In the eyes of cost-cutting hospital administrators, bioethics programs are sometimes perceived as a luxury rather than a necessity. During periods of austerity, bioethics programs are often the first to not receive funding or not be maintained, says Joseph J. Fins, MD, MACP, the E. William Davis, Jr. Professor of Medical Ethics and chief of the Division of Medical Ethics at Weill Cornell Medical College, and director of medical ethics and attending physician at New York Presbyterian Hospital-Weill Cornell Medical Center in New York City. A number of programs have recently come under threat.
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Because overtreatment imposes unnecessary harms upon a patient, it violates the normative rules of beneficence and nonmaleficence that pervade medical ethics, argues Erin Fuse Brown, JD, MPH, assistant professor of Law at Georgia State University College of law in Atlanta and former Visiting Fellow in Ethics and Health Policy with the Lincoln Center for Applied Ethics at Arizona State Universitys Sandra Day OConnor College of Law.
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Some bioethicists argue that it is not ethically justifiable to offer reused pacemakers overseas since these are not approved for use in the United States, but this goes on every day in the developing world, says James N. Kirkpatrick, MD, an assistant professor of medicine at the Hospital of the University of Pennsylvania.
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By refurbishing and repackaging pacemakers, we are de facto creating a new product, which no longer adheres to the original specifications, says Thomas Crawford, MD, an assistant professor of medicine in the Cardiovascular Division at the University of Michigan School of Medicine in Ann Arbor and co-chair of Project My Heart Your Heart, a program which collects used devices from patients and funeral directors to be someday donated to developing countries.
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The debate over medical futility has in large part been neglected, and should be expanded beyond pull the plug decisions to include doctors involvement in the details of end-of-life care, argues Lawrence J. Schneiderman, MD, founding co-chair of the University of California, San Diego Medical Center Ethics Committee.
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It is vital for providers caring for pediatric patients not to jump to a diagnosis just because it is in the Diagnostic and Statistical Manual of Mental Disorders (DSM)V, argues Harold J. Bursztajn, MD, associate clinical professor of psychiatry at Harvard Medical School in Cambridge and co-founder of the Program in Psychiatry and the Law at Beth Israel Deaconess Medical Center.
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While Americans typically support organ donation, data show the number of actual donations is actually quite low and cannot keep up with demand, says Leslie M. Whetstine, PhD, an assistant professor of philosophy at Walsh University in North Canton, OH.
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