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Ethics consults typically involve intensive care unit patients where issues can be thoroughly examined over a lengthy period of time, but what if a provider has minutes instead of days to make a decision?
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Many providers and health systems are unaware of the opportunity to leverage payment reform to develop or align community-based resources in order to provide better care and more support to patients post-discharge under the Patient Protection and Affordable Care Act (PPACA), according to James Corbett, JD, MDiv, a fellow at Harvard Medical Schools Division of Medical Ethics and Vice President of Community Health and Ethics at Steward Health Care System in Boston, MA. They may not connect that payment reform presents a tremendous opportunity, he says.
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It is important that the medical community understands that the cardiology and cardiac surgery communities are confronting end-of-life issues and the need to make appropriate treatment decisions based on an assessment of the likelihood that it will make a difference in a positive way, usually in a frail, sick, elderly patients life, argues Patrick OGara, MD, FACC, president-elect of the American College of Cardiology and executive medical director of the Carl J. and Ruth Shapiro Cardiovascular Center at Brigham and Womens Hospital in Boston.
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The relief of suffering, including suffering from untreated pain, is fundamental to the idea of ethical practice in medicine, according to Nancy Berlinger, PhD, a research scholar at The Hastings Center in Garrison, NY.
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Would you expect that offering state tax incentives or credits would increase organ donation?
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A growing number of states are promoting Physician Orders for Life Sustaining Treatment (POLST) Paradigm Programs, with the goal of helping physicians to better respect their patients wishes for end-of-life care.
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It is vital for providers caring for pediatric patients not to jump to a diagnosis just because it is in the Diagnostic and Statistical Manual of Mental Disorders (DSM)V, argues Harold J. Bursztajn, MD, associate clinical professor of psychiatry at Harvard Medical School in Cambridge and co-founder of the Program in Psychiatry and the Law at Beth Israel Deaconess Medical Center.
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In the eyes of cost-cutting hospital administrators, bioethics programs are sometimes perceived as a luxury rather than a necessity. During periods of austerity, bioethics programs are often the first to not receive funding or not be maintained, says Joseph J. Fins, MD, MACP, the E. William Davis, Jr. Professor of Medical Ethics and chief of the Division of Medical Ethics at Weill Cornell Medical College, and director of medical ethics and attending physician at New York Presbyterian Hospital-Weill Cornell Medical Center in New York City. A number of programs have recently come under threat.
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The debate over medical futility has in large part been neglected, and should be expanded beyond pull the plug decisions to include doctors involvement in the details of end-of-life care, argues Lawrence J. Schneiderman, MD, founding co-chair of the University of California, San Diego Medical Center Ethics Committee.
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While Americans typically support organ donation, data show the number of actual donations is actually quite low and cannot keep up with demand, says Leslie M. Whetstine, PhD, an assistant professor of philosophy at Walsh University in North Canton, OH.
