Subject(s)
Education, Medical, Graduate , Emergency Medicine/education , Resuscitation/methods , Adult , Child , Death , Forensic Medicine , Humans , Informed ConsentSubject(s)
Ethics, Medical , Refusal to Treat/legislation & jurisprudence , Resuscitation Orders/legislation & jurisprudence , Risk Assessment , Terminal Care/legislation & jurisprudence , Cardiopulmonary Resuscitation , Humans , Informed Consent/legislation & jurisprudence , Moral Obligations , Morals , Patient Education as Topic/legislation & jurisprudence , Personal Autonomy , Physician-Patient Relations , Social ValuesSubject(s)
Child Advocacy , Ethics, Medical , Refusal to Treat , Risk Assessment , Withholding Treatment , Attitude of Health Personnel , Child Advocacy/legislation & jurisprudence , Decision Making , Humans , Infant , Parents , Physician-Patient Relations , Professional-Family Relations , Refusal to Treat/legislation & jurisprudence , Value of LifeABSTRACT
During the past 10 years, the issues surrounding the right to refuse various forms of treatment have remained complex, and the development of appropriate societal responses has become more elusive. This article considers the role that the judiciary, the legislature, and the legal profession have played in the resolution of these medical, legal, and ethical dilemmas. The courts, legislatures, and lawyers will never be removed completely from involvement in these matters, nor should they be. Yet, a continuation of the medical profession's responsible approach to these issues will insure that their involvement will be kept to a minimum.
Subject(s)
Euthanasia, Passive , Euthanasia , Patient Advocacy/legislation & jurisprudence , Patient Compliance , Aged , Child , Child Advocacy , Decision Making , Female , Humans , Male , Role , United StatesABSTRACT
Ethics committees have emerged as a way for institutions to evaluate and resolve some of the difficult decisions facing critical care medicine. This article examines their origin, scope, function, and potential problems.
Subject(s)
Critical Care , Ethics Committees, Clinical , Ethics, Institutional , Ethics , Professional Staff Committees , Decision Making , Health Occupations , Humans , Interdisciplinary Communication , Judicial Role , Life Support Care/legislation & jurisprudence , Referral and Consultation , United States , Withholding TreatmentABSTRACT
In summary, cardiac surgery for adults with mental retardation raises a series of controversial legal, economic, ethical, medical, and nursing dilemmas. During the past 20 years, many improvements have taken place in the care of these patients. However, in the future, judicial and statutory mandates requiring high-quality medical care for persons with mental retardation may conflict increasingly with hospital cost-control legislation and thereby affect clinical decisions. For example, it is conceivable that elective repair of an ostium secundum atrial septal defect in an asymptomatic patient will expend the limited resources necessary to carry out emergency revascularization in a symptomatic patient with impending myocardial infarction. This issue becomes even more delicate when the asymptomatic patient is a mentally retarded ward of the state, and the symptomatic patient is a middle-aged man supporting a wife and several college-age children. There may be no easy solution to this problem, and it will provide the grist for many bioethicists. Fortunately, from a practical point of view, we do not currently have to choose between these patients to receive treatment. Our hope is that health care for mentally retarded patients will not be compromised. We believe that decisions about patient management should be based on enlightened clinical judgment rather than on preconceived notions about this population. In the quest for optimal health care delivery, the special needs of these patients should be considered when cardiac catheterization and possible cardiac surgery are contemplated. Although we have presented an approach to a patient with cardiac disease requiring cardiac surgery, we believe that this approach can be utilized for any retarded patient requiring acute medical care. Currently, because there has not been much training in this area, many physicians and nurses lack first-hand experience in caring for the mentally retarded. This inexperience may lead to difficulty in making appropriate decisions. Therefore, we advocate additional exposure in medical and nursing school curricula to the complex health care needs of this population. In conclusion, there appear to be two major issues that pose dilemmas: first, acceptance of the rights of this population to optimal medical management and, second, implementation of appropriate diagnostic and therapeutic strategies.
Subject(s)
Cardiac Surgical Procedures , Delivery of Health Care , Ethics, Medical , Human Rights , Intellectual Disability , Patient Selection , Resource Allocation , Adult , Hospitalization , Humans , Massachusetts , Risk AssessmentABSTRACT
KIE: Three state court decisions since 1983 that approved the withholding or withdrawal of artificial feeding are discussed. In Barber v. Superior Court, the California Court of Appeal dismissed a murder indictment against two physicians who, at the request of the family, had removed a comatose man's respirator and intravenous (IV) feeding lines. The ruling, based on a "proportionate-disproportionate" benefit standard, marked the first time an appellate court equated discontinuation of IV feeding with removal of a respirator. The Massachusetts Appeals Court, in In re Hier, used a "substituted judgement" standard to decide that an aged patient who had repeatedly pulled out her gastrostomy tube need not undergo surgery to reinsert it. The New Jersey Supreme Court, in In re Conroy, was the first state supreme court to rule that artificial feeding may be withheld from an incompetent patient if it is disproportionately burdensome.^ieng
