Medical Ethics Advisor – March 1, 2023
March 1, 2023
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More Transparency Might Bolster Trust in FDA Advisory Committees
The FDA does not always convene an advisory committee meeting in connection with application reviews, but may do so when questions related to safety or the data submitted to support approval arise. In the modern environment, some believe if they cannot see it, foul play must be afoot. Some of that could be allayed by transparency and more public education.
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Out of Options: When Parents Abandon Pediatric Psychiatric Patients at Hospital
Parents often are faced with an impossible choice. They must decide whether to bring home a child who poses a threat to self and others, or risk a child abandonment charge. The criteria for acute psychiatric hospitalization are so high that children might be discharged only to be rehospitalized within weeks or days — and retraumatized in the process.
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How to Respond to a Consult Request for ‘Difficult’ Family
Clinicians sometimes overlook the fact there are many contributing factors when a patient or family member displays “difficult” behavior. Ethicists can help clinicians parse those, recognize their own internal biases, and think about the family’s perspective.
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Ethicists Can Intervene if Patient/Physician Relationship Is Beyond Repair
It is important to remember that if serious conflict with a patient arises, clinicians should not act in a knee-jerk way. A primary care practitioner might use ethics practice guidelines to create a consistent approach for dealing with these cases.
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Physicians’ Well-Being Top Ethics Issue
Ethicists should encourage their organizations to survey physicians to identify which factors are adversely affecting well-being. Meaningful change cannot occur without actively engaging physicians in determining what changes they believe will significantly improve their health and well-being.
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Efforts Underway to Diversify Clinical Ethics Field
Success depends on available ethics resources and overall organizational diversity. Broader changes to the ethics field resulting in more diversity would require regulatory, legal, or accreditation oversight. Absent that, it is going to be one institution at a time, or one or several ethicists at a time, trying to create the right kind of mix of diversity and representation.
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Should Ethicists Hide Consult Notes from Patients?
Ethics consults often are accompanied by conflict, intense emotions, sensitive or controversial topics, and disagreements about values. Ethics notes tend to incorporate more narrative and explicit analysis than other clinical notes. For the sake of transparency, instead of shielding notes, consider excluding details that are likely to cause harm.
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Making More Protected Time for Clinical Ethics Work
To make a good case for investing in protected time, ethicists can engage with department heads to identify the unmet needs of healthcare providers. Testimonials from providers who have benefitted from ethics consultation demonstrate direct benefit to patient care.
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Ethical Problems with Rural Cancer Patients’ Access to Care
Patients and clinicians should discuss any available data regarding differences in care delivered at potential treatment sites, potential accompanying outcomes differences, and the costs and benefits of pursuing treatment at each site. Rural patient navigators should be involved in this discussion, considering the complexity of care coordination for patients with cancer.
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Remote Mental Healthcare Facing Ethical, Legal Pushback
Patients might assume they are talking with a licensed therapist, when they actually are speaking with an unlicensed therapist or a mental health coach. That is an ethical violation.
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Physicians Should Educate Patients About Cannabis-Impaired Driving
Primary care providers should discuss frequency of use, dosage, tolerance levels, and withdrawal symptoms. Also, inform patients of the harms, risks, and legal consequences of cannabis-impaired driving.