Medical Ethics Advisor – July 1, 2022
July 1, 2022
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Study Recruitment for End-of-Life Research Raises Ethical Questions
Is it harder for someone near the end of life to participate in research (or to serve as a research advisor) compared to someone with diabetes? A question like this led a group of researchers to explore ethical challenges posed by study recruitment of patient and family advisors for research on end-of-life or palliative care.
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Ethics Knowledge Gaps Exist on Assessing Capacity, Identifying Surrogate Decision-Maker
Clinicians must determine if patients can understand the question, state a choice, appreciate the risks and benefits, and rationalize why their decision aligns with their care preferences. The fact that few participants understand decision-makers and surrogates carries important implications for the ethics field.
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Notable Case Puts Spotlight on Ethics of High-Dose Painkillers
Some clinicians are wary of administering high doses of painkillers at the end of life that could hasten death.
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Q&A: Ethicists Can Help Clinicians Manage High-Dose Pain Medication Cases
Cases involving high-dose pain medicines can cause conflicts within the clinical team. A palliative care expert explains the ethics of these situations and how to find resolutions.
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Unexpected Events Make Patient’s DNAR Status Complex
Ethicists developed a conditional medical orders form, which summarizes preferences for resuscitation, ventilation, and artificial hydration and nutrition. The form is meant to be used when offering advance care planning or at the bedside of terminally ill patients. It can facilitate more ethical care in nuanced situations.
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Few Severe Stroke Patients Receive Palliative Care
Severe stroke can be similarly devastating as cancer — not only for the patient, but for family members caring for that patient. They all may need symptom relief and emotional support that palliative care can provide.
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Ethical Concerns Persist with Speculative Cell Banking
Clinicians are facing questions from some patients about speculative cell banking. Researchers recently published a paper intended to be a resource to prepare clinicians in all fields to discuss the limitations of gene cell therapy with their patients. They also hope they have created a resource for the general public.
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Researchers Offer Definition of Teach-Back for Surgical Informed Consent
Shared-decision making in the informed consent process may be enhanced by implementing teach-back in preoperative discussions.
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Variation in Ethical Justification of Randomized Clinical Trials
Ideally, when a researcher presents a randomized clinical trial to an ethics board (and to study participants), the term “equipoise” is defined explicitly. This ensures both the study investigator and the IRB mean the same thing when they say the randomization of patients is ethically justified.
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Participant Protection Is IRB’s Mission, but Difficult to Measure
It is possible to examine if IRBs advise researchers appropriately regarding reducing risks. Consider the types of questions and requests the IRB has in response to the risks in a particular research protocol.
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Researchers Need a Plan to Monitor Participants’ Mental Health Risks
Consider the characteristics of the trial and study population to determine the likelihood and magnitude of risks that may emerge. Identify triggers, thresholds, and responsibilities for action in response to risk-signaling data. Also, consider appropriate response mechanisms and capabilities, along with data privacy-related concerns.
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When Machine Learning Tools Are Used to Predict Suicide Risk
As advanced as these tools can be, they are prone to producing high rates of false-positives and false-negatives. Thus, these tools cannot be the only way that risk is evaluated, and should be paired with psychometrically sound risk assessment and strong clinical judgment.
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Financial Conflicts of Interest Are Major Contributor to Academic Success
Reporting many conflicts with drug companies correlated well with publishing more papers and publishing more high-impact research. Those are key metrics for success and promotion for university-based researchers. The report findings suggest relationships with the pharmaceutical industry also are the key to a successful career for some cancer researchers.