Last week, 87-year-old Lorraine Bayless collapsed at Glenwood Gardens, an assisted living facility in Bakersfield, Calif., and later died.

While it’s not unexpected that an elderly person would die, what’s troubling is that after she collapsed, a nurse called 911, yet wouldn’t administer CPR or look for someone else to do it, despite the request of the emergency dispatcher. 

The management of Glenwood Gardens backed up the staffer’s decision to not start CPR. 

“Our practice is to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives,” Jeffrey Toomer, executive director of Glenwood Gardens, said in written statement. “That is the protocol we followed.”

Toomer was not the only one backing the decision not to start CPR. Bayless' daughter told a reporter for KGET, the NBC affiliate in Bakersfield, that she was also a nurse and was satisfied with the care her mother received. It seems unlikely that a lawsuit will follow.

So why might the staffer and the facility balk at using CPR to try to save the life of a dying woman? One reason is that the woman who called 911 may not have felt comfortable trying CPR for some reason or perhaps felt out of practice. Another might be that since the facility had a call and wait policy, perhaps she worried for her job. One possible reason for Glenwood Garden’s policy is that there is always a nagging worry that no good deed will go unpunished — if CPR is given but it is done improperly will there be liability for the assisted living facility. As it happens, none of these reasons are good ones not to try CPR.

Even without training someone might be able to help if guided by a knowledgeable person. The dispatcher offered to walk the caller through what to do but the caller still declined.  And liability is not really much of a worry unless you do something extremely absurd every state shields those who try to be Good Samaritans against lawsuits.

It is true that CPR does not work as well as we might wish. Even when someone sees a heart attack happen or a patient collapse, as was true in this case, the odds of preventing death in someone that age are not great.

Still, I can’t help thinking that unless there is some medical fact about the patient that we don’t know—she had terminal cancer or a Do Not Resuscitate request in place —there is no ethical justification for calling 911 and then waiting until they come before starting CPR. Anyone of us could be confronted with this choice. 

Every one of us should think hard about what we ought to do when someone needs our help to live.

Arthur Caplan, Ph.D., is the head of the Division of Medical Ethics at NYU Langone Medical Center.

Related story:

Policy questioned after nurse refuses to do CPR

Doug Pensinger / Getty Images

Colorado tight end Nick Kasa was asked about his romantic interests during interviews at the recent NFL Scouting Combine.

University of Colorado tight end Nick Kasa is trying to get drafted so he can play for an NFL team. But does he “like girls?" It is surely nobody’s business but his own.

That is why he deserves a lot of credit for wondering earlier this week why representatives of NFL teams asked about his romantic interests during interviews at the recent NFL Scouting Combine.

The Combine is an annual jamboree for college athletes trying to make it into the NFL. After teams gather information on a player from game tapes, medical records and background checks, it's a one-shot opportunity for wanna-be draftees to show what they're made of, with a battery of physical, psychological, and personal tests. How they fare at the Combine often determines whether and how early they get selected in the draft -- and whether they get the contracts and signing bonuses that can reach into the tens of millions of dollars.

While players' romantic reputations have been widely discussed in years past -- including the basketball stars Magic Johnson and Kobe Bryant and football stars such as Tim Tebow -- there hasn't been such public attention paid to their sexual orientations.

The story about Kasa being asked about his preference for pink or blue was quickly followed by a lot of Internet buzz, mostly heated speculation about whether Notre Dame star linebacker Manti Te'o might be gay. Te'o has been the focal point of headlines for many weeks about his involvement in a hoax that included a fake girlfriend. It is such a bizarre story that no amount of speculation or innuendo about his private life has been kept off-limits. That goes for the media, the web and NFL teams.

Two execs confirm teams want to know about Te'o's sexuality

It may be hard to believe, but there is currently no federal law that protects people from being questioned about their sexual orientation when seeking a job. Any protections that do exist can be found in state laws, collective bargaining agreements and individual company policies. In Indiana, where the Combine takes place, sexual orientation is not a protected status for private employers. Only 16 states prohibit discrimination based on sexual orientation or gender identity. While the growing public acceptance of same-sex marriage indicates that further protections are likely to be established, there may yet be a wrangle over what to do if information obtained in states where questions about gender preference are legal is later used to discriminate against a potential employee.

The NFL is launching an investigation to determine whether Teo, Kasa, or any other players were asked a question about their sexual orientation. Representatives of several teams have gone on record to say that they did not and never would ask such a question.

But if a team official did ask an athlete ‘who do you love?’, let's hope that it wasn't out of a misplaced fear that drafting a player who likes girls, boys or both could become a distraction to the team – either in the locker room, in the press, or in the public sphere. After dealing with criminal acts such rape, spousal abuse, drug addiction and repeat drunk driving in various professional sports leagues over the years, having a gay athlete on a squad should be the least of any manager or coach’s worries.

As the NFL seems intent on doing, all professional sports should make it clear: No probing of any athletes' sexual orientation will be allowed.  Any use of such information, however acquired, should result in a severe penalty for the team that does it. Period.

But even if things are resolved in this instance, there are still larger questions to tackle. In particular, would enough of our society truly support a sports star who is openly gay? Would it make a difference if the player was a projected first-round pick like Te'o or a likely late-round pick like Kasa? Would teams find it easier to manage issues that arise around an athlete who is openly gay than one who isn't?

Since homosexuality is still considered relevant to employment eligibility in some states where teams play, these questions point to the need for the NFL and all sports organizations to back change in federal law.

Sports has – admittedly, often grudgingly -- led the way for society regarding race, gender, and disability. However, compared to companies such as Google and Citibank now urging changes through the U.S. Supreme Court, sports leagues and teams have lagged when it comes to helping change outdated perceptions about sexual orientation.

But sports can and should do what is right by making it clear that sexual preference has no role to play in who gets to play.

Related:

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Arthur L. Caplan, Ph.D., is the head of the Division of Medical Ethics at NYU Langone Medical Center. Arthur R. Miller, CBE, is a leading scholar in the field of American civil procedure and a University Professor at New York University and Chairman of The NYU Sports & Society Program. Lee H. Igel, Ph.D., is an associate professor in the Tisch Center at NYU.

The mass murder of 20 children and six adults Friday in Newtown, Conn., has provoked yet another round of recrimination, finger pointing and breast-beating. Was the shooter mentally deranged? If there was more gun control, would this have happened? Did violent video games play any role? What we fervently want as we continue to reel from a story whose misery seems to know no bounds is to find a clear cause - a reason why this happened - so that we can fix it.

We hope to see something in all the stories, analyses, commentaries, Facebook postings and Twitter speculation that gives us the reason behind what happened and thus a guarantee that if we understand and act on it then no 6 year old or her parent need to worry ever again what might happen at their school. We hope that no college, hospital or mall will ever again have a reason to practice drills for "shooters" and no play or movie-goer grow anxious over who has snuck into the theater with evil intent.

But, there is no simple answer. We have ourselves to blame for where we find ourselves in terms of mass shootings. Our culture is too far down the road of tolerating and even extolling violence. We do so in our popular entertainment, we permit the mass marketing of violence to young kids, and we thrill to it in too many of our sports. A lot of people make a lot of money selling violence. I doubt that will change.

Nor will the easy availability of guns. We have been well aware of the cost of easily obtained high-powered guns for a long time.  Even if we move toward tighter gun control laws and seek to reduce access to automatic weapons and ammo, which I favor, we have so many guns in circulation that these efforts are too little, too late. Will deaths fall if killers are not armed as if for combat with automatic weapons and full body armor? Yes. But, will ready access to automated weapons, guns and this kind of equipment disappear any time soon in America? I am afraid not.

So what are we left with as a way to construct a response to Newtown and all the Newtowns before it? I think we need to rethink how we think about violence in the situation in which we find ourselves — armed to the teeth in a very violent society that is nervous and full of fear. The only way to reduce risk in such a tinderbox is to give up a bit of liberty.

First, make the discussion of violence a public health priority. Ask health care workers to talk about the threat of violence in all its forms as a huge public health problem — from suicide to domestic abuse to mass murder. Insist that doctors and nurses talk about guns and weapons with their patients noting their risks and the need for safety handling and storage when they are present.

Ditch efforts, such as Florida’s, to prohibit these discussions. Take the stigma out of talking about the possibility that someone you know will may be prone to violence and offer clear directions about what to do about that.  Let prying in the name of health into what is now deemed private be the accepted norm.

Second, fix the broken mental health system. Not all who are violent are mentally ill.  And mental illness is not always a reason not to hold someone responsible for their actions. Still, no one with a kid who has a mental health problem, and I mean no one, has ready access to competent mental health assistance.  Ask parents who have a kid with anorexia, compulsions, a personality disorder or schizophrenia how easy it is to get services and you will quickly get an unhappy earful.  

If you have a heart attack in any American town or city you can expect an ambulance within minutes. If you or someone you knows has a mental breakdown or ongoing drug abuse why cant we expect the same rapid response and treatment capability? We also need more incentives for doctors, nurses and social workers to specialize in mental health. The nation needs fewer dermatologists and allergists and a lot more psychiatrists and psychologists.

Third, start to screen kids in school — all schools --  for signs of problems involving violence be it bullying, domestic abuse or social isolation. We screen kids for hearing and vision problems but looking for early signs of mental illness is somehow off-limits. A kid can be labeled as at risk of diabetes but not suicide or violence. A bit of screening and some early counseling for those found to be at risk of violence is not going to lead to the thought police controlling the next generation of Americans.

As much as we want it there is no quick fix for Aurora, Columbine, Newtown, Virginia Tech, West Nickel Mines and the scores of other school, mall and public building massacres America has seen over the past two decades. Given where we find ourselves, the fix means giving up a smidgeon of liberty to better protect safety. It means seeing violence as a public health problem that is just as real as swine flu or obesity. It means committing to a hard societal slog from a very bad place to something a bit better.

.

Arthur Caplan, Ph.D., is the head of the Division of Medical Ethics at NYU Langone Medical Center.

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The quest for relief from pain has now resulted in the deaths of 19 people and a total of 247 confirmed infections of fungal meningitis from tainted steroid injections. Thousands more who got the injections, made by the New England Compounding Center in Massachusetts, are worried that they too may wind up sick or dead. 

The horrific outbreak has resulted in the outrage about a lack of oversight of the compounding pharmacy.

But, this tragedy has another aspect that is not getting sufficient attention. Why are so many Americans getting spinal injections?

Most people in the United States will experience low back pain at least once during their lives. Back pain is one of the most common reasons people go to the doctor or miss work. It has also spawned a lucrative industry of spinal injection treatments whose efficacy, safety and long-term utility are mixed.

Epidural steroid injections are a common treatment for many forms of low back pain such as bulging discs, sciatica and leg pain. Experts agree that injections should be a last resort after patients in pain have tried anti-inflammatory medications and physical therapy. Millions of Americans get shots but far too many as a first attempt at relief, rather than a last resort.

The use of spinal injections, which have been around for 50 years, has been growing rapidly with one study reporting a 629 percent increase in Medicare expenditures for epidural steroid injections over the last decade.

Back pain injections can cost as much as $600 per shot. Insurance will pay much of the cost and there are often a lot of shots given. Sadly, there are lots of programs all over America that advise you on the Internet and in newspaper ads to come in and get a shot for back pain before trying anything else – that’s just lousy medicine.

Do the shots work? Many patients who get them say they do. But  the evidence is not convincing that people do better with shots than pain relievers and anti-inflammatory drugs. One recent, blinded study, published in the British Medical Journal, showed that patients reported as much pain relief with saline placebo shots as those who got epidural steroid injections.

Another study, published in 2007 in the medical journal Spine, showed that shots are most useful for people with herniated disks and pain radiating into their legs or arms but fewer than half of the injections given are for these conditions.

The explosion in back pain injection treatment closely parallels the explosion of obesity in the United States. Not surprisingly, the treatments that have the best evidence of helping relieve back pain are losing weight, exercising more and maintaining better posture. We are becoming a society that relies on symptom relief for health issues, not fixing the underlying problem.

No one should have to fear getting a fungus that might kill them when they go to get treatment for their back pain. Our legislators and regulators have let us down when it comes to keeping an eye on mom and pop drug makers. But, too many of us are using spinal injections as the first response to back pain. And too many doctors and clinics are pushing that treatment as an easy fix. Nothing is easy when it comes to pain. Medicine needs to stop promoting quick and very lucrative fixes for back pain when for a lot of people who suffer an alteration in lifestyle should be what the doctor orders.

Arthur Caplan is the head of the Division of Medical Ethics at NYU Langone Medical Center.

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Despite the great demand, very few Americans donate their organs when they die. But the reason for that may not be what you’d think -- it’s your relatives.

That’s what David Shaw, honorary lecturer at the University of Aberdeen in Scotland, thinks the real problem is. In an article published Tuesday in the British Medical Journal, he writes that one of the biggest reasons more people don’t wind up donating is veto by their family.

Even when you have signed a donor card or checked off your driver’s license a family member can still object to your being an organ donor.  And some do -- at least 10 percent of the time or more, says Shaw. (That number may be even higher, according to other U.S. researchers.) Shaw says doctors ought to forget cousin Fred’s second-guessing or your sister’s distaste for donation  and ought to honor your written wishes and use you as a donor.

Interestingly enough, that’s actually the law in the U.S. In nearly every state, a signed driver’s license or organ donor card is fully adequate for allowing donation no matter what your brother-in-law or other family member thinks. But despite that, doctors are still swayed by the family’s wishes.

Shaw is up against some tough problems when he urges doctors to ignore family protests. Is it really realistic for organ and tissue procurement to proceed no matter how upset family members might be about it?

And even if doctors are willing to plow ahead no matter what kind of emotional chaos is occurring in the next room, which hospital wants to risk a headline that says, “Liver removed while widow wails; Doc says ‘But I had a signed driver’s license’”?

Shaw is right to urge doctors not to give up at the first sign of family discomfort. When you sign a card or your driver’s license, you should expect that you will be able to be a donor.

I would argue, however, that the problem with family objections is not fearful doctors backing down in the face of distressed or divided families. The problem is what you and I often fail to do when we sign those cards and licenses — tell others!

If you sign your driver’s license at motor vehicles it is not likely that the friendly employee you waited an hour to see is going to be there when you die. Your family and friends will be. You need to tell them while you are alive that you want to be an organ and tissue donor. That is the antidote for avoiding an outbreak of objections when your number is up and being a donor is the last way you can help those in need. If you make it clear while alive what your wishes are that is the most important step you can take to having them honored when you are not.

Arthur Caplan is the head of the Division of Medical Ethics at NYU Langone Medical Center.

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The German Medical Association has issued a remarkably blunt and straightforward apology, more than six decades after the end of World War II, for the role it played during the Holocaust in the mass murder, sterilization and barbaric medical experiments done on Jews and many other groups.

The apology, made Wednesday at the Bundesärztekammer (German Medical Association) meeting in Nuremberg, makes no excuses.

Unanimously adopted by the delegates of the Physician's Congress, the declaration says that contrary to popular belief doctors were not forced by political authorities to kill and experiment on prisoners but rather engaged in the Holocaust as leaders and enthusiastic Nazi supporters.

The apology notes that “outstanding representatives of renowned academic medical and research institutions were involved” in organizing and carrying out the mass extermination of millions.

In the statement, the German doctors said they “remember the living and deceased victims and their descendants and ask them for forgiveness."

I don’t know if forgiveness will be forthcoming. 

But in the history of apologies for crimes and abuses carried out in the name of medicine this is the most important ever made. It does nothing to soften the horror of the Holocaust but it both ascribes responsibility where it belongs and ends any further efforts to deny or obfuscate what actually happened.

My father was there to see some of it. On April 29, 1945, Army Sgt. Sidney D. Caplan was among the troops that liberated the Dachau death camp outside of Munich Germany. By the end of the war, nearly 6 million Jews and countless others had been killed.

The Nuremberg trials that followed the defeat of the German Reich showed the intimate role that medicine had played in the Holocaust. Many know about Dr. Josef Mengele's gruesome experiments, but now the actions of mainstream medicine have been acknowledged.

German medicine as field has remained silent about it all these decades – until today.

The world must still grapple with the Holocaust as genocide carried out in the name of science and medicine. But it no longer needs to try and push those involved in German medicine to speak about their role. They have done so and they deserve full credit for it.

The world should acknowledge that medicine has finally stared its worst crimes directly in the face and shuddered.