Hot Topics: Clinical Ethics
By Charles Foster Cross posted from The Conversation To be clear, and in the hope of heading off some trolls, two observations. First: of course I don’t welcome the epidemic. It will cause death, worry, inconvenience and great physical and economic suffering. Lives and livelihoods will be destroyed. The burden will fall disproportionately on the […]
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by Craig Klugman, Ph.D.
Doctors in Italy have run out of beds. They have run out of ventilators. They are now having to decide who may live and who will likely die.…
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by Stephen P. Wood, MS, ACNP-BC
I haven’t had this question from a patient yet, but I know it’s coming. The information disseminated by us, to us and for us is a bit conflicting when it comes to COVID-19, the disease caused by the novel virus SARS-CoV-2.…
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This post is presented in conjunction with the March 2020 issue of the American Journal of Bioethics. You can read the full article and commentaries here.…
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This post is presented in conjunction with the March 2020 issue of the American Journal of Bioethics. You can read the full article and commentaries here.…
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by Vera Lúcia Raposo, Ph.D.
Last December it was made public that He Jiankui was sentenced to 3 years in prison and a fine of 3M yuan due to the genetic modification of two twin babies.…
Full ArticleRecommendation for life support from 22 weeks. Kristina Bessolova/Shutterstock Dominic Wilkinson, University of Oxford When new guidance relating to the outcome and medical care of babies born extremely prematurely was recently released, it led some to call for UK abortion law to be revised. This was because one of the new recommendations from the British […]
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Adult patients are presumed to have decisional capacity and have a right to refuse medical treatment, not only from an ethical perspective but also a legal one. Patients with capacity have the right of bodily integrity and personal autonomy, and the right to not be touched without consent. The situation becomes more problematic when adult patients, whom have been determined to lack decisional capacity, actively object to recommended medical treatment or intervention believed to be in their best interest. For this patient population treatment over objection becomes a challenging ethical and legal issue that should not be taken lightly by healthcare providers. These patients, who may have the ability to not only verbally express strong preferences against treatment, may also physically resist any bodily intrusions. In most cases the required effort to force treatment, using sedation or restraints, becomes ethically problematic. At the same time, in cases where it seems apparent that the patient will benefit from the recommended medical treatment, allowing patients without capacity to not receive this treatment is ethically troublesome.
There is no universal answer to situations in which patients without capacity refuse treatment. The question is: Should we employ a case specific approach that carefully considers the following factors: the patient’s reason for refusal (preferences), harms/risks/consequences without the recommended treatment, the likelihood of the proposed treatment doing good, associated risks of the proposed treatment, and the likely emotional effect of forced treatment on the patient?
One of the most ethically complex decisions in medicine is in deciding when to override the autonomy and/or preferences of a patient deemed to lack decisional capacity and treat over the patient’s objection. This challenge exists even in the presence of a healthcare agent or surrogate decision-maker. The ethical justification for overriding a patient’s refusal of medical treatment relies on the assessment of decisional capacity and even if determined to lack capacity, patients may have capacity for some decisions but not for more complex decisions. Capacity is fluid and can fluctuate over time, particularly with conditions in which cognitive impairment is present. There are clinical situations in which beneficence outweighs autonomy and in which the use of a soft paternalistic intervention is ethically justifiable whenever it may effectively lead to a greater well-being. A soft paternalistic intervention serves to protect patients from decisions that may significantly and needlessly alter their life. In a situation in which the autonomy and/or preferences of a patient are considered to be most important, the use of a paternalistic intervention would not be justified, regardless of the patient’s well-being.
Allowing a patient to suffer preventable harm that can almost certainly be averted with medical intervention seems to be contrary to the ethical principle of beneficence. The challenge is in identifying and balancing the risk vs. benefit.
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Professor Dominic Wilkinson, Professor of Medical Ethics, University of Oxford. Consultant Neonatologist This morning, the High Court judgement around medical treatment for five-year old Tafida Raqeeb was published. Tafida sustained severe brain damage from bleeding in the brain eight months ago. Her parents wish to take her to a hospital in Italy to continue […]
Full ArticleProfessor Dominic Wilkinson, Professor of Medical Ethics, University of Oxford. Consultant Neonatologist This morning, the High Court judgement around medical treatment for five-year old Tafida Raqeeb was published. Tafida sustained severe brain damage from bleeding in the brain eight months ago. Her parents wish to take her to a hospital in Italy to continue […]
Full ArticleArtificial Intelligence in Clinical Neuroscience: Methodological and Ethical Challenges
Using Implementation Science to Enact Specific Ethical Norms: The Case of Code Status Policy
Beneficence, Interests, and Wellbeing in Medicine: What It Means to Provide Benefit to Patients
What the HEC-C? An Analysis of the Healthcare Ethics Consultant-Certified Program: One Year in
The Healthcare Ethics Consultant-Certified Program: Fair, Feasible, and Defensible, But Neither Definitive Nor Finished
Clinicians’ Perspectives on the Duty to Inform Patients About Medical Aid-in-Dying
Patient’s Perspectives of Experimental HCV-Positive to HCV-Negative Renal Transplantation: Report from a Single Site
How Bioethics and Case Law Diverge in Assessments of Mental Capacity: An Argument for a Narrative Coherence Standard
A Narrative Coherence Standard for the Evaluation of Decisional Capacity: Turning Back the Clock
Worry that ‘all hands’ responses may expose doctors and nurses to infection prompts a debate about prioritizing the survival of the many over the one.
Full ArticleSome private clinics are charging UK patients thousands of pounds for unproven and unregulated treatments using the “healing powers” of stem cells.
Full ArticleConscientious objection—everybody seems to be talking about it these days. What are the rights of physicians, pharmacists, nurses, or other healthcare workers to say that something may be legal but they refuse to do it?
Full ArticleBecause of rare illness, Louise Moorhouse is on a special diet of pills or foul-tasting shakes. There’s a drug that would allow her to eat like anyone else – she took it for three years during a clinical trial. But the NHS won’t pay for it, reports the BBC’s Deborah Cohen – and the drug company stopped giving it to her once the trial was over.
Full ArticleThe University of Illinois at Chicago’s acclaimed child psychiatrist Mani Pavuluri put vulnerable children at serious risk in one of her clinical trials by testing the powerful drug lithium on children younger than 13 — violating research rules, failing to properly alert parents of the study’s risks and falsifying data to cover up the misconduct.
Full ArticleFrance has banned several types of textured breast implants that have been linked to a rare form of cancer. The ban, which covers macro-textured and polyurethane implants, took effect on Friday. It was announced this week by France’s National Agency for Safety of Medicines and Health Products, or ANSM, in a letter to manufacturers.
New research suggests that a controversial gene-editing experiment to make children resistant to HIV may also have enhanced their ability to learn and form memories.
Full ArticleMeasles was declared eliminated in the United States in 2000, but scattered outbreaks have occurred in recent years. This year there have been five — in New York, Texas, and Washington State — for a total of more than 120 cases.
Full ArticleIn the fall of 2015, Dr. Herbert Dardik, chief of vascular surgery at Englewood Hospital and Medical Center in New Jersey, nodded off in the operating room.
Note that Dr. Dardik, then 80, was not performing the operation. He’d undergone a minor medical procedure himself a few days earlier, so he’d told his patient that another surgeon would handle her carotid endarterectomy, in which plaque is removed from the carotid artery to improve blood flow.
But when she begged Dr. Dardik at least to be present during the operation, he agreed to sit in. “I was really an accessory,” he recalled. “It was so boring, I kind of dozed off” — whereupon an alarmed nurse-anesthetist reported the incident to administrators.
Within days, the hospital’s chief of anesthesiology and chief medical officer were in Dr. Dardik’s office, praising his surgical skill while urging him to reduce his workload.
Full ArticleThe moment has arrived at last. A woman in a hospital gown steels herself, ready to push. A nearby monitor displays her baby’s heart rate in big, neon numbers. A nurse in crisp scrubs coos in her ear, offering words of encouragement, advice. The scene would resemble any other delivery room if it weren’t for the view outside the window: the soft curvature of the blue Earth against the blackness of space, 250 miles below.
Delivering a child in microgravity may sound like science fiction. But for one start-up, it’s the future.
Delivering a child in microgravity may sound like science fiction. But for one start-up, it’s the future.
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