Medical Ethics Advisor – May 1, 2021
May 1, 2021
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Policies Support Clinicians if Asked to Provide Inappropriate Care
When a family demands possibly inappropriate life-sustaining interventions, clinicians often turn to hospital policies for guidance. The authors of a recent study examined the effectiveness of Yale New Haven Hospital’s Conscientious Practice Policy. A theme emerged, focused on the inconsistent use of the policy. Whether it was used depended mostly on how resistant the family was to limiting interventions.
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Changing Practice Models in Healthcare Raise Some Ethical Concerns
With all the ongoing changes in healthcare, such as physician contract clauses, new regulatory requirements, private equity ownership, and physician leadership, hospitals worry about the implications on revenue, patient satisfaction, and compliance. There also are important ethical considerations. The authors of a new policy paper from the American College of Physicians examined these.
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Is It a Problem to Pay Research Participants?
Paying people to participate in clinical research can be seen as ethically problematic. Yet community members expressed the opposite view, according to the results of a recent study.
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Challenges with Surrogate Informed Consent
The central ethical question is whether a surrogate’s judgment for consenting or refusing a medical intervention on behalf of a patient is consistent and congruent with this patient’s preferences, interests, and values.
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Some Code Status Discussions Are Rushed, Incomplete, or Misleading
Learning how to engage in code status conversations is as important as learning how to perform medical procedures. Clinicians would not ask patients in completely neutral terms whether they want a procedure that has no chance of working or would inflict serious harm. Any conversation around resuscitation status should take into account patients' goals and values, what is important to them in life, and the minimum acceptable quality of life.
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No Evidence of Bias on Pediatric Ethics Rounds
Researchers compared sociodemographic factors between patients admitted to an academic children’s hospital during ethics rounds in the PICU, PCTU, and NICU in 2017 and 2018 who were identified as having ethics issues and all other patients admitted to those same units during the same period. The researchers expected racial and/or socioeconomic differences between the groups, with socially vulnerable patients disproportionately identified as having ethical issues on rounds. But they did not find this to be the case.
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Novel Program Decreases Transport to ED for Hospice Patients
Ventura County, CA, paramedics underwent 30 hours of training on crisis counseling, grief, and palliative care. When EMS responded to a 911 call and determined a patient was in hospice, they contacted trained staff. During a three-year study period, the percentage of hospice patients transported to the ED was 36% in the first year, 33% in the second year, and 24% in the third year. This was compared to 80% of hospice patients transported, on average, during the six months before project implementation.
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Ethical Responses Needed if Clinicians Say Discharge Is Unsafe
For some patients, there are no caregivers at home. Others may be living in unsafe conditions. Ethicists can help by brainstorming scenarios, and trying to connect resources accordingly.