Alexis C. Madrigal, writing for The Atlantic: If the recent numbers are any indication, there is a bloodbath in digital media this year. Publishers big and small are coming up short on advertising revenue, even if they are long on traffic. […] In a print newspaper or a broadcast television station, the content and the distribution of that content are integrated. The big tech platforms split this marriage, doing the distribution for most digital content through Google searches and the Facebook News Feed. And they’ve taken most of the money: They’ve “captured the value” of the content at the distribution level. Media companies have no real alternative, nor do they have competitive advertising products to the targeting and scale that Facebook and Google can offer. Facebook and Google need content, but it’s all fungible. The recap of a huge investigative blockbuster is just as valuable to Google News as an investigative blockbuster itself. The former might have taken months and costs tens of thousands of dollars, the latter a few hours and the cost of a young journalist’s time. That’s led many people to the conclusion that supporting rigorous journalism requires some sort of direct financial relationship between publications and readers. Right now, the preferred method is the paywall. The New York Times has one. The Washington Post has one. The Financial Times has one. The Wall Street Journal has one. The New Yorker has one. Wired just announced they’d be building one. (Editor’s note: CNN is building a paywall, too.) Many of these efforts have been successful. Publications have figured out how to create the right kinds of porosity for their sites, allowing enough people in to drive scale, but extracting more revenue per reader than advertising could provide.

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Source: Slashdot – Prepare for the New Paywall Era

A real-life case study, published on New England Journal of Medicine, documents the ethical dilemma that a Florida hospital faced after a 70-year-old unresponsive patient arrived at the hospital. The medical staff, the journal notes, was taken aback when it discovered the words “DO NOT RESUSCITATE” tattooed onto the man’s chest. Furthermore, the word “NOT” was underlined with his signature beneath it. The patient had a history of chronic obstructive pulmonary disease, diabetes mellitus, and atrial fibrillation. Confused and alarmed, the medical staff chose to ignore the apparent DNR request — but not without alerting the hospital’s ethics team, which had a different take on the matter. From the report: We initially decided not to honor the tattoo, invoking the principle of not choosing an irreversible path when faced with uncertainty. This decision left us conflicted owing to the patient’s extraordinary effort to make his presumed advance directive known; therefore, an ethics consultation was requested. He was placed on empirical antibiotics, received intravenous fluid resuscitation and vasopressors, and was treated with bilevel positive airway pressure. After reviewing the patient’s case, the ethics consultants advised us to honor the patient’s do not resuscitate (DNR) tattoo. They suggested that it was most reasonable to infer that the tattoo expressed an authentic preference, that what might be seen as caution could also be seen as standing on ceremony, and that the law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interests. A DNR order was written. Subsequently, the social work department obtained a copy of his Florida Department of Health “out-of-hospital” DNR order, which was consistent with the tattoo. The patient’s clinical status deteriorated throughout the night, and he died without undergoing cardiopulmonary respiration or advanced airway management.

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Source: Slashdot – An Unconscious Patient With a ‘DO NOT RESUSCITATE’ Tattoo