Medical Ethics Advisor
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Poor Agreement Between ED Patients and Physicians on Goals of Care
Ideally, goals of care discussions do not happen for the first time when the patient presents to the ED. When goals of care conversations are held earlier in a patient’s disease course, advance care planning is possible. This can alleviate the use of aggressive interventions in the event the patient decompensates or does not make a meaningful recovery.
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Evolving Efforts to Integrate Critical Care and Palliative Care
Palliative care should be integrated into serious illness care at any point following diagnosis. This can happen in conjunction with curative treatment, or as a standalone intervention focused on comfort at the end of life.
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New Data on Pediatric Clinical Ethics Consults
Pediatric cases involve, at a minimum, three stakeholders: The patient, the parents, and the healthcare team. This decision-making triad can lead to a multitude of ethical quandaries.
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Ethicists Challenged to Respond to Physicians’ Inappropriate Behavior
If a physician yells at a nurse or patient because of a disagreement over the treatment plan, involvement by human resources or another department is needed. But if a physician’s belligerence or disrespect affects someone’s decision-making, that is an ethical problem.
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Clinicians Reveal Why They Never Request Ethics Consults
Some clinicians request an ethics consult once, but never again. Others never call ethics a single time in their entire careers. Ethicists are left to wonder why.
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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.