Medical Ethics Advisor – October 1, 2022
October 1, 2022
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Fraud Allegations Involving Alzheimer’s Disease Study Raise Concerns
In a paper published in 2006, the authors provided evidence indicating accumulation of a specific form of beta-amyloid protein was a cause of Alzheimer’s disease. However, recent accusations suggest images allegedly were altered, raising doubts about the initial conclusions. Regardless of what happened, this case has jumpstarted a conversation about instituting more preventive measures, conducting faster investigations into fraud allegations, and levying more severe consequences for researchers found guilty of misconduct.
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Ethicists Asked to Weigh in on Medical Necessity of Abortion
If ethicists are asked to weigh in, they should suggest a second medical opinion (if time permits) and encourage the institution to clarify any legal questions, ideally before there is an emergency. Institutions also should assure clinicians they will have support from the ethics committee in the event of overzealous prosecution.
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New Requirements Are Discouraging Physicians from Writing DNR Orders
Ethicists should help develop related protocols. For practitioners, code status conversations should be treated with the seriousness of surgery. That means involving the right people and taking the time to ensure medical understanding and prognosis, as well as patient values and goals, before talking about a care plan. When possible, practitioners should bring up DNR at the end of a meaningful conversation.
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Some IRBs Expand Their Purview to Consider Scientific Merit
The most common ethics-related reasons for protocol deferral were inadequate informed consent, insufficient protection of participants’ safety, inadequate detail of risk assessment, and inadequate minimization of risks. Some study protocols were not approved due to issues of scientific merit, such as adequate adverse event reporting or the importance of the knowledge to be gained. Read on to learn how to prevent these problems and avoid delays.
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Court-Appointed Guardians for Unrepresented Patients
Ethicists are seeing a range of issues arise during consults involving unrepresented patients, including conflicts over how aggressive treatment should be, whether to treat at all, how to discharge, and how to follow up with compliance with treatment. Creating a template for actions to take related to unrepresented persons who present to the hospital is a proactive first step.
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Making Ethical Decisions on Genetic Testing, Precision Medicine
Physicians are obligated to consider the benefits and harms of genetic testing. They must be prepared to engage in discussions with patients, and offer assistance in understanding the risks, benefits, and uncertainties of direct-to-consumer genetic testing. Clinicians must safeguard privacy, security, and confidentiality of patient information.
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Ethicists Strive to Make Training for Consults More Consistent
Hospital administrators vary in their awareness of the need for training for ethics consultants. They want to believe the committee is doing good work. But as ethics committees often do not capture metrics to measure their work product quality, it is hard for leaders to question the training quality.
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Encourage Reluctant Clinicians to Contact Ethics
Ethicists can contact department chairs and clinical leadership to express interest in participating in grand rounds or educational forums. Contact nursing leaders to offer in-service training sessions on frequently encountered ethical issues. Join hospital committees to learn more about ethical issues clinicians are encountering. The idea is to gain the support of individual clinicians, the medical staff, and hospital leaders.
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Updated Recommendations on Pediatric End-of-Life Care
A report includes a review of essential elements of care for patients and families. The authors covered discussions on goals of care, how to establish end-of-life care goals, advance care planning, and palliative and hospice involvement.
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Nurses and Physicians Find Ethics Consults Helpful, But for Different Reasons
Ethicists are challenged to meet the needs of everyone involved during an ethics consult. Now, ethicists can turn to some new data on how those differ.