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05/17/2017

Nudges in the ICU: When and How Should Intensivists Guide Surrogates’ Decisions?

Coming up next week at the ATS International Conference in Washington, DC: "Nudges in the ICU: When and How Should Intensivists Guide Surrogates’ Decisions?"

This 2-hour session will address the use of behavioral economics and “nudges” in the ICU to guide surrogate decision-making. In particular, it will explore methods for effectively deploying nudges—tools for clinicians to use in the ICU—and an ethical framework within which to do so that adequately balances autonomy and paternal beneficence.

At the conclusion of this session, the participant will be able to:
  • Discuss principles of behavioral economics (a.k.a. decision psychology) that physicians might employ to ethically and effectively guide end-of-life decision making in the ICU
  • Clarify misconceptions about the meaning and importance of patient autonomy and informed assent among ICU patients lacking decisional capacity
  • Discuss special considerations when deploying behavioral economics with pediatric patients and their parent surrogates

Behavioral Economics, Choice Architecture, and Nudges in the ICU
G.L. Anesi, MD, MBE, Philadelphia, PA

Intensivists’ Use of Informed Assent When Patients Lack Capacity
J.R. Curtis, MD, MPH, Seattle, WA

Default to DNR?
R.D. Stapleton, MD, PhD, Burlington, VT

Integrated ICU Team Communications and the Nursing Perspective
D.K. Costa, PhD, RN, Ann Arbor, MI

The (Ambiguous) Role of Autonomy in Surrogate
Decision-Making
D.B. White, MD, Pittsburgh, PA

Helping Parents with Decisions
M.F. Haward, MD, Bronx, NY

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This entry was posted in Health Care and tagged . Posted by Thaddeus Mason Pope, JD, PhD. Bookmark the permalink.

05/17/2017

Nudges in the ICU: When and How Should Intensivists Guide Surrogates’ Decisions?

Coming up next week at the ATS International Conference in Washington, DC: "Nudges in the ICU: When and How Should Intensivists Guide Surrogates’ Decisions?"

This 2-hour session will address the use of behavioral economics and “nudges” in the ICU to guide surrogate decision-making. In particular, it will explore methods for effectively deploying nudges—tools for clinicians to use in the ICU—and an ethical framework within which to do so that adequately balances autonomy and paternal beneficence.

At the conclusion of this session, the participant will be able to:
  • Discuss principles of behavioral economics (a.k.a. decision psychology) that physicians might employ to ethically and effectively guide end-of-life decision making in the ICU
  • Clarify misconceptions about the meaning and importance of patient autonomy and informed assent among ICU patients lacking decisional capacity
  • Discuss special considerations when deploying behavioral economics with pediatric patients and their parent surrogates

Behavioral Economics, Choice Architecture, and Nudges in the ICU
G.L. Anesi, MD, MBE, Philadelphia, PA

Intensivists’ Use of Informed Assent When Patients Lack Capacity
J.R. Curtis, MD, MPH, Seattle, WA

Default to DNR?
R.D. Stapleton, MD, PhD, Burlington, VT

Integrated ICU Team Communications and the Nursing Perspective
D.K. Costa, PhD, RN, Ann Arbor, MI

The (Ambiguous) Role of Autonomy in Surrogate
Decision-Making
D.B. White, MD, Pittsburgh, PA

Helping Parents with Decisions
M.F. Haward, MD, Bronx, NY

Full Article

This entry was posted in Health Care and tagged . Posted by Thaddeus Mason Pope, JD, PhD. Bookmark the permalink.

05/16/2017

End of Life in Global Perspective

by Craig Klugman, Ph.D.

In its April 29th issue, The Economist published an article on people’s “hopes and worries for their end-of-life wishes.” The study compares responses to a set of questions from subjects in the Brazil, Italy, Japan, and the US. The data was part of a larger study conducted by the journal and the Kaiser Family Foundation on perceptions of health held by people in the four countries. The results supports other studies conducted in recent years in the U.S. and also gives insight into how we compare to the rest of the world.

The study is extensive, drawing comparisons about conversations with a health care provider, experiencing the death of a loved one, being aware of a dying loved one’s end of life wishes, loved one’s experience with pain and access to treatment, as well as awareness and use of hospice (US awareness at 36% is 3 times higher than any other nation).…

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This entry was posted in Cultural, End of Life Care, Featured Posts and tagged . Posted by Craig Klugman. Bookmark the permalink.

05/16/2017

Welcome 2017 HIV and Drug Abuse Prevention Research Ethics Training Institute Fellows!

The Fordham University HIV and Drug Abuse Prevention Research Ethics Training Institute (RETI) is pleased to announce that the following individuals have been selected as 2017 fellows: The Fordham University  HIV and Drug Abuse Prevention Research Ethics Training Institute (RETI), now in its 7th year, is a training grant sponsored by the National Institute on Drug Abuse (NIDA) (R25 DA031608-07), Principal Investigator, … More Welcome 2017 HIV and Drug Abuse Prevention Research Ethics Training Institute Fellows!

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05/16/2017

Inner Sense and Gender Dysphoria

Steve Phillips posted on “Caring for people with gender dysphoria” almost one year ago. In his post, he referenced a talk at a previous CBHD Summer Conference by Prof. Robert George, where Dr. George posited that the concept that the belief that one’s gender is based one’s innate or inner sense rather than one’s biological/physical sex is rooted in the Gnostic idea that human beings... // Read More »

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05/16/2017

Unwanted Medical Treatment – Increasing Lawsuits to Defend Patient Rights

Sally Jordan In two recent articles (here and here), I argued that there are a growing number of lawsuits brought against clinicians who administer unwanted medical treatment, particularly at the end of life.  The latter article was picked up a...

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This entry was posted in Health Care and tagged . Posted by Thaddeus Mason Pope, JD, PhD. Bookmark the permalink.

05/16/2017

Unwanted Medical Treatment – Increasing Lawsuits to Defend Patient Rights

Sally Jordan In two recent articles (here and here), I argued that there are a growing number of lawsuits brought against clinicians who administer unwanted medical treatment, particularly at the end of life.  The latter article was picked up a...

Full Article

This entry was posted in Health Care and tagged . Posted by Thaddeus Mason Pope, JD, PhD. Bookmark the permalink.

05/15/2017

Bioethics Symposium – More Legitimacy: Social Justice, Vulnerable Populations and Bias

Join Kaiser Permanente from November 2-4, 2017, in Berkeley for "Bioethics Symposium - More Legitimacy: Social Justice, Vulnerable Populations and Bias."

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This entry was posted in Health Care and tagged . Posted by Thaddeus Mason Pope, JD, PhD. Bookmark the permalink.

05/15/2017

Bioethics Symposium – More Legitimacy: Social Justice, Vulnerable Populations and Bias

Join Kaiser Permanente from November 2-4, 2017, in Berkeley for "Bioethics Symposium - More Legitimacy: Social Justice, Vulnerable Populations and Bias."

Full Article

This entry was posted in Health Care and tagged . Posted by Thaddeus Mason Pope, JD, PhD. Bookmark the permalink.

05/15/2017

A review of Table 19: Reinforcing the dominant cultural narrative that all unintended pregnancies are wonderful and wanted

A friend and I recently watched the movie Table 19 because we were looking for a fun comedy. Unfortunately, the movie was neither fun nor funny. Indeed, the movie did not deliver on a number of fronts, which is why I do not recommend it. I want to focus on a specific plot line that this movie employed—one that is common in movies and books—and that I find problematic. In case you are interested in watching this movie despite my warnings, there are spoilers ahead.

The basic plot is that Eloise McGarry, played by Anna Kendrick, ends up sitting at the table of “rejects” at a wedding. She was originally the maid of honor to the bride, but she and the bride’s brother, Teddy, broke up after two years of dating and she was consequently demoted from the bridesmaids’ table to the “loser” table, Table 19. As the movie progresses, we find out that the reason Eloise and Teddy broke up is because of an argument surrounding an unintended pregnancy. Eloise was upset with Teddy when she told him she was pregnant because he did not immediately respond positively. Instead, he asked her what she wanted to do about the pregnancy. His lack of enthusiasm enraged her and she told him that they would be ridiculous parents, which angered him, causing him to break up with her via text message. Because this is a typical Hollywood movie, it has a happy ending with Eloise and Teddy getting back together and happily welcoming their baby into the world.

Unintended pregnancies account for almost half of all pregnancies in the United States so it is not surprising that they are used as a plot twist in many movies and books. What is problematic is that many movies and books expect both members of the heterosexual couple to respond joyfully to the news of an unintended pregnancy and there is shock and discord if this is not the response. This is precisely what happened in Table 19. While some unintended pregnancies are wanted pregnancies (perhaps they are mistimed or the couple didn’t think they could conceive but they always wanted to), many unintended pregnancies are not wanted pregnancies. Just because a couple is now pregnant does not mean that they automatically switch from not wanting to become pregnant to being thrilled that they are pregnant. The dominant cultural narrative that all pregnancies are wonderful and wanted is harmful to women, men, and couples.

Eloise and Teddy are a couple in their 20s who seem somewhat irresponsible and lacking direction. They are trying to figure out what to do with their lives individually and as a couple. Given their circumstances, it is understandable that they may not be ready for a baby. Their inability to have a mature and reasoned conversation about their unintended pregnancy further buttresses that they might not be ready for a baby. But according to the dominant cultural trope, they are supposed to be able to pull it all together in order to be an intact heterosexual couple who are excited to have a baby. While this is how the movie Table 19 ends, not all stories have happy endings and it is important to recognize that there is a diversity of responses to unintended pregnancies.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.  

 

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This entry was posted in Health Care, Reproductive Medicine and tagged , , . Posted by Bioethics Today. Bookmark the permalink.