Medical Ethics Advisor
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Ethical Responses Needed if Clinicians Say Discharge Is Unsafe
For some patients, there are no caregivers at home. Others may be living in unsafe conditions. Ethicists can help by brainstorming scenarios, and trying to connect resources accordingly.
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No Evidence of Bias on Pediatric Ethics Rounds
Researchers compared sociodemographic factors between patients admitted to an academic children’s hospital during ethics rounds in the PICU, PCTU, and NICU in 2017 and 2018 who were identified as having ethics issues and all other patients admitted to those same units during the same period. The researchers expected racial and/or socioeconomic differences between the groups, with socially vulnerable patients disproportionately identified as having ethical issues on rounds. But they did not find this to be the case.
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Some Code Status Discussions Are Rushed, Incomplete, or Misleading
Learning how to engage in code status conversations is as important as learning how to perform medical procedures. Clinicians would not ask patients in completely neutral terms whether they want a procedure that has no chance of working or would inflict serious harm. Any conversation around resuscitation status should take into account patients' goals and values, what is important to them in life, and the minimum acceptable quality of life.
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Challenges with Surrogate Informed Consent
The central ethical question is whether a surrogate’s judgment for consenting or refusing a medical intervention on behalf of a patient is consistent and congruent with this patient’s preferences, interests, and values.
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Is It a Problem to Pay Research Participants?
Paying people to participate in clinical research can be seen as ethically problematic. Yet community members expressed the opposite view, according to the results of a recent study.
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Changing Practice Models in Healthcare Raise Some Ethical Concerns
With all the ongoing changes in healthcare, such as physician contract clauses, new regulatory requirements, private equity ownership, and physician leadership, hospitals worry about the implications on revenue, patient satisfaction, and compliance. There also are important ethical considerations. The authors of a new policy paper from the American College of Physicians examined these.
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Policies Support Clinicians if Asked to Provide Inappropriate Care
When a family demands possibly inappropriate life-sustaining interventions, clinicians often turn to hospital policies for guidance. The authors of a recent study examined the effectiveness of Yale New Haven Hospital’s Conscientious Practice Policy. A theme emerged, focused on the inconsistent use of the policy. Whether it was used depended mostly on how resistant the family was to limiting interventions.
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Lack of Metrics, Specificity, and Regulations Concern Some Ethics Services
To some, there is a perception that regulatory agencies still consider ethics a small-volume service handled by a volunteer committee instead of a critical, high-volume service run by paid ethics staff. A few professionals in the trenches believe this critical subject is taken too lightly.
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Healthcare Professionals Should Complete Their Own Advance Care Planning Directives
If providers manage their own plans, they can share firsthand insights. They will be in a better position to inform, guide, and support their patients. It will make them a more effective, trusted, and knowledgeable resource.
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Ethics Services Taking First Steps Toward Preventive Work
Preventive ethics work, aimed at topics of high institutional concern, shows how ethicists can not only comment on issues but also sometimes prevent them from occurring.