Subject(s)
Complementary Therapies/education , Integrative Medicine/education , Pain Management , Pain , Palliative Care , Palliative Medicine/education , California , Education, Medical , Goals , Holistic Health/education , Hospice Care , Humans , Integrative Oncology , Neoplasms/complications , Pain/etiology , Pain Management/methods , UniversitiesABSTRACT
The Denver Community Bioethics Committee (DCBC) is an independent, community-based group that undertakes ethics consultations for any individual or organization. Its members include adult protection professionals, physicians, elder-law attorneys, chaplains, nurses, social workers, and lay persons. In its 11-year history, the Committee has heard numerous cases concerning end-of-life care, futile treatment, and patients' rights. In 2003, a Colorado hospice provider asked the DCBC for assistance in developing a policy on deactivation of pacemakers and defibrillators in competent hospice patients. The hospice had encountered concerns from some physicians and cardiac care clinicians that deactivating such devices treads the fine line between legitimate withdrawal of burdensome treatment and assisted death. Although the specific deliberations of the DCBC are confidential, this article summarizes contributions from the committee's discussion, as well as independent research undertaken by the author.
Subject(s)
Defibrillators, Implantable/ethics , Ethics, Clinical , Euthanasia, Active, Voluntary/ethics , Pacemaker, Artificial/ethics , Right to Die/ethics , Suicide, Assisted/ethics , Aged , Colorado , Ethics Committees, Clinical , Ethics, Medical , Humans , Informed Consent , Male , Patient Rights , Personal AutonomyABSTRACT
OBJECTIVES: To pilot brief reproductive health counseling for women obtaining pregnancy testing in a managed-care setting who did not desire pregnancy. METHODS: Women received counseling, access to contraception and a booster call at 2 weeks. Changes in contraceptive behavior were evaluated. RESULTS: Of 85 women who completed counseling, 58 (68%) completed follow-up. Participants reported that counseling was useful at baseline (94%) and follow-up (83%). The staff found the intervention important (100%) and implementation feasible (100%). Forty-one percent of participants improved their use of contraception (from no use or from less effective use to more effective use). Twenty-nine percent continued highly effective use and 9% recessed from highly effective use. Of 22 participants with risk of sexually transmitted disease, 3 (14%) began using condoms consistently, while 1 (5%) continued using condoms consistently. CONCLUSIONS: Counseling at pregnancy testing was well accepted by the staff and participants. Observed behavioral changes suggest that this intervention may be effective in increasing effective use of contraception.
