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.
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.
Would you expect that offering state tax incentives or credits would increase organ donation?
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.
Some bioethicists argue that it is not ethically justifiable to offer reused pacemakers overseas since these are not approved for use in the United States, but this goes on every day in the developing world, says James N. Kirkpatrick, MD, an assistant professor of medicine at the Hospital of the University of Pennsylvania.
By refurbishing and repackaging pacemakers, we are de facto creating a new product, which no longer adheres to the original specifications, says Thomas Crawford, MD, an assistant professor of medicine in the Cardiovascular Division at the University of Michigan School of Medicine in Ann Arbor and co-chair of Project My Heart Your Heart, a program which collects used devices from patients and funeral directors to be someday donated to developing countries.
Because overtreatment imposes unnecessary harms upon a patient, it violates the normative rules of beneficence and nonmaleficence that pervade medical ethics, argues Erin Fuse Brown, JD, MPH, assistant professor of Law at Georgia State University College of law in Atlanta and former Visiting Fellow in Ethics and Health Policy with the Lincoln Center for Applied Ethics at Arizona State Universitys Sandra Day OConnor College of Law.
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.
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.
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.
