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According to a recent study,1 terminally ill patients who had end-of-life discussions with physicians had earlier hospice enrollment (65.6% vs. 44.5%), compared to patients who did not have these discussions. Also, longer hospice stays were associated with better patient quality of life, while more aggressive medical care was associated with worse patient quality of life.
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In early October, the American Medical Association in Chicago issued a statement by board member Jeremy Lazarus, MD, regarding Congressional action on mental health care coverage:
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A palliative care program can save hospitals an average of at least $279 per day, up to $374 per day, according to a study of eight hospitals by the Center to Advance Palliative Care and the National Palliative Care Research Center.
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Just as in certain consumer-driven businesses, the mantra was always "the customer is always right," in health care, the mantra at least the one attributed to physician attitudes and principles historically has been "the patients' needs come first."
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In addition to physician ethics, the pay-for-performance concept also has been instituted by the Centers for Medicare & Medicaid (CMS) related to its statement that its policy will be to no longer pay for any on a list of so-called "never" events that occur at hospitals. The policy became effective Oct. 1.
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More and more questionable ties between physicians and drug companies are being uncovered in an investigation into such financial relationships conducted by Sen. Charles Grassley (R-IA).
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Bridges to Excellence (BTE) CEO Francois de Brantes doesn't mince words when asked if he thinks there is an ethical conflict between the payment model of pay-for-performance essentially giving physicians additional payments for good performance based on certain quality measures and ethical decision-making by physicians.
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Decision making in health care ethics consultation cases often involves difficult, complex issues and mediating differences of opinion.
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When a judge recently ordered a pharmaceutical company to provide an investigational drug to a teenage boy who had not met the enrollment criteria for a phase II trial, the IRB world took note.
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Considering the question of whether there are new challenges, new laws, or new ways of looking at ethical decisions for institutional review boards, one major organization chair responsible for IRBs, responds: "I think its kind of ratcheted up over the years, thats for sure."
