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'Lights... camera:' Bill calls for videotaped surgeries
A bill under consideration in Massachusetts would require hospitals grant patients who request it the right to have their surgeries videotaped — a move that critics say would be expensive, difficult to implement, a violation of patients' privacy, and distracting to surgical teams.
"Leona's law" was introduced in January by state Rep. Martin Walsh (D-MA), who said he was spurred to act by the experience of a family friend whose mother, for whom the bill is named, died during hip surgery.
Hospitals and surgeons worry that it will create unnecessary expense and distraction for hospitals, another layer of privacy concerns, and potentially a new tool for malpractice plaintiffs. Surgeons have pointed out that surgical errors constitute only a small percentage of medical errors, and furthermore, that most surgical errors happen within a patient's body, and a video camera set up in the surgical suite would be unlikely to capture such events.
Walsh, in comments to Boston media, acknowledged that the bill faces stiff opposition from the medical community. The bill originally called for all surgeries in all licensed hospitals in Massachusetts to be videotaped; Walsh modified the bill to require surgeries to be taped only upon a patient's request. At the time Medical Ethics Advisor went to print, the bill had not yet been heard in legislative committee.
The Massachusetts Hospital Association released a statement that the bill posed a "Big Brother-style intrusion into the surgical suite" and would prompt a "gotcha impulse" in people interested in filing lawsuits.
Videotape of surgeries — for which releases are obtained from patients beforehand — are often used in teaching hospitals and medical schools. However, the tapes are not available for patient use.
Medical researchers not as unbiased as they think
Medical research scientists routinely make ethical value judgments that they aren't even aware of, according to a Weill Cornell Medical College research study reported in May's European Journal of Epidemiology. But the authors of the study say the ethical judgments don't always create bias, and they can result in better research.
The study finds that the framing of the research question, identification of the problem, as well as the design and methodology of the study are all subject to conscious or unconscious value judgments by investigators — for example, when research is conducted into racial health disparities.
"Epidemiologists must endorse particular public policy aims of their research in order to make methodological decisions throughout the research process," reports Inmaculada de Melo-Martín, PhD, MS, one of the authors of the study and an associate professor of medical ethics at Weill Cornell. "In the case of research into racial disparities, the researcher decides how to define race — whether by genetic markers or by census data. Both definitions are valid on their own, but in deciding which one to use, the scientist makes value assumptions about which would best promote the social aims of the research, such as eliminating racial disparities."
De Melo-Martín said many scientists "make these value judgments without being aware of it — while at the same time wrongly believing any such value-laden decisions automatically lead to bias." To counteract that misconception, she suggests that training in epidemiology and other research fields include instruction relating to the ethical dimensions of research. (De Melo-Martín I, Intemann KK. Can ethical reasoning contribute to better epidemiology? A case study in research on racial health disparities. Eur J Epidemiol 2007; 22:215-221.)