Medical Ethics Advisor – December 1, 2020
December 1, 2020
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Families Are Confused, Skeptical About ‘Inappropriate’ Treatment
Many, if not most, ethics consults involve conflicts over withdrawal of life-sustaining treatment at the end of a patient’s life. Yet families are likely to be quite confused by commonly used terms such as “futile” and “potentially inappropriate.”
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Communicate Collaboratively Before End-of-Life Care Conversations Disintegrate
Once communication breaks down, it is difficult to rebuild. Clinicians, ethicists, and palliative care all should be talking to each other to be sure the family hears a common message.
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Physicians Reported Moral Distress About Surrogate Decision-Makers
Parties clash regarding comfort levels and how aggressive treatment should be. The lack of advance directives for so many patients exacerbates the problem. Nurses and other colleagues can join the conversations to assist or outright substitute for physicians who are unwilling or unable to engage deeply.
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Genomic Results by Mail Might Leave People with More Questions Than Answers
Genomic results may oversimplify complex concepts, and patients may be without clinical experts who can properly fill in the gaps.
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End-of-Life Care Should Not Vary Depending on Provider
Clinicians must be careful about imposing medical staff priorities over patients’ priorities. Making presumptions is dangerous. Ethicists can help by explaining the provider’s responsibility to offer accurate information.
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Ethical Guidance Needed if Researchers Identify Diagnostic Errors
Clinicians know there is a clear ethical obligation to disclose errors to patients. However, the individual who finds a diagnostic error may not be a clinician in direct contact with the patient. Instead, it might be a researcher who is reviewing a chart long after a patient was discharged. What are researchers’ ethical obligations if they find an error no one else had discovered?
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Revised Policy on Organ Transplants for Children with Disabilities Targets Discrimination
Children with disabilities can be organ donors, contributing to the supply. Excluding these patients as organ recipients would not be fair. A new policy statement does not consider intellectual and developmental disabilities (IDD) completely irrelevant, but the authors do not consider IDD to be dispositive for listing decisions either.
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New Approaches for Ethically Challenging ED Cases
For emergency providers, time is precious. If a full-blown consult is not possible, ethicists can help discern the most critical aspect of a concern these clinicians may express. Quick, in-person responses; phone consults; and telemedicine consults all are possible approaches.
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Ethics Volunteers Still Can Be ‘Fired’ from Committee
It may be worth giving time to the member without ethics knowledge who is willing to learn or a person still developing proper interpersonal skills. Leaders can help teach these skills, transforming borderline members into essential contributors.