ABSTRACT
ABSTRACT: Orthopaedic hardware explantation is a multifaceted topic with complex legal, ethical, and scientific aspects that require thorough exploration. Issues of device ownership, explant-induced disease propagation, and potential device resale pose legal risks to providers and health-care institutions. Ethically, implant removal highlights the potential that performing procedures at the request of the patient will incentivize patient compliance and strengthen the patient-surgeon relationship. However, the return of explanted hardware to patients could hinder scientific study and innovation, ultimately limiting advancement in risk reduction and patient outcomes. Continued research into these topics remains paramount to ensure that clinicians and institutions deliver optimal patient care while abiding with legal and ethical imperatives. This article addresses the legal, ethical, and scientific issues that are pertinent to returning an explanted orthopaedic implant to the patient and the potential ramifications of such practice.
Subject(s)
Orthopedics , Device Removal , Humans , Morals , Orthopedic EquipmentSubject(s)
Burns/therapy , Decision Making/ethics , Patient Advocacy , Patient Rights , Right to Die/history , Treatment Refusal , Aged , Ethics, Medical , History, 20th Century , Humans , Lawyers , Male , Motion PicturesABSTRACT
We believe that clinical ethics consultants (CECs) should offer advice, options, and recommendations to attending physicians and their teams. In their article in this issue of The Journal of Clinical Ethics, however, Kornfeld and Prager give CECs a somewhat different role. The CEC they describe may at times be more aptly understood as a medical interventionist who appropriates the roles of the attending physician and the medical team than as a traditional CEC. In these remarks, we distinguish the role of the CEC from that of the physician, in contrast to some of these authors' recommendations, which confuse the two roles.
Subject(s)
Ethics Consultation , Physicians , Consultants , Ethicists , Ethics, Clinical , HumansABSTRACT
In analyzing moral distress, perhaps greater attention should be given to the possible implicit sources of feelings of distress, as well as explicit sources.
Subject(s)
Consciousness , Unconsciousness , Attention , Emotions , Humans , MoralsABSTRACT
John H. Evans's views on the multiple roles of healthcare ethics consultants are based on his claim that bioethics is a "distinct profession" that has a "system of abstract knowledge." This response to Professor Evans disputes both of his claims. It is argued that clinical ethicists are consultants but not professionals. Their roles as consultants require more than one abstract form of knowledge (principlism). Instead, clinical ethicists rely upon a variety of ethical perspectives and other skills to help resolve conflicts and facilitate healthcare decisions and policy making, whether it is in clinical, research, policy, or organizational contexts. The credibility and effectiveness of clinical ethicists depend upon their knowledge of ethics, their practical experience, and personal abilities, not one form of abstract knowledge.
Subject(s)
Conflict of Interest , Delivery of Health Care/ethics , Ethicists/legislation & jurisprudence , Ethics Consultation/ethics , Ethics, Clinical , Ethics, Institutional , Moral Obligations , HumansSubject(s)
Castration/ethics , Coercion , Criminals , Informed Consent/ethics , Prisoners , Punishment , Sex Offenses , Torture/ethics , Humans , MaleSubject(s)
Humans , Male , Female , Child , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Ethics, Medical , Clinical MedicineABSTRACT
The model of clinical ethics consultation (CEC) defended in the ASBH Core Competencies report has gained significant traction among scholars and healthcare providers. On this model, the aim of CEC is to facilitate deliberative reflection and thereby resolve conflicts and clarify value uncertainty by invoking and pursuing a process of consensus building. It is central to the model that the facilitated consensus falls within a range of allowable options, defined by societal values: prevailing legal requirements, widely endorsed organizational policies, and professional standards of practice and codes of conduct. Moreover, the model stipulates that ethics consultants must refrain from giving substantive recommendations regarding how parties to a moral disagreement in the clinic should evaluate their options. We argue that this model of CEC is incomplete, because it wrongly assumes that what counts as the proper set of allowable options among which the parties are to deliberate will itself always be clearly discernible. We illustrate this problem with a recent case on which one of us consulted-a neonate born with trisomy 18 (T18). We try to show that law, policy, and standards of practice reveal no clear answer to the question posed by the case: namely, whether forgoing gastrostomy tube feedings for a baby with T18 is allowable. We suggest there may be other kinds of cases in which it may simply be unsettled whether a given choice falls within the set of allowable options within which consensus is to be facilitated. What should an ethicist do when confronting such unsettled cases? We agree with the facilitation model that an ethicist should remain neutral among the allowable options, when it is clear what the allowable options are. But, in unsettled cases, the role of a consultant should be expanded to include a process of moral inquiry into what the allowable options should be. We end by raising the issue of whether this means an ethicist should share his or her own conclusions or views about the allowability of a given clinical option.
Subject(s)
Consensus , Decision Making/ethics , Ethics Consultation , Moral Obligations , Organizational Policy , Palliative Care/ethics , Trisomy , Choice Behavior/ethics , Chromosomes, Human, Pair 18 , Ethics Consultation/ethics , Ethics Consultation/standards , Ethics Consultation/trends , Ethics, Institutional , Ethics, Medical , Female , Fluid Therapy/ethics , Humans , Infant, Newborn , Legislation, Medical , Parenteral Nutrition/ethics , Prenatal Diagnosis , Trisomy/diagnosis , UncertaintyABSTRACT
One of the most significant concerns about the legalization of physician-assisted death in the United States relates to the possibility that a chronically or terminally ill person would choose to end her or his life for financial reasons. Because we believe that the life insurance industry is uniquely poised to help minimize any such incentive, we submit that it has a moral obligation to do so. In particular, we propose that the industry encourage greater flexibility in the payout of policy benefits in the event an insured should be diagnosed with a terminal illness or suffer from intractable pain.
Subject(s)
Euthanasia , Insurance Benefits/legislation & jurisprudence , Insurance, Life/legislation & jurisprudence , Suicide, Assisted , Humans , Public Policy , Suicide, Assisted/legislation & jurisprudence , United StatesSubject(s)
Hospitals, Public , Suicide, Assisted , Depressive Disorder , Economics , Ethics , Euthanasia, Passive , Federal Government , Government , Health Facilities , Humans , Jurisprudence , New York , Organizational Policy , Pain , Palliative Care , Physicians , Public Policy , Terminally Ill , United States , WashingtonSubject(s)
Bioethical Issues , Bioethics , Social Values , Abortion, Induced , Dissent and Disputes , Emotions , Euthanasia , Euthanasia, Passive , Fetus , Freedom , Group Processes , Humans , Individuality , Persistent Vegetative State , Personal Autonomy , Personhood , Politics , Probability , Public Policy , Suicide, Assisted , Uncertainty , Value of LifeSubject(s)
Ethicists , Ethics , Professional Role , Referral and Consultation , Abortion, Eugenic , Biomedical Technology , Child , Decision Making , Drugs, Investigational , Education , Ethics Committees , Ethics Consultation , Humans , Interdisciplinary Communication , Interprofessional Relations , Jurisprudence , Medicine , Neoplasms , Parents , Patient Care , Philosophy , Pregnancy , Pregnant Women , Prenatal Diagnosis , Professional Competence , Societies , Therapies, Investigational , Treatment RefusalSubject(s)
Confidentiality , Decision Making , Disclosure , Insurance, Health, Reimbursement , Jurisprudence , Privacy , Psychotherapy , Utilization Review , Coercion , Goals , Health Care Rationing , Humans , Informed Consent , Managed Care Programs , Medical Records , Mental Competency , Mental Disorders , Mentally Ill Persons , Outpatients , Patient Care , Patient Selection , Physician-Patient Relations , Social Change , State Government , Time Factors , United StatesABSTRACT
In this study, we investigated physicians' attitudes, knowledge, and reported practices regarding the effects of perceived legal constraints on the abatement of life-sustaining treatment from patients who are clearly dying. A factor in assessing these issues is the concept of defensive medicine -- that is the perception that doctors are being forced to order every possible laboratory test and second opinion, or to continue providing non-beneficial life-sustaining treatment, solely to protect themselves from future legal claims. This perception appears widespread among practicing physicians. However, we believe that defensive medicine represents only part of a complex constellation of factors that comprise physicians' reluctance to abate treatment. This phenomenon encompasses medical, legal, social, psychological, and spiritual factors interacting in ways that are not fully understood. We remain cognizant of the potential impact of all these factors. For purposes of this article, however, we have chosen to focus on legal and psychological aspects of physicians' reluctance to abate treatment and the corresponding ethical implications.
