Medical ethicist Art Caplan is head of the division of medical ethics at New York University's Langone Medical Center. Every Wednesday, Caplan joins Boston Public Radio for "Ask the Ethicist," where he tackles complex medical dilemmas. Today on the show Caplan talked about Alzheimer's disease and sexual consent, shady medical journals, and bills about abortion passed in Arizona and Arkansas.
Questions below are paraphrased, and Caplan's responses are edited where noted [...].
Henry Rayhons is a former Iowa state legislator who was accused of sexually abusing his former wife, Donna Lou Rayhons. Prosecutors are charging Henry Rayhons on the grounds his wife was able to consent. Donna Lou had Alzheimer's disease at the time, and has since passed away. What do you make of this?
We've had a push to say that even within marriage, you have the right to refuse sex with your husband. It may not be the basis of a fruitful marriage going forward, but [...] what is a yes? In all these college cases, assault cases, [we're] trying to figure out, What are the signals [of consent]?
Doctors are also conflicted about how to tell patients about Alzheimer's disease, and how to talk to families about it.
About 50 percent of doctors in a recent survey did not convey a diagnosis of Alzheimer's [...] to the patient's family. [...] We are not discussing it, we are not planning for it.
And presumably, the family should be the ones to know to help navigate difficult decisions, including the awkward but necessary talk about sexual activity. In the case of Henry and Donna Lou Rayhons, there were some family dynamics at play, too.
I suspect that the older children from the previous marriage weren't so crazy about this new marriage, and they were probably the ones chasing the husband to say, Don't touch mom anymore. [...] You need to have a frank discussion. What about intimacy? What about where I want to be? What kind of medical care do I want? [...] We could settle this if we could learn to talk about Alzheimer's.
Meanwhile, Henry Rayhons will stand trial.
I can't imagine this guy's going to get convicted.
You wrote about 'publication pollution' this week. What is that?
There's a big problem out there in the science world. Lots of journals have been created within the past 10 years that are called 'open access.' Meaning, instead of having to go through the usual peer-review process where fellow scientists read your articles and you hope they will get accepted. You can say I want to publish this, and I want to pay the journal, and they'll publish it.
How does this happen?
People show up at meetings and they say, hey, you know what? Cocoa Puffs are good for you. I have a study and here it is in the Journal of Cocoa Puff-ology. And legislators sit there, and some journalists, and they say, it must be good. But the journals are just money-making schemes.
How can we — media, doctors, scientists, and the public who reads these things — combat this?
One solution is [to ask,] Are they cited? Do people refer to them? Do they have an impact, in other words. [...] The scientific community really needs to toughen up its peer review.
Yes, but how?
When you peer review you gotta sign your peer-review, and it should be public. [...] If I send a journal article in [they will] send it out to a couple peer reviewers, and that would be done anonymously. [...] I think their names should be public [so they can be] held accountable.
And the reason they're anonymous is because they don't want to put themselves at professional risk — is that the argument against publishing names?
Some people say, I'm not going to be tough in peer review because [someone] will get mad at me. [What they should say is,] 'Here's our peer review, this is the quality, this is the kind of person that does it,' and if you think the peer review is bad you have a chance to say so.
Two new laws in Arizona and Arkansas require that doctors inform women who are about to undergo a drug-induced abortion that that procedure could be 'reversed.' What do you think about this, Art?
I don't know that they are reversible. These are emergency contraception [measures]. You take the drug in 24 to 36 hours [after conception] to prevent the embryo from implanting. [...] I don't know that you can stop that process, and I don't know what the effects would be on the women if you didn't do anything further.
And you think using laws to dictate the terms of medical procedures isn't ideal, right?
Where is organized medicine? Where is journalism? Where is society to say stop telling doctors what to say to patients? Why would I want the Arizona legislature to say what to say to patients? It's ridiculous. [...] Abortion politics is corroding the doctor-patient relationship. If the legislators want to tell the doctors things, go to medical school. Then tell us. [...]
And you think the medical community should be up-in-arms over bills like these, right?
They should be willing to go to court. This is a little bit like the Scopes trial. [...] If you don't think that they can be reversed or stopped or changed, and 99 percent of doctors don't, [...] I think you gotta do it. This is the place where ethics demand a little courage. [...] We live in a country that has decided that corporations are people, and [they have] free speech. Shouldn't doctors?
>> Art Caplan is on Boston Public Radio every Wednesday. He's cohost of the podcast Everyday Ethics.
