to the dialysis centre three times a week, hook himself to a machine which clean out the toxins in his blood for at least 4 hours each session. He is on the kidney transplant list in a local government hospital but the chances of his being chosen is slim.

He wants to go to China for a kidney transplant. He has come into contact with a person who promise that he will be able to buy a kidney for Uncle Joe. You are Uncle Joe's best friend. What will you tell him?

What will you do? (3)

A young couple in your church has been married for five years but is childless. They have decided to seek treatment for their infertility by “in vitro fertilization” (IVF). They came to your office, agitated and in tears because one of the church leaders have told them that IVF is “unnatural” and the child conceived by this method is the “spawn of the devil!”

How will you educate your congregation?