Medical Ethics Advisor
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‘Informed Assent’ for CPR Is Reasonable Approach for Some Hospitalized Patients
This concept was developed to satisfy the right of physicians to initiate DNR orders in futile situations and their duty to communicate to patients and lawful surrogates. Through informed assent, physicians state they will write a DNR order because it would be futile and harmful to the patient to attempt CPR in their current serious illness.
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Adults with Developmental Disabilities at Risk for Poor End-of-Life Care
Policies should specify that the wishes of these patients should be known. They should be able to access all medically appropriate care, without bias, and have the right to avoid medical interventions they wish to refuse.
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Researchers Are Revamping Processes to Gather Community Input
Input from community members can help researchers make the study more effective by providing participants with regular updates on the results and proactively translating research consent forms into preferred languages. Investigators also could hire a staff representative of the community who can navigate cultural nuances and speak the preferred languages.
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Ethical Approaches to Address Nursing Workloads, Staffing Shortages
Ethicists can perform an invaluable role by working closely with senior management and medical staff leaders to develop collaborative initiatives to acknowledge the problem’s magnitude and engage nursing representatives in developing creative solutions.
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Informed Consent Requirements May Hinder Innovation in Stroke Treatments
IRBs and regulatory bodies should consider the changing scope of acute stroke care, and collaborate with investigators to design studies that can ethically answer important questions and allow innovation and progress in the field.
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IRBs Tend to Err on the Side of Protection, Not Inclusion
Researchers must strike a balance between protecting and including participants in their protocol design. Building in additional safeguards for those deemed vulnerable could help.
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Nurses at Rural Facilities Explain Barriers to End-of-Life Care
Family members often disagree with one another and misunderstand the meaning of “lifesaving measures.”
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Fraud Allegations Involving Alzheimer’s Disease Study Raise Concerns
In a paper published in 2006, the authors provided evidence indicating accumulation of a specific form of beta-amyloid protein was a cause of Alzheimer’s disease. However, recent accusations suggest images allegedly were altered, raising doubts about the initial conclusions. Regardless of what happened, this case has jumpstarted a conversation about instituting more preventive measures, conducting faster investigations into fraud allegations, and levying more severe consequences for researchers found guilty of misconduct.
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Ethicists Asked to Weigh in on Medical Necessity of Abortion
If ethicists are asked to weigh in, they should suggest a second medical opinion (if time permits) and encourage the institution to clarify any legal questions, ideally before there is an emergency. Institutions also should assure clinicians they will have support from the ethics committee in the event of overzealous prosecution.
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New Requirements Are Discouraging Physicians from Writing DNR Orders
Ethicists should help develop related protocols. For practitioners, code status conversations should be treated with the seriousness of surgery. That means involving the right people and taking the time to ensure medical understanding and prognosis, as well as patient values and goals, before talking about a care plan. When possible, practitioners should bring up DNR at the end of a meaningful conversation.