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Ewan C Goligher, E Wesley Ely, Daniel P Sulmasy, Jan Bakker, John Raphael, Angelo E Volandes, Bhavesh M Patel, Kate Payne, Annmarie Hosie, Larry Churchill, Douglas B White, James Downar
OBJECTIVE: Many patients are admitted to the ICU at or near the end of their lives. Consequently, the increasingly common debate regarding physician-assisted suicide and euthanasia holds implications for the practice of critical care medicine. The objective of this article is to explore core ethical issues related to physician-assisted suicide and euthanasia from the perspective of healthcare professionals and ethicists on both sides of the debate. SYNTHESIS: We identified four issues highlighting the key areas of ethical tension central to evaluating physician-assisted suicide and euthanasia in medical practice: 1) the benefit or harm of death itself, 2) the relationship between physician-assisted suicide and euthanasia and withholding or withdrawing life support, 3) the morality of a physician deliberately causing death, and 4) the management of conscientious objection related to physician-assisted suicide and euthanasia in the critical care setting...
February 2017: Critical Care Medicine
Daniel P Sulmasy
Arguments against physicians' claims of a right to refuse to provide tests or treatments to patients based on conscientious objection often depend on two premises that are rarely made explicit. The first is that the protection of religious liberty (broadly construed) should be limited to freedom of worship, assembly, and belief. The second is that because professions are licensed by the state, any citizen who practices a licensed profession is required to provide all the goods and services determined by the profession to fall within the scope of practice of that professional specialty and permitted by the state, regardless of any personal religious, philosophical, or moral objection...
January 2017: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Daniel P Sulmasy, John M Travaline, Louise A Mitchell, E Wesley Ely
This article is a complement to "A Template for Non-Religious-Based Discussions Against Euthanasia" by Melissa Harintho, Nathaniel Bloodworth, and E. Wesley Ely which appeared in the February 2015 Linacre Quarterly. Herein we build upon Daniel Sulmasy's opening and closing arguments from the 2014 Intelligence Squared debate on legalizing assisted suicide, supplemented by other non-faith-based arguments and thoughts, providing four nontheistic arguments against physician-assisted suicide and euthanasia: (1) "it offends me"; (2) slippery slope; (3) "pain can be alleviated"; (4) physician integrity and patient trust...
August 2016: Linacre Quarterly
Daniel P Sulmasy, E Wesley Ely, Charles L Sprung
No abstract text is available yet for this article.
October 18, 2016: JAMA: the Journal of the American Medical Association
Lois Snyder Sulmasy, Carrie A Horwitch
No abstract text is available yet for this article.
September 27, 2016: JAMA: the Journal of the American Medical Association
Kyle E Karches, Daniel P Sulmasy
Medical educators and powerful physician organizations agree on the importance of professionalism for the formation of good physicians. However, the many definitions of professionalism found in the literature lack content and differ significantly, undermining attempts to describe and implement professionalism curricula. The work of the contemporary moral philosopher Alasdair MacIntyre on the virtues may help provide some of the content that the concept of professionalism currently lacks. MacIntyre shows the importance of the virtues, particularly justice, courage, and truthfulness, for the success of any "practice," defined as a form of cooperative human activity...
July 2016: Family Medicine
Grace W K Ho, Lauren Skaggs, Gayane Yenokyan, Anela Kellogg, Julie A Johnson, Mei Ching Lee, Katherine Heinze, Mark T Hughes, Daniel P Sulmasy, Joan Kub, Peter B Terry, Alan B Astrow, Jing Zheng, Lisa Soleymani Lehmann, Marie T Nolan
OBJECTIVE: There is a growing body of literature describing the characteristics of patients who plan for the end of life, but little research has examined how caregivers influence patients' advance care planning (ACP). The purpose of this study was to examine how patient and caregiver characteristics are associated with advance directive (AD) completion among patients diagnosed with a terminal illness. We defined AD completion as having completed a living will and/or identified a healthcare power of attorney...
May 30, 2016: Palliative & Supportive Care
Mei Ching Lee, Daniel P Sulmasy, Joseph Gallo, Joan Kub, Mark T Hughes, Stuart Russell, Anela Kellogg, Sharon G Owens, Peter Terry, Marie T Nolan
INTRODUCTION: Many patients with advanced heart failure (HF) experience the life-extending benefits of implantable cardioverter-defibrillators (ICD), but at the end stage of HF, patients may experience shocks with increasing frequency and change the plan for end-of-life (EOL) care including the deactivation of the ICD. This report describes family members' experiences of patients with ICD making decisions at EOL. Understanding the decision-making of patients with ICD at EOL can promote informed decision-making and improve the quality of EOL care...
March 31, 2016: American Journal of Hospice & Palliative Care
Lynn A Jansen, Daruka Mahadevan, Paul S Appelbaum, William M P Klein, Neil D Weinstein, Motomi Mori, Racky Daffé, Daniel P Sulmasy
BACKGROUND: Prior research has identified unrealistic optimism as a bias that might impair informed consent among patient-subjects in early-phase oncology trials. However, optimism is not a unitary construct; it also can be defined as a general disposition, or what is called dispositional optimism. The authors assessed whether dispositional optimism would be related to high expectations for personal therapeutic benefit reported by patient-subjects in these trials but not to the therapeutic misconception...
April 15, 2016: Cancer
Daniel P Sulmasy
This article traces the history of the concept of dignity in Western thought, arguing that it became a formal Catholic theological concept only in the late nineteenth century. Three uses of the word are distinguished: intrinsic, attributed, and inflorescent dignity, of which, it is argued, the intrinsic conception is foundational. The moral norms associated with respect for intrinsic dignity are discussed briefly. The scriptural and theological bases for adopting the concept of dignity as a Christian idea are elucidated...
February 8, 2016: Medicine, Health Care, and Philosophy
Lois Snyder Sulmasy, Daniel P Sulmasy
No abstract text is available yet for this article.
March 15, 2016: Annals of Internal Medicine
Jiayun Xu, Marie T Nolan, Katherine Heinze, Gayane Yenokyan, Mark T Hughes, Julie Johnson, Joan Kub, Carrie Tudor, Daniel P Sulmasy, Lisa Soleymani Lehmann, Joseph J Gallo, Felicia Rockko, Mei Ching Lee
PURPOSE: National reports on end-of-life symptom management reveal a gap in the evidence regarding symptoms other than pain and studies of diseases other than cancer. This study examines the frequency and severity of symptoms and quality of life (QOL) in persons with advanced cancer, amyotrophic lateral sclerosis (ALS), and congestive heart failure (CHF). METHODS: The present study is a cross-sectional examination of symptoms and QOL measured using the McGill QOL Questionnaire, among 147 participants...
November 2015: Applied Nursing Research: ANR
Martha Abshire, Jiayun Xu, Cheryl Dennison Himmelfarb, Patricia Davidson, Daniel Sulmasy, Joan Kub, Mark Hughes, Marie Nolan
AIMS AND OBJECTIVES: The purpose of this study was to consider how fear and symptom experience are perceived in patients with heart failure at the end of life. BACKGROUND: Heart failure is a burdensome condition and mortality rates are high globally. There is substantive literature describing suffering and unmet needs but description of the experience of fear and the relationship with symptom burden is limited. DESIGN: A convergent mixed methods design was used...
November 2015: Journal of Clinical Nursing
Hilary Daniel, Lois Snyder Sulmasy
Telemedicine-the use of technology to deliver care at a distance-is rapidly growing and can potentially expand access for patients, enhance patient-physician collaboration, improve health outcomes, and reduce medical costs. However, the potential benefits of telemedicine must be measured against the risks and challenges associated with its use, including the absence of the physical examination, variation in state practice and licensing regulations, and issues surrounding the establishment of the patient-physician relationship...
November 17, 2015: Annals of Internal Medicine
Kyle E Karches, Daniel P Sulmasy
The 2010 guidelines regarding management of cardiovascular implantable electronic devices (CIEDs) conclude that patient requests to deactivate these devices at the end of life should be honored. Nevertheless, many clinicians and patients report feeling uncomfortable discontinuing such therapies, particularly pacemakers. If the principles of clinical ethics are followed, turning off CIEDs at the end of life is morally permissible. Clinicians managing CIEDs should discuss the option of deactivation with the patient at the time of implantation and be prepared to reopen the question as warranted by the patient's clinical course and respect for the patient's authentic values...
September 2015: Cardiac Electrophysiology Clinics
Pallavi Galera, Stefanie Haynes, Paula Sulmasy, Jeffrey A Bailey, Mindy Greene, Michelle Vauthrin, Doreen Brettler, James Liebmann, J Mark Madison, Robert Weinstein
Therapeutic leukapheresis can control the white blood cell count (WBC) of pregnant women with chronic myelogenous leukemia (CML) who have hyperleukocytosis without leukostasis. The medical justification for this treatment has not been objectively documented. We report a 27-year-old woman, diagnosed with CML at 10-week gestation, who developed severe dyspnea on exertion. A workup that included chest CT and echocardiography with a bubble study detected no cardiopulmonary pathology to explain her symptoms, and thus she was referred for leukapheresis...
August 2016: Journal of Clinical Apheresis
Micah T Prochaska, Daniel P Sulmasy
Physician recommendations have historically been a part of shared decision making. Recent literature has challenged the idea that physician recommendations should be part of shared decision making at the end of life, particularly the making of recommendations to surrogates of incapacitated patients. Close examination of the studies and the available data on surrogate preferences for decisional authority at the end of life, however, provide an empirical foundation for a style of shared decision making that includes a physician recommendation...
November 2015: Journal of Pain and Symptom Management
Kelly Wolenberg, Daniel Kim, Farr Curlin, Daniel Sulmasy
No abstract text is available yet for this article.
May 2015: Academic Medicine: Journal of the Association of American Medical Colleges
Daniel P Sulmasy, Lois Snyder Sulmasy
No abstract text is available yet for this article.
September 2015: Journal of Medical Ethics
Pallavi Galera, Hannah C Martin, Linda Welch, Paula Sulmasy, Jan Cerny, Mindy Greene, Michelle Vauthrin, Jeffrey A Bailey, Robert Weinstein
Sirolimus is an immunosuppressant used to prevent graft versus host disease in allogeneic hematopoietic stem cell transplant recipients. It has a large volume of distribution (12 ± 7.5 l/kg) and within the intravascular space ∼95% of it is bound to red blood cells. Because of potential toxic effects at high trough levels, therapeutic drug monitoring is recommended for sirolimus. We present a case of severe hepatic dysfunction due to Hepatitis B and sirolimus toxicity, in a 51-year-old male stem cell transplant recipient...
December 2015: Journal of Clinical Apheresis
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