Tag Archives: Bioethics Disscussion

Waiting for medical records “after discharge” is of no help for decision making Autonomy

Medical records: Waiting for medical records “after discharge” is of no help.  Reviewing medical records  in the hospital allows the patient and/or a surrogate decision maker to obtain the greatest amount of information possible over the cross section of medical specialties providing care.  It provides a clear picture of the condition of the patient with respect to cognition, pain and prognosis. Review of reports of CT scans, x-rays, and MRI’s can bring a clear picture of improvement and deterioration in the patient’s condition. All of this will ensure that consent is based upon complete information and make it easier for…

Funding for physician discussion of end-of life decisions Clinical Bioethics

Each patient deserves more than a brief discussion about end of life decision-making. In  “A Piece of My Mind” section of this month’s JAMA (volume 303, No.13, April 7, 2010) Paul Kettl M.D. argues for monetary compensation to be provided to physicians for end of life discussion and planning. He fails to make clear, however, that the decision rests with the patient, not what is best for the family. Physicians must be careful not to wear too many hats and should turn to skilled clinical bioethicists and if necessary the Hospital Ethics Committee for review and recommendations. This will protect…

New York will pass the Family Health Care Decisions Act Withdrawal/Withholding of Care

 It has been 17 years since this bill was first introduced.   The New York State Senate will pass the Family Health Care Decisions Act (FHCDA), setting forth clear guidelines for family members and others close to the patient to make medical decisions for incapacitated patients. It will also provide physicians with uniform protocols to follow. In many instances there will continue to be confusion and concern for the rights of the patient. Diligent and thoughtful efforts will be needed to apply these guidelines properly. The following are some of the important points for clinicians:   If there is disagreement about…

Death Panels and Advanced Care Planning Autonomy

A recent article in the Journal of the American Medical Association, JAMA, discusses the need for effective public health announcements to encourage people to explain their end of life wishes and their values, goals and preferences. It has been well established that physicians are reluctant to discuss end of life choices with their patients and the norm has been to put it off until the patient is in advanced terminal disease when it is, indeed, more difficult to discuss. Studies have also shown that the majority of patients said they would choose to forego futile care but few are presented…

Doctor’s Mothers and Autonomous Choices Autonomy

Physicians continue to tell patients what they would do if it were their mother. This is just another form of paternalism and disregard for autonomous decision making. Physicians remain exceedingly reluctant to confront the difficult subject of end of life care. The New York times, on January 11, 2009 published an article, by Denise Grady, – “Facing End-of-Life Talks, Doctors Choose to Wait.” Discussing a survey of 4,074 doctors who took care of cancer patients, who had only four to six months left, but was still feeling well. 65 percent said they would talk about the prognosis, but wait to…

The Proper Role of Bioethics Autonomy

In Bioethics we learn that the patient has a right to make autonomous decisions. There has, however, been a bias built into to applicable legislation in many states, which interprets “autonomy” as the dignity to refuse treatment and avoid what is termed a protracted death. This slant on autonomy and the right to refuse treatment can cause some patients to be fearful of having an advanced directive, or, cause death due to withholding of artificial life support when not intended or requested by the patient. It is not, the job of Bioethicists to emphasize the right to refuse treatment, but instead the…

Kidney Transplants and Informed Consent Autonomy

At the 42d meeting of the American Society of Nephrology in San Diego this week, entitled “Renal Week,” Elisa J. Gordon, PhD, MPH, of Northwestern University presented a study on informed consent, that found that  “kidney transplant consent forms are written at considerably higher reading levels than they should be.” She is of the view that consent forms should be written at a 5th to 8th grade reading to ensure that transplant candidates are well informed about transplantation processes, understand the material, and can provide informed consent. My concern is that many physicians see forms as a satisfactory replacement for…

A Staged Approach to Withdrawing Life Support Withdrawal/Withholding of Care

A South Korean Ethics Committee uses a staged approach to Withdrawing Life Support In follow up to this blog’s April 23, 2009 post: “Letting the Conscious But Incompetent, Non Terminally Ill, Patient Die.” A South Korean hospital used a staged approach to consider the withdrawal of artificial life support based upon the condition of the patient. On June 11, 2009 an Ethics Committee at the Yonsei University Severance Hospital in Seoul Korea decided to remove a 77-year-old woman in a vegetative state from a respirator in accordance with a Supreme Court ruling.  Severance Hospital President Park Chang-il said:     “Though we…

Daniel Hauser – and Medical Confidentiality Dilemmas in Clinical Bioethics

I agree with the court’s rulings in the case of Daniel Hauser, highlighted in the media recently. In this case there is as absolute need to continue chemotherapy. It should however be pointed out that the Court ignored Mrs. Hauser’s demand for confidentiality and contributed to this case becoming a spectacle in the media and making Mrs. Hauser the focus of overwhelming media attention, pitting her beliefs against most of the country’s. This injudicious conduct may have contributed to the panic of the mother to leave the jurisdiction and hide herself and her son. The legal issues in this case…

Life, for some in Texas, is Cheap Abandonment

HEALTH AND SAFETY CODE CHAPTER 166.039. PROCEDURE WHEN PERSON HAS NOT EXECUTED OR ISSUED A DIRECTIVE AND IS INCOMPETENT OR INCAPABLE OF COMMUNICATION For the most vulnerable patients, without friends or family, life for some medical patients in Texas, is cheap.  On vague and specious grounds and without proper oversight or transparency, physicians may withdraw life sustaining treatment from a patient, even if the patient is conscious, talking, and aware of his or her surroundings. This statute allows this to occur if a physician treating the patient concludes that the patient will die within six months and there is no…