Medical Ethics Advisor
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Spiritual Care in ICU: Persistent Unmet Needs
The authors of a recent literature review looked at the current state of spiritual care in the ICU setting. The findings reveal both the benefits of spiritual care services and the persistent unmet needs.
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Study: Advance Care Plans Lacking When Serious Complications Occur
When patients with significant underlying comorbidities suffer life-threatening or serious complications at Indiana University Health, the palliative team is consulted. All too often, they find there is no advance directive in place.
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Call for Uniform Brain Death Standard: Opponents ‘Increasingly Vocal and Influential’
There are growing calls for a uniform brain death standard, but court cases and in-hospital conflicts continue to increase.
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Study Sheds Light on How Clinical Ethics Consults Are Categorized
Ethics consultations are categorized in a surprisingly heterogeneous way, found a recent analysis of 30 articles. The most common categories were do not resuscitate orders, capacity, withholding, withdrawing, and surrogate or proxy. Only 26% of the typologies (seven of 27 unique typologies) contained the five most common categories.
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New Guidance on Ethics of Providers’ Internet Searches on Patients
Despite multiple ethical concerns raised regarding providers searching for online information about their patients, specific recommendations have been lacking.
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Ethics of Virtual Visits: In-Person Visits Declined 33% in First Year
Some accountable care organizations are replacing in-person visits with lower-cost virtual visits. Using data from more than 35,000 patients from 2014 to 2017 within a Massachusetts-based ACO, researchers found that the use of virtual visits reduced in-person visits by 33%.
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Almost One-Third of Proxies Do Not Know Patient’s Current Code Status
Is a person’s goal to be cured, to live long enough to see a particular event, to be comfortable, or something else? Researchers wanted to know how many ICU proxies believed they knew the answer. They also wondered how many proxies felt confident that they knew what limits their loved one would place on pursuing that goal — would the patient choose not to resuscitate?
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Analysis of Serious Ethical Violations Uncovered Failure to Identify Egregious Wrongdoing
Often, training is viewed as a way to stop ethical violations. But a recent analysis of 280 cases suggests this is not the answer. Nearly all cases of serious ethical violations involved repeated instances of intentional wrongdoing that went undetected.
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Policies Can Set Boundaries, Ensure Ethical Discharges
Often, clinicians perceive the discharge plan is focused on the question of “What are we obliged to do?” instead of “What should we do?”
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How Effective Is Ethics? Ask Clinicians, Examine Processes
Researchers found some unexpected variations between the requests for ethics consults and the retrospective reports from the clinicians who made the request.