Medical Ethics Advisor – October 1, 2020
October 1, 2020
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The Wide Variability in Ethics Consult Mandates
Only half of hospitals have put any policies in place mandating ethics consults in certain situations, according to a recent analysis. These policies share few common features.
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Race Disparities Identified in End-of-Life Care
Minority patients receive more aggressive end-of-life interventions than white patients, according to the authors of a recent study. The answer has to do, in part, with the history of maltreatment of vulnerable populations. Some minority patients, or their family members, have been the recipients of substandard medical care.
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Lack of Ethical Leadership Can Be Source of Moral Distress
Ethical leadership requires perspectives of all stakeholders be considered. If managers do not actively encourage staff to offer input, people are going to be reluctant or unwilling to voice concerns.
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Many Ethics Services Need Better Information on Volume
Researchers found inconsistencies in the way ethics consult volume was reported, which made estimates of growth over time inaccurate. These investigators created a methodology to allow many more factors to be weighed, which could lead to a more accurate estimate of how many consults ethics services should be performing.
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Unnecessary Restraint and Seclusion of Psychiatric Patients Is Ethical Concern
Violation of patient autonomy and the possibility of harming people (physically or psychologically) are major ethical concerns. But there are no recommendations quantifying what is considered an unacceptably high rate of seclusion or restraint. Without such guidelines, outlier facilities may not even realize their practices are outside the norm.
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Data Show Mistreatment of Medical Students Is Common
It is hard to say if the problem is worse, or if residents are just reporting it more. Regardless, this is a longstanding problem, but few effective solutions or prevention tactics have been implemented.
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End-of-Life Experience Varies Depending on Geographical Region
Investigators were surprised by the striking degree to which the use of hospitalization and hospice varied across the United States, even among large metropolitan areas.
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ICU Nurses Feel Marginalized During Ethical Conflicts
A pair of researchers analyzed open-ended responses from a survey with ICU nurses, and identified three themes.
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Sepsis Outcomes Improve, But Not at Minority-Serving Hospitals
ICU deaths declined 2% steadily annually at non-minority hospitals, according to a recent report. This was not true of minority-serving hospitals. Those hospitals also reported longer lengths of stay and more critical illness than non-minority hospitals.