Dying patients discuss physician-assisted suicide

Researchers in Oregon, the only state where physician-assisted suicide is legal, found that about 17% of that state’s residents facing death have discussed having a physician help them end their lives. But Susan Tolle, MD, director of the Center for Ethics in Health Care at Oregon Health and Science University (OHSU) explains that only about 2% of dying patients actually formally request physician-assisted suicide. The study did not address possible reasons why so many fewer patients actually requested assistance than considered it. OHSU researchers found that 44% of the dying patients included in the survey were in favor of physician-assisted suicide, 15% stated they are neutral about it, and 41% said they oppose letting physicians help terminally ill patients commit suicide. Tolle reports in the September Journal of Clinical Ethics that patients most likely to consider physician-assisted suicide are younger, white, do not report having strong religious beliefs, and suffer from cancer. The Center for Ethics in Health Care at OHSU conducts research on all end-of-life issues, and neither supports nor opposes the option of physician-assisted suicide. The study was funded by the National Institutes of Health and a grant from the Robert Wood Johnson Foundation.

Public plea spurs new liver, plus some debate

A billboard advertising a cancer-stricken Houston man’s need for a liver yielded what he hoped — a liver transplant — but has raised ethical questions about how donated organs are assigned. Todd Krampitz, 32, received his new liver in August after a family that read media reports about the Internet and billboard campaign his family conducted to locate a donor organ contacted LifeGift Organ Donation Center in Houston with a specific request that the liver be given to Krampitz.

The happy ending to Krampitz’ story has a tinge of controversy, however. The United Network for Organ Sharing has decided to study public solicitation for organs although federal law permits directed donations of organs from deceased individuals. The Krampitz web site (www.toddneedsaliver.com) offers information on becoming an organ donor, and supporters of the idea point to the number of calls to organ donation centers that came following publicity of the Krampitz case.

Medical schools tighten conflicts-of-interest standards

A recent study by the Association of American Medical Colleges (AAMC) indicates that U.S. medical schools have made significant progress since 2001 in clarifying and strengthening their financial conflicts of interest (COI) standards in clinical research, with 95% now having a policy in place that applies to all human subjects research.

In 2001, the AAMC issued guidelines recommending researchers with a significant financial interest not be permitted to conduct research on human subjects unless the researcher could demonstrate compelling circumstances to proceed, and made full disclosure to research subjects and in other communications. AAMC recently conducted a survey to assess the degree to which COI policies of the nation’s accredited medical schools reflected the recommendations of the task force and responded to the changed circumstances of clinical research.

Despite this substantial progress, the survey results also indicate that certain policies and procedures still need more attention from the academic medicine community.

The AAMC survey found 81% of medical schools permit a researcher with a significant financial interest to conduct human subjects research when they find that compelling circumstances exist, 40% did not require researchers to disclose significant financial interests in oral presentations of research results, 9% did not include outside representatives on standing conflict of interest committees, and 41% of schools with standing committees did not include the evaluation of significant financial interests prior to final institutional review board approval.

Video: How to talk about medical errors

Suggestions for dealing head-on with bad outcomes and medical errors are presented in "Discussing Unanticipated Outcomes and Disclosing Medical Errors," a videotape recently completed by John Banja, PhD, associate professor at Emory University Center for Ethics in Atlanta. The tape has been made available to hospitals throughout Georgia. The video is one of the products of a grant that was awarded to the Georgia Hospital Association Research and Education Foundation by the Agency for Healthcare Research and Quality in 2001.

The video includes a panel discussion among a hospital risk manager and two health care attorneys who tackle three clinical vignettes involving medical error, and a series of empathic communication techniques that can be useful to health professionals when they conduct "bad news" conversations. Banja said the video should be especially useful to health professionals who must engage in uncomfortable conversations such as those that follow unanticipated outcomes or medical errors.

The video is available for free on-line viewing at the Center for Ethics’ web site, www.ethics.emory.edu. The suggestions contained in the tape are not meant to serve as legal standards or guidelines, but as recommendations only. For more information about the film, contact Banja by e-mail at jbanja@emory.edu, or phone (404) 727-4954.