Tag Archives: Clinical Bioethics

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…

Autonomy: the Basis of Respect and Dignity Abandonment

“Be a good girl and take your medicine.” Part 1 This statement was made to a 60 year old end stage leukemia patient who demanded to be discharged from the hospital. The patient refused the prescribed medications.  No attempt was made to discuss the risks attendant in not taking the prescribed medication. The patient was cogent and articulate – able to make medical decisions for herself. The physician walked out of the patient’s room in the ICU. No social worker, bioethicist had been called to assist. Patient Jane was merely told, “Be a good girl and take your medicine.” What…

What’s wrong with Romney’s Plan to just send more people to Emergency Rooms: Ethnic and racial disparities in Health Care – All Patients are Not Created Equal Disparities in Racial and Ethnic Medical Treatment

All patients are not created equal Many emergency departments and hospitals in low socioeconomic areas, sometimes referred to as “safety net hospitals,” have closed, resulting in serious problems for poor and minority populations due to reduced or no access to emergency care. This results in exacerbating illness or injury due to either waiting time to get, or failing to seek, medical attention. When patients later become desperate, ambulance calls increase; emergency rooms in distant hospitals become overcrowded; all resulting in further delayed emergency room care. Medical specialists have become more reluctant to be on-call out of concern for overburdened emergency…

Withdrawing Life Sustaing Treatment – Early Withdrawal of Life Sustaining Treatment in Severe Traumatic Brain Injuries, by Bernard W. Freedman JD, MPH Clinical Bioethics

CDC Statistics Traumatic Brain Injuries On August 29, 2011 the Canadian Medical Association published the findings of a multicenter cohort study evaluating the withdrawal of life-sustaining treatment for patients who had suffered a traumatic brain injury. This study is of particular interest because by the nature of the injury  patients cannot make decisions for themselves and generally such decisions in patients in end-of-life care have a variety of comorbidities which make an evaluation of the efficacy of the decisions to withdraw life sustaining care difficult.  720 patients were evaluated from six different major medical centers. Of the 720, 228 patients…

Withdrawing Life Sustaing Treatment – End of Life Care: the Doctor-Patient Relationship A Refusal to Communicate Clinical Bioethics

The New England Journal of Medicine recently published an article entitled: “ The Palliative Care Information Act in Real Life,” (NEJM 364;No.20 May 2011), regarding a New York statute that requires a physician to have discussions of end of life treatment options with the patient when the patient is “terminally ill.” Alan Astrow MD and Beth Popp, MD, the authors of the article, are troubled by the phrase terminal illness. They argue that the definition in the statute is vague and an improper interference with the physician-patient relationship. The fact that they find the phrase, “terminal illness” troublesome, is troublesome. The…

Rationing “scarce medical resources” and lying to the patient – do these go hand in hand? Clinical Bioethics

Rationing “scarce medical resources” and lying to the patient – do these go hand in hand? 7 comments Claudia Ruiz M.D • I don’t think so, I’m from Mexico, and I have worked plenty with the mayan communities, they really don’t have any acces to medicines o medical attention. We did our best to get them what they need, but sometimes it is impossible. Anyways, I never lie to my patients, they deserve to know the truth always. Maybe it is a different situation in the United States and the HMOs, but in principle, I don’t think it is ethical…

Rationing Medical Care Part II Clinical Bioethics

Efforts to encourage (or compel) physicians to lie to their patients were faced years ago when “gag clauses” were inserted into contracts between HMO’s and contracted physicians. The gag clause established a contractual obligation on the part of the physician to withhold information regarding treatment modalities that were not within the HMO protocol of allowable categories of care.  Contractually, it is common to exclude specific types or categories of care – “We will pay for this, we won’t pay for that.” Every contract of insurance has exclusions. Gag clauses, however, go further. They contractually bar physicians from fulfilling their fiduciary duties…

Clinical Bioethics – Rationing – the Ethics of Lying to the Patient – Part I Clinical Bioethics

Rationing : Withholding Medical Care by Lying to the Patient Rationing of medical care and “triage” are different. Triage prioritizes the use of limited medical resources when resources are insufficient for immediate treatment.  Rationing is the withholding of available care for political/economic reasons. With respect to rationing, therefore, it must be decided whether or not the patient is going to be told the truth. The requirement of informed consent cannot cease to exist because of political/economic policy. Nevertheless the degree of informed consent may vary with the degree and type of risk. Informed consent for a blood pressure medication may…

Withdrawing Life Sustaing Treatment -From Conscious, Non Terminal, Incompetent Part II Withdrawal/Withholding of Care

Physician Liability: Withdrawing and Withholding Life Sustaining Care From  Conscious, Non Terminal, Incompetent Patients – Part II There are different standards that must be appreciated and respected before a physician can support a decision to withdraw life sustaining treatment from a non terminal and incompetent patient. This scenario requires the highest degree of protection for the patient. Our fundamental rights are the most important when we are the most vulnerable. Patients in this category are weak, often confused and subject to the effect of bias and undue influence. When illness requires life sustaining treatment family members may experience sympathy for…

Survival in Hospital Cardiac Arrest – Challenges for Hospitalists Bioethics Conflicts

The September 2010 publication of “The Hospitalist” reviews the overall survival rates for cardiac arrest patients. This article reports that patients frequently have unrealistic expectations and overestimate their chances of survival. Patients predict post-arrest CPR survival at 64%, while the rate is 17%. Most important is that in nearly half of the patients who initially expressed the desire for CPR, once they were informed of the actual estimates, they changed their minds and code status was changed. It is difficult for many hospitalists to discuss DNR orders with patients. There is not a trusting relationship formed over time. Therefore it is…