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http://www.webmedcentral.com/images/Header_Logo.giftext/html2010-10-12T15:48:45+01:00http://www.webmedcentral.com/Dr. D. John DoyleBaby K. A Landmark Case In Futile Medical Care
http://www.webmedcentral.com/article_view/969
Baby K., an anencephalic child born without a cerebral cortex in 1992, is a landmark clinical and legal case of special importance to medical ethics because of the complex issues it raises with respect to the notions of dignity and personhood, the concept of brain death, and the question of medical futility. At issue was (1) whether it was clinically and ethically inappropriate to artificially ventilate and provide other "futile" medical measures to Baby K. instead of letting nature to take its course, and (2) whether doctors should be required to provide treatment they believe to be futile.text/html2010-12-03T17:37:57+01:00http://www.webmedcentral.com/Dr. Daniel HowesVentilator Allocation In A Pandemic: Discussion And A Model For Rationing Restricted Resources
http://www.webmedcentral.com/article_view/1258
In a state of emergency, increased demands for limited resources force a shift in the standards of care. With preparation and thoughtful deliberation, we can ensure that these changes in care continue to be consistent with our ethical principles.
In a respiratory infectious disease outbreak or other disaster, the demand for ventilators may outstrip the supply. Once efforts to shift demand or increase supply have been exhausted, clinicians may be put in the very difficult position of rationing this life-sustaining resource. The values and principles of these situations have been well outlined in the work of the University of Toronto Joint Centre for Bioethics (JCB) in their document Stand on Guard for Thee - Ethical considerations in preparedness planning for pandemic influenza, but it has been challenging to develop a practical method of implementing the values they describe.
We build on the values outlined by the JCB with addition of the very practical value of expediency. We outline also a protocol to maximize benefit from a limited resource during a crisis (ventilators in a flu pandemic) with a discussion that focuses on ethical and practical implementation.text/html2012-01-05T11:06:00+01:00http://www.webmedcentral.com/Mr. Donald B StouderClinical Bioethics in the Twenty First Century: An Integral Perspective
http://www.webmedcentral.com/article_view/2789
My hypothesis is that the dominant theory and practice of clinical bioethics ignores one or more fundamental perspectives or methodologies, and is therefore often incomplete and ineffective.Offered as a corrective are the integral theories of philosopher Ken Wilber, also known as the AQAL (All Quadrants All Levels) approach. Current debates within the field of clinical bioethics will be discussed and a system based on AQAL will be introduced which will provide a more inclusive, integral process for case consultations, policy development, and community education.text/html2013-02-09T11:44:26+01:00http://www.webmedcentral.com/Mr. Mohamed M NajimudeenEuthanasia
http://www.webmedcentral.com/article_view/971
Euthanasia or mercy killing is a sensational issue all over the world. Is it a clean murder Or is it to alleviate the sufferings of a dying patient who cannot be cured This argument continues from the time of Francis Bacon who lived in 17th century.Euthanasia is classified in many ways.1. Voluntary , Non-voluntary and involuntary Euthanasia
2. Active and passive euthanasia and
3. Positive and negative euthanasia.1. Voluntary euthanasia a. Voluntary euthanasia is defined as the death is caused with the consent of the patient. Voluntary euthanasia is legal in Belgium, Luxembourg, the Netherlands, Switzerland, and the U.S. states of Oregon and Washington. When the patient brings about his or her own death with the assistance of a physician, the term assisted suicide is often used instead. b. Non-voluntary euthanasia: The death is induced where the consent of the patient is not available. Examples include child euthanasia c. Involuntary euthanasia: The euthanasia conducted against the will of the patient 2. Active and passive euthanasia:a. Active euthanasia entails the use of lethal substances or forces to kill and is the most controversial means. An individual may use a euthanasia device to perform active voluntary euthanasia on himself or herself.b. Passive euthanasia: Passive euthanasia entails the withholding of common treatments, such as antibiotics, necessary for the continuance of life. Whether the administration of increasingly necessary, albeit toxic doses of opioid analgesia is regarded as active or passive euthanasia is a matter of moral interpretation, but in order to pacify doctors' consciences, it is usually regarded as a passive measure3 Positive and Negative EuthanasiaPositive euthanasia refers to the actions that actively causes death Negative euthanasia is withdrawing the life supports.Religious views:Islamic view: Killing a person in Islamic perspective amounts to death penalty. The duty of the doctor and the relatives to take care of a patient and not to kill a person. However if the doctor believes that the condition of the patient is terminal and the patient is suffering in agony, the doctor can withdraw the life support with the consent of the relatives.There is no place to give medications to kill a patient (1) The Christian stand on euthanasia has always been against any form of euthanasia or assisted suicide. Pope John Paul II wrote in The Gospel of Life, “ I confirm that euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a person. This doctrine is based on the natural law and upon the written word of God, is transmitted by the Church’s Tradition and taught by the ordinary and universal Magisterium.”(2) The whole concept of euthanasia is incompatible with the Hindu ethos. It should never be encouraged but rather other dignified and moral means to care for the terminally ill have to be employed.(3) "As a general rule, both Hinduism and Buddhism oppose suicide as an act of destroying life. However, a distinction is made in both traditions between self-regarding (or self-destructive) reasons and other-regarding (or compassionate) motives for seeking death... Those who assist in [a] suicide may be subject to karmic punishment, for they have violated the basic principle of ahimsa However, a very different perspective emerges when individuals seek death for spiritual motives, of which there are basically two kinds. The first revolves around compassion; concern for the welfare of others as one is dying can be seen as a sign of spiritual enlightenment. So a person can decide to forego treatment to avoid imposing a heavy burden of care giving on family or friends. He or she may also stop treatment to relieve loved ones of the emotional or economic distress of prolonged dying...(4)Why Euthanasia?Euthanasia will help to relieve the suffering of the patient and their relatives. If a patient is suffering in agony due to unbearable pain and the condition cannot be cured the patient and the relatives should have an alternative.Why not euthanasia?
This can be abused by doctors and relatives. Relatives with vested interests like wealth inheritance can easily influence a compassionate doctor. Some doctors may make” right to die” as” right to kill”Conclusion: When a patient is suffering from severe pain during the terminal illness the relations and the caring doctor should be able to decide without any vested interest. Die with dignity and right to kill are phrases for media discussion. Each case should be decided on its own merit without general cover uptext/html2013-05-11T07:42:32+01:00http://www.webmedcentral.com/Prof. Halvor NordbyEthics in Prehospital Emergency Medicine: An Ethical Dilemma in Patient Communication
http://www.webmedcentral.com/article_view/4247
Abstract: This case report discusses an ethical dilemma about consent and patient autonomy from prehospital emergency services. It is argued that the dilemma involves deep ethical problems, and that these problems have not received sufficient attention in the literature on the ethical dimension of emergency medicine and prehospital provider-patient communication. The discussion illustrates a general point: Focusing on ethics and communication falls under the more general task of elucidating non-technical skills. In recent years it has been widely recognized that non-technical skills are of crucial importance in emergency work and prehospital patient care (1, 2, 3). Knowledge of ethical caring frameworks is an essential element of non-technical skills, and such frameworks should therefore receive more attention in education and practice that aim to prepare emergency personnel for difficult situations.BackgroundThis article discusses an ethical dilemma experienced by two students in a national further education course for paramedics in Norway where one of the authors of this case report has been responsible for the module Ethics and communication. The two paramedics described the dilemma in conversation and, as they were uncertain about their conduct, asked for some comments about the ethical dimension of their actions.The case appeared to raise interesting questions about paramedics’ entitlement to put psychological pressure on patients. Consequently, it was recognized that it would be a good idea to analyze the situation as a case study. This was suggested to the paramedics who had experienced the case, and they consented to the project. They said that they believed that there should be more focus on ethics and communication in prehospital work, and that analyzes of dilemmas of the kind they experienced could lead to more focus on this area of emergency medicine. On the basis of the paramedics’ oral description of the situation, the case was initially written down. This transcribed description was shown to the paramedics, adjusted in the light of their comments and then rewritten in completely general terms. The purpose of doing a complete general rewriting was to make sure that the case description could not be traced to any specific location, person or circumstances. Thus, the case described below is not the actual dilemma experienced by the paramedics, but a typical imagined example of the kind of situation they experienced. By describing and analyzing the case on this kind of general type level, it is possible to arrive at substantial conclusions that fit a variety of cases that fall under the general dilemma that we describe.text/html2013-07-15T04:38:29+01:00http://www.webmedcentral.com/Dr. Gentian VyshkaPatient\'s Rights and End-of-Life Decisions: The Albanian Experience
http://www.webmedcentral.com/article_view/4335
As human beings we are bound up with the medical profession. It is certain that at some point in our life we rely on their help. Even if such help is avoided throughout life, some life activities involve recourse to medical care.
During the exercise of its activity the medical profession is faced with many ethical dilemmas, where the solution is not in the law, where choice and decision making become difficult in terms of ethics and where they must rely on their values and judgments. That’s why the involvement of the medical profession in everyone’s lives makes the understanding of the law governing the medical profession extremely important. Patient rights are part of human rights.
This article’s aim is to present one important patient right - the right to die. Whilst is accepted the increasing role of the medical profession in determining the shape of the law in medical care, this article focuses on understanding how different courts deal with cases involving the right to die. The article offers a framework on patient’s right to die in Albania, and the well-known international experience on the issue.text/html2018-03-19T05:33:37+01:00http://www.webmedcentral.com/Dr. Deepak GuptaI do not believe (have faith) in this: Can I say NO?: Future of Post-Hire Post-Market-Safety-Surveillance (PMSS) for Physicians
http://www.webmedcentral.com/article_view/5440
When the author had conceptualized post-hire Post-Market-Safety-Surveillance (PMSS) [1] for physicians in general and operating room personnel in particular wherein their co-workers and supporting staff may futuristically rate the individuals in question regarding how likely the rating personnel may consider the rated personnel medico-surgically managing their own selves or their next of kin, it was not considered what if the personnel do not have faith in this PROCESS of co-workers' and supporting staff's rating and choose to refuse it. The primary reasons to refuse rating their team members/leaders could be variable.
The first question is, "I do not believe (have faith) in this PROCEDURE: Can I say NO?" It is a genuine concern wherein the raters can refuse rating a procedure that they will NOT consider for themselves or their next of kin. However, the ethical question arises whether they can assist a procedure that they will not even consider for themselves or their next of kin. The answer would be that it is the patient's choice that matters. That is correct but the proceduralists too may choose to transfer out a patient if their choices do not match. However, the matching of choices has yet not percolated to the supporting medical staff including anesthesia care providers wherein the question for supporting medical staff still remains, "I do not believe (have faith) in this PROCEDURE: Can I say NO?" A controversial example of surgical procedure can be robotic-assisted diagnostic-only laparoscopy wherein some third-party payers (medical insurance providers) may put forth their feet down and say NO. A correspondingly controversial example of anesthetic procedure can be epidural analgesia being disfavored by some surgical teams because their past experiences with peri-operative epidural analgesia among their patients may prompt them to say NO.
The second question is, "I do not believe (have faith) in this PROCEDURE for this PATIENT: Can I say NO?" This is the common peri-operative question and one of the goals for comprehensive preoperative assessments by both operative and anesthetic teams. Patient-specific factors can make usually safe procedures potentially unsafe for specific patients and herein lies the decision-making burden on the teams to decide for/against a procedure in good faith taking into account the medical dilemma as well as the ethical dilemma. However, it is also valid to consider what the follow up consequences will be if either one or both teams say NO and decide against the performance of procedure. There can be three scenarios that can evolve: (a) the patients are managed with alternative medical/surgical options while they stay under the care of the same teams; or (b) the contradicting teams show resolve and partner with alternative collaborative teams to perform the procedures if the procedure rooms' scheduling processes allow these changes; or (c) the unsatisfied and un-resilient patients can choose to leave the care of the teams and find alternative operative and anesthetic teams on their own who can accommodate their wishes for the procedures despite patient-specific safety concerns raised by the original teams. An example of surgical procedure can be robotic-assisted laparoscopic procedure in steep Trendelenburg position in patients whose cardio-respiratory hemodynamics are intolerant to steep Trendelenburg position. An example of anesthetic procedure can be epidural analgesia in patients wherein there may be no clear-cut insertion guidelines if these patients are being preoperatively medicated with newly-introduced innovative anti-coagulants and anti-platelet agents.
The third and final question is, "I do not believe (have faith) in this PROCEDURE for this PATIENT by this PROCEDURALIST: Can I say NO?" This one is the most controversial avenue because it is NOT available to all in a balanced way with equal opportunities for unpretentious say. Operative teams may have been choosing their supporting staff including anesthetic teams (overtly or covertly), (a) to maintain cordial procedure-room atmospheres for assumingly safer-work environments by ensuring easy-to-work-with supporting personnel, and (b) for their patients' safety wherein their patient outcomes may warrant them to personally know their anesthetic teams' and supporting staff teams' proficiencies and efficiencies in regards to assisting their procedures. Although futuristic idea of post-hire PMSS may open up avenues for supporting staff members to follow their own personal convictions regarding assisting procedures, it is still a long way far ahead because the supporting staff members including the non-proceduralist anesthetic team members may be replaceable with more ease due to availability of alternatives/substitutes/replacements when required to assist a procedure as compared to their proceduralist-team counterparts who lead the execution of those procedures.
In summary, the informed choice by the consenting patient can be expanded and boosted by aware and educated dynamic inputs from the teams that include proceduralist members, supporting medical staff members as well as anesthesia care providers (either in the role of proceduralists themselves or just as supporting medical staff members). Probably depending on a choice for/against the PROCESS of co-workers and supporting staff rating their proceduralist team members per futuristic idea of post-hire PMSS1, it will be sometime before we can get firm answers for the evadable question "I do not believe (have faith) in this PROCEDURE/PATIENT/PROCEDURALIST/PROCESS: Can I say NO?"text/html2019-07-24T05:47:33+01:00http://www.webmedcentral.com/Dr. Deepak GuptaLegal death asks, \"What\'s in a name?\"
http://www.webmedcentral.com/article_view/5588
Legal death asks, “What’s in a name?” Before defining death, we must understand what life is and, after understanding life, we must ponder why we are defining death. Essentially, death is the time-point when the body, as a whole, is ready to begin its irreversible decomposition and decay so that the elements forming the body can return back to the nature. So, when death is body’s readiness, as a whole, to irreversibly decompose and decay, where does organ harvesting, retrieval and transplantation fit in this continuum? Whichever way medical science tries to define it, legal death for medical scenarios may not be death in actuality considering that herein legal death may have been only designed, defined, propagated and accepted so that (a) the whole heart and other organs can be considered ready to be harvested with body medically becoming ready for “abandonment” as soon as the artificial life support is withdrawn and (b) the medically futile draining of kin’s/payers’/system’s resources can be contained whenever the artificial life support systems essentially start evolving into artificially supporting non-salvageable-dying-bodies. Summarily, confusing usage of word “death” during legal death for medical scenarios may have to be removed from our medicine because the answer to the question “What’s in a name?” is “A name is a name is a name”.text/html2019-09-19T07:15:28+01:00http://www.webmedcentral.com/Dr. Deepak GuptaCOST CONSENT
http://www.webmedcentral.com/article_view/5594
In medicine, patients’ consent for their medical management has evolved as a core ethical principle. One question arises: How responsibly do the patients give consent for their medical management [1-2]? Then the question comes: How can the patients responsibly give consent when they are not fully aware of what costs they are bearing for their medical management until much later after the delivery of their healthcare when they get to know what their dues are and what their medical debts have become [3]? When the third party payers took over, our healthcare management had become a joyride and peace of mind for all of us until now because, just like when families eventually reach their limits and are forced to appropriate their expenditures, the third party payers are already getting on to their edges while pushing their limits to absorb the exorbitantly increasing healthcare expenditures [4-5]. It is understandable that when the core necessity for life is food, the rising healthcare expenditure may be alternatively called the booming healthcare business creating lots of jobs putting food on lots of plates. However, when considering from patients’ individualistic points-of-view, it is important to recognize that the time has come when the patients should be made aware of the costs of whatever they are consenting to and whatever their consented medical management may evolve into depending on the multiple factors including the iatrogenic factors. Thereafter, the consenting process will become more responsible and accountable. One never knows whether the utopic future of contained healthcare expenditure debts without curtailing healthcare business jobs may dawn when the regulatory power falls upon the patients’ shoulders and thus lies within their hands wherein they restart learning after all to responsibly consent for their medical management taking into account not only their own socioeconomic limits and their third party payers’ socioeconomic limits but also their societies’ socioeconomic limits.
The questions will continue to linger: What is the healthcare cost of patients’ consents for their medical management to their cost-bearing third party payers? Is separation of consenting party and paying party costing healthcare costs and raising them inadvertently? Who pays for human errors? Who covers the healthcare costs for patients’ mortality and morbidity [6-10]? What happens to the cost-bearing (or cost-sharing) when patients’ mortality and morbidity is iatrogenic? Do facilities automatically bear the costs of complications? Or do the third party payers bear the costs of complications? Or do the patients (and their kin in case of patients’ mortality) bear the costs of complications? What happens if the burden of costs is added to the consenting processes during the decision-making by the patients’ for their emergency medical management wherein time is the essence even though costs do not lose their essence eventually and completely? Will allowing exceptions’ rules for emergently consented patient-physician interactions or physician-ordered tests/procedures/prescriptions may instigate slippery slope for inducting exceptions’ rules in unclear and ill-defined emergencies to eventually revival of currently followed expectations of systems to not even share costs’ data before the consenting processes for elective patient-physician interactions or physician-ordered tests/procedures/prescriptions despite asking for pre-authorizations from the third party payers for the same or similar patient-physician interactions or physician-ordered tests/procedures/prescriptions? Will it be too burdensome as well as cumbersome for the modern digitalized world to generate daily updates of cumulative costs which the patients and their third party payers are incurring during the patients’ stay in the healthcare facilities? Will these costs’ information become too-much-information overwhelming the patients if they are regularly made aware of the daily costs incurred during their stay in the healthcare facilities? Will personal costs incurred coerce patients against their personal healthcare? Don’t the societal costs coerce societies taking actions against costly healthcare? Isn’t it all about the swinging pendulum aiming at elusive equilibrium wherein the societies initially thought that it was good to take over the cost-bearing responsibilities in order to shield the patients from the costs incurred during their healthcare but eventually the times are forcing them to reconsider and revisit sharing and delegating the economic responsibilities regarding patients’ healthcare back to the patients themselves so that they can collectively discuss and decide based on what the total costs are and how far they can bear those costs as responsible teams? In a nut-shell, there will always be ever-lingering questions but that should not deter the bottom line.
The bottom line should be that the patients should always be told the total costs of the consented patient-physician interactions or physician-ordered tests/procedures/prescriptions. The patients must then presume that X-amounts may be paid on behalf of them by their third party payers while they themselves will have to pay (co-pay) Y-amounts; Z-amounts from the total cost may be forgiven by the facilities/physicians depending on their negotiations with them or their third party payers. Essentially, even though the total costs (X+Y+Z) for the consented patient-physician interactions or physician-ordered tests/procedures/prescriptions may be pre-determined and pre-fixed, the individual components (X, Y, Z) may vary secondary to almost always bilateral negotiations among the three parties (patients, their healthcare facilities/physicians and their third party payers) superseding almost non-existent multilateral negotiations. Some patients may say that this disclosure of costs may coerce them while making their healthcare decisions while some patients may say that this disclosure of costs may make their healthcare decisions more responsible.
Summarily, healthcare has been, is and will always be self-paid [11-12]. When the patients consent after considering all the costs even when the consenting patients are not the primary healthcare cost-bearing entities, the patients are realizing that even though their third party payers are the primary cost-bearing entities, the patients themselves as integral constituents of their societies are the cost-bearing entities eventually and thus responsible for appropriate appropriations of their healthcare expenditures not only individually as responsible patients but also collectively as responsible societies.text/html2020-12-03T07:27:53+01:00http://www.webmedcentral.com/Dr. Deepak GuptaConscientious Objection to The Necessity of Unnecessary Healthcare Bubble
http://www.webmedcentral.com/article_view/5668
Sommer et al. should be congratulated for exploring multifaceted effects on patients secondary to cancellations/postponements of interventions [1]. However, the follow-up question should have been: If non-emergency interventions’ completion had been necessary within a certain stipulated time frames, they might not have been canceled/postponed beyond those time frames. Doesn’t this imply that canceled/postponed interventions might not have been necessary within those time frames considering that they had been allowed to get canceled/postponed? Isn’t the primary concern for patients physical suffering due to cancellations/postponements? Isn’t the primary concern for providers economical suffering due to cancellations/postponements? The psychological-social-spiritual suffering due to cancellations/postponements might be difficult to quantify when conflicted dilemmas of quantifying evaluators (patients, providers and payers) cannot be ruled out. The conflicted dilemma for patients has evolved with patients themselves becoming the product considering that their direct payments for their healthcare are meager, if any, in the third-party payer systems. The conflicted dilemma for providers has evolved with them turning oblivious to the costs of their services borne by patients and payers in the third-party payer systems [2-3]. The conflicted dilemma for third party payers is how to balance preventative services for at-risk population draining them by the sheer numbers which need coverage vs. curative/palliative services for the diseased few draining them by the exorbitant costs as entailed in modern therapeutics.
Conscientious objection is an inevitable consequence of this dilemma because what seems unnecessary to some seems necessity to others [4-5]. Whether it is war or medicine, the conscientious objectors are awakening society to gauge the necessity of anything which has evolved to be accepted as necessary. Concurrently, the society expects conscientious objectors to understand that war and medicine may remain necessary until conscientious objectors achieve a critical mass forcing society to reevaluate the necessities which have gotten society tethered to them leaving the society no other option but to keep waging unnecessary battles or promoting unnecessary interventions to sustain its economy revolving around wartime or iatrogenic activities. It may seem ironic to talk about war and medicine in the same breath but both may seemingly intend to save lives most of the times and may still inadvertently cost lives some of the times while in the interim, both are reshaping the economy always without ever being economical. Therefore, the conscientious objectors should be considered as checkpoints needed to keep a check on unnecessary necessities overwhelming the society.
Summarily, until and unless indigenous and exotic healthcare bubbles learn to adapt based on the experiences of indigenous and exotic litigation bubbles [6-16], society is stuck between a rock and a hard place because necessity used to necessitate inventions but now inventions have started to invent necessities.text/html2022-02-22T04:26:44+01:00http://www.webmedcentral.com/Dr. Deepak GuptaJust Like HeLa Cells, Who Owns Banked Biomes?
http://www.webmedcentral.com/article_view/5769
We grew up in developing countries and knew only about blood “component” banks. Then we moved to a developed country and were introduced to tissue “sperm” banks. Now we are expecting that the developed group of nations may be looking up to the developing group of nations for filling up poop “biome” banks [1-3] unless the developing group of nations becomes developed too fast turning their populations’ ancient biomes too modern and thus worthless for banking. It may be good time to learn from history that just like component and sperm, biome owned by its producer may be a sought-after commodity [4-5] which others may need to better their health. The recipients may be willing to pay for biomes because life-styles of healthier biomes’ owners are difficult to emulate as recipients' life-histories and life-styles have not allowed recipients’ bodies to develop healthy biomes on their own [6]. Now the question arises whether we are objectifying and monetizing not only our cells but also our wastes as well.
First, we must start accepting that excreted biomes are not wastes to abhor but represent inner ecosystems to adore. Henceforth, transactional objectivity with corresponding monetary activity may ensure checks and balances in this evolving future wherein not only what we own as our cells can be put to good use for others but also whom we home as our biomes can be used to alleviate suffering in others. Subsequently, whether one is sharing biomes with a local bank or the global vault, whether the one who is sharing biomes is a naïve native or a shrewd capitalist, and whether or not one is sharing information with recipient about one's life-history and life-style so that the recipient can emulate maintenance of healthier inner ecosystem with transplanted one’s biome, life-changing biomes may be assumed as figuratively priceless as "immortal" HeLa cells [7-8].
Summarily, when one signs over one's biome to bank or vault, one must realize that one is sharing one's signature product which one's body as a machine has tediously developed over a lifetime checking and balancing its inner and outer ecosystems.text/html2022-12-05T00:39:38+01:00http://www.webmedcentral.com/Dr. Deepak GuptaAffiliation For Publication: Requirement Or Optional
http://www.webmedcentral.com/article_view/5805
Hippocrates of Kos, Father of Medicine, published theories and practices. The question is whether he documented affiliation to any ancient institution as pre-requirement before publication unless he himself rose to such status that his name had become an institution in itself. Alternatively, ancient institutions in their infancy might have been too young to rein in ancient authors. Moreover, ancient authors might have been loner pioneers actually giving birth and thence nurturing those infant-aged ancient institutions. Fast-forward two millenniums, Bernardus Carnotensis [1] allegedly quoted nanos gigantum humeris insidentes [2] to suggest modern dwarfs riding on ancient giants. Analogously, modern academics may have grown exponentially while drawing on much larger institutional investment and more powerful peer feedback as compared to what their ancient predecessors might have depended on. Thus, the question now becomes whether anyone without affiliation [3] can publish to document theories and practices and whether anyone with affiliation can forgo disclosure of affiliation to publish independently developed theories and independently finessed practices. The counterargument can be that none can be perfectly independent when developing theories or finessing practices especially when modern academic physicians are employed to innovate while overseeing multidisciplinary research teams plus teaching plethora of students and treating diverse patient population. This opportune era has become possible secondary to institutions hands-down outgrowing at faster rate with wider reach thus outpacing and outperforming loner pioneers’ individualistic growth. However, when authors may not be acknowledging their own lives or their families wherein their seen-heard-felt life-family experiences too may be contributing by seeding publishable theories and inspiring designable practices, the documentation of affiliation by authors may be optional rather than required especially when authors may have envisaged theories and/or reshaped practices while experiencing life inside as well as outside institutions unless documentation of affiliations may only be for the sake of disclosing conflicts of interest [4].