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Medical decisionmaking

Philipp Kellmeyer, Thomas Cochrane, Oliver Müller, Christine Mitchell, Tonio Ball, Joseph J Fins, Nikola Biller-Andorno
Closed-loop medical devices such as brain-computer interfaces are an emerging and rapidly advancing neurotechnology. The target patients for brain-computer interfaces (BCIs) are often severely paralyzed, and thus particularly vulnerable in terms of personal autonomy, decisionmaking capacity, and agency. Here we analyze the effects of closed-loop medical devices on the autonomy and accountability of both persons (as patients or research participants) and neurotechnological closed-loop medical systems. We show that although BCIs can strengthen patient autonomy by preserving or restoring communicative abilities and/or motor control, closed-loop devices may also create challenges for moral and legal accountability...
October 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Debjani Mukherjee
Mr. Hope's family's expectations and his staff's concerns raise important issues about surrogate decisionmaking, communication regarding prognosis, and staff angst. Unfortunately, Mr. Hope himself is unable to reliably understand and communicate his preferences, especially for complex medical decisions, so the ethics consultant is left to negotiate the disagreement between his family and his healthcare providers, who presumably both believe they are acting in his best interest.
July 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Tyler S Gibb, Michael J Redinger
In its simplest interpretation, this is a case about goals of care and appropriate code status. At the outset, we must confess that we found this case to be extremely interesting-not for the novelty of the issues or its ethical complexity but because it is truly a case of the ordinary. Too often when teaching or discussing clinical ethics cases, we are distracted by the exotic and the unusual and ignore the mundane cases that every practicing clinical ethicist must be able to competently manage. 1,2,3.
July 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Catherine A Marco, Arvind Venkat, Eileen F Baker, John E Jesus, Joel M Geiderman
Prescription drug monitoring programs are statewide databases available to clinicians to track prescriptions of controlled medications. These programs may provide valuable information to assess the history and use of controlled substances and contribute to clinical decisionmaking in the emergency department (ED). The widespread availability of the programs raises important ethical issues about beneficence, nonmaleficence, respect for persons, justice, confidentiality, veracity, and physician autonomy. In this article, we review the ethical issues surrounding prescription drug monitoring programs and how those issues might be addressed to ensure the proper application of this tool in the ED...
May 13, 2016: Annals of Emergency Medicine
Małgorzata Szeroczyńska, Marek Czarkowski, Małgorzata Krajnik, Romuald Krajewski, Leszek Pawłowski, Anna Adamczyk, Agnieszka Barczak-Oplustil, Piotr Aszyk, Andrzej Kobyliński, Tomasz Pasierski, Piotr Sobański, Wojciech Bołoz On Behalf Of The Polish Working Group On End-Of-Life Ethics
INTRODUCTION In numerous countries legislation has been put in place allowing citizens to appoint persons authorized to make medical decisions on their behalf, should the principal lose such decision‑making capacity. OBJECTIVES The paper aimed to prepare a draft proposal of legal regulations introducing into Polish legislation the institution of the health care agent. PATIENTS AND METHODS The draft proposal has been grounded in 6 expertise workshops, in conjunction with several online debates. RESULTS The right to appoint a health care agent should apply to all persons of full legal capacity, and to minors over 16 years of age...
May 5, 2016: Polskie Archiwum Medycyny Wewnętrznej
(no author information available yet)
The medical team found the patient to lack medical decisionmaking capacity. However, the team felt that the patient was still able to respond appropriately to some situations. KS had displayed a consistent refusal of all medical treatments that made her uncomfortable or caused pain. During her sister's visits, the patient would be much more receptive to eating. A meeting was planned with the patient's sister in which the ethicist explained that the patient was not able to make her own decisions. The patient's sister agreed that she would honor the patient's wishes but would let the team make any decisions outside of what she knew about the patient's preferences...
April 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Ruaim Muaygil
This case presents several fundamental ethical issues. The first issue is the patient's refusal of treatment (a nasogastric tube [NGT] insertion). Second, the patient's refusal of a seemingly beneficial treatment, combined with her medical history, ultimately necessitates an assessment of her decisionmaking capacity. Third, the sister's reluctance to participate in decisionmaking requires a discussion of appropriate surrogate decisionmakers. Finally, the main ethical component to this case is a cultural one, which should be addressed appropriately...
April 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Shilpa Shashidhara
This case illustrates the dilemma that occurs when a patient refuses treatment. When a patient refuses recommended interventions, it can cause much distress among the medical team and family. On the surface, the ethical issue appears to be in regard to treatment refusal. However, when we look deeper, it becomes evident that the question is truly about whether the patient has the ability to make this treatment decision, given her worsening dementia, recent hemorrhage, and depression. In this case, an essential component of an ethics consultation would be to assess this patient's decisionmaking capacity to determine if her refusals are informed...
April 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Ruchika Mishra
KS is a 76-year-old Burmese woman who presented to the hospital with right-sided weakness that had begun two days prior. Although KS had been diagnosed earlier with dementia and had a medical history of stroke, she was living at a nursing home and was able to walk on her own and use her right arm to feed herself. Since her last stroke three years ago, she had also developed aphasia, and her speech has been minimal. During her current hospitalization, KS was found to have a cerebral hemorrhage, but after consultation with neurosurgery, the team determined that no medical interventions were available, and a higher level of care was not required...
April 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Kim J Overby, Joseph J Fins
In 1996, Sandra Jensen became the first person with Down syndrome to receive a heart-lung transplant. Although it took place almost 20 years ago, her experience continues to shed light on contemporary challenges that individuals with neurodevelopmental disorders face in securing access to transplantation. While overt discrimination has decreased, barriers persist in physician referrals, center-specific decisionmaking regarding wait-listing, and the provision of accommodations for optimizing the assessment and medical management of these individuals...
April 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Jeanne Snelling
Use of the best-interests test as the legal standard to justify medical treatment (or its cessation) in respect to legally incompetent adults or minors has come under sustained critique over the years. "Best interests" has variously been alleged to be indeterminate as well as susceptible to majoritarian ideology and inherent bias. It has also been alleged to be inferior to rights-based approaches. Against the background of several particularly hard cases involving minors discussed by Gillett in a prior article in this journal, this article considers some of these critiques...
January 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Hui-Lian Che, Mei-Yu Yeh, Ru-Shang Jiang, Shu-Mei Wu
Taiwanese nurses face increasingly demanding working conditions along with a distinctive culture where family members participate in medical decisionmaking. This research explores Taiwanese nurses' perceptions of patient education, with a focus on the difficulties. Data were collected by in-depth focus group discussions with nursing staff (n=53) from the medical and surgical wards of two teaching hospitals. Transcripts were analyzed and revealed six themes: source of fulfillment and pressure; excessive workload; alternating between patients; not knowing who to teach; difficulty in communication; and disrupted confidence and work rhythm...
March 2016: Nursing & Health Sciences
Alexander T Janke, Daniel L Overbeek, Keith E Kocher, Phillip D Levy
Clinical research often focuses on resource-intensive causal inference, whereas the potential of predictive analytics with constantly increasing big data sources remains largely unexplored. Basic prediction, divorced from causal inference, is much easier with big data. Emergency care may benefit from this simpler application of big data. Historically, predictive analytics have played an important role in emergency care as simple heuristics for risk stratification. These tools generally follow a standard approach: parsimonious criteria, easy computability, and independent validation with distinct populations...
February 2016: Annals of Emergency Medicine
B Jessie Hill
Children have a constitutional right to bodily integrity. Courts do not hesitate to vindicate that right when children are abused by state actors. Moreover, in at least some cases, a child's right to bodily integrity applies within the family, giving the child the right to avoid unwanted physical intrusions regardless of the parents' wishes. Nonetheless, the scope of this right vis-à-vis the parents is unclear; the extent to which it applies beyond the narrow context of abortion and contraception has been almost entirely unexplored and untheorized...
April 2015: Duke Law Journal
Bernice A Pescosolido, Sigrun Olafsdottir
Culture has long affected individuals' response to problems. A classic puzzle in the sociology of health and illness is discrepancy between theory and research regarding cultural beliefs and knowledge of medical care service use. "Utilization research," examining individuals' responses to the onset of health problems, has not consistently affected culture on the uptake of formal treatment. First, while ethnographic research often describes how culture shapes illness behaviors, survey-based studies rarely find significant beliefs or predispositions once "need" is controlled...
December 2010: Sociological Forum
Ira Byock, Amy Lynn Sorrel
California palliative care specialist, author, and consultant Ira Byock, MD, calls the issues surrounding end-of-life care "a public health crisis." But he says many of the same solutions to improving the health care system overall - shared decisionmaking, advancements in medical education, better payment and delivery structures - apply equally to this area of medical care. Dr. Byock is the General Session keynote speaker at TexMed 2015 in May.
April 2015: Texas Medicine
Erika G Martin, Roderick H MacDonald, Lou C Smith, Daniel E Gordon, James M Tesoriero, Franklin N Laufer, Shu-Yin J Leung, Daniel A O'Connell
A recent New York law requires medical providers to offer HIV tests as part of routine care. We developed a system dynamics simulation model of the HIV testing and care system to help administrators understand the law's potential epidemic impact, resource needs, strategies to improve implementation, and appropriate outcome indicators for future policy evaluations once postlaw data become available. Policy modeling allowed us to synthesize information from numerous sources including quantitative administrative data sets and practitioners' content expertise, structure the information to be viewed both numerically and visually, and organize consensus for decisionmaking purposes...
2015: Journal of Policy Analysis and Management
Ben A Rich
Recently the scope of protections afforded those healthcare professionals and institutions that refuse to provide certain interventions on the grounds of conscience have expanded, in some instances insulating providers (institutional and individual) from any liability or sanction for harms that patients experience as a result. With the exponential increase in the penetration of Catholic-affiliated healthcare across the country, physicians and nurses who are not practicing Catholics are nevertheless required to execute documents pledging to conform their patient care to the Ethical and Religious Directives for Health Care Services as a condition of employment or medical staff privileges...
April 2015: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Amitai Ziv, Rachet Talmi, Meirav Gary-Cohen, Wendy Chen
This editorial is in response to Bar-Sela, Bentur, Schultz and Corn's article entitled "Spiritual care in hospitals and other healthcare settings in Israel--a profession in the making", published in Harefuah in May 2014. The integration of spiritual support into hospitals marks an interesting trend in light of the current emphases in the Israeli medical system on technological advancement, financial feasibility and quantifiable quality measures. This step is evidence of the importance still attached by policy and decisionmakers to those human aspects of illness and disease, which are difficult to define and measure...
November 2014: Harefuah
John Wallace, Charles Byrne, Mike Clarke
OBJECTIVE: Little is known about the barriers, facilitators and interventions that impact on systematic review uptake. The objective of this study was to identify how uptake of systematic reviews can be improved. SELECTION CRITERIA: Studies were included if they addressed interventions enhancing the uptake of systematic reviews. Reports in any language were included. All decisionmakers were eligible. Studies could be randomised trials, cluster-randomised trials, controlled-clinical trials and before-and-after studies...
2014: BMJ Open
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