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

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 Standard

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 Standard

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 Sustaining Treatment -From Conscious, Non Terminal, Incompetent Part II Standard

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 Standard

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…

Letting the Conscious Non-Terminal, Incompetent, Patient Die: Hold On a Minute – Not So Fast – Part I Standard

It is an injustice to cause patients to unnecessarily prolong the process of dying. Actual futile care must be avoided. But it is equally an injustice to easily acquiesce to patient’s demands that my result in unnecessary death. On August 17, 2010 the Supreme Court of Pennsylvania decided a case involving a non-terminal, profoundly mentally retarded patient. The patient was conscious and non-terminal. David is 53 years old. David’s parents were the guardians. His parents argued that putting him on the ventilator was not in his best interest and requested terminal extubation. The hospital refused. After several weeks his condition…

Withdrawing Life Sustaining Treatment – Betancourt v Trinitas – Appellate Court Decision Standard

The New Jersey Superior Court–Appellate Division dismissed the appeal in Betancourt v Trinitas finding the appeal moot. The court stressed it’s concern over the  “sparse record” presented at the time of  the original hearing in the trial court as well as on appeal and found that the evidence was not “conclusive in several areas necessary to fully adjudicate the substantial issues raised.” This is sometimes referred to as insufficiency of evidence. If the person or entity bringing the case does not provide sufficient evidence the court will dismiss the claim. In this case Tinitas Hospital’s request to withdraw the ventilator….

Withdrawing Life Sustaining Treatment – Betancourt v Trinitas – Life, Not Policy Standard

Ruben Betancourt, 72 years old, was unconscious following the dislodging of a ventilator breathing tube after surgery at Trinitas Medical Center, which resulted in anoxic encephalopathy. He was readmitted to Trinitas in July 2008 with a diagnosis of renal failure. He received dialysis treatments, remained on a ventilator, and feeding tube. The physicians at Trinitas diagnosed Mr. Betancourt as being in a persistent vegetative state and told the family of their intention to stop dialysis and allow him to die. The Superior Court in New Jersey held a two day hearing and thereafter enjoined the hospital from withdrawing life support without the consent…

Red Flag Rules and the Practice of Medicine Standard

Red Flags Rules require financial institutions and businesses that give credit to consumers to establish some sort of program or procedure to identify customers who may be involved in identity theft. Since most medical providers provide medical services and allow the patient to pay their bill at a later time, and in concert with insurance benefits, the FTC intends to treat medical practice as a “creditor” and thus come within the scope of Red Flag rules. “Creditor” is defined by this law as any business or organization that defers payments for goods or services.”     On May 21, 2010…

Bad Ad Program for Misleading Drug Ads Standard

  The U.S. Food and Drug Administration has created a program to help recognize misleading prescription drug promotion and provide an easy way to report concerns. The program will engage health care providers at medical conventions and partner medical societies to distribute educational materials. Phases 2 and 3 will expand the FDA’s to update educational materials developed for Phase 1. The FDA’s traditional monitors prescription drug promotion presentations created by drug companies themselves. Health care professionals are encouraged to report a potential violation in drug promotion by sending an email to badad@fda.gov or calling 877-RX-DDMAC. Reports can be submitted anonymously….